scholarly journals Point-of-Care Diagnostic Device for Traumatic Pneumothorax: Low Sensitivity of the Unblinded PneumoScan™

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
M. Rehfeldt ◽  
A. Slagman ◽  
B. A. Leidel ◽  
M. Möckel ◽  
T. Lindner
Keyword(s):  
Chest Trauma ◽  
Point Of Care ◽  
Diagnostic Tools ◽  
Trauma Room ◽  
Trauma Room Management ◽  
Life Threatening ◽  
Traumatic Pneumothorax ◽  
Low Sensitivity ◽  
Positive Results ◽  
Rule Out

Background. Traumatic Pneumothorax (PTX) is a potentially life-threatening injury. It requires a fast and accurate diagnosis and treatment, but diagnostic tools are limited. A new point-of-care device (PneumoScan) based on micropower impulse radar (MIR) promises to diagnose a PTX within seconds. In this study, we compare standard diagnostics with PneumoScan during shock-trauma-room management. Patients and Methods. Patients with blunt or penetrating chest trauma were consecutively included in the study. All patients were examined including clinical examination with auscultation (CE) and supine chest radiography (CXR). In addition, PneumoScan-readings and thoracic ultrasound scan (US) were performed. Computed tomography (CT) served as gold standard. Results. CT scan revealed PTX in 11 patients. PneumoScan detected two PTX correctly but missed nine. 15 false-positive results were found by PneumoScan, leading to a sensitivity of 20% and specificity of 80%. Six PTX were detected through CE (sensitivity: 54,5%). CXR detected four (sensitivity: 27,3%) and thoracic US two PTX correctly (sensitivity: 25%). Conclusion. The unblinded PneumoScan prototype did not confirm the promising results of previous studies. The examined standard diagnostics and thoracic US showed rather weak sensitivity as well. Until now, there is no appropriate point-of-care tool to rule out PTX.

scholarly journals Does Radar Technology Support the Diagnosis of Pneumothorax? PneumoScan—A Diagnostic Point-of-Care Tool

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
T. Lindner ◽  
M. Conze ◽  
C. E. Albers ◽  
B. A. Leidel ◽  
P. Levy ◽  
...  
Keyword(s):  
Clinical Examination ◽  
Predictive Value ◽  
Chest Trauma ◽  
Point Of Care ◽  
Diagnostic Value ◽  
Technology Support ◽  
Trauma Room ◽  
X Ray ◽  
Life Threatening ◽  
Chest X Ray

Background. A nonrecognized pneumothorax (PTX) may become a life-threatening tension PTX. A reliable point-of-care diagnostic tool could help in reduce this risk. For this purpose, we investigated the feasibility of the use of the PneumoScan, an innovative device based on micropower impulse radar (MIR).Patients and Methods. addition to a standard diagnostic protocol including clinical examination, chest X-ray (CXR), and computed tomography (CT), 24 consecutive patients with chest trauma underwent PneumoScan testing in the shock trauma room to exclude a PTX.Results. The application of the PneumoScan was simple, quick, and reliable without functional disorder. Clinical examination and CXR each revealed one and PneumoScan three out of altogether four PTXs (sensitivity 75%, specificity 100%, positive predictive value 100%, and negative predictive value 95%). The undetected PTX did not require intervention.Conclusion. The PneumoScan as a point-of-care device offers additional diagnostic value in patient management following chest trauma. Further studies with more patients have to be performed to evaluate the diagnostic accuracy of the device.

scholarly journals Diagnosing Sepsis in the Intensive Care Unit: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Kerina Denny ◽  
Ross Lindell-Innes ◽  
Aaron Heffernan ◽  
David L. Paterson ◽  
John F Mcnamara ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Organ Dysfunction ◽  
Point Of Care ◽  
Clinical History ◽  
Diagnostic Tools ◽  
Retrospective Diagnosis ◽  
Life Threatening ◽  
Culture Negative

Abstract Background: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. In the intensive care unit (ICU), organ dysfunction is common. The challenge lies in determining when organ dysfunction can be attributed to infection. We aimed to retrospectively determine what proportion of patients commenced on antibiotics for presumed sepsis in a mixed ICU had blood-culture positive sepsis, blood-culture negative sepsis, or an aseptic mimic.Methods: One hundred antibiotic naïve ICU patients who were clinically deemed to have an infection were enrolled. Retrospective interpretation of clinical history, biochemical, and microbiological data was performed by three clinicians from the fields of intensive care and infectious disease who aimed to differentiate infective from non-infective insults.Results: There was good interrater reliability amongst clinician assessors using this approach (Krippendorf’s alpha 0.868) for the retrospective diagnosis of infection. In the examined cohort, 35 percent of patients met the criteria of blood culture positivity and an additional 41 percent of patients were assessed as having probable blood culture negative sepsis. Twenty-four percent of patients were retrospectively determined to not have had sepsis.Conclusions: Misdiagnosis of infection as a cause for organ dysfunction in the ICU is common. The false attribution of organ dysfunction to infection in the ICU has significant clinical and research implications, and highlights the need for accurate point-of-care sepsis diagnostic tools.

scholarly journals Nanotechnology-Based Approaches for the Detection of SARS-CoV-2

2020 ◽  
Vol 2 ◽  
Author(s):  
Ritika Gupta ◽  
Poonam Sagar ◽  
Nitesh Priyadarshi ◽  
Sunaina Kaul ◽  
Rajat Sandhir ◽  
...  
Keyword(s):  
Point Of Care ◽  
Resonance Energy Transfer ◽  
Resonance Energy ◽  
Cost Effective ◽  
Diagnostic Techniques ◽  
Localized Surface Plasmon ◽  
Diagnostic Tools ◽  
Diagnostic Systems ◽  
Economic Activities ◽  
Low Sensitivity

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a pandemic has been validated as an extreme clinical calamity and has affected several socio-economic activities globally. Proven transmission of this virus occurs through airborne droplets from an infected person. The recent upsurge in the number of infected individuals has already exceeded the number of intensive care beds available to patients. These extraordinary circumstances have elicited the need for the development of diagnostic tools for the detection of the virus and, hence, prevent the spread of the disease. Early diagnosis and effective immediate treatment can reduce and prevent an increase in the number of cases. Conventional methods of detection such as quantitative real-time polymerase chain reaction and chest computed tomography scans have been used extensively for diagnostic purposes. However, these present several challenges, including prolonged assay requirements, labor-intensive testing, low sensitivity, and unavailability of these resources in remote locations. Such challenges urgently require fast, sensitive, and accurate diagnostic techniques for the timely detection and treatment of coronavirus disease 2019 (COVID-19) infections. Point-of-care biosensors that include paper- and chip-based diagnostic systems are rapid, cost-effective, and user friendly. In this article nanotechnology-based potential biosensors for SARS-CoV-2 diagnosis are discussed with particular emphasis on a lateral flow assay, a surface-enhanced Raman scattering-based biosensor, a localized surface plasmon resonance-based biosensor, Förster resonance energy transfer, an electrochemical biosensor, and artificial intelligence-based biosensors. Several biomolecules, such as nucleic acids, antibodies/enzymes, or aptamers, can serve as potential detection molecules on an appropriate platform, such as graphene oxide, nanoparticles, or quantum dots. An effective biosensor can be developed by using appropriate combinations of nanomaterials and technologies.

scholarly journals Comparative study between bedside chest ultrasound and chest CT scan in the diagnosis of traumatic pneumothorax

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Walid Abu Arab ◽  
Muhammad Abdulhaleem ◽  
Salah Eltahan ◽  
Moustafa Elhamami
Keyword(s):  
Ct Scan ◽  
Diagnostic Tool ◽  
Chest Trauma ◽  
Prospective Clinical Study ◽  
Life Threatening ◽  
Chest X Ray ◽  
Traumatic Pneumothorax ◽  
Surgical Emphysema ◽  
Chest Ct Scan ◽  
Higher Sensitivity

Abstract Background Traumatic pneumothorax (PTx) is common in chest trauma. Its incidence ranges between 10 and 28%. Chest X-ray (CXR) is the traditional imaging for the potential traumatic PTx, while CT chest is considered the gold standard diagnostic tool. However, it requires that the patient to be transferred from the Emergency Department (ED) with its resuscitative facilities. Chest US (E-FAST) has emerged as a sensitive tool that can be used on bedside basis with much higher sensitivity than CXR. The objective of this study was to compare between accuracy and usefulness of the bedside US chest and CT chest in the diagnosis of traumatic PTx, as well as its ability to quantify its size. This was a prospective clinical study that included two hundred patients who have been admitted to the ED. The inclusion criteria included any patient with chest trauma. Exclusion criteria included patients with clinical surgical emphysema, patients with life threatening PTx, and patients who did not undergo CT chest. Results Forty-seven hemithoraces were proved positive for PTx by CT chest, while forty-five hemithoraces out of those 47 were confirmed by bedside chest US. The sensitivity for chest US is 95.74% in detection of traumatic PTx. No false-positive cases were diagnosed. All of the forty-five hemithoraces diagnosed by chest US have been confirmed by CT scan making a specificity of 100%. Conclusions Chest US is a useful rapid diagnostic tool in the diagnosis and quantification of the traumatic PTx at ED. It avoids the delay in transportation of the critically ill patients to perform CT chest.

Mucormycosis

2021 ◽  
pp. 89-92
Author(s):  
Mahesh Babasaheb Kolap ◽  
Abhijeet Vijay Dashwant
Keyword(s):  
Point Of Care ◽  
Its Region ◽  
Developed Countries ◽  
Underlying Disease ◽  
Population Based ◽  
Screening Tests ◽  
Diagnostic Tools ◽  
Clinical Approach ◽  
Middle Income ◽  
Low Sensitivity

Mucor mycosis is an angio invasive fungal infection, due to fungi of the order Mucorales. Its incidence cannot be measured exactly, since there are few population-based studies, but multiple Studies have shown that it is increasing. The prevalence of mucor mycosis in India is about 80 times the prevalence in developed countries, being approximately 0.14 cases per 1000 population. Diabetes mellitus is the main underlying disease globally, especially in low and middle-income countries. In developed countries the most common underlying diseases are hematological malignancies and transplantation. The epidemiology of mucor mycosis is evolving as new immune modulating agents are used in the treatment of cancer and autoimmune diseases, and as the modern diagnostic tools lead to the identification of previously uncommon genera/species such as Apophysomyces or Saksenaea complex. In addition, new risk factors are reported from Asia, including post-pulmonary tuberculosis and chronic kidney disease. New emerging species include Rhizopus homothallicus, Thamnostylum lucknowense, Mucor irregularis and Saksenaea erythrospora. Diagnosis of mucormycosis remains challenging. Clinical approach to diagnosis has a low sensitivity and specificity, it helps however in raising suspicion and prompting the initiation of laboratory testing. Histopathology, direct examination and culture remain essential tools, although the molecular methods are improving. The internal transcribed spacer (ITS) region is the most widely sequenced DNA region for fungi and it is recommended as a first-line method for species identification of Mucorales. New molecular platforms are being investigated and new fungal genetic targets are being explored. Molecular-based methods have gained acceptance for confirmation of the infection when applied on tissues. Methods on the detection of Mucorales DNA in blood have shown promising results for earlier and rapid diagnosis and could be used as screening tests in high-risk patients, but have to be validated in clinical studies. More, much needed, rapid methods that do not require invasive procedures, such as serology-based point-of-care, or metabolomics-based breath tests, are being developed and hopefully will be evaluated in the near future.

scholarly journals Epidemiology and Diagnosis of Mucormycosis: An Update

2020 ◽  
Vol 6 (4) ◽  
pp. 265 ◽  
Author(s):  
Anna Skiada ◽  
Ioannis Pavleas ◽  
Maria Drogari-Apiranthitou
Keyword(s):  
Point Of Care ◽  
Its Region ◽  
Developed Countries ◽  
Underlying Disease ◽  
Population Based ◽  
Screening Tests ◽  
Diagnostic Tools ◽  
Clinical Approach ◽  
Middle Income ◽  
Low Sensitivity

Mucormycosis is an angioinvasive fungal infection, due to fungi of the order Mucorales. Its incidence cannot be measured exactly, since there are few population-based studies, but multiple studies have shown that it is increasing. The prevalence of mucormycosis in India is about 80 times the prevalence in developed countries, being approximately 0.14 cases per 1000 population. Diabetes mellitus is the main underlying disease globally, especially in low and middle-income countries. In developed countries the most common underlying diseases are hematological malignancies and transplantation. Τhe epidemiology of mucormycosis is evolving as new immunomodulating agents are used in the treatment of cancer and autoimmune diseases, and as the modern diagnostic tools lead to the identification of previously uncommon genera/species such as Apophysomyces or Saksenaea complex. In addition, new risk factors are reported from Asia, including post-pulmonary tuberculosis and chronic kidney disease. New emerging species include Rhizopus homothallicus, Thamnostylum lucknowense, Mucor irregularis and Saksenaea erythrospora. Diagnosis of mucormycosis remains challenging. Clinical approach to diagnosis has a low sensitivity and specificity, it helps however in raising suspicion and prompting the initiation of laboratory testing. Histopathology, direct examination and culture remain essential tools, although the molecular methods are improving. The internal transcribed spacer (ITS) region is the most widely sequenced DNA region for fungi and it is recommended as a first-line method for species identification of Mucorales. New molecular platforms are being investigated and new fungal genetic targets are being explored. Molecular-based methods have gained acceptance for confirmation of the infection when applied on tissues. Methods on the detection of Mucorales DNA in blood have shown promising results for earlier and rapid diagnosis and could be used as screening tests in high-risk patients, but have to be validated in clinical studies. More, much needed, rapid methods that do not require invasive procedures, such as serology-based point-of-care, or metabolomics-based breath tests, are being developed and hopefully will be evaluated in the near future.

Next-generation Diagnostics for Melioidosis: Evaluation of a Prototype i-STAT Cartridge to Detect Burkholderia pseudomallei Biomarkers

2018 ◽  
Vol 69 (3) ◽  
pp. 421-427 ◽  
Author(s):  
Kevin L Schully ◽  
Charles C Young ◽  
Mark Mayo ◽  
Amy L Connolly ◽  
Vanessa Rigas ◽  
...  
Keyword(s):  
Blood Culture ◽  
Burkholderia Pseudomallei ◽  
High Sensitivity ◽  
Diagnostic Tools ◽  
Next Generation ◽  
Blood Samples ◽  
Life Threatening ◽  
Low Sensitivity ◽  
Culture Positive ◽  
Culture Negative

AbstractBackgroundInfection with the gram-negative bacterium Burkholderia pseudomallei can result in melioidosis, a life-threatening disease that can be difficult to diagnose. Culture remains the gold standard for diagnosis but requires laboratory resources not available in many endemic regions. A lateral flow immunoassay has shown promise for POC diagnostics but suffers from low sensitivity when used on blood samples. PCR also has low sensitivity on blood, attributed to the low bacterial numbers in blood observed in melioidosis patients, even when bacteraemic.MethodsA prototype i-STAT cartridge was developed to utilize the monoclonal antibody specific for the capsule of pathogenic Burkholderia species employed on the LFI. The resulting POC assay was evaluated on 414 clinical specimens from Darwin, Australia and Cambodia.ResultsThe i-STAT assay accurately distinguished Australian blood culture positive melioidosis patients from Australian patients hospitalized with other infections (AUC = 0.91, 95% CI 0.817 - 1.0). We derived an assay cutoff with 76% sensitivity and 94% specificity that correctly classified 88% (n = 74) of the Australian patients. Interestingly, only 46% (6/13) of the culture-positive melioidosis patients in Cambodia were classified correctly. Of great importance however, the assay detected capsule from blood samples for 32% of blood culture negative melioidosis patients in both cohorts and previously undiagnosed melioidosis patients in Cambodia. In addition the assay showed high sensitivity and specificity for urine, pus and sputum.ConclusionsDiagnostic tools that are not dependent upon the growth kinetics or the levels of bacteremia of B. pseudomallei represent the next-generation of diagnostics and must be pursued further.

Gold-Aptamer-Nanoconstructs Engineered to Detect Conserved Enteroviral Nucleic Acid Sequences

2019 ◽  
Author(s):  
Veeren Chauhan ◽  
Mohamed M Elsutohy ◽  
C Patrick McClure ◽  
Will Irving ◽  
Neil Roddis ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
In Silico ◽  
Point Of Care ◽  
Lateral Flow ◽  
Nucleic Acid Sequence ◽  
In Silico Screening ◽  
Lateral Flow Assays ◽  
Life Threatening ◽  
Software And Hardware ◽  
Nucleic Acid Sequences

<p>Enteroviruses are a ubiquitous mammalian pathogen that can produce mild to life-threatening disease. Bearing this in mind, we have developed a rapid, accurate and economical point-of-care biosensor that can detect a nucleic acid sequences conserved amongst 96% of all known enteroviruses. The biosensor harnesses the physicochemical properties of gold nanoparticles and aptamers to provide colourimetric, spectroscopic and lateral flow-based identification of an exclusive enteroviral RNA sequence (23 bases), which was identified through in silico screening. Aptamers were designed to demonstrate specific complementarity towards the target enteroviral RNA to produce aggregated gold-aptamer nanoconstructs. Conserved target enteroviral nucleic acid sequence (≥ 1x10<sup>-7</sup> M, ≥1.4×10<sup>-14</sup> g/mL), initiates gold-aptamer-nanoconstructs disaggregation and a signal transduction mechanism, producing a colourimetric and spectroscopic blueshift (544 nm (purple) > 524 nm (red)). Furthermore, lateral-flow-assays that utilise gold-aptamer-nanoconstructs were unaffected by contaminating human genomic DNA, demonstrated rapid detection of conserved target enteroviral nucleic acid sequence (< 60 s) and could be interpreted with a bespoke software and hardware electronic interface. We anticipate our methodology will translate in-silico screening of nucleic acid databases to a tangible enteroviral desktop detector, which could be readily translated to related organisms. This will pave-the-way forward in the clinical evaluation of disease and complement existing strategies at overcoming antimicrobial resistance.</p>

Telemedicine-guided point-of-care ultrasound can be feasible and effective in a life-threatening situation: The case of a field hospital during the COVID-19 pandemic (Preprint)

2020 ◽  
Author(s):  
Tarso Accorsi ◽  
Karine De Amicis Lima ◽  
Alexandra Brigido ◽  
Deborah Belfort ◽  
Fabio Habrum ◽  
...  
Keyword(s):  
Point Of Care ◽  
Image Interpretation ◽  
Acquisition Time ◽  
Point Of Care Ultrasound ◽  
Field Hospital ◽  
Portable Ultrasound ◽  
Local Staff ◽  
Assessment Protocol ◽  
Life Threatening ◽  
Threatening Situation

BACKGROUND Lightweight portable ultrasound is widely available, especially in inaccessible geographical areas. It demonstrates effectiveness and diagnosis improvement even in field conditions but no precise information about protocols, acquisition time, image interpretation, and the relevance in changing medical conduct exists. The COVID-19 pandemic implied many severe cases and the rapid construction of field hospitals with massive general practitioner (GP) recruitment. OBJECTIVE This prospective and descriptive study aimed to evaluate the feasibility of telemedicine guidance using a standardized multi-organ sonographic assessment protocol in untrained GPs during a COVID-19 emergency in a field hospital. METHODS Eleven COVID-19 in-patients presenting life-threatening complications, attended by local staff who spontaneously requested on-time teleconsultation, were enrolled. All untrained doctors successfully positioned the transducer and obtained key images guided by a remote doctor via telemedicine, with remote interpretation of the findings. RESULTS Only four (36%) general practitioners obtained the appropriate key heart image on the left parasternal long axis window, and three (27%) had an image interpreted remotely on-time. The evaluation time ranged from seven to 42 minutes, with a mean of 22.7 + 12. CONCLUSIONS Telemedicine is effective in guiding GPs to perform portable ultrasound in life-threatening situations, showing effectiveness in conducting decisions.

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