Finger Prick Research Articles

IMPACTO DAS ANOMALIAS CONGÊNITAS NA MORTALIDADE NEONATAL: UMA REVISÃO SOBRE FATORES DE RISCO E PREVENÇÃO

This integrative review aimed to analyze the incidence of congenital anomalies in neonates and identify associated risk factors, as well as explore the most effective preventive measures described in the scientific literature. Congenital anomalies are structural or functional defects that develop during intrauterine life and are a major cause of neonatal and infant mortality. An estimated 303,000 newborns die annually within the first month of life due to these conditions (WHO, 2016). This study was conducted through the analysis of scientific articles published in the PubMed, SciELO, and Google Scholar databases, using keywords such as "congenital anomalies," "neonates," and "risk factors." Studies published in the last ten years, in Portuguese and English, addressing the incidence and risk factors of congenital anomalies in neonates were included. The results showed that the most common congenital anomalies include neural tube defects, cardiac malformations, and chromosomal abnormalities, such as Down syndrome (PACHECO et al., 2009). The prevalence of these conditions varies according to geographic region and population (BRASIL, 2021). Several maternal risk factors were identified, including advanced maternal age, smoking, alcohol consumption, and exposure to teratogenic substances during pregnancy (ANDRADE et al., 2017). Additionally, adverse socioeconomic conditions and lack of access to quality prenatal care were highlighted as important determinants for the increased incidence of congenital anomalies (LANSKY et al., 2014). Preventive strategies suggested by the literature include folic acid supplementation before and during pregnancy, proper vaccination of pregnant women, and genetic counseling (BRASIL, 2013; ACGO, 2018). Early diagnosis through neonatal screening tests, such as the heel prick test, pulse oximetry, and hearing screening, is crucial for early identification of anomalies and enabling interventions that can improve health outcomes for neonates (MINISTÉRIO DA SAÚDE, 2021). The review also emphasized the importance of early interventions, such as corrective surgeries and supportive therapies, to improve the prognosis of neonates affected by congenital anomalies (CHRISTIANSON, 2006). These interventions can significantly reduce morbidity and mortality rates associated with these conditions, improving the quality of life of affected individuals. In conclusion, this integrative review identified significant risk factors for congenital anomalies and highlighted the importance of preventive interventions and early diagnosis to improve neonatal health outcomes. The effective prevention and management of congenital anomalies require a multidisciplinary approach, including awareness among healthcare professionals, effective public policies, and family involvement in implementing preventive strategies. Ongoing research is recommended to further understand the causes, risk factors, and effective interventions to reduce the incidence of congenital anomalies and improve neonatal health outcomes.

ANÁLISE ACERCA DO CONHECIMENTO DE GESTANTES E PUÉRPERAS SOBRE A IMPORTÂNCIA DA TRIAGEM NEONATAL EM UMA UNIDADE DE SAÚDE E SEUS IMPACTOS QUANDO NEGLIGENCIADA

Neonatal screening based on the “heel prick test” biological matrix is a fundamental test performed in newborns for the screening of genetic, metabolic, and infectious diseases that can lead to health problems or irreversible deficiencies if neglected. The heel prick test is a public health policy adopted in many countries, including Brazil, and is widely recognized as one of the most important procedures in preventive medicine, in order to guarantee comprehensive care and universal access. Thus, the National Neonatal Screening Program (PNTN) was created in 2001, to promote and implement screening actions with a special focus on prevention, early intervention, and monitoring of children whose disease is included in the program's criteria. It is necessary that the health team guide the pregnant woman during the prenatal period, and the puerperal women, as well as their respective companions, on how and where to perform the “heel prick test”, highlighting its purpose to ensure effective awareness. Therefore, the present study aims to analyze the level of knowledge about neonatal screening in pregnant and postpartum women in the public health network. As well as introduce them to the importance of tracking in a timely manner to manage positive cases through monitoring and follow-up during treatment.

Examining systemic inflammation as a pathway linking peer victimization to depressive symptoms in adolescence.

Adolescents exposed to victimization are at an increased risk for a variety of adverse mental health outcomes, including depressive symptoms. Yet, the biological pathways underlying these associations remain poorly understood. Focusing on within-person processes, we examined whether low-grade systemic inflammation mediated the longitudinal associations between peer victimization and depressive symptoms in adolescence. 207 adolescents (at baseline Mage = 12.69 years; SD = 0.49; 43.5% female) participated in a multi-wave longitudinal study, with assessments repeated every 6 months over 1.5 years. At each assessment wave, participants self-reported their peer victimization experiences and depressive symptoms. Dried blood spots were collected at each wave using a finger prick procedure to assay a key marker of low-grade systemic inflammation, interkeukin-6 (IL-6). Data were analyzed using random-intercept cross-lagged panel models. The cross-lagged paths from IL-6 to depressive symptoms were significant across all models and waves (β12 = .13; β23 = .12; β34 = .08), indicating that when adolescents' levels of low-grade systemic inflammation were above their person-specific average, they reported increased levels of depressive symptoms in the subsequent months. However, no significant cross-lagged within-person associations emerged between peer victimization and either IL-6 or depressive symptoms. The findings provide no evidence for the hypothesized mediating role of inflammation in the within-person associations between peer victimization and depressive symptoms. Nevertheless, they extend prior research by indicating that elevated levels of low-grade systemic inflammation predict the development of depressive symptoms in adolescence.

Treatment switch from multiple daily insulin injections to sulphonylureas in an African young adult diagnosed with HNF1A MODY: a case report

BackgroundMaturity onset diabetes of the young is one of the commonest causes of monogenic diabetes and can easily be mistaken for type 1 diabetes. A diagnosis of maturity onset diabetes of the young can have direct implications for genetic counseling, family screening, and precision diabetes treatment. However, the cost of genetic testing and identifying individuals to test are the main challenges for diagnosis and management in sub-Saharan Africa. We report the very first documented case of HNF1A maturity onset diabetes of the young in the sub-Saharan African region.Case presentationA 20-year-old female Black African young adult diagnosed with type 1 diabetes aged 14 presented for routine out-patient diabetes consultation. She was on multiple daily insulin injections; total combined dose 0.79 IU/kg/day with an HbA1c of 7.7%. The rest of her laboratory examinations were normal. On extended laboratory analysis, she had good residual insulin secretion with post-meal plasma C-peptide levels at 1150 pmol/L. She tested negative for glutamic acid decarboxylase (GAD65), islet antigen-2 (IA-2), and zinc transporter 8 (ZnT8) islet autoantibodies. Targeted next-generation sequencing (t-NGS) for monogenic diabetes was performed using DNA extracted from a buccal sample. She was diagnosed with HNF1A maturity onset diabetes of the young, with the c.607C > T; p.(Arg203Cys) pathogenic variant, which has never been reported in sub-Saharan Africa. Her clinical practitioners provided genetic and therapeutic counseling. Within 10 months following the diagnosis of maturity onset diabetes of the young, she was successfully switched from multiple daily insulin injections to oral antidiabetic tablets (sulphonylurea) while maintaining stable glycemic control (HBA1c of 7.0%) and reducing hypoglycemia. She expressed a huge relief from the daily finger pricks for blood glucose monitoring.ConclusionThis case reveals that HNF1A maturity onset diabetes of the young (and probably other causes of monogenic diabetes) can present in sub-Saharan Africa. A diagnosis of maturity onset diabetes of the young can have significant life-changing therapeutic implications.

Force of Infection (FOI) and Multiplicity of Infection (MOI) in Plasmodium falciparum Infected Children Aged 1.5-12 Years Living in the Malaria Endemic Area of Banfora, Burkina Faso.

The aim of this study was to explore molecular measures of P. falciparum malaria burden (FOI and MOI) in the context of seasonal malaria chemoprevention. We analyzed malaria cases collected as part of a longitudinal cohort study. The cohort included P. falciparum-negative children aged 1.5 to 12, as confirmed by PCR 21 days after a radical cure using DHA-PQ or AS. Children were followed up for six months using active and passive case detection methods. At each visit, dried blood spots and blood smears were collected by finger prick, along with clinical data. Parasite DNA was extracted and analyzed by nested PCR for detection and genotyping of P. falciparum parasites. A total of 458 P. falciparum isolates collected during follow-up from October 2020 to March 2021 were genotyped. During the follow-up, children contracted 1.05 (95% IC [0.81-1.30]) new P. falciparum infections/child/time of exposure, and the MOI value was 3.00 (SD 1.60). Age is a protective factor (IRR: 0.74; 95% CI: 0.61, 0.90) against the occurrence of an episode of malaria, unlike an increase in MOI (IRR: 1.63; 95% CI: 1.04, 1.99), which is a favorable factor (p < 0.05). This study confirms the reduction in malaria transmission in our study area, probably due to the massive deployment of control tools.

7484 Pseudohypoglycemia In A Patient With Raynaud’s Phenomenon

Abstract Disclosure: J. Fedorko: None. P. Subarajan: None. A.P. Amblee: None. C.A. Poku: None. Background: The term ‘pseudohypoglycemia’ is used to describe the disparity between actual and measured capillary glucose and clinical presentation. It has been used to describe situations when a patient has the characteristic symptoms of low blood glucose (BG) Whipple’s triad), but the patient’s BG levels are within normal limits. Alternatively, this term can also be used to describe falsely low BG levels on finger-stick (capillary) readings in a patient with normal serum glucose levels and without the characteristic Whipple’s triad. Case: A 55-year-old female with Raynaud’s phenomenon was seen in Endocrine clinic with persistent hypoglycemia noted on finger-stick glucose readings. Her finger-stick glucose reading was 43, and was subsequently given 24 grams of glucose gel. Ten minutes later, a repeat finger stick BG was 44. She had no weakness, tremors, shakiness, vision changes, confusion, seizures, lightheadedness, dizziness, tachycardia, palpitations, nervousness, hunger, paresthesias irritability, confusion, seizures, loss of consciousness, or any other symptoms or signs of hypoglycemia. She had no such previous episodes and her fasting BG ranged from mid-70s to 80, with post-meal BG ranging from 100 to mid-100’s. Her most recent hemoglobin A1c was 5.5. She regularly experiences cyanosis of fingers consistent with Raynaud’s phenomenon, triggered by cold air in winter and air conditioners in summer. She does not take any medications for these episodes. Given the absence of classic Whipple triad and normal BG from peripheral blood draw, the patient’s low finger stick BG readings were attributable to Raynaud’s phenomenon. It is postulated to be secondary to decreased perfusion in the digital microcirculation and increased blood transit time in the fingers, resulting in a local increase in glucose consumption and thus low capillary finger stick BG levels. Simultaneously done serum glucose levels are usually normal. Conclusion: Pseudohypoglycemia can occur in patients with impaired peripheral circulation such as Raynaud’s phenomenon, acrocyanosis, peripheral vascular disease, shock, or with increased glycolysis by blood cells like in leukemia, polycythemia and rare infections like African trypanosomiasis, hyperviscosity syndromes like Waldenstrom’s and monoclonal gammopathy of undetermined significance. In patients with low finger-stick (capillary) glucose levels who do not display Whipple’s triad, and have comorbid conditions that might interfere with the BG reading, it is important for clinicians to recognize the difference between true and pseudohypoglycemia. This can be confirmed with a simultaneously done normal serum glucose level and will prevent unnecessary investigations or excessive treatment. Presentation: 6/3/2024

12273 Do The First 48 Hours Of Hospitalization Require More Vigilance In Geriatric Patients At Risk Of Hypoglycemia?

Abstract Disclosure: S. Ravi: None. H. Afsana: None. Hypoglycemia (HG; blood glucose &amp;lt;70 mg/dL) is a commonly encountered problem in hospitalized patients and is associated with significant morbidity and mortality as well as increased healthcare costs. Elderly patients are particularly vulnerable to HG as they are more likely to have autonomic dysfunction, resulting in fewer discernible symptoms as well as an impaired counterregulatory response, making it more likely that events go undetected and uncompensated. A survey of the literature identifies a number of risk factors for developing HG, including nephropathy, liver disease, infection, cognitive dysfunction, as well as sulfonylurea and long-term insulin use. Given the significant risks posed by HG, we pose the question: how can we do better to identify geriatric patients at high risk of HG events? In this retrospective chart review, data was collected from charts of patients aged 65-99 years with HG, who presented to the ED and were hospitalized for various reasons at a community hospital. Patients were included if a diagnosis of HG was documented in the EMR during hospitalization regardless of diagnosis of Diabetes Mellitus (DM). In 219 total individuals, potential associated variables were analyzed using descriptive statistics, chi-square tests, and Fisher’s exact tests. When data was not complete for any individual variables, the incomplete data was excluded during respective analysis. Among 219 patients, 128 (58.45%) presented at the time of admission, 33 (15.07%) presented within 24 hours after, 15 (6.85%) presented between 24 - 47 hours after, and 43 (19.63%) presented ≥48 hours after admission. Overall, 80.37% of HG events occurred within the first 48 hours of hospitalization. Interestingly there was no significant relationship identified between severity of HG events and HbA1c. The percent distribution identified delayed or missed meals (33%), insulin use (26%), and infection (8%), as the most common potential causes. These findings suggest that it is beneficial to extend the suspicion of HG events to all geriatric patients, regardless of diagnosis of DM. While validated tools have been proposed to identify diabetic patients at risk for HG, fewer studies have been done to identify potential markers of HG risk in all geriatric patients. It may be that the first 48 hours pose a critical period to identifying and better managing these patients’ blood sugars. While use of continuous glucose monitoring in the inpatient setting has been proposed as a potential solution, other cost-effective methods include ensuring timely delivery of meals and food intake, as well as closer finger stick glucose monitoring in the first 48 hours. Higher powered studies across a wider variety of clinical settings are required to further investigate hypoglycemic events in geriatric patients and to synthesize validated assessment tools. Presentation: 6/2/2024

A-346 Evaluating 14-3-3η Detection in Finger Prick Blood Using Lateral Flow Technology: Advancing Clinical Laboratory Diagnostics

Abstract Background The protein 14-3-3η is a critical biomarker in the diagnosis and monitoring of autoimmune rheumatologic disorders, and its early detection is pivotal for patient outcomes. Previous research has established the significance of 14-3-3η as a biomarker, particularly in inflammatory polyarthritis, as well as patients’ and physicians’ interest in near-patient testing. While 14-3-3η is traditionally measured in serum via ELISA, this study explores the innovative use of lateral flow technology (LFT) for its detection in finger prick blood, addressing the urgent need for near-patient testing.This research aims to evaluate the technical and clinical performance of 14-3-3η measurement using LFT in comparison to standard ELISA methods, with an emphasis on its detectability in finger prick blood. Methods This study included two phases of testing involving patient serum and spiked whole blood. In the serum phase, 53 samples (19 NEG, ≤0.19 ng/mL, and 34 POS, 0.27 to 28 ng/mL 14-3-3η) were tested using LFT. LFT results were compared to JOINTstat® ELISA measurements for concordance. For whole blood, recombinant 14-3-3η and ELISA-positive serum samples were spiked into whole blood at increasing concentrations (0.4 to 3.2 ng/mL) and tested with LFT. Concordance criteria included visual inspection of test and control lines, with results captured and analyzed using a reference key card. The study was extended to assess 14-3-3η levels in consented patients with 22 matched finger prick and venous serum samples​​. Results In serum testing, LFT demonstrated 100% positivity in detecting 14-3-3η for POS samples. Among NEG samples, 85% tested negative, with 15% positive, indicating a strong concordance between LFT and ELISA. The LFT's ability to semi-quantitatively measure 14-3-3η was confirmed by a significant Kruskal-Wallis test (p&amp;lt;0.0001) across four intensity groups. In whole blood testing, LFT correctly identified all samples spiked at concentrations ≥0.5 ng/mL. The Spearman correlation showed a strong and significant association (r=0.96 to 0.98, p=0.001) between LFT test line intensity and spiked 14-3-3η levels. Finally, the equivalence testing for finger prick and venous serum samples affirmed the LFT’s reliability, with a strong correlation (p&amp;lt;0.0001), underscoring its potential for near-patient testing​​. Conclusions The study validates LFT as a reliable and semi-quantitative method for detecting 14-3-3η in finger prick blood, demonstrating strong concordance with traditional ELISA measurements. The findings support the feasibility of LFT in near-patient testing for early detection, prognosis, and monitoring of autoimmune diseases, paving the way for enhanced patient accessibility. Future research will focus on integrating this technology into routine clinical care and examining its impact on patient management and outcomes.

A-062 Determination Neonatal 17-Hydroxyprogesterone Cutoff Levels for Congenital Adrenal Hyperplasia in Korea: 3 years' experience

Abstract Background Newborn screening for congenital adrenal hyperplasia (CAH) is a crucial practice with significant global adoption. While it offers substantial benefits, it also presents challenges due to high false positive rates, which can lead to mental strain for families and unnecessary hospital visits. Our research delved into the impact of birth weight (BW), gestational age (GA), and GA combined with sampling time on 17-hydroxyprogesterone (17-OHP) concentration. Specifically, we aimed to establish appropriate 17-OHP cutoff values for preterm, low birth weight weight (LBW), and sick newborns. Methods A total of 2,429 newborns born between October 2020 and January 2024 were screened for CAH. Samples were collected from neonates on a filter paper with a heel prick method. The 17-OHP concentration was measured by AutoDELFIA Neonatal 17-hydroxyprogesterone kit (PerkinElmer, Turku, Finland). This assay is a solid phase, time-resolved fluoroimmunoassay based on the competitive reaction between europium labeled 17-OHP and sample 17-OHP for a limited amount of binding sites on 17-OHP specific polyclonal antibodies. The 99.5 percentile was applied to the cutoff of 17-OHP for CAH. Results 17-OHP concentrations in newborns with lower BW and GA were significantly higher than those in normal BW and term newborns. 17-OHP concentration showed a statistically significant negative correlation with BW (r = -0.512, p &amp;lt; 0.001) and GA (r = -0.578, p &amp;lt; 0.001). Not only the full-term subgroup, but also preterm subgroups had a same tendency of 17-OHP concentration decrease with increasing sampling time. Application of newly establishing 99.5 percentile cutoff criteria significantly reduced recall rates to 1.02%, 0.81%, and 1.45% according to each criterion of BW, GA, and GA with sampling time, respectively. Conclusions This research introduces novel 17-OHP cutoff values for preterm, low birth weight (LBW), and sick newborns in the context of congenital adrenal hyperplasia (CAH). We analyzed the distribution of these cutoff values, considering factors such as birth weight, gestational age, and the timing of sample collection. Notably, applying the newly established cutoff criteria led to a significant reduction in false positive rates. Our laboratory’s data can serve as a valuable reference for other institutions aiming to set appropriate cutoffs, thereby minimizing unnecessary follow-up tests and enhancing the efficiency of CAH screening. As we continue to accumulate additional data, further reserch in this field remains promising.

A-348 Portable aptamer-based home monitoring system for blood phenylalanine measurement

Abstract Background Aptatek BioSciences, Inc. has developed a home monitoring tool for blood phenylalanine (phe) levels. The Aptatek system integrates a proprietary aptamer assay approach with a user-friendly handheld, smartphone-enabled test platform. PKU (phenylketonuria), is an inborn error of phenylalanine (Phe) metabolism If undiagnosed or untreated, phe accumulates in all body tissues, including the blood and brain, where it is especially neurotoxic and when untreated it can cause significant cognitive impairment and neurological defects. PKU management targets maintaining blood Phe concentration within the therapeutic range (120-360uM) to avoid severe neurological sequelae, mainly through nutritional therapy. Methods PheCheck™ includes a portable hand-held reader, software accessible as a mobile phone application, and a disposable single-use lateral flow cassette, blood collection, cap, and buffer chamber. PheCheck™ detects phe by binding of the phe in a small blood sample using small molecule-specific DNA aptamers. A patient (or caregiver) collects 5μl of capillary blood using a lancet to lance the fingertip and use the collection cap to collect the specimen. Once collected, the specimen is placed into the buffer chamber where the blood is diluted and processed in preparation for a lateral flow assay. The buffer chamber is placed on top of a lateral flow cassette to release the solution into the cassette. The lateral flow cassette is inserted into a small electronic reader after specimen incubation. The reader will detect a fluorescent signal from the strip and report the quantitative Phe concentration present in the specimen to the integrated mobile phone application. The reader has a simple design with a single operating push button, USB data connection port, and replaceable battery compartment. The reader reads the output of the lateral flow cassette and reports the result to a Smartphone app. The app is designed to either display the quantitative results or store the results without displaying the quantitative value. Results Twelve patients were trained on the PheCheck system and observed using the system for self-testing. Patients also prepared dried blood spot cards for comparative testing using LC-mass spectrometry. Patients were asked to return to the clinic within two weeks to retest. The blood phenylalanine levels measured by the PheCheck system were within targeted standard deviation of the dried blood spots demonstrating the feasibility of portable home-based testing for routine monitoring of blood phenylalanine levels in phenylketonuria patients. Such a portable system would enable real time monitoring and adjustment of diet or therapy for chronic diseases such as PKU. Conclusions Aptatek has developed a DNA aptamer based portable monitor for measuring blood phenylalanine levels. The system quantitatively measures phenylalanine from a 5-microliter finger stick blood sampler. Aptamer-based detection of phenylalanine provides reliable quantitation across a wide clinical concentration range and encouraging performance relative to gold standard testing of venous blood draw or dried blood spots. Analysis of samples from patients on Palynziq indicate that the PheCheck system could provide more reliable testing than venous blood draws. The system shows strong promise for routine home monitoring of blood phe levels by patients.

Sensitivity and accuracy of single-mode fiber optic sensor for non-invasive glucose measurement

Abstract Routine glucose level monitoring is essential for diabetic patients. Standard measurement methods based on finger pricking are inconvenient and susceptible to infection risk. Therefore, simple and non-invasive measurements are urgently needed. Compared to other approaches, glucose level measurement using optical methods offers many advantages, such as set-up simplicity, high sensitivity, and high accuracy. We optimize the sensing performance of glucose level sensors based on a single-mode fiber optic. The fiber optic serves as a medium for light propagation from a diode laser to a photodiode and, at the same time, serves as an active sensing medium. In the sensing area, the fiber optic cladding is partly (i.e., 1 – 5 cm) stripped to allow direct contact, which leads to evanescent wave absorption by glucose molecules. The length of fiber optic stripping and bending radius, which determine the sensitivity and accuracy of the sensor, varied. Bent fiber optic sensors consistently show a higher sensitivity and accuracy than straight ones. Maximum sensitivity of 2.35 mV/(mg/dL) was attained for a 3 cm stripping length and 4.5 cm bending radius. The lowest sensitivity of the sensor, 0.453 mV/(mg/dL), was acquired at the stripping length of 5 cm for the straight fiber optic sensor. The highest accuracy of the developed sensor is 99% for bent fiber optic sensors.

Comparison of Glucose Measurement Techniques Using Venous and Capillary Blood Samples in Diabetics Regarding Patient Satisfaction

Aim: This study was conducted to compare the satisfaction of patients diagnosed with diabetes mellitus regarding blood glucose measurement based on the blood glucose measurement techniques (intravenous and capillary) used. Material and Method: A randomized controlled study was conducted with 110 patients with diabetes mellitus. Patients were randomized into the experimental group (n=55) and control group (n=55). Patient Information Form, Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ), and Blood Glucose Measurement Patient Satisfaction Form were used in the study. The control group patients had their blood sugar measured using capillary blood from a finger prick. The experimental group patients had their blood glucose measured intravenously using venous blood, followed by capillary blood glucose measurement from a finger prick. Data analysis was conducted using chi-square test and independent t-test. Results: There were statistically significant differences in the satisfaction of diabetic patients with the blood glucose measurement technique between the use of venous blood and intravenous blood glucose measurement by finger prick (p

The Effect of Mother's Voice and Father's Voice Listened by Newborns During Heel Blood Collection on Pain Level and Physiological Parameters: A Randomized Controlled Study.

The newborn can learn the voices of its mother and father during intrauterine life, and the reencounter with these familiar voices after birth has a relaxing and calming effect on the baby. The purpose of this study was to determine the effect of mother's voice and father's voice that newborns listened to during the heel blood collection procedure on pain level and physiological parameters. The study was a randomized controlled trial. The study consisted of a total of 90 newborns as participants (mother voice group=30, father voice group=30, and control group=30) at the Düzce Atatürk State Hospital Gynecology Service, Türkiye. Newborns randomly assigned to the intervention groups were made to listen to the mother's voice/father's voice during the heel prick procedure. The newborn in the control group received standard heel blood collection procedures. When the pain level of newborns was examined, it was determined that the lowest Newborn Infant Pain Scale score was in the mother's voice group (P <.05). When the physiological parameter results were evaluated, it was determined that the highest oxygen saturation value and the lowest heart rate were found in the mother's voice group (P <.05). It was determined that the mother's voice was the most effective method in relieving the pain that occurred during the heel prick procedure and in the positive course of physiological parameters in newborns. According to the results of the study, it is recommended to use the mother's voice in order to reduce the pain caused by the heel prick attempt in newborns and to regulate their physiological parameters.

Performance of ParaHIT® HRP2-Based Rapid Diagnostic Test and Proportions of Plasmodium falciparum Histidine-Rich Protein 2/3 Gene Deletions in Togo.

In areas where malaria is endemic and microscopes are unavailable, rapid diagnostic tests (RDTs) are essential tools for early diagnosis and prompt and effective treatment. However, HRP2-based RDTs are threatened by the emergence of Plasmodium falciparum parasites that do not carry the pfhrp2 or pfhrp3 gene, leading to false-negative results. Therefore, the aim of this study was to evaluate the performance of the ParaHIT RDT together with the proportion of pfhrp2/3 gene-deleted P. falciparum parasites in Togo. The performance of RDTs compared with microscopy and polymerase chain reaction (PCR) was determined using capillary blood collected by finger prick during a cross-sectional study conducted from September 2021 to January 2022 in children aged 6-59 months at two sentinel sites. Blood spots were collected for molecular analysis. Amplicons from the target regions (exon 2 of hrp2 and hrp3 genes) were generated by multiplex nested PCR and sequenced using Illumina's MiSeq protocol. A total of 278 samples were analyzed for ParaHIT RDT evaluation. The sensitivity and specificity of the RDT test compared with microscopy were 96.4% and 85.7%, respectively, which increased to 97.9% and 90.7%, respectively, when compared with PCR. Of the microscopically and PCR-positive P. falciparum samples, 138 were sequenced to detect pfhrp2/3 deletions. None of the parasites had a single pfhrp2 deletion or a single pfhrp3 deletion. The ParaHIT RDT demonstrated an acceptable level of performance in this evaluation, confirming the use of HRP2-based RDTs for the detection of P. falciparum infection in areas where microscopy is not available in Togo.

High level of immunoglobulin G targeting mycoplasma or cytomegalovirus in the newborn increases risk of ADHD

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder typically detected in childhood. Although ADHD has been demonstrated to have a strong genetic component, environmental risk factors, such as maternal infections during pregnancy, may also play a role. We therefore measured the immunological response to 5 abundant microorganisms (Toxoplasmosis Gondii, cytomegalovirus (CMV), Herpes Simplex Virus 1, Epstein Barr Virus and mycoplasma pneumoniae) in newborn heel prick samples of 1679 ADHD cases and 2948 matching controls as part of the iPSYCH Danish case-cohort study. We found an association between high anti-CMV (OR 1.30, 95 % CI [1.09,1.55], p = 0.015) and anti-mycoplasma (OR 1.30, 95 % CI [1.07,1.59], p = 0.037) signal and those newborns later being diagnosed with ADHD. The risk estimate remained increased when controlling for ADHD polygenic risk score as well as penicillin prescriptions. We saw a dose–response association with the amount of positive anti-microorganism titers increasing the risk of being diagnosed with ADHD later in life (p = 0.01 for the trend), suggesting that the more activated the immune system is prior to or at birth, the higher the risk is for a later diagnosis with ADHD. If the associations are causal, they emphasize the importance of a healthy life style during pregnancy to reduce the risk of infections when pregnant and the associated risks for the child.

A Multi-Epitope Protein for High-Performance Serodiagnosis of Chronic Chagas Disease in ELISA and Lateral Flow Platforms.

We developed a protein to rapidly and accurately diagnose Chagas disease, a life-threatening illness identified by the WHO as a critical worldwide public health risk. Limitations in present day serological tests are complicating the current health situation and contributing to most infected persons being unaware of their condition and therefore untreated. To improve diagnostic testing, we developed an immunological mimic of the etiological agent, Trypanosoma cruzi, by combining ten pathogen-specific epitopes within the beta-barrel protein structure of Thermal Green Protein. The resulting multi-epitope protein, DxCruziV3, displayed high specificity and sensitivity as the antibody capture reagent in an ELISA platform with an analytical sensitivity that exceeds WHO recommendations. Within an immunochromatographic platform, DxCruziV3 showed excellent performance for the point of application diagnosis in a region endemic for multiple diseases, the municipality of Barcelos in the state of Amazonas, Brazil. In total, 167 individuals were rapidly tested using whole blood from a finger stick. As recommended by the Brazilian Ministry of Health, venous blood samples were laboratory tested by conventional assays for comparison. Test results suggest utilizing DxCruziV3 in different assay platforms can confidently diagnose chronic infections by T. cruzi. Rapid and more accurate results will benefit everyone but will have the most noticeable impact in resource-limited rural areas where the disease is endemic.

Real-time PCR for malaria diagnosis and identification of Plasmodium species in febrile patients in Cubal, Angola

BackgroundMalaria is the parasitic disease with the highest morbimortality worldwide. The World Health Organization (WHO) estimates that there were approximately 249 million cases in 2022, of which 3.4% were in Angola. Diagnosis is based on parasite identification by microscopy examination, antigen detection, and/or molecular tests, such as polymerase chain reaction (PCR). This study aimed to evaluate the usefulness of real-time PCR as a diagnostic method for malaria in an endemic area (Cubal, Angola).MethodsA cross-sectional study was carried out at the Hospital Nossa Senhora da Paz in Cubal, Angola, including 200 patients who consulted for febrile syndrome between May and July 2022. From each patient, a capillary blood sample was obtained by finger prick for malaria field diagnosis [microscopy and rapid diagnostic test (RDT)] and venous blood sample for real-time PCR performed at the Hospital Universitario Vall d’Hebron in Barcelona, Spain. Any participant with a positive result from at least one of these three methods was diagnosed with malaria.ResultsOf the 200 participants included, 54% were female and the median age was 7 years. Malaria was diagnosed by at least one of the three techniques (microscopy, RDT, and/or real-time PCR) in 58% of the participants, with RDT having the highest percentage of positivity (49%), followed by real-time PCR (39.5%) and microscopy (33.5%). Of the 61 discordant samples, 4 were only positive by microscopy, 13 by real-time PCR, and 26 by RDT. Plasmodium falciparum was the most frequent species detected (90.63%), followed by P. malariae (17.19%) and P. ovale (9.38%). Coinfections were detected in ten participants (15.63%): six (60%) were caused by P. falciparum and P. malariae, three (30%) by P. falciparum and P. ovale, and one (10%) triple infection with these three species. In addition, it was observed that P. falciparum and P. malariae coinfection significantly increased the parasite density of the latter.ConclusionsRDT was the technique with the highest positivity rate, followed by real-time PCR and microscopy. The results of the real-time PCR may have been underestimated due to suboptimal storage conditions during the transportation of the DNA eluates. However, real-time PCR techniques have an important role in the surveillance of circulating Plasmodium species, given the epidemiological importance of the increase in non-falciparum species in the country, and can provide an estimate of the intensity of infection.Graphical abstract

Relationship between dietary diversity and haemoglobin concentration among women of reproductive age (15−49 years) in the Upper East Region of Ghana

Purpose The purpose of this study is to investigate the relationship between dietary diversity and haemoglobin concentration of women of reproductive age (WRA), 15−49 years in the Binduri District, of the Upper East Region (UER) of Ghana. Design/methodology/approach This cross-sectional study was conducted among 153 non-pregnant, non-lactating WRA from three randomly selected communities in the Binduri District of the UER of Ghana. Socio-demographic information, 24-h dietary recall and minimum dietary diversity scores (DDS) of the women were obtained using an interviewer-administered questionnaire. Haemoglobin concentration of the participants was measured by finger prick using Hemocue 301 Analyzer and classified according to WHO standards. Linear regression analysis was used to assess the relationship between DDS and haemoglobin concentrations of the participants. Findings Total study participants were 153 with mean age of 32.8 ± 8.7 years. Anaemia prevalence of 66.7% and a mean DDS of 4.0 ± 1.2 was recorded. DDS was found to be a strong predictor of haemoglobin concentration (p = 0.00, R2 = 0.48). Practical implications Interventions that increase DDS may be effective in improving haemoglobin levels of WRA. Originality/value The results showed that DDS is a strong predictor of haemoglobin concentration of the WRA in this study. As the dietary diversity of the women increased, their mean haemoglobin concentration also improved. To the best of the authors’ knowledge, this is the first study of its kind to be conducted in the study area.

Correlation between the prothrombin time values obtained by point-of care prothrombin time meter and clinical laboratory in paediatric intensive care unit of a developing country

Background: Monitoring of prothrombin time (PT) is essential for adequate management of children in pediatric intensive care unit (PICU) who require serial and repeated PT measurements. In contrast to laboratory testing, point-of-care (POC) PT meters have been configured especially for bedside that are cost effective with rapid turnaround time. Our study aimed to assess its feasibility for routine use in PICU by assessing the correlation between PT values obtained through the POC PT meter and those acquired from the laboratory. Methods: A total of 200 children of either gender aged between 1 month to 12 years, admitted to PICU of Indus hospital Karachi Pakistan from February to August 2023 were analysed in this cross-sectional study. Venous blood samples were collected in PT bottles and transported to the pathology department within a time frame of 20-30 minutes for analysis. Concurrently, a drop of blood was obtained via finger prick and promptly assessed using the POC device-Coaguchek INRange system, (Roche diagnostics Ltd, USA). Pearson’s correlation was applied. Results: 200 children (96 males, 104 females) having a mean age of 6.42±3.55 years. The mean PT values with POC meter and Laboratory were 2.588±1.299 and 2.574±1.304 respectively (p=0.100). Very strong correlation of PT between POC PT meter and laboratory evaluation was observed (r=0.996, p&lt;0.001). Conclusions: The strong correlation observed between POC PT meter and laboratory supports the use of these devices for timely coagulation monitoring, potentially improving patient outcomes in PICUs.

Comparative Efficacy of Interventions for Analgesia During Heel Prick in Newborn Infants – A Systematic Review and Network Meta-Analysis

Comparative Efficacy of Interventions for Analgesia During Heel Prick in Newborn Infants – A Systematic Review and Network Meta-Analysis