Department of Electrical and Computer Engineering

North South University

Direct Research
Cheap Alternate Medical Diagnostic
System & Device

Md. Sadman-Al-Islam ID # 1610503042

Ahmed Zisan ID # 1611243042

Faculty Advisor
Dr. Mohammad Monirujjaman Khan
Associate Professor,
Department of Electrical & Computer Engineering (ECE).
Fall, 2020.

DECLARATION
1
This is to certify that this Project is our original work. No part of this work has been submitted

elsewhere partially or fully for the award of any other degree or diploma. Any material

reproduced in this project has been properly acknowledged.

Students’ name & Signature

1. Md. Sadman – Al - Islam

2. Ahmed Zisan

APPROVAL

2
The review paper entitled “Cheap Alternate Medical Diagnostic System & Device” by

Sadman-Al-Islam ID #1610503042 and Ahmed Zisan ID # 1611243042 is approved in

partial fulfillment of the requirement of the Degree of Bachelor of Science in Computer Science

and Engineering on February 2021 and has been accepted as satisfactory.

Supervisor’s Signature

Dr. Mohammad Monirujjaman Khan

Associate Professor
Department of Electrical and Computer Engineering
North South University
Dhaka, Bangladesh.

Department Chair’sSignature

Dr. Rezaul Bari

Associate Professor
Department of Electrical and Computer Engineering
North South University
Dhaka, Bangladesh.

ACKNOWLEDGMENT

3
First of all, we wish to express our gratitude to the Almighty for giving us the strength to

perform our responsibilities and complete the report.

The capstone project program is very helpful to bridge the gap between the theoretical

knowledge and real life experience as part of Bachelor of Science (BSc) program. This report has

been designed to have a practical experience through the theoretical understanding. We also

acknowledge our profound sense of gratitude to all the teachers who have been instrumental for

providing us the technical knowledge and moral support to complete the project with full

understanding.

It is imperative to show our appreciation for our honorable faculty member Dr. Mohammad

Monirujjaman Khan for his undivided attention and help to achieve this milestone. Also, our

gratefulness is divine to the North South University, ECE department for providing us a course

such as CSE 498R in which we could really work on this project and materialize it the way we

have dreamt of.

4
 ABSTRACT

Millions of people are dying or living in severe critical situations due to their suffering from

various lethal and life-threatening diseases. Even though the disease is not severe, regular health

check-up and screening for pre-determined or hereditary disorders often become a hassle because

of the complex treatment and diagnosis techniques. Expensiveness make the patients distressed

along with their family, especially in resource-poor middle and lower-income countries.

Alternative and cost-effective ways to diagnose and detect multiple diseases by analyzing their

specific clinical manifestations are being developed in today’s world of science and technology.

Widespread introduction of such systems has been a blessing for low-income countries with low

resource mechanisms. These devices play a vital role in diagnosing critical medical conditions by

replacing the conventional systems with cheaper alternate ways. In this study, widely used and

well recognized reasonable alternate diagnostic systems and devices have been listed with

classifications and their proper applications in the medical field.

5
 Table of Content
Page

Chapter 1: Introduction…………………………………………………………….. 01
1.1 Introduction ……………………………………………………………………………….
1.2 Background Study...………………………………………………………………………..
1.3 Problem statement…………………………………………………………………………
1.4 Literature Review………………………………………………………………………….
1.5 Organization of the paper………………………………………………………………….
Chapter 2: Method and Materials………………………………………………..
2.1 Test Kits…………………………………………………………………………………...
2.1.1 Early result pregnancy test………………………………………………………………
2.1.2 HCG pregnancy test strips………………………………………………………………
2.1.3 Rapid Detection Pregnancy test…………………………………………………………
2.1.4 LH Ovulation test……………………………………………………………………….
2.1.5 blood sugar Testing Kit…………………………………………………………………
2.2 Biosensors and Nano-particles……………………………………………………………
2.2.1 Diagnosis of Infectious Diseases……………………………………………………….
2.2.2 Diagnosis of HIV……………………………………………………………………….
2.2.3 Diagnosis of Hepatitis…………………………………………………………………..
2.2.4 Diagnosis of Influenza………………………………………………………………….
2.2.5 Diagnosis of Ebola……………………………………………………………….……..
2.3 Applications of Biosensor in Animal Health……………………………………………..
2.4 Biosensors in Cardiac Diseases…………………………………………………………..
2.5 Microfluidic Technology…………………………………………………………………
2.5.1 Lab on chip (LOC) Technology………………………………………………….……..
2.5.2 Point of Care Test (POCT) ……………………………………………………….……
2.5.3 CD-based Devices………………………………………………………………...……
2.5.4 Paper-based Devices……………………………………………………………………
2.6 Test by a Single Drop of Blood………………………………………………………….

6
2.6.1 Diagnosis of Sickle Cell Anemia………………………………………………………
2.6.2 Detection of Dengue, Ebola virus or yellow virus ……………………………………
2.6.3 Detection of Tuberculosis……………………………………………….……..………
2.6.4 Detection of HIV and Hepatitis C………………………………………….……..……
2.7 IoT based healthcare and patient monitoring and diagnosis system……………………..
2.7.1 IoT based monitoring system…………………………………………………………..
2.7.1.1 ESP32 Processor……………………………………………………………………..
2.7.1.2 Heartbeat Sensor……………………………………………………………………..
2.7.1.3 Body Temperature Sensor (LM35) ………………………………………………….
2.7.1.4 Room temperature Sensor (DHT11) …………………………………………….…..
2.7.1.5 CO Sensor (MQ-9) …………………………………………………………………..
2.7.1.6 CO2 Sensor (MQ-135) ………………………………………………………………
2.7.1.7 ECG Sensor ………………………………………………………………………….
2.7.2 IoT based diagnosis of cardiovascular diseases………………………………………..
2.7.3 Diagnosis of diabetes and blood level monitoring……………………………………..
2.8 Smart Heath Monitoring System…………………………………………………………
2.8.1 Sensor-based health monitoring system………………………………………………..
2.8.2 Smartphone based heath monitoring system…………………………………………...
2.8.3 Web-based Imaging technology………………………………………………………..
2.8.4 Microcontroller based health monitoring system………………………………………
2.9 latest Technology in Diagnostic System…………………………………………………
2.9.1 Application of Artificial Intelligence…………………………………………………..
2.9.2 Detection of hypoglycemia from raw ECG signal……………………………………..
2.9.3 Blood sugar monitoring without finger pricks…………………………………………
Chapter 3: Result and Analysis……………………………………………...
Result and Analysis………………………………………………………………………….
Chapter 4: Conclusion and Future Work…………………………………
Conclusion and future Work…………………………………………………………………
Bibliography………………………………………………………………………

7
 List of Figures

Figure No Figure Caption Page No

HCG pregnancy test strips

Schematic representation of a biosensor
Mechanism to detect Influenza A virus
Mechanism of detection of Ebola virus
Direct detection of Ebola virus using optofluidic biosensor
Low-cost device to detect Ebola, Dengue and Yellow fever
Detection of Tuberculosis by GeneXpert MTB/RIF
Device for HIV and Hepatitis C test
Hardware components for the healthcare monitoring system. a)
ESP32 processor, b) heart beat sensor, c) body temperature sensor, d)
room temperature sensor, e) CO sensor, f) CO2 sensor

Heartbeat Sensor
ECG Sensor
Taxonomy of the reviewed smart health monitoring systems
Prototype of heart disease monitoring system
Block diagram of Arduino based heath monitoring system
A device from “Abbott” that continuously monitors diabetics’ blood
sugar levels without requiring backup finger prick tests

8
 List of Tables

Figure No Figure Caption Page No

Comparison with other articles

9
 CHAPTER 1

INTRODUCTION

10
1.1 Introduction

In the modern era of advanced science and technology, medical field is greatly benefitted with

massive expansion of effective healthcare system, medication, diagnostic and treatment tools.

The sole purpose of treatment system lies in the betterment of patients in the shortest, most cost-

effective and caring ways possible. However, when the advancement of medical tools and

devices are developing in full swing, rate of patients getting affected and killed from different

diseases is also increasing every day. Even in this 21st century where we have already entered a

new decade, millions of people are dying for various infectious disorders and the scenario is

more crucial in underdeveloped as well as developing countries [1]. The cost of providing

effective healthcare services is now considered unsustainable and hard to afford in most high-

income developed countries. With a view to contributing more in the medical sector, researchers

in this field have been working relentlessly to introduce more affordable and sustainable ways of

treatment procedures and ensure fruitful healthcare services worldwide.

1.2 Background Study

Alternative and cheaper ways of diagnostic systems and devices are being introduced in medical

science without compromising any quality, effectiveness and outcome of the provided care [2].

Alternate ways of widely used medical diagnostics include low-cost pregnancy kit, blood sugar

testing machine, biosensor and nano-biosensors, microfluidics system, webcam-based imaging,

ELISA-LOC system, point of care tests (POCT), rapid detection tests (RDT), nucleic acid

11
amplification tests (NAAT), acupuncture and many more significantly used diagnostic methods

and devices.

1.3 Problem statement

In this modern era, we are getting a huge number of facilities in medical sector. The structure of
medical diagnosis system has improved a lot in the last decade. Then again, there are some issues
which are bothering medical diagnosis system still now.

 Death because of late diagnosis

 Time consuming
 Expensive
 Unavailability
 Distance

1.4 Literature Review

Many human beings are demise or residing in extreme imperative conditions due to their

struggling from quite a number deadly and life-threatening diseases. Even though the sickness is

now not severe, ordinary fitness check-up and screening for pre-determined or hereditary

problems regularly end up a problem due to the fact of the complicated therapy and analysis

techniques. Expensiveness make the sufferers distressed alongside with their family, particularly

in resource-poor center and lower-income countries. Alternative and most economical

approaches to diagnose and realize more than one ailment with the aid of examining their

particular medical manifestations are being developed in today’s world of science and

technology. Widespread introduction of such structures has been a blessing for low-income

12
international locations with low aid mechanisms. These units play a fundamental position in

diagnosing fundamental scientific prerequisites via changing the traditional structures with more

cost-effective alternate ways. In this study, broadly used and properly identified sensible

alternate diagnostic structures and gadgets have been listed with classifications and their perfect

functions in the clinical field.

1.5 Organization of The Paper

This paper is organized with

 Test kits

 Biosensors and Nano-particles

 Microfluidic Technology

 Test by a Single drop a blood

 IoT based healthcare and patient monitoring and diagnosis system

 Smart health monitoring system

 Latest technology in diagnostic system

 Comparison and analysis

 Conclusion and future work.

13
 CHAPTER 2

METHOD AND

MATERIALS

14
2.1 Test Kits
2.1.1 Early Result Pregnancy Test

This accurately conducted test can detect all four of different forms of the human chorionic

gonadotropin (hCG) hormones present in urine. The test sticks are prepared to show the result

within three to four minutes and if it is done in the day expected menstruation date, the result is

more accurate [6].

Pregnancy or gestation period begins when a woman develops a fetus (offspring) inside her

womb after the fusion of an egg and sperm cell. Diagnosis for pregnancy can be carried out in a

variety of ways. All the pregnancy tests work by measuring the level of human chorionic

gonadotropin hormone which is produced by the placenta. It is usually found in a woman’s urine

and blood immediately after the implantation of an embryo in her uterus which can take 6 to 12

days after fertilization. The amount increases every day after that and almost takes 19 days to

rise the optimal level needed to be detected by any urine pregnancy test [5].

2.1.2 HCG Pregnancy Test Strips

This procedure is also done using test strips and a cup is required to submerge the strip to look

for a result. The visibility of two different color bands indicates positive test result. It is one of

the most reasonable ways to test for pregnancy [6]. The figure below represents two different

bands for positive result and only one band for negative result.

15
 Figure 1: HCG pregnancy test strips [6]

Fig. 1 shows the HCG pregnancy test strips. This represents two different bands for positive result and
only one band for negative result

2.1.3 Rapid Detection Pregnancy Test

This manual test comes with the fastest delivery of results within around a minute. The presence

of a wide, color changing tip that turns white from pink makes the test rapid while the “flood-

guard” feature helps to prevent any user error [6].

2.1.4 LH Ovulation Test

In order to aim for a pregnancy and when a woman should conceive, time of ovulation is a basic

to learn about. Although it is assumed that women ovulate in a certain timeframe according to

their menstruation cycle, the time might shift every once in a while. For this reason, it is better to

be assured through the luteinizing hormone test for ovulation. Like a regular pregnancy test, the

woman needs to pass urine through the strip and wait for three to four minutes. Positive result

indicates that she would be ovulating within 24 to 48 hours [6].

16
2.1.5 Blood Sugar Testing Kit
Glucose biosensors are vastly used in diagnosing diabetes mellitus measuring the precise blood

glucose level consistently. Biosensors of blood glucose level detection are being used as a home-

applicable method worldwide [8].

2.2 Biosensors and Nano-particles

Fig. 2 shows the schematic representation of a biosensor. Biosensors are defined as analytical

devices used to transform any biological response into an electrical signal and these devices are

widely used in diagnosing diseases. It consists of an analyte, a transducer, a sensing bioreceptor

with digital output and a signal. When the analyte is captured, biological response is converted to

the signal to be received. In the vast area of medicine and various diagnostic and treatment

techniques, the clinical applications of biosensors and nanoparticles are growing rapidly.

17
 Figure 2: Schematic representation of a biosensor [7]

2.2.1 Diagnosis of Infectious Diseases:

Identification of pathogens various infectious diseases including urinary tract infection,

antimicrobial susceptibility and antibiotic resistance, viral disorders are being studied using the

biosensor technology which is more cost-effective than other conventional methods. Biosensors

are recognized for their great impact to turn the current analytical methods into diagnostic

strategies by restructuring their sensing module for the detection of biomolecules, especially

nano-sized objects such as protein biomarkers and viruses [9].

18
2.2.2 Diagnosis of HIV
Human immunodeficiency virus (HIV) severely infects the CD4+ helper T lymphocyte cells and

rapidly enter into the bloodstream while replicating in an unregulated manner. The final stage of

this infection is named as acquired immunodeficiency syndrome (AIDS) which is known to be

the most dreadful disease as well as a major issue in public health. Rate of mortality for this viral

infection is increasing worldwide. To ensure specificity and sensitivity in diagnosing this viral

infectious disease, biosensing technology is considered as a well performing technique. HIV

aptamer, glycoprotein 41 of HIV 1 are detectable by using biosensors [9].

2.2.3 Diagnosis of Hepatitis

Development of impedimetric biosensors modified with gold nanoparticles in order to detect

sequence selective DNA (deoxyribonucleic acid) hybridization in diagnosing hepatitis B virus is

well recognized. Paper based electrochemical biosensors have also been used to identify the

DNA of hepatitis viruses, especially hepatitis B virus which is the most lethal among all virus

types under this class. In the detection and monitoring of hepatitis A, a thermosensitive surface-

imprinted polymer-based biosensor is developed. In this method, temperature is controlled to

capture the virus and analyze further.

2.2.4 Diagnosis of Influenza

Fig. 3a shows the process of the diagnosis of influenza [10]. Conventional techniques of

diagnosing this virus are not sufficient and time consuming. Alternative methods are developed

in this regard. In the detection and isolation of H9N2 sub-type of influenza A virus, attachment

19
of anti-matrix protein 2 antibodies to some iron magnetic nanoparticles was conducted to isolate

the virus followed by the addition of fetuin A and gold nanoparticles to detect the virus tacking

advantage from fetuin-hemagglutinin interaction. Afterwards the extracted complex was treated

with an acid solution to collect the gold nanoparticles on a carbon electrode. This particular

biosensor was reported to provide the rapid detection of H9N2 subtype of influenza A virus.

Figure 3a: Mechanism to detect Influenza A virus

Another procedure involves the immobilization of DNA by using carbon nanotubes to detect

influenza virus. A DNA probe is attached to the biosensor and characterization is achieved by the

analyses of Fourier transform infrared interaction and Raman spectrometry. Observance of the

occurred changes on the surface of the biosensor helped in the detection of output signal of the

system. A fluorescent biosensor is also developed to detect H5N1 influenza virus in human

serum.

20
2.2.5 Diagnosis of Ebola
Fig. 3b elaborately exhibits the method of diagnosis of Ebola. Infection caused by Ebola viruses

are life threatening and often symptoms like hemorrhage, certain organ failure or shock-like

syndromes are observed. To diagnose the viral infection rapidly with point of care determination,

electrochemical biosensor is used. Enzyme-amplified detection is carried out by labelling a

biotinylated hybrid with streptavidin and alkaline phosphatase conjugate [12]. The experiment is

thoroughly optimized with an electrochemical spectroscopy and the viral presence is detected by

using this biosensor.

Figure 3b: Mechanism of detection of Ebola Virus [12]

Fig. 3c shows the technique is shown where the developed biosensor functions by using specific

antibodies and depends on the light transmission impact through plasmonic nanoholes. Direct

detection of the whole viral strains of Ebola is conducted by using optofluidic biosensor.. The

21
immobilization of the selected antibodies against Ebola glycoproteins on the biosensors and the

transmission spectra is analyzed followed by the washing procedure [13].

Figure 3c: Direct detection of Ebola virus using optofluidic biosensor [13]

2.2.6 Diagnosis of Dengue

Even though enzyme linked immune-sorbent assay (ELISA) is widely used in the

detection of dengue virus, researchers have been considering the advantages of biosensors in this

concern. The cost effectiveness, enhanced specificity and sensitivity, on-site monitoring with

quantitative analysis, simpler optimization along with rapid outcome are the major reasons

behind the popular use of this alternative method [14]. A silicon nanowire biosensor is broadly

used to detect the dengue serotype 2. Covalent attachment of a peptide nucleic acid on a silicon

nanowire surface is verified by the hybridization measurement of the resistance alteration in

silicon nanowire biosensor before and after the binding of the selected dengue serotype 2 with

the peptide nucleic acid sequence.

22
 A surface plasmon resonance biosensor is also developed to detect anti-dengue virus in

human serum sample [15]. Four dengue virus serotypes are used as ligands on the biosensor and

the obtained results show higher sensitivity and specificity in determining the ratio of each

dengue serotype used where a minimal amount of patient’s serum sample is needed.

2.3 Applications of Biosensor in Animal Health

Biosensor and wearable technologies are extensively being used in animal health care and

management because of their timely diagnosis capacity with minimized economic loss. It is

particularly useful in dairy cattle and poultry farms. Determination of body temperatures and pH,

detection of sweat and saliva constituents, stress, behavior and movement, presence of any

pathogens and prevention of diseases, antibiotic detection to minimize antibiotic resistance all

together rely on the activity of biosensors.

2.4 Biosensors in Cardiac Diseases

Conventional techniques to detect and diagnose cardiovascular diseases include ELISA,

fluorometric, immunoaffinity column assay and so on which are expensive, time-consuming and

require trained personnel to handle the procedure. Biosensors function by electric measurement

and are able to determine biochemical molecular condition with the expected selectivity and

specificity. Specific biomarker of interest is used here. In order to detect heart failure or other

cardiovascular difficulties in an early stage, hafnium oxide (HfO 2) based biosensor is developed

that can detect early-stage level of the human interleukin 10 (IL-10). Attachment and interaction

of recombinant IL-4 with selected monoclonal antibodies aid the detection of cytokine levels

23
after the administration of device. The interaction is characterized and analyzed by

electrochemical impedance spectroscopy and fluorescence patterns.

Biosensors can also ensure the quantitative measurement of cardiac markers present in undiluted

serum. Extended applications are widely observed in immunosensor array for the clinical

immunophenotyping of acute leukemias, microfluidic impedance assay for controlling

endothelin-induced cardiac hypertrophy, effect of oxazaborolidines on immobilized

fructosyltransferase in dental diseases; histone de-acylase (HDAC) inhibitor assay from

resonance energy transfer, biochip for a quick and accurate detection of multiple cancer markers

and neurochemical detection by diamond microneedle electrodes [8].

Fluorescent biosensors function as imaging agents in cancer and drugs discovery and detection.

GFP (green fluorescent protein) based and FRET (fluorescence resonance energy transfer)

biosensors significantly work in the regulation of enzymes at a cellular level in this field of

medical science. The biosensor is a combination of small scaffolds where various fluorescent

probes are attached through receptor. The receptor then identifies specific analyte or target

molecule and transduce a fluorescent signal which can be readily detected and analyzed. Using

these biosensors, detection and diagnosis of arthritis, cardiovascular and inflammatory diseases,

viral infection, neurodegenerative diseases, cancer and metastasis are conducted. Potentiality and

specificity of specific drugs are analyzed by these biosensors for preclinical evaluation and

clinical validation as well as in monitoring disease progression, early detection of biomarkers

and response to certain therapeutics or treatment measures.

24
2.5 Microfluidic Technology
Microfluidics is referred to a specialized field of biomedical engineering extensively based on

the optimization and analysis of biological fluids such as blood, urine, saliva etc. by using

microchannels. This process is faster and more convenient compared conventional ways of

biological fluid analysis. Microfluidics based diagnosis and used devices are broadly classified

into two categories where first one is the development and use of a device that deals with the

flow of biological fluids through microchannels and the other one is based on technology that

deals with the detection or sensing of biomarkers of biological fluids for analysis [16].

Examination through this technique is reported to be a vital element during endemics and

epidemics where analysis of biological fluids can easily pave the way for effective diagnosis and

detects the causative agents or microorganisms that eventually help to predict the proper

treatment procedure. And thus, microfluidics can facilitate diagnosis, treatment options and

prevention in the wide arena of medical field. Different types of microfluidics tools and device

systems are discussed in this section.

2.5.1 Lab on Chip (LOC) Technology

LOC system is generally based on molecular biology and microfluidics. Development of this

technology has reduced the time and pressure in the process of treatment-action in any medical

condition which often become fatal due to the intervals in treatment options [16]. LOC devices

comprise of three basic components such as fluid flow controlling devices like microchannels,

mixers, microvalves etc., sensors (optical or electrochemical attached to the chip) and decision-

making capability technology like micro-electro mechanical system (MEMS), micro total

25
analytical system etc. [17]. Flow cytometry, MEMS, micro total analytical system, PCR

technology, soft lithography, lateral flow immunoassay (LFIA), immunochromatography, pulse

field gel electrophoresis (PFGE), optical or electrochemical sensors technology are applied in

LOC system [16].

2.5.2 Point of Care Test (POCT)

Point of care test is termed as medical diagnostic system conducted at the time of making clinical

examination in order to improve health care procedure. The treatment measures are effectively

predicted by this test method [16]. POCT is broadly divided into two categories such as small

handled devices that provide both qualitative and quantitative results by detecting one or

multiple analytes (examples include glucose biosensor strips, lateral flow strips that detect

cardiac markers) and large devices that are used near the patient’s bedside. Example of large

device includes small hematological and immunology assays [16].

Four steps are involved in devices of POCT including i) sample collection and pre-preparation,

ii) reagent mixing, iii) analytical assay running and iv) detection of result [16]. Some of the most

recent and developed POCTs are discussed below.

2.5.3 CD-based devices

Lab on a compact disc (CD) based devices are widely used to demonstrate several fluidic

functions like mixing, valving, separation, bubble or droplet formation in the area of advanced

26
microfluidics technology [18]. Complicated biological assays like ELISA or nucleic acid

analysis have been optimized in CD based devices.

2.5.4 Paper-based devices

Paper based devices have been designed and developed by creating hydrophobic barriers that can

establish “zero cost diagnostics” [18]. Paper matrix is composed of huge number of cellulose

fibers allowing it to maintain the capillary force and control the fluid flow efficiently in

diagnosis. Under the network of paper-based system, colorimetric approach, fluorescent-based

approach, electrochemical and electrochemiluminescence approach have been reported in the

detection and analysis of certain analytes [18]. Among these, the colorimetric approach is

globally used for qualitative and quantitative detection and analysis. Use of papers with

plasmonic resonance that are impregnated in nanoparticles has enhanced the sensitivity of this

approach and this has been used for kidney biomarker detection. Diagnosis of hepatitis B virus

DNA is conducted by using electrochemical paper sensor. Researchers of Massachusetts Institute

of Technology (MIT) have developed a simpler and cost-effective noninvasive paper-based

device that can aid the improved diagnosis and treatment rate for cancer [19]. The test functions

as a pregnancy kit and determines cancer within minutes. The technology is particularly based on

nanoparticles that interact with proteases (proteins that are known to be overexpressed in

numerous tumors having the ability to cleave peptide bonds), which can release hundreds of

biomarkers that can be detected in the patient’s urine [19].

2.6 Test by a Single Drop of Blood

27
Whitesides research group of Harvard has fabricated a low-cost device that can analyze blood

samples or water sample and diagnose diabetes, malaria as well as detect water pollutants [4].

The functional potentiality can be extended to further diagnose HIV, Ebola, Dengue, influenza or

hepatitis. A single drop of blood sample is inserted into the device embedded on a paper strip and

diagnosis can be done within minutes. The device is connected to a cellular phone via cable and

thus patients can be monitored from anywhere in the world [4].

2.6.1 Diagnosis of Sickle Cell Anemia

The same group of researchers developed a method to centrifuge blood using a simpler and

mobile kit where results can be obtained within 10 minutes [4]. Sickle cell disease is a known

disease of red blood cells where the cells grow in an abnormal way and often get destroyed;

causing anemia. Obtained result is visible depending on the floatation ability of the collected

blood sample.

2.6.2 Detection of Dengue, Ebola Virus or Yellow Fever

Fig. 4a shows some low-cost device to detect Ebola, Dengue and Yellow fever. Researchers of

MIT have created a cost-effective device that can test for dengue, Ebola and yellow fever within

around 10 minutes [4]. Based on the techniques of molecular biology, screening with a single

drop of blood is enough to diagnose the aforementioned diseases.

28
 Figure 4a: Low-cost device to detect Ebola, Dengue and Yellow fever [4].

2.6.3 Detection of Tuberculosis

Fig. 4b shows the detection of Tuberculosis by GeneXpert MTB/RIF. To detect tuberculosis and

resistance against the widely used antibiotic for tuberculosis named rifampicin, a device called

GeneXpert MTB/RIF has been created that can provide faster results with accuracy, yet a bit

more expensive than the previously mentioned ones [4

Figure 4b: Detection of Tuberculosis by GeneXpert MTB/RIF [4].

29
2.6.4 Detection of HIV and Hepatitis C

Fig. 4c shows device for testing HIV and Hepatitis C. A diagnostic kit has been developed by a

Canadian company named MedMira [4] and reported to be an effective device to test for both

HIV and Hepatitis C in a low-cost and rapid way.

Figure 4c: Device for HIV and Hepatitis C Test [4].

2.7 IoT based Healthcare and Patient Monitoring and Diagnosis

System
IoT or “Internet of Things” has been a recent and well-recognized approach in covering almost

every sector of modern technological research. The system represents an interconnection of

devices over the internet [20]. Since the accessibility of internet is extensively widespread all

over the world, especially the current scenario in Bangladesh is massive despite being a

developing country. One of the most impressive outcomes of IoT based technology has been

reported in the field of medicine and diagnostics. Applications of IoT are widespread throughout

medical science, among them an overall monitoring system of patients has been well recognized.

30
2.7.1 IoT based monitoring system
A system has been proposed by Islam, Rahaman and Islam where they majorly focused on

monitoring the fundamental signs of all types of patients and the patients’ room environment

[21]. This IoT based healthcare system is designed to monitor the pulse and body temperature of

patients along with room humidity, total level of carbon dioxide and carbon monoxide via

sensors while transmitting the received data through Wi-fi (wireless fidelity) that enable the

medical staffs and doctors to optimize the data from the server. The developed system also

provides a solution for the problem of maintaining a single database of patients in hospitals using

a web server, apart from the personalization of critical health-related criteria [21]. This system

comprises a heartbeat sensor, an ESP32 processor, CO sensor (MQ-9), CO 2 sensor (MQ-135),

body temperature sensor (LM35) and room temperature sensor (DHT11) [21].

31
Figure 5a: Hardware components for the healthcare monitoring system. a) ESP32 processor, b) heart beat

sensor, c) body temperature sensor, d) room temperature sensor, e) CO sensor, f) CO2 sensor [21].

Fig. 5a shows the hardware components of healthcare monitoring systems. Here (a) is ESP32 processor,
(b) is heart beat sensor, (c) is body temperature sensor, (d) is room temperature sensor, (e) is CO sensor
and, (f) is CO2 sensor [21].

2.7.1.1 ESP32 Processor

Fig. 5a (a) shows the ESP32 microcontroller. One of the principal IoT learning tools is known as

ESP32. This provides a complete Linux system at a very low price on a small platform. Using

GPIO pins, ESP32 links system sensors and actuators. In the healthcare system, ESP32 and IoT

combine to be a modern technology for innovation. With integrated antenna switches, RF-balun,

control amplification, low-noise amplifier and filters as well as power management modules, the

ESP32 is heavily designed. It may operate as a full stand-alone device or as a slave to a host

MCU, minimizing overhead interaction within the main processor of the application. The EPS32

32
can communicate through its SPI/SDIO or I2C/UART interfaces with other Wi-Fi and Bluetooth

devices. [21].

2.7.1.2 Heartbeat Sensor

Fig. 5b shows a heartbeat sensor. With the theory of plethysmography, the heartbeat sensor was

created. It tests the change in the volume of blood in the organ of someone that causes the

intensity of light to pass through that organ. In systems where the heart pulse rate has to be

monitored, the timing of the pulses is more crucial. The heartbeat rate determines the blood

volume distribution, and when the light is absorbed by the blood, the signal pulses are equivalent

to the heartbeat pulses [41].

Figure 5b: Heartbeat Sensor [41].

2.7.1.3 Body Temperature Sensor (LM35)

Fig. 5a (c) exhibits this sensor. The LM35 series is an accurately optimized output voltage

temperature circuit that is linearly proportional to the centigrade temperature. The LM35 has a

33
view point over the Kelvin's linear temperature sensors, as a practical centigrade scaling does not

allow the user to remove the enormous constant voltage from the display. [21].

2.7.1.4 Room Temperature Sensor (DHT11)

Fig. 5a (d) depicts this sensor. DHT11 is a temperature and humidity sensor which is used

frequently. The sensor comes equipped with a dedicated NTC temperature measurement device

and an 8-bit microcontroller to process temperature and humidity values in series. The sensor is

also factory-calibrated, making it easy to interact with other microcontrollers. [21].

2.7.1.5 CO Sensor (MQ-9)

Fig. 5a (e) depicts this sensor. For LPG, CO, and CH4 detection, MQ-9 is the most suitable.

Because of its high sensitivity and fast reaction time, measurements can be taken easily. T he

sensitivity of the sensor can be modified using the potentiometer. [21]

2.7.1.6 CO2 Sensor (MQ-135)

Fig. 5a (f) portrays this sensor. MQ-135 gas sensors are used for the detection of NH3, nicotine,

benzene, smoke, and CO2, as well as for testing air quality control systems. The MQ-135 sensor

module comes with a digital pin that allows this sensor to operate even without a microcontroller

and is useful for precise gas detection. Analog pins are used to measure the gases in PPM. The

analog pin is operated by TTL and operates at 5 V and hence it can be used with most modern

microcontrollers. [21]..

34
2.7.1.7 ECG Sensor
Fig. 5c shows the ECG Sensor. An ECG Sensor with disposal electrodes attaches directly to the

chest to detect every heartbeat. The electrodes of ECG sensor will convert heart beat to electric

signal. ECG sensor is very light weight, slim and accurately to measures continuous heart beat

and shows data rate of heart beat. The AD8232 is a little chip used to measure the electrical

activity of the heart. The electrical activity can be charted as an ECG or Electrocardiogram.

Electrocardiography is used to help diagnose various heart conditions [41].

Figure 5c: ECG Sensor [41].

Fig. 5d shows taxonomy of the reviewed smart health monitoring systems listed by a review

paper of all the systems of IoT in health monitoring applications prioritize of hardware

components, that is, which components were used more than others. All systems have therefore

35
been classified into three distinct categories: (1) Sensor-based health monitoring systems, (2)

Smartphone-based health monitoring systems, (2) Smartphone-based health monitoring systems,

(3) Microcontroller-based health monitoring systems [22].

Figure 5d: Taxonomy of the reviewed smart health monitoring systems

2.7.2 IoT Based Diagnosis of Cardiovascular Diseases

Mobile and IoT technologies have been serving continuously in solving the problem of heart

diseases and patients care. It is feasible to monitor the vital functions of human no matter where

they are and what they are doing with IoT based diagnostic techniques. In addition, the data

collected can be sent with low-cost to the remote physicians, which means that these specialists

are constantly and in real-time aware of the physical state of patients. [40]

36
Fig. 5e shows the prototype of heart disease monitoring system. An IoT-based mobile

monitoring device for heart disease patients has been proposed. This device is designed to

continuously track the physical signs of patients such as blood pressure, ECG, SpO2, as well as

important environmental indicators, and provide four different modes of data transmission that

balance the need for health care and the need for connectivity and computing resources [40].

Figure 5e: Prototype of heart disease monitoring system

Due to the popularity of smart phones and the openness of the Android platform, an Android

smartphone is used in this proposed system as the connector. In Java, an application is further

implemented on a smart phone. This application is responsible for receiving and storing, the

monitored data through Bluetooth from the sensing devices and for transmitting the required data

according to the various modes of operation. A web-based program for doctors to query tracked

data is introduced on the remote server side. Figure 5f represents some devices used in the

system and an example of monitoring GUI (graphics user interface) at the doctor side. Figure 5f

(a) depicts a sensing device for SpO2 and pulse rate. 5d (b) shows an Android smart phone as the

connector of this system and 5f f(c) shows the monitoring GUI of patients’ SpO2 and pulse rate

for remote practitioners [40]. This system is significant for a developing country like Bangladesh

37
where a large number of people are rural residents and often suffer from intermediate to severe

cardiovascular diseases (CVD) that leads to untimely death.

2.7.3 Diagnosis of Diabetes and Blood Glucose Level Monitoring

For monitoring diabetic patients, tracking shifts in blood glucose levels is important. Strict

regulation of glucose decreases the risk of hypoglycemia, which can be potentially fatal if not

promptly treated. [42]

2.8 Smart Heath Monitoring System

2.8.1 Sensor-based Health Monitoring System

The sensor-based health monitoring system collects information through an electronic data signal

about the patient's health status and informs the patient via an audio alarm. ECG, temperature

and pulse rate sensors are commonly used amongst the different types of sensors. Body

temperature sensors (Max 30205), pulse rate sensors, temperature sensors have been used by

most health monitoring systems (BME 680) [23]. Other sensors such as humidity sensors, RFID

sensors, biochemical detection sensors such as glucometers, body position sensors and CO2

sensors are also used in many health monitoring systems. It is also proposed to develop a wrist

wearable body area network (WBAN) architecture for the healthcare system using cloud

computing [24]. In both industrial and home settings, the system performs. The established

device, however, is wire-connected. Having the computer wireless would improve the system's

versatility. A smart intensive care unit (ICU) system based on radio-frequency identification

(RFID) that collects medical data in a real-time system was shown [25]. The device has 3 layers.
38
They are the physical layer, logical layer, and application layer. The physical layer includes the

sensors used for the purpose of collecting data. The data obtained by the sensors in the physical

layer is analyzed in the logical layer. The logical layer manages the inter-sensor interactions

and media access management tasks. Based on the processed data generated by the logical layer,

the application layer takes actions.

2.8.2 Smartphone based Health Monitoring System

One of the world's most powerful tools is smartphones [22]. Normally, a smartphone holds 14

types of sensors [26] and even more sensors will be added in the future. The wireless sensor,

Bluetooth module, Accelerometer, Fingerprint sensor, Gyroscope, Magnetometer, Barometer,

Proximity, GPS tracker, Camera, NFC-near field sensor are some of the sensors included in a

smartphone and they are also commonly used in the implementation of health monitoring

systems [27]. A smartphone's mass storage facility is another primary benefit of a smartphone.

Modern smartphones can store data of the patient in primary storage easily. For data streaming,

device information management, and easy interaction, smartphones based on Android can be

used. A mobile voice health monitoring system has been developed using a smartphone that uses

the accelerometer sensor [28]. A miniature accelerometer is used as a voice sensor in the

reviewed system, and the smartphone is used as a medium for data acquisition. The device is

positioned around the patient's neck. Although the frame-based vocal parameters are used by this

device, the raw accelerometer data could also be used for monitoring purposes. There is a further

proposal for a multi-lead ECG health monitoring device based on a smartphone. [29]. Seven lead

real-time ECG is used for the acquisition of the signal in this device. Up to 500 Hz is the

sampling rate. It is very difficult for doctors to detect anomalies because of the large amount of

39
ECG data. So, it uses an automated warning system. When the device detects irregular ECG

data, the alarm turns on. Another mobile phone-based wireless health service system is

developed [30]. The system is designed for family health treatment. The contact between the

server and the Android terminal is processed by the data communication system. A continuous

heart rate monitoring system has been introduced that uses wireless signals for transmitting the

heartbeat of an individual to a smartphone [31]. Patients can quickly get their real-time heart rate

information from the computer monitor as the device monitors the continuous heart rate.

2.8.3 Webcam-based Imaging Technology

An alternative and recognized way for optical detection in the field of medical diagnostics in

large areas with low resource settings is charge coupled device (CCD) cameras which is simpler

and cost-sensitive [3]. The device is able to detect multi-wavelength fluorescence and can be

used for fabricating microscopes, sensitive plate readers, lens-less optical detectors for medical

diagnostics [3].

2.8.4 Microcontroller based Health Monitoring System

In health monitoring systems, microcontrollers are the most popular and used devices worldwide

[32]. For the fast processing of raw sensor data, MCU's are very useful. To interface between the

sensors, an MCU was used. [32].

Fig. 5f shows the block diagram of Arduino based health monitoring system [34]. An Arduino-

based monitoring system of health parameters managed by a smartphone application is proposed.

All the data provided from sensors is in analog form. Data is sent to the board of Arduino Uno.

40
Via an integrated analog to digital converter, the analog values obtained are converted to digital.

By Bluetooth, the digital values are passed to a smartphone. A Bluetooth module used by the

device that does not cover a wide area [34

Figure 5f: Block diagram of Arduino based health monitoring system [34].

An m-Health solution for diabetes patients is introduced which is a home environment system

[35]. This system allows a patient with diabetes to monitor his/her health status, physical

activity, food management, insulin dosage, and to consult physicians.

An IoT based smart health monitoring technique is developed where the system application is

divided into three layers [36]. They are the detecting layer, the application layer, and

the transportation layer. A DS18B20 sensor is being used for the detection of body temperature

in the detection section and a pulse sensor is being used for the detection of a pulse. In the

41
transportation layer, through the Wi-Fi module and Ethernet shield, the information is uploaded

from Arduino to the cloud. The application layer eventually gathers data from the server.

Another system is developed to detect the abnormalities in ECG and transmits the signal via

Bluetooth [37]. It is a low-cost device and the three ECG signals are sent to a circuit and finally

presented in an oscilloscope. Using the Wi-Fi or IR modules might overcome the range

limitation of Bluetooth module. An IoT based patient monitoring system is proposed where the

Raspberry Pi is the main logic unit of the system [38]. Sensor signals are sent via an amplifier

circuit and signal conditioning unit to the raspberry pi (SCU). The Raspberry Pi data can be

accessed from any area of the world through the internet. Even so, the system only works in

indoor environments. Another system of a smart home and heartbeat monitoring system using a

wireless sensor network (WSN) has been developed [39].

2.9 Latest Technology in Diagnostic System

2.9.1 Application of Artificial Intelligence

Diabetes remains an incurable lifelong disease, despite the recent advancement of science and

technology in healthcare. Diabetes education is an important way of helping patients achieve

their metabolic regulation and quality of life, aimed at enhancing self-management skills.

Important progress has been made by artificial intelligence (AI) technologies in converting

accessible genetic data and clinical information into important knowledge. [43] 

The long-term chronic condition is known as diabetes mellitus (DM). The number of people

worldwide suffering from diabetes has reached 451 million, according to recently released data

from the International Diabetes Federation. [44] Therefore, diabetes diagnosis and control is

highly important and knowledge about diabetes is an essential part. Increasing AI-based tools for

42
diabetes healthcare have been built over the past several years [45]. More versatile and scholarly

access to skills and information on different aspects of diabetes self-management is provided for

patients, including diabetes prevention, lifestyle and dietary advice, exercise, insulin injection,

and monitoring of complications, to name a few [43].

Artificial intelligence is an interdisciplinary term focused on computer science, control theory,

information theory, neuropsychology, linguistics, and philosophy. [46]. In general, AI comprises

artificial methods to impart intelligence on computers [43]. In medical research, the

implementation of AI is becoming extensive and has yielded tremendous benefits. The main

benefits involve broad coverage, low cost, high efficiency, portability, diversity, and

"productivity" at the service end. At the same time, AI improves the route towards full-course,

individualized, and intelligent management of chronic diseases. Some of the most representative

and active reports are from systems of medical experts. The expert systems will make inferences

and decisions based on broad bodies of clinical expertise and experience gained by medical

experts by the use of AI technologies, thus emulating the decision-making processes used by

human experts. [47]

AI technologies have been increasingly incorporated with medical technology, such as machine

learning and data mining, and are eventually becoming key elements of medical growth. In

disease detection and prediction, surgical robotics, image recognition, virtual medical assistance,

pharmaceutical research and development, and health management, AI offers specific benefits

[48-53]. AI technologies have been widely used in diabetes prediction, dietary and exercise

guidance, insulin injection guidance, complication control, and self-management in the area of

diabetes education.

43
2.9.2 Detection of Hypoglycemia from Raw ECG Signal

Glucose testing has historically been done by a needle prick or capillary blood glucose test.

Doctors can monitor blood sugar levels through advanced artificial intelligence (AI) applications,

using a few heartbeats of raw ECG signals captured through wearable sensors. [42] Using a non-

invasive wearable system, a new technology was developed to detect low glucose levels via an

electrocardiogram (ECG). The device is related to the new artificial intelligence that can detect

hypoglycemic events from raw ECG signals. [54]

The electrophysiology of the heart is influenced by hypoglycemia, and since it has slightly

different effects on the heart of each person, an AI system makes it possible to control glucose

levels in a highly customized way. [55] Currently, continuous glucose monitors (CGM) are used

for hypoglycemia diagnosis in patients who are needed to undergo continuous monitoring of

blood sugar levels. However, when blood sugar levels become down, CGM uses an invasive

needle that sends alarms. With invasive finger-prick blood checks, the system needs calibration

two times a day. As well as CGMs, the novel artificial intelligence device works, offering data

on glucose levels without invasive needles. In two pilot studies with healthy participants, the

researchers tested the system and found that the average specificity and sensitivity was 82

percent in the detection of hypoglycemia, which works much the same as the current CGM

process. [42]

2.9.3 Blood Sugar Monitoring without Finger Pricks

44
Both type I and type II diabetic patients need to check blood glucose level routinely. In order to

calibrate or change the display, the currently accepted models require users to measure a drop of

blood twice daily. Many people are discouraged by the discomfort of finger sticks and the cost of

checking supplies from keeping close tabs on their blood sugar, which is important to control

insulin usage and change what they eat. [56] The recently developed and approved Food and

Drug Administration (FDA) FreeStyle Libre Flash Glucose Monitoring System [57] is a

complete setup that uses a small sensor attached to the upper arm. To see the present amount of

blood sugar and shifts over the past eight hours, patients wave a reader device over it.

Figure 6: A device from “Abbott” that continuously monitors diabetics’ blood sugar levels without

requiring backup finger prick tests [56].

Fig. 6 shows a device from “Abbott”. This device can continuously monitor diabetics’ blood

sugar levels without requiring backup finger prick tests. [56].

45
For up to 10 days, both day and night, the system provides real-time glucose readings. Glucose

levels can also be read by the sensor through clothing, making monitoring discreet and easy.

[57].

The system provides three critical pieces of data with each scan:

 A real-time glucose results.

 An historic eight-hour trend.

 A directional trend arrow which shows where the level of glucose is heading.

The touch-screen reader often keeps data for up to 90 days, enabling individuals to control their

glucose levels over time. [57].

The FreeStyle Libre CGM eliminates finger sticks for calibration, which translates into less

manual effort [58]. People with diabetes can scan their CGM (a painless procedure) instead of

testing finger sticks several times per day to get real-time glucose readings to be used for insulin

dosing, meal preparation, etc. In addition to improved health control for daily diabetes, large

volumes of data and trend analyses can also help diabetic patients to minimize their risk of low

blood sugar and assist them in assessing the dosage of insulin and meal preparation. [58]

46
 CHAPTER 3

RESULTS AND
ANALYSIS
47
Result and Analysis

No. Name Medical condition/s Type of used diagnostic Cost-

device/s effective/
expensive

1 This Blood sugar test and diabetes Test strips, IoT and AI Cost-
paper management, pregnancy test, tests based-devices/systems, effective
for cardiac diseases, viral infections microfluidics,
and critical conditions like cancer, biosensors.
organ transplantation.

48
2 Ref [47] Parkinson’s disease AI based device Cost-
effective

3 Ref [13] Detection of live viruses Optofluidic nano- Expensive

plasmonic biosensor

4 Ref [32] Overall health monitoring Microcontroller and IoT Cost -

based effective

5 Ref [45] Overall diabetes management AI based Cost-

effective

6 Ref [49] Surgical measures Robotic technology Expensive

7 Ref [52] Drug design and discovery AI based Moderately

expensive

8 Ref [55- Blood glucose test AI based (eliminating Cost-

58] finger prick) effective

9 Ref [48] Obstructive lung disease AI based Expensive

Table 1: Comparison with other articles

49
 CHAPTER 3

CONCLUSION AND
FUTURE WORK

50
Conclusion and Future work
Since medical diagnostic procedure is considered to be a critical element for effective healthcare

and medical treatment, advanced tools and devices used in this concern need to be cost-effective,

affordable and sustainable for every patient, especially for people living in middle-income and

low-income countries. These poorly resourced countries require robust, low-cost, easy-to-use

and portable diagnostic devices that are compatible to meet every diverse or adverse medical

51
condition [3]. At the same time, it would be time-saving and the medical staffs would be able to

learn the proper use of the diagnostic methods or devices. Low-cost and alternatively used

medical diagnostics and devices function with proper specificity and sensitivity without dropping

the quality of treatment or diagnosis as well as maintaining the overall health condition of the

patients. Future study and advancement specially in lower income regions of the world, will

increase the accuracy and specificity of these devices.

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