Comorbidities and their association with COVID-19 mortality in Mexico between January 2020 and August 2021

By August 17, 2021, 4.3 million people had died globally as a result of SARS-CoV-2 infection. While data collection is ongoing, it is abundantly obvious that this is one of the most significant public health crises in modern history. Consequently, global efforts are being made to attain a greater understanding of this disease and to identify risk factors associated with more severe outcomes. The goal of this study is to identify clinical characteristics and risk factors associated with COVID-19 mortality in Mexico. The dataset used in this study was released by Sistema Nacional de Vigilancia Epidemiologica de Enfermedades Respiratorias (SISVER) de la Secretaría de Salud and contains 2.9 million COVID-19 cases. The effects of risk factors on COVID-19 mortality were estimated using multivariable logistic regression models with generalized estimation equation and Kaplan-Meier curves. Case fatality rates, case hospitalization rates are also reported using the Centers for Disease Control and Prevention (CDC) USA death-to-case ratio method. In general, older males with pre-existing conditions had higher odds of death. Age greater than 40, male sex, hypertension, diabetes, and obesity are associated with higher COVID-19 mortality. End-stage renal disease, chronic obstructive pulmonary disease, and immunosuppression are all linked with COVID-19 patient fatalities. Smoking and Asthma are associated with lower COVID-19 mortality which is consistent with findings from the article published in Nature based on National Health Service (NHS) of UK dataset (17 million cases). Intensive care unit (ICU), patient intubation, and pneumonia diagnosis are shown to substantially increase mortality risk for COVID-19 patients.

Comparative study of a mathematical epidemic model, statistical modeling, and deep learning for COVID-19 forecasting and management

The COVID-19 pandemic has caused a global crisis with 47,209,305 confirmed cases and 1,209,505 confirmed deaths worldwide as of November 2, 2020. Forecasting confirmed cases and understanding the virus dynamics is necessary to provide valuable insights into the growth of the outbreak and facilitate policy-making regarding virus containment and utilization of medical resources. In this study, we applied a mathematical epidemic model (MEM), statistical model, and recurrent neural network (RNN) variants to forecast the cumulative confirmed cases. We proposed a reproducible framework for RNN variants that addressed the stochastic nature of RNN variants leveraging z-score outlier detection. We incorporated heterogeneity in susceptibility into the MEM considering lockdowns and the dynamic dependency of the transmission and identification rates which were estimated using Poisson likelihood fitting. While the experimental results demonstrated the superiority of RNN variants in forecasting accuracy, the MEM presented comprehensive insights into the virus spread and potential control strategies.

Epileptic Seizure Detection for Imbalanced Datasets Using an Integrated Machine Learning Approach

Epileptic Seizure (Epilepsy) is a neurological disorder that occurs due to abnormal brain activities. Epilepsy affects patients' health and lead to life-threatening situations. Early prediction of epilepsy is highly effective to avoid seizures. Machine Learning algorithms have been used to classify epilepsy from Electroencephalograms (EEG) data. These algorithms exhibited reduced performance when classes are imbalanced. This work presents an integrated machine learning approach for epilepsy detection, which can effectively learn from imbalanced data. This approach utilizes Principal Component Analysis (PCA) at the first stage to extract both high- and low- variant Principal Components (PCs), which are empirically customized for imbalanced data classification. Conventionally, PCA is used for dimension reduction of a dataset leveraging PCs with high variances. In this paper, we propose a model to show that PCs associated with low variances can capture the implicit pattern of minor class of a dataset. The selected PCs are then fed into different machine learning classifiers to predict seizures. We performed experiments on the Epileptic Seizure Recognition dataset to evaluate our model. The experimental results show the robustness and effectiveness of the proposed model.

The efficacy of serial physical examination in management of penetrating abdominal trauma to avoid negative laparotomy in selected cases

Background: Patients with Penetrating Abdominal Injury (PAI) are at risk of harboring life-threatening injuries. Many patients are in need of emergency operative intervention. However, there are some patients who can be safely managed non-operatively. Every patient with an abdominal penetrating trauma should have a thorough clinical examination. Repeating the clinical examination at regular intervals is the cornerstone of selective management, as symptoms and signs that were initially absent may appear later. Objective: To see the efficacy of serial physical examination in patients with penetrating abdominal injury thus avoiding non-therapeutic laparotomy in the overall management of patients. Methods: Convenient and purposive 60 PAI patients admitted in casualty block of Dhaka Medical College & Hospital were selected for selective non operative management (SNOM). On admission the abdominal wound was inspected and neither digital nor direct probing of the wound was attempted. Patients selected for admission had an intravenous line established, a thoracic and abdominal X-ray taken and urine and blood samples were taken. If necessary, a nasogastric tube was inserted. Asymptomatic haemodynamically stable patients were admitted for clinical observation in a single unit during which period the patient was examined by a senior surgeon for clinical re-assessment. Patients were discharged when feeding was normal and if there were clear signs of improvement. Results: Over a 6 month period 60 consecutive patients with penetrating abdominal wound were reviewed. In total 52 patients (86.67%) were managed with clinical re-assessment and discharged without laparotomy. Eight patients (13.33%) underwent laparotomy after observation. Small bowel, liver, mesenteric vessels were most frequently affected. Non-therapeutic laparotomy rate was 0%. After laparotomy the morbidity rates were 62.5% (p = 0.92). One local wound infection occurred without prior laparotomy. Average hospital stay after observation was 2.8 days, after laparotomy 9.8 days. Delayed laparotomy did not increase morbidity or hospitalization. Conclusion: Our experience with penetrating abdominal trauma supports the concept of selective conservatism based on repeated physical examination. In a well-established trauma center this has proven to be highly effective with remarkably low rates of non-therapeutic laparotomies and absence of missed diagnosis of visceral injuries. Journal of Surgical Sciences (2017) Vol. 21 (2): 76-79

C -reactive protein in assessment of severity acute pancreatitis

Background: Acute pancreatitis (AP) is an acute inflammation of the pancreas and clinical evolution is frequently unpredictable. Numerous predictive markers have been studied to assess severity in AP, including clinical assessment, clinical-physiological scoring systems, imaging techniques, and biochemical markers in different body fluids. Objective: This study was done to see the association between level of CRP and severity of acute pancreatitis. Methods: 50 patients diagnosed as acute pancreatitis based on operational definition admitted in Dhaka Medical College Hospital was included in the study. Patients' admission date back from 1ST August, 2016 to 31december, 2015. Conservative management started from the date of admission as per standard conservative management protocol. Patients were monitored by RANSON scoring system and categorized as mild if RANSON score is <3 and categorized as severe if the score is ≥3. At the same time serum CRP level was measured on day 2, 3 and 7. Then the correlation between the severity of the disease and measures of CRP was established by unpaired t test and x2 test. Results: Over 6 months of study period 50 patients were treated for pancreatitis in different medical and surgical unit of Dhaka Medical College Hospital. Etiological analysis revealed mostly caused by biliary disease (40%) followed by idiopathic, alcoholic, post ERCP and post traumatic. Based on RANSON score about 34 patient developed mild acute pancreatitis and 16 patient developed severe acute pancreatitis. Then CRP value of this two groups was compared on day 2, 3, 7 by unpaired t test with P value<.001 in all 3 days. ROC curve was plotted to determine specificity and sensitivity with a cut off value of CRP 132mg/l. Sensitivity and specificity was 75% and 55.8% accordingly. Conclusion: In a patient with acute pancreatitis the use of RANSON scoring system is not always possible as many of the investigation are not easily available in our set up. In our study we have found that serum CRP level is significantly (cut off value 132) higher in patient with sever acute pancreatitis. This will allow high proportion of patients with mild disease to be managed in low-cost hospital beds. Acute pancreatitis is an important cause of hospital admission with acute abdomen. It is responsible for significant morbidity and also mortality in patients Journal of Surgical Sciences (2017) Vol. 21 (2): 80-84

Factors Affecting Hospital Morbidity and Mortality after Esophageal Resection for Esophageal Carcinoma

Background: Since its introduction, esophageal resection has been notable for high rates of morbidity and mortality. Despite many retrospective reviews, conclusions regarding which patients may be at undue risk for complications are difficult to infer. Aim of this study was to evaluate the preoperative and postoperative factors affecting the hospital morbidity and mortality following esophageal resection for esophageal carcinoma. The study has been performed to standardize the criteria of patient selection and intensive postoperative care for patients undergoing esophageal surgery for esophageal carcinoma. Methods: It is a descriptive longitudinal study, performed in department of thoracic surgery, Dhaka Medical College Hospital from 1st July 2015 to 30th June 2016. Total 50 cases were included in this study. Purposive sampling was done and surgical intervention was carried out by surgeon’s ranked assistant professor or above. Results: Of the 50 collected cases, mean age was 52.10 (±14.69) years with minimum age of 32 and maximum, 80 years. 78% were male and 22% female. 28 (56%) patients underwent one stage esophageal resection for esophageal carcinoma and 22 (44%) patients underwent two stage esophageal resection. Out of 50 patients undergoing esophageal resection, complications occurred in 52% of patients leading to postoperative morbidity, 10% patients died following surgery during hospital stay and uneventful recovery occurred in 38% of patients. Respiratory complication was the leading cause of hospital morbidity (42.30%) following esophageal resection with predominance (30.77%) among stage III patients. Mortality rates were 5.26% in stage I patients, 11.11% in stage II patients and 15.38% in stage III patients. Comparison among different classes of ASA (American Society of Anaesthesiologists) score revealed better post operative outcome in patients with Class I and poor results in Class III patients. Post operative mortality rates of age group 61 to 70 and 71 to 80 were 33.33% and 50% respectively compared to 00.0% in 31-40 age group. Outcome of patients with squamous cell carcinoma and adenocarcinoma were quite similar. Conclusion: This study showed that respiratory complication was the leading cause of hospital morbidity and mortality following esophageal resection for esophageal carcinoma. Old age, poor lung function test results, high ASA score and stage III disease have been found to be associated with poor post operative outcome after esophageal resection Journal of Surgical Sciences (2019) Vol. 23 (1) : 3-9

Outcome of tension free open mesh repair of inguinal hernia

Background: In the practice of General Surgery, hernia repair is the second most common procedure after appendectomy. Several methods have been developed over the years to try to improve hernia repair. Good result can be expected using Bassini's, McVay's, Shouldice's techniques provided the exact nature of hernia is recognized and the repair is done without tension using healthy tissue. The introduction of synthetic mesh started a new era in hernia surgery. The use of synthetic mesh repair of primary and recurrent hernias has gradually gained acceptance among surgeons. Objective: To find out the outcome and complications of open inguinal hernia repair with prolene mesh. Methods: This is a prospective cross sectional study conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from December, 2011 to May, 2012. One hundred patients of inguinal hernia admitted in different surgical units of BSMMU, Dhaka for elective surgery were studied. We have given 1 gm ijv Cephradine per operatively and then 500 gm cephradine ijv 6 hourly for 24 hours followed by oral form of Cephradine for next 5 days. Polypropylene mesh of 11 cm x 7 cm size was used in all cases. All the operations were done by open tension free prolene mesh repair technique. Patients were followed for one year to see the outcome. Results: Out of 100 cases of inguinal hernia, 71 patients (71%) had indirect inguinal hernia and 29 cases (29%) had direct inguinal hernia; 90 cases (90%) were primary hernia and only 10 cases (10%) were recurrent hernia; 58 cases were right sided, 34 cases (34%) were left sided and 8 cases (8%) were bilateral. Complications of mesh repair of groin hernia in this study included wound infection (5%), scrotal oedema (2%), mesh infection (0%), scrotal hematoma (2%), echymoces of peri-incisional skin (5%), early wound and groin pain (7%), chronic inguinodynia (2%), hernia recurrence (1%). Conclusion: In the present study an attempt is made to evaluate the outcome of patients undergoing inguinal hernia repair by prolene mesh. The results confirm that Lichtenstein tension free mesh repair of inguinal hernia is safe and reliable for both primary and recurrent groin hernia, with less recurrence rate. Patient's compliance was good with minimum morbidity. Journal of Surgical Sciences (2018) Vol. 22 (1): 21-24