Effectiveness of a diagnostic algorithm for dengue based on an artificial neural network.

Introduction: Dengue is a disease with a wide clinical spectrum. The early identification of dengue cases is crucial but challenging for health professionals; therefore, it is necessary to have effective diagnostic instruments to initiate timely care. Objective: To evaluate the effectiveness of an algorithm based on an artificial neural network (ANN) to diagnose dengue in an endemic area. Methods: A single-center case-control study was conducted in a secondary-care hospital in Ciudad Obregón, Sonora. An algorithm was built with the official operational definitions, which was called the "direct algorithm," and for the ANN algorithm, the brain.js library was used. The data analysis was performed with the diagnostic tests of sensitivity, specificity, positive predictive value (ppv), and negative predictive value (npv), with 95% confidence intervals and Cohen's kappa index. Results: A total of 233 cases and 233 controls from 2022 were included. The ANN presented a sensitivity of 0.90 (95% CI [0.85, 0.94]), specificity of 0.82 (95% CI [0.77, 0.87]), npv of 0.91 (95% CI [0.87, 0.94]) and ppv of 0.81 (95% CI [0.76, 0.85]) and a kappa of 0.72. The direct algorithm had a sensitivity of 0.97 (95% CI [0.94, 0.99]), specificity of 0.96 (95% CI [0.92, 0.98]), npv 0.97 (95% CI [0.94, 0.98]), ppv 0.96 (95% CI [0.93, 0.98]) and kappa 0.93. Conclusions: The direct algorithm performed better than the ANN in the diagnosis of dengue.

Predict the incidence of Guillain Barré Syndrome and arbovirus infection in Mexico, 2014-2019.

The Dengue (DENV), Zika (ZIKV), and Chikungunya (CHIKV) virus infections have been linked to Guillain-Barré syndrome (GBS). GBS has an estimated lethality of 4% to 8%, even with effective treatment. Mexico is considered a hyperendemic country for DENV due to the circulation of four serotypes, and the ZIKV and CHIKV viruses have also been circulating in the country. The objective of this study was to predict the number of GBS cases in relation to the cumulative incidence of ZIKV / DENV / CHIKV in Mexico from 2014 to 2019. A six-year time series ecological study was carried out from GBS cases registered in the Acute Flaccid Paralysis (AFP) Epidemiological Surveillance System (ESS), and DENV, ZIKV and CHIKV estimated cases from cases registered in the epidemiological vector-borne diseases surveillance system. The results shows that the incidence of GBS in Mexico is positively correlated with DENV and ZIKV. For every 1,000 estimated DENV cases, 1.45 GBS cases occurred on average, and for every 1,000 estimated ZIKV cases, 1.93 GBS cases occurred on average. A negative correlation between GBS and CHIKV estimated cases was found. The increase in the incidence of GBS cases in Mexico can be predicted by observing DENV and ZIKV cases through the epidemiological surveillance systems. These results can be useful in public health by providing the opportunity to improve capacities for the prevention of arbovirus diseases and for the timely procurement of supplies for the treatment of GBS.

[Association of Notified Cases and Treatment Success Rates in Pulmonary Tuberculosis].

Background: Tuberculosis has long been recognized as a public health problem in large cities. The goals of the "Stop TB" strategy of the WHO specifically promote its study at the subnational level. Therefore, we aimed to describe the state of pulmonary tuberculosis (PTB) at the municipality level in Mexico. Methods: We obtained data on new cases of PTB and treatment success rates (TSRs) per municipality from each state in Mexico, reported by the Mexican Social Security Institute to the National Epidemiological Surveillance System during 2013. Regression model was used to quantify associations between PTB and TSR by the municipality. Results: We included 4090 cases of PTB distributed in 432 municipalities. There were 121 municipalities with TSRs < 85%. Lower TSRs were associated with older age, male sex, and comorbidities. Conclusions: Results suggest a negative outcome of PTB treatment in patients with HIV and in those with malnutrition. The number of reported cases by the municipality was not associated with a negative treatment outcome.

Association of Pulmonary Tuberculosis and HIV in the Mexican Institute of Social Security, 2006-2014.

BACKGROUND: Tuberculosis and HIV remain a public health problem in developed countries. The objective of this study was to analyze the incidence trends of pulmonary TB and HIV comorbidity and treatment outcomes according to HIV during the period 2006 to 2014 in the Mexican Institute of Social Security. METHODS: Analyzed data from this registry including pulmonary tuberculosis patients aged 15 years and older who had been diagnosed during the years 2006 to 2014 in the Mexican Institute of Social Security. The outcomes that we use were incidents rate, failure to treatment and death. Regression models were used to quantify associations between pulmonary tuberculosis and HIV mortality. RESULTS: During the study period, 31,352 patients were registered with pulmonary tuberculosis. The incidence rate observed during 2014 was 11.6 case of PTB per 100,000. The incidence rate for PTB and HIV was 0.345 per 100,000. The PTB incidence rate decreased by 0.07%, differences found in the PTB incidence rate by sex since in women decreased by 5.52% and in man increase by 3.62%. The pulmonary TB with HIV incidence rate decreased by 16.3% during the study period (In women increase 4.81% and in man decrease 21.6%). Analysis of PTB associated with HIV by age groups revealed that the highest incidence rates were observed for the 30 to 44 years old group. Meanwhile, the highest incidence rates of PTB without HIV occurred among the 60 and more years old individuals. We did not find statistically significant differences between treatment failure and PTB patients with HIV and without HIV. The treatment failure was associated with sex and the region of the patient. We found a strong association between HIV and the probability of dying during treatment. Our data suggested that patients suffering from both conditions (PTB and HIV) have no difference in the probability of failure of treatment contrary to other reports. Hypotheses to this is adherence to tuberculosis treatment with people living with HIV/AIDS, detection of PTB in patients suffering from HIV/AIDS or PTB patients on antiretroviral therapy were more likely to have successful treatment outcomes than those not on antiretroviral treatment. We have found that PTB and HIV increases the probability of dying during treatment compared to the cases of PTB without HIV, consistent with published other study HIV increases the mortality rates associated with PTB. CONCLUSIONS: No association between pulmonary tuberculosis with HIV and treatment failure was observed, but pulmonary tuberculosis and HIV increases the probability of dying during treatment compared to the pulmonary tuberculosis cases without HIV.

[Acute otitis media: could it be a sentinel indicator of health care?]. / Otitis media aguda: ¿indicador centinela de la atención de la salud?

BACKGROUND: Acute otitis media is the most common bacterial disease in children under five years; therefore, is one of the most common causes of pediatric consultation. Our objective was to determine the feasibility to consider this disease as a sentinel factor of medical attention. METHODS: All the new cases of acute otitis media registered between 2008 and 2011 were collected and analyzed. Proportions, ratios, and incidence rates were determined. Also, the limits for proportions were calculated using mid P exact test. RESULTS: In children under five years, we observed 20 % of the cases of non-suppurative otitis media, and suppurative otitis media in 17 %. The reason for acute respiratory infection in relation to cases of otitis media in children of this age increased from 87:1 in 2008 to 53:1 in 2011. CONCLUSIONS: The reason of suppurative otitis media decreased in children under five years, even in 2009, when it was registered the highest number of new cases of acute respiratory infection. It was not feasible to determine if acute otitis media is a sentinel indicator; however, we could monitor medical attention indirectly.

INTRODUCCIÓN: la otitis media aguda es la enfermedad bacteriana más frecuente en los niños menores de cinco años, por lo que constituye una de las causas más comunes de consulta médica pediátrica. El objetivo de esta investigación fue conocer el panorama epidemiológico de la otitis media aguda, con la finalidad de determinar la factibilidad de considerarla un indicador centinela de la atención médica. MÉTODOS: se recolectaron y analizaron todos los casos nuevos de otitis media aguda que se presentaron entre 2008 y 2011. Se determinaron proporciones, razones y tasas de incidencia, y se calcularon los límites para proporciones por prueba exacta de P-media. Resultados: en los niños menores de cinco años de edad se observó 20 % de los casos de otitis media no supurativa y 17 % de los casos de otitis media supurativa. En ese grupo de edad, aumentó la razón de casos de infecciones respiratorias agudas en relación con los de otitis media: 87:1 en 2008 a 53:1 en 2011. CONCLUSIONES: la razón de otitis media supurativa disminuyó en los menores de cinco años, incluso en el año de 2009, cuando se registró el mayor número de casos nuevos de infección respiratoria aguda. No fue factible determinar si la otitis media aguda es un indicador centinela; sin embargo, fue posible monitorear indirectamente la atención médica.