Disease Pattern of Geriatric People of the Host Community in Cox's Bazar, Bangladesh

Introduction: Diseases of elder people are a global problem. The prevalence of disease in elderly people is increasing day by day as old people often have limited regenerative abilities and are more susceptible to disease, syndromes, injuries, and sickness than younger adults. Objective: This study was conducted to identify the disease pattern of geriatric people of the host community in Cox's Bazar, Bangladesh. Method: A descriptive type of cross-sectional study was conducted among 381 geriatric persons in 5 selected hospitals of Cox's Bazar. The sample size was calculated in a 95% confidence interval and with a 5% level of significance. Data collection was done by using a semi-structured pre-tested questionnaire. Data quality was ensured through multiple procedures of review and cross-checking. Results: The findings revealed that a total of 32.0% had heart disease and 31% had arthritis. More than one-fifth (22.0%) of the respondents had diabetes and 18% of the total respondents had different types of communicable diseases. The occurrence of non-communicable diseases in geriatric people is significantly associated with their age and sex. Conclusion: The findings from this study illustrate that non-communicable disease is very much prevalent among the geriatric population as well as a threat to public health. The hospitals and health service providers should emphasize the management and prevention of these diseases. Also, lifestyle modification can play a vital role in preventing non-communicable diseases.

Major Inflammatory Markers and Their Significance in Predicting Severity of COVID-19 Disease Pattern

The unanticipated outbreak of the COVID-19 pandemic has shocked the world in terms of both lives and livelihood. SARS-CoV-2 virus primarily affects the respiratory system, although other organ systems are also involved. Early diagnosis followed up by a retrospective analysis and tracking of a few markers relevant to the immunological status of the individual may aid in determining the state of the patient's disease prognosis. The aim of the present study was to evaluate immunological parameters such as neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP), and D-dimer, taking into account the patient's age and oxygen saturation level. Our retrospective analysis of clinical data revealed that such parameters as CRP, D-dimer, and NLR should be taken into consideration to predict severe COVID-19-related complications. The data obtained indicate that patients over age 60 are especially vulnerable to severe COVID-19.

Similarity Learning between Patients with Large Age-Gap: Model Development and Validation Study (Preprint)

BACKGROUND Similarity-based machine-learning methodologies are suitable for personalized prediction and recommendation research, which is actively applied in healthcare field along with the generalization of EHR data. In particular, the similarity learning model which carefully reflects age can be efficiently used in predicting chronic diseases, closely related to ageing. OBJECTIVE We aimed to design a similarity model for patients in different age-groups in order to predict the two major chronic diseases: Diabetes and Hypertension. METHODS We developed an idea about learning the overlapping periods of two individuals by moving the viewpoint of them to future and past respectively. From this idea, we build separated similarity learning models through three sequential age-group intervals; 30-40, 40-50, 50-60 age-groups intervals. Each model has same structure based on deep neural network. For similarity learning, we set several demographic/bi-annual check-up information and diagnosis records as input features and disease based yes-or-no similarity labels as output features. RESULTS As a result of applying hypertension patients’ pair, diabetes patients’ pair, and non-diabetes/diabetes patient pair to our methodology, the similarity value was very high, close to 1 in the former two cases, and the similarity value was low, close to zero, in the last case. This proves that similarity learning appropriately reflects the disease status between individuals. In addition, we tried to find out how the conventional single-timepoint methodology and our methodology differ in the measurement of similarity for several special cases in which the patient's disease condition changes. As a result, it was found that the similarity results between the existing methodology and our methodology differ from at least 0.2 to at most 0.9 in four special cases where the patient's condition changes. This suggests that our methodology responds more sensitively to the patient's condition changing over time and can be applied more efficiently to disease prediction in those cases. CONCLUSIONS We developed an age-sensitive similarity learning model for personalized prediction of chronic diseases targeting Koreans. As a result, for the cases that patient's disease pattern changes, by designing and learning a deep similarity learning model using divided age groups which has not been previously attempted, we have shown that similarity learning results are better than conventional single-timepoint methodology. Moreover, we proposed the possibility of overcoming data shortage limitations that occur frequently in medical datasets through a similarity learning model considering patients’ age differences.

Predictive role of serum rheumatoid factor in different disease pattern of psoriasis and psoriatic arthritis

Background Psoriasis is a multisystem inflammatory disorder with variable morphology, clinical pattern and multiple comorbidities. Interplay between genetic and environmental factors leading to an aberrant immune response in the skin may contribute to disease development. The assessment for risk factors, signs, and symptoms of potential comorbid diseases is an important component of patient management. The aim of this study is to determine rheumatoid factors (RF) positivity and its levels in psoriasis patients, and describe its relationship with the demographic and clinical characteristics, comorbidities, and disease patterns of psoriasis. Results Rheumatoid factor was positive in psoriatic patients more than control,30% of patients had positive rheumatoid factor while only 10% of control had positive results. Rheumatoid factor level was 63.8 ± 186.7 IU/ml in psoriasis vs. 9.3 ± 12.3 in control. Thirty percent of psoriasis patients have positive rheumatoid factor vs. 10% of control. There was no significant statistical difference between psoriasis patients with or without arthritis as regard rheumatoid factor positivity and titer; rheumatoid factor was positive in 20% in psoriatic patients with arthritis vs. 26% in psoriatic patients without arthritis. In psoriatic patients, the status of rheumatoid factor did not relate to disease severity, onset, course, site of affection, presence of scalp, nail affection, and presence of dactylitis (p value>0.5). Conclusion Psoriasis was associated with higher seropositivity of RF compared to age-matched non-psoriatic healthy controls. Occurrence and level of rheumatoid factor were not associated with severity or clinical pattern of psoriasis.

Understanding New Ideas in Cryptoglandular Fistula-in-Ano

Outcomes of surgical treatment for anorectal abscesses and chronic fistulas varies widely, as there is lack of unified classification and systematic surgical approach to address a wide range of disease pattern. Acute anorectal abscess and chronic fistula-in-ano should be considered the same disease at both end of a spectrum. This article describes in detail the pathogenesis and relevant anorectal anatomy to aid understanding of a new concept of classifying anorectal abscess and fistula based on natural patterns. A better understanding of patterns allows more accurate surgical treatment. Recent evidence shows that definitive surgical treatment for anal fistula during acute abscess stage is safe and feasible. An optimum surgical treatment should focus on eradication of intersphincteric infection, removal of secondary branches or abscesses, allow healing by secondary intention and preserve continence as best as possible. Common challenges faced by clinicians include confusion in classification, inaccurate delineation of fistula, challenging acute abscesses, unable to locate internal opening and facing complex features such as high fistula or multiple branches. Suggested solutions are discussed and a structured treatment strategy according to types and patterns is proposed. Surgical treatment should follow the principles above and combination of surgical techniques is beneficial compared to individual modality.

The Westernmost Mediterranean islands present an endemic varroosis disease pattern

Aim of study: This is the first intensive study of the incidence of Varroa destructor (Acari: Varroidae) in the Westernmost Mediterranean islands (Balearics). Area of study: Mallorca, Menorca, Eivissa and Formentera (Balearic Islands), Spain. Material and methods: The study was carried out in autumn 2010 and in spring 2011 because the presence of the mite is higher in these seasons. A total of 462 honeybee colonies were analyzed from different apiaries on. One sample of adult bees (worker bees, n > 200) and another of bee brood (at all stages of development, n> 400) were collected from each colony. All were frozen until analysis. To detect Varroa each sample was examined individually basing the study on the guide edited by the World Organisation for Animal Health, with some modifications. The beekeepers involved were interviewed to characterize Balearic beekeeping. Main results: Regarding the prevalence, results showed that in the Balearic Islands the percentage was higher in spring (34.78%) than in autumn (44.09%) but the infestation rate was lower in both seasons (Autumn: 0.94%, Spring: 0.77%). The focality percentage was also higher in spring (87.10%) than in autumn (82.61%). The data suggests that Varroa mites in the archipelago have an endemic rather than epidemic disease distribution pattern. Research highlights: These results open an interesting scenario to develop a future resistance breeding strategy against V. destructor in these small islands.

Multi-System Inflammatory Syndrome Presenting as Non-Specific Colitis: A Medical Diagnosis with a Surgical Presentation

A 20-year-old woman with previous COVID-19 diagnosis presented with abdominal pain and colitis on CT scan. She was admitted in septic shock, with etiology of colitis unclear. After resuscitation, antibiotics, and steroids, she clinically deteriorated. Worsening Clostridioides difficile infection was most likely and she was taken to the operating room. Intraoperatively, only a segment of transverse colon appeared abnormal on gross and endoscopic evaluation. Total colectomy was deferred in favor of segmental resection. Given her unusual disease pattern and recent COVID-19 infection, diagnosis of MIS-C was considered. Steroids were continued and treatment broadened to include heparin and IVIG. The patient returned to the operating room for planned reexploration, endoscopy, and end colostomy. On hospital day three, the patient had an acute mental status change. Computed tomography demonstrated acute cerebral edema with brainstem herniation. The family chose comfort-care measures. Final pathology from the transverse colon demonstrated COVID-19-associated vasculitis