Colombia reported almost 70,000 cases of dengue fever in 2022, according to WHO statistics, and although there isn't a specific treatment for dengue, access to adequate medical care could reduce case fatality rates of severe dengue to less than 1 percent of patients.
Sandra Patricia Usaquén Perilla, a doctoral student of Engineering with emphasis in industrial engineering at Universidad del Valle (Univalle) and a professor of Biomedical Engineering at Universidad del Valle (Univalle) and a professor of Biomedical Engineering at Universidad del Valle (Univalle). Universidad Militar Nueva Granada, explained that for these reasons, researchers have developed two projects: One, on the application of ultrasound for early detection of severe dengue; and another, which uses "system dynamics" to model the dengue care system.
"Patients with dengue can be treated in hospitals of different levels of complexity, and the scientific literature indicates that early detection of severe dengue facilitates its management and reduces its lethality," Professor Usaquén said.
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Foto: Sandra Patricia Usaquén Perilla (mano izquierda) y Laura Valentina Bocanegra Crédito: Laura Valentina Bocanegra
Use of ultrasound
Professor Usaquén explained that, although detection of the dengue virus is done by blood test, the use of ultrasound is a non-invasive and rapid tool for detecting signs of severe dengue, which can enable faster and more effective intervention by healthcare professionals.
It can be used to track the evolution of the disease and prioritize resources, for example, deciding whether a patient needs to be transferred from a rural area to a city hospital.
"If we can detect patients with severe symptoms earlier, we can intervene more quickly and effectively," says Prof. Usaquén.
In the scientific paper called Modelo conceptual para la clasificación del dengue basado en la tecnología de ultrasonido portátil (pocus) y las curvas de aprendizaje, the researchers presented a conceptual evaluation model for Point of Care Ultrasound (POCUS) equipment, where they incorporated the learning curve factor, taking as an application case the classification of a tropical disease such as dengue fever.
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Dr. Jonathan Kirsch, assistant professor in the Department of Internal Medicine at the University of Minnesota; he was a Fulbright Scholar from 2017-2018 in Cali, Colombia, and helped train rural physicians in the use of ultrasound for this purpose.
"The use of ultrasound for dengue has an intermediate level of difficulty and requires upfront and ongoing training-the challenge in the rural setting is that you have to train people initially," Professor Kirsch said, adding that once the ultrasound is acquired in a hospital, it has a low maintenance cost.
Professor Kirsch pointed out that the techniques cannot yet accurately predict whether someone is going to be hospitalized or can be sent home.
Photo: Aedes aegypti biting a human. Photo credit: James Gathany - PHIL, CDC, Public domain, https://commons.wikimedia.org/w/index.php?curid=4269685
Modeling at the hospital level
In book chapter called “Design and Evaluation of Strategies to Mitigate the Impact of Dengue in Healthcare Institutions Through Dynamic Simulation” the researchers explained that they used another tool to understand the dengue care process: "system dynamics."
Laura Valentina Bocanegra Villegas, a graduate of Univalle and a key collaborator with Professor Usaquén in this chapter, explained that the modeling of temperature and precipitation, as key variables in the life cycle of the mosquito, allows the development of a model with a 95% confidence index that shows the behavior of the disease over time.
"Campaigns to eliminate potential water reservoirs are an important and effective strategy to prevent the spread of dengue and other vector-borne diseases by reducing mosquito breeding sites in the community," Bocanegra said, adding that it is valuable for decision makers to have a model that includes the life cycle of the Aedes Aegypti mosquito, which is the host that transmits dengue and the behavior of the care system for this disease.
To this end, a simulation was carried out in a hospital in the state of Veracruz, Mexico.
"The model can help researchers and decision-makers understand the effects of insecticide use, changes in temperature and precipitation on the demand and saturation of hospital resources," Bocanegra said.
Cuauhtemoc Sanchez Ramirez, a research professor at the Instituto Tecnologico de Orizaba in the state of Veracruz in Mexico and co-author of the chapter, said that dengue can be a disease that impacts several systems, such as the population, health systems, health budgets, among others; therefore, it helps to analyze it in a systemic way, which helps to understand its impact on the different systems mentioned above.
"The model allows us to analyze different scenarios or policies that would help reduce its impact, which is important for decision makers," Professor Sanchez Ramirez said.
If you would like to contact the researcher or learn more about the project, please write to the Communications Office, Faculty of Engineering: comunicaingenieria(at)correounivalle.edu.co.
Cover photo: Video retraining conducted within the project "THE PORTABLE ECOGRAPHY IN THE CLASSIFICATION OF DENGUE IN A HEALTH INSTITUTION OF CALI 2018 - 2020". July 2019. Credit: Sandra Usaquén P.
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