Gender difference of knowledge, practices towards hands washing and masks wearing during covid‐19 pandemic in Thong Nhat hospital
The study was carried out on 205 medical records that were diagnosed with ovarian tumors in pregnant women who met the criteria at the record archive of Thai Binh Obstetrics and Gynecology Hospital.
The results showed that ovarian tumors < 5 cm in size accounted for the highest rate of 74.1%.
Dermoid cysts are the most common among common tumors, accounting for 45.9%.
Torsion occurs mainly in the first 3 months of pregnancy.
UBT properties on ultrasound: 56.1% of cases are described on ultrasound.
In which: 42.6% sound sparse, 90.4% regular border and 13.9% with I septum and papillary.
42.3% were discovered by chance at antenatal care and ultrasound.
Anti-inflammatory and inhibition of enzyme xanthine oxidase activity of some species of gnetum
This research uses survey data from reality in seven provinces across the country to assess whether factors such as the content of food safety control, obstacles or perceptions of the people affect the level of food safety.
This study results show that the control contenthas a positive relationship with the level of food safety.
However, the obstaclesfrom people when choosing food do not have any positive or negative impact on the level of food safety.
The ecommendation from the article is that managers may increase providing information and knowledge about food to people, which will make food safer.
The effectiveness of surgical by PLIF/TLIF O-arm among patients with lumbar spondylolisthesis
Describe the clinical signs, lab works and the early results of management the patients with lupus membranous nephropathy, at the Children's Hospital 2.
Methods: Descriptive study, case series.
The specific renal symptom is nephrotic syndrome, with 12/15 cases, along with hematuria, hypertension and acute kidney failure.
The blood test is concluded decreased complement and positive anti-nucleus antibody.
All the patients are managed with the guideline of Children's Hospital 2 and their proteinuria level decreases to zero after six to twelve months following the guideline, with stable kidney function.
The influence of some occupational factors related to the stress level of health care workers infected by COVID-19 at 108 Military Central Hospital in 2022
To acess the risk factor of anastomotic stricture following rectal cancer surgery.
Method: Restrospective study.
Results: Among the 256 patients included, 9 (3.52%) were diagnosed as having anastomotic stricture.
Multivariable logistic regression analysis revealed that postoperative radiotherapy (OR=8.18, 95% CI=1.66 - 40.32), intersphincteric resection (ISR) (OR=11.4, 95% CI=2.30 - 56.42), anastomotic leak (OR= 23.24.95% CI = 3.34 - 161.80) were independent risk factors of anastomotic stricture.
Conclusion: ISR, postoperative radiotherapy and anastomotic leak were independent risk factors of anastomotic stricture.
Situation of fluor-contaminated teeth in Thai children aged 12 years, in Con Cuong district, Nghe An province in 2015
To assess some clinical characteristics and lesions on CT scan of pediatric traumatic brain injury treated at the Department of Neurological &, Spinal Surgery, Thai Binh General Hospital.
No deaths.
Conclusion: The cause of traumatic brain injury in children due to traffic accidents is still high; Primary school age accounts for the highest percentage, so it is necessary to pay more attention to this subject to reduce the rate of trauma in general and traumatic brain injury in particular.
Methods: Cross-sectional descriptive study on 67 cases of traumatic brain injury in children treated at Thai Binh General Hospital from February to September 2020.
Result: 67/534 patients, accounting for the rate (12, 5%): including 51 males (76.1%), 16 females (23.9%), Median age 10.1, youngest: 2 years old, oldest: 18 years old.
Kindergarten (20.9%), primary school (40.3%); junior secondary school (14.9%); high school (23.9%).
Traffic accidents, the most common cause, accounted for (55.2%).
The rate of minor traumatic brain injury according to GCS: 65 patients (97.0%); moderate: 2 patients (3.0%).
CTscan: skull fracture (31.3%); epidural hematoma (28.4%); both these lesions (22.4%).
Management attitude: Conservative treatment for 63 patients (94.0%); surgery for 4 patients (6.0%).
Discharge results: Good-66 patients (98.5%).
Radiculopathy or transient nervous syndrome after spinal anesthesia: A case report
Investigating the incidence, risk factors and predictive values right ventricular systolic dysfunction (RVSD) in adult patients undergoing open heart surgery.
Method: Retrospective observational was conducted in adult patients undergoing open heart surgery at the Cardiovascular Center, University Medical Center Ho Chi Minh City from August 2019 to May 2021.
Results: The study recruited 105 patients.
Patients with 3 criteria of RVSD was of 29.5%, whereas 87.6% of patients showed reduced tricuspid annular plane systolic excursion.
The independent risk factors of postoperative RVSD included preoperative RVSD, atrial fibrillation, anticoagulation therapy, tricuspid regurgitation severity, preoperative right ventricular end diastolic area.
RVSD increased the severity indicators in postoperative intensive care period such as prolonged vasoactive and inotropic support time, mechanical ventilation time, intensive care and hospital stay.
Conclusion: RVSD was commonly encountered in adult patients undergoing open heart surgery and indicated higher severity in postoperative period.
Clinical, paraclinical characteristics of patients with community acquired pneumonia
Community acquired pneumonia is one of the leading causes of hospitalization, death and the leading medical expense.
Objective: to study clinical and paraclinical manifestation of community acquired pneumonia at patients hospitalized at Can Tho University Hospital of Medicine and Pharmacy.
Subjects and Methods: a sectional descriptive study was conducted on 76 patients in Can Tho University Hospital of Medicine and Pharmacy between May 2017 and May 2018.
Results: The common functional symptoms was 82.9% sputum cough, 47.4% dyspnea, 19.7% chest pain, 13.2% dry cough.
Mean white blood cell counts were 12.68±5.41 / mm3 and 64.5% of patients had leukocytosis > 10.000 / mm3, 35.5% of patients had leukocytes ≤10.000 mm3.
Mean CRP (C-reactive Protein) values were 51.46±61.35 mg / L and 82.9% had CRP>10mg / L, 17.1% had CRP ≤10mg/L.
On chest X-ray, 60.5% of patients with alveolar lesions, 13.2% of nodal infiltrates, 11.8% of interstitial lesions, 6.6% of bronchial lesions, and 7.9% are not hurt.
Conclusion: clinical and paraclinical manifestation of community acquired pneumonia is very diverse.
Study on the values of NLR, PLR index in predicting treatment response for patients with non-small cell lung cancer using platinum-based chemotherapy
To describe the clinical and paraclinical characteristics of total hysterectomy after LEEP at the National Hospital of Obstetrics and Gynecology.
A retrospective study of 51 patients underwent total hysterectomy after LEEP at the National Hospital of Obstetrics and Gynecology, from January 2017 to December 2020.
The study showed that cervical biopsies detected only 19.6% CIN-III and 3.92 cervical cancers, while LEEP detected 19.6% CIN-III, 64.92% cervical cancers (45.06% CIS and 19.6% invasive cancers).
Hysterectomy speciments have persisted 3.92% CIN-III, 27.45% cervical cancers (13.73% CIS, 1.96% AIS, 11.76% invasive cervical cancer).
Cervical cytology in cases where NILM (negative for intraepithelial lesion or malignancy), ASCUS and LSIL do not correspond to histopathological degree; LEEP detected cervical cancers higher than punch biopsies, the rate of severe disease in hysterectomy specimens is low, but the higher the degree of lesions, the higher the residual lesions after LEEP treatment.
Diet of post-operative patients with colorectal cancer at University medical center Ho Chi Minh city
A cross-sectional descriptive study to assess the nutritional status and related factors on 40 cirrhotic patients at Hanoi Medical University Hospital showed the following results: the average muscle strength of the subjects was 20.7 ± 7.9 kg.
The rate at risk of malnutrition, according to SGA, is high, accounting for 60%, the rate of muscle strength loss is 75%.
Elderly patients, viral cirrhosis, decompensated cirrhosis, and diets that do not meet the recommended requirements for energy and protein have a higher risk of malnutrition than the other group, which is statistically significant with p < 0.05.
Therefore, the assessment of nutritional status plays a very important role to detect early nutritional problems, to plan early nutritional interventions to increase the effectiveness of treatment for patients with cirrhosis.
Development of a standardized extraction procedure to control nuciferine content from leaves of lotus (Nelumbo nucifera Gaertn.) collected in Dong Thap province
A 33-year-old man with a previously healthy history was admitted to the hospital with insomnia and sleep apnea that persisted for several days.
On clinical examination, no special symptoms were found.
The patient underwent surgery to remove the tumor, histology is Ganglioneuroma.
One month after surgery, the patient no longer had any unpleasant symptoms.
Evaluation of the quantiferon-tuberculosis gold plus assay in children with tuberculosis disease without bacteriological confirmation
The displacement of the medial canthus greatly interfere facial harmony and disturbs function of the lacrimal system.
In this article, we present two cases of medial canthoplasty using Z plasty for repositioning the medial canthus and anchor screws for tendon fixation.
The results were evaluated by the standard anthropometric measurement of eyelid aperture: the ratio of the deformity palpebral aperture width site to the normal palpebral aperture width site.
Outcomes of laparoscopic surgery and role of abdominal drainage in treatment of choledochal cyst in children at Vietnam national's children hospital
Descripbe clinical and subclinical characteristics of Thalassemia patients at Thai Binh Children's Hospital in 2019 - 2020.
Method: Studying on 64 children with Thalassemia treated at Thai Binh Children's Hospital.
Results: The proportion of male and female patients is similar.
The highest time of diagnosis was from 1 to 6 years old (37, 5%).
20, 3% of pediatric patients are hospitalized 5 - 10 times in 1 year.
Children with severe, moderate and mild iron overload were 28, 1%, 12, 5% and 31, 3%.
Grade 2 splenomegaly accounted for the highest rate of 25, 0%.
Patients admitted to the hospital had a hemoglobin level of 60 - 90 g / l, accounting for the highest rate of 68, 8%.
The average number of blood transfusions in 1 year of pediatric patients from 1 to 3 times accounted for the highest rate of 54, 6%.
Clinical characteristics of patients with silicosis being treated at the National lung hospital, 2019 - 2020
Evaluation of medical treatment results in an unruptured ectopic pregnancy with single-dose and find out some factors related to treatment outcome.
Subjects and methods: From January 2018 to December 2021, 42 patients were diagnosed with unruptured ectopic pregnancy and received medical treatment with single-dose MTX at 103 Military Hospital.
Results: Treatment of unruptured ectopic pregnancy with single-dose MTX shows high efficiency, with a success rate of 90.48%.
The smaller the initial ectopic pregnancy mass size and the lower the concentration of βhCG before treatment they are, the higher the success rate will be.
Side effects of MTX are much lower.
Conclusion: This study shows that the medical treatment of unruptured ectopic pregnancy with single-dose MTX is highly effective.
The initial ectopic pregnancy mass size and the concentration of βhCG before treatment affect the treatment outcome.
Treatment of small intestinal bleeding by double-balloon enteroscopy
The study aims to describe clinical features of adjustment disorder with brief depressive reaction.
The less common symptom of this disorder was psychomotor retardation (39.4%).
This was a cross-sectional descriptive study including 66 patients who were diagnosed with adjustment disorder with brief depressive reaction (F43.2) and admitted to the National Institute of Mental Health, Bach Mai hospital.
Results: the majority of patients were at the age of 20 - 29 and 30 - 39 years old with the same rate of 27.3%.
The mean age of patients was 33.6 ± 13.9.
The most common psychological trauma was work orstudy trauma (69.7%).
Among the 3 main symptoms of depression, symptoms of decreased energy and increased fatigue were the most commonwith the rate of 80.3%.
Among 7 common symptoms of depression sleep disorder was account for the highest proportion (93.9%).
No symptom of suicidal behavior was found.
Among 8 physical symptoms of depression, waking up in the morning earlier than 2 hours occurred most frequently (93.9%).
Two cases report of eosinophilic meningitis were treated at infectious disease department in military hospital 175
To determine the rate of adherence to using Levothyroxine (L-T4) and related factors in elderly patients with primary hypothyroidism at the Endocrinology clinic, Huu Nghi hospital.
Factors related to adherence to L-T4 drug use: Education level and treatment goals.
Recommendations: instruct patients to refer to documents, books, magazines, the internet and the guidance of medical staff about hypothyroidism.
Subjects and methods: a cross-sectional descriptive study on 82 primary hypothyroidism patients, aged 60 to 87 years, who attended the medical examination at the Endocrine Clinic, Huu Nghi Hospital from August 2020 to August 2021.
Tests were conducted including TSH, FT4.
Results and discussion: 85.4% of patients adhered to drug treatment.
Level of information communication: high 69.5%; average 15.9%; as low as 14.6%.
There were 78.1% reaching the treatment target (Euthyroid), 21.9% not reaching the treatment goal.
Conclusion: The rate of adherence to using L-T4 in elderly primary hypothyroidism patients is about 85.4%.
Situation and some factors related to standard precautions knowledge and attitude of nursing students of Vinh medical university, 2018
To describe the status of knowledge and attitudes towards standard prevention and to learn some factors related to standard knowledge and attitude of nursing students in Vinh University of Medicine, 2018.
Methods: Apply quantitative research method (cross-sectional description with analysis). Qualitative combination on 337 undergraduate nursing students in Vinh Medical University.
Results: 5.9% of nursing bachelors have knowledge of standard prevention.
65.9% of the students had a positive attitude about prevention, 33.2% had a neutral attitude and only 0.9% had a negative attitude in prevention.
attitude, PNC attitude.
Female students have a positive attitude about PNC 4.1 times higher than male students with CI 95% (1.7 - 7.9).
Students with positive attitude, knowledge about hand hygiene 2.7 times higher than CI 95% (1, 3 - 3, 5), knowledge about safe injection and prevention of sharp injury is high 4.6 times, knowledge about hygiene cough and respiration is 3.7 times higher than students with negative attitude with CI 95% (1.8 - 7.2).
Assessment of responsibilities after 3 months of stereotatic body radiation therapy in early-stage non-small cell lung cancer according to recist and percist
Hypereosinophilia (HE) has generally been defined as a peripheral blood eosinophil count greater than 1.5 x109 / L.
But severe HE is uncommon and relatively rare in children especially under 2 year old and efficacy of imanitib on peaditric patient remain unclear.
First time a case with rearrangement PDGFRB was found at National Children's Hospital.
He manifested the expansion of an eosinophil clone combined to aenemia; enlarge spleen caused initial confused diagnostic. His absolute eosinophilia count level from 11.470 / μL (White blood cell 37x 109/L, eosinophil 31%) to 54.984 / μL (White blood cell 174x 109/L, eosinophil 31, 6%).
Evaluating results of paclitaxel carboplatin in the treatment of recurrent endometrial cancer, in K hospital
Fractures of both bone of the lower leg are common injuries.
Average bone healing time: patient in group ≤ 4 years old is 4.1 ± 0.5 weeks; in group 4 - 10 years old is 6.3 ±0.3 weeks.
Treatment is on a case-by-case basis.
Conservative treatment of closed fractures of lower legs is applied mainly in children.
At the department of bone axamination and outpatient treatment, Viet Duc University Hospital, from October 2020 to October 2021, treating 61 patients with closed fractures of lower legs shape bone by casting with excellent results. The results are as follows: 93.4% patients with typ A fracture, 6.6% typ B1 fracture according to AO / ASIF classification.
Treatment results according to Lyshome scale at the time 2 weeks, 4 weeks and 6 weeks after cast removal, with the rate 42.6% respectively; 60.7% and 83.6%.
Results of of evaluating ankle joint funtion by FADI scale showed that the average score at 4 weeks after cast removal was 77.8±8.9, after 6 weeks was 101.9±6.9.
Classification of bone healing on X-ray according to RUST scale with average score of 7.41 ± 1.12 at 4 weeks in cast; 8.28 ± 0.78 after cast removal, 9.25 ± 1.01 after 2 weeks cast removal and 10.85 ± 0.67 after 6 weeks cast removal.
The rate of bone healing according to the RUST scale at the time of replacement was 42.6% and after 6 weeks of cast removal was 100%.
Knowledge of nursing students in relation to the prevention of varicose veins of the lower extremities
Talus aneurysm bone cysts are benign, rare.
Open approach to talus body is difficult due to the narrow surgical area, blood supply and almost surface of talus is articular cartilage.
Ankle arthroscopic for tumor removal, autologous bone grafting in treatment of talus aneurysm bone cysts is an advantage but difficult technique, overcoming the difficulties mentioned above.
We report a case of a giant aneurysm bone cyst that occupies the entire body of the talus, treatment with ankle arthroscopic tumor removal, autologous bone grafting at Vietduc University Hospital, good result, no reccurrent after 32 months of follow-up.
Evaluation of out-patient prescriptions in Thai Nguyen central hospital 2019
The aim of this research was to evaluate out-patient drug-prescribing in Thai Nguyen Central Hospital.
The percentage of encounters which had antibiotics or injections in the prescription was 40.50% and 3.5%, respectively
A cross-sectional descriptive study was conducted to evaluate the drug-prescribing patterns based on the World health Organization (WHO) prescribing indicators.
400 prescriptions were collected in Thai Nguyen Central Hospital.
The study results showed that patient details like name, age and gender was written in all (100%) prescriptions.
Diagnostic abbreviation were used in 21.25% prescriptions.
Name, concentration, quantity, route of administration of drugs were mentioned in 100% of drugs.
Total 1314 drugs were prescribed in 400 prescriptions.
Average number of drug prescribed was 3.29±1.32.
The percentages of drugs prescribed by generic name and from the essential drugs list were 29.45% and 39.27%.
The correlation between liver dysfunction and flare of systemic lupus erythematosus
Scaffold is a carrier or biological scaffold, or biological scaffold, that plays an important role in stem cell transplant technology.
In this article, we would like to briefly introduce the scaffold, the materials, the structure, the properties of the scaffold and the 3D modeling of the scaffold.
Psychometric properties of the Communication Assessment scale to evaluate communication skills among healthcare workers
Aim to prevalence of liver disease in patient systemic lupus erythermatosus (SLE) and the correlation between liver dysfunction and flare of lupus.
Method: A cross sectional study was carried out on 157 patient diagnosed with SLE according criteria of SLICC 2012. The study was conducted at Department of Allergy and Clinical Immunology in Bachmai Hospital.
Result: 44/157 (28, 0%) patient had liver disease.
White blood cell in case group 5, 267±4, 019 G / L lower than control group 8, 509±4, 331 G / L (p=0, 000).
C4 serum case group 0, 099±0, 076 g / L lower than control group 0, 135±0, 127 g / L (p=0, 038).
SLEDAI case group 12, 556±7, 229 greater than control group 8, 179±5, 191 (p=0, 002).
Conclusion: Exacerbation of SLE induce liver diseases.
Research on change of left ventricular diastolic function by echocardiography in periodic hemodialysis patients
To describe the current situation of using drugs to treat gout on inpatients at Can Tho City General Hospital.
Only 6 medical records showed adverse events during the treatment process, accounting for 5.77%.
In which, digestive disorders accounted for the highest percentage with 50.0%.
Conclusion: Gout inpatients were mainly indicated for the use of colchicin and meloxicam.
The main regimens used in monotherapy were paracetamol and colchicin, the multitherapy regimen mainly used colchicin, meloxicam and paracetamol.
Drug side effects were low at 5.77%.
Subjects and methods: Retrospective, cross-sectional, descriptive, non-intervention study based on inpatient medical records for gout treatment at Can Tho City General Hospital with admission time from June 2019 to December 2019.
Results: The majority of patients were prescribed colchicine, accounting for 91.35%, followed by oral and injected meloxicam, with 55.77.0% and 29.81% respectively.
Inpatients using a single regimen mainly used paracetamol (accounting for 36.11%) and colchicine (accounting for 22.22%).
The most commonly used 2-drug inpatient regimen included: colchicin + oral paracetamol (30.43%), oral meloxicam + oral paracatamol (19.57%).
The 3-drug combination regimen on the inpatient group includes: colchicin + injected meloxicam + oral paracetamol (accounting for 61.11%).
The four-drug combination regimen was colchicin + injected meloxicam + oral methylprednisolon + infused paracetamol.
The majority of inpatients had the regimen changed due to improved clinical symptoms (accounting for 64.13%).
Approximately 25.54% of patients need changes due to more severe clinical symptoms.
Several factors related to hardware failure of short-segment fixation in treatment of thoracolumbar burst fracture
To describe the physical activity level of elderly hypertensive persons and to identify related factors during the year 2020.
Method: 352 elderly people with hypertension were selected in 9 communes / wards of 03 districts / cities of Nam Dinh province to participate in the study.
The scales used include: The World Health Organization's physical activity rating scale; Perception scale of physical activity barrier; Scale to assess the level of confidence in physical activity; Social support scale.
Results: 100% of the subjects participated in at least, had participated in one of physical activities; 47.7% of subjects had an adequate level of recommended physical activity.
Those who were not aware of the barriers to physical activity had only 0.4 times the level of physical activity compared to those who were aware; those with family support were 2.5 times more physically active than those with little or no family support; people in rural areas have a physical activity level 6.5 times higher than those in urban areas; people aged 60 - 70 had a physical activity level 1.9 times higher than those aged >70 years.
Conclusion: The activity level of the elderly with high blood pressure is still low.
Interventions need to help patients recognize barriers and ways to deal with them, thereby increasing time to participate in physical activities.
Revision hip arthroplasty by mini-invasive technique with anterior approach
Objectives: To evaluate of risk factors by cha2ds2-vasc score in Patients are diagnosed stroke with non-valvular atrial fibrillation.
Method: Descriptive cross-sectional study on 91 patients are diagnosed stroke with nonvalvular atrial fibrillation.
Conclusion: CHA2DS2-VASc score is easily applicable and is recommended in routinely clinical practice.
Prevalence and relevant factors with vulvovaginal candidiasis during pregnancy
To describe the characteristics of chest computed tomography (CT) imaging of Invasive Pulmonary Aspergillus (IPA) diseases with clinical signs, confirmed by laboratory tests.
Subject and method: 47 patients were diagnosed with invasive Aspergillus lung fungus by 1 or from 2 methods: Microbiology (microscopy, identification culture); Immunological (Galactomanna antigen, Aspergillus LFD rapid test, 1, 3-β-D-gluca antigen concentration); Indirect fungal identification test (IgG, IgE, IgM); molecular biology (real-time PCR), pathophysiology.
Method: Retrospective, descriptive, cross-sectional study.
Result: Average age 54 ± 14 years; male / female was 2/1; cough with phlegm (36.2%); shortness of breath (48.9%); fever (40.4%); hemoptysis (6.4%); duration of symptoms was mostly 1 - 3 weeks before admission; 100% of patients had underlying diseases, of which 63.8% had host factors of EORTC / MSG, the most were hematologic malignancies (34%) and prolonged use of corticosteroids (23.4%).
Positive diagnostic techniques: Sputum culture (21/47 = 44.7%), culture of bronchoalveolar lavage / BAL (15/47 = 31.9%); pathology: Endoscopic bronchial biopsy (15/47 = 31.9%); transthoracic biopsy (11/47 = 23.4%); blood galactomannan test (12/47 = 25.5%); galactomannan BAL (2/47 = 4.3%), blood LFD (5/47 = 10.6%); LFD BAL (2/47 = 4.3%).
Note / multiple-notes (66 - 70%), solidified (38.3 - 51.1%), cavity / multi-cavity (29%), glass opacity around nodule / halo (53.2 - 66%), thickening of airway wall (20%).
Conclusion: Chest CT has an important role in orienting and supporting the diagnosis of invasive Aspergillus lung fungus.
Situation of surgical site infection after gastrointestinal surgery and some related factors at the department of gastroenterology at Saint Paul general hospital in 2021
Non of live-born needs heart intervention during 6 months postpartum with the number of spontaneous closures in 20 of the 44 infants (45.45%).
Conclusions: Isolated VSD diagnosed prenatally does not appear to have chromosomal abnormalites and has a favorable clinical outcome follow-up until 6 months of age.
Objectives: To describe the outcome of the fetus having VSD was diagnosted in Tu Du hospital and the rate of chromosomal anomalies in such cases.
The characteristics of pregnancies and VSD were analyzed, including follow-up until 6 months of age.
Results: Out of 46 cases of VSD included in the study, muscular VSD was 43.47%, perimembranous VSD was 41.30%, the outlet VSD was 13.06%, the inlet VSD was 2.17% and mean size of the opening was 2.06 ± 1.95 mm.
Working conditions of construction workers at a site in Thanh Hoa province in 2021
Medical students are one of the subjects with a very high rate of stress due to the pressure of the learning environment.
The proper understanding of stress helps you know how to adjust, reduce as well as prevent it effectively.
Objectives: To describe the knowledge of stress of 3rd year students majoring in Medical Doctor, Hanoi Medical University.
Subjects and methods: A cross-sectional descriptive study was carried out on 3rd year students majoring in Medical Doctor, Hanoi Medical University, by a questionnaire consisting of 2 parts: General information and Students' knowledge about stress.
Results: The majority of students had accurate knowledge about the manifestations, causes, effects, and ways of coping with stress.
However, there are students who do not know or misunderstand, which results in the facts that: Boredom, negative thoughts and suicidal intentions (63.2%) are manifestations of stress; stress is caused by the Contact with stressed people (47.5%); by the Fate of each person (27.7%); Stress leads to psychosis, madness (58.9%); Use tranquilizers (29%) when stressed.
Conclusion: students have correct but incomplete knowledge of stress some confusion.
Adequate and accurate provision of basic knowledge about stress is essential in order to improve their understanding of this issue.
Factors related to the response of paclitaxel – carboplatin in ovarian carcinoma with stage IIIC, IV
Patient safety (ATNB) is to minimize possible medical incidents, thereby reducing the risk of harm to the patient during treatment and care at health facilities.
Establishing a culture of patient safety is a top priority in improving the professional environment and improving the quality of treatment.
Objective: Describe the status of patient safety culture of medical staff at the general hospital Subjects and method: Cross-sectional study on 638 medical staff (HCWs) working at Xanh Pon Hospital, having worked at the hospital from 6 months or more, as of June 2020.
Results: More than three-quarters of health workers gave positive reviews about the existing VHWs of Green Po General Hospital, of which two groups of criteria with the lowest positive response rate were Faculty / Division Staff (49.4%) and Behavior without accusation when there is error by the Faculty / Department (53.1%).
The rate of positive assessment of each of the 12 aspects of the VHWs ranged from 57.0% to 92.6%.
Clinical charateristics of gingival enlargment in a group of Vietnamese people
The present study aims to evaluate the outcomes after inguinal hernia surgery by TAPP technique.
Result: 92.6% of patients did not have any systemic complications after surgery, 100% of the cases were not infected with incisions, the proportion of satisfied patients accounted for 88.9%, very satisfied accounted for 11.2%.
Conclusion: Surgery to treat inguinal hernia with TAPP method is a less invasive treatment, less pain after surgery, very small surgical scar, short postoperative time, gentle, patients quickly return to work and normal life.
Primary osteoporosis in postmenopausal women
A cross-sectional study wasconducted in 2018 on 290 junior high school students from 04 semi-boarding ethnic minority high schools in Tua Chua district, Dien Bien province, in order to describe the status of anemia, iron storage and vitamin D deficiency. The results showed that the overall anemia prevalence was 30.3% at the average threshold of public health significance; depleted iron stores were 22.4% (in which, low and depleted iron stores were 53.8%); iron deficiency anemia prevalence was 6.6%; The mean hemoglobin concentration was 122.9g / l±11.1 and the median ferritin concentration was 28.4μg/l.
Low vitamin D ratio was 9.3%; the rate at risk of vitamin D deficiency was 86.6%.
There was a statistically significant difference in the rate of low vitamin D by age group (p<0.05).
It is necessary to have timely intervention solutions to improve anemia, iron storage and vitamin D deficiency for junior high school students in ethnic and difficulty areas of Dien Bien province in particular and the Northern mountainous region in general.
Stress and associated factors among patients with post- Covid-19 in Ho Chi Minh city
To describe the nutritional status and some related factors in women of childbearing age in the Northern Midlands and mountains in 2019.
A cross-sectional descriptive study was conducted on 488 women in the childbearing age from 15 - 49 years old.
Results: This study showed that the rate of chronic energy deficiency in women of childbearing age was 8.6%.
The age group 15 - 24 years old had the highest rate of chronic lack of energy at 19.1%.
The prevalence of overweight and obesity was 15.0% and 0.4%, respectively, mainly in the 35 - 49 age group.
There was a relationship between age, household economic conditions and nutritional status of women of childbearing age with p < 0.001.
Follow up and take care of oral mucositis and lesions of the gastrointestinal disoders in patients treated with hematopoietic stem cell transplantation
To evaluate radiographic and clinical outcomes following anterior cervical discectomy and fusion with cage and plate in patients with degenerative spondylosis.
Mean decrease in disc space height was 5.4 ± 2.4%.
Six patients (27.3%) had dysphagia.
Fifteen patients (68.2%) had excellent results according to Odom's criteria.
The mean post-operation NDI score was 5.1 ± 5.8 (median 2.5 range 1 - 21).
Conclusions: Single-level ACDF with cage and plate for cervical spondylosis is an effective treatment, achieves high rate of fusion and preserves the alignments of cervical spine.
Methods: A prospective study.
Patients were performed this technique between August 2013 and October 2017.
Radiographic follow-up included static and flexion / extension radiographs obtained to assess fusion, focal and segmental kyphosis, and change in disc space height.
The Odom's criteria and NDI were used to assess outcomes at most recent follow-up.
Results: Twenty-two patients with singlelevel degenerative spondylosis underwent ACDF with cage and plate during the study period.
The mean duration of follow-up was 17.6 ± 7.3 months.
Radiographic evidence of fusion was present in 21 patients (95.5%).
The focal alignment at operated level on postoperative radiographs was slightly changed (mean α2 was 4.30 ± 5.50) and segment alignment was a little increased lordosis with mean Cobb angle β2 was 15.70 ± 12.40.
Description of the effect of CO2 pump on pulse, blood pressure on laparoscopic abdominal surgery patients at Xanh Pon general hospital in 2021
Evaluation of lung damage and analysis of some related factors in patients with systemic scleroderma.
Methods: A cross-sectional descriptive study on 81 patients diagnosed with systemic scleroderma according to ACR / EULAR 2013 criteria at the National Hospital of Dermatology from January 2020 to July 2022.
Results: Interstial lung damage accounted for 80, 2% total patient, pulmonary hypertension 48, 1%, combined ILD and PAH 34, 5%.
Restrictive ventilation disorder 60, 5%, FVC 77, 06±18, 04.
There was a statistically significant difference in the Rodnan score betwween SSc with PE and without PAD (18, 4 and 14, 3; p=0, 023).
There was a statistically significant difference in the indices of FVC (72, 9% and 93, 8%; p=0, 02); restrictive ventilation disorder (OR=0, 23 and p=0, 008); anti-Scl70 (OR=0, 29 and p=0, 03); and Rodnan scores (OR=4, 61; p=0, 009) between patients with ACS with ILD and without ILD.
There is a risk of decreased FVC in patients with positive anti Scl-70 antibodies (OR=0, 37 and p=0, 037).
There is a correlation between FVC and Rodnan score (p=0, 00).
Surveying fifth – year students’ awareness about cervical cancer and hpv vaccination in Faculty of Pharmacy – Nguyen Tat Thanh university
Health workers is an important resource for every facilities.
The results of univariate analysis showed that, the factor related to the satisfaction of health workers include: gender, age, number of years working at Yen Phong general clinic (p<0.05).
"There is no patient's satisfaction if there is no medical staff's satisfaction" (the statement of a well-known hospital manager - Joe Jansante). The satisfaction of medical staff will improve the quality of health services.
Objectives: Determining the status and some factors related to health workers satisfaction at Yen Phong general clinic, Bac Ninh province.
Methods: Cross-sectional survey, quantitative research.
Results: This study collected information from 203 health workers Yen Phong general clinic, Bac Ninh province through questionnaire interviews.
Research results show that 5/5 fields have satisfaction rates of over 83%.
Conclusion: The overall satisfaction rate of health workers is quite high (84.24%).
The average score is 4, 21 ± 0, 37.
The clinical, paraclinical features and results of induction of labour by foley catheter baloon in Can Tho obstetrics and gynecology hospital
Management of pregnancies in which the cervix is unfavorable is an important task for obstetricians, induction of labour by Foley Baloon is an easy-to-implement, minimally invasive and complicating method.
Objectives: to descript the clinical, paraclinical features and results of induction of labour by Foley Catheter Baloon in Can Tho Obstetrics and Gynecology Hospital.
Materials and method: cross-sectional study involving 104 patients that were admitted for induction of labour with unfavourable cervix, that is, a Bishop score < 4 between October 2016 and March 2018.
Situation of chronic obstructive pulmonary disease management in Thai Nguyen hospital of tuberculosis and lung diseases phase 2014 - 2018
Chronic obstructive pulmonary disease is a chronic disease leading cause of death and disability.
The aim of our study was to describe the current situation of management and management of chronic obstructive pulmonary disease at Thai Nguyen Hospital of Tuberculosis and Lung Diseases in 2014 - 2018.
The study found out prevalence of chronic obstructive pulmonary disease in male patients accounted for 89.24%, 60 - 69 years old account for 40.18%.
The patients had some related diseases including hypertension (63.29%), bronchitis (58.22%) and diabetes (51.64%).
The degree of airflow obstruction according to Global Initiative for Chronic Obstructive Lung Disease - GOLD 2018 phase 2 was 46.4%.
Human resources and resources at the Chronic pulmonary disease Management Unit meet the standards.
Good treatment results accounted for the largest proportion with 80.04%.
In summary, the model of Chronic pulmonary disease Management Unit at Thai Nguyen Hospital of Tuberculosis and Lung Disease in 2014 - 2018 finds that treatment management is stable, sustained, and sustainable.
Investigating the relationship between histology of varicocele and testicular functions in varicocelectomy patients
The prevalence of thyroid dysfunction due to iron overload in children with transfusion-dependent thalassemia ranges from 6 - 30%, depending on ferritin levels, age, blood transfusion volume, and chelation therapy.
Objective: To determine thyroid function in children with transfusion-dependent thalassemia and factors affecting thyroid function.
Methods: Cross-sectional descriptive analysis of 51 thalassemia cases 9 - 16 years old who received blood transfusion ≥ 10 times per year.
Patients with a history of hypothyroidism were excluded from the study.
Results: The highest rate was central hypothyroidism 39.2% (20/51 cases), primary hypothyroidism 3.9% (2/51 cases), and subclinical hypothyroidism 1.9% (1/51 cases).
The hypothyroid group had a median age of 11.5 years (9 - 15 years), pre-transfusion hemoglobin level of 7.24 ± 0.13 g / dl, transfused blood volume of 113 ml / kg / yr (64 - 175 ml / kg / yr), ferritin concentration of 2, 472 ng / ml (1, 184 - 6, 143 ng / ml) compared with the euthyroid group was 11 years old (9 - 16 years), 7.25 ± 0.10 g / dl, 117 ml / kg / year (69 - 237 ml / kg / yr), 2, 000 ng / ml (540 - 5, 765 ng / ml), respectively; no statistical difference.
Conclusion: Thyroid dysfunction in thalassemia patients varies from subclinical hypothyroidism, primary hypothyroidism to central hypothyroidism.
Research on the demands of using traditional medicine therapy for smoking cessation of smokers in Ha Noi
Also, in patients with adrenal insufficiency prompt adaptation of glucocorticoid doses may be needed.
Moreover, The role of sex hormones as well as peculiar pituitary and thyroid aspects of COVID-19 have been included.
Finally, in view of the mass vaccination, potential implications for diabetic and endocrine patients should be considered
Careful management including treatment modifications may be required for protecting the patients rather with known diabetes from the most dangerous consequences of COVID-19 or hospitalized with COVID-19, but also in patients with SARS-CoV-2 induced newly onset diabetes. Obesity increases susceptibility to SARSCoV-2 and the risk for COVID-19 adverse outcome.
In addition, adequate nutritional management needs to be granted to patients with obesity or undernourishment in order to limit their increased susceptibility and severity of COVID-19 infection.
Lack of vitamin D, hypocalcemia and vertebral fractures have also emerged as frequent findings in the hospitalized COVID-19 population and may negatively impact on the outcome of such patients.
Abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm: case report and literature review
There were 35 samples which were contaminated with mold, of which 25 samples were co-infected with yeast.
Especially, 6/8 of the Arillus Longan samples presented fungal contamination over 10, 000 CFU / g, specifically those in C and E stalls (34 x 104 and 12, 3 x 103 CFU / g respectively).
Some samples in A and B stalls had high moisture but low fungus contamination of under 10 CFU / g and some organoleptic irregularities, suggesting the presence of dye, preservatives, changes in pH levels, etc. Yeast appeared in 60% of the samples such as Fructus Lycii, Fructus Schisandrae chinensis, Fructus Morindae citrifoliae, and Arillus Longan, but they were not identified.
Maternal and fetal factors related to the accuracy of mcdonald’s formula in fetal weight estimation
Hypertrophic pyloric stenosis is a disease that occurs in the second week of life, of unknown origin, which consists of the narrowing of the pylorus due to concentric muscular hypertrophy, causing gastric outlet obstruction with progressive vomiting that leads to malnutrition, dehydration, and serious metabolic disorders.
Hypertrophic pyloric stenosis is exceedingly rare in newborns and is rarely reported in the literature.
This report is of a premature newborn, low birth weight with hypertrophic pyloric stenosis.
The patient presented with vomiting milk at 4 days of age, epigastric distension and dilated gastric shadow on the abdominal radiograph.
The child was treated in the direction of gastroesophageal reflux but the disease did not progress, the child still vomited milk fluid.
Gastrointestinal circulation with contrast showed only dilated stomach.
Re-ultrasound on day 10 showed thickened pylorus.
The patient underwent pyloromyotomy with open surgery.
Postoperative progress, the patient improved without vomiting milk, discharged after 1 week.
Analysis of some factors related to indication for intubation of large hemispheric infarction patients
The study aims to determine the incidence of infection and subclinical characteristics that cause vaginitis in women using the CHROMagar medium and culture technique.
achieving high efficiency can deploy the technique of culture and identification on the CHROMagar.
Results: There were 333 case included in the study.
The rate of vaginitis with identified cause was 40, 2%, in which the rate of vaginitis caused by Candida sp was 26, 7%, Gardnerella vaginalis was 11, 7% and caused by Trichomonas vaginalis 1, 2%.
In 89 case of Candida sp infection identified on CHROMagar, Candida were found to be 68, 5%, Candida glabrata was 25, 9%, Candida tropicalis was 4, 5%, Candida krusei was 1, 1%.
Conclusion: Using microscopy specimens and cultured techniques, it is possible to detect the agent that causes vaginitis.
The incidence of vaginitis is mainly Candida sp.
Determination of total tin in blood by inductively coupled plasma mass spectrometry (ICP-MS) for biological monitoring risk of tin exposure
Percutaneous Coronary Intervention (PCI) has revolutionized the management of chronic and acute coronary artery syndrome.
In clinical practice, stent delivery failure in complex, tortuous and calcific coronary anatomy is encountered in approximately 2.7 - 5% of cases, leading to incomplete revascularization and procedural failure.
The mother-child technique can be safely and effectively treated with some complex lesions which are uncrossable.
This technique permits deep intubation and reach into the coronary artery and facilitates a smooth pathway to the lesion
Knowledge and practice compliance of nurses at Gastroenterology Endoscopic Department, 108 Military Central Hospital
The purpose of our study is to apply the method of blood processing on direct dilution and measuring samples by Inductively coupled plasma mass spectrometry (ICP-MS) to determine tin, the technique is used in biological surveillance of people at risk of tin exposure.
Results: The results showed that the sample dilution method has many advantages and suitable for blood sample processing, agreeable for analysis on ICP-MS. The limit of quantification (LOQ) of the method was 1 g / L.
Relative standard deviation (3.90% - 6.68%), method recovery of 96.47% were acceptable according to AOAC criteria.
The results was found that, the average of blood tin concentration of 130 workers with occupational exposure was 2.59 g / L higher than the control group (0.53 g / L), the difference was statistically significant with p<0.001.
Conclusions: The technique of determining tin in blood is simple, easy to implement, has high accuracy, fast analysis speed, batches, and meets biological monitoring for subjects at risk of exposure to tin.
Parvovirus B19 infection – associated anemia in pediatric kidney transplant recipients: Description of two cases
This paper was a report of a study to describe nurses' practice, attitudes, knowledge / skills about Evidence-Based Practice (EBP) and identify the related factors to nurses' cognitive on EBP.
Results: The findings showed that participants had medium scores on practice (mean = 3.59; SD = 0.80) and knowledge / skills (mean = 3.66; SD = 0.53), and nurses had negative attitudes towards EBP (mean = 3.81; SD = 0.81).
Statistically significant differences were found for practice, attitudes, and knowledge / skills between those with more than 10-years' experience compared to those with less than or equal to 5-years' experience.
They cited barriers to implementing EBP were time, cost, limited knowledge of research, and no nurses with research knowledge in a practice setting.
Conclusion: The findings suggested that it is necessary to devise appropriate strategies to improve EBP practice, attitudes, and knowledge / skills for nurses. This would also encourage them to apply the latest evidence to patient care and contribute to improving the quality of medical services.
Results of nursing care for post- operative patient with trauma brain injury at Viet Duc university hospital 2022
The study was conducted to evaluate the nutritional status of patients with chronic obstructive pulmonary disease at the Department of Chronic Lung Diseases of the National Lung Hospital from December 2020 to May 2021.
Research method: Cross-sectional descriptions of 106 patients were collected by convenience sampling.
Results: Subjects with BMI within the normal range (18.5 ≤ BMI < 25) was 32.08%.
Underweight (BMI < 18.5) subjects was 58.49% and overweight and obese subjects (BMI ≥ 25) was 9.43%.
The mean BMI of the study population was 18.1±3.13 and 81.13% of the study subjects were identified as having undernutrition according to SGA.
In 106 studies, 51 patients (48.11%) were diagnosed with severe malnutrition (SGA-C), 35 patients (33.02%) were diagnosed with mild or moderate malnutrition (SGA-B) and 20 patients (18.87%) with good nutritional status (SGA-A).
Conclusion: the proportion of malnourished COPD patients accounts for a high proportion, so it is necessary to take measures to improve the nutritional status of patients with chronic obstructive pulmonary disease at the National Lung Hospital.
Result of balloon kyphoplasty in the treatment of thoraco-lumbar vertebrae compression patients due to osteoporosis at Dong Anh general hospital
Colorectal cancer (CRC) is one of the most common malignancies in the world.
Determining the status of MSI helps screen Lynch syndrome, a predictive marker for response to chemotherapy as well as immunotherapy.
Microsatellite instability (MSI) is a hallmark feature of Lynch syndrome cancers and occurs in about 12 - 15% of sporadic colorectal cancers as well.
Objective: Evaluate MSI status in CRC and correlate with histopathology.
Methods: 97 patients with colorectal cancer were studied by Immunohistochemistry method with markers MLH1, PMS2, MSH2, MSH6.
Result: MSI rate 12.4%.
Age <50 is more common in MSI tumor (41.7%) than Microsatellite stability (MSS) tumor (30.6%), high rate in proximal conlon 83.3%.
Mucinous type 50%, poor differentiation 66.7%, tumor infiltrating lymphocytes 58, 3% are common features in MSI tumor.
Conclusion: Colorectal cancer (CRC) with MSI status has distinctive clinicopathologic features, such as young patients under 50, proximal colon, mucinous and medullary phenotypes, poor differentiation and tumor infiltrating lymphocytes.
Results of surgical treatment for benign mediastinal teratomas at Viet Duc university hospital in the period of 2015 - 2021
To report on adverse drug events (ADEs) in adults using glucocorticosteroids (GCs) for 3 months or more.
Conclusions: It is necessary to monitor closely outpatients prescribed with GCs in order to limit adverse events
Results: We interviewed 157 patients about ADEs during their course of GC therapy.
The median age of this group was 60 and most of them were female (64, 1%).
More than half of the patients (59, 9%) reported using GCs for more than 12 months.
Many patients with adrenal insufficiency were indicated GCs as replacement therapies (38, 2%).
Cushing's syndrome was the most frequent adverse event (55, 4%).
Gender was associated with Cushing's syndrome (OR = 2, 72; 95% CI, 1, 32 - 5, 58) in patients with long - term use of GC.
Anesthesia for patients with Brugada syndrome
Conclusion: The decline ADLs affects in-hospital deaths, re-hospitalization and mortality of all causes at 90 days.
It is necessary to detect and prevent dependent ADLs, consider dependent ADLs as a predictive factor of clinical results.
Objectives: to determine the proportion of patients with dependent ADLs prior to hospital admission, to investigate the relationship between dependent ADLs with clinical result (inpatient complications, hospital deaths, re-hospitalization of all causes, and mortality of all causes at 90 days of follow-up). Methods: Cross-sectional study and prospective cohort study.
Result: 105 elderly patients with non-ST elevation myocardial infarction have an average age of 76.1 years, ratio male / female=1.84: 1.
At the time of admission, 27.4% of patients with previous dependent ADLs were recorded with an average score of 5.39 points.
The mortality rate in the dependent ADLs group was higher than in the independent ADLs group (63.6% and 23.4%, p=0.009).
Dependent ADLs increased hospitalization rates (OR=5.49, 95% CI=1.40 - 21.46; p=0.02), increased mortality from all causes (OR=5.92, 95% CI=1.07 - 32.61, p=0.041) at the 90-day follow-up.
The results of complete mesocolic excision in stage II,III colon cancer treatment at K hospital
Evaluation the hemodynamic variablility and ICU parameters in surgery result of primary mitral valve regurgitation with left ventricular dysfunction (EF ≤ 60%).
Material and methods: Retrospective study - cases series, 34 patients primary mitral valve regurgitation with left ventricular dysfunction were operated from 2015 to 2019 at Cho Ray hospital.
Results: 35, 3% rhematic disease, mitral valve replacement were 26, 5%. Median cardiopulmonary bypass time were 128, 1  66, 1; median aortic cross-clamping time were 94, 3  53, 3.
In 34 cases, there are 2 patients were death, mortality rate were 5, 9%, operative complications were 38, 2% overall, in there re-explored for bleeding were 2, 9%, drainage pericardial effusion and fleural effusion were 11, 8% and 22, 6%, pneumonia were 8, 8%, median intensive care unit stay were 93 hours, median mechanical ventilation support were 24 hours, median inotrope support were 72 hours.
There were new arrhythmias, 9 cases with temporary pacing (26, 5%), 1 case with permanent pacing (2, 9%), 1 case ventricular fibrillation (2, 9%).
Post-op renal failure were increased 17, 7%, aminotransferase were increased 41, 2%, median bilirubinemia level were higher two times than pre-op.
Conclusions: Surgery of primary mitral valve regurgitation with left ventricular dysfunction increase arrhythmia rate; mechanical ventilation support time and inotrope support time were prolonged; kidney and liver function were influenced significantly.
However it provided satisfactory early-term outcome, similar to many cardiac surgery center on the world, specially there are some improved operation techniques and many postoperative support devices.
Risk factors of cardiovascular disease among a Hanoi-based university’s staff
Germ cell tumors account for about 10% of primary tumors in the mediastinum, which are derived from primordial germ cells of the fetal sex cord.
Germ cell tumors are common in the anterior mediastinum, 5% in the posterior mediastinum; ages 20 - 40 years old.
Histopathological classification of Germ cell tumors include: (1) benign and malignant teratomas; (2) seminoma; (3) embryonal carcinoma; (4) endodermal sinus tumor; (5) choriocarcinoma and (6) mixed cell tumors.
More than 80% of germ cell tumors are benign, of which the majority are benign teratomas.
The distribution of the disease in both sexes is similar, however, men have a higher propensity to develop malignant germ cell tumors than women.
Among the most common malignant germ cell tumors are seminoma (accounting for about 30%), followed by embryonal carcinoma and malignant teratoma about 10% each; endodermal sinus tumor and choriocarcinoma together account for about 5%; The remaining malignant germ cell tumors accounting for about 40% of cases are of mixed cell type.
We report a case of primary testicular germ cell tumor in the mediastinum, confirmed by histopathology and immunohistochemical staining; treated with surgery and chemotherapy, initially gave good results.
Result of treatment of neuromuscular respiratory failure at the pediatric intensive care unit of Vietnam National Children's Hospital
To study the survival and some factors influencing on the survival in advanced non - small cell lung cancer patient with EGFR mutation used Gefitinib as the primary treatment.
Subject and method: 69 non - small cell lung cancer patients used Gefitinib 250 mg per day until progressive disease or unacceptable toxicity.
Results: Response rate was 85, 5%; Disease control rate was 94, 2%; Progression free survival time 12, 6 ± 1, 1 months; overall survival 21, 8 ± 2, 5 months.
The patient's overall condition and EGFR gene mutation significantly related the Progression - free survival time.
Malignant pleural mesothelioma - a literature review and case report
This study is to determine the results and to determine associated factors in relation to the treatment of neuromuscular respiratory failure at the Pediatric Intensive Care Unit (PICU) of Vietnam National Children Hospital, from 1/5/2017 to 7/30/2019.
This is a descriptive study of 49 pediatric patients (17 retrospective studies, 32 retrospective cases) diagnosed with neuromuscular disease with respiratory failure treated at PICU.
Unknown cause of neuromuscular disease represents 40, 8% of the patients.
The mortality rate was 12.2%, the average duration of treatment was 24.3 ± 23.6 days, the shortest is 2 days, the longest is 112 days. The average duration of mechanical ventilation is 21.8 ± 23 days, the shortest is 1 day, the longest is 102 days, the prolonged mechanical ventilation is 37.5%.
The most common complications were pulmonary collapse (39.5%), followed by ventilatorassociated pneumonia (27.1%), also cardiac arrest complications (10.4%) and pneumothorax (4.2%).
The risk of death increases 13 times when patients stayed > 46 days at PICU, mechanical ventilation lasts > 43 days.
In conclusion, the neuromuscular disease in children with serious illnesses at PICU has a difficult treatment with high mortality.
Rapid detection of Salmonella spp. in meat by loop-mediated isothermal amplification (LAMP)
Salmonella is the main pathogens that contaminate animal products and cause human Salmonella food poisoning.
The objective of this study establish a rapid detection process for Salmonella spp.
in meat samples by Loop Mediated Isothermal Amplification (LAMP) method specific to invA gene, meeting the requirements of analytical applications.
The results of the study have built direct analysis processes of Salmonella from food based on the Loop Mediated Isothermal Amplification reaction, including: (1) Take meat sample (25 gram) are enriched in 150 ml Buffer Pepton Water (BPW): 75 ml Rappaport Vassiliadis Soya Broth (RVS) in a period of 10 hours, prior to DNA extraction for LAMP; (2) To improve the method of rapid DNA extraction from food enrichment fluid that using 100 mM NaOH buffer (meat), 5 minutes heating at 95 °C, 30 seconds ultrasound, 10.000 rpm / g centrifugation in 2 minutes of collection DNA for LAMP reaction.
The results of evaluating of method show that the LAMP method have sensitivity (SE) is 100%, accuracy is (AC) 94%, specificity (SP) is 94%, the false positive rate is 6% and false negative rate is 0%.
The above results indicate the LAMP has been set up and the standard method according to TCVN 10780 - 1: 2017 (ISO 6579 - 1: 2017) are equivalent for detection of Salmonella in meat, but the time for analysising of LAMP is shorter, only 10 hours.
Factors that influence the occurrence of multiple pregnancies after frozen embryo transfer on day 3
The diagnosed is based on the presence of a hemolytic anemia with a positive direct antiglobulin test (or direct Coombs test) and the absence of any other hereditary or acquired cause of hemolysis.
Treatment aim is reduce autoantibodies by using glucocorticoids and other immunosuppressive therapies: intravenous immunoglobulin, cytotoxic agents, monoclonal antibodies and splenectomy.
The correlation between the two methods of plaques forming units (PFU) and cell culture infectious dose 50% (CCID50) of the measles vaccine candidate for the Vietnamese national reference standard
Results: overbite was reduced 1.67 mm, Par w was changed 22.53 point, great improvement 86.7%.
Conclision: Clear Aligner are effective in deepbite treatment.
New mutation of AR gene in patients with androgen insensitivity syndrome
Postpartum trophoblastic tumours have been reported to be relatively resistant to chemotherapy and associated with a poor prognosis due to their late diagnosis.
The choice of treatment regimen at the time of disease detection depends on the clinical course and location of the lesion in order to ensure the patient's survival and quality of life.
Conclusion: Postpartum metastatic trophoblastic neoplasms are completely curable with combination chemotherapy that preserves the uterus if no primary uterine lesion is detected.
Comment on some anatomical characteristics of renal vessels in living donor kidney transplantation at 103 military hospital
According to the Centers for Disease Control and Prevention (CDC), each year seasonal flu kills about 650, 000 people around the world, with about 10 million hospitalizations.
People often call "cold - flu", but incorrectly, to refer to diseases with similar symptoms, caused by other viruses that also cause illness in the respiratory tract.
Humoral rejection
Evaluation of the effectiveness of chronic urticaria treatment with a 10mg oral dose of levocetirizine.
Conclusion: 10mg oral levocetirizine therapy effectively controls symptoms of chronic urticaria.
Subject and method: A clinical trial, self-compared before and after treatment on 40 chronic urticaria patients examined at the Dermatology out-patient clinic of 103 Military Hospital from September 2021 to June 2022.
Patients were treated with a 10mg oral dose of levocetirizine daily for four weeks.
Urticaria activity score and quality of life score were recorded weekly.
Result: The mean chronic urticaria patient's age was 42.27 ± 15.37.
After 4 weeks of treatment, the UAS index decreased from 4.58 ± 1.01 at the beginning of treatment to 1.33 ± 1.33 at the end of therapy.
The quality of life improved markedly more than those at the beginning of treatment, with a mean score of 31.50 ± 8.82.
Forty-five percent of chronic urticaria patients had excellent response without symptoms after 4 weeks treated with a 10mg dose of levocetirizine therapy.
The most common side effect was sedation (12.5%).
Croes nomogram to predict treatment success of PCNL on patients in lateral position
Objective: To determine what the using rate of modern birth control methods in Krong Nang district, Đak Lak province is, and the other factors related to the rate.
Methods: Using cross-sectional methods, we did study on 554 ethnic minority women who had at least two kids and who were under 49 years old, still living with their husbands. Subjects should reside in Krong Nang district, Đak Lak province for over a year.
Results: The using rate of modern birth control methods among the ethnic minority women in Krong Nang district, Đak Lak province is 85.18%.
The factors that contribute to the increase of the rate include: High level of education, the desire to use birth control methods, and the satisfaction of the current using method.
Conclusions: The using rate of modern birth control methods among the ethnic minority women with two children in Krong Nang district, Đak Lak province is 85.18%.
Family management education needs to be further carried on in order to provide more knowledge of the modern birth control methods to the people there
Attitude of medical and nursing students toward interprofessional education in duy tan university
To evaluate the results of CO2 laser application in the treatment of maxillofacial soft tissue disorders at the Center of Odonto - Stomatology, Hue Central Hospital.
Re-examination after 6 months: Good wound healing 91.4%; Recurrence 5.7%.
Conclusion: The result of good healing shows that CO2 laser is really effective in the treatment of facial soft tissue disorders, but there are still bad healing and recurrences after 6 months of treatment.
Subject and method: 146 patients with tumors and soft tissue lesions in the maxillofacial region, indicated for CO2 laser surgery at Center of Odonto-Stomatology, Hue Central Hospital from 01/2019 - 01/2022.
A prospective study with clinical intervention.
Result: The mean age was 32 years.
For superficial lesions: Warts 39.0% and benign melanoma 36.6%.
The re-examination after 3 months: The recognition of scars grade 3: 34.1% and grade 2: 24.4%; the percentage of scar color level were quite 34.1%, good 24.4%; Good healing 80.5%, recurrence 0%.
Re-examination after 6 months: recognition of scars grade 0: 46.3% and grade 1: 22.0%, the result of scar color was good 51.2%; Good healing 87.8%; recurrence 7.3%.
For lesions in the mouth: the low frenal attachment 24.8%, the mucinous tumor of 20.9%; re-examination after 3 months: good healing 72.4%; Recurrence 0%.
Research on relationship between plasma prolactin contents and results of treatment with Sertraline and Olanzapine in female depressive patients
It is a cross-sectional study with a combination of quantitative and qualitative methods.
PSS-SR scale was applied to 400 health care staff who directly treated and cared for patients infected by Covid-19. These staffs were from the National Hospital for Tropical Diseases and Ninh Binh General Hospital.
Occupational factors were considered, including working department, duration of working hours, and time to interact with infected patients.
FUNC score in prediction intracerebral hemorrhage patients at Hue central hospital
To describe disease characteristics of neonates born to mothers with COVID-19 at Duc Giang general hospital and find some relative factors between neonates and these mothers.
Caesarean section was 74.3%, of which caesarean section due to COVID-19 was 14.2%.
The rate of resuscitation in the delivery room was 6.2%.
A neonate tested positive for COVID-19 (0.9%).
There were 96.4% discharged.
Diseases included early onset neonatal sepsis (6.5%), respiratory failure (21.2%), jaundice (16.8%).
Causes of respiratory failure after birth were asphyxia (6.2%), apnea of prematurity (4.4%), transient tachypnea (3.5%).
Neonates whose mothers with severe-critical COVID-19 had higher rates of premature births, respiratory support at birth, and phototherapy for jaundice and early onset neonatal sepsis than those whose mothers with mild - moderate (p< 0, 001).
After multivariate regression analysis, there is an independent factor that is the neonates whose mothers with severe-critical COVID-19 has a 20 times higher risk of requiring respiratory support at birth (p< 0, 01).
Neonates whose mothers used anticoagulants before giving birth had a higher rate of blood clotting disorders than mothers did not.
Methods: This study was retrospective and prospective description and case series in neonates born to mothers with COVID-19 from September 1st 2021 to March 31st 2022.
Neaonates with early onset neonatal sepsis accounted for the highest rate, followed by respiratory failure.
Neonates whose mothers with severe-critical COVID-19 has higher risk of requiring respiratory support at birth.
Neonates whose mothers used anticoagulants before giving birth had a higher rate of blood clotting disorders than those whose mothers did not.
Results: A total of 113 neonates (three twins) and 110 mothers were enrolled in the study.
The mean maternal age was 29.33 ± 5.48.
There were 56.4% of mothers vaccinated against COVID-19.
There were 14, 5% of mothers with severe-critical COVID-19.
The rate of male was 54.9%.
The rate of premature neonates was 12.4%.
The neonates with the birth weight ≥ 2500 grams was 92.9%.
Characteristics of posterior cranial fossa magnetic resonance imaging of chiari malformation type I in adults
Today, as a result of recent advances in diagnostic techniques and treatment modalities, the number of patients diagnosed with multiple primary malignancies has been increasing.
In addition, surgery has been an essential oncology modality in the multimodal management of cancer patients.
We report a case of a 71-year-old male with multiple primary tumors in two different organs: lung and rectum; that has been operated successfully at VietDuc University Hospital.
Knowledge and practice of treatment adherence among outpatients with tuberculosis at Cao Loc medical center in 2019
To describe the real knowledge and practice of treatment compliance among outpatients undergoing follow-up treatment for tuberculosis at Cao Loc Medical Center, Lang Son province in 2019.
Method: A cross-sectional descriptive design was conducted, using the selfcompleted questionnaires to assess the patients' knowledge and practice of follow-up treatment adherence during the period from March to May in 2019 at Cao Loc medical center, Lang Son province; 60 outpatients in consolidation phase of treatment met the sampling criteria participated to the study.
Results: Among 60 patients participated in the study, the percentage of patients who had appropriate knowledge of treatment adherence was 58.3%; the percentage of patients who recognized 4 principles of treatment was only 21.7%, of which the percentage of patients who knew the principle of regularly taking medicine accounted for 43.3%.
The percentage of patients who had proper practice of treatment principles was 48.3%; in which the principle of taking medicine regularly was 40.0%.
Research on some risk factors of recurrent ischemic stroke due to middle cerebral artery in Bach Mai hospital
To identify gastric residual volume and patient satisfaction when drinking 200ml of maltodextrin 12.5% solution 2 hours before surgical anesthesia.
Subject and method: A prospective, cross-sectional study was performed on 102 spine surgery patients who were given maltodextridine sugar water 12.5% 2 hours before surgery at the Department of Spine surgery, 108 Military Central Hospital from September 2021 to March 2022.
Result: Health classification according to ASA accounted for the majority in group II 82.35%; group III accounted for 7.84%.
The amount of gastric residual volume in the intervention group (29.68 ± 14.89ml) was lower than the control group (32.45 ± 12.77ml), the difference was not statistically significant (p>0.05).
The level of thirst in the intervention group was lower than in the control group before surgery and 2 hours after surgery.
The intervention group taking maltodextrin solution before surgery had a satisfaction rate 2.86 times higher than the group not taking it.
Conclusion: It is safe for patients to drink 200ml of maltodextrin 12.5% solution 2 hours before anesthesia, and it also reduces thirst for spine surgery patients.
There is a diference in the satisfaction level between the intervention group anh the control group.
Current epidemiological situation of level-1 hypertension in the elderly in Vinh City - Nghe An Province
We have conducted an epidemiological survey about level-1 hypertension in the elderly in Vinh City - Nghe An Province, according to 4 criteria: disease severity, gender, living region and previous occupation.
The result shows that the ratio of people having level-1 hypertension accounts for a high proportion, and men has a higher rate than women.
Vessel wall characteristics on high-resolution mri of ischemic stroke associated with intracranial stenosis
Evaluation outcome after surgery of obstructed total anomalous pulmonary venous connection in National Hospital of Pediatrics, Hanoi, Viet Nam.
Methods: From January 2011 to February 2016, a total of 35 consecutive patients of obstructed total anomalous pulmonary venous connection underwent surgery in National Hospital of Pediatrics, Hanoi, Viet Nam.
Results: The mortality was 14, 3% (5/35) with hospital mortality was 11, 4% and late mortality was 2, 9%.
Follow-up was complete with all survivors showing no postoperative pulmonary venous obstruction.
Conclusions: Mid-term results after surgery of obstructed total anomalous pulmonary venous connection are favorable.
Assessment venous thromboembolism risk in hospitalized medical patients with cardiovascular disease by Padua score
Previous studies have shown that homocysteine level and the C677T polymorphism in the gene encoding Methylenetetrahydrofolate reductase (MTHFR) may be involved in thedevelopment of osteoporosis in Asian population.
The aim of this study was to verify the association of thispolymorphism with osteoporosis in older Vietnamese men. A cohors study on 400 men aged 50 years and over (200 osteoporosis and 200control).
BMD at lumbar spine 1 - 4 and the left proximal femur including the femoral neck and the total hip were measured by dual-energy X-ray absorptionmetry in all subjects.
The frequencies of C and T alleles are (79.25%) and (20.75%), respectively, the distribution of C and T alleles follows the Hardy-Weinberg law.
In which, CT and TT genotypes appeared in the disease group (36.5% and 6%) higher than in the control group (30.5% and 2%) the difference was statistically significant (p=0.036); CT / TT genotype carriers have an increased risk of osteoporosis 1.54 times compared with CC genotype carriers (95% CI: 1.02 - 2.31), in which the femoral neck position is 2.04 times (95% CI: 1.23 - 3.38); after testing multivariate logistic regression with risk factors ages, BMI, history of smoking, alcohol consumption, history of fracture, physical activity showed that the CT / TT genotype increased the risk of osteoporosis by more than 1, 52 times compared with the CC genotypebut not statistically significant.
The clinical and subclinical characteristics of osteoporosis at the geriatric department of National hospital of traditional medicine
Coronary artery disease (CAD) which is a common cardiovascular disease, is the leading cause of death worldwide.
There are 4 variables capable of estimating significant obstructive coronary artery: hypertension, diabetes, elevated LDL-c, type of chest pain.
The result of the study determines regression equation: Y = - 6.317 + 3.074 × (hypertension) + 2.877 × (diabetes) + 2.651 × (elevated LDL-c) + 2.377 × (typical chest pain) with a correct predictive value of 69.9%.
Conclusion: An estimation priori probability model which includes hypertension, diabetes, elevated LDL-c, type of chest pain, can predict significant obstructive coronary with patients suspected CAD.
Guidelines of CAD give a estimation priori probability model based on reseach: validation, updating, extension of Diamond - Forrester model.
Determined probability obstructive coronary and related factors; 2.
Examined the predictive value obstructive coronary artery of extensive Diamond - Forrester model in the patient having chest pain suspected CAD at Hoan My Cuu Long General Hospital in 2020 - 2021.
Materials and methods: A cross - sectional study with analysis.
There are 136 patients having chest pain suspected CAD at Hoan My Cuu Long General Hospital in 2020 - 2021.
Results: From 6/2020 to 4/2021, there were 136 patients having chest pain suspected CAD: 35.3% were male, 64.7% were female; average was 69.86±10.52.
The ratio of the patient with significant stenosis coronary artery was 58.8%.
The value of Bisap score for predicting severity and mortality in acute pancreatitis
Although there has been much progress in early diagnosis and treatment of acute pancreatitis (AP), the mortality in severe acute pancreatitis remains high at 15 - 30%.
The BISAP score has a high value for Predicting Severity and Mortality in Acute Pancreatitis, which has been investigated and recommended by many authors.
Objective: Determine the Value of BISAP Score for Predicting Severity and Mortality in AP.
Materials and Method: A cross-sectional descriptive study of 44 patients presenting with AP was admitted at Department of Internal Gastroenterology - Clinical Hematology in Can Tho Central General Hospital from May 2016 to May 2018.
Results: Of the 44 patients, 10 (22.7%) patients developed severe acute pancreatitis (SAP), and 2 (4.5%) patients died.
The area under the curven (AUC) of BISAP for predicting serverity and mortality in AP were 0.77, and 0.75.
The sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) of BISAP score, with a cut-off of 3 in predicting SAP, were 70.0%, 88.2%, 63.6%, and 90.9%, respectively.
BISAP ≥ 3 predicted mortality with sensitivity: 50.0%, specificity: 76.2%, PPV: 9.1%, and NPV: 97.0%, Conclusions: BISAP may be a valuable predictive tool of AP severity and mortality among patients with AP in the first 24 hours after admission.
Assessing the outcome treatment of the idiopathic nephrotic syndrome
The deepening international economic integration of Vietnam has brought both opportunities and challenges for Vietnamese agricultural products including more fierce competition with foreign agricultural products. Vietnam's agricultural industry needs to constantly invest, improve product quality and design, step by step affirm its position and reputation of Vietnamese agricultural products including tea on the global market.
These changes must originate from sustainable tea production and must add value to tea production to help farmers increase their income and reduce poverty.
Tea grown in the Northwest region and neighboring areas has a lot of potential, but the improvement of added value for tea production still faces many difficulties and limitations.
This paper proposes solutions to improve the added value of tea production to improve the quality of the entire tea supply chain in Vietnam.
Guideline adherence and short-term clinical outcomes in elderly patients with acute coronary syndrome
To evaluate asymptomatic hyperuricemia and associated factors in male, we studied 798 male patients who visited Hanoi Medical University Hospital from January 2020 to May 2021.
A crosssectional descriptive study was applied.
Alcohol consumption, hypertension, overweight / obesity, dyslipidemia are risk factors for hyperuricemia (with p value < 0.05).
There was a positive correlation between uric acid level and total cholesterol, triglyceride concentration in blood (with p value < 0.05).
The state of asymptomatic hyperuricemia in men was elevated, especially in those with dyslipidemia, hypertension and alcohol consumption.
Anthropometric and bone turnover markers status of growth retardation children from 7 to 10 years old in 3 elementary schools in Tien Hai district, Thai Binh province
Nowadays, overweight and obesity are non-communicable diseases.
Overweight and obesity are related to a variety of diseases in the endocrine, cardiovascular, urinary, respiratory system.
While the implications of being overweight, obesity with diabetes, hypertension and other cardiovascular diseases have been paid much attention; the link between overweight, obesity and male hypogonadism, cancer has not been given adequate attention
Zebrafish - A modern animal model for medical research and drug discovery: The prominent advantages
Determine the prevalence of HPV-16/-18 infection on lung biopsy tissue samples in lung cancer patients and analyze clinical and subclinical characteristics in HPV-16/-18-positive LC patients.
Subjects and methods: Developing a multiplex realtime PCR method to detect HPV-16/-18 on clinical specimens.
This study was conducted on 273 lung cancer patients treated at the 108 Military Central Hospital from 7/2021 - 9/2022.
HPV-16/-18 DNA in lung cancer biopsy tissue samples was determined by our inhouse developed / optimized multiplex realtime PCR technique.
Results: The rate of HPV-16/-18 infection in lung cancer was 5.1%, of which HPV-16 accounted for 57.1% and HPV-18 accounted for 42.9%.
HPV-16/-18 infection in female patients positive for EGFR mutations had significantlyhigher than in male patients negative for EGFR mutations (p<0.05).
Needs for home care services among patients after stroke in Hue city, Vietnam
To identify the needs for home care services among patients after stroke in Hue city and explore the factors affecting them.
The health sector should have plan to provide professional care services and make them available to meet care needs of the patients.
A cross-sectional study was conducted in Hue city.
157 stroke patients who were discharged were directly interviewed based on the structured questionnaire.
The questionnaire included the patients' functional status, the care status and the need for care services at home.
A multivariate logistic regression model was applied to explore factors related to patients' needs.
Results showed that 81.5% of respondents said that they desired to receive care services at their home. Need for physical, mental and social care accounted for 84.1%; 79.6% and 82.2% respectively.
Status of daily living activities, chronic diseases and willingness to pay for home care of the patients were found to be significantly associated with their care needs (p<0.05).
Conclusion: Most patients after stroke have high need for home care.
Relationship between CD44, ALDH immune phenotypes and endoscopic and histopathologic features in gastric adenocarcinoma
Determining the rate of inappropriate drug use in elderly patients by the STOPP / START criteria at the Department of Cardiology and Geriatrics, Bac Lieu General Hospital.
Conclusions: The situation of prescribing appropriate drugs is high, but there are still shortcomings in prescribing drugs for elderly patients.
Materials and methods: A cross-sectional descriptive study with an analysis of 235 medical records at the Department of Cardiology and Geriatrics, Bac Lieu General Hospital.
Results: In 235 medical records, the patients's age was 73.60 ± 7.56, the duration of treatment at the Department was 7.29 ± 4.29, the number of diseases was 6.85 ± 2.20.
The most common group of diseases are diseases of the circulatory system.
Through applying the STOPP / START criteria, the percentage of patients had at least one PIP was 25.1%.
In which, the rate of patients had at least one PIM was 21.3%.
PIM criteria on the use of sedatives, first-generation H1-antihistamines, and benzodiazepines accounted for the highest percentage.
The proportion of patients with at least one PPO was 12.3% and potential prescribing omissions that using beta-blocker with ischaemic heart disease accounted for the highest proportion.
Analysis of the management of drug quality violations in Vietnam in 2019
Describe the current adherence to vitamin K antagonist treatment among patients with atrial fibrillation at Quang Ninh General Hospital and to identify factors related to treatment adherence.
Explain the compliance reminder and explain the disease and risk factors.
Conclusion: The fact of patient adherence to treatment is quite low at 38, 4%.
Some factors related to patient compliance are knowledge, ethnicity, the INR, as well as the instructions of the health care provider.
Therefore, it is advisable to increase counseling and guidance on compliance for patients, thereby improving knowledge and compliance practices of patients.
A cross-sectional descriptive study was conducted in 211 patients with atrial fibrillation who were prescribed vitamin K antagonists, at Cardiological Ward of Quang Ninh General Hospital from October 1, 2019 to March 31, 2020.
Results: The percentages of patients had knowledge of the atrial fibrillation and anticoagulant therapy at average and good levels were 44, 6% và 46, 4%, respectively.
The general status of adherence to treatment is 38, 4%.
In which, compliance with anticoagulant treatment is 72, 5%, adherence to diet is 51, 2% and compliance with alcohol restriction regime is 91, 5%.
Several factors are associated with anticoagulant treatment adherence: Ethnicity, INR group.
Knowledge of disease and treatment.
Guide the medication regimen, monitor complications.
Guide periodic medical regimen.
Exposure assessment of btex compounds among safeguards in underground parking garages in high buildings in Ha Noi
Multi - storey parking structures have potentially high concentrations of benzene (B), toluene (T), ethyl benzene (E) and xylene (X), as known BTEXs, which could have adverse effects on human health This study aims to estimate BTEX levels and sources and to assess the occupational health risk for safeguards in underground parking garages in high buildings in Hanoi.
27 samples were conducted using active diffusion monitors and analyzed by a GC / FID device.
Health risk assessment was conducted using chronic daily intake (CDI) and slope factor (SF).
The mean concentrations were 16.99 μg / m3, 200.36 μg / m3 and 625.22 μg / m3 for benzene, toluene and xylene, respectively.
Petroleum vapor and vehicle emission were two main sources to contribute to BTEX compounds.
Non - carcinogenic risks from toluene and xylene were low when values of hazard quotient (HQ) were lower than 1.
Number of socio-economic factors influence to the habit of taking care of your child's teeth students in Vinh Phuc province
Commenting on the clinical symptoms of patients with oral cavity cancer in National Hospital ofOdonto-Stomatology Hospital, Hanoi and National Military Hospital 108.
Subjects and methods: descriptive study of 61 patient records that are diagnosed with of oral cavity cancer from 2014 to 2020, recording information on age, gender, morphology, location and stage of the disease, clinical symptoms.
Squamous cell carcinoma accounts for 100%, of which mainly in stage II and stage III, accounting for 60, 65% and 26, 22%.
The common clinical symptoms are pain was seen in - 76.91%, increased salivation - 65, 6% and necrotic ulcer - 63, 9%.
Conclusions: Oral cavity cancer is a severe disease, often detected at an advanced stage.
The typical signs need to be paid attention and detected early so that the treatment is more convenient and effective.
EVALUATION OF THE SUCCESSFUL EFFECTIVENESS OF ABSTINENCE THERAPY IN PREGNANT WOMEN DIAGNOSED WITH GESTATIONAL DIABETES AT BINH CHANH DISTRICT HOSPITAL
To evaluate the treatment effect of follicular lymphoma with rituximabcontaining regimen at the Department of Hematology, Cho Ray Hospital from 2014 to 2021.
The low, medium, and high risk groups were 18.5%, 29.6% and 61.1%, respectively.
Mean hemoglobin was 126 ± 2.4 g / L, mean granulocyte count was 4.4 ± 0.2 G / L, mean platelet count was 257.8 ± 13.6 G / L, mean serum LDH concentration was 431.3 ± 31 U / L, mean β2 - microglobulin was 3240 ± 273.1 g/L.
All patients were treated with Rituximab-containing regimens consisting of RCHOP (72.2%), RB (18.5%), RCVP (3.7%) and Rituximab monotherapy (5.6%).
88.9% of patients maintained Rituximab.
The overall response rate was 98.2% (complete response (CR) 77.8%, partial response (PR) 20.4%).
Median follow-up was 38.5 months.
The mean survival time was 71.5 ± 4.3 months.
The 7-year overall survival rate was 73.3%.
The median 7-year progressionfree survival was 64 months.
The mean progression-free survival was 57.5 months.
Subjects and methods: Descriptive study of a series of CD20 (+) follicular lymphoma patients diagnosed and treated according to rituximab-containing regimens at the Department of Hematology - Cho Ray Hospital from January 2014 to July 2021.
The 24-month progression-free survival rate was 82%.
The 7-year progression-free survival rate was 44.9%.
Overall relapse rate was 20.4%, progression was 1.8%, transformation was 18.2%.
The mortality rate of the study was 18.5%.
Treatment-related side effects include grade 2 and 3 granulocytopenia, mild anemia, and rarely thrombocytopenia.
Elevated liver enzymes are common but mild.
Conclusion: The treatment of follicular lymphoma patients with rituximab-containing regimen achieved a high response rate.
Results: Through the study of 54 patients with follicular lymphoma, we initially recorded the following results: the mean age of the patient was 53.4 (from 26 to 83 years old).
Male / Female ratio: 1: 1.1.
Peripheral lymphadenopathy is the most common symptom (81.5%), most patients have symptom B (59.3%).
The disease manifests mainly in the lymph nodes (59.3% in the lymph nodes alone, 37% in the lymph nodes with extranodal involvement).
In which, abdominal lymph nodes are 90.7%, head and neck lymph nodes are 74.1%; Mediastinal lymph nodes are 50% and axillary lymph nodes are 50%.
bone marrow involvement 20.4%, and in other organs: orbit 7.4%, gastrointestinal tract 13%, lung and pleura 9.3%.
Stage III accounts for 40.7%, stage IV accounts for 31.5%.
Clinical and subclinical features of marginal zone lymphoma (MZL) at the national institute of hematology and blood transfusion
The objective of this study was to use the quantitative descriptive analysis (QDA) method to evaluate the organoleptic properties of white radish and cucumber fermented with a combination of water and salt in a rice bran medium.
Thirty (30) panellists were selected and trained to evaluate various attributes, including color, shape, texture, taste and overall acceptability of two fermented products.
Using the principal component analysis (PCA) method, the study identified two important principal components accounting for more than 80% of the variance, 88.75% and 81.40%, respectively, in the sensory attribute analysis data of pickled white radish and cucumbers.
The samples were mixed with the ratio of rice bran: water: salt as 49: 48: 3 (sample of pickled radish F3), 49: 48: 3 (sample of pickled cucumber M3) and 45: 52: 3 (sample of pickled cucumber M4) achieved the highest sensory value and were the most loved.
These findings demonstrated the utility of the quantitative descriptive analysis method in the identification and measurement of organoleptic properties of pickled white radish in rice bran bed
Treatment of Crohn’s disease in children with adalimumab after being infected with SARS-CoV-2 at Children’s Hospital No. 2: a case report
A qualitative study using in-depth interviews with staff working at National Hospital of Tropical Diseases (NHTD) and Ninh Binh Provincial General Hospital when the hospitals providing treatment services for COVID-19 patients in 2020 to explore the positive and negative impacts on healthcare workers during the COVID-19 pandemic.
Factors positively affected the healthcare workers were responsibility and ethics; professional issues; social relationship such as support from family, colleagues, patient cooperation and government policy and social support.
Factors negatively impacted were family having baby; nonprofessional staff and stigma.
It is necessary to further strengthen psychological and material support for employees and their family members to improve the quality of work and spiritual life of medical staff during the anti-epidemic period.
Application of one-trocar laparoscopy with laser excision of processus vaginalis in hernia repair for girls
Determining some factors affecting people's awareness of autism spectrum disorder in children in Vu Hoi and Viet Thuan communes, Vu Thu district, Thai Binh province in 2021.
Method: cross-sectional descriptive epidemiological study explores the factors that affected people's awareness of autism spectrum disorder symptoms in children in Vu Hoi commune and Viet Thuan commune.
Results: factors including education levels, income, and occupations effectively affect participants's awareness of autism spectrum disorder symptoms in children.
In contrast, gender and the information channel do not affect participants's awareness.
Hoffa’s disease: A case report
Primary liver cancer is a common cancer with a high mortality rate.
The HLA-DQ gene encodes polypeptide chains of MHC class II molecules involved in the activation of antigen-presenting cells in the immune response.
The single nucleotide polymorphism (SNP) rs2856718 of HLA-DQ gene may be associated with chronic hepatitis B virus infection and hepatocellular carcinoma (HCC).
This study was aimed to determine the distribution of SNP rs2856718, and to evaluate the association between this SNP and the risk of HCC.
RT-PCR technique was used to genotype SNP rs2856718 in 93 HCC patients and 93 healthy individuals.
The results determined that the rate of GG, AG, and AA genotypes was 39.8%, 46.2%, 14% for the HCC group and 30.1%, 53.8%, 16.1% for the control group, respectively.
No association was found between SNP rs2856718 with the risk of HCC and other risk factors.
Outcome assessment after surgical treatment of tuberculum sellae meningiomas by using supraorbital keyhole approach: 50 cases report
To describe some clinical and laboratory characteristics of patients with primary central nervous system diffuse large Bcell lymphoma and evaluation of treatment results after 3 courses high dose methotrexate and rituximab.
Subjects: 50 patients were treated at the National Institute of Hematology and Blood Transfusion from January 1st, 2020 to May 31st, 2022.
Methods: descriptive crosssectional study, retrospection and prospection.
Results: Focal neurologic deficit and headache were the most common symptoms (54% and 52%).
Tumor lesions were seen in many locations, in which the frontal lobe accounted for the highest (30%).
The percentage of patients positive with BCL2, BCL6, c-Myc by immunohistochemical staining was 84%, 86% and 30%, respectively.
Non-germinal center B cell like subtype accounted for 94%.
39/50 patients were treated with enough courses of Methotrexate 8g / m2 combination with Rituximab and the percentage of patients with complete response was 56.4%.
The overall response rate (CR+PR) of the BCL6-positive group was statistically significantly higher than that of the BCL6-negative group with p=0.01.
Antibiotic susceptibility and treatment results for pneumococcal pneumonia at the Thanh Hoa children's hospital period 2021- 2022
The chemical investigation of this extract, through chromatography method, led to the isolation of two flavonoids, their chemical structures were identified as apigenin 7-O-rutinoside (1) and isoquercitrin (2).
Prevalence of Neisseria gonorrhoeae, Chlamydia trachomatis and HPV infections detected by realtime PCR among women of reproductive age at Hanoi Obstetrics and Gynecology Hospital
Study clinical, subclinical features and to evaluate therapeutic efficacy of Secukinumab in patients with active Ankylosing Spondylitis (AS).
Conclusion: At week 16, Secukinumab has been effectively shown to improve clinical symptoms as well as subclinical symptoms in patients with AS.
It is also considered safe for use in these patients.
Patients and methods: Descriptive, comparative, retrospective and prospective study, combination with treatment intervention in patients diagnosis with AS, following to modified ACR-1984 criteria (New York criteria) who are inpatient or outpatient in the Department of General Internal Medicine - Endocrinology of Hue University of Medicine and Pharmacy and in the Department of Nephrology and Rheumatology of Hue Central Hospital from May 2018 to August 2019.
Results: The study recruited of 38 patients, (76.3% males) with mean age of 29.76 ± 9.75 years old. The age of onset was about 23 years old and the percentage of patients who were diagnosed AS under 30 years old was 73.7%.
The majority of patients were hospitalized with severe pain (92.1%), in which 86.8% of patients sufferred from spinal pain, 71.1% of patients showed peripheral joint pain, commonly seen in hip joints (44.7%).
Other common symptoms were lumbar Schober (about 3 cm), hand to ground distance (about 20 cm), median BASDAI score: 4.15 ± 1.01, median ASDAS-CRP: 3.81 ± 0.94, increasing CRP (81.58%), increasing erythrocyte sedimentation rate (81.6%), the percentage of HLA-B27 (+): 81.25% (for patients who have received this test).
For patients treated with Fraizeron, in general, there were changes in patient global assessment, nocturnal back pain, peripheral swelling, lumbar Schober, hand to ground distance, BASDAI, ASDAS-CRP, erythrocyte sedimentation rate, CRP.
These changes were positive with p < 0.05.
When we assessed the safety of Secukinumab, we did not record any clinical or subclinical undesirable effects.
Situation of reasonable antibiotic use in Thai Binh and Nam Dinh general hospitals in 2017
COPD is a chronic obstructive pulmonary disease, characterized by chronic inflammation of the airway mucosa leading to a gradual, irreversible decrease in pulmonary ventilation function values.
COPD is one of the top three causes of death worldwide, and 90% of deaths occur in low and middle income countries.
Patients with COPD are often managed and consistently account for a leading share of primary health care services in each country.
Exacerbations of the disease often occur and patients often need to be hospitalized for treatment.
However, many COPD patients are hospitalized because of pneumonia, not just an exacerbation.
The early differential diagnosis of these two conditions is extremely important because the problem of mortality is very different.
We report a case of pneumonia / COPD in a 65-year-old male patient who came to the National Lung Hospital for examination and treatment along with the diagnostic criteria to consult, discuss and propose methods with colleagues. appropriate diagnostic approach when encountering similar cases.
Determine the role of TREC quantitation in predicting the outcome of patients with allogeneic hematopoietic stem cell transplantation at a Blood transfusion hematology hospital
Describe the clinical characteristics clinical feature of depression in heart failure patients ".
Subjects and research methods: Using a cross - sectional descriptive method, analyzing clinical characteristics of depression by direct interviews with heart failure inpatients at the Viet|Nam Nationnal Heart Institute Bach Mai Hospital from August 2020 to July 2021.
Results: There were 60 patients with depression out of 128 heart failure patients, accounted 46, 87%.
Analyzing 60 patients with depression, we found that: Most characteristic of depressive symptoms is reduced energy leading to increased fatiguability (90%).
Among depressive common symptoms, disturbed sleep is the highest proportion (96, 7%), especially suicidal thought or behavior appears in 3, 3% of patients.
Evaluate result’s ureteroscopy lithotripsy by holmium laser at Viet Duc university hospital
To describe the phenotype and genotype of IOPD patientsat the National Children's Hospital (NCH).
Conclusion: The detection of common mutations, phenotypic characteristics in Vietnamese people, helps to plan for management and appropriate genetic counseling.
Objects and methods: Study on case series of 52 IOPD patients from 2014 at the NCH.
Results: 49/52 IOPD patients were classical type.
Average age of diagnosis 4.5 months (10 days - 24 months).
Male / female rate: 23/29.
5/51 families have a history of siblings with similar illness.
Phenotypic characteristics: muscle weakness, poor feeding, respiratory failure, heart failure, large tongue, slight increase in transaminase and CK, hypertrophic cardiomyopathy with LVMI of 183g / m2.
Genotype characteristics of GAA: 32/32 patients were identfied mutations.
Treatment adherence in tuberculosis patients at district health centers in can tho city in 2021
To evaluate the cephalometric dento-skeletal characteristics of deepbite patients.
Meterials and method: 60 deepbite patients was examinated and treated in National Hospital of Odonto Stomatology, analysis index in the cephalometric.
Initial results of neoadjuvant chemotherapy on epithelial ovarian cancer figo IIIC-IV at Hanoi medical university hospital
Non-adherence to treatment is a challenge and a major barrier to tuberculosis (TB) control globally.
Treatment adherence is the key and foundation of TB treatment, contributing to reduce the burden caused by TB and improve the quality of life for TB patients.
Objectives: To determine the proportion of treatment adherence and related factors in TB patients managed at district health centers, Can Tho city.
Materials and methods: A cross-sectional study was conducted with a sample of 300 TB patients managed at district health centers, Can Tho city.
Adherence to TB treatment was assessed using the General medication adherence scale (GMAS).
Results: The treatment adherence proportion was 91.0%.
Factors associated with treatment adherence with p-value under 0.05 such as: having a job (OR=13.0), friendly medical staff's caring attitude (OR=5.12), medical staff supervised drug using (OR=10.6) and side effects of anti-TB drugs were mild (OR=10.7).
Conclusions: Treatment adherence is closely related to support from health facilities receiving and treating TB patients.
It is necessary to have longitudinal studies combined with qualitative researches to assess the level of treatment adherence in depth and continuously.
The total lung capacity among workers exposed to silica dust in the workplace and related factors
This study assessed the results of using a local flap to cover defect after surgery for basal cell carcinoma in the cheek area.
We had a cross-sectional study of 28 patients (13 males and 15 females, aged from 26 to 87) who underwent reconstruction by a local flap to cover the cheek defect after resection of basal cell carcinoma; the study was conducted at the Head and Neck Surgery Department of Vietnam National Cancer Hospital between June 2018 and June 2021; results were assessed during hospital stay and 6 months after surgery.
The most affected site was infraorbital, with 57.1%.
These defects after resection varied from 1.5 × 1.5 cm to 5 × 8 cm which were covered by 15 rotation flaps, 7 transposition flaps and 6 advancement flaps.
After surgery, 100% of flaps survived completely, 9 cases caused contraction of surrounding organs.
Follow-up after 6 months with 20 patients showed good results in scarring, similarity in color, flap thickness, and the condition of contraction of surrounding organs is significantly improved.
The study showed that cheek defect reconstruction by using local flap after surgery for basal cell carcinoma achieved good results both in function and in asthetic.
The size, position, and type of flap used are the main factors affecting the surgical outcome.
The percutaneous biliary duct drainage in treatment of acute cholangitis due to gallbladder stones
Objectives: To describe clinical features of depressive disorders in patients with spinal cord injury.
Subjects and research methods: A cross-sectional descriptive study of 107 inpatients with spinal cord injury who were treated at Rehabilitation Center, Bach Mai Hospital and Minimally Invasive Spine Department, Central Acupuncture Hospital from August 2020 to August 2021.
Results: The study subjects sociademographic characteristics: men - 87.9%; average age - 43.25 ± 13.74; living in rural areas - 65.4%: lower than secondary education - 38, 3%.
Some main clinical features: 32.7% patients with depressive disorders, (18.7% mild level) according to ICD-10 criteria; the most common onset symptom was sadness, pessimistic thought (40%); all patients have depressed mood (100%); most commonly low self-esteem, self-confidence and pessimistic thought about the future with the same 94.3%.
Depression was often first triggered by sadness, pessimistic thought.
The most typical symptom was a depressed mood, the most common symptom was low self-esteem, self-confidence and pessimistic thought about the future.
Transpercutaneous closure of perimembranous ventricular septal defects by symmatric occluder
To assess the current situation of using hypertension drugs for outpatients at the examination department of Hau Nghia Regional General Hospital - Long An.
Study of Crosssectional description, retrospection, non-intervention on 180 patients who came to examine and treat hypertension at the examination Department, stored on the software of the Hau Nghia Regional General Hospital - Long An.
Among the drug groups used to treat hypertension, the group of drugs used the most was calcium channel blockers (58.25%), the lowest was diuretics with 3.88%.
The regimens used for patients, the number of regimens using one drug accounted for the largest proportion, accounting for 86.67%.
The regimen using 2 drugs accounted for 12.22% and the lowest was the combination regimen of 3 drugs with only 2 patients, accounting for 1.11%.
In monotherapy was preferred by the doctor over combination therapy, in which Amlodipine was the most prescribed drug.
The number of times of drug use per day of some drugs did not comply with recommendations and drug interactions accounted for a high proportion.
The treatment regimen of hypertension was mainly monotherapy with calcium blockers, the most common being Amlodipine.
However, the number of drugs used per day of some drugs did not comply with recommendations and drug interactions accounted for a high proportion.
Influencing of preoperative anxiety on postoperative recover among patients undergoing elective abdominal surgery in Thai Nguyen national hospital
Objective: This study was conducted to determine the influence of preoperative anxiety on postoperative recever among patients undergoing elective abdominal surgery in Thai Nguyen National Hospital.
Results and conclusion: The mean score of preoperative anxiety was 51.9 ± 7.7 in which patients had moderete level were (79.3%), low level were 7.3%, high level were 13.4%.
Mean score of pain scale was 5.6 ± 1.1 in which most of patients had moderate level of pain, patients had severe level of pain accounted for 30.5%, mean of length of hospital stay was 10.7 ± 1.8 days.
Preoperative aniety could explain 13.3% of variance of postoperative pain and 5.6% the variance of lenth of hospital stay
Construct the model of cost-effectiveness analysis of pembrolizumab versus standard therapy in the treatment of non- small cell lung cancer in Viet Nam
The mortality rate was 2.4% among the births.
Conclusion: The preliminary results have shown that vaginal progesterone combined with cervical cerclage may be effective for preventing preterm birth in singleton pregnant women having short cervix.
Objectives: To determine the rate of preterm birth before 37 weeks of gestation after using vaginal progesterone combined with cervical cerclage among singleton pregnant women who have a short cervix of ≤25 mm.
Results: The rate of preterm birth <37 weeks was 28.6% and between 28 - 36 weeks was 19.1%.
The mean birthweight was 2, 852.4g; the rate of very low birthweight (<1, 500g) and low birthweight (<2, 500g) were 11.9% and 14.3%, respectively.
The low apgar score of ≤3 was 2.4%.
Survey of women’s knowledge during childbearing age about congenitals in Dan Tien community in 2020
To describe the characteristics of hemostasis and coagulation by ROTEM of open-heart surgery patients and investigate the correlation between ROTEM test and hemorrhage in these patients.
Materials and method: A descriptive cross-sectional study of 68 open-heart surgery patients at department of Thoracic-Cardiovascular Surgery - Hue Central from March of 2020 to July of 2021.
Results: The mean age of the study group was 56, 20 ± 17, 95 and coronary heart disease accounted for the highest rate, accounting for 42, 6%.
Clinically significant and non-clinical hemorrhage were 22, 1% and 77, 9%, respectively.
Prolonged clotting time (CT) of INTEM, EXTEM and FIBTEM accounted for 25%, 16% and 48, 5%, respectively.
Indexes A5, A10 of INTEM, EXTEM, FIBTEM decreased by 17, 6%, 10, 3%, 13, 2%, 8, 8%, 2, 9%, 10, 3%, respectively.
Indexes of CT, alpha angle, A5 of INTEM, EXTEM and FIBTEM have statistically significant differences between the two hemorrhage groups with and without clinical significance (p ≤ 0, 05).
The A10 index of INTEM and FIBTEM had a statistically significant difference between the two groups (p < 0, 05), but the difference of EXTEM was not statistically significant (p > 0, 05).
INTEM CT, EXTEM CT and FIBTEM CT indexes had a positive correlation with postoperative hemorrhage (r > 0, p < 0, 05), in contrast to INTEM ANPHA, INTEM A5, INTEM A10, FIBTEM ANPHA, FIBTEM A5, FIBTEM A10 had negative correlation with postoperative hemorrhage (r < 0, p < 0, 05).
Efficacy and side effects of Bismuth quadruple therapy in the first-line and second-line treatment in patients with helicobacter pylori in Vietnam
To evaluate the sleep quality of nursing students at Dai Nam University and find out some related factors.
Subjects and methods: A cross-sectional descriptive study on 220 nursing students studying from the first to the fourth year at Dai Nam University.
Results: 44.5% of students have PSQI score ≤ 5.
Sleep quality is related to pressure of school results, family expectations, overtime participation, alertness and balance. at work (p < 0.05).
Conclusion: Students' sleep quality is not good, it is necessary to improve students' understanding of the importance of sleep and there needs to be a harmonious coordination between schools and families to minimize unnecessary pressure available for students.
Case series report: Pericardial effusion in post Covid-19 patients
A before-after controlled clinical trial was conducted on 200 new recruits from the Armored Tank Corps.
The intervention group of 100 recruits was trained to provide knowledge about occupational deafness, the harmful effects of noise on the auditory organs, and measures to prevent noise.
In addition, the recruits were also trained in the use of standard noise-canceling helmets of the Armored Tank Army.
The control group consisted of 100 recruits who did not participate in the training.
The results showed that, before intervention, 28% of recruits in the intervention group knew that occupational deafness could not be treated.
After the intervention, this number increased to 64%.
The intervention efficiency was 92.16%, higher than the control group with a statistically significant difference (p<0.05).
After training, on how to properly use ear caps to prevent noise, the effectiveness in the intervention group was 17.24% with p<0.05.
Comparision between drug - eluting stents and bare metal stents for stenting the ductus arteriosus in infants with ductal dependent pulmonary circulation
To describe of clinical features, imaging finding and evaluate the results of intracranial aneurysm microsurgical treatment by clipping.
Prospective described study of 41 cases of cranial aneurysm indicated to surgical treatment at Neurosurgery Department - Hue central hospital from March - 2017 to June - 2019.
Checked DSA after surgery, 96.9% of aneurysm was completely removed.
The proportion of ruptured intracranial aneurysm is very low, but the outcome is often bad.
Nowadays, there are many method treatment for intracranial aneurism, but microsurgical treatment still remains its important roles and is improvement for better outcome.
Intestinal pseudo-obstruction in systemic lupus erythematous: A rare complication
Describing some clinical characteristics and assessing on the treatment outcomes of first-line chemotherapy with Paclitaxel - Carboplatin in patients with stage IV non-small cell lung cancer (NSCLC).
Post-treatment serum CEA was 7, 95 ± 6, 22 ng / mL and significantly lower than pre-treatment serum CEA was 14, 73 ± with p 0, 013 < 0.05.
Median progression-free survival (PFS) was 6, 0 months (5, 7 - 6, 3), median overall survival (OS) was 11, 1 months (8, 6 - 13, 5).
Most toxicity is at low level and controllable.
Conclusions: First-line chemotherapy with Paclitaxel - Carboplatin regimen in the treatment of patients with stage IV NSCLC improves functional symtoms, disease response and control rate, PFS and OS with acceptable toxicity.
Study subjects: 42 patients with stage IV NSCLC received first-line chemotherapy with Paclitaxel - Carboplatin at Oncology Center - Military Hospital 103 and Cancer Department - National Lung Hospital from January 2018 to December 2021.
Methods: A retrospective combined with prospective descriptive study, cross sectional and interventional study without concurrent control.
Results: The average age of patients enrolled in this study was 58, 7 ± 9, 1.
Adenocarcinoma was accounting for 69%.
Most patients were at stage IVA, accounting for 74%.
The functional response rate was 68, 5%.
The overall response rate was 33.4% and the disease control rate was 69%.
Situation of soil transmitted helminth infection in pupils at two primary school in Ha Tinh city, in 2021
Cesarean scar pregnancy is a rare type of ectopic pregnancy, often causing serious complications if not diagnosed early and treated promptly.
The average amount of blood loss was 84.85mL.
The mean time taken to reach negative serum βhCG levels after treatment was 4.42 weeks.
Conclusion: Using ultrasound-guided Foley balloon catheter placement combined with dilation and curettage has a high success rate with a short hospitalization period and a short post-procedure follow-up time compared to other old combined cesarean section treatments.
The increasing rate of cesarean section, cesarean scar pregnancy is considered a new issue that deserves attention today as an undesirable consequence after cesarean section with a geographical location far from central hospitals, Kien Giang General Hospital always tries to access treatment methods to improve treatment efficiency for people in the province.
Objective on clinical and preclinical characteristics of caesarean scar pregnancy at Kien Giang General Hospital.
Demonstrate the efficacy of management for caesarean scar pregnancy treatment by using ultrasound-guided Foley balloon catheter placement combined with dilation and curettage (D and C) at Kien Giang General Hospital.
Materials and methods: This is a cross-sectional descriptive study of 33 patients with cesarean scar pregnancy up to 8 weeks' gestation were treated at Obstetrics and Gynecology Department in Kien Giang General Hospital.
Results: Most of the Caesarean scar pregnancy patients in the study had successful treatment results, accounting for 93.9%.
Results of treatment of preterm neonate respiratory distress by nasal continuous positve airway pressure at thai nguyen national hospital
To investigate amikacin dosage regimens, amikacin therapeutic drug monitoring (TDM) and adverse drug events.
Furosemide and iodinated contrast were found to be factors significantly associated with nephrotoxicity in patients treated with amikacin.
Methods: A cross-sectional retrospective study was conducted between May 2019 and May 2020 at ICU University Medical Center Hochiminh City (UMC HCMC).
Data was collected from patients' medical profiles.
Results: Seventy-four patients were included into the study. The median Charlson comorbidity index was 2.0 (1.0 - 3.0).
Fifty-nine patients received once-daily dosing (ODD) with the mean loading dose of 16.5 ± 3.4 mg / kg.
Among 51 patients administered TDM, the median peak concentration in the ODD group was 46.5 (40.0 - 54.3) mcg / mL versus 32.2 (30.6 - 40.2) mcg / mL in the multiple-daily dosing (MDD) group.
Twenty-one (28.4%) patients developed amikacin-associated nephrotoxicity; concomitant use of iodinated contrast or furosemide was associated with the risk of nephrotoxicity.
Conclusion: Results from the study revealed the benefits of once-daily amikacin dosing regimen and applying TDM amikacin at ICU UMC HCMC.
The analgesic effect of unilateral ultrasound-guided erector spinae plane block (ESPB) for minimally invasive cardiac surgery
To determine changes of mothers' practice about nutritional care for children 6 - 24 months old with acute respiratory infections at Nam Dinh Children's Hospital after health education intervention.
Subjects and research methods: Study subjects include 75 mothers with children 6 - 24 months old with ARIs at Nam Dinh Children's Hospital, quasi experimental study design.
Results: The mean score of practice before the intervention was 5.8 ± 2.1 and after the intervention increased to 8.3 ± 1.9, the difference was statistically significant with p < 0.05, t = 3.2.
Research has shown that the effectiveness of health education interventions has significantly improved maternal nutrition care practices, so that children with acute respiratory infections have better nutritional care.
Conclusion: After the intervention with health education, nutrition care practice of mothers with children 6 - 24 months has increased, the level of practice has increased from 57.3% before the intervention to 80% after the intervention.
Assessment of in vitro necrotic effects and DNA fragmentation of extracts of Wedelia chinensis (Osbeck) Merr. on human peripheral blood mononuclear cells
This study is to identify and measure the impacts of human resource management on employee engagement at Hoan My Minh Hai General Hospital.
This study's data sets were collected from 238 employees working for the hospital, then analyzed by using the Cronbach's alpha, Exploratory Factor Analysis (EFA) and multivariate linear regression analysis.
This study's results show that there are 5 factors affecting the employee engagement including (1) I raining and development, (2) Salaries and benefits, (3) Leadership, (4) Evaluation and monitor of job performance, and (5) Recruitment.
In which, the Training and development factor has the strongest impact on the employee engagement.
Nutritional status of children ages 7-10 years old in some elementary school in Tien Hai district, Thai Binh province
This study identifies A10398G alteration of mitochondrial ND3 gene in plasma exosome of 29 non-small cell lung cancer (NSCLC) patients, 31 controls and 13 pairs of tumor tissue and adjacent tissue of NSCLC patients, thereby assessing the relationship between this alteration in plasma exosome and tissue as well as the pathological characteristics of NSCLC patients.
Using the PCR-RFLP method, the homoplasmy and heteroplasmy of A10398G were initially identified in mitochondrial DNA from both exosomes and lung tissues.
The rate of variant 10398G in plasma exosome was 62.1% in the NSCLC group and 61.3% in the control group.
However, there was no statistically significant difference in A10398G between the patient and control groups.
The alteration of A10398G in plasma exosome and in tissue correlated with each other (correlation coefficient 0.69; p = 0.009).
However, this alteration was not related to age, gender, smoking, alcohol drinks status, tumor size, histological stage and TNM stage.
Surgical costs in Vietnam: A multi-center cross sectional study
Center for Research and Production of Vaccines and Biologicals conducted this study aims to evaluate the stability of rotavin vaccine new formulation produced in Vietnam the Rotavin vaccine new formulation was added with Hydrolyzed gelatin as stabilizer to maintain the stability of vaccine in storage condition at 2 - 8oC, for introducing Rotavin vaccine with conveniently storage and distribution the vaccine in the National Expanded Immunization Program.
The PFU method was used to determine the titer of the Rotavin vaccine new formulation stored under accelerated temperature at 37 °C, 25 °C and realtime storage temperature at 2 - 8 °C at different time points from date of manufacture. The results showed that Rotavin vaccine having stable titer for 7 days at 37oC, for 45 days at 25oC and for 24 months at 2 - 8oC.
Study on status of hypertension and result of anti hypertensive treatment in patients with cerebral infarction at Can Tho general hospital central (2017- 2018)
On studying about high blood pressure status, it is proven that the rate of high blood pressure increase on patients who are diagnosed with cerebral infarction is considerably high.
Conclusions: the rate of high blood pressure increase on patients who were diagnosed with cerebral infarction was high (90.7%).
As a result, there should be a solution on controlling blood pressure and preventing seizure relapse.
More importantly, to those who have uncontrolled high blood pressure, the probability of undergoing stroke is even higher.
Objectives: to evaluate the rate and level of high blood pressure increase on cerebral infarction patients, to evaluate the results of controlling high blood pressure increase on cerebral infarction patients.
Subjects and methods: cross-sectional studying on 118 patients at Can Tho GHC from 2017 to 2018.
During the first period, the level of increase took up 51.4% while that of the second period was 48.6%.
The rate of patients to whom the treatment took effect after one week reached 100%.
Open heart surgery using the vertical right axillary mini-thoracotomy for treatment of large ventricular septal defect at Hanoi national children’s hospital
Conclusions: Initial results of left atrial myxoma rejection, using minimally invasive total or video-assisted technique wassafe and effectivewith low complications, could be recommended to apply routinely in cardiac surgery centers
Asymptomatic form was in 3 patients (9.7%), hemodynamic symptoms were in 26 patients (83.9%), embolism symptoms were presented in 4 patients (12.9%), systemic symptoms (25.8.
Anemia and elevated erythrocyte sedimentation rates were observed in 45.2% and 74.2%, respectively.
Echocardiography results: the average tumor size was 4, 8 ± 1, 8 cm (from 1.7 to 8 cm), the site of attachment was mainly in the atrial septum (77.4%).
Cardiopulmonary bypass time was 158 ± 43 minutes (from 100 to 252 minutes), cross-clamp time was 84 ± 34 minutes (from 42 to 153 minutes).
Ventilation time was 10, 8 ± 7, 0 hours (from 3 to 30 hours), intensive care unit stay was 1, 5 ± 1, 0 days (from 0.5 to 4 days), and in-hospital stay was 9.5 ± 5.0 days (from 3 to 30 days).
There was no hospital mortality. Cerebrovascular accident was presented in one (3.2%), femoral artery stenosis was in one (3.2%), atrial fibrillation after surgery was in one (3.2%). There was no bleeding, that require reoperation, and no other serious complications.
Assessing the fetal medicine foundation prediction model of gestational diabetes mellitus in pregnancy at University medical center
More than 50 million people worldwide suffered from epilepsy, however, approximately 30% are drug resistant.
The incidence of adverse events was 44.8%, with mild severity, and no patient discontinued the ketogenic diet.
The rate of children suffering from acute malnutrition is 13.8% (initial) and 0% (after 3 months).
The ketogenic diet (KD) has been firmly shown to be effective on some epilepsy syndromes, especially drug-resistant epilepsy syndromes in children.
KD is still a new and challenged treatment in Vietnam.
This is a descriptive prospective study of 31 pediatric patients with drugresistant epilepsy, treated with a ketogenic diet at Children's Hospital 2, Ho Chi Minh City from September, 2019 to July, 2020.
The patients were supplemented with vitamins, minerals and corrected the side effects.
The feasibility was 93.5% (29/31).
Tolerance rates were 75.86% (1 month), 65.52% (2 months) and 62.07% (3 months).
37.9% of patients had decreased seizures by 50% after 3 months of ketogenic diet.
The ureteroscopic lithotripsy with holmium yag laser for ureteral stones: experience in treatment from 2012 to 2021 at can tho university of medicine and pharmacy hospital
To determine some related factors of common cardiovascular diseases in elderly people in Bac Me district, Ha Giang province in 2021.
There was no association between body mass index (BMI), waist circumference / hip ratio (WHR), Triglycerides index, HDL-c index, diabetes and CVDs in the elderly.
Conclusion: The risk of some common cardiovascular diseases increases with age.
The results of this study suggest that: Age, smoking, Hypercholesterolemia, and high LDL-c are risk factors of some common cardiovascular diseases in the elderly.
Subjects and methods: A Cross-sectional study on 700 elderly people in Bac Me district.
Subjects were screened and tested (electrocardiogram, echocardiogram, serum biochemical tests) to diagnose some common cardiovascular diseases and collected information about related factors.
Results: The risk of cardiovascular diseases (CVDs) in groups of subjects using alcohol regularly was 2.1 times higher than that in the non-drinking groups.
Subjects with dyslipidemia had a 1.5 times higher risk of CVDs than the other group.
Multivariable logistic regression analysis showed that 4 factors were statistically significant with cardiovascular diseases, including age, smoking, Cholesterol-total index, and LDL-c index. When the Cholesterol-total index and LDL-c index increased by 1 unit (1 mmol / L), the risk of cardiovascular disease increased by 4.8 and 5.3 times, respectively.
In addition, for every 5 years of age increase, the risk of CVDs increases by 5.4 times.
Subjects with smoking had a 19.5 times higher risk of CVDs than the non-smoking group.
Adherence to antiretroviral therapy of outpatient hiv / aids patients in Muong La district general hospital, Son La province in 2019 and some factors associated
Ureteral stone is a common disease, the traditional treatment methods such as open surgery, laparoscopy, extracorporeal shockwave lithotripsy have revealed many weaknesses in the treatment result. Currently, the advantages of ureteroscopic lithotripsy with laser energy sources are much more than other methods.
Conclusion: Laser lithotripsy for ureteral stone was really safe and high efficiency.
Objectives: To evaluate the results of treatment.
Materials and methods: This was a retrospective study was conducted on 821 patients with ureteral stones were treated by Holmium YAG Laser ureteroscopic lithotripsy at Can Tho University of Medicine and Pharmacy Hospital from September 2012 to September 2021.
Results: There were 821 patients which had 465 male (56.64%), 356 female (43.36%); the mean age was 46.1 ± 10.9 years old.
The largest number of stones was 4.
There was no severe complication.
Results of radical cystectomy followed by the ileal orthotopic bladder substitution with Abol-Enein’s technique at 108 Military Central Hospital
Nowadays, mobile medicine, digital medicine, medical information technology or telehealth are being focused to improve the quality of medical services and meet the increasing healthcare needs of community.
Telehealth is a new health care trend in the world which is integrated with information technology.
This health service may include diagnosis, treatment, medication delivery, counseling, inquiry, emergency management or disease prevention that can be overcome the challenges of geographical distance.
Telehealth stands out with advantages such as fast, convenient, easy access and low cost.
In particular, when the world in general and Vietnam in particular are still facing the dangers of the Covid-19 pandemic, the application of remote medicine in diagnosis, treatment and health care not only help the treatment be maintained smoothly, promptly and quality, but also support to ensure epidemic safety.
However, in reality, some medical facilities still have many difficulties in applying telehealth for doctors and patients, facilities and equipment requirements are still a huge obstacle.
Evaluation of the quality of life of patients after total cystectomy, bladder reconstruction using intestinal for bladder cancer treatment
Colorectal polyp is a common disease and has risks of malignancy.
Combining the two methods did not increase the sensitivity by 91.7%, but increased the specificity in diagnosis by 78%.
Conclusion: The JNET, Judo classification has the ability to help predict the histopathological results of colorectal polyps.
White light endoscopy can help to detect polyps, but it is still limited in accurately predicting polyp histopathology.
Advanced endoscopic techniques have been developed to help observe in more detail the mucosal surface, submucosal vascular structure, thereby accurately predicting polyp histopathology results, supporting accurate treatment.
Objectives: To compare the JNET classification on narrow band endoscopy (NBI) and the Kudo classification on endoscopic staining with indigocarmin with histopathological results in colorectal polyps.
Methods: descriptive study evaluating diagnostic tests.
Results: Among 2000 patients undergoing colonoscopy to screen polyp and colorectal cancer in Gastroenterology and Hepatology Center, Bạch Mai hospital, the study obtained 339 patients with a total of 490 polyp which were removed by endoscopic therapy or surgery from 1/2021 to 4/2022.
Of 490 polyps, there were 408 neoplastic polyps (386 adenomatous polyps and 22 cancerous polyps).
MODELLED COST-EFFECTIVENESS ANALYSIS OF AS-NEEDED BUDESONIDE/FORMOTEROL IN PATIENTS WITH MILD ASTHMA IN VIETNAM
Objectivies: To determine risk factors for death in patients with COVID-19 admitted to the ICU of Duc Giang Gernaral hospital, in 2022.
Methods: the design of this study was a retrospective descriptive method on 91 critically ill patients with COVID-19.
Results: of the 91 patients admited to ICU, 81, 3% died and 18, 7% survival.
The factors associated with the risk of in-hospital death were age ≥65 years, vacinated, comorbities of hypertension and patients admited in critcal state (p<0, 05).
Cox regression analysis was found that risk factors affected to in-hospital death was comorbities of hypertension (HR=1, 93, 95% CI 1, 05 - 3, 55) and patients admited in critcal state (HR=1, 84, 95% CI 1, 13 - 2, 99).
Conclusions: The main risk factors of in-hospital death was comorbities of hypertension and patients admited in critcal state in ICU
Recognition of stroke-related knowledge among patient's families: The reality and the improvement after health education
The objective of the study was to evaluate the initial outcomes of submental island flap in oral cavity defects reconstruction.
Results showed that the mean age was 62.1 ± 12; Male / Female ratio was 1/1.
In a total of 12 patients, there were 6 floor of the mouth cancer patients; 5 tongue cancer patients, and 1 lower gingiva cancer patient.
The mean operative time was 175 ± 27 minutes and mean duration of hospital stay was 13.3 ± 4.4 days.
Flap survival was 11 and partial necrosis occurred in 1 patient.
The postoperative speech and swallowing function were at good and intermediate level.
Prevalence and risk factors of otitis media with effusion in kindergarten age range in Quoc Tuan commune, An Duong district, Hai Phong
To describe some clinical epidemiology characteristics and some causes of acute urticaria in children admitted to Hai Phong Children hospital in 2020 - 2021.
Through question, 47.5% of patients had undefined causes, infectious causes were the most common (41.9%), followed by food (6.5%), weather (1.4%).
There is no relationship between the allergen-specific IgE test results and the patients' causes when questioned.
Children in the suburbs are more hospitalized than in the inner city.
The disease occurs year-round with common symptoms of rash, itching, fever and abdominal pain.
Most of the patients did not know the causes of acute urticaria when questioned.
Acute urticaria is often accompanied by infection.
Test Allergy Panel 60 most common allergens are dust mites, house dust mites, cockroaches, silkworm pupa, shrimp, cow's milk allergens, egg whites, tomatoes less commonly.
Subjects: 217 patients diagnosed with acute urticaria at Haiphong children's hospital during the study period from October 1st, 2020 to September 30th, 2021.Methods: Cross-sectional study.
Results: The average age of the patients is 5.73±3.51 years, ages under 6 accounts for the majority.
Acute urticaria patients are hospitalized all year round, but more often in the months of July to November.
Children whose parents have allergies are 7 times more likely to develop urticaria than others.
Common symptoms are wheals (100%), itchy (98.6%), fever (40.1%), abdominal pain (19.4%).
Patients had eosinophilia (2.3%), 47% of patients increased serum IgE.
Total laparoscopic pancreaticoduodenectomy: the first case report at bach mai hospital and literature review on indications and results
Evaluating the effectiveness and side effects of Tolvaptan in the patients with severe acute euvolemic and hypervolemic hyponatremia.
The main dose of Tolvaptan was 7.5mg and 11.25mg (accounting for 45.5% and 36.4%), 13.6% used the 15mg dose and only 4.5% used the 18.75mg dose.
Average urine flow (ml / h) of Tolvaptan group at the time of 03h; 06h; 12h and 24h was: 205.00 ± 61.00; 225.45 ± 52.44; 195.91 ± 48.17 and 167.27 ± 41.19, respectively.
The average increase in serum sodium (mmol / L) of Tolvaptan group at the time of 03h; 06h; 12h and 24h was respectively 2.32 ± 0.78; 4.50 ± 0.67; 8.18 ± 1.44 and 13.68 ± 1.62.
Results: The classic treatment group required many managements, including maximum water restriction, average amount of NaCl 0.9% perfusion (500ml bottle) was 6.60 ± 1.5; medians of 3% NaCl perfusion (100ml bottle) and Furosemide (20mg ampoule) were 6.00 (5.00 - 7.00) and 1.00 (0.00 - 2.00) respectively, while the Tolvaptan group needed neither water restriction nor 3% NaCl nor Furosemide.
The average amount of NaCl 0.9% (500ml bottle) used in the Tolvaptan group was 2.45 ± 1.34 less than in the classic group (6.60 ± 1.5), p < 0.001.
The length (hour) of treatment to achieve the serum sodium target in both groups was greater than the expected duration: the median in the classical treatment group was 36.00 (24.00 - 46.00) compared with 22.00 (18.50 - 33.50), p = 0.001; The median treatment duration in the Tolvaptan group was 24.00 (23.50 - 35.00) vs 22.00 (20.00 - 35.00), p = 0.016.
The real treatment duration of the Tolvaptan group was lower than that of the classic treatment group (p = 0.027).
The median time needed to improve the symptoms of vomiting and fatigue was 03 h and 12 h in the Tolvaptan group, lower than in the classic treatment group (06 h and 22 h), p = 0.002 and 0.001, respectively.
As regards the side effects of treatment: Edema and hypokalemia were only seen in the classical treatment group with the rate of 20% and 55%, in contrast, Tolvaptan group did not develop the edema or hypokalemia, whereas 81.8% of patients of this group had polyuria, (p = 0.003 and p < 0.001). During the study, there were no patients with hypernatremia that exceeded the threshold evoking the risk of demyelination.
Current of injury predicts early outcome of threshold in implanting permanent cardiac pacemaker
Most adults in the community have been infected with Cytomegalovirus (CMV), most are asymptomatic and the virus will remain latent for life.
There have been convincing medical evidence that CMV is an important pathogen in immunocompromised subjects.
However, recent studies have shown that re-infection or reactivation of CMV in critical illness patients without immunosuppression is common and is associated with increased mortality and morbidity.
The most common lesions are interstitial pneumonia and hepatitis.
The diagnosis should be based on a comprehensive assessment of the patient's disease history such as identifying risk factors (severe sepsis, prolonged hospital stay, repeated blood transfusion), liver damage, lung (interstitial lung diseases), reducing blood counts that cannot be explained by other causes.
The CMV PCR test in the blood as well as in the tracheal lavage fluid helps to confirm the diagnosis, but there is no clear threshold to make treatment decisions.
Gancilovir is the main and effective treatment for this group of patients.
Comments on impaired glucose tolerance test results in patients at risk of type 2 diabetes mellitus at Thai Binh Medical University Hospital
Lactic acidosis is an accumulation of too much lactic acid in the blood, a common metabolic acidosis, especially in severe cases, when lactic acidosis is a complication of main disease.
In clinical practice, people are divided into 2 types: Lactic acidosis type A is often caused by lack of oxygen in the tissue, type B is caused by the combination with other diseases.
Lactic acidosis typically occurs due to glucose metabolism in the absence of tissue oxygenation or by the liver's inability to remove lactic acid.
Severe acidosis can reduce the contractile force of the heart, increase pulmonary vascular resistance, increase myocardial sensitivity to arrhythmia, increase blood potassium, inhibit metabolism in cells or at molecular level.
Mortality is high, from 40 - 60% of cases.
Results of application STR in monitoring of chimerism for allogeneic hematopoietic stem cell transplantation patients at the National institute of hematology and blood transfusion from 2018 to 6/2022
The osmotic demyelination syndrome (ODS) has been recognized as a complication of the rapid correction of hyponatremia.
The pathophysiology of ODS consists loss of myelin due to osmotic stress.
It has a high mortality and usually need aggressive supportive management in the intensive care unit.
We report a case of ODS due to overcorrection of severe hyponatremia with pathognomonic clinical and radiologic signs making a nearly complete neurological recovery.
Conclusion: Osmoic demyelination syndrome is a complication of overcorrection of severe hyponatremia.
Treatment options for ODS are limited to case report however a combination of immunoglobulin, steroid and plasma exchange was administered not only during the early stage of illness but also helped to improve the neurological outcome.
Relationship between plasma c-reactive protein concentration with carotid arteriosclerosis and plasma glucose control in type 2 diabetic mellitus patients
To compare the outcomes of thyroid surgery with and without drainage at Viet Nam National Cancer Hospital from 2019 to 2021.
Materials and method: A cross-sectional descriptive study on patients undergoing thyroid surgery with and without drainage at Viet Nam National Cancer Hospital from 1/2019 to 8/2021.
Evaluation includes pain level after surgery, hospital length stays, and monitoring postoperative complications.
Results: 204 patients who underwent thyroid surgery were divided into two groups (102 patients with drainage and 102 patients without drainage) with similar clinical characteristics and surgical methods.
There was no significant difference in postoperative complications (fluid collection, hematoma, bleeding, hypoparathyroidism, hoarseness, pain level after surgery, hospital stay) between the two groups.
The mean length of hospital stays was statistically significantly shorter in the group without drainage (4.9±0.86 days vs 5.64±1.03 days, p<0.001).
Not using drainage also significantly improved the level of satisfaction after surgery (p=0.008).
Conclusions: Thyroid surgery without drainage has reduced hospital stay and increased patient satisfaction while ensuring monitoring outcomes and postoperative complications.
Thoracoscopy surgery to assist in nuss rocedure for pectus excavatum
To describe the status of knowledge and practice on food safety of street food processors and traders in Tan Thinh ward, Thai Nguyen city in 2021.
Subjects and research methods: The study was conducted by descriptive method with a cross-sectional design on all street food processors and traders in Tan Thinh ward, Thai Nguyen city.
Collect information using pre-designed interview questions.
Using the checklist to observe the practice of the research subjects.
Research results: Among the additives mentioned, only 27.7% of the research subjects said that borax was not allowed to be used in food processing; 51.5% said it was a colorant; 55.0% answered formol; 20.3% answered other substances (nitrite, nitrate, oestradiol,...).
Some food safety practice of the study subjects accounted for a low percentage: Clean hands before processing 62.4%, ice stored separately 64.4%, food stored in glass cabinets 69.8%, waste was stored in trash cans with lids 61.9%.
The research subjects had good knowledge and practice about food safety account for a high rate (85, 6% and 83, 7%).
Besides, some research subjects had bad knowledge and bad practice (14, 4% and 16, 3%).
External root resorption of the second molar associated with mesially impacted mandibular third molar from Conbeam computed tomography
To determine people's awareness, psyche, and behavior in preventing the Covid-19 epidemic using medical services at Thu Duc District Hospital from March to April 2020.
Methods: Form a descriptive cross-sectional study with a sample size including 437 people who: ame for medical examination and treatment at Thu Duc District Hospital from March to April 2020.
The questionnaire developed by the research team was sent to the people via the Google Form application on mobile devices, the responses were recorded, processed, and analyzed on STATA software version 13.0.
Results: 63.8% of people were concerned about the disease since the first cases were reported; 89.2% think the epidemic is very serious.
The rate of general optimism about epidemic prevention and control is 64.3%, some content is not very optimistic: only 53.3% think that the current health system can manage when the epidemic spreads. 49.0% believe that the government will regulate the food problem well when the disease spreads.
The majority of people well followed regulations on social distancing, the overall well behavior rate on Covid-19 prevention is 91.8%.
Conclusion: People have high confidence in epidemic prevention and control ability but are less optimistic about the health system and controlling social factors of the disease spreads widely.
The treatment outcome of one trocar laparoscopic appendectomy for acute appendicitis in can tho general hospital
Describe Glycomark (1.5AG) concentrations in patients with type 2 diabetes at Viettiep hospital (9/2021).
Conclusion: 1, 5AG is a potentially supportive test in monitoring and treating patient with type 2 diabetes.
Research on the role of Glycomark compared with Glucose and HbA1C in monitoring and treatment of patients with type 2 diabetes.
Subjects and methods: 134 patients with type 2 diabetes who were treated at Viettiep hospital (9/2021), cross sectional description.
Results: the average of 1, 5 AG concentration was 7.0 ± 5.9 (μg / mL).
56 patients with good and acceptable glucose blood control (n=25), by FBG, 83.9%; 28.0% had 1.5AG<10μg / mL, respectively.
53 patients with low glucose blood control by FBG, 46.3% had 1.5 AG≥ 10μg / mL.
51 patients with good and acceptable glucose blood control (n=25), by HbA1c, 11.8%; 13.7% had 1.5AG<10μg / mL, respectively.
54 patients with low glucose blood control by HbA1c, 63.0% had 1.5 AG≥10μg / mL.
AUCHbA1c = 0, 988; AUC1, 5-AG = 0, 932; AUCGlucose =0, 875, p < 0, 01.
School violence of students at Tra Vinh city high school, Tra Vinh province in 2019
Patent processus vaginalis is a common condition in children.
Treatment using laparoscopic percutaneous closure processus vaginalis with Dormia basket support has many advantages and reduces costs compared to using specialized needles.
This study assessed the safety and effectiveness of laparoscopic percutaneous closure processus vaginalis with Dormia basket support among 50 children who were operated with this procedure.
The average age of the children was 6.5 ± 7.7 years old.
The average surgery time was 30.2 ± 15.6 minutes, with 23.2 ± 13.7 minutes in one-side cases and 31.7 ± 14.8 minutes in two-side cases.
After the surgery, the patient could sit up and move in bed after 5.7 ± 1.0 hours and walk slowly around the room after 13.1 ± 1.9 hour. The average hospital stays were 26.4 ± 12.8 hours.
We followed up with the patients after 3 and 6 months of surgery, and all cases achieved good results.
The Reminiscence Therapy Library supports people with dementia
Type 2 diabetes mellitus is a healthcare burden globally.
Genetic factor plays an important role in pathophysiology of type 2 diabetes, however, few studies were conducted to assess genetic markers in Vietnamese diabetic population.
In this study, we evaluated the association between ADIPOQ rs266729 and type 2 diabetes in Vietnamese population.
Methods: This is a case-control study.
Seven hundreds and sixty-eight subjects including type 2 diabetic patients and controls were recruited and genotyped for ADIPOQ rs266729 by real-time PCR.
Results: ADIPOQ rs266729 was significantly associated with type 2 diabetes in Vietnamese population by different statistical models.
The risk to develop type 2 diabetes in rs266729 carriers was 1.27 - 2.30 time higher compared to controls.
Conclusion: ADIPOQ rs266729 is strongly associated with type 2 diabetes mellitus in Vietnamese population.
Research on fluorosis concentration in drinking water resources in Vietnam 2019
To investigate microalbuminuria and related factors in patients with type 2 diabetes at Hanoi Medical University Hospital in 2021.
Research methods: Cross-sectional description, Convenience sampling collected 134 research group subjects Results: Of the 134 patients participating in the study, 87 patients accounted for 64.9% of the test for Mircoalbuminuria (+).
There was no association between sex and Mircoalbuminuria.
The rate of positive Mircoalbuminuria increased gradually over time of disease detection, the results were statistically significant p < 0.01.
For patients with an increase in BP and B / M index, there is a higher risk of mircoalbuminuria than the normal group. Patients with hypertension have a higher risk of mircoalbuminuria than the normal group.
Blood glucose levels and HbA1C increase the risk of Mircoalbuminuria (+) in patients with type 2 diabetes.
Conclusion: Time to disease detection, increased waist circumference, increased blood pressure, decreased HDL-C index and poor blood sugar control are risk factors for the occurrence of microalbuminuria in patients with type 2 diabetes.
Effect of endoscopic submucosal dissection on treatment high-grade dysplasia and early gastric cancer
To evaluate the results of appendicitis endoscopic surgical treatment in pregnant women at Thai Binh Provincial General Hospital.
Retrospective describe of 35 pregnant women diagnosed with appendicitis treated using laparoscopic surgery.
100% of patients underwent laparoscopic appendectomy.
Average surgery time 50, 7 ± 13, 6 minutes (30 - 70 minutes).
Surgery time was longer in the group of appendicitis (56, 7 ± 8 (40 - 70) minutes) compared with appendicitis without peritonitis (p < 0, 05).
There were 3 cases of hospital transfer due to fever, threat of miscarriage, threat of preterm birth.
Results of treatment 91, 4% of the results were good; 8, 6% of the average results, no case of death of the pregnant woman, no death of the fetus.
Abdomen endoscopic surgical treatment can be used to treat appendicitis in pregnant women with low rate of complications for both the women and fetus.
Evaluation of antifungal treatment results in patients with fungal Pneumonia at the National hospital for tropical diseases
Results: Evaluation of response after 4 cycles of VCD (Velcade - Cyclophosphamide - Dexamethasone) by MFC recorded before ASCT, the proportion of patients with MRDnegative accounted for 42, 9%.
However, after ASCT, the number of patients with MRDnegative increased to 85, 7%.
Meanwhile, the rate of patients achieving VGPR after 4 cycles of VCD is 21, 4% and after ASCT this rate changes into 50%.
In addition, MFC also applied few prognostic markers as CD27, CD28, CD81, CD117.
Conclusion: Evaluation of MRD in MM patients after ASCT with MFC showed that MRD in patients with transplant was better than without transplant.
Besides, MFC also provides markers with prognostic role in newly diagnosed MM to help guide the treatment process.
To evaluate the effectiveness of pain relief after shoulder joint surgery interscalene brachial plexus block
Evaluation of the relationship between NBI endoscopic images and histology of colorectal polyps.
Subjects and methods: Colorectal polyps were detected by colonoscopy with NBI using olympus CV 170 flexible colonoscope.
Polyps are resected and / or biopsied for pathological tissue through endoscopy, comparing the NBI endoscopic images with the histopathological results of the polyp.
Results: In 77 patients, polyps with large size, rough surface or segmented, the rate of adenoma is higher.
The prevalence of dysplasia in pedunculated and sessile polyps was similar.
The larger the polyp size, the higher the degree of severe dysplasia. The sensitivity of NBI endoscopy in the diagnosis of adenomatous polyps is 93.6%, the specificity is 85%.
Conclusion: Colonoscopy with NBI shows high sensitivity and specificity in classifying and predicting histopathological colorectal polyps.
Clinical features of acute hypertensive basal ganglia intracerebral hemorrhage
Describe the clinical, subclinical, and clinical features of plasma replacement therapy in the combination treatment of triglyceride-induced pancreatitis (TG).
Complications: 7.1% filter obstruction, 7.1% catheter obstruction, 14.3% allergies. Cure rate: 92.9%; mortality 7.1%.
Conclusion: Plasma exchanged is a complete and effective treatment of conjunctivitis due to TG increase; should be widely and routinely deployed in the hospital.
Subjects and methods: 14 patients diagnosed with pancreatitis with TG value> 11.3 mml / L, plasma exchange treatment combined with routine treatment of acute pancreatitis at the Intensive care and Control poisioning department from February 2018 to February 2021.
Descriptive research.
Results: Men: 78.6%, women: 21.4%; average age 62 ± 17; history: 64.3% drink alcohol, 57.1% have dyslipidemia, 42.9% diabetes mellitus.
Time of admission; 100% abdominal pain on the navel, 85.7% nausea, vomiting; 100% bloating, 71.4% urinary retention, defecation; 64.3% of back pain point.
Average Amylase index: 642 ± 347 UI / L, TG: 35.7 ± 13.2 mmol / L; Cholesterol: 13.7 ± 4.2 mmol/L.
CT abdomen: 14.3% Baltaza E; 50% of Baltaza D; 35.7% Baltaza C Results, plasma replacement: 71.4% instead of 01 time; 21.4% replaced 02 times; 7.2% changed 03 times.
Alternative solution: 85.7% is fresh plasma and 14.3% is 5% albumin.
The concentration of TG after the first filtration: decreased from 35.7 to 7.8; after 2nd time: 2.4 mmol / L.
Some risk factors related to febrile seizures in children from 3 months to 5 years old at thai nguyen national hospital
Study on 18FDG-PET / CT imaging characteristics of lesions in stomach cancer before treatment.
The mean SUVmax tumor value of patient group M1 was 14.97±8.12 higher than that of patient group M0 was 10.69±8.2, p>0.05.
Methods: Retrospective study, descriptive analysis on 36 stomach cancer patients undergoing PET / CT before treatment at Military Hospital 103 from March 2021 to August 2022.
Results: 36 patients with stomach cancer from March 2021 to August 2022.
The mean tumor thickness was 16.5±7.69, the mean SUVmax of the tumor with a thickness of over 15 mm was higher than that of a tumor with a thickness of less than 15 mm, p<0.05.
The average SUVmax tumor of bowel type was higher than that of diffuse type, p<0.05.
There was no statistically significant difference in SUVmax value by stage T After 8FDG PET / CT, stage N0 accounted for 47.22%, stage N1 accounted for 11.11%, stage N2 accounted for 13.89%, stage N3 accounted for 27.78%.
There was no statistically significant difference in SUVmax by stage N The highest SUVmax of metastatic lesions was 10.96±4.45 on average.
The liver is the most common site of distant metastasis with the rate of 13.89%.
There were 2 patients with distant metastases in 2 organs (5.56%).
The clinical and X-ray characteristics and result of osteosynthesis surgery of mandibular angle fractures at Viet Duc university hospital
A method using solid phase extraction (SPE) and high performance liquid chromatography with diode array detector (HPLC-DAD) has been optimized for the simultaneous determination of notoginsenoside R1 and three ginsenosides Rg1, Re, Rb1 in solid, oil, and liquid dietary supplements.
The substances were separated by an InertSustain C18 column (250 mm × 4.6 mm i. d.; particle size 5 µm) with a gradient program composed of acetonitrile and water.
Linearities were in the range of 4.0 - 400 µg / mL with the coefficients of determination were more than 0.999.
The limits of detection and limits of quantitation were 2.13 - 6.89 µg / g and 7.11 - 22.98 µg / g, respectively.
The recovery values of the compounds were in the range of 87.2 - 103.5%.
The precision study showed the intra-day relative standard deviation (RSD) of 1.41 - 2.91%, and inter-day RSD of 1.87 - 4.85%, which meet the AOAC International requirements.
The method was applied to determine the content of notoginsenoside R1, ginsenoside Rg1, ginsenoside Re, and ginsenoside Rb1 in 20 dietary supplement samples containing Ginseng and Pseudoginseng.
Clinical symptoms, radiological features and results of surgery for brain lymphoma in Viet Duc hospital
To evaluate the effectiveness of screening for HBV, HCV, and HIV viruses of blood units by nucleic acid test (NAT) of blood units in voluntary blood donors at Tay Nguyen Regional General Hospital Subjects: The study sample size included 17.200 blood samples from volunteers at Tay Nguyen Regional General Hospital from January 2021 to December 2021.
Case report of papillary fibroelastoma at the heart institute of Ho Chi Minh city
The study aimed to assess the nutritional status of the officers under the management of the Thai Binh Provincial Standing Committee.
Evaluate nutritional status by body mass index BMI, WHR, Blood test indicators: Serum Albumin, Cholesterol, Triglycerides, LDL-cholesterol, HDL-cholesterol.
Results: The results showed that the prevalence of overall CED was 0.6%.
The prevalence of overall overweight was 14.4%, The prevalence of overweight in women (7.3%) was lower than that of men (15.8%).
The percentage of officials at risk of being overweight based on the WHR index was 43.1%, of which female was 44.5% higher than male was 42.8%.
Health classified as B1 had the highest rate of 88.9%, type A was 7.1%, type B2 was 3.2%, type C was 0.8%.
Correlation between high-sensitivity c-reactive proteins levels (hs-CRP) and some biochemical test index in type 2 diabetes patients
The objective of the study was to describe the antibiotic resistance situation of hospital-acquired strains of Escherichia coli, Staphylococcus aureus isolated from patients admitted to the Intensive Care Unit of Thanh Nhan Hospital - Ha in 2016.
In this study, the patient samples had cultured, performed the antibiogram and then carried out a cross-sectional description.
Rerults shown that 25 strains of Staphylococcus aureus (accounting for 7.5%) and 38 strains of Escherichia coli (accounting for 11.48%) were isolated from 1434 cultured hospital infection samples.
Staphylococcus aureus had a rate of resistance to carbapenem group of 62.5%, ampicilline of 95% and were still fully sensitive to vancomycine.
Escherichia coli had a resistance rate to cephalosporins group from 45.5% to 60.5%, carbapenems such as meropenem, imipenem, ertapenem had a low resistance rate of less than 9.1%.
Survey of health insurance cost at Tay Nguyen university hospital period in 2017 – 2021
Total 53 patients medulloblastoma surgery in Viet Duc hospital with histopathological results, from 9/2016 to 9/2019.
blood transfusion Intraoperative ranges from 250ml to 1050ml.
There were no complications after surgery 69.86%, other complications were 3 - 9%.
GOS score after surgery at grade 1 and 2 accounted was 83%, grade 3 accounted was 9.46%, grade 4 accounted was 7.54%.
Medulloblastoma is a grade 4 brain tumor according to WHO.
Tumor size > 30 mm, almost in cerebella vermis.
GOS results after surgery at grade 1, 2 accounted was 83%, grade 3 was 9.46% and grade 4 was 7.54%.
Age from 02 - 43, mean age 13.66±11.52.
Male / Female ratio = 1.52/1.
Headache occurred in 83%.
MRi, 17% in the cerebellar hemisphere, 83% in cerebella vermis.
Tumor size 30 - 50 mm was 81.13%.
The mean preoperative Karnofsky score was 85.68±12.21.
Soft density tumors 81.14%, rich in vessels 83%.
Gross Total Rececion (GTR) 73.6%, Near Total Resection (NTR) 24.52%.
Livespo ® navax: a new generation probiotic that supports the treatment and prevention of acute respiratory infections caused by viral infections
Describe the current status of knowledge about the prevention of brain stroke of elderly people with type II diabetes at Central Endocrinology Hospital.
Method: A cross-sectional study conducted from November 2019 - June 2020 on 248 elderly patients with diabetes at the National Hospital of Endocrinology in 2020.
Results: The ratio of right-brain knowledge is the organ lesion of brain stroke was 89, 1%.
The percentage of study subjects with good knowledge of signs of stroke is relatively good: sudden and intense headache is 76, 2%; Suddenly weak on one side of the person is 99, 6%; Suddenly difficult to say is 98, 8%; only 25, 4% of the correct answers to the sudden onset of dementia were signs of a brain stroke.
Knowledge of the subject's right actions when encountering a suspected case of brain stroke is good, namely: 96% of the correct answers must avoid falling for patients when a brain stroke occurs; 96, 4% said that stroke patients should be taken to hospital as soon as possible; only 0, 4% of the respondents responded to the stroke at home.
Research some factors related to the severity of bronchiolitis patients at the Thai Binh pediatric hospital in 2020
The aim of the study was to determine rheoencephalography parameters and some relative factors of abnormal rheoencephalography in patients with hypertension.
Materials and methods: A cross-sectional study was carried out in 50 hypertensive patients and 50 healthy ones.
Results: The results showed that the crest obtuse wave was 72% and the crest auxiliary wave was 84%.
In hypertensive patients, the rates of patients who had decreased cerebral blood flow in their arteries were 50%, 48%, and 38%, respectively. The rates of patients who had decreased cerebral blood pressure in their arteries were 54%, 58%, and 58%, respectively.
The decreased cerebral blood flow rate in patients who are over 60 years old with dyslipidemia is higher than in the others.
Patients with grade III hypertension have a higher decrease in cerebral blood flow intensity and the increased cerebral blood pressure rate compared with grade I hypertension. Conclusions: The decreased cerebral blood flow and the increased cerebral blood pressure in hypertensive patients are higher than that in normal people.
Trust and Groups of applications - Important factors affecting the mobile healthcare application usage behavior in Vietnam
Classifies groups of PNH patients based on clinical and biological characteristics as well as surveying the distribution of PNH populations across disease groups.
Subjects and Methods: Case series, retrospective study on 125 patients, diagnosed PNH based on FLAER population deficiency through flow cytometry, examined and treated at Ho Chi Minh City Blood Transfusion and Hematology Hospital Minh during the period from November 2016 to the end of December 2020.
The study used WHO standards for classification of PNH disease groups and built a data table on clinical and subclinical characteristics of each PNH disease group.
We recorded that the median Hb index of the patients in our study was 7, 3 g / Dl, the median platelet count was 48 x109/L, the median granulocyte count was 2, 5 x109/L.
42% of patients have decreased Haptoglobin; increased bilirubin and increased LDH occurred in 20, 6% and 20% of patients, respectively.
Considering the percentage of FLAER-deficient cell population, we found that the average percentage of PNH population on Neutrophils and Mono cells accounted for the highest proportion in the classical PNH group, followed by the group with bone marrow lesions and the end.
Relationship between tumor grade according to WHO classification 2016 and some other pathologic features of clear cell renal cell carcinoma
This study aims to analyze the endoscopic and pathological characteristics of colorectal laterally spreading tumors (LSTs) to assist malignant risk stratification.
Method: A total of 42 patients were enrolled with colorectal laterally spreading tumors from 11/2018 to 8/2021 in Bachmai hospital.
Results: LSTs with mean diameters were 38.2 ± 18.4 cm.
KUDO clasification rate of LSTs type IIIL, IV were 66.7% and 42.9, respectively.
Patients with tumor diameter ≥ 40 mm accounted for 38.1%.
Adenoma was the main histological type in patients with tumors of all diameters, accounting for 69%, malignancy lesion was 31%.
Conclusion: LST malignancy was found to be correlated with lesion diameter, location, and morphological appearance
Investigate the inhibition of S.mutans, Lactobacillus spp. causing tooth decay from terminalia catappa L.
Describe the patient's motor status and determine the movementrelated factors of the patient after lower limb surgery at the Department of Orthopedic Trauma - Burns, The general Hospital in Nam Đinh in 2020.
Method: Research subjects include 149 patients after lower limb combined surgery at the Department of Orthopedic Trauma-Burns, in the general Hospital in Nam Dinh.
Results: Most patients start to move on the 2nd day after surgery.
On the 3rd day after surgery, 79.2% of the patients had satisfactory exercise practice and when discharged from the hospital, the number of patients with satisfactory exercise was 92.6%.
Initial research shows that the level of mobility of patients after surgery is quite high, but still 8.4% of patients have not met the requirements.
Conclusion: When the patientsl are discharged from the hospital, the majority of patients have satisfactory movements and better than the 3rd day after surgery.
Surgical methods, the patient's pain correlated with the patient's movement after surgery.
Research the clinical, paraclinical features and treatment results of green pit viper bites in military hospital 121 in 2020-2021
To study clinical characteristics and some factors related to cognitive impairment in patients with Paranoid schizophrenia at Hai Phong Psychiatric Hospital in 2021.
Subjects: 41 paranoid schizophrenic patients with symptoms of cognitive impairment treated at Hai Phong Psychiatric Hospital from January 2021 to September 2021.
Research Methods: Cross-sectional descriptive method.
Conclusion: Reduced attention retention: 75.6%.
Short-term memory impairment: 63.4%.
Disorientation disorder: 80.5%.
Language disorders account for: 60.9%.
Partial decline in executive function: 34.1%, total decline in executive function: 19.5%.
There is no gender difference in patients with paranoid schizophrenia with cognitive impairment.
The current status safety of procedure about pregnancy surgery of medical staffs at Quynh Phu general hospital in 2019
To investigate results and predictive factors when treating with mechanical thrombectomy for patients suffering from acute ischemic stroke due to atherosclerosis-related large vessel occlusion.
Subjects and methods: A descriptive, longitudinal follow-up study of 64 patients with acute anterior and posterior circulation ischemic stroke were treated by mechanical thrombectomy at Nghe An Friendship General Hospital from January 2020 to December 2021.
Results: The mean duration of endovascular procedure was 60.3 minutes; good reperfusion rate was 84.4%; favorable functional outcome (mRS 0 - 2) after 3 months was 56.3%; mortality rate after 3 months was 14.4% in the general group, but was 46, 7% in the posterior circulation sub-group; rate of symptomatic intracranial hemorrhage was 7.8%, 24-hour post-onset NIHSS more than 8 was the independent predictor of outcomes after 3 months.
Conclusion: The mechanical thrombectomy had high rates of reperfusion and favorable functional outcome but required rescue therapies, it also had a low percentage of symptomatic intracranial hemorrhage, but mortality rate was high in the basilar artery occlusion sub-group.
Effective treatment of advanced - stage non small lung cell cancer with egfr mutations: a clinical case and overview of treatment
To describe clinical characteristics of patients with multiple sclerosis, treated at the neurology department, Bach Mai hospital from 1/2018 - 7/2020.
Methods: A retrospective study was performed on 71 patients with multiple sclerosis.
Results: There were 54 female patients with multiple sclerosis, female / male ratio ≈ 3: 1.
The average age of the disease was 41.9 ± 13.6 years old, usually under 40 years old.
Common symptoms are optic nerve damage, motor paralysis due to spinal cord injury alone, and sensory disturbances.
The majority (81.69%) of patients recovered after the first episode, lasting from 1 to 6 months.
Neuromyelitis optica - NMOwas seen with the highest rate (39.44% of the patients).
Conclusion: Patients with multiple sclerosis have diverse clinical symptoms, mainly lesions causing motor paralysis and sensory disturbances.
Despite the high rate of recovery after the first episode, the patient's quality of life is severely affected by multi-phenotypic, multi-site lesions.
Status of antibiotic use in the treatment of multi-resistant gram-negative infections at Hanoi medical university hospital
In this study, the ethanol extracts of three medicinal plants are tested for α-glucosidase inhibitory activity.
The degree of α-glucosidase inhibitory activity is determined by measuring the absorbance spectrophotometrically at 405 nm in order to reduce the formation of para-nitrophenol.
Medicinal plants including Artocarpus altilis (Park.)
(G celosioides) are selected based on traditional medicine.
The results show that the P guajava has a strong ability to inhibit α-glucosidase with an IC50 value of up to 1.98 µg / mL, compared to acarbose of 1.57 µg/mL.
In addition, P guajava and G celosioides show the best potential for xanthine oxidase inhibitory and antioxidant activity, compared to the others, which promises to be applied in the treatment of gout.
The role of minimally invasive lateral thoracotomy in lobectomy with lymph node dissection treatment of non-small cell lung cancer
Multi-antibiotic resistance is an urgent problem for the global health sector.
Mechanical ventilation, ICU admission, and appropriate antibiotic treatment are factors related to treatment outcome (p<0.05).
Conclusion: Antibiotics used in the treatment of multidrug-resistant gram-negative infections are mostly consistent with reference guidelines.
Objective: Characterization of antibiotic use in the treatment of multi-resistant Gram-negative infections.
Materials and methods: A cross-sectional descriptive design, recording the laboratory characteristics of 237 patients in the Department of Emergency Medicine and Endocrinology-Respiratory Medicine of Hanoi Medical University Hospital from January 2021 to December 2021.
Results: The mean age of the patients was 73.2 ± 15.8 years old.
The average number of hospital days for all patients was 18.3 ± 12.4 days.
More than 60% of patients received a combination of 2 antibiotics both before and after the antibiogram.
The concordance with the antibiogram before the antibiogram was 25.0%, and after the antibiogram was 61.6%.
Among the patients taking antibiotics, 62.5% had to change after having the antibiogram, and 35.4% did not have to change.
Prevalence of hyperuricemia and relationships with serum uric acid at hanoi medical university hospital
To investigate the clinical, paraclinical features and establish prognostic factors for mechanical ventilation in pediatric Guillain - Barré syndrome.
Conclusion: The clinical and paraclinical features of pediatric Guillain - Barré syndrome in Children Hospital 2 were like other studies in children and adult.
There were no independent prognostic factors for mechanical ventilation in pediatric Guillain-Barré syndrome.
Methods: We retrospectively collected the clinical, paraclinical data of 112 patients aged < 16 years who were diagnosed Guillain - Barré syndrome and treated at Neurology Department of Children Hospital 2 between 2017 and 2021.
Results: Among 112 children with Guillain - Barré syndrome, 59% (n = 65) were male, the median age was 67, 5 months (interquartile range 33, 141), usually starting in the summer and fall months.
46% (n = 52) of patients had antecedent infection or vaccination.
The most common symptom was lower limb weakness (96%, n = 108), upper limb weakness (82%, n = 92), followed by pain, sensory disturbance (67%, n = 76).
Around one-tenth of patients required mechanical ventilation, no deaths have been recorded.
46% (n = 52) of patients had improved GBS Disability Score before discharge.
Pain, sensory disturbance (81% vs 58%, p<0, 05) and albuminocytological dissociation (90% vs 58%, p<0, 05) was significantly higher in demyelinating GBS patients compared to axonal GBS patients.
There were no statistically significant independent prognostic factors for mechanical ventilation in pediatric Guillain-Barré syndrome.
Clinical and angiographic characteristics of patients with atherosclerotic iliac artery lesions
Prebiotics are a group that improves the human intestinal microbiota.
The relationship between prebiotics and human health has been an area of increasing interest in recent years.
Fructo-oligosaccharides and galacto-oligosaccharides are the two important groups of prebiotics with beneficial effects on human health.
Besides that, more and more carbohydrates have shown a good potential to be prebiotics has been studied.
This study presents a review of the characteristics, properties, and analytical methods used for the determination of prebiotics in food products.
Most of the methods found using chromatographic methods, especially HPAEC - PAD but also another method, such as spectrometric methods have been presented.
A discussion was presented highlighting the drawbacks of current analytical methods and the need to develop these methods to analyze the complex food samples containing prebiotics.
The efficacy of amnioinfusion in management of oligohydramnios at Hai Phong Hospital of Obstetrics and Gynecology
Real-time, convex probe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is used to reveal etiologies of enlarged mediastinal / hilar lymphadenopathy, lesions.
The study evaluated the diagnostic efficacy and safety of EBUS-TBNA when used as an initial diagnostic tool.
We restrospective 75 patients between September 2017 and July 2021.
Results: In the 72 cases with adequate results, the diagnostic accuracy of EBUS-BNA was calculated 69%; the diagnostics specific, the sensitive, the positive predictive value, the negative predictive value was 62%, 100%, 38.9%, and 100%.
There was no reported complication.
Conclusions: EBUS-TBNA is safe and efficacy procedure, so EBUS - TBNA should be used as an initial diagnostic tool for the assessment of mediastinal and hilar lymph nodes, lesions.
Study on the Production of Reference Material of Heavy Metals (As, Cd, Pb, Hg) in Water
Investigating the frequency and risk factors of 30-day in-hospital mortality in acute exacerbation COPD patients.
At the end of this study, 8 deaths were recorded, accounting for 7.6%.
Factors associated with mortality after multivariable regression analysis included impaired consciousness OR 64.88, p=0.013, neutrophil count OR 1.14, p=0.008 and atelectasis on chest X-ray with OR 94.42, p=0.005.
Conclusion: The mortality rate of COPD exacerbations hospitalized in 30 days was still high.
In which, a number of factors were related to death including: impaired consciousness, neutrophil count and atelectasis on chest X-ray.
Methods: Prospective Cohort Results: From October 2020 to May 2021, we recorded 106 patients hospitalized for COPD exacerbations with an average age of 68.5±8.2 years.
The male: female ratio was 14: 1.
The characteristics of medical history recorded that 31.1% of patients were still smoking, mMRC score ≥ 2 accounted for 74.5%.
45.3% of patients had malnutrition and a history of hospitalization because of acute exacerbation in the past year accounted for 70.7%.
The distribution of study population according to GOLD A, B, C, D was 7.5%, 21.7%, 6.6%, 64.2%.
In terms of spirometry, the average FEV1 was 41.6 ± 21.6%, of which the degree of severe obstruction 45.3%, very severe 21.7%.
The clinical features recorded at the emergency room were 9.4% of patients with impaired consciousness, average pulse 112.9 ± 9.5 times / min, mean systolic blood pressure was 140.3 ± 32, 9 mmHg, average respiratory rate was 23.4 ± 6.2 breaths / minute, SpO2 was 89.6 ± 9.6%.
Laboratory characteristics were WBC 13.2 ± 7.5 K / uL, Neutrophil 9.7 ± 7.0 K / uL, pH 7.36 ± 0.13, PaCO2 48.1 ± 20.4 mmHg, acidosis respiration 25.5%.
Evaluating the therapeutic effect of “Bach phu thang” on patients with benign prostatic hyperplasia
The study was conducted to evaluate the results of the treatment of pregnant women with COVID-19 at Duc Giang General Hospital.
The rate of newborn babies infected with COVID-19 is low among pregnant women infected with COVID-19.
Subjects and research methods: All pregnant patients diagnosed with COVID-19 were treated at Duc Giang General Hospital from September 2021 to March 2022 Results: Patients were hospitalized mainly in the third trimester of pregnancy, in which 37 weeks' gestation accounted for 73.4%, the most common symptom when pregnant women had COVID-19 was fever 51.9%; cough 43.5%; runny nose 22.7%, women are hospitalized mainly in the third trimester of pregnancy, in which gestational age from 37 - 41weeks accounts for 73.4%.
The majority of pregnant women with the disease were mild and asymptomatic, accounting for 80.4%, and severe and critical cases accounted for 10.2%.
The rate of vaccination against COVID-19 in pregnant women is 46.9%, in the group of patients with severe and critical disease 92.3% of patients have not been vaccinated.
The rate of caesarean section increased when pregnant women with COVID-19 had to be hospitalized 55.55% compared to normal delivery 19.45%, of which cesarean sections for reasons directly related to COVID-19 accounted for 22.5%.
ICU admission rate is 7.03%, maternal mortality rate due to COVID-19 is low, accounting for 0.8%.
Conclusion: This study shows that vaccination of pregnant women with COVID-19 vaccine reduces severe morbidity and mortality, and increases the rate of cesarean section and premature delivery.
The rate of completing the first hour resuscitation bundle and outcomes in pediatric septic shock
Method: A total of 42 patients were enrolled with colorectal laterally spreading tumors to perform ESD from 11/2018 to 8/2021 in Bachmai hospital.
Results: At our institution, 42 consecutive superficial colorectal tumors larger than 20 mm in diameter in 42 patients were treated by ESD.
The rate of complete resection with tumor-free lateral and vertical margins was 83.3%. The rate of perforation was 0%.
Conclusion: Colorectal ESD achieved a high rate of en bloc resection and complete resection and is applicable in the colorectum.
Morphological and functional changes of the right ventricle by echocardiography in patients with systemic lupus erythematosus, scleroderma associated with pulmonary hypertension
To identify peripheral neuropathy in oxaliplatin-based adjuvant chemotherapy patients.
Subject and method: Retrospective study on 151 gastric and colon cancer patients treated with 6-month adjuvant chemotherapy regimens with XELOX, mFOLFOX6 at the Department of General Oncology - 108 Military Central Hospital.
Result: The most common acute peripheral neuropathy was numbness of extremities when experiencing cold (64.4% in XELOX regimen and 65.4% in mFOLFOX6 regimen), numbness at the infusion site was more common in XELOX regimen (38.4% vs 15.4%; p=0.001); jaw pain was more common in XELOX regimen (20.5% vs 3.8%; p=0.002).
Chronic peripheral neuropathy with numbness of the extremities increasing gradually with the cumulative dose of oxaliplatin (from 3.8% after cycle 1 to 74.4% after 12 cycles of mFOLFOX6 and from 2.7% after cycle 1 to 71, 2% after 8 cycles of XELOX) but mainly at grade 1, 2 and gradually decreased after stopping treatment (73.1% lasted for 24 months with XELOX regimen and 94.8% with mFOLFOX6 regimen).
Conclusion: Peripheral neuropathy due to oxaliplatin includes acute cold-related injury, occurs during and immediately after infusion; and chronic toxicity increases gradually with cumulative dose but mainly grade 1, 2 and decreases after stopping treatment.
Results of open shinbone fractures treatment with using external fixed frame at Viet Duc hospital
Cost-effectiveness analyses of interventions in the treatment for asthma have been performed in many countries around the world, including omalizumab.
Systematic review and meta - analysis of the current state of the literature on the cost-effectiveness of omalizumab in the treatment for asthma has been conducted according to PRISMA guidelines based on database sources Pubmed, Cochrane and Embase with appropriate selection and exclusion criteria and assess quality of studies according to CHEERS.
The systematic review and meta-analysis were performed through the ICER / QALY index converted to US Dollars (USD) 2020 based on the consumer price index (CPI).
With 212 studies found based on search keywords, after screening according to selection and exclusion criteria, 06 studies were included in the meta - analysis.
According to the CHEERS checklist, the quality of the studies ranging from 17 to 22 points with 60% good quality studies.
This systematic review noted a relatively large variation in ICER / QALY between studies, ranging from $11, 769/QALY to $897, 559/QALY.
In patients with uncontrolled severe persistent allergic asthma, particularly with corticosteroids, add-on therapy with omalizumab may be considered cost-effective when compared with standard therapy.
The results of meta - analysis showed that ICER / QALY of add-on therapy with omalizumab compared with standard therapy resulted in $59.052/QALY (95% confidence interval: $34, 457 - $83, 648/QALY; p < 0.01).
The add-on therapy with omalizumab may be considered cost-effective when compared with standard therapy in severe asthma
Assessment of perioperative glucose control and postoperative complications in patients at general surgery department of Cantho general hospital
The aim of the study was to evaluate nutritional status among students aged 11 - 14 in Tu Son town, Bac Ninh province using the body fat percentage index.
There should be activities to educate about healthy eating habits and physical activity for students to maintain a suitable weight for height and improve health.
A cross-sectional study was conducted on 430 students at two junior high schools in Tu Son town.
The percentage of body fat was evaluated using body composition monitor Omron HBF375.
The average of body fat percentage among boys was 19.41%; girls was 21.33% (P < 0.001).
From the percentile threshold of body fat percentage built in this study, we determined the nutritional status for children in Tu Son town.
Accordingly, the rate of students with a normal nutritional status was 78.61%, the rate of overweight - obesity was 15.81%.
Thus, the rate of overweight - obesity among students in Tu Son town was relatively high.
The rate and characteristics of pulmonary congestion evaluated by lung ultrasound in heart failure patients
The results showed that the average satisfaction point for the working environment was 3.35/5 (5 point scale), accounting for 67%; The average overall satisfaction score with direct leaders and colleagues is 3.71 (on a 5-point scale), accounting for 74.2%; The average point of overall satisfaction with internal regulations, salary and benefits is 3.48 (5 point scale), accounting for 69.6%.
The average overall satisfaction with job, learning opportunities and advancement is 3.55 (5 point scale), accounting for 71%.
Some factors that affect job satisfaction with nursing include: Job placement, health policy, psychological atmosphere, office culture. The study recommends that the hospital managers need to pay attention and treat nurses equally, generate completely self-funded sources to pay nurses compensation and benefits in alignment with their dedication and efforts, and assign jobs suitable to the position of each nurse.
Nursing team needs to practice well the code of conduct, maintain and promote good discipline, discipline, responsibility and cultural lifestyle in the workplace, always dedicated, loving and caring.
Association of IL36RN and CARD14 mutations with some clinical manifestations in patients with pustular psoriasis in Vietnam
Assessment characteristics clinical and computed tomography images in spontaneous supratentorial intracerebral hematoma. Method: From May 2017 to May 2022, a retropective study of 35 patients diagnosed with spontaneous supratentorial intracerebral hematoma (SSIH) by computed tomography (CT) at 108 Military Central Hospital.
The most common sites of SSIH are in the thalamus (60%), basal ganglia (34.3%), the rest are lobes.
The average volume of SSIH was 67.44 ± 24.32ml.
The degree of midline deviation was mainly grade II (71.4%), the rest was grade III (28.6%).
The degree of cerebral edema is mainly grade I (80%), the rest is grade II (20%).
Results: The study was conducted on 35 patients with SSIH, the mean age of the study group was 58.46 ± 9.97, male (82.9%), female (17.1%).
The main history was hypertension (83.3%), alcoholism (8.3%), use of platelet inhibitors (8.3%) and cirrhosis (2.8%).
The rate of patients admitted before 6 hours was 31.4%.
The majority of patients were hospitalized within 6 - 72 hours (65.7%).
Clinical symptoms often had a sudden onset (97.1%).
The most common clinical symptoms were neurologic paralysis (47.9%), cranial nerve palsy (28.8%), and headache (17.8%), vomiting had a low rate (5.5%).
The mean Glasgow Coma Sclae (GCS) admission was 9.8 ± 1.75 points (8 - 14 points).
The majority of patients admitted to the hospital in a comatose state with GCS scores from 9 to 12 (60%).
The prognostic value of urinary L-FABP in septic patients with acute kidney injury
To evaluate pain relief effects of physical therapy on patients with herniated disc at grade 1 and 2.
Subject and method: Descriptive study, longitudinal follow-up of 65 patients diagnosed with lumbar spinal disc hernia at grade 1 and grade 2, treated at Department of Physiotherapy, 103 Central Hospital of Lao People's Army from January to June, 2022.
Result: The most common disc hernia was L4 - 5 (40%) and L5-S1 (33.85%); mainly grade 2 pain, low back pain spreading to the legs, accounting for 67.69%; with severe pain accounted for 75.93%, moderate pain 24.61%; concentrated in working age 31 - 50 accounted for 73.84%, mainly heavy workers 66.15%.
After the treatment course, the pain level decreased significantly, the level of painless and mild pain increased by 90.77%, the average pain decreased to 9.23% and no more severe pain remained.
Conclusion: Physical therapy has a good analgesic effect in treatment of lumbar disc herniation grade 1 and 2.
Clinical characteristics of emotional disturbances in patients with outpatient epilepsy
Hepatectomy is a radical treatments for hepatocellular carcinoma (HCC) in the early or intermediate stages, well-preserved liver function, and good health status.
Surgical therapy for hepatocellular carcinoma gives good chance for HCC patients to survival.
Objective: To evaluate the outcomes of hepatectomy for HCC, the complication rate, overall survival time, and related factors.
Subject and method: This was a research of 50 patients who underwent hepatectomy at Can Tho Central General Hospital, during the period between January 2017 and July 2020.
Result: The average age was 60.76 years and the male / female ratio was 2/1; the majority of patients hospitalized due to abdominal pain accounted for 72%.
The patients who had positive HBsAg and antiHCV were 68% and 36%, respectively; Almost patients had the well-preserved liver function with Child-Pugh A 92%.
Postoperative mortality and morbidity were 2% and 18%, respectively.
The 1-year and 2-year survival time after surgery were 86% and 72%, respectively.
There was significant correlation between the liver function and the overall survival time.
Conclusion: Nowdays liver resection for hepatocellular carcinoma are remarkably effective with controllable postoperative mortality and complications.
Investigation on antibiotic use in the treatment of staphylococcal sepsis at ICU departments at Cho Ray hospital
Acute hepatopancreatic necrosis disease (AHPNS) caused by V parahaemolyticus is the main cause affecting the sustainable development of the shrimp farming industry.
The results show that the extraction factors, affecting the efficiency of extracting eucalyptus essential oil and the suitable conditions for distillating eucalyptus oil by steam attraction method are: materials / water ratio of 1/7, 140 °C, 4.5 hours.
The use of eucalyptus oil to inhibit AHPNS causing vibrio in the testing shows a positive result in which the resistance is positively correlated with the antimicrobial activity of esensial oil.
The lowest obtained sterile ring diameter was 9.35 mm, corresponding to the amount of 25 ul of essential oil and the highest diameter of sterile ring was 23.55 mm with an herbal concentration of 100 ul.
Using white eucalyptus oil emulsion to treat AHPNS on white shrimp showed that the mortality rate decreased and still developed well.
Prediction of the risk of coronary artery disease in the next 10 years by Framingham scores in diabetic patients
To examine clinical features and treatment outcomes of patients with chronic alcohol abuse.
Method: Analyse clinical features and treatment outcomes of 45 patients with alcohol abuse who received inpatient treatment in the Psychiatric Department, 103 Military Medical Hospital.
Results: The average duration of alcohol abuse was 14.81± 5.85 years, average amount of alcohol consumed was 1024.45 ± 126.74 ml and heavy alcoholism was 68.89%.
The symptoms of alcohol abuse: visual illusion (84.44%), jealousy delusion (64.44%), emotional excitement (57.78%).
100% patients were treated by benzodiazepin and vitamin B1 and 86.67% of patients recovered completely after 3 weeks.
Conclusion: Clinical features of patients with chronic alcohol abuse are varied and abundant.
Nutritional status and some biological indexes of the second year university students at Nam Dinh university of nursing
Illustrate characteristics of Immature Granulocyte (IG) value in complete blood count of leukemia at Children's Hospital 1.
However, this indicator has not really been noticed in clinical practice.
As a result, it is necessary to pay more attention to the IG value on complete blood count, in order to improve prognosis of leukemia
Methods: Cross section study of 130 children who were diagnosed of leukemia at Children's Hospital 1 from 1/2019 to 7/2021.
Results: Decrease of at least two blood cell lineages was recorded in more than 94% of cases.
Abnormal cell, such as CA, LA, normoblast..., was seen on complete blood count in around 58, 5% of cases. It was shown that IG was elevated in around 50% of cases.
Especially, 100% of cases was recorded at least one of three abnormal manifestations: at least two blood cell lineages were decreased, abnormal cells were noted, and value of IG was increased.
All cases which reported abnormal white blood cells in IG were not diagnosed of AML.
Conclusions: Increased IG is a suggestive marker for medical conditions such as infection, inflammation, or cancer, such as acute leukemia... It was pointed out that 100% of cases was recorded at least one of three abnormal manifestations: at least two blood cell lineages were decreased, abnormal cells were noted, and value of IG was increased.
Characteristics and in-vitro resistance to bacteria causing acute exacerbations of copd at Ho Chi Minh city university medical center 2020
This study is conducted to determine factors affecting investment in livestock development under GAHP in Hanoi city.
Data were collected by direct interviews with 210 pig raising households in 6 districts of Chuong My, Thanh Oai, Quoc Oai, Thuong Tin, Thach That, Gia Lam in Hanoi city.
EARLY COMPLICATIONS AFTER ENDOVASCULAR TREATMENT OF RUPTURED DESCENDING THORACIC AORTIC ANEURYSM: A CASE REPORT AND LITERATURE REVIEW
Propose operating indication, classification of buried penis degree and technique for buried penis correction.
Foreskin-conserving surgery gives beautiful cosmetic results.
Evaluate the results of surgical correction.
433 patients suffered from buried penis were operated from April 2013 to January 2022.
Following up results with 25 months of 312 patients: good result was 47.8% (149/312), average result was 52.2% (163/312). The good result of light buried penis was 100% (20/20), of average buried penis was 79.4% (50/63), of heavy buried penis was 34.4% (79/229).
Conclusion: Buried penis should be diagnosed early and determine the buried degree for treatment indications.
Designing the anatomy atlas of lesser rice field rat Rattus losea (Swinhoe, 1871) and european rabbit Oryctolagus cuniculus (Linnaeus, 1758)
The anatomy atlas of male and female Lesser ricefield rat Rattus losea and European rabbit Oryctolagus cuniculus such as images with organs in their position are provided in this paper.
After being anesthetized, anatomized, specimence are taken photos that are then used for drawing and annotating (in Vietnamese and English) by using the Adobe Illustrator CS6 software.
Organs of Lesser ricefield rat and European rabbit in this atlas are displayed in color which are different from images in the previous documents.
This is a precious document to make the lesson are more effective and flexible
Clinical case report: Regional anesthesia and combined analgesia for surgery intertrochanteric in a 105-year-old patient
A 66-year-old woman was referred for evaluation of hepatic mass discovered on incidentally abdominal ultrasound.
A central hepatectomy was performed and the tumor was completely removed.
Pathology diagnosed a malignant neoplasm of unknown type and immunohistochemistry confirmed a grade 2 neuroendocrine tumor.
Non-hepatic original lesions were not found.
This case highlights that the diagnosis of primary hepatic neuroendocrine carcinoma stills a challenge which needs to distinguish from other focal liver lesions, as well as, differentiate from a secondary metastatic neuroendocrine tumor.
Assessment outcomes of internal osteosynthesis treatment of closed distal humerus fracture in adult
To survey the genotype and allele proportion of AGT M235T gene polymorphism in patients with acute myocardial (AMI).
Subjects and methods: This was a cross-sectional and descriptive study in patients with AMI at the Department of Cardiology and Department of Invasive Cardiology, Cho Ray Hospital from January 2020 to June 2020.
AGT M235T gene polymorphism was determined by polymerase chain reaction (PCR) at the Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City.
Results: During the study period, 120 patients with AMI had a mean age of 64.5±11.5 years and 69.2% were men.
Hypertension (86.7%) and dyslipidemia (86.2%) were the most common risk factors for coronary artery disease.
The proportion of ST-segment elevation myocardial infarction was 55.0% and the Killip I class was the most frequent (78.3%).
The rate of MM, MT, and TT genotypes of AGT M235T polymorphism were 0%, 21.7%, and 78.3% respectively.
The proportion of M and T alleles were 17.8% and 82.2%.
Conclusions: TT genotype and T allele of AGT M235T genetic variant have the highest proportion in patients with AMI.
Establishing an out-patient counseling procedure for medication usage at district 10 medical center
Methodology: An analytical cross-sectional study was conducted with directly interview of 2.203 participants using questionnaires; blood pressure was measured by using Omron machine; height, waist circumference, buttocks, body weight and body mass index (BMI) were also measured.
Results: The percentage of hypertension in group aged 18 - 69 years in 3 wards was 33.5%; the mean of systolic blood pressure was 123.28 ± 15.74 mmHg; diastolic blood pressure had the mean of 77.22 ± 9.90 mmHg.
There were 11 risk factors related to hypertension including age, gender, overweight, waist / buttocks ratio, smoking, habits of consuming animal fat, diabetes, hypercholesterolemia, cardiovascular disease, awareness of hypertension, hypercholesterolemia, hyperglycemia, monitoring of nutritional ingredients in daily meals.
Conclusion: The prevalence of hypertension in 18 - 69 years of age in 3 wards of Thu Duc district from 2018 to 2019 was quite high.
There were 11 related factors of hypertension including 2 demographic factors, 2 mediators and 7 lifestyles.
Docetaxel in advanced stage non small cell lung cancer at Nghe An oncology hospital
A cross-sectional study on 60 patients to evaluate the post-treatment results of wisdom tooth extraction under general anesthesia at Hanoi Medical University Hospital in 2022.
Result: Over 95% of patients had mild to moderate anxiety before surgery.
Regarding symptoms of swelling and pain, most of the patients had light pain (over 90%) after the first day and the third day.
Evaluation of other symptoms: numbness completely disappeared after 3 days of follow-up, there was no case of fever.
100% of patients had clot formation within the first day.
However, there are a few cases of mild bleeding.
Conclusion: The majority of patients who suffered from wisdom tooth extraction under general anesthesia at Hanoi Medical University Hospital had good results and few complications.
Preliminary outcome of patient with laparoscopic right colon cancer resection at Thanh Nhan hospital
The purpose of the study was to examine the level of awareness about the clinical practice environment at the hospital among nursing students of Tra Vinh University in 2021.
A descriptive cross-sectional study was applied to analyze the data of 205 students selected.
The study results showed a positive level of awareness with an average score of 130.83±8.73.
'Interaction and participation' had an average score of 41.6±2.99, 'Student-centered' had an average score of 45.92±3.56,' Allow individual participation' had an average score of 10.53±1.82, 'Nursing work value' had an average score of 9.11±1.11,' Promoting learning at work' had an average score of 16.42±2.80, and 'Lack of creativity' had an average score of 7.23±1.48.
The research results provide implications for the further improvement of nursing training at Tra Vinh University in particular and universities and colleges with nursing training in general.
Chemotherapy-induced neutropenia and febrile neutropenia among breast cancer patients treated with 4AC - 4T regimen at Thai Nguyen oncology center
α-thalassemia disease is mostly caused by mutations in the HBA1 and HBA2 genes that lead to the deficiency in the α-globin chain, which builds up the haemoglobin molecule.
Depending on the number of missing α chains, the clinical manifestations of the disease are at different levels.
This disease is inherited in an autosomal recessive manner, hence identifying healthy individuals carrying mutations in the α-thalassemia gene is essential for prenatal and premarital genetic counselling to reduce the incidence in the community.
Multiplex ligation-dependent probe amplification (MLPA) technique was used to determine 15 people who were suspected of carrying the α-thalassemia gene based on their complete blood count. This study identified that there were 12/15 people carrying - -SEA mutation, 1/15 carrier having - α3.7 mutation, 1/15 carrier having - α4.2 mutation and 1/15 person carrying point mutation Hb constant spring - αHbCs.
Prevalence of anemia in chronic kidney disease patients undergoing hemodialysis with erythropoietin treatment and some related factors at Gia Dinh people's hospital, year 2022
Our heart is a very special organ, surprising everyone, it is the heart that works tirelessly with nearly 100, 000 beats (contractions) in a day, so each year the heart beats 37 million times, and in general, an average person has 3 billion heartbeats in a lifetime.
What a durable and efficient part.
Normally the heart beats at regular intervals (heart sounds are heard at regular intervals) but sometimes our heart beats fast or slow or irregular.
An arrhythmia can be dangerous and in many cases must be treated with a pacemaker.
Determination of acute toxicity and anti – inflammatory activity of Gomphrena celosioides Amaranthaceae extract
In Viet Nam, the study of No ngay dat (Gomphrena celosioides Mart.)
This is a highly potential medicinal plant for the treatment of inflammatory diseases and should be isolated some bioactivity compounds or investigates the others pharmacological effects.
is still limited.
Therefore, this study was conducted for the purpose of determining acute toxicity and evaluating the anti - inflammatory effects of Gomphrena celosioides aqueous extract.
Materials and Methods: To determine acute toxicity, the study enrolled mice for oral dosing at the maximum possible oral dose and recorded live or death of mice in the next 72 hours.
A carrageenan - induced paw edema assay was performed to evaluate the anti-inflammatory effects of Gomphrena celosioides.
After inflammation, the mice were given a therapeutic dose and monitored the paw volume every day during the test.
Results and Discussion: The results showed that aqueous extract at 11, 8g / kg (Dmax) did not kill the test mice and not have acute oral toxicity.
Besides that, aqueous extract also has anti-inflammatory effect at 300mg / kg and 600mg/kg.
Conclusion: Gomphrena celosioides is not toxic at the tested dose and shows significant anti - inflammatory activity.
Factors affecting the acceptance of users to use mobile health services in Hanoi City
To evaluate the results of treated for acute liver failure by high-volume plasma exchange.
Subject and method: 45 patients with acute liver failure were collected at the poison control center from June 2017 to April 2021 using a descriptive, prospective, interventional study.
Result: Hepatic encephalophathy and SOFA after PEX decreased significantly compared to before PEX.
All 3 times of plasma exchange, the level of AST, ALT, total bilirubin, direct bilirubin, INR decreased and fibrinogen, prothrombin ratio increased statistically.
53.3% of patients survived after the end of high-volume plasma exchange.
Conclusion: High volume plasma exchange has good effect, improves prognosis for patients with acute liver failure.
This study aimes to analyse the usage of type 2 diabetes medication for outpatients at the Ministry of Public Security Traditional Medicine Hospital and to rate their adherence to the treatment.
In this study, Type 2 diabetic patients were treated as outpatients and managed for at least 12 months at the clinic of the hospital.
The results show that after 12 months of treatment, the average fasting blood glucose value decreased from 7.6 ± 1.76 mmol / l to 7.42 ± 1.81 mmol / l and the percentage of the patients either with blood glucose changes or reached the FPG target, increased from 38.3% to 70.0%, a statistically significant difference with p <0.05.
After 6 months of treatment from the time of T-6 to T0, HbA1c index decreased by 7.1 ± 1.0 to 6.4 ± 0.9% and the percentage of the patients either with HbA1C value changes or achieved the target, increased from 50.0% to 75.0%.
The percentage of the patients who had good compliance was 60.8%.
The two factors affecting the level of compliance of the patients with the drug were the age and the number of diabetes medicines used in the application.
Keywords: Type 2 diabetes, adherence to treatment, outpatients.
Abstracts: This study analyzes the direct treatment cost for exacerbation of chronic obstructive pulmonary disease (COPD) at the Department of Pulmonology, E Hospital from October 2019 to March 2020.
The results also show that the cost of treatment in Vietnam is lower than some countries in the region and the proportions of the cost components presented in different studies in Vietnam are different.
Keywords: Direct cost, exacerbation of COPD, E hospital.
Knee osteoarthritis, a common condition in postmenopausal women, is due to obesity and increased bone hypertrophy and osteophytes.
Osteoporosis is a gradual loss of bone after menopause.
Objectives of the study: To determine the osteoporosis rate in women with knee osteoarthritis and to investigate risk factors for osteoporosis in patients with knee osteoarthritis.
Methods: Osteoporosis and risk factors for osteoporosis are assessed in 68 patients with postmenopausal knee osteoarthritis.
Results: The proportion of women with knee osteoarthritis associated with osteoporosis was 37/68 (54.4%).
There were 46/68 patients (67.6%) with muscle mass index - SMI below 6.75. The skeletal muscle index in the osteoporosis group was 6.25 ± 0.75.
A study of 46 patients diagnosed with gallstones by ultrasound, with indications for assessment of gallbladder function to consider percutaneous gallstone lithotripsy at several hospitals in Hanoi from August 2019 to March 2020.
Result: mean age 41.76 ± 16.11, common age 30 - 50.
Gallstones are more common in women than in men, with a male / female ratio of 1: 1.1.
Average BMI accounted for 76.9%; 45.7% of cases had one stone; gravel with size >10 mm accounted for the majority of 76.1%; 89% of stones were mobile, 95.7% of stones were hyperechoic with shadow.
Gallbladder contractility index ≥ 40% accounted for 95.7%.
The average gallbladder contractility index was 64.2 ± 16.1%, this index in men was 64.6 ± 15.5%, and in women, it was 63.7 ± 16.9%.
95.7% of cases still had gallbladder contractile function.
Conclusion: Ultrasound plays an important role and has many advantages in diagnosing gallstones and evaluating gallbladder function before percutaneous gallstone lithotripsy.
Keywords: Gallstones, gallbladder function, ultrasound, gallstone lithotripsy.
Keywords: Rosuvastatin, SNEDDS, specification, droplet size, entrapment efficiency.
Vietnam possesses an extremely abundant and diverse ecosystem with many species of plants used for medicinal purposes.
is a plant of the Fabaceae family that is effective in arthritis, rheumatoid arthritis, amenorrhea, hepatitis, tuberculosis, and chronic bronchitis.
Keywords: Millettia speciosa, maackiain, calycosin, genistein, medicarpin.
This study evaluates PELOD-2 score mortality prediction ability in children with multiple organ dysfunction.
The descriptive cross-sectional study was carried out on 110 children with Multiple Organ Dysfunction at the Pediatric intensive care unit in Vietnam National Childrens Hospital from 1st January 2015 to 31th June 2016.
The study results show that the average PELOD2 score was high (8.8 ± 3.85 points); the PELOD-2 score of the mortality group was significantly higher than the survivor group with 7.07 ± 2.37 and 10.43 ± 4, 28, respectively; mortality rate was directly proportional to PELOD-2 score; the PELOD-2 score could separate the mortality group from the survivor group with the area under the ROC curve of 0.76 and the cut-point PELOD-2 score of 8.5.
If children with multiple organ dysfunction had over 10 points of PELOD-2 score, their mortality prediction value was nearly the same as the actual mortality rate.
The study concludes that PELOD-2 score was significantly correlated with associated multiple organ dysfunction syndrome and useful in predicting mortality.
Keywords: Multiple organ dysfunction, PELOD-2 score.
Keywords: Nephrotic syndrome, steroid resistance, histourlology.
This study was aimed at describing clinical and preclinical characteristics and evaluating treatment outcomes of children diagnosed with steroid resistant primary nephrotic syndrome.
54 children showing typical steroid resistant primary nephrotic syndrome and hospitalized at the Department of Nephrology-Dialysis (the Vietnam National Paediatrics Hospital) from January 2015 to March 2015 were subjected for the study.
The data revealed that out of steroid resistant patients, 57.4% exhibited early resistance, while 42.6% others represented late resistance.
The most common clinical symptoms were found to be edema (100%), the followed by hematuria (14.8%) and hypertension (7.4%).
Renal biopsy showed 70.8% of locally partial fibrosis, a mínimum of 25% of lesions and diffuse fibrosis of 4.2%.
Treatment efficacy was 46.3% of complete remission.
Objective: To evaluate the outcome of side-to-end anastomosis after low anterior resection in rectal cancer patients.
In the study, 1 patient with pneumonia who had stable medical treatment and discharged from the hospital after 12 days.
90% of patients did not need to reduce peristalsis even after 1 month of diarrhea, and 100% of patients do not need to reduce peristalsis after 6 months.
100% of patients had the ability to stop defecation with solid stool > 15 minutes at the time of 6 months after surgery.
Conclusion: Side-to-end anastomosis is a simple method, safety and feasibility.
Keywords: Rectal cancer, side-to-end anastomosis.
Result: The mean age of patients was 58.4 years old, the male rate was 35.7%.
The average distance from the pole to the edge of the anus was 7.7 cm.
Subject and method: A cross-sectional descriptive study, gastric mucosal patterns seen with NBI were divided into 4 types.
Result: 89 cases from 01/11/2020 to 30/05/2021. The prevalence of mucosal patterns was 32 (36%) type 1, 34 (38.2%) type 2, 21 (23.6%) type 3, and 2 (2.2%) type 4.
Sensitivities for detecting H pylori infection of type 2 + type 3 + type 4 was 97.22%, specificity was 77.42%, positive predictive value was 83.33%, negative predictive value was 96%.
Conclusion: Narrow band imaging endoscopy has high value for predicting H pylori infection.
Keywords: Narrow band imaging, Helicobacter pylori.
Objective: To describe and compare mucosal admittance (MA) in patients with reflux esosive esophagitis (EE) and healthy controls.
Keywords: Gastroesophageal reflux disease, mucosal admittance, TCM (Tissue Conductance
Subject and method: A cross-sectional descriptive study was conducted from 3/2020 to 6/2020 among patients who had EE on endoscopy compared to healthy controls who went for medical checkup and did not have EE.
Result: The study recruited 58 patients (34 with EE and 24 without EE).
The mean age was 37.4 ± 8.6 (years), the most common clinical symptoms were epigastric pain (29.3%), regurgitation (15.5%), and heartburn (8.6%).
The numbers (percentage) of patients without EE, EE grade A, and B esophagitis were 24 (41.4%), 32 (55.2%), and 2 (3.4%), respectively.
The median MA at 5 cm and 15 cm above Z line (squamocolumnar junction) were 9.7 and 47.4, respectively.
The MA in patients with EE was significantly higher than that at health controls at both positions (p<0.001).
However, there was no significant difference in both positions between 2 groups with GERD Q score ≥ 8 and GERD Q score < 8 (p>0.05).
Conclusion: Mucosal admittance was higher in patients with esophagitis than healthy control.
Objective: To evaluate the efficacy and safety of Diquas in patients after LASIK surgery.
Subject and method: Prospective non comparative trial.
Fifty eyes of 25 patients after LASIK.
Assessed TBUT, schirmer I, fluorescein, rose bengal staining score and the subjective symptoms (foreign body sensation, eye pain, dry feeling, feeling of burning, fatigue of the eyes, blurred vision, lacrimation) before and after treatment with diquas 1 month, 2 months and 3 months.
Recorded the symptoms of adverse reactions (red eye, swelling of the conjunctiva or eyelid, pain eye, blurred vision, headache...).
Result: At the 1 month, 2 months and 3 months after treatment with Diquas: TBUT, schirmer I increased significantly in eyes after LASIK, fluorescein and rose bengal staining score decreased significantly with p<0.01.
The subjective symptoms (foreign body sensation, eye pain, dry feeling, feeling of burning, fatigue of the eyes, blurred vision) were improved as well (p<0.01).
Six eyes after LASIK were red and pain itching after treatment 1 week.
Conclusion: Diquas has the efficacy and safety in patients after LASIK surgery.
Objectives: To describe some clinical, paraclinical characteristics and PET / CT imaging of 30 patients with inoperable stage III non-small cell lung cancer.
Keywords: Concurrent chemoradiotherapy, PET / CT, inoperable stage III non-small cell lung cancer.
Objective: To describe clinical and laboratory characteristics in septic shock patients due to Gram negative bacteria treated at 108 Military Central Hospital.
Leukocytosis was 61.4%, mainly mild elevated.
Hundred percent of patients had high level of PCT with 91% patients had PCT > 10ng / ml.
coli is the major cause with 59.1%, followed by K pneumoniae with 15.9%.
Keywords: Clinical, laboratory, septic shock, Gram-negative bacteria 1.
Subject and method: 44 septic shock patients due to Gram negative bacteria treated at 108 Military Central Hospital.
These patients met septic shock criteria according to Survival Sepsis Campaign (SSC) 2016 and their blood culture results were positive with Gram-negative bacteria.
The most common organ failure was kidney failure with 74.4%, followed by liver failure with 68.2% and respiratory failure with 65.9%.
The mortality rate was high as 65.9%, the most common primary infection site was GI tract with 45.6%, followed by respiratory tract (25%), urinary tract (20.5%).
Gallstone is a common disease, there are many methods for diagnosis of bile duct stones: Ultrasonography, magnetic resonance 3.0T and edoscopic ultrasonography, research to understand value of methods.
Conclusion: Comparision with the gold standard ERCP, EUS is highest valuable next is MRI 3.0 and finaly is ultrasonography in the diagnosis of biliary obstruction.
Keywords: Biliary obstruction, endoscopic ultrasound, ultrasonography, magnetic resonance 3.0T.
Objective: Study of the value of ultrasonography, magnetic resonance 3.0T and edoscopic ultrasonography in the diagnosis of bilary obstruction.
Subject and method: 62 patients with bile duct stones were treated at the Gastroenterology Department of the 108 Military Central Hospital from January 2017 to April 2018.
Study of the value of ultrasonography, magnetic resonance 3.0T and edoscopic ultrasonography in the diagnosis of bilary obstruction comparrision with the gold standard ERCP.
Result: Male 56.4%, female 43.6%, M / F = 1.3, the clinical mainly a Charcot, right lower rib pain 72.6%, fever 48.3%, jaundice 45.1%.
EUS correct bile duct stone were 88.9%; Ultrasonography 72.2%, magnetic resonance 3.0T 83.3%.
EUS and MRI 3.0 have moderate similarity in the diagnosis of bile duct stones with K = 0.690.
Objective: This study aims to evaluate knowledge about thalassemia of single young adults in Yen Bai Province.
Subject and method: By multi-stage sampling methods, 385 subjects aged from 18 to 30 years were recruited.
Participants responded to the 21-item questionnaire about the disease and its prevention and treatment.
Result: It was found that 90.1% of respondents achieved unsatisfactory score in the knowledge test (less than 15 out of 21 score).
They demonstrated low understandings about the diseases in all surveyed knowledge domains (inheritance, preventions, and treatment).
No differences in terms of knowledge across gender, occupation, ethnics, house locations, and family history with thalassemia.
Nevertheless, subjects who have completed at least high school showed significant better understandings about the disease than others.
Conclusion: This study highlights the need to improve knowledge about thalassemia among single young adults in Yen Bai Province.
Keywords: Thalassemia, disease prevention, Yen Bai Province.
Objective: To compare effectiveness of the neurally adjusted ventilatory assist (NAVA) with pressure support ventilation (PSV) in weaning process.
Subject and method: 65 patients in the Bach Mai Hospital's ICU were enrolled in the randomized control trial from the 1st of October 2015 to 30th of October 2017, in which 33 patients were mechanically ventilated by NAVA and 32 patients were on PSV.
Conclusion: The neurally adjusted ventilatory assist has reduced patient - ventilator asynchronization.
Keywords: Neurally adjusted ventilatory assist, weaning from mechanical ventilation.
Objective: To evaluate the urlological diagnosis and results of treatment for patients with hepatocellular carcinoma.
Conclusion: The ability of HCC diagnosis is acceptable, but it is hard to treat, in Thai Nguyen C Hospital.
Objective: To evaluate the effectiveness of brachial plexus block under the guidance of ultrasound in nerve and vascular connecting microsurgery of the forearm.
Subject and method: 45 patients, ASA I, II, aged from 16 to 65 underneath forearm microsurgery.
The ultrasound-guided brachial plexus block was performed with 0, 375% marcain (dosage 1.5mg / kg) mixed 2% lidocain (dosage 2mg / kg). Assessing the degree of sensory and motor block according to Hollmen's scale and Bromage scale.
Keywords: Brachial plexus block, ultrasound, microsurgery.
Objective: Evaluating the change in hemodynamic and respiratory, circulatory status of potential brain dead donors.
Subject and method: 47 patients (18 - 64 years), diagnosed according to the criteria of brain death positive 1st time, were measured hemodynamic parameters PiCCO (transpulmonary thermodilution) aims to evaluate the change in hemodynamic and respiratory, circulatory status of potential brain dead organ donor.
Record hemodynamic parameters through PiCCO, respiratory function, SOFA score.
Result and conclusion: Brain death causing severe physiological changes leading to organ dysfunction.
Consequences are hemodynamic disorders (hypotension), respiratory disorders (reduced lung exchange and increased extra lung water), liver dysfunction (increased glucose, coagulation) and renal dysfunction (diabetes mellitus), hypothermia, hypernatremia.
Keywords: PiCCO, brain dead donors.
Objective: To evaluate the effectiveness of radioembolization method with Yttrium-90 for the treatment of hepatocellular carcinoma.
Keywords: Radioembolization with Yttrium-90 microspheres, hepatocellular carcinoma.
Subject and method: A prospective interventional uncontrolled study of 52 intermediate and advanced stage hepatocellular carcinoma patients having portal venous thrombosis with an average tumor size of 9.8 ± 3.0 cm and treated by radioembolization with Yttrium-90 microspheres was conducted at 108 Military Central Hospital from October 2013 to September 2017.
The survival from the first time of intervention and the 1 -, 2 -, 3 - and 4-year survival rates were analysed by Kaplan Meier curves.
In addition, clinical therapeutic response was assessed by both AFP levels and tumor response at follow - up times according to the mRECIST and RECICL criteria (2010).
Result: There were 52 patients with 52 radioembolizational interventions with Yttrium-90 microspheres.
The 1 -, 2 -, 3 - and 4-year survival rates were 69.8%, 52.2%, 46.4% and 17.4%, respectively. Well-tolerated clinical improvement was recorded in 88.5% of patients; 55.2% of patients had a significant AFP level at three months after the procedure; the mean size of liver tumors decreased from 9.8 ± 3.0 cm before treatment to 4.7 ± 2.7 cm after 12 months of treatment (p<0.001); the overall response rate at 3 months was 50.0%, in which complete response and partial response were 13.5% and 36.5%, respectively.
Conclusion: Radioembolization with Yttrium-90 microspheres for hepatocellular carcinoma treatment improves clinical response, AFP level, tumor response and good long-term survival after intervention.
Objective: To describe the history and clinical manifestations of food allergy in children with bronchial asthma treated in the Vietnam National Childrens' Hospital from June 2015 to June 2016.
The clinical symptoms of food allergy are varied. Cow's milk and seafood caused IgE allergy and non - IgE.
Keywords: Food allergy, asthma, children.
Subject and method: A cross-sectional descriptive study consisting of 172 bronchial asthma patients who underwent medical history, family history and clinical signs of food allergy.
Result: Allergic rhinitis was the most common (47.67%).
The suspicion of food allergies was 41.19%.
Clinical signs of food allergy IgE include: Urticaria was the most common clinical manifestation (76.19%), 47.62% of respiratory symptoms, 28.57% of shortness of breath.
For slow food allergy (non-IgE), clinical characteristics were diarrhea (62.50%), abdominal pain (25.00%), eczema (50.00%), contact dermatitis (12.50%).
The most common causes of IgE food allergy were cow's milk (28.57%), crab (23.81%), shrimp (19.05%), fish (14.29%).
Non-IgE allergenic causes were cow's milk (37.50%), shrimp (25.00%), crab (25.00%), egg white (12.50%).
Conclusion: Allergic rhinitis is the most common dementia.
Objective: This study was undertaken to evaluate safety, effect and risks of Aortic root enlargement (ARE) technique.
No severe complicated case.
Conclusion: The ARE is a safe and feasible procedure to the patients with small aortic root undergoing aortic valve replacement (AVR).
Keywords: Aortic root enlargement, prosthesis - patient mismatch.
Subject and method: A retrospective study with 12 cases of aortic root enlargement operated from September 2015 to January 2018 at Hanoi Heart Hospital.
Result: 12 cases aortic root enlargement / 536 cases within aortic replacement - 2.2%.
The mean age 55.4 ± 17.9, female / male 3 / 1.
Mean aortic clamp time 98 ± 14.9 minutes, mean cardiopulmonary bypass time 121 ± 10.9 minutes.
The first six hour bleeding 226.3 ± 135.5ml.
Postoperative aortic transvalvular pressure gradients (peak / mean) were 26 ± 7.4 / 15.6 ± 4.6 mmHg.
No case of re-operation for bleeding.
Objective: To evaluate the efficacy of labour induction by modifier double ballon Foley catheter in pro - long term gestational age with indication of vaginal delivery.
Keywords: Labour induction, double balloon, pro-long term gestational age.
Result: With success criteria is defined as Bishop score after labour induction, the success rate with modifier double balloon Foley catheter was 86.2%, the increase of Bishop scores averaged 4.2 points with p<0.001.
The vaginal birth rate after induction was 86.9%.
There was not any complication for the women and the newborn babies.
Conclusion: Our findings suggest that the modifier double balloon Foley catheter results in higher ripening success rates and is associated with a high rate of vaginal birth, withoit compromising maternal or fetal safety.
Foreign body ingestion is a quite common situation in everyday life.
However, apendiceal perforation due to accidentally ingesting a fish bone is a very rare phenomenon.
Often, the exact diagnosis is missed preoperatively because it has no specific symptoms, so it is easily confused with other diseases such as acute appendicitis, colonic diverticulitis, cecal infammation, acute cholecystitis, etc. Delay in diagnosis and treatment can be associated with higher rates of morbidity and mortality.
In order to add to the library of experience for clinical practice, we would like to submit this case report of a 49-year old male who was diagnosed with acute appendicitis preoperatively.
However during the emergency laparoscopy, the patient's appendix was detected to have been perforated by a fish bone, which led to abscess at the right iliac fossa.
The patient had the foreign body removed, an appendectomy, a peritoneal lavage and the right iliac fossa drained.
The postoperative recovery was uneventful and the patient was discharged safely.
Objective: This study aimed to identify the quality of life (QoL) in male patients with genital warts at Ho Chi Minh City Hospital of Dermato-Venereology.
Subject and method: Samples were collected from 120 male patients, age ≥ 18 years old, with genital warts from July 2019 to January 2020. Genital warts were diagnosed base on clinical manifestations, QoL was evaluated by DLQI (Dermatology Life Quality Index).
Result: A mean of DLQI was 4.41 ± 4.07.
Most patients had negative impact on their quality of life (62.5%).
The main dimensions affected were embarrassment, relationships, and sexual life.
No association was identified between the DLQI and age group, residence, education level, marital status, number of partners, and duration of illness (p>0.05).
Conclusion: In addition to the treatment, we should establish psychosocial support systems for patients suffering from genital warts.
Keywords: Genital warts, dermatology life quality index, HPV.
Objective: To assess recurrence-free survival and factors involved after surgery of radioactive iodine refractory differentiated thyroid cancer patients.
Conclusion: Tumor size and invaded recurrent tumor are independent prognostic factors for recurrent-free survival in radioactive iodine refractory differentiated thyroid cancer.
Keywords: Differentiated thyroid cancer, radioactive iodine refractory, recurrence-free survival.
Subject and method: We prospectively studied a cohort of 95 patients with radioactive iodine refractory differentiated thyroid cancer from December 2018 to November 2021 at 108 Military Central Hospital.
Patients underwent recurrent resection entered the study.
Recurrent tumor resection was considered the primary event, while the endpoint of the study was recurrence-free survival.
Result: The median time follow up was 24 months. Twenty five patients had relapses.
According to the Kaplan-Meier tests, 1, 2, and 3-year recurrence-free survival were 94.4%, 80.6%, and 62.5%, respectively.
In univariable and multivariable Cox proportional hazard analysis, factors such as tumor size and invaded recurrent tumor had an important association with recurrence-free years.
Objective: To evaluate the preventive effectiveness of Blumea lacera extract on chronic renal failure by adenine in animal model.
Keywords: Blumea lacera, chrinic renal fairlure, adenine.
Subject and method: Blumea lacera was extracted by 96% ethanol three time, then the liquid was evaporated with low pressure to get EtOH extract.
Swiss mice were devised in three groups: (1) Control group, distilled water ingestion.
(2) Prevention group (M): Adenine oral administration (100mg / kg) every 2 days, in other day, Blumea lacera EtOH extract was oral administrated (equivalent to 8g rude / kg).
(3) Renal failure group (ST): Adenine oral administration (100mg / kg) every 2 days.
Animal was monitored within 35 days as whole body condition, weight, dead and other parameter such as blood cell count, urea, creatine, were identified.
Result: At the end of 35 day duration, the similarity between control group and M group was identified.
ST group significantly showed the higher in dead rate, urea and creatine concentration than other groups, red blood cell was significantly lower than those in other groups.
Conclusion: Blumea lacera EtOH extract showed the renal failure prevention on renal failure animal model by adenine.
Objective: To evaluate the initial results of coronary angiography and percutaneous coronary intervention at 103 Central Hospital of Laos People's Army.
Conclusion: The initial implementation of coronary angiography and intervention at 103 Central Hospital of Laos People's Army has brought about very positive initial results, the complication is within the permissible limit.
Keywords: Coronary artery disease, percutaneous coronary angiography, percutaneous coronary intervention.
Subject and method: A retrospective cross - sectional descriptive study on 37 patients with angiography and percutaneous coronary intervention at the 103 Central Hospital of Laos People's Army from April 2021 to April 2022.
Result: The average age of the patients was 76.58 ± 6.24 years, the common risk factors were: Hypertension (62.1%), obesity (48.6%), dyslipidemia (45.9%), diabetes (31.1%), tobacco (32.4%).
Injury to the left anterior descending artery was the most common (54%).
Multi-vessel coronary lesions also accounted for nearly 50%.
Left anterior descending artery intervention accounted for 51.7%.
Successful intervention rate was 88.8%.
The rate of complications in the intervention was 0%.
The complication after intervention was 8.1%, the mortality rate was 0%.
Objective: To evaluate left ventricular synchrony parameters using gated myocardial perfusion single photon emission computed tomography (GSPECT) in post myocardial infarction (MI) patients.
Subject and method: A cross-sectional study was conducted on 34 subjects without cardiovascular disease and 104 post-MI patients.
77% and 81% of post-MI patients had increased PSD and HBW with left ventricular dyssynchrony.
PSD and HBW has increased significantly in post-MI patients with NYHA III-V, low EF compared to NYHA I-II patient group without left ventricular dysfunction.
Conclusion: Left ventricular dyssynchrony parameters were commonly detected by GSPECT in post-MI patients.
PSD and HBW increased significantly in post-MI patients and were related with NYHA and left ventricular dysfunction.
Keywords: Myocardial perfusion imaging, left ventricular dyssynchrony, myocardial infarction.
Objective: To evaluate the treatment of acute obstructive renal failure due to ureteral stones cured by surgical interventions at 103 Central Hospital of Lao People's Army.
Keywords: Acute obstructive renal failure, ureteral stone.
Patient's characteristics: 8 bilateral ureteral stones (36.3%), 8 ureteral stones with accquired solitary kidney (36.3%), and 6 ureteral stones with functional solitary kidney (27.2%).
Objective: To determine plasma magnesium (Mg) level and to evaluate the association between plasma Mg level and outcomes of patients with sepsis.
The plasma Mg1 level was lower than the plasma Mg3 level.
The Mg1-deficient group had higher SOFA scores than the non-deficient group.
The septic shock group had a lower Mg1 level than the non-shock group.
There was no statistically significant difference in plasma Mg1 levels between the 30-day mortality and survival groups.
Keywords: Sepsis, magnesium.
Subject and method: A prospective descriptive study was conducted on 125 patients with sepsis treated at 108 Military Central Hospital from November 2019 to February 2021.
Plasma Mg levels were measured at admission (Mg1) and on day 3 after admission (Mg3), 30-day follow-up of survival and mortality.
Result: In 125 patients with sepsis, the rate of Mg1 deficiency was 48.8%.
The plasma Mg1 and Mg3 levels were 0.70 (0.6 - 0.81) mmol / L vs 0.75 (0.65 - 0.85) mmol / L respectively, p=0.001.
SOFA score in the Mg1 deficient group was higher than in the non - deficient group (8.48 ± 4.06 vs 6.8 ± 3.92, p<0.05).
Mg1 level in the shock group was lower than in the non-shock group (0.65 (0.57 - 0.73) mmol / L vs 0.75 (0.67 - 0.87) mmol / L, p<0.001).
There was no statistically significant difference in plasma Mg1 levels between the mechanical ventilation and non-ventilation groups, between the renal and non-renal failure groups, between the liver failure and non-liver failure groups, and between the 30-day mortality and survival groups.
Conclusion: Mg1 deficiency was common in patients with sepsis.
Objective: To describe the quality of life and related factors after surgical treatment of hepato-biliary and pancreatic cancer.
Conclusion: The quality of life after surgery in hepato-biliary and pancreatic cancer was average. The factors associated with the quality of life were the post-day hospital, cancer organs, and cancer stage.
Subject and method: A descriptive cross-sectional study on 102 patients who underwent surgery at Hepato-Biliary and Pancreatic Department in 108 Military Central Hospital from August 2018 to June 2020. The FACT-HEP was used in this study.
Result: Mean age was 57.7 ± 12.5 years.
Male / female: 3/1.
The proportion of patients in stage II and stage III was 32.3%.
Related factors in patients'quality of life after surgery were the post-day hospital, cancer organs, and cancer stage.
Objective: To describe geriatric characteristics and post-COVID-19 conditions among COVID-19 infected older outpatients.
Subject and method: From May 2022 to July 2022, this cross-sectional study included 316 patients (aged ≥ 60 years; mean age 66.8 ± 6.3 years; males, 26.6%) attending the post - COVID clinic at the University Medical Center, Ho Chi Minh City.
Patients were explained to complete a structured questionnaire through personal interviews to collect demographic characteristics, comorbidities, geriatric issues, and post-COVID-19 conditions.
Result: In total, 276/316 patients (87.3%) had any post-COVID-19 conditions, including fatigue (65.5%), attention disorder (10.1%), headache (31.0%), hair loss (4.1%), dyspnea (17.7%), lower limb weakness (20.9%), and decreased physical activity (26.6%).
In comprehensive geriatric assessment, the rates of limitations activities of daily living (ADLs) and instrumental ADLs, depression, frailty, poor sleep quality, and fear of falling were 1.9%, 13.6%, 22.2%, 11.4%, 64.2%, and 43.0%, respectively.
Hypertenstion, diabetes, and osteoarthritis were the three most frequently comorbidities reported in our study.
Conclusion: Our study found substantial rates of post-COVID-19 conditions among older outpatients and fatigue was the most commonly reported symptom.
Keywords: Older outpatients, post-COVID-19 conditions, geriatric assessment.
Objective: To evaluate of characteristics of sarcopenia by the formula of Ishii in the type 2 diabetes mellitus.
Result: The average age of the research group was là 66.56 ± 8.84 (males: 66.70 ± 9.31, females: 66.44 ± 8.38); The average handgrip strengh was 27.67 ± 8.48 kg (males: 33.11 ± 8.01, females: 22.55 ± 5.03); The average calf circumference was 33.84 ± 2.92 cm (males: 34.54 ± 2.79, females: 33.18 ± 2.89).
The prevalence of sarcopenia was 22.8% (males: 29.3% and females: 16.6%); in group < 60 ages: 6.9%, ≥ 60 ages: 27.8%; in group > 10 years: 28.6%, ≤ 10 years: 17.0%; in group hypertension: 26.9%, nonhypertension: 17.5%; in group BMI ≤ 22.5: 31.1%, BMI > 22.5: 17.3%; in group eGFR < 60ml / min/1.73 m 2: 39.3%, ≥ 60ml / min/1.73 m 2: 7.6%.
Keywords: Sarcopenia, type 2 diabetes millitus, formula of Ishii.
Keywords: Cerebellar hemorrhage, brainstem compression, craniectomy, external ventricular, Drainage.
Objective: Endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone gastroenterostomy (GE) is difficult because of the anatomic changes in the digestive tract.
The aim of study was to evaluate the efficacy of ERCP by using a front-viewing endoscope in patients who have undergone Billroth II GE.
Subject and method: A prospective study was conducted on 10 common bile duct stricture cases with Billroth II GE underwent ERCP using a conventional endoscope.
Result: Ten patients with Billroth II GE underwent ERCP. Three patients had choledocholithiasis and seven patients had malignantbiliarystrictures.
The probability of success of endoscopic treatment was 7/10 patients (70%) included bile duct stone removal 3/3 (100%) and biliary stent placement for malignant tumors 4/7 (57.1%), there was no case of complication.
Conclusion: ERCP using a front-viewing endoscope is feasible and may be the priority utilization in patients with Billroth II GE who have indication of removing bile duct stones or stenting biliary before deciding on surgery.
Keywords: Billroth II gastroenterostomy, modification in ERCP, common bile duct stricture.
Objective: To identify gastric residual volume and patient satisfaction when drinking 200ml of maltodextrin 12.5% solution 2 hours before surgical anesthesia.
Keywords: Maltodextrin 12.5%, nursing care, spine surgery.
Objective: To evaluate the complications of cranioplasty after decompressive craniectomy and identify the association of these complications with some risk factors.
Some factors related to common complications: Early cranioplasty (< 3 months) was related to infection and graft collapse with p<0.05, late cranioplasty was associated with postcranioplasty seizure (p=0.007).
The disturbance of spinal fluid circulation was associated with postcranioplasty seizure and bone flap resorption (p<0.05).
Conclusion: Although cranioplasty is a simple surgical procedure, it is usually associated with a relatively high complication rate.
Control of a patient's risk factors and early recognition of complications may help practitioners avoid the exhaustive list of complications.
Keywords: Cranioplasty, hydrocephalus, infection, seizure.
Subject and method: Retrospective cohort study of 202 patients from August 2018 to January 2021, who had undergone decompressive craniectomy followed by cranioplasty at 108 Military Central Hospital.
All patients were followed up to 6 months after cranioplasty and complications were recorded both by imaging and clinically.
The major complications were recorded and evaluated in relation to a number of risk factors: Reason for craniectomy, comorbidities (hypertension, diabetes mellitus, anticoagulation), location of cranioplasty, duration from decompressive craniectomy to cranioplasty. Algorithms used for analysis include Student's t-test, Chi - square tests and Fisher's exact tests.
Confidence intervals were calculated as the 95% CI.
Result: The overall postoperative complication rate was 23.26%.
The common complications included: Infection (6.44%), graft collapse (6.44%), seizures (6.44%), bleeding (3.46%).
The early cranioplasties (within 3 months after decompressive craniectomy) and disturbance of cerebro - spinal fluid circulation were risk factors for increased postoperative complication rate (p<0.05).
Objective: To evaluate tracheal reconstruction surgeries for tracheal stenosis after prolonged endotracheal intubation or tracheostomy and early results.
Subject and method: A cross-sectional study in 72 patients with tracheal stenosis after prolonged endotracheal intubation, tracheostomy had indications for tracheal reconstruction performed at 108 Military Central Hospital and Cho Ray Hospital from January 2014 to December 2017.
Result: 72 patients were operated with collar incision (93.1%), T - shaped cervical sternal incision (6.9%) and median sternotomy (4.2%).
The main techniques were used tracheal end-to-end anastomosis 86.1%, cricoid cartilage-tracheal anastomosis 12.5%, suprahyoid release (Montgomery) 2.8%.
The tracheal resected segment was mainly in the group of 1 - 2 cm (40.3%), the average length of the resected segment was 25.4 ± 9.7 (mm).
Immediate complications were 5 cases (7%), early complications in the postoperative period 11 (13.4%) cases.
The surgical results, according to Grillo 4 groups classification: Good (73.6%), satisfactory 18.1%, failure 6.9%, mortality 1.4%.
Conclusion: Tracheal reconstruction surgeries for tracheal stenosis after prolonged endotracheal intubation or tracheostomy have good early results and low complication rate.
Keywords: Tracheal stenosis, endotracheal intubation, tracheostomy.
Objective: To describe the clinical manifestations of patients with acne vulgaris and measure the serum level of IGF-1 and related factors in patients with acne vulgaris and compare to the normal controls.
Conclusion: Serum level of IGF-1 in the group of patients with acne vulgaris was significantly higher than the control group (p<0.001).
Keywords: Insulin-like growth factor-1, serum, acne vulgaris.
Subject and method: A cross-sectional descriptive study was conducted on 59 patients with acne vulgaris the Ho Chi Minh City Hospital of Dermato-Venereology in 2020 - 2021 and 30 healthy people in the control group.
Result: The median age of acne patients was 17 years.
The median age of onset for acne patients was 13 years.
The median duration of illness was 6 months.
Patients with acne vulgaris had a mean GAGS score of 20.85 ± 5.55 points.
The patients with medium severity level accounted for the highest proportion with 30 patients (50.8%).
The average serum level of IGF-1 in patients with acne vulgaris was 296.42 ± 71.21ng / ml.
The serum level of IGF-1 in the normal group was 227.41 ± 101.86ng / ml.
Objective: This paper describes a method for the radiolabeling of monoclonal antibody bevacizumab in the production of 99mTc-bevacizumab radiopharmaceutical in the radioimmunoscintigraphy (RIS).
Bevacizumab is a humanized monoclonal and recombinant antibody that is an anti-vascular endothelial growth factor (VEGF) and effective in blocking the process of angiogenesis.
Subject and method: Bevacizumab was labeled with radioisotope 99mTc by direct method using stannous chloride as reductant.
The labeling optimization was conducted such as pH, temperature, time, molar ratio.
The radioimmunoconjugates were tested for radiolabeling yield, radiochemical purity and stability.
Result: The results of the optimized study showed that bevacizumab was labeled with 99mTc in 0.5M phosphate buffer, pH = 7.5 at room temperature for 15 minutes.
Conclusion: The conjugation of 99mTc-bevacizumab initially met the required criteria of radiopharmaceutical and could be used for preclinical evaluations.
Keywords: Monoclonal antibody bevacizumab, radioisotope 99mTc, radioimmunoscintigraphy.
Objective: To investigate the image findings of branchial plexus injuries on CT myelography, MRI and electrodiagnosis.
Subject and method: The study was performed on 40 patients with trauma history and clinically suspected brachial plexus lesions, which were then diagnosed by CT myelography and MRI at the Department of Diagnostic Imaging, 108 Military Central Hospital, electrically diagnosed at Department of Functional Explorations, Hanoi Medical University Hospital and operated at Institute of Trauma and Orthopedics, 108 Military Central Hospital during nearly 2 years, from May 2015 to February 2017.
Result: CT myelography can diagnose complete and partial root avulsions with 5 levels according to Nagano classification.
MRI can detect some types of damage such as root avulsion, rupture, edema of the roots and trunks, electrodiagnosis can detect preganglionic and postganglionic damage, complete or partial root lesions.
Conclusion: CT myelography, MRI and electrodiagnosis are useful diagnostic imaging methods for brachial plexus lesions.
Keywords: Electrodiagnosis, CT myelography, magnetic resonance imaging, root avulsion, brachial plexus.
ASSESSMENT RESULTS CONSERVATIVE TREATMENT OF PERIODONTAL DISEASE BY LASER DIODE Objectives: Assessment results conservative treatment of periodontal disease by laser diode.
After 1 - 4 weeks the GI index: desired effect 60%, average 32, 7% and bad result 7, 3%.
OHI-S index: is well improved after 1 and 4 weeks of treament. After 1 - 4 weeks: good 70, 3%, average 20, 5% and bad 9, 2%.
Conclusion: The conservative treatment of the periodontal disease is using diode laser. This is just clearly effective in improving periodontal indexes such as reducing the level of periodontal pockets' depth, improving gum indexes and detal hygiene indexes at the time after treatment compared with those at the time before treatment.
Keywords: periodontal disease, diode laser.
SURVEY on serum albumin of chronic renal failure patients treating with maintenance hemodialysis Subject: Survey on serum albumin and it's relationship with some features of maintenance hemodialysis patients.
Method: Examination, laboratory data and serum albumin have done in 83 patients with maintenance hemodialysis.
Results: Average serum albumin concentrations was 35.13 ± 3.59g / l, the ratio of hypoalbuminia was 44.6%.
Average serum albumin concentrations were significantly lower in patients with ≥60 years old than those in <60 years old (≥60 years old: 32.55 ± 3.05 g / l; <60 years old: 35, 95 ± 3, 38 g / l, p<0.001), in patients on dialysis ≥ 5 years than those in <5 years (≥5 years: 32.8 ± 2.44 g / l; <5 years: 35.93 ± 2.55 g / l, p<0.01) and in patients with hepatic virus infection than those in non infection (hepatic virus infection: 34.42 ± 3.54 g / l; non infection: 36.55 ± 3.33 g / l, p<0.05).
There was mildly negative corelation between serum albumin and CRP-hs (r= - 0.51, p <0.001).
Keywords: serum albumin, hemodialysis patient; C-reactive protein.
EVALUATION OF ANGLE CLASS III MALOCCLUSION AND ORTHODONTIC TREATMENT USING MBT-TIP EDGE STRAIGHT WIRE TECHNIQUE The deviation and misalignments of teeth and jaw can lead to Angle class III malocclusion which causes cross-bite in front incisor and molar teeth with relatively high prevalence.
Keywords: Angle class III malocclusion, cross-bite, orthodontic alignments.
The prevalence of patients with Angle class III malocclusion due to alveolar bone or the combination of maxillary laterally deficiency and mandibular prognathism can vary in ethnicities and residential habitats. In clinical practice, we have conducted the treatments for 38 cases of Angle class III malocclusion aiming for the following objectives: Evaluate dentofacial phenotypes, X-ray images of Angle class III malocclusion patients.
Analyze the results of treatments using MBT tip-edge straight wire technique in patients with Angle class III malocclusion.
The treatment results have shown that: In 38 Angle class III malocclusion cases, the prevalence of the malocclusion was 31.75% due to abnormality in alveolar bones, 21.05% due to underdeveloped of maxillary bones, due to prognathism of mandibular jaw accounting for 5.26% and due to the combination of maxillary deficiency and mandibular prognathism accounting for the greatest percentage of 42.10%.
The average PAR indices were 27.2626±3.15 before treatment and 3.86±1.21 after treatment.
Based on the relationship between PAR indices and needed space for Angle III treatment, the number of patients who require tooth extractions was accounted for 68.42%.
THE RESULT OF ACL RECONSTRUCTION BY HAMSTRING TENDON USING BIOABSORBABLE SCREW FIXATION IN QUANG NINH GENERAL HOSPITAL Target: evaluating the results of ACL reconstruction by hamstring tendon using bioabsorbable screw fixation in Quang Ninh general hospital.
Method: descriptive study among 57 patients having ACL rupture who were diagnosed and treated by arthroscopic surgery in Quang Ninh general hospital from May 2011 to May 2013.
Result: 57 patients with average time of 21.9 months, the recovery of knee fuction after operation according to Lysholm scoring system increased from 52 to 96.1.
The rate of excellent and good level was 94.7%.
Conclusion: arthroscopic ACL reconstruction by hamstring tendon using bioabsorbable screw fixation is effective and able to be conducted in provincial hospitals
INVESTIGATE CLINICAL MANIFESTATIONS AND ANTIBIOTIC RESISTANCE OF ESCHERICHIA COLI ON SEPTICEMIA PATIENTS IN THE NATIONAL HOSPITAL OF TROPICAL DISEASES AND MILITARY HOSPITAL 103 Objectives: Describe clinical, subclinical manifestations and antibiotic resistance of E coli on septicemia patients.
Subjects: 56 septicemia patients due to E coli were treated in the NHTD and Military hospital 103 from December 2012 to June 2014.
Methods: A Cross-sectional study was conducted.
Results and conclusions: Of 56 patients, there were 66.07% of male; and patients over 60 year old was predominant (33.93%); followed by age of 50 - 59 (30.35%).
Clinical symptoms were: high fever (96.4%), abdominal pain (39.6%); dyspnea (26.8%); respiratory failure (21.6%), unconsciousness (25.2%); poliakiuria 21.6% and septic shock (26.8%).
48.21% bacteria isolates were ESBL strains including the highest resistant ratio to Ampicilin (85.71%), and followed by Trimethoprim / sulfamethoxazole (64.29%); Cephazolin (50%); Ciprofloxacin and Levofloxacin (35.71%).
We found that some antibiotics has still been sensitive containing Doripenem (96.43%); Ertapenem (94.64%); Amikacin (96.43%) and Cefepime (89.29%).
Keywords: MIC, septicemia, ESBL
Objective: To determine the safety and effectiveness of primary suture for penetrating colon injuries.
Methods: Retrospective review of medical record of 68 patients havingpenetrating colon injuries during January 2004 to January 2010.Two-tailed Fisher′s Exact or ᵡ² test were used for statistical analysis.
Abdominal contamination: mild contamination was 47 (69, 1%), moderate in 14 (20, 6%), major in 1 (10, 3%). Delay from time of injury to operation: ≤ 8h57 (83, 8%), >8 h 11 (16, 2%).
31 (45, 6%) patients were treat by primary repair of colon injuries and ostomy was performed in 54, 4% (37) of patients. The incidence ofprimary repairfailure was 3, 2% (1/31), without intraabdominal abscess or death.
Keywords: HIV / AIDS, high school students
The sample size of the study comprised of 293 students randomly selected with cluster sampling technique, and stratified by grade 10, 11, and 12.
The results indicated that knowledge and practice on HIV / AIDS in student is high.
72, 4% of students had acceptable knowledge, 76, 6% with acceptable practice, but only 40, 3% of students had positive attitudes.
In practice, alarmingly, there was 20 among them having ever sexual relation, with 45% of them not always using condom when thay had sexual relations.
There was a statistically significant association between grades and knowledge, attitude, practice.
The study also indicated the significant association between knowledge and attitude, attitude and practice.
ASSESSMENT OF SOME DIABETES MELLITUS MONITORING INDICATORS THROUGH CONSULTATION AT HAI PHONG PREVENTIVE MEDICINE CENTER IN 2014 A study on 98 patients, including 61 male patients and 37 female patients from 45 to 55 years old showed that the patients had positive improvement in terms of practical knowledge and attitude after consultation and had statisticcally meaningful reduction of indicators such as blood lipid HbA1c (≤ 6.5%) at 48.9%, glucose when hungry was only at 14.2% and blood pressure (110/70 mmHg - 120/80 mmHg).
The reduction of indicators of waist, weight, obesity and alarm bell is not statisticcally meaningful.
Consultation provided positive improvements in terms of knowledge, attitute toward practice and statistically meaningful reduction of HbA1c, glucose when hungry, blood lipid and blood pressure đường huyết đói, lipid máu, huyết áp.. Abbreviations: DTD: Diabetes, DH: glucose, HA: blood pressure, TTGD: communication and education, TTGDSK: health education and communication, WHO: World Health Oganization, NCEP: National Cholesterol Education Program, ADA: American Diabetes Association, IDC: International Diabetes Center.
Keywords: Albumin, chronic kidney disease.
Material: In this study, we validated the serum albumin and some asociated factors in 108 chronic kidney failure patients with eGFR < 60 ml / ph.
Method: Descriptive cross - sectional study.
Results: Average age of patients 46.75 ± 15.9, male / female ratio 3/1.
There are 37.9 percent patients who have serum albumin above 35 g / l, 39 percent patients who have serum albumin level > 30 g / l and < 35 g / l, 23.1 percent patients who have serum prealbumin < 30 g/l.
TO EVALUATE THE DIAGNOSTIC EFFECTIVENESS AND THE LONG-TERM RESULTS OF LAPAROSCOPIC SURGERY IN TUBAL-INFERTILITY AT MILITARY HOSPITAL 103 Objectives: to evaluate the diagnostic effectiveness & the long-term results of laparoscopic surgery in tubal-infertility.
Subjects & methods: A prospective and cross - sectional study on 180 cases of tubal-infertility that managed by laparoscopic surgery at Military Hospital 103 from 01/2003 to 01/2013.
The results: Laparoscopy not only shows the accuracy in the investigation of the patency of Fallopian tubes, but also shows degrees of tubal damage, tubal adhession and the the causes of tubal blockage, that help surgeon to choose the methods of operative-laparoscopy for treatment of tubal-infertility or decide to convert patients to Invitro-Fertilization (IVF).
The long-term effectiveness of laparoscopic surgery for treatment of tubal-infertility: The post-operative - laparoscopy pregnancy rate was 40.5%, of that: 37.7% was intra-uterine-pregnancy & 2.8% was ectopic pregnancy that depends on degrees of tubal damage, methods of operative-laparoscopy & post-operative-laparoscopy period of time.
Conclusion: the laparoscopic surgery plays an important role in the diagnosis and treatment of tubal-infertility.
Keywords: tubal-infertility; laparoscopic surgery.
ANATOMICAL FEATURES OF TEMPORARY COLOSTOMY The morbidity of temporary colostomy is closely related to indications, technics and anatomical features of the colostomy.
Aims: describe the anatomical features of temporary colostomy at Viet Duc hospital.
Patients and Methods: This observational retrospective research on 131 patients above 16 years with temporary colostomy, describing the anatomical features of the colostomy before it's closure at Viet Duc Hospital from 1/2012 to 10/2014.
Results: The indication of colostomy consist of 28, 2% of severe infection of anal - perineal region, 25, 2% of colorectal trauma.
53, 4% colostomy was at sigmoid colon, the average time to close the colostomy was 4, 6 months.
Conclusions: the main indications of colostomy are severe infection of anal - perineal region and colorectal trauma.
The variation of the site and the type of colostomy depends on purpose of treatment.
Keywords: temporary colostomy, anatomical feature
DESCEMET STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY FOR PHAKIC EYES WITH BULLOUS KERATOPATHY: RESULTS AND COMPLICATIONS Objective: To evaluate results and complications after Descemet stripping automated endothelial keratoplasty (DSAEK) combined with phacoemulsification and intraocular lens (IOL) implantation for phakic eyes with bullous keratopathy.
Adjustment of intraocular lens power allows to compensate for the hyperopic shift.
Complications found in our series were upside-down graft, graft failure and intraocular hypertension.
Keywords: endothelial keratoplasty, DSAEK, bullous keratopathy, phaco surgery
Patients and Method: A prospective no controlled clinical trial study on 17 eyes of 16 patients underwent DSAEK and concurrent phacoemulsification with IOL implantation.
The main outcome measures include surgical result (best spectacle corrected visual acuity (BSCVA), calculated and implanted IOL power, refractive status); intraoperative and postoperative complications.
Results: Preoperatively, BSCVA of 14/17 eyes (82.4%) was lower than CF 3m.
At 6 months postoperatively, surgical success rate was 14/17 eyes (82.4%), among them there were 13 eyes (92.9%) which had BSCVA more than 20/70.
After adjustment of average +1, 04D ± 0.97D to calculated IOL power, postoperatively mean SE is +0.87D ± 2.22D (from - 3.0D to +5.88D).
After suture removal, the mean astigmatism at 6 months postoperatively was only 1.27D ± 0.86D.
Surgical complications included up-side-down graft (1 eye), graft failure (3 eyes) and intraocular hypertension (5 eyes).
Conclusion: DSAEK combined with phacoemulsification and IOL implantation is an effective method in management of phakic eyes with bullous keratopathy.
KNOWLEDGE OF THE BUSINESS OF FOOD SAFETY IN 6 COMMUNES / WARDS OF NINH BINH CITY IN 2015 A cross sectional survey of 130 people producing food processing in the 6 communes / wards of Ninh Binh city in 2015 showed that the majority of producers are women (67.7%), mainly in the working age, from 31 - 60 years (86.9%).
Nobody overall satisfactory food safety knowledge in both inner city and suburban.
Keywords: food safety, knowledge
Educational attainment of the direct production process is high half (50.8%).
GPA on food safety knowledge of the inner city and suburban 21.1 21.5.
GPA of both areas is 21.2.
The total average score for men was 21.6 and 21.1 for females.
GPA's food safety knowledge with secondary level was 20.7.
GPA higher food safety knowledge of qualified people THTP 21.3.
Highest on THTP qualified persons was 22.3.
Rate producer satisfactory general knowledge on food safety in the inner city 2 and suburbs is 51.5%.
KNOWLEDGE, ATTITUDE AND PRACTICE ABOUT CONTRACEPTIVE PILLS OF HANOI STUDENTS Circumstances, the reasons for the study: Vietnam is facing with many issues related to adolescents and youth.
Methods: Design the cross-sectional descriptive study, using pre-designed questions to guide 2700 students who are formal, the first year, unmarried students of six universities or colleges in Hanoi read and fill out the self - study.
Results: Only 69.6% and 78.3% students know about the daily contraceptive pills and emergently contraceptive pills.
Percentage of students know about the indications and using time are low, from 2.0% to 43.7%; 28.2% of them uncertain with opinion "Using daily contraceptive pills is the best choice for adolescents who have sexed".
There are 12.4% and 2.9% students agree / strongly agree with the view "Using emergency contraceptive pills is the best choice for sexually active adolescents".
The ratio of students are used daily contraceptive pills for the first time and the recent time is 0.0%; 0.7%, the rate for emergently contraceptive pills is 14.2%; 13.0%.
Conclusion: Knowledge, attitudes of students about contraception is limited while 16, 2% of them had sexed.
Keywords: Contraceptive.
CLINICAL, PARACLINICAL FEATURES AND RESULT OF GENEXPERT TEST IN BRONCHOALVEOLAR LAVAGE FLUID OF SUSPECTED PULMONARY TUBERCULOSIS PATIENTS Objectives: 1.
Positive Mantoux test: 23.4%.
Chest CT: injuries accounted for 44.9% coagulation, 23.5% node lesions.
Bronchoscopy: no lesions accounted for 34.7%, the most common is the right upper lobe lesion 22.4%, 17.3% left upper lobe.
In diagnosed tuberculosis patients, GeneXpert test has Se 77, 4%, Sp 100%, PPV 100%, NPV 91%.
The case of culture-positive TB bacteria, GeneXpert test has Se 92, 9%, Sp 85, 1%, PPV 54, 2%, NPV 98, 4%.
Conclusion: In the our study, the sensitivity and specificity of the GeneXpert test in bronchoalveolar lavage were hight and It should be used as the initial diagnosis test in individuals suspected of having pulmonary tuberculosis.
Keywords: Tuberculosis, ESP, Genexpert.
Describe the clinical and paraclinical features of suspected pulmonary tuberculosis patients treated at the respiratory center Bach Mai hospital 2.
Age over 60 accounted for the highest percentage of 33.7%.
The common clinical symptoms: fever 53.1%, fatigue 36.7%, productive cough 51%, cough and chest pain accounted for 37.8%, 37.7% crackles.
The objective is to analysis some risks of APOs including spontaneous abortions (SAs), stillbirths (SBs) and birth defects (BDs) in Phu Cat district, Binh Dinh province.
Cross - Sectional Analytic Study that consists of 6, 600 women from 15 - 49 years old who had been pregnant is conducted in Phu Cat district at the time of 1/2012.
Data analysis is based on multivariable logistic regression model.
The research shown that parity ≥ 3 is at higher risk of all three types of APOs (p <0.001).
SA - related factors are women's age ≥ 35 (aOR = 3.66; p < 0.01); living in the mountainous areas (aOR = 2.03, p < 0.05), in the vicinity of Phu Cat Airport (aOR = 2.82, p < 0.01); exposure to pesticides and herbicides before and during pregnancies (aOR = 1.27 with p < 0.05 for husbands and aOR = 1.34 with p <0.01 for wives).
SB - related factors are women's age ≥ 35; 1st pregnancies of mother whose husbands had had smoking habit of ≥ 6 years (p < 0.05).
BD - related factors are genetic diseases of husband (aOR = 1.9, p < 0.05).
Keywords: Adverse pregnancy outcomes, spontaneous abortions, stillbirths, birth defects, toxic chemicals during the war, smoking, pesticides and herbicides.
On clinically, 10 flaps have been used including 8 flaps survival, 2 flaps necrosis.
Conclusion: DIEP flap is ideal material for breast reconstruction, understanding the anatomical characteristics of the perforator can aid the surgeon in more harvesting safety the DIEP flap.
The perforator presents a rectilinear course is usually in lateral row and easydissection than the perforator presents an oblique course.
The anatomical variations may make difficulties for the surgeon and affecton the safety of the DIEP flap.
The purpose of study is to investigate anatomical vascular of the deep inferior epigastric perforator flap and its clinical applications.
Results: 131perforator vessels dissected from 30 flaps, average 4, 37 per/1flap.
78 (59, 54%) perforators in a medial row with 62 (79, 49%) perforators is oblique course.53 (40, 46%) perforators in a lateral row with 39 (73, 58%) is rectilinear course.79 (60, 3%) perforators locatein a distance of 10 - 40 cm from the umbilicus.
Vascular complications were: 3/64 patients (4, 68%) were arterial stenosis 3 months posoperation with good results by to put arterial stents. Not complication of thrombosis post-operation.
Keywords: Anastomosis vasculary in the Renal transplantation.
We report the result of the vascular anastomosis in the renal transplantation from living donor at 115 people's hospital.
Patients and Methods: Patients were operated renal transplantation at 115 people's hospital from february 2004 to april 2014.
Determine vascular complications by the physical examination and paraclinical examination.
A prospective, descriptive study was performed.
Results: All 64 patiens in this study.
The mean age: 41, 42 ages ± 11, 65 (19 - 69 ages), 44 males (68, 75%) and 20 females (31, 25%).
7/64 patients (10, 93%) has more than 2 arteries, 2/64 patients (3, 12%) with 2 renal veins.
10/64 patients (15, 62%) realized vascular anastomosis irregular in there 9/64 patients (14, 06%) has to transpose the vein.
Conclusion: Laser suture lysis is a safe and effective method of promoting filtration following trabeculectomy.
CLINICAL AND LABORATORY FEATURES AND TREATMENT OF RENAL FAILURE DUE TO ACUTE PANCREATITIS Objectives: To describe clinical and laboratory features and to assess the treatment of acute renal failure due to acute pancreatitis.
Methods: An observational study was performed on 68 acute renal failure patients caused by acute pancreatitis at the intensive care unit of Bach Mai hospital from 09/01/2012 to 08/31/2014.
Results: The incidence of acute renal failure caused by acute pancreatitis was 23, 1%.
RIFLE class R 35%, class I 43% and class F 22% (according to RIFLE classification [1]).
The renal function of R, I class returned to normal on the second - the third, F class on the fifteenth - sixteenth.
The mortality rate was 11, 7%.
CONTENTS OF SKILLS TRAINING AND STUDENTS' FEEDBACK The study was conducted with 371 medical students.
Objectives: To study opinions of students about contents of skills training at Hanoi Medical University Results: Skills training course had 33 skills, including examination, procedures and patient safety which were very appropriate to teach medical students (92.5%; 96.8%).
Contents of skills and learning objectives were suitable for students (97.3%; 98.1%), teaching-learning checklists were easy to understand and very useful when learning skills (91.6%; 96.8%).
Assessing checklists could help students self assessment better (96.5%).
Students learnt and practiced skills generally by checklists (81.1%; 92.2%).
Training courses provided opportunities for students to practice skills well (98.4%).
Using simulated patients in training skills were very appropriate and helped students learning better (95.4%; 94.3%).
Conclusion: The contents of skills training course was appropriate to teach students with useful learning objectives and checklists.
This course have created a good opportunity for students to practice skills with model and simulated patients.
CONTRAST-INDUCED NEPHROPATHYIN PATIENTS UNDERGOING CORONARY ANGIOGRAPHY AND PERCUTANEOUS CORONARY INTERVENTION IN THE MILITARY HOSPITAL 103 Objectives: To investigate the changes in serum urea and creatinine levels and contrast-induced nephropathy in patientsundergoing coronary angiography or percutaneous coronary intervention.
Subjects and methods: 136 patients undergoingcoronary angiography or PCI were enrolled.
Result: Serum creatinine level after coronary angiography andPCI was higher than before procedure.
There was no significant difference between serum urea level after coronary angiography and PCI and before procedure.
Eight (10.7%) patients undergoingPCI and 2 (3.1%) patients undergoing coronary angiography without PCI hadCIN CIN was encountered in 8.0% patients aged over 75 years, 6.3% diabetes patients, 11.1% chronic renal failure patients and 14.3% NYHA III-IV heart failure patients.
Conclusion: Serum creatinine level after coronary angiography andPCI increased CIN occurred in 7.3% cases.
Key words: Contrast-induced nephropathy, Serum creatinine, Percutaneous coronary intervention.
Histopathology’ s small-intestinal resections due to crohn disease
Three cases of small intestine Crohn disease are observed in bowel resection specimen for perforation or for occlusion during the period April - October 1999 in our AP lab...
The combination of acute blood loss and cancerous condition in patients with ruptured hepatocellular carcinoma (rHCC) requires a multi disciplinary approach in management.
The initial objective of management is hemostasis and haemodynamic stability and after that to assessfor the remaining liver function.
In case of unstable hemodynamic conditions, treatments should be considered as transcatheter arterial embolization (TAE), liver resection or TAE then elective liver resection and those approachs are shown effective.
However, no randomized controlled trial nor well-designed comparative study has been performed to determine the best method for hemostasis.
Most of the evidence comes from cohort studies.
Liver resection is still method of choice in cases where the tumors is rectable cut and located in the peripheral and good critical care settings.
Keywords: Ruptured hepatocellular carcinoma, transcatheter arterial embolization, emergency liver resection.
Evaluation of the critical illness polyneuropathy in the intensive care unit by electromyography
Objective: The nerve conduction and needle EMG studies and relationship evaluation between clinical and electrophysiologic of critical illness polyneuropathy.
Although specific therapies have not been discovered, the supportive treatment, the aggressive management of sepsis and the elimination of contributory medications may be beneficial.
Moreover, the nerve conductions displayed minor changing with prolongation of distal motor latencies, F wave latencies and the slowing of nerve conduction velocities, reduction of amplitude of compound muscle action potentials and sensory nerve action potential amplitudes.
Conclusions: The Critical Illness Polyneuropathy (CIP) in Intensive Care Unit (ICU) usually an acute axonal motor - sensory polyneuropathy that increased mortality.
Result of conservative management for right sided colonic diverticulitis
Background: The optimal management of right-sided colonic diverticulitis is still controversial, ranging from conservative antibiotic treatment to aggressive resection.
4/54 patients (5 times) underwent recurrent right-sided colonic diverticulitis (7.4%).
Conclusion: Conservative management with bowel rest and antibiotics could be considered as a safeand effective optionfor treating right-sided colonic diverticulitis.
Keywords: Right sided colonic diverticulitis, Conservative treatment, Antibiotic
The purpose of this study is to evaluate the value of nonoperative treatment for right-sided colonic diverticulitis..
Object and method: In this prospective interventional study, 81 consecutive patientsare diagnosed right sided colonic diverticulitis who received conservative treatment with bowel rest andbroad-spectrum antibiotics from January 2012 at the People of Gia Đinh Hospital.
The treatment was selected bythe patient.
Results: The median age was 36 (17 - 72 years) withfemale was 37%.
All patients presented with acute right abdominal pain.
The mean duration of symptoms was 1.7 days (range: 1 - 7days).
No morbidity and mortality. The average treatment time 5 days (1 - 10 days). The meanfollow-up length was 35 months with 54 patients are still connected.
Noise levels in a neonatal intensive care unit
Objective: The aim of this study was to describe characteristics of the noise level in a Neonatal Intensive Care Unit.
Method: Noise levels (dB) were collected at different periods and areas in the Neonatal Intensive Care Unit of Children's Hospital 1 Vietnam.
Results: Mean sound level was highest on Monday (76.4 ± 2.7 dB) and lowest on Saturday (67.3 ± 1.9 dB).
Data also showed that administration area had the highest noise level (78.4 ± 3.4 dB) and isolation area had the lowest intensity (66.4 ± 8.2 dB).
Some factors may contribute to increased sound levels were stated as healthcare instruments, pulse oximeters alarm sounds and high-frequency oscillatory ventilators.
Conclusion: Noise levels in our Neonatal Intensive Care Unit were found to be above the levels recommended by the American Academy of Pediatrics and the American Environmental Protection Agency.
Keywords: Noise level, neonatal intensive care unit.
Background: Sodium salt intake has been widely known as one of the risk factors of high blood pressure.
Mean sodium salt intake in males (12.7 g / day) was higher than that in females (10.5 g / day), p< 0.05.
The intake was highest in Thua Thien Hue (12.3 g / day), followed by Ho Chi Minh city (11.1 g / day) and Ha Noi (10.7 g / day).
Conclusion: In conclusion, sodium salt intakes in adults in studied sites were 2 times higher than recommendation of World Health Organization.
Intervention studies should be conducted in future to reduce salt intake in order to control high blood pressure in community.
However, there has not been any large survey on sodium salt consumption in whole country since over 10 years, while prevalence of high blood pressure has been increasing in Vietnam.
Objectives: to assess sodium salt intake in seasonings in adults living in Hanoi capital, Thua Thien Hue province, and Ho Chi Minh city.
Methods: A cross - sectional study was conducted in 2008 - 2009.
A total of 1518 subjects participated in the study.
Seasoning intake was evaluated by weighing method at household.
Sodium content in seasonings was assessed by High-performance liquid chromatography (HPLC) method, then sodium salt content in the seasoning was calculated based on molecular weight of NaCl.
Therefore, sodium salt intake was equal to amount of seasonings multiply with content of sodium salt in the seasonings.
Cardiac tumor
Particularly, there were 2 cardiac myxomas in right ventricle (1 intracavitary and 1 intramural).
The authors also met a case of hemangioma in the wall of left atrium.
The study was carried out at the K hospital in 346 premenopausal breast cancer patients tages II, III with ER and axillary lympho node positive. The rerults show that the recurrent rate decrease significaltly in group treated by chemotherapy combine with hormonaltherapy cmpare with hormonaltherapy alone group (15, 6% Vs 28, 3%).
The desease free survival rates after 1; 2; 3; and 4 years are also higher in adjuvant chemotherapy group compare with control.
These rates are 97, 53% vs 90, 56%; 88, 38% vs 74, 77%; 80, 05% vs 59, 28%; 75, 51% vs 51, 64%.
The overal survival rates are higher in treated group compare with homaltherapy alone group. These are 100% vs 93, 89%; 96, 01% vs 87, 99%; 88, 98% vs 84, 56%; 87, 09% vs 80, 53%.
However, there is no significal different in 3rd and 4th year because of treatment after recurrent
Calibrating out-put of photon beams from radiation therapy linacs system at national cancer hospital, comparing results with national and international levels
The accuracy and stability of the out-put (dose rate) of external beam facilities, in general and of Radiation Therapy Linacs, in particular plays a very important role related to outcome of cancer treatment.
How to assure and maintain the stability as well as the accuaracy of those out-puts is strongly depended on competency and experience of Medical Physicist (s) at the Radiation Oncology Institution.
The content of this paper present the methods of national and international external audit to assess the stability and accuracy of dose rate for photon beams from the Linear Accelerators system at K Hospital, Hanoi.
The TLD batches of LiF in the form of capsule were irradiated with the dose of 200c Gy (200MU) at the depths of 5 cm for energy of 6MV and 10 cm for energy of 15MV.
The results were compared to the VAEI, Newcastles Hospital - Australia and IAEA.
They are very reassuring with the accuracy of is 99.7% and 100.6% for 6MV and 15MV respectively.
On night-time EEG, the frequency of EDs was 69.2%; EDs from temporal regions, frontal regions, total frontal and related regions were 23.1%, 21.2% and 34.6%, respectively.
Night-time EEG, as compared with day-time EEG, was associated with higher frequency of EDs (RR = 1.84).
Conclusion: Prolonged night-time EEG is an useful technique in determining epileptiform discharges in epileptic patients.
Keywords: electroencephalogram, epileptiform discharges.
Backgroud: Electroencephalogram is one of the most important technique in supporting diagnostic epilepsy.
For these reasons, we performed EEG in night-time period with many hours to evaluate epileptic patients.
Methods: This was a case series study of 52 epileptic patients at International Neurosurgery Hospital from Oct 2013 to Apr 2014. Two EEG recordings of every patient in which the first EEG was day-time EEG in 15 - 20 minutes and the second one was night-time EEG in 7 - 10 hours.
Results: On day-time EEG, the frequency of EDs was 32.7%; EDs from temporal regions, frontal regions, total frontal and related regions were 11.5%, 3.9% and 13.5%, respectively.
Anaemia and iron deficiency anemia in the first trimester of pregnancy in thu duc district hospital, in 2020
Background: Anaemia in pregnancy is a significant global health problem.
Keywords: anaemia, iron deficiency anemia, pregnant women, first trimester
It is estimated that iron deficiency anaemia accounts for approximately 50% of cases.
Previous studies claimed that maternal anemia was risk factor for adverse pregnancy outcomes such as low birth weight, postpartum hemorrhage, preterm birth, and increase the risk of maternal and perinatal mortality.
Objectives: To investigate the prevalence of anemia and iron deficiency anemia in the first trimester of pregnancy and its associated factors among pregnant women who visited Thu Duc District Hospital.
Prevalence and care, sanitation habits study related diarrhea in children under 5 years in tien giang province
According to the World Health Organization (WHO), the annual worldwide there are about 1.3 thousand million episodes of diarrhea occurred in children under 5 years.
Indeveloping countries, where the average number of episodes of diarrhea per child per year within this age group is 3.3, has about 4 million children deaths from this disease. Objectives: To determine the prevalence of diarrhea in children under 5 years old in Tien Giang province and identify routine care, environmental sanitation-related diarrhea in children under 5 years in Tien Giang province. Method: Cross-sectional study. Results: Over 719 women surveyed in 30 communes in the province of Tien Giang in 2009, we recorded the prevalence of diarrhea among children under 5 years old in the past year is 34.08%.
Factors: Eating cool food, hand washing habits of mother before eating, hand washing habits of children before eating and using the toilets is clearly related to diarrhea. Conclusion: The prevalence of diarrhea in Tien Giang province is relatively high.
The eating habits and personal hygiene is very influential to the onset or spread of diarrhea in children.
Effectiveness of endovenous laser ablation in treating the incompetent saphenous vein
Objective: To assess the safety and preliminary efficacy of endovenous laser treatment in eliminating the incompetent saphenous vein.
Methods: 70 patients with reflux at the saphenous vein were treated endovenously in a descriptive study.
Patients were evaluated at 1 week and at 1, 6 months to determine efficacy and complications.
Conclusion: Endovenous laser treatment is a highly effective procedure for eliminating saphenous venous reflux in varicose veins.
In this study, we report the results of H pylori infection diagnosis with Urease test on the biopsy specimen in 200 peptic ulcer (PUD) patients.
With 83.5% patient having used drugs before endoscopy, the percentage of H pylori (+) from the corpus and the antral specimen isn't significantly different (65% vs 68.5%) but using specimens from both sites increases significantly the H pylori positivity from 65% to 78%.
Quantitative determination of enantiomer of rabeprazole in pharmaceutical tablets by capillary electrophoresis method using a dual chiral selector system
Background: Rabeprazole, 2 - {[[4 - (3-methoxypropoxy) - 3-methyl-2-pyri-dinyl] methyl] sulfinyl} - 1H-benzimidazole is one of latest proton-pump inhibitors developed for suppression of gastric acid secretion by inhibition of the H+ / K+-ATPase.
Conclusion: A straightforward, expeditious, reliable method for the determination of rabeprazole enantiomers in pharmaceutical tablets was developed and validated.
Keywords: esomeprazole, rabeprazole, capillary electrophoresis (CE), cyclodextrin derivatives (CD)
It is one of the most potent therapeutic agents used for treatment of several gastrointestinal disorders such as gastric and duodenal ulcers.
Objectives: The aim of this study is to develop an analytical method based on CE using two types of cyclodextrine derivatives for the determination of rabeprazole enantiomers in pharmaceutical tablets.
Methods and subject: Subject of study was pharmaceutical tablets of Rabeprazole.
Rabeprazole was determined by CE with DAD detector.
Comparison of pcr-rflp and mlpa for detection homozygous deletion of exon 7 and 8 of smn1 gene in patients suspected sma
Background: Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder.
SMA incidence is approximately 1 in 10, 000 live births and the carrier rate is 1 in 40 to 1 in 50.
The prevalence of propionibacterium acnes and their in vitro antibiotic resistances in patients with vulgaris acne in hospital of dermato-venereology in ho chi minh city
The relations between MIC with factors: disease duration, family history, and previous history of therapy for acne were surveyed.
There was not any relation between MIC and the factors: disease duration, family history, and previous history of therapy for acne.
Conclusions: Clindamycin and Trimethoprim / sulfamethoxazole for treating vulgaris acne are not recommended in HDV HCMC.
Tetracycline, Doxycline, and Minocycline should be considered in treatment of acne.
Antibiotics therapy in acne extends several months, and the failure in treatment relates to the development of resistant propionibacterium strains.
Antibiotics resistant characteristics of P acnes change in different countries.
In Viet Nam, there has not been any study on isolation of P acnes and their antibiotic-resistance.
Studying this problem will support physicians in medical practice.
Objective: To determine the prevalence of Propionibacterium acnes and their in vitro antibiotic resistances in patients with vulgaris acne in Outpatient Department of HDV HCMC.
Methods: A case series study was designed.
All patients with vulgaris acne satisfying recruited criteria were examined and extracted comedone for culturing P acnes.
Resistance to antibiotics was defined by minimal inhibitory concentration (MIC) according to EUCAST.
The prevelence of helminth infections in southern region – lam dong province and evaluation of community – based helminth prevention methods
Background: Soil-transmitted helminth infections are one of the most common infectious diseases in the whole world and affect to poor people and underdeveloped communities.
Keywords: helminth deworming, neglected tropical diseases, community communication
Helminth diseases have so far been classified as "Neglected tropical diseases (NTD)", without adequate investment, only a few domestic and foreign organizations supported high-risk regions preventing helminths, but not regular.
Therefore, the application of some community-based helminth prevention in the Southern region - Lam Dong province is necessary.
Objectives: To determine the prevalence of helminth infections in the Southern region - Lam Dong province and to evaluate the effectiveness of community-based helminth prevention methods.
Methods: Descriptive cross-sectional study and community intervention.
Results: The prevalence of soil-transmitted helminth infections was 24.46% (171/699), flukes 0.00% (0/699), tapeworms 0.00% (0/699).
After intervention, in 3 communes, where were applied model of community-based helminth deworming by Mebendazole 500mg after 6 months and 12 months, the prevalence of soil-transmitted helminth infection was 1.71% (12/700) and 2.00% (14/700).
In 3 other communes, where were applied model of community communication and environmental sanitation after 6 months and 12 months, the prevalence of soil-transmitted helminth infections was 5.29% (37/700) and 4.86% (34/700).
Conclusions: This study determined the prevalence of helminth infections and flukes in the Southern region - Lam Dong province and evaluated the effectiveness of community-based helminth prevention methods.
Study of the lung cancer at binh dan hospital 2014-2016
Background: Lung tumor is very different.
On examination: dicrease of respiration in one side 12%.
X ray: tumors 75%.
tumor of the left lung 30%, right lung 45%.
CT: tumors of the left lung 27%, tumor of the right lung 48%.
Bronchoscopy: Tumor and biopsy or lavage, tumor + 70%.
Thoracoscopy: Peripheric tumor, biopsy 62%.
Surgery: 36 patients were operated.
All are thoracoscopy.
When tumor in stage I and II, no adhesion of thoracic wall, with respiration function more than 50% FEV1, we operated by thoracoscopy.
When the tumor is above 2 cm, 80% is cancer.
In 36 patients, 26 patients were cancers: Adenocarcinoma (ACA) (18), Squamous cell carcinoma (SCCA) (6), Large cell carcinoma (2), Small cell carcinoma (0).
Results: Patients were transferred to thoracic ward in 12 - 24 hours.
In 24 - 48 hours, drain was retired when Xray of the thorax that the lung is good expanded.
Complications: - Bleeding: 1 cases we must perform thoracotomy to stop bleeding.
- Respiration failure: 30% the lung is still collapse partially.
- Infection: 4 cases having infection of the wound but no severe.
Death cases: none.
Objective: Accessed the diagnosis, pathology classification and evaluated the stage of lung cancer. We perform the operations and follow-up the results.
Conclusion: Nowadays, thoracoscopy of pulmonary cancer is in majority of cases.
The tumor may be detected early.
Materials and method: It is a retrospective, case-series study.
With symptoms and signs of tumors of the lung.
Results: Epidemiology: Male / female 3/2, middle age 42, 55% habited in the city, 40% smoking during many years.
Clinical picture: Thoracic pain 72%, cough 53%, hemoptisy 24%, fever 20%, loss of weight 17%.
Survey of serum procalcitonin in children aged from 2 months to 15 years with pneumonia admitted to dong thap general hospital
Objective: Explore serum procalcitonin levels (PCT) by Brahms-PCT-LIA test and assessthe correlation between PCT and severity of pneumonia, serumC-reactive protein levels (CRP), white blood cell counts (WBC), rate of peripheral blood neutrophils, chest X-ray.
Results: 72% of 150 surveyed children with pneumonia had normal serum PCT level (<0.5 ng / ml), 18.7% of them had PCT increased from 0, 5 to 2 ng / ml and 9.3% of them had PCT>2 ng/ml.
There was correlation betweenseverity of pneumonia (p <0.001), serum CRP levels (p <0.001), types of lesions on chest X-ray (p <0.05) and PCT levels.
Conclusion: 72% of children with pneumonia had normal serum PCT levels.
Severity of pneumonia, serum CRP levels and alveolar infiltrationrate on chest X-ray increasedwith increasing levels of serum PCT whereas interstitial infiltrationrate had downtrend.
Characteristics of pneumonia after open heart surgery at nhi dong 1 hospital from 06-2008 to 06-2010
Objective: To determine epidemiological, clinical, paraclinical characteristics, pathogens, and treatment of pneumonia after open heart surgery in Nhi dong 1 hospital, and the factors related to pneumonia. Method: A cross-sectional study was performed on 207 patients operated in Nhi dong 1 Hospital from 06 - 2008 to 06 - 2010 for repair congenital heart diseases (CHD).
48.3% of cases had the past history of pneumonia.
28.3% of cases had to be hospitalized because of pneumonia just before surgery and the average duration of treatment was 11 ± 16.2 days.
Diagnosis of pneumonia was done 3.1 ± 2.9 days after surgery.
55% of patients acquired pneumonia while they were being on ventilator.
90% patients acquired pneumonia in the Intensive care unit.
46.7% had fever which appeared after surgery 26.3 ± 27.9 hours.
Dense pus in the intubation tube was present in 40% of cases; 18.3% had cough; 70% had tachypnea and 100% had chest retraction (on 27 extubated patients); 91.7% had rales on lung field.
Average value of CRP was 42.7 ± 36.7 mg / L.
Hematogram demonstrated increasing of white blood cell (WBC) (16, 011 ± 2.622 / mm3, 78.3% had WBC > 12.000 / mm3), anemia 28.3%, blood platelets < 100.000 / mm3 in 10% of cases.
The rate of positive blood culture was 9.1%, of positive sputum culture in intubation tube and in NTA were 28.6% and 14.3%.
14 of 17 positive-culture cases showed infection of Acinetobacter, Klesiella, Enterobacter, Escherichia coli which were sensitive to Ceftazidim, quinolones, Imipenem, Ticarcillin and Polymycin B; 2 cases infected Staphylococcus coagulase negative which were sensitive to Vancomycin and Rifampicin; 1 case infected Candida albicans infections.
70% had diffuse leision on chest X ray.
First antibiotics empirically given were Ceftriaxon 43.3% and Vancomycin 28.3%.
Only 29.4% of cases were given first antibiotics appropriated with antibiogram.
Fever disappeared 22 ± 46.1 hours after using antibiotics; the duration of antibiotic treatment was 22.45 ± 30.25 days.
Pneumonia cases were collected and decribed. Comparision between pneumonia patients and the others was done to find the factors related to pneumonia.
The mortality of pneumonia was 1.67%.
Factors related to pneumonia after open heart surgery were chilren under 12 months old, girl, complex congenital heart disease, history of pneumonia before surgery, severe pulmonary hypertension, open chest, other complications beside pneumonia, time of cardiopulmonary bypass, ventilaton, central catheter, chest tube, urine tube and hospitalization. Conclusion: Activities of control nosocomical infection is very important to decrease the rate of post-operative pneumonia.
The high risk patients (children < 12 months old, complex congenital heart disease, severe pulmonary hypertension, pneumonia just before surgery) should be given a different prophylactic antibiotic instead of cefazolin.
Combination of antibiotics should be considered to cover both positive and negative-gram bacteria in treatment of pneumonia after open heart surgery.
Chi square, Student and Fisher tests were used to determine these factors. Results: 60 cases (28.99%) had post-operative pneumonia.
Average age was 11.9 ± 9.5 months; almost patients was under 12 months old (63.3%).
Female: male ratio was 1.3: 1.
Pneumonia occurred more commonly in patients with complex CHD than in patients with simple CHD (p = 0.003).
3.3% had non-cardiac malformations.
Comparision of chirocaine and isotonic bupivacaine for combined spinal-epudural for hip replacement in elderly patients
Intergroup differences between chirocaine and bupivacaine were insignificant both with regarde to the onset time and the duration of sensory and motor blockade (2, 5±1, 7min versus 3±1, 8min; 61, 6±13, 5min versus 60, 7±13, 6min).
Objective: The standard treatment of high and intermediate anorectal malformation (ARM) have high complication rate of the colostomy and multiple anesthesias.
All patients were evaluated as regard to operative details, postoperative complications, and bowel function on short and long-term follow up, which ranged from 6 to 52 months.
Results: All most patients were treated entirely through the posterior sagittal and fistula transposition approach 100 cases (99.1%); except one male patient with rectovesical fistula, who required laparotomy.
Without intraoperative and anesthetic complications.
Three patient died after surgery because of the bacteremia condition.
The hospital stay ranged between 4 - 43 days (median 15 days).
Postoperative anal stenosis occurred in 12 patients, all treated with anal dilatation.
Constipation occurred in 10 patients (15.22%).
30 patients (32.6%) have incontinence but only one patient more than 2 years.
Conclusion: One-stage repair of intermediate and high ARM both in male and female neonates is technically feasible and safe.
The economic and psychological burden to the family.
The early postoperative complications are acceptable and can be managed successfully.
It avoids the risk of complications related to colostomy, the risks of multiple anesthesias and reduces the economic and psychological burden to the family.
Keywords: Anorectal malformations, primary repair, neonates.
A growing interest in one - stage correction of ARM was noted recently.
The aim of this study was to examine the feasibility, safety, and short-term outcome of primary repair of high and intermediate ARM in neonates.
Methods: This prospective study included 101 infants (40 females and 61 males) with either high (n = 59) or intermediate (n = 42) ARM treated in Children hospital during a period of 4 years duration from January 2007 to June 2011.
Preoperative imaging using ultrasonography and X-ray was performed to assess the severity of ARM and any associated anomalies.
Virtual screening on caspase-1 inhibitors
Background - Objectives: Caspase-1 is an enzyme which plays an important role in the metabolism of interleukin-1β, a pre-inflammatory cytokine of many immune responses.
Conclusion: With the obtained results, it is neccessary to perform the in vitro and in vivo bioactive assays of 26 potential caspase-1 inhibitors.
Keywords: caspase-1, interleukin-1β, interleukin-18, osteoarthritis, rheumatoid arthritis
Inhibition caspase-1 reduce the synthesis of interleukin-1β and interleukin-18, which alleviates progress of diseases, such as osteoarthritis and rheumatoid arthritis.
Virtual screening models have been generated to explore potential caspase-1 inhibitors from chemical databases.
Material - Method: In silico modelling, including 3D pharmacophore, 2D-QSAR and docking, were developed based on the database of 134 caspase-1 inhibitors and caspase-1 crystal structure with pdb code 2hbq.
Results: The six-feature 3D pharmacophore model consisting of one hydrophobic interaction feature, four hydrogen bond acceptor and one hydrogen bond donor was used to screen the similarity conformations of the actives.
The 2D-QSAR model was applied on prediction of active compounds.
The docking modelling on 2hbq structure showed that there are interactions between ligands and important residues, such as Arg179 and Cys285.
The virtual screening were resulted in 26 hit with highly caspase-1 inhibitory activities.
Characterics of upper gastrointestinal bleeding in the elderly at the cho ray hospital
Background: Upper gastrointestinal bleeding (UGIB) in the elderly is a common medical emergency.
History of UGIB accounted for 25%, including hemorrhagic rupture of esophageal varice account for 15%, due to duodenal ulcer 10%.
History of anti-inflammatory drugs accounted for 56.1%.
Co-morbidity accounted for 79.2%. In which most cardiovascular diseases, hypertension, osteoarthritis.
The motarlity rates increase with the number of co-morbidity.
In 33 cases of UGIB on alone, only 3 deaths (8.3%), while 27 cases more than three co-morbidity the 13 death cases accouted for 48.1% (p = 0, 001).
The main causes of death was co-mobidity (67.74%).
Conclusion: UGIB in the elderly usually admitted later, in a state of shock with severe or multiple co-mobidity associated.
Gastrointestinal bleeding in the elderly is difficult itseft held, or recurrent, multiple blood transfusions.
Although, there are many advances in diagnosic and treatment but mortality rates from gastrointestinal bleeding almost no decline over recent decades, and mortality in patients with gastrointes intestinal is largely due to diseases associated.
Objective: identify the clinical, of subclinical gastrointestinal bleeding in the elderly, the other factors related to recurrent bleeding and motarlity in internal medicine digest deparment Cho Ray hospital.
Methods: prospective studies, cross-sectional descriptive, conducted on one hundred and seventy three elderly patients was diagnosed with upper gastrointestinal bleeding, treatment in internal digestive department Cho Ray hospital from october 2010 to march 2011.
Results: the mean age of the patients was 72.06 years with male / female ratio of 1.54 times.
Hospitalized patients with atypical symptoms of UGIB 16.2% such as: abdominal pain, fatigue, dizziness, syncope, ascites, jaundices, diarrhea, inconscious, coughing blood... 16.1% hospitalizations late after 36 hours since the initial symptoms.
Patients hospitalizied in serious condition (with Hb < 10 g / dl) accounting for 75.1%.
Intradural extramedullary tumors: report of 2 cases
The spinal cord compression symptomatology caused by intraspinal tumors is often insidious in the onset, very difficult to differentiate with other pathologies. The tumor is larger when we meet the complete syndrome and usually the neurological function of the patient can not recover after total surgical resection of the tumor.
The pathological result of the tumor: Neurofibroma.
woman is admitted in hospital with bad neurologic status: paraplegia with mictural disorder.
Fortunately the patient can move slowly her lower limbs in the second post-operative day and when she returns home she have progressively motor recovery of lower limbs with the rehabilitation.
The pathological result of the tumor: Meningioma.
Study of stenosis or aneurysm of the peripheric arteries 2014-2016 at binh dan hospital
Background: In three years, 2014 - 2016, at Binh Dan hospital we recieved 188 patients who have stenosis of peripheral arteries.
24 cases have other operations.
Keywords: aneurysm / occlusion peripheral artery
Diagnosis and treament of this desease are complicated and diversified.
This research's aim is to determine the proportion of exactly diagnosis and of successfully treatments.
Meterials and method: Perspective case-series.
All patients who have stenosis or aneurysm of the peripheric arteries were performed DSA.
Results: During 3 years (2014 - 2016), at Binh Dan hospital, we received 188 patients who have stenosis of the peripheric arteries.
Ultrasonic diagnosis of dengue hemorrhagic fever in children at cantho children hospital
Method: This is a cross sectional study of 38 children with DHF in Can Tho Children Hospital.
Results: The proportion of "thickened gall bladder wall", "pericholecystic fluid", "ascites" and "pleural effusion" were 77.3%, 78.6%, 80%, 100%, respectively in the patients getting worse.
Conclusion: Ultrasound features of thickened gall bladder wall, pleural effusion and ascites can help to predict DHF shock.
To make comment on diagnosis and treatment large hepatectomy with ton that tung’s method for hepatorupture due to closed abdominal trauma and a hepatocellular carcinoma at pediatric thanh hoa hospital
Objectives: To make comment on diagnosis and treatment large hepatectomy with Ton That Tung's method for hepatorupture due to closed abdominal trauma and a hepatocellular carcinoma.
Methods: Cases stady.
Results: 3 cases: 2 cases of liver rupture due to closed abdominal trauma and a hepatocellular carcinoma was opened large hepatectomy with Ton That Tung's method in the Thanh Hoa Children's Hospital have good results.
Conclusions: Large hepatectomy with Ton That Tung's method is safe and effectively can apply in the Thanh Hoa Children's Hospital.
Keywords: Large hepatectomy with Ton That Tung's method, severe hepatorupture due to closed abdominal trauma, hepatocellular carcinoma.
Longterm outcomes of the tricuspid valve treatment in patients with mitral valve surgery at heart institute ho chi minh city from year 2000 to 2012
Objective: To evaluate the long-term outcome of the tricuspid regurgitation treatment in patients with mitral valve surgery at Heart Institute HCMC.
Predicted factors for better long-term outcomes in repaired valve patients to unrepaired ones are functional TR, normal left ventricular systolic diameter (SVG) and normal right ventricular diameter (VD).
Method: Combined retrospective and prospective cohort study with 652 patients hospitalized for mitral valve surgery with TR symptoms in the period from 2000 to 2012.
Results: 652 patients were recruited, of which 581 repaired tricuspid valve during mitral valve surgery (89.11%), 71 unrepaired tricuspid valve (10.89%).
38 died in / after surgery (5.82%) due to severe heart failure (13 / 38), septic shock (7/38) and other reasons.
Follow-up time is 6.16 ± 3.59 years.
Both groups had the same improvement in the TR grade (>2+), NYHA and PAPS when assessing at dis-charged time.
For long-term outcomes, tricuspid valve repaired patients had lower risk comparing to unrepaired ones in TR grade >2+, with HR = 0.62 (95% CI, 0: 48 - 0.81 and p = 0.001), NYHA increasing 1 grade with HR = 0.68 (95% CI, 0.48 - 0.92 and p = 0.01) and PAPS increasing > 50 mmHg with HR = 0.72 (95% CI, 0.54 - 0.97 and p = 0.03).
Conclusion: Assessing tricuspid valve treatment efficacy at dis-charge time did not showed the difference between 2 groups (repaired vs unrepaired), but long-term outcomes show the significant difference.
Tricuspid repaired patients had the lower risk of TR severe grade (>2+), NYHA increasing 1 grade and PAPS increasing > 50 mmHg compared to un-repaired ones with statistically significant (p <0.05).
Evaluation of brain mri lesions in dementia
Background: There are many specific types and causes of dementia, often showing slightly different symptoms. However, symptoms usually overlap, and it is impossible to make a diagnosis based on symptoms alone.
All of them had brain MRI abnormalities, including brain atrophy, white matter lesions, vascular lesions and ventricular dilatation.
The rate of severe white matter lesions Fazekas>1 was higher in vascular dementia compared with other dementias.
Small vessel disease was the vascular lesion which was most frequently seen in vascular dementia (100%).
Higher ratings of MTA and PA were associated with lower MMSE. Ventricular dilatation rate was the highest among patients with MMSE score ranging from 0 to 11.
Conclusion: 100% of dementia patients in this study have abnormalities on brain MRI.
Medial temporal atrophy and posterior atrophy were most frequently seen in Alzheimer's patients, but only posterior atrophy distinguished Alzheimer's disease from other dementias.
White matter lesions and small vascular disease play a very important role in vascular dementia.
In addition, the study also showed that severe degree of medial temporal atrophy and posterior atrophy and the presence of ventricular dilatation reflected the severe degree of dementia.
Keywords: medial temporal atrophy, posterior atrophy, Mini Mental State Examination.
Diagnosis may be aided by brain scanning techniques, especially brain MRI (Magnetic Resonance Imaging).
Objective: The aim of this study was to describe the brain MRI lesions in dementia and the patterns of brain MRI lesions in each type of dementia. In addition, the study also investigated relationships between severe degree of some brain MRI lesion patterns and MMSE (Mini Mental State Examination) score.
Methods: This was a case - series study.
We conducted a survey on brain MRI in patients with dementia who went for medical examination at the neurological consulting - room or were hospitalized in the Department of Internal Medicine of University Medical Center in Ho Chi Minh City from November 2012 to April 2013.
Results: 61 patients could be studied. Mean age is 75.75; female ratio is 59%.
Introduction: Pericardial effusion (PE) is the most common cardiac problem among the cardiac complications of malignant diseases.
The clinical presentation is often severe and even life threatening in the presence of cardiac tamponade.
The goal of treatment is to promptly reduce the cardiac compression for the patient and to prevent recurrence of effusion.
Objective: Evaluate the early results of partial pericardiectomy for treatment of malignant pericardial effusion (pericardial effusion due to malignant causes).
All the cases of PE were secondary from cancers of other organs (mostly from cancer of the lungs and breasts).
Survey on mould contamination and aflatoxin b1 in some kinds of material medicine in district 5 – ho chi minh city.
Objective: Determine contaminated level of mould, yeast and aflatoxin in material medicine.
Methods: Colony forming unit of mould and yeast were determined by dilution plating in general enumeration medium (PDA).
Mould identification by examination of the colony characters in general and selective media and using microscope.
Aflatoxin B1 was quantitative by ELISA.
Conclusion: It should be interested to specified limits of fungal and mycotoxin contamination in material medicine.
Background: Blood glucose control with intravenous insulin infusion therapy increases the risk of hypoglycemia.
Conclusion: Hypoglycemia was a common complication in critically ill patients with intravenous insulin infusion.
Severe hypoglycemia related significantly to increasing hospital mortality.
Keywords: blood glucose control, hypoglycemia, intravenous insulin infusion, critical care, intensive care
Objective: Identify the incidence of hypoglycemia and the rate of achieving blood glucose target in critically ill patients with intravenous insulin infusion therapy.
Results: A total of 416 patient-days and 1735 BG values were evaluated.
The rate of achieving blood glucose target was 36, 4%.
The daily incidence of hypoglycemia and severe hypoglycemia were 14.5% and 7.8%, respectively.
Throughout days of insulin infusion, the rate of patients with at least one hypoglycemia and severe hypoglycemia were 67.3% and 25.5%, respectively.
Hypoglycemia did not increase mortality significantly (OR=1.17, p=0.783), however severe hypoglycemia related to increasing hospital mortality (OR = 6.3, p = 0.016).
The risk factors of hypoglycemia included diabetes mellitus, cardiovascular diseases, admission ICU for medical conditions, renal replacement therapy and mechanical ventilation.
Pure laparoscopic technique with complete resection of distal ureter and a bladder cuff for the upper tract urothelial carcinoma
Background: Upper urinary tract transitional cell carcinomas (TCCs) are relatively rare, accounting for 5 - 7% of all renal tumors and 5% of all urothelial tumors.
Operating time: 120 minutes.
Blood loss: 100 ml.
Hospital stays: 04 days.
Conclusion: Our method has shown its clear and remarkable benefits compared to the others. It is feasible, reproducible and safe.
Keywords: Upper urinary tract transitional cell carcinomas, laparoscopic surgery.
Management of distal ureter including excision of the bladder cuff presents a significant challenge laparoscopically and has not yet been standardized.
Multiple techniques have been described to manage the distal ureter, none clearly superior to others.
The challenge has been development of a technique that is safe, easily reproducible, and oncologically sound.
Objectives: Introduce a new surgical therapeutic modality in treatment of upper urinary tract transitional cell carcinomas.
Methods: Case report study.
Results: 52 years old, male patient.
Background: The study aimed at evaluating short-term outcomes of Whipple procedure in patients with diseases of the head of pancreas and periampullary area.
Methods: Between April 1997 and October 2003, 101 patients with diseases of the head of pancreas and periampullary area underwent pancreaticoduodenectomy at the General Surgery Department, Cho Ray hospital, were analyzed.
The overall perioperative morbidity rate was 32% required relaparotomy in 5 patients.
Compared with the period of 1997 - 2001, the mortality and morbidity reduced from 11% to 6.8% and 32% to 27.5% respectively during 2002 - 2003.
Conclusions: Pancreatic fistula was not major terrible problem with high mortality after Whipple procedure and rarely required re-laparotomy as before.
It might be argued that better preoperative preparation, intensive postoperative care and major progresses in surgical techniques and introduction of octreotide lead to the favorable results of Whipple procedure.
Reconstruction surgery of face and neck defects by pectoralis major myocutaneous pedicle flap
Objective: evaluate the results of face and neck reconstruction surgery by pectoralis major myocutaneous pedicle flap.
Materials and Method: our clinical study was performed on 5 patients of pharyngeal and hypopharyngeal cancer at the ENT Department, Cho Ray Hospital: 2 cases of lateral anterior pharyngeal wall reconstruction (right piriform sinus cancer, hypopharyngolaryngeal cancer), 1 case of anterior neck skin defect reconstruction (laryngeal cancer invading the anterior neck skin), 2 cases of near total pharynx and anterio-superior mouth of the esophagus reconstruction.
Result: 100% well transformed pedicle flap, no cutaneous pharyngeal fistula, well eating and swallowing, patients satisfaction..
Conclusion: the pectoralis major myocutaneous pedicle flap has initially gained some recognizable achievements.
Keywords: reconstruction, pectoralis major myocutaneous pedicle flap
Is corticosteroid and cyclosporine treatment for hepatitis b virus related nephrotic syndrome really safea case report and literature review
Objectives: We report a case with HBV-related nephrotic syndrome who was successfully treated with an anti-viral agent Tenofovir and immunosuppressive drugs Prednisone and Cyclosporine.
Keywords: HBV-related nephrotic syndrome, membranoproliferative glomerulonephritis, tenofovir, immunosuppressive agents, children.
Method: Case report.
Results: An eleven-year-old female patient had the first-time admission in our hospital because of general edema, yellow urine and high blood pressure (PB 15/10 cmHg) on January 2015.
Blood tests encompassed albumin 1.77g%, cholesterol 8.88 mmol / l, highest creatinine 251 micromol / l, C3 37.5 mg / dl and C4 4.9 mg / dl, ANA (-), Anti DsDNA (-), 6 ENA profile (-), HBsAg (+), HBeAg (+), Anti HBc total (+), HBV-DNA 1106x106 copies / ml, Anti HCV (-), AST 80U / l, ALT 69U/l.
Urinary analysis was reported as pro ++++, ery +++, 24-hour protein quantitation was 12.6 g/1.73 m 2 / day.
Nephrotic syndrome and high blood pressure did not reduce after one-month treatment with Prednisone 2 mg / kg / day but achived complete remission of nephrosis and virology (negative serum HBeAg, HBV-DNA ≤ 250 copies / ml) with combination of immunosuppressive agents Cyclosporine, Prednisone and anti-viral medication Tenofovir.
Metabolic syndrome in type 2 diabetes mellitus in vinh long hospital
Background-Objectives: The relationship between metabolic syndrome and cardiovascular disease is well-etablished and consistent.
The root cause of metabolic syndrome is insulin resistance, and it has a substantially increased in people with type 2 diabetes accordingly.
However, the prevalence slightly varies in demographic and geographic conditions.
We conducted a study to determine the prevalence of metabolic syndrome in Vinh Long hospital. Methods: A cross-sectional study of 362 subjects with type 2 diabetes in Vinh Long General Hospital from November 2008 to August 2009.
Metabolic syndrome is defined according to the International Diabetes Federation (IDF) criteria, including abdominal obesity with at least two of high triglycerides, low high-density lipoprotein cholesterol, elevated blood pressure and high blood glucose.
Results: The prevalence of metabolic syndrome using IDF criteria was 59% in subjects with type 2 diabetes, with higher rate in females than males.
The highest proportion was hypertriglyceridaemia about 87.1%; rates of hypertension, decreased HDL-C and abdominal obesity was nearly equal 67.8%, 64.7%, 65% respectively.
The high prevalence of MS was associated with age, body mass index (BMI) and hypertension. Conclusion: metabolic syndrome is extremely common in population of type 2 diabetes mellitus
Anti-inflammatory and toxicity studies of the preparation from betel leaves extract (piper betle l.)
Mice were treated daily for 60 consecutive days. 2 test groups received orally at the dose 120 and 180 mg / kg.
Body weight was measured weekly.
Hematological and biochemical parameters, relative organ weight were determined at the end of the 60 days administration.
Results: The preparation from Betel leaves extract at the dose of 60, 120 and 180 mg / kg was capable of reducing carrageenan-induced inflammation.
The TK preparation was showed a potent Antiproliferative effect (69.27%) in the chronic inflammation model (120 mg / kg, p o).
In acute toxicity study, LD50 of TK preparation was determined 4069.23 mg / kg (p o).
Sub-chronic toxicity study: Oral administration of the TK preparation at the dose 120 and 180 mg / kg did not induce death or significant changes in body weight, relative weight of vital organs, hematological parameters and was not associated with liver and kidney toxicity.
The present study was designed to evaluate the anti-inflammatory activities and the oral toxicity of the preparation from Betel leaves extract (TK).
Keywords: Carrageenan, cotton pellet granule, anti-inflammatory, Piper betle L, Betel leave, acute toxicity, sub-chronic toxicity.
Materials and Methods: Swiss albino mice weight body 18 - 22g, 6 - 8 weeks age, purchased from the Institute of Vaccines and Medical Biological - Nhatrang.
The mouse paw edema was measured plethysmometrically from 1, 2, 3 hours and 1 day, 2 days after injection carrageenan. Pellet granule was weighed on fresh and dried at the end of 8th day.
Study sample was followed OECD guidelines OECD 423 for assessing the acute oral toxicity of the plant extracts.
Surveying some models of publicizing state companies in health system, this survey is aimed to studying and searching in medical sciences
This survey is aimed to studying and searching in medical sciences. "
Background: Paroxysmal supraventricular tachycardia (PSVT) is a distinct clinical syndrome.
The analysis of ECG was helpful for differentiating between AVNRT and AVRT.
Had a high prevalence of hypertension and heart valve diseases in the study population but didn't have the difference between two groups.
In drugs used to control the rate such as beta blocker, calcium blocker, digoxin, flecanide, adenosine was to be used most.
We used trans esophageal atrial stimulation to diagnose PSVT in 37 patients.
Conclusions: Patients with AVRT have a lower mean age at arrhythmia symptom onset compared with those with AVNRT.
The analysis of ECG was helpful for differentiating between AVNRT and AVRT.
A correct diagnosis by standard ECG is more frequent in AVNRT.
Trans esophageal atrial stimulation is useful for patients who did not have the ECG of tachycardia and help to differentiate the mechanisms of PSVT.
Keywords: Paroxysmal supraventricular tachycardia, electrophysiology, atrioventricular (AV) nodal reentrant, AV reentrant.
Previous studies have shown that only 80% of narrow QRS supraventricular tachycardia (SVT) types can be differentiated by standard 12-lead electrocardiographic (ECG) criteria.
Atrioventricular (AV) nodal reentry and AV reentry is the common forms of PSVT.
This study was designed to determine the clinical and electrophysiological features of atrioventricular nodal reentry and AV reentry supraventricular tachycardia.
Methods: From 04/2012 to 03/2013 at Tam Duc Cardiovascular Hospital, we studied 99 consecutive patients with paroxysmal narrow QRS supraventricular tachycardia have AV nodal reentrant or AV reentrant.
Results: In our study, the mean age of99 patients at hospitalization was 45.42 ± 12.95years (47.20 ± 13.07 in patients with AVNRT and 42.43 ± 12.34 in patients with AVRT, p=0.07).
The mean age of symptom onset was 37.08 ± 13.62 (39.29 ± 14.34 in AVNRT group and 33.37 ± 11.59 in AVRT group, p=0.03).
The most symptoms of the PSVT were palpitations, fatigue, sweating, dizziness and chest pain.
Clinical and paraclinical characteristics of congenital rubella syndrome at neonate section - gyn-ob department - hue central hospital
Women infected with Rubella during pregnancy are likely to have children of high birth defects.
Rubella virus via mother blood infect the fetus and cause congenital Rubella syndrome in newborn, accounting for up to 90% when maternal Rubella infection in the early months of pregnancy.
Objective: To study clinical and paraclinical characteristics of congenital Rubella syndrome at neonate section - GYN-OB Department - Hue Central Hospital.
Subjective and Methods: The descriptive study on 92 newborns diagnosed with congenital Rubella syndrome and having a full range of tests: Hematology, Microbiology, Biochemistry and Imaging from April to december2011.
Results: 88, 1% maternal Rubella infection in the first semester and 11, 9% in the second semester of pregnancy; 90, 2% having skin symptoms; 64, 1% low birth weight; 16, 3% visual defect symptoms, 13% hearing defect; 78, 3% congenital heart defects; 67, 3% of congenital brain malformations; 68, 8% IgG positive; 18, 4% IgM positive; 43, 5% having low platelet in blood counts.
Conclusion: The clinical and paraclinical features of congenital Rubella syndrome is very diverse.
The rate of birth defects when mothers infected with Rubella in the first semester of pregnancy is high.
Researching on isolation and culture carcinoma cells from human hepatocellular carcinoma tissue
Objectives: To establish a cell culture procedure from hepatocellular carcinoma (HCC) tissue.
Methods: After collecting from the hospital, HCC tissue was processed preliminary to remove adipose and necrotic tissue. Then, the sample was cut into 2 x 2 x 3 mm3 pieces.
Four culture methods were used: single cell culture by splitting enzyme, cutting to small pieces, lame squeeze and tissue culture.
For each method, DMEM / F12 medium supplemented with 10% of FBS, and 1% of antibiotic-antimycoticin an incubator (37 °C, 5% CO2) was used.
Effective culture was evaluated and compared between four methods in order to select the best.
Results: The results showed that the tissue culture is the highest effective method and the success rate is 90% (27/30 samples).
Conclusions: We can initially determine an appropriate method for culture from human HCC tissue.
This is the premise, essential step to carry out further research on cancer cells.
C reactive protein (crp), body fat percentage and features of the metabolic syndrome (mets) in children with overweight and obesity
Background-Objective: Inflammation (assessed by CRP) and the MetS are associated with cardiovascular disease and the prevalence of Mets in children has increased alarmingly.
There are differences in the average value of BFP between components groups in which group of 0 - 1 components were 25.24 ± 3.46, groups of 2 - 3 components were 25.98 ± 3.61, group of 4 - 6 components were 26.80±4.23, p<0.05 and the more components to diagnose Mets was, the more risk of BFP was.
The optimal threshold for BFP to predict cardiovascular risk factor was 25.10% (95% CI: 51.32 - 62.12).
Conclusions: Mets is an alarming problem of public health even in developing countries and Vietnam.
Cut-off values of BFP in this study could be the optimal threshold to predict cardiovascular risk factor of children with overweight and obesity.
The aims of this study was to determine the prevalence of MetS and to assess the association between plasma CRP and other components of the MetS.
Methods: A cross-sectional study was undertaken on 510 overweight and obesity children from 10 to 15 years old.
Body mass index (BMI), waist circumference (WC), blood pressure, BFP by bioelectrical impedance analysis (BIA), glucose, CRP and lipid profile were determined in all subjects.
Receiver operating characteristic (ROC) analysis was applied to determine the cut-off values.
Metabolic syndrome was defined according to the definition of IDF (International Diabetes Federation).
Results: The prevalence of metabolic syndrome was 31.37%.
Background and purpose: lagre hemispheric infarction (LHI) with neurological deterioration is the first death-causing ischemic stroke in the first week.
Determining early factors selecting the patients helps indicate decompressive hemicraniectomy that decreases the mortality and improves life-quality.
Methods: This is the describing and analyzing prospective trial in LHI patients admitted within 48 hours of symptom onset.
We analysed demographic, clinical, laboratory, and CT parameters following two survival and neurological death groups.
Results: In fifty-seven LHI patients, tweenty two were died of brain swelling and thirty-five were survival.
Logistic regression analysis identified the following independent predictors of fatal brain edema: conscious disorder at the onset (p < 0, 001; OR = 13, 56 với CI 95%: 3, 50 - 52, 63); ventricular compression (p = 0, 01; OR = 15, 5 với CI 95%: 2, 9 - 84, 1); and ASPECTS = 0 (p = 0, 039; OR = 5 với CI 95%: 1, 1 - 23, 4).
ASPECTS = 0 associated with frontal and / or occipital hypodensity (panhemispheric hypodensity) had a predicting significance with specificity 100% and sensitivity 27, 7%.
Conclusions: Patients with conscious disorders (drowsiness, stupor), ventricular compression and ASPECTS = 0 on CT are capable to leading to fatal brain swelling.
The presence of panhemispheric hypodensity is related to neurogical death with high specticity but low sensitivity.
Spontaneous isolated superior mesenteric artery dissection: case report
Spontaneous isolated superior mesenteric artery dissection (SISMAD) is rare and has a high mortality risk.
There are many classification as well as many treatment options including conservative treatment, endovascular intervention and surgery.
We, therefore, reported on our experience in the diagnosis and treatment of SISMAD and reviewed literature.
In our two cases, there was one case of conservative treatment followed by surgical intervention, a case of successful endovascular intervention.
Conservative treatment with or without anticoagulant is the first choice for the treatment of SISMAD.
Endovascular interventions should be strictly adhered to because there is still a risk.
Surgical intervention is indicated only when bowel necrosis or rupture of the arteries exsists.
Keywords: Spontaneous isolated superior mesenteric artery dissection.
Age estimation of vietnamese individuals based on tooth cement annulation
Background: Among the three dental hard tissues, cementum continues to be deposited slowly throughout life.
Vertitcal ground sections of each tooth were prepared and examined under light microscopy.
The images were transferd to a computer and the cemental lines were counted with the help of Photoshop software.
Results: A strong positive correlation was found between age and the number of incremental lines in human cementum (r=0.911).
Conclusion: Age estimation based on tooth cement annulation (TCA) is considered as areliable method in forensic.
Keywords: tooth cementum annulations (TCA), incremental line, age estimation
It is assumed that cementum is formed in dark and light layers that are added yearly.
Each pair of lines corresponds to one year of life.
Objective: To examine the correlation between age and the number of incremental lines in human cementum.
The age of the individuals at the time of tooth extraction ranged from 12 - 78 years.
Patients with primary immunodeficiency (PID) have dysregulated immune processes, which can result in an increased susceptibility to infectious diseases, autoimmune disorders, and malignancies.
However, untreated autoimmune disease or chronic tissue damage due to uncontrolled inflammation may cause even equal or greater harm.
Cross-specialty cooperation is invaluable to treat autoimmune diseases in patients with PID.
Keywords: primary immunodeficiency
A wide variety of autoimmune diseases are found in patients with PID such as cytopenias, endocrinopathies, enteropathies or other autoimmune disorders including arthritis, hepatitis, glomerulonephritis, lupus, neurologic diseases, skin diseases and occular involvement.
There is no general tissue or organ restriction, nor is there a gender or age predominance like that seen in autoimmune diseases affecting the general population.
Autoimmunity in patients with PID is believed to be due to a variety of possible underlying mechanisms.
These include: (1) secondary lymphopenia, which permits proliferation and expansion of autoreactive lymphocytic clones, (2) defects of immune tolerance, the state of unresponsiveness to agents that otherwise would elicit an immune response, (3) defects in apoptosis / clearance of apoptotic bodies or cellular debris, (4) hyperactivation of lymphocytes, (5) defects in signaling pathways, (6) defects in early complement components.
When autoimmunity develops before a patient has experienced recurrent infections, the diagnosis of an underlying PID may be neglected and delayed for years.
Two clinical clues that an underlying PID may be present are the development of an autoimmune disorder at an unusually early age and the presence of autoimmune processes that affect multiple organ systems, not necessarily at the same time, and cannot be unified under a single rheumatologic diagnosis.
Most autoimmune diseases in patients with PID are managed with the same therapies used in patients without PID.
In some cases, the treatment required to control the autoimmune process may cause secondary immunodeficiency and further increase the risk of infection or malignancy.
Background: Kidney transplantation significantly improves the quality of life of the end stage renal disease (ESRD) patients.
We report some results on these topics. Patients and Methods: case studies on post transplant patients (pts) from 1992 to 2010 in Cho Ray Hospital.
Results: 19 male's patients have babies, 5 pts have 2 babies, 1pt has twin birth.
Three women's patients were pregnant after kidney transplantation (1pts after the transplantation 21 momths, 2 pts after 36 monthsConclusions: With kidney transplantation, the health of the pts recovered and could have baby.
Objectives: This study aims to evaluate acute toxicity and anti-inflammatory, analgesic effects of ethanol extract of Kyllinga nemoralis (EEKN) in mice.
Keywords: Kyllinga nemoralis, acute toxicity, anti-inflammatory, analgesic
Results: LD-50 could not be determined, the maximum dose (Dmax) was 2 g EEKN / kg of mouse body weight, equivalent to 50 g of dry Kyllinga nemoralis / kg of mouse body weight.
Objectives: To describe the demographic features, clinical manifestations and laboratory resultsof EV71 infection cases with neurological symptoms at Children Hospital No2 from July 2011 to December 2012.
Conclusion: EV71-infected patients with neurological symptoms may or may not be in hand, foot and mouth lesions.
Acute disease progression can cause severe cardiopulmonary complications, but the rate of complete cure is very high if the patient is treated properly and promptly.
Keywords: enterovirus 71, neurological symptoms
Methods: Retrospective, descriptive case series.
Results: 328 cases positive for EV71with neurological symptoms wereincluded.
Percentage of male group is higher than female one, sex ratio male: female is 1, 58: 1.
Mean age is 27 months.
There are 79.6% of children under 36 months of age.
All patientshave fever.
There are 94.5% of patients with skin rashes, 64.9% with mouth ulcers and 3% do not have skin and mucous membrane lesions.
Cytogenetic and molecular characteristics of acute promyelocytic leukemia
Purpose: To evaluate cytogenetics and molecular characteristics in acute promyelocytic leukemia (APL), for monitoring minimal residual disease (MRD) by quantitative PCR method at Blood Transfusion Hematology hospital.
Keywords: acute promyelocytic leukemia, FISH, RT-PCR, t (15; 17), PML / RARA
Initial results of two trocars laparoscopic cholecystectomy
Background: Single incision laparoscopic cholecystectomy is a world's technique improvement and tendency, there are many studies using an umbilicus trocar to remove gallbladder but they had to be used a specified port and laparoscopic instruments that have abscent in hospitals.
Results: forty five cases of two-trocar single - incision laparoscopic cholecystectomy perumbilical have been performed. The successful ratio was 86.8%, median age was 48 years (range 27 - 79).
The average operating time was 60.4 minutes (rang 30 - 180) and the median hospital stay was 2 days.
Six (13.3%) cases were additional trocar 5 mm to stop bleeding the gallbladder bed and drainage.
Conclusion: with the ratio of successful 86.8% and complication 2.2% without death, laparoscopic cholecystectomy with two trocas is one of choices for invisible scar surgery.
We present our inital results of laparoscopic cholecystectomy using two trocars with a single - incision perumbilical and common laparoscopic instruments.
The aim of the study: to evaluate the initial results of this technique in 45 cases cholecystectomy.
Method: A case series study.
Subject: patients who were diagnosed, accepted laparoscopic cholecystectomy with two trocars and were selected, at emergency department of Binh Dan Hospital, Ho Chi Minh city.
Maternal factors causing hearing loss to children included influenza and fetal derangement.
Fetal factors include low Apgar level, jaundice, oxygenation and orofacial cleft.
Discussion: The results were compared to the article around the world Conclusion: The clarification of deafness in infant is necessary for helping infant.
Timely detection and intervention give children a great opportunity to recuperate their ability to listen, develop language skills, help them to learn, integrate into the community and reduce the burden on the children themselves, their family and the society.
Keywords: Deafness, infant, TEOAR method.
The project "Evaluation of newborn hearing loss screening program in Nguyen Tri Phuong Hospital" hence was conducted to examine the rate of hearing loss occurring in infants using Otoacoustic Emissions (OAE) to determine several causes of deafness from mothers and children themselves.
The proportion of male and female infants was approximately equal (50.4% and 49.6%).
Children's age (in days) was 2.85 ± 1.35.
The average fetal age was 38.64 ± 0.034.
Results of the first OAE test: 108 (8%) cases failed the test with 4.6% children had unilateral hearing loss and 3.4% had hearing loss in both sides.
Surgical treatment of hypertensive intracerebral hemorrhage: report of 63 cases
Background: Hypertensive intracerebral hematoma (ICH) is a serious and potentially lethal condition which needs the intensive care and treatment. The essential is the medical treatment but in some special cases the surgical intervention can ameliorate the prognosis of the disease.
The DSA (Digital subtraction angiography) were performed in some cases, especially in the young patients, to rule out the vascular etiologies such as the AVM or aneurysm.
The time from the onset of stroke to the removal of blood clot: from 24 hours to 8 days.
By many reasons we had not any operative case within the first 24 hours. The surgical approach was individualized on the basis of the site and size of the ICH.
Allowed techniques included conventional open craniotomy and burr hole and placement of a catheter for evacuation of the ICH, with or without stereotactic frame.
Conclusions: The decision about whether and when to operate remains controversial but we find also some points of consensus: Non surgical candidates: Patients with small hemorrhage (< 10 cm3) or minimal neurological deficits should be treated medically; Patients with GCS score £4 should also be treated medically because they uniformly die or have extremely poor functional outcome that cannot be improved by surgery.
In the future, the efficacy of any medical or surgical treatment has yet to be proved in a large multi-center randomized trials.
The authors present their remarks on the result of 63 operative cases in 115 People's hospital from July - 1994 to July - 2003.
Methods: This is a retrospective study of 63 cases of ICH operated on in 10 years (from July-1994 to July-2003).
with 30 supratentorial ICH and 14 infratentorial ICH. There were 19 cases which were operated on using the burr hole and suction technique with Backlund's needle or modified backlund's needle without stereotactic frame, 44 cases which were operated on with conventional open craniotomy techniques.
On admission, all patients underwent a standard neurological examination (GOS: Glasgow Coma Scale) and a computed tomographic scan.
The surgical candidates were chosen with many criteria: antecedent of hypertension, age, site and size of the ICH, patient's neurological status.
Plasma: set up to organize plasma collection and plasma derivatives
Plasma is a component of blood that plays an important role in the survival of the body.
Today with high-tech plasma is also a source of raw materials for the production of recombinant preparations from plasma (plasma fractionnation), they have been widely used around the world.
Plasma derivatives such as: Fresh frozen plasma; Cryoprecipitate-depleted plasma; Virus "inactivated" plasma; Cryoprecipitate rich in factor VIII; Human albumin solusions; Factor VIII concentrate; Factor IX concentrate; Immunoglobulin for intramuscular IMIG; Immunoglobulin is used for intravenous IVIG (intravenous gamaglobulin) injection; Immunoglobulin anti Rh D (Anti-D RhlG).
Currently we are used plasma derivatives with a high cost and they are not always available.
Based on available standards and reference of Vietnam, European and American standards, Regional Blood Transfusion Centers of Vietnam will be to implement plasmapherisis as a source of raw materials for plasma fractionation to prepate drugs, that reduce costs and prevent other risks when dependent on the source of medicine that raw materials from other communities.
Keywords: collect plasma, set up to organize plasma collection and plasma derivatives
Early outcome of surgical treatment of aortic valve stenotic disease
Background: Aortic valve stenosis processes insidously and has high mortality when symptoms develop.
Sokolow-Lyon index reduces from 48.4 mm to 40.8 mm after valve replacement (P<0.001).
13 patients with preoperative low EF improve to 49.9% postoperatively (P<0.001).
Postoperative complications including arrythmia, myocardial infraction, renal failure and infection happened at rate of 12%, 4%, 15%, and 6% respectively.
Operative mortality is 4%. Conclusion: Aortic stenotic disease in elderly patients is usually due to calcification of valves, whereas in young patients it results from biscupid aortic valve.
Most of patients admit to hospital besause of severe heart failure.
Aortic valve replacement improves heart failure status as well as ejection fraction, moreover, it regress left ventricular hypertrophy and reduces left ventricular dimension.
Surgery is the mainstay of this disease. Objectives: To investigate causes and clinical characteristics of aortic stenosis. To evaluate improvements as well as complications after aortic valve replacement. Method: Case series, retrospectively.
Comparing clinical status, parameters on laboratory results preoperatively with that postoperatively.
Evaluating complications ocurring during in-hospital course. Result: Fifty cases submitted to aortic valve replacement due to aortic stenosis in Cho Ray hospital from January 2006 to June 2009 were evaluated.
In aetiology, 42% of them are calcific in 70 year-over group, and 50% of them are biscupid valve in 70 year-under group.
Concomitant coronary disease and ascending aortic aneurysm respectively acount for 30% and 4%.
58% of heart failure patients in class III-IV preoperatively decrease to 8% postoperatively (P<0.001).
Preoperative cardio-thoracic ratio is 0.63, and is 0.60 postoperatively (P<0.001).
Early outcome of nerve stimulator guided brachial plexus block with nerve stimulation) for the hand, forearm surgery at nguyen tri phuong hospital
Purpose: This study is performed to anesthezied during surgery and release pain after surgery.
Beside, this method of anesthesia can be applied to reduce postoperative pain in a long time (about 4 - 8 hours).
Methods: Prospective study on 10 patients.
Block brachial plexus under conduction of nerve stimulation machine.
Pulse, blood presure, SpO2, resspiratory rate of patients were monitored (right) before, during and after analgesis injection. Results: Anesthetize to surgery: 100%.
Need to inject Midazolam: 60%.
Need to inject Propofol: 10%.
Feel pain when drill bone: 10%.
Feel pain when cut skin: 30%; Tachycardia: 70% ((from 100 to 120p / m); Hypertension: 30% (under 150/95 mmHg).
Investigating characteristics of bacteria causing community- acquired pneumonia in nguyen tri phuong hospital 2010- 2011
Objective: Investigating characteristics of bacteria causing community - acquired pneumonia in Nguyen Tri Phuong Hospital 2010 - 2011.
The most popular Gram positve bacteria are S pneumonia (15%).
Keywords: community - acquired pneumonia; gram positive bacteria; gram negative bacteria
Methods: Adult community - acquired pneumonia patients admitted Nguyen Tri Phuong Hospital from June 2010 to December 2011, having positive sputum or BAL culture, including 228 patients with 146 males and 82 females.
Results: Most patients are in moderate and severve risk group.
Gram - negative bacteria (81.5%) are majority to gram - positive bacteria (18.5%).
The most popular strains are H influenza (19%); after that are Klebsiella spp.
Gram positive bacteria are also rather high (18.5%), Streptococcus pneumonia (15%) and Staphylococcus aureus (3.5%).
According to severity, the majority are Gram-negative bacteria, most are H influenza (9%), P aeruginosa (9.5%) and K pneumonia (6%).
The effectiveness of simethicone by diminishing the presence of bubbles in colonoscopy preparation
Background: Simethicone has been used in many countries to improve endoscopic view in colonoscopy by diminishing the presence of bubbles.
However, there have been no clinical trial in Viet Nam which mentioned about Simethicone as a drug for colonoscopy preparation.
Objectives: To determine the effectiveness of simethicone by diminishing bubbles in lower gastrointestinal endoscopy.
Methods: This is a case series study.
All of the inpatients and outpatients who are performed diagnostic and therapeutic colonoscopy at the endoscopy department, University Medical Center at Ho Chi Minh city. We studied 450 inpatients and outpatients receiving Simethicone.
Results: All of pantients have no bubble in the colon when using Simethicone.
Conclusions: Lower gastrointestinal endoscopic preparation with Simethicone is a safe and simple method which can improve lower gastrointestinal endoscopic visibility by diminishing the presence of bubbles.
Keywords: simethicone, oral bowel preparation, colonoscopy
Two - trocar single incision laparoscopic cholecystectomy (silc)
Three cases were additional trocar 5 mm to stop bleeding the gallbladder bed and drainage. There was no case conversion open.
There have been no deaths or complications during or after surgery.
Two-port single incision cholecystectomy is technically feasible, safety and may further improve the surgical outcomes in terms of postoperative pain and cosmesis. It can be considered for routine practice by surgeons who are familiar with the two-port laparoscopic surgery technique.
Single - port laparoscopic cholecystectomy was applied in some hospitals but they had to be used a specified port and laparoscopic instruments.
We report our early results in laparoscopic cholecystectomy using two trocars with a single - incision perumbilical with common laparoscopic instruments.
Methods: From August 2010 to September 2011, we performed 19 two-port single incision laparoscopic cholecystectomy perumbilical.
Cholecystectomy was performed and the gallbladder was extracted through the umbilical port.
Results: nineteen cases of two-trocar single - incision laparoscopic cholecystectomy perumbilical have been performed.
Case report: acute fatty liver of pregnancy
Acute fatty liver of pregnancy (AFLP) has an incidence of approximately one in 10000 - 15000 pregnancies, potentially fatal complication that occurs in the third trimester or early postpartum period.
Although the exact pathogenesis is unknown, this disease has been linked to an abnormality in fetal fatty acid metabolism.
Early diagnosis of AFLP sometimes can be difficult because it shares features with other common conditions such as pre-eclampsia, viral hepatitis and cholestasis of pregnancy.
However, a careful history and physical examination, in conjunction with compatible laboratory and imaging results, are often sufficient to make the diagnosis, and liver biopsy is rarely indicated.
Supportive care and expeditious delivery are essential to optimal maternal-fetal outcomes and remain as the mainstay treatment for AFLP.
Keywords: Fatty, Liver, Pregnancy
Aim: to evaluate the effects of pain relief on modified brachial blockage through interscalene line with Marcaine and general anesthesia, only maintaining inhalation anesthetic Sevoran in shoulder joint endoscopic surgery.
operation time is 98.78 ± 35.44 min (40 - 180).
Endotracheal withdrawing is after 19.66±4.3 min.
time for pain relief is 341.59 ± 38.04 min (EVS=2).
Time for post operation is 209.29 ± 36.41 min (120 - 300).
In addition no change in respiration, SpO2, EtCO2 and ECG is noticed.
Blood pressure decreases 8.40%.
Method: prospective study, transective description based on clinical aspects.
No complicationoccurs.
Cost is markedly low.
Keywords: interscalene block, shoulder joint, shoulder arthroscopy
Objects: 41 patients, ASA I-II. Applying methods of modified brachial blockage through interscalene line on selected patients for shoulder joint endoscopic surgery from October 2012 to September 2013 at Nguyễn Tri Phương Hospital.
Results: anesthetic site is the midline of Winnie's classic interscalene and Kulenkampff's supraclavicular, posterior border of stenocleidomastoid muscle in the interscalene fissure.
Injection site is inward, backward caudal in angle 80 degrees, corresponding lateral interspinous C6C7.
Average time for blockage is 4 min.
After blockage, induction is only tracheal intubation in anesthesia and maintaining inhalation anesthetic, Sevoran.
Preparation time for operation is 23± 9.03 min.
Background: Hepatocellular carcinoma is ranked among the five most common cancer in the world, is the cause of death from cancer ranked third.
Laparoscopic hepatectomy has many advantages compared to open hepatic surgery, but it is technically difficult and complex, the risk of bleeding during surgery is very high and the indication for operation was much different perspective.
Objective: We focus on evaluation of the technical and preliminary results of the 2 cases laparoscopic hepatectomy.
Methods: We described two cases of laparoscopic hepatectomy due to hepatocellular carcinoma in our hospital.
Results: In our two cases, operative time 120 minutes, intraoperative blood loss 50 - 350 ml, tumor size 2.5 - 5 cm, surgical margin 1.5 - 2 cm, length of stay 4 - 7 days, no postoperative complications were documented.
Conclusion: Laparoscopic hepatectomy is potentially feasible, safe and effective, shorter hospital stays, recovery soon.
Keywords: hepatocellular carcinoma, laparoscopic hepatectomy
Background: Ropivacaine is a newer local anesthetic, proven to have a better safety margin than Bupivacaine.
To maintain anesthetic's advantages and improve the quality of intra and post operation analgesia, the addition of Fentanyl to Ropivacaine has shown to enhance the quality of analgesia without compromising its benefits such as early mobilization and early micturition.
Objectives: The main objective: to determine the duration of sensory block.
Secondary objectives: to determine the duration and level of motor block, the incidence of side effects and complications.
Method: We performed a prospective observational study in 65 patients undergoing arthroscopy knee surgery under spinal anesthesia.
Patients were received Ropivacaine 0.5% 10 mg combined Fentanyl 25 mcg.
The efficacy of spinal anesthesia, the duration of postoperative analgesia, and the duration of motor block and side effects of each patient were assessed during operation and within the first 24 hours post-operation.
Results: All patients got adequate anesthesia for surgery.
Results: Physiological characterization showed that in the dose of 0.34 mg / kg, crude venom and isolated fractions have peripheral analgesic effect.
Among them, fraction 4 has peripheral analgesic effect comparable to aspirin (50 mg / kg).
Snake venom is a cocktail of highly bioactive components and has important pharmacological activities such as hypotensive, antibacterial, anti - inflammation, anti - nociception, local anesthesia, general anesthesia platelet aggregation inhibition... Recently, snake venom has also been shown to have the effect of preventing the development of cancer cells very effectively.
In this study, we research anti-nociceptive and anti-inflammatory effects of crude and fractions of snake venom Bungarus fasciatus.
Method: The subject of this study was snake venom Bungarus fasciatus provided from snake house Vinh Son in Vinh Phuc province.
Mid-term assessement of surgical procedures in management vaginal apical prolapse
Assess the post-op results of clinical symptoms improvement with follow-up from 20 to 32 months.
Results: 2 surgical procedures for vaginal apical prolapse including Level I repair and posterior mesh colporrhaphy.
Prevalence and factors associated with repeat induced abortion among ever married women at reproductive age in nhon ai willage, phong dien district, can tho city
Background: Similar to many countries on the world, repeat induced abortion is common in Viet Nam, but studies about this problem were still few.
Nhon Ai willage is a willage belong to Phong Dien district which population work is fairly good, but numbers of induced abortion was increasing from 305 cases in 2006 up to 456 cases in 2007.
It was possible underestimated because women could conduct many abortions at many places.
Objectives: To find prevalence and factors associated with repeat induced abortion among married women at reproductive age in Nhon Ai willage, Phong Dien district, Can Tho city.
Method: We conducted a cross-sectional study by using a questionnaire to interview face-to-face 488 ever married women from 15 - 49 years old that had been chosen with systematic sampling technique in Nhon Ai willage from 23 to 29/03/2009.
Results: Prevalance of repeat induced abortion was 16.2% (CI 95% 12.9 - 19.5%).
Inducing abortion in public sectors reduced risk of repeat induced abortion (OR = 0.21, CI 95%: 0.09 - 0.49) and counseling about harmful effects of abortion was also reducing repeat induced abortion (OR = 0.53, CI 95%: 0.30 - 0.94) through increasing using of effective and long-acting contraceptive methods after abortion. Conclusion: Need for enhancing counseling about harmful effects of abortion, concurrently counseling and supplying contraceptive methods to make contraceptive practice after abortion of aborters effectively.
The role of laparoscopic surgery to diagnose cases of unknown origin ascites
Patients and method: Cross sectional, descriptive retrospective studys, Patients with unknown origin ascites were performed laparoscopically biopsy suspicious tissue in the abdominal cavity.
Results: From 2002 to 2008, there were 18 cases underwent diagnostic laparoscopic surgery due to unknown origin ascites, Among them, they were 13 (68, 4%) cases of peritoneal tuberculosis, 2 (10, 5%) cases of cancer and the rest of chronic inflammation.
Conclusion: Unknown origin ascites can be diagnosed safely and precisely by laparoscopic biopsy.
Pathogenous bacteria in wound infection and its antibiotic resistance in 175 hospital
Background: Nowadays, situation of surgery's infectionin some hospitals still is concern problem.
Conclusion: Perfoming adequate disinfection priniples in practical surgery and taking care patients post-operation is needed.
Appearance of opportunistic infection's agents and its common antibiotic resistance is difficult to therapy.
Objective: To investigate distribution of pathogenous bacteria in wound infection and its antibiotic resistance.
Results: Having studied 26/152 wound infection patients - Percentage of wound infection in clean operating is quite hight: 17.11%.
The most common bacteria cause of wound infection is Gram Positive Cocci and Gram - negative Rods.
These bacteria have hight resistance to common antibiotic.
Lumbar retroperitoneoscopy: anatomic factors related to creating a retroperitoneal working space
Objective: To study anatomic factors which facilitate better and safer creation of working space for lumbar retroperitoneoscopy.
Conclusion: The anatomic structure of the retroperitoneal region, especially the connective tissue (aerolar tissue) and the fat between transversalis fascia and the peritoneum, facilitated the dissection of this region.
Besides, the first trocar could be placed anterior to the posterior axillary line without injuring the colon and the peritoneum.
Material and method: We studied 35 cases undergoing lumbar retroperitoneoscopy.
All patients got CT scan before the operation.
Parameters such as thickness of pararenal fat or intermediate layer between transversalis fascia and the posterior peritoneum, distance between lumbar quadratus muscle and the posterior axillary line in the 90 degree oblique position, distance between the posterior axillary line and the ascending or descending colon in the 90 degree oblique position were viewed on CT scan.
Results: 34.3% cases of perirenal fat were not thicker than 0.5 cm, and there was no fat found in 2 cases.
The length of this fat layer extending from the posterior axillary line amounted to 8 cm.
5.1% of cases had the distance between the colon and the posterior axillary line inferior to 1 cm.
In 46% cases, the posterior axillary line was found right beside or posterior to the lumbar quadatus muscle.
There was no injury of colon and peritoneum in this study.
Investigation of intracranial stenoses artery by transcranial color-coded sonography at patients with acute ischemic stroke
Method: We prospectively studied 196 patients with acute ischemic stroke in people hospital 115.Results: Intracranial stenoses is a considerable cause, prevalent among 39.8% of all stroke subtypes.
Risky factors of atherosclerosis are age of over 69, prospection of transient ischemic attack or intracranial stenoses, prospection of blood lipid turbulence, prospection of smoke, dyastolic pressure at admission over 88 mmHg, LDL Cholesterol at admission over 121 mg / dL, NIHSS score at admission over 11.
TCCS has high value in diagnosing the steno level of 50% and over at midle cerebral artery, intracranial internal carotid artery and basilar and basilar artery.
Conclusions: Intracranial stenoses is a considerable reason causing ischemic stroke. TCCS is reliable in assessment of basal cerebral artery narrowing and prove to be useful for noninvasive management of patients with acute ischemis stroke.
Objective: The aim of this study is to investigate and optimize factors affecting the preparation of miconazole nitrate loaded nanostructure lipid carrier.
Correspondingly, the physicochemical properties of miconazole nitrate loaded NLC had an average particle size of 58.1 nm, stability factor of 0.33% and entrapment efficiency of 80.5%.
Conclusion: The process of preparing miconazole nitrate loaded nanostructure lipid carrier was successfully optimized.
Keywords: Miconazole nitrate, nanostructure lipid carrier, optimization.
Method: The software Design Expert 7.1.5 was used for experimental design and optimization.
Factors were investigated during the preparation of NLC including the amount of MN (mg) / 100 ml THF, the tween 80 concentrations (percentage), the concentration of lipid mixture and MN (percentage) and, stirring speed (rpm) and stirring time (s).
Background: Hospital-acquired pneumonia (HAP) is the most common nosocomial infection and is the leading cause of mortality in hospital-acquired infections.
Conclusion: Acinetobacter baumannii (29.7%) is one of the leading cause of Hospital-acquired pneumonia at respiratory department of Nguyen Tri Phuong hospital from 7/2017 - 7/2018.
Keywords: hospital-acquired pneumonia, antibiotic resistance
Objectives: To determine the hospital acquired pneumonia of agent and antibiotic resistance at respiratory department of Nguyen Tri Phuong hospital from 7/2017 to 7/2018.
Results: The gram negative agents were 83.8%. In which, Acinetobacter baumannii (29.7%) is the leading cause of Hospital-acquired pneumonia, following is Klebsiella pneumonia (16.2%).
The gram negativeagents resisted Ampicillin (93.3%), Cefotaxime (80%).
The gram positive agents resisted Penicillin (83.3%), Azithromycin (75%).
Acinetobacter baumannii resisted Piperacillin / Tazobactam, Cefepime, Cefotaxime, Amikacin.
Klebsiella pneumonia resisted Ampicillin (100%), Amoxicillin / Clavulanic acid (83.3%), Cefotaxime (83.3%).
Assessment of early result surgical therapy for hepatocellular carcinoma in cho ray hospital
Aim: To evaluate the early results and some risk factors that include to the complications and recurrent rateafter hepatectomy for hepatocellular carcinoma.
Keywords: hepatocellular carcinoma, surgical therapy for hepatocellular carcinoma.
There are 68% pts with pain symptons, 42.7% with AFP > 400ng / ml, 80% pts with tumor dimension > 5 cm.
The mean time operation 140 minutes, the mean operative blood loss 353.3 ml, the mean blood tranfusion 139.3 ml with blood tranfusion rate 14.6%.
The common complications are 13.3% included: bleeding: 1.3%, decompensation hepatic failure: 1.3%, pleural effusion: 6.7%, bile leakage: 2.7%.
Conclustion: Nowadays hepatectomy for hepatocellular carcinoma get good result. We can manage the complications by intermittent pedicle clamping control bleeding and keep the future liver remnant to be perfused.
Surgical therapy for hepatocellular carcinoma gives good chance for HCC patients to survival.
Background: Probiotic products were usually used as adjunctive therapy for gastrointestinal disorders cause by imbalance of gut microbiota.
Conclusions: 05/13 strains had good ability of low pH, bile salt and digestive enzyme tolerance, comply with FAO / WHO criteria on probiotic selection, 06/13 strains had medium tolerance ability, 02/13 strains could not tolerate to gastrointestinal juice.
There should be recommendation of using time and protecting method for strains that do not comply with digestive juice tolerance criteria.
To be effective, probiotic microorganisms must have ability to survive in gastrointestinal fluids.
Objectives: Investigating tolerance of bacterial strains isolated from commercial probiotic products to gastric acid, bile salt, pepsin and pancreas enzymes.
Materials and methods: 13 strains of Lactobacillus, Bifidobacterium, Bacillus, Streptococcus and Enterococcus were isolated from probiotic products.
These strains were examined ability of gastric acid, bile salt, pepsin and pancreas enzyme tolerance in suitable simulated juices.
After certain times, using spread plate technique and colony counting to determine survival percentage of tested strains.
Results: In simulated gastric juice combined with pepsin test, all of 13 strains survived at pH 3.5; 11 strains at pH 2.5; just 2 strains (L kefir and B bifidum) could survive at pH 1.5.
In experiment for ability of bile salt tolerance, there were 12 strains could resist 0.5% bile salt and 5 strain resisted 2% bile salt.
There only B polyfermenticus strain was not surviving in juice containing pancreas enzyme after 4 hours.
The collection of the high-resolution g-banded chromosomes in prometaphase
During prometaphase, karyotype with high resolution over 500 bands helps detect numerical and structural abberation of chromosomes effectively which be hardly discovered at normal resolution in metaphase.
Aims: To collect high-resolution G-banded chromosomes during prometaphase from human peripheral blood cells.
Subjects and methods: Culturing peripheral blood cells, then collecting the cells at prometaphase by two methods: add Thymine; or add BrdU and Thymine.
Results: Chromosomes at prometaphase were identified based on nuclear morphology of cells staining with Cresyl Violet; and successfully acquired the karyotype at prometaphase using Thymine.
Conclusions: The process of the culture with added Thymine allows to collect 60.6% of karyotypes with resolution more than 500 bands, which effectively supports prenatal screening and diagnosis of genetic diseases in humans.
Keywords: karyotype, prometaphase, G-banded chromosomes, high-resolution.
Background: Frailty is a common geriatric syndrome, increasing the adverse clinical outcomes in older adults.
Weakness was the most prevalent component.
Keywords: frailty, older adults, type 2 diabetes mellitus
Frailty and type 2 diabetes mellitus (T2DM) can occur concurrently in older adults.
Frailty discernment, therefore, has a vital part in the care for and management of this population.
Among other frailty evaluating tools, Fried's criteria is the most used and serves as the gold standard in frailty assessment.
Objective: To identify the prevalence of frailty by Fried's criteria and proportion of each - -component criterium in older outpatients with T2DM.
Methods: This multicenter cross-sectional study was conducted from January 2019 to July 2020.
Frailty was defined by Fried's criteria.
Results: This study included 638 outpatients (aged ≥60 years; mean age 71.9±7.2 years; male 55.5%).
Prevalence of frailty was 28.2%, pre-frailty was 53.9%, and robust was 17.9%.
Evaluation of treatment results duodenal - head of the pancreas tumors
Background: Cancer of the pancreas, duodenum, ampulla of Vater cancer, cancer of the bile ducts are relatively rare disease.
Hence the need to comprehensively assess, careful clinical lesions, clinical tests, ultrasound, CT scan, as well as the actual surgery.
The disadvantage for the deducted surgery or positive basis is often detected late disease, the tumor has spread or metastasized.
So unless surgery or positive basis is still low, despite the modern diagnostic tool for the early detection, especially in the early pancreatic cancer.
Objective: To review the initial results of treatment of duodenal pancreatic head tumors.
Methods: Retrospective study of cases of duodenal pancreatic head tumors were diagnosed and treated at the Saigon General Hospital from 1 / 1/2003 at 31 / 12/2012.
Results: In 10 years we collected 56 cases of duodenal pancreatic head tumors were diagnosed and treated at the Hospital of Saigon.
Conclusion: Radical surgery (Whipple) when tumors make small, less invasive into the bloodstream.
Surgery to block the pancreatic - duodenal tumors in the pancreas duodenum disease - the first is more complex surgical complications as well as complications during and after surgery.
To achieve good results the most important issues is indicated for the treatment.
Background: According to published papers, Transcatheter Arterial Embolization is effective in conservative treatment in solid organ rupture caused by blunt abdominal trauma.
Conclusion: TAE in blunt abdominal trauma is shown effective and proved to increase successfulness of conservative treatment.
Keywords: Transcatheter arterial embolization, Blunt abdominal injury.
TAE is now a therapeutic option which is approved by AAST (American Association for Surgeon of Trauma).
Estimate the effectiveness of TAE in ruptured solid organ due to blunt abdominal trauma.
Method: It is clinical trial, prospective, non randomized.
We evaluate the effectiveness by comparaision of fluid volume and shock index pre and post intervention.
Histological features of chronic infective uncinate processes with polyps
Objective: determine histological features of postoperated uncinate processes.
Material and method: 39 patients with chronic sinusitis and surgical treatment.
Results: There are 17/39 (43, 6%) chronic inflamation with typical polyps, very large retention cysts in laminar propria, and microscopic polyps.
Conclusion: These pictures help to find out the relationship between various types of sinusitis and histologic features of uncinate processes.
Distribution of hcv genotype based on core region among patientd with chronic hepatitis c at the university medical center in hochiminh city by real-time rt-pcr method
Backgrounds: Hepatitis C virus (HCV) is one of the common causes of chronic hepatitis, cirrhosis and liver cancer.
There are 47 foreign patients in this study. There is difference between the two HCV genotype rate of Vietnamese and foreign patients.
Conclusion: Genotype 6 has the highest rate.
HCV genotyping based on core region can performed by Real-time RT-PCR method before treatmentof hepatitis C Keywords: HCV genotype, real-time RT-PCR, core region.
HCV has 6 genotypes and 50 subtypes, among them, Genotype 1 is difficult to respond to Interferon treatment.
HCV genotyping from sera of foreign patients with chronic hepatitis C based on core region by Real-time RT-PCR method.
Tests were performed in the Biomolecular lab.
Objective: The description descriptation, the status, implementation of childing with parent mother in the Products of the European Institute of European European 2017.
Method: Crosscut description description for parsing.
Result: Results for the relationship found with the current action with milk mother Conclusion: Knowledge of breastfeeding: knowledge of the highest percentage of knowledge about the first milk is 100% colostrum, the benefits of colostrum 100%, the benefit of breastfeeding 100%, the time Maintaining a milk supply of 90.6%, benefits for mother in breastfeeding was 88.6%, breastfeeding when weaning accounted for 86.9%, the lowest known restrictions of formula milk accounted for 23.7%.
Breastfeeding: The highest proportion of consent for early initiation of breastfeeding was as early as possible, accounting for 94%, exclusive breastfeeding was 94%, breastfeeding was 90.8% 4% to 6 months of exclusive breastfeeding, 88% consent to breastfeeding counseling, 86% for breastfeeding and 86%, do not agree to give milk to drink water after each feed accounted for 86.5%, not agree to feed milk formula for several days to breast milk accounted for 86.3%.
Attitude and practice of breastfeeding were statistically significant (p < 0.05).
Keywords: Grow kids by mom milk.
Remarks on conservative treatment of ruptured spleen in adult
During 5 years from 11/1999 to 8/2004, we selected patients with traumatic spleen injuries for non-operative management.
Standard abdominal CT scan was performed in 53 cases (67%).
Splenic injuries grade I was in 16 cases (20.3%), grade II: 39 cases (49.4%); grade III: 21 cases (26.6%) and grade IV: 3 cases (3.8%).
Non-operative management included stay in bed, fluid transfusion, drugs for hemostasis, analgesic, prophylatic antibiotics and vitamin C Success rate was 98.7% (78/79 cases), failure in one case with grade IV splenic injury who required splenectomy; there was no mortality.
60 male and 19 female, age range 7 to 78, most common age group was 20 - 30yrs, mean age was 33.2 + 16.4, which was labor group in the population.
Fifty-one patients (64.4%) lived in the rural region and 28 patients (35.4%) in HCM city.
Most of patients were admitted to the hospital in the polytramatic context (41 cases - 51.9%), adominal trama only accounted for 38 cases (48.1%); mean ISS was 10.2 + 8.7.
The most frequent cause was traffic accident encountered in 53 cases (67.1%).
Clinical hypovolumic shock due to hemorrhage was manifested in 10 cases (12.7%), patients were usually in the stable status (lowest systolic blood pressure > 90 mmHg in 63 cases - 79.7% and highest pulse rate < 100 in 55 cases - 69.6%), transfusion was required in 11 cases and mean volume of blood for transfusion was 4 units per patient.
Clinical abdominal examination showed no distended abdomen in 65 cases (82.3%), left upper quandrant pain in 66 cases (83.5%), no rebound tenderness in 66 cases (83.5%).
Mean value of hematocrit was 33.8 + 5.9, hematocrit had no change from admision to 48 hours after in 63 cases (79.7%).
Abdominal ultrasound demonstrated no fluid in 13 cases (16.5%), little fluid in 44 cases (55.7%) and moderate fluid in 17 cases (21.5%).
The results of early ambulation for patients after total knee arthroplasty in university medical center ho chi minh city
Background: Rehabilitation after total knee arthroplasty (TKA), especially early ambulation within 24 hourS, has been applied in Vietnam. However, there has been no study about the efficacy of this method so far.
Conclusion: Early ambulation after TKA is a safe intervention and is associated with decreased pain, improved knee ROM, reduced LOS and postoperative complications.
Keywords: Total knee arthroplasty, early ambulation, early rehabilitation, length of stay
Objective; This study aimed to evaluate the outcomes of early ambulation within 24 hours after TKA.
Methods: A descriptive cross-sectional study was carried out at University Medical Center in Ho Chi Minh City from October 2019 to June 2020.
Results: A total of 31 patients with early ambulation after TKA were enrolled in the study.
The mean length of stay (LOS) in our study was found to be 6 ± 0.9 days.
The average active and passive range of motion (ROM) in knee flexion was 69° and 96° respectively.
There was a significant decline in VAS score from the first posoperative day to the fifth posoperative day (p <0.001).
No complication (infections, deep venous thrombosis, pneumonia, falling, etc) was recorded.
Combined spinal-epidural anesthesia (csea) for lower limb orthopaedic surgery
From June to September 2007, the anesthesia department of SAI GON - ITO Hospital used CSEA for 65 patients of 39 - 90 years old (average 68.4 ± 11.2) under going Orthopaedic operation.
Duration of the intervention: 125 ± 14.5 minutes.
Purpose: To evaluate the effect of CSEA for lower limb orthopaedic surgery.
Methods: Prospective clinical trial study.
Heart rate, respiratory rate and blood pressure change a few during maintenance of operation.
Conclusion: Combined spinal-epidural anesthesia technique were adequate, decreased rate of complications and side-effects.
Objectives: Analize the SPECT results for cancer diagnosing and following up patients were examined by SPECT ECAM-Siemens at Dept. of Nuclear medicine and Oncology, Bach Mai hospital fom June 2007 to June 2008.
Patients and methods: Restrospective study of 4900 patients were examined by SPECT ECAM-Siemens at Dept. of Nuclear medicine and Oncology, Bach Mai hospital fom June 2007 to June 2008.
Results: - SPECT imaging with Tc99m-MIBI has a great value in diagnosing primary tumor and lymphatic node metastasis and in following up posttherapeutic recurence of cancer.
Evaluate the role of pelvic mr imaging in preoperative staging of rectal cancer
Introduction: Colorectal cancer is the most common cancer of the gastrointestinal tract.
Conclusions: Pelvic MR imaging is a promising technique for accurate preoperative staging of rectal cancer.
Rectal cancer is the second most common cancer in Vietnam.
Preoperative staging of rectal cancer has an important role to select the most appropriate treatment.
Purpose: To access the role of pelvic MR imaging in preoperative staging of rectal carcinoma.
Materials and methods: Preoperative pelvic MRI of 114 patients with rectal cancer was performed in University Medical Center at HCMC.
Results: The accuracy of pelvic MR imaging for defining the T stage of rectal cancer was 87.5%.
The sensitivity and specificity to evaluating the invasion of rectal tumor were T2 (88.9% - 89.1%), T3 (92.9% - 92.3%), T4 (81.5 - 100%), respectively.
The sensitivity and specificity to detecting lymph node metastases were 90.3% and 63.6%, respectively.
Pre-operative clinical and para-clinical characteristics of patients under 17 years of age with tetralogy of fallot operated at cho ray hospital
Objectives: to determine Pre-operative clinical and para-clinical characteristics of patients under 17 years of age with tetralogy of Fallot operated at Cho Ray hospital.
Conclusions: From the results of this study, we think that - in the years to come - a proper therapeutic strategy should be designed for early detection and surgical intervention of Tetralogy of Fallot, and thorough pre-operative preparations in order to reduce the risks during and after the operation.
Method: case-series. Results: From JAN/2005 to JUN/2008, there were 50 patients under 17 years of age with Tetralogy of Fallot operated at Cho Ray hospital.
Descriptive statistical analysis on pre-operative clinical and para-clinical characteristics shows a high male proportion (male-to-female ratio 2: 1), 84% of them living in provinces.
Clinical symptoms occuring before 1 year of age account for 88% of cases, most commonly seen are cyanosis, tiredness and cyanotic syncope; however, only 76% of them are diagnosed before 1 year of age.
In addition, they also help in updating the Z values of the sizes of cardiac chambers, which are served as guidances for the choice of operation as well as for prognosis.
Application of benchekroun's procedure to perform urinary continent stoma in binh dan hospital
Objectives: To evaluate the efficacy of Benchekroun's technique for performing urinary continent stomas.
Materials and methods: We have applied this technique on the patients with urinary incontinence whom medical treatment or other surgical treatments have been defeated, and the method of clean intermittent self-catheterization have not been appropriated.
The continent stomas have performed on original bladder wall or on intestinal wall of neobladder.
Results: 16 cases of continent stoma according to Benchekroun's hydraulic valve have been performed since 1999 in Binh Dan hospital.
15 patients have been followed-up from 12 to 48 months with successful rate about 73, 3%.
Conclusion: According to the author's experience, this is an intelligent idea for urinary continent derivation, simple technique but high efficacy. This procedure can help neurologic bladder patients to realize easily the method of clean intermittent self catheterization via the stomas
Sagittal condylar inclination of each angle type of occlusion
For each subject, the following was performed: find Angle type of occlusion and analysis with a Quick-axis axiograph to find sagittal condylar inclination of the right and left sides.
All data were analyzed using SPSS (version 16.0 for Windows).
Results: The 70 subjects were evaluated individually for each joint and the mean values of sagittal condylar inclination angles of the right and left sides, respectively were determined: class I 40.700 (27 cases) and 42.460 (37 cases), class II 42.250 (22 cases) and 45.970 (13 cases), and class III 43.22° (21 cases) and 41.59° (20 cases).
The sagittal condylar inclination of Angle class II was higher than class I and class III, but these differences were not significant.
Conclusion: Results suggest that condylar movement in the sagittal direction is not uniform. This value was different intra - and interindividual, and not depend on dental classification.
Keywords: Sagittal condylar inclination, Axiography, Class I, Class II, Class III.
The author mentioned the pitfalls in diagnosis and treatment of the two complicated duodenal injuries.
The pancreatoduodenectomy was performed in one case which had been operated on 2 times.
The other was diagnosed of localised abscess due to duodenal rupture and was simply drainaged.
Both cases were discharged with good results.
Accuracy of direct smear, kato-katz and sasa techniques in the diagnosis of hookworm and strongyloides stercoralis infestation
Objective: to determine accuracy of the three techniques: direct smear (DS), Kato-Katz (KK) and Sasa (SS) in the detection of hookworm and Strongyloides stercoralis infestation among primary and secondary schoolchildren of Cu Chi district, HCM city in 2007.
For Strongyloides stercoralis, the prevalence is 2.20%, SS technique is 9.6 [3, 84 - 30, 9] times as sensitive as DS (21.3% vs 91.8%). Conclusions and recommendations: the studied subjects belong to hookworm infested community of group III and light S stercoralis infested community.
Combination of DS-KK is the first-choice method for detection in endemic area of hookworm and S stercoralis in Viet Nam.
In hospital, Sasa technique should be recommended for patients under corticosteroid therapy with suspect S stercoralis infestation.
The optimal standing time before reading KK smear is 30 - 45 minutes at 28oC - 29oC.
Methods: a cross-sectional descriptive study was conducted among 2, 778 primary & secondary schoolchildren of Cu Chi district, HCM city in 2007.
These techniques were compared to the gold standard which was defined when at least one of the three techniques indicated possitive results in case of hookworms, and when DS and / or SS indicated positive results in case of eelworm.
Sensitivity, negative predictive value, mean degeneration time of hookworm egg, prevalence, mean of eggs per gram of feces were analysed with Stata 8.0.Results: hookworm prevalence is 33.87%, and geometric mean of eggs per gram of feces is 3.89 [3.5 - 4.3], with 4.52% cases as moderate and severe infestations.
Overall for hookworm, sensitivities of DS, KK, SS are 40.4%, 68.9%, 56.4%, respectively, and negative predictive values are 76.6%, 86.2%, 81.8%, respectively.
In severe infestation, DS and SS are 3.08 and 5 times as sensitive as KK, respectively; combination of SS-DS is 5.91 and 4.26 times as sensitive as than combinations of KK-DS and KK-SS, respectively.
It is more appropriate to wait for 30 - 45 minutes before reading the KK smear; if the standing time is longer, degeneration of eggs will appear in two forms: eggs with destroyed embryo (75.53%) or atrophied eggs (27.47%).
A prospective, multicenter trial with 8-year outcomes: effect of bilateral internal mammary arteries usage on coronary bypass grafting surgery
Background: Arterial conduits have been proven to be superior than venous conduits.
Post-operative myocardial infection, acute renal failure and sternal infection rates were 3%, 3% and 0.5%, respectively.
Mortality rate was 2%.
Mean follow-up was 44 months, the longest was 93 months.
There three deaths not related to coronary pathologies.
90.2% of patients were asymptomatic or at CCS I and 96.4% at NYHA I or II.
Conclusions: Coronary artery bypass grafting with bilateral mammary artery conduits is feasible and safe with promising long-term results and superior graft patency rate.
Keywords: Coronary artery bypass graftting, bilateral mammary artery conduits.
The study aimed at evaluating the feasibility, safety and analyzing long-term outcomes of the technique applied in Vietnamese patients.
Data are collected and processed using R Results: 202 patients with BIMA grafts were included into the study.
Mean age was 55.5 ± 7.8.
Mean EuroSCORE was 2.8 ± 2.3%.
691 grafts including 607 mammary artery grafts were performed, and the average number of grafts was 3.4 per patient.
Lower genital tract infection in infertile women
Genital tract infection is the most common cause that makes women see the gynecologists and this is also one of the important reasons leading to infertility.
Early diagnosis and prompt treatment of genital infection is one of the effective managements to prevent infertility later on.
Objective: This study aims to identify the lower genital tract infection in cases of infertility, and understand the involved factors.
Subjects and Methods: Descriptive cross - sectional study on 92 cases of infertility visited the Hue University Hospital through clinical examination, wet-mount and gram staining, as well as microbiological culture from vaginal discharge, Chlamydia testing with samples from the cervix, serological tests for syphilis also were done.
Results: Prevalence of lower genital tract infection is 42, 4%.
The mean age of subjects is 29, 29 ± 5, 97, the average time of infertility is 2, 83 ± 2, 47.The most common disorder is vulvo-vaginal infection; the popular pathogens are bacterial vaginosis, Candida and Chlamydia.
Factors associated with lower genital tract infection such as age, occupation, education, geography, classification of infertility, routine vaginal douching, water source for hygiene, history of lower genital tract infections.
Conclusions: The lower genital tract infections account for a significant proportion in the case of infertility.
The diagnosis and treatment of these disorders is necessary to get pregnancy easier as well as to prevent the fetus from infection.
Objective: to evaluate the role of adjunctive treatment of pleurodesis by talc through chest drainage tube in the treatment of secondary spontaneous pneumothorax (SSP).
After monitoring in 1 - 4 year period, rate of recurrent pneumothorax was 8.82% and lately complication was light chest pain (44.12%) (only occurred after excessive actions but they didn't influence patient's activities significantly).
The causes of death were unrelated to the pleurodesis.
Simultaneously, we haven't detected orther severe complications (acute respiratory failure, hypotension,...) in the follow-up after talc pleurodesis.
Conclusion: Pleurodesis by talc through chest drainage tube was high effective and safe in the treatment of SSP.
Method: Clinical experimental study Result: From 01/2002 to 12/2006, there were 123 cases of SSP (included 109 male and 14 female patients).
The incidence ratio of male: femal was 7.79: 1.
Most of them occurred in age group over 40 (95.12%).
The average age was 62.3 (range, 21 to 85).
Recurrent SSP occurred more than first SSP (which didn't response with chest drainage; time for chest drainage lasted over 7 - 10 days) (76.42% versus 23.58%).
Rate of success of talc pleurodesis at discharged time was 93.5%, with an average duration of drainage chest tube was 3, 89 days (range, 1 to 21).
Three early complicated signs were chest pain (53.66%), fever (26.02%) in the first four - hour time and cough (28.46%) in a 4 - 12 hour time after talc pleurodesis.
Besides, there were 3 cases of empyema but they had good responses to antibiotic therapies.
Treatment of knee joint instability secondary to rupture of the anterior cruciate ligament and the posterior cruciate ligament
Background: The ACL (anterior cruciate ligament) and the PCL (posterior cruciate ligament) are the two major ligaments in the knee that work together to provide stability in the knee.
They are usually caused by high - or medium-velocity knee dislocations..
Our hospital is a national traumatology-orthopaedic center where a large number of trauma patients and athletic - injury patients with severe multiple ligament injuries of the knee are treated.
We begin to operate arthroscopically assisted combined ACL / PCL reconstruction in 2008.
Missing
Objective: Identifiing the prevalence and distribution of osteoporosis and indentification risk factor of osteoporosis of Hospital of Cai Nuoc district, Ca Mau province. Methodes: A cross-sectional study was done in 2009.Results: Total of 154 women and 106 men aged from 50y and over.
The prevalence of Osteoporosis was 21.53%.
Osteoporosis prevalence among the age groups increased with age (p < 0.05).
Among the 71 cases vertebral fractures, the prevalence of osteoporosis was 53.5%.
In multivariable analysis; Advanced age and low body weight, both of which are related to BMD (r=0.63, p<0.05).
In logistic regression analysis; Advanced age, low body weight and osteopenia related to Vertebral fractures. Conclusion: The prevalence of Osteoporosis was 21.53%.
Among the 71 cases vertebral fractures, the prevalence of osteoporosis was 53.5%.
Advanced age, low body weight and osteopenia related to Vertebral fractures.
The study of cytopathologic characteristics of thyroid follicular lesions
Background: Practicallly, the term thyroid follicular lesions on fine needle aspiration (FNA) is still the gray zone for clinicians and pathologists in making decision for manage the patients due to histopathological diversity of these lesions so far.
Keywords: follicular lesion of thyroid cytopathology
Therefore, the purposes of this study is to figure out whether cytopathologic features are more specific for follicular lesions.
Objective: Identifying cytopathologic characteristics of thyroid follicular lesions.
Methods: retrospective cross-sectional descriptive study.
Subjects: 91 cases of thyroid follicular lesions were diagnosed from 01/9/2013 to 31/3/2015.
Thyroid follicular carcinoma (1.2%) was shared the same characteristics with with follicular adenomas but with more atypical nuclei.
Follicular variants of papillary thyroid carcinoma (PTC), in addition features of micro follicle arrangement, 100% cases have nucleus changes of PTC.
Conclusion: these characteristics such as: thyroid colloid, cells density, the cellular arrangement, micro follicle and nucleus changes characteristics could help the diagnosis "follicular lesion" in more details and could help the clinicians manage the patients more effectively.
"button-hole" technique - method to be selected in the treatment of penoscrotal transposition
Objective: Penoscrotal transposition is a rare anomaly of the external genitalia.
Time-honored surgical methods which have been proposed rely on the creation of rotational flaps to mobilize the scrotum to its normal anatomical location.
We describe a different approach to this anomaly by transposing the penis and not the scrotum called "Button hole" technique and to evaluate surgical outcomes of correcting penoscrotal transposition in pediatric patients operated by "Button hole" technique.
Results: There were 72.7% of the cases had excellent cosmetic result and completely successful outcome.
There have been no cases of redo operation.
Preoperative imaging of the inner ear malformations in cochlear implant candidates
Objective: The aim of this study is to determine the preoperative imaging of the inner ear malformations in cochlear implant candidates.
Keywords: cochlear implantation, inner ear malformation
Results: There were 12 patients with inner ear malformations (7.59%): 6 patients with incomplete partition type II (most commonly, 50%), 3 patients with cochlear ossification (25%), 2 patients with cochlear hypoplasia type III (16.67%) and 1 patient with incomplete partition type III (8.33%).
Labyrinthine malformations were found in 7 cases including: cystic lateral semicircular canal (4 cases, 33.33%), enlarged vestibular aqueduct (2 cases, 16.67%) and semicircular canal aplasia (1 case, 8.33%).
Surgeons spent more time for cochlear implantation in those inner ear malformations cases, about was 18.5 minutes longer on average, partly due to difficulty in identifying the round window. The risk of intra-operative cerebrospinal fluid leak was higher (16.67%) as well.
Conclusion: Inner ear malformations remain a challenge to cochlear implant surgeons.
Understanding and experience about such anomalies will aid surgeons in making surgical strategy to obtain an optimal outcome.
The features of epidemiology, clinic, paraclinic of peri-ventricular and intra-ventricular hemorrhage in preterm newborn with low birth weight less than 15 days at children’s hospital no 1
In low birth weight - preterm newborns, peri-ventricular and intra-ventricular hemorrhage is a common disease in risk, with high mortality rates, serious sequelae impacts on future long-term development of children.
54.2% infants had vitamin K1 injection early in the first 24 hours.
90.4% low birth weight - preterm hemorrhagic newborns has coordinated pathology, high rate of neonatal sepsis (50.7%), patent ductus arteriosus (45.3%), pneumonia (29.3%), fetus due to rubella infection (26.7%).
53% of hemorrhagic infants has congenital defects, frequently are the existion of oval hole (50%), atrial septal (47.8%).
70% of hemorrhagic newborns need forms of support respiratory during treatment.
33.7% of diseased newborns has ischemic signs in clinical practice.
49.4% has neurological signs, which in common are unability in breastfeeding (42.2%) and decreased strength muscle (24.4%).
42.2% of hemorrhagic newborns is in anemia at the threshold of Hemoglobin <13.5 g / dl.
Diseased newborns have an average of Hct: 40.01 ± 9.53 (%), average Hb: 13.76 ± 3.57 (g / dl), average platelet ± 148.000 / mm3 12.370/mm3.
60.4% hemorrhagicnewborns is identified to have metabolic acidosis.
Investigation of epidemiological, clinical, subclinical characteristics related to peri-ventricular and intra-ventricular hemorrhage in low birth weight preterm newborns contributes to aware and diagnose soon.
Trans-fontanel brain ultrasonography awareshemorrhagy 54% of cases in the first week.
Nearly 76% of hemorrhagy on both sides.
36.1% of cases is in acute bleeding form, 63.9% in subacute form.
On multivariate analysis, involvedhemorrhagy has in cases they need anti-shock resuscitation / cardiac arrest - apnea right at hospital admission (p = 0.016); infants with respiratory support (p = 0.041); infants with low platelets <50.000 / mm3 (p = 0.015); infants with Rubella infection (p = 0.017).
Conclusion: The rate of hemorrhagy of low birth weight - preterm newborns proves the disease quite popular.
We must pay attention to all newborns admitted to hospital for early diagnosis, especially on the ones had anti-shock resuscitation, cardiac arrest - apnea at admission; infants with respiratory support, with low platelet count, with Rubella infection.
Cerebral ultrasound in the first week facilitate early detection.
Objective: Identify the epidemiological, clinical and subclinical characteristics of peri-ventricular and intra-ventricular hemorrhage in low birth weight - preterm newborns (<37 weeks and <2500 g) less than 15 days old at Children's Hospitals I and the relation between some of these characteristics with peri-ventricular and intra-ventricular hemorrhage.
Design: Cross-sectional, descriptive and analysis studies.
Results: In 336 low birth weight - preterm newborns qualifying for the team of the research, 83 infants with ultrasound trans-fontanel cerebral identified hemorrhage, no cases of hemorrhagic meningitis were reported.
The hemorrhagic rate is 24.7%, respectively.
The hemorrhagic grading rate: 96.4% level I (80/83), 1.2% level II (1/83), level III 0% (0/83), 2.4% level IV (2/83).
Male infants in illness are more than female.
The rate of male: female 1.18,: 1.
Formulation and manufacturing process of enteric coated tablet of rabeprazole sodium 20 mg
Objective: Formulation and manufacturing process of enteric coated tablet of rabeprazole sodium 20 mg (RBPZ).
Conclusion: Formulation and manufacturing process of enteric coated tablet of RBPZ 20 mg were successfully established.
Keywords: Rabeprazole sodium, enteric coat, Eudragit L-100.
Method: Core tablet was prepared by direct compression or wet granulation process.
Seal coating layer: hypromelose (HPMC) or ethylcelulose (EC); enteric coating layer Eudragit L-100 55 were studied to find out suitable coating system.
Batch size was scaled-up to 20000 tablets.
The quantitative procedures in finished product and in dissolution testing were carried out as proposed in-house specification and was validated according to current guidelines.
Stability study in accelerated and long - term conditions were carried out according to ASEAN's guideline.
Results: Basic formulation of core tablet comprised stabilisant B, mannitol, L-HPC with suitable proportion.
Wet granulation process with ethanol 96% was chosen, HPMC was used as seal coating layer and Eudragit L100 - 55 was used as enteric coating layer.
The quantitative procedures in finished product and in dissolution testing were validated and met all requirements.
Studying of associated balanced anesthesia for biliary stones operation in elderly patients
The adverse hemodynamic effects during anesthesia correlated with coexisting diseases.
Introduction: Meckel's diverticulum is the most commom congenital malformation of gastrointestinal tract (present in 2% - 4% of population).
Results: The patient is indicated surgical intervention to resect a segmente of the intestine, including the diverticulum, and end-to-end anastomosis without complication in postoperation.
Conclustion: Meckel's diverticulum is the most commom congenital malformation of gastrointestinal tract.
Due to the rarity of cases in adults, especially bleeding from the Meckel's diverticulum.
An adequate knowledge of embryological, clinical, pathologic and radiologic characteritis of Meckel's diverticulum will aid the early and accurate diagnosis of complicated cases.
Keywords: Meckel's diverticulum.
Objective: To determine clinical, pathologic and radiologic characteritis of Meckel's diverticulumheamorrhage.
- To determinethe safety and effectiveness in management of Meckel's diverticulumheamorrhage.
Investigation on β-cyclodextrin production from hydrolyzed starch by immobilized cgtase
Background: Cyclodextrins are cyclic oligosaccharides composed of 6, 7, or 8 α-1, 4-linked glucose units, respectively classified as α, β and γ. in which β-cyclodextrin (β-CD) is used most.
Conclutions: Optimum conditions of cylic reaction from hydrolyzed starch with immobilized CGTase on alginate were indentified with the yield of β-CD was 181, 7 g / L.
Keywords: β-CD; CGTase; immobilizated enzyme; alginate, hydrolyzed starch.
They are produced by the catalytic action of cyclodextrin glucanotransferase.
The enzyme displays its cyclic action on substrates with α-1, 4-glycosyl chain, such as starch, amylose, amylopectin, dextrins, matodextrins, or glycogen Objectives: In this study, we investigated the producing of β-CD from hydrolyzed starch with immobilized CGTase on alginate.
Methods: Surveying of conditions to product β-CD with immobilizated GTase including hydrolyzed starch concentration, concentration of CGTase and reaction time.
β-CD was produced by solvent process with cyclohexan.
Recycling of immobilized enzyme was determined until enzymatic activity or the conversion efficiency of starch into β-CD was about 50% from baseline.
Results: The result showed that the optimal conditions of β-CD production on hydrolyzed starch with immobilizated CGTase were hyrolyzed starch 26%, reaction time 61h, enzym CGTase concentration 2, 91 KU / L.
Convertion yield to β-CD from starch was 51%.
And immobilized CGTase was re-used 5 times in β-CD production.
Background: Primary aldosteronism is among the most common cause of secondary hypertension.
Conclusion: Somatic KCNJ5 mutations are common in patients with aldosterone producing adenoma.
Further studies are needed to evaluate impact of KCNJ5 mutations on cardiovascular complications.
Keywords: aldosterone producing adenoma, somatic KCNJ5 mutation
Recently somatic mutations KCNJ5 genes have been demonstrated associated with the pathogenesis of aldosterone producing adenoma.
In Viet Nam until now there is no study on prevalence of primary aldosteronism in resistant hypertension.
Objectives: To assess the prevalence and characteristics of somatic KCNJ5 mutation in patients with aldosterone producing adenoma.
Methods: cross - sectional, observational study in patients with aldosterone producing adenoma underwent adrenalectomy at University Medical Center.
Genomic DNA was extracted from fresh adrenal tissue of these patients and were respectively amplified and sequenced by Sanger technique for KCNJ5 mutations.
Results: Of 34 patients with aldosterone producing adenoma, 20 (58.8%) had somatic mutations of the KCNJ5 gene.
Patients with somatic KCNJ5 mutations were younger (42.1 ± 8.9 vs 49.2 ± 9.9 years, p = 0, 017), had shorter duration of hypertension (5.8 ± 3.5 vs 10.0 ± 5.7 years, p = 0, 006) and lower potassium concentration (2.5 ± 0.6 vs 2.9 ± 0.5 mmol / L, p = 0.04) than patients without somatic KCNJ5 mutation.
In addition, patients with somatic KCNJ5 mutations had larger tumor size (21.4 ± 5.5 vs 19.6 ± 6.9 mm) but this difference was no statistically significant.
Knowledge - attitude - practice of cervical cancer screening among the housewives at the age of 18-65 in ho chi minh city from 25/2/2008 to 11/5/2008
Background: Cervical cancer is one of the two popular kinds of cancer in women worldwide. Objective: To evaluate knowledge - attitude - practice of cervical cancer screening among the housewives in Ho Chi Minh City. Method: Cross-sectional study among the housewives of Ho Chi Minh City from 02/25/2008 to 05/11/2008.
Data were collected by self-answered questionnaires from a total of 768 women. Results: The proportion was 27.7% for good knowledge about cervical cancer and cervical cancer screening.
75.7% housewives thought that cervical cancer screening is necessary.
Among the housewives who had sexual intercourse, the proportion of women having gynaecological examination within the last three years was 23.3% and just only 12% of them had annual gynaecological examination.
Among women had gynaecological examination, only 19.3% of them knew that they had been done a Pap test. Conclusions: we need more projects increasing the knowledge about cervical cancer screening program, changing women's awareness, and increasing the proportion of women who have annual gynaecological examination for cervical cancer screening.
Background: Postpartum anxiety and depression are common and health problems for postpartum women, with the most serious and worrying consequences of postpartum depression being suicided and harm to the baby.
The study aimed to evaluate the prevalence of anxiety, depression and related factors in the group of postpartum women.
Objective: Determine the rate of postpartum anxiety and depression of women and related factors.
Methods: Descriptive cross-sectional study with analysis on 200 postpartum women at Phu Yen Obstetrics and Pediatrics Hospital.
Results: The proportion of women 4 - 6 weeks postpartum with signs of anxiety and depression is 31%, 22%, and the group of women with both anxiety and depressive symptoms accounts for 21.5% of which 37.2% of women reported having had suicidal thoughts in the previous 7 days.
The study found a statistically significant relationship between postpartum anxiety and depression with the following factors: housing characteristics, prenatal psychological preparation, marital affection, husband uses alcohol, worries about problems in life and postpartum insomnia.
Conclusion: Health education, knowledge and counseling for women before and after childbirth on maternal and child health care issues is one of the effective steps to prevent anxiety and depression of postpartum women.
Research results serve as a basis for future studies.
Background: Injuries and deaths caused by road traffic accidents constitute a major concern of many countries.
The total number of hospital admissions, injuries, and deaths caused by traffic accidents are 26, 023, 18, 355 and 1, 129 at Cho Ray; 11, 962, 11, 960 and 2 at Orthopedics; 508, 2, 042 and 8 at Trung Vuong.
Ways to reduce the number of injuries and deaths are to communicate with and educate people on rules of road transport, to enforce the current laws and regulations and to improve infrastructure.
Conclusion: Traffic accidents adversely affect people's physical and mental health and they also have a huge monetary impact on the injured and their families.
Actions by local authorities and community members are required to reduce the number of injuries and deaths caused by traffic accidents.
Keywords: Traffic, trafic and health
Traffic accidents and injuries is a key topic of discussion in big cities, including Ho Chi Minh City.
Objectives: To determine the causes of traffic accidents in Ho Chi Minh city, the effect of traffic accidents on people's health and the economic impact of traffic accidents on victims‚ daily lives and their families.
To make recommendations on how to reduce the number of injuries and to improve road safety.
Methodology: Qualitative research, in-depth interviews with a representative of the Transportation Dept.
of Ho Chi Minh City and a representative of the Police Dept of Cu Chi district and five focus group discussions in communities in Cu Chi district, combined with a document review at the Board for Traffic Safety in the Transportation Dept.
Results: The five main causes of traffic accidents are: Traveling the wrong way along the road, excessive speed, carelessness, making improper turns while on the road, and improper pedestrian crossing (reported by the Transportation Dept. of HCM City).
Brachial plexus block via peripheral nerve stimulator
Purpose: This study is performed to anesthezied during surgery and pain relief after surgery.
Beside, we can use it to pain relief for that patients after surgery for a longtime (about 4 - 8 hours / bolus).
That technique is easier to do and less expenditure than general anesthesia.
Keywords: Brachial plexus block, peripheral nerve stimulator.
Pulse, blood presure, SpO2, resspiratory rate of patients were monitored right before and after analgesis injection.
Results: Anesthetize to surgery: 100%.
Need to inject Midazolam: 56.6%, Propofol: 3.3%.
Little pain when drill bone or cut skin: 3.3%.
Increase pulse: 20% (from 100 to 120p / m), hypertension: 3.3% (under 150/95 mmHg).
Conclusions: Brachial plexus block are one of technique anesthesia that we can use to surgery for the hand or forearm.
Using combination oxygen and air via nasal cannula for oxygen weaning to preterm infants in children’s hospital n0 i.
Objective: To determine the results of using combination oxygen and air via nasal cannula for oxygen weaning to preterm infants.
Conclusions: using diluted oxygen and undiluted 100% oxygen < 7 days via nasal cannula decrease unnecessary duration on respiratory support and days of oxygen delivery in comparision with using undiluted 100% oxygen ≥ 7 days.
Method: prospective, descriptive and analyzed study.
Preterm infants born at ≤ 32 weeksgestation who were clinically stable on NCPAP of 5 cmH2O with FiO2 < 30% for at least 24 h were weaned off NCPAP to nasal cannula diluted oxygen followed by gradual weaning from oxygen, switched to nasal cannula undiluted 100% oxygen for lack of air / oxygen blender.
FiO2 of blender measured every 8 hours per day.
The end point of study is successful weaning in 24 hours or when 40 weeks postmentrual age (PMA) reach.
Results: 30/32 (93.8%) infants were successfully weaned in 24 hours.
In comparison with the group "undiluted 100% oxygen ≥ 7 days'', the group" diluted oxygen "and the group" undiluted100% oxygen < 7 days "had fewer days on cannula (14.9 ± 4.7 and 9.6 ± 4 vs 21.6 ± 6.8; p = 0.02 and 0.000), shorter oxygen days (18.5 ± 7.7 and 13.2 ± 4.6 vs 30 ± 11.4; p = 0.02 and0.000).
Hiv-1 subtype diversity in naïve patient in ho chi minh city
Background: To date, the diversity of HIV-1 mutations for avoiding host immune system and resisting against antiviral drugs remains the giant challenge to human being for successful treatment in this century.
Results: Among 200 collected samples, the results show that 185 (92.5%) samples were amplified and sequenced sucessfully.
There are 175 individuals (94.59%) belong to CRF01-AE; 5 individuals (2.7%) belong to subtype B; and 3 individuals (1.6%) belong to CRF01-AE-B.
Conclusion: Our study shows the major subtype in HCMC is CRF01-AE.
Keywords: HIV-1, subtype, CRF01-AE
Many studies show different geographic distributions of about 11 subtypes and 48 circulating recombinant forms (CRFs) of HIV-1, and big differences of transmission ability as well as disease progression.
There is not much data of this issue in Vietnam.
Objective: Determine the subtype of HIV-1 inHo Chi Minh City during 2010 - 2011.
Methods: This study was designed descriptively and prospectively, performed at HCMC Hospital for Tropical Diseases from 1/2010 to 12/2011.
Criteria for screening: naïve patients were diagnosed with HIV infection following Vietnam Ministry of Health 2009 Guidelines for diagnosing and treatment HIV / AIDS (3).
Total whole blood samples were extracted RNA from plasma, synthesized cDNA, amplified and sequenced envelop gene.
Then, we used software Mega 5.05 to analyze sequences and build phylogenetic tree.
A survey of clinical examination and treatment process at outpatient clinic – trung vuong emergency hospital
Background: To provide objective information about the process of clinical examination and treatment at outpatient clinic - Trung Vuong Emergency Hospital, which will serve as a background to improve medical care which is rapidly and more efficient.
Conclusions: The study showed that all stages of the clinical examination and treatment process still consumed long time, therefore, it is necessary to improve process, so that patients could receive a fasting and more efficient service, resulting in patient satisfaction.
Objectives: To assess all stages of clinical examination and treatment procedure, average time: total time, ticket-taking time, clinic distribution, clinical examination, laboratory tests, prescription, payment, medication refill, factors associated with average time of the process: both objective and subjective.
Methods: A cross-sectional study, on patients ≥ 16 year-old at Outpatient Clinic - Trung Vuong Emergency Hospital, during working hours, from 1/2011 to 8/2011.
Results: There were 4 - 12 stages during the process, most in 7 (42, 29%).
100% patients through stage 1, 2, 4, 5; 93.6% through stage 13, 92.9% through stage 14.
Actual total time of the procedure (from start to end): 246, 87 ± 10.55 minutes (4.11 ± 1.7 hours).
Stage 1 73.41 ± 48.43 minutes, stage 2: 1.84 ± 10.15 minutes, stage 3: 9.83 ± 7.93 minutes, stage 4: 7.43 ± 5.02 minutes, stage 5: 13.05 ± 9.28 minutes, stage 6: 10.44 ± 5.99 minutes, stage 7: 96.46 ± 75.98 minutes, stage 8: 33.6 ± 23.82 minutes, stage 9: 12.63 ± 8.95 minutes, stage 10: 12.87 ± 10.03 minutes, stage 11: 9.03 ± 5.98 minutes, stage 12: 10.8 ± 8.24 minutes, stage 13: 8.82 ± 6.73 minutes, stage 14: 36.4 ± 21.6 minutes.
Mean time over all stages: 191.62 ± 83.42 minutes (3.18 ± 1.39 hours).
Mean time in service group: 180 ± 97 minutes, insurance + service group: 247 ± 102 minutes, insurance group: 252 ± 104 minutes. Group had longest time include: age> 60, at internal medicine clinics, chronic disease group, insurance group.
Objective: To determine the rate of the choice modern contraceptive methods among women using contraception advice centers - Hung Vuong Hospital from November 2015 to May 2016.
Results: the sample included 340 women, all of them were married.
The women accepted the modern contraceptive methods with the rate was 77.1% (CI 95% (72.6 - 81.6)), in which, intrauterine device which was accepted at most with 38.5% and sterilization was accepted at least with 0.4%.
Among women didn't choose the modern contraceptive methods, the most reason was that they were afraid of having difficulty getting pregnant with 53.8%.
Women had used modern contraceptive methods selected modern contraceptive methods 11.6 times higher than women only ever used traditional contraceptive methods.
No association between occupational, marital age, number of children present, demand for more children with acceptance of modern contraceptive methods.
Conclusion: Need proactive about the early guidance and advice about effective contraception for young women, especially women with low education because these are groups of people with inappropriate contraception.
Key work: modern contraceptive methods.
Effects of 810nm diode-laser on human gingival fibroblast migration
Results: Group 1 cells migrate the weakest.
Group 2 cell migration was stronger than control group only at 24 h but the difference was not statistically significant.
Group 3 cells migrated the most.
Cell migration in group 3 was significantly different from cells in group 1 at 24 h (p<0.01) and significantly different from all other groups at 48 h (p <0.001).
Conclusion: Laser can modulate hGF proliferation.
This study contributed more evidence for possible effects of laser on wound healing process after periodontal treatment.
Clinically, the types of devices and setting parameters are diverse.
Therefore, it is necessary to find out the meaning of the impact of the parameters.
Objectives: To evaluate effects of 810nm diode laser on migration of human gingival fibroblasts (hGF) according to different settings.
Methods: This in vitro study used hGF obtained from gingival tissue in the maxillary anterior tooth region of healthy donors.
The cell monolayer was irradiated with 810nm diode-laser which operated at different parameters: group 1 - elimination of inflamed tissue and pocket epithelium; group 2 - disinfection; group 3 - biostimulation and group 4 - control group (non-irradiated).
Cell migration was evaluated by using in vitro scratch assay after 24 and 48 hours.
One-way ANOVA test were applied to analyze these data.
The clinical and paraclinical features of cholangiocarcinoma
Objectives: to study clinical and paraclinical factors to help early diagnose in the cholangiocarcinoma.
CT Scanner had the sensitivity 74%.
PTR and ERCP displayed clearly the bile ducts and the location of obstruction.
The poor pronostic with the death in one month from the moment of discover disease.
Conclusion: cholangiocarcinoma is difficult to diagnosis and treat.
To early and exactly diagnose should have approriated screening plan, do classic tumor markers.
Endoscopy laparostomy should be done for the patients having operative indication to gagne a convenable treatment plan.
Methods: A descpriptive retrospective study with all of patients diagnosed cholangiocarcinima, at the moment of dischargement, at Chôï raãy Hospital from 01/2004 to 12/2006.
Results: there were 148 patients with 87 men and 61 women. The average age was 61.7 ± 14.5.
The common clinical picture was gradual increased jaundice, dullness pain at right subcostal, loss weight and anemia.
The most common position was the liver hilus, taked 64.2%. The diagnose was difficult to base clinical signs combined with abdominal ultrasonography, CT scanner, PTC, ERCP, CA 19 - 9.
At the level of 35U / l of CA 19 - 9, its sensitivity was 79.2%.
Development and evaluation of a real-time pcr assay for the detection of acinetobacter baumannii
Backgrounds: Nosocomial infections are currently serious problems for community health since they are mostly multidrug resistant bacteria.
Conclusions: The real-time PCR protocol could be used for rapid identification of A baumannii in hospital environment.
Keywords: A baumannii, carbapenemase, blaOXA-51, meronem, real-time PCR
One of the leading agents causing nosocomial infections is Acinetobacter baumannii.
Objectives: The study aimed to develop a real-time PCR protocol to detect A baumannii.
Methods: The real-time PCR was optimized to amplify blaOXA-51 and 16S rRNA genes specific to A baumanii and Acinetobacter spp.
correspondingly.
The identification of A baumannii by real-time PCR was compared to those obtained with Phoenix bacterial identification system.
Results: The result showed that the real-time PCR protocol correctly detect A baumaniii based on blaOXA-51 gene with the sensitivity of 11 copies / reaction.
Detection rate for A baumannii was 90.8% and 70.8% by real-time PCR and automatic bacterial detection system respectively.
Evaluating the effectiveness of management, protection and health care of cadres in vinh long province in 3 years 2016-2018
Objective: We carried out the project "Evaluating the effectiveness of management, protection and health care of cadres in Vinh Long province in 3 years 2016 - 2018" with the aim of: Statistics of disease patterns of cadres in Vinh Long province in 3 years 2016 - 2018 and preliminarily evaluate the effectiveness of management - protection and health care for cadres in Vinh Long province.
A total of 12/65 cases exhibited disorders of uric acid metabolism, other common diseases are osteoarthritis.
Up to 58/65 people (92.3%) achieved average health or more.
Concluctions: The management, protection and health patterns of cadres in Vinh Long province in 3 years 2016 - 2018 is quiet good.
Keywords: obesity, high blood pressure
Methods: 65 subjects are central government officials in Vinh Long during 3 years from 2016 to 2018.
Descriptive methods of retrospective clinical and subclinical manifestations with other management measures.
Results: The average age was 67.2 years, with 5 cases recorded as obesity, 32/65 (49.2%) suffered from high blood pressure mainly in old age> 60 years (77.5%), middle-aged people only have 2/16 shifts (12.5%).
Cardiovascular disease occurs mainly in retired elderly people, myocardial anemia is the most common.
Fat metabolic disorders are more common in old age 26/50 (52%), liver dysfunction has 14/65 = 21.5% and is more common in old age.
Fatty liver disease is more common; Prostate enlargement is seen only in elderly people (12/65 = 18.5%).
There are three cases of chronic obstructive pulmonary disease (COPD) and 08 cases of sinusitis in old age.
Diabetes is mainly type II diabetes, most of them are over 60 years old.
Survey of clinical, paraclinical features and treatment of acute pancreatitis at tien giang central general hospital
Background and Objectives: Acute pancreatitis is an acute damning process of pancreas, which usually occurs suddenly with complex clinical features.
Amanesis: 77% drinking alcohol, 8% diabetes, 27% dyslipidemia, 6% acute pancreatitis.
Functional symptoms: 100% abdominal pain, 41% nausea and vomiting.
Physical symptoms: 41% abdominal distention.
Average blood amylase was 530.4 ± 28.3 U / L.
57% patients have hyperlipidemia and 14% ones have hypertriglyceridemia.
34% patients have ultrasound picture of acute pancreatitis.
Conclusions: Acute pancreatitis is prevalent in men (77%), between 31 - 50 years old (67%), with amanesis of drinking alcohol (77%).
In Vietnam, a number of studies and statistics show that acute pancreatitis is increasing.
The rate of cure is 94% and mortality rate is 1%.
Keywords: Acute pancreatitis, Atlanta 2007, intra abdominal pressure.
Currently there are many studies and treatment regimens for acute pancreatitis but the rate of complications and death from severe pancreatitis is still high is from 20 to 50%.
Therefore, we conduct research on this topic to assess the disease status as well as the outcome of treatment at the unit.
Methods: Across - sectional study. Collected samples were patients with acute pancreatitis according to Atlanta 2007.
Results: 97 patients were selected.
Average age: 40 ± 9.89 years old, 67% patient is between 31 - 50 years old.
Plasma lipoprotein-associated phospholipase a2 activity in vietnamese patients with acute coronary syndrom
Objective: We aimed to identify activity of lipoprotein-associated phospholiase A2 in plasma of VietNamese patients with acute coronary syndrom (ACS) and to evaluate the association of this biomarkerwith the clinical severity of ACS.
Method: Cross sectional analysis was conducted on 323 Vietnamese patients with ACS (210 males and 113 females), mean of age 63 ± 13ys (patient group) and 91 Vietnamese volunteers (54 males and 37 female) wrere apparently healthy and matched by age, sex (control group).
The samples were taken from January 2011 to February 2012 at Cho Ray Hospital.
Results: Distribution of Lp-PLA2 activity in plasma of these study populations were normal. Mean of Lp-PLA2 activity in plasma of patients with ACS: 211 ± 58 nmol / min / mL, higher than that of people without ACS: 182 ± 58 nmol / min / mL and related with severity of ACS on univariate and multivariable analysis: unstableangina: 189 ± 49 nmol / min / mL, non ST elevation myocardial infarction: 212 ± 56 nmol / min / mL and ST elevation myocardial infarction: 216 ± 59 nmol/min/mL.
Conclusion: Total extract and fractions extracted from the root DSVN had antioxidant effects on 1, 1-diphenyl-2-picrylhydrazyl radical test.
In which, ethyl acetate fraction was strongest in this activity.
Keywords: Codonopsis javanica, Lam Dong, antioxidant, DPPH.
cultivated in Lam Dong Province "was carried out.
Methods: Roots of DSVN 3 years old cultivated in Lam Dong were provided by Cao Lam Co Ltd.
Extraction and isolated into fractions by under reflux and liquid-liquid partition.
The free radical scavening effect on 1, 1-diphenyl-2-picrylhydrazyl radical test of fractions were examined.
Results: IC50 of total extract, diethyl ether, ethyl acetate, n-butanol and water are 654.10 µg / ml; 874.62 µg / ml; 280.46 µg / ml; 945.41 µg / ml, 1113.30 µg / ml, respectively.
Applied result of thoracoscopic surgery in treatment of mediastinal tumor at hospital 103
Objectivess: To assess initial results of thoracoscopic surgery in treatment of mediastinal tumors at Hospital 103Materials and methods: Cross-sectional descriptive study on 51 patients with mediastinal tumors, who were undergone Thoracoscopic Tumomectomy at Hospital 103, from 9/2008 to 9/2010.Results: 51 patients with mediastinal tumors: 23 males and 28 females.
Conclusions: Thoracoscopic surgery for mediastinal tumors is a safe and technically feasible procedure and may offer significant postoperative advantages over open procedures.
The mean age was 46.6 (15 - 69).
The major symptoms were myasthenia gravis and chest pain.
There were no major postoperative complications or recurrences to date.
Histopathology: Thymoma (35: benign 31, malignant 4), cancer of oesophage (10), simple goitre (2) cases.
Using the scopis building blocks planning software to determine frontal sinus drainage pathway types in relation to frontal cells
Objectives: The goals of this study is to determine the prevalence of Agger Nasi cell, supra Agger cell, supra Agger frontal cell (classified by IFAC 2016), and the frontal sinus drainage pathway types (based on its anatomic relationships with these cells), using Scopis Building Blocks planning software.
Keywords: IFAC 2016, frontal cells, Agger Nasi cell, supra Agger cell, supra Agger frontal cell, frontal sinus drainage pathway types, Scopis Building Blocks planning software.
Methods: This is a descriptive cross-sectional study of radiological datas from 208 frontal recesses of 114 patients at Ear Nose Throat hospital of Ho Chi Minh city from June 2016 to June 2017.
Results: Analysis by Scopis Building Blocks software of 208 CT scans was performed.
The proportion of Agger Nasi cells was 95.7%, supra Agger cells was 16.35%, and supra Agger frontal cells was 12.98%.
In 199 cases that Agger Nasi cells are presented, the percentage of frontal sinus drainage pathway posterior to this cell is 65.83%, medial to this cell is 32.67%, lateral to this cell is 1.51%.
In 34 cases that supra Agger cells are presented, the percentage of frontal sinus drainage pathway posterior to this cell is 26.47%, medial to this cell is 70.59%, lateral to this cell is 2.94%.
In 34 cases that supra Agger frontal cells are presented, the percentage of frontal sinus drainage pathway posterior to this cell is 11.11%, medial to this cell is 81.48%, lateral to this cell is 7.41%.
Evaluate the surgical outcomes of vertical reduction mammaplasty combined with a superomedial pedicle in giagantomastia
Introduction: Giagantomastia not only affects the aesthetic function but also limits patient's daily activities.
Breast symmetry, hidden scars and conserving the nipple areola's function are difficulties to surgeons.
There are various techniques combined with different types of dermoglandular pedicles were reported.
However, vertical reduction mammoplasty combined with a superomedial pedicle is safe and effective technique to treat mild to moderate breast hypertrophy with low rate of necrosis and loss of sensation of the nipple areolar complex.
Objective: Evaluate the surgical outcomes of vertical reduction mammoplasty combined with a superomedical pedicle.
Method: Prospective research conducted in patients with giagantomastia operated using vertical reduction mammoplasty combined with a superomedial pedicle in the Plastic & Aesthetic Department - Cho Ray Hospital from 01/2014 to 04/2016
Procedure development for the extract from curcuma longa l.
Objective: Development of the extraction procedure for the dried extract from Curcuma longa L Materials and Methods: Rhizomes of Curcumae longae were purchased in Ho Chi Minh City.
Intelligent software: FormRules v3.3 (Intelligensys, Ltd, 2007) was applied for cause-and-effect study and INForm v3.7 (Intelligensys, Ltd, 2008) was used for multivariateoptimization.To
Results: It's proven that curcumin I content was related to ethanol concentration only whereas the extraction yield was influenced by all investigated factors.
Based on these cause-effect models, the extraction parameters - including ethanol concentration, material-solvent ratio and extraction times - were successfully optimized.
Conclusion: With the intelligent software assistance as a framework, the extraction process for Curcuma longa rhizome was optimized to obtain the maximum content of curcumin I and the highest extraction yield.
The optimized extraction parameters were successfully verified by experiments.
Study of the characteristics of clinical presentations and postoperative care for spinal sugery patients with traumatic thoraco-lumbar injuries
Objective: To study the characteristics of clinical presentations and postoperative care for spinal sugery patients with traumatic thoraco-lumbar injuries and evaluate the results of surgical treatment for traumatic thoraco lumbar injuries.
Keywords: Thorcolumbar injury, surgery, potoperative pain.
Methods: A prospective study was conducted to evaluate the clinical manifertations and postoperative care management for 49 patients with traumatic thoracolumbar injuries who underwent surgical treatment at Departement of neurosurgery and spinal surgery in provincial general Hospital of Gia Lai from january 2014 to September 2014.
The most prominent manifestations were as following: pain (100%), pneumonia (4.1%) skin ulcer (6.1%).
Conclusions: Post operative clinical presentations of the patients with traumatic thoracolumbar injuries is complicated, facing to the risks of infection functional deficits.
The nursing care for all systems were necessary and to contribute to successful results of surgical treatment for the patients with traumatic thoracolumbar injuries the surgical treatments of the patients with traumatic thoraco lumbar injurier have good results.
Laparoscopy in blunt abdominal trauma and stab wound
Background Depite the development of diagnosis means in abdominal trauma settings, such as radiography, DPL, ultrasound, CT sanner..., the incidence of unnescessary laparotomy is still in high level.
No morbidity, 01 cases died because of severe cranial injury.
Concluscion Laparoscopy has a high sensitivity and specitivity in finding and excluding holow injuries.
The thoracolaparoscopy seems to be a safe, effective and mini-invasive approach in thoraco-abdominal penetrating wound.
the laparotomy cause some significance complications, long hospital stay time, uncosmetis.
Laparoscopy in blunt abdominal trauma and stab wound have been studying at many trauma centers over the world.
In VietNam, its role hasn't been evaluated yet.
The laparoscopy were indicated in the folowing situation: the suspicion of hollow injury sur clinical and images in blunt trauma and in abdominal penetrating wound without signs of hypovolemic shock, peritonitis, evisceration.
37 of 39 injuries have been discovered.
The sensitivity is 95%, the specitivity of small bowleand large bowle are 100% and 97%.
Clinical and imaging characteristics for diagnosis of traumatic carotid cavernous fistula
Objectives: To analyze clinical symptoms and diagnostic imaging features of traumatic carotid cavernous fistula.
There are 39% of patients presented with progressive visual failure below 5/10, in which 12% patients were blind one eye.
Doppler ultrasound reveals dilation of ophthalmic vein in 98% patients with bruit.
There are 7% of patients have severe lesion on head CT Scan such as cerebral hemorrhage or infraction, pseudo aneurysm in the sphenoid sinus.
Cerebral angiography is the most accurate for diagnostic of carotid cavernous fistula and analysis the hemodynamic changing after present of the fistula.
Conclusions: Traffic accident is the main cause of direct carotid cavernous fistula in Vietnam.
This disease can be diagnosed by clinical examination and simple test as Doppler ultrasound of the ophthalmic vein.
It can cause more severe symptoms not only to the visual but also to the brain.
Most of the patients in this study were admitted at 12 weeks after the first symptom.
Data base was analyzed using Stata 10.0 software.
Results: There are 172 cases traumatic carotid cavernous fistula had enrolled during study period time.
The mean of age is 33, male gender is dominant with 86%, and traffic accident accounted for 92% cases.
The period time from head trauma to diagnostic is 12 weeks.
Patient's symptoms were revealed with redness in one eye associated with progressive proptosis in 81%, with bruit in 99%.
Cranial nerve palsy was found in 55%, in which cranial VI palsy is 31%.
Background: Hepatoblstoma is the most common pediatric malignant hepatic tumor.
Besides, the resectability of the tumor also increased significantly (17%). Formal hepatectomy was performed in 63, 9%, wedge resection was performed in 27.8% and tumor biopsy was only performed in 8.3%.
All the surgical margins were clear. Intraoperative hemorrhage could happen (5.5%).
The ICU time was short (1.5 days), the oral feeding time was short (2.2 days), the hospital stay was acceptable (25.4 days).
Keywords: hepatoblastoma, chemotherapy, hepatectomy.
Surgery is the mainstay of treatment.
However the rate of the resectability of the tumor is not high at the time of diagnosis.
Neoadjuvant chemotherapy facilitate the heaptectomy therefore increase the resectability of the tumor.
Materials and methods: Study retrospectively the medical documents of all the patients diagnosed hepatoblastoma were managed with neoadjuvant chemotherapy based on SIOPEL protocol and operated at Children's hospital 2 from 01/2012 to 03 / 2017.
Results: Mean age was 19 months and age group ≤ 2 years was 77.8%.
Preliminary outcomes of ab cochlear implant at nguyen tri phuong hospital
Objective: Assessment the initial outcomes of AB multichannel cochlear implant surgery.
One post-lingual hearingloss adult may have daily conversation, using telephone has been improved.
Conclusion: Cochlear implantation has provided a major advance in the treatment of severe to profound sensorineural hearing loss.
However, improvements in auditory speech recognition and speech production occur over a long time-course of rehabilitation in prelingually deafened children.
In adult postlingual hearingloss the time is shorter.
Keywords: Cochlear implant
Subjective: Profound neurosensorial hearingloss without benefit from hearing aid have indication for cochlear implant at Nguyen Tri Phuong hospital from 1/2014 to 9/2014.
Method: Descriptive study with interventional surgery.
Result: Nine patients from severe to profound neurosensorial hearingloss underwent Cochlear Implant with AB Cochlear (Advanced Bionic company).
Eight of them are children, one adult.
Preliminary outcomes: cochlear implant with no complications during and post surgery.
After surgery, all of them have intensive speech rehabilitation.
Eight pre-lingual congenital hearingloss children have respond to sound, speech perception and some of them can produce speech a little bit, some words, some short phrase,.
The detection of renal lithiasis in community: test of urinary sediments after gymnastic exercises
In order to apply the appropriate techniques in primary health care, we used the test of urinary sediments after gymnastic exercises (for red blood cells detection).
Among 6858 people randomly chosen, we noticed: 1, 7% people get renal lithiasis.
- Positon, shape and size of the stone and the way to do gymnastic exercises influenced the result of the test.
X ray and ultrasourd helped to diagnose the patients who have positive test.
Diagnostic evaluation of procalcitonin in patients with parasitic infections
Conclusion: Serum procalcitonin levels are normal in parasitic infections except severe malaria with Plasmodium falciparum.
CRP increases high in parasitic infections.
The aim of the study is to evaluate procalcitonin concentration in patients with parasitic infection, especially for malarial parasites.
Material-Method: Series of prospective study are described from September 2007 to October 2008 at Department of Tropical Diseases in Cho Ray hospital.
There are four groups, group 1: healthy volunteers (n = 30), group 2: severe malaria (n = 10), group 3: uncomplicated malaria (n = 6), group 4: other parasites (n = 5).
Compare results between group 2 and group 1: FBC = 1, 717, PBC = 0, 198 (There is no difference (P > 0, 05); FCRP = 196.102, PCRP < 0.001 (There is a difference (P < 0.001); FPCT = 5.463, PPCT = 0.025 (There is a difference (P < 0, 05).
Compare results between group 3 and group 1: FBC = 8, 162, PBC = 0, 007 (There is a difference (P < 0.05); FCRP = 39.729, PCRP < 0, 001 (There is a difference (P < 0.001); FPCT = 48.260, PPCT < 0.001 (There is a difference (P < 0, 001): Compare results between group 4 and group 1: FBC = 2.440, PBC = 0.128 (There is no difference (P > 0.05).
FCRP = 23.066, PCRP < 0, 001 (There is a difference (P < 0.001).
FPCT = 0.339, PPCT = 0.564 (There is no difference (P > 0.05).
Diagnostic value of clinical manifestation for peripheral artery disease of lower extremity in diabetes
The prevalence of lower extremity PAD in diabetes group was 22.8%. Conclusion: The signs and symptoms which were common such as claudication, abnormal pigment of skin of lower extremity had high specificity but low sensitivity when using the CDU as' gold standard'.
To campaign for organ donation after death: difficulty and advantage - practical experience at cho ray hospital
Background: Organ Transplantation in Vietnam was performing very early, but until 1992, the first kidney transplantation from living related donor has been successful at the 103 hospital.
But Organ donation from living donor has not enough to satisfy a need of transplantation. We should receive organ donation from Brain-dead or Cardiac death donors.
Materials and methods: prospective studies, case series by interviewing the potential donor families with brain death and severe cardiovascular diseases patients are treated at the Neurosurgical intensive care and Cardiology department in Cho Ray Hospital from Aug. 2014 to May 2015.
Results: from Aug. 2014 to May 2015, we approached to 30 potential donor's families: 28/30 (93.33%) patients (pts) with Brain death and 2/30 (6.67%) pts with the risk of cardiac arrest at Cardiology Dept.. 46.66% of potential donor's families had information about organ donation after death, 20.0% have thought about organ donation.
But that is not really what happened, 96.67% the potential donor's families have refused organ donation at that times.
Characterisitics of tricuspid regurgitation in patients with mitral valve surgery at heart institute in hochiminh city
Objective: To describe the clinical and paraclinical characteristics of patients with tricuspid regurgitation (TR) undergoing mitral valve surgery at the Heart Institute Ho Chi Minh City.
Method: Retrospective study - describe and analyze 652 patients hospitalized for mitral valve surgery with TR from mild (grade 1 or 2) to severe (grade 3 or 4) in the period from 2000 to 2012.
Results: Female patients (65.64%) and age average is 46.85.
Mild TR (level 1 & 2) is in 94 patients (14.41%) and grade 3 & 4 in 558 patients (85.86%).
Atrial fibrillation is higher in patients with severe TR (63.8%) compared with patients with mild TR (36.17%), significant difference (p < 0.001).
NYHA class 2.19 and patients with moderate - severe (grade 2 & 3) are at high percentage of 96.48%.
Organic TR (46.24%) in medium - severe patients is higher than mild ones (7.45%) with significant difference (p < 0.001).
The prognostic factors for TR with moderate - severe grade to mild disease including atrial fibrillation (OR = 2.07, p = 0.01), organic TR (OR = 3.08, p =0.004), right ventrial diameter (OR=1.09, p=0.006) and PAPS (OR = 1.02, p = 0.02).
Conclusion: Patients having mitral valve surgery with TR were hospitalized late with heart failure symptoms such as heart failure, TR severe (>2), high tricuspid annulus diameter, high PAPS, organic TR and high prevalance in women than men.
The indication for surgery was correlated with site, size, general status, lesion of the bleeding peptic ulcer and rebleeding or failure of endoscopic treatment as well as bleeding degree.
Surgical procedures including simple suture (n=10), Weinberg's operation (n=3), and subtotal gastrectomy (n=18).
Postoperative rebleeding rate was 19.4% (6/31) and was the highest in simple suture procedure.
Mortality rate was 25.8% (8/31).
Anatomical characteristics of median nerve in vietnamese carpal tunnel
From dissection of 30 hands of 15 cadavers, we observed some of anatomical characteristics of median nerve in Vietnamese carpal tunnel.
Multiform of motor and sensory branch of median nerve explains some of symptoms and electrodiagnosis of carpal tunnel syndrome
Difference in clinical features and treatment results between t-and b-cell lymphomas: a study at hcm city oncology hospital
Purpose: To evaluate a difference in clinical features and treatment results between T-and B-cell lymphomas. Methods: We analyze the clinical features and treatment results of the 316 patients with Non-Hodgkin's lymphomas (NHL) treated in the HCM City Oncology Hospital between January 2007 and December 2008.
Conclusion: Our results suggest that it is needed more effective therapy to improve the prognosis of T-cell lymphomas.
Results: Sixty-two patients (20%) had a T-cell lymphomas and 254 (80%) a B-cell lymphomas. The elderly patients > 60 years were frequently in B-cell lymphomas.
When the large cervical lymph nodes were usually in B-cell lymphomas, the rate of patients added KPS status < 70 was higher in T-cell lymphomas.
There was no difference in staging, value of LDH and Interntional Prognostic Index in between both arms.
T-cell lymphomas patients have a smaller complete remission and a significantly shorter disease-free survival (DFS) and overal survival (OS). Multivariable analysis showed immunophenotype was independent factor that it can predict DFS.
Serum cardiac troponin i levels in healthy normal people
Background: Cardiac Troponin I is the most myocardial-specific, sensitive biochemical marker for the diagnosis of cardiac injuries, especially in acute myocardial infarction.
Objective: To investigate serum cardiac Troponin I levels in healthy normal people.
Method: cross - sectional, descriptive.
Results: We studied 94 healthy normal people, 42 men, 52 women, mean aged: 41, 62 ± 13, 09.
There was no difference in cardiac Troponin I levels between the young people (< 40ys) and the elderly (≥ 40ys).
However, there was the difference in cardiac Troponin I levels between men and women; man - cardiac Troponin I levels were higher.
Treatment of stress urinary incontinence in women by method of tension-free vaginal tape
Introduction: T V.T
(Tension-free Vaginal Tape) is a new technique proposed by Pr.
Umsten from Sweden since 1996 for treatment of stress urinary incontinence (SUI) in women.
Objectives and Methodes: We have applied this technique in Binh Dan hospital since the end of the year 2002 to treat stress urinary incontinence in women, with or w / o cystocele.
Because the price of original tape of the Ethicon company is very expensive, we had to use a polypropylene sheet (30 x 30 cm) and divide it into many tapes with 1 cm width.
Results: During 3 years, we have treated 12 women with SUI (4 of them associated with cystocele) Successful incidence was 11/12 ~ 91, 6% with average follow-up time post-op ~ 7, 7 months (3 - 18 months).
Conclusion: We have applied successfully the technique of T V.T
The influence factors of the sexual intercourse before marriage of women workers in binh tan district, ho chi minh city, 2008
Background: Social problem last sexual intercourse behavior martially being to care many peoples, sexual intercourse behavior in advance martially used to securely second best risk element in poor countries (WHO) conductivity come to HIV / AIDS, transmitted diseases cross a road sexually, pregnancy in addition to accord 2
Objectives: Fathom elements affect last behavior nuptial that in work woman at boarding-house district Flask Township is New, Hồ Chí Minh city in the year 2008
Method: Qualitative research, gather information by 5 group discussions, 6 worker deep interviews and related parties at New Flask township Ho Chi Minh city from April / 2008 to July / 2008
Results: show a number of causes predispose sexual intercourse behavior in advance before marriage like most knowledgeable worker is low about reproduction health, haven't been come closet to reproduction health services, care sexual intercourse tale manner looked up in advance nuptial that be normal, element objectively such as last cohabitation is nuptial, have only two people in lonely spot, family faraway situation ought to Fewer to care and division will from intimate, person's acrimonious protestant manner on all sides, lead on sexual behavior hiding concern men, send out misbegotten resolution himself...
Conclusion: Sexual intercourse behavior in advance is nuptial in worker it be often insecurity to predispose to hitch transmitted diseases to cross a road sex, HIV / AIDS, in an interesting condition in addition to accord, abortion scraping, in addition still to affect heavily up to spirit health.
Objectives: In Vietnam, the combination of amoxicilin and sulbactam is relatively common.
However, neither the current Vietnamese Pharmacopoeia nor other reference Pharmacopoeias present the monograph of this combination.
At present, in Vietnam, there are not any publication on the quantitative analysis of amoxicilin and sulbactam yet.
Therefore, this study was conducted to simultaneously quantitative of amoxicilin and sulbactam in powder for injection by HPLC method.
Methods: Simultaneous quantitative procedure of amoxicillin and sulbactam by HPLC - PDA were developed and validated in accordance with ICH guidelines.
Results: HPLC conditions for the quantification procedure of amoxicillin and sulbactam are: Knauer C18 column (250 x 4.6 mm; 5 mm), a mixture of ACN - TFA solution pH 3.0 (7: 93) as mobile phase, injection volumn of 10 μL; flow rate of 1.2 mL / min, detection wavelength of 205 nm.
The procedure is selective with a linear range of 30.0 - 97.5 ppm (r = 0.9996) for amoxicillin and of 15.00 - 48.75 ppm (r = 0.9997) for sulbactam, high precision (RSD < 2%), high accuracy with a recovery rate of 98.0 - 102.0%.
Conclusions: A quantitative procedure of amoxicillin and sulbactam in powder for injection was successfully developed.
Keywords: HPLC, amoxicilin, sulbactam, powder for injection
Fulminant myocarditis and multiorgan failure due to h1n1 influenza a infection – a case report
A / H1N1 influenza infection affected mainly on respiratory tract from mild dyspnea to severe complications as acute respiratory distress syndrome, multiorgan failure and death.
Fulminant myocarditis is rare fatal one of many complications due to A / H1N1 influenza virus.
We report a 15 year-old man with history of 3 day duration of fever and gradual increasing dyspnea and presented at Choray hospital with severe dyspnea, circulation collapse and multiorgan failure.
A positive H1N1 influenza polymerase chain reaction of naso-pharyngeal swab was reported.
The patient survived after aggressive management including intubation, mechanical ventilation, circulatory support, vaso active, antibiotics and antiviral therapies.
Background: Ventilator-associated pneumonia (VAP) is a common condition in patients at intensive care units (ICUs) increasing mortality and morbidity.
aureus (8.5%).
A baumannii was resistant to most antibiotics and 73% isolated A baumannii was still sensitive to colistin.
Other pathogens showed alarmingly high rate of antibiotic resistance.
Conclusion: A trend of increased rate of VAP at the ICU of Military Hospital 175 was clearly confirmed.
The main causative pathogens were highly resistant germs.
Therefore, infection control program need to be strengthened in the whole hospital, especially at the ICU.
Keywords: Ventilator - Associated Pneumonia (VAP), antibiotic resistance, Military Hospital 175.
Objectives: The study was carried out to determine the VAP rate, associated factors, pathogens and antimicrobial resistance at the ICU, Military Hospital 175.
Method: Cross sectional, observational study.
VAP diagnosis was based on criteria issued by Ministry of Health in 2015.
Samples were collected by intratracheal tube aspiration or bronchoscopy aspiration.
Culture and antibiogram were carried out on automated Vitek 2 System.
The main causative pathogens were A baumannii (40.7%); K pneumonia (18.6%); P aeruginosa (13.6%); Staph.
Studying the risk factors of stroke
The study evaluates the frequency of risk factors of ischemic stroke and heamorrhagic stroke.
This study finds: evidence-adequate factors; HTN 67.7%, diabetes mellitus 20.3%, heart diseases 11.1%, TIAs 10%, past history of stroke 43% and evidence-little factors: smoking 66%, lipidemia disorders, little exercise 65%.
Aims: To assess nurse's knowledge and medi-care for anaphylactic shock. Methods: Survey on 140 nurses those working in clinical departments at Hospital K using a questionnaire.
Analysis of results based on age groupe and education - training levels. Results: 100% have true answer on drugs as a cause of anaphylactic shock, but 17% have false answer on blood's accessories as a cause of anaphylactic shock; 60% have false answer on respiratory and circulation signs of anaphylactic shock. Conclusion: High rates of inadequate answers indicate that we have a lot of work to do to improve the knowledge of the nurses.
The efficacy of toothpastes containing 5% calcium sodium phosphosilicate, 8% strontium acetate, or 5% potassium nitrate in reducing dentine hypersensitivity
Conclusion: Toothpastes containing 5% Calcium Sodium Phosphosilicate, 8% Strontium Acetate, or 5% Potassium Nitrate provided a significant efficacy in DH reducing, immediately in 60 seconds and gathered in 8 weeks of product use.
Keywords: dentine hypersensitivity (DH),, Calcium Sodium Phosphosilicate, Strontium Acetate, Potassium Nitrate.
Clinical trials have reported for evaluating the clinical efficacy of these products.
Objective: To evaluate the clinical efficacy in reducing DH of toothpastes containing 5% Calcium Sodium Phosphosilicate, 8% Strontium Acetate, or 5% Potassium Nitrate.
Subjects and methods: Eight-week, parallel group, single blind, stratified, randomized clinical study was conducted on 336 teeth with moderate and serious DH to tactile stimuli using Yeaple Probe and to air blast (40 - 65psi, 22±20C).
Subjects of 4 groups were applied with selected toothpaste on the hypersensitive teeth, then were instructed to brush their teeth twice daily for 8 weeks with the toothpastes containing 5% Calcium Sodium Phosphosilicate, 8% Strontium Acetate, 5% Potassium Nitrate, or Fluoride toothpaste.
DH to tactile stimuli and to air blast was conducted at baseline, 60 seconds, 14 days, 28 days and 56 days.
Results: The toothpastes provided a clinical efficacy in DH reducing in all interval evaluation times with tactile stimuli and air blast, and changed DH from moderate and serious level to mild and none level after 8 weeks.
Eight percent - Strontium Acetate toothpaste showed the most effective values to both stimuli at all interval times of evaluation.
Eosophagectomy via thoracoscopy and laparoscopyfor esophageal burn stricture
No operative mortality.
Late complications were seen in 2 patients (13, 33%) with cervical anastomotic stricture.
Average postoperative hospital stay was 13 days.
Conclusions: Eosophagectomy via thoracoscopy and laparoscopy or laparotomy is a safe method for esophageal burn stricture in the big medical centers and experienced surgeons.
07 cases of very high esophageal stricture which had to be done tongue base - gastric conduit or left colon anastomosis.
03 cases of total esophagogastro resection and used of replaced left colon. The gastric tube or left colon was introduced through the posterior mediastinum to the cervical level to anastomose with the cervical eosophage.
Average age was 31 (from 22 to 51).
Research of ca125 value in following ovarian carcinoma
Introduction: Quantitative measurement of CA125 (Cancer Antigen 125) can follow ovarian cancer after treatment but it has not been studied yet completely in VietNam.
CA125 concentration after chemotherapy have the correlation with CA125 concentration after 3 cycles of chemotherapy (R = 0, 93).
There are no different statistical significance between them (sensivity, specificity, mean, standard deviation...).
Conclusions: CA125 can be used to follow ovarian cancer after treatment.
We ought to associate serum CA125 assay with other tests (CT scan or ultrasound...) for accurately and early detection the recurrence / metastasis of ovarian carcinomas.
We can use CA125 concentration after 3 cycles of chemotherapy to replace CA125 concentration after chemotherapy in follow ovarian carcinomas
Our study can resolve this problem.
Aims: Determine the correlation between CA125 concentration after chemotherapy with recurrence metastasis of ovarian carcinomas.
Determine the sensivity and the specificity of CA125 for recurrence / metastasis of ovarian carcinomas.
Determine the correlation between CA125 concentration after chemotherapy with other factors (age, stage, pathology results, chemotherapy response...). Method: We made retrospective study of 77 ovarian carcinoma patients, who were operated at HoChiMinhcity Cancer Hospital and treated with Cisplatin agents, from 2002 to 2003 (100% cases have the microscopic diagnosis).
Results: CA125 concentration after chemotherapy have the correlation with recurrence / metastasis of ovarian carcinomas (R = 0, 513).
CA125 concentration after chemotherapy have the correlation with chemotherapy response of ovarian carcinomas (R = 0, 550).
Background / Objectives: The objective of this study is to determine the prevalence and many factors related to secondary hypogonadism and growth hormone deficiency in acute traumatic brain injury patients.
Patients with a Glasgow score at admission> 9 points will reduce the risk of secondary hypogonadism 43% (p> 0.05).
Women had risk of reduced growth hormone 1.49 times more likely than men (p> 0.05).
Admission blood glucose level ≥ 180 mg / dl, the lower Glasgow at the hospital admission are factors increasing the risk of reduced growth hormone (p> 0.05).
Conclusions: Prevalence of secondary hypogonadism and growth hormone deficiency in patients with acute traumatic brain injury were 88.7% and 20.6%, respectively.
Men had risk of secondary hypogonadism more than women. Women hadrisk of reduced growth hormone more likely than men.
More severe patients were, higher risk of secondary hypogonadism and growth hormone deficiency.
Subjects / methods: The study was designed as a cross sectional investigation.
Convient - consecutive patients with moderate and severe head trauma were enrolled during acute phase after injury.
Baseline serum concentrations of hormones were measured in the morning: FSH, LH, testosterone (male), astradiol và progesterone (female), IGF1.
Results: The study included 112 cases of brain injury in the acute phase at Cho Ray Hospital, 20 patients died during hospitalization (17.9% proportion).
Males dominate with 86.6%.
There were 99 patients with secondary hypogonadism, accounting for 88.7%.
There are 23 cases of reduced growth hormone, representing 20.6%.
Men had risk of secondary hypogonadism nearly 130 times more than women (OR = 0.008, p = 0.000).
Background: Congenital mitral regurgitation is a rare condition which often remains undiagnosed and scarcely received adequate treatments.
43.3% of the patients were malnourished.
Common complications were pulmonary hypertension (83.3%), heart failure (43.3%), arrhythmia (10%) and death (6.7%).
6 types of congenital mitral valve injury were noted on echocardiogram: leaflet prolapse, annular dilation, abnormal leaflet, commissural fusion, chordae tethering, papillary muscle abnormality.
Leaflet prolapse and annular dilation were the most common types (73.3% and 63.3% respectively).
Type II of mitral regurgitation (according to Carpentier and Mitruka) has the highest percentage (63.3% and 90%).
Severe regurgitation follows ASE guidelines accounted for over half of the cases (60%).
93.3% of patients received treatment with vasodilator (93.3%), diuretics (32.3%), inotropic (16.7%), antiarrhythmic (3.3%).
90% of patients were eligible for surgical interventions but only 13.3% underwent the operation at the appropriate time and criteria; reasons include miss out surgical indications, uncooperative patients that did not follow the regime nor revisit for follow up examinations.
33.3% of the cases were consulted for surgery in which 20% patients have not been operated yet.
Conclusion: Congenital mitral regurgitation patients who did not receive adequate treatment and follow-up have many complications: heart failure, pulmonary hypertension, arrhythmia, and death.
The affected children bear the burden of severe heart failure for many years, owing to the unrecognized condition, improper non-surgical therapy or delayed surgical intervention, leading to unrecoverable postoperative dilated myocardiopathy and mortality.
Keywords: congenital mitral valve regurgitation, carpentier classification, mitruka classification, ASE guidelines for regurgitation
This study aims to help reduce the overwhelmed underdiagnosis of congenital mitral regurgitation and to review the current choices of surgical and non-surgical therapies for the treatment of congenital mitral regurgitation at Children Hospital 1.
Objective: This study determines the clinical, echocardiographic, non-surgical treatment characteristics, as well as the proportion of correctly indicated surgery of congenital mitral regurgitation.
Methods: Prospective case series.
We studied 31 patients with congenital mitral regurgitation, including both the outpatient and inpatient cases, diagnosed by the Department of Cardiology at Children Hospital 1, during the period between 06/2020 and 06/2021.
Female is predominant (70%) and the male to female ratio was 2.3: 1.
Background: Food hygiene and safety is nowadays a major public health issue in Vietnam.
The proportion of catering teams' cooks with good knowledge and practice of food safety and hygiene was low.
Keywords: food poisoning, food hygiene and safety.
Objectives: To determine the proportion of catering teams' cooks with knowledge and practice of food hygiene and safety and related factors in Can Giuoc, Long An province, in 2013.
Result: The proportions of cooks with good knowledge and practice of food safety were about 44% and 43% respectively.
There weren't any catering teams with facilities and food preparation and storage that met the requirements.
Conclusion: The food safety and hygiene compliance of catering teams was very poor.
Gross findings of the ovarian epithelial carcinoma
Objectives: Study gross findings of the ovarian epithelial carcinoma at National Hospital for Obstetrics and Gynecology.
Methods and materials: cross - descriptive study of 273 cases diagnosed ovarian epithelial carcinoma at National Hospital for Obstetrics and Gynecology from January, 2000 to June, 2008.
Results and conclusion: We have found that most tumors are at one side of the ovary (97%), 8 cases are bilateral and mucinous type.
A large number of tumor with undifferentiated type, malignant Brenner tumors and mixed type had rough surface.
Most tumors diagnosed endometrioid carcinoma, undifferentiated carcinoma and malignant Brenner tumor and mixed type appeared cystic with blood and / or necrosis.
Among these epithelial carcinoma, mucinous type is the most common (27.8%), following serous type and endometrioid type (27.1%); mixed type is the most uncommon (1.1%).
Background: Gastrointestinal stromal tumors (GIST) are lesions originated on digestive tract walls, which are treated by surgical resection.
Average lenght of hospital stay was 6 days (2 - 10 days).
All patients achieved complete R0 resection.
Conclusion: Laparoscopic GIST resection, not only for small lesions but also for tumors above 5 cm, is safe technique.
Keywords: Gastrointestinal stromal tumors; Laparoscopic resection; Wedge resection.
Laparoscopic resection (LR) for small gastric gastrointestinal stromal tumors (GIST) is now widely accepted, but its application for large (above 5 cm) GISTs remains controversial.
This study aims to evaluate the feasibility and safety of LR for gastric GISTs.
Methods: Between 1/2010 and 8/2018, 24 patients who underwent surgical treatment for primary GIST of the stomach were enrolled in this study.
Patient demographics, imaging studies, operative findings, methods of laparoscopic resection, postoperative course and pathologic characteristics were examined.
Results: Laparoscopic partial wedge resections or tumor excisions were successfully performed on 23/24 patients. The median age was 61 (range 45 - 83) years and there were 19 males (79%).
16 cases had tumor size above 5 cm.
No tumors were ruptured during surgical manipulation and no major morbidity or mortality.
Mean operative time was 139 min (60 - 235 min).
20/24 patients (83.4%) had a Harris-Hip score of "Good" or "Very good", mean of the quality of life score was 0.89 ± 0.11 (0.65 - 1.00).
Conclusion: Combination of locking plate and fixation of lesser trochanter for AO type A2 proximal femoral fracture resulted in good bone healing, fast functional recovery and low rate of complications.
Keywords: proximal femoral fracture, locking plate
Objectives: To determine the effectiveness of using locking plate with fixed lesser trochanter for the treatment of this type of fracture.
Results: Our sample had the average age of 70.6 ± 16.0 (32 - 90), with female accounting for 65.4%.
In our sample, type A2.3, A2.2 and A2.1 fractures accounted for 46.3%; 30.8% and 23.1%, respectively 2/26 postoperative deaths due to comorbidity were excluded.
Bone healing rate was 24/24, neck and body angle decreased on average 3.8 ± 7.30 (p = 0.1303 >0.05).
Characteristics of pneumonia caused by influenza a h1n1 in children
Objectives: To describe demographic, clinical and laboratory characteristics of pediatric patients with pneumonia caused by influenzae A H1N1 and factors relating to respiratory distress in them.
Methods: A serial case study based on medical records of patients with influenza AH1N1 infection identified by PCR in the Children's Hospital 2 from 01/01/2009 to 31/12/2010.
Results: There were 43 cases of pneumonia caused by virus influenzae A H1N1.
The rate of pneumonia in male was 51.2%, female 48.8%; age ≤ 5 was 83.7%; the rate of having underlying disease was 18.6%.
Perioperative myocardial cell damage is a major problem during coronary artery bypass graft (CABG) surgery.
Conclusion: After CABG, the aortic cross - clamping time is one of several important factors increased the cardiac markers levels.
Serum troponin I and T higher than 69mg / L and 1.39mg / L in 24 hours postoperation of CABG are correlated best with the diagnosis of perioperative MI.
CK-MB has longtime been used to establish a diagnosis of myocardial infarction (MI) and cardiac troponin I (cTnI) and cTnT are highly specific and sensitive markers of myocardial injury and ischemia.
The aim of this study is to determine whether serum markers of myocardial injury are elevated after CABG surgery and whether their increases are associated with CPB and aortic cross - clamping and to establish threshold values for cTnT and cTnI that strongly suggest substantial myocardial damage and necrosis in 24 hours postoperation.
Method: we studied 330 patients who underwent CABG at Heart Institute of HCM city.
Postoperative troponin I level (165pts), troponin T (165 pts) and CK-MB (330 pts), ECG, clinical data and clinical events were recorded prospectively.
The diagnosis of perioperative MI was defined by a new Q wave on ECG and / or reduced 25% of R wave and / or serum level of the CK-MB higher than 100 UI / L within 12 - 48 hour postoperative.
Results: In this study 29 patients (8.8%) had sustained a perioperative MI according to current diagnosis criteria.
Background: Combination of percutaneous coronary intervention (PCI), antiplatelet and antithrombotic drugs increases gastrointestinal (GI) bleeding risk.
GI bleeding events accounted for 1.7%.
Risk factors of GI bleeding included history of peptic ulcer OR = 8.8 (1.7 - 45.6), p = 0, 036, Killip IV OR = 13.7 (3.5 - 53.8), p = 0, 001, renal failure during hospitalization OR = 5.6 (1.5 - 21.1), p = 0, 015 and mechanical ventilation OR = 73.7 (14.5 - 374.5), p < 0.0001.
In multivariable analysis, only 2 independent risk factors were found, including history of epigastric pain OR = 17.6 (1.4 - 225.8), p = 0.027 and mechanical ventilation OR = 115.2 (10.5 - 1259.1), p < 0.0001.
Length of hospitalization of patients with GI bleeding was greater than that of patients without GI bleeding (14.7 ± 13.4 days vs 7.5 ± 4.6 days, p < 0.0001).
Patients with GI bleeding had higher mortality rate than patients without GI bleeding (44.4% vs 4.7%, p = 0, 001).
Conclusions: The prevalence of acute GI bleeding in patients with acute MI ater PCI is 1.7%.
Risk factors of GI bleeding include history of epigastric pain and mechanical ventilation.
Patients with GI bleeding have longer hospital stay and higher mortality rate than those without GI bleeding.
Keywords: Gastrointestinal bleeding, acute myocardial infarction, percutaneous coronary intervention
This complication may lead to prolonged hospital stay, higher risk of recurrent myocardial infarction (MI), in-stent thrombosis and mortality.
Meanwhile, there are few researches on this problem.
Objectives: To identify prevalence, characteristics and risk factors of acute GI bleeding, length of hospitalization and in-hospital mortality rate of patients with acute MI who develop GI bleeding after PCI.
Methods: Descriptive cross-sectional study was conducted.
Patients diagnosed with acute MI and underwent PCI at Gia Dinh's People hospital from January 2014 to April 2016 were recruited.
We collected research data from the patients and clinical records, with the use of data sheets.
Univariable and multivariable logistic regression analyses identify risk factors of GI bleeding in patients with acute MI after PCI.
Results: From January 2014 to April 2016, 516 patients with acute MI were hospitalized and underwent PCI at Gia Dinh's People hospital.
Characteristics of thalassemia at children’s hospita|l in cantho city from 12/2010 to 06/2011
Thalassemia is the hereditary hemolytic anemia disease, due to defects in the synthesis of hemoglobin chain, causes chronic hemolysis in many different levels.
The rate of cases with a family history of severe thalassemia disease is 8.1%.
Common clinical features: anemia (97.3%), splenomegaly (97.3%), hepatomegaly (78.4%) and malnutrition (70.3%).
Paraclinical characteristics: the average of Hb: 5.8 ± 1.5 g / dL; MCV: 66.1 ± 8.6 fl; MCH: 20.2 ± 4.0 pg.
Peripheral blood smear: hypochromia red blood cells: 92.3%.
The average of blood ferritin: 967.7 ± 728.5 μg / L, the rate of blood ferritin> 1000 μg / L: 43.2%.
Skull x-ray abnormalities: 8.1%.
Characteristics of treatment: blood transfusion rate is 94.6%.
Iron emission rate: 16.2%.
No case of splenectomy.
Conclusions) The rate of severe anemia was 62.2%.
Thalassemia is common in the Mediterranean, Africa, Middle East and Southeast Asia. However, today genes causing thalassemia has spread worldwide making thalassemia becoming a global problem.
This is also a cause of high rates of malnutrition (70.3%).
Most patients have elevated levels of blood ferritin (> 1000 μg / L accounts for 43.2%), because most patients are severe, got blood transfusion so many times, but not to get iron emission sufficiently.
Treatment is mainly blood transfusion (94.6%).
The rate of iron emission was very low (16.2%).
No cases were reported splenectomy.
Good management will help severe thalassemia patients can be live nearly normal, while reducing the incidence of disease, significantly reducing the burden for health budgets of countries.
Objective: Describe the epidemiological, clinical, paraclinical characteristics and treatment of thalassemia at Children's Hospital in CanTho city from 12/2010 to 06/2011.
Methods: Descriptive case series study conducted on 37 patients from 2 months to 15 years old was diagnosed with thalassemia, inpatient treatment at Children's Hospital in CanTho city from 12/2010 to 06/2011.
Results: The rate of categories: β-thalassemia / HbE: 35.1% β-thalassemia: 29.7% α-thalassemia: 21.6%; α-thalassemia / HbC: 5.4%; HBE: 5.4%, Hb Lepore + HBS: 2.7%.
The average age at admission: 7.4 ± 4.1.
Most cases of onset before 2 years of age, accounting for 56.8%.
Background: Hand foot mouth disease (HFMD) becomes an important health concern in Vietnamese children.
The severe evolution with neurological, cardiac or respiratory complications may lead to death.
There are limited prospective studies looking for the risk factors of severe prognostic. Objectives: To identify the factors correlated to severe evolution of HFMD.
Methods: We conducted a prospective study on 235 children with HFMD grade 1 and 2a admitted to the pediatric department of the Hospital for Tropical Diseases from June 2012 to June 2013. Results: 77 patients (32.8%) developed into HFMD grade 2b, 3, or 4 compared to 158 patients without severe evolution.
These severe evolutions commonly occured on day 3 (41.6%) and day 2 (34.7%) of the illness, essentially during the 24 hours after admission (79.3%).
The factors correlated to severity were: mean temperature after 24 hours >380C, tachycardy, high blood pressure after 24 hours of admission, presence of skin lesions without mouth ulcers and EV71 infection.
Keywords: Hand foot mouth disease, correlated factors to severity
The epidemiologic, clinical and laboratory features of children with congenital rubella syndrome (crs) admitted the children’s hospital 2 from jan 1st 2010 to jun 30th 2011
Objectives: To describe the epidemiologic, clinical and laboratory features of children with Congenital Rubella Syndrome (CRS) admitted the Children's Hospital 2 from Jan 1st 2010 to Jun 30th 2011.
In our study, 9.26% of cases was dead, 18.52% of cases would be dead, 72.22% of cases has become temporarily and discharge.
Conclusions: Congenital Rubella Syndrome take in very low percentage of patients with congenital defects admitted the Children's Hospital 2 from Jan 1st 2010 to Jun 30th 2011.
Signs and symptoms are multiform, but there has had 61.68% of all cases which were demonstrated of Rubella-specific IgM antibody at first time.
Methods: Cases serial prospective descriptive trial.
Results: There were 107 children with CRS admitted the Children's Hospital 2 from Jan 1st 2010 to Jun 30th 2011 among 118.947 inpatients (0.09%).
In almost cases, their mother weren't used Rubella vaccine.
Clinical signs and symptoms consist of congenital cataracts and / or glaucoma (38%); congenital heart disease (69.15%), in that Patent Ductus Arteriosus exist in 85.13% cases, Atrial Septal Defect exist in half cases (54.1%), Pulmonary artetial stenosis exist in 6.7% of cases, Ventricular Septal Defect exist in 5.4% of cases; 45.94% of cases has only one congenital heart lesion, 47.3% of cases has two congenital heart lesions and 6.7% of cases has three congenital heart lesions; purpura / petechie (42.6%); hepatomegaly (46.2%); splenomegaly (45.4%); microcephaly (3.7%); jaudice (26%).
Some cases have complications or sequelae during treatment such as septicemia (3.7%), cerebral hemorrhage (8.4%), hydrocephaly (2.8%), hypotonia (1.87%) leading to mental and psychomotor retardation.
None case has hearing impairment or meningoencephalitis.
Demonstration of Rubella-specific IgM antibody exist in 61.68% of cases.
A survey of characteristics of ruptured saccular intracranial aneurysms by digital subtraction angiography
Background and purpose: Excluding completely intracranial aneurysms (IAs) from cerebral circulation is the goal of surgical and endovascular treatment.
According to Ratio of sac to neck size (RSN), the narrow and medium neck sizes were 88.4%.
97.5% of RIAs had an uneven edge.
The relationship to the major neighboring artery from RIA was 6.8%.
The aplitic A1 segment at the opposite side for ACA of RIAs was 48.8%.
Cerebral vasospasm after SAH was 28.3%.
No correlation was found between location, RIA size or neck size and the clinical state of the patients.
However, a definite correlation was found between cerebral vasospasm and the clinical state of the patients (Fisher test, p<.001).
Conclusion: Knowledge gained about the characteristics of RIAs by DSA is useful in order to choose methodology of the treatment as well as planning the technical treatment effectively.
The choice of methodology as well as the planning of the treatment is influenced by characteristics of the IAs.
Digital Subtraction Angiography (DSA) is the gold standard for evaluating this condition.
We describe the characteristics of ruptured IA (RIAs) by DSA and find the correlation between the characteristics of RIA with the clinical state of the patients.
Materials and methods: The descriptions of 237 patients definitely diagnosed with RIA by DSA at Cho Ray Hospital from June 2012 to February 2013 were reviewed for this study.
Results: Most of patients were hospitalized with Hunt - Hess from I to III (74.3%).
94.5% of RIAs were from the internal carotid.
Small and medium size RIAs were 97%, only 1.3% were the giant aneurysm.
RIAs of the small neck size were 88.5%.
Background: The traditional practice of prolonged fasting, by ít catabolic action, may increase insulin resistance.
Conclusion: The 2-hour preoperative intake of 400ml maltodextrin 12.5% does not appear to alter the amount of residual gastric volume before the induction of thyroidectomy, suggesting that this is a safe procedure, in terms of aspiration risk.
Furthermore, the intake of such fluid might improve the feeling of thirst preoperatively and 2h - postoperatively.
Keywords: preoperative fasting; carbohydrate loading; maltodextrin; residual gastric volume
2 hour - preoperatively intake of maltodextrin beverage 12.5% instead of fasting is expected to have potential benefits to the metabolism without increasing the risk of aspiration related to residual gastric volume.
Objectives: To compare the residual gastric volume and feeling of thirst between patients ingested maltodextrin beverage and prolong fasted patients.
Methods: In this randomized - controlled trial, sixty patients scheduled for thyroidectomy were assigned to the treatment or control group.
Patients in the treatment group (n=30) received 400 ml maltodextrin 12.5% 2h before the induction.
Conversely, control patients (n=30) underwent fasting of clear fluid over 2h.
Before the induction, the residual gastric volume of two groups was measured by ultrasonography.
Results: There was no statistical difference of residual gastric volume between the two groups (p >0.05).
Protocol for the detection of vaca genotypes and caga gene of helicobacter pylori from gastric biopsies by a novel multiplex polymerase chain reaction assay
We set up a multiplex PCR-based protocol for the detection and genotyping of cagA and vacA genes.
The protocol includes clinical samples selection, DNA extraction, multiplex PCR optimization and sensitivity determination.
The set up protocol was then applied to some gastric cancer and gastritis biopsies.
We showed that this can be a rapid and simple method to detect and genotype H pylori in clinical samples.
The multiplex PCR protocol can be developed into a rapid and accurate diagnostic kit as well as a tool to study H pylori infection epidemiology and the relationship between cagA and vacA genotypes with clinical manifestations in patients.
Assessment of knowledge and attitudes of modern contraceptive methods among aborters at tu du hospital (2017)
Objectives: Determine the rate of aborters with proper knowledge and attitudes to three contraceptive methods: condom, combined contraceptive pill and emergency contraception pill and whether some factors related to the knowledge and attitude of aborter from 9 - 11 weeks at Tu Du Hospital - Ho Chi Minh City.
Research methods: Cross sectional study from December 2016 to April 2017 among 9 - 11 weeks aborter at Tu Du Hospital - Ho Chi Minh City.
The rates of having proper attitude about condom, combined contraceptive pill and emergency contraception pill respectively were: 29.9% (KTC 95%: 25.4 - 34.6), 19.2% (KTC 95%: 15.2 - 22.4): 19.4% (KTC 95%: 15.7 - 23.6).
Factors related to knowledge and attitude of aborters were: age, address, qualification, occupation, ethnic group, marital status, number of children, number of abortions, contraceptive use.
Conclusions: Reduce unwanted abortion rate to improve the reproductive health for women, health providers should educate women to have the proper knowledge of contraceptive methods.
Keywords: Knowledge; attitude; condom, combined contraceptive and emergency contraception pills
Diagnosis of neck nodes on hiv/aids patients
Human immunodeficiency virus (HIV) infection can be called the epidemic of the 20th century.
There are 13 cases (36.1%) of tuberculosis lymphadenitis combined with tuberculosis pneumonia and 23 cases (63.9%) single tuberculosis lymphadenitis.
8 strains with 6 specieswered isolated from the 26 studied patients (26.92%).
To purpose: To take the specimens from neck nodes, especially for HIV / AIDS patients, should be used FNA (fine needle aspiration) and PCR method is needed for diagnostic of tuberculosis lymphadenitis.
Special radiological images of pulmonary tuberculosis in diabetic patients
Results: Multiple special radiological images of pulmonary tuberculosis in diabetic patients were described: Pulmonary cavities (58.03%) with atypical situations as at the hilum, and the fundus of the lungs and symmetrical hila.
Conclusion: Radiological images of pulmonary tuberculosis in diabetic patients were more different than nondiabetic pulmonary tuberculosis.
Effects of acupuncture on facial nerve paralysis in traditional medicine department of tien giang general hospital
Background and aims: Facial nerve paralysis is a common disease in clinical practice caused by cold, infection, injury, tumor, but the major cause is cold with the rate of 82%.
Objectives: This study was carried to evaluate the efficiency of acupuncture on facial nerve paralysis in Traditional Medicine Department of Tien Giang General Hospital.
Results: 46 patients were enrolled this study with the ratio of cases total recovery was 87% and the ratio of cases has been improved the abnormal signs of mouth, eye closure and tear flow was 13%.
Conclusion: By this study, a therapeutic formula for facial nerve paralysis had been established
Background: The PIRO score (The predisposition, infection, response and organ dysfunction) was designed as a stratification tool to deal with the inherent heterogeneity of septic patients.
Objective: To assess the performance of the PIRO score in predicting mortality in septic patients in the emergency department and to compare this score with SOFA and sofa scores.
Design: Prospective observational study on septic patients from August 2016 to March 2017 in the ED at
The similarity between clinical manifestations of anemia syndrome according to western medicine and qi blood deficiency syndrome according to vietnamese traditional medicine
Background: Qi and blood are two indispensable substances in the body.
Determining the percentages of each clinical symptom in each level of anemia and rate of manifesting qi deficiency, blood deficiency, qi blood deficiency.
Results: A survey of 344 patients with anemia according to WHO at Traditional Medicine Hospital-HCM city, the research team has the following conclusions: According to the percentage of functional symptoms of animea population, the vast majority is fatigue 80.23% and there is a gradual decrease with order: Dizziness (74.13%), insomnia (55.81%), short breath (54.36%), spontaneous sweating (49.13%), palpitation (36.92%), numbness in the extremities (25.58%).
Regarding to the physical symptoms in population with anemia, pale skin accounting for 84.9% is the most one and decreasing in the order are white nails (76.5%), pale tongue (45.4%), flabby tongue (22.1%).
The highest expression of the pulse is weak pulse (46.2%), fine weak pulse (32.6%), faint pulse / fine pulse (15.4%).
Expression of quid blood deficiency in population consists of 42%, quid deficiency takes 14%, blood deficiency includes 11%.
The rate of quid blood deficiency increases in average anemia group compared to mild anemia group.
Keywords: Anemia, Quid deficiency, Blood deficiency, Quid blood deficiency.
Blood which is red essence nourishes the body, transports the yang qi, smooths muscle, circulates incessantly throughout the body.
Qi warms the muscle, transformes into blood, controls blood.
Blood deficiency, Qi deficiency or Qi blood deficiency form distress symptoms that are easy to misunderstand in clinic and confuse with symptoms of anemia according western medicine.
Aims of the study: Determining the similarity between clinical manifestations of anemia syndrome according to western medicine and qi blood deficiency syndrome according to Vietnamese traditional medicine.
Method: Study design: Cross - sectional descriptive study.
Audience research: Inpatients of Traditional medicine hospital-HCM city were diagnosed anemia according to WHO criteria, with or without clinical manifestations and agreed to participate in the study, regardless of age - sex - occupation.
Methodology: Receiving patients according to criteria of chosing and eliminating diseases, interviewing and analyzing statistically the manifestations of clinical diagnosis of qi deficiency, blood deficiency, qi blood deficiency according to traditional medicine.
Conclusion: There was a high prevalence of C-shaped canals in the mandibular second molars among Vietnamese.
Keywords: C-shaped canal, molar, mandibular, cone beam CT
There were no significant differences in the distribution of C-shaped canals between age groups and tooth positions, but there was significant difference in the distribution between male and female (p=0.008).
The prevalence of bilateral C-shaped canals was 75.8% among 62 patients with bilateral mandibular second molars in which had at least one tooth with C-shaped root canal.
In addition, the study found higher prevalence of one C-shaped canal at cervical third then separating into two or three canals at middle third, finally merging into one.
A case study of malaria infected monkey in binh phuoc province
Conclusion: The monkey in Binh Phuoc province has been infected with Plasmodium inui.
Objectives: Identification type of malaria parasite in malaria infected monkeys.
The results has shown that all samples have been negative with malaria parasites.
ASN sequencing was conducted then by the Tropical Clinic of Kingdom of Belgium concluded that 96% was similar to P inui.
The concern is that if there is a transmission of malaria from animal to human?
Surgical correction of buried penis: report of 47 cases
Objectives: There were some techniques of buried penis correction.
A Z - plasty is performed at the penoscrotal junction in order to rotate scroral skin to cover the penile skin defect. Results: Early results are good.
This technique is easily performed, gives a good result and preserves the prepuce. Conclusion: The technique with the incision along the peno-scrotal raphe and a Z-plasty can correct the buried penis and preserves the prepuce.
Evaluating the effect of self-improved instrument on placing double-j in retroperitoneal laparoscopy at can tho central general hospital.
Objectives: present the technique of placing double-J with new instrument and evaluate its effect on placing double-J in retroperitoneal laparoscopy. Materials and method: This is a prospective study at Can Tho central general hospital from January 2009 to September 2009 for 47 patients who needed to place double-J with self-improved instrument in retroperitoneal laparosopy.
Results: Success 100%, Positions of placing double-J: 15 cases at renal pelvis, 29 cases at upper ureter, 3 cases at pelvic ureter.
Mean placing double-J: 4, 1 minutes (1, 8 - 15 minutes), no complication, no urine leakage, no sepsis.
Saving estimates expenses for 47 patients about 30, 3 million VND Conclusions: the technique of placing double-J with self-improved instrument is simple for surgeons performing in the first time, and able to place double-J at any position from renal pelvis to bladder.
This instrument help to reduce the markedly operative time of safe placing doulbe-J in laparoscopic surgical, and able to use in open surgical.
These cases were detected by histopathology Results: The disease was increased with age and most common at the over 50 years.
Male / female rate is of 1.5.
The great marority of colorectal cancer were carcinoma (97%).
Most common was adenocarcinoma (84%). Conclusions: Study of morphological of 68 cases of colon cancer: Male / female ratio is 41/27.
The rate of cancer of right colon is high.
Macroscopy: Ulcerated carcinoma is common (59%).
Knowledge, attitudes and needs of sex education among students of ngo tat to secondary school, phu nhuan district, hcmc, in 2008
The students who didn't receive sex information from any source of supply, had less correct knowledge than the students received at least one source (with PR = 0.29, 95% CI of PR = 0.13 - 0.62). Conclusion: Sex education in secondary school age is very necessary.
So now it needs to have a suitable sex education program for this age.
The study sample comprised of 669 students whom were chosen by the cluster sampling technique. Results: The proportion of students having correct knowledge of sex was 31.5%.
There was 97 percent of students agreed with sex education and 35.7 percent of them thinked that sex education should be started in 6th grade.
The proportion of students receiving sex information from friends was 36%, from books, newspapers, documents was 51.7%.
About needs of sex education, sex information for students should be provided by doctors or health staffs (44% students chosed), or by books, newspapers, documents (48.4% student chosed).
The students having correct knowledge of sex agreed with "masturbation is ordinary" more than the students having incorrect knowledge (with PR=2.03, 95% CI of PR = 1.65 - 2.51).
Endovascular intervention for renal arteriovenous fistulas: cases report
Introduction: Renal arteriovenous fistulas are abnormal communications between the renal arterial and venous systems.
These malformations are either congenital or acquired.
Treatment can be considered to the individual patient, options for therapy range from observation to embolization to nephrectomy.
Generally, the initial therapy for treatment of renal arteriovenous fistulas is angiographically guided embolization of the fistula.
Purpose: This article evaluates the initial results of endovascular intervention for renal arteriovenous fistulas.
Materials and results: This article describes the clinical signs, the imaging features and the endovascular intervention procedure of two cases of renal arteriovenous fistulas: one case of congenital renal arteriovenous fistula and one case of acquired renal arteriovenous fistula done after penetrating injury of the kidney.
The causes, diagnosis, treatment and complications of renal arteriovenous fistulas are discussed.
Conclusion: Arterial embolization is the preferred treatment for symptomatic arteriovenous fistulas.
Keywords: renal arteriovenous fistula, endovascular intervention, arterial embolization
Setting up a cost effective molecular diagnostic test for kras gene mutation with technique of allene specific real time pcr combined dual pairing oligotids
Introduction: Monoclonal anti - epithelial growth factor receptor (EGFR) antibodies has gained FDA's approval for colorectal cancer management, however, only those habouring wild type Kras gene are clinically relevant be immune-therapied by the drug.
Which means, such income - fitted molecular test for kras gene mutational status is essential in selecting appropriate patients for anti-EGFR based targeted therapies.
Furthermore, PCR reaction number was dropped from seven down to 3, therefore, reducing the laboratory cost accordingly.
Conclusion: We have succeeded implementing the molecular diagnostic test for Kras gene mutation.
Selective arterial embolization of giant renal angiomyolipoma associated with tuberous sclerosis complex
Objective: To report a giant renal angiomyolipoma (AML) tumor associated with tuberous sclerosis treated with selective arterial embolization (SAE) in the left kidney and describe follow-up results in 4 years for right kidney.
Material and Methods: We reported a case, a 43-year-old man hospitalized for flank pain in the left and hematuria, SAE for rupture of right AML 4 years ago.
CT result: AML in two kidneys, the right side had sign of SAE before, the left side had a giant AML tumor, size: 10 * 10 * 8 cm, hemorrhage in the center of the tumor.
Patient was performed SAE for left AML.
Results: The patient had no hematuria and reduced left flank pains; kidney function is normal.
The right kidney, up to the present time, we have monitored for 4 years, currently, size of AML decreased from 7 * 8 * 10 cm down 6 * 7 * 7 cm (47.5%, volume).
Conclusion: SAE is safe and effective in treating renal AML tumors, for rupture tumors, giant tumors, AML associated with tuberculous sclerosis complex, to maintain maximum kidney function.
Keywords: AML tumor, SAE
Objective: Survey of knowledge, attitude and behavior towards the management of fever of mothers of children treated at pediatric Department, Tien Giang General Hospital.
Results: Knowledge: 48.7% of women who know how to use a thermometer to determine which children with fever; 26% of mothers answered correctly that the child has a fever when the temperature> 37.5 °C; the majority of mothers said that fever is caused by infection or changes in weather (both 34%).
Attitude: 55.3% of women said that if high fever requires hospitalization treatment; 52% of mother's contraction that fever is a sign of serious illness; 73.3% of mothers said that if high fever can lead to seizures.
About the behavior of the mother when the child has a fever: 40% of women said that they can self-treat fever at home; 63.3% of mothers knew remove child clothes if the child is fever; 53.3% of mothers said wiping cool as high fever; 62.7% of mothers agreed to children antibiotics when fever; 79.3% of women disagreed wind scraping, cutting ceremony when fever.
Age group, education level, occupation, number of children, children with a history of previous hospitalizations related to knowledge, attitude and behavior of mothers about fever right.
There is an association between fever and correct knowledge about proper behavior when management a high fever in children Conclusion: The need to strengthen advocacy, health education to mothers about fever and manage fever.
Keywords: Fever, knowledge, attitude, behavior
Predictors of rebleeding after endoscopic therapy for peptic ulcer bleeding
Objectives: Futher knowledge regarding the predictors of rebleeding after endoscopic therapy for peptic ulcer bleeding (PUB) may be useful for establishing additional haemostatic measures in very high-risk patients.
These independent predictors of recurrent hemorrhage after endoscopic therapy may be used to select patients who are most likely to benefit from aggrestive post-hemostasis care including intensive care unit observation.
Keywords: Peptic ulcer bleeding, endoscopic therapy.
The aim of study was to identify predictors of rebleeding after endoscopic therapy.
Methods: Consecutive patients with bleeding peptic ulcers who received endoscopic therapy between May 2010 and May 2013 at Cho Ray hospital were studied.
Data on clinical presentation, endoscopic, and treatment outcomes were collected prospectively.
Multiple logistic regession analysis was used to indentify independent risk factor for rebleeding after endoscopic therapy.
Results: During the study period, 207 patients were admitted with bleeding peptic ulcer required endoscopy treatment: with a mean age of 50.04 (SD 18.11), male / female= 2.9/1.
The pooled rate of rebleeding after endoscopic therapy was 19.8%.
The independent predictors of rebleeding after endoscopic therapy were active bleeding (Forrest Ia, OR 5.55, 95% CI: 1.65 - 18.63; Forrest Ib, OR 3.79, 95% CI: 1.49 - 9.65), large ulcer size (≥ 2 cm) (OR 18.38, 95% CI: 5.78 - 58.48), posterior duodenal ulcer (OR 4.72, 95% CI: 1.13 - 19.6), low dose PPI therapy (IV PPI < 3 times / day or oral PPI) (OR 3.2, 95% CI: 1.12-14.73).
Conclusions: Mayjor predictors for rebleeding in patients receiving endoscopic therapy are active bleeding at endoscopy, large ulcer size, posterior duodenal ulcer, low dose PPI therapy.
Correlation between carotid artery intima-media thickness measured by ultrasonography with atherosclerotic risk factors
We presented a cross-sectional study of 60 patients hospitalized at Nguyen Trai hospital for chest pain, with the aim of assessing the correlation between carotid intima-media thickness (IMT) with the atherosclerotic risk factors.
IMT of carotid arteries were assessed by B-mode ultrasound with the use of the electronic caliper of the machine in real time.
IMT of right carotid artery positively correlated with systolic blood pressure, LDL and negatively correlated with HDL; IMT of left carotid artery positively correlated with LDL.
Outcome of the pterygium surgery with conjuntival autografting
Purposes: to determine the recurrence rate following the pterygium surgery with conjuntival autografting.
The pterygium surgery with conjuntival autografting was performed form 11/2015 to 5/2016, for 54 eyes of 54 patients.
Data for pterygium recurrence was collected and analyzed using SPSS version 16.
Results: Following surgery, the recurrence rate of pterygium was 7.4%.
The visual acuity increased from 0.63 ± 0.31 to 0.87 ± 0.13.
No severe complication was reported after surgery.
Conclusion: Pterygium surgery with conjunctival autografting is affective in reducing the recurrence rate of pterygium.
Keywords: Pterygium, conjunctival autografting.
Objective: Evaluate the factors that influence the onset and characteristics of the pulmonary hypertensive crisis after congenital heart surgery and then finding a way to follow up and best patient care.
Keywords: Congenital heart disease, pulmonary hypertension, pulmonary hypertension crisis and cardiac surgery.
Methods: Retrospective descriptive study.
Results: Through research we found the PH medium group have extubated early (before 8 hrs post-op).
There were 8 patients (25%) appeared pulmonary hypertesion crisis with clinical signs: pulse rapidly and then slowly, SPO2 dropped, blood pressure system down, CVP increased, the status of oliguria or anuria after that.
Is the most common complication of right heart failure (15.6%) and mortality (9.3%), all patients in the group with preoperative severe PH.
Conclusions: The complex congenital heart diseases such as: AVSD, truncus arteriosus, TGA, high-risk postoperative appearance Pulmonary hypertension crisis.
The triggers favorable factors such as endotracheal suction and stress after tracheal extubation, hypoxia, atelectasis, pain is believed to be the onset of PH crisis.
So early surgery to reduce mortality and complications of CHD with PH.
For Postoperative CHD with PH nursing care we need to closely monitor the hemodynamic indexes, triggers, avoid exertion, hypoxia, and pain relief for patients.
Objectives: Multilayer amniotic membrane transplantation in the traumatic keratoplasty replace donor cornea with dimension from 2 - 5 mm whether the Eye bank were unabiliable supply to make the ocular surface steadly.
Setting: Traumatic Department, The Eye hospital of HCM city from August 2005 - December 2006.
Method: This prospective study comprised 19 cases whose mean age was 34.42 years (range from 19 to 69 years), divided in two groups: 12 cases central perforation of cornea (group 1) and 7 cases peripheral perforation of cornea (group 2).
Three layers frozen amniotic membrane with larger dimension 2 mm outside the edge of the perforation of cornea to cover on it after burrying button of one layer amniotic membrane into the hole, and to suture continously from the edge of the perforation of cornea to the edge of layers of amniotic membrane by nylon 10 - 0.
Average follow-up was 10.2 ± 1.6 months (range from 1 months to 12 months).
Both group was corneal epithelialisation 100%, less neovascularisation.
Postoperative complications: Flat anterior chamber 2/19 cases (10.52%), persistent of button AM in anterior chamber 2/19cases (10.52%), adherent iris under AM 4/19 cases (21.05%).
Prevelence of and related factors to hypertension among elderly people in thu thua district, long an province
Background: Prevalence of hypertension in Vietnam has been increasing, compared to the country profile Long An is among the high prevalence, where the prevalence of hypertension among elderly people ≥ 60 years old is 52.5%.
Keywords: hypertension, risk factor.
Especially, in Thu Thua district, the number of patients coming to hospitals for hypertension treatment is raising.
Objectives: To determine about prevalence of and the related factors to hypertension among the elderly people living in Thu Thua District, Long An Province in 2014.
Methods: Cross-sectional study was conducted on 780 people selected among the total 8, 359 elderly people ≥ 60 years old living in Thu Thua District - Long An Province from April to August 2014.
Result: The overall prevalence of hypertension is 64.5%, there is no statistical significance between male and female gender.
There are correlation between hypertension and the age groups, smoking, salty eating habit, and physical exercises.
The prevalence of hypertension among the smokers, salty eating habit, physical inactivity people are higher than other groups.
Conclusion: The prevalence of hypertension in Thu Thua district is high, particularly among the smokers, salty eating habit people, and physical inactivity people.
District health authorities should pay well attention for the elderly health according to the national target health programs on cardiovascular diseases and hypertension.
Objective: Study on the clinical and paraclinical characteristics and result of temporary and permanent pacemaker placement in treatment of bradycardia.
The lowest rhythm is 0.5 volt, highest is 1volt as the permitted level.
No case of following complications: ventricular fibrillation, hematoma, pneumothorax or hemothorax, infection, wire breakage. All cases of pacemaker placement have stable hemodynamic and good rhythm setting.
The permanent pacemaker is necessary in patients with chronic bradycardia or unrecoverable causes.
Keywords: Temporary pacemaker, permanent pacemaker placement, bradycardia.
Patients: Patients with chronic bradycardia or by unrecoverable causes.
Method: Clinical intervention study.
The main anesthetic method is local anesthesia.
For temporary pacemaker placement with the right subclavian vein input, 1 case use right internal jugular vein; for permanent pacemaker placement we use left subclavian vein input.
4 vascular disorder case had to use right subclavian vein input.
There are 103 cases need permanent pacemaker placement including 89 case use one chamber method with VVI, 14 case with two chamber method with VDD, DDD, and DDDR, the myth and other index meet the permitted criteria.
Actual state of antibiotic use of the deparment of surgery at tra vinh general hospital in 2017
Rationale: At present, antibiotic resistance is a global problem, especially in developing countries, including Vietnam.
100% of surgery cases used antibiotics.
Conclusion: From the actual state of antibiotic use, more research on the appropriateness of antibiotic indications is needed.
Keywords: antibiotics, surgery.
Assessment of actual state of antibiotic use is fundamental to improve the effective use of antibiotics in treatment.
Objective: To describe the current status of antibiotic use in surgery departments of Tra Vinh General Hospital in 2017.
Method: A descriptive cross-sectional study of medical records.
Results: 385 medical records were included.
Cases using one antibiotic accounted for 42.1%; two antibiotics 39.5%.
The most common route was intravenous slow-delivery with 33.2%, while oral route was 32.0%.
Average usage time was 4 - 5 days, accounting for 49.1%.
Commonly used antibiotics were second generation cephalosporins, third generation cephalosporins, penicillins + beta-lactamase inhibitors, and aminoglycosides.
Some research for adverse effects of the disease corticosteroid thrombocytopenia order of exemption in adults in hue bvtw
Most commonly leukocytosis, low potassium, low calcium hyperglycemia and less common.
Leukocytosis and low potassium occur in much younger, and age, they increase blood sugar more frequently.
Data processing software MedCalc 10, Epi Infor 6.Results: The age 16 to 30 have the highest rates accounting for 51.1%, mean age 33.9 ± 14.1.
ITP was the first rate is 40%, relapse 60%.
The rate of insomnia are very high 82.2%, older 17/37 patients; gastritis 51.1%, hypertension 24.4%, olders 8/11 patients; Cushing was 17.8%, youths 6/8 patients; gained weight 40%, youths 8/18 patients.
In the patient group with high rates of recurrence: patients with insomnia 25/37, 16/23 patients with gastritis, Cushing 6 / 8 patients.
Leukocytosis percentage 95.6%, 21/43 patients younger; hyperglycemia temporary 22.2%, older 6/10 patients; potassium were more low calcium (40%, 6.7%) occur more frequently in group young. Conclusions: Insomnia, gastritis, weight gain is most common.
Hypertension, and insomnia is common in older people, weight gain and Cushing also common youth.
Background: Chronic kidney disease (CKD) is a major health issue for HIV patients, associated with increase in risk of adverse events.
Decrease of clearance creatinin is defined when clearance creatinin decrease ≥25% compared to the time of starting ARV.
Result: 442 patients were included with ARV - taking time is 34.6 ± 18.2 months.
Clearance creatinin increases after taking ARV, especially after 48 - 60 months.
The prevalence of decrease ≥25% of clearance creatinin is 9.0% and risk factors are age, WHO clinical stage 4 and Hb <11 g / dl.
The sensitivity and specificity of decrease ≥25% clearance creatinin in predicting chronic renal failure are 83.3 and 92.3%, respectively.
Conclusion: ARV improves glomerular filtration rate.
Decrease ≥25% of clearance creatinin is a reliable indicator for mornitoring renal function.
Keywords: HIV, ARV, glomerular filtration rate, GFR, clearance creatinin, ClCr, renal failure, decrease clearance creatinin, WHO clinical stage, T--CD4 stage, age, anemia
CKD in HIV patients is resulted from many reasons: HIV; comorbidity diseases; coinfection diseases and adverse effects of ARV.
When researching the glomerular filtration rate (GFR) of HIV patients, the studies have conflicting results.
The reported prevalence of CKD among HIV patients was 5%; however, the criteria were GFR <60 ml / min/1.73 m 2 leading to the underestimate of renal damage.
According to Mizushima (2014), after 18 months of taking ARV, 12.4% in TDF - containing group decreased ≥25% of clearance creatinin; however, the monitoring time was short, therefore the predictive value of this index for chronic renal failure could nott be assessed exactly.
Objective: Monitor changes in clearance creatinine of HIV outpatient taking ARV over time.
The incidence rate and risk factors of decrease ≥25% of clearance creatinine over time. The sensitivity and specificity of this index in predicting chronic renal failure.
Methods: A retrospective observational cross - sectional study.
First step applying therapeutic drug monitoring for vancomycin, gentamicin in gia đinh hospital
Levels of drug are trusted by doctors to adjust vancomycin dose. For gentamicin in single daily dosing, applying the process were difficult due to many reasons. In which, most physicians were afraid when have to use high doses as recommended by the process (5 - 7 m / kg for singles daily dosing).
Results, 100% peak concentration do not reach to recommended by the process.
For gentamicin multi daily dosing, 100% were interfered to increase the dose and 100% reached to the recommended concentration level. Board of theory: Therapeutic drug monitoring of narrow therapeutic range drug such as vancomycin and gentamicin is necessary to ensure effective treatment and minimize toxicity.
Apply the process of therapeutic drug monitoring base on the actual clinical practice in order to reach for the most effective with as low-cost as possible.
Evaluation of treatment of mandibular condylar neck fractures by osteosynthesis via submandibular approach
Objectives: Follow-up and evaluate the treatment results of mandibular condylar neck fractures by osteosynthesis via submandibular approach.
Method: Prospective study, 109 patients with 124 condylar neck fractures treated at Department of Maxillofacial Surgery-National Hospital of Odonto-Stomatology, HoChiMinh City, were followed-up clinically and on radiographs up to 6 months.
Results and conclusion: This study showed that osteosynthesis of condylar neck fractures via submandibular approach provided the success for anatomy and function, acceptable aesthetic and low rate of complication.
Role of magnetic resonance imaging in restaging locally advanced rectal cancer after neoadjuvent therapy
Background: Rectal cancer is located in a narrow space, associated with many anatomical structures in the pelvic cavity, so the rate of local recurrence and distant metastasis is higher than in the rest of the colon.
Regarding malignant involvement of circumferential resection margin, the sensitivity, specificity, PPV, NPV, accuracy were 100%, 27.5%, 23%, 96.67% and 54%, respectively.
Conclusions: The combination of morphological and functional sequences provides superior reliability compared to the solely morphological ones in evaluation of post-neoadjuvant chemotherapy T staging.
In regard to the lymph node staging standard whose short diameter is 5 mm, MRI gives high diagnostic accuracy.
Additionally, with respect to circumferential resection margin involvement, MRI plays a major role in rule-out diagnosis, with great negative predictive value.
Keywords: rectal adenocarcinoma, tumor restaging after neoadjuvant chemotherapy, magnetic resonance imaging
Magnetic resonance imaging (MRI) allows distinguishing complex anatomical structures in the anorectal region and tumor changes after chemotherapy and radiotherapy.
However, it is challenging for radiologists to identify the presence and infiltration depth of residual tumor with restaging MRI.
Objective: To evaluate the accuracy of MRI in tumor restaging of rectal adenocarcinoma after neoadjuvant chemotherapy in comparison with pathological results.
Methods: A total of 52 consecutive rectal adenocarcinoma cases diagnosed by multidisciplinary team and treated by neoadjuvant chemotherapy before radical surgery was restrospectively analysed in this study during the period 2016 - 2021 at University Medical Center.
The combination of T2W and DWI improved diagnostic accuracy to 67%, overstaging to 17% and understaging to 19%.
Concerning post-neoadjuvant chemotherapy mesenteric lymph node staging, the sensitivity of MRI was 83%, the specificity was 83%, PPV was 71%, NPV was 90.9%, and accuracy was 83.33%.
Study categories of renal arteries in pedicles of the vietnamese kidneys
Background: The surgery of pedicle of kidney plays an important role in kidney transplant procedure, but the description of anatomical categories of the Vietnamese renal arterial supply is still little.
Therefore, we carried out the study to provide the surgeons with more information about various types of renal arteries in pedicle of the Vietnamese kidney. Aim: Describe anatomical categories of renal arteries in pedicle of the Vietnamese kidney to apply for renal surgery. Material and Method: We conducted a cross sectional descriptive study in 78 cadavers of Vietnamese adults in the Anatomy Department Laboratory of the University of Medicine and Pharmaceutical of HCMC from 2003 to 2010.Result: There are 156 kidneys with 199 renal arteries (184 hilar arteries, 15 upper and lower polar arteries coming from the arotic artery).
The appearance rate of upper polar arteries is quite high (38.64%), whereas the appearance rate of lower polar arteries is low (5.77%).
All forms of renal arteries present as other authors had stated Conclusion: The existence of multiple renal arterial supply is quite common.
Anatomy variations in renal arteries, upper polar artery and lower polar artery have shown multiform renal artery in pedicle of kidney. And the presence of multiple renal arteries.. increases the complexity of the transplant procedure as in the studies of Spanos (1973), Benedetti (1995) and Troppmann (2001).
Studies of cyp2c19 genotype by multiplex realtime pcr in gastric biopsies from patients infected with h.pylori
Background: At present, H pylori infection is the major problem of the society, especially in developing countries.
Results: In this study with 228 biopsy samples, the allele frequencies of CYP2C19 * 1 / * 1, * 1 / * 2, * 1 / * 3, * 2 / * 2, and * 2 / * 3 were found in 118 (51.8%), 85 (37.3%), 13 (5.7%), 6 (2.6%) and 6 (2.6%), respectively.
Homozygous CYP2C19 * 3 / * 3 was not found.
There for, 51.8% of the patients were predicted as extensive metabolizers, 43% as intermediate metabolizers and 5.2% as poor metabolizers.
Conclusion: The study shows the multiplex real-time PCR for identifying CYP2C19 genotype is simple, reducing the risk of contamination, and affordable in Vietnam.
Identifying CYP2C19 genotype for each patient will be increase the PPI drugs absorption, so that may improve treatment success rate, reduce the rate of treatment failure and relapse related to Pylori infection in Vietnamese patients.
Keywords: Multiplex real-time PCR, CYP2C19 * 1, CYP2C19 * 2 and CYP2C19 * 3
Approximately 50% of the global population infected with H pylori.
This is the main cause of a series of gastric diseases such as chronic gastritis, duodenal ulcers and gastric cancer.
Biopsy samples were obtained from patients with diagnosis of H pylori infection (University Medical Center, Ho Chi Minh City, Vietnam).
The tissue was grinded, DNA was extracted, multiplex real-time PCR was carried out to detect both the CYP2C19 * 2 and CYP2C19 * 3.
The correlation between anemia indexes and creatinin clearance rate on kidney-stone patients with renal insufficiency
Introduction and purpose: To study the change of erythrocytes, hemoglobin, hematocrit based on renal insufficiency stages and the relationships between erythrocytes, hemoglobin, hematocrit with creatinin clearance rate on kidney-stone patients with renal failure.
Patients & Method: The prospective cross-sectional study was performed on 58 kidney-stone patients with renal failure in Department of Urologic Surgery, 103 Hospital.
Results: The erythrocytes, hemoglobin, hematocrit decreased gradually when the creatinin clearance rate decreased (using Cockcroft-Gault formula).
There was positive correlations between the creatinin clearance rate and erythrocytes (r = - 0.36), hemoglobin (r = - 0.36), hematocrit (r = - 0.28).
The correlations between creatinin clearance rate and erythrocytes as well as hemoglobin are stronger than hematocrit.
Conclusion: There was a positive correlation between the creatinin clearance rate and anemia indexes on kidney-stone patients with renal insufficiency.
Keywords: anemia, creatinin clearance rate, kidney stone, renal insufficiency
Result of cardiac valve replacement in children in heart institut
In the group of patients with mitral valve replacement all patients were alive.
The 2 patients with mitral bioprosthesis were reoperated because of structural valve deterioration.
Actuarial survival free from valve-related complications was 64, 3 ± 21% at 5 years.
Conclusions: Cardiac valve replacement can be performed with low mortality and low complication rate in children without associated complex cardiac lesions.
For mitral valve replacement mechanical prostheses are better suited than bioprostheses.
Oral acenocoumarol is effective and safe for long-term anticoagulation in children with left-sided mechanical prostheses.
The age of the patients ranged from 7 to 15 years.
Patients with mechanical prostheses were treated with oral acenocoumarol.
The total follow up was 36, 2 patient-years in patients with mitral valve replacement and 103, 9 patient-years in patients with aortic valve replacement.
Results: In the group of patients with aortic valve replacement there were 1 hospital death and 1 late death.
One patient was reoperated because of hemolysis due to residual mitral regurgitation after concomittant mitral valve repair.
3 patients developed obstructive valve dysfunction.
Actuarial survival free from valve-related complications was 78, 6 ± 10, 5% at 5 years.
Mean doses of continuously infused morphine at postoperative day 1, day 2 and day 3 were 36.1, 32.0 and 23.5 µg / kg / hou respectively.
Blood sampling and dressing change are common painful procedures within 72 hours after surgery.
Conclusions: Most neonates received postoperative analgesia and pain scores using CRIES pain scales decreased in the 72-hour postoperative period.
Pharmacologic interventions were morphine and acetaminophen.
Keywords: Postoperative pain management, CRIES pain scale, morphine, acetaminophen.
Results: Among 73 studied neonates, male / female ratio was 1.7.
Mortality rate was 4.1%.
Mean age of admission and receiving surgical operation was 5.5 and 7.7 days.
The most common condition was esophageal atresia (16.4%).
Mean pain scores using CRIES pain scale at postoperative day 1, day 2 and day 3 were 4.2, 3.4 and 2.2 respectively.
Among 70 cases (95.9%) received analgesia, morphine was used in 38 cases (54.3%), acetaminophen in 16 cases (22.9%) and 14 cases received the combination of morphine and acetaminophen (20%).
Experimental study on hepatoprotective and renal protective effects of ethanol extracts from psidium guajava linn)
Aims of study: The previous study revealed that 70% ethanol fruit extracts from white guava and red guava collected in Tien Giang Province showed anti-hyperglycemic effects in diabetic mice.
Hepatic malondialdehyde (MDA), renal MDA and hepatic glutathione (GSH) contents were used as observation parameters.
Results: Streptozotocin-induced diabetic mice or ovariectomized experimentally diabetic mice in control groups expressed an increase in hepatic MDA, renal MDA and decrease in hepatic GSH contents as compared to physiological groups (normal mice), indicating oxidative damage in liver or kidney.
Two week-treatment of guava extracts restored these parameters to the normal values.
The effect of guava extracts was better than that of gliclazide.
The effect of red guava was equivalent to that of estradiol valerate (Progynova® 0.5 mg / kg) in OVX diabetic mice.
Conclusion: 70% ethanol fruit extracts from white guava or red guava had hepatoprotective and renal protective effects in ovariectomized experimentally diabetic mice.
Keywords: Psidium guajava (Guava) fruit, streptozotocin, bilateral ovariectomy (OVX), hepatoprotective effect, renal protective effect.
To be continued, the present study focused to determine hepatoprotective and renal protective effects of 70% ethanol fruit extracts from white guava or red guava in diabetic mice and in ovariectomized experimentally diabetic mice.
Methods: Overnight-fasted female mice were intraperitoneal (i. p.)
injection of streptozotocin at dose of 170 mg / kg.
After 1 week, diabetic mice were randomly assigned to control group, positive control group (gliclazide) or test groups (at oral dose of 1 g guava extract / kg administered for 2 weeks).
In parallel, mice were 2-week orally treated by positive control drugs (quercetin, gliclazide, and estradiol valerate) or guava extracts (1 g / kg).
Objectives: To determine pre - and post-operative characteristics of Coarctation of aorta with Ventricular septum defect (CoA with VSD) patients who were repaired one-stage totally in Nhi dong 1 hospital from November 2010 to May 2013.
85% of cases had malnutrition, 25% had hypertension, 90% had heart failure.
Echocardiography demonstrated that is 45% preductal CoA with 70% hypoplasic aortic arch, 30% outlet VSD with mean diameter 6.94 ± 0.51 mm and 65% severe pulmonary hypertension.
The mean time of cardiopulmonary bypass was 165.8 ± 7.6 minutes, of aortic clamps was 83.65 ± 5.07 minutes.
100% of CoA cases were totally repaired by resection and end to end (or end to sides) anatomosis and 75% of cases were closed VSD by pericardiac patch.
The mean time of intubation is 72.57 ± 1.31 hours, of chest tube is 127.3 ± 19.7 hours, of staying in ICU is 6.9 ± 6.6 days.
Common complications were hypertension (85%), pneumonia (45%), low cardiac output (25%), bleeding (20%), arrhythmia (20%), chylothorax (20%).
Keywords: Coarctation of aorta with VSD
Method: case series study.
20 CoA with VSD cases were totally one-stage repaired in Children hospital number 1.
Diagnosis was done based on 2 times of echocardiography.
Data pre - and post-operation were collected before patients discharged.
Results: There were 20 CoA with VSD cases.
Objective: to investigate characteristics of radiology immages of lateral ventricle tumors.
There was no relation between surgical outcomes and these features.
Keywords: radiology features, surgical outcomes, lateral ventricle tumors.
Patient and method: retrostective study on 34 patients who were diagnosed as lateral ventricle tumors at vietduc hospital from January 2011 to June 2013.
Results: there were 34 patients in the study, including 22 males and 12 females with the mean ages 27.7±13.47.
Conclusion: lateral ventricle tumors is usually without specific clinical symptoms.
Most of lateral ventricle tumors were in one side of lateral ventricles with clearly border.
Smad4 gene mutations of colorectal cancer
Background: Colorectal cancer (CRC) is among the 5 most common cancers.
This research also recorded 1 patient with clinical polyposis, carrying a mutation on SMAD4 gene concurrent with mutation on p53 and KRAS gene.
Conclusions: This is the first study describing mutation ratio (17, 8%) on SMAD4 gene in Viet Nam.
Keywords: Colorectal cancer, SMAD4 gene mutation, Juvenile polyposis syndrome (JPS).
SMAD4 gene is related to transforming growth factor β (TGF - ß) signaling pathway, which plays an important role in many biological processes including cancer initiation and progression.
The function of TGF-β / SMAD4 signaling pathway is tumor suppression in early stage by cell cycle arrest and apoptosis.
Mutations on SMAD4 gene disrupt cell signaling leading to uncontrolled growth and division as well as polyp formation.
Objective: Description of SMAD4 gene mutations in colorectal cancer and the correlation between SMAD4 gene mutations with clinicopathological characteristics.
Methods: Cross - sectional study.
101 tumor samples were received, performed next generation sequencing process on Immumina System.
Results: The study reported that rate of SMAD4 mutation was 17.8%.
There was no correlation between gene mutations with age, gender, stage and tumor location.
Efficiency of misoprostol home self-administration in medical abortion for pregnancy up to 50 days of age at 12 district hospital
Backgrounds: Medical abortion is the usage of drugs to terminate pregnancy.
Conclusion: Medical abortion with mifepristone 200 mg oral regimen in the hospital and placed under the tongue 400μg after 36 to 48 hours in the house is safe and effective.
Keywords: medical abortion, prospective - longitudinal study
The domestic and foreign researches have proven that medical abortion has been effective, safe and highly acceptable.
Methods: Prospective longitudinal study, carried out at 204 pregnant women with gestational age less than 50 days examined at 12 District hospital, Ho Chi Minh City in the period from October 2015 to March 2016.
All women have unintended pregnancies and wanted to apply medical abortion method.
Results: The success rate of medical abortion regimen was 99% CI 95% (97 - 100).
The extent and duration of vaginal bleeding after using Misoprostol is: (I) Time average vaginal bleeding 10.9 ± 5.9 days.
(ii) The degree of vaginal bleeding after use Misoprostol: a lot is 5.88%, 61.27% more of that, much of the 32.35%, and 0.49% less business.
The rate of adverse events seen in the study is: The level is 33.82% more abdominal pain, a lot is 7.35%.
Nausea (26.47%), diarrhea (22.06%), fatigue (22.06%), dizziness (20.1%), headache (19.11%), vomiting (11.76%) and in addition some rare side effects such as allergic reactions (3.43%) and fever (1.96%).
Studying efficacy of spinal anesthesia using bupivacaine and morphine in arthroscopic knee joint surgery
Purpose: To evaluate the efficacy of spinal anesthesia, postoperative analgesia, side effects of the spinal anesthesia using 10 mg Bupivacaine 0.5% and 100 µg Morphine in arthroscopic knee joint surgery. Methods: We performed a prospective, randomized, controlled study in 90 patients undergoing arthroscopic knee joint surgeries under spinal anesthesia.
Total analgesic requirements in the first 24 hours postoperation in group 3 were significantly lower than that in group 1 and group 2.
There were no statistically significant differences in side effects betweeen 3 groups. Conclusion: Comparing with spinal anesthesia using Bupivacaine 0.5% alone or with Fentanyl, the combination of Bupivacaine 0.5% 10 mg and Morphine 100 µg for arthroscopic knee joint surgery was safe, prolonged duration of postoperative analgesia and reduced the total analgesic requirements in the first 24 hours postoperation without increasing side effects.
Patients were randomly allocated to three groups: group 1: received Bupivacaine 0.5% 10 mg, group 2: received Bupivacaine 0.5% 10 mg combined Fentanyl 20 µg, group 3: received Bupivacaine 0.5% 10 mg combined Morphine 100 µg.
The efficacy of spinal anesthesia, duration of postoperative analgesia, total analgesic requirements, side effects of each patients were recorded during operation and within the first 24 hours postoperation. Results: All of patients got adequate anesthesia for surgery.
There were no significant differences in age, sex, weight, height, ASA between three groups.
The duration of completed analgesia was statistically different between 3 groups: Group 3: 812.03 ± 134.01 minutes, Group 2: 284.43 ± 38.34 minutes, Group 1: 229.13 ± 49.96 minutes.
Pain scores at rest and at movement at 2, 4, 6, 12h postoperation in group 3 were significantly lower than that in group 1.
Pain scores at 18, 24h postoperation were similar between 3 groups.
Conclusions: TEPT can becarried out on newborns easily, safety and associated with an excellent result.
Noted and analysed clinical and paraclinical data to diagnose; avantages and disavantages during surgery; postoperative outcomes and complications.
Mean operating time was 53.38 minutes.
Investigation, classification and response to malaria foci in malaria elimination in the central region, 2015-2018
Background: In malaria elimination, surveillance system is considered as a core intervention.
Reporting, investigation and classification of cases and investigation, response to malaria foci still face to many difficulties.
Conclusions: The quality of classification of malaria case is very important, thereby affecting the results of classification of malaria foci in malaria elimination.
The activities to respond to malaria foci should be implemented fully, properly and on time, in order to cut off spread at all active foci.
Keywords: malaria elimination, malaria foci
In particular, detection, investigation, classification of cases and response to malaria foci are the key activities.
Objectives: To classify cases, malaria foci and to assess activities of investigation and classification of cases and malaria foci in study sites.
Method: Retrospective study. Results: A total of 120 indigenous cases were recorded between 2015 and 2018, the prevalance of indigenuos cases declined; in 2018 indigenous cases accounted for 61.33%, especially in Ea Lam commune, indigenous cases only attributed 25%.
A total of 30 malaria foci were evaluated, the foci status changed unstably at study sites, changed by year.
In 2018, there were 13 active foci; 5 residual non-active foci; and 12 cleared foci.
In that year, 69.23% of the malaria foci were investigated.
In terms of evaluation of foci response, reactive case detection (RACD) was carried out with 100% of the active foci, with a low total population, only 365 people and 3 new positive cases were detected and vector investigation was carried out with 33.33% of the total foci and 0% was carried out Indoor residual spraying (IRS).
Myelolipoma of adrenal gland: report of five cases
The tumors of adrenal gland have many kinds, their locations may be in the cortex and the medulla; with or without endocrine manifestation.
Myelolipoma is the primary tumor, no endocrine cells origine, detected incidentally, and its frequency is rarely.
Microscopically, myelolipoma composed two components: mature fatty tissue and hematopoietic tissue with megakaryocyte and others elements.
During 2001 - 2003, Cho Ray hospital was collected 5 cases with imaging results correlated with pathology findings.
Their behavior is benign and no recidive problem after removing the tumors.
Results of myopia and astigmatism treatment by laser excimer
Recently laser-in-situ-keratomileusis (LASIK) has been increasingly used in Việt Nam to correct refractive errors.
Conclusion: Lasik is a effective procedure to correct low and modere myopia.
This study was perfomed to evaluate the efficacy, safety, predictability, stability and complications of Lasik on vietnammese'eyes.
Patients and methods: 272 consecutive Lasik operations of 145 patients age range 18 - 52 years, mean age 28.99 years.
The Moria Lsk one microkeratome and Scan 197 laser excimer were used in this study.
The mean sphere was - 6.16D, the mean visual acuity before operation was 8/10 (with correction).
Examinations were performed after 1 day, 1 week, 1 month, after 3, 6, 12, 24 months.
Computed tomography appearance of urothelial cell carcinoma of upper urinary tract
Purpose: describe the computed tomography (CT) appearance of urothelial cell carcinoma of UUT (UUT) and determine the value of the computed tomography in the assessment of invasive, regional lymph nodes of urothelial cell carcinoma of UUT.
Homogeneous lesions accounted for 76.1%, 11.9% necrosis, 6% calcification.
Conclusions: On CT, appearances of urothelial cell carcinoma of UUT are expressed well. CT has little value in the assessment of invasive, pretty good value in assessing regional lymph nodes.
Materials and Methods: 67 patients who underwent surgery or endoscopic biopsy results urothelial cell carcinoma of UUT and CT before at Binh Dan hospital.
Case-series study design.
Results: 67 patients who underwent surgery or endoscopic biopsy results urothelial cell carcinoma of UUT, in which the position of the urethral carcinoma accounted for 50.8%, distal the urethral carcinoma accounted for 19.4%, the left urinary system accounted for 67.2%.
Lesions of the renal pelvis averaged 3.4 ± 1.2 cm in size; lesions in the urethra averaged 4.8 ± 3.8 cm in size.
On unenhanced CT, 78.1% of renal pelvis carcinoma renal is the same attenuation with parenchyma, 100% lesion with attenuation higher than in the urine in the renal pelvis.
The filling defects of renal pelvic accounted for 78.1%.
For kidney cancer, nephrosis accounted for 77.6%, the slow rate excreted the contrasted agent accounted for 47.8%.
Jaundice is a commun problem in the newborns.
Methodology: Sectional, descriptive and analytic study.
Results: The transcutaneous bilirubin was available and accurate to survey the TSB.
The correlative coeficient of TSB to TcB (measured on forehead), Rt was 0.98.
TSB (ìmol / L) could estinmate by multipling the TcB (TBI-transcutaneous bilirubin index) with 10.
If indicating TSB when the TcB value was higher than the cut-off point of hour-specific TSB values on the bilirubin nomogram (< 48 h = 14; 48 - 72 h= 22; >72h = 26), the sensitivity of this technique was 100%; while the specificity, 75.00%; the positive predictive value, 68.66%; the negative predictive value, 100% and the area under the curve ROC, 0.9872.
Conclusions: Our study demonstrates that the TcB with Bilitest was available and accurate in the screening cases who needed the phototherapy on the healthy term newborns.
Infants with TcB above the cut-off point of hour-specific TSB values on the bilirubin nomogram should be controled the TBS for phototherapy indication.
Further studies were needed to assess the value of this technique in variable populations.
Hyperbilirubinemia, when excessive, can lead to potentially irreversible bilirubin-induced neurotoxicity.
The survey of total serum bilirubin (TSB) is thus necessary, but expensive and invasive.
The transcutaneous bilirubin (TcB) can be a intermediary method to estimate the TSB.
Objectives: To evaluate the value of transcutaneous bilirubin method in screening cases, newborns needed the phototherapy on the healthy term newborns.
Materials: Study was executed on 100 jaundice and 30 non - jaundice healthy term newborns of maternity ward of the hospital of Medicine-Pharmacy University of HCM city.
We used the Bilitest (Technomedica-Russia), a reflectance bichromatic photometry, to measure TcB.
All transcutaneous evaluations were performed contemporaneously with a veinous TSB measurement.
All TSB assays were performed by high performance liquid chromatography, as well as by diazo dichlorophenyldiazonium tetrafluoroborate techniques.
Preliminary evaluation the role of arthroscopy in the treatment of tibial plateau fractures at the cho ray hospital
Introduction: Tibial plateau fractures are one of the most popular fractures of the joints.
70% cases associated intra-articular lesions and the lateral meniscus tear is the most popular.
We used the Rasmussen's score, the majority had the good results. Conclusion: Arthroscopy plays an important role in the treatment of tibial plateau fractures.
Cancer of the parotid gland: diagnosis and treatment
A retrospective study on 87 patients with cancer of the parotid gland treated at the HCMC Cancer Hospital from 2001 to 2003, we record: mean age is 45 ± 10, male / female ratio is 0.64. Most of the patients were diagnosed at stage II (44.8%); in this group, 55.2% of cases are mucoepidermoid carcinomas, and half of the patients have high grade tumours.
The common complication of surgery is temporary facial nerve paresis (69%).
The 4-year disease free survival rate is 73.08% and the 4-year overal survival rate is 86.7%.
The following factors are seen to have pronostic value: tumour stage (p = 0.0110), perineural spread (p = 0.0451), the histologic grade (p = 0.0358).
Multivariate analysis showed that the histologic grade, perineural spread are independent pronostic fators
Background: Sedentary behavior is rapidly emerging as an important issue in public health.
There was also a significant association between BMI categories and time spent for learning after school (p<0.01).
Conclusions: Adolescents spent a lot of time in sedentary activities, especially in learning after school.
Intervention programs should be set up to reduce the pressure of education on children in Ho Chi Minh City.
Keywords: Adolescents, Ho Chi Minh City, overweight, obesity, sedentary behaviors, Vietnam
Young people who spend a large amount of time in sedentary behaviors are at risk of overweight and chronic diseases.
A clear understanding of adolescents' patterns of sedentary behaviors is required to develop effective intervention programs to promote healthy living.
Our study aimed to describe time (min / day) spent in sedentary behaviors and their relationship with age, gender and nutrition status among junior high school children in urban districts at Ho Chi Minh City.
Methods: In a cross-sectional study of 1989 junior high school students of HCMC in 2010, students were measured for BMI and questioned on their sedentary behaviors based on validated sedentary behavior questionnaire.
Sedentary behaviors were grouped into three categories: small-screen recreation, learning after school, and other sedentary activities.
Overweight and obesity definition were based on the age - and sex-related Internal Obesity Task Force BMI cutoff values.
Results: Students spent 365 ± 198 min per day (around 6h / day) in sedentary activities.
Sedentary activities were associated with gender (p<0.001), age (p<0.001) and with socioeconomic level (p<0.001).
The study also recognized that Fentanyl and Isoflurane was used in all patients.
The average time of the operation was 88 minutes.
The most common reason is caused by appendicitis that occurs in 51.68%.
The patients who come to the hospital with local peritonitis (38.20%) or general peritonitis (61.80%) and with or without shock.
General anesthesia method is a technique of safe and the first effective choice in these cases.
The prevalence of the intravenous agent that used over 75% was Prpofol. And there is 75.86% of the patients was used rocuronium as a muscle relaxant agent.
Evaluation of the activities of central sterile supply department (cssd). children hospital 2 for the first 6 months of 2009
Objectives: Evaluation of the Activities of Central Sterile Supply Department (CSSD), Children Hospital 2 for the first 6 months of 2009 Method: Descriptive cross-sectional design Results: Compared to the first 6 months of 2008, in the first 6 months of 2009 CSSD saved a lot of chemical substance and package amounting to 123, 530, 757 VND.
Instruments reprocessed in the CSSD ensure to better protect patients and healthcare workers and allow nurses to spend more time on patient care and follow-up.
CSSD is in high demand and has met other relevant departments' requirements.
Population size estimation of men who have sex with men in ho chi minh city using social app multiplier method
Background: Men who have sex with men (MSM) are among the HIV high risk population in HCMC.
Keywords: population size estimation, MSM, Size of MSM
The HIV incidence rate in MSM has increased from 1.3% in 2010 to 47.6% in 2019.
However, information on the size of MSM population remains unclear.
Objective: This study aimed to estimate the size of the MSM population in HCMC and compare based on three different data sources.
Objectives: To survey the press ulcer in all the patients who had to monitor life signs less than every 6 hours in the critical care rooms of Nguyen Tri Phuong hospital from July to October 2016.
Keywords: Press ulcer.
Methods: Observing, descriptive study.
Results: The rate of press ulcer in critical care room were 8.23% (Heamo - Dialysis Department 50%, Respiratory Dpt: 16.6%, Neurology Dpt: 13.3%, Post-Surgical Care Unite: 20%, Neuro - Surgery Dpt: 21.4%, General Surgery Dpt: 16.6%, Digestive Surgery Dpt: 16.6%, Toxic and Critical Care Dpt: 8%).
67% occurred in patients > 60 years old. 42.1% in very high risk of press ulcer patients, 11.2% in high risk and 3.8% in medium risk.
Time from admitting to press ulcer occurring less than 5 days: 16.2%, 5 - 20 days: 4.9%, and more than 20 days: 11.7%.
Conclusion: Press ulcer still occurred in critical care room patients.
In surgery departments had high rates of ulcer related to: digestive surgery, head surgery, mal nutrition, debilitated, unconscious in long time and artificial respiratory machine.
Evaluation the effect of lung resections on lung functions
pH, paCO2 were less variations, paO2 reduce 16.4%.
Lobectomy: FVC reduce 19.5% to pre-operative, FEV1 reduce 18.5%.
pH, paCO2 were less variations, paO2 reduce 6.7%. Conclutions: Spirometry were much reduce 1 month post-operative and recovered at 3 month post-operative but still reduce to pre-operative.
The level of them depend on each resections.
pH and paCO2 post-operatives were stable.
Methods: 626 health officials (29% male, 71% female) have answered the 25-question questionnaire on their knowledge, attitude and behavior on smoking status in the hospital.
Results: Approximately 40% have good knowledge on tobacco components and their bad effects on health, 10% have known the WHO recommended measures in helping smoking cessation.
38% have total confidence in explaining tobacco bad effects on health; 17.3% have total confidence in helping their patients to quit smoking; 25.6% believe that non smoking regulations in hospital are seriously respected.32.6% male and 1.3% female health officials continue smoking, 61.5% of those even smoke in the hospital's non - smoking environment.
Introduction: Iron-deficient anemia is an important problem in clinical practice.
Keywords: Reticulocyte hemoglobin content (CHR), hemoglobin (Hb)
Reticulocyte hemoglobin content can estimate exactly anemia due to iron deficiency as well as the fast respone to therapy along with other laboratory tests such as serum iron, ferritin, transferrin.
Objectives: Evaluation of reference rangeof reticulocyte hemoglobin content in healthy adults.
Materials: 178 healthy adults come to check regularly for health condition.
Results: Evaluation of 178 healthy adults come to check for health and have normal in conclusion.
Reference range of reticulocyte hemoglobin content is 36.37 ± 10.59.
There was positive correlation between reticulocyte hemoglobin content (CHR) and mean corpuscular volume (MCV) (r= 0.683 - 0.726, p=0.0001), mean corpuscular hemoglobin (MCH) (r= 0.798 - 0.830, p=0.0001), as well as negative correlation between CHR and number of red blood cell (r= - 0.478 - - 0.206, p= 0.006 - 0.0001).
Conclusions: Reticulocyte hemoglobin content can estimate of iron deficiency anemia and response to erythropoiesis from bone marrow beside the other hematologic laboratory tests.
Evaluate the improvement of lower urinary tract symptomsand some related factors after bipolar transurethral vaporization of the prostate
Objectives: evaluate the improvements of Lower urinary tract symptoms (LUTS) and some related factors of patients with benign prostatic hyperplasia (BPH) after bipolar transurethral vaporization of the prostate (B-TUVP).
Conclusions: After B-TUVP, the improvements of postoperative LUTS were statistically significant.
Keywords: Lower urinary tract symptoms (LUTS), bipolar transurethral vaporization of the prostate.
Patients and methods: from August 2013 to June 2015, a prospective and cross-sectional study was performed on 106 patients with benign prostatic hyperplasia treated by bipolar vaporization of the prostate at Department of Urologic Surgery - 103 Military Hospital.
Results: mean age 71.1 yo, prostate 48.8 gram on average.
Preoperative QoL was 5.2; at 1 - 6 - 12 months after surgery, QoL reduced 1.4 - 0.88 - 0.8, with the improvement percentage 72.7% - 82.4% - 84.3%, respectively.
Preoperative Qmax was 6.2 ml / s on average; at 1 - 6 - 12 months after surgery, Qmax increased 19.9 - 21.2 - 21.2 (ml / s), with the improvement percentage 245% - 277% - 276%, respectively.
Preoperative PVR was 81.2 ml on average; at 1 - 6 - 12 months after surgery, PVR reduced 10.6 - 8.8 - 6.8 (ml), respectively.
Patients' age was correlated statistically to the improvements of postoperative IPSS, QoL, Qmax and PVR also.
Application of flow cytometry in diagnosis and management of mature lymphoid malignancies
Lymphoproliferative disorders are rather frequent diseases, associated with specific clinical or biological features but also sometimes of fortuitous discovery.
Multiparameter flow cytometry plays a major role for a rapid diagnostic indication, on peripheral blood or bone marrow samples in most instances, guiding complementary analyses and allowing for the proper therapeutic management of patients.
The development of 8 - and 10-colour clinical instruments has had considerable impact on the diagnosis of non-Hodgkins lymphomas by flow cytometry.
A reasonably complete immunophenotypic profile of any lymphocyte population can today be achieved from a couple of well-designed panels.
Keywords: Lymphoproliferative disorder (LPD), Non-Hodgkin Lymphoma (NHL), flow cytometry (FCM)
Constructing vhi of vietnamese version
Background: In Vietnam, the VHI scale do not have the Vietnamese version.
Conclusion: VHI of Vietnamese version was translated, validated, normed and become suitable for Vietnamese cultural.
Objective: Building on and calibrate the Vietnamese VHI for Vietnamese population.
Method: Clinical trial - Step 1: to do forward and backward translation.
Step 3: Use a pilot test in 20 patients in order to building the last VHI of Vietnamese version.
Results: Forward translation: 4 papers of the forward translation translated independently by 4 native speaking of English teacher at graduated level.
Backward translation: 4 papers of the forward translation translated into the English versions independently by 4 bilingual speakings of English and Vietnamese.
That Vietnamese VHI was then given to 6 ENT experts who checked the content and after that the pilot test was done in 20 laryngeal patients.
Objectives: This study is to develop a simultaneous quantitative analysis of majors saponin in VG soft capsules by HPLC-CAD.
Conclusion: The result showed the developed HPLC-CAD method can be used for simultaneous quantitative analysis of major saponins in VG soft capsules including G-Rb1, G-Rd, G-Rg1, và M-R2 Keywords: Vietnamese gingseng, soft gelatin capsule, HPLC-CAD, ginsenoside, majonoside-R2.
Evaluating the effect of neoadjuvant chemotherapy in patients with advanced-stage ovarian cancer
Results: At the end of neoadjuvants chemotherapies, 2 patients (6, 7%) had achieved a clinical complete response (CR), 24 (80, 0%) a partial response (PR), 4 (13.3%) had stable disease (SD) and no patients showed disease progression (PD).
Surgical debulking was proposed to all patients after neoadjuvant chemotherapy, residual tumor size after surgery < 2 cm was 24 patients (80%).
Conclusion: Neoadjuvant chemotherapy followed by optimal debulking may be a safe and valuable treatment alternative in patients with primarily unresectable advanced-stage bulky ovarian cancer.
The percentage of patients having residual tumor size < 2 cm after neoadjuvant chemotherapy and surgery was rather high 80%.
Background: Platelet is an important factor correlation to unstable atherosclerosis plaque và thrombosis.
Keywords: mean platelet volume, acute myocardial infarction Abbreviations: MPV: Mean platelet volume, MPV / PC: Mean platelet volume / Platelet count ratio
The bigger platelet is, the more rapid metabolism and enzyme synthesis process, and receptor expose are.
Therefore, parametes of platelet such as mean platelet volume and mean platelet volume / platelet count ratio can estimate prognosis of patients with acute myocardial infarction.
Objectives: Validity of mean platelet volume and mean platelet volume / platelet count ratio in patients with acute myocardial infarction.
Method. Cross-sectional study of 233 patients with acute myocardial infarction in Cho Ray Hospital from Jan/2018 - May/2018.
Results: Mean platelet volume is normal in 93.1%, ratio mean platelet volume / platelet count ratio is normal in 81.1%.
Introduction: The key steps in the minimally invasive approach are designed to assure the drainage of offending sinus cavities without injury to any drainage pathways.
Objectives: to acess the effect of minimally invasive sinus surgery.
Results: data were analysed from 30 cases of minimally invasive sinus surgery: 81.9% of patients showed an overall improvement of symptoms after one year follow-up.
Conclusion: Minimally invasive sinus surgery is rational choice for chronic rhinosinusitis.
The prevalence of vaginitis – cervicitis and related factors in hiv – infected women come to thuduc preventive medicine center
Background: Vaginitis - Cervicitis, which are sexually transmitted infections (STIS), are common among women during reproductive years, particularly among women infected with HIV.
Conclusion: The Prevalence of vaginitis is higher than hat of cervicitis in HIV - infected women.
Treatment and prevention of vaginitis - cervicitis may decrease HIV transmission in the community.
Studies have shown that there is a relationship between HIV and STIs.
Diagnosis is not difficult but treament is very important because it can decrease he transmission to sexual partners and newborn babies.
Objectives: To define the prevalence of common causes of vaginitis - cervicitis and related factors in HIV - infected women at ThuDuc Preventive Medicine Center.
Results: Prevalence of vaginitis was 33.09% (the rates of agents were yeast vaginitis 14.71%, Gardnerella vaginalis 13.6% and Trichomonas vaginalis 0.74% and unknown cause 4.04%).
Vaginitis was not significantly associated with age, except for bacterial vaginosis, education level, condom usage and severity of HIV infection.
Cervicitis was significantly associated with correct way of condom usage, history of opportunistic infection prophylaxis.
Assessment on distribution and using of anti-malaria drug for self-treatment in dak o commune, bu gia map district, binh phuoc province
Backgrounds: Over the years, malarial prevention program have applied various measures to prevent Malaria effectively, including the supply medicines of self-treatment for inhabitant go to sleep in the forest.
Result: Representative of 204 households was interviewed in the 8/8 of the village, the high illiteracy rate of 20.1% (41/204) and the number of illiterate concentrated mainly in Stieng ethnic group 82.9% (34/41).
Percentage of people know at least one of the malaria symptoms was 74.0% (151/204), but some people do not know any malaria symptoms is high; 19.6% (40/204).
Among those who regularly sleep in the forest for cultivation only 31.2% (34/109) had received anti-malarial medicines for self-treatment, but in only 26.5% (9/34) of them carrying medicines when go to sleep in the forest.
Evaluation of neuro-vascular bundles preservation in radical prostatectomy
Introduction: Prostate cancer is the first malignant tumor of the urinary system in male.
The urinary continence and erectile function gradually recovered after 6 months.
We noticed the difference between unilateral and bilateral nerve preservation.
Results: In total, 14 cases of nerve preservation including 3 cases (21.4%) of unilateral preservation and 11 cases (78.6%) of bilateral preservation.
Urinary continence after surgery: 12 cases (85.7%) of complete continence and 2 cases (14.3%) of incontinence grade 1.
Sexual function after surgery: 11 cases (78.6%) good and fairly good, 3 cases (21.4%) average results.
Bilateral is more effective than unilateral preservation.
Keywords: Radical prostatectomy, nerve-sparing.
Radical prostatectomy is a choice for the localized stages in patients with life expectancy more than 10 years. Nowadays, treatment is focused on quality of life.
Urinary incontinence and erectile dysfunction after surgery are the two main problems to be solved.
Neuro-vascular preservation techniques help reduce these complications.
Objectives: Evaluation the effectiveness of neuro-vascular bundles preservation on the quality of life after surgery based on two criteria: urinary continence and erectile dysfunction.
Patients and methods: Serial cases, descriptive clinical study.
Neuro-vascular bundles preservation were performed in localized prostate cancer (stage T1 - 2).
Results of the transarterial oily chemo embolization in treatment of primary hepatocellulo carcinoma in older patients at thong nhat hospital ho chi minh city
Objective: The aim of this study was to evaluate the result of Transarterial Oily Chemo Embolization (TOCE) in treatment of primary hepatocellulo carcinoma in older patients at Thong Nhat hospital, from April 2005 to May 2009.Materials and methods: We studied 66 older patients with primary hepatocellulo carcinoma, 34 patients was treated by TOCE and 32 patients was not treated by TOCE.
There was no signigficant difference (p > 0.05) between these two groups at age, gender, Child-Pugh, clinical and paraclinical characteristics and viral hepatitis.
The most common cause of primary hepatocellulo carcinoma in older patients is: 75.8% hepatitis B virus (HBV), 16.7% hepatitis C virus (HCV) and 7.6% other.
The session of TOCE for 1 time: 29.4%, 2 times: 41.2%, 3 times: 17.6%, 4 times: 11.8%.
The mean tumor size before TOCE is 5.9 ± 2, 51 cm and after TOCE 4.85 ± 2.04 cm (p < 0.05).
Resistance Index of (RI) of carotid artery increased with the risk of 10 year - coronary artery according to Framingham. Conclusions.
Resistance Index of carotid artery has showed the relationship with the risk of 10 year - coronary artery according to Framingham.
One study before has showed that there was an relationship between carotid artery function and heart disease.
In Viet Nam, there is a few research in studying the relationship between carotid artery function in doppler ultrasound and the risk of 10 year - coronary artery according to Framingham in patients with dyslipidemia. Objectives.
Cross-sectional descriptive, analysis, prospective study. Results.
In this study, 131 patients with dyslipidemia over 40 years old have been taken doppler ultrasound to estimate carotid artery function and calculated the 10 year-carotid artery risk arcoding to Framingham.
There was an increase in diastolic velocity (Vd) in different group about the 10 year-carotid artery risk with no signigicant statistic.
The study of clinical-histopathologic features of medulloblastoma in children
Background: Medulloblastoma is the most common malignant tumor of central nervous system found in children.
Headache and vomitting symptoms were appeared in children and needed medical attention.
Anaplasia medulloblastoma was often seen with recurrent capacity and metastasic.
Histopathologic classification of medulloblastoma together with clinical features and radiology are essential in making proper diagnosis and treatment, in order to reduce the mortality and morbidity. Objectives: To determine the clinical epidemiological features and identify the correlation between clinical features and histopathology of medulloblastoma in children. Methods: The descriptive cross-sectional design was carried out on 60 cases diagnosed with medulloblastoma in children from 1 - 15 years old at Cho Ray Hospital in 2005 - 2009.Results: In forty-eight cases diagnosed with medulloblastoma in children from 1 - 15 years old, the average age was 7.88.
The occurrence in male was higher than female (1.30: 1).
The time between onset of symptoms and diagnosis with the initial treatment was less than 3 months (80%).
Patients often have the following symptom: Elevated intracranial pressure (93.75%) and cerebellar syndromes (81.25%) (Headache 98%, vomiting 100%, vertigo 58.33%, papilledema 75%, ataxia 81.25%).
79.2% of the tumors were localized to cerebellar vermis, 16.6% in cerebellar hemisphere and metastasic to cerebrum (2.1%) and spinal (2.1%).
Based on histopathologic features, medulloblastoma was classified into four subtypes according to the WHO (2007): desmoplastic medulloblastoma (35.4%), medulloblastoma with extensive nodularity (4.2%), anaplastic medulloblastoma (60.4%) and large cell medulloblastoma (0%).
Conclusions: The age group of patient was often found at 6 - 10 years old (45.83%).
Contributing to the survey of characterics of lymph nodes in clinical examination, sonography and pathology of squamous cell carcinoma of pharynx and larynx at cho ray hospital from 10/2017 to 6/2018
Backgrounds: Today, sonography is a non - expensive technique can provide us with much useful information about lymph node pathology.
Conclusion: Sonography is a simple diagnostic imaging technique with relatively high sensitivity and NPV to diagnose metastatic lymph nodes in squamous cell carcinoma of pharynx and larynx.
Keywords: squamous cell carcinoma of pharynx and larynx, cervical lymph nodes, sonography of lymph nodes
Besides, to follow patients with sonography, a non - invasive imaging technique, can help us diagnosis an early metastasis of lymph node or a recurrence after radiation or surgery.
Objectives: To investigate cervical lymph nodes in squamous cell carcinoma of pharynx and larynx in clinical examination, sonography and pathology.
Methods: A cross - sectional study describes case series.
Results: There were 13 cases had metastatic lymph nodes among 43 examined cases.
Lymph nodes were diagnosed in 100% cases on sonography, their sizes were between 0.5 to 1 cm and counted for 60.4%.
Sensitivity (Sn) = 92.3%; Specificity = 76.6%.
Technique and results of implantable vascular access device at department surgery of no1 pediatric hospital in 2002.
IVAD is positioned under the skin.
- It can remain in patients for many years. - Less restriction in normal physical activities. - Avoid the fear of pain, the incorporation of child patient. - Permit high flow rates of fluid, safety, efficiency.
Determination of pre- and post-partum depression rate in women with high risk pregnancies in tu du hospital
Background: Nowadays, life expectancy of human being have been lasting longer by great improvements of medicine.
Going along with this is the increase of post-partum depression seen to be a silent disease, which is affecting millions of postnatal women all over the world.
Until now, there are a few of researchers about this subject in Vietnam.
This study aimed at verifying the prevalence of postpartum depression in women with high risks pregnancies who give birth in Tu Du hospital from June, 2007 to December, 2008.Methods: A longitudinal - sectional study was done by sending questionnaire to women with high risks pregnancies in Tu Du hospital.
Data collected from 335 respondents, who satisfied the selective criteria, was statistically analyzed to find out: the prevalence of PD, describing the sample characteristics & determine the effects of some factors on PD.
SPSS 16.0 software were used to computerize and analyze data with 305 cas. Results: the prevalence of post-natal depression was 21.6%, "baby-blues" was 30.2%.
We found that lack of support for baby care after birth, baby - blues, abnormal condition during pregnancy, childbirth is not as expected, depression during pregnancy, baby bad health status, method of delivery, support husband, baby cry at night, economic status, family conflict with her husband and delivery times are factors to make the women PDD.
This difference is statistically significant in single variable analysis. Conclusion: the clinical psychiatrists need to have insights about PD to choose more suitable therapies or apply methods of psychosocial support in order to prevent the PDD and to improve patients' quality of life & possibility of recovery.
Tubularised incised plate technique for hypospadias repair
Objective: To describe the results in using Snodgrass technique for middle and posterior hypospadias at the Children hospital number 2.
Keywords: posterior hypospadias, urethroplasty
The comparison of neuropsychological performance between early- onset alzheimers disease (eoad) and late- onset alzheimers disease (load)
Background: Early - onset Alzheimers disease (EOAD) has been overshadowed by the more common late - onset AD (LOAD) due to differ diverse clinical features and frequency of nonamnestic presentation.
Cases selected among the patient diagnosed Alzheimer disease (probable - DSM 5) with MMSE scores ≥ 15. Results: 21 EOAD and 27 LOAD were analyzed neuropsychological test: MMSE, clock-drawing test, modified Boston naming, verb fluency, trail-making A, immediate recall, delayed recall, delayed recognition, digit span forward, digit span backward.
EOAD group have worse result at modified Boston naming test and clock-drawing test (p <0.05), represented language and visual impairment than LOAD.
Conclusion: EOAD have differ neuropsychological test from LOAD.
Keywords: early-onset, late-onset, neuropsychology, Alzheimers disease
Objective: The study was to examine the reparative dentin bridge induced by calcium silicate cement after direct pulp capping on rats by scanning electron microsope (SEM) and energy-dispersive X-ray spectroscopy (EDX).
Methods: The study was conducted on the maxillary first molar of 8-week-old male rats.
After pulp exposure, the cavity were capped with Biodentine™ and MTA.
The reparative dentin bridge induced by material were evaluated by SEM and EDX.
Results: The dentinal tubule structures were clearly observed through the reparative dentin bridge. However, the number of tubules seemed lower the primary dentin.
The mineralization level of the new reparative dentin bridge is similar to the primary dentin level.
Keywords: reparative dentin bridge, calcium silicate cement, direct pulp capping, SEM, EDX
A study to find out the causes of overload in out-clinic department oncologic hospital
After finding the result, we suggest a better organization of primary child care, mutual aid, assistance of persons and equiqment to local medical station, Oncologic hospital has to increase the medical network and technological transfer to local medical station.
The role of computed tomography angiography in evaluating carotid lesions in patients with acute cerebral ischemic stroke
Background: Carotid artery atherosclerotic disease is an important cause of cerebral ischemic stroke.
Multiple logistic regression analyses confirmed plaque hypoattenuation (p = 0.02, OR=2.77) are independent predictors of stroke.
Conclusions: High-grade stenosis and occlusion, increased carotid artery wall thickness, ulcerated plaque, plaque hypoattenuation and plaque enhancement were more commonly associated with the symptomatic side.
Plaque hypoattenuation is predictive factor for acute cerebral ischemic stroke.
By contrast, smooth plaque surface and plaque calcification seem to be the protective factors.
Keywords: ischemic stroke, atherosclerosis, CT angiography, carotid artery
Computed tomography angiography (CTA) allows to evaluate carotid artery stenosis and give information regarding the plaque composition and surface morphology.
The CTA features of carotid lesion such as stenosis carotid artery, ulcerated plaque and plaque hypoattenuation seem to be related to stroke.
Objective: To describe the CTA features of plaque in patients with acute cerebral ischemic stroke and determine the correlation between these features and acute stroke events, thereby providing predictive factors for future stroke.
Methods: One hundred and two patients presenting with acute cerebral ischemic stroke and having a CTA were studied.
The CTA features of carotid lesion such as degree of stenosis, carotid artery wall thickness, size, surface morphology, composition and enhancement of plaque are assessed.
Results: Univariable analysis showed that carotid occlusions (p <0.001), high - grade stenosis (p = 0.04, OR =4.68), carotid artery wall thickness (p=0.01), ulcerated plaque (p = 0.001, OR=7.03), plaque hypoattenuation (p = 0.001, OR = 3.82) and plaque enhancement (p=0.02, OR=4.07) were significantly more common in the ipsilateral carotid arteries than in the contralateral carotid artery.
In addition, some features were more commonly associated with the asymptomatic side, such as smooth plaque surface (p <0.001, OR=0.23) and plaque calcification (p <0.001, OR=0.19).
Effects of propofol and fentanyl target-controlled infusion procedure in severe traumatic brain injury patients
Background: Traumatic Brain Injury (TBI) are public health problems of the world.
Patients studied were at department of anesthesia and critical care Nguyen Dinh Chieu hospital in Ben Tre province from 10/2011 to 9/2013.
Results: The patients with severe TBI post-craniectomy: male ratio 84.21%, ASA III 86.84%, increased ICP 44.74%, patient ages 15 - 65, critical care time 2 - 8 days.
With the average dose of propofol TCI is 0.73 ± 0.15 mcg / ml fentanyl dose coordinated with average 0.73 ± 0.15 ncg / ml.
TCI Adjusts to increase or decrease to Ramsay sedation score of 4 - 5, PI (Pain Intensity scale) 1 - 3, treatment to meet the requirements.
Coordinate different treatments, such as maintaining MAP 91.7 - 101.2 mmHg, fluid and electrolytes balance.
Result: very little appeal resistance mechanically ventilation (2/38 patients > more one times); MAP, CPP, ICP before and after intubation suction or perform various procedure no statistically significant (p> 0.05), after treatment CVP, CPP, GCS, MAP more improve from while first treatment is statistically significant (p< 0.05); deaths in critical care time was 13.16%.
Conclusion: This study demonstrated TCI propofol and fentanyl appropriate dose adjustment to take effect sedated patients, pain relief better, rare resistance mechanically ventilation and irritated when suction endotracheal tube; does not affect the circulatory system is to maintain good CPP.
This result admits TCI propofol and fentanyl is a safe method can replace drugs and other methods for sedation in intensive care patients following severe TBI.
Keywords: Intracranial pressure, severe traumatic brain injury, propofol and fentanyl target-controlled infusion, neurologic critical care.
Severe TBI is pathology complicated, therefore the treatment is a combination of different methods.
Sedation, analgesia are essential part of the therapy, and several drugs already in current use.
However, none of these drugs has proved to be superior to another.
There are many ways to coordinate, how to use drugs to achieve their treatment goals.
Propofol and fentanyl sedation target-controlled infusion (TCI) system has proven to be the only way has many advantages such as better hemodynamic stabilization, neuroprotective, reduced oxidative metabolism, reduce ICP, stable cerebral perfusion pressure (CPP).
Objective: To evaluate the effects of method analgo-sedation propofol and fentanyl TCI in the neurosurgical critical care with severe TBI patient.
Methods: This is a cross - sectional descriptive studied 38 cases of post-craniectomy severe brain injury, Glasgow Coma Scale (GCS) ≤ 8.
Patients were monitored ICP monitoring, mechanical ventilation, target concentration of propofol and fentanyl TCI for sedation is continuous with titration follow sedative and pain scores.
Background: Septic shock is a common clinical syndrome in the pediatric intensive care unit.
Keywords: septic shock, first hour resuscitation bundle
Adherence to the treatment regimen reduces mortality.
Objectives: To access the rate of completing the first hour resuscitation bundle according to the American College of Critical Care Medicine ACCM 2017 and outcomes in pediatric septic shock in the emergency department at Childrens Hospital 2.
Methods: Retrospective, descriptive study of patients with septic shock from 1 month to 15 years old in the emergency department at Childrens Hospital 2 from January 2018 to December 2019.
Evaluation after three years setting up typical village on food hygiene and safety of food sold on the street sides in long thanh district, dong nai province 2006-2008
Background: Foods is the important problem paying attention by everybody in the society. Foods is indispensable to our lives, it's the demand of daily life.
Setting up the suitable solutions in the reality made the active changes, hygiene and safe food conditions changed following to 10 standards of food sold on the street sides.
Objective: To describe the characteristics of places selling food on the street sides and to estimate the changes before and after the intervention basing on 10 standards of food sold on the street sides.
Method: Intervention and description study.
Results: Hygiene and safe food conditions following to 10 standards before and after the intervention: enough clean water clear increasing from 81.01% to 98.20%; private equipment increasing from 72.47% to 90.54%; processing on enough high tables increasing from 32.28% to 86.79%; labour safety clothing increasing from 25.32% to 52.70%; using additive spices out of the authorized list decreasing from 19.00% to 10.00%.
Conclusions: After 3 years setting up the typical village model on hygiene and safe food at 5 villages and 1 town in Long Thanh district, An Phuoc village was recognized attaining the standards of typical village model.
Surgical management of postoperative biliary strictures
Without death.
The risk factors of stricture are type of surgery, prior surgical repair of bile duct stricture, ischemia of proximal biliary tract, choledochal cyst, cholangiolithiasis and cholangitis.
Keywords: postoperative biliary stricture; biliary stone
Aims: The goal of this study is to evaluate the role of surgery in managing this disease.
Methods: retrospective and prospective study.
We rule out the stricture due to cancer.
Results: Between May 2005 and May 2012, 41 patients with postoperative biliary strictures underwent surgical treatment. The average of age is 50, 5, with 30 females, 11 males.
Liver and coagulation function in secondary bleeding postoperationin ent patient
We have consolidated some problems: - the secondary bleeding after operation often occur the most is tonsillectomy (80.6%), and on the sixth and seventh days after operation, at the age between 20 - 29 years old.
Background: Acute appendicitis (APP) is a less common cause of abdominal pain in elderly patients than in younger patients, but the severity among elderly patients appears to be higher.
Regarding clinical symptoms, all of patients complained about abdominal pain, of whom right iliac fossa is the most common position of abdominal pain (58.46%), followed by the abdominal pain at the epigastric position (45.38%).
There were 45.38% patients reported the pain shift.
The mean WBC count was 13.93 ± 4.97 and the proportion of leukocytosis was 63.08%.
The means of creatinine, SGOT, SGPT were 87.05 ± 23.07, 30.00 ± 19.9, 27.91 ± 21.34, respectively.
There were no association had been found between clinical symptoms and background profile of patients.
Conclusion: The findings showed that some common menifestations of APP in elderly population treated at Nguyen Tri Phuong Hospital could be used to create a set of criteria specific for diagnosis of APP in elderly.
Diagnosing an elderly patient who presents with abdominal pain due to APP is a difficult challenge due to atypical manifestations, comorbidities and socio-behavioral factors which are associated with this group of patients.
Therefore, identification clinical presentation of patients with APP is crucial to improve punctuation and accuracy of APP diagnosis.
Objectives: The primary purpose of the present study is to identify all medical history, physical examinations and laboratory findings related to APP and their relationships with the occurrence of APP in elderly patients who are hospitalized and treated at Nguyen Tri Phuong Hospital.
Methods: A retrospective study was carried out at Nguyen Tri Phuong Hospital with a total of 130 older patients with APP in Nguyen Tri Phuong Hospital.
Medical records of participants were reviewed to explore all clinical presentation of participants.
Results: In this study female accounted for large portion of study population (61.54%).
Nosocomial pneumonia in intensive care unit (icu)
Purpose: Study the causes and antibiotic treatment of Nosocomial Pneumonia in Intensive Care Unit.
Materials and method: Descriptive, cohort and postpective study.
50 patients admitted Intensive Care Unit (ICU) / Nhan Dan Gia Dinh Hospital, HCMC - from Jan 2009 to April 2010, were diagnosed as Nosocomial Pneumonia by CDC criteria. All of them had microbiological tests and antibiotic succeptibility test surveillance.
Results: Klebsiella and Acinetobacter are the predominant causes of nosocomial pneumonia in ICU with 36% and 32%, respectively.
Ventilator-Associated Pneumonia (VAP) was 54%.
Only 12/50 patients (24%) Nosocomial Pneumonia were initially treated with appropriate antibiotics.
Conclusion: Nosocomial pneumonia are usually caused by antibiotic resistant bacteria leading to difficult treatment.
The ratio of apropriate initial treatment with antibiotics in nosocomial pneumonia in ICU is low.
Congenital heart diseases in neonates at children's hospital 1
Objective: Determine the proportion of congenital heart diseases (CHD) among the neonates admitted to the Neonatal Special Care Unit of Children's Hospital 1 and epidemiologic features, clinical manifestations, laboratory findings, treatments, mortality and classification of neonatal congenital heart diseases. Method: Case series study. Results: From 1st January 2009 to 31st August 2009, 517 among 4581 neonates (11, 2%) admitted to Children's Hospital 1 were diagnosed CHD, in which the proportion of acyanotic CHD was 83.4%.
The percentage of paternal and maternal exposure with teratogens (insecticides, detergents, hair dye, leather dye and dioxin) were 2.32% and 1.54% respectively.
Common chief complains suggesting CHD were cough (55.5%), poor suction (45.3%), irritation (37.9%) and tachypnea after birth (34%).
Some cases had extracardiac symptoms such as jaundice (22%), fever (15.1%), and abdominal distention (6.2%).
Common signs of acyanotic CHD group were cough, wheezing (64%), dyspnea (53.3%), irritation (46.7%) and of cyanotic CHD group were cyanosis (100%), dyspnea (90.2%), irritation (82.3%), poor suction (56.8%).
Physical examination of the acyanotic CHD group showed heart murmurs (74.8%), tachypnea (69%), labored breathing (56.3%), hepatomegaly (52.6%) while main manifestations of the cyanotic CHD group were central cyanosis (100%), heart murmur (80%), tachypnea (76.3%) and hepatomegaly (58.6%).
Congenital extracardiac malformations included malformations of the digestive system (20.1%), multi-organ malformations (12.96%) and Down syndrome (6.96%).
Many others diseases accompanied with CHD were sepsis (46.22%), pneumonia (42.36%), jaundice (23.79%) and hyaline membrane disease (14.31%).
Blood gases of the cyanotic CHD group showed Pa02 ≤ 60 mmHg (93.02%), PaC02 ≥ 45 mmHg (60.47%) and acidosis (41.8%).
Chest X ray (CXR) showed cardiomegaly (64.6%), left heart enlargement (29.78%), right heart enlargement (22.05%) and lung infiltration (42.36%).
On ECG, 27.13% had left ventricular enlargement, 23.25% right ventricular enlargement and 13.18% biventricular enlargement.
On echocardiography, 19.35% had EF < 60%, 53.8% PAPs > 35 mmHg, left and right heart dilation were 15.1% and 13.4%, respectively.
The mortality rate was 12.4%, predominant in cyanotic CHD group (57.8%) compared with 42.2% in acyanotic CHD.
Main causes of death in cyanotic CHD were heart failure, cardiogenic shock, and hypoxic spell while in acyanotic CHD were multi-organ malformations, septic shock and nosocomial infections.
Conclusion: Congenital heart disease's frequency is significantly high. CHD is also the most common cause of neonatal death.
Male: female ratio was 1.68: 1. Almost came from southern provinces (75.7%) and age on admission was almost between 0 - 6 days old.
Majority were the first child (58%), normal delivered (64.2%), had gestation age ≥ 37 weeks (61.2%), normal APGAR score (47.8%) and normal range of birth weight (2500gr - ≤ 3500gr) (51.6%).
91.6% of cases had parents aged 19 - 25 years old and parents' occupations were almost farmers (36%) and housekeepers (56.5%).
59.6% of mothers were ill during pregnancy which were maternal febrile illness (43.9%) and TORCH infections (6.96%).
19.7% of mothers had nongestational illnesses such as sinusitis (5.03%), gastritis (3.48%).
59.9% of mothers had drug exposures during pregnancy (acetaminophen 29.8%, decolgen 8.3%).
Background: Kale (Brassica oleracea) is one of the rich nutrient foods with many health benefits.
Keywords: kale, antibacterial, antifungal
Recent studies have shown that kale is effective in preventing cancer, antioxidants.
However, the studies of antimicrobial and antifungal activities are still unknown.
In this study, we confirm and evaluate some biological effects of kale.
Material and method: The aim of this study is to determine the natural compounds in Brassica oleracea to use in antimicrobial and antifungal activities.
Result: In this study, natural compounds found in kale such as polyphenol, flavonoid, tannin and alkaloid have been identified.
These extracts are against five bacterial pathogens such as Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Streptococcus pneumoniae; to two fungal pathogens like Candida albicans and Candida tropicalis.
However, this extract does not have the ability to be against two bacterial pathogens such as Staphylococcus aureus and Staphylococus epidermidis at investigated concentrations.
Conclusion: In this study, for the first time, we were carried out to to determine the natural compounds in kale to use in antimicrobial and antifungal activities.
T lymphocyte subpopulations (tcd4+, tcd8+, cd3+/hla-dr) in patients with acute viral hepatitis b
CD8+ T cells and CD4+: CD8+ ratio were nonsignificantly different among the acute cases as compare to heathy subjects.
Patients with acute hepatitis B showed increased amount of TCD3+ / HLA-DR+ especially in woman (p< 0.001) which may represent a potential marker of immune system activation.
Conclusion: The quantification of TCD3+ / HLA-DR+ suggest that there is the activation of immune system during acute hepatitis B.
Evaluation the quality of life in asthma before and after 3 months treated by guideline of gina 2006 via juniper's asthma quality of life questionnaire with standardised activities (aqlq(s)
101 asthma patients age from 12 to 70 were diagnosed as asthma, the diagnostic criteria used are recommended by the Global Initiative for Asthma of WHO and NHBLI (GINA) at the University Medical Centre in Ho Chi Minh City in Viet Nam. Tthese patients have takens medical history, physical examination, chest xray, lung function, and completion AQLQ (S).
They have been reasssestsed after 3 months afterwards. Results: Significant improvement in clinical symtoms, lung fuction and quality of life have ben observed after 3 months of asthma treatment. Conclusion: The Juniper's Asthma Quality Of Life Questionnaire With Standardised Activities (AQLQ (S) can be used to assess the quality of life of asthma patients.
The treatment in the GINA 2006 is very efficient
Peroneus longus: an alternative graft for anterior cruciate ligament
Sural nerve and sensory branch of superficial peroneal nerve were far away from peroneus tendons.
Conclusion: Peroneus longus tendon may be a source of tendon graft as an alternative in the case that other conventional grafts can not met the requirement of ligamentous reconstruction.
Method We describe some anatomic characteristics of peroneus and hamstring tendons in 15 mummified cadavers.
We also measure and then compare the forces to destroy the doubled peroneus tendon and 4 bands of hamstring tendons of 5 fresh amputated lower limbs.
Characteristics of gastric polyp
Background: Almost gastric polyps have no symptoms and are found incidentally through upper gastrointestinal endoscopy.
Statistical software was SPSS 16.0.
T - test was for quantitative variable.
Chi - Square or Fisher test were for qualitative variable.
Values had statistical significance if p value was less 0.05.
Results: 76% of patients (725/954) were histological diagnosed as gastric polyp, including 43.7% hyperplastic polyp, 54.2% fundic gland polyp and 2.1% tubular adenoma.
The characteristics of hyperplastic polyp were 43.5% in antrum, 95.6% sessile, 98.7% similar with surrounding mucosa, 4.1% erosive surface, 0.3% low grade dysplasia.
The characteristics of fundic gland polyp were 48.9% in gastric body, 98.5% sessile, 100% similar with surrounding mucosa, 0.3% erosive surface, 100% non-dysplasia.
The characteristics of adenoma were 46.7% in antrum, 33.3% pedicle, 26.7% unsimilar with surrounding mucosa, 6.7% erosive surface, 86.6% low grade dysplasia, 6.7% moderate grade dysplasia.
There were significant differences between non-neoplastic and neoplastic polyp, such as pedicle polyp (OR = 17.25, p < 0.0001), difference with surrounding mucosa (OR = 64.18, p < 0.0001), size of polyp (p = 0.026).
Conclusion: Most of gastric polyp were non-neoplastic.
Some gastric polyps are pre-cancerous.
The appearance and size of polyp were useful for differentiating non-neoplastic polyps from neoplastic polyps (adenoma).
An erosion or ulcer of gastric polyp surface can result in occult bleeding and anemia.
Rarely, a large size polyp in antrum can lead pylorus obstruction.
The Helicobacter pylori infection and PPI usage influent an incidence of types of gastric polyp.
Objectives: Determine the prevalence of types of gastric polyp, characteristics of each type and differences in endoscopic appearance between non-neoplasia and neoplasia polyp.
954 patients with polypoid lesion were recruited within 2 year period (2014 and 2015).
The variable were obtained such as age, sex, characteristics of gastric polyp including location, size quantity, appearance, color, surrounding mucosa and pathology.
The metastases from thyroid carcinoma: nine cases diagnosed at the ward - pathology hopital c danang
Retrospective study of Nine cases Bone metastases from thyroid carcinoma during 1992 - 2002 at the ward pathology - Hospital C Danang, we observed that: Metastatic tumor are the most frequent of all malignant neoplasms of bone the ratio is 45% of all cases: Bone metastases are most common in older patients over 50 years of age: 66, 6%.
The skull was the most common site of skeletal metastases 66, 6%, vertebrae: 11, 1%, sternum: 11, 1%, pelvis: 11, 1%.
22, 2% of patients with skeletal metastases had no bone pain.
The histological type of all cases are follicular carcinoma. The metastatic neoplasms are easily diagnosed and sometimes it is possible to indentify suggest the primary site.
Background: New European Hypertension Guidelines (ESC / ESH 2018) emphasized the importance of treatment adherence as a major cause of poor blood pressure control.
Higher education levels were associated with drug compliance (OR = 2, 515; 95% CI: 1, 006 - 6, 332; p = 0, 049).
Men has lower rate of lifestyle adherence than women (OR = 0.389; 95% CI: 0.222 - 0.681; p = 0.001).
There was a significant asscociation between overall treatment adherence and blood pressure control (OR = 3.250; CI 95%: 1.485 - 7.112; p = 0.003).
Gender was related to healthy lifestyle adherence.
Overall treatment adherence was associated with successful blood pressure control.
Objectives: Evaluate adherence of hypertensive patients to pharmacotherapy and non-pharmacological measures, patient-related factors associated with treatment adherence, the association between treatment adherence and blood pressure control.
Methods: A cross-sectional, descriptive study.
8-item Morisky adherence scale was used to assess medication adherence.
Non-pharmacological adherence was assessed in four categories: salt restriction, smoking habit, alcohol consumption and physical exercise.
Results: Of 243 patients included in the study, mean age was 63.6 ± 8.2 years, 59.7% were female.
Percentage of patients adhered to antihypertensive medications, lifestyle modifications were 78.6%, 51.9%% respectively.
Background: One of the complications of diabetes is chronic renal failure.
Conclusion: Serum cystatin C is a valuable biomarker for the diagnosis of chronic renal failure due to type 2 diabetes.
Keywords: cystatin C, diagnosis, follow-up treatment, type 2 diabetes, chronic renal failure
Without controlled treatment effectively, patients may be required dialysis, kidney transplant, have the risk of sepsis or even death.
Thus, studying of serum cystatin C as a biomarker to support in the diagnosis and follow-up treatment in type 2 diabetic patients with chronic renal failure.
There were 144 patients included in the study, divided into 3 groups: Study group with 57 type 2 diabetic patients having chronic renal failure, comparison group with 57 type 2 diabetic patients without any disease process involving the kidney, and control group with 30 healthy people.
Cystatin C levels will be investigated and compared in groups, between groups to determine the value of cystatin C for diagnosis and follow-up treatment.
Results: The mean serum cystatin C concentration in study group was 1.36 ± 0.92 mg / L, higher than comparison group 0.81 ± 0.24 mg / L and control group 0.69 ± 0.11 mg/L.
At cut-off value of 1.04 mg / L, sensitivity and specificity of serum cystatin C were 89.09% and 93.26%.
From 01/2002 to 31/2005, 170 patients were included (83 volvulus and 87 non volvulus (case control)), in the preoperative sonographic evaluation.
Results: In the group with intestinal volvulus, ultrasound diagnosis has sensitivity, specificity, PPV, NPV 78.3, 90.8, 89, 81.4.
The sonographic signs have variable values, need the association of the signs following equation logistics: 4, 88xWhirlpool+3, 19x intestinal wall thickness +1.29x intestinal obstruction >2.9. It has sensitivity, specificity, PPV, NPV 90.4, 78.2, 79.8, 89.5.
In the diagnosis of volvulus due to malrotation, only whirlpool's sign has value for diagnosis of volvulus with sensitivity, specificity, PPV, NPV 84.5, 92, 84.5, 92.
When there are sonographic signs of suspected volvulus, the presence of intestinal wall thickening has a predictive value of ischemia and necrosis (OR=30.6).
Conclusion: abdominal ultrasound has a value in the diagnosis of intestinal volvulus and intestinal malrotation with or without complication.
Diagnostic value of neutrophil cd64 expression and its relation with degree of severity, mortality in sepsis/ septic shock patients
Backgrounnd: Sepsis is the leading cause of death in the intensive care unit.
However, nCD64s abitily to predict mortality was not proven.
Conclusion: nCD64 were capable of early diagnosis of sepsis.
nCD64 were also correlated with the severity of the disease: the higher this value, the worse the patient.
Keywords: nCD64, sepsis, septic shock, intensive care unit
Besides CRP, procalcitonin, interleukins... which help to diagnose sepsis, recently, there have been many studies in the world suggesting another potential biomarker - neutrophil CD64 (nCD64).
Therefore, we did this research to clarify the diagnosis and prognosis roles of nCD64 in sepsis patients.
Method: A prospective, cross-sectional study was done on 73 patients (49 sepsis patients and 24 non-sepsis patients) at the Intensive Care Unit of Cho Ray Hospital from 01/2019 to 10/2019.
Result: Concentrations of nCD64 on sepsis patients at T0 (admission to the ICU) and T48 (after 48 hours) were 3286 (2164; 5263) and 2148 (1378; 3623.5) molecules / cell respectively.
These concentrations were statistically significant differenced with those on non-sepsis patients 660.5 (432.25; 886) molecules / cell (p<0, 001).
nCD64 can diagnose sepsis with AUC = 0.942. At the cutoff point 1653, the sensitivity was 87.8%, the specificity was 95.8%.
nCd64 concentrations were moderately positively correlated with SOFA and APACHE II score, with r = 0.55 and 0.43 respectively (p <0.001).
Knowledge, atitude and practice about pesticides among farmers who growing vegetables in dalat city, lam dong province in 2008
Introduction: The application of chemical plant protection in the agricultural community does not comply with the safety regulations well in practice is the cause of the risk of harm to public health and habitat. Objective: This cross-section study is to describe the knowledge; attitude and practice concerned to plant protection chemicals of vegetable in Da Lat City, Lam Dong Province in 2008, and determine the connection between knowledge, attitude and practice among the local people.
Thereby to evaluate how the local practice of safety chemical regulation is. Method: The study conducted 201 farmers growing vegetables in Da Lat City, Lam Dong Province in May 2008.
In four geographic clusters intensive farming of vegetables selected, the audience research investigators interviewed directly in the field of knowledge, attitudes, practices related to their preservation and use of chemical protection plants. Results: The rate of people with correct general knowledge about the chemical plant protection only 35%, however, most of them knew when spraying plant protection chemical more than permitted dosage and when harvesting sooner than isolation period are both harmful to consumers.
Only 29% of people in the study had good attitude in obeying the safety regulations and only 27% of them done safety adherences. Conclusion: People's knowledge, attitude and practice related to agricultural chemicals are still weak.
At this time, local people still do not pay good attention enough to safety practices of these chemicals; therefore, it is still the risk for community health.
There should be measures to promote and encourage people here to practice safe working when using plant protection drugs, and there are positive measures to monitor and support, such as communication education, prevention recommendations from agricultural and extension center, checking from plant protection offices...
The warm ischemia time were respected, the washing and preservation of the kidney were done with Euro-Collins solution at 4 Celsius degree.
The remaining kidney functioned good with the average of serum creatinine were 1.10 ± 0.22mg% to compare with 0.86 ± 0.46mg% before the nephrectomy.
Keywords: Retroperitoneal living donor nephrectomy
Since Gaur had introduced the retroperitoneal laparoscopic techniques, many Asian authors reported the efficacy of it in LLDN that is RPLDN.
In Viet Nam, RPLDN was the first time done in Cho Ray Hospital. The aim of this report is introduction of our experience of RPLDN on the first series in Viet Nam.
Objectives: Determining plasma D-Dimer concentration by immunoturbidimetric assay to contributing for the effective use of D-Dimer for the diagnosis of ischemic stroke.
Conclusions: At the cut-off value is 575 ng / ml, plasma D-Dimer concentration is helpful for the diagnosis of ischemic stroke.
Keywords: ischemic stroke
Methods: In a cross-sectional descriptive study, plasma D-Dimer concentration measured using immunoturbidimetric assay in 23 patients with ischemic stroke at Da Nang C Hospital.
The control group to D-Dimer were collected in 23 healthy people. Results: Ischemic stroke group: D-Dimer: 2217.6±1579.3 ng / ml, higher than the normal value (<500 ng / ml); male: 1791.9±1376.3 ng / ml, female: 2771±1723.1 ng / ml (p>0.05).
Control group: D-Dimer: 133.7±113.6 ng / ml.
Base on the ROC curve, the optimal cut-off value of plasma D-Dimer as an indicator for diagnosis of ischemic stroke to be 575 ng / nl, which yielded a sensitivity of 95.65% (95% CI: 78.1% - 99.9%) and a specificity of 100% (95% CI: 85.2% - 100%).
The positive predict value was 100% (95% CI: 84.6% - 100%).
The negative predict value was 95.8% (95% CI: 78.3% - 99.9%).
Background: Hydatidiform mole is characterised by an overgrowth of trophoblasts within the uterus.
The two-week post evacuation β-hCG level was a significant independent prognostic factor for the risk of developing persistent GTD in patients with complete molar pregnancies (p < 0.001).
The optimal cut-off value of two-week post evacuation β-hCG level was 850 mUI / mL with 73% sensitivity, 79% specificity, 62% positive predictive value, and 86% negative predictive value.
Conclusion: Post evacuation β-hCG level is a predictor of developing persistent GTD in women with complete molar pregnancies.
Keywords: complete mole, gestational trophoblastic disease, persistent gestational trophoblastic neoplasia.
Objectives: To evaluate the role of post evacuation β-hCG levels to predict the risk of developing persistent GTD in women with complete molar pregnancies.
Method: Reviewed past medical records of all patients from Hung Vuong hospital diagnosed with complete molar pregnancies between November 2011 and November 2012.
Results: Out of the 131 women, 42 was diagnosed as persistent GTD.
Objective: to determine the epidemiological, cause, clinical, laboratory characteristics and treatment of of hemolytic anemia syndrome in children at children hospital N0 1 from 1st June 2005 to 1st June 2006.Method: single-center, prospective study and case series.
Common clinical symptoms were pallor 96%, dark urine 66%, jaundice 60%, hepatosplenomegaly 58%, fever 54%, and skull deformation 20%.
38% hemolytic anemia patients had Hb < 6 g / dl.
The rate of RI > 1%, increased Bilirubin, Ferritin and Fe were 50%, 35.56%, 40.63%, 45.16%.
76% patients were given the packed red cell.
Conclusion: Hemolytic anemia syndrome was common in children.
Common causes of hemolytic anemia syndrome were Thalassemia 42%, autoimmune hemolytic anemia 24%, complex 14%.
Among children got Thalassemia, the rate of children under 6 year old was 66.67%.
Result: this study included 50 hemolytic anemia patients that were admitted to the Children's Hospital No. 1 Ho Chi Minh City, for the first time, from 1st June 2005 to 1st June 2006.
Common causes of hemolytic anemia syndrome is Thalassemia 42%, autoimmune hemolytic anemia 24%, complex 14%, unclear cause 12%, Glucose-6-phosphate dehydrogenase (G6PD) deficien cy 6%.
This syndrome is common in Mekong delta and suburb 42%.
Male - to - female ratio is 1.7: 1.
Purposes: Accessment of ocular involvement in acute leukemia at ChoRay hospital.
Methods: The longitudinal prospective study with the description of the cases without comparison. Study was performed from jun 2005 to jun 2006 in 85 newly diagnosed cases of acute leukemia in the Haematology of Cho Ray Hospital (aged between 16 years and 81 years) were examined for eye changes with in 2 - 3 days of diagnosis before starting chemotheraphy.
Results: Ocular lesions were present in 43 patients (50.59%), intraretinal hemorrhages in 38 (45%), white-centered hemorrhages in 26 (31%), cotton-wool spot in 11 (13%) and other lesions were detected.
Some of the patients had more than one ocular lesion in one or both eyes.
There was no difference in ocular involvement between acute myeloid leukemia and acute lymphoid leukemia Conclusion: Since ocular lesions were detected in many acute leukemia patients, eye examination should be included as a part of routine evaluation at initial diagnosis in the patients.
Investigation on pantoprazole indication in clinical treatment
Objective: To investigate the improper use of the proton pump inhibitor pantoprazole in clinical treatment. Methods: Study model is retrospective method with random observation on 70 hospital files of patients received pantoprazole in treatment.
The indications of pantoprazole were classified into 3 groups: with risk factors for upper gastrointestinal bleeding, prevention against stress ulcers, and improper indication. Results: Investigation was done on 70 patients: 37 with internal medicine and 33 with surgery, including 31 females and 39 males, aged 52 (18 - 91) and 43 (10 - 86) [median (range)], respectively to internal medicine and surgery (p>0.05).
The indications for pantoprazole were similar between the internal and the surgical group: 10.8 and 12.1% with risk factors, 35.2 and 48.4% for stress ulcer prevention, and 54.0 and 45.5% of improper use, respectively.
The mean of time for using pantoprazole in 70 patients was 8 (2 - 139) days, accounting for 72 (4.2 - 100)% of the length of hospital stay. Conclusion: The unjustified indication of pantoprazole was observed in around 50% of the patients, indicating the widespread misuse of proton pump inhibitors in hospital practice.
Based on the results of this study, a guideline for rational prescribing of pantoprazole needs to be implemented in order to reduce the improper use of this drug.
The plasma concentration of cytokines (tnf-, il-1, il-1, il-2, il-6, il-8, il-10) in patient with multiple organ dysfunction syndrome at icu-cho ray hospital
Introduction: Multiple organ dysfunction syndrome (MODS) is common in ICU with high mortality rate.
Infection and polytrauma can develop to MODS by the cascade of cytokines and chemokines complicated the imbalance of inflammatory - anti-inflamatory and coagulation - anticoagulation responses.
Understanding role of cytokines in pathophysiology of MODS could partly facilitate the efforts in improving mortality of MODS patients. Patient and method: We carried a cross-sectional, descriptive study with 102 adult patients admitted ICU of Cho ray hospital from January 2005 to December 2007 and had diagnosed multiple organ dysfunction syndrome based on Knaus' s criteria.
Result: The serum concentrations of cytokines as follow: TNF-α 17, 59 (8, 5 - 34, 38), IL-1a was 0, 71 (0, 00 - 6, 76), IL-1b was 1, 97 (0, 84 - 6, 69), IL-2 was 7, 93 (0, 00 - 19, 73), IL-6 was 267, 20 (86, 30 - 489, 09), IL-8 was 185, 85 (78, 24 - 685, 00) and IL-10 was 16, 00 (4, 6 - 59, 83).
The ratio of IL-6/IL-10 was 11, 39 (3, 76 - 42, 59) and IL-10/TNF-α was 1, 12 (0, 33 - 2, 76). Conclusion: Our study showed that there were significantly ranges of plasma concentration of cytokines in MODS patients.
The plasma concentrations of TNF-, IL-6, IL-8 increased in MODS but there was not significantly difference between deads and survivors.
Case report: electrical storm after acute myocardial infarction – diagnosis and treatment approach
Background: Electrical storm is a fatal arrhythmic complication of acute myocardial infarction with poor prognosis. There have been only few reports on this scenario in Vietnam.
Keywords: electrical storm, myocardial infarction, percutaneous coronary intervention
Case presentation: A 56-year-old gentleman was admitted to Nhan Dan Gia Dinh hospital due to acute heart failure after anterior myocardial infarction, 08 days after the onset of the symtomps.
The patient underwent coronary angiogram and elective percutaneous coronary intervention.
He suffered from electrical storm with multiple, recurrent ventricular tachycardia and ventricular fibrillation despite cardioversion shock.
The patient tolerated well with no recurrent fatal arrthymias. He was discharge after 2 weeks inpatient treatment.
Conclusions: Electrical storm requires individualised approach for diagnosis and treatment, which is based on patients response to recommended antiarrhythmic agents, hemodynamic status, cardiac function and risk and benefit balance of the therapeutic interventions.
Surgery treatment for nodule goiter
Background: Nodule goiter is popular thyroid disease and most common appearance in nodule of thyroid.
Total thyroidectomy is a choice in future.
Conclusion: Total lumbectomy and near total thyroidectomy are the choice to treat nodule goiter (mono, multinodular or malignant.. Keywords: surgery, nodule goiter.
Objective: Evaluate the result of surgery of nodal goiter in Tien Giang General Hospital.
Methods: Case series study.
Results: Female 83.3%.
The tumor size is 2 - 4 cm, and multinodular. Ultrasound and Fine Needle Aspiration are two important and essential test to diagnose and treat nodule goiter.
Total lumbectomy and near total thyroidectomy are two elected techniques to treat nodule goiter (mono or multinodular) or malignant thyroid nodule with acceptant complication rates.
A reported case of anti-ampa receptor encephalitis
To describe the clinical manifestation and disease course of the first case diagnosed with AMPA receptor encephalitis at Neurology Department of Childrens Hospital 2, November 2020.
The 10-year-old, previously healthy boy has had a clinical course divided into two separated periods with a partial alleviation.
In each period, the patient represents multiple focal seizures, cognitive-behavioral disorder, and amnesia.
The brain magnetic resonance imaging (MRI) is persistently normal.
Electroencephalography (EEG) records many focal spikes and spike-waves.
Antibodies to AMPA receptors are detected in the serum and cerebrospinal fluid by indirect fluorescent antibody test.
This patient is treated with immunotherapy, including methylprednisolone and intravenous immunoglobulin (IVIG), and antiepileptic drugs such as oxcarbazepine, topiramate, and levetiracetam.
This case report contributes to the understanding of disease manifestation, response to the immunotherapy, and relapses in AMPA receptor encephalitis.
The efficacy of canal wall down mastoidectomy surgery with tympanoplasty in chronic otitis media with cholesteatoma
Background: Cholesteatoma is a dangerous disease which can cause many serious complications because of its nature of developing, eroding and destroying the adjacent structures of middle ear.
95% of cases had erosion of incus.
Keywords: chronic otitis media (COM), cholesteatoma, canal wall down mastoidectomy (CWDM), tympanoplasty
Vietnamese patients, with low economy status and poor follow up ability, require a proper surgery for chronic otitis media with cholesteatoma.
Objectives: to evaluate the efficacy of canal wall down mastoidectomy (CWDM) with tympanoplasty in chronic otitis media with cholesteatoma.
Methods: A clinical series study was conducted on 40 patients with cholesteatoma underwent canal wall down mastoidectomy with tympanoplasty at ENT Hospital - Ho Chi Minh city from 07/2016 to 07/2017.
Results: Female / male rate was 1.2/1.
The most frequent clinical sign was otorrhea (75%).
Eroding scutum - retracted pars flaccida was mostly seen endoscopically (52.5%).
Mixed hearing loss was the most common, accounted for 75%.
Sequelae and risk 3 years after laser treatment for retinopathy of prematurity
Purpose: This study evaluates laser therapy-related treatment sequelae and clinical outcomes in patients diagnosed with retinopathy of prematurity after 3 years of follow up and the correlation between risks of the disease and these results.
Structural sequelae: corneal opacity was 1.1%; cataract was 3.3%; synechiae 10.3%; retinal vessel drag was 12.3%; retinal detachment was 3.3%.
Conclusions: Results of this study significantly contribute to efforts to re-examine patient more thoroughly and extensively, with a particular focus on detecting and treating changes which influence the visual acuity of patients, especially refractive error.
Keywords: retinopathy, prematurity, sequalae, risks
Methods: This is a retrospective, analytic study.
Clinical data are obtained from patients who were treated by laser photocoagulation from January 2009 to December 2009 after 3 years of follow up at the Pediatrics Department of HoChiMinh City Eye Hospital, Vietnam.
Mean gestational age was 29.6±2.5 weeks, mean birth weight was 1335g±289g, mean follow up age was 40.2±3.5 months.
Favorable visual acuity outcome was 89.3%. Favorable structural outcome was 93.4%.
Visual functional sequelae: refractive error was 95% (myopia was 82.7% with mean SE was −6.2D); anisometropia was 35%; strabismus was 9.9%; amblyopia was 17.6%.
Thiabendazole effectiveness in treatment for cutaneous larva migrans due to gnathostoma spinigerum in 2011
Objectives: To highlight this CE / CLM syndrome's clinical, laboratory findings, and thiabendazole effectiveness in CE / CLM due to G spinigerum.
Methods: Cross-sectional study and Non-controlled clinical trial.
Result: CE / CLM syndrome manifests as a diversified symptomes and signs model with an erythematous, serpiginous, pruritic, cutaneous eruption caused by accidental percutaneous penetration and subsequent migration of larvae of G spinigerum, specially in typical triad forms (> 95%).
Oral thiabendazole is high effectiveness and well tolerated when given as a single dose (cure rate of 91.37 - 96.55%) without severe side-effects.
Conclusion: CE / CLM is a muco-cutaneous lesion resulting from exposure of the skin to infective larvae of G spinigerum.
Clinical manifestations as diversified symptom broads, easy to misdiagnosis of other dermatological and infectious diseases.
Treatment with single dose thiabendazole was high efficacy in cure rate.
Detection of bcr/abl mutations which strongly resist to imatinib using aso-pcr at blood transfusion and hematology hospital
Objective: Using ASO-PCR to detect the 6 types (Y253F, Y253H, E255K, E255V, T315I) of BCR / ABL mutation which strongly resist to Imatinib (IM) in chronic myeloid leukemia (CML).
Methods: This study was performed in 30 IM-resistant CML patients which were analyzed BCR / ABL mutations by direct sequencing at Blood transfusion and Hematology hospital from January 2012 to May 2013.
Results: By adjusting primer annealing temperature, we determined optimal primer annealing temperature for ASO-PCR to dectect the 6 types of BCR / ABL mutation (G250E and Y253H at 650C, Y253F at 550C, E255K and E255V at 680C, and T315I at 630C).
Concomitantly, the results of detecting the 6 types of BCR / ABL mutation in 30 patients showed that there were 17 mutations in 15 patients by using ASO-PCR and 15 mutations in 14 patients by using direct sequencing. These results indicate that ASO-PCR is more sensitive than direct sequencing technique.
Conclusion: Successful development of ASO-PCR procedure for detecting the 6 types of BCR / ABL mutation helps the doctors in selecting suitable therapy regiment for patient.
Moreover, ASO-PCR is simple and effective technique which can apply for detecting the known BCR / ABL kinase domain mutations in other hematology hospitals.
Keywords: chronic myeloid leukemia, mutations resistance to Imatinib, ASO-PCR
Objective: To assess the effect of counseling and walking on women with perimenopausal syndrome and to determine the factors that influence to the effects.
Conclusion: Counseling and walking was shown to enhanced quality of life for women with perimenopausal syndrome.
Overweight was reduced the effect of the intervention.
Keywords: counseling, walking, quality of life, perimenopause.
Methods: Quasi-experimental study was carried out in women at the age of 45 to 55 with perimenopausal syndrome at Tu Du hospital from November 2012 to April 2013.
89 womens were enrolled in an counseling and walking program.
The participants had been guided to walk at least 3 days per week for 12 weeks.
Result: Quality of life (QOL) was improved significantly in psychosomatic and vasomotor symptoms.
The odds of improved QOL in group walked >3 days per week were 2.48 times higher than group walked ≤3 days per week (95% CI 1.05 - 5.83).
Women with high body mass index (BMI) was improved QOL less 3 times than women with BMI normal (95% CI 0.11 - 1.00).
A review of 30 cases of perforated diverticulis of colon
Introduction: Perforated diverticulitis of colon is a severe complication, most require urgent surgery to prevent patient's death.
Clinical symptoms included abdominal pain (96.7%), abdominal tenderness (83.3%), fever (30%), abdominal swelling (23.3%).
All patients had WBC above 10.000 / uL.
Plain abdominal radiography revealed free intraperitoneal gas (7/30).
CT-Scan was performed in 19/30 patients revealing perforated diverticula (62.3%), wall thickness of bowel and pericolic infiltration (15.8%), appendicular abscess (10.5%) and tumors of the colon (10.5%).
Colon resection with primary anastomosis was performed in 23.3%, colon resection with colostomy 43.3%, colostomy without resection 23.3%, Lavage and drainage without resection 10%.
The morbidity: wound infection 16.7%, abdominal wall infection 6.7%, leakage 0% and no death.
Conclusion: Perforated diverticulitis of colon could be diagnosed early by CT-Scan.
Colectomy with primary anastomosis could be performed in patients with abscess or perforated of right colon diverticulitis.
Keywords: perforated diverticulitis, Hinchey classification.
The clinical manifestations of this disease vary from small intra mesenteric abscess to fecal peritonitis.
Despite the development of modern diagnostic and treatment, perforated diverticulitis of colon has remained a challenge for surgeons.
Morbidity and mortality of this disease are still high.
Early diagnosis and prompt effective treatment are essential to improve clinical outcome.
Purpose: We report the clinical characteristics and early outcomes of the patients with perforated colon diverticulitis.
Results: There were 30 patients including 24 males and 6 females with the mean age of 58.8 years (22 - 87), 3 patients had history of diverticulitis.
26/30 patients needed hospitalization due to abdominal pain.
Objective: This study evaluate the efficacy and safety of transurethral enucleation with bipolar (TUEB) at Binh Dan hospital.
Keywords: transurethral enucleation with bipolar
Methods: Between December 2018 and July 2019, 40 patients underwent TUEB at Binh Dan Hospital.
All patients were preoperatively assessed with maximum urinary flow rate (Qmax), quality of life (QoL) assessment, International Prostate Symptoms Score (I P.S S), Transabdominal Ultrasound Gland volume evaluation, prostate-specific antigen (PSA).
Postoperative outcomes include 1-month postoperative IPSS, QoL and Qmax.
Catheterization time and hospital stay were short and the rates of complication was low.
Increasing the laboratory quality with proficiency testing schemes of quality control centrer for medical laboratory under ministry of health at university of medicine and pharmacy from year 2015 to first 6 months of year 2018
The results of Chemistry and Hematology schemes were improved yearly, the first 6 months of year 2018 was over 80%.
Quality Control Center for Medical Technology deploys the PT schemes of Blood smear, Parasitology, blood transfusion that are only proficiency testing schemes until now at Vietnam.
Increase the QMS training and develop the PT schemes accredited with national and international standards to cover laboratory test list, especially highland, difficult economy such as Kon Tum, Gia Lai, Phu Yen, etc, based on 3 pile module: QCC-MTF-UMPHCM hospital to promote the strength of professional experts, to intergrate the Club of Vietnamese association of school of medical Technology and Asean association of schools of medical technology that Medical Technology Faculty (MTF) of University of Medicine and Pharmacy, Ho Chi Minh City (UMPHCM) is the chairman and Vice president.
Keywords: Proficiency testing, quality management system.
Assess the quality of these laboratories with Chemistry and Hematology schemes.
Orient module to develop another PT schemes.
Methods: A cross-sectional descriptive study, 634 laboratories of Ministries, provinces, districts, clinics in public and private from Da Nang province to Southern from year 2015 to first 6 months of year 2018.
Results: There is 61.8% of participation precent in first 6 months of year 2018.
Chemistry scheme was the greatest participation proportation; the next largest participation was Hematology.
The proportion of 14 routine analytes of chemistry and 5 routine analytes is over 80% in first 6 months of 2018, except of Amylase (75.6%) và Uric acid (78.5%).
Conclusion: Percentage of participation increased between 2015 and 2018 (from 24.9% in 2015 to 61.8% in 2018).
Ludloff approach in treatment of ddh
Ludloff surgery is indicated for children from 8 months of year to 18 months of year if conservative treatment fails.
From 1998 to 2004, there were 15 cases of DDH (from 2 months of age to 21 months of age) treated by Ludloff surgery.
Using criteria for evaluation of Robert and Seringe (1982) to evaluate the development of femoral head.
All patients had a full range of motion.
Leg-length discrepancy: 53.2% (short leg: 6.6%).
Development of a mouse model of neutropenia induced by cyclophosphamid and doxorubicin
Objective: A mouse model of neutropenia induced by cyclophosphamide and doxorubicin was developed to provide a tool for screening bone-marrow protecting agents.
Methods: Neutropenia was induced by a single intraperitoneal injection of cyclophosphamid and doxorubicin.
Neubauer cell counter and white blood cell count were applied to determine grade of neutropenia.
Conclusion: This mouse model can be applied for screening agents that exert protective effect on cyclophosphamid and doxorunicin-induced neutropenia.
Keywords: Cyclophosphamid, doxorubicin, Neutropenia, Mouse model
Confrontation of imprint cytology and histology in the diagnosis of gastrointestinal lesions
Imprint cytology is a very simple, cheap, easy, reliable and increasing popular method for the evaluation of lesions of the gastrointestinal tract.
Endoscopic mucosal biopsies from 167 patients (103 from upper gastrointestinal tract lesions and 64 from lower gastrointestinal tract lesions) were studied to correlate the matching of diagnosis histologic imprint cytology in the diagnosis of gastrointestinal lesions.
Of these 89 from benign lesions and 75 from malignant lesions, 3 from probably malignant lesions.
Imprints were false positive in 5 cases (all of stomach) and false negative in 12 cases (1 esophagus, 5 stomach, 6 colon).
The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and overall diagnostic accuracy for cytology irrespective of the site was 85.3%, 93.5%, 89.3%, 93.3%, 85.8% respectively.
In confrontation with histopathology, imprint cytology method can be used in the diagnosis of gastrointestinal tract lesion with quick accurate result.
The clinical, endoscopic and pathogical characteristics of early-onset colorectal cancer in vietnamese population
Background: The Asia Pacific consensus for colorectal cancer (CRC) recommends that screening program should begin by the age of 50.
Results: The rate of early-onset CRC was 28% (112/400) with the male-to-female ratio of 1.3.
22.3% (25/112) of patients only experienced abdominal pain and / or change in bowel habit without alarming symptoms.
42.9% (48/112) of patients considered their symptoms as intermittent pattern.
The rate of familial history of CRC in early-onset group was significantly higher that of the late-onset group (21.4% versus 7.6%, p<0.001).
The distribution of CRC lesions in rectum, distal and proximal colon were 51.8% (58/112), 26.8% (30/112) and 21.4% (24/112), respectively; which was not different from that in the late-onset group (c2, p = 0.29).
The rates of poorly differentiated tumor were also not significantly different between the two groups: 12.4% (14/112) in early-onset group versus 8.3% (24/288) in late-onset group (c2, p = 0.25).
Conclusion: A high proportion of CRC appeared at an earlier age than that recommended for screening by the Asia Pacific consensus.
Family history was a risk factor of early-onset CRC.
Little has been known about the features of early-onset CRC in Vietnamese population.
Aim: To describe the clinical, endoscopic and pathological characteristics of early-onset CRC in Vietnamese population.
Method: A prospective, cross-sectional study was conducted at the University Medical Center from March 2009 to March 2011.
All patients with definite pathological diagnosis of CRC were recruited.
Early-onset CRC group were analyzed in comparison with the late-onset (i. e. ≥ 50-year-old) CRC group.
Applications of automated hematology analyzer sysmex 4000i in cell tests of body fluids
Background: Cells survey test in various body fluids was used as a tool for clinicians to define disease for a long time.
Results: The reliability coefficient of red blood count results is 0.97 and the amount of variability of 2 measurements was 12% (CI 95%).
Coefficient of reliability of measurement results is 0.988 and the White Bridge of variation was 12.5%.
Reliability coefficient of mononuclear leukocytes was measured 0.81, fluctuating around 11%.
And the coefficient of reliability of measurement results is multi-WBC 0.80, range 12% variation in the resistance.
Translation 32 peritoneal samples accounted for 27% rate, 17 pleural fluid samples accounted for 14% rate, a sample service pericardium proportion of 1%, 53 CSF samples accounted for 44% rate, after accounting for sample 1 peritoneal 1% rate, dialysis services accounted for 16 sample rate of 13%. Conclusion: Using a method to read the number of cells in certain types of machine translation using Sysmex 4000i convenient than classical methods in the diagnosis and treatment of patients at Cho Ray Hospital.
Classical method (stain body fluid smear and read by microscope) is a common test in laboratory but it takes about 15 - 30 minute. And the result depend on sudjective thinking of hematology technician.
So sometime it don't help in treatment. Today, automated hematology machine (Sysmex 4000i) can analyse of body fluid with faster result (approximate 2 minute) and completely objective.
So the diagnostic and treatment are better. Thus, we study to value the reliability and effect of this method to use commonly.
The clinician'll receive the result more quickly and objective. Objectives: Comparison of two analytical results by means of classical translationand methods run the Sysmex 4000i. Methods: There are 120 samples taken from 120 patients with epidemic, each blood sample were counted by means of classical methods and machines 4000i.
A systematic comparison of artificial intelligence techniques in modelling controlled release tablet formulation
The results of examined data (matrix table formulation, controlled release diclofenac sodium microspheres formulation) showed that the performance of neural network was superior when compared to genetic programming. Conclusion: In evaluating models generated by the two technologies, neural networks showed a higher capability of predicting unseen data than genetic programming.
Epidemiologic, clinical, labolatory characteristics in patients with severe symptomatic atheroslerotic carotid stenosis at university medical center of ho chi minh city
Background: Severe symptomatic atheroslerotic carotid stenosis (ACS) is an important origin of ischemic stroke.
The degree of severe CAS increased 0.9% (95% CI, 0.2 - 1.4) for each 10 mg / dL elevation of total cholesterol or 3% (95% CI, 0.8 - 5.3) for each 1 unit elevation of the LDL / HDL ratio.
Hypertension, smoking, diabetes mellitus and coronary disease were present in 36 (95%), 22 (58%), 11 (29%), 18 (47%) patients, respectively. In this study, systolic and diastolic blood pressure had no significantly linear association with degree of severe ACS (p = 0.55, 0.76, respectively).
Conclusion: Patients with severe symptomatic ACS are at high risk of ipsilateral ischemic stroke.
Keywords: Atheroslerotic carotid stenosis; DSA: digital subtraction angiography; LDL / HDL ratio.
In Vietnam, few studies of this condition have been conducted. Therefore, a study of risk factors, clinical and laboratory characteristics of SSACS is necessary.
Objectives: To describe the epidemiologic, clinical and laboratory characteristics of severe symptomatic ACS patients at University Medical Center of Ho Chi Minh city.
Method: This is a retrospective and descriptive case series study.
Results: The sex-ratio of male: female was 4.4: 1.
The average age was 65.3 ± 9.36, 34.2% had age under 60.
Clinical examination found hemiparesis in 26 (68.4%) patients, central facial palsy in 8 (21.05%), hemiparesthesia in 7 (18.4%), aphasia in 2 (5.3%), carotid bruit in 3 (7.9%).
26 patients (68.4%) had ischemic stroke on the ipsilateral side of severe cases.
Background: Randomized trials comparing Video-Thoracoscopic Surgery (VTS) mediastinal tumors resection to open method are very few.
Median operative time (min) was 128.9 (OPEN) versus 75.8 (VTS), p < 0.0001.
Median blood loss (ml) 253.3 (OPEN) versus 65.2 (VTS), p < 0.0001.
Median postoperation time was 7.8 days (OPEN) versus 5.4 days (VTS), p< 0.0001.
Median chest tube duration (days) was 3.1 (OPEN) versus 2.1 (VTS), p < 0.0001.
Median pain score postoperative was 6.6 (OPEN) versus 4.5 (VTS), p <0.0001.
Complication rates were 6.7% (OPEN) versus 0.9% (VTS), p = 0.011.
Conclusions: The results confirm that VTS mediastinal tumors resection is associated with a statistically significant shorter operative time, less blood loss, shorter LOS, shorter chest tube duration, less postoperative pain score than in OPEN group.
Keywords: mediastinal tumors, video thoracoscopic surgery-VTS, VATS
We analyzed a cohort to compare the clinical outcomes of the two techniques.
From July 2010 to July 2013 at Thoracic Surgery Department Cho Ray hospital.
Determinants of perioperative morbidity and mortality including age, gender, tumors size, ASA class, and Charlson Comorbidity Index (CCI).
The results of screening relatives of patients with colon cancer
Background: Current guidelines recommend screening colonoscopy in first-degree relatives of patients with colon cancer.
Objectives: The aim of this study was to ascertain the percentage of neoplasia in first-degree relatives patients.
Methods: Endoscopic screening conducted according to a protocol.
Results: A total of 470 first-degree relatives patients were identified and participated in screening colonoscopy, the cancer rate are 11.06%.
Conclusion: This study demonstrates that colonoscopic screening of first-degree relatives of the patients are recommended.
Objectives: Rhinomanometry before and after using intranasal corticosteroids spray in allergic rhinitis.
Methods: A cross sectional descriptive studies, clinical trials with comparision.
The study 62 patients with allergic rhinitis that were separated in two randomize groups: Group 1: using Budesonide 1.28 mg / ml and Fexofenadine 60 mg, Group 2: using NaCl 9‰ and Fexofenadine 60 mg.
Evaluating nasal obstruction, rhinomanometry before treatment and after one-week and one - month treatment.
Results: The mean value of total inspiratory nasal air flow (NAF) was 472.48 ± 140.3 (before congestion), 551.03 ± 118.24 (after congestion) ml / s in Group 1 and 473.61± 136.92, 540.13 ± 132.99 ml / s were the mean values of total inspiratory NAF in Group 2 respectively. The mean value of total inspiratory nasal air resistance (NAR) was 0.55 ± 0.19 (before congestion), 0.5 ± 0.16 (after congestion) Pa / cm per second at 150-Pa pressure point in Group 1 and 0.54 ± 0.17 và 0.52 ± 0.14 Pa / cm per second were the mean values of total inspiratory NAR in Group 2 respectively.
We found that both assesment nasal obstruction subjectively by patient's sensation and objectively by rhinomanometry, group 1 was better than group 2 statistically significantly.
Conclusion: Using Budesonide in treatment allergic rhinitis improve nasal obstruction, NAF, NAR.
Budesonide should be used long term will bring good results for patients with allergic rhinitis.
Keywords: Rhinomanometry, Corticosteroid nasal spray
Severe pneumonia in hiv/aids patients at the hospital for tropical diseases in 2020
Background: Pneumonia is one of the common causes of hospitalization in HIV infected patients.
Fever and cough (91.8%) were clinical symptoms most seen.
In chest X ray, 100% cases had interstitial lesions and 83.7% were associated with alveolar lesions.
P jirovecii was the principal agent detected with 69.4% of cases, followed by bacteria 63.3%, fungi 34.7% and TB 36.5% (35/49).
73.5% of PCP were co-infected with other pathogens.
Conclusion: Severe pneumonia happened when the patient was in AIDS stage.
P jirovecii was the most common pathogen detected, and was often co-infected with many other agents, making difficulties for the treatment.
Cotrimoxazole prophylaxis in HIV-infected patients should be more considered.
Keywords: severe pneumonia, HIV / AIDS, P jirovecii, PCP
The high mortality rate is due to an immune status deficiency from the host, but also due to a non accurate treatment of the pathogens in cause which are very various.
In Vietnam, studies looking for causative agents in pneumonia among these individuals are quite limited.
Objectives: To describe the epidemiology, the clinical and laboratory features, the treatment of HIV / AIDS patients with severe pneumonia at the Hospital for Tropical Diseases and to determine the prevalence of the causative pathogens detected in the respiratory tract of those cases.
Methods: A cases serie study. Participants were HIV / AIDS patients with severe pneumonia admitted to Ward E, Hospital for Tropical Diseases from January to June 2020.
98% patients were in AIDS stage (median TCD4 count as 14 cells / mm3); 85.7% did not have pneumocystic jirovecii prophylaxis with cotrimoxazole before hospitalization.
Evaluation of clinical manifestations, laboratory findings and imaging diagnostics in fascioliasis patients at some central and west-highland area, vietnam, 2006-2008
Background and objectives: Fascioliasis caused by Fasciola gigantica and Fasciola hepatica that are increasing and threating of public health in the tropic areas, including of Vietnam.
This study carried out to describe and evaluate the clinical, laboratory findings, imaging diagnostics in fascioliasis patients.
Study method: 750 patients with Fascioliasis disease were enrolled in a descriptive, cross-sectional study design.
Results: the major clinical symptoms on these patients: epigastric and Chauffard Rivet triangle pain (96.8%), gastrointestinal disturbances: abdominal pain plus constipation (14.93%), diarrhea loose stool (22.93%), nausea and / or vomit (29.87%), mild fever (68%), headache and subshoulder muscles fatigue (98%), malaise (68%), allergic reaction with pruritis and urticaria (65.2%), lose weight (28%), mild anemia (3.6%), particular in Hazouhn syndrom (0.93%), rare symptoms may be hepatomegaly (1.6%), chest pain, dyspnoea (<1%), jaundice; Laboratory findings were positive ELISA test with Fasciola gigantica antigen (96.4%), hepatobiliary lesions by ultrasound (95.73%), eosinophilia is the predominant indicator (83.07%), mild congestive gastro-duodenal membranous layer by endoscopy (79.84%) or congestion accompanied ulcer traces (82.26%) and copro-examination with Fasciolae egg, all of negative.
Conclusions: clinical manifestations are indistinguishable from hepatobiliary and digestive tract diseases; laboratory parameters and imaging diagnostics, especially in FasELISA, eosinophile and liver lesions by ultrasound were very useful in positive diagnosis and follow-up fascioliasis.
The result of fontan completion for functional single ventricles at the heart institute of hcm city.
Objective and methods: Retrospective study of patients with functional single ventricle underwent Fontan Completion at the Heart Institute of HCM city.
35 patients were followed up, only 1 late death due to severe thrombosis of the conduit graft.
Conclusion: modified Fontan should be performed for patients with functional single ventricle to increase longterm outcome and avoid late complications.
Currently, Extra-cardiac conduit is the most widely applied procedure for this kind of operation.
Keywords: Fontan completion.
All patients preoperatively had sinus rhythms.
Pulmonary arterial mean pressure = 14 ± 2 mmHg (11 - 16 mmHg).
35 patients underwent Extra-cardiac conduit procedure with prosthesis (Dacron or Goretex grafts), 2 patients were performed direct anatomosis between IVC and PA 30-day mortality was 5.4% (2 cases).
There was a significant increase in post-operative SpO2: 95 ± 3.6% in comparison with pre-operative SpO2: 76 ± 5.3% (p < 0.01).
The most common complication was pleural effusion.
Redo vasoepididymostomy after failed invitro fertilization with epididymal sperm retrieval
Introduction: Some patients had failed vasoepididymostomy previously and had undergone one or more cycles of intracytoplasmic sperm injection with epididymal sperm retrieval.
If the latter failed, the patients could have a redo vasoepididymostomy to have children. Conclusions: Two-suture lateroterminal invagination vasoepididymostomy can be redone if the previous anastomosis and epididymal sperm retrieval for invitro-fertilization had failed.
The patency and pregnancy rates are promising.
Some results were still unsuccessful, with the patient requesting a second anastomosis, if possible.
Objective: Evaluating feasibility of redo vasoepididymostomy for patients with failed both previous vasoepididymostomy and epididymal sperm retrieval.
Materials and methods: A clinical prospective analysis of obstructive azoospermic patients who failed both prior vasoepididymostomy and intracytoplasmic sperm injection with epididymal sperm retrieval, were admitted to Binh Dan hospital between October 2005 and May 2007.
Results: Vasoepididymostomy were redone bilaterally in 4 patients and unilaterally in 8 patients.
7/12 (58.33%) of patients had sperm return and 5/12 (41.66%) wives were pregnant and delivered live births after at least 2-year followup.
Discussions: Surgical anastomosis of vasal tractus and invitro fertilization with intracytoplasmic sperm injection have been two options for obstructive infertile patients to have biological children.
When surgery failed, the usual choice of the patients was invitro fertilization.
The association between endoscopic gastric atrophy according to the kimura - takemoto classification and pathological atrophic gastritis
Background and aims: This study aims (1) to evaluate the association between endoscopic gastric atrophy (EGA) and OLGA gastritis stage, and (2) to assess the association of high-stage OLGA gastritis with gastric neoplasia. Methods: A prospective cross-sectional study was conducted on 280 dyspeptic outpatients.
Conclusions: OLGA high-stage gastritis was associated with gastric dysplasia and mostly diagnosed in patients with moderate - to - severe EGA.
EGA was assessed according to Kimura - Takemoto classification.
Histological gastric atrophy was assessed according to internationally validated criteria, and gastritis stage was established according to the OLGA staging system.
Gastric neoplasia was assessed based on the Vienna classification.
stage III - IV) was confirmed in 13 (4.6%) patients who were all more than 40-year-old (p = 0.01), had H pylori infection (p = 0.0006) and moderate - to - severe EGA (p<0.001).
Low grade dysplasia was found in 7 patients, including 4/13 (30.7%) with high-stage gastritis versus 3/267 (1.1%) with low-stage gastritis (p < 0.0001).
Six of these 7 patients had moderate - to - severe EGA (p = 0.048).
Assess the effect of high-dose steroids in the management of traumatic optic neuropathy
The nonrandomized presenting with visual loss after facial trauma from 3/2003 to 3/2004 were evaluated.
The efficacy in prophylactic treatment of cyclic vomiting syndrome in children, application of naspghan consensus 2008 in national children’s hospital
Objectives: Evaluate the efficacy of prophylactic treatment of CVS in children in application of NASPGHAN consensus 2008.
The most common adverse effect in Cyproheptadine group were increased appetite (22.2%) and weight gain (22.2%) and in Amitriptylin group was constipation (5.6%).
Conclusion: Children with cyclic vomiting syndrome often had late final diagnosis.
The prophylactic treatment of CVS was difficult due to high rate of in cooperation and lack of follow - up.
Good cooperation and follow - up is in need for better disease control.
Keywords: cyclic vomiting syndrome, prophylactic treatment, National Children's Hospital
Methods: Open - label clinical trial, compare before and after 6 months of treatment in 30 patients diagnosed with CVS under 18 years old admitted to National Children's Hospital.
Results: The mean age of onset was 24.0 ± 22.2 months, the mean age of diagnosis was 36.6 ± 32.2 months.
The mean interval from onset to proper diagnosis was 13.5 ± 10.4 months.
Cyproheptadine and Amitriptylin were used in 73.3% and 26.7% of patients, respectively.
The rate of cooperation and appropriate follow - up was 60%.
The percentage of patients need increasing dose and drug combination in each group were 53.8% and 30.8%, 100% and 20%, separately.
Acute pancreatitis in systemic lupus erythematosus: a case report
Background: A rare complication of SLE, acute pancreatitis presents has a poor prognosis.
After a day of admission, the patient has abdominal pain, nausea, vomiting which suggest diagnosis of lupus pancreatitis.
Serum amylase levels are: 1989U / L and urinary amylase: 2080U / L and serum lipase: 1496.91U/L.
Conclusions: Acute pancreatitis should be thought of SLE, which have abdominal pain.
Keywords: Lupus, pancreatitis
If we don't have the specific treatment, the mortality is 61%.
When the patient is diagnosed early and treated with intravenous steroids and fluids, they have a much better prognosis (The mortality is 20%).
Here we report a rare case of acute pancreatitis.
Materials and Methods: A case report of acute pancreatitis in systemic lupus erythematosus and review of the literature over the past 30 years including epidemiology, clinical, laboratory tests, treatment and prognosis.
Results: A 19-year-old woman was diagnosed with SLE in 2011.
The patient had complications on the kidneys, joints, and hematologic during 5 years of the treatment at Nguyen Tri Phuong Hospital.
Patients were treated with multiple protocols (Steroids, Rituximab, Celcept).
The patients admitted into Binh Dan Hospital for the kidney biopsy.
Efficacy and complications of percutaneous transvenous mitral commissurotomy at cho ray hospital
These are the results of this study: - Mitral valve area was 0.82 ± 0.14 cm2 before PTMC and was 1, 96 ± 0, 20 after PTMC - Markedly symptomatic improvement (1.5 degree of NYHA classification reduced) - Complications: death 0.73%, cardiac tamponade 0.73%, mitral regurgitation 21.15% (18.41 first degree, 2.74% second degree)
Morbidity and mortality of neonates admitted in pediatric department - dong thap general hospital from 2004 to 2006
Objectives: Study of morbidity and mortality of neonates admitted in paediatric department at Dong Thap Hospital from 2004 to 2006.
Method: Cross-sectional description and analysis study.
Results: The number of neonates admitted to the pediatric department - Dong Thap General Hospital was 1, 875 from January 1st 2004 to December 31st 2006.
The common causes of death were: prematurity: 35.5%, infection: 32.2%, asphyxiation: 16.8% and congenital malformation: 8.9%.
The death prediction factors were serious signs at the time of admission (OR = 13.4), congenital malformation (OR = 3.5), transferred from district hospital (OR = 3.2), admission before 24 hours after birth (OR = 2.5), low birth weight (OR = 1.8), prematurity (OR = 1.8).
Conclusions: The pattern of neonatal morbility and mortality at the Pediatric department - Dong Thap General Hospital, looks similar to that of developing countries.
The neonatal death rate would be reduced significantly if health staff's skills in resuscitating, treating and taking care of premature low birth weight newly born babies were improved.
Objective: The purpose of this study is to compare the home tooth bleaching effect of NUPROGoldTM 10% on different daily-applied time: the shortened time in the day (2 hours) and the extended time overnight (7 hours).
Method: Clinical study was carried out on 19 patients; two bleaching trays with window on right side or left side were made for each patient.
One tray was used overnight 7 hours for right side and the other was used 2 hours in the day for left side and vice versa.
Vitapan 3D-Master were used to evaluate tooth color (value, chroma, hue) on right side and left side on the days of 0, 2nd, 7th, 14th.
Results: The results show statistically significant changes in value (p<0.001) and in chroma (p<0.05) in comparison from baseline but no changes in hue (p>0.05).
There are no statistically significant differences in bleaching effect between the two side (p>0.05).
Conclusions: after bleaching treatment, teeth became bright in value, light in chroma but no changes in hue.
Wearing bleaching tray with the extended time overnight 7 hours or the shortened time in the day 2 hours results in the same effect.
Keywords: tooth bleaching, value, chroma, hue.
Determining the fip gene in the mycelium of ganoderma colossum
Background: The immunomodulatory proteins - FIPs were first isolated in various types of the Ganodermataceae, but have not identified yet in Vietnamese mushroom G colossum.
Objectives: This research aimed to amplify the DNA fragment of FIP in the mycelium of G colossum.
Conclusions: This research firstly determined the presence of FIP gene isolated from cultured mycelium of G colossum in Vietnam.
This finding served as a foundation for further experiments of FIP gene, as well as the production of recombinant protein in herbal drugs to prevent and support the treatment for diseases.
Keywords: Ganoderma colossum, FIPs
Study on antioxidant effects of ganoderma lucidum on cyclophosphamide-induced hepatotoxicity
Karst (Lingzhi or Reishi) is a medicinal mushroom widely used in Asia, and has antioxidant effect, promotes immune function and induces some positive benefits for cancer patients, as well as patients with liver disease.
The purpose of this study was to evaluate the in vitro antioxidant activity and hepatoprotective effect of ethanol extract and aqueous extract of Ganoderma lucidum cultivated in Vietnam on liver damage induced by cyclophosphamide in mice.
Methods: For in vitro study, the free radical scavenging effect on 1, 1-diphenyl-2-picrylhydrazyl radical (DPPH) test and the anti-lipid peroxidation effect on malonyl dialdehyde (MDA) test of test extracts were examined.
Aqueous extract alleviated significantly the increase of hepatic MDA content caused by cyclophosphamide.
Ethanol extract had no effect on cyclophosphamide-induced increase of MDA content. Conclusion: Ganoderma lucidum cultivated in Vietnam had shown an antioxidant activity and produced the hepatoprotective effect against cyclophosphamide-induced liver damage.
Background: Cortisol is a well-established biomarker of stress.
Keywords: cortisol, saliva, stress, sCort level
The measurement of salivary cortisol level (sCort) has attracted researchers interest because saliva collection is a non-invasive and subject-friendly procedure that does not require medical staff.
Results: The results showed that sCort levels on a stressful day were significantly higher than those on an ordinary day at two time points (10: 00 and 12: 00, p=0.000 and p=0.038, respectively).
In addition, on an ordinary day, the sCort level at awakening was significantly higher than at 10: 00 (p=0.005), 12: 00 (p=0.005), and 16: 00 (p=0.000).
Meanwhile, the sCort concentration was lowest at 16: 00, without significant difference between ordinary and stressful days.
Research and analysis of utilization of health care service in urban area can tho city compared to rural area hau giang province, 2010
However, when they got serious illness, the upper level hospital was health facility that people prefered to access.
In opinion of respondents, there were 31.7%, 31.5% of health staff in district health center had treatment capacity, while this proportion in local health station was only 21.3% and 17.3%, respectively.
Conclusion: The results from this study reveal some solutions to health sector and stakeholders of assuring the equity in ultilization and supply with health care service between rural and urban areas in Can Tho and Hau Giang
Objective: Describe utilization and supply with health care service in urban and rural areas of Can Tho city and Hau Giang province and social determinants related to this situation.
Methodology: Combined quantitative and qualitative study, in which quantitative study is a cross sectional study.
Result: The proportion of people got illness within six months in Can Tho city and Hau Giang province were respectively 24.5% and 19.2%.
In children, respiratory disease had highest percentage (26%), the common disease in adult was aching of joint and bone 28.4%, hypertension had high proportion in group of people over than 60 years old 35.8%.
Time and travel distance from home to local health station in two areas were shorter than to district health center.
Study the change of central venous pressure through catheter placed in basilic vein in treatment of dengue hemorrhagic fever shock at cantho children’s hospital.
Objective: To study the change of central venous pressure (CVP) placed through the basilic vein and to find a correlation between the value of central venous pressure with clinical features in Dengue hemorrhagic fever shock.
Patients and methods: included 43 patients ≤ 15 years old and hospitalized with diagnosis of Dengue Hemorrhagic fever with shock (level 3, level 4) at intensive care unit of Can tho Children's Hospital from 03/2009 - 08/2010.
Each patients had their CVP measures through catheter placed in basilic vein.
Results: The average value of CVP measured for the first time was 7.3 ± 3.0 CmH2O, after 30 minutes was 9.5 ± 2.6 CmH2O, after 60 minutes was 10.2 ± 2.3 CmH2O, after 2 hours was 10.4 ± 2.3 CmH2O, after 3 hours was 10.5 ± 2.4 CmH2O, after 6 hours was 10.5 ± 2.5 CmH2O, after 12 hours was 10.8 ± 2.5 CmH2O, after 24 hours was 12 ± 2.8 CmH2O, and after 36 hours was 12.4 ± 4.1 CmH2O.
There are an inverse correlations between CVP value measured for the first time with capillary refill time (r = - 0.32, p <0.05) and with increased heart rate (r = - 0.43, p <0.05).
There is a moderate correlation between CVP value with systolic blood pressure (r = 0.31, p <0.05).
Conclusion: The value of CVP is the most obvious change in the first hour of treatment.
CVP values ​​slightly changed in the 2, 3, 6 and 12 hours interval.
There are an inverse correlations between CVP value measured for the first time with capillary refill time and with increased heart rate. There is a moderate correlation between CVP value with systolic blood pressure.
Knowledge on fertility and infertility in adult males.
Introduction: Male infertility may have a role in half of infertile couples.
About half the cases agree that infertility can be caused by man or woman with the same proportion (48.8%) and 26.4% believe that couples could not have secondary infertility if they had children before.
Regarding the risk factors affecting sperm quality, although some factors are mentioned with high percentage such as alcohol (52.6%), mumps with orchitis (59.6%), genital infections and STDs (61.4%) but almost accounted for around half of cases.
Only 47.2% of cases understand that the important role of poor sperm quality causes male infertility.
Recognizing that the examination and treatment of infertile need to have both man and woman accounted for only 48.8%.
There are still some people who choose only pray (5.2%) or go to traditional healers (4.4%) to wish to have children.
Related to the ability of medical intervention for fertility, there are 53.0% believed that infertile people should come to highest level hospitals to be treated and most of them do not know the treatment methods.
Conclusion: There are a lots of problems related to understanding on fertility and infertility in adult male and medical staff should do better education and counsels.
Sufficient knowledge offers people more opportunities to access and get correct choice in health services, better cooperation with medical personnel in examination, diagnosis of infertility causes and effective treatments.
Key words: Fertility, infertility
In many different causes of male infertility, some cases can be prevented if people have the knowledge and practice of proper behavior.
In addition, the right understanding of fertility in infertile men keep them in good cooperation with physicians in treatment process.
This study investigated the knowledge of adult male in fertility and infertility.
Subjects and methods: cross-sectional descriptive on 500 men aged 18 - 50 about knowledge of male reproductive physiology and causes of male infertility as well as their attitude when get infertility by prepared questionnaire.
Results: adult males who 81.2% got married and 91.1% of them had children.
Only 43.6% understood that spermatogenesis in males takes place from puberty to old age, up to 46.4% believed that normal ejaculation means normal fertility ability and some of them even believe that more frequent sexual intercourse means more chance of fertility (30.8%).
Only 37.4% of them understood the frequency of sex 2 - 4 times / week results in the best chance to get pregnant.
Only a few know the concept of infertility (14.0%) as well as the current rate of infertility in Vietnam (24.8%).
The relation between the cea, ca19-9 levels and histopathological characteristics in colorectal cancer.
Aim: Studying the combination of CEA and CA 19 - 9 levels with histopathological characteristics as well as monitoring recurrence and metastasis in patients with colorectal cancer.
The percentage of patients with recurrence was 9.1%, metastases was 18.2%.
Conclusions: The measurement of CEA and CA 19 - 9 had prognostic value in patients with colorectal cancer at the late stage (Dukes C and Dukes D).
In addition, CEA and CA 19 - 9 were an efficient way to detect and monitor patients with recurrence or metastasis.
Key words: Colorectal cancer, CEA, CA 19 - 9, recurrence, metastasis
Materials and method: 66 patients diagnosed and treated for colorectal cancer at Hue Central Hospital from April 2012 to July 2013.
The level of CEA > 5 ng / ml was defined as abnormal (CEA (+)), while the cutoff for the CA 19 - 9 was set at 37 U / mL (CA 19 - 9 (+)).
Results: The positive rates of serum CEA and CA19 - 9 before surgery was 46.9%, 16.7%.
When combination of CEA and CA 19 - 9, this rate increased to 50%.
Adenocarcinoma was the highest percentage of 94.0%, 6.0%.
The well differentiated adenocarcinoma was 62.1%, Dukes B (53%).
The elevation of serum CEA related to the Dukes stage (p<0.05).
Glaucoma situation and related factors of persons over 40 years old in hue city.
Introduction: Glaucoma is a common eye disease that is quite dangerous to public health as one of the major causes of permanent blindness.
Although glaucoma can be prevented, most glaucoma patients are underdiagnosed. It's require a screening system to help patients detect glaucoma and treat it promptly.
Objective: 1) To describe the glaucoma situation of person over 40 years old in Hue city.
2) To find out some factors related to glaucoma at study sites.
Methods: A desciptive cross-sectional method was conducted with 2025 people over 40 years old in 27 wards of Hue city.
Results: The percentage of glaucoma is 4.7%, with closed glaucoma accounting for 55.2%, with 9.1% of people suspected of glaucoma.
The percentage of glaucoma patients suffering from blindness was 21.7%.
There was an association between glaucoma and age, gender, hypertension, diabetes, cardiovascular disease, family history of glaucoma, previous history of ocular surgery.
Primary result for diagnostic and absolute alcohol management for peripheral arteriovenous malformations.
Background: Peripheral arteriovenous malformations are not popular lesions, but management is a challenging for clinicians.
All remain cases are worth to reduce symptoms and also nidus size on angiography.
Conclusion: To diagnose peripheral arteriovenous malformations, clinical examination and imagings combination is playing important role, especially digital substraction angiography is gold standard for classification and therapeutic planning.
The most important is understanding angioarchitecture of AVMs and select safe position to inject alcohol.
Key words: peripheral arteriovenous malformation, absolute alcohol
Classification is based on ISSVA 2014 consensus.
There are very few paper or research on this matter in Vietnam.
Wayne Francis Yakes and Young Soo Do are pioneer and have many published papers in management arteriovenous malformations (AVMs) by absolute alcohol in the world.
Materials and method: We report 13 consecutive AVMs which have been diagnosed and managed by absolute alcohol in Gia Dinh Hospital from 2015 to 2019.
We treat them and follow cohortly up them for evaluating our result.
Results: Diagnose of peripheral arteriovenous malformations is based on clinical signs; however, imagings is playing important role to give planning for treatment.
Two of thirteen cases are totally get rid of nidus that treatment release symptoms and proved on angiography.
Two cases have been reduced nidus size as much as we can, and small remaining nidus which we considered as recurrent or persistent post procedure.
Evaluation of the dentin desensitizing efficacy of paste containing 8% arginine and calcium carbonate during dental scaling procedure.
Background: Dentin hypersensitivity (DH) is a short, sharp pain of teeth that can affect quality of life and treatment of oral dental diseases.
The objective of this study was to evaluate the dentin desensitizing efficacy after single application of paste containing 8% Arginine and Calcium carbonate (A-C) during dental scaling procedure (DSP).
Methods: This single-blind randomized clinical trial was conducted with 64 patients including 328 teeth with DH in which, group A: application of 8% A-C paste immediately before DSP and group B: application of 8% A-C paste immediately after DSP.
On each patient, teeth with DH in both sides of jaw were randomized in 2 groups: the treatment was applied by 8% A-C paste, and the control was applied by pumice prophylaxis paste (PPP).
DH scores were evaluated5 times: T0 (base-line), T1 (the group A: immediately after application of 8% A-C paste in the treatment and PPP in the control; the group B: similar to the group A but immediately after DSP), T2 (the group A: immediately after DSP; the group B: immediately after application of 8% A-C paste in the treatment and PPP in the control), T3 (1 week later), and T4 (4 weeks later).
Results: In group A: the treatment had a reduced DH score immediately after applying the 8% A-C paste from T1 to T4 (the reduced percentage of DH of T1, T2, T3, and T4 were 43.11%, 43.11%, 44.89%, and 44.45% respectively) in comparison with baseline score.
The group B: immediately after DSP, the DH score increased in both groups but the treatment had a reduced DH score immediately after applying the 8% A-C paste from T2 to T4 (42.32%, 44.81% and 43.98% respectively) in comparison with the T1.
Conclusion: A single application of the 8% A-C paste immediately before or after DSP had an effect on reducing the DH immediately and this effect lasted 4 weeks later.
Key words: Dentin hypersensitivity, paste containing 8% Arginine and Calcium carbonate
A case report of breast cancer in breast augmentation surgery with injection of free liquid silicone.
Breast augmentation surgery with an injection of free liquid silicone has been performed from the early 1960s but was abandoned by most practitioners because numerous complications have been reported, such as migration of silicone to other parts of the body, inflammation, discoloration, and the formation of granulomas, ulceration and fistulae, anaplastic large cell lymphoma, Silicone-Induced Granuloma, breast carcinoma.
The nipple-sparing mastectomy was performed for two breasts that were injected with liquid silicone.
In the right breast with adenocarcinoma, surgical margins above nipple-areolar were assessed intra-operatively by frozen section before immediate breast reconstruction was carried out in the same operation.
TRAM flap procedure reconstructed for right breast and implant breast reconstruction for the left breast.
We received amazing post-operative results.
Key words: breast cancer, liquid silicone injection, breast reconstruction
Combination of sst2 and bnp in predicting the mortality of st- elevation myocardial infarction.
Background: Serum levels of ST2 are associated with prognosis in nonischemic heart failure, but the predictive value of ST2 in patients with ST elevation myocardial infarction is unknown.
Key words: sST2, BNP, STEMI, cardiac outcomes
Results: ST2 levels were measured in serum from 38 patients with STEMI.
Baseline levels of ST2 were significantly higher in those patients who died (<35 ng / ml versus >35 ng / mL, P=0, 01) or developed new congestive heart failure (< 35 ng / ml versus > 35 ng / mL, P=0.002) by 30 days.
Furthermore, when sST2 > 35 ng / ml and BNP > 500 pg / ml showed a tightly relationship with cardiac outcomes within 30 days (P<0, 0001).
The prefered learning styles of nursing students at thai nguyen university of medicine and pharmacy.
Background: Each individual may prefer one or several learning styles.
Conclusions: The preferred learning styles are varied among nursing students.
The faculty should not solely pay attention to any single learning style. They should design their teaching to meet students' various styles, especially the Aural, Read / Write, and Kinesthetic preferences. Key words: learning styles, nursing education, teaching methods
This study aims to explore preferred learning styles of nursing students.
Materials and Methods: In this cross-sectional research, 156 participants, who were the second-year nursing students at Thai Nguyen University of Medicine and Pharmacy, were surveyed by self-administered questionnaires.
The assessment of learning styles was developed with the reference to the VARK questionnaire developed by Flemming. Students' learning styles were categorized as Visual, Aural, Read / Write, and Kinesthetic style.
Results: It was found that 32.7% of the students did not demonstrate clear preferences to any learning styles.
While nearly one-half (28.2%) of respondents prefer one learning style, the percentage of students who were simultaneously interested in two, three, and four learning styles are 17.9%, 12.2%, and 9%, respectively.
Notably, the results found no significant difference in students' preferences to three learning styles, which were Aural, Read / Write, and Kinesthetic.
However, there was significant lower score of preference of Visual style in comparison to all other three styles.
Role of some clinical scales in assessment of outcomes in patients with intracerebral haemorrhage.
Background: Intracerebral haemorrhage (ICH) accounts for the highest of hospital mortality of all stroke types, outcome is favourable in about 12 - 39% of patients.
Results: median age was 64.32±13.625, IHSS was 15.17±10.793, 43.3% patients with NIHSS LOC was 0.
Essen ICH = 0 about 93.8% patients complete recovery and with Essen ICH ≥ 7 had 100% death. The Essen ICH score showed a high prognostic accuracy for functional outcomes and death.
In which, the Essen scale is superior to ICH and mICH Key words: Essen ICH, Intracerebral hemorrhage
Clinical, laboratory characteristics and outcomes of acute calculous cholecystitis treatment.
Background: Acute calculous cholecystitis is a common digestive disease.
Conclusion: The treatment of acute calculous cholecystitis consists of surgery and conservative management, in which laparoscopic cholecystectomy is an effective and safe method for surgery candidates.
Key words: acute cholecystitis, acute calculous cholecystitis, laparoscopic cholecystectomy, gallstones
Laparoscopic splenectomy: techniques and results.
Purpose: This study was evaluated report pathology and results of laparoscopic splenectomy of the spleen disease.
Methods: All 61 pateints of laparoscopic splenectomy in Hue central hospital (2010 - 2015) are assembled, analyse the pathology, surgical techniques, complications and results.
Results: Laparoscopic splenectomy was indicated of major benign spleen disease.
Mean age 36 ± 9.2 (range 16 - 71).
Successfull laparoscopic splenectomy (95, 2%), two pateints were going on laparostomy.
Duration of stay in hospital was 5 to 7 days.
Solely infarc-related artery versus staged percutaneous coronary intervention in st elevation myocardial infarction patients with multivessel coronary disease.
Today, there are different interventional approaches for patients undergoing ST elevation myocardial infarction (STEMI) with multiple vessel diseases.
Objectives: to compare the mid-term results of two strategies of myocardial revascularization used for the management of patients with STEMI with multiple vessel diseases.
Material and methods: we analyzed retrogradely 64 profiles of patients diagnosed STEMI with multiple vessel diseases on coronary angiography and underwent angioplasty in Cardiovascular department from 5/2013 - 1/2014.
The patients had been divided into 2 groups: group 1 (percutaneous coronary intervention (PCI) of the sole Infarct-related artery followed by medical therapy, n=33) and group 2 (staged PCI in STEMI patients with multiple vessel diseases, n=31).
Results: group 2 had comparable combined end-points (death + Myocardial infarction + revascularization) rate but higher rate of detection of significantly stenosed non-culprit vessels than those of group 1.
Key words: Acute myocardial infarction, Multivessel disease, Primary percutaneous coronary intervention
Optimization atrioventricular delay using echo for cardiac resynchronization therapy patients.
Objective: To determine correlation of echo-doppler optimization of atrioventricular delay in cardiac resynchronization therapy with left ventricular invasive hemodynamics optimization.
If we optimize AVsense and AVpace, for replacing invasive LV dP / dtmax, EA VTI method was better option Key words: CRT, optimization
Conclusions: Comparing with invasive LV dP / dtmax, measurement of the maximal VTI of mitral inflow is more concordant than LV VTI in AVsense and AVpace optimization.
Technique characteristics of thoracic epidural analgesia following abdominal surgery.
Objective: To describe the technical characteristics of thoracic epidural analgesia after upper abdominal surgery.
Key words: Technical characteristics, thoracic epidural analgesia
Subjects and methods: A prospective descriptive study, 50 patients aged 18 years or older, with ASA I - III, indicated upper abdominal surgery had epidural catheter placement at the thoracic interspinal space of T7 - T8 or T8 - T9.
The epidural space was determined by loss of resistance technique.
Failure to define the epidural space, perforation of the dura, median or paramedian line of needle insertion, distance from the skin to the epidural space, displacement or catheter occlusion during analgesia were recorded.
Results: Success rate was 98%, the epidural space were not identified in 2%, perforation of the dura in 4%.
Needle insertion via median line was in 80.9% and paramedian one in 19.1%.
The distance from the skin to epidural space of 4 to 5 cm, 3 - 4 cm and over 5 cm was 58%, 24.5% and 18.4%, respectively.
Catheter was clogged immediately after placement when performing dose test was 2.04%, dislodgement of catheter when transporting patients from the operating to the recovery room and occlusion on the second day was 2.04%.
Study on factors influencing patient satisfaction with quality of pharmacy services at faculty of pharmacy, hue university of medicine and pharmacy hospital.
Background: The study aims to develop a scale measuring the quality of pharmacy services and analyze the factors influcencing patient satisfaction with quality of pharmacy services at the outpatient drug dispensary.
Key words: quality of pharmacy services, patient satisfaction.
Subjects and methods: The tool to assess the satisfaction level and related factors were developed and explored through interviewing patients.
Evaluate results through measurement and analysis methods.
Results: The new reliable scale was constructed with 26 observed variables.
Five factors including: dispensing operation, facilities, professional qualifications, medications and staffs most affected patient satisfaction in descending order; explained by 55.3% of the variation in satisfaction among patients.
Conclusions: A new scale has been developed to measure patient satisfaction of pharmacy services.
Patients were satisfied with the quality of pharmacy services at the outpatient drug dispensary.
Dispensing operation was the most important factor of patient satisfaction.
Situation analysis of health human resources in some provinces of the central and highlands region.
Background: Health human resources has always been considered a very important component of the health system, is a key element to ensure the effectiveness and quality of medical services.
Health care needs of the people has increased, they require higher and higher requirements for health workers both in quantity and quality.
Therefore, we conducted a study situation review of the health human resources in some provinces of the central and the Central Highlands region.
Subjects and Methods: Cross-sectional descriptive study of health workers which works at the Health Department of Quang Tri, Thua Thien Hue, Khanh Hoa and Dak Lak based on health workforce reports.
Results: The number of health workers per 10, 000 population was 34.9; the prevelance of health workers with postgraduate qualifications is 9.3%, graduate qualifications was 20.7%, 2nd degree is 62.3%.
The number of medical physician per 10, 000 persons was 5.8, the prevelance of medical physician with a graduate qualifications was 50.5%; postgraduate qualifications is 49.5%, medical physician at the provincial level accounted for 46.8%, district level (33, 9%) and commune level (19.3%).
Key words: health human resource, health worker, medical physician
Using doppler to assess the fetal health for the prediction of gestational outcome.
Doppler ultrasound is a non invasive technique whereby the movement of blood is studied by detecting the change in frequence of reflected sound, Doppler blood flow velocity waves form of fetal side umbilical artery, middle cerebral artery...) and maternal side (uterine arteries) are discussed and monograms for routine practice are presented.
Key words: Doppler, umbilical artery, middle cerebral artery, uterine arteries
The frequency of some clinical symptoms according to traditional medicine in patients with shoulder and neck pain.
Backgrounds: Shoulder and neck pain is a common disease in the world as well as in Viet Nam and tends to increasingly rejuvenate, it impacts on patient's ability to work and quality of life.
Heat symptom are the most common: dry thirsty mouth (34.5%).
About pain feature, common symptoms such as press relieve pain (64.4%), dull pain (71.3%) and persistent pain (69%).
About the pulse: sunken pulse 65.5%, slow pulse (31.1%), moderate pulse (47.1%), weak pulse (55.2%). Conclusion: symptoms have high rate such as pink moist tongue, white fur, dull pain, sunken pulse.
Symptoms have low rate such as bluish purple tongue, sticky slimy fur.
There were significant relationships between clinical groups and age, gender, disease duration, warm compress relieve pain, body palpation and pulse frequency (p <0.05).
Key words: frequency, symptoms, shoulder and neck pain, traditional medicine.
Surveying the clinical symptoms according to the traditional medicine on purpose of making diverse diagnostic and towards comprehensive treatment.
Therefore, in this study we contribute to build standardization of diagnostic symptoms according to traditional medicine.
Objectives: To survey the frequency of some clinical symptoms according to traditional medicine and find outseveral factors related with frequency appear clinical groups of shoulder and neck pain.
Materials and Methods: Including 87 patients were diagnosed with shoulder and neck pain treatment at the Traditional Medicine Department of Hue Central Hospital and Thua Thien Hue Traditional Medicine Hospital.
Research methodology is descriptive cross-sectional.
Results: about the tongue body: higher abnormal group is 18.4% pale tongue, 27.6% enlarged tongue.
About the tongue fur: 75.9% white fur, 58.6% thin fur, slippery fur (31%) is higher than dry fur (17.2%).
Cold symptom are the most common: warm compress relieve pain (62.1%).
Serum thyroglobulin and anti thyroglobulin levels in patients with thyroid nodules.
Objectives: To compare the levels and pathological values of serum Tg and TgAb between the patients with benign and malignant thyroid nodules and evaluate the relationship between serum Tg and TgAb levels with the rim characteristic and elasticity score of the nodule by thyroid elasto-echography.
Subjects: 30 patients with thyroid nodules, Serum Tg and TgAb levels and thyroid elasto-echography are examen before operation.
Results: The ratio of the positive Tg level of malignant thyroid nodules was higher than the benign thyroid nodules (16.7% vs 8.3%) but the serum Tg level was not significantly different (33.48 ± 38.67 ng / ml vs 27.32 ± 28.44 ng / ml, p > 0.05) and The ratio of positive TgAb level of malignant thyroid nodules was higher than that of benign thyroid nodules (22.2% vs 0%) but serum TgAb level was not different (64.15 ± 14.91 UI / ml vs 16.9 ± 14.48 UI / ml, p > 0.05).
The combination of the ratio of positive Tg and positive TgAb level did not show any difference in the ratio of pathological value between benign and malignant thyroid nodules (5.6% vs 0%).
Serum Tg levels in patients with irregular rim thyroid nodules were higher than those in patients with regular rim thyroid nodules but the serum Tg level was not different when evaluated with the elastic score.
Conclusions: The mean level and ratio of the pathological value of serum Tg and TgAb did not differ between malignant and benign thyroid nodules.
There is a relationship between serum Tg level and irregular rim characteristic of thyroid nodule (p < 0.05).
Key words: serum thyroglobulin level, serum anti thyroglobulin level, thyroid nodule
The accuracy of clinical staging of stage i-iiia non-small cell lung cancer by using thoracic computed tomography.
Purpose: To assess the accuracy of clinical staging of stage I-IIIA non-small cell lung cancer (NSCLC) by using thoracic computed tomography (CT).
Key words: non-small cell lung cancer, clinical staging, thoracic computed tomography
Patients and Methods: Medical records of patients with NSCLC operated in two years 2018 - 2019 at Surgery Department No 2, HCMC Oncology Hospital were studied retrospectively.
Results: Thoracic CT diagnosed tumor stage with an accuracy of 79% but failed to detect T3 - 4 disease in 8% of cases.
Agreement was poor between clinical and pathologic stage (Kappa coefficient= 0.186).
Only 48% of patients was diagnosed accurately, and clinically understaged patients (45%) were more frequent than clinically overstaged one.
Thoracic CT had a low sensitivity of only 19% in detecting stage IIIA disease, with 13 stage IIIA patients (21%) were missed diagnosis.
Conclusion: Thoracic CT is not an ideal means for clinical staging of stage I-IIIA non-small cell lung cancer.
To prevent the worsened outcomes associated with inaccurate staging, physicians should rely on established staging guidelines.
Study about the effectiveness of atorvastatin and aspirin combination in anti-inflammatory in patients with acute cerebral infarction.
Background: The relationship between effective therapy of Atorvastatin+Aspirin in patients with acute cerebral infarction and inflammatory factors hs-CRP, fibrinogen.
Materials and Methods: Clinical research trials and longitudinal follow-up, 66 patients with acute cerebral infarction treated at General-endocrinology internal Department-Hue University Hospital.
Data were processing by conventional statistics methods and SPSS 15.0.
Results: i) The concentration of hs-CRP, serum fibrinogen in patients with acute cerebral infarction increased very high: hs-CRP concentration was 6.46±4.49mg / L; fibrinogen was 4.59±1.52g/L.
There was a close correlation between hs-CRP and fibrinogen at hospitalization (r=0.5055; p<0.001); moderate positive correlation between hs-CRP with the size of acute cerebral infarction at hospitalization (r=0.3775; p<0.01) and between fibrinogen with NMN the size of acute cerebral infarction (r=0.3343; p<0.01).
ii) The anti-inflammatory effect of Atorvastatin and aspirin combination versus aspirin alone: +The difference of the hs-CRP, fibrinogen concentration at the hospital and after 1 month of treatment with Atorvastatin+Aspirin was (paired t 6.16; p<0.01) and (paired t 6.51; p<0.01), respectively.
Conclusion: Patients with acute cerebral infarction treated by Atorvastatin+Aspirin combination have significant effectiveness in reducing the concentration of inflammatory factors hs-CRP, fibrinogen compared with aspirin therapy alone.
Obturator hernia: a case report.
Obturator hernia is a rare pelvic hernia which accounts for 1% of all abdominal hernia.
Clinical manifestation is ussually unspecific.
Obturator hernia is often diagnosed by computed tomography or ultrasound.
We present a case of obturator hernia in an elderly women who was successfully diagnosed and treated at Hue Univeristy of Medicine and Pharmacy.
Key words: obturator hernia, mechanical obstruction, intestinal obstruction, Richter obturator hernia, strangulation
Fear of falling and associated factors among hue community-dwelling elderly.
Background: Fear of falling (FoF) causes several detrimental effects on elderly's physical and mental health, which diminishes the elderly to perform daily activities that they are capable of.
Elderly heathcare programs should encourage seniors to lead a healthy lifestyle and ensure environment safety to reduce the burden of falls.
Key words: fear of falling, FES-I, community-dwelling elderly, Hue city
Method: A cross-sectional study was conducted in 427 community-dwelling older adults in Hue City.
Using Fall Efficacy Scale - International (FES-I) and The Lawton Instrumental Activities of Daily Living Scale (IADL) to assess levels of fear of falling and independence of older adults perform daily living activities.
Logistics regression analysis was used to investigate the association between fear of falling and related factors.
Results: The prevalence of high fear of falling among community-dwelling elderly was 42.9%, among which walking on a slippery and an uneven surface were two main activities that older adults concerned.
There were significantly associations between high fear of falling and female, physical activities, sedentary lifestyle, walking difficulty and environmental discomfort (p < 0.05).
Conclusion: Fear of falling among community-dwelling elderly was relatively prevalent.
The application of acr lungrads and lung low dose computed tomography in diagnosis and follow up lung nodules: early report in 6 case.
Background: The lung low dose computed tomography and ACR LungRADS was routinely apply in diagnosis and follow up lung nodules in Hue University Hospital.
Classification of American College of Radiology, LungRADS, is a newly application but showed many advantages in comparison with others classification such as increasing positive predict value (PPV), no result of false negative and cost effectiveness.
These 6 case report in order to show an early evaluation of the application of ACR LungRADS in diagnosis and follow up lung nodules at Hue University Hospital.
Key words: LungRADS, screening lung nodule, low dose CT, lung cancer
Clinical and paraclinical study of parotid salivary gland tumors at hue university of medicine and pharmacy hospital.
Background: Parotid gland tumors account for 80% of all salivary gland neoplasms, but 80% of parotid tumors are benign.
Preoperative fine needle aspiration biopsy (FNA) results showed 35.5% pleomorphic adenoma.
Conclusion: FNA - Fine Needle Aspiration, Ultrasound and CT scanner were very valuable for diagnosis. Key words: salivary gland neoplasms, tumors
In the presence of a parotid mass, a physical examination is the first diagnostic tool and, in most cases, it guides the clinician in the appropriate direction.
A fine needle aspiration biopsy (FNA) has been indicated by several authors for the diagnostic work-up.
Ultrasonography, computed tomography, and / or magnetic resonance imaging are useful complementary studies for proper surgical planning.
Objective: Study clinical, paraclinical features of parotid gland tumor surgery.
Materials and Methods: 31 patients with parotid gland tumor who were examined at Hue University of Medicine and Pharmacy Hospital from June2019 to June 2020 were recorded about clinical, paraclinical of tumour. Results: Parotid salivary gland tumors in men account for 54.8, the mean age of patients was 53.7±12.3.
Majority of the parotid gland tumor size in ultrasound were between 2 and 4 cm (67.7%), homogenous (67.7%).
Majority of the parotid gland tumor size in CT scanner encountered were between 2 and 4 cm (67.7%), homogenous (61.3%) and in the superficial lobe (96.8).
Phytochemical constituents, antioxidant activity and acute oral toxicity of pomegranate (punica granatum l.) fruit peel extract.
Background: The natural antioxidants have an important role in the prevention of many diseases.
Conclusion: The PFP extract is relatively safe and revealed high antioxidant activity.
Key words: Punica granatum L; polyphenols; flavonoids; gallic acid; quercetin; antioxidant activity; acute oral toxicity
The aim of study is to investigate phytochemical components, antioxidant activity and acute oral toxicity of Pomegranate (Punica granatum L) fruit peel (PFP) extract.
The PFP extract was evaluated for antioxidant activity by DPPH assay and MDA assay.
In vivo acute oral toxicity test was conducted using Karber-Behrens method to determine LD50.
Results: Results illustrated that PFP mainly contains flavonoids, alkaloids, tannins, triterpenes, saponins, and coumarins.
PFP extract exhibited the total polyphenol and flavonoid contents with 189.97 mg gallic acid equivalent / g dry weight and 9.42 mg quercetin equivalent / g dry weight, respectively.
The DPPH free radical scavenging and anti-lipid peroxidation activities of PFP extract were expressed with IC50 value of 4.80 μg / mL and 0.38 μg / mL, sequentially.
Simultaneously, the Dmax (the maximum dose administered to mice that no toxicity was observed) of PFP extract was determined to be 21.28 g / kg, equivalent to 35.64 g dried herb.
Clinical, endoscopic and pathogical characteristics of colorectal cancer at da nang hospital from 2016 to 2017.
Objective: To study the clinical, endoscopy and pathogical characteristics of colorectal cancer at Da Nang Hospital.
Tumor size: ≥ 3/4 perimeter (39%), occupying the whole circumference (37.0%), occupying ≥ 1/2 perimeter (15.6%), accounting for 1/4 Perimeter (8.4%).
The colon completely narrowed rate: 70.73%., incompletely was 29.27%.
Histopathological classification: adenocarcinoma (85.85%), Mucinous adenocarcinoma: (9.27%) and non-differentiated epithelial carcinoma was 4.88%.
Conclusion: Colorectal cancer was quite popular and was usually detected at advanced stages. Therefore, screening for subjects with risk factors for early detection and treatment is recommended.
Key words: Colorectal cancer, endoscopy, pathogical characteristics...
Methods: A retrospectively descriptive study, performed from 01/01/2016 to 31/12/2017 at Da Nang Hospital.
Male is higher than female, male / female ratio is 1.4/1.
The period from the first symptoms to admission < 3months predominated (83.8%).
The predominant symptoms: Abdominal pain (85.85%), bloody stool (63.41%), defecation (62.44%), anemia (34.63%), weight loss (25.85%), fatigue (17.56%), abdominal distention (12.19%), nausea and vomiting (5.36%).
Location of Lesions: Rectum (43.42%), sigmoid colon (20%), right colon (10.73%), cecum (10.73%), transverse colon (7.80%), left-colon (7.32%).
Type of lesion on endoscopy: Exophytic (63.41%), ulceration-Exophytic (21.95%), ulceration (7.32%), polyp chemotherapy (7.32).
To evaluate dect’s role in gout and examine the relationship with clinical and paraclinical.
Background: To identify Urate crystals from synovial fluid under polarized microscopy is considered the gold standard in diagnosing Gout disease.
The cases were selected continuously, there were no cases of losing samples.
Multivariate logistic regression analysis was used to determine the independent association between clinical and paraclinical variables with DECT images.
Results: 61 out of 80 Gout patients with DECT positive accounted for 77.25%, There was an association between DECT and number of Gout attacks (> 3 times), duration of illness (> 36 months), tophi seeds.
No correlation was found between clinical variables and background characteristics in the study.
In the subclinical, urate crystal deposition images show a clear imprint on goute disease, while other variables do not find expression.
Conclusion: DECT is closely related to the frequency of gout attacks, disease duration and tophi.
Gout disease is a consequence of lifestyle behaviors, inappropriate eating habits, and exposure to risk factors in life.
Key words: DECT (Dual-energy Computed Tomography), Hoa Hao-Med, Gout
However, it is not always possible to suck up enough fluid or in case of pain, it is impossible to suck the fluid.
Dual-energy Computed Tomography (DECT) is a new tool for diagnosing Gout disease.
DECT shows the deposition of urate crystals and bone structure images using different display colors.
However, there is no agreement from the research results in the world.
In Vietnam, no original research has been published.
Objective: To evaluate DECT's role in Gout and examine the relationship with clinical and paraclinical factors.
Methods: A cross-sectional study was conducted in patients who visited the Hoa Hao-Medic clinic in Ho Chi Minh City.
Gout disease is diagnosed with clinical and paraclinical criteria; and have DECT results.
Advanced-stage hepatocellular carcinoma: is there any room for locoregional therapies?.
Purpose: To classify patients with advanced hepatocellular carcinoma (HCC) who might benefit from locoregional therapies.
Conclusion: Advanced HCC was a heterogeneous population in terms of CT findings, liver function tests and PS.
Detailed classification of this subgroup could optimize treatment outcomes.
Key words: Hepatocellular carcinoma, computed tomography, Child-Pugh, ALBI, locoregional therapy
Materials and methods: Data of 62 patients with advanced HCC from 11/2020 to 08/2022 at Hue University of Medicine and Pharmacy Hospital were analyzed.
Criteria for considering locoregional therapies include tumor size ≤ 10 cm, segmental portal vein thrombosis, Child-Pugh A and PS 0 - 1.
Results: Mean age: 59.4 ± 11 years, male: female ratio 9: 1.
Study the change of high-sensitive troponin t concentration in children sepsis at binh dinh general hospital.
Objective: Determining the relationship between the change of high-sensitivity Troponin T concentration with the degree of infection, mortality, and positive blood culture in sepsis.
Patients and Methods: based on 39 pediatric patients who were diagnosed sepsis at Pediatric department of Binh Dinh General Hospital, from 4/2012 - 7/2013.
Results: Hs-Troponin T concentrations increased in 84.6% of patients with a median of 29.9 pg / ml and quartile is 17.9 to 112.9.
There isn't significant difference statistically hs-Troponin T levels according to age of patients with p >0.05.
There is a moderate positive relationship between the hs-Troponin T concentration with the severity of sepsis (rs = 0.39, p <0.05).
There is a statistically significant correlation between increased hs-Troponin T levels with mortality of sepsis with p <0.01.
There is a statistically significant correlation between increased hs-Troponin T levels with positive blood culture in sepsis with p<0.05.
Conclusion: There is statistically significant relationship between the hs-Troponin T concentration with the degree of of infection, mortality, and positive blood culture in sepsis.
Key words: Troponin T, sepsis
Stigma and discrimination aganist people living with hiv/aids in khanh hoa province in 2013.
Introduction: The objectives of the study are to describe the status and influence, and the harms of stigma and discrimination against people living with HIV / AIDS in Khanh Hoa.
Methodology: Cross-sectional study using the combination of quantitative and qualitative methods, with 200 people living with HIV / AIDS, aged 16 and older.
Results: 4.5% of people living with HIV / AIDS reported their rights have been violated, 3% of people living with HIV / AIDS outcasts, shunned and 8% were refused to participate in community activities.
The harmful effect of stigma and discrimination are both of physical and spiritual: the HIV-infected people intend to suicidal accounted for 10% and 72.5% of people did not accessing Voluntary Counselling and Testing room (VCT) for fear of being stigmatized; 16.7% people did not access Anti Retroviral Therapy (ART) due to fear of stigma.
Suggestion for differential diagnosis of some diseases in seperating/screening process for suspected patients with covid-19 at hue university of medicine and pharmacy hospital.
These suggestions hopefully contribute to improving the separating / screening process in clinics and emergency rooms when COVID-19 is spreading and causing disease around the world Key words: separating, screening, COVID-19, SARS-CoV-2, chest CT scanner
Introduction: Surgery is the mainstay of treatment for pancreatic head cancer for improvement of patient survival.
The postoperative mortality rate was 2.4%.
The mean overall survival time was 12.35 ± 1.36 months; survival rate after 2 years is 20.3%.
Factors such as resection of pancreatic head tumor, no lymph node metastasis, and no distant metastasis all increased the patients survival time (p<0.05) Conclusion: Surgical treatment of pancreatic head cancer is feasible and safe; and pancreaticoduodenectomy increase the patients survival time Keywords: pancreatic head cancer, whipple procedure, pancreaticoduodenectomy
Studies in Vietnam have focused less on survival after surgery.
Therefore, we conducted a study to evaluate the results of surgical treatment of pancreatic head cancer at Viet Duc Hospital.
Patients and methods: A Retrospective study of patients with pancreatic head cancer have been operated at Viet Duc University Hospital from 01/2014 to 12/2015.
Results: There were 83 pancreatic head cancer patients operated at Viet Duc hospital.
The mean age was 57.7 ± 11.5 (age), male and female were 57.8% and 42.2%, respectively.
18.1% of patients had malnutrition before surgery; The rate of tumor resection (Whipple procedure) was 57.9%.
The rate of bypass was 36.1%, the rate of exploratory surgery was 6%.
The postoperative complications were bleeding, pancreatic leak, Choledochojejunostomy leak accounted for 6%; 3.6% and 1.2%, respectively.
The outcomes of laparoscopic sphincter-preserving proctectomy for low rectal cancer.
The time for postoperative-feeding is 5.3 ± 1.4 days.
There were no intraoperative complications.
The incidence of postoperative complications was 22.8%, but most were mild, with no deaths.
The overall median length of postoperative hospital stay was 10.7 ± 2.8 days.
Most patients discharged from the hospital gave good results, 77.1%.
The postoperative follow-up showed that all these patients had good results.
Conclusion: Laparoscopic sphincter-preserving proctectomy for low rectal cancer can be conducted safely, without intraoperative complications, and with few acceptable postoperative complications.
Keywords: sphincter-preserving proctectomy, rectal cancer, laparoscopic proctectomy.
Introduction: Laparoscopic sphincter-preserving proctectomy for low rectal cancer is a topic that has attracted many study authors.
This study aims to evaluate the surgical and oncological outcomes of patients with low rectal cancer who underwent laparoscopic sphincter-preserving proctectomy.
Patients and methods: This is a prospective descriptive study on a group of patients with low rectal cancer according to the Japanese classification. This group of patients underwent laparoscopic sphincter-preserving proctectomy with a unified technique by a single surgical team.
Results: 35 patients were included in this study with a median age of 65.07 ± 11.2 years, of which 68.6% were male, and 31.5% were female.
All 35 patients had tumors below the peritoneal fold and mainly clinical stage II (74.3%).
The average operative time was 247.7 ± 46.5 minutes.
The mean intraoperative blood loss was 28.3 ± 6.5ml.
There are many major cardiac surgery centers performed partial AVSD surgery in Vietnam however there have not been yet many general studies on the diagnosis, the diagnostic means, the role of echocardiography in diagnosis, prognosis and indications for surgery, treatment methods as well as preoperative characteristics affecting treatment results, changes in cardiac morphology and function after surgery of Vietnamese patients.
ECG: analyzed by standard ECG reading.
2.2.3.3 Echocardiography: performed at all the times of examination, according to ESC 2010 guideline.
The diagnostic criteria for partial AVSD and morphological, functional and hemodynamic parameters.
2.2.3.4 Surgical parameters and surgical techniques: recorded parameters related to surgica l procedures (identification of structural abnormalities), performed surgical techniques, time-based parameters surgery and complications.
We also offered a number of criteria to evaluate short-term treatment results: early mortality after surgery, the rate of severe patients discharge, the proportion of patients requiring permanent pacemaker implant, the rate of early reoperated within 30 days, the reduction of MR and PAP degree and some other parameters.
2.2.4 Data processing Data entry: information cards of subjects were extracted from medical records, encoded with passcodes to ensure confidential information.
The answers were cleaned manually, then entered using Microsoft Excel software.
Data analysis 10 The data was processed, converted and analyzed by Stata 12.0 software.
In the process of processing, cleaning the missing values, entered incorrectly, unreasonably, less clearly than comparing with paper questionnaire.
Descriptive statistics are performed by calculating frequencies, averages, and ratios to find the distribution of demographic variables (age, gender), clinica l and subclinica l characteristics.
2 Therefore, we performed the study Study on clinical, subclinica l and echocardiographic characteristis of patients with partial AVSD before and after the surgery.
Inference statistics are shown by the Fisher - Exact test (because there are> 20% of cells have expected frequency <5) when testing the difference between 4 patient groups by 4 age groups in proportion Clinica l and subclinical characteristics.
Use ANOVA statistical tests (normal distribution and uniform variance) or Krusal - Wallis test (if non-standard distribution) to compare the differences between quantitative indicators by 4 age groups.
Student Use the Student's t - test paired test (with standard distribution) or Wilcoxon signed - rank test (without standard distribution) to compare the difference before and after in terms of quantitative indicators from time to time.
For qualitative variables, compare the ratios before and after using the Chi square test of McNemar (with table 2x2) and McNemar - Bowker test (with table 2xn) to evaluate at the above times compared to the time of admission.
Statistical significance level α = 0.05 is applied.
11 Calculate the value of echocardiography in diagnosis: Diagnosis of surgery Total (+) (-) Diagnosis of echocardiography (+) a c a + c (-) b d b + d Total a + b c + d a + b + c + d Sensitivity = a / (a+b); Specificity = d / (c+d) Positive predictive value = a / (a + c); Negative predictive value = d / (b + d). The results were presented in tables and charts 2.3.
Research ethics The study did not violate ethical regulations when studying biomedical research.
Before recruited in this study, patients were fully explained about the purpose, requirements and content of the study.
After that, those patients who voluntarily participated would be included in the research, had full corrective surgery when indicated and consulted with the whole hospital, the report of the consultation and the patients agree to surgery.
The patient's condition and other personal information is kept confidential.
The study was approved by the hospital-level ethics committee.
Do not take patients to test unrecognized treatments.
The purpose of the study is to protect and improve public health.
12 RESEARCH CHART 13 CHAPTER 3 RESEARCH RESULTS 3.1 General characteristics of the study patient group The median age was 192 months (16 years), the youngest of 4 months, the oldest of 64 years.
We divided patients into 4 age groups, from 2 years old and younger (22.4%), from 2 to 5 years old (14.9%), from 5 to 16 years old (13.4%) and over 16 years old (49, 3%).
The distribution of patients by gender male / female is 46.3% and 53.7%.
3.2 Clinical and subclinical characteristics of the subjects 3.2.1 Clinical characteristics of research subjects - Reasons for detecting the disease: various, dyspnea accounted for 22.4% and other reasons 29.9%.
- Functional characteristics: the most common symptom is shortness of breath with 56.7% of patients at NYHA II, 1.5% at NYHA III, no patients at NYHA IV.
- Physical characteristics: the splitted S2 at pulmonary valve location were 46.3% and 23.9%, respectively, systolic murmur of MR and TR were 88.1% and 53.7% respectively.
Objectives of the study a.
- Patients with Down syndrome were 7.5%.
- Children get often recurrent bronchitis and delayed weight (40% and 26.7% in children under 2 years, respectively).
3.2.2 Subclinical characteristics of research subjects 3.2.2.1 Some subclinical characteristics of the research subjects Chest X-ray: 94.0% with cardiothoracic ratio > 50%, 49.3% with signs of increased pulmonary circulation.
ECG: - Some basic parameters: sinus rhythm was 91%, 5 patients with atrial fibrillation (7.5%) and 1 patient with BAV III (1.5%).
ECG 14 axis was mainly left axis (62.7%).
01 case of WPW (1.5%), no other arrhythmias.
- Some characteristics of conduction system: incomplete right bundle branch block was primary (67.2%).
BAV I was also common (34.3%).
3.2.2.2 Some characteristics of the Doppler echocardiography of the research subjects Some basic parameters - The majority of patients had good systolic left ventricular (EF) function before surgery and there was no difference between age groups.
There were 16.4% of cases with left ventricular dilatation, but up to 92.5% with right ventricular dilatation.
Investigate the clinical, subclinical characteristics and Doppler echocardiography of patients with partial AVSD.
- Heart valve anatomy characteristics: 97% with cleft on anterior leaf of MV.
89.6% of patients had 2 balanced papillary muscle (10.4% had 2 muscle columns but unbalanced).
22.4% had cleft on septal leaf of TV.
22.4% had dysplasia TV.
- Valve regurgitation characteristics: 65, 7% were severe regurgitation of mitral valve, and 47, 8% were severe regurgitation of tricuspid valve.
- Heart septal perforation: large primium ASD (100%) with median diameter of 22 mm, 94% left-right shunt, 6% had bidirectional shunt but not often.
- Some hemodynamic characteristics: 13.6% of patients did not have pre-operated HTAP, the severity of HTAP was: 18.2% mild, 39.4% moderate and 28.8% severe.
The highest PAP group (≥ 60 mmHg) was the oldest (median is 20 years old).
b.
- A strong and splited T2 sound is almost non-existent in patients after surgery.
3.3.2 Subclinical changes after surgery 3.3.2.1 Changes of some subclinical characteristics Chest x-ray: 94% patients hadcardiothoracicratio ≥ 50% before surgery which reduced to 32.7% one month after surgery, signs of increased pulmonary circulation decreased from 49.4% to 1.9%.
ECG: There was no significant change with parameters such as heart rate pattern, ECG axis, bundle branch block, atrioventricular block.
3.3.2.2 Changes in echocardiography characteristics aftersurgery Some basic parameters: increased LV end - diastolic diameter, in contrast, decreased RV end - diastolic diameter compared to before surgery and no significant change in the EF index.
Changes in regurgitation of atrioventricular valve: there was a significant improvement in the degree of MR and TR over time.
The degree of ventricular valve regurgitation over time Characteristics M-1 (1) Mo (2) M1 (3) M3 (4) M6 (5) p n (%) n (%) n (%) n (%) n (%) Mitral regurgitation No - Mild 9 (13, 4) 39 (58, 2) 36 (69, 2) 29 (70, 7) 29 (74, 4) p2 - 1: <0, 001 p3 - 1: <0, 001 p4 - 1: <0, 001 p5 - 1: <0, 001 Moderate 14 (20, 9) 25 (37, 3) 15 (28, 9) 9 (22, 0) 7 (17, 9) Severe 44 (65, 7) 3 (4, 5) 1 (1, 9) 3 (7, 3) 3 (7, 7) Tricuspide regurgitation No - Mild 14 (20, 9) 46 (68, 7) 48 (92, 3) 37 (90, 2) 34 (87, 2) p2 - 1: <0, 001 p3 - 1: <0, 001 p4 - 1: <0, 001 p5 - 1: <0, 001 Moderate 21 (31, 3) 17 (25, 4) 4 (7, 7) 4 (9, 8) 5 (12, 8) Severe 32 (47, 8) 4 (6, 0) 0 0 0 Evaluation of changes in PAP over time: Preop mean systolic PAP was 43.3 mmHg, 1 month - 3 months - 6 months after surgery were 25 - 26 and 25 mmHg respectively.
3.3.3 Surgical parameters and related to the preoperative condition Reconstruct some assessment of atrioventricular valve abnormalities at surgery compared with preoperative echocardiography - Surgeons agreed with the diagnosis of partial AVSD: 100%.
- There was a high agreement on the rate of diagnosis of cleft of MR (97% ultrasound and 94% surgeon).
The value of echocardiography in diagnosing some atrioventricular valve abnormalities 17 Table 3.36. Value of echocardiogram in the diagnosis of atrioventricular valve abnormalities Parameter Cleft of MV Dilatation ring of MV Cleft of TV Hypoplasia of septal TV Sensitivity 98 2, 4 66.6 29, 2 Specificity 25 96 79, 7 88, 5 Predictive positive value 98, 4 50 13, 3 80 Negative predictive value 50 38 98 44 The results show that: assessing MV abnormalities had high sensitivity and positive predictive value.
Evaluate clinical, subclinical and morphologica l, fuctional cardiac changes after surgery in patients with partial AVSD 2.
The techniques used for repairing MV and repairing TV: close of cleft MV was the most common (94%), for TV, the most used techniquewas the De Vega method (49.3%).
The relationship assessment showed that the degree of MR, TR before surgery was closely related to the number of methods used to repair valves.
Analysis of the relationship of preoperative systolic PAP with the perioperative: there was a close relationship with the time of mechanical ventilation, the higher of pre-operative PAPs, the longer the mechanical ventilation would last.
But no association was found between the degree of preoperative MR and the surgical period.
Summary of some short-term treatment results Parameters Patients (n) Percent (%) Discharge 67 100 Reoperation 2 3, 0 18 Permanent pacemaker implant 1 1, 5 Temporary pacemaker implant 4 6, 0 Discharge to die at home 0 0 Death 0 0 Evaluation of treatment results based on criteria of reducing MR, PAPs or both: there was a clear improvement (comparing the time 1 week - 1 month after surgery with preoperation): the degree of MR well reduced after 1 week - 1 month surgery was 73.1% and 82.7%, respectively; similar to the reduction in systolic PAPs 1 week - 1 month of 89.4% and 90.4%, respectively; combining these two criteria, the ratio was 61.2% and 73.1%, respectively.
Some complications during and after surgery: no premature death, BAV III rate was 11.9% but 6/8 cases recovered to sinus before discharge, in addition to the rate of pneumonia - bronchopneumonia accounting for 17.9%, heart failure 7.5% and some other complications.
CHAPTER 4 DISCUSS 4.1 General characteristics of the study patient group Patient age: the late detection of congenital heart disease was a feature of our current socio-economic conditions.
A study of 40 years of partial AVSD surgery at the Mayo Clinic, the median age of patients was 9.6 years, 6.1 years and 7.2 years, respectively during the 50s, 70s and 80s.
4.3 Clinical, subclinical and morphological changes, cardiac function after surgery in the study patient group 4.3.1 Clinical changes after surgery 19 4.3.1.1 Changes in functional signs: There was a statistically significant change in functional signs before and after surgery (dyspnea NYHA II, III before surgery accounted for 58.2%, 100% at NYHA I at any time postoperative), this result was similar to the result of the author Dao Quang Vinh and some other authors.
This showed an improvement in patients after surgery regardless of age.
4.3.2.2 Change of physical signs: - There was a clear change in heart auscultation, the rate of systolic murmur of MR and TR were recorded to decrease much compared to before surgery.
MR after surgery was the leading cause of the re-surgery of patients with partial AVSD, the new appearance or the increase of MR murmur would be a sign that suggested the next indications to be done for evaluation (echocardiography).
- A strong, splitting T2 sound did not appear after surgery (showing a significant decrease in blood flow to the lungs, a significant reduction in PAP).
4.3.2 Subclinical changes after surgery 4.3.2.1 Change of some subclinical characteristics Chest X Ray Cardiothoracic ratio, signs of increased pulmonary circulation and significant decreased PAP after surgery indirectly showed that pulmonary vascular disease was not a problem of the patient in this study.
ECG There were no significant changes with most of the basic parameters except for a significantly lower heart rate compared to before surgery.
Particularly 5 cases of atrial fibrillation before surgery were over 40 years old, 2 patients had sinus rhythm after surgery.
This wasreally important for the patient, as atrial fibrillation was the 20 premise of the risk of stroke.
There were 2 cases of BAV III with permanent pacemaker (3%), lower than some other studies reported by Di Mambro et al. 7.5%.
+ Chest X-ray: increased cardiothoracic ratio and increased pulmonary circulation suggestive of left to right shunt flow.
4.3.2.2 Changes in echocardiography characteristics after surgery Some basic parameters Longitudinal follow-up showed a significant change in the LV end-diastolic diameter (Dd) which was greater than before surgery, in contrast, the RV end-diastolic diameter was smaller before surgery and there was no significant change in the EF index.
Our results were similar to those reported by Nguyen Thi Mai Ngoc and author Dao Quang Vinh.
There was no left-right shunt after surgery to help reduce the volume and pressure RV, so it did not affect ventricular septal and left ventricle.
Left ventricular systolic function remained within normal range before surgery and along the time of follow-up, as the study of author Dao Quang Vinh showed that surgery did not adversely affect heart function.
Characteristics of MR and TR after surgery The rate of MR severe was high before surgery and decreased significantly after surgery.
Three patients with severe MR at 3 months, 6 months were> 50 years old and 2 of them had atrial fibrillation before surgery.
+ ECG: there are some typical signs such as left axis (62.7%), incomplete right bundle branch block (67.2%).
Stulak et al's study showed that the reoperation time was about 10 years.
We therefore need to continue 21 monitoring and evaluating the progression of MR with echocardiography.
Repair of TR also achieved good results, similar to the research results of author Dao Quang Vinh, author Waqar et al.
Results in terms of hemodynamics In our study, it showed a significant decrease of PAP compared to before surgery at all times with median PAPs value at the time before surgery, 1 week, 1 month, 3 months after surgery and 6 months, respectively, 43.4 - 25 - 26 and 25 mmHg and at all ages.
Thus the surgical effect was seen in patients of all age groups, young or old.
Limitations of the study: - Small sample size: 67 patients, the age of patients scattered.
- Short-term vertical follow up.
- Some other diagnostic imaging methods have not been applied (such as real-time 3D esophageal echocardiography).
CONCLUSION 1 Clinical, subclinical and echocardiography characteristics in patients with partial AVSD 1.1 Clinical characteristics - Median age: 192 months (male / female ratio: 1/1.16), patients over 16 years accounted for 49.3%.
Common function signs were shortness of breath with NYHA II accounting for 56.7%.
+ Echocardiography: characterized by the presence of the primum ASD (100%) in combination with cleft of anterior mitral valve (97%).
- Physical signs: detected murmur of MR was 88.1% and murmur of TR was 53.7%.
The splitted S2 at pulmonary valve location were 46.3% and 23.9%, respectively.
1.2 Subclinical characteristics - Chest X-ray: 94.0% with cardiothoracic ratio ≥ 50%, 49.3% with increased pulmonary circulation.
- ECG: 91% of sinus rhythm, 7.5% of atrial fibrillation, 1.5% of BAV III.
The left axis accounted for 62.7%, uncomplete right bundle branch block was 67.2% and BAV I was 34.3%.
1.3 Doppler echocardiography characteristics: unified the diagnosis to identify a partial AVSD with the diagnosis of 100% surgeons.
- 100% had the large primum ASD (unique atrial ASD type rate is 9%).
- 97% had cleft of MV.
The increase in pulmonary pressure was proportional to the diameter of the ASD and the degree of pulmonary pressure was closely related to the time of mechanical ventilation after surgery.
- 86.6% had moderate - severe MR.
The degree of MR was related to the techniques used to repair valve.
- 79.1% had moderate - severe TR.
The degree of TR is related to the techniques used to repair valve.
- The diagnostic value of cleft MV was highly sensitive (98%) as well as the positive predictive value (98.4%) - HTAP with PAPs median was 43.3 mmHg.
The level of HTAP was related to the age and diameter of ASD and was closely related to the duration of mechanical ventilation.
No more murmur of TR recorded.
2.2 Subclinical and morphological, function cardiac changes after surgery - Chest X-ray showed a clear improvement: cardiothoracic ratio ≥ 50% accounting for 94% pre surgery 1 month after surgery accounted for 32.7%.
- ECG: 2 cases transferred atrial fibrillation to sinus, 2 cases BAV III irreversibly (3%).
2.3 Changes in morphology and cardiac function according to Doppler echocardiography parameters after surgery There was a clear improvement immediately after surgery and maintained up to 6 months with some key parameters as follows: - 100% no residual ASD.
- Severe MR decreased from 65.7% 7.7%.
No more severe TR.
- PAPs significantly decreased from 43.3 25 mmHg.
REQUEST Based on the research results, we have the following recommendations: 1.
Many patients in the study were found to be above the age of 16, much higher than the age recommended for surgery for a variety of reasons.
When patients have signs of suspected CHD with increased pulmonaryperfusion diagnostic echocardiography is 24 required.
The degree of valve regurgitation is proportional to number of valve repair techniques.
At the same time, the degree of atrioventricular valve regurgitation, or the degree of preoperative HTPA are prognostic parameters, therefore they also need to be fully and accurately assessed by echocardiography.
However, the detailed assessment of MV and TV anatomical lesion by transthoracic echocardiography still havs some certain limitations, we need to learn and apply new diagnostic methods to improve the diagnosis.
Thus, we can be assured to surgery for these patients unless contraindication.
Transthoracic echocardiography is a simple, inexpensive, easy-to-use diagnostic tool to evaluate treatment results and long - term follow-up.
The layout of the dissertation - The dissertation has 136 pages including sections: Introduction (3 pages), chapter I: Overview (33 pages), chapter II: Objects and research methods (26 pages), chapter III: Results (39 pages), Chapter IV: Discussion (32 pages), Conclusion (2 pages), Recommendations (1 page).
- The dissertation has 52 tables, 8 charts, 31 pictures, 2 diagrams.
CHAPTER I OVERVIEW 1.1 Basic knowledge about partial AVSD 1.1.1 History of research and embryology, anatomical abnormalities of partial AVSD In 1846, AVSD was first described by Peacock, the lesion identification was incomplete atrial and ventricular septal wall.
In 1875, Rokitansky was the one who used the term complete and partial to describe this pathology.
4 The anatomical standard of partial AVSD is primum ASD and cleft of anterior leaf mitral valve (few cases do not have).
Partial AVSD has separated mitral valve and tricuspide valve with separated and complete valve rings.
1.1.3 Pathophysiology of partial AVSD Because of anatomical abnormalities, many patients with AVSD have one or more of the following disorders: shunt via ASD, left and right atrioventricular valve regurgitation.
Without surgery, about 15% of untreated patients will develop pulmonary vascular disease and atrial fibrillation in adolescence.
1.1.4 Diagnosis of partial AVSD 1.1.4.1 Diagnosis of partial AVSD The clinical manifestations of the partial AVSD change and are related to hemodynamic changes.
Clinical symptoms often appear late with the symptoms such as shortness of breath, palpitations, and fatigue.
Physical signs: a systolic murmur due to increased flow through the pulmonary valve, the seconde sound of pulmonary valve is loud and splited (prolonging the pulmonary component of the T2).
In addition, the systolic murmur of MR or TR can be heard.
1 INTRODUCTION OF THE DISSERTATIONPREAMBLE AVSD (atrioventricular septal defect) is an anomal characterized by a lack of atrioventricular septal wall with a variety of abnormalities of the atrioventricular valves.
1.1.4.2 Paraclinical partial AVSD Chest X ray Right ventricular and pulmonary arterylobes are usuallydilated and there is signs of increased pulmonary perfusion.
ECG Classically, the ECG has a left axis with angles from 0 to - 900.
Signs of right ventricular hypertrophy with rsR'in the precordial leads.
Left precordial leads or qRs or qRS reflect the degree of right ventricular hypertrophy.
Right bundle branch block is also common.
5 Doppler echocardiography Echocardiography allows to identify and classify the AVSD morphology.
In addition to assess morphological changes, echocardiography also evaluates changes in hemodynamic adn functional parameters.
Atrioventricular valve morphology: mitral valve and tricuspide valve are on the same plane, mitral valve leaves and tricuspide leaves cling to the tip of the ventricular septum, with 2 separate atrioventricular valve holes.
Cleft of atrioventricular valve: the subcostal view, the parasternal short axis view and apical four-chamber view provide a clear view of the atrioventricular valves.
Cleft of anterior mitral valve directly toward to the inlet ventricular septum.
Variation in the left ventricular outlet: the anteriorly aortic shift, not wedged between the MV and TV loop, causes the aorta anterior to the atrioventricular junction which may cause LVOTO.
Characteristics of the primum ASD: Focal are seen extending to the atrioventricular valve, no atrioventricular segment, size varies but often is wide.
Several other combined characteristics: The extension of the LVOT with the ratio of outlet / inlet > 1.
Counter-clockwise displacement of the MV chordare.
The balance / imbalance of the two ventricles and the two atriums.
And some other abnormalities can be seen (ventricular dysplasia, stenosis of the RVOT) Hemodynamic and functional parameters Echocardiographic parameters include: left ventricular size and function, right ventricular size, degree of MR, TR, ASD shunt, PAP and pulmonary flow (Qp), aortic flow (Qs).
6 The above parameters can be assessed simply and accurately by Doppler echocardiography and can be repeated many times, safely and inexpensively.
In the world, the basic knowledge about the disease as well as the treatment of surgery have been studied for a long time.
In 1954, Lillehei and co-workers successfully carried out the first partial AVSD repair surgery with the good results.
The study of Hani K Najm collected data of 180 childrens who had surgery to repair of partial AVSD from 7/1982 to 12/1996 in Canada, the average age was 3.6 years (1 month - 16.4 years).
The short term death rate is 1.6%.
Other complications: atrial arrhythmia, transient atrioventricular block soon after surgery.
The average postoperative follow up time with echocardiography was 4.6 ± 3.6 years (2 months - 13.7 years) showed that ASD residual shunts accounted for 1%, mild (or no), moderate and severe MR were 85%, 14% and 1% respectively.
Research of Krupickova et al. (2000 - 2015) on 51 symptomatic patients with partial and transitional AVSD with mean age of 179 days (0 - 357 days), of which 31% of patients had severe valve anomalies.
The in hospital death rate was 5.9%, 22% of patients had to undergo re-surgery (4 days - 5.1 years), 1 patient had to replace mechanical valve.
Multivariate analysis showed that unfavorable anatomical status of MV is an independent risk factor for reoperation MV.
Besides, the study of Barnett and colleagues on adult patients (from 13 - 65 years old, the average age is 48 years old), with a Qp / Qs ratio of 3.9 (from 2.4 to 4.4) showed no deaths during hospital stay, improved heart failure through NYHA postoperative evaluation of patients.
This suggests the safety and the effect of partial AVSD 7 surgeryand should be recommended for all patients to prevent changes in morphology and cardiac function.
The appropriate time for surgical treatment as well as long-term results are issues that have been interested and studied by many authors around the world.
1.2.2 Studies in Vietnam In Vietnam, there is a lot of difficulty in early diagnosistherefore many patients come for treatment at high age compared to the recommended age of operation.
Le Thi Thanh Xuan and Nguyen Tan Vien published research results on ehocardiography of morphology and hemodynamics in children with AVSD.
The results showed that the complete AVSD accounted for 71.6%, the rest was partial AVSD; 44% had atrioventricular valve regurgitation, of which none had severe atrioventricular valve regurgitation, 48% had pulmonary hypertesion, 11% had other combined heart defects.
Research of Bui Duc Phu and Le Ba Minh Du at Hue Central Hospital on surgical results of 17 cases of AVSD from 1/2000 to 6/2005.
There are no death related surgery, the atrioventricular valve regurgitation improved.
Most recently (in 2015), Dao Quang Vinh conducted a study to evaluate the results of partial AVSD surgery.
The study included 89 patients, the early and first 6-month mortality rate accounted for 1.1%, 1.1% severe MR need to be reoperated.
The severity of MR decreased and heart failure improved.
CHAPTER 2 SUBJECTS AND METHODS OF THE STUDY 2.1 Object of research Including 67 patients, diagnosed with partial AVSD and had indication for operation at Hanoi Heart Hospital.
The period was from January 2011 to December 2014.
The rate of reoperation is still high of 10 - 25%, depending on each the center, mainly due to the progression of MR (mitral valve regurgitation) or LVOTO (left ventricular ouflow tract obstruction).
8 Inclusion criteria: Patients were recruited when the following criteria were met: a.
The patient was diagnosed of partial AVSD based on echocardiography results in Ha Noi Heart Hospital: + Primum atrial septal atrial (or unique atrial form).
+ MV and TV are separate and located on the same plane.
+ There are cleft (s) of anterior MV leaflet (few do not have).
c. Patients agreed to participate in the study.
Exclusion criteria: a.
Therefore, long-term follow-up after surgerywith echocardiography is a mandatory indication for patients with AVSD.
f. Patients did not come for follow-up visits or later than 2 weeks.
The patient evaluation follow up times included: before surgery (time M-1), after surgery and before 9 discharge (usually about 1 week after surgery - time M0), 1 month after surgery (time M1), 3 months after surgery (time of M3) and 6 months after surgery (time of M6).
2.2.3.1 Clinical parameters - General characteristics - Clinical characteristics: general and local signs 2.2.3.2 Subclinical parameters Chest X ray: measured cardiothoracic ratio and evaluate status of pulmonary circulation.
RESEARCH ON THE PREVALENCE OF HELICOBACTER PYLORI INFECTION IN PATENTS WITH CHRONIC URTICARIA AND THE EFFECTIVENESS WITH BACTERIA ERADICATION BY TRIPLE THERAPY
1: The rate of H pylori infection in chronic urticaria Patients N% H pylori infection 159 64, 9 H pylori Not-infection 86 35, 1 Total 245 100 Conclusion: The rate chronic urticaria infected H pylori (CU / H.
pylori+) is 64, 9% Table 3.
2: Relationship between H pylori infection and the duration of symptoms Patients Time CU / H.
pylori+ (n=159) CU / H.
pylori - (n= 86) Total P n% n% n% < 1 hour 20 12, 6 2 2, 3 22 9, 0 < 0, 01 1 hour-6 hours 38 23, 9 39 45, 4 77 31, 4 < 0, 01 > 6 hours 101 63, 5 45 52, 3 146 59, 6 < 0, 01 Conclusion: 59, 6% of patients had a duration time of wheals and pruritus lasting> 6 hours.
Rate of CU / H pylori+ has a long 12 duration of wheals and pruritus > 6 hours greater than the CU/H.
pylori - group (p <0.01).
Treatment effect chronic urticaria with combination H pylori eradicated treatment by triple regimen Table 3.
Score the group CU / H pylori + eradicated reduced score to 33.2 ± 5.9, significantly lower than before treatment and lower than the other 2 groups (p12 <0.05; p13 <0.05) Table 3.
9: Side effects Patients Symtopm CU / H.
pylori+ (n=107) CU / H.
pylori - (n=86) p n% n% Drowsiness 0 0 1 1, 2 > 0, 05 Tiredness 1 0, 9 0 0 > 0, 05 Dry mouth 2 1, 9 0 0 > 0, 05 Conclusion: After 4 weeks of treatment, the proportion of patients with side effects was very low and there was no difference between the two groups.
Determine the rate of Helicobacter pylori infection in patients with chronic urticaria and clinical relevance of the disease.
In 2015, Huiyuan Gu analyzed 16 studies found that the rate of H pylori infection in chronic urticaria is 49, 74% higher in the control group. The difference indicates that H pylori infection may be a risk factor for developing chronic urticaria, increasing the risk of chronic urticarial.
Regarding the duration time of symptom, 59.6% of patients had the duration time lasting> 6 hours, in which, the rate of CU / H.
pylori+ group was significantly higher than the CU / H.
Percentage of patients with severe wheals in CU / H.
pylori+ group (55.3%) was significantly higher than the CU / H.
pylori - group 4.2.
After 4 weeks of treatment, the mean UAS score of all 3 groups decreased compared to before treatment.
CU / H pylori+ eradicated group, the highest reduction, remains 1, 9 ± 0, 7.
This point is significantly lower than before treatment (p (1) (3) < 0, 05) and the lowest among 3 groups, the difference was significant with p12 <0.05; p13 <0.05.
Fukuda's study found that among patients with H pylori positive, microbial eradicated, 35% of patients had complete remission and 65% had partial remission of urticaria symptoms.
Disease control After 3 months treatment cessation, the rate patients well - controlled disease of the CU / H.
pylori+ eradicated group was (36, 8%), significantly higher than the CU / H.
In 2018, Robert Pawowicz reported a double-blind, placebo-controlled trial assessing the effectiveness of H pylori eradication treatment in patients with CU which was significantly effective but only temporary.
Through analyzing reports in the literature, it might be the following reasons: Firstly, is that bacteria can act as an irritant of pathophysiological processes leading to the CU?
Antibody production may continue even after the H pylori eradication, contributing to the interpretation of cases with urticaria infected H pylori, eradication of bacteria, but still urticaria expression.
Secondly is that the deteriorating clinical condition has been identified as possibly due to bacterial infection.
22 CONCLUSION Through a study of 245 patients of chronic urticaria who were treated at Hai Phong University Medical Hospital from 8/2016 - 02/2018, the thesis has some main conclusions: 1.
The prevalence of Helicobacter pylori infection in patients with chronic urticaria and clinical relevance of the disease.
This score was significantly lower than before treatment and compared with the other two groups.
Before treatment, CU-QoL score of the CU / H.
Determine the prevalence of Helicobacter pylori infection in patients with chronic urticaria and clinical relevance of the disease.
Effective treatment of chronic urticaria is evaluated by the Urticaria Control Test (UCT).
Many studies on the role of H pylori in chronic urticaria have been conducted and proposed some theories to explain the relationship between H pylori infection and chronic urticaria: Firstly, some protein components of H pylori may play a role in mast cell activation causing chronic urticaria.
Secondly, bacteria act as full and self-allergenic antigens, causing an immune response.
IgG and IgA antibodies associated with 19-kDa of H pylori lipoproteins have been found to play a role in CU.
Thirdly, some inflammatory mediators have been released during the immune response to H pylori infection, which may play an important role in the pathogenesis of urticaria, at least to create out of nonspecific hypersensitivity of skin vessels with substances that enhance vasodilation.
Finally, the process of bacterial infection reduces the barrier function of the gastrointestinal mucosa, facilitating allergy food particles into the blood.
H pylori may also increase the amount of eosinophil cationic protein with a toxin secreted by eosinophilic activation that contributes to chronic urticaria.
4 Chapter 2 SUBJECTS AND METHODS 2.1.
SUBJECTS AND MATERIALS 2.1.1.
SUBJECTS * Purpose 1: 245 patients were treated chronic urticaria (CU) in Haiphong Medical University hospital from 8/2016 to 02/2018.
Age ≥ 18.
METHODS 2.2.1.
Study Design: prospective, interventional, follow-up 2.2.2.
Sample size of Study - Purpose 1: Convenient sampling.
From 8/2016 to 02/2018, 245 patients with chronic urticaria treated at Hai Phong Medical University Hospital, responding selection and exclusion criteria.
RESEARCH ON CRICULATION SUPPORT EFFECTS OF VENO ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION (VA-ECMO) IN TREATMENTING ACUTE MYOCARDITIS PATIENTS
- Acute kidney injury: RIFLE classification - Organ failure: SOFA score 2.5.
Collect data for the study following the medical report form 2.6.
Data analysis: following medical statistic method CHAPTER 3: STUDY RESULTS 3.1.
Characteristics of patients From 2015 - 2018, there were 54 patients having full criteria's for inclusion: female 66.7% (36 patients), average age 35.6 11.17 years old (min 18 - max 67), 18 cardiac arrest patients (33.3%). 10 Table 3.1: Some indexes of patients before ECMO Total (X ±SD) Survival (X ±SD) Non-survival (X ±SD) p APACHE II 10.3±5.45 (n=54) 8.9±4.43 (n=44) 16.4±5.52 (n=10) <0.05 SOFA before ECMO 7.8±2.68 (n=54) 7.4±2.68 (n=44) 9.6±2.01 (n=10) <0.05 Lactat (mmol / l) 7.60±4.47 (n=54) 7.2±4.08 (n=44) 9.05±5.94 (n=10) >0, 05 EF (%) 34.3±13.92 (n=49) 33.2± 13.55 39.8± 15.46 (n=8) >0.05 SAVE Median: 2.5 (n=54) Median 5 (n=44) Median - 3 (n=10) <0.05 Troponin T (ng / L) Median 4409 (n=53) Median 4409 (n=43) Median 4756 (n=10) >0.05 The duration of cardiac arrest (minutes) Median 35 (n=18) Median 30 (n=11) Median 40 (n=7) <0.05 Remark: SOFA score, APACHE II score, serum lactate, Troponin Tprofoundly increased and EF dramatically decreased, the median time of cardiac arrest was 31 minutes, these showed that the patients having severe myocardial injury and cardiogenic shock.
Chart 3.1: The duration of ECMO and the number of membrane Remark: 95% patients were supported VA-ECMO within 2 weeks, almost cases only used one membrane.
11 3.2.
Objective 1: The improvements of circulation, arterial blood gas, organ function 3.2.1.
Objective 2: Some prognostic factors of mortality and complications of VA-ECMO 3.3.1.
1 INTRODUCTION Myocarditis is defined as an inflammation of the myocardium with the most reason caused by virus.
Some prognostic factors of mortality - The survival rate was 82.14% 3.3.1.1.
Cardiac arrest associated with mortality rate Table 3.7: Cardiac arrest associated with mortality rate Survival (n=44) Non-survival (n=10) OR CI-95% Cardiac arrest 11 (25%) 7 (70%) 7.14 0.03 - 0.65 Non - cardiac arrest 33 (75%) 3 (30%) Remark: The mortality rate in cardiac arrest patients was 7, 14 times as many as the mortality rate in non-cardiac arrest patients.
3.3.1.2. Pulse pressure associated with mortality rate Table 3.8: Pulse pressure associated with mortality rate on day 5 Survival n (%) Non-survival n (%) OR CI-95% Pulse pressure on day 5 (mmHg) >20 31 (96.8) 1 (3.2) 12.5 0.01 - 0.8 <=20 10 (71.4) 4 (27.8) Remark: The mortality of patients having pulse pressure less than 20 mmHg on ECMO day 5 was 12.5 times higher than patients having pulse pressure greater than 20 mmHg 16 Chart 3.4: SAVE and serum lactat associated with mortality Remark: SAVE score with cut-off - 8 point having sensitivity 87%, specificity 90% and AUC 0.934 for mortality prediction 3.3.2.
17 Chart 3.5: Lower limb arterial thrombosis complication Remark: Lower limb arterial thrombosis complication during stopped ECMO was twice as many as after the arterial thrombosis complication stopped ECMO.
Characteristics 54 acute myocarditis patients with mean age 35.6 (min 13-max 67), 31 - 50 range having 57.4%, and female accounted for 66.7%, the results was similar to the other authors. Almost acute myocardisits patients were female, some studies showed that the male-female ratio may be different but young people suffered from acute myocarditis higher than the elder did.
The severe acute myocarditis such as fluminant myocarditis can lead to cardiogenic shock, life threatening arryhythmia and death.
18 The results showed that almost patients with cardiogenic shock complicated multiple organ failure syndrome (MOFS), their APACHE II, SOFA score and serum lactate were 10.3 5.45, 7.8 2.68, 7.6 4.47 mmol / l, respectively.
The high serum lactate concentration reflected the severe cardiogenic schock leading tissue hypoperfusion.
The ECMO duration and number of ECMO membrance ECMO duration in this study was 7.6 2.9 days, one patient did not respone, did not maintain blood pressure and died that only supported ECMO more than one day.
Subgroup analysis showed that 34 patients (63%), 17 patients (31.4%) and 3 patient were supported less than 7 days, from 8 - 14 days, greater than 14 days respectively.
According to these results, the ECMO duration of nearly two third acute myocarditis patients within one week.
With the unrespond patients, the more use vasopressors and inotropic drugs, the more oxygen demand of myocardium that make the heart injury unrecoverable and the patients die.
Objective 1: The improvements of circulation, arterial blood gas, organ function 4.2.1.
The improvements of circulation Desipte high dose vasopressor with median 70 μg / kg / minute, mean arterial pressure's patients before ECMO 62.4 24.60 mmHg.
After ECMO, mean arterial pressure (MAP) incresased significantly that was 76.79.93 mmHg.
19 Before ECMO the serum lactate concentration median was 7.55 mmol / l and markedly decreased on day 2 with median 1.9 mmol / l which demostrated better tissue perfusion and higher MAP.
There were 18 ventricular arrhythmia patients (33.3%), 3 ventricular extrasystole patients, 11 third-degree AV block patients (20.4%) and 22 sinus rhythm patients on admission.
It mean that nearly a half patients having life threatening arrhythmia.
The median of Troponin T profoundly decreased from 4409.0 ng / L on admission to 259.0 ng / L on stopped ECMO day. It reflected that the myocardial necrosis was deacreasing.
Peripheral veno arterial extra corporeal membrane oxygenation (VA-ECMO) is a form of cardiopulmonary life support, where blood is drained from the venous system (inferior vena cava or superior vena cava) circulated outside the body by a centrifugal pump, and went through oxygenator for oxygenating and CO2 eliminating then reinfused into the circulation throughout arterial system (most common abdominal arotic artery). Thanks to VA - ECMO stopped vicious circle of pathogenesis and waiting of myocardial recovery.
The improvement of arterial blood gas Before ECMO, because of severe cardiogenic shock arterial blood gas was severe metabolic acidosis with pH 7.30.14, PaCO2 32.614.3 mmHg và HCO3 16.14.88 mmol / l, the metabolic acidosis sharply improved from ECMO day 2.
The improvement of organ function In this study, Having been 7.82.68 before ECMO, SOFA score did not change sifnificantly during ECMO, even slightly increased because of the two things, the first if the patients had acute kidney injury, they need severe weeks for recovering, the second before ECMO the patient's platelet was 19271.2 G / l, after ECMO support, the platelet was 11146.0 G / l on ECMO day 2 and 8943.3G / l on stopped ECMO day, however after one day 20 SOFA score rapidly declined with mean 4.52.31 owing to improved cardiovascular and coagulation score 4.3.1.
Some prognostic factors of mortality The survival rate was 82.14%, it was higher than the other author's rate.
Some complications of VA-ECMO 4.3.2.1.
Bleeding complications In this study, the ECMO cannula bleeding complication on ECMO day 2, day 4 and on stopped ECMO day were 37%, 61.5% 21 and 51.8% respectively. The lower rate of bleeding complication was arterial line site that was 18.5% on ECMO day 2 and 46.2% on stopped ECMO day, while the lowest rate was central line site, 12.5% on ECMO day 5.
Lower limb arterial thrombosis complication In our study, No severe lower limb arterial thrombosis complication during ECMO that need intervention, however 5 cases whom had lower limb arterial thrombosis after stopped ECMO by ultrasound was treated by anticoagulant agents.
Nowadays, the studies showed that VA-ECMO has efficacy on acute myocarditis with the 60 - 70% survival rate.
Acute pulmonary edema and neurologic complications 16 patients (29.6%) had acute pulmonary edema found by clinical signs such as bloody frothy sputum through out endotube, it may be involve left ventricle distension because during VA ECMO, the arterial outflow cannula generates retrograde flow towards the AV, resulting in higher afterload and increased left ventricular end diastolic pressure.
For markedly decreased ejection fraction patients, VA-ECMO can cause increased left ventricle wall tension and myocardial oxygen demand that made more severe acute pulmonary edema and more severe outcome.
In our study, only 1 patient had cerebral infraction, however it is certain that 44 survival patients (81.5%) without sneurologic 22 sequelae so we can completely ruled out neurologic in these patients. The remaining 9 death patients, we could not rule out whether the patient had a neurologic complications event or not because of patient's severe condition that did not allow performed brain CT scan.
CONCLUSION With 54 VA-ECMO supported acute myocarditis patients, our study showed that: 1 / The improvements of circulation, arterial blood gas, organ function VA-ECMO helped improve circulation parameters, arterial blood gas, organ function in acute myocarditis patients.
In Viet Nam, there have been a fews studies about this issue, therefor we perfrom the study: Research on circulation support effects of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in treatmenting acute myocarditis patients with two objectives: 1.
- The improvement of arterial blood gas: Metabolic acidosis was 23 tremendous improved after ECMO, pH before ECMO and stopped ECMO day were 7.300.14 and 7.440.12 respectively (p<0.05).
VA-ECMO should be appied for acute myocarditis patients complicated cardiogenic shock, life threatening arryhythmias and carefully considered in cardiac arrest patients 2.
The assessment of clinical outcomes of veno - arterial extracorporeal membrane oxygenation in adult patients with cardiogenic shock due to acute myocarditis
some complications of veno - arterial extracorporeal membrane oxygenation in cardiogenic shock patients due to acute myocarditis
There were 3 119 references including 2 Vietnamese references and 117 English references.
CHAPTER 1: OVERVIEW 1.
ACUTE MYOCARDITIS 1.1.
Acute myocaditis account for 6% cause cardiogenic shock. Clinical presentations of the disease range from nonspecific systemic symptoms that it resolves spontaneously to fulminant cardiogenic shock, life threatening arryhythmia and cardiac arrest.
Based on observations of acute myocarditis due to coxsackie virus in humans as well as in mice, acute myoarditis caused by virus is a continuum of distinct disease processes including 3 phases.
The first phase is viral infection and replication in myocardium.
Viral proteolysis and cytokine activation cause myocardial damage leading apotosis.
It is difficult to recognise this phase by clinical sign because of the patients having asymptomatic or unspecific clinical.
The second phase involving the host's immune activation, it simulates cellular and humoral immune responses that reduces viral replication leading to myocardial recovery.
However, immune activation is not decreasing possibly due to the activation of Tcells against myocardium throughout the peptides of viruses.
This leading to release cytokines such as tumor necrosis factor (TNF), IL-1, and IL - 6 resulting in more myocardium damage.
Overactivation of cellular immunity or viruses are not completedly eliminated and continue replicating leading the third phase.
This phase, left ventricle was enlarged due to remodeling phenomenon, it causes left ventricle 4 function disorder and heart failure.
If the inflammatory decreases, the left ventricle function will improved but the continuing inflammatory leading to dilated cardiomyopathy.
Respiratory support: depend on patients that need nasal cannula, mask cannula, non invasive ventilation and invasive ventilation.
Mechanical circulatory support Mechanical circulatory support is indicated if the cardiogenic shock patients did not response with conventional treatment.
The advantage of ECMO system can setup quickly, bedside for supporting patients for some weeks.
The survival rate in Matsumoto study 70.2% (26 of 37 patients), four of fifteen unweaned group switched from VA - ECMO to left ventricle assist device were survival after heart tranplantation or continuous treatment.
Aoyama study revealed the survival rate was 57.7% and EF before ECMO and acute kidney injury complication of the mortality group were more severe.
The survival rate of Diddle study was 61%, but the patients having acute kidney injury had higher mortality with OR 3.6, CI 1.4 - 9.3, CI 95%.
According to X Liao, 78.8% surviaval rate, before ECMO serum lactate concentration was very high. The patients having high quantities of blood product transfusion, renal failure, encephalorrhagia, high bilirubin levels, or multiple organ failure (MOF) during ECMO were associated with poor outcome.
Wigfield study found that main factor caused death in VA-ECMO patients was MOF.
CHAPTER 2: MATERIALS AND METHODS 2.1.
- Exclusion criteria: angiographically detectable coronary artery disease (coronarystenosis ≥50%); known pre-existing cardiovascular disease or extra-cardiac causes that could explain the syndrome b / And suffered from cardiogenic shock by 2012 the European Society of Cardiology's criterion - Hypotension: systolic blood pressure < 90 mmHg for 30 minutes, or vasopressors required to achieve a blood pressure ≥ 90 mmHg - Evelated left ventricular filling pressure: pulmonary congestion or adequate or elevated filling pressure (wedge pressure > 20 mmHg) - Signs of impaired organ perfusion (at least one of the following): altered mental status, cold, clammy skin, oliguria, increased serum lactate levels.
Methods 2.3.1.
Study design: progressing, intervention and before-after study 7 2.3.2.
The variables of study 2.3.5.1.
Charateristics of patient and ECMO parameters - Name, family name, age, gender, weight, past medical history (healthy, heart failure, hypertension, COPD), fever, dyspnea, chest pain, cold, clammy skin, cardiac arrest, vasopressor and inotropic dose, IE index, SAVE score, APACHE II score.
ECG on admission, ventricular fibrillation, ventricular tachycardia, ventricular extrasystole, third-degree AV block, atrial rhythm, sinus rhythm.
ECMO cannulation techniques (percutaneous or surgery cannulation).
The duration of ECMO, the number of membranes, CO, flow, FiO2 of ECMO.
The improvement of organ function 8 SOFA score before ECMO, day 2, day 3, day 4, day 5 and stopped ECMO 2.3.5.5.
Coagulation factors associated complications such as PT, APTTs, fibrinogen, D-dimer, ethanol test before ECMO, day 2, day 3, day 4, day 5, stopped ECMO and one day later stopped ECMO.
- Heparin dose: bolus dose, day 1, day 2, day 3, day 4, day 5 and stopped ECMO - Acute pulmonary edema, CRRT 2.4.
However, bacteria can acquire drug resistance by mutating the bacterial target the antibiotic is directed against, inactivating the drugs or pumping them out.
"We reasoned that harnessing the immune system to simultaneously attack bacteria on two different fronts makes it hard for them to develop resistance," said Dotiwala.
He and colleagues focused on a metabolic pathway that is essential for most bacteria but absent in humans, making it an ideal target for antibiotic development.
This pathway, called methyl-D-erythritol phosphate (MEP) or non-mevalonate pathway, is responsible for biosynthesis of isoprenoids - - molecules required for cell survival in most pathogenic bacteria.
The lab targeted the IspH enzyme, an essential enzyme in isoprenoid biosynthesis, as a way to block this pathway and kill the microbes.
Given the broad presence of IspH in the bacterial world, this approach may target a wide range of bacteria.
Researchers used computer modeling to screen several million commercially available compounds for their ability to bind with the enzyme, and selected the most potent ones that inhibited IspH function as starting points for drug discovery.
Since previously available IspH inhibitors could not penetrate the bacterial cell wall, Dotiwala collaborated with Wistar's medicinal chemist Joseph Salvino, Ph D, professor in The Wistar Institute Cancer Center and a co-senior author on the study, to identify and synthesize novel IspH inhibitor molecules that were able to get inside the bacteria.
The team demonstrated that the IspH inhibitors stimulated the immune system with more potent bacterial killing activity and specificity than current best-in-class antibiotics when tested in vitro on clinical isolates of antibiotic-resistant bacteria, including a wide range of pathogenic gram negative and gram positive bacteria.
In preclinical models of gram negative bacterial infection, the bactericidal effects of the IspH inhibitors outperformed traditional pan antibiotics.
All compounds tested were shown to be nontoxic to human cells.
"Immune activation represents the second line of attack of the DAIA strategy," said Kumar Singh, Ph D, Dotiwala lab postdoctoral fellow and first author of the study.
"We believe this innovative DAIA strategy may represent a potential landmark in the world's fight against AMR, creating a synergy between the direct killing ability of antibiotics and the natural power of the immune system," echoed Dotiwala.
Co-authors: Rishabh Sharma, Poli Adi Narayana Reddy, Prashanthi Vonteddu, Madeline Good, Anjana Sundarrajan, Hyeree Choi, Kar Muthumani, Andrew Kossenkov, Aaron R Goldman, Hsin-Yao Tang, Joel Cassel, Maureen E Murphy, Rajasekharan Somasundaram, and Meenhard Herlyn from Wistar; and Maxim Totrov from Molsoft LLC.
Work supported by: The G Harold and Leila Y Mathers Foundation, funds from the Commonwealth Universal Research Enhancement (CURE) Program and the Wistar Science Discovery Fund; The Pew Charitable Trusts supported Farokh Dotiwala with a Wistar Institute recruitment grant; Additional support was provided by the Adelson Medical Research Foundation and the Department of Defense.
Support for The Wistar Institute facilities was provided by Cancer Center Support Grant P30 CA010815 and National Institutes of Health instrument grant S10 OD023586.
Wistar Institute scientists have discovered a new class of compounds that uniquely combine direct antibiotic killing of pan drug-resistant bacterial pathogens with a simultaneous rapid immune response for combatting antimicrobial resistance (AMR).
These finding were published today in Nature.
The World Health Organization (WHO) has declared AMR as one of the top 10 global public health threats against humanity.
It is estimated that by 2050, antibiotic-resistant infections could claim 10 million lives each year and impose a cumulative $100 trillion burden on the global economy.
The list of bacteria that are becoming resistant to treatment with all available antibiotic options is growing and few new drugs are in the pipeline, creating a pressing need for new classes of antibiotics to prevent public health crises.
"We took a creative, double-pronged strategy to develop new molecules that can kill difficult-to-treat infections while enhancing the natural host immune response," said Farokh Dotiwala, M B.B S, Ph D, assistant professor in the Vaccine & Immunotherapy Center and lead author of the effort to identify a new generation of antimicrobials named dual-acting immuno-antibiotics (DAIAs).
Existing antibiotics target essential bacterial functions, including nucleic acid and protein synthesis, building of the cell membrane, and metabolic pathways.
Risk factors of stunting in children under 2 in Northern Mountain and Central Highland.
English summary: The study aims to research risk factors of stunting in children under 2 years old in Northern Mountain and Central Highland.
Disease-control study design was applied on 600 children under with disease group (stunted children) and controlled group (non stunted children) in 4 disadvantaged provinces (Lao Cai and Lai Chau in the Northern Mountain; Gia Lai and Kon Tum of Central Highland).
Results showed that risk factors of child stunting were low birth weight, short birth interval (less than one year), child anemia, parental height, parental smoking, household poverty, and child age.
Keyword: Malnutrition, stunting, underweight, anemia, Zinc deficiency, birth weight.
Nutritional status and their risk factors of hemodialys patients in Thanh Nhan hospital Hanoi.
The risk factors related to malnutrition: average of energy consumption of the patient is 1362 Kcal / day with the proportion 17%: 16%: 67% for Protid: Lipid: Glucid respectively.
The index PCR indicate 21.5% of the patients (27.6% in male, 11, 4% in female) received daily not enough the protein quantity.
Low protein quantity consumed (<1g / kg body weight) increased significantly the risk of low serum albumin levels (OR= 2.98; p<0.05).
Keyword: Malnutrition, food consumption, hemodialysis.
English summary: Nutritional status and their risk factors have been investigated in 93 hemodialysis patients in Thanhnhan hospiatal - Hanoi, during November 2004 - July 2005.
Results indicated that prevalence of chronic energy malnutrition (BMI <18.5) is 38.7% (28.6% in female, 44.8% in male).
Prevalence of overweight and obesity (BMI >23) is 14% (25.7% in female, 6.9% in male); 47.3% in normal range of BMI (18.5 - 22.9).
Body fate quantity increased proportional to age of the patient, and significantly higher in female than that of men.
Prevalence of low-serum albumin (<35g / L) is 22.6% (24.1% in male, 22.6% in female).
Combine both protein and energy deficiency (BMI<18.5 & Alb < 35g / L) was observed in 10.8% of the patients.
Prevalence of anemia is 97.8% (25, 8% in severe level; 43% in mild levels, and 29% in moderate level).
Efficacy assessment of multi-factor control in type ii diabetis patients admitted to Thai Binh preventive health center.
Author: Nguyen Thi Ngoc Han, Dang Bich Thuy, Vu Dinh Trien Tạp chí DD&TP / Journal of Food and Nutrition Sciences - Tập 6 - Số 1 - Tháng 4 / Vol. 6 - No. 1 - April - Năm 2010 / Year 2010.
Laws and current utilization of hormones in agricultural production in Vietnam and some other countries-effects of hormone residues in foods on human health.
There have been lots of studies confirming a close correlation between the use of food with hormone residues and life threatening diseases.
A number of substances such as anti-thyroid substances (tapazol, 4 (6) - R-thiouracil), β-agonist (clenbuterol), diethylstilbestrol have been used as growth stimulants.
The natural hormones such as estradiol, testostrogene, progesterol... acted as sexual hormones.
Keyword: Food laws, food safety, weight gain and growth stimulants, food preservatives, hormone.
Author: Vu Thi Thu, Tran Thi Dinh Tạp chí DD&TP / Journal of Food and Nutrition Sciences - Tập 9 - Số 2 - Tháng 6 / Vol. 9 - No. 2 - June - Năm 2013 / Year 2013.
English summary: Most countries over the world have food laws or ordinances in order to protect consumers' health.
Food laws have been established in many countries a long time ago. They have been specified by regulations and decrees on the use of toxic substances in general and hormones in particular in food production.
In Vietnam, the National Assembly has issued the legislation 55/2010/QH12 that monitors the use of weight gain substances, growth stimulants, food preservatives... However, the utilization of hormones in livestock and crops appears complicated and difficult to control.
In developed countries, the European Union for instance, hormones were used since 1980 but due to the strict laws, the utilization has been becoming less than in Asian countries. In Vietnam, due to the illegal import of hormones such as β-agonist and toxic substances from China and other adjacent countries, their utilization has on the rise, leading to food insecurity and negatively effecting the production of meat and vegetables of farmers.
Nutritional anemia in pregnant women at 6 - 16 gestational week in Ha Nam.
Keyword: Anemia, iron deficiency, nutrition, pregnant women, Ha Nam province.
English summary: A cross-sectional survey to describe the situation of nutritional anemia in pregnant women and related factors was conducted in 2013 in Ha Nam province with 657 pregnant women at 6 - 16th gestational week.
Results showed that the population had anemia at moderate level of 20.7% among pregnant women.
In which, moderate anemia took 3.7%; mild anemia took 17% and no severe anemia.
The rate of low iron storage (serum ferritin <30 µg / L) was 17.4%, of which 4.3% had depleted iron storage (serum ferritin <15µg / L).
Anemia rate in pregnant women tended to increase by age.
The study provided data on anemia in pregnant women to design necessary interventions.
The situation of knowledge, attidue and practice (KAP) about the safety of foods - hygine of four objects in northern cities.
English summary: Nowadays, Vietnam has a lot of foods poisoning and other diseases, which are caused by foods population in every year.
According to the researchs results of survey (KAP) with above 1100 people in 3 cities (Ha Noi, Thai Binh, Ha Tinh) in 2005, realized that: The knowledge of safety of foods hygiene get average (85.4%), among of them, the producer of food are lower than (82.9%), and Thai Binh city are minimum (79.1%).
The attitude about the safety of foods hygiene get average (92.2%), among of them, the manager of food are lower than (82.4%), and Thai Binh city are minimum (85.5%).
The pratice of safety of foods hygiene is the worst, average (73.6%), among of them, the manager of food only get (52.5%), and Thai Binh city are minimum (65.4%).
Keyword: Knowledge, Attitude and prATice, safety of foods hygiene.
Metabolic syndrome and nutrition.
Development of atherosclerosis generally takes more than a decade without any obvious signals for "healthy" working people in our community.
Therefore, the evaluation of accumulated risk for atherosclerosis with, if necessary, immediate intervention for it is important for the prevention of serious events.
The disorders in lipids, glucose and blood pressure is caused by insulin resistance in the metabolic syndrome.
The reduced insulin sensitivity is based on adipocyte dysfunction, which is characterized by secretion of a inflammatory cytokine, TNF-α secretion is included by excess of fat intake.
High fat intake changes 30% of visceral adipocytes to the TNF-α expressing adipocytes in an animal model.
Thus, nutritional control has become much emphasized for the prevention of metabolic syndrome.
The management of nutrition, practicularly excess fat intake, is now expected to effectively prevent the development of atherosclerosis, not only in United States and Japan, but also possibly in Vietnam.
English summary: Concept of metabolic syndrome became popular in many countries in a couple of years.
The fact surprising us is the high frequency of metabolic syndrome; the frequency in men over 40 y. o. is estimated to be 20 - 30% in Japan.
The common feature is characterized by co-existence of dyslipidemia, hypertension, glucose intolerance, and central obesity (visceral fat accumulation), even though each degree of abnormality may be mild.
The subjects with metabolic syndrome are considered to be at high risk for development of atherosclerosis.
Nutritional status of anorexia children under 5 years old at the national hospital of pediastrics.
Keyword: Anorexia, nutritional status, National Hospital of Pediatrics.
English summary: Objectives: To assess nutritional status of under 5-year-old anorexia children at the nutrition clinic in National Hospital of Pediatrics.
Subjects: 124 children under 5 years old and their mothers.
Study method: Cross sectional descriptive study.
Results: The rate of anorexia was highest among children aged 12 - 24 months (38.7%) and the rate of malnutrition was also highest in this age group (30.4%).
Anorexia was very rare in children <6 months of age (4%) and wasting was not found.
The rate of malnutrition among anorexia children is highest in stunting (32.3%), then underweight (28.2%) and wasting (13.71%), but mostly moderate malnutrition (77.5 - 88.6%).
Underweight was more common in children 48 - 60 months of age (31.6%), stunting was more common in children aged 12 - 24 months (35%) followed by children aged 24 - 36 months (22.5%).
Knowledge and practices on food safety regulations of restaurant and food kiosk owners in Hanoi in 2008.
There was a strong association between restaurant service life, work experience of assistants and the practices on food safety regulations (p<0.01), as well as that between knowledge and actual practices on food safety regulations (p<0.01).
Keyword: KAP, food hygiene and safety, restaurant.
English summary: A study was conducted in 2008 in 4029 restaurants and food kiosks by interviewing the 4029 owners in 14 districts of the old Hanoi.
Only 49.3% of the kiosks had been certificated to meet the food safety conditions.
The proportion of owners having adequate knowledge and practices on food safety regulation was 61.8%, and 52.2%, respectively.
Knowledge, practice of food safety among street food sellers at Ben Cat town, Binh Duong province, in 2014.
Results: Most of street food sellers interested in knowledge about health care (75.8%), less concerned knowledge of kitchen hygiene (10.8%) and knowledge about food poisoning (25.8%).
The proportion of right knowledges of food safety is low (6.1%).
However, attainted all conditions of food safety of sellers was good practice for no smoking, do not spit in processing of region, no jewelry, no paint nails, health care, training knowledge of food safety (upon 60%), however not wearing fully work-wear (9, 7%).
There was association between right in food safety and right practices in food safety [PR = 9.4; KTC95% (5.1 - 17.3), p < 0.001].
There was association between right knowledge in food safety and all conditions of food safety [PR = 1, 7; KTC95% (1.2 - 2.3), p < 0.015].
Conclusion: Advanced knowledge of kitchen hygiene and knowledge about food poisoning.
To propagandize wear uniform, mask, hat of food processing.
To identify the relationship between the sanitary conditions of food safety with knowledge and practices of street food sellers.
Methods: The descriptive cross - sectional study was performed on 360 street food were selected by syntematic random method.
We used the question to interviewed directly food handler's practices. We used chi-squared test to measure the relationshipin variables.
Chronic energy deficiency and associated factors among seafood processing workers in Thuy Dac San company, Hochiminh city in 2017.
Conclusion: The rate of chronic energy deficiency in seafood processing workers was high according to the classification of the World Health Organization.
Keyword: CED, chronic energy deficiency, seafood processing workers.
Author: Le Thi Xuan Quynh, Pham Thi Lan Anh, Vuong Thuan An Tạp chí DD&TP / Journal of Food and Nutrition Sciences - Tập 14 - Số 5 - Tháng 9 / Vol. 14 - No. 5 - September - Năm 2018 / Year 2018.
Methodology: A cross-sectional study was conducted in 320 workers in Binh Chanh district, Ho Chi Minh City.
The subjects were measured body height, weight and interviewed with the structured questionnaires.
Chronic energy deficiency was determined when BMI & lt; 18.5 kg / m 2.
The association between CED and gender, age group, marital status, working age, job characteristics, overtime, and exercise habits were analyzed.
Results: The prevalence of chronic energy deficiency was 26.3% (male 23.7%, female 28.1%).
There was a statistically significant association between CED and age group, marital status, exercise habits.
Dietary intake of patients with type ii diabetes at the endocrine - neurological department, Hung Yen general hospital.
Keyword: Dietary intake, Type II diabetes, Hung Yen Hospital.
English summary: The study was conducted using epidemiological method in a cross sectional survey of 160 patients with type II diabetes aged 30 - 60 years old at the Endocrine and Neurological Department in Hung Yen General Hospital. It aimed to describe dietary intake of the study population.
Research results showed that subjects usually ate three meals a day.
Only 41.9% of the patients ate on time.
Energy intake of the subjects was 1365.6±383.9 kcal.
Only 32.5% of respondents met their energy requirement; 55% of the subjects met protein requirement; 73.8% of subjects meet lipid requirement; 28.8% of the subjects met the carbohydrates requirement.
Malnourished patients often had low energy intake and overweight - obese ones were more commonly found having exceeded diet.
Quantifying amino acid content in soyabean and its products by HPLC method.
English summary: Seventeen different kinds of amino acids were quantified in a study, using high performance liquid chromatography method (HPLC) in the Lab of Food hygiene and food safety control center of the National Institute of Nutrition.
The results showed that the content of those total amino acids in soybean is in the range from 33 to 40g/100g.
The content of those total amino acids in tofu is in the range from 7 to 10g/100g, and in soybean milk is in the range from 11 to 18mg / l.
In the analyzed products, beside glutamate acid with the highest rate, some other essential amino acids also have a high content.
Especially, tofu bought in Mo market has the highest content of amino acids compared with tofu in the other markets.
Keyword: Amino acids, soybean, Soya products, HPLC.
At the same time, closely coordinate with relevant authorities including the Ministry of Health, Ministry of Agriculture and Rural Development and hospitals.
English summary: The prevalence of antibiotic-resistant bacteria in food in Vietnam has reached an alarming level.
Having appropriate policies and flexible and flexible application measures suitable to Vietnam's characteristics can be effective in preventing the outbreak and spread of drug-resistant bacteria.
Food safety conditions in food production, processing and trading establishments and food management agencies at all level in thanh hoa province.
Markets with food business satisfying the prescribed requirements of 44.4%, safe food stores reaching 66.7% and 88.9% of school day-board kitchens meeting the prescribed conditions.
Keyword: Food producing, prcessing and trading management, food safety conditions, Thanh Hoa province.
In 2018, 5.4% of communes, wards and towns were recognized as food safety communes.
100% of communes have established Steering Committees, but effective implementation of food safety has reached only 74.0%; 50.0%. 16.7% of communes carried out the certification of food origin as prescribed.
48% of owners of communal food facilities had knowledge of food safety conditions.38% have practiced food safety conditions.
There is a close related between knowledge and practice of these subjects.
Some indicators assess lipid nutrition status of patients with hepatitis traeated at general hospital, Thai Binh city in 2017.
Conclusions: Patients with hepatitis have elevated liver enzymes, dyslipidemia, increased body fat percentage in most hepatitis groups; Particularly high in VGR and VGR.
Keyword: Lipid nutritional status, hepatitis, dyslipidemia, liver enzyme, Thai Binh.
English summary: Purpose: The study aims to assess the lipid nutritional status of patients with hepatitis.
Methods: A prospective, cross-sectional study was conducted through interviews, weight and height measurements of 124 inpatient hepatitis patients in General Internal Medicine Department, General Hospital, Thai Binh City in 2017.
Results: All patients with acute hepatitis (VGC), chronic hepatitis (VGM) and alcoholic hepatitis (VGR) have elevated liver enzymes.
In particular, VGR group had the highest rate of dyslipidemia.
Specifically: The percentage of body fat mass increased 59.5% of patients with VGC, 43.3% of patients with VGM and 58.9% of patients with VGC.
There were 63.7% of patients with subcutaneous fat and 50% of patients with visceral fat mass elevated, both of which were highest in patients with VGR (80.0%).
The percentage of patients with hepatitis has low blood cholesterol levels of 10.5% and 58.9% have elevated blood cholesterol, in which patients with VGR have higher rates of cholesterol than patients with VGC and VGM.
Effectiveness of food-bases intervention on micronutrient status of SanDiu minority children in Thai Nguyen.
English summary: Objectives: to evaluate the effectiveness of intervention by food supply on micronutrient deficiencies of malnourished Sandiu minority children from 1 to 5 years old.
Methods: A cross-sectional and intervention study was conducted on 144 San Diu minority women and their children of 1 to 5 years old (72 malnourished and 72 non-malnourished) in Dong Hy of Thai Nguyen, from April to November of year 2013.
The proportion of children having less than 3.5 millions of Red blood cells / mm3 reduced from 24% to 16%; The proportion of children with Hemoglobin level less than 110g / l reduced from 26% to 14%; The proportion of children with ferritin less than 30 µg / l reduced from 16% to 8%.
Conclusions: micronutrient status of malnourished San Diu minority children in Nam Hoa commune, Dong Hy district, Thai Nguyen province was significantly improved after the food-based intervention.
Keyword: micro-nutrient deficiency, food intake, intervention, children, ethnic minority File attachments:
Raising awareness of parents and children in proper physical activity and healthy weight is an important component for childhood overweight and obesity control.
English summary: Assess the pattern of physical activity (PA) among children and parental feeding practices is the core contents for studies or interventions for controlling childhood overweight and obesity.
Objectives: (1) To determine some characteristics of physical activity among primary school children in Hai Phong City; 2) To determine the association between childhood overweight / obesity and parents' perception of their children's weight or appearance.
Methodology: A cross-sectional study measured anthropometry indexes of 256 children aged 6 - 10 years old and interviewed the children and their parents.
Results: The availability of playgrounds and parks was a promoting factor for children taking part PA.
There were associations between childhood overweight / obesity and parents' perception of their children's weight or appearance: 53.3% and 46.4% of the parents having overweight / obese and abdominal obese children, respectively thought that their children were normal.
The odds for overweight / obese children whom parents thought that they were normal weight or thin to be more overweight / obese were 1.8 or 61.2, respectively (p<0.001).
Keyword: Physical activity, sedentary activity, primary school children, overweight and obesity, Hai Phong province.
Some antioxidants in the diets of Vietnamese adults.
Meanwhile, the lycopene content in the diet in plain region was significantly lower than the city and moutatneous region 9n=30, p<0, 05).
Conclusion: The content of protective factors, antixidants including vitamin E, beta-caroten and ly-copene in the adult diet were lower than the recommended daily allowance, which revealed a possible risk of lipid metabolism status and non-communicable diseases.
Keyword: Antioxidant, vitamin E, beta-carotene, lycopene.
English summary: Objective: to evaluate the intake of antioxidants, namely vitamin E, beta-caroten and lycopene in the diets of Vietnamese adults in 4 geographic regions. The data will be used for further investtigation of the relationship between protective factors and lipid metabolism status.
Method: 120 samples of one-day dietary portion, which are representative for adult diets in 8 provinces belong-ing to the 4 geographic regions, were randomly collected based on previous data of food cosump-tion surveys.
These samples were analyzed for vitamin E, beta-caroten and lycopen by HPLC method, using UV and fluorescent detectors.
The levels of vitamin E and beta-carotene in the diet in metropolitian area were significantly higher than those in the moutaneous, sea-coast region, and plain region (non-parametric test, n=30, p<0, 05).
Management of food safety activities in street food businesses in Bac Giang city.
English summary: Building a management - oriented street food is indispensable demand of the entire society.
Results of a study on 128 street food businesses showed that: Percentage of street food businesses that were assessed as eligible food safety accounting for 78.1%; 14.4% still had unclear origin of raw materials, food additives, processing aids; 18.0% of street food businesses did not take a medical examination as prescribed. Some food additives found were not in the list; 08 frying oil samples (23.5%) were detected positive for the use of rancid scorched several times; starch was found in 24 samples of food utensils (bowls, plates after cleaning); 30.0% of beverage samples, 20% of the samples products processed from cereals (rice vermicelli, noodles, bread rolls, rolls, cakes molded..) did not meet Coliform bacteria standards; 60% of samples of vegetables eaten raw, 40.0% of beverage sample, 20% of processed meat and grain samples did not meet standards of the Escherichia coli bacterium.
Keyword: Street food, food safety.
Study on antimicrobial activities of aminoreductone.
English summary: Maillard reaction is significant for foods because it strongly affects the quality and acceptance.
In this study, antimicrobial activities of aminoreductone (AR), a product formed during the initial stage of the Maillard reaction, were screened against food-spoilage and pathogenic bacteria and compared to the effects of common antibiotics (amikacin (AN), ciprofloxacin (CIP), meropennem (MEM) and levofloxacin (LVX)).
The inhibitory effects of AR against all 7 isolates were examined by the standard disc diffusion methods, which are widely used to study the bioactivity of chemical compounds.
The inhibition zone for each isolate by AR (2.5 mg) was from 15±0 mm (Bacillus cereus ATCC® 13061™) to 28.25±0.35 mm (Staphylococcus aureus ATCC® 25923™) in diameter, suggesting that all isolates exhibited sensitivity to AR.
Because AR showed the advanced effect of growth inhibition in combination with antibiotics, AR is a naturally formed antimicrobial agent presenting in thermally processed foods with potential health benefits in medical practice.
Trends of food consumption pattern in Vietnam during XX century and its public health significance.
Swan-Neck Deformity By David R Steinberg, MD, Perelman School of Medicine at the University of Pennsylvania Reviewed / Revised Apr 2022 | Modified Sep 2022 View Patient Education Topic Resources Swan-Neck Deformity A swan-neck deformity consists of hyperextension of the proximal interphalangeal (PIP) joint, flexion of the distal interphalangeal (DIP) joint, and sometimes flexion of the metacarpophalangeal (MCP) joint.
With simultaneous thumb instability, pinch is greatly impaired.
This deformity can usually be corrected by interphalangeal arthrodesis along with tendon reconstruction at the MCP joint.
Although characteristic in rheumatoid arthritis, swan-neck deformity has several causes, including untreated mallet finger, laxity of the ligaments of the volar aspect of the proximal interphalangeal (PIP) joint (eg, as can occur after rheumatic fever or in systemic lupus erythematosus [SLE] as Jaccoud arthropathy), spasticity of intrinsic hand muscles, rupture of the flexor tendon of the PIP joint, and malunion of a fracture of the middle or proximal phalanx.
The inability to correct or compensate for hyperextension of the PIP joint makes finger closure impossible and can cause severe disability.
Treatment of swan-neck deformity is aimed at correcting the underlying disorder when possible (eg, correcting the mallet finger or any bony malalignment, releasing spastic intrinsic muscles).
Mild deformities in patients with rheumatoid arthritis may be treated with a functional ring splint.
Severe disability may require surgical treatment.
True swan-neck deformity does not affect the thumb, which has only one interphalangeal joint.
However, severe hyperextension of the interphalangeal joint of the thumb with flexion of the metacarpophalangeal (MCP) joint can occur; this is called a duck bill, Z (zigzag) type, or 90 ° - angle deformity.
Evaluation of the Hip By Alexandra Villa-Forte, MD, MPH, Cleveland Clinic Reviewed / Revised Feb 2022 | Modified Sep 2022 View Patient Education Physical Examination of the Hip Arthrocentesis of the Hip Topic Resources How to Examine the Hip An evaluation of the hip includes a physical examination and sometimes arthrocentesis.
How to Examine the Hip VIDEO Arthrocentesis of the Hip Arthrocentesis of the hip is usually done using ultrasound guidance by an orthopedic specialist or an interventional radiologist and is not discussed here.
Physical Examination of the Hip Examination begins with gait evaluation.
A limp is common among patients with significant hip arthritis and may be caused by any of the following: Pain Leg shortening Flexion contracture Muscle weakness Knee problems Loss of internal rotation (an early change in hip osteoarthritis or any hip synovitis), flexion, extension, or abduction can usually be demonstrated.
Placement of one hand on the patient's iliac crest detects pelvic movement that might be mistaken for hip movement.
Flexion contracture can be identified by attempting leg extension with the opposite hip maximally flexed to stabilize the pelvis.
Tenderness over the femoral greater trochanter suggests bursitis (which is extra-articular) rather than an intra-articular disorder.
Pain with passive range of motion (assessed by internal and external rotation with the patient supine and the hip and knee flexed to 90°) suggests intra-articular origin.
However, patients may have simultaneous intra-articular and extra-articular disorders.
Intravenous Vitamin Therapy (Myers' Cocktail) By Laura Shane-McWhorter, PharmD, University of Utah College of Pharmacy Reviewed / Revised Jan 2023 View Patient Education Claims Evidence Adverse Effects Drug Interactions References Intravenous (IV) vitamin therapy (also known as IV micronutrient therapy and hydration therapy) facilitates rapid, high blood levels of vitamins.
In 2018, the US Federal Trade Commission (FTC) charged a company marketing and selling the Myers' cocktail and other IV vitamin and mineral infusions of making "deceptive and unsupported health claims" about the ability of these infusions to treat such diseases as cancer, multiple sclerosis, diabetes, fibromyalgia, and heart failure.
The FTC argued that these health treatments and efficacy claims were false or not supported by competent and reliable scientific evidence (see FTC Cases and Proceedings).
Adverse Effects In people with abnormalities in blood levels of magnesium or potassium, infusions containing magnesium or, less commonly, potassium, can cause arrhythmias or muscle weakness.
If the infusion is administered too quickly, it can lower blood pressure (probably due to the magnesium), which can lead to light-headedness and fainting.
However, some people may have a gradual increase in blood pressure.
Other adverse effects that have been reported are depression, insomnia, and upset stomach.
The safety of IV vitamin therapy in pregnant and breastfeeding women has not been studied.
Drug Interactions Which drugs interact with IV vitamin treatments depends on which vitamins and minerals are infused and their doses.
Following are a few examples of interactions: IV vitamin B6 can lead to poorer responses to drugs taken to stimulate hematopoiesis (eg, erythropoietin, epoetin alfa, and darbepoetin alfa).
The Myers' cocktail is a popular formula among complementary and alternative medicine providers for IV vitamin therapy (1).
Ceftriaxone could bind together with infused calcium in the blood, and this combination could damage the kidneys, lungs, or gallbladder.
The Myers' formula consists of high doses of B vitamins, vitamin C, minerals (magnesium and calcium), hydroxocobalamin, pyridoxine, and dexpanthenol, mixed with sterile water.
Another multivitamin IV treatment containing thiamine, folic acid, magnesium, and a multivitamin has also been called "banana bags."
It has been used in routine clinical care to treat patients suspected of undernutrition, such as those who chronically ingest large amounts of alcohol.
Claims IV vitamin therapy is supposedly best used for people who cannot get enough vitamins and minerals because they cannot eat enough food or an illness prevents them from absorbing nutrients (2).
Some advocates claim that IV vitamin therapy can enhance wellness even in people who do not have vitamin (or mineral) deficiencies.
Clinics and companies offering the Myers' cocktail and other high-dose IV vitamin formulations claim that these infusions can do the following: Treat dehydration after extreme exercise or too much alcohol intake Boost the immune system Increase levels of energy and reduce fatigue Relieve stress, anxiety, and depression Eliminate toxins from the body Make skin healthier Treat asthma, allergies, chronic sinusitis, high blood pressure, fibromyalgia, diabetes, heart disease, acute muscle spasms, and Parkinson disease Treat migraine and tension headaches Evidence There is insufficient scientific evidence that IV vitamin therapy has any of the above beneficial effects or is effective for treating any disease (3, 4).
Dehydroepiandrosterone (DHEA) By Laura Shane-McWhorter, PharmD, University of Utah College of Pharmacy Reviewed / Revised Jan 2023 View Patient Education Claims Evidence Adverse Effects Drug Interactions References More Information Dehydroepiandrosterone (DHEA) is a steroid produced by the adrenal gland and is a precursor of estrogens and androgens.
In addition, DHEA is banned by numerous professional sports organizations as it is classified as a "prohormone."
DHEA levels are known to naturally decrease with age and therefore people in search of the unattainable fountain of youth have turned to DHEA supplementation as a possible solution to ailments associated with age.
Studies have been reported showing both positive and negative results.
More thorough studies are warranted not only with aging but with all clinical health conditions.
An analysis of data from 4 randomized controlled trials in women and men aged ≥ 55 years found that daily supplementation of DHEA compared to placebo resulted in significant increases in lumbar spine and trochanter bone mineral density in women but not men, although men had a significant decrease in fat mass (1).
A 2013 meta-analysis of data collected from studying 1353 older men in a number of trials indicated that DHEA supplementation was associated with a reduction of fat mass; however, no effect was observed for numerous other clinical parameters, including lipid and glycemic metabolism, bone health, sexual function, or quality of life (2).
A similar analysis was performed in women with adrenal insufficiency and indicated that DHEA supplementation may improve the quality of life and symptoms of depression, while having no effect on anxiety and sexual well-being (3).
A 2020 systematic review and meta-analysis of 15 randomized controlled trials in 853 subjects reported that, compared to placebo, DHEA significantly improved depressive symptoms.
However, the authors stated there was low quality of evidence because included studies had small populations with varying psychiatric diagnoses, and the results were divergent (4).
A 2006 systematic review of 5 studies found little evidence of a beneficial effect of DHEA supplementation on cognitive function of middle‐aged or older people who did not have dementia (5).
Effects on the body are similar to those of testosterone.
The Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines on complementary and alternative medicine treatments for depression treatment have stated that DHEA may be considered as third-line treatment for depression (6).
Adverse Effects Adverse effects are unclear.
There are theoretical risks of gynecomastia in men, hirsutism in women, acne, headache, mood changes, and stimulation of prostate, liver, and breast cancers.
It may decrease HDL cholesterol, increase triglycerides, and worsen polycystic ovarian syndrome (PCOS).
There are case reports of mania and one of seizure.
DHEA has triggered mania in people taking antidepressants.
DHEA may antagonize the anti-estrogenic effects of tamoxifen, aromatase inhibitors (such as anastrozole), and fulvestrant.
DHEA may increase the concentrations of the benzodiazepine triazolam, and decrease the effectiveness of bacillus Calmette-Guérin (BCG) vaccination for tuberculosis.
DHEA can also be synthesized from precursors in the wild Mexican yam; this form is the most commonly available.
However, consumption of wild yam is not recommended as a supplement as the body is unable to convert the precursors to DHEA.
Claims DHEA supplements are said to improve mood, energy, sense of well-being, and the ability to function well under stress.
They are also said to improve muscle strength and athletic performance, stimulate the immune system, deepen nightly sleep, lower cholesterol levels, decrease body fat, build muscles, increase bone mineral density, relieve depression, reverse aging, improve the appearance of aging skin, improve brain function in patients with Alzheimer disease, treat infertility in females undergoing assisted reproduction, increase libido, and decrease symptoms of systemic lupus erythematosus.
A prescription DHEA ovule or suppository has been used to treat vaginal atrophy.
Evidence The medicinal claims of DHEA have not been fully supported by the evidence.
Stroke Rehabilitation By Salvador E Portugal, DO, New York University, Robert I Grossman School of Medicine Reviewed / Revised Aug 2021 | Modified Sep 2022 View Patient Education Rehabilitation after stroke aims to preserve or improve range of motion, muscle strength, bowel and bladder function, and functional and cognitive abilities.
Ambulation problems, spasticity, visual field defects (eg, hemianopia), incoordination, and aphasia require specific therapy.
Hemiplegia For patients with hemiplegia, placing 1 or 2 pillows under the affected arm can prevent dislocation of the shoulder.
A posterior foot splint applied with the ankle in a 90° position can prevent equinus deformity (talipes equinus) and footdrop.
Resistive exercise for hemiplegic extremities may increase spasticity and thus is controversial.
However, reeducation and coordination exercises of the affected extremities are added as soon as tolerated, often within 1 week.
Active and active-assistive range-of-motion exercises are started shortly afterward to maintain range of motion.
Active exercise of the unaffected extremities must be encouraged, as long as it does not cause fatigue.
Various activities of daily living (eg, moving in bed, turning, changing position, sitting up) should be practiced.
For hemiplegic patients, the most important muscle for ambulation is the unaffected quadriceps.
Specific programs are based on the patient's social situation (eg, prospects of returning to home or work), ability to participate in a rehabilitation program supervised by nurses and therapists, learning ability, motivation, and coping skills.
A gait abnormality in hemiplegic patients is caused by many factors (eg, muscle weakness, spasticity, distorted body image) and is thus difficult to correct.
Also, attempts to correct gait often increase spasticity, may result in muscle fatigue, and may increase the already high risk of falls, which often result in a hip fracture; functional prognosis of hemiplegic patients with a hip fracture is very poor.
Consequently, as long as hemiplegic patients can walk safely and comfortably, gait correction should not be tried.
Additional treatments for hemiplegia may include the following: Constraint-induced movement therapy: The functional limb is restrained during waking hours, except during specific activities, and patients are forced to do tasks mainly with the affected extremity.
Robotic therapy: Robotic devices are used to provide intensive repetition of the therapeutic movement, guide an affected extremity in executing the movement, provide feedback (eg, on a computer screen) for patients, and measure patient progress.
Partial weight-supported ambulation: A device (eg, treadmill) that bears part of a patient's weight is used during ambulation.
The amount of weight borne and speed of ambulation can be adjusted.
This approach is often used with robotics, which allows patients to contribute to ambulation but provides force as needed for ambulation.
Total body vibration: Patients stand on an exercise machine with a platform that vibrates by rapidly shifting weight from one foot to the other.
A stroke that impairs comprehension often makes rehabilitation very difficult.
The movement stimulates reflexive muscle contraction.
Ambulation problems Before ambulation exercises can be started, patients must be able to stand.
Patients first learn to stand from the sitting position.
The height of the seat may need to be adjusted.
Patients must stand with the hips and knees fully extended, leaning slightly forward and toward the unaffected side.
Using the parallel bars is the safest way to practice standing.
The goal of ambulation exercises is to establish and maintain a safe gait, not to restore a normal gait.
Most hemiplegic patients have a gait abnormality, which is caused by many factors (eg, muscle weakness, spasticity, distorted body image) and is thus difficult to correct.
Also, attempts to correct gait often increase spasticity, may result in muscle fatigue, and may increase the already high risk of falls.
During ambulation exercises, patients place the feet > 15 cm (> 6 in) apart and grasp the parallel bars with the unaffected hand.
Patients take a shorter step with the hemiplegic leg and a longer step with the unaffected leg.
Patients who begin walking without the parallel bars may need physical assistance from and later close supervision by the therapist.
Generally, patients use a cane or walker when first walking without the parallel bars.
The diameter of the cane handle should be large enough to accommodate an arthritic hand.
For stair-climbing, ascent starts with the better leg, and descent starts with the affected leg (good leads up; bad leads down).
If possible, patients ascend and descend with the railing on the unaffected side, so that they can grasp the railing.
Looking up the staircase may cause vertigo and should be avoided.
During descent, patients should use a cane.
The cane should be moved to the lower step shortly before descending with the bad leg.
Patients must learn to prevent falls, which are the most common accident among stroke patients and which often result in hip fracture.
To prevent secondary disabilities (eg, contractures) and help prevent depression, rehabilitation should begin as soon as patients are medically stable.
For hemiplegic patients, who almost always fall on their hemiplegic side, leaning their affected side against a railing (when standing or climbing stairs) can help prevent falls.
Doing strengthening exercises for weak muscles, particularly in the trunk and legs, can also help.
For patients with symptomatic orthostatic hypotension, treatment includes support stockings, drugs, and tilt table training.
Because hemiplegic patients are prone to vertigo, they should change body position slowly and take a moment after standing to establish equilibrium before walking.
Comfortable, supportive shoes with rubber soles and with heels ≤ 2 cm (3/4 in) should be worn.
Spasticity In some stroke patients, spasticity develops.
Spasticity is an increased, involuntary, velocity-dependent muscle tone that causes resistance to movement (1).
Spasticity may be painful and debilitating.
Slightly spastic knee extensors can lock the knee during standing or cause hyperextension (genu recurvatum), which may require a knee brace with an extension stop.
Preventive measures for pressure ulcers must be started even before patients are medically stable.
Flexor spasticity develops in most hemiplegic hands and wrists.
Unless patients with flexor spasticity do range-of-motion exercises several times a day, flexion contracture may develop rapidly, resulting in pain and difficulty maintaining personal hygiene.
Patients and family members are taught to do these exercises, which are strongly encouraged.
A hand or wrist splint may also be useful, particularly at night.
Heat or cold therapy can temporarily decrease spasticity and allow the muscle to be stretched.
Hemiplegic patients may be given benzodiazepines to minimize apprehension and anxiety, particularly during the initial stage of rehabilitation, but not to reduce spasticity.
The effectiveness of long-term benzodiazepine therapy for reducing spasticity is questionable.
Methocarbamol has limited value in relieving spasticity and causes sedation.
Patients can safely begin sitting up once they are fully conscious and neurologic deficits are no longer progressing, usually ≤ 48 hours after the stroke.
Pract Neurol 12 (5): 289 - 298, 2012. doi: 10.1136 / practneurol-2011 - 000155 Hemianopia Patients with hemianopia (defective vision or blindness in half the visual field of one or both eyes) should be made aware of it and taught to move their heads toward the hemiplegic side when scanning.
Family members can help by placing important objects and by approaching the patient on the patient's unaffected side.
Repositioning the bed so that patients can see a person entering the room through the doorway may be useful.
While walking, patients with hemianopia tend to bump into the door frame or obstacles on the hemiplegic side; they may need special training to avoid this problem.
When reading, patients who have difficulty looking to the left may benefit from drawing a red line on the left side of the newspaper column.
When they reach the end of a line of text, they scan to the left of the column until they see the red line, cueing them to begin reading the next line.
Using a rule to keep focused on each line of text may also help.
Occupational therapy After a stroke, fine coordination may be absent, causing patients to become frustrated.
Occupational therapists may need to modify patients' activities and recommend assistive devices (see table Assistive Devices).
Early in the rehabilitation period, when the affected extremities are flaccid, each joint is passively exercised through the normal range of motion 3 to 4 times / day.
Occupational therapists should also evaluate the home for safety and determine the extent of social support.
They can help obtain any necessary devices and equipment (eg, bathtub bench, grab bars by the bathtub or toilet).
Occupational therapists can also recommend modifications that enable patients to do activities of daily living (ADLs) as safely and independently as possible—for example, rearranging the furniture in living areas and removing clutter.
Patients and caregivers are taught how to transfer between surfaces (eg, shower, toilet, bed, chair) and, if necessary, how to modify ways of doing ADLs.
For example, patients may be taught to dress or shave using only one hand and to eliminate unnecessary motion while preparing food or shopping for groceries.
Therapists may suggest using clothing and shoes with touch fasteners (eg, Velcro) or dinner plates with rims and rubber grips (to facilitate handling).
Patients with impairments in cognition and perception are taught ways to compensate.
For example, they can use drug organizers (eg, containers marked for each day of the week).
Regaining the ability to get out of bed and to transfer to a chair or wheelchair safely and independently is important for the patient's psychologic and physical well-being.
Cognitive Errors in Clinical Decision Making By Brian F Mandell, MD, PhD, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University Reviewed / Revised May 2021 | Modified Sep 2022 View Patient Education Types of Cognitive Error Risk Factors for Cognitive Error Although quantitative mathematical models can guide clinical decision making, clinicians can only rarely use formal computations to make patient care decisions in day-to-day practice.
Availability error Availability error is when clinicians choose the first thing that comes to their mind.
This often misestimates the actual pretest probability of a disease because a recent or memorable experience makes a given diagnosis more "available" to come to mind.
Experience often leads to overestimation of probability when there is memory of a case that was dramatic, involved a patient who fared poorly, or a lawsuit.
For example, a clinician who recently missed the diagnosis of pulmonary embolism in a healthy young woman who had vague chest discomfort but no other findings or apparent risk factors might then overestimate the risk of pulmonary embolism in similar patients and become more likely to order chest CT angiography for similar patients despite the low probability of disease.
Experience can also lead to underestimation.
For example, a junior resident who has seen only a few patients with chest pain, all of whom turned out to have benign causes, may do a cursory evaluation for cardiovascular or thromboembolic disease even among patient populations in whom the disease prevalence is moderately high.
Representation error Representation error is when clinicians focus on the presence or absence of classic manifestations of a disease without taking into account disease prevalence.
For example, although several hours of vague chest discomfort in a thin, athletic, healthy-appearing 60-year-old man who has no known medical problems and who now looks and feels well does not match the typical profile of a myocardial infarction, it would be unwise to dismiss that possibility because myocardial infarction is common among men of that age and has highly variable manifestations.
Conversely, a 20-year-old healthy man with sudden onset of severe, sharp chest pain and back pain may be suspected of having a dissecting thoracic aortic aneurysm because those clinical features are common in aortic dissection.
The cognitive error is not taking into account the fact that aortic dissections are exceptionally rare in a 20-year-old, otherwise healthy patient without a family history of such events; that disorder can be dismissed and other, more likely causes (eg, pneumothorax, pleuritis) should be considered.
Rather, an intuitive understanding of probabilities is combined with cognitive processes called heuristics to guide clinical judgment.
Representation error also occurs when clinicians fail to recognize that positive test results (for any test with a less than 100% specificity) in a population where the tested disease is rare are more likely to be false positive than true positive.
Premature closure Premature closure is jumping to conclusions.
This is one of the most common errors; clinicians make a quick diagnosis (often based on pattern recognition), fail to consider other possible diagnoses, and prematurely stop collecting data.
The suspected diagnosis is often not even confirmed by appropriate testing.
Premature closure errors may occur in any case but are particularly common when patients seem to be having an exacerbation of a known disorder—eg, if a woman with a long history of migraine presents with a severe headache (and actually has a new subarachnoid hemorrhage), the headache may be mistakenly assumed to be another attack of migraine.
A variation of premature closure occurs when subsequent clinicians (eg, consultants on a complicated case) unquestioningly accept a previous working diagnosis without independently collecting and reviewing relevant data.
Electronic medical records may exacerbate premature closure errors because incorrect diagnoses may be propagated until they are removed.
Anchoring errors Anchoring errors are when clinicians steadfastly cling to an initial impression even as conflicting and contradictory data accumulate.
For example, a working diagnosis of acute pancreatitis is quite reasonable in a 60-year-old man who has epigastric pain and nausea, who is sitting forward clutching his abdomen, and who has a history of several bouts of alcoholic pancreatitis that he states have felt similar to what he is currently feeling.
However, if the patient states that he has had no alcohol in many years and has normal blood levels of pancreatic enzymes, clinicians who simply dismiss or excuse (eg, the patient is lying, his pancreas is burned out, the laboratory made a mistake) these conflicting data are committing an anchoring error.
Heuristics are often referred to as rules of thumb, educated guesses, or mental shortcuts.
Clinicians should regard conflicting data as evidence of the need to continue to seek the true diagnosis (acute myocardial infarction) rather than as anomalies to be disregarded.
There may be no supporting evidence (ie, for the misdiagnosis) in some cases in which anchoring errors are committed.
Confirmation bias Confirmation bias is "cherry-picking," which means clinicians selectively accept clinical data that support a desired hypothesis and ignore data that do not.
Confirmation bias often compounds an anchoring error when the clinician uses confirmatory data to support the anchored hypothesis even when clearly contradictory evidence is also available.
For example, a clinician may steadfastly cling to patient history elements suggesting acute coronary syndrome (ACS) to confirm the original suspicion of ACS even when serial ECGs and cardiac enzymes are normal.
Attribution errors Attribution errors involve making decisions based on negative stereotypes, which can lead clinicians to ignore or minimize the possibility of serious disease.
For example, clinicians might assume that an unconscious patient with an odor of alcohol is "just another drunk" and miss hypoglycemia, ketosis, or intracranial injury, or they might assume that a known drug abuser with back pain is simply seeking drugs and miss an epidural abscess.
Psychiatric patients who develop a physical disorder are particularly likely to be subject to attribution errors because not only may they be subject to negative stereotyping but they often describe their symptoms in unclear, inconsistent, or confusing ways, leading unwary clinicians to assume their complaints are functional in nature.
Affective error Affective error involves letting personal feelings (positive or negative) about a patient affect decisions.
For example, avoiding unpleasant but necessary tests or examinations because of fondness or sympathy for the patient (eg, avoiding a pelvic examination and STD testing on a patient who is religious or a highly positioned executive or avoiding blood cultures on a seriously ill patient who has poor veins).
Heuristics usually involve pattern recognition and rely on a subconscious integration of somewhat haphazardly gathered patient data with prior experience rather than on a conscious generation of a rigorous differential diagnosis that is formally evaluated using specific data from the literature.
Similarly, affective error includes failing to pursue a standard evaluation on an unlikeable patient (eg, minimizing the significance of dyspnea in a verbally abusive patient or someone with chronic obstructive pulmonary disease who continues to smoke).
Risk Factors for Cognitive Error Internal and external factors can increase the risk of cognitive error.
Internal factors include Medical knowledge, training, and experience Fatigue / sleep deprivation Balance between being risk accepting / risk averse External factors include Workload Distractions Team resource management and peer pressures Minimizing cognitive errors Some specific strategies can help minimize cognitive errors.
Typically, after history and physical examination are done, clinicians often form a working diagnosis based on heuristics.
At this point, it is relatively easy to insert a formal pause for reflection, asking several questions: If it is not the working diagnosis, what else could it be?
What are the most dangerous things it could be?
Is there any evidence that is at odds with the working diagnosis?
These questions can help expand the differential diagnosis to include things that may have been left out because of cognitive errors and thus trigger clinicians to obtain further necessary information.
Such informal reasoning is fallible because heuristics may cause several types of unconscious errors (cognitive errors).
Studies suggest that more medical errors involve cognitive error than lack of knowledge or information.
Types of Cognitive Error There are many types of cognitive (reasoning) errors, and although it is obviously more important to avoid errors than to properly classify them once made, being aware of common types of cognitive errors can help clinicians recognize and avoid them.
Cognitive errors may roughly be classified as those involving Faulty assessment of pre-test probability (overestimating or underestimating disease likelihood) Failure to seriously consider all relevant possibilities Pearls & Pitfalls There are numerous named types of cognitive error, but they tend to fall into 2 groups: faulty assessment of pre-test probability and failure to seriously consider all relevant possibilities.
Both types of error can easily lead to improper testing (too much or too little) and missed diagnoses.
Confidentiality and HIPAA By Charles Sabatino, JD, American Bar Association Reviewed / Revised May 2021 | Modified Sep 2022 View Patient Education Traditionally, ethical health care has always included the need to keep patients' medical information confidential.
Access to medical records Typically, patients or their authorized representatives should be able to see and obtain copies of their medical records and request corrections if they identify errors.
For purposes of the Privacy Rule, an authorized "personal representative" of the patient is a guardian with authority over health decisions, a proxy appointed in a power of attorney for health care, or a family member or friend authorized to serve as a surrogate for health decisions under state law.
Notice of privacy practices Health care providers must provide a notice about their possible uses of personal medical information and about patient rights under HIPAA regulations.
Limits on use of personal medical information HIPAA limits how health care providers may use PHI.
The act does not restrict physicians, nurses, and other practitioners from sharing information needed to treat their patients.
Disclosures to health information exchanges and public health agencies for public health purposes during events such as the COVID-19 pandemic are also permissible disclosures under guidelines of the Office for Civil Rights in the US Department of Health and Human Services.
However, practitioners may use or share only the minimum amount of protected information needed for a particular purpose.
In most situations, personal health information may not be used for purposes unrelated to health care.
HIPAA requires that the patient's specific authorization must be obtained before disclosing information for marketing purposes.
Health care providers must disclose any payments that will be received as a result of marketing.
However, health care providers can freely communicate with patients about treatment options, products, and other health-related services, including disease-management programs.
Confidential communications Practitioners should take reasonable steps to ensure that their communications with the patient are confidential and in accord with patient preferences.
For example, physician-patient medical discussions generally should be in private, or a patient might prefer that the physician call their office rather than home.
Nonetheless, unless the patient objects, practitioners can share medical information with a patient's immediate family members or someone known to be a close personal friend if the information relates to that person's involvement with the patient's care or payment for care and the information is limited to what is necessary to that person's involvement.
Practitioners are expected to exercise professional judgment.
An authorized personal representative of the patient should be treated the same as the patient with respect to access to information and participation in decision-making.
Thus, the representative has the same access to information and may exercise the same rights regarding confidentiality of information.
Collectively, these are covered entities under HIPAA.
Nevertheless, practitioners may restrict information or access if there are reasonable concerns about domestic violence, abuse, or neglect by the representative.
Health care practitioners are sometimes required by law to disclose certain information, usually because the condition may present a danger to other people.
For example, certain infectious diseases (eg, COVID-19, HIV, syphilis, TB) must be reported to state or local public health agencies.
Signs of child and, in many states, adult or elder abuse or neglect, typically must be reported to protective services.
Conditions that might seriously impair a patient's ability to drive, such as dementia or recent seizures, must be reported to the Department of Motor Vehicles in some states.
Complaints Patients may file complaints about compliance with these privacy practices.
Complaints can be made directly to the health care practitioner, the Office for Civil Rights in the US Department of Health and Human Services, or the privacy compliance officer designated by the institution in compliance with HIPAA.
There are civil and criminal penalties for improper disclosure of personal health information.
Key provisions of HIPAA are embodied in three rules (now contained in an omnibus rule): the Privacy, Security, and Breach Notification rules, all of which are intended to protect the privacy and security of individually identifiable health information, referred to as protected health information (PHI).
The soundest course for health care practitioners is to be well informed about HIPAA, to act in good faith, and make reasonable attempts to comply.
The Privacy Rule sets standards for the protection of PHI and gives patients important rights with respect to their health information.
The Security Rule establishes safeguards that covered entities and their business associates must implement to protect the privacy, integrity, and security of electronic PHI.
The Breach Notification Rule requires covered entities to notify affected individuals, the federal government, and in some cases, the media of a breach of unsecured PHI.
The Office for Civil Rights in the US Department of Health and Human Services enforces these three rules and provides guidance on complying with the rules.
Key aspects of the Privacy Rule are elaborated below.
Alcohol Toxicity and Withdrawal By Gerald F O'Malley, DO, Grand Strand Regional Medical Center; Rika O'Malley, MD, Grand Strand Medical Center Reviewed / Revised Dec 2022 View Patient Education Pathophysiology Symptoms and Signs Diagnosis Treatment Topic Resources Alcohol Consumption Screening... CIWA-Ar Clinical Institute... Alcohol (ethanol) is a central nervous system depressant.
However, acute alcohol intoxication is a significant factor in injuries, particularly those due to interpersonal violence, suicide, and motor vehicle crashes.
Treatment may include IV thiamin to prevent Wernicke encephalopathy Benzodiazepines or phenobarbital to manage agitation and / or seizures Thiamin 100 mg IV is given to prevent Wernicke encephalopathy.
Alcohol-tolerant people are cross-tolerant to some drugs commonly used to treat withdrawal (eg, benzodiazepines).
Benzodiazepines are the mainstay of therapy.
Dosage and route depend on degree of agitation, vital signs, and mental status.
Diazepam, given 5 to 10 mg IV or orally hourly until sedation occurs, is a common initial intervention; lorazepam 1 to 2 mg IV or orally is an alternative.
Chlordiazepoxide 50 to 100 mg orally every 4 to 6 hours, then tapered, is an older acceptable alternative for less severe cases of withdrawal.
Phenobarbital 10 mg / kg (ideal body weight) IV may be used as an alternative, or in conjunction with benzodiazepines if benzodiazepines alone are ineffective, but respiratory depression is a risk with concomitant use.
Carbamazepine, gabapentin, or valproic acid (when there is no liver disease or pregnancy) may also be used as an adjunct to benzodiazepines or when benzodiazepines are contraindicated (1).
Phenothiazines and haloperidol are not recommended initially because they may lower the seizure threshold.
For patients with a significant liver disorder, a short-acting benzodiazepine (lorazepam) or one metabolized by glucuronidation (oxazepam) is preferred.
Chronic alcohol abuse interferes with the ability to socialize and work.
(NOTE: Benzodiazepines may cause intoxication, physical dependence, and withdrawal in patients with alcohol use disorder and therefore should not be continued after the detoxification period.
Carbamazepine 200 mg orally 4 times a day may be used as an alternative and then tapered)
For severe hyperadrenergic activity or to reduce benzodiazepine requirements, short-term therapy (12 to 48 hours) with titrated beta-blockers (eg, metoprolol 25 to 50 mg orally or 5 mg IV every 4 to 6 hours) and clonidine 0.1 to 0.2 mg IV every 2 to 4 hours can be used, but only as an adjunct and only if absolutely necessary.
A seizure, if brief and isolated, needs no specific therapy; however, some clinicians routinely give a single dose of lorazepam 1 to 2 mg IV as prophylaxis against another seizure.
Repeated or longer-lasting (ie, > 2 to 3 minutes) seizures should be treated and often respond to lorazepam 1 to 3 mg IV.
Routine use of phenytoin is unnecessary and unlikely to be effective.
Outpatient therapy with phenytoin is rarely indicated for patients with simple alcohol withdrawal seizures when no other source of seizure activity has been identified because seizures occur only under the stress of alcohol withdrawal, and patients who are withdrawing or heavily drinking may not take antiseizure drugs.
Delirium tremens may be fatal and thus must be treated promptly with high-dose IV benzodiazepines, preferably in an intensive care unit.
Dosing is higher and more frequent than in mild withdrawal.
Very high doses of benzodiazepines may be required, and there is no maximum dose or specific treatment regimen.
Although estimates vary across studies, about 13.9% of adults meet criteria for an alcohol use disorder (abuse or dependence) in any given year (1).
Diazepam 5 to 10 mg IV or lorazepam 1 to 2 mg IV every 10 minutes is given as needed to control delirium; some patients require several hundred milligrams over the first few hours.
In patients with severe symptoms, evidence suggests dosing regimens of diazepam starting at 10 mg IV with doubling of the dose every 10 to 15 minutes until the patient is sedated is efficacious.
Patients refractory to high-dose benzodiazepines may respond to phenobarbital 120 to 240 mg IV every 20 minutes as needed; however, if phenobarbital is used after benzodiazepines, respiratory depression can be significant.
As an alternative, phenobarbital may be used as the first agent.
Severe drug-resistant DT can be treated with a continuous infusion of lorazepam, diazepam, midazolam, propofol, or dexmedetomidine, usually with concomitant mechanical ventilation.
Physical restraints should be avoided if possible to minimize additional agitation, but patients must not be allowed to escape, remove IVs, or otherwise endanger themselves.
Appreciably elevated temperature with DT is a poor prognostic sign.
Binge drinking, defined as consuming ≥ 5 drinks per occasion for men and ≥ 4 drinks per occasion for women, is a particular problem among younger people.
JAMA Psychiatry 72 (8): 757 - 766, 2015. doi: 10.1001 / jamapsychiatry.2015.0584 Pathophysiology of Alcohol Toxicity and Withdrawal One serving of alcohol (one 12-oz can of beer, one 6-oz glass of wine, or 1.5 oz of distilled liquor) contains 10 to 15 g of ethanol.
Alcohol is absorbed into the blood mainly from the small bowel, although some is absorbed from the stomach.
The concentration peaks about 30 to 90 minutes after ingestion if the stomach was previously empty.
Large amounts consumed rapidly can cause respiratory depression, coma, and death.
About 5 to 10% of ingested alcohol is excreted unchanged in urine, sweat, and expired air; the remainder is metabolized, mainly by the liver, where alcohol dehydrogenase converts ethanol to acetaldehyde.
Acetaldehyde is ultimately oxidized to CO2 and water at a rate of 5 to 10 mL / hour (of absolute alcohol); each milliliter yields about 7 kcal.
Alcohol dehydrogenase in the gastric mucosa accounts for some metabolism; women have lower gastric alcohol dehydrogenase activity than men.
Alcohol exerts its effects by several mechanisms.
Chronic effects Tolerance to alcohol develops rapidly; similar amounts cause less intoxication.
Tolerance is caused by adaptational changes of central nervous system cells (cellular, or pharmacodynamic, tolerance) and by induction of metabolic enzymes.
People who develop tolerance may reach an incredibly high blood alcohol content (BAC).
However, ethanol tolerance is incomplete, and considerable intoxication and impairment occur with a large enough amount.
Large amounts chronically consumed damage the liver and many other organs.
But even people who have developed tolerance may die of respiratory depression secondary to alcohol overdose.
Alcohol-tolerant people are susceptible to alcoholic ketoacidosis, especially during binge drinking.
Alcohol-tolerant people are cross-tolerant to many other central nervous system depressants (eg, barbiturates, nonbarbiturate sedatives, benzodiazepines).
The physical dependence accompanying tolerance is profound, and alcohol withdrawal has potentially fatal adverse effects.
Chronic heavy alcohol intake typically leads to liver disorders (eg, fatty liver, alcoholic hepatitis, cirrhosis); the amount and duration required vary (see Alcohol-Related Liver Disease).
Patients with a severe liver disorder often have coagulopathy due to decreased hepatic synthesis of coagulation factors, increasing the risk of significant bleeding due to trauma (eg, from falls or vehicle crashes) and of gastrointestinal bleeding (eg, due to gastritis, from esophageal varices due to portal hypertension); alcohol abusers are at particular risk of gastrointestinal bleeding.
Chronic heavy intake also commonly causes the following: Gastritis Pancreatitis Cardiomyopathy, often accompanied by arrhythmias and hypertension Peripheral neuropathy Brain damage, including Wernicke encephalopathy, Korsakoff psychosis, Marchiafava-Bignami disease, and alcohol-related dementia Certain cancers (eg, liver, head and neck, esophageal), especially when drinking is combined with smoking Indirect long-term effects include undernutrition, particularly vitamin deficiencies.
On the other hand, low to moderate levels of alcohol consumption (≤ 1 to 2 drinks / day) may decrease the risk of death due to cardiovascular disorders (1).
Numerous explanations, including increased high density lipoprotein (HDL) levels and a direct antithrombotic effect, have been suggested.
Alcohol withdrawal manifests as a continuum, ranging from tremor to seizures, hallucinations, and life-threatening autonomic instability in severe withdrawal (delirium tremens).
Special populations Young children who drink alcohol are at significant risk of hypoglycemia because alcohol impairs gluconeogenesis and their smaller stores of glycogen are rapidly depleted.
Women may be more sensitive than men, even on a per-weight basis, because their gastric (first-pass) metabolism of alcohol is less due to lower activity of alcohol dehydrogenase in the gastric mucosa.
Drinking during pregnancy may result in fetal alcohol spectrum disorder.
Symptoms and Signs of Alcohol Toxicity and Withdrawal Acute effects Symptoms progress proportionately to blood alcohol content (BAC).
Actual levels required to cause given symptoms vary with tolerance, but in typical users the following occur: 20 to 50 mg / dL (4.3 to 10.9 mmol / L): Tranquility, mild sedation, and some decrease in fine motor coordination 50 to 100 mg / dL (10.9 to 21.7 mmol / L): Impaired judgment and a further decrease in coordination 100 to 150 mg / dL (21.7 to 32.6 mmol / L): Unsteady gait, nystagmus, slurred speech, loss of behavioral inhibitions, and memory impairment 150 to 300 mg / dL (32.6 to 65.1 mmol / L): Delirium and lethargy (likely) Emesis is common with moderate to severe intoxication; because emesis usually occurs with obtundation, aspiration is a significant risk.
In US states, the legal definition of intoxication is a BAC of ≥ 0.08% (≥ 80 mg / dL, [17.4 mmol / L]); 0.08% is used most commonly.
Toxicity or overdose In alcohol-naïve people, a BAC of 300 to 400 mg / dL (65.1 to 86.8 mmol / L) often causes unconsciousness, and a BAC ≥ 400 mg / dL (86.8 mmol / L) may be fatal.
Diagnosis is clinical or based on diagnosis of typical complications (eg, alcohol-related liver disease).
Sudden death due to respiratory depression or arrhythmias may occur, especially when large quantities are drunk rapidly.
Other common effects include hypotension and hypoglycemia.
The effect of a particular BAC varies widely; some chronic drinkers seem unaffected and appear to function normally with a BAC in the 300 to 400 mg / dL (65.1 to 86.8 mmol / L) range, whereas nondrinkers and social drinkers are impaired at a BAC that is inconsequential in chronic drinkers.
Chronic effects Stigmata of chronic use include vascular spiders, and, in men, signs of hypogonadism and feminization (eg, smooth skin, lack of male-pattern baldness, gynecomastia, testicular atrophy).
Undernutrition may lead to enlarged parotid glands.
Withdrawal A continuum of symptoms and signs of central nervous system (including autonomic) hyperactivity may accompany cessation of alcohol intake.
A mild alcohol withdrawal syndrome includes tremor, weakness, headache, sweating, hyperreflexia, and gastrointestinal symptoms.
Tachycardia may be present and blood pressure can be slightly elevated.
Symptoms usually begin within about 6 hours of cessation.
Some patients have generalized tonic-clonic seizures (called alcohol-related seizure, or rum fits) but usually not > 2 in short succession.
(See also Alcohol Use Disorder and Rehabilitation.)
Seizures generally occur 6 to 48 hours after cessation of alcohol.
Alcoholic hallucinosis (hallucinations without other impairment of consciousness) follows abrupt cessation from prolonged, excessive alcohol use, usually within 12 to 24 hours.
Hallucinations are typically visual.
Symptoms may also include auditory illusions and hallucinations that frequently are accusatory and threatening; patients are usually apprehensive and may be terrified by the hallucinations and by vivid, frightening dreams.
Symptoms do not resemble the delirious state of an acute organic brain syndrome as much as does delirium tremens (DT) or other pathologic reactions associated with withdrawal.
Consciousness remains clear, and the signs of autonomic lability that occur in DT are usually absent.
When hallucinosis occurs, it usually precedes DT and is transient.
Delirium tremens usually begins 48 to 72 hours after alcohol withdrawal; anxiety attacks, increasing confusion, poor sleep (with frightening dreams or nocturnal illusions), profuse sweating, and severe depression also occur.
Fleeting hallucinations that arouse restlessness, fear, and even terror are common.
About half of adults in the US currently drink alcohol, 20% are former drinkers, and 30 to 35% are lifetime abstainers.
Typical of the initial delirious, confused, and disoriented state is a return to a habitual activity; eg, patients frequently imagine that they are back at work and attempt to do some related activity.
Autonomic lability, evidenced by diaphoresis and increased pulse rate and temperature, accompanies the delirium and progresses with it.
Mild delirium is usually accompanied by marked diaphoresis, a pulse rate of 100 to 120 beats / minute, and a temperature of 37.2 to 37.8 ° C Marked delirium, with gross disorientation and cognitive disruption, is accompanied by significant restlessness, a pulse of > 120 beats / minute, and a temperature of > 37.8 ° C; risk of death is high.
During delirium tremens, patients are suggestible to many sensory stimuli, particularly to objects seen in dim light.
Vestibular disturbances may cause them to believe that the floor is moving, the walls are falling, or the room is rotating.
As the delirium progresses, resting tremor of the hand develops, sometimes extending to the head and trunk.
Symptoms vary among patients but are usually the same for a particular patient with each recurrence.
Diagnosis of Alcohol Toxicity and Withdrawal Usually a clinical diagnosis Acute intoxication: Sometimes blood alcohol content (BAC) and a rapid blood glucose test Chronic use: Complete blood count, magnesium, liver tests, and PT / PTT Withdrawal: Evaluation to rule out central nervous system injury and infection Diagnosis is usually made based on typical signs and symptoms.
In acute alcohol intoxication, laboratory tests are generally not helpful; diagnosis is usually made clinically.
Exceptions include fingerstick glucose to rule out hypoglycemia and sometimes tests to determine BAC.
Confirmation by breath or blood alcohol levels is useful for legal purposes (eg, to document intoxication in drivers or employees who appear impaired).
BAC levels do not always correlate to level of intoxication; for a given BAC level, chronic drinkers may have less impairment compared to a person who does not drink regularly.
However, finding a low BAC in patients who have altered mental status is helpful because it expedites the search for an alternate cause.
Clinicians should not assume that a high BAC in patients with apparently minor trauma accounts for their obtundation, which may be due to intracranial injury or other abnormalities.
Such patients should also have additional evaluation to search for evidence of trauma or toxicity due to other substances.
Chronic alcohol abuse and dependence are clinical diagnoses; experimental markers of long-term use have not proved sufficiently sensitive or specific for general use.
Screening tests such as AUDIT (Alcohol Use Disorders Identification Test) or the CAGE questionnaire can be used.
However, heavy alcohol users may have a number of metabolic derangements that are worth screening for, so complete blood count, electrolytes (including magnesium), liver tests (including coagulation profile [PT / PTT]), serum ammonia, and serum albumin are often recommended.
In severe withdrawal and toxicity, symptoms may resemble those of central nervous system injury or infection.
For most drinkers, the frequency and amount of alcohol consumption does not impair physical or mental health or the ability to safely carry out daily activities.
Because concomitant medical and surgical conditions can occur simultaneously with alcohol withdrawal, medical evaluation with CT and lumbar puncture may be needed.
Patients with mild symptoms do not require routine testing unless improvement is not marked within 2 to 3 days.
A clinical assessment tool for severity of alcohol withdrawal is available.
Treatment of Alcohol Toxicity and Withdrawal Supportive measures For withdrawal, benzodiazepines and sometimes also phenobarbital or propofol Toxicity or overdose Treatment of alcohol toxicity may include the following: Airway protection Sometimes IV fluids with thiamin, magnesium, and vitamins The first priority is ensuring an adequate airway; endotracheal intubation and mechanical ventilation are required for apnea or inadequate respirations.
IV hydration is needed for hypotension or evidence of volume depletion but does not significantly enhance ethanol clearance.
When IV fluids are used, a single dose of thiamin 100 mg IV is given to treat or prevent Wernicke encephalopathy.
Many clinicians also add multivitamins and magnesium to the IV fluids.
Pearls & Pitfalls IV hydration does not significantly enhance ethanol clearance.
Disposition of the acutely intoxicated patient depends on clinical response, not a specific BAC.
Withdrawal Patients with severe alcohol withdrawal or delirium tremens should be managed in an intensive care unit until these symptoms abate.
Preoperative Evaluation By Paul K Mohabir, MD, Stanford University School of Medicine; André V Coombs, MBBS, Texas Tech University Health Sciences Center Reviewed / Revised Nov 2020 | Modified Sep 2022 View Patient Education Procedural Risk Factors Patient Risk Factors More Information Topic Resources Body Mass Index (Quetelet's... Algorithm for risk stratification... Before elective surgical procedures, whether done in an outpatient or inpatient setting, the surgical team may consult an internist for a formal preoperative evaluation to minimize risk by identifying correctable abnormalities and by determining whether additional perioperative monitoring and treatment are needed.
For example, if an emergency procedure is required (eg, for intra-abdominal hemorrhage, perforated viscus, necrotizing fasciitis), there is usually no time for a full preoperative evaluation.
However, the patient's history should be reviewed as expeditiously as possible, particularly for allergies and to help identify factors that increase risk of emergency surgery (eg, history of bleeding problems or adverse anesthetic reactions).
History A relevant preoperative history includes information about all of the following: Current symptoms suggesting an active cardiopulmonary disorder (eg, cough, chest pain, dyspnea during exertion, ankle swelling) or infection (eg, fever, dysuria) Risk factors for excessive bleeding (eg, known bleeding disorder, history of bleeding excessively with dental procedures, elective surgeries, or childbirth) Risk factors for thromboembolism (Professional. see p Deep Venous Thrombosis (DVT)) Risk factors for infection Risk factors for cardiac disease Known disorders that increase risk of complications, particularly hypertension, heart disease, kidney disease, liver disease, diabetes, asthma, and COPD (chronic obstructive pulmonary disease) Previous surgery, anesthesia, or both, particularly their complications Allergies Tobacco, alcohol, and illicit drug use Current prescription and nonprescription drug and supplement use History of obstructive sleep apnea or excessive snoring If an indwelling bladder catheter may be needed, patients should be asked about prior urinary retention and prostate surgery.
Physical examination Physical examination should address not only areas affected by the surgical procedure but also the cardiopulmonary system, as well as a search for any signs of ongoing infection (eg, upper respiratory tract, skin).
When spinal anesthesia is likely to be used, patients should be evaluated for scoliosis and other anatomic abnormalities that may complicate lumbar puncture.
Any cognitive dysfunction, especially in older patients who will be given a general anesthetic, should be noted.
Preexisting dysfunction may become more apparent postoperatively and, if undetected beforehand, may be misinterpreted as a surgical complication.
Testing Because healthy patients undergoing elective surgery have a low prevalence of silent disease that would otherwise influence perioperative management, routine preoperative testing should not be done in those without clinical symptoms or significant underlying disease.
Such testing is not cost-effective and results in false-positive tests, unintended patient alarm, and delays in surgery.
Preoperative testing should therefore be individualized and based on the patient's clinical presentation, although preoperative beta-hCG (human chorionic gonadotropin) pregnancy testing should be done in all women of childbearing age (1, 2, 3).
The goal of a thorough preoperative evaluation should be to provide patients with a personalized surgical plan to minimize operative risk and postoperative complications.
In symptomatic patients, those with known underlying disease, or those undergoing operations with a higher risk of significant bleeding or other complications, laboratory evaluation may include the following tests: Complete blood count (CBC) and urinalysis (glucose, protein, and cells) usually are done.
CBC is particularly relevant in patients > 65 or in younger patients with significant anticipated blood loss.
Serum electrolytes and creatinine and plasma glucose are measured unless patients are extremely healthy and < 50, the procedure is considered very low risk, and use of nephrotoxic drugs is not expected.
Liver tests are often measured if abnormalities are suspected based on the patient's history or examination.
Coagulation studies and bleeding time are needed only if patients have a personal or family history of bleeding diathesis or a disorder associated with bleeding.
ECG is done for patients at risk of coronary artery disease (CAD), including all men > 45 and women > 50, and for severely obese patients (body mass index ≥ 40 kg / m 2) with at least one risk factor for atherosclerotic cardiovascular disease (eg, diabetes, smoking, hypertension, or hyperlipidemia) or poor exercise tolerance (4).
Chest x-ray only in patients with symptoms of or risk factors for underlying cardiopulmonary disease.
Pulmonary function testing may be done if patients have a known chronic pulmonary disorder or symptoms or signs of pulmonary disease.
Patients with symptomatic CAD need additional tests (eg, stress testing, coronary angiography) before surgery.
In some cases, elective procedures should be delayed when possible so that certain underlying disorders (eg, hypertension, diabetes, hematologic abnormalities) can be optimally controlled.
Circulation 120 (1): 86 - 95, 2009. doi: 10.1161/CIRCULATIONAHA.109.192575 Procedural Risk Factors Procedural risk is highest with the following: Heart or lung surgery Hepatic resection Intra-abdominal surgeries that are estimated to require a prolonged operative time or that have a risk of large-volume hemorrhage (eg, Whipple procedure, aortic surgery, retroperitoneal surgery) Open prostatectomy Major orthopedic procedures (eg, hip replacement) Patients undergoing elective surgery that has a significant risk of hemorrhage should consider banking blood for autologous transfusion should it be needed.
Autologous transfusion decreases the risks of infection and transfusion reactions.
In other cases, patients deemed high risk for major surgery may be identified preoperatively as candidates for less invasive interventions.
Emergency surgery has a higher risk of morbidity and mortality than the same surgery done electively.
Patient Risk Factors The contribution of patient risk factors to perioperative morbidity and mortality is best estimated by validated quantitative risk calculators.
For example, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) has developed a risk calculator to predict perioperative adverse events (see ACS NSQIP Surgical Risk Calculator).
Use of these tools not only allows uniformity in interpreting surgeons' outcomes data but also contributes to better shared decision-making and informed consent for patients and family members (1).
Older age is associated with decreased physiologic reserve and greater morbidity if a complication occurs.
However, chronic disorders are more closely associated with increased postoperative morbidity and mortality than is age alone.
Older age is not an absolute contraindication to surgery.
Cardiac risk factors Cardiac risk factors dramatically increase surgical risk.
Perioperative cardiac risk is typically assessed using the American College of Cardiology / American Heart Association's Revised Cardiac Risk Index (see Figure: Algorithm for risk stratification for noncardiac surgery).
It considers the following independent predictors of cardiac risk: History of coronary artery disease (CAD) History of heart failure History of cerebrovascular disease Diabetes requiring treatment with insulin Serum creatinine (2.0 mg / dL) Risk of cardiac complications increases with increasing risk factors: No risk factors: 0.4% (95% confidence interval 0.1 to 0.8%) 1 risk factor: 1.0% (95% confidence interval 0.5 to 1.4%) 2 risk factors: 2.4% (95% confidence interval 1.3 to 3.5%) ≥ 3 risk factors: 5.4% (95% confidence interval 2.8 to 7.9%) A high-risk surgical procedure (eg, vascular surgery, open intrathoracic or intraperitoneal procedure) also independently predicts a high cardiac perioperative risk.
A thorough preoperative medical evaluation may require input from nonsurgical consultants (eg, internists, cardiologists, pulmonologists) to help assess surgical risk.
Patients with active cardiac symptoms (eg, of heart failure or unstable angina) have a particularly high perioperative risk.
Patients with unstable angina have about a 28% risk of perioperative myocardial infarction.
In patients with stable angina, risk is proportional to their degree of exercise tolerance.
Patients with active cardiac symptoms thus require thorough evaluation.
For example, the cause of heart failure should be determined so that perioperative cardiac monitoring and treatment can be optimized before elective surgery.
Other cardiac testing, such as stress echocardiography or even angiography, should be considered if there is evidence of reversible cardiac ischemia on preoperative evaluation.
Preoperative care should aim to control active disorders (eg, heart failure, diabetes) using standard treatments.
Also, measures should be taken to minimize perioperative tachycardia, which can worsen heart failure and increase risk of myocardial infarction; for example, pain control should be optimized and beta-blocker therapy should be considered, especially if patients are already taking beta-blockers.
Coronary revascularization should be considered for patients with unstable angina.
If a heart disorder cannot be corrected before surgery or if a patient is at high risk of cardiac complications, intraoperative and sometimes preoperative monitoring with pulmonary artery catheterization may be advised.
Such consultants may also help manage preexisting disease (eg, diabetes) and help prevent and treat perioperative and postoperative complications (eg, cardiac, pulmonary, infectious).
Sometimes the cardiac risk outweighs the benefit of surgery.
In such cases, a less invasive procedure may provide or serve as a bridge to definitive treatment (eg, tube cholecystostomy for cholecystitis) and decrease morbidity and mortality.
Algorithm for risk stratification for noncardiac surgery * Active clinical conditions include unstable coronary syndromes, decompensated heart failure, significant arrhythmias, and severe valvular disorders.
† See the ACC / AHA ‡ Clinical risk factors include coronary artery disease, history of heart failure, history of cerebrovascular disease, diabetes mellitus, and preoperative creatinine > 2.0 mg/dL.
ACC = American College of Cardiology; AHA = American Heart Association; HR = heart rate; MET = metabolic equivalent.
Fleisher LA, Fleischmann KE, Auerbach AD, et al Infections Incidental bacterial infections discovered preoperatively should be treated with antibiotics.
However, infections should not delay surgery unless prosthetic material is being implanted; in such cases, surgery should be postponed until the infection is controlled or eliminated.
Patients with respiratory infections should be treated and have evidence that the infection has resolved before receiving inhalational anesthesia.
Viral infections with or without fever should be resolved before elective surgery is done, especially if a general anesthetic is going to be used.
Psychiatric consultation is occasionally needed to assess capacity or help deal with underlying psychiatric problems that can interfere with recovery.
Fluid and electrolyte imbalances Fluid and electrolyte imbalances should be corrected before surgery.
Hypokalemia, hyperkalemia, hypocalcemia, and hypomagnesemia must be corrected before general anesthesia to decrease risk of potentially lethal arrhythmias.
Dehydration and hypovolemia should be treated with IV fluids before general anesthesia to prevent severe hypotension on induction—blood pressure tends to fall when general anesthesia is induced.
Nutritional disorders Undernutrition and obesity increase the risk of postoperative complications in adults.
Nutritional status is assessed preoperatively using history, physical examination, and laboratory tests.
Severe nutritional risk factors include the following: A body mass index < 18.5 kg / m 2 or a history of unintentional weight loss > 10% of body weight over 6 months or 5% over 1 month Suggestive physical examination findings (eg, muscle wasting, signs of specific nutritional deficiencies) Low serum albumin levels (< 3 g / dL without evidence of renal or hepatic dysfunction) It is important to ask whether weight loss was intentional, because unintentional weight loss may reflect a catabolic state refractory to nutritional repletion, suggesting serious underlying pathology such as cancer.
Serum albumin is an inexpensive, widely available, and reliable indicator of undernutrition; it should be measured preoperatively in patients who may be undernourished.
Values < 2.8 g / dL predict increased morbidity (including poor wound healing) and mortality.
Because the half-life of serum albumin is 18 to 20 days, levels may not reflect acute undernutrition.
If more acute undernutrition is suspected, a protein with a shorter half-life can be measured; for example transferrin (half-life 7 days) or transthyretin (pre - albumin; half-life 3 to 5 days).
Older patients may benefit from involvement of an interdisciplinary geriatric team, which may need to involve social workers, therapists, ethicists, and other practitioners.
Preoperative and perioperative nutritional support with the aid of a dietitian to prevent and treat specific nutritional and electrolyte deficiencies is most likely to improve outcomes in patients whose histories of weight loss and protein levels indicate severe undernutrition (2).
In some cases, surgery can be delayed so patients can receive nutritional support, sometimes for several weeks (eg, in chronically undernourished patients, to help prevent the refeeding syndrome).
Significant obesity (body mass index > 40 kg / m 2) increases perioperative mortality risk because such patients have increased risk of cardiac and pulmonary disorders (eg, hypertension, pulmonary hypertension, left ventricular hypertrophy, heart failure, coronary artery disease).
Obesity is an independent risk factor for deep venous thrombosis and pulmonary embolism; preoperative venous thromboembolism prophylaxis is indicated in most obese patients.
Obesity also increases risk of postoperative wound complications (eg, fat necrosis, infection, dehiscence, and abdominal wall hernias).
Because not all surgical procedures are elective, the acuity and type of proposed operation should be considered as well as the patient's risk with surgery.
Tubal Dysfunction and Pelvic Abnormalities By Robert W Rebar, MD, Western Michigan University Homer Stryker M D.
Hysterosalpingography rarely indicates tubal patency falsely but indicates tubal obstruction falsely in about 15% of cases.
This test can also detect some pelvic and intrauterine abnormalities.
For unexplained reasons, fertility in women appears to be enhanced after hysterosalpingography if the test result is normal.
Thus, if hysterosalpingography results are normal, additional diagnostic tests of tubal function can be delayed for several cycles in young women.
Sonohysterography (injection of isotonic fluid through the cervix into the uterus during ultrasonography) is done to detect or further evaluate intrauterine and tubal abnormalities; it has replaced hysterosalpingography in many specialized infertility centers.
Rarely, laparoscopy is done to further evaluate tubal lesions.
Diagnosis and treatment are often done simultaneously during laparoscopy or hysteroscopy.
Treatment of Tubal Dysfunction and Pelvic Abnormalities Antibiotics if cervicitis or PID is present Laparoscopy and / or hysteroscopy Assisted reproductive techniques Cervicitis or PID, if present, is treated with antibiotics.
Treatment of existing infection is important in general and may improve cervical mucus.
School of Medicine Reviewed / Revised Sep 2022 View Patient Education Etiology Diagnosis Treatment Topic Resources Fallopian Tube Obstruction Tubal dysfunction is fallopian tube obstruction or epithelial dysfunction that impairs oocyte, zygote, and / or sperm motility; pelvic structural abnormalities can impede fertilization or implantation.
Antimicrobial therapy does not treat pelvic adhesions caused by current or past pelvic infection.
During laparoscopy, pelvic adhesions can be lysed, or pelvic endometriosis can be fulgurated or ablated by laser.
During hysteroscopy, intrauterine adhesions can be lysed, and submucous fibroids and intrauterine polyps can be removed.
Pregnancy rates after laparoscopic treatment of pelvic abnormalities are low (typically no more than 25%), but hysteroscopic treatment of intrauterine abnormalities is often successful, with a pregnancy rate of about 60 to 70%.
Assisted reproductive techniques are often either a necessity or an alternative particularly in women < 30 years.
Etiology of Tubal Dysfunction and Pelvic Abnormalities Tubal dysfunction can result from Pelvic inflammatory disease Ectopic pregnancy Ruptured appendix Lower abdominal surgery leading to pelvic adhesions Inflammatory disorders (eg, inflammatory bowel disease, tuberculosis) Pelvic structural abnormalities that can impede fertility include Intrauterine adhesions (Asherman syndrome) Fibroids obstructing the fallopian tubes or distorting the uterine cavity Intrauterine polyps Certain malformations (eg, bicornuate uterus) Endometriosis can cause tubal, uterine, or other lesions that impair fertility.
Also, cervical factors, including cervicitis or injury (eg, conization procedures for cervical intraepithelial neoplasia, obstetric cervical laceration), may contribute to infertility by impairing the production of cervical mucus.
Diagnosis of Tubal Dysfunction and Pelvic Abnormalities Tests for cervical gonorrhea or chlamydia, if cervicitis or PID are suspected Hysterosalpingography or sonohysterography Hysteroscopy to further evaluate abnormalities Rarely laparoscopy If pelvic infection is suspected, tests should be done for gonorrhea or chlamydia.
Also, screening for sexually transmitted infections is typically done as part of routine preconception care.
All infertility evaluations include assessment of the fallopian tubes.
Most often, hysterosalpingography (fluoroscopic imaging of the uterus and fallopian tubes after injection of a radiopaque agent into the uterus) is done 2 to 5 days after cessation of menstrual flow.
Lower-Extremity Edema During Late Pregnancy By Emily E Bunce, MD, Wake Forest School of Medicine; Robert P Heine, MD, Wake Forest School of Medicine Reviewed / Revised Dec 2020 | Modified Sep 2022 View Patient Education Etiology Evaluation Treatment Key Points Topic Resources Some Causes of Edema During... Some Findings That Suggest... Edema is common during late pregnancy.
When extensive, cellulitis, which usually causes focal erythema, may resemble general edema.
Table Evaluation Evaluation of patients with lower-extremity edema during late pregnancy aims to exclude DVT, preeclampsia, peripartum cardiomyopathy, and other pathologic causes of edema.
Physiologic edema is a diagnosis of exclusion.
History History of present illness should include symptom onset and duration, exacerbating and relieving factors (physiologic edema is reduced by lying in the left lateral decubitus position), and risk factors for DVT, preeclampsia, and peripartum cardiomyopathy.
Risk factors for DVT include Venous insufficiency Trauma Hypercoagulability disorder Thrombotic disorders Cigarette smoking Immobility Cancer Obesity Risk factors for preeclampsia include Chronic hypertension Personal or family history of preeclampsia Age < 17 or > 35 First pregnancy Multifetal pregnancy Diabetes Vascular disorders Hydatidiform mole Abnormal maternal serum screening results Obesity Risk factors for peripartum cardiomyopathy include Age > 30 History of cardiomyopathy African descent Multifetal pregnancy History of hypertension and / or hypertensive disorders of pregnancy (eg, preeclampsia) Review of symptoms should seek symptoms of possible causes, including the following: Nausea and vomiting, abdominal pain, and jaundice: Preeclampsia Pain, redness, or warmth in an extremity: DVT or cellulitis Dyspnea: Pulmonary edema, peripartum cardiomyopathy, or preeclampsia Sudden increase in weight or edema of the hands and face: Preeclampsia Headache, confusion, mental status changes, blurry vision, or seizures: Preeclampsia Past medical history should include history of DVT, pulmonary embolism, cardiac disease, preeclampsia, and hypertension.
Physical examination Examination begins with review of vital signs, particularly blood pressure.
Areas of edema are evaluated for distribution (ie, whether bilateral and symmetric or unilateral) and presence of redness, warmth, and tenderness.
General examination focuses on systems that may show findings of preeclampsia.
Eye examination includes testing visual fields for deficits, and funduscopic examination should check for papilledema.
Cardiovascular examination includes auscultation of the heart and lungs for evidence of fluid overload (eg, audible S3 or S4 heart sounds, tachypnea, rales, crackles) and inspection of neck veins for jugular venous distention.
The abdomen should be palpated for tenderness, especially in the epigastric or right upper quadrant region.
Neurologic examination should assess mental status for confusion and seek focal neurologic deficits.
Red flags The following findings are of particular concern: Blood pressure ≥ 140/90 mm Hg Unilateral leg or calf warmth, redness, or tenderness, with or without fever Systemic symptoms or signs of preeclampsia, particularly mental status changes Symptoms or signs of pulmonary edema Interpretation of findings Although edema is common during pregnancy, considering and ruling out the most dangerous causes (preeclampsia, peripartum cardiomyopathy, and DVT) are important: If blood pressure is > 140/90 mm Hg, preeclampsia should be considered.
If edema involves only one leg, particularly when redness, warmth, and tenderness are present, DVT and cellulitis should be considered.
Bilateral leg edema suggests a physiologic process, preeclampsia, or peripartum cardiomyopathy as the cause.
Symptoms or signs of pulmonary edema, particularly in patients who have preeclampsia (or other risk factors), suggest peripartum cardiomyopathy.
Clinical findings help suggest a cause (see table Some Causes of Edema During Late Pregnancy).
Additional findings may suggest preeclampsia (see table Some Findings That Suggest Preeclampsia).
Table Testing If preeclampsia is suspected, urine protein is measured; hypertension plus proteinuria indicates preeclampsia.
Urine dipstick testing is used routinely, but if diagnosis is unclear, urine protein may be measured in a 24-hour collection.
It typically involves the lower extremities but occasionally appears as swelling or puffiness in the face or hands.
Many laboratories can more rapidly assess urine protein by measuring and calculating the urine protein: urine creatinine ratio.
Proteinuria is no longer required to diagnose preeclampsia; abnormal laboratory or clinical findings of preeclampsia in patients with hypertension may also confirm preeclampsia.
If DVT is suspected, lower-extremity duplex ultrasonography is done.
If peripartum cardiomyopathy is suspected, ECG, chest X-ray, and echocardiography are done.
BNP or NT-proBNP is measured.
Treatment Specific causes of edema during pregnancy are treated.
Physiologic edema can be reduced by the following: Intermittently lying on the left side (left lateral decubitus position), which moves the uterus off the inferior vena cava Intermittently elevating the lower extremities Wearing elastic compression stockings Wearing loose clothing that does not restrict blood flow, particularly in the legs Key Points Edema is common and usually benign (physiologic) during late pregnancy.
Physiologic edema is reduced by lying in the left lateral decubitus position, elevating the lower extremities, using compression stockings, and wearing loose clothing that does not restrict blood flow.
Evaluate patients for DVT if they have unilateral leg edema, redness, warmth, and tenderness.
Etiology The most common cause of edema in pregnancy is Physiologic edema Physiologic edema results from hormone-induced sodium retention.
Evaluate patients for peripartum cardiomyopathy if they have dyspnea and if the physical examination detects evidence of fluid overload.
Because preeclampsia significantly increases the risk of peripartum cardiomyopathy, rapidly evaluate patients who have preeclampsia and possible cardiac dysfunction and / or pulmonary edema for peripartum cardiomyopathy.
Edema may also occur when the enlarged uterus intermittently compresses the inferior vena cava during recumbency, obstructing outflow from both femoral veins.
Pathologic causes of edema are less common but often dangerous.
Preeclampsia results from pregnancy-induced hypertension; however, not all women with preeclampsia develop edema.
Peripartum cardiomyopathy can cause other nonspecific symptoms of pregnancy, including dyspnea and fatigue.
Recurrent Pregnancy Loss (Recurrent Abortion; Habitual Abortion) By Antonette T Dulay, MD, Main Line Health System Reviewed / Revised Oct 2022 View Patient Education Etiology Diagnosis Treatment Key Points Recurrent pregnancy loss is ≥ 2 to 3 spontaneous abortions.
Placental causes include preexisting chronic disorders that are poorly controlled (eg, systemic lupus erythematosus [SLE], chronic hypertension).
Fetal causes are usually Chromosomal or genetic abnormalities Anatomic malformations Chromosomal abnormalities in the fetus may cause 50% of recurrent pregnancy losses; losses due to chromosomal abnormalities are more common during early pregnancy.
Aneuploidy is involved in up to 80% of all spontaneous abortions occurring at < 10 weeks gestation but in < 15% of those occurring at ≥ 20 weeks.
Diagnosis of Recurrent Pregnancy Loss Clinical evaluation Tests to identify the cause The diagnosis of recurrent pregnancy loss is clinical, based on history of 2 or 3 prior spontaneous abortions.
Evaluation for recurrent pregnancy loss should include the following to help determine the cause: Genetic evaluation (karyotyping) of both parents and any products of conception as clinically indicated to exclude possible genetic causes Screening for acquired thrombotic disorders: Anticardiolipin antibodies (IgG and IgM), anti-beta2 glycoprotein I (IgG and IgM), and lupus anticoagulant Thyroid-stimulating hormone Diabetes testing Hysterosalpingography or sonohysterography to check for structural uterine abnormalities Cause cannot be determined in up to 50% of women.
Determining the cause may require extensive evaluation of both parents.
Screening for hereditary thrombotic disorders is not routinely recommended unless supervised by a maternal-fetal medicine specialist.
Treatment of Recurrent Pregnancy Loss Treatment of the cause if possible Some causes of recurrent pregnancy loss can be treated.
If the cause cannot be identified, the chance of a live birth in the next pregnancy is 27 to 75% (1, 2).
Am J Obstet Gynecol 197 (6): 581.e1 - 581.e6, 2007. doi: 10.1016 / j. ajog.2007.09.016 Key Points Recurrent pregnancy loss is ≥ 2 to 3 spontaneous abortions.
Causes of recurrent pregnancy loss may be maternal, paternal, fetal, or placental.
Chromosomal abnormalities (particularly aneuploidy) may cause 50% of recurrent pregnancy losses.
Etiology of Recurrent Pregnancy Loss Causes of recurrent pregnancy loss may be maternal, paternal, fetal, or placental.
Common maternal causes include Uterine or cervical abnormalities (eg, polyps, myomas, adhesions, cervical insufficiency) Maternal (or paternal) chromosomal abnormalities (eg, balanced translocations) Poorly controlled chronic disorders (eg, hypothyroidism, hyperthyroidism, diabetes mellitus, hypertension, chronic kidney disease) Acquired thrombotic disorders (eg, related to antiphospholipid antibody syndrome with lupus anticoagulant, anticardiolipin [IgG or IgM], or anti-beta2 glycoprotein I [IgG or IgM]) are associated with ≥ 3 recurrent losses after 10 weeks, after other maternal and genetic causes have been excluded.
Loss of one or more apparently normal pregnancies after 10 weeks can raise suspicion of antiphospholipid antibody syndrome (1).
The association with hereditary thrombotic disorders is less clear but does not appear to be strong, except for possibly factor V Leiden mutation.
Paternal causes are less clear, but risk of miscarriage is higher if the father has certain semen analysis abnormalities.
Paternal age > 35 has been studied, but data about increased risk of spontaneous abortion were conflicting.
Overview of High-Risk Pregnancy By Raul Artal-Mittelmark, MD, Saint Louis University School of Medicine Reviewed / Revised Sep 2022 View Patient Education Risk Assessment During Pregnancy In a high-risk pregnancy, the mother, fetus, or neonate is at increased risk of morbidity or mortality before, during, or after delivery.
High-risk pregnancies require close monitoring and sometimes referral to a perinatal center, especially if women have complex high-risk conditions.
These centers offer many specialty and subspecialty services, provided by maternal, fetal, and neonatal specialists (1).
When referral is needed, transfer before, rather than after, delivery results in lower neonatal morbidity and mortality rates.
The most common reasons for referral before delivery are Preterm labor (often due to premature rupture of the membranes) Preeclampsia Preexisting or developing disorders (eg, diabetes, hypertension, severe [morbid] obesity) Risk assessment reference 1.
Risk assessment is part of routine prenatal care.
Risk is also assessed during or shortly after labor and at any time that events may modify risk status.
Risk factors are assessed systematically because each risk factor present increases overall risk.
Risk Assessment During Pregnancy Several pregnancy monitoring and risk assessment systems are available.
The most widely used system is the Pregnancy Assessment Monitoring System (PRAMS), which is a project of the Centers for Disease Control and Prevention (CDC) and state health departments.
PRAMS also enables the CDC and states to monitor changes in health indicators (eg, unintended pregnancy, prenatal care, breastfeeding, smoking, drinking, infant health).
Female Orgasmic Disorder By Allison Conn, MD, Baylor College of Medicine, Texas Children's Pavilion for Women; Kelly R Hodges, MD, Baylor College of Medicine, Texas Children's Pavilion for Women Reviewed / Revised Mar 2021 | Modified Sep 2022 View Patient Education Etiology Symptoms and Signs Diagnosis Treatment Key Points Female orgasmic disorder involves orgasm that is absent, infrequent, markedly diminished in intensity, or markedly delayed in response to stimulation despite normal levels of subjective arousal.
Because the type of stimulation that triggers orgasm varies widely, clinicians must use clinical judgment to determine whether the woman's response is deficient, based on her age, sexual experience, and adequacy of the sexual stimulation she receives.
Treatment of Orgasmic Disorder Self-stimulation Psychologic therapies Data support encouraging self-stimulation (masturbation).
First-line treatment of female orgasmic disorders is directed masturbation, which involves a series of prescribed exercises.
A vibrator placed on the mons pubis close to the clitoris may help, as may increasing the number and intensity of stimuli), simultaneously if necessary.
Education about sexual function (eg, need to stimulate other areas of the body before the clitoris) may help.
Sex therapy for women, with or without their partners, can often help them with concerns about sexual performance and feelings.
Other psychologic therapies, including cognitive-behavioral therapy and psychotherapy, may help women identify and manage fear of vulnerability and issues of trust with a partner.
Recommending the practice of mindfulness and using mindfulness-based cognitive therapy (MBCT) can help women pay attention to sexual sensations (by staying in the moment) and not judge or monitor these sensations.
Currently, no data suggest that any drug is efficacious in the treatment of female orgasmic disorder.
Key Points Diagnose orgasmic disorder based on DSM-5 clinical criteria.
Female orgasmic disorder can be primary or secondary: Primary: Women have never been able to have an orgasm.
Treat with directed masturbation, usually as first-line therapy.
Recommend sex therapy and other psychologic therapies to help women identify and manage factors that contribute to orgasmic disorder.
Secondary: Women were previously able to have an orgasm but are now no longer able to do so.
Etiology Factors that contribute to female orgasmic disorder include Contextual factors (eg, consistently insufficient foreplay, early ejaculation by the partner, poor communication about sexual preferences) Psychologic factors (eg, anxiety, stress, lack of trust in a partner) Cultural factors (eg, lack of recognition of or attention paid to female sexual pleasure) Drug therapy (eg.
some antipsychotics or, commonly, selective serotonin reuptake inhibitors [SSRIs]) Lack of knowledge about sexual function Damage to genital sensory or autonomic nerves or pathways (eg, due to diabetes or multiple sclerosis) Vulval dystrophy (eg, lichen sclerosus) Symptoms and Signs Women with orgasmic disorder often have other types of sexual dysfunction (eg, dyspareunia, pelvic floor dysfunction).
Anxiety disorders and depression are also more common among women with this disorder.
Diagnosis Clinical criteria (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5]) Clinicians interview both partners separately and together if possible; the woman is asked to describe the problem in her own words and should include specific elements (see table Components of the Sexual History for Assessment of Female Sexual Dysfunction).
Diagnosis of orgasmic disorder is clinical, based on criteria in the DSM-5: Delayed, infrequent, or absent orgasm or markedly decreased intensity of orgasm after a normal sexual arousal phase on all or almost all occasions of sexual activity Distress or interpersonal problems due to orgasmic dysfunction No other disorder or substance that exclusively accounts for the orgasmic dysfunction Symptoms must have been present for ≥ 6 months.
Postterm Pregnancy By Julie S Moldenhauer, MD, Children's Hospital of Philadelphia Reviewed / Revised Jul 2021 | Modified Sep 2022 View Patient Education Treatment Key Points Postterm pregnancy refers to gestation that lasts ≥ 42 (> 41 6/7) weeks.
Risks include Abnormal fetal growth (macrosomia and dysmaturity syndrome) Oligohydramnios Meconium-stained amniotic fluid Nonreassuring fetal test results Fetal and neonatal death Need for neonatal intensive care Dystocia (abnormal or difficult labor) Cesarean delivery Operative vaginal delivery Perineal lacerations Postpartum hemorrhage Postmaturity refers to the condition of the fetus that results when the placenta can no longer maintain a healthy environment for growth and development, usually because the pregnancy has lasted too long.
The fetus may have dry, peeling skin, overgrown nails, a large amount of scalp hair, marked creases on the palms and soles, lack of fat deposition, and skin that is stained green or yellow by meconium.
Meconium aspiration syndrome is a risk.
Antenatal surveillance should be considered at 41 weeks; it involves one of the following: Nonstress testing Modified biophysical profile (nonstress testing and assessment of amniotic fluid volume) A full biophysical profile (assessment of amniotic fluid volume and fetal movement, tone, breathing, and heart rate) Treatment Induction of labor and delivery Sometimes cesarean delivery If there is evidence of fetal compromise or oligohydramnios, delivery is required.
Induction of labor can be considered at 41 to 42 weeks, particularly if the cervix is favorable, and is recommended after 42 weeks.
Key Points Accurate gestational age estimation is essential in making a diagnosis of postterm pregnancy; ultrasonography early in gestation (up to 20 weeks) is the most accurate method.
Consider antenatal surveillance (eg, nonstress testing, biophysical profile) at 41 weeks.
If there is evidence of fetal compromise or oligohydramnios, delivery is required.
Consider inducing labor at 41 to 42 weeks; it is recommended after 42 weeks.
Late-term pregnancy is defined as 41 0/7 to 41 6/7 weeks.
Antenatal surveillance should be considered at 41 weeks.
Induction of labor should be considered after 41 weeks and is recommended after 42 weeks.
Accurate gestational age estimation is essential in making a diagnosis of postterm pregnancy.
In women with regular, normal menstrual cycles, gestational age can be estimated based on the first day of the last normal menstrual period.
If dating is uncertain or inconsistent with menstrual dating, ultrasonography early in gestation (up to 20 weeks) is the most accurate with accepted variation of + / − 7 days.
Later in gestation, the variation increases to + / − 14 days at 20 to 30 weeks gestation and + / − 21 days after 30 weeks.
Postterm pregnancy increases risks for the woman and fetus.
Noninvasive Prenatal Screening Strategies By Jeffrey S Dungan, MD, Northwestern University, Feinberg School of Medicine Reviewed / Revised Oct 2022 View Patient Education 1st-Trimester Screening 2nd-Trimester Screening Sequential 1st - and 2nd-Trimester Screening Topic Resources Ultrasonography Showing Enlarged.. Noninvasive maternal screening, unlike invasive testing, has no risk of test-related complications.
Screening in multiple gestations All forms of screening in singleton pregnancies (described above) are available to patients with a twin pregnancy.
For twin pregnancies, screening performance using traditional methods (triple, quad) has lower sensitivity and specificity than in singleton pregnancies.
Cell-free DNA (cfDNA) screening performance appears to be comparable for singleton and twin pregnancies.
Because most dichorionic twin gestations are discordant for chromosome abnormalities, diagnostic testing is required to distinguish which twin is affected.
However, screening for sex chromosome abnormalities in twin pregnancies is usually not available.
No serum screening or cfDNA screening protocols are validated for triplet or higher-order pregnancies.
1st-Trimester Screening Traditionally, 1st-trimester combined screening includes measurement of Maternal serum beta-hCG (total or free) Pregnancy-associated plasma protein A (PAPP-A) Fetal nuchal translucency (by ultrasonography) Fetal Down syndrome is typically associated with high levels of beta-hCG, low levels of PAPP-A, and enlarged fetal nuchal translucency.
Although enlarged nuchal translucency is associated with increased risk of fetal Down syndrome, no threshold value for nuchal translucency is considered diagnostic.
In large prospective US trials involving women of various ages, overall sensitivity for detection of Down syndrome was about 85%, with a false-positive rate of 5%.
Specialized ultrasound training and adherence to rigorous quality-assurance monitoring of nuchal translucency measurements are necessary to achieve this level of screening accuracy.
By more precisely assessing the risk of fetal abnormalities, noninvasive maternal screening can help women decide whether to have invasive testing.
First-trimester screening should be offered to all pregnant women.
It provides information early so that a definitive diagnosis can be made with CVS.
An important advantage of 1st-trimester screening is that termination of pregnancy is safer during the 1st rather than the 2nd trimester.
Cell-free fetal nucleic acid testing An increasingly used approach, called noninvasive prenatal screening or cell-free DNA (cfDNA) screening, can identify fetal chromosomal abnormalities in singleton pregnancies by analyzing circulating cell-free fetal nucleic acids in a maternal blood sample.
This test can be done as early as 10 gestational weeks and is replacing traditional 1st - and 2nd-trimester noninvasive screening in many centers.
Cell-free fetal nucleic acids, most commonly DNA fragments, are shed into the maternal circulation during normal breakdown of placental trophoblast cells.
Variation in amounts of fragments from particular chromosomes predicts fetal chromosomal abnormalities with higher accuracy than traditional 1st - and 2nd-trimester combined screening using serum analytes and ultrasonography.
Also, sex chromosomal abnormalities (X, XXX, XYY, and XXY) can be identified in singleton pregnancies, although with somewhat lower accuracy.
Early validation trials reported > 99% sensitivity and specificity for the identification of Down syndrome (trisomy 21) and trisomy 18 in high-risk pregnancies.
Noninvasive maternal screening for fetal chromosomal abnormalities should be offered to all pregnant women who have not already decided to have amniocentesis or chorionic villus sampling (CVS).
Cell-free DNA (cfDNA) screening was historically recommended for women with preexisting risk factors for fetal trisomy.
However, in a recent large multicenter trial that studied the effectiveness of cfDNA screening in a low-risk population, sensitivity for detection of fetal Down syndrome was equivalent to that in a high-risk population.
Given the lower incidence of fetal Down syndrome in younger pregnant women, the specificity and positive predictive value were lower than if only high-risk women were screened.
However, cfDNA screening was superior to traditional analyte screening in low-risk women in overall performance.
Cell-free DNA screening has largely replaced serum analyte screening in high-risk women, and in low-risk women it is rapidly surpassing the use of traditional 1st - and 2nd-trimester combined screening with serum analytes and ultrasonography (1).
The American College of Obstetricians and Gynecologists recommends offering cell-free DNA screening to all pregnant women (2).
Abnormal results from cfDNA screening should be confirmed with diagnostic karyotyping using fetal specimens obtained through invasive techniques.
However, even if CVS is to be done, maternal serum screening should still be offered to check for fetal neural tube defects.
An elevated MSAFP level suggests open spina bifida, anencephaly, or abdominal wall defects.
Unexplained elevations in MSAFP may be associated with increased risk of later pregnancy complications, such as stillbirth or intrauterine growth retardation.
Quadruple screening (aimed mainly at trisomy 21): Maternal levels of beta-hCG, unconjugated estriol, alpha-fetoprotein, and sometimes inhibin A: This screening may be used as an alternative or adjunct to 1st-trimester screening.
Second-trimester multiple marker screening is used to help assess the risk of Down syndrome, trisomy 18, and a few rarer single-gene syndromes (eg, Smith-Lemli-Opitz syndrome).
Maternal serum tests are widely available, but detection rates for Down syndrome are not as high as those obtained with 1st-trimester screening or with cfDNA.
Also, termination of pregnancy is riskier in the 2nd trimester than in the 1st trimester.
Second-trimester screening may also include Targeted ultrasonography Maternal serum screening for neural tube defects An elevated level of MSAFP may indicate a fetal malformation such as open spina bifida.
Results are most accurate when the initial sample is obtained between 16 and 18 weeks gestation, although screening can be done from about 15 to 20 weeks.
Designating a cutoff value to determine whether further testing is warranted involves weighing the risk of missed abnormalities against the risk of complications from unnecessary testing.
Usually, a cutoff value in the 95th to 98th percentile, or 2.0 to 2.5 times the normal pregnancy median (multiples of the median, or MOM), is used.
This value is about 80% sensitive for open spina bifida and 90% sensitive for anencephaly.
Closed spina bifida is usually not detected.
Amniocentesis is eventually required in 1 to 2% of women originally screened.
Lower cutoff values of MSAFP increase sensitivity but decrease specificity, resulting in more amniocenteses.
Women who have been screened for fetal chromosome disorders by cfDNA should have serum screening with MSAFP alone, not with multiple marker screening.
Ultrasonography is the next step if further testing is warranted.
Corrections for maternal weight, diabetes mellitus, race, and other factors may be necessary.
Targeted ultrasonography with or without amniocentesis is done if no explanation can be determined with basic ultrasonography.
Ultrasonography can Confirm gestational age (which may be underestimated) Detect multifetal pregnancy, fetal death, or congenital malformations In some women, ultrasonography cannot identify a cause for elevated alpha-fetoprotein levels.
Some experts believe that if high-resolution ultrasonography done by an experienced operator is normal, further testing is unnecessary.
However, because this test occasionally misses neural tube defects, many experts recommend further testing by amniocentesis regardless of ultrasonography results.
Amniocentesis with measurement of alpha-fetoprotein and acetylcholinesterase levels in amniotic fluid is done if further testing is needed.
Elevated alpha-fetoprotein in amniotic fluid suggests A neural tube defect Another malformation (eg, omphalocele, congenital nephrosis, cystic hygroma, gastroschisis, upper gastrointestinal atresia) Contamination of the sample with fetal blood Presence of acetylcholinesterase in amniotic fluid suggests A neural tube defect Another malformation Elevated alpha-fetoprotein plus presence of acetylcholinesterase in amniotic fluid is virtually 100% sensitive for anencephaly and 90 to 95% sensitive for open spina bifida.
Abnormal amniotic fluid markers indicate that a malformation is likely even if high-resolution ultrasonography (which can detect most of these malformations) does not detect a malformation, and parents should be informed.
Maternal serum screening for chromosomal abnormalities During the 2nd trimester, the most common approach to screening is with cfDNA or multiple serum markers.
These markers, adjusted for gestational age, are used mainly to refine estimates of Down syndrome risk beyond that associated with maternal age.
With triple screening (ie, alpha-fetoprotein, hCG, and unconjugated estriol), sensitivity for Down syndrome is about 65 to 70%, with a false-positive rate of about 5%.
Screening can be done during the 1st trimester 2nd trimester Both trimesters (called sequential or integrated screening) Any of the three approaches is acceptable.
Quad screening is triple screening plus measurement of inhibin A Quad screening increases sensitivity to about 80%, with a 5% false-positive rate.
If maternal serum screening suggests Down syndrome, ultrasonography is done to confirm gestational age, and risk is recalculated if the presumed gestational age is incorrect.
If the original sample was drawn too early, another one must be drawn at the appropriate time.
Amniocentesis is offered particularly if risk exceeds a specific prespecified threshold (usually 1 in 270, which is about the same as risk when maternal age is > 35).
Triple screening can also assess risk of trisomy 18, indicated by low levels of all 3 serum markers.
Sensitivity for trisomy 18 is 60 to 70%; the false-positive rate is about 0.5%.
Combining ultrasonography and serum screening increases sensitivity to about 80%.
Analysis of cfDNA does not depend on gestational age and thus is not prone to dating errors.
Targeted ultrasonography Targeted ultrasonography is offered at some perinatal centers and is used to assess risk of chromosomal abnormalities by searching for structural features associated with fetal aneuploidy (so-called soft markers).
However, no structural finding is diagnostic for a given chromosomal abnormality, and all soft markers may also be seen in fetuses that are chromosomally normal.
Maternal levels of alpha-fetoprotein should be measured during the 2nd trimester to check for neural tube defects.
If results from prior trisomy screening were negative (risk-reducing), many of these soft markers have no clinical relevance and may be ignored (1).
Nonetheless, the discovery of such a marker may lead to offering the woman amniocentesis to confirm or exclude a chromosomal abnormality.
If a major structural malformation is present, a fetal chromosomal abnormality is more likely.
Disadvantages include unnecessary anxiety if a soft marker is detected and unnecessary amniocentesis.
Several experienced centers report high sensitivity, but whether a normal ultrasound indicates a substantially reduced risk of fetal chromosomal abnormalities is unclear.
Sequential screening followed by amniocentesis for high-risk patterns increases sensitivity for Down syndrome to 95%, with a false-positive rate of only 5%.
Pearls & Pitfalls Measure maternal levels of alpha-fetoprotein during the 2nd trimester to check for neural tube defects regardless of other tests planned and the timing of those tests.
A variation of sequential screening, called contingent sequential screening, is based on the level of risk indicated by 1st-trimester screening: High risk: Invasive testing is offered without doing 2nd-trimester screening.
Intermediate risk: 2nd-trimester screening is offered.
Low risk (eg, < 1 in 1500): 2nd-trimester screening for Down syndrome is not offered because the 1st-trimester risk is so low.
Patients with abnormal 1st-trimester, 2nd-trimester, or sequential screening should be offered diagnostic testing (eg, amniocentesis).
However, some patients may choose to pursue further testing for fetal trisomy with cfDNA (cell free DNA) analysis (1).
Results of cfDNA testing may indicate low risk and be reassuring but are not definitive.
Benign Ovarian Masses By Kilpatrick, MD, MEd, Baylor College of Medicine Reviewed / Revised Feb 2023 View Patient Education Symptoms and Signs Diagnosis Treatment Key Points Benign ovarian masses include functional cysts (eg, corpus luteum cysts) and neoplasms (eg, benign teratomas).
They may hemorrhage into the cyst cavity, distending the ovarian capsule or rupturing into the peritoneum.
Most functional cysts are < 1.5 cm in diameter; few exceed 5 cm.
Functional cysts usually resolve spontaneously over days to weeks.
Polycystic ovary syndrome is usually defined as a clinical syndrome, not by the presence of ovarian cysts.
But ovaries typically contain many 2 - to 6-mm follicular cysts and sometimes contain larger cysts that contain atretic cells.
Benign ovarian tumors Benign ovarian tumors usually grow slowly and rarely become malignant.
They include the following: Benign (mature) teratomas: These tumors are germ cell tumors; they are also called dermoid cysts because although derived from all 3 germ cell layers, they consist mainly of ectodermal tissue.
Fibromas: These slow-growing connective tissue tumors are usually < 7 cm in diameter.
Symptoms and Signs of Benign Ovarian Masses Most functional cysts and benign tumors are asymptomatic, but some cause intermittent dull or sharp pelvic pain or, infrequently, deep dyspareunia.
Most are asymptomatic; some cause pelvic pain.
Hemorrhagic corpus luteum cysts may cause pain or signs of peritonitis, particularly when they rupture.
Occasionally, severe abdominal pain results from adnexal torsion of a cyst or mass, usually > 4 cm.
Rarely, ascites and pleural effusion accompany ovarian fibromas; this triad of findings is called Meigs syndrome.
Diagnosis of Benign Ovarian Masses Transvaginal ultrasonography Sometimes tests for tumor markers Masses are usually detected incidentally during pelvic examination or imaging but may be suggested by symptoms and signs.
A pregnancy test is done to exclude ectopic pregnancy or threatened abortion in a patient with pelvic pain or abnormal uterine bleeding.
Transvaginal ultrasonography is usually the first-line test to confirm the diagnosis.
Masses that have radiographic characteristics of cancer (eg, mixed cystic and solid components, surface excrescences, multilocular appearance, thick septations, irregular shape) or that are accompanied by ascites require consultation with a specialist and excision.
Tests for tumor markers are done if ovarian cancer is suspected.
CA 125 is usually measured in postmenopausal women with an ovarian mass, but its use in premenopausal women requires clinical judgment.
This and other tumor markers are not reliable for diagnosis because they lack adequate sensitivity, specificity, and predictive values.
Evaluation includes pelvic examination, transvaginal ultrasonography, and sometimes measurement of tumor markers.
For example, tumor marker values may be falsely elevated in women who have endometriosis, uterine fibroids, peritonitis, cholecystitis, pancreatitis, inflammatory bowel disease, or various cancers.
Tumor markers are best used for monitoring response to treatment in patients with known ovarian cancer Treatment of Benign Ovarian Masses Monitoring with serial transvaginal ultrasonography for selected cysts Sometimes surgery (cystectomy or oophorectomy) Many functional cysts < 5 cm resolve without treatment; serial ultrasonography is done to document resolution.
If asymptomatic women of reproductive age have simple, thin-walled cystic adnexal masses 5 to 8 cm (usually follicular) without imaging characteristics of cancer, expectant management with repeated ultrasonography (eg, every 6 to 8 weeks) is appropriate.
Benign tumors require treatment.
Masses with radiographic characteristics of cancer require exploratory laparoscopy or laparotomy and excision.
If technically feasible, surgeons aim to preserve the ovaries (eg, by cystectomy).
Oophorectomy is done for the following: Fibromas that cannot be removed by cystectomy Cystadenomas Cystic teratomas > 10 cm Other types of cysts that cannot be surgically removed separately from the ovary In postmenopausal women, most cysts or masses, particularly if they are > 5 cm Key Points Ovarian cysts and benign ovarian tumors are common gynecologic issues.
Functional cysts, which develop as part of the menstrual cycle, tend to be small (usually < 1.5 cm in diameter), to occur in premenopausal woman, and to resolve spontaneously.
Functional cysts and benign tumors are usually asymptomatic, but sometimes they cause dull or sharp pelvic pain.
Excise masses that have radiographic characteristics of cancer (eg, cystic and solid components, surface excrescences, multilocular appearance, irregular shape) or that are accompanied by ascites.
Treatment varies depending on the type of mass; surgery with cystectomy or oophorectomy is done if the mass is symptomatic or cancer is suspected.
Excise certain cysts and benign tumors, including cysts that do not spontaneously resolve.
Ovarian cysts or other ovarian masses are a common gynecologic issue.
Functional cysts, which develop as part of the menstrual cycle, are common and usually resolve without treatment.
Masses that are symptomatic or do not resolve may need to be removed surgically to be treated and checked for ovarian cancer.
Functional ovarian cysts There are 2 types of functional cysts: Follicular cysts: These cysts develop from graafian follicles (fluid-filled sacs that contain ova and are located in the ovaries).
Corpus luteum cysts: These cysts develop from the corpus luteum (which forms from the dominant follicle after ovulation).
Avoidant / Restrictive Food Intake Disorder (ARFID) By Evelyn Attia, MD, Columbia University Medical Center; B Timothy Walsh, MD, College of Physicians and Surgeons, Columbia University Reviewed / Revised Jul 2022 | Modified Sep 2022 View Patient Education Symptoms and Signs Diagnosis Treatment Key Points Avoidant / restrictive food intake disorder (ARFID) is characterized by restriction of food intake; it does not include having a distorted body image or being preoccupied with body image (in contrast to anorexia nervosa and bulimia nervosa).
Diagnosis of ARFID Clinical criteria Criteria for avoidant / restrictive food intake disorder (1) include the following: The food restriction leads to significant weight loss, failure to grow as expected in children, significant nutritional deficiency, dependence on nutritional support, and / or marked disturbance of psychosocial functioning The food restriction is not caused by unavailability of food, a cultural practice (eg, religious fasting), physical illness, medical treatment (eg, radiation therapy, chemotherapy), or another eating disorder—particularly anorexia nervosa or bulimia nervosa There is no evidence of a disturbed perception of body weight or shape.
However, patients who have a physical disorder that causes decreased food intake but who maintain the decreased intake for much longer than typically expected and to a degree requiring specific intervention may be considered to have avoidant / restrictive food intake disorder.
Treatment of ARFID Cognitive behavioral therapy Cognitive behavioral therapy is commonly used to help patients normalize their eating.
Key Points Avoidant / restrictive food intake disorder can cause significant weight loss and life-threatening nutritional deficiencies and markedly impair social functioning (eg, participating in family meals).
Diagnose based on specific criteria, particularly distinguishing avoidant / restrictive food intake disorder from anorexia nervosa or bulimia nervosa.
Avoidant / restrictive food intake disorder typically begins during childhood but may develop at any age.
The exact cause of the disorder is unknown, but it may have genetic and psychosocial components, including trauma, anxiety, autism, and developmental disabilities.
ARFID may initially resemble the picky eating that is common during childhood—when children refuse to eat certain foods or foods of a certain color, consistency, or odor.
However, such food fussiness, unlike avoidant / restrictive food intake disorder, usually involves only a few food items, and the child's appetite, overall food intake, and growth and development are normal.
Patients with avoidant / restrictive food intake may not eat because they lose interest in eating or because they fear that eating will lead to harmful consequences such as choking or vomiting.
They may avoid certain foods because of their sensory characteristics (eg, color, consistency, odor).
Symptoms and Signs of ARFID Patients with avoidant / restrictive food intake disorder avoid eating food and restrict their food intake to such an extent that they have ≥ 1 of the following: Significant weight loss or, in children, failure to grow as expected Significant nutritional deficiency Dependence on enteral feeding (eg, via a feeding tube) or oral nutritional supplements Markedly disturbed psychosocial functioning Nutritional deficiencies can be life threatening, and social functioning (eg, participating in family meals, spending time with friends in situations where eating may occur) can be markedly impaired.
Overview of Trauma - and Stressor-Related Disorders By John W Barnhill, MD, New York-Presbyterian Hospital Reviewed / Revised Apr 2020 | Modified Sep 2022 View Patient Education Trauma - and stressor-related disorders involve exposure to a traumatic or stressful event.
Acute stress disorder and PTSD are similar except that acute stress disorder typically begins immediately after the trauma and lasts from 3 days to 1 month, whereas PTSD lasts for > 1 month, either as a continuation of acute stress disorder or as a separate occurrence that begins up to 6 months after the trauma.
Previously, trauma - and stressor-related disorders were considered anxiety disorders.
However, they are now considered distinct because many patients do not have anxiety but instead have symptoms of anhedonia or dysphoria, anger, aggression, or dissociation.
For people with personality disorders (unlike many others who seek counseling), the distress caused by the consequences of their socially maladaptive behaviors is usually the reason they seek treatment, rather than any discomfort with their own thoughts and feelings.
Thus, clinicians must initially help patients see that their personality traits are the root of the problem.
Personality disorders usually start to become evident during late adolescence or early adulthood, although sometimes signs are apparent earlier (during childhood).
Traits and symptoms vary considerably in how long they persist; many resolve with time.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists 10 types of personality disorders, although most patients who meet criteria for one type also meet criteria for one or more others.
Some types (eg, antisocial, borderline) tend to lessen or resolve as people age; others (eg, obsessive-compulsive, schizotypal) are less likely to do so.
About 10% of the general population and up to half of psychiatric patients in hospital units and clinics have a personality disorder.
Overall, there are no clear distinctions in terms of sex, socioeconomic class, and race.
However, in antisocial personality disorder, men outnumber women 6: 1.
In borderline personality disorder, women outnumber men 3: 1 (but only in clinical settings, not in the general population).
For most personality disorders, levels of heritability are about 50%, which is similar to or higher than that of many other major psychiatric disorders.
This degree of heritability argues against the common assumption that personality disorders are character flaws primarily shaped by an adverse environment.
The direct health care costs and indirect costs of lost productivity associated with personality disorders, particularly borderline and obsessive-compulsive personality disorder, are significantly greater than similar costs associated with major depressive disorder or generalized anxiety disorder.
Types of Personality Disorders DSM-5 groups the 10 types of personality disorders into 3 clusters (A, B, and C), based on similar characteristics.
However, the clinical usefulness of these clusters has not been established.
Cluster A is characterized by appearing odd or eccentric.
It includes the following personality disorders with their distinguishing features: Paranoid: Mistrust and suspicion Schizoid: Disinterest in others Schizotypal: Eccentric ideas and behavior Overview of Cluster A Personality Disorders VIDEO Cluster B is characterized by appearing dramatic, emotional, or erratic.
It includes the following personality disorders with their distinguishing features: Antisocial: Social irresponsibility, disregard for others, deceitfulness, and manipulation of others for personal gain Borderline: Inner emptiness, unstable relationships, and emotional dysregulation Histrionic: Attention seeking and excessive emotionality Narcissistic: Self-grandiosity, need for admiration, and lack of empathy Overview of Cluster B Personality Disorders VIDEO Cluster C is characterized by appearing anxious or fearful.
It includes the following personality disorders with their distinguishing features: Avoidant: Avoidance of interpersonal contact due to rejection sensitivity Dependent: Submissiveness and a need to be taken care of Obsessive-compulsive: Perfectionism, rigidity, and obstinacy Overview of Cluster C Personality Disorders VIDEO Symptoms and Signs of Personality Disorders According to DSM-5, personality disorders are primarily problems with Self-identity Interpersonal functioning Self-identity problems may manifest as an unstable self-image (eg, people fluctuate between seeing themselves as kind or cruel) or as inconsistencies in values, goals, and appearance (eg, people are deeply religious while in church but profane and disrespectful elsewhere).
Interpersonal functioning problems typically manifest as failing to develop or sustain close relationships and / or being insensitive to others (eg, unable to empathize).
Personality disorders vary significantly in their manifestations, but all are believed to be caused by a combination of genetic and environmental factors.
People with personality disorders often seem inconsistent, confusing, and frustrating to people around them (including clinicians).
These people may have difficulty knowing the boundaries between themselves and others.
Their self-esteem may be inappropriately high or low.
They may have inconsistent, detached, overemotional, abusive, or irresponsible styles of parenting, which can lead to physical and mental problems in their spouse and / or children.
People with personality disorders may not recognize that they have problems.
Diagnosis of Personality Disorders Clinical criteria (DSM-5) Personality disorders are underdiagnosed.
When people with personality disorders seek treatment, their chief complaints are often of depression or anxiety rather than of the manifestations of their personality disorder.
Once clinicians suspect a personality disorder, they evaluate cognitive, affective, interpersonal, and behavioral tendencies using specific diagnostic criteria.
More sophisticated and empirically rigorous diagnostic tools are available for more specialized and academic clinicians.
Diagnosis of a personality disorder requires the following: A persistent, inflexible, pervasive pattern of maladaptive traits involving ≥ 2 of the following: cognition (ways or perceiving and interpreting self, others, and events), affectivity, interpersonal functioning, and impulse control Significant distress or impaired functioning resulting from the maladaptive pattern Relative stability and early onset (traced back to at least adolescence or early adulthood) of the pattern Also, other possible causes of the symptoms (eg, other mental health disorders, substance use, head trauma) must be excluded.
Many gradually become less severe with age, but certain traits may persist to some degree after the acute symptoms that prompted the diagnosis of a disorder abate.
For a personality disorder to be diagnosed in patients < 18 years, the pattern must have been present for ≥ 1 year, except for antisocial personality disorders, which cannot be diagnosed in patients < 18 years.
Because many patients with a personality disorder lack insight into their condition, clinicians may need to obtain history from clinicians who have treated these patients previously, other practitioners, family members, friends, or others who have contact with them.
Treatment of Personality Disorders Psychotherapy The gold standard of treatment for personality disorders is psychotherapy.
Both individual and group psychotherapy are effective for many of these disorders if the patient is seeking treatment and is motivated to change.
Typically, personality disorders are not very responsive to drugs, although some drugs can effectively target specific symptoms (eg, depression, anxiety).
Disorders that often coexist with personality disorders (eg, depressive disorders, anxiety, substance-related disorders, somatic symptom disorders, and eating disorders) can make treatment challenging, lengthening time to remission, increasing risk of relapse, and decreasing response to otherwise effective treatment.
For treatment recommendations for each disorder, see table Treatment of Personality Disorders.
Table General principles of treatment In general, treatment of personality disorders aims to Reduce subjective distress Enable patients to understand that their problems are internal to themselves Decrease significantly maladaptive and socially undesirable behaviors Modify problematic personality traits Reducing subjective distress (eg, anxiety, depression) is the first goal.
These symptoms often respond to increased psychosocial support, which often includes moving the patient out of highly stressful situations or relationships.
Drug therapy may also help relieve stress.
Reduced stress makes treating the underlying personality disorder easier.
An effort to enable patients to see that their problems are internal should be made early.
Patients need to understand that their problems with work or relationships are caused by their problematic ways of relating to the world (eg, to tasks, to authority, or in intimate relationships).
Achieving such understanding requires a substantial amount of time, patience, and commitment on the part of a clinician.
Clinicians also need a basic understanding of the patient's areas of emotional sensitivity and usual ways of coping.
Family members and friends can help identify problems of which patients and clinicians would otherwise be unaware.
Maladaptive and undesirable behaviors (eg, recklessness, social isolation, lack of assertiveness, temper outbursts) should be dealt with quickly to minimize ongoing damage to jobs and relationships.
Behavioral change is most important for patients with the following personality disorders: Borderline Antisocial Avoidant Behavior can typically be improved within months by group therapy and behavior modification; limits on behavior must often be established and enforced.
Sometimes patients are treated in a day hospital or residential setting.
Treatment is with psychosocial therapies and sometimes drug therapy.
Because family members and friends can act in ways that either reinforce or diminish the patient's problematic behavior or thoughts, their involvement is helpful; with coaching, they can be allies in treatment.
Modifying problematic personality traits (eg, dependency, distrust, arrogance, manipulativeness) takes a long time—typically > 1 year.
The cornerstone for effecting such change is Individual psychotherapy During therapy, clinicians try to identify interpersonal problems as they occur in the patient's life.
Clinicians then help patients understand how these problems are related to their personality traits and provide skills training to develop new, better ways of interacting.
Typically, clinicians must repeatedly point out the undesirable behaviors and their consequences before patients become aware of them.
This strategy can help patients change their maladaptive behaviors and mistaken beliefs.
Although clinicians should act with sensitivity, they should be aware that kindness and sensible advice by themselves do not change personality disorders.
Key Points Personality disorders involve rigid, maladaptive personality traits that are marked enough to cause significant distress or to impair work and / or interpersonal functioning.
Treatments become effective only after patients see that their problems are within themselves, not just externally caused.
Psychosocial therapies are the main treatment.
Personality traits represent patterns of thinking, perceiving, reacting, and relating that are relatively stable over time.
Drugs help control specific symptoms only in selected cases—eg, to control significant anxiety, angry outbursts, and depression.
Personality disorders are often resistant to change, but many gradually become less severe over time.
Skodol AE, Bender DS, Oldham JM: Personality pathology and personality disorders.
In American Psychiatric Association Publishing Textbook of Psychiatry, 7th Edition, edited by LW Roberts, Washington, DC, 2019, pp.
Personality disorders exist when these traits become so pronounced, rigid, and maladaptive that they impair work and / or interpersonal functioning.
These social maladaptations can cause significant distress in people with personality disorders and in those around them.
Drug-Induced Autoimmunity By Jennifer M Barker, MD, Children's Hospital Colorado, Division of Pediatric Endocrinology Reviewed / Revised Apr 2023 View Patient Education Patients receiving drugs in the novel class of cancer therapeutics called immune checkpoint inhibitors, have an increased risk for development of autoimmune disorders, including endocrine disorders.
Hypophysitis, autoimmune thyroid disease (both hyperthyroidism and hypothyroidism), type 1 diabetes, and primary adrenal insufficiency have been reported (1, 2).
Treatment is replacement of hormones documented to be deficient.
These might include thyroid hormone, insulin, or glucocorticoids.
(It is 3 to 4 times faster than using sutures.)
If wounds have significant underlying tension, place deep, absorbable sutures before stapling to decrease tension.
Begin at one end of the laceration.
Indications Relatively straight, sharp-edged lacerations of the trunk or an extremity, and superficial lacerations of the scalp Contraindications Absolute contraindications Anticipated MRI, because the magnetic field can tear staples from the skin Relative contraindications Lacerations on the face or neck because the cosmetic result is often inferior to that with suturing Lacerations on hands or feet because pain is more often increased Anticipated head CT because tissue staples create scan artifact Wound closure of any type may be contraindicated for wounds that are contaminated, relatively old, or that would be at higher risk of infection if closed, such as small bites to hands or feet, puncture wounds, or high-velocity missile wounds.
Evert the edges of the wound using forceps, preferably done by a second operator.
Sometimes, the skin can be everted simply by pinching it between the your thumb and forefinger.
Once the edges are in eversion, gently place the staples across the wound.
To ensure the best closure, place the center of the staple device perpendicular to and over the center of the wound.
Once the stapler handle is squeezed, the staple is automatically placed into the wound and bent to the proper configuration.
When placed properly, the crossbar of the staple is elevated a few millimeters above the surface of the skin.
Work from one end of the laceration to the other, placing each staple about 0.5 to 1 cm from its predecessor, as needed to achieve proper apposition of the edges along the entire length of the wound.
Aftercare Apply antibiotic ointment if desired, then leave uncovered or cover with a sterile bandage.
Have the patient remove the dressing and gently cleanse the wound in 24 to 48 hours.
Scalp lacerations can be cleansed by showering within a few hours.
Remove staples using the same time interval as sutures.
(See How To Repair a Laceration With Simple Interrupted Sutures: Aftercare.)
To remove staples, use a dedicated instrument made specifically by the manufacturer of that stapling device.
Place the lower jaw of the staple remover under the crossbar and squeeze the handle.
Warnings and Common Errors Improper wound edge apposition (causing wound edges to overlap) and failure to evert the wound edges are the most common errors.
Align the middle of the staple with the center of the wound.
Pressing too hard on the device when stapling can place the staples too tightly, causing wound ischemia.
Removal of staples can be more uncomfortable than removal of sutures.
Staples can cause significant scarring if left in place too long.
Tips and Tricks Rather than starting at one end of the laceration, many practitioners find it easier to start in the middle and then place subsequent staples in the middle of each open section, until there are no remaining gaps in the wound.
Complications Improper wound edge apposition leading to poor wound closure and cosmetic result In patients who scar easily, a larger scar Worse cosmetic effect, particularly if staples are left in too long Infection Equipment Wound hygiene and closure techniques need not be sterile procedures.
If forceps are not available, the skin can be everted by pinching the skin (eg, with thumb and forefinger).
Clean procedure, barrier protection Face mask and safety glasses (or a face shield), head caps, gowns, gloves Sterile drapes, towels (for wound debridement and suturing) Antiseptic cleaner such as chlorhexidine Syringes, needles, and local anesthesia Tissue forceps Stapling device (including removal device) Antibiotic ointment Nonocclusive dressing Additional Considerations Suturing and stapling have comparable healing outcomes, wound tensile strength, complication rates, patient tolerance, efficiency of closure, scar width, color, general appearance, suture or staple marks, infection rates, cost, and patient acceptance.
In animal studies, staples had less wound inflammation and greater resistance to infection in contaminated wounds.
The major advantage to using staples is faster time to close the wound.
How To Apply a Volar Arm Splint By Miranda Lewis, MD, University of Washington Reviewed / Revised Jul 2021 | Modified Sep 2022 View Patient Education Indications Contraindications Complications Equipment Additional Considerations Positioning Step-by-Step Description of Procedure Aftercare Warnings and Common Errors Tips and Tricks Topic Resources Volar splint How To Apply a Volar Arm... A volar splint is device applied to immobilize the wrist and hand.
Lay out a length of splint material matching the distance from just proximal to the MCP joints to the mid-forearm volar surface of the forearm—it should be just shorter than the area covered by the padding.
Apply the splint material from the MCP joints to the mid-forearm along the volar surface.
Indications Isolated distal radius fracture Carpal bone fractures that do not require a thumb spica splint (triquetrum, hamate, pisiform, trapezoid) Severe wrist sprains Immobilization for soft tissue injuries of the hand or wrist (eg, cellulitis) Contraindications None Complications Thermal injury (caused by the exothermic reaction between plaster or fiberglass and water) Excessive pressure causing skin sores and / or ischemic injury Excessive tightness of circumferential wrapping may contribute to compartment syndrome Equipment Stockinette (enough to cover the area from metacarpophalangeal [MCP] joints to the mid-forearm) Roll padding (eg, cotton roll) 7.5-cm (3-inch) width Plaster or fiberglass splinting material, 7.5 - to 10-cm (3 - to 4-inch) width—wide enough to cover from the MCP joints and extend along the volar surface of the hand and forearm to the mid-forearm Strong scissors and / or shears Elastic bandage, usually 7.5 - to 10-cm (3 - to 4-inch) width Lukewarm water and bucket or other container Nonsterile gloves Additional Considerations The volar splint does not prevent pronation or supination.
Maintain the wrist at 10 to 20° extension until the splinting material hardens.
How To Apply a Volar Arm Splint VIDEO Aftercare Advise the patient to keep the splint dry.
If these motions should be immobilized, a sugar tong splint should be used.
Volar splint Positioning The patient should be positioned so that the operator has appropriate access to the patient's affected hand.
Splint the wrist at 10 to 20° extension.
Apply stockinette, covering the area from distal to the MCP joints to the mid-forearm.
Wrap the padding from the MCP joint to the mid-forearm slightly beyond the area to be covered by the splint material; overlap each turn by half the width of the padding and periodically tear the wrapping across its width to decrease the risk of tissue compression.
Pulmonary Barotrauma By Richard E Moon, MD, Duke University Medical Center Reviewed / Revised Apr 2023 View Patient Education Diagnosis Treatment Prevention Key Points More Information Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume.
The most common form of pulmonary barotrauma is pneumomediastinum.
Mediastinal air can track into the neck, causing subcutaneous emphysema detectable as crepitation, and voice changes.
A crackling sound rarely heard over the heart ("mediastinal crunch," Hamman sign).
Air can sometimes track caudad into the peritoneal cavity (falsely suggesting a ruptured viscus and the need for laparotomy), but it does not typically cause peritoneal signs.
Tension pneumothorax, although rare with barotrauma, can cause hypotension, distended neck veins, hyperresonance to percussion, and, as a late finding, tracheal deviation.
Alveolar rupture can allow air into the pulmonary venous circulation with subsequent arterial gas embolism, which is particularly dangerous when it involves the brain, but can also affect other organs (eg, spinal cord, heart, skin, kidneys, spleen, gastrointestinal tract).
Compression of the lungs may occur during very deep descent in breath-hold diving; compression may rarely decrease lung volume below residual volume, causing mucosal edema, vascular engorgement, pulmonary edema, and hemorrhage, which manifest clinically as dyspnea and hemoptysis on ascent.
Diagnosis of Pulmonary Barotrauma Chest imaging Chest x-ray is done to look for signs of pneumothorax or pneumomediastinum (radiolucent band along the cardiac border).
If chest x-ray is negative but there is strong clinical suspicion, then chest CT, which may be more sensitive than plain film x-rays, may be diagnostic.
Ultrasound may also be useful for rapid bedside diagnosis of pneumothorax.
Factors increasing risk of pulmonary barotrauma include certain behaviors (eg, rapid ascent, breath-holding, breathing compressed air) and lung disorders (eg, COPD [chronic obstructive pulmonary disease]).
Pneumoperitoneum without a ruptured viscus should be suspected when pneumoperitoneum is present without peritoneal signs.
If patients have any neurologic deficits found on neurologic examination, arterial gas embolism to the brain should be suspected.
Treatment of Pulmonary Barotrauma 100% oxygen Sometimes tube thoracostomy Suspected tension pneumothorax is treated with needle decompression followed by tube thoracostomy.
If a smaller (eg, 10 to 20%) pneumothorax is present and there is no sign of hemodynamic or respiratory instability, the pneumothorax may resolve when high-flow 100% oxygen is given for 24 to 48 hours.
If this treatment is ineffective or if a larger pneumothorax is present, tube thoracostomy (using a pigtail catheter or small chest tube) is done.
No specific treatment is required for pneumomediastinum; symptoms usually resolve spontaneously within hours to days.
After a few hours of observation, most patients can be treated as outpatients; high-flow 100% oxygen is recommended to hasten resorption of extra-alveolar gas in these patients.
Rarely, mediastinotomy is required to relieve tension pneumomediastinum.
Prevention of Pulmonary Barotrauma Prevention of pulmonary barotrauma is usually the top priority.
Proper ascent timing and techniques are essential.
Pneumothorax and pneumomediastinum are common manifestations.
Patients at high risk for pneumothorax during diving include those with pulmonary bullae, Marfan syndrome, chronic obstructive pulmonary disease, or previous spontaneous pneumothorax.
Such individuals should not dive or work in areas of compressed air.
Patients with asthma may be at risk of pulmonary barotrauma, although many people with asthma can dive safely after they are evaluated and treated appropriately.
Patients with pneumomediastinum after a dive should be referred to a diving medicine specialist for assessment of risks of future dives.
After COVID-19 infection, some people develop lung pathology (such as bullae) that could increase their risk for pulmonary barotrauma while diving.
Proposed guidelines (1, 2) recommend spirometry and chest imaging for anyone who has had respiratory or cardiac symptoms (including chest pain, palpitations, significant cough, or dyspnea) due to COVID-19 infection Prevention references 1.
Diving Hyperb Med 52 (1): 66 - 67, 2022. doi: 10.28920 / dhm52.1.66 - 67 Key Points Although rare, pulmonary barotrauma can result in tension pneumothorax, which must be immediately decompressed.
Patients require neurologic examination and chest imaging.
Examine all patients who have pulmonary barotrauma for signs of brain dysfunction, which suggests arterial gas embolism.
Treat all patients with suspected pulmonary barotrauma with 100% oxygen pending diagnostic testing.
Pneumothorax is treated.
Prevention involves decreasing risky behaviors and counseling high-risk divers.
Overexpansion and alveolar rupture can occur when breath holding occurs (usually while breathing compressed air) during ascent, particularly rapid ascent.
The result can be Pneumothorax (causing dyspnea, chest pain, and unilateral decrease in breath sounds) Pneumomediastinum (causing sensation of fullness in the chest, neck pain, pleuritic chest pain that may radiate to the shoulders, dyspnea, coughing, hoarseness, and dysphagia).
Ear and Sinus Barotrauma By Richard E Moon, MD, Duke University Medical Center Reviewed / Revised Apr 2023 View Patient Education Diagnosis Treatment Prevention Key Points More Information Barotrauma is tissue injury caused by a pressure-related change in body compartment gas volume.
When pressure within the middle ear remains elevated during or after ascent from a dive, the facial nerve can be compressed (facial baroparesis), resulting in ipsilateral upper and lower facial paresis.
Weakness of both upper and lower face distinguishes facial baroparesis from stroke or arterial gas embolism (1).
Inner ear barotrauma (IEBT) occurs due to rupture of the labyrinthine window (round or oval window) or tears of the Reissner, basilar, or tectorial membranes.
Symptoms, which include tinnitus, hearing loss, dizziness, disequilibrium, vertigo, nystagmus, ataxia, nausea, and vomiting, often worsen with activity and loud noise, and improve with rest.
Symptoms usually start during descent when there is difficulty equalizing middle ear pressure, but can occur during ascent, possibly due to air expansion within the cochlea or vestibular apparatus.
Symptoms can also occur days after a dive, often provoked by lifting or straining (2).
Sinus barotrauma most often affects the frontal sinuses, followed by the ethmoid and maxillary sinuses (3).
Divers experience mild pressure to severe pain, with a feeling of congestion in the involved sinus compartments during ascent or descent and sometimes epistaxis.
Pain can be severe, sometimes accompanied by facial tenderness on palpation.
Maxillary sinus overpressurization can compress the maxillary branch of the trigeminal nerve, causing hyperesthesia over the cheek.
It can affect the ear (causing ear pain, hearing loss, and / or vestibular symptoms) or the sinuses (causing pain and congestion).
Overpressurization in the sphenoid sinus occasionally compresses the optic nerve, causing decreased vision or blindness (3, 4).
Rarely, the sinus may rupture and cause pneumocephalus with facial or oral pain, nausea, vertigo, or headache.
Rupture of a maxillary sinus can cause retro-orbital air with diplopia due to oculomotor dysfunction.
Compression of the trigeminal nerve in the maxillary sinus can cause facial paresthesias.
Physical examination may detect tenderness in the sinuses or nasal hemorrhage.
Barotrauma can also occur due to the reduction in ambient pressure during ascent to altitude.
Diagnosis sometimes requires audiometry and vestibular testing.
PMID: 9830365 PMCID: PMC1305327 Diagnosis of Ear and Sinus Barotrauma Clinical evaluation Sometimes, audiometry and vestibular testing Barotrauma causing only pain in the ear or sinuses is usually diagnosed clinically.
Patients with symptoms of inner ear barotrauma (eg, tinnitus, hearing loss, or vertigo) should be examined for signs of vestibular dysfunction and undergo urgent formal audiometry, vestibular testing, and possibly surgery.
Treatment, when required, may involve decongestants, analgesics, and sometimes oral corticosteroids or surgical repair of serious inner or middle ear or sinus injuries.
These patients should be referred to an otolaryngologist because prompt surgical treatment of labyrinthine window tears can reverse hearing loss.
Imaging (eg, plain x-rays, CT) is not necessary for diagnosis of uncomplicated sinus barotrauma, but CT is useful if sinus rupture or cranial nerve compression is suspected.
Treatment of Ear and Sinus Barotrauma Decongestants and analgesics Sometimes oral corticosteroids, surgical repair, or both Most ear and sinus barotrauma injuries resolve spontaneously and require only symptomatic treatment and outpatient follow-up.
Treatment with medications for sinus and middle ear barotrauma is identical.
Decongestants (usually oxymetazoline 0.05%, 2 sprays each nostril twice a day for 3 to 5 days or pseudoephedrine 30 to 60 mg orally 2 to 4 times a day up to a maximum of 240 mg / day for 3 to 5 days) can help open occluded chambers.
Severe cases can be treated with nasal corticosteroids.
Pain can be controlled with nonsteroidal anti-inflammatory drugs or opioids.
If bleeding or evidence of effusion is present, antibiotics are given (eg, amoxicillin 500 mg orally every 12 hours for 10 days, trimethoprim / sulfamethoxazole 1 double-strength tablet orally twice a day for 10 days).
For middle ear barotrauma, some physicians also advocate a short course of oral corticosteroids (eg, prednisone 60 mg orally once a day for 6 days, then tapered over 7 to 10 days).
Referral to an otorhinolaryngologist is indicated for severe or persistent symptoms.
Urgent surgery (eg, tympanotomy for direct repair of a ruptured round or oval window, myringotomy to drain fluid from the middle ear, sinus decompression) may be necessary for serious inner or middle ear or sinus injuries.
Prevention of Ear and Sinus Barotrauma During a dive, ear barotrauma during descent may be avoided by frequently swallowing or exhaling against pinched nostrils to open the eustachian tubes and equalize pressure between the middle ear and the environment.
Pressure behind ear plugs cannot be equalized, so they should not be used for diving.
Prophylaxis with oxymetazoline 0.05% nasal spray, 2 sprays per nostril twice daily or pseudoephedrine 30 to 60 mg orally 2 or 4 times a day up to a maximum of 240 mg / day, beginning 12 to 24 hours before a dive, can reduce the incidence of ear and sinus barotrauma.
Diving should not be done if congestion does not resolve or if an upper respiratory infection or uncontrolled allergic rhinitis is present.
Key Points If patients have tinnitus, hearing loss, or vertigo, arrange urgent audiometry and vestibular testing.
Consider CT if unsure of clinical assessment or if sinus injury is complicated by cranial nerve compression.
If symptoms are severe, prescribe an analgesic and a decongestant.
Decrease risk of ear and sinus barotrauma by counseling against diving when the nose is congested and sometimes by prescribing prophylactic oxymetazoline or nasal pseudoephedrine.
Typically, divers experience ear fullness and pain during descent; if pressure is not quickly equilibrated, middle ear hemorrhage or tympanic membrane rupture may occur.
Inflow of cold water to the middle ear may result in vertigo, nausea, and disorientation while submerged.
On examination of the ear canal, the tympanic membrane may show congestion, hemotympanum, perforation, or lack of mobility during air insufflation with a pneumatic otoscope; conductive hearing loss is usually present.
It can also result from excessive release of thyroid hormone from the thyroid without increased synthesis.
The other causes of subclinical hyperthyroidism are the same as those for clinically apparent hyperthyroidism.
Patients with serum TSH < 0.1 microU / mL (0.1 mU / L) have an increased incidence of atrial fibrillation (particularly older patients), reduced bone mineral density, increased fractures, and increased mortality.
Patients with serum TSH that is only slightly below normal are less likely to have these features.
Treatment of Hyperthyroidism Treatment of hyperthyroidism depends on cause (1) but may include Radioactive iodine Methimazole or propylthiouracil Beta-blockers Iodine Surgery Radioactive sodium iodine (iodine-131, radioiodine) In the United States, iodine-131 is the most common treatment for hyperthyroidism.
Radioiodine is often recommended as the treatment of choice for Graves disease and toxic nodular goiter in all patients, including children.
Dosage of iodine-131 is difficult to adjust because the response of the gland cannot be predicted; some physicians give a standard dose of 8 to 15 millicurie.
Others adjust the dose based on estimated thyroid size and the 24-hour uptake to provide a dose of 80 to 120 microcurie / g thyroid tissue.
When sufficient iodine-131 is given to cause euthyroidism, about 25 to 50% of patients become hypothyroid 1 year later, and the incidence continues to increase yearly.
Thus, most patients eventually become hypothyroid.
Such release is commonly caused by the destructive changes of various types of thyroiditis.
Larger doses, such as 10 to 20 millicurie, often cause hypothyroidism within 6 months, and thus ablative therapy (ie, iodine-131) has become the preferred approach.
Radioactive iodine is not used during lactation because it can enter breast milk and cause hypothyroidism in the infant.
It is not used during pregnancy because it crosses the placenta and can cause severe fetal hypothyroidism.
There is no proof that radioiodine increases the incidence of tumors, leukemia, thyroid cancer, or birth defects in children born to previously hyperthyroid women who become pregnant later in life.
Methimazole and propylthiouracil These antithyroid drugs block thyroid peroxidase, decreasing the organification of iodide, and impair the coupling reaction.
Propylthiouracil in high doses also inhibits the peripheral conversion of T4 to T3.
Methimazole is the preferred drug.
The usual starting dosage of methimazole is 5 to 20 mg orally 2 or 3 times a day.
Normalization of TSH lags normalization of T4 and T3 levels by one or more weeks.
Therefore, when T4 and T3 levels normalize, the dosage is decreased to the lowest effective amount, usually methimazole 2.5 to 10 mg once a day in order to avoid inducing hypothyroidism.
The most common causes overall include Graves disease Multinodular goiter Thyroiditis Single, autonomous, hyperfunctioning "hot" nodule Graves disease (toxic diffuse goiter), the most common cause of hyperthyroidism, is characterized by hyperthyroidism and one or more of the following: Goiter Exophthalmos Infiltrative dermopathy Graves disease is caused by an autoantibody against the thyroid receptor for thyroid-stimulating hormone (TSH); unlike most autoantibodies, which are inhibitory, this autoantibody is stimulatory, thus causing continuous synthesis and secretion of excess T4 and T3.
Maintenance doses of methimazole may be continued for one or many years depending on the clinical circumstances.
Carbimazole, which is used widely in Europe but is unavailable in the US, is rapidly converted to methimazole.
The usual starting dose is similar to that of methimazole; maintenance dosage is 2.5 to 10 mg orally once a day or 2.5 to 5 mg twice a day.
Because of severe liver failure in some patients < age 40, especially children, propylthiouracil is recommended only in special situations (eg, in the 1st trimester of pregnancy, in thyroid storm).
The usual starting dose of propylthiouracil is 100 to 150 mg orally every 8 hours.
Rapid control can be achieved by increasing the dosage of propylthiouracil to 150 to 200 mg every 8 hours.
Such dosages or higher ones (up to 400 mg every 8 hours) are generally reserved for severely ill patients, including those with thyroid storm, to block the conversion of T4 to T3.
Maintenance dosing with propylthiouracil is 50 mg twice a day or 3 times a day About 20 to 50% of patients with Graves disease remain in remission after a 1 - to 2-year course of either drug.
The return to normal or a marked decrease in gland size, the restoration of a normal serum TSH level, and less severe hyperthyroidism before therapy are good prognostic signs of long-term remission.
Graves disease (like Hashimoto thyroiditis) sometimes occurs with other autoimmune disorders, including type 1 diabetes mellitus, vitiligo, premature graying of hair, pernicious anemia, connective tissue disorders, and polyglandular deficiency syndrome.
The concomitant use of antithyroid drug therapy and levothyroxine does not improve the remission rate in patients with Graves disease.
Because toxic nodular goiter rarely goes into remission, antithyroid drug therapy is given only in preparation for surgical treatment or iodine-131 therapy.
Adverse effects include rash, allergic reactions, abnormal liver function (including hepatic failure with propylthiouracil), and, in about 0.1% of patients, reversible agranulocytosis.
Patients allergic to one drug can be switched to the other, but cross-sensitivity may occur.
If agranulocytosis occurs, the patient cannot be switched to the other drug; other therapy (eg, radioiodine, surgery) should be used.
Pearls & Pitfalls If agranulocytosis occurs with one of the antithyroid peroxidase drugs (methimazole or propylthiouracil), avoid using another drug in the same class; use another therapy (eg, radioiodine, surgery) instead.
Potential adverse effects or other characteristics vary between the two drugs and guide the indications for each.
Methimazole need only be given once a day, which improves adherence.
Furthermore, when methimazole is used in dosages of < 20 mg a day, agranulocytosis is less common; with propylthiouracil, agranulocytosis may occur at any dosage.
Methimazole has been used successfully in pregnant and nursing women without fetal or infant complications, but rarely methimazole has been associated with scalp and gastrointestinal defects in neonates and with a rare embryopathy.
Heredity increases the risk of Graves disease, although the genes involved are unknown.
Because of these complications, propylthiouracil is used in the 1st trimester of pregnancy.
Propylthiouracil is preferred for the treatment of thyroid storm, because the high dosages used (over 800 mg a day) partially block the peripheral conversion of T4 to T3 in addition to decreasing production in the thyroid.
The combination of high-dose propylthiouracil and dexamethasone, also a potent inhibitor of T4 to T3 conversion, can relieve symptoms of severe hyperthyroidism as seen in patients with thyroid storm and restore the serum T3 level to normal within a week.
Beta-blockers Symptoms and signs of hyperthyroidism due to adrenergic stimulation may respond to beta-blockers; propranolol has had the greatest use, but atenolol or metoprolol may be preferable.
Manifestations typically responding to beta-blockers: Tachycardia, tremor, mental symptoms, eyelid lag; occasionally heat intolerance and sweating, diarrhea, proximal myopathy Manifestations typically not responding to beta-blockers: goiter, exophthalmos, weight loss, bruit, increased oxygen consumption, and increased circulating thyroxine levels Propranolol is indicated in thyroid storm (see table Treatment of Thyroid Storm).
It rapidly decreases heart rate, usually within 2 to 3 hours when given orally and within minutes when given intravenously.
Esmolol should be used only in the intensive care unit because it requires careful titration and monitoring.
Beta-blockers are also indicated for tachycardia with hyperthyroidism, especially in older patients, because antithyroid drugs usually take several weeks to become fully effective.
Calcium channel blockers may control tachyarrhythmias in patients in whom beta-blockers are contraindicated.
The pathogenesis of infiltrative ophthalmopathy (responsible for the exophthalmos in Graves disease) is poorly understood but may result from immunoglobulins directed to the TSH receptors in the orbital fibroblasts and fat that result in release of proinflammatory cytokines, inflammation, and accumulation of glycosaminoglycans.
Iodine Iodine in pharmacologic doses inhibits the release of T3 and T4 within hours and inhibits the organification of iodine, a transitory effect lasting from a few days to a week, after which inhibition usually ceases.
Iodine is used for emergency management of thyroid storm, for hyperthyroid patients undergoing emergency nonthyroid surgery, and (because it also decreases the vascularity of the thyroid) for preoperative preparation of hyperthyroid patients undergoing thyroidectomy.
Iodine generally is not used for routine treatment of hyperthyroidism.
The usual dosage is 2 to 3 drops (100 to 150 mg) of a saturated potassium iodide solution orally 3 times a day or 4 times a day or sodium iodide in 1 L 0.9% saline solution 0.5 to 1 g IV given slowly once a day.
Complications of iodine therapy include inflammation of the salivary glands, conjunctivitis, and rash.
Surgery Surgery is indicated for patients with Graves disease whose hyperthyroidism has recurred after courses of antithyroid drugs and who refuse iodine-131 therapy, patients who cannot tolerate antithyroid drugs, patients with very large goiters, and in some younger patients with toxic adenoma and multinodular goiter.
Surgery may be done in older patients with giant nodular goiters.
Postoperative recurrences vary between 2 and 16%; risk of hypothyroidism is directly related to the extent of surgery.
Vocal cord paralysis and hypoparathyroidism are uncommon complications.
Ophthalmopathy may also occur before the onset of hyperthyroidism or as late as 20 years afterward and frequently worsens or abates independently of the clinical course of hyperthyroidism.
Saturated solution of potassium iodide 3 drops (about 100 to 150 mg) orally 3 times a day should be given for 10 days before surgery to reduce the vascularity of the gland.
Methimazole must be given first because the patient should be euthyroid before iodide is given.
Dexamethasone can be added to rapidly restore euthyroidism.
Surgical procedures on the anterior neck are more difficult in patients who previously underwent thyroidectomy or radioiodine therapy.
Treatment of thyroid storm A treatment regimen for thyroid storm is shown in the table Treatment of Thyroid Storm.
Table Treatment of infiltrative dermopathy and ophthalmopathy In infiltrative dermopathy (in Graves disease), topical corticosteroids or corticosteroid injections into the lesions may decrease the dermopathy.
Dermopathy sometimes remits spontaneously after months or years.
Ophthalmopathy should be treated jointly by the endocrinologist and ophthalmologist and may require selenium, corticosteroids, orbital radiation, and surgery.
Surgical thyroidectomy may help resolve or prevent progression of ophthalmopathy.
Typical ophthalmopathy in the presence of normal thyroid function is called euthyroid Graves disease.
Teprotumumab, an insulin - like growth factor 1 (IGF-1) receptor inhibitor, is very effective therapy for moderately severe ophthalmopathy (2).
Radioiodine therapy may accelerate progression of ophthalmopathy when ophthalmopathy is active, and is thus contraindicated in this active phase.
Management of subclinical hyperthyroidism In patients with subclinical hyperthyroidism who are taking levothyroxine, reduction of the dose is the most appropriate management unless therapy is aimed at maintaining suppressed TSH levels in patients with thyroid cancer.
Therapy is indicated for patients with endogenous subclinical hyperthyroidism (serum TSH < 0.1 mU / L), especially those with atrial fibrillation or reduced bone mineral density.
The usual treatment is iodine-131, but low doses of methimazole are also effective.
Toxic solitary or multinodular goiter (Plummer disease) sometimes results from TSH receptor gene mutations causing continuous thyroid activation.
2020. doi: 10.1056/NEJMoa1910434 Key Points Hyperthyroidism has many causes; the most common etiology is Graves disease, caused by excessive hormone synthesis by an abnormal thyroid.
Other causes of hyperthyroidism include excessive stimulation of a normal thyroid gland (eg, by thyroid-stimulating hormone [TSH], human chorionic gonadotrophin [hCG], ingestion of iodine or iodine-containing drugs), excessive hormone synthesis by an abnormal thyroid (eg, toxic nodular goiter), excessive release of thyroid hormones (eg, due to thyroiditis), or ingestion of excessive quantities of thyroid hormone.
Symptoms and signs are many but include tachycardia, fatigue, weight loss, nervousness, and tremor; patients with Graves disease may also have exophthalmos and infiltrative dermopathy.
Free thyroxine (T4), and / or free or total triiodothyronine (T3) are elevated, and TSH is suppressed (except in rarer cases of pituitary causes of hyperthyroidism).
Hormone synthesis can be suppressed with methimazole (or in certain cases, propylthiouracil) and adrenergic symptoms relieved with beta-blockers; long-term treatment may require thyroid ablation with radioactive iodine or surgery.
Thyroid storm—resulting from untreated or inadequately treated severe hyperthyroidism—is a life-threatening emergency that presents with severe symptoms of hyperthyroidism and may result in cardiovascular collapse or shock; it is treated with a regimen of antithyroid drugs, iodine, and hemodynamic support.
Patients with toxic nodular goiter have none of the autoimmune manifestations or circulating antibodies observed in patients with Graves disease.
Also, in contrast to Graves disease, toxic solitary and multinodular goiters usually do not remit.
Inflammatory thyroid disease (thyroiditis) includes subacute granulomatous thyroiditis, Hashimoto thyroiditis, and silent lymphocytic thyroiditis, a variant of Hashimoto thyroiditis.
Hyperthyroidism is more common in subacute granulomatous thyroiditis and results from destructive changes in the gland and release of stored hormone, not from increased synthesis.
Hypothyroidism may follow.
Inappropriate TSH secretion is a rare cause.
Patients with hyperthyroidism have essentially undetectable TSH except for those with a TSH-secreting anterior pituitary adenoma or pituitary resistance to thyroid hormone.
TSH levels are high, and the TSH produced in both disorders is biologically more active than normal TSH.
An increase in the alpha-subunit of TSH in the blood (helpful in differential diagnosis) occurs in patients with a TSH-secreting pituitary adenoma.
Drug-induced hyperthyroidism can result from amiodarone, checkpoint inhibitors used in cancer therapy, alemtuzumab used in treatment of multiple sclerosis, or interferon-alfa, which may induce thyroiditis with hyperthyroidism and other thyroid disorders.
Although more commonly causing hypothyroidism, lithium can rarely cause hyperthyroidism.
Patients receiving these drugs should be closely monitored.
Thyrotoxicosis factitia is hyperthyroidism resulting from intentional or accidental overingestion of thyroid hormone.
Excess iodine ingestion causes hyperthyroidism with a low thyroid radioactive iodine uptake.
It most often occurs in patients with underlying nontoxic nodular goiter (especially older patients) who are given drugs that contain iodine (eg, amiodarone) or who undergo radiologic studies using iodine-rich contrast agents.
The etiology may be that the excess iodine provides substrate for functionally autonomous (ie, not under TSH regulation) areas of the thyroid to produce hormone.
Hyperthyroidism usually persists as long as excess iodine remains in the circulation.
Hydatidiform mole (molar pregnancy) and choriocarcinoma produce high levels of serum human chorionic gonadotropin (hCG), a weak thyroid stimulator.
Levels of hCG are highest during the 1st trimester of pregnancy and result in the decrease in serum TSH and mild increase in serum free T4 sometimes observed at that time.
The increased thyroid stimulation may be caused by increased levels of partially desialated hCG, an hCG variant that appears to be a more potent thyroid stimulator than more sialated hCG.
Hyperthyroidism in molar pregnancy, choriocarcinoma, and hyperemesis gravidarum is transient; normal thyroid function resumes when the molar pregnancy is evacuated, the choriocarcinoma is appropriately treated, or the hyperemesis gravidarum abates.
Symptoms include palpitations, fatigue, weight loss, heat intolerance, anxiety, and tremor.
Nonautoimmune autosomal dominant hyperthyroidism manifests during infancy.
It results from mutations in the TSH receptor gene that produce continuous thyroid stimulation.
Metastatic thyroid cancer is a possible cause.
Overproduction of thyroid hormone occurs rarely from functioning metastatic follicular carcinoma, especially in pulmonary metastases.
Struma ovarii develops when ovarian teratomas contain enough thyroid tissue to cause true hyperthyroidism.
Radioactive iodine uptake occurs in the pelvis, and uptake by the thyroid is usually suppressed.
Pathophysiology of Hyperthyroidism In hyperthyroidism, serum T3 usually increases more than does T4, probably because of increased secretion of T3 as well as conversion of T4 to T3 in peripheral tissues.
In some patients, only T3 is elevated (T3 toxicosis).
T3 toxicosis may occur in any of the common disorders that cause hyperthyroidism, including Graves disease, multinodular goiter, and the autonomously functioning solitary thyroid nodule.
If T3 toxicosis is untreated, the patient usually also develops laboratory abnormalities typical of hyperthyroidism (ie, elevated T4 and iodine-123 uptake).
Diagnosis is clinical and with thyroid function tests.
The various forms of thyroiditis commonly have a hyperthyroid phase followed by a hypothyroid phase.
Symptoms and Signs of Hyperthyroidism Most symptoms and signs are the same regardless of the cause.
Exceptions include infiltrative ophthalmopathy and dermopathy, which occur only in Graves disease.
Pearls & Pitfalls Older adults with hyperthyroidism may have symptoms more akin to depression or dementia.
The clinical presentation may be dramatic or subtle.
A goiter or nodule may be present.
Many common symptoms of hyperthyroidism are due to enhanced sensitivity to adrenergic hormones, such as nervousness, palpitations, hyperactivity, increased sweating, heat hypersensitivity, fatigue, increased appetite, weight loss, insomnia, weakness, and frequent bowel movements (occasionally diarrhea).
Hypomenorrhea may be present.
Signs may include warm, moist skin, tremor, tachycardia, widened pulse pressure, and atrial fibrillation.
Older patients, particularly those with toxic nodular goiter, may present atypically (apathetic or masked hyperthyroidism) with symptoms more akin to depression or dementia.
Most do not have exophthalmos or tremor.
Atrial fibrillation, syncope, altered sensorium, heart failure, and weakness are more likely.
Symptoms and signs may involve only a single organ system.
Eye signs include stare, eyelid lag, eyelid retraction, and mild conjunctival injection and are largely due to excessive adrenergic stimulation.
They usually remit with successful treatment.
Infiltrative ophthalmopathy, a more serious development, is specific to Graves disease and can occur years before or after hyperthyroidism.
It is characterized by orbital pain, lacrimation, irritation, photophobia, increased retro-orbital tissue, exophthalmos, and lymphocytic infiltration of the extraocular muscles, causing ocular muscle weakness that frequently leads to double vision.
Eye Manifestations of Graves Disease Eye Manifestations of Graves Disease—Exophthalmos © Springer Science+Business Media Close-up View of Exophthalmos © Springer Science+Business Media Eye Manifestations of Graves Disease—Inability to Close the Eyes © Springer Science+Business Media Eye Manifestations of Graves Disease—Infraorbital Bags © Springer Science+Business Media Infiltrative Ophthalmopathy A patient with Graves disease manifests ocular signs, including widened palpebral fissures, lid retraction, strabismus, and exophthalmos.
From Mulligan M, Cousins M In Atlas of Anesthesia: Preoperative Preparation and Intraoperative Monitoring.
Edited by R Miller (series editor) and JL Lichtor.
Infiltrative dermopathy, also called pretibial myxedema (a confusing term, because myxedema suggests hypothyroidism), is characterized by nonpitting infiltration by proteinaceous ground substance, usually in the pretibial area.
It rarely occurs in the absence of Graves ophthalmopathy.
The lesion is often pruritic and erythematous in its early stages and subsequently becomes brawny.
Infiltrative dermopathy may appear years before or after hyperthyroidism.
Thyroid storm Thyroid storm is an acute form of hyperthyroidism that results from untreated or inadequately treated severe hyperthyroidism.
It is rare, occurring in patients with Graves disease or toxic multinodular goiter (a solitary toxic nodule is a less common cause and generally causes less severe manifestations).
It may be precipitated by infection, trauma, surgery, embolism, diabetic ketoacidosis, or preeclampsia.
Thyroid storm causes abrupt florid symptoms of hyperthyroidism with one or more of the following: fever, marked weakness and muscle wasting, extreme restlessness with wide emotional swings, confusion, psychosis, coma, nausea, vomiting, diarrhea, and hepatomegaly with mild jaundice.
Hyperthyroidism can be classified on the basis of thyroid radioactive iodine uptake and the presence or absence of circulating thyroid stimulators (see table).
The patient may present with cardiovascular collapse and shock.
Thyroid storm is a life-threatening emergency requiring prompt treatment.
Diagnosis of Hyperthyroidism TSH Free T4, plus either free T3 or total T3 Sometimes radioactive iodine uptake Diagnosis of hyperthyroidism is based on history, physical examination, and thyroid function tests.
Serum TSH measurement is the best test because TSH is suppressed in hyperthyroid patients except in the rare instance when the etiology is a TSH-secreting pituitary adenoma or pituitary resistance to the normal inhibition by thyroid hormone.
Free T4 is increased in hyperthyroidism.
However, T4 can be falsely normal in true hyperthyroidism in patients with a severe systemic illness (similar to the falsely low levels that occur in euthyroid sick syndrome) and in T3 toxicosis.
If free T4 level is normal and TSH is low in a patient with subtle symptoms and signs of hyperthyroidism, then serum T3 should be measured to detect T3 toxicosis; an elevated level confirms that diagnosis.
The cause can often be diagnosed clinically (eg, the presence of signs specific to Graves disease).
If not, radioactive iodine uptake by the thyroid may be measured by using iodine-123.
When hyperthyroidism is due to hormone overproduction, radioactive iodine uptake by the thyroid is usually elevated.
Etiology of Hyperthyroidism Hyperthyroidism may result from increased synthesis and secretion of thyroid hormones (thyroxine [T4] and triiodothyronine [T3]) from the thyroid, caused by thyroid stimulators in the blood or by autonomous thyroid hyperfunction.
When hyperthyroidism is due to thyroiditis, iodine ingestion, or overtreatment with thyroid hormones, radioactive iodine uptake is low.
TSH receptor antibodies can be measured to evaluate for Graves disease.
Measurement is done in pregnant women with a history of Graves disease during the 3rd trimester of pregnancy to assess the risk of neonatal Graves disease; TSH receptor antibodies readily cross the placenta to stimulate the fetal thyroid.
Most patients with Graves disease have circulating antithyroid peroxidase antibodies, and fewer have antithyroglobulin antibodies.
Inappropriate TSH secretion is uncommon.
The diagnosis is confirmed when hyperthyroidism occurs with elevated circulating free T4 and T3 concentrations and normal or elevated serum TSH.
If thyrotoxicosis factitia is suspected, serum thyroglobulin can be measured; it is usually low or low-normal—unlike in all other causes of hyperthyroidism.
Subclinical hyperthyroidism Subclinical hyperthyroidism is low serum TSH in patients with normal serum free T4 and T3 and absent or minimal symptoms of hyperthyroidism.
Subclinical hyperthyroidism is far less common than subclinical hypothyroidism.
Many patients with subclinical hyperthyroidism are taking levothyroxine.
Riot-Control Chemical Agents By James M Madsen, MD, MPH, U S.Army Medical Research Institute of Chemical Defense (USAMRICD) Reviewed / Revised Jan 2023 View Patient Education Pathophysiology Symptoms and Signs Diagnosis Treatment Riot-control agents are compounds that were initially developed for crowd control but that have also been used in military conflicts (see also Overview of Chemical-Warfare Agents).
DM is thought to exert its effects partly via the oxidation of its arsenic moiety from As (III) to As (V) and the subsequent release of chlorine.
OC causes pain by binding to transient receptor potential vanilloid (TRPV1) receptors in neurons that are then stimulated to release neurokinin A, calcitonin - gene-related peptide, and substance P These compounds induce neurogenic inflammation associated with pain, capillary leakage, edema, mucous production, and bronchoconstriction.
Symptoms and Signs of Riot-Control Chemical Injuries Although there are minor differences between compounds, most riot-control agents cause nearly immediate irritation and pain involving the eyes, mucous membranes, and skin, which may also become briefly erythematous.
Respiratory effects resulting from inhalation are typically obviously audible (eg, coughing, sneezing, and wheezing) due to type 1 damage, although type 2 damage (delayed-onset shortness of breath due to incipient acute lung injury) can occur with high doses.
Deaths are usually due to pulmonary edema resulting from high doses delivered in confined spaces.
The largely obsolete agent DM may cause either immediate or delayed-onset irritation along with vomiting.
Effects of all of the riot-control agents typically resolve within a half an hour, although agent left on the skin may cause blisters.
Reactive airways dysfunction syndrome (RADS) can occur long after exposure and persist indefinitely, although it is impossible to predict which patients will develop this complication.
Diagnosis of Riot-Control Chemical Injuries Clinical evaluation Diagnosis is made by history, signs (lacrimation, blepharospasm, erythema, type 1 respiratory signs), and symptoms (transient irritation and pain with, at high doses, delayed-onset shortness of breath or chest tightness).
Riot-control agents are also referred to as harassing agents, tear agents, or lacrimators and are often misleadingly called tear gas, but in fact they do not exist as gases or vapors.
Chest x-rays are usually clear and not needed unless patients develop dyspnea, which suggests pulmonary edema.
Laboratory studies do not contribute to diagnosis.
Evidence of incipient pulmonary edema should prompt urgent evacuation to a pulmonary intensive care unit.
Treatment of Riot-Control Chemical Injuries Termination of exposure Skin decontamination If eye pain does not resolve spontaneously, eye decontamination Cold compresses and analgesics if necessary for pain At the first sign of exposure or potential exposure, masks are applied when available.
People are removed from the affected area when possible.
Decontamination is by physical or mechanical removal (brushing, washing, rinsing) of solid or liquid agents.
Water may transiently exacerbate the pain caused by CS and OC but is still effective, although fat-containing oils or soaps may be more effective against OC.
Eyes are decontaminated by copious flushing with sterile water or saline or (with OC) open-eye exposure to wind from a fan.
Referral to an ophthalmologist is needed if slit-lamp examination shows impaction of solid particles of agent.
Instead, they are solids that can be dispersed as liquids (by dissolving the solid agent to form a solution and then spraying the solution) or as aerosols (small particles released explosively or as smoke).
Most effects resulting from riot-control agents are transient and do not require treatment beyond decontamination, and most patients do not need observation beyond 4 hours.
However, patients should be instructed to return if they develop effects such as vesication or delayed-onset shortness of breath.
Like anticholinergic agents, they are intended to cause incapacitation rather than serious injury or death, although deaths due to pulmonary edema (acute lung injury) have occurred.
Military versions of these agents include chloroacetophenone (CN, also marketed as Mace®), chlorobenzylidenemalononitrile (CS), dibenzoxazepine (CR), and diphenylaminoarsine (adamsite, or DM, a so-called vomiting agent).
Oleoresin capsicum (OC, pepper spray) is a more recently developed riot-control agent used primarily for law enforcement and personal protection.
Chloropicrin (PS) is a compound used during World War I that is occasionally regarded as a riot-control agent, although it is more properly classified as a pulmonary agent.
Pathophysiology of Riot-Control Chemical Injuries CN and CS alkylate enzymes such as lactic dehydrogenase; this mechanism may be responsible for transient tissue injury that resolves with rapid replacement of the inactivated enzymes.
Release of cytokines such as bradykinin contributes to the pain caused by these compounds, as does generation of hydrochloric acid at high doses.
How To Reduce Anterior Shoulder Dislocations Using Traction-Countertraction By Matthew J Streitz, MD, San Antonio Uniformed Services Health Education Consortium Reviewed / Revised Sep 2022 View Patient Education Indications Contraindications Complications Equipment Additional Considerations Relevant Anatomy Positioning Step-by-Step Description of Procedure Aftercare Warnings and Common Errors Tips and Tricks Topic Resources Nerves, Arteries, and Ligaments... How To Reduce Anterior Shoulder... Traction-countertraction is often used to reduce anterior shoulder dislocations.
Contraindications to Traction-Countertraction Contraindications to simple closed reduction: Greater tuberosity fracture with > 1 cm displacement Significant Hill-Sachs deformity (≥ 20% humeral head deformity due to impaction against glenoid rim) Surgical neck fracture (below the greater and lesser tuberosities) Bankart fracture (anteroinferior glenoid rim) involving a bone fragment of over 20% and with glenohumeral instability Proximal humeral fracture of 2 or more parts These significant associated fractures require orthopedic evaluation and management, because of the risk of the procedure itself increasing displacement and injury severity.
Additional Considerations for Traction-Countertraction Reduction attempts are more likely to succeed if patients are calm and can relax their muscles.
Procedural sedation and analgesia (PSA) is often needed if substantial pain, anxiety, and muscle spasms impede the procedure.
Relevant Anatomy for Traction-Countertraction In most anterior dislocations, the humeral head is trapped outside and against the anterior lip of the glenoid fossa.
The most commonly used traction-countertraction method requires one or more assistants, physical force, and occasionally, endurance.
Positioning for Traction-Countertraction Position the patient supine on the stretcher.
Step-by-Step Description of Traction-Countertraction Neurovascular examination Do a pre-procedure neurovascular examination of the affected arm, and repeat the examination after each reduction attempt.
Procedural sedation and analgesia (PSA) usually is needed.
Traction-countertraction is no longer a first-line method for reduction but is still somewhat popular, owing mainly to its high success rate, safety, operator comfort, and mostly, tradition.
Reduce the shoulder — Traction-countertraction Wrap a sheet around the patient's upper torso, passing the sheet under the axilla of the dislocated shoulder, and tie the ends of the sheet around the hips (not around the waist, which causes back strain) of the assistant standing at the opposite side of the stretcher.
Abduct the affected arm 45° and flex the elbow to 90°.
Wrap a 2nd sheet around the flexed forearm proximally and then around your hips.
With your arms straight, hold the affected forearm with both hands, maintaining forearm flexion.
Then, lean backward, which will apply traction to the patient's arm.
Simultaneously, have the assistant lean backward, creating the countertraction force to the axilla.
The body weight of you and your assistant, rather than arm strength, provides the continuous force required for this technique.
If the sheet rides up on the patient's forearm, correct for this situation by slightly increasing the forearm flexion.
The procedure may take many minutes to be successful.
Use gentle, limited external rotation to facilitate reduction if necessary.
If reduction does not occur, have a second assistant wrap a sheet around the affected humerus near the humeral head and apply a gentle lateral-cephalad force; this force leverages the distracted humeral head laterally towards the glenoid fossa.
How To Reduce Anterior Shoulder Dislocations: Traction-Countertraction VIDEO Aftercare for Traction-Countertraction Successful reduction is preliminarily confirmed by restoration of a normal round shoulder contour, decreased pain, and by the patient's renewed ability to reach across the chest and place the palm of the hand upon the opposite shoulder.
Warnings and Common Errors for Traction-Countertraction Apparent shoulder dislocation in a child is often a fracture involving the growth plate, which tends to fracture before the joint is disrupted.
Allow sufficient time for muscle spasm to resolve before proceeding through the procedure; too-rapid reduction is a common cause of failure with this technique.
Tips and Tricks for Traction-Countertraction Wrapping the sheets around the operators' hips (instead of the waist) prevents back strain.
Tying the sheet using a proper square knot decreases the chance of the sheet untying during the procedure.
Adequate sedation and pain control are key.
Indications for Traction-Countertraction Anterior dislocation of the shoulder Reduction should be attempted soon (eg, within 30 minutes) after the diagnosis is made.
If a neurovascular deficit is suspected, a less forceful method is preferred.
Primary Open-Angle Glaucoma By Douglas J Rhee, MD, University Hospitals / Case Western Reserve University Reviewed / Revised Apr 2023 View Patient Education Etiology Pathophysiology Symptoms and Signs Diagnosis Treatment Key Points Topic Resources Eye: Anterior and Posterior... Normal Optic Nerve Glaucoma (Moderate) Glaucoma (Advanced) Glaucoma (Optic Disk Hemorrhage) Medications Used to Treat... Primary open-angle glaucoma is a syndrome of optic nerve damage associated with an open anterior chamber angle and an elevated or sometimes average intraocular pressure (IOP).
In primary open-angle glaucoma, there is an abnormality of extracellular matrix in the part of the trabecular meshwork (TM) that is immediately adjacent to the Schlemm canal (called the juxtacanalicular TM) similar to accelerated aging; trabecular meshwork cellularity may also decrease.
Elevated-pressure glaucoma Two thirds of patients with glaucoma have elevated (> 21 mm Hg) IOP.
Aqueous humor drainage is inadequate, whereas production by the ciliary body is normal.
Identifiable mechanisms (ie, secondary open-angle glaucomas) are not present.
Secondary mechanisms include developmental anomalies, scarring caused by trauma or infection, and plugging of channels by detached iris pigment (ie, pigment dispersion syndrome) or abnormal protein deposits (eg, pseudoexfoliation syndrome).
Normal-pressure glaucoma or low-tension (low-pressure) glaucoma In at least one third of patients with glaucoma, IOP is within the average range, but optic nerve damage and visual field loss typical of glaucoma are present.
These patients have a higher incidence of vasospastic diseases (eg, migraines, Raynaud syndrome) than the general population, suggesting that a vascular disorder compromising blood flow to the optic nerve may play a role.
Glaucoma occurring with average-range IOP is more common among Asian patients. Symptoms and Signs of Primary Open-Angle Glaucoma Early primary open-angle glaucoma symptoms are uncommon.
Usually, the patient becomes aware of visual field loss only when optic nerve atrophy is marked; the typically asymmetric deficits contribute to delay in recognition.
Symptoms are a result of visual field loss.
However, some patients have complaints, such as missing stairs if their inferior visual field has been lost, noticing portions of words missing when reading, or having difficulty with driving earlier in the course of the disease.
Intraocular pressure (IOP) may be normal or high but is almost always higher in the eye with more optic nerve damage.
Optic nerve appearance The optic nerve head (ie, disk) is normally a slightly vertically elongated circle with a centrally located depression called the cup.
The neurosensory rim is the tissue between the margin of the cup and the edge of the disk, and is composed of the ganglion cell axons from the retina.
Characteristic optic nerve changes include Increased cup: disk ratio (particularly an increasing ratio over time) Thinning of the neurosensory rim Pitting or notching of the rim Nerve fiber layer hemorrhage that crosses the disk margin (ie, Drance hemorrhage or splinter hemorrhages) Vertical elongation of the cup Quick (ie, sharp change in the course of angulations in the exiting blood vessels [called bayoneting]) Thinning of the neurosensory rim (optic nerve or retinal nerve fiber layer) over time alone can be diagnostic of glaucoma regardless of the IOP or visual field and is the initial sign of damage in 40 to 60% of cases.
In other cases, the initial sign of damage is some visual field change.
Wedge-shaped dark areas may develop, reflecting damage to the retinal nerve fiber layer.
Visual field defects Visual field changes caused by lesions of the optic nerve include Nasal step defects (which do not cross the horizontal meridian—an imaginary horizontal line between the upper and lower parts of the visual field) Arcuate (arc-shaped) scotomata extending nasally from the blind spot Temporal wedge defects Paracentral scotomata In contrast, deficits of the more proximal visual pathways (ie, from the lateral geniculate nucleus to the occipital lobe) involve quadrants or hemispheres of the visual field; thus, deficits do not cross the vertical meridian.
Diagnosis of Primary Open-Angle Glaucoma Visual field testing Ophthalmoscopy Measurement of central corneal thickness and intraocular pressure (IOP) Exclusion of other optic neuropathies Diagnosis of primary open-angle glaucoma is suggested by the examination, but similar findings can result from other optic neuropathies (eg, caused by ischemia, cytomegalovirus infection, or vitamin B12 deficiency).
Diagnosis is by ophthalmoscopy, gonioscopy, visual field examination, and measurement of central corneal thickness and IOP.
Before a diagnosis of normal-pressure glaucoma can be established, the following factors may need to be ruled out: Inaccurate IOP readings Large diurnal fluctuations (causing intermittent normal readings) Optic nerve damage caused by previously resolved glaucoma (eg, a previously elevated IOP due to corticosteroid use or uveitis) Intermittent angle-closure glaucoma Other ocular or neurologic disorders that cause similar visual field defects Central corneal thickness is measured to help interpret the result of IOP measurement.
Optic disk photography or a detailed optic disk drawing is helpful for future comparison.
The frequency of follow-up examinations varies from weeks to months, depending on the patient's reliability, severity of the glaucoma, and response to treatment.
Treatment of Primary Open-Angle Glaucoma Decreasing intraocular pressure (IOP) 20 to 40% Initially, medications (eg, prostaglandin analogs such as latanoprost or tafluprost, beta-blockers such as timolol) Sometimes surgery, such as laser trabeculoplasty or guarded filtration procedure Vision lost by glaucoma cannot be recovered.
The goal is to prevent further optic nerve and visual field damage by lowering IOP.
The target level is 20 to 40% below pretreatment readings or the IOP at which damage is known to have occurred.
In general, the greater the damage caused by glaucoma, the lower the IOP must be to prevent further damage.
If damage progresses, the IOP goal is lowered further and additional therapy is initiated.
Initial treatment used to be medical therapy, proceeding to laser therapy and then incisional surgery if the target IOP is not met; however, subsequent evidence suggests that initial treatment with laser trabeculoplasty preserves visual fields and results in less frequent subsequent incisional glaucoma surgeries than treatment with medications (1).
Surgery may be the initial treatment if IOP is extremely high, the patient does not wish to use or has trouble adhering to medical therapy, or if there is significant visual field damage at presentation.
Treatment includes laser surgery and / or topical medications (eg, prostaglandin analogs, beta-blockers) and often requires incisional surgery to increase aqueous drainage.
Medical therapy Multiple medications are available (see table).
Topical agents are preferred.
The most popular are prostaglandin analogs, followed by beta-blockers (particularly timolol).
Other medications include alpha-2-selective adrenergic agonists, carbonic anhydrase inhibitors, rho kinase inhibitors, and cholinergic agonists.
Oral carbonic anhydrase inhibitors are effective, but adverse effects limit their use.
Patients taking topical glaucoma medications should be taught passive eyelid closure with punctal occlusion to help reduce systemic absorption and associated adverse effects, although the effectiveness of these maneuvers is controversial.
Patients who have difficulty instilling drops directly onto the conjunctiva may place the drop on the nose just medial to the medial canthus, then roll the head slightly toward the eye so that the liquid flows into the eye.
Typically, to gauge effectiveness, clinicians start medications in one (one-eye trial) or both eyes.
Table Surgery Surgery for primary open-angle glaucoma and normal-pressure glaucoma includes laser trabeculoplasty, a guarded filtration procedure, and procedures that enhance only a portion of the drainage pathway.
Selective laser trabeculoplasty (SLT) uses a pulsed double-frequency neodymium: yttrium-aluminum-garnet laser.
(See also Overview of Glaucoma.)
SLT and argon laser trabeculoplasty (ALT) are equally effective initially, but SLT may have greater effectiveness in subsequent treatments.
SLT is emerging as the standard of care for the initial treatment for newly diagnosed patients.
Argon laser trabeculoplasty (ALT) may also be considered but is rarely used in lieu of SLT.
Laser energy is applied to either 180º or 360º of the trabecular meshwork to improve the drainage of aqueous humor.
Within 2 to 5 years, about 50% of patients require additional drug therapy or surgery because of insufficient IOP control.
A guarded filtration procedure is the most commonly used filtration procedure.
A hole is made in the limbal sclera (trabeculectomy), which is covered by a partial-thickness scleral flap that controls egress of aqueous from the eye to the subconjunctival space, forming a filtration bleb.
Adverse effects of glaucoma filtration surgery include acceleration of cataract growth, pressures that are too low, and transient accumulation of fluid in the choroidal space (ie, choroidal effusion) during the perioperative period.
Patients with trabeculectomies are at increased risk of bacterial endophthalmitis and should be instructed to report any symptoms or signs of bleb infection (blebitis) or endophthalmitis (eg, worsening vision, conjunctival hyperemia, pain) immediately.
Partial-thickness procedures bypass portions of the outflow pathways, unlike full-thickness procedures, even if guarded, that create a direct conduit between the anterior chamber and subconjunctival space.
Etiology of Primary Open-Angle Glaucoma Although open-angle glaucomas can have numerous causes (see table), 60 to 70% of cases in the United States have no identifiable cause and are termed primary open-angle glaucoma.
In general, trabecular meshwork bypass procedures appear to be safer but less effective than trabeculectomy: The ab externo approach (an approach from outside the eye), including viscocanalostomy, deep sclerectomy, and canaloplasty, involves a deep dissection of greater than > 98% thickness of the scleral passage, leaving a window of Descemet membrane and / or the inner wall of the Schlemm canal and trabecular meshwork.
The canal is dilated by using a viscoelastic solution (in viscocanalostomy) or a microcatheter (in canaloplasty).
Deep sclerectomy generally relies on the formation of a conjunctival bleb.
In the ab interno approach (an approach from inside the eye), a device is used to remove (eg, with ab interno goniotomy or trabeculectomy) or bypass (eg, with some stent procedures) the trabecular meshwork, creating direct communication between the anterior chamber and collecting channels.
Ophthalmology 130 (2): 139 - 151. doi: 10.1016 / j. ophtha.2022.09.009 Key Points Primary open-angle glaucoma is usually related to elevated intraocular pressure (IOP) but may occur with normal IOP.
Vision loss due to glaucoma cannot be recovered.
Begin diagnostic evaluation with ophthalmoscopy, measurement of IOP, and visual field testing.
Both eyes usually are affected, but typically not equally.
Aim to decrease IOP by 20 to 40%.
Begin treatment with laser surgery and / or topical medications (eg, prostaglandin analogs such as latanoprost or tafluprost, beta-blockers such as timolol).
Consider incisional surgery if laser surgery and / or topical medications are not effective or if visual loss is severe.
Risk factors for primary open-angle glaucoma include Older age Positive family history Black race Thinner central corneal thickness Systemic hypertension Diabetes Myopia In Black people, glaucoma is more severe and develops at an earlier age, and blindness is 6 to 8 times more likely.
Pathophysiology of Primary Open-Angle Glaucoma Intraocular pressure (IOP) can be elevated or within the average range.
Trachoma (Egyptian Ophthalmia; Granular Conjunctivitis) By Zeba A Syed, MD, Wills Eye Hospital Reviewed / Revised Apr 2023 View Patient Education Symptoms and Signs Diagnosis Treatment Key Points Topic Resources Trachomatous Inflammation—Follicu... Trachomatous Scarring (TS)... Trachomatous Trichiasis... Trachoma is a chronic conjunctivitis caused by Chlamydia trachomatis and is characterized by progressive exacerbations and remissions.
The causative organism is Chlamydia trachomatis (serotypes A, B, Ba, and C).
In the United States, trachoma is rare, occurring occasionally among American Indians and immigrants.
The disease occurs mainly in children, particularly those between the ages of 3 and 6.
Older children and adults are much less susceptible because of increased immunity and better personal hygiene.
Symptoms and Signs of Trachoma Trachoma usually affects both eyes.
It is the leading cause of preventable blindness worldwide.
Trachomatous inflammation-follicular (TF): Characterized by 5 or more follicles in the upper tarsal conjunctiva Trachomatous inflammation-intense (TI): Characterized by pronounced inflammatory thickening of the tarsal conjunctiva that obscures more than half of the normal deep tarsal vessels Trachomatous scarring (TS): Characterized by scarring in the tarsal conjunctiva Trachomatous trichiasis (TT): Characterized by at least one eyelash rubbing the eyeball Corneal opacity (CO): Characterized by easily visible corneal opacity over the pupil Rarely, corneal neovascularization regresses completely without treatment, and corneal transparency is restored.
With treatment and healing, the conjunctiva becomes smooth and grayish white.
In a population survey in the Nile Delta of Egypt, 6.5% of adults had trachoma; of those, 13% had visual impairment and 8% were blind.
Diagnosis of Trachoma Clinical findings (eg, tarsal lymphoid follicles, linear conjunctival scars, corneal pannus) Diagnosis of trachoma is usually clinical because testing is rarely available in endemic areas.
Lymphoid follicles on the tarsal plate or along the corneal limbus, linear conjunctival scarring, and corneal pannus are considered diagnostic in the appropriate clinical setting.
C trachomatis can be isolated in culture or identified by nucleic acid amplification tests (NAAT) and immunofluorescence techniques, and testing should be done when it is readily available.
In resource limited-settings, testing may be limited to cases of diagnostic uncertainty.
In the early stage, minute basophilic cytoplasmic inclusion bodies within conjunctival epithelial cells in Giemsa-stained conjunctival scrapings differentiate trachoma from nonchlamydial conjunctivitis.
Inclusion bodies are also found in adult inclusion conjunctivitis, but the setting and developing clinical picture distinguish it from trachoma.
Initial symptoms are conjunctival hyperemia, eyelid edema, photophobia, and lacrimation.
Palpebral vernal conjunctivitis appears similar to trachoma in its follicular hypertrophic stage, but symptoms are different, milky flat-topped papillae are present, and eosinophils (not basophilic inclusion bodies) are found in the scrapings.
Treatment of Trachoma Antibiotics, preferably systemic but alternatively topical Surgery for eyelid deformities and / or corneal opacity SAFE (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) program in endemic areas The World Health Organization (WHO) recommends that individual or sporadic cases of trachomatous inflammation-follicular be treated topically.
The WHO also recommends topical treatment for trachomatous inflammation-intense, but that systemic treatment should be considered.
Trachomatous scarring alone does not require treatment until it progresses to cause trachomatous trichiasis.
For systemic treatment, a single oral dose of azithromycin 20 mg / kg (maximum 1 g) is 78 to 95% effective.
Alternatives include erythromycin 500 mg twice daily for 14 days or doxycycline 100 mg twice a day for 10 days (not to be used in pregnant or breastfeeding women or in children under the age of 8).
For topical treatment, tetracycline 1% ointment to both eyes twice a day for 6 weeks can be used.
The WHO recommends eyelid surgery for trachomatous trichiasis.
If corneal opacity has advanced into the central cornea, it is considered the stage of untreatable irreversible blindness.
Later, corneal neovascularization and scarring of the conjunctiva, cornea, and eyelids occur.
The procedure is complex, and the frequent and intense aftercare to prevent rejection and infection makes corneal transplant impractical for many patients in most resource-limited nations.
Trachoma control in endemic areas The WHO has endorsed a 4-step program for control of trachoma in endemic areas.
This program is known as SAFE: S urgery to correct eyelid deformities (eg, entropion and trichiasis) that place patients at risk of blindness A ntibiotics to treat individual patients and mass drug administration to reduce the disease burden in the community F acial cleanliness to reduce transmission from infected individuals E nvironmental improvement (eg, access to potable water and improved sanitation) to reduce transmission of disease and reinfection of patients In hyperendemic areas, mass administration to the entire community older than 6 months of a single oral dose of azithromycin 20 mg / kg (maximum 1 g) or tetracycline or erythromycin ophthalmic ointment applied twice daily for 5 consecutive days each month for 6 months has been effective as treatment and prophylaxis.
Endemic trachoma has been dramatically reduced by using community-wide oral azithromycin in a single dose or in repeated doses.
However, reinfection due to re-exposure is common in endemic areas.
Reinfections can be reduced with fly control; better access to clean water, washing, and sanitation; building more hygienic latrines; and moving livestock and latrines farther from family living quarters.
Key Points Trachoma is a chronic, exacerbating, and remitting chlamydial conjunctivitis that is common among children ages 3 through 6 in certain resource-limited areas worldwide.
Manifestations develop in stages and include conjunctivitis, formation of tarsal follicles, thickening and scarring of tarsal conjunctiva, trichiasis, and corneal neovascularization and scarring.
About 7% of patients develop decreased vision or blindness; trachoma is the leading cause of preventable blindness worldwide.
Diagnosis is usually clinical, but standard methods to detect chlamydia can be done when available.
For endemic areas, the World Health Organization also advocates corrective surgery, mass administration of antibiotics, emphasizing facial cleanliness, and environmental interventions to reduce transmission.
Trachoma is endemic in resource-limited parts of North Africa, the Middle East, the Indian subcontinent, Australia, and Southeast Asia, affecting 1.9 million people.
It is also the cause of about 1.4 percent of blindness worldwide (1).
Subconjunctival Hemorrhages By Zeba A Syed, MD, Wills Eye Hospital Reviewed / Revised Apr 2023 View Patient Education Topic Resources Subconjunctival Hemorrhage Subconjunctival hemorrhages are extravasations of blood beneath the conjunctiva.
Subconjunctival hemorrhages usually result from minor local trauma, straining, sneezing, or coughing; rarely, they occur spontaneously.
The extent and location of hyperemia can help determine etiology.
Diffuse hyperemia of the bulbar and tarsal conjunctivae is typical of conjunctivitis.
Subconjunctival hemorrhages alarm the patient but are of no pathologic significance except when associated with blood dyscrasia, which is rare, or facial or ocular injuries.
Subconjunctival hemorrhages are absorbed spontaneously, usually within 2 weeks.
Topical corticosteroids, antibiotics, vasoconstrictors, and compresses do not speed reabsorption; reassurance is adequate therapy.
Niacin Deficiency (Pellagra) By Larry E Johnson, MD, PhD, University of Arkansas for Medical Sciences Reviewed / Revised Nov 2022 View Patient Education Etiology Symptoms and Signs Diagnosis Treatment Key Points Topic Resources Pellagrous Glove Casal Necklace Pellagrous Skin Changes... Pellagrous Skin Changes (Feet) Pellagrous Skin Changes (Hand) Dietary niacin deficiency (causing pellagra) is uncommon in countries with low rates of food insecurity.
Bound niacin, found in maize, is not assimilated in the gastrointestinal tract unless it has been previously treated with alkali, as when tortillas are prepared.
Corn protein is also deficient in tryptophan.
The high incidence of pellagra in India among people who eat millet with a high leucine content has led to the hypothesis that amino acid imbalance may contribute to deficiency.
Deficiencies of protein and many B vitamins commonly accompany primary niacin deficiency.
Secondary niacin deficiency may be due to diarrhea, cirrhosis, or alcohol use disorder.
Pellagra also may occur in carcinoid syndrome (tryptophan is diverted to form 5-hydroxytryptophan and serotonin) and in Hartnup disease (absorption of tryptophan by the intestine and kidneys is defective).
Symptoms and Signs of Niacin Deficiency Pellagra is characterized by skin, mucous membrane, central nervous system, and gastrointestinal symptoms.
Advanced pellagra can cause a symmetric photosensitive rash, stomatitis, glossitis, diarrhea, and mental aberrations.
Symptoms may appear alone or in combination.
Skin symptoms include several types of lesions, which are usually bilaterally symmetric.
Clinical manifestations include the three Ds: localized pigmented rash (dermatitis); gastroenteritis (diarrhea); and widespread neurologic deficits, including cognitive decline (dementia).
The distribution of lesions—at pressure points or sun-exposed skin—is more pathognomonic than the form of the lesions.
Lesions can develop in a glovelike distribution on the hands (pellagrous glove) or in a boot-shaped distribution on the feet and legs (pellagrous boot).
Sunlight causes Casal necklace and butterfly-shaped lesions on the face.
Skin Manifestations of Pellagra Pellagrous Glove This photo shows scaly, erythematous to brown plaques on the sun-exposed dorsal surface of both hands resulting from niacin deficiency.
© Springer Science+Business Media Casal Necklace This photo shows hyperpigmented scaly rash in the shape of a necklace in a patient with pellagra.
Image courtesy of the Public Health Image Library of the Centers for Disease Control and Prevention.
Pellagrous Skin Changes (Buttocks) This image shows hyperpigmented and hyperkeratotic skin changes characterized by pellagra (niacin deficiency).
Image courtesy of Karen McKoy, MD.
Pellagrous Skin Changes (Feet) This image shows hyperpigemented and hyperkerototic skin changes characterized by pellagra (niacin deficiency).
Diagnosis is usually clinical, and dietary supplementation (oral or, if needed, intramuscular) is usually successful.
Pellagrous Skin Changes (Hand) This image shows hyperpigemented and hyperkerototic skin changes characterized by pellagra (niacin deficiency).
Glossitis and stomatitis characterize acute deficiency.
As the deficiency progresses, the tongue and oral mucous membranes become reddened, followed by pain in the mouth, increased salivation, and edema of the tongue.
Ulcerations may appear, especially under the tongue, on the mucosa of the lower lip, and opposite the molar teeth.
Gastrointestinal symptoms early in the deficiency include burning in the pharynx and esophagus and abdominal discomfort and distention.
Later, nausea, vomiting, and diarrhea may occur.
Diarrhea is often bloody because of bowel hyperemia and ulceration.
Central nervous system symptoms include psychosis, encephalopathy (characterized by impaired consciousness), and cognitive decline (dementia).
Psychosis is characterized by memory impairment, disorientation, confusion, and confabulation; the predominant symptom may be excitement, depression, mania, delirium, or paranoia.
Any relationship between niacin status and hypertension is uncertain.
Diagnosis of Niacin Deficiency Clinical evaluation Diagnosis of niacin deficiency is clinical and may be straightforward when skin and mouth lesions, diarrhea, delirium, and dementia occur simultaneously.
More often, the presentation is not so specific.
Differentiating the central nervous system changes from those in thiamin deficiency is difficult.
A history of a diet lacking niacin and tryptophan may help establish the diagnosis.
A favorable response to treatment with niacin can usually confirm it.
If available, laboratory testing can help confirm the diagnosis, particularly when the diagnosis is otherwise unclear.
Urinary excretion of N1-methylnicotinamide (NMN) is decreased; < 0.8 mg / day (< 5.8 mcmol / day) suggests a niacin deficiency.
Treatment of Niacin Deficiency Nicotinamide and other nutrients Because multiple deficiencies are common, a balanced diet, including other B vitamins (particularly riboflavin and pyridoxine), is needed.
Nicotinamide is usually used to treat niacin deficiency, because nicotinamide, unlike nicotinic acid (the most common form of niacin), does not cause flushing, itching, burning, or tingling sensations.
Nicotinamide is given in doses of 250 to 500 mg orally daily.
Key Points Niacin deficiency can cause pellagra, mainly in countries with high rates of food insecurity.
Pellagra causes a photosensitivity rash, mucositis, gastrointestinal disturbances, and neuropsychiatric dysfunction.
Diagnose clinically if possible.
Use nicotinamide to treat the deficiency; a favorable response can confirm the diagnosis.
Dietary sources of niacin include liver, red meat, fish, poultry, legumes, and whole-grain or enriched cereals and breads.
Because dietary tryptophan can be metabolized to niacin, foods rich in tryptophan (eg, dairy products) can compensate for inadequate dietary niacin.
Etiology of Niacin Deficiency Primary niacin deficiency results from extremely inadequate intake of both niacin and tryptophan, which usually occurs in areas where maize (Indian corn) constitutes a substantial part of the diet.
Chromium Toxicity By Larry E Johnson, MD, PhD, University of Arkansas for Medical Sciences Reviewed / Revised Dec 2021 | Modified Sep 2022 View Patient Education Only 1 to 3% of biologically active trivalent chromium (Cr) is absorbed.
High doses of trivalent chromium given parenterally cause skin irritation, but lower doses given orally are not toxic.
Exposure to hexavalent chromium (CrO3) in the workplace may irritate the skin, lungs, and gastrointestinal tract and may cause perforation of the nasal septum and lung carcinoma.
Overview of Learning Disorders By Stephen Brian Sulkes, MD, Golisano Children's Hospital at Strong, University of Rochester School of Medicine and Dentistry Reviewed / Revised Feb 2022 | Modified Sep 2022 View Patient Education Symptoms and Signs Diagnosis Treatment More Information Topic Resources Common Specific Learning... Overview of Learning Disorders Learning disorders are conditions that cause a discrepancy between potential and actual levels of academic performance as predicted by the person's intellectual abilities.
Specific learning disorders affect the ability to Understand or use spoken language Understand or use written language Understand and use numbers and reason using mathematical concepts Coordinate movements Focus attention on a task Thus, these disorders involve problems in reading, mathematics, spelling, written expression or handwriting, and understanding or using verbal and nonverbal language (see table Common Specific Learning Disorders).
Most learning disorders are complex or mixed, with deficits in more than one system.
Although the total number of children in the US with learning disorders is unknown, in the 2019 - 2020 school year, 7.3 million students (or 14% of all public school students) ages 3 to 21 in the US received special education services under the Individuals with Disabilities Education Act (IDEA).
Among students receiving special education services, 33% (or about 5% of all students) had specific learning disabilities (1).
Boys with learning disorders outnumber girls 5: 1.
Although formal diagnoses may help some children get assistance, characterizing different capabilities as disorders risks medicalizing them as somehow pathological.
The important thing is to identify people who need different or additional help learning and provide access to the assistance they need.
Overview of Learning Disorders VIDEO Learning disorders may be congenital or acquired.
No single cause has been defined, but neurologic deficits are presumed to be involved whether or not other neurologic manifestations (ie, apart from the learning disorder) are present.
Genetic influences are often implicated.
Learning disorders involve impairments or difficulties in concentration or attention, language development, or visual and aural information processing.
Child Abuse Negl 106: 104485, 2020. doi: 10.1016 / j. chiabu.2020.104485 Symptoms and Signs of Learning Disorders Children with learning disorders typically have at least average intelligence, although such disorders can occur in children with lower cognitive function as well.
Symptoms and signs of severe learning disorders may manifest at an early age, but most mild to moderate learning disorders are not recognized until school age, when the rigors of academic learning are encountered.
Academic impairments Affected children may have trouble learning the alphabet and may be delayed in paired associative learning (eg, color naming, labeling, counting, letter naming).
Diagnosis includes cognitive, educational, speech and language, medical, and psychologic evaluations.
Speech perception may be limited, language may be learned at a slower rate, and vocabulary may be decreased.
Affected children may not understand what is read, have very messy handwriting or hold a pencil awkwardly, have trouble organizing or beginning tasks or retelling a story in sequential order, or confuse math symbols and misread numbers.
Executive function impairments Disturbances or delays in expressive language or listening comprehension are predictors of academic problems beyond the preschool years.
Memory may be defective, including short-term and long-term memory, memory use (eg, rehearsal), and verbal recall or retrieval.
Problems may occur in conceptualizing, abstracting, generalizing, reasoning, and organizing and planning information for problem solving.
People with executive function problems often have difficulty organizing and completing assignments.
Visual perception and auditory processing problems may occur; they include difficulties in spatial cognition and orientation (eg, object localization, spatial memory, awareness of position and place), visual attention and memory, and sound discrimination and analysis.
Behavior problems Some children with learning disabilities have difficulty following social conventions (eg, taking turns, standing too close to the listener, not understanding jokes); these difficulties are often components of mild autism spectrum disorders as well.
Short attention span, motor restlessness, fine motor problems (eg, poor printing and copying), and variability in performance and behavior over time are other early signs.
Difficulties with impulse control, non-goal-directed behavior and overactivity, discipline problems, aggressiveness, withdrawal and avoidance behavior, excessive shyness, and excessive fear may occur.
Treatment consists primarily of educational management and sometimes medical, behavioral, and psychologic therapy.
Learning disabilities and attention-deficit / hyperactivity disorder (ADHD) often occur together.
Diagnosis of Learning Disorders Cognitive, educational, medical, and psychologic evaluations Clinical criteria Children with learning disorders are typically identified when a discrepancy is recognized between academic potential and academic performance.
Speech and language, cognitive, educational, medical, and psychologic evaluations are necessary for determining deficiencies in skills and cognitive processes.
Social and emotional-behavioral evaluations are also necessary for planning treatment and monitoring progress.
Evaluation Cognitive evaluation typically includes verbal and nonverbal intelligence testing and is usually done by a school psychologist.
Psychoeducational testing may be helpful in describing the child's preferred manner of processing information (eg, holistically or analytically, visually or aurally).
Neuropsychologic assessment is particularly useful in children with known central nervous system injury or illness to map the areas of the brain that correspond to specific functional strengths and weaknesses.
Speech and language evaluations establish integrity of comprehension and language use, phonologic processing, and verbal memory and can also assess pragmatic (social) language.
Educational assessment and performance evaluation by teachers' observations of classroom behavior and determination of academic performance are essential.
Reading evaluations measure abilities in word decoding and recognition, comprehension, and fluency.
Writing samples should be obtained to evaluate spelling, syntax, and fluency of ideas.
Mathematical ability should be assessed in terms of computation skills, knowledge of operations, understanding of concepts, and interpretation of "word problems"
Medical evaluation includes a detailed family history, the child's medical history, a physical examination, and a neurologic or neurodevelopmental examination to look for underlying disorders.
Although infrequent, physical abnormalities and neurologic signs may indicate medically treatable causes of learning disabilities.
Gross motor coordination problems may indicate neurologic deficits or neurodevelopmental delays.
Developmental level is evaluated according to standardized criteria.
Psychologic evaluation helps identify ADHD, conduct disorder, anxiety disorders, depression, and poor self-esteem, which frequently accompany and must be differentiated from learning disabilities.
Attitude toward school, motivation, peer relationships, and self-confidence are assessed.
Clinical criteria Diagnosis of learning disorders is made clinically based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and requires evidence that at least one of the following has been present for ≥ 6 months despite targeted intervention: Inaccurate, slow and / or effortful word reading Difficulty understanding the meaning of written material Difficulty spelling Difficulty writing (eg, multiple grammar and punctuation errors; ideas not expressed clearly) Difficulty mastering number sense (eg, understanding the relative magnitude and relationship of numbers; in older children, difficulty doing simple calculations) Difficulty with mathematical reasoning (eg, using mathematical concepts to solve problems) Skills must be substantially below the level expected for the child's age and also significantly impair performance at school or in daily activities.
Also, the difficulties should not be better accounted for by intellectual disability or other neurodevelopmental disorders.
Neurodevelopmental disorders are neurologically based conditions that appear early in childhood, typically before school entry.
Treatment of Learning Disorders Educational management Medical, behavioral, and psychologic therapy Occasionally drug therapy Treatment of learning disorders centers on educational management but may also involve medical, behavioral, and psychologic therapy.
Effective teaching programs may take a remedial, compensatory, or strategic (ie, teaching the child how to learn) approach.
A mismatch of instructional method and a child's learning disorder and learning preference aggravates the disability.
Some children require specialized instruction in only one area while they continue to attend regular classes.
Other children need separate and intense educational programs.
Optimally and as required by US law, affected children should participate as much as possible in inclusive classes with peers who do not have learning disabilities.
Drugs minimally affect academic achievement, intelligence, and general learning ability, although certain drugs (eg, psychostimulants, such as methylphenidate and several amphetamine preparations) may enhance attention and concentration, allowing children to respond more efficiently to instruction.
Many popular remedies and therapies (eg, eliminating food additives, using antioxidants or megadoses of vitamins, patterning by sensory stimulation and passive movement, sensory integrative therapy through postural exercises, auditory nerve training, optometric training to remedy visual-perceptual and sensorimotor coordination processes) are unproved.
These disorders impair development of personal, social, academic, and / or occupational functioning and typically involve difficulties with the acquisition, retention, or application of specific skills or sets of information.
The disorders may involve dysfunction in attention, memory, perception, language, problem-solving, or social interaction.
Other common neurodevelopmental disorders include attention-deficit / hyperactivity disorder, autism spectrum disorders, and intellectual disability.
© Springer Science+Business Media W-Dermatitis This photo shows irritant diaper dermatitis ("W-dermatitis").
© Springer Science+Business Media Candidiasis (Diaper Rash) Image provided by Thomas Habif, MD. Severe Diaper Rash Due to Neglect This photo shows severe diaper dermatitis due to neglect.
© Springer Science+Business Media Erythema Multiforme (Back) Erythema multiforme is characterized by target or iris lesions, which are annular lesions with a violaceous center and pink halo separated by a pale ring.
DR P MARAZZI / SCIENCE PHOTO LIBRARY Milia This photo shows small, pearl-colored cysts commonly seen on the face of neonates.
SCIENCE PHOTO LIBRARY Oral Candidiasis Due to HIV This photo shows fluffy white exudate on the tongue of a child with HIV infection.
© Springer Science+Business Media Atopic Dermatitis (Acute) Atopic dermatitis usually develops in infancy.
In the acute phase, lesions appear on the face and then spread to the neck, scalp, and extremities.
Contact Dermatitis (Tattoo) This photo shows allergic contact dermatitis on the forearm of a child after a temporary, black "henna" tattoo was applied.
© Springer Science+Business Media Contact Dermatitis (Allergic) Skin manifestations of allergic contact dermatitis range from erythema through vesiculation to edema with bullae.
Changes often occur in a pattern or distribution that suggests a specific exposure.
In this image, linear streaking on an extremity suggests plant contact (eg, poison ivy or poison sumac).
Image provided by Thomas Habif, MD. Overall, the most common causes of rash in infants and young children include Diaper rash (with or without candidal infection) Seborrhea Atopic dermatitis (eczema) Viral exanthem Numerous viral infections cause rash.
Some (eg, chickenpox and measles, both of which are currently uncommon because of vaccination but should be considered in unvaccinated children; erythema infectiosum) have a fairly typical appearance and clinical manifestation; others are nonspecific.
Cutaneous drug reactions are usually self-limited maculopapular exanthems, but sometimes more serious reactions occur.
Uncommon but serious causes of rash include Staphylococcal scalded skin syndrome Meningococcemia Kawasaki disease Stevens-Johnson syndrome Table Evaluation of Rash in Infants and Young Children History History of present illness focuses on the time course of illness, particularly the relationship between the rash and other symptoms.
Review of systems focuses on symptoms of causative disorders, including gastrointestinal symptoms (suggesting immunoglobulin A-associated vasculitis [formerly called Henoch-Schönlein purpura] or hemolytic-uremic syndrome), joint symptoms (suggesting immunoglobulin A-associated vasculitis or Lyme disease), headache or neurologic symptoms (suggesting meningitis or Lyme disease).
Past medical history should note any drugs recently used, particularly antibiotics and anticonvulsants.
Most rashes are not serious.
Family history of atopy is noted.
Physical examination Examination begins with a review of vital signs, particularly to check for fever.
Initial observation assesses the infant or child for signs of lethargy, irritability, or distress.
A full physical examination is done, with particular attention to the characteristics of the skin lesions, including the presence of blistering, vesicles, petechiae, purpura, or urticaria and mucosal involvement.
Children are evaluated for meningeal signs (neck stiffness, Kernig and Brudzinski signs), although these signs are often absent in children < 2 years.
Red flags The following findings are of particular concern: Blistering or skin sloughing Diarrhea and / or abdominal pain Fever and inconsolability or extreme irritability Mucosal inflammation Petechiae and / or purpura Urticaria with respiratory distress Interpretation of findings Well-appearing children without systemic symptoms or signs are unlikely to have a dangerous disorder.
The appearance of the rash typically narrows the differential diagnosis.
The associated symptoms and signs help identify patients with a serious disorder and often suggest the diagnosis (see Table: Some Causes of Rash in Infants and Children).
Bullae and / or sloughing suggest staphylococcal scalded skin syndrome or Stevens-Johnson syndrome and are considered dermatologic emergencies.
Conjunctival inflammation may occur in Kawasaki disease, measles, staphylococcal scalded skin syndrome, and Stevens-Johnson syndrome.
Etiology of Rash in Infants and Young Children Rashes can be caused by infection (viral, fungal, or bacterial), contact with irritants, atopy, drug hypersensitivity, other allergic reactions, inflammatory conditions, or vasculitides (see Table: Some Causes of Rash in Infants and Children).
Any child presenting with fever and petechiae or purpura must be evaluated carefully for the possibility of meningococcemia.
Bloody diarrhea with pallor and petechiae should raise concern about the possibility of hemolytic uremic syndrome.
Fever for > 5 days with evidence of mucosal inflammation and rash should prompt consideration of and further evaluation for Kawasaki disease.
Testing For most children, the history and physical examination are sufficient for diagnosis.
Testing is targeted at potential life threats; it includes Gram stain and cultures of blood and cerebrospinal fluid for meningococcemia; complete blood count, renal function tests, and stool tests for hemolytic uremic syndrome).
Treatment of Rash in Infants and Young Children Treatment of rash is directed at the cause (eg, antifungal cream for candidal infection).
For diaper rash, the goal is to keep the diaper area clean and dry, primarily by changing diapers more frequently and gently washing the area with mild soap and water.
Sometimes a barrier ointment containing zinc oxide or vitamins A and D may help.
Pruritus in infants and children can be lessened by oral antihistamines: Diphenhydramine: For children > 6 months, 1.25 mg / kg every 6 hours (maximum 50 mg every 6 hours) Hydroxyzine: For children > 6 months, 0.5 mg / kg every 6 hours (maximum for children < 6 years, 12.5 mg every 6 hours; for those ≥ 6 years, 25 mg every 6 hours) Cetirizine: For children 6 to 23 months, 2.5 mg once a day; for those 2 to 5 years, 2.5 to 5 mg once a day; for those > 6 years, 5 to 10 mg once a day Loratadine: For children 2 to 5 years, 5 mg once a day; for those > 6 years, 10 mg once a day Some common adverse effects of antihistamines include dry mouth, drowsiness, dizziness, nausea and vomiting, restlessness or moodiness (in some children), urinary hesitancy, blurred vision, and confusion.
Key Points Most rashes in children are benign.
Examples of Rashes in Children Molluscum Contagiosum on a Child's Face The photo shows lesions of molluscum contagiosum.
For most rashes in infants and children, the history and physical examination are sufficient for diagnosis.
Children with rash due to serious illness typically have systemic manifestations of disease.
Lesions are typically 1 to 5 mm, solitary or grouped, firm, painless papules.
They are pearly to pink in color, dome shaped, and may be umbilicated.
© Springer Science+Business Media Molluscum Contagiosum in a Child With HIV Infection This photo shows very severe lesions on the face of a child with HIV infection.
Giant molluscum indicates advanced immunodeficiency.
Cough in Children By Deborah M Consolini, MD, Thomas Jefferson University Hospital Reviewed / Revised Nov 2022 View Patient Education Etiology Evaluation Treatment Key Points Topic Resources Some Causes of Cough in Children Cough is a reflex that helps clear the airways of secretions, protects the airway from foreign body aspiration, and can be the manifesting symptom of a disease.
Review of systems should note symptoms of possible causes, including abdominal pain (some bacterial pneumonias), weight loss or poor weight gain and foul-smelling stools (cystic fibrosis), and muscle soreness (possible association with viral illness or atypical pneumonia but usually not with bacterial pneumonia).
Past medical history should cover recent respiratory infections, repeated pneumonias, history of known allergies or asthma, risk factors for TB (eg, exposure to a person who has known or suspected TB infection, exposure to prisons, HIV infection, travel to or immigration from countries that have endemic infection), and exposure to respiratory irritants.
Physical examination Vital signs, including respiratory rate, temperature, and oxygen saturation, should be noted.
Signs of respiratory distress (eg, nasal flaring, intercostal retractions, cyanosis, grunting, stridor, marked anxiety) should be noted.
Head and neck examination should focus on presence and amount of nasal discharge and the condition of the nasal turbinates (pale, boggy, or inflamed).
The pharynx should be checked for postnasal drip.
The cervical and supraclavicular areas should be inspected and palpated for lymphadenopathy.
Lung examination focuses on presence of stridor, wheezing, crackles, rhonchi, decreased breath sounds, and signs of consolidation (eg, egophony, E to A change, dullness to percussion).
Abdominal examination should focus on presence of abdominal pain, especially in the upper quadrants (indicating possible left or right lower lobe pneumonia).
Examination of extremities should note clubbing or cyanosis of nail beds (cystic fibrosis).
Cough is one of the most common complaints for which parents bring their children to a health care practitioner.
Red flags The following findings are of particular concern: Cyanosis or hypoxia on pulse oximetry Stridor Respiratory distress Toxic appearance Abnormal lung examination Interpretation of findings Clinical findings frequently indicate a specific cause (see Table: Some Causes of Cough in Children); the distinction between acute and chronic cough is particularly helpful, although it is important to note that many disorders that cause chronic cough begin acutely and patients may present before 4 weeks have passed.
Other characteristics of the cough are helpful but less specific.
A barky cough suggests croup or tracheitis; it can also be characteristic of psychogenic cough or a postrespiratory tract infection cough.
A staccato cough is consistent with a viral or atypical pneumonia.
A paroxysmal cough is characteristic of pertussis or certain viral pneumonias (adenovirus).
Failure to thrive or weight loss can occur with TB or cystic fibrosis.
Nighttime cough can indicate postnasal drip or asthma.
Coughing at the beginning of sleep and in the morning with waking usually indicates sinusitis; coughing in the middle of the night is more consistent with asthma.
In young children with sudden cough and no fever or URI symptoms, the examiner should have a high index of suspicion for foreign body aspiration.
Testing Children with red flag findings should have pulse oximetry and chest x-ray.
Etiology of Cough in Children Causes of cough differ depending on whether the symptoms are acute (< 4 weeks) or chronic (> 4 weeks).
Children with stridor, drooling, fever, and marked anxiety need to be evaluated for epiglottitis typically in an operating room by an ear, nose, and throat specialist prepared to immediately place an endotracheal or tracheostomy tube.
If foreign body aspiration is suspected, chest x-ray with inspiratory and expiratory views should be done (or in some centers a chest CT).
Children with TB risk factors or weight loss should have a chest x-ray and purified protein derivative (PPD) testing or an interferon-gamma release assay.
Children with repeated episodes of pneumonia, poor growth, or foul-smelling stools should have a chest x-ray and sweat testing for cystic fibrosis.
Acute cough in children with upper respiratory infection symptoms and no red flag findings is usually caused by a viral infection.
Testing is rarely indicated unless it is necessary for infection control (eg, a COVID-19 outbreak in a school or day care center).
Many other children without red flag findings have a presumptive diagnosis after the history and physical examination.
Testing is not necessary in such cases; however, if empiric treatment has been instituted and has not been successful, testing may be necessary.
For example, if allergic sinusitis is suspected and treated with an antihistamine that does not alleviate symptoms, a head CT may be necessary for further evaluation.
Suspected gastroesophageal reflux disorder unsuccessfully treated with an H2 blocker and / or proton pump inhibitor may require evaluation with a pH or impedance probe study or endoscopy.
Treatment of Cough in Children Treatment of cough is management of the underlying disorder.
For example, antibiotics should be given for bacterial pneumonia; bronchodilators and anti-inflammatory drugs should be given for asthma.
Children with viral infections should receive supportive care, including oxygen and / or bronchodilators as needed.
Little evidence exists to support the use of cough suppressants and mucolytic agents.
Coughing is an important mechanism for clearing secretions from the airways and can assist in recovery from respiratory infections.
Use of nonspecific drugs for cough suppression is discouraged in children.
Key Points Clinical diagnosis is often adequate.
A high index of suspicion for foreign body aspiration is needed if children are 6 months to 6 years of age.
Antitussives and expectorants lack proof of effect in most cases.
The most common cause of acute cough is Viral upper respiratory infection The most common causes of chronic cough are Asthma (most common) Gastroesophageal reflux disorder (GERD) Postnasal drip Foreign body aspiration and diseases such as cystic fibrosis and primary ciliary dyskinesia are less common, but they can all result in persistent cough.
Obtain a chest x-ray if patients have red flag findings or chronic cough.
Table Evaluation of Cough in Children History History of present illness should cover duration and quality of cough (barky, staccato, paroxysmal) and onset (sudden or indolent).
The physician should ask about associated symptoms.
Some of these symptoms are ubiquitous (eg, runny nose, sore throat, fever); others may suggest a specific cause: headache, itchy eyes, and sore throat (postnasal drip); wheezing and cough with exertion (asthma); night sweats (tuberculosis [TB]); and, in infants, spitting up, irritability, or arching of the back after feedings (gastroesophageal reflux).
For children 6 months to 6 years, the parents should be asked about potential for foreign body aspiration, including older siblings or visitors with small toys, access to small objects, and consumption of small, smooth foods (eg, peanuts, grapes).
Necrotizing Enterocolitis By William J Cochran, MD, Geisinger Clinic Reviewed / Revised Aug 2021 | Modified Sep 2022 View Patient Education Etiology Symptoms and Signs Diagnosis Treatment Prevention Key Points Topic Resources Radiologic Features of Necrotizin... Necrotizing enterocolitis is an acquired disease, primarily of preterm or sick neonates, characterized by mucosal or even deeper intestinal necrosis.
It is believed that an ischemic insult damages the intestinal lining, leading to increased intestinal permeability and leaving the intestine susceptible to bacterial invasion.
NEC rarely occurs before enteral feedings have begun and is less common among breastfed infants.
However, once feedings are begun, ample substrate is present for proliferation of luminal bacteria, which can penetrate the damaged intestinal wall, producing hydrogen gas.
The gas may collect within the intestinal wall (pneumatosis intestinalis) or enter the portal veins.
Dysbiosis (alteration of the intestinal microbiome), such as that which occurs after treatment with antibiotics or acid-suppressing drugs, may also be a contributing factor because it increases potentially pathogenic bacteria.
The initial ischemic insult may result from vasospasm of the mesenteric arteries, which can be caused by an anoxic insult triggering the primitive diving reflex that markedly diminishes intestinal blood flow.
Intestinal ischemia may also result from low blood flow during an exchange transfusion, during sepsis, or from the use of hyperosmolar formulas.
Similarly, congenital heart disease with reduced systemic blood flow or arterial oxygen desaturation may lead to intestinal hypoxia / ischemia and predispose to NEC.
NEC may occur as clusters of cases or as outbreaks in neonatal intensive care units.
Some clusters appear to be associated with specific organisms (eg, Klebsiella, Escherichia coli, coagulase-negative staphylococci, Pseudomonas, Clostridioides difficile), but often no specific pathogen is identified.
It is the most common gastrointestinal emergency among neonates.
Complications of necrotizing enterocolitis Necrosis begins in the mucosa and may progress to involve the full thickness of the intestinal wall, causing intestinal perforation with subsequent peritonitis and often free intra-abdominal air.
Perforation occurs most commonly in the terminal ileum; the colon and the proximal small bowel are involved less frequently.
Sepsis occurs in 20 to 30% of infants with NEC, and death may occur in 20% of infants with NEC.
Symptoms and Signs of NEC Infants may present with feeding difficulties and bloody or bilious gastric residuals (after feedings) that may progress to bilious emesis, ileus manifested by abdominal distention, or gross blood in stool.
Sepsis may be manifested by lethargy, temperature instability, increased apneic spells, and metabolic acidosis.
Diagnosis of NEC Detection of blood in stool Abdominal x-rays Ultrasonography Early x-rays may be nonspecific and reveal only ileus.
However, a fixed, dilated intestinal loop (sentinel loop) that does not change on repeated x-rays is very concerning for NEC.
X-ray signs diagnostic of NEC are pneumatosis intestinalis and portal vein gas.
Pneumoperitoneum indicates bowel perforation and an urgent need for surgery.
Ultrasonography is being used increasingly in cases of NEC.
Symptoms and signs include feeding intolerance, lethargy, temperature instability, ileus, bloating, bilious emesis, hematochezia, reducing substances in the stool, apnea, and sometimes signs of sepsis.
With ultrasonography, clinicians have the ability to look at bowel wall thickness, pneumatosis intestinalis, and blood flow.
This technique, however, is very operator dependent, and plain x-rays are still more commonly used.
Treatment of NEC Feedings stopped Nasogastric suction Fluid resuscitation Broad-spectrum antibiotics Total parenteral nutrition (TPN) Sometimes surgery or percutaneous drainage The mortality rate is 20 to 30%.
Aggressive support and judicious timing of surgical intervention maximize the chance of survival.
Support Nonsurgical support is sufficient in over 75% of cases.
Feedings must be stopped immediately if NEC is suspected, and the intestine should be decompressed with a double-lumen nasogastric tube attached to intermittent suction.
Appropriate colloid and crystalloid parenteral fluids must be given to support circulation, because extensive intestinal inflammation and peritonitis may lead to considerable 3rd-space fluid loss.
TPN is needed for 10 to 14 days while the intestine heals.
Systemic antibiotics should be started at once with a beta-lactam antibiotic (eg, ampicillin) and an aminoglycoside (eg, gentamicin, amikacin).
Additional anaerobic coverage (eg, clindamycin, metronidazole) may also be considered.
Diagnosis is clinical and is confirmed by imaging studies.
Antibiotics should be continued for 10 to 14 days (for dosage, see Table: Recommended Dosages of Selected Parenteral Antibiotics for Neonates).
Because some outbreaks may be infectious, patient isolation should be considered, particularly if several cases occur within a short time.
The infant requires close monitoring; frequent complete reevaluation (eg, at least every 12 hours); and serial abdominal x-rays, complete blood counts (CBCs), platelet counts, and blood gases.
Intestinal strictures are the most common long-term complication of NEC, occurring in 10 to 36% of infants who survive the initial event.
Strictures typically manifest within 2 to 3 months of an NEC episode.
Strictures are most commonly noted in the colon, especially on the left side.
Short bowel syndrome develops in about 10% of infants with NEC.
Surgery Surgical intervention is needed in < 25% of infants.
Absolute indications are intestinal perforation (pneumoperitoneum), signs of peritonitis (absent intestinal sounds and diffuse guarding and tenderness or erythema and edema of the abdominal wall), or aspiration of purulent material from the peritoneal cavity by paracentesis.
Treatment is primarily supportive and includes nasogastric suction, parenteral fluids, total parenteral nutrition, antibiotics, isolation in cases of infection, and, sometimes, surgery.
Surgery should be considered for an infant with NEC whose clinical and laboratory conditions worsen despite nonsurgical support.
Primary percutaneous peritoneal drainage is an option and can be done at the bedside.
In this procedure, the surgeon makes an incision in the right lower quadrant through which the abdomen is irrigated with warm saline solution.
A drain is then placed to allow continued drainage of the abdomen.
When drainage has stopped, the drain can be pulled back a little each day and subsequently removed.
This procedure is done more commonly in very sick, extremely low-birth-weight infants who would be at risk if taken to an operating room; however, it may be associated with a higher mortality.
For infants undergoing laparotomy, the gangrenous bowel is resected, and ostomies are created.
(Primary reanastomosis may be done if the remaining intestine shows no signs of ischemia.)
With resolution of sepsis and peritonitis, intestinal continuity can be reestablished several weeks or months later.
Prevention of NEC At-risk infants should ideally be fed breast milk, and feedings should begin with small amounts that are gradually increased according to standardized protocols.
Over 90% of cases of necrotizing enterocolitis (NEC) occur in premature infants.
(Preterm formula is an appropriate substitute if breast milk is not available.)
Hypertonic formula, drugs, or contrast material should be avoided.
Anemia, low oxygen saturations, and polycythemia should be treated promptly.
When possible, antibiotics and acid-supressing drugs should be avoided.
Probiotics (eg, Bifidus infantis, Lactobacillus acidophilus) help prevent NEC, but further studies to determine optimal dosing and appropriate strains are required before routine use (1).
Neonatology 13: 1 - 11, 2019. doi: 10.1159/000504371 Key Points Necrotizing enterocolitis (NEC) is intestinal necrosis of uncertain etiology; it occurs mainly in preterm or sick neonates after enteral feedings have begun.
It occurs in about 1 to 8% of neonatal intensive care unit admissions.
Complications include intestinal perforation (most often in the terminal ileum) and peritonitis; sepsis occurs in 20 to 30%, and death may occur in 20%.
Initial manifestations are feeding difficulties and bloody or bilious gastric residuals (after feedings) followed by bilious emesis, abdominal distention, and / or gross blood in stool.
Diagnose using plain x-rays.
Supportive treatment using fluid resuscitation, nasogastric suction, broad-spectrum antibiotics, and total parenteral nutrition is effective in > 75% of cases.
Surgery to resect gangrenous bowel and treat perforation is needed in < 25% of infants.
Risk factors General risk factors for necrotizing enterocolitis in addition to prematurity include Prolonged rupture of the membranes with amnionitis Birth asphyxia Small-for-gestational-age infants Congenital heart disease Anemia Exchange transfusions Alteration of the intestinal microbiome (dysbiosis) Non-human milk feeding Three intestinal factors are usually present: A preceding ischemic insult Bacterial colonization Intraluminal substrate (ie, enteral feedings) Etiology of NEC The exact etiology of necrotizing enterocolitis is not clear.
However, the increased permeability and immature immune function of the immature intestinal tract are predisposing factors.
Kernicterus (Bilirubin Encephalopathy) By Kevin C Dysart, MD, Nemours / Alfred I duPont Hospital for Children Reviewed / Revised Mar 2021 | Modified Sep 2022 View Patient Education Symptoms and Signs Diagnosis Treatment Kernicterus is brain damage caused by unconjugated bilirubin deposition in basal ganglia and brain stem nuclei.
A definite diagnosis of kernicterus can be made only by autopsy.
Treatment of Kernicterus Prevention of hyperbilirubinemia There is no treatment once kernicterus develops; it must be prevented by treating hyperbilirubinemia.
Normally, bilirubin bound to serum albumin stays in the intravascular space.
However, bilirubin can cross the blood-brain barrier and cause kernicterus when serum bilirubin concentration is markedly elevated (hyperbilirubinemia), serum albumin concentration is markedly low (eg, in preterm infants), or bilirubin is displaced from albumin by competitive binders (eg, sulfisoxazole, ceftriaxone, and aspirin; free fatty acids and hydrogen ions in fasting, septic, or acidotic infants).
Symptoms and Signs of Kernicterus In preterm infants, kernicterus may not cause recognizable clinical symptoms or signs.
Early symptoms of kernicterus in term infants are lethargy, poor feeding, and vomiting.
Opisthotonos, oculogyric crisis, seizures, and death may follow.
Kernicterus may result in intellectual disability, choreoathetoid cerebral palsy, sensorineural hearing loss, and paralysis of upward gaze later in childhood.
It is unknown whether minor degrees of kernicterus can cause less severe neurologic impairment (eg, perceptual-motor problems, learning disorders).
Diagnosis of Kernicterus Clinical evaluation There is no reliable test to determine the presence of kernicterus, and the diagnosis is made presumptively.
Agoraphobia in Children and Adolescents By Josephine Elia, MD, Nemours / A I.
Agoraphobia must be distinguished from the following: Specific phobias (eg, to a certain situation) Social anxiety disorder Panic disorder Depression, which can cause patients to avoid leaving the house for reasons unrelated to anxiety Treatment Behavioral therapy Behavioral therapy is especially useful for agoraphobia symptoms.
Medications are rarely useful except to control any associated panic attacks.
duPont Hospital for Children Reviewed / Revised May 2023 View Patient Education Diagnosis Treatment Agoraphobia is a persistent fear of being trapped in situations or places without a way to escape easily and without help.
(See also Agoraphobia in adults.)
Agoraphobia is uncommon among children, but it may develop in adolescents, particularly those who also have panic attacks.
Diagnosis Psychiatric assessment Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) criteria For agoraphobia to be diagnosed, patients must consistently have unreasonable fear or anxiety about ≥ 2 of the following for ≥ 6 months: Using public transportation Being in open spaces Being in enclosed spaces Standing in line or being in a crowd Being outside the home alone Also, the fear must cause patients to avoid the distressing situation to the extent that they have difficulty functioning normally (eg, going to school, visiting the mall, doing other typical activities).
Cystinuria By Christopher J LaRosa, MD, Perelman School of Medicine at The University of Pennsylvania Reviewed / Revised Dec 2022 View Patient Education Pathophysiology Symptoms and Signs Diagnosis Treatment Key Points Cystinuria is an inherited defect of the renal tubules in which reabsorption of cystine (the homodimer of the amino acid cysteine) is impaired, urinary excretion is increased, and cystine stones form in the urinary tract.
Pathophysiology of Cystinuria The primary defect results in diminished renal proximal tubular reabsorption of cystine and increased urinary cystine concentration.
Cystine is poorly soluble in acidic urine, so when its urinary concentration exceeds its solubility, crystals precipitate and cystine kidney stones form.
Resorption of other dibasic amino acids (lysine, ornithine, arginine) is also impaired but causes no problems because these amino acids have an alternative transport system separate from that shared with cystine.
Furthermore, they are more soluble than cystine in urine, and their increased excretion does not result in crystal or stone formation.
Their absorption (and that of cystine) is also decreased in the small bowel.
Symptoms and Signs of Cystinuria Symptoms of cystinuria, most commonly renal colic, may occur in infants but usually appear between ages 10 and 30.
Urinary tract infection and chronic kidney disease due to urinary tract obstruction may develop.
Diagnosis of Cystinuria Analysis of collected kidney stones Microscopic examination of urinary sediment Measurement of urinary cystine excretion Radiopaque cystine stones form in the renal pelvis or bladder.
Staghorn stones are common.
Symptoms are colic caused by stones and perhaps urinary infection or the sequela of chronic kidney disease.
Cystine may appear in the urine as yellow-brown hexagonal crystals, which are diagnostic.
Excessive cystine in the urine may be detected with the nitroprusside cyanide test.
Quantitative cystine excretion is typically > 400 mg / day in cystinuria (normal is < 30 mg / day).
Treatment of Cystinuria High fluid intake Alkalinization of the urine Dietary sodium restriction Dietary animal protein restriction (when possible) End-stage renal disease may develop.
Decreasing urinary cystine concentration below about 250 to 300 mg / L (1 to 1.25 mmol / L) decreases renal toxicity and can allow clearance of cystine in solution.
This decrease is accomplished by increasing urine volume with fluid intake sufficient to provide a urine flow rate of 1.5 to 2 L / m2 / day, which could require fluid intake as high as 2 to 4 L / day (1).
Hydration is particularly important at night when urinary volume and pH drop.
Alkalinization of the urine to pH > 7.0 with potassium citrate or potassium bicarbonate 1 mEq / kg orally 3 to 4 times a day and in some cases acetazolamide 5 mg / kg (up to 250 mg) orally at bedtime increases the solubility of cystine significantly.
Mild restrictions of dietary sodium (100 mEq / day) and animal protein (0.8 to 1.0 g / kg / day) may help reduce cystine excretion.
When high fluid intake and alkalinization do not reduce stone formation, other oral drugs may be tried.
Diagnosis is by measurement of cystine excretion in the urine.
Penicillamine (7.5 mg / kg 4 times a day in young children and 125 mg to 0.5 g 4 times a day in older children) improves cystine solubility, but toxicity limits its usefulness.
About half of all patients develop some toxic manifestation, such as fever, rash, arthralgias, or, less commonly, nephrotic syndrome, pancytopenia, or a lupus-like reaction.
Pyridoxine supplements (50 mg once / day) should be given with penicillamine.
Tiopronin (100 to 300 mg 4 times a day) can be used instead of penicillamine to treat some children because it has a lower frequency of adverse effects.
Captopril (0.3 mg / kg 3 times a day) is not as effective as penicillamine but is less toxic.
Close monitoring of response to therapy is very important.
Animal models (eg, gene knockout mice) are currently being used toward the development of novel therapies for cystinosis (2).
Treatment is with increased fluid intake and alkalinization of the urine.
Urolithiasis 47 (1): 57 - 66, 2019. doi: 10.1007 / s00240 - 018 - 1101 - 7 Key Points Defective urinary resorption of cystine increases urinary cystine levels, leading to cystine kidney stones and sometimes chronic kidney disease.
Yellow-brown hexagonal crystals in the urine are pathognomonic; quantitative cystine excretion is typically > 400 mg / day.
Treat with increased fluid intake to give urine output of 1.5 to 2 L / m2 / day, and alkalinize urine with potassium citrate or potassium bicarbonate.
Restrict dietary sodium and animal protein.
Drugs such as penicillamine, tiopronin, or captopril may be necessary, but adverse effects are a concern.
Cystinuria was originally classified according to urinary excretion of cystine and dibasic amino acids in obligate carriers.
In this classification, parents of affected children were assessed as having either normal (type I), moderate (type III), or significant (type II) increases in cystine excretion.
A newer classification is based on genotype: Type A patients have homozygous mutations in the gene SLC3A1 and type B patients have homozygous mutations in SLC7A9.
These genes encode proteins that together form a heterodimer responsible for cystine and dibasic amino acid transport in the proximal tubule.
Cystinuria should not be confused with cystinosis (see Hereditary Fanconi syndrome).
Multiple Mononeuropathy (Mononeuritis Multiplex) By Michael Rubin, MDCM, New York Presbyterian Hospital-Cornell Medical Center Reviewed / Revised Apr 2022 | Modified Sep 2022 View Patient Education Multiple mononeuropathies are characterized by sensory disturbances and weakness in the distribution of ≥ 2 affected peripheral nerves.
Underlying disorders are treated.
Multiple mononeuropathy is usually secondary to Connective tissue disorders (eg, polyarteritis nodosa, systemic lupus erythematosus [SLE], other types of vasculitis, Sjögren syndrome, rheumatoid arthritis [RA]) Sarcoidosis Metabolic disorders (eg, diabetes, amyloidosis) Infectious disorders (eg, Lyme disease, HIV infection, leprosy) However, diabetes usually causes sensorimotor distal polyneuropathy.
Multiple mononeuropathies are characterized by pain, weakness, and paresthesias in the distribution of the affected nerves.
Multiple mononeuropathy is often asymmetric at first; nerves may be involved all at once or progressively.
Extensive involvement of many nerves may simulate polyneuropathy.
Symptoms and examination findings may be nearly pathognomonic for multiple mononeuropathy.
When they are not, electrodiagnostic testing is done to establish the diagnosis, localize the lesion, assess severity, and estimate prognosis.
Congenital Adrenal Hyperplasia Caused by 11Beta-Hydroxylase Deficiency By Andrew Calabria, MD, The Children's Hospital of Philadelphia Reviewed / Revised Aug 2022 | Modified Sep 2022 View Patient Education Symptoms and Signs Diagnosis Treatment Key Points Topic Resources Adrenal hormone synthesis 11Beta-hydroxylase (CYP11B1) deficiency involves defective production of cortisol, with accumulation of mineralocorticoid precursors, resulting in hypernatremia, hypokalemia, and hypertension and increased production of adrenal androgens, leading to virilization.
Lancet 390 (10108): 2194 - 2210, 2017. doi: 10.1016/S0140 - 6736 (17) 31431 - 9 Symptoms and Signs Female neonates may present with genital ambiguity, including clitoral enlargement, labial fusion, and a urogenital sinus.
Male neonates usually appear normal, but some present with penile enlargement.
Some children present later, with precocious puberty or, in females, menstrual irregularities and hirsutism.
Salt retention with hypernatremia, hypertension, and hypokalemic alkalosis may result from increased mineralocorticoid activity due to increased deoxycorticosterone levels.
Diagnosis Plasma levels of 11-deoxycortisol and adrenal androgens Prenatal diagnosis is not available.
Diagnosis of 11beta-hydroxylase deficiency in neonates is established by increased plasma levels of 11-deoxycortisol and adrenal androgens (DHEA, androstenedione, and testosterone).
Plasma renin activity is often suppressed because of increased mineralocorticoid activity; this test may be useful in older children but is less reliable in neonates.
If the diagnosis is uncertain, levels of 11-deoxycortisol and adrenal androgens are measured before and 60 minutes after ACTH stimulation.
In affected adolescents, basal plasma levels may be normal, so ACTH stimulation is recommended.
Diagnosis is by measurement of cortisol, its precursors, and adrenal androgens and sometimes by measuring 11-deoxycortisol after adrenocorticotropic hormone administration.
Hypertension occurs in about two thirds of patients with CYP11B1 deficiency and distinguishes it from CYP21A2 deficiency, which causes hypotension.
Because both CYP11B1 deficiency and CYP21A2 deficiency can cause increased levels of 17 - hydroxyprogesterone, which is measured during routine newborn screening, patients with mild to moderately increased levels of 17 - hydroxyprogesterone should have 11-deoxycortisol levels measured.
Hypokalemia may occur but not in all patients.
Pearls & Pitfalls 11Beta-hydroxylase deficiency causes hypertension and sometimes hypokalemia, in contrast to 21-hydroxylase deficiency, which causes hypotension and hyperkalemia.
Treatment Corticosteroid replacement Sometimes antihypertensive therapy Sometimes reconstructive surgery Treatment of 11beta-hydroxylase deficiency is cortisol replacement, typically with hydrocortisone 3.5 to 5 mg / m 2 orally 3 times a day, with total daily dose typically ≤ 20 mg / m 2, which prevents further virilization and ameliorates hypertension by reducing levels of 11-deoxycortisol, deoxycorticosterone, and adrenal androgens that are stimulated by ACTH.
Unlike CYP21A2 deficiency, mineralocorticoid replacement is not required, because sodium and potassium homeostasis is maintained from mineralocorticoid effects of deoxycorticosterone.
Response to treatment should be monitored, typically by measuring serum 11-deoxycortisol and adrenal androgens and by assessing growth velocity and skeletal maturation.
Blood pressure should be monitored closely in patients who presented with hypertension.
Antihypertensives, such as potassium-sparing diuretics or calcium channel blockers, may be required.
Affected female infants may require surgical reconstruction with reduction clitoroplasty and construction of a vaginal opening.
Often, further surgery is required in adulthood, but with appropriate care and attention to psychosexual issues, normal sexual function and fertility may be expected.
Key Points Children with 11beta-hydroxylase deficiency have excess mineralocorticoid activity and increased adrenal androgens, which cause hypertension, hypokalemia, and virilization.
In females, androgen excess usually manifests at birth with ambiguous external genitals (eg, clitoral enlargement, fusion of the labia majora, a urogenital sinus rather than distinct urethral and vaginal openings); later in life they may have hirsutism, oligomenorrhea, and acne.
Male infants usually appear normal but may later have precocious puberty.
Diagnose by steroid hormone levels and sometimes adrenocorticotropic hormone stimulation.
Treat with corticosteroid replacement and sometimes antihypertensives; females may require reconstructive surgery.
11Beta-hydroxylase deficiency causes about 5 to 8% of all cases of congenital adrenal hyperplasia.
Some states also include testing for cystic fibrosis, disorders of fatty acid oxidation, other organic acidemias, and severe combined immunodeficiency.
HIV screening is required by some states and is indicated for children of mothers known to be HIV-positive or those engaging in HIV high-risk behaviors.
Toxicology screening is indicated when any of the following are present: maternal history of drug use, unexplained placental abruption, unexplained premature labor, poor prenatal care, or evidence of drug withdrawal in the neonate.
Screening for critical congenital heart disease (CCHD) using pulse oximetry is part of routine newborn assessment.
Previously, newborns were screened for CCHD by prenatal ultrasonography and by physical examination, but this approach failed to identify many cases of CCHD, which led to increased morbidity and mortality.
The screening is done when infants are ≥ 24 hours old and is considered positive if Any oxygen saturation measurement is < 90%.
The oxygen saturation measurements in both the right hand and foot are < 95% on 3 separate measurements taken 1 hour apart.
There is > 3% absolute difference between the oxygen saturation in the right hand (preductal) and foot (postductal) on 3 separate measurements taken 1 hour apart.
Any infant with a positive screen should have additional testing, including chest x-ray, electrocardiography, and echocardiography.
The infant's pediatrician should be notified, and the infant may need to be evaluated by a cardiologist.
Hearing screening varies by state.
Hearing loss is one of the most frequently occurring birth defects.
About 3/1000 infants are born with moderate, profound, or severe hearing loss.
Hearing loss is even more common among infants admitted to an intensive care unit at birth.
Currently, some states screen only high-risk neonates (see Table: High-Risk Factors for Hearing Deficits in Neonates); others screen all neonates.
Initial screening often involves using a handheld device to test for echoes produced by healthy ears in response to soft clicks (otoacoustic emissions); if this test is abnormal, auditory brain stem response (ABR) testing is done.
Some institutions use ABR testing as an initial screening test.
Further testing by an audiologist may be needed.
Table High-Risk Factors for Hearing Deficits in Neonates Factor Specifics Birth weight < 1500 g Apgar score ≤ 7 at 5 minutes Serum bilirubin > 22 mg / dL (> 376 micromol / L) in neonate whose birth weight is > 2000 g > 17 mg / dL (> 290 micromol / L) in neonate whose birth weight is < 2000 g Disorders Perinatal anoxia or hypoxia Neonatal sepsis or meningitis Craniofacial abnormalities Seizures or apneic spells Congenital infections Rubella Syphilis Herpes simplex infection Cytomegalovirus infection Toxoplasmosis Maternal exposure Aminoglycosides Family history Early hearing loss in a parent or close relative
Blood typing is indicated when the mother has type O or Rh-negative blood or when minor blood antigens are present because hemolytic disease of the newborn is a risk.
All neonates are evaluated for jaundice throughout the hospital stay and before discharge.
The risk of hyperbilirubinemia is assessed using risk criteria, measurement of bilirubin, or both.
Bilirubin can be measured transcutaneously or in serum.
Many hospitals screen all neonates and use a predictive nomogram to determine the risk of extreme hyperbilirubinemia.
Follow-up is based on age at discharge, predischarge bilirubin level and / or rate of bilirubin rise from one determination to another, and risk of developing jaundice.
Most states test for specific inherited diseases, including phenylketonuria, tyrosinemia, biotinidase deficiency, homocystinuria, maple syrup urine disease, galactosemia, congenital adrenal hyperplasia, sickle cell disease, and hypothyroidism.
Classes of oral drugs used to treat hypertension include Adrenergic modifiers (beta - and alpha-antagonist, alpha-2-agonist, beta-blocker) Angiotensin-converting enzyme (ACE) inhibitors Angiotensin IIreceptor blockers (ARBs) Calcium channel blockers (CCBs) Thiazide diuretics Vasodilators Oral therapy for persistent hypertension in children should generally begin with an ACE inhibitor or a CCB.
(ARBs are equally effective and do not cause a cough, but there are more data in children on the use of ACE inhibitors.)
Both classes of drugs can be given as a single daily dose and seem to be equally effective.
ACE inhibitors should be used in patients with chronic kidney disease or diabetes because these drugs may also protect the kidneys.
CCBs should be used in menstruating girls if there is risk of pregnancy because ACE inhibitors and ARBs have significant effects on a fetus.
CCBs also have no significant effect on blood chemistries.
Thiazide diuretics have been used as initial treatment, but salt intake in adolescents is usually so high that they are rarely effective.
If initial therapy with a single drug does not achieve the target BP, a second drug should be added.
If the first drug is an ACE inhibitor or ARB, thiazide diuretics have proved to work well as second drugs, but a CCB could be added instead.
If the first drug is a CCB, then an ACE inhibitor or an ARB usually works as a second drug, but if there is a risk of pregnancy, they need to be avoided, and a thiazide diuretic or other drug can be tried instead.
If a thiazide diuretic is used, chlorthalidone is the ideal one to use because it can be given once a day.
Except in special conditions, vasodilators and alpha - and beta-blockers are 3rd-line drugs, which if needed should be used after consultation with a specialist.
Pediatrics 140 (3): e20171904, 2017. doi: 10.1542 / peds.2017 - 1904 Adrenergic Modifiers Adrenergic modifiers include central alpha-2-agonists, postsynaptic alpha-1-blockers, and peripheral-acting nonselective adrenergic blockers (see table Oral Adrenergic Agents for Hypertension in Children).
Alpha-2-agonists (eg, clonidine) stimulate alpha-2-adrenergic receptors in the brain stem and reduce sympathetic nervous activity, lowering BP.
Because they have a central action, they are more likely than other antihypertensives to cause drowsiness, lethargy, and depression; they are no longer widely used.
Clonidine can be applied transdermally once a week as a patch; thus, it may be useful for nonadherent patients.
Postsynaptic alpha-1-blockers (eg, prazosin, terazosin, doxazosin) are no longer used for primary treatment of hypertension because evidence suggests no reduction in mortality.
Table Angiotensin-Converting Enzyme (ACE) Inhibitors ACE inhibitors (see table Oral ACE Inhibitors for Hypertension in Children) reduce BP by interfering with the conversion of angiotensin I to angiotensin II and by inhibiting the degradation of bradykinin, thereby decreasing peripheral vascular resistance without causing reflex tachycardia.
These drugs reduce BP in many hypertensive patients, regardless of plasma renin activity.
Because these drugs provide renal protection, they are the drugs of choice for patients with diabetes and for hypertensive children with many types of kidney disorders.
A dry, irritating cough is the most common adverse effect (much less common in children than in older patients), but angioedema is the most serious and, if it affects the oropharynx, can be fatal.
Angioedema is most common among blacks and smokers.
ACE inhibitors may increase serum potassium and creatinine levels, especially in patients with chronic kidney disease and those taking potassium-sparing diuretics, potassium supplements, or nonsteroidal anti-inflammatory drugs (NSAIDs).
ACE inhibitors are contraindicated during pregnancy and should be used with caution in adolescent females who are at risk of pregnancy.
In patients with renal disorders causing renal dysfunction, serum creatinine and potassium levels should be checked within 2 to 4 weeks of starting therapy.
If the levels are increased, then they should be monitored at least every 3 to 6 months (more frequently if the increases are significant).
ACE inhibitors can cause acute kidney injury in patients who have hypovolemia, severe heart failure, severe bilateral renal artery stenosis, or severe stenosis in the artery to a solitary kidney.
Thiazide-type diuretics enhance the antihypertensive activity of ACE inhibitors more than that of other classes of antihypertensives.
Spironolactone and eplerenone also appear to enhance the effect of ACE inhibitors.
Table Angiotensin II Receptor Blockers (ARBs) ARBs (see table OralAngiotensin IIReceptor Blockers (ARBs) for Hypertension in Children) block angiotensin II receptors and therefore interfere with the renin-angiotensin system as do ACE inhibitors.
ARBs and ACE inhibitors are equally effective as antihypertensives.
ARBs may provide added benefits via tissue ACE receptor blockade.
The 2 classes have the same beneficial effects in patients with left ventricular failure or with nephropathy due to diabetes and other types of kidney diseases.
An ARB should not be used together with an ACE inhibitor.
ARBs may be safely started in children and adolescents with reduced renal function, but creatinine and potassium levels need to be checked in 1 to 4 weeks If the levels are increased, then they should be monitored at least every 3 to 6 months (more frequently if the increases are significant).
Incidence of adverse events is low; angioedema occurs but much less frequently than with ACE inhibitors.
Precautions for use of ARBs in patients with renovascular hypertension, hypovolemia, and severe heart failure are the same as those for ACE inhibitors (see table Oral ACE Inhibitors for Hypertension in Children).
ARBs are contraindicated during pregnancy and in adolescents who may become pregnant. Table Calcium Channel Blockers (CCBs) CCBs (see table Oral Calcium Channel Blockers (CCBs) for Hypertension in Children) are peripheral vasodilators and reduce BP by decreasing total peripheral vascular resistance (TPR); they sometimes cause reflexive tachycardia, but these drugs have minimal direct effects on the heart.
Table Thiazide Diuretics In addition to other antihypertensive effects, thiazide diuretics (see table Oral Thiazide Diuretics for Hypertension in Children) cause a small amount of vasodilation as long as intravascular volume is normal.
All thiazides are equally effective in equivalent doses.
Thiazide diuretics cause potassium loss, so serum potassium should be followed until the level stabilizes.
Unless serum potassium is normalized, potassium channels in the arterial walls close and the resulting vasoconstriction makes achieving the blood pressure goal difficult.
Patients with potassium levels < 3.5 mEq / L (< 3.5 mmol / L) are given potassium supplements or are instructed about dietary changes that can increase potassium intake.
Hypokalemia is less of a problem in hypertensive children, in whom thiazides are usually combined with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB), which tend to raise potassium levels.
In most patients with diabetes, thiazide-type diuretics do not affect control of diabetes.
Uncommonly, diuretics precipitate or worsen type 2 diabetes in patients with metabolic syndrome.
Table Vasodilators Direct vasodilators, including minoxidil and hydralazine (see table Oral Vasodilators for Hypertension in Children), work directly on blood vessels, independently of the autonomic nervous system.
Minoxidil is more potent than hydralazine but has more adverse effects, including sodium and water retention and hypertrichosis.
Minoxidil should be reserved for severe, refractory hypertension.
Hydralazine is used during pregnancy (eg, for preeclampsia) and as an adjunct antihypertensive.
Long-term, high-dose (> 300 mg / day) hydralazine has been associated with a drug-induced lupus syndrome, which resolves when the drug is stopped.
Generally, drug treatment should begin with a single drug at the low end of its dosing range and increased every 1 to 4 weeks until BP is controlled, the upper end of the dosing range is approached, or adverse effects develop that affect the use of the drug.
At that point, if the BP goal has not been attained, a second drug can be added and titrated as with the initial drug.
Bicuspid Aortic Valve By Lee B Beerman, MD, Children's Hospital of Pittsburgh of the University of Pittsburgh School of Medicine Reviewed / Revised Apr 2023 View Patient Education Symptoms and Signs Diagnosis Treatment More Information Bicuspid aortic valve is the presence of only two (rather than the normal three) valve cusps.
Circulation 119 (6): 880 - 890, 2009. doi: 10.1161/CIRCULATIONAHA.108.795401 Symptoms and Signs of Bicuspid Aortic Valve Children with bicuspid aortic valve may be asymptomatic if there is little or no valve dysfunction.
Symptoms depend on the type of complication and can include fever in infective endocarditis or dyspnea, fatigue, syncope, palpitations, and exercise intolerance due to valvular regurgitation or stenosis.
Examination reveals an early systolic click, a systolic ejection murmur and, if aortic regurgitation is present, a diastolic decrescendo murmur.
Diagnosis of Bicuspid Aortic Valve Physical examination Echocardiography Diagnosis is by physical examination findings and echocardiography.
Physical examination usually reveals a prominent early systolic ejection sound (click) at the apex and base of the heart.
This finding is often best heard with the patient sitting; the examiner listens at the apex for a click just after the first heart sound (S1), simulating a prominent split of S1.
Bicuspid aortic valve is the most common congenital cardiovascular abnormality.
There may be a basal systolic murmur due to aortic stenosis or a high-pitched diastolic murmur if aortic regurgitation is present.
Echocardiography shows the characteristic finding of fusion of two of the three aortic valve leaflets.
Fusion of the right coronary and left coronary leaflets is the most common morphology.
Children with fusion of the right coronary and noncoronary leaflets are more likely to have progression of valve dysfunction and to require intervention during childhood.
Treatment of Bicuspid Aortic Valve Balloon dilation or surgical repair Treatment of bicuspid aortic valve is indicated if severe valve dysfunction develops and if symptoms occur.
Treatment consists of balloon dilation or surgical repair of stenotic valves.
Regurgitant valves are treated with surgery.
Ascending aorta or root replacement may be indicated if there is severe or progressive enlargement of those structures.
It is present in 0.5 to 2% of live births (1).
Patients with bicuspid aortic valve are predisposed to developing infective endocarditis, aortic regurgitation, and / or aortic stenosis.
Bicuspid aortic valve can also be associated with dilation of the aortic root or ascending aorta and with coarctation of the aorta.
There is a genetic predilection for bicuspid aortic valves, with a 9% reported family prevalence, so first-degree relatives of patients with a bicuspid aortic valve should undergo screening echocardiography.
Recognition of a bicuspid valve, even in a patient who has normal valve function, is important for purposes of follow-up because of the association of bicuspid valves with an aortopathy that results in progressive aortic root or ascending aortic dilation and aneurysm formation.
Renal Glucosuria (Renal Glycosuria) By L Aimee Hechanova, MD, Texas Tech University Health Sciences Center, El Paso Reviewed / Revised May 2022 | Modified Sep 2022 View Patient Education Symptoms and Signs Diagnosis Treatment Renal glucosuria is glucose in the urine without hyperglycemia; it results from either an acquired or an inherited, isolated defect in glucose transport or occurs with other renal tubule disorders.
With such findings, transport defects other than glucosuria should be sought.
Diagnosis of Renal Glucosuria Urinalysis The disorder is typically initially noted on routine urinalysis, and is defined as glucosuria in the absence of hyperglycemia (serum glucose < 140 mg / dL).
Some experts require a normal result on an oral glucose tolerance test for the diagnosis.
Treatment of Renal Glucosuria No treatment needed Isolated renal glucosuria is benign; no treatment is necessary.
Renal glucosuria is the excretion of glucose in the urine in the presence of normal plasma glucose levels.
Renal glucosuria can be inherited.
This form usually involves a reduction in the glucose transport maximum (the maximum rate at which glucose can be resorbed) and subsequent escape of glucose in the urine.
The inherited disorder is usually transmitted as an incompletely recessive trait (heterozygotes have modest glucosuria).
Renal glucosuria may occur without any other abnormalities of renal function or as part of a generalized defect in proximal tubule function (Fanconi syndrome).
It also may occur with various systemic disorders, including cystinosis, Wilson disease, hereditary tyrosinemia, and oculocerebrorenal syndrome (Lowe syndrome).
Symptoms and Signs of Renal Glucosuria Renal glucosuria is asymptomatic and without serious sequelae.
However, if there is an associated generalized defect in proximal tubular function, symptoms and signs may include hypophosphatemic rickets, volume depletion, short stature, muscle hypotonia, and ocular changes of cataracts or glaucoma (oculocerebrorenal syndrome) or Kayser-Fleischer rings (Wilson disease).
Isolated Hematuria By Geetha Maddukuri, MD, Saint Louis University Reviewed / Revised Dec 2022 View Patient Education Pathophysiology Etiology Evaluation Treatment Key Points Topic Resources Some Common Specific Causes... Hematuria is red blood cells (RBCs) in urine, specifically > 3 RBCs per high-power field on urine sediment examination.
The most common specific causes differ somewhat by age, but overall the most common are Urinary tract infections (UTIs) Prostatitis Urinary calculi (in adults) Congenital or acquired anatomic abnormalities Cancers Vigorous exercise may cause transient hematuria.
Cancer and prostate disease are a concern mainly in patients > 50, although younger patients with risk factors may develop cancer.
Glomerular disorders can be a cause at all ages.
Glomerular disorders may represent a primary renal disorder (acquired or hereditary) or be secondary to many causes, including infections (eg, group A beta-hemolytic streptococcal infection), connective tissue disorders and vasculitis (eg, systemic lupus erythematosus [SLE] at all ages, immunoglobulin A-associated vasculitis [Henoch-Schönlein purpura] in children), and blood disorders (eg, mixed cryoglobulinemia, serum sickness).
Worldwide, IgA nephropathy is the most common form of glomerulonephritis.
Thin basement membrane disease and mild IgA nephropathy may cause isolated hematuria; however, most other glomerular causes of hematuria are accompanied by proteinuria.
Schistosoma haematobium, a parasitic fluke that causes significant disease in Africa (and, to a lesser extent, in India and parts of the Middle East), can invade the urinary tract, causing hematuria.
Schistosomiasis is considered only if people have spent time in endemic areas.
Mycobacterium tuberculosis may also infect the lower or upper urinary tract and cause hematuria, occasionally causing urethral strictures.
Other causes of hematuria include Urinary tract instrumentation or procedure (eg, Foley catheterization, prostate or kidney biopsy, lithotripsy) Radiation cystitis Drug-induced hemorrhagic cystitis Vascular etiology—which is rare (eg, renal infarction, renal vein embolism, renal arteriovenous malformation) Table Evaluation of Isolated Hematuria History History of present illness includes duration of hematuria and any previous episodes.
Urine may be red, bloody, or cola-colored (gross hematuria with oxidation of blood retained in the bladder) or not visibly discolored (microscopic hematuria).
Urinary obstructive symptoms (eg, incomplete emptying, nocturia, difficulty starting or stopping) and irritative symptoms (eg, irritation, urgency, frequency, dysuria) should be noted.
Patients should be asked about the presence of pain and its location and severity and whether they have vigorously exercised.
Review of systems should seek symptoms of possible causes, including joint pain and rashes (connective tissue disorder), and hearing loss or ocular manifestations (hereditary nephritis, also called Alport syndrome).
Presence of fever, night sweats, or weight loss should also be noted.
Past medical history should include questions about any recent infections, particularly a sore throat that may indicate a group A beta-hemolytic streptococcal infection. Conditions known to cause urinary tract bleeding (particularly kidney calculi, sickle cell disease or trait, and glomerular disorders) should be sought, along with any history of congenital urinary tract anomalies.
Also, conditions that predispose to a glomerular disorder, such as a connective tissue disorder (particularly systemic lupus erythematosus [SLE] and rheumatoid arthritis), endocarditis, shunt infections, and abdominal abscesses, should be identified.
Risk factors for genitourinary (GU) cancer should be identified, including smoking (the most significant), drugs (eg, cyclophosphamide, phenacetin), and exposure to industrial chemicals (eg, nitrates, nitrilotriacetate, nitrites, trichloroethylene).
Family history should identify relatives with known polycystic kidney disease, a glomerular disorder, or GU cancer.
Patients should be asked about travel to areas where schistosomiasis is endemic, and tuberculosis risk factors should be assessed.
Isolated hematuria is urinary RBCs without other urine abnormalities (eg, proteinuria, casts).
Drug history should note use of anticoagulants, antiplatelet drugs (although controlled anticoagulation itself does not cause hematuria), and heavy analgesic use.
Physical examination Vital signs should be reviewed for fever and hypertension.
The heart should be auscultated for murmurs (suggesting endocarditis).
The abdomen should be palpated for masses; flanks should be percussed for tenderness over the kidneys.
In men, a digital rectal examination should be done to check for prostate enlargement, nodules, and tenderness.
The face and extremities should be inspected for edema (suggesting a glomerular disorder), and the skin should be inspected for rashes (suggesting vasculitis, SLE, or immunoglobulin A-associated vasculitis).
Red flags The following findings are of particular concern: Gross hematuria and concurrent proteinuria Persistent microscopic hematuria, especially in older patients Age > 50 Hypertension and edema Systemic symptoms (eg, fever, night sweats, weight loss) Interpretation of findings Clinical manifestations of the various causes overlap significantly, so urine and often blood tests are required.
Depending on results, imaging tests may then be needed.
However, some clinical findings provide helpful clues (see table Some Common Causes of Hematuria).
Blood clots in urine essentially rule out a glomerular disorder.
Red urine is not always due to RBCs.
Glomerular disorders are often accompanied by edema, hypertension, or both; symptoms may be preceded by an infection (particularly a group A beta-hemolytic streptococcal infection in children).
Calculi usually manifest with excruciating, colicky pain.
Less severe, more continuous pain is more likely to result from infection, cancer, polycystic kidney disease, glomerulonephritis, and loin pain-hematuria syndrome.
Urinary irritative symptoms suggest bladder or prostate infection but may accompany certain cancers (mainly bladder and prostate).
Urinary obstructive symptoms usually suggest prostate disease.
An abdominal mass suggests polycystic kidney disease or renal cell carcinoma.
A family history of nephritis, sickle cell disease or trait, or polycystic kidney disease suggests that as a cause.
Travel to Africa, the Middle East, or India suggests the possibility of schistosomiasis.
Systemic symptoms (eg, fever, night sweats, weight loss) may indicate cancer or subacute infection (eg, tuberculosis [TB]) or an autoimmune (connective tissue) disorder.
On the other hand, some common findings (eg, prostate enlargement, excessive anticoagulation), although potential causes of hematuria, should not be assumed to be the cause without further evaluation.
Red or reddish brown discoloration may result from the following: Hemoglobin or myoglobin in urine Porphyria (most types) Foods (eg, beets, rhubarb, sometimes food coloring) Drugs (most commonly phenazopyridine, but sometimes cascara, diphenylhydantoin, methyldopa, phenacetin, phenindione, phenolphthalein, phenothiazine, and senna) Pathophysiology of Isolated Hematuria Red blood cells (RBCs) may enter urine from anywhere along the urinary tract—from the kidneys, collecting system and ureters, prostate, bladder, and urethra.
Testing Before testing proceeds, true hematuria should be distinguished from red urine by urinalysis.
In women with vaginal bleeding, the specimen should be obtained by straight catheterization to avoid contamination by a nonurinary source of blood.
Red urine without red blood cells (RBCs) suggests myoglobinuria or hemoglobinuria, porphyria, or ingestion of certain drugs or foods.
Generally, the presence of hematuria should be confirmed by testing a 2nd specimen.
Presence of casts, protein, or dysmorphic RBCs (unusually shaped, with spicules, folding, and blebs) indicates a glomerular disorder.
White blood cells or bacteria suggest an infectious etiology.
However, because urinalysis shows predominantly RBCs in some patients with cystitis, urine culture is usually done.
A positive culture result warrants treatment with antibiotics.
If hematuria resolves after treatment and no other symptoms are present, no further evaluation is required for patients < 50, especially women.
If patients < 35 (including children) have only microscopic hematuria and no urine findings suggesting a glomerular disorder, no clinical manifestations suggesting a cause, no risk factors for cancer, and an identified benign cause (eg, infection, mild trauma), they can be observed, with urinalysis repeated every 6 to 12 months.
In females, normal or abnormal uterine bleeding may be misdiagnosed as hematuria.
If a benign cause is not evident or hematuria is persistent, testing is indicated (1), beginning with ultrasonography or CT with contrast, sometimes followed by cystoscopy.
Patients < 50 with gross hematuria or unexplained systemic symptoms require ultrasonography or CT of the abdomen and pelvis.
If urine or clinical findings suggest a glomerular disorder, renal function is evaluated by measuring blood urea nitrogen, serum creatinine, and electrolytes; doing a urinalysis; and periodically determining the urine protein / creatinine ratio.
Further evaluation of a glomerular disorder may require serologic tests, kidney biopsy, or both.
All patients ≥ 35 require cystoscopy, as do patients who are < 35 but have risk factors, such as a family history of cancer, or systemic symptoms (1).
Etiology of Isolated Hematuria Most cases involve transient microscopic hematuria that is self-limited and idiopathic.
Urinalysis and urine sediment examination help differentiate glomerular from nonglomerular causes.
Risk of serious disease increases with aging and with duration and degree of hematuria.
Cystoscopy and imaging tests are usually needed for patients > 35 or for younger patients with systemic symptoms or risk factors for cancer.
Transient microscopic hematuria is particularly common in children, present in up to 5% of their urine samples.
Brain Abscess By John E Greenlee, MD, University of Utah Health Reviewed / Revised Mar 2022 | Modified Sep 2022 View Patient Education Etiology Symptoms and Signs Diagnosis Treatment Key Points Topic Resources Cerebellar Abscess A brain abscess is an intracerebral collection of pus.
Enterobacteriaceae may be isolated in chronic ear infections.
After chronic suppurative otitis media, anaerobic bacteria, streptococci, and gram-negative bacteria are common causes.
Fungi (eg, Aspergillus) and protozoa (eg, Toxoplasma gondii, particularly in HIV-infected patients) can cause abscesses.
Symptoms and Signs of Brain Abscess Symptoms result from increased intracranial pressure, mass effect, and sometimes focal brain injury.
Classically, headache, nausea, vomiting, lethargy, seizures, personality changes, papilledema, and focal neurologic deficits develop over days to weeks; however, in some patients, these manifestations are subtle or absent until late in the clinical course.
Fever, chills, and leukocytosis may develop before the infection is encapsulated, but they may be absent at presentation, subside over time, or not develop.
Diagnosis of Brain Abscess Contrast-enhanced MRI or, if unavailable, contrast-enhanced CT When symptoms suggest an abscess, contrast-enhanced MRI with diffusion-weighted images or, if MRI is unavailable, contrast-enhanced CT is done.
A fully developed abscess appears as an edematous mass with ring enhancement, which may be difficult to distinguish from a brain tumor or occasionally infarction; CT-guided aspiration, culture, surgical excision, or a combination may be necessary.
Culturing pus aspirated from the abscess can make targeted antibiotic therapy of the abscess possible.
However, antibiotics should not be withheld until culture results are available.
Symptoms may include headache, lethargy, fever, and focal neurologic deficits.
Lumbar puncture is not done because it may precipitate transtentorial herniation and because cerebrospinal fluid (CSF) findings are nonspecific (see table Cerebrospinal Fluid Abnormalities in Various Disorders).
Treatment of Brain Abscess Antibiotics (initially cefotaxime or ceftriaxone plus metronidazole for Bacteroides species or plus vancomycin for Staphylococcus aureus based on suspicion, then as guided by culture and susceptibility testing) Usually CT-guided stereotactic aspiration or surgical drainage Sometimes corticosteroids, antiseizure drugs, or both All patients receive antibiotics for a minimum of 4 to 8 weeks.
Initial empiric antibiotics include one of the following: Cefotaxime 2 g IV every 4 hours Ceftriaxone 2 g IV every 12 hours Both are effective against streptococci, Enterobacteriaceae, and most anaerobes but not against Bacteroides fragilis.
If clinicians suspect Bacteroides species (as in chronic sinusitis or otitis), metronidazole 15 mg / kg (loading dose) followed by 7.5 mg / kg IV every 6 hours is also required.
If S aureus is suspected (eg, after cranial trauma or neurosurgery or in endocarditis), vancomycin 1 g every 12 hours is used (with cefotaxime or ceftriaxone) until sensitivity to nafcillin (2 g every 4 hours) is determined.
Response to antibiotics is best monitored by serial MRI or CT Drainage (CT-guided stereotactic or open) provides optimal therapy and is necessary for most abscesses that are solitary and surgically accessible, particularly those > 2 cm in diameter.
If abscesses are < 2 cm in diameter, antibiotics alone may be tried, but abscesses must then be monitored with frequent serial MRI or CT (initially as often as every 2 to 3 days); if abscesses enlarge after being treated with antibiotics, surgical drainage is indicated.
Patients with increased intracranial pressure (assessed by signs and neuroimaging findings) may benefit from a short course of high-dose corticosteroids (dexamethasone 10 mg IV once, then 4 mg IV every 6 hours for 3 or 4 days).
Antiseizure drugs are frequently used to prevent seizures.
Rate of recovery depends on how successful the abscesses are eradicated and the patient's immune status.
Diagnosis is by contrast-enhanced MRI or CT.
If immunocompromised patients (eg, patients with uncontrolled HIV infection) have an abscess due to Toxoplasma gondii or a fungus, they may have to take antibiotics for the rest of their life.
Key Points Brain abscess can result from direct extension (eg, of mastoiditis, osteomyelitis, sinusitis, or subdural empyema), penetrating wounds (including neurosurgery), or hematogenous spread.
Headache, nausea, vomiting, lethargy, seizures, personality changes, papilledema, and focal neurologic deficits develop over days to weeks; fever may be absent at presentation.
Do contrast-enhanced MRI or, if MRI is unavailable, contrast-enhanced CT.
Treat all brain abscesses with antibiotics (usually initially with ceftriaxone or cefotaxime plus metronidazole if clinicians suspect Bacteroides species or plus vancomycin if they suspect S aureus), typically followed by CT-guided stereotactic aspiration or surgical drainage.
If abscesses are < 2 cm in diameter, they may be treated with antibiotics alone but must then be monitored closely with MRI or CT; if abscesses enlarge after being treated with antibiotics, surgical drainage is indicated.
Treatment is with antibiotics and usually CT-guided stereotactic aspiration or surgical drainage.
An abscess forms when an area of cerebral inflammation becomes necrotic and encapsulated by glial cells and fibroblasts.
Edema around the abscess may increase intracranial pressure, as may the abscess itself.
Etiology of Brain Abscess A brain abscess can result from Direct extension of cranial infections (eg, osteomyelitis, mastoiditis, sinusitis, subdural empyema) Penetrating head wounds (including neurosurgical procedures) Hematogenous spread (eg, in bacterial endocarditis, congenital heart disease with right-to-left shunt, or IV drug abuse) Unknown causes The bacteria involved are usually anaerobic and sometimes mixed, often including anaerobes, such as Bacteroides and anaerobic and microaerophilic streptococci.
Staphylococci are commonly involved after cranial trauma, neurosurgery, or endocarditis.
Table Antiglomerular basement membrane antibody disease Antiglomerular basement membrane (GBM) antibody disease is an autoimmune glomerulonephritis and accounts for up to 10% of RPGN cases.
It may arise when respiratory exposures (eg, cigarette smoke, viral upper respiratory infection) or some other stimulus exposes alveolar capillary collagen, triggering formation of anticollagen antibodies.
The anticollagen antibodies cross-react with GBM, fixing complement and triggering a cell-mediated inflammatory response in the kidneys and usually the lungs.
The term Goodpasture syndrome refers to a combination of glomerulonephritis and alveolar hemorrhage in the presence of anti-GBM antibodies.
Glomerulonephritis without alveolar hemorrhage in the presence of anti-GBM antibodies is called anti-GBM glomerulonephritis.
Immunofluorescent staining of renal biopsy tissue demonstrates linear IgG deposits.
Immunofluorescent staining demonstrates nonspecific granular immune deposits.
The condition accounts for up to 40% of RPGN cases.
Pathogenesis is usually unknown.
Pauci-immune RPGN Pauci-immune RPGN is distinguished by the absence of immune complex or complement deposition on immunofluorescent staining.
It constitutes up to 50% of all RPGN cases.
Almost all patients have elevated antineutrophil cytoplasmic antibodies (ANCAs), usually antiproteinase 3-ANCA or myeloperoxidase-ANCA, and systemic vasculitis.
Double-antibody disease Double-antibody disease occurs with the presence of anti-GBM and ANCA antibodies.
They include patients with either of the following: Immune complexes but no obvious cause such as infection, systemic rheumatic disease, or glomerular disorder Pauci-immune features but absence of ANCA antibodies Symptoms and Signs of RPGN Manifestations are usually insidious, with weakness, fatigue, fever, nausea, vomiting, anorexia, arthralgia, and abdominal pain.
Some patients present similarly to those with postinfectious glomerulonephritis, with abrupt-onset hematuria.
About 50% of patients have edema and a history of an acute influenza-like illness within 4 weeks of onset of renal failure, usually followed by severe oliguria.
Nephrotic syndrome is present in 10 to 30%.
Hypertension is uncommon and rarely severe.
Patients with anti-GBM antibody disease may have pulmonary hemorrhage, which can manifest with hemoptysis or be detectable only by findings suggestive of diffuse alveolar infiltrates on lung imaging (pulmonary-renal syndrome or diffuse alveolar hemorrhage syndrome).
Diagnosis of RPGN Progressive renal failure over weeks to months Nephritic urinary sediment Serologic testing Serum complement levels Renal biopsy Diagnosis is suggested by acute kidney injury in patients with hematuria and dysmorphic red blood cells (RBCs) or RBC casts.
Testing includes serum creatinine, urinalysis, complete blood count (CBC), serologic tests, and renal biopsy.
Diagnosis is usually by serologic tests and renal biopsy.
Serum creatinine is almost always elevated.
Urinalysis shows hematuria is always present, and RBC casts are usually present.
Telescopic sediment (ie, sediment with multiple elements, including white blood cells [WBCs]; dysmorphic RBCs; and WBC, RBC, granular, waxy, and broad casts) is common.
On CBC, anemia is usually present, and leukocytosis is common.
Serologic testing should include anti-GBM antibodies (anti-GBM antibody disease); antistreptolysin O antibodies, anti-DNA antibodies, or cryoglobulins (immune complex RPGN); and antineutrophil cytoplasmic antibodies (ANCA) titers (pauci-immune RPGN).
The feature common to all types of RPGN is focal proliferation of glomerular epithelial cells, sometimes interspersed with numerous neutrophils, that forms a crescentic cellular mass (crescents) and that fills Bowman space in > 50% of glomeruli.
The glomerular tuft usually appears hypocellular and collapses.
Necrosis within the tuft or involving the crescent may occur and may be the most prominent abnormality.
In such patients, histologic evidence of vasculitis should be sought.
Immunofluorescence microscopy findings differ for each type: In anti-GBM antibody disease, linear or ribbon-like deposition of IgG along the GBM is most prominent and is often accompanied by linear and sometimes granular deposition of C3.
In immune complex RPGN, immunofluorescence reveals diffuse, irregular mesangial IgG and C3 deposits.
In pauci-immune RPGN, immune staining and deposits are not detected.
However, fibrin occurs within the crescents, regardless of the fluorescence pattern.
Diagnosis is based on history, urinalysis, serologic tests, and renal biopsy.
In double antibody RPGN, linear staining of the GBM is present.
In idiopathic RPGN, some patients have immune complexes and others have absence of immune staining and deposits.
Treatment of RPGN Corticosteroids Cyclophosphamide Rituximab Plasma exchange Treatment varies by disease type, although no regimens have been rigorously studied.
Therapy should be instituted early, ideally when serum creatinine is < 5 mg / dL (442 micromol / L) and before the biopsy shows crescentic involvement of all glomeruli or organizing crescents as well as fibrotic interstitium and atrophic tubules.
Even patients with kidney involvement and higher creatinine levels should be aggressively treated if they do not require immediate renal replacement therapy.
Treatment becomes less effective as these features become more prominent and may be harmful in some patients (eg, older patients, patients with infection).
Corticosteroids and either cyclophosphamide or rituximab are usually given.
For immune complex and pauci-immune disease, corticosteroids (methylprednisolone 1 g IV once a day over 30 minutes for 3 to 5 days followed by prednisone 1 mg / kg orally once a day) may reduce serum creatinine levels or delay dialysis for > 3 years in 50% of patients (1, 2).
Cyclophosphamide is usually given and may particularly benefit antineutrophil cytoplasmic antibody (ANCA) - positive patients; IV monthly pulse regimens may cause fewer adverse effects (eg, leukopenia, infection) than oral therapy because of reduced cumulative dosing.
Prednisone and cyclophosphamide are typically started concurrent with plasma exchange for anti-GBM (glomerular basement membrane) antibody disease and continued to minimize new antibody formation.
Treatment is with corticosteroids, with or without cyclophosphamide or rituximab, and sometimes plasma exchange.
Patients with idiopathic disease are usually treated with corticosteroids and cyclophosphamide, but data regarding efficacy are scarce.
Rituximab may be dosed at 375 mg / m 2 IV per week for 4 weeks as used in the RAVE trial (formal title: R ituximab in A NCA-Associated V asculitis; [2]).
An alternative regimen is an initial dose of 1g followed by another 1-g dose 2 weeks later.
Rituximab has not been used in the treatment of anti-GBM disease.
Plasma exchange (daily 3 - to 4-L exchanges for 14 days) is recommended for anti-GBM antibody disease.
Plasma exchange may also be considered for immune complex and pauci-immune ANCA-associated RPGN with pulmonary hemorrhage or severe renal dysfunction on presentation (serum creatinine > 5 to 7 mg / dL [442 to 618.8 micromol / L] or dialysis dependency), but its use remains controversial.
Plasma exchange is thought to rapidly remove free antibody, intact immune complexes, and mediators of inflammation (eg, fibrinogen, complement).
Aggressive immunosuppressive therapy may also be beneficial in patients who present with higher creatinine levels.
Plasmapheresis combined with prednisone and cyclophosphamide benefited patients with renal involvement who did not require immediate renal replacement therapy, even if creatinine levels were elevated above 5 to 7 mg / dL (442 to 618.8 micromol / L; [4]).
Kidney transplantation is effective for all types, but disease may recur in the graft; risk diminishes with time.
In anti-GBM antibody disease, the anti-GBM titers should be undetectable for at least 12 months before transplantation.
It is relatively uncommon, affecting 10 to 15% of patients with glomerulonephritis, and occurs predominantly in patients 20 to 50 years.
Key Points Consider rapidly progressive glomerulonephritis if patients have acute kidney injury with hematuria and dysmorphic RBCs or RBC casts, particularly with subacute constitutional or nonspecific symptoms (eg, fatigue, fever, anorexia, arthralgia, abdominal pain).
Evaluate with serologic tests and early renal biopsy.
Types and causes are classified by findings using immunofluorescence microscopy and serologic tests (eg, anti-glomerular basement membrane [GBM] antibody, anti-neutrophil cytoplasmic antibody [ANCA] —see table).
Initiate treatment early, with corticosteroids, cyclophosphamide, and in some cases plasma exchange.
Consider kidney transplantation after disease activity is controlled.
Renal biopsy is unnecessary but is often done as part of a hematuria evaluation.
Early on, thin basement membrane disease may be difficult to differentiate from Alport sydrome because of histologic similarities.
Treatment of Thin Basement Membrane Disease For frequent gross hematuria, flank pain, or proteinuria, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) Long-term prognosis is excellent, and no treatment is necessary in most cases.
Patients with frequent gross hematuria, flank pain, or proteinuria (eg, urine protein / creatinine ratio of > 0.2) may benefit from ACE inhibitors or ARBs, which may lower intraglomerular pressure.
Thin basement membrane disease is a type of nephritic syndrome.
It is hereditary and usually transmitted in autosomal dominant fashion.
Not all genetic mutations have been characterized, but in some families with thin basement membrane disease there is a mutation in the type IV collagen alpha-4 gene.
Prevalence is estimated to be 5 to 9%.
Symptoms and Signs of Thin Basement Membrane Disease Most patients are asymptomatic and are incidentally noted to have microscopic hematuria on routine urinalysis, although mild proteinuria and gross hematuria are occasionally present.
Renal function is typically normal, but a few patients develop progressive renal failure for unknown reasons.
Recurrent flank pain, similar to that in immunoglobulin A nephropathy, is a rare manifestation.
Diagnosis of Thin Basement Membrane Disease Clinical evaluation Sometimes renal biopsy Diagnosis is based on family history and findings of hematuria without other symptoms or pathology, particularly if asymptomatic family members also have hematuria.
Subarachnoid Hemorrhage (SAH) By Ji Y Chong, MD, Weill Cornell Medical College Reviewed / Revised Apr 2020 | Modified Sep 2022 View Patient Education Etiology Pathophysiology Symptoms and Signs Diagnosis Prognosis Treatment Key Points Topic Resources QT Interval Correction (EKG) Mean Vascular Pressure (systemic... Subarachnoid Hemorrhage Subarachnoid hemorrhage is sudden bleeding into the subarachnoid space.
A congenital intracranial saccular or berry aneurysm is the cause in about 85% of patients.
Bleeding may stop spontaneously.
Aneurysmal hemorrhage may occur at any age but is most common from age 40 to 65.
Less common causes are mycotic aneurysms, arteriovenous malformations, and bleeding disorders.
Pathophysiology of SAH Blood in the subarachnoid space causes a chemical meningitis that commonly increases intracranial pressure for days or a few weeks.
Secondary vasospasm may cause focal brain ischemia; about 25% of patients develop signs of a transient ischemic attack (TIA) or ischemic stroke.
Brain edema is maximal and risk of vasospasm and subsequent infarction (called angry brain) is highest between 72 hours and 10 days.
Secondary acute hydrocephalus is also common.
A 2nd rupture (rebleeding) sometimes occurs, most often within about 7 days.
Symptoms and Signs of SAH Headache is usually severe, peaking within seconds.
The most common cause of spontaneous bleeding is a ruptured aneurysm.
Loss of consciousness may follow, usually immediately but sometimes not for several hours.
Severe neurologic deficits may develop and become irreversible within minutes or a few hours.
Sensorium may be impaired, and patients may become restless.
Seizures are possible.
Usually, the neck is not stiff initially unless the cerebellar tonsils herniate.
However, within 24 hours, chemical meningitis causes moderate to marked meningismus, vomiting, and sometimes bilateral extensor plantar responses.
Heart or respiratory rate is often abnormal.
Fever, continued headaches, and confusion are common during the first 5 to 10 days.
Secondary hydrocephalus may cause headache, obtundation, and motor deficits that persist for weeks.
Rebleeding may cause recurrent or new symptoms.
Symptoms include sudden, severe headache, usually with loss or impairment of consciousness.
Diagnosis of SAH Usually noncontrast CT and, if negative, lumbar puncture Diagnosis of subarachnoid hemorrhage is suggested by characteristic symptoms.
Testing should proceed as rapidly as possible, before damage becomes irreversible.
Noncontrast CT is done within 6 hours of symptom onset.
MRI is comparably sensitive but less likely to be immediately available.
False-negative results occur if volume of blood is small or if the patient is so anemic that blood is isodense with brain tissue.
If subarachnoid hemorrhage is suspected clinically but not identified by neuroimaging or if neuroimaging is not immediately available, lumbar puncture is done.
Lumbar puncture is contraindicated if increased intracranial pressure is suspected because the sudden decrease in cerebrospinal (CSF) pressure may lessen the tamponade of a clot on the ruptured aneurysm, causing further bleeding.
Pearls & Pitfalls Suspect subarachnoid hemorrhage if headache reaches peak, severe intensity within seconds of onset or causes loss of consciousness.
Do lumbar puncture if subarachnoid hemorrhage is suspected clinically but CT shows no hemorrhage or is not available; however, lumbar puncture is contraindicated if increased intracranial pressure is suspected.
CSF findings suggesting subarachnoid hemorrhage include Numerous red blood cells (RBCs) Xanthochromia Increased pressure RBCs in CSF may also be caused by traumatic lumbar puncture.
Secondary vasospasm (causing focal brain ischemia), meningismus, and hydrocephalus (causing persistent headache and obtundation) are common.
Traumatic lumbar puncture is suspected if the RBC count decreases in tubes of CSF drawn sequentially during the same lumbar puncture.
About 6 hours or more after a subarachnoid hemorrhage, RBCs become crenated and lyse, resulting in a xanthochromic CSF supernatant and visible crenated RBCs (noted during microscopic CSF examination); these findings usually indicate that subarachnoid hemorrhage preceded the lumbar puncture.
If there is still doubt, hemorrhage should be assumed, or the lumbar puncture should be repeated in 8 to 12 hours.
In patients with subarachnoid hemorrhage, conventional cerebral angiography is done as soon as possible after the initial bleeding episode; alternatives include magnetic resonance angiography and CT angiography.
All 4 arteries (2 carotid and 2 vertebral arteries) should be injected because up to 20% of patients (mostly women) have multiple aneurysms.
On ECG, subarachnoid hemorrhage may cause ST-segment elevation or depression.
It can cause syncope, mimicking myocardial infarction.
Other possible ECG abnormalities include prolongation of the QRS or QT intervals and peaking or deep, symmetric inversion of T waves.
Prognosis for SAH About 35% of patients die after the first aneurysmal subarachnoid hemorrhage; another 15% die within a few weeks because of a subsequent rupture.
After 6 months, a 2nd rupture occurs at a rate of about 3% / year.
Diagnosis is by CT or MRI; if neuroimaging is normal, diagnosis is by cerebrospinal fluid analysis.
In general, prognosis is grave with an aneurysm, better with an arteriovenous malformation, and best when 4-vessel angiography does not detect a lesion, presumably because the bleeding source is small and has sealed itself.
Among survivors, neurologic damage is common, even when treatment is optimal.
Treatment of SAH Treatment in a comprehensive stroke center Nicardipine if mean arterial pressure is > 130 mm Hg Nimodipine to prevent vasospasm Occlusion of causative aneurysms Patients with subarachnoid hemorrhage should be treated in a comprehensive stroke center whenever possible.
Hypertension should be treated only if mean arterial pressure is > 130 mm Hg; euvolemia is maintained, and IV nicardipine is titrated as for intracerebral hemorrhage (1).
Bed rest is mandatory.
Restlessness and headache are treated symptomatically.
Stool softeners are given to prevent constipation, which can lead to straining.
Anticoagulants and antiplatelet drugs are contraindicated.
Vasospasm is prevented by giving nimodipine 60 mg orally every 4 hours for 21 days to prevent vasospasm, but BP needs to be maintained in the desirable range (usually considered to be a mean arterial pressure of 70 to 130 mm Hg and a systolic pressure of 120 to 185 mm Hg).
If clinical signs of acute hydrocephalus occur, ventricular drainage should be considered.
Treatment is with supportive measures and neurosurgery or endovascular measures, preferably in a comprehensive stroke center.
Aneurysms are occluded to reduce risk of rebleeding.
Detachable endovascular coils can be inserted during angiography to occlude the aneurysm.
Alternatively, if the aneurysm is accessible, surgery to clip or stent the aneurysm can be done, especially for patients with an evacuable hematoma or acute hydrocephalus.
If patients are arousable, most vascular neurosurgeons operate within the first 24 hours to minimize risk of rebleeding and risks due to angry brain.
Key Points Possible complications after subarachnoid hemorrhage include chemical meningitis, vasospasm, hydrocephalus, rebleeding, and brain edema.
Suspect subarachnoid hemorrhage if headache is severe at onset and reaches peak intensity within seconds or causes loss of consciousness.
Etiology of SAH Subarachnoid hemorrhage is bleeding between the arachnoid and pia mater.
If subarachnoid hemorrhage is confirmed, scan both carotid and both vertebral arteries using conventional cerebral angiography, magnetic resonance angiography, or CT angiography because many patients have multiple aneurysms.
If possible, send patients to a comprehensive stroke center for treatment.
In general, head trauma is the most common cause of subarachnoid hemorrhage, but traumatic subarachnoid hemorrhage is usually considered a separate disorder.
Spontaneous (primary) subarachnoid hemorrhage usually results from ruptured aneurysms.
Renal Atheroembolism By Zhiwei Zhang, MD, Loma Linda University School of Medicine Reviewed / Revised Mar 2023 View Patient Education Symptoms and Signs Diagnosis Treatment Prognosis Key Points Topic Resources Renal Atheroembolism Renal Cortical Necrosis Renal atheroembolism is occlusion of renal arterioles by atherosclerotic emboli, causing progressive chronic kidney disease.
A foreign body immune reaction often follows embolization, leading to continued deterioration in renal function for 3 to 8 weeks.
Acute renal impairment may also result from massive or recurrent episodes of embolization.
Symptoms and Signs of Renal Atheroembolism Symptoms are usually those of acute or chronic renal dysfunction with uremia (see Acute Kidney Injury [AKI]: Symptoms).
Abdominal pain, nausea, and vomiting can result from concomitant compromised arterial microcirculation of abdominal organs (eg, pancreas, gastrointestinal tract).
Sudden blindness and formation of bright yellow retinal plaques (Hollenhorst plaques) can result from emboli in retinal arterioles.
Signs of widespread peripheral embolism (eg, livedo reticularis, painful muscle nodules, overt gangrene, which is often referred to as the trash syndrome) are sometimes present.
Diagnosis of Renal Atheroembolism Clinical suspicion Sometimes, renal biopsy Location of source of emboli Diagnosis is suggested by worsening renal function in a patient with recent manipulation of the aorta, particularly if there are signs of atheroemboli.
Differential diagnosis includes contrast-induced and drug-induced nephropathy.
If suspicion of atheroembolism remains high, percutaneous renal biopsy is done; it has a sensitivity of about 75%.
Diagnosis is important because there may be treatable causes of emboli in the absence of vascular obstruction.
It results from rupture of atheromatous plaques.
Cholesterol crystals in the emboli dissolve during tissue fixation, leaving pathognomonic biconcave, needle-shaped clefts in the occluded vessel.
Sometimes skin, muscle, or gastrointestinal biopsy can provide the same information and indirectly help establish the diagnosis.
Blood and urine tests can confirm the diagnosis of acute kidney injury or chronic kidney disease but do not establish cause.
Urinalysis typically shows microscopic hematuria and minimal proteinuria; however, proteinuria is occasionally in the nephrotic range (> 3 g / day).
Eosinophilia, eosinophiluria, and transient hypocomplementemia may be present.
If renal or systemic emboli recur and their source is unclear, transesophageal echocardiography is done to detect atheromatous lesions in the ascending and thoracic aorta and cardiac sources of emboli; dual helical CT may help characterize the ascending aorta and aortic arch.
Treatment of Renal Atheroembolism Treatment of embolic source when possible Supportive measures Modification of risk factors Sometimes the source of emboli can be treated (eg, anticoagulation for patients with emboli from a cardiac source and atrial fibrillation and for patients in whom a clot becomes a source of new emboli).
However, no direct treatment of existing renal emboli is effective.
Corticosteroids, antiplatelet medications, vasodilators, and plasma exchange are not helpful.
There is no demonstrated benefit of anticoagulation and, according to most experts, its use may actually enhance atheroembolism.
Symptoms are those of renal failure; symptoms and signs of widespread arterial embolic disease may be present.
Treatment of renal dysfunction includes control of hypertension and management of electrolytes and fluid status; sometimes dialysis is required.
Modifying risk factors for atherosclerosis may slow its progression and induce regression.
Strategies include management of hypertension, hyperlipidemia, and diabetes; smoking cessation; and encouragement of regular aerobic exercise and good nutrition (Atherosclerosis: Treatment).
Prognosis for Renal Atheroembolism Patients with renal atheroemboli have a poor overall prognosis.
Key Points Renal atheroembolism usually results from manipulation of the aorta during vascular surgery, angioplasty, or arteriography, and rarely from spontaneous atherosclerotic embolization.
Suspect the diagnosis if renal function deteriorates after the aorta or another large artery is manipulated.
Confirm the diagnosis based on clinical findings and occasionally with percutaneous renal biopsy.
Treat supportively, correcting modifiable risk factors and, when possible, treating the embolic source; however, the overall prognosis remains poor.
Long-term prognosis is usually poor.
Treatment aims to prevent further embolization.
Atheromatous plaque rupture usually results from manipulation of the aorta or other large arteries during vascular surgery, angioplasty, or arteriography.
Spontaneous plaque rupture, which occurs most often in patients who have diffuse erosive atherosclerosis or who are being treated with anticoagulants or fibrinolytics, is rare.
Atheroemboli tend to cause incomplete occlusion with secondary ischemic atrophy rather than renal infarction.
Tigecycline By Brian J Werth, PharmD, University of Washington School of Pharmacy Reviewed / Revised May 2022 | Modified Sep 2022 View Patient Education Pharmacokinetics Indications Contraindications Use During Pregnancy and Breastfeeding Adverse Effects Dosing Considerations Tigecycline, a derivative of the tetracycline minocycline, is the first available glycylcycline antibiotic.
Tigecycline has in vitro activity against the following: Many gram-positive bacteria, including methicillin-susceptible and methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae that are penicillin-susceptible, and vancomycin - susceptible Enterococcus faecalis Many gram-negative bacteria, such as multidrug-resistant Acinetobacter baumannii, Stenotrophomonas maltophilia, beta-lactamase-negative Haemophilus influenzae, and most Enterobacterales (formerly Enterobacteriaceae; including some strains that produce extended-spectrum beta-lactamases [ESBLs] and other strains that were carbapenem-resistant based on production of a carbapenemase or metallo-beta-lactamase) Many atypical respiratory pathogens (chlamydiae, Mycoplasma species), Mycobacterium abscessus, M fortuitum, and anaerobes, including Bacteroides fragilis, Clostridium perfringens, and Clostridioides difficile (formerly Clostridium difficile) It is not effective against Pseudomonas aeruginosa, Providencia species, Morganella morganii, or Proteus species.
Tigecycline is indicated for Complicated skin and soft-tissue infections Complicated intra-abdominal infections Community-acquired pneumonia However, a recent meta-analysis showed that patients treated with tigecycline (particularly those treated for ventilator-associated pneumonia) had a higher mortality than those given other antibiotics, resulting in a black box warning from the U S.Food and Drug Administration.
In general, tigecycline should be reserved for infections with multidrug-resistant (MDR) organisms when other treatment options are more toxic or less effective.
Because of its parenteral activity against C difficile, tigecycline may be a useful antibiotic when a patient requires concurrent treatment of an MDR infection and a C difficile infection.
Contraindications to Tigecycline Tigecycline is contraindicated in patients who have had an allergic reaction to it and in children < 8 years of age.
Tigecycline has a black box warning because it increases the risk of mortality and so should be reserved for situations where there are no suitable alternatives.
Use During Pregnancy and Breastfeeding Tigecycline, like tetracyclines, can affect fetal bones and teeth.
If a pregnant woman takes it during the 2nd or 3rd trimester, it may cause permanent discoloration of the fetus's teeth.
Whether tigecycline enters breast milk and is safe to use during breastfeeding is unknown; however, it has limited oral bioavailability.
Adverse Effects of Tigecycline Adverse effects of tigecycline include Nausea, vomiting, and diarrhea Photosensitivity Hepatotoxicity Nausea and vomiting are common.
Tigecycline inhibits protein synthesis by binding to the 30S ribosomal subunit.
Increases in serum amylase, total bilirubin concentration, prothrombin time, and transaminases can occur in patients treated with tigecycline.
Isolated cases of significant hepatic dysfunction and hepatic failure have been reported in patients being treated with tigecycline.
Many of tigecycline 's adverse effects are similar to those of tetracyclines (eg, photosensitivity).
Dosing Considerations for Tigecycline Dose is adjusted in patients with hepatic dysfunction but not in those with renal dysfunction.
Serum levels of warfarin may increase, but international normalized ratio does not appear to increase.
It is bacteriostatic.
Pharmacokinetics Tigecycline is given IV.
Tigecycline has a large volume of distribution (> 12 L / kg), penetrating well into bone, lung, liver, and kidney tissues.
However, because of its extensive distribution into tissue, blood levels are low, so tigecycline is probably not a good choice for patients with bacteremia especially those with intravascular sources of infection.
Most of the drug is excreted in bile and feces.
No dosing adjustment is required in patients who have renal insufficiency.
Indications for Tigecycline Tigecycline is effective against many resistant bacteria, including those with resistance to tetracyclines.
Sulfonamides By Brian J Werth, PharmD, University of Washington School of Pharmacy Reviewed / Revised May 2022 | Modified Sep 2022 View Patient Education Pharmacokinetics Indications Contraindications Use During Pregnancy and Breastfeeding Adverse Effects Dosing Considerations Topic Resources Mechanisms of Action: Folic... Sulfonamides are synthetic bacteriostatic antibiotics that competitively inhibit conversion of p - aminobenzoic acid to dihydropteroate, which bacteria need for folate synthesis and ultimately purine and DNA synthesis.
They are metabolized mainly by the liver and excreted by the kidneys.
Sulfonamides compete for bilirubin-binding sites on albumin.
Indications for Sulfonamides Sulfonamides are active against A broad spectrum of gram-positive and many gram-negative bacteria Plasmodium and Toxoplasma species Sulfasalazine can be used orally for inflammatory bowel disease.
Sulfonamides are most commonly used with other drugs (eg, for nocardiosis, urinary tract infection, and chloroquine-resistant falciparum malaria).
Topical sulfonamides can be used to treat the following: Burns: Silver sulfadiazine and mafenide acetate Vaginitis: Vaginal cream and suppositories with sulfanilamide Superficial ocular infections: Ophthalmic sulfacetamide Contraindications to Sulfonamides Sulfonamides are contraindicated in patients who have had an allergic reaction to them or who have porphyria.
Sulfonamides do not eradicate group A streptococci in patients with pharyngitis and should not be used to treat group A streptococcal pharyngitis. Use During Pregnancy and Breastfeeding Evidence regarding an association between sulfonamides and birth defects is mixed.
Animal studies with sulfonamides show some risk, and adequate studies have not been done in pregnant women.
Use near term and in breastfeeding mothers is contraindicated, as is use in patients < 2 months of age (except as adjunctive therapy with pyrimethamine to treat congenital toxoplasmosis).
If used near term during pregnancy or in neonates, these drugs increase blood levels of unconjugated bilirubin and increase risk of kernicterus in the fetus or neonate.
Humans do not synthesize folate but acquire it in their diet, so their DNA synthesis is less affected.
Sulfonamides enter breast milk.
Adverse Effects of Sulfonamides Adverse effects of sulfonamides can result from oral and sometimes topical sulfonamides; effects include Hypersensitivity reactions, such as rashes, Stevens-Johnson syndrome, vasculitis, serum sickness, drug fever, anaphylaxis, and angioedema Crystalluria, oliguria, and anuria Hematologic reactions, such as agranulocytosis, thrombocytopenia, and, in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, hemolytic anemia Kernicterus in neonates Photosensitivity Neurologic effects, such as insomnia, and headache Hypothyroidism, hepatitis, and activation of quiescent systemic lupus erythematosus may occur in patients taking sulfonamides.
These drugs can exacerbate porphyrias.
Incidence of adverse effects is different for the various sulfonamides, but cross-sensitivity is common.
Sulfasalazine can reduce intestinal absorption of folate (folic acid).
Thus, use of this drug may trigger folate deficiency in patients with inflammatory bowel disease, which also reduces absorption, especially if dietary intake is also inadequate.
Mafenide may cause metabolic acidosis by inhibiting carbonic anhydrase.
Dosing Considerations for Sulfonamides To avoid crystalluria, clinicians should hydrate patients well (eg, to produce a urinary output of 1200 to 1500 mL / day).
Sulfonamides can be used in patients with renal insufficiency, but peak plasma levels should be measured and sulfamethoxazole levels should not exceed 120 mcg / mL.
Sulfonamides can potentiate sulfonylureas (with consequent hypoglycemia), phenytoin (with increased adverse effects), and coumarin anticoagulants.
Sulfonamides include the following: Mafenide Sulfacetamide Sulfadiazine Sulfadoxine Sulfamethizole Sulfamethoxazole Sulfanilamide Sulfasalazine Sulfisoxazole Three sulfonamides, sulfisoxazole, sulfamethizole, and sulfasalazine, are available as single drugs for oral use.
Sulfamethoxazole is coformulated with trimethoprim (as TMP / SMX).
Sulfadoxine combined with pyrimethamine is available for oral use.
Sulfonamides available for topical use include silver sulfadiazine and mafenide burn cream, sulfanilamide vaginal cream and suppositories, and sulfacetamide ophthalmic.
Resistance Sulfonamide resistance is widespread, and resistance to one sulfonamide indicates resistance to all.
Pharmacokinetics Most sulfonamides are readily absorbed orally and, when applied to burns, topically.
Sulfonamides are distributed throughout the body.
Introduction to Gram-Negative Bacilli By Larry M Bush, MD, FACP, Charles E Schmidt College of Medicine, Florida Atlantic University; Maria T Vazquez-Pertejo, MD, FACP, Wellington Regional Medical Center Reviewed / Revised Apr 2022 | Modified Sep 2022 View Patient Education Gram-negative bacilli are responsible for numerous diseases.
Some are commensal organisms present among normal intestinal flora.
These commensal organisms plus others from animal or environmental reservoirs may cause disease.
Urinary tract infections, diarrhea, peritonitis, and bloodstream infections are commonly caused by gram-negative bacilli.
Gram-negative bacteria cause plague, cholera, and typhoid fever.
These infections are rare in the US but are more common in areas of the world that have poor sanitation and / or an unsafe water and food supply.
These infections can be serious.
Klebsiella, Enterobacter, and Serratia Infections By Larry M Bush, MD, FACP, Charles E Schmidt College of Medicine, Florida Atlantic University; Maria T Vazquez-Pertejo, MD, FACP, Wellington Regional Medical Center Reviewed / Revised Apr 2022 | Modified Sep 2022 View Patient Education Treatment The gram-negative bacteria Klebsiella, Enterobacter, and Serratia are closely related normal intestinal flora that rarely cause disease in normal hosts.
Treatment Antibiotics based on results of susceptibility testing Treatment is with 3rd-generation cephalosporins, cefepime, carbapenems, fluoroquinolones, piperacillin / tazobactam, or aminoglycosides.
However, because some isolates are resistant to multiple antibiotics, susceptibility testing is essential.
Klebsiella strains that produce extended-spectrum beta-lactamase (ESBL) may develop resistance to cephalosporins during treatment, particularly with ceftazidime; these ESBL strains are inhibited to a variable extent by beta-lactamase inhibitors (eg, sulbactam, tazobactam, clavulanate, vaborbactam, avibactam).
Carbapenemase-producing species of K pneumoniae (KPC) have been isolated internationally as well as in the US, making treatment of some infections very problematic.
Ceftazidime / avibactam, imipenem / relebactam, and meropenem / vaborbactam (which include new beta-lactamase inhibitors that also inhibit KPC carbapenemases) as well as eravacycline and cefiderocol have activity against KPC isolates.
Enterobacter strains may become resistant to most beta-lactam antibiotics, including 3rd-generation cephalosporins; the beta-lactamase enzyme they produce (AmpC beta-lactamase) is not inhibited by the usual beta-lactamase inhibitors (clavulanate, tazobactam, sulbactam).
However, these Enterobacter strains may be susceptible to carbapenems (eg, imipenem, meropenem, doripenem, ertapenem).
Carbapenemase-resistant Enterobacterales have also been detected.
Infections with Klebsiella, Enterobacter, and Serratia are often hospital-acquired and occur mainly in patients with diminished resistance.
These three bacteria can cause a wide variety of infections, including bacteremia, surgical site infections, intravascular catheter infections, and respiratory or urinary tract infections that manifest as pneumonia, cystitis, or pyelonephritis and that may progress to lung abscess, empyema, bacteremia, and sepsis, as in the following: Klebsiella pneumonia, a rare and severe disease with dark brown or red currant-jelly sputum, lung abscess formation, and empyema, is most common among people with diabetes and people with an alcohol use disorder.
Serratia, particularly S marcescens, has greater affinity for the urinary tract.
Enterobacter most often cause nosocomial infections but can cause otitis media, cellulitis, and neonatal sepsis.
Diagnosis is by culture of blood and / or other infected tissue.
Susceptibility testing is also done.
Hepatitis B (HepB) Vaccine By Margot L Savoy, MD, MPH, Lewis Katz School of Medicine at Temple University Reviewed / Revised Oct 2022 View Patient Education Preparations Indications Contraindications and Precautions Dose and Administration Adverse Effects More Information The hepatitis B vaccine is 80 to 100% effective in preventing infection or clinical hepatitis B in people who complete the vaccine series.
Two single-antigen vaccines, Engerix-B and Recombivax HB, are conjugated with aluminum.
A newer formulation, HepB-CpG, uses the immune-stimulating adjuvant, cytidine-phosphate-guanosine oligodeoxynucleotide (CpG-ODN).
A combination formulation that combines hepatitis A and hepatitis B vaccines (Twinrix) is available.
Indications for Hepatitis B Vaccine HepB vaccine is a routine childhood vaccination (see Table: Recommended Immunization Schedule for Ages 0 - 6 Years).
HepB vaccine also is indicated for all adults aged 19 through 59 years who have not been previously vaccinated.
HepB vaccine also is indicated for adults aged 60 years and older who have not been previously vaccinated and who have any of the following: A desire for protection from hepatitis B A sexually active lifestyle in people who are not in a long-term, mutually monogamous relationship (eg, > 1 sex partner during the previous 6 months) Need for evaluation or treatment of a sexually transmitted infection Current or recent use of illicit injection drugs Sex between men Employment in which workers may be exposed to blood or other potentially infectious body fluids (eg, health care, custodial, or public safety workers) Diabetes in people < 60 years (as soon as feasible after diagnosis) and sometimes in those ≥ 60 years (based on shared clinical decision-making between clinician and patient regarding the risk of becoming infected, having severe consequences if infected, and having an adequate immune response to vaccination) End-stage renal disease (eg, being treated with hemodialysis) HIV infection A chronic liver disorder (eg, people with hepatitis C, cirrhosis, fatty liver disease, alcohol-related liver disease, autoimmune hepatitis, or alanine aminotransferase [ALT] or aspartate aminotransferase [AST] level greater than twice the upper limit of normal) Household contact and / or sexual contact with people who are positive for hepatitis B surface antigen (HBsAg) Travel to endemic areas Time spent (as patients, residents, or employees) in correctional facilities or in facilities that provide sexually transmitted infection treatment, HIV testing and treatment, drug abuse treatment and prevention services, services to injection-drug users or men who have sex with men, or care for patients with developmental disabilities or with end-stage renal disease (including those receiving long-term hemodialysis) The combination HepA and HepB vaccine can be used in people ≥ 18 years who have indications for either hepatitis A or hepatitis B vaccine and who have not been previously vaccinated with one of the vaccine components.
Contraindications and Precautions of Hepatitis B Vaccine The main contraindication for HepB vaccine is A severe allergic reaction (eg, anaphylaxis) after previous dose or to baker's yeast or any vaccine component The main precaution with HepB vaccine is Moderate or severe illness with or without a fever (vaccination is postponed until the illness resolves) Dose and Administration of Hepatitis B Vaccine The dose for Engerix-B and Recombivax HB is 0.5 mL IM up to age 20 years or 1 mL IM for adults (≥ 20 years).
The dose for HepB-CpG is 0.5 mL IM for adults ≥ 18 years.
The vaccine is typically given to children in a 3-dose series at age 0 months, at 1 to 2 months, and at 6 to 18 months.
Infants who did not receive a dose a birth should begin the series as soon as feasible.
For more information, see Hepatitis B Advisory Committee on Immunization Practices Vaccine Recommendations and Centers for Disease Control and Prevention (CDC): Hepatitis B Vaccination.
All children not previously vaccinated with HepB vaccine should be vaccinated at age 11 or 12 years.
A 3-dose schedule is used; the first and second doses are separated by ≥ 4 weeks, and the third dose is given 4 to 6 months after the second dose.
However, a 2-dose schedule using Recombivax HB can be used; the second dose is given 4 to 6 months after the first.
Adults age 19 through 59 years who have not been previously vaccinated should complete a 2 - or 3 -, or 4-dose series.
The usual schedule for adults using Engerix-B or Recombivax HB is a 3-dose series with 2 doses separated by ≥ 4 weeks, and a third dose 4 to 6 months after the second dose.
HepB-CpG is given in 2 doses at least 4 weeks apart and can be given as a substitute in a 3-dose series with a different HepB vaccine.
HepB-CpG should not be given during pregnancy because safety data are not available on its use during pregnancy.
Unvaccinated adults who are being treated with hemodialysis or who are immunocompromised should be given 2 doses of Engerix-B 20 mcg / mL given simultaneously in a 4-dose schedule at 0, 1, 2, and 6 months.
If people are not vaccinated or not completely vaccinated, the missing doses should be given to complete the 3-dose HepB series.
The second dose is given 1 month after the first dose; the third dose is given ≥ 2 months after the second dose (and ≥ 4 months after the first dose).
If the combined hepatitis A and hepatitis B vaccine is used, 3 doses are given at 0, 1, and 6 months, or 4 doses are given on days 0, 7, and 21 to 30, followed by a booster dose at 12 months.
If a person was lost to follow-up before the series was completed, the series does not need to be restarted.
Adverse Effects of Hepatitis B Vaccine Serious adverse effects are very rare and include anaphylaxis.
Mild effects include pain at the injection site and occasionally an increase in temperature to about 38° C More Information The following English-language resources may be useful.
Advisory Committee on Immunization Practices (ACIP): Hepatitis B ACIP Vaccine Recommendations Centers for Disease Control and Prevention (CDC): Hepatitis B Vaccination: Information for Healthcare Providers Summary of changes to the 2022 adult immunization schedule
Preparations of Hepatitis B Vaccine Hepatitis B (HepB) vaccine is produced using recombinant DNA technology.
A plasmid containing the gene for hepatitis B surface antigen (HBsAg) is inserted into common baker's yeast, which then produces HBsAg.
This vaccine cannot cause hepatitis B virus infection because no potentially infectious viral DNA or complete viral particles are produced during this process.
Several vaccines are available.
Locked-In Syndrome By Kenneth Maiese, MD, Rutgers University Reviewed / Revised May 2022 | Modified Sep 2022 View Patient Education Symptoms and Signs Diagnosis Prognosis Treatment Locked-in syndrome is a state of wakefulness and awareness with quadriplegia and paralysis of the lower cranial nerves, resulting in inability to show facial expression, move, speak, or communicate, except by coded eye movements.
Because patients lack the motor responses (eg, withdrawal from painful stimuli) usually used to measure responsiveness, they may be mistakenly thought to be unconscious.
Thus, all patients who cannot move should have their comprehension tested by requesting eye blinking or vertical eye movements.
As in vegetative state, neuroimaging is indicated to rule out treatable disorders.
Brain imaging with CT or MRI is done and helps identify the pontine abnormality.
Positron emission tomography (PET), single-photon emission computed tomography (SPECT), functional MRI, or evoked responses may be done to further assess cerebral function if the diagnosis is in doubt.
In patients with locked-in syndrome, electroencephalography (EEG) shows normal sleep-wake patterns.
Prognosis for Locked-In Syndrome Prognosis for patients with locked-in syndrome depends on the cause and the subsequent level of support provided.
For example, locked-in syndrome due to transient ischemia or a small stroke in the vertebrobasilar artery distribution may resolve completely.
When the cause (eg, Guillain-Barré syndrome) is partly reversible, recovery can occur over months but is seldom complete.
Favorable prognostic features include Early recovery of lateral eye movements Early recovery of evoked potentials in response to magnetic stimulation of the motor cortex Irreversible or progressive disorders (eg, cancers that involve the posterior fossa and the pons) are usually fatal.
Locked-in syndrome typically results from a stroke (pontine hemorrhage or infarct) that causes quadriplegia and disrupts and damages the lower cranial nerves and the centers that control horizontal gaze.
Treatment of Locked-In Syndrome Supportive care Communication training Supportive care is the mainstay of treatment for patients with locked-in syndrome and should include the following: Preventing systemic complications due to immobilization (eg, pneumonia, urinary tract infection, thromboembolic disease) Providing good nutrition Preventing pressure ulcers Providing physical therapy to prevent limb contractures There is no specific treatment for locked-in syndrome.
Because cognitive function is intact and communication is possible, patients should make their own health care decisions.
Speech therapists may help establish a communication code using eye blinks or movements.
Some patients with locked-in syndrome communicate with each other via the Internet using a computer terminal controlled by eye movements and other means.
Other disorders that result in severe widespread motor paralysis (eg, Guillain-Barré syndrome) and cancers that involve the posterior fossa and the pons are less common causes.
Locked-in syndrome can also result from infection, tumors, toxins, trauma, arteriovenous malformations, and opioid use.
Symptoms and Signs of Locked-In Syndrome Patients with locked-in syndrome have intact cognitive function and are awake, with eye opening and normal sleep-wake cycles.
They can hear and see.
However, they cannot move their lower face, chew, swallow, speak, breathe, move their limbs, or move their eyes laterally.
Vertical eye movement is possible; patients can open and close their eyes or blink a specific number of times to answer questions.
Diagnosis of Locked-In Syndrome Clinical evaluation Diagnosis of locked-in syndrome is primarily clinical.
Overview of Intestinal Protozoan and Microsporidia Infections By Chelsea Marie, PhD, University of Virginia; William A Petri, Jr, MD, PhD, University of Virginia School of Medicine Reviewed / Revised Jun 2022 | Modified Sep 2022 View Patient Education Diagnosis Protozoa is a loose term for certain nucleated, unicellular organisms (eukaryotes) that lack a cell wall and are neither animals, plants, nor fungi.
Diagnosis Making a diagnosis of intestinal protozoan and microsporidia infections based on symptoms and physical findings is difficult; stool testing for parasite antigens or DNA and microscopic examination of stool for cysts or organisms are necessary.
Fecal antigen tests that are sensitive and specific are available for Cryptosporidium species E histolytica G duodenalis Microscopic diagnosis may require several samples, concentration methods, and special stains; thus, the laboratory should be notified which pathogen or pathogens are suspected.
Some patients require semi-invasive diagnostic techniques such as endoscopic biopsy (see table).
Molecular diagnosis using polymerase chain reaction-based assays is available for many enteric protozoa.
The most important intestinal protozoan pathogens that cause enteric infections in humans include Cryptosporidium species (see Cryptosporidiosis) Cyclospora cayetanensis (see Cyclosporiasis) Cystoisospora belli (previously known as Isospora belli —see Cystoisosporiasis) Entamoeba histolytica (see Amebiasis) Giardia duodenalis (previously known as G lamblia, G intestinalis —see Giardiasis) Members of the phylum Microsporidia used to be classified as protozoa but are now, based on DNA studies, thought to be fungi or closely related to them.
Multiple pathogenic parasites and nonpathogenic commensal organisms may be present in the intestine at the same time.
Intestinal protozoa are spread by the fecal-oral route, so infections are widespread in areas with inadequate sanitation and water treatment.
They are also common in the US in settings where fecal incontinence and poor hygiene prevail, as may occur in mental institutions and day care centers.
Occasionally, large foodborne and waterborne outbreaks of intestinal protozoan infection have occurred in the US (eg, the multi-state outbreak of Cyclospora cayetanensis infection attributed to contaminated fresh vegetable trays in 2018 and the massive waterborne Cryptosporidium outbreak in Milwaukee in 1993).
Some gastrointestinal protozoa are spread sexually, especially with practices involving oral-anal contact.
Several protozoan species cause severe opportunistic infections in immunocompromised patients, including those with AIDS.
Systemic protozoal diseases are discussed elsewhere and include malaria, babesiosis, toxoplasmosis, leishmaniasis, Chagas disease, and African trypanosomiasis.
Anisakiasis (Herring Worm Disease; Cod Worm Disease; Seal Worm Disease) By Chelsea Marie, PhD, University of Virginia; William A Petri, Jr, MD, PhD, University of Virginia School of Medicine Reviewed / Revised Sep 2022 View Patient Education Symptoms and Signs Diagnosis Treatment Prevention Key Points Topic Resources Anisakis Life Cycle Anisakiasis is infection with larvae of worms of the Anisakis simplex complex and the other anisakid species, Pseudoterranova decipiens complex and Contracecum osculatum complex.
Symptoms and Signs of Anisakiasis Symptoms of gastric anisakiasis typically include abdominal pain, nausea, and vomiting within hours of ingesting the larvae.
Involvement of the small intestine is less common and may result in an inflammatory mass and subacute symptoms resembling Crohn disease that develop 1 to 2 weeks later.
Ectopic infections outside the lumen of the gastrointestinal tract may rarely occur.
Anisakiasis typically resolves spontaneously after several weeks; rarely, it persists for months.
Diagnosis of Anisakiasis Upper endoscopy Anisakiasis can be diagnosed by seeing the parasite during upper endoscopy, and patients may cough up larvae and bring them in for analysis.
Stool examination is unhelpful.
Serologic testing is available in some countries.
Treatment of Anisakiasis Endoscopic removal of the larvae Possibly albendazole Endoscopic removal of the larvae is curative.
Treatment of presumptive anisakiasis with albendazole 400 mg orally twice a day for 6 to 21 days may be effective, but data are limited.
Prevention of Anisakiasis Proper freezing conditions are key to preventing anisakiasis in sushi.
Infection is acquired by eating raw or poorly cooked saltwater fish or squid; larvae burrow into the mucosa of the gastrointestinal (GI) tract, causing abdominal pain and sometimes vomiting.
Anisakis larvae are destroyed by Cooking to > 63° C (> 145° F) Freezing at −20° C (−4° F) or below for 7 days Freezing at −35° C (−31° F) or below until solid, then storing at that temperature for ≥ 15 hours, or at −20° C (−4° F) for 24 hours Larvae may resist pickling, salting, and smoking.
Key Points Humans acquire Anisakis when they consume the intermediate hosts (fish or squid) that are raw or undercooked; thus, anisakiasis is common in Japan and other cultures where raw fish is traditionally consumed.
Anisakiasis typically causes abdominal pain, nausea, and vomiting within hours of ingesting the larvae; an inflammatory mass may form in the small intestine and symptoms may resemble Crohn disease.
Anisakiasis typically resolves spontaneously after several weeks.
Do upper endoscopy to diagnose anisakiasis.
Endoscopic removal of the larvae is curative.
Anisakis is a parasite that resides in the GI tract of marine mammals.
Excreted eggs hatch into free-swimming larvae, which are ingested by fish and squid; human infection is acquired by ingestion of these intermediate hosts in a raw or undercooked state.
Thus, infection is particularly common in locations such as Japan, Korea, and other areas where raw fish is traditionally consumed.
Larvae burrow into the stomach and small bowel of humans.
Commercial sushi prepared in the United States and elsewhere where fish is frozen under conditions that kill anisakid larvae is safe.
Toxoplasmosis By Chelsea Marie, PhD, University of Virginia; William A Petri, Jr, MD, PhD, University of Virginia School of Medicine Reviewed / Revised Dec 2022 View Patient Education Pathophysiology Symptoms and Signs Diagnosis Treatment Prevention Key Points More Information Topic Resources Toxoplasma gondii... Retinitis (Toxoplasmosis) Interpretation of Toxoplasma Toxoplasmosis is infection with Toxoplasma gondii.
The risk of developing serious disease is very low except for a fetus infected in utero and people who are or become severely immunocompromised with AIDS or other diseases.
Acute infection should be suspected in immunocompromised patients if the IgG is positive.
However, IgG antibody levels in AIDS patients with Toxoplasma encephalitis are usually low to moderate, and IgG antibodies are sometimes absent; IgM antibodies are not present.
If the suspected diagnosis of CNS toxoplasmosis is correct, clinical and radiographic improvement should become evident within 7 to 14 days.
If symptoms worsen over the 1st week or do not lessen by the end of the 2nd week, a brain biopsy should be considered.
Ocular disease is diagnosed based on the appearance of the lesions in the eye, symptoms, course of disease, and results of serologic testing.
Treatment of Toxoplasmosis Pyrimethamine and sulfadiazine plus leucovorin (to prevent bone marrow suppression); alternatively, the fixed drug combination trimethoprim - sulfamethoxazole in some situations Clindamycin or atovaquone plus pyrimethamine when the patient is allergic to sulfonamides or does not tolerate sulfadiazine Treatment of toxoplasmosis is not indicated for immunocompetent patients who are asymptomatic or have mild, uncomplicated acute infection; treatment is required only when visceral disease is present or symptoms are severe or persist.
However, specific treatment is indicated for acute toxoplasmosis in the following: Neonates Pregnant women with acute toxoplasmosis Immunocompromised patients Pearls & Pitfalls No treatment is required for immunocompetent patients who are asymptomatic or have mild, uncomplicated acute toxoplasmosis.
Treatment of immunocompetent patients The most effective regimen in immunocompetent patients with visceral involvement or severe or persistent symptoms is pyrimethamine plus sulfadiazine, for 2 to 4 weeks.
Dosage is Pyrimethamine 50 mg twice a day for 2 days, then 25 to 50 mg once a day in adults (in children, 2 mg / kg orally on day 1, then 1 mg / kg once a day; maximum 25 mg / day) plus Sulfadiazine 1 g orally 4 times a day in adults (in children, 50 mg / kg twice a day) Folinic acid (leucovorin) is given concurrently to help protect against bone marrow suppression: adults 10 to 20 mg orally once a day (children 7.5 mg orally once a day) In patients who have or develop sulfonamide hypersensitivity, clindamycin 600 to 800 mg orally 3 times a day is given with pyrimethamine and leucovorin instead of sulfonamides.
Another option is atovaquone plus pyrimethamine and leucovorin.
Pathophysiology of Toxoplasmosis T gondii is ubiquitous in birds and mammals.
The fixed combination of trimethoprim with sulfamethoxazole has been used as an alternative as well as pyrimethamine and leucovorin plus clarithromycin, or dapsone, or azithromycin, but they have not been extensively studied.
Treatment of patients with AIDS or other immunocompromising conditions It is important to optimize antiretroviral therapy.
Higher doses of pyrimethamine are used in immunocompromised patients, most of whom have AIDS with CNS toxoplasmosis or, uncommonly, involvement of other organs.
A loading dose of pyrimethamine 200 mg orally is given the first day, then 50 mg once a day in patients < 60 kg and 75 mg once a day in those > 60 kg, plus sulfadiazine 1, 000 mg orally 4 times a day in patients < 60 kg and 1, 500 mg orally 4 times a day in patients > 60 kg for at least 6 weeks and 4 to 6 weeks after resolution of clinical signs and symptoms.
Pyrimethamine bone marrow suppression can be minimized with leucovorin (also called folinic acid—not folate, which blocks the therapeutic effect).
Dosage of leucovorin is 10 to 25 mg orally once a day (7.5 mg once a day in children).
Even when leucovorin is given, the complete blood count should be monitored weekly.
If pyrimethamine is not available, trimethoprim - sulfamethoxazole, 5 mg / kg trimethoprim and 25 mg / kg sulfamethoxazole IV or orally twice a day is a potentially effective alternative, but pyrimethamine is more active than trimethoprim against the parasite's dihydrofolate reductase.
If patients cannot take sulfonamides, pyrimethamine and leucovorin plus clindamycin 600 mg 4 times a day can be used.
Atovaquone 1, 500 mg twice a day with or without pyrimethamine and leucovorin is another option.
This obligate intracellular parasite invades and multiplies asexually as tachyzoites within the cytoplasm of any nucleated cell (see figure).
Relapses are particularly common in AIDS patients with CD4 counts < 200 / mcL. Maintenance therapy is continued until the CD4 counts remain > 200 / mcL for > 6 months on antiretroviral therapy.
There are several options for maintenance therapy: Sulfadiazine, pyrimethamine, and leucovorin Clindamycin, pyrimethamine, and leucovorin Atovaquone, pyrimethamine, and leucovorin Atovaquone and sulfadiazine Atovaquone Sulfadiazine and pyrimethamine and leucovorin can be continued at lower doses than used for initial treatment: Sulfadiazine is given 1 g twice a day to 4 times a day with pyrimethamine 25 to 50 mg once a day and leucovorin 10 to 25 mg once a day.
An alternative for patients who do not tolerate sulfonamides is clindamycin 600 mg 3 times a day plus pyrimethamine 25 to 50 mg once a day plus leucovorin 10 to 25 mg once a day, but an additional agent is needed to prevent pneumonia.
If pyrimethamine is not available or not tolerated, trimethoprim - sulfamethoxazole 1 double strength tablet twice a day can be used for maintenance.
Other options for chronic maintenance therapy include atovaquone 750 to 1, 500 mg twice a day with pyrimethamine 25 mg once a day plus leucovorin 10 mg once a day; atovaquone 750 to 1, 500 mg plus sulfadiazine 1 g twice a day to 4 times a day; or atovaquone alone 750 to 1, 500 mg twice a day.
The relapse rate may be higher with the atovaquone - based alternatives.
Treatment of ocular toxoplasmosis Treatment of ocular toxoplasmosis is based on results of a complete ophthalmologic evaluation (degree of inflammation; visual acuity; size, location, and persistence of lesion).
Doses are Pyrimethamine 100 mg day 1 as a single loading dose, then 25 to 50 mg orally once a day in adults (in children, 2 mg / kg on day 1, then 1 mg / kg once a day) plus Sulfadiazine 2 to 4 g orally day 1as a loading dose, then 500 mg to 1 g four times a day in adults (in children, 50 mg / kg twice a day) plus Folinic acid (leucovorin) 5 to 25 mg orally once a day with each dose of pyrimethamine as long as pyrimethamine is given in adults (in children, 7.5 mg once a day) The Centers for Disease Control and Prevention (CDC) recommends that therapy for ocular toxoplasmosis be continued for 4 to 6 weeks, followed by reevaluation of the patient's condition (see also CDC: Toxoplasmosis: Resources for Health Professionals).
When host immunity develops, multiplication of tachyzoites ceases and tissue cysts form; cysts persist in a dormant state for years, especially in brain, eyes, and muscle.
Patients with ocular toxoplasmosis are also frequently given corticosteroids to reduce inflammation.
Treatment of pregnant patients Treatment of pregnant women with acute toxoplasmosis can decrease the incidence of fetal infection.
Spiramycin 1 g orally 3 or 4 times a day has been used safely to reduce transmission to the fetus in pregnant women with acute toxoplasmosis during the first 18 weeks of pregnancy, but spiramycin is less active than pyrimethamine plus sulfonamide and does not cross the placenta.
Spiramycin is continued until fetal infection is documented or excluded at 18 weeks gestational age when amniotic fluid is obtained and tested using a polymerase chain reaction (PCR) - based assay.
If no transmission has occurred, spiramycin can be continued to term.
If the fetus is infected or a mother becomes infected after 18 weeks, pyrimethamine plus sulfadiazine plus leucovorin is used.
Pyrimethamine is a potent teratogen and should not be used during the 1st and early 2nd trimester.
NOTE: Spiramycin is not commercially available in the US, but is available through the U S.Food and Drug Administration's Division of Anti-Infective Drug Products (phone: 301 - 796 - 1400).
Consultation with an infectious diseases expert is recommended.
Treatment of infants with congenital toxoplasmosis Infants with congenital toxoplasmosis should be treated with pyrimethamine plus a sulfonamide for 1 year (1).
The dormant Toxoplasma forms within the cysts are called bradyzoites.
Infants should also receive leucovorin while receiving pyrimethamine and for 1 week after pyrimethamine is stopped to prevent bone marrow suppression.
Recommendations from the National Reference Laboratory for Toxoplasmosis (PAMF-TSL) and the Toxoplasmosis Center at the University of Chicago for treatment of congenitally infected infants are Pyrimethamine 1 mg / kg orally twice a day for the first 2 days; then from day 3 to 2 months (or 6 months if symptomatic) 1 mg / kg once a day, then 1 mg / kg 3 times per week to complete 12 months of therapy plus Sulfadiazine 50 mg / kg twice a day plus Folinic acid (leucovorin) 10 mg 3 times a week Treatment reference 1.
Pediatrics 139 (2): e20163860, 2017. doi: 10.1542 / peds.2016 - 3860 Prevention of Toxoplasmosis Washing hands thoroughly after handling raw meat, soil, or cat litter is essential to help prevent toxoplasmosis.
Food possibly contaminated with cat feces should be avoided.
Meat should be cooked to 165 to 170° F (73.9 to 76.7° C).
If contact is unavoidable, pregnant women should at least avoid cleaning cat litter boxes or wear gloves when doing so.
Gloves should also be worn while gardening to avoid contact with soil.
Primary chemoprophylaxis is recommended for patients with HIV and a positive IgG T gondii serologic test once CD4 cell counts are < 100 / mcL.
Sexual reproduction of T gondii occurs only in the intestinal tract of cats; the resultant oocysts passed in the feces remain infectious in moist soil for months.
Trimethoprim / sulfamethoxazole one double-strength tablet once a day, which also is prophylactic against Pneumocystis jirovecii, is typically used.
If this dosage is not tolerated, alternatives are one double-strength tablet 3 times a week or one single-strength tablet once a day.
Alternatives for patients who cannot tolerate trimethoprim / sulfamethoxazole at all include dapsone 50 mg once a day plus pyrimethamine 50 mg once a week and leucovorin 25 mg once a week; or dapsone 200 mg once a week plus pyrimethamine 75 mg once a week plus leucovorin 25 mg once a week.
Chemoprophylaxis is continued until the CD4 cell count is > 200 / mcL.
Key Points T gondii reproduces sexually in the intestinal tract of cats; most human infections result from direct or indirect contact with cat feces but can be acquired transplacentally or by ingestion of poorly cooked meat that contains cysts.
About 11% of the US population have been infected with T gondii, but symptomatic disease is rare and occurs mainly in fetuses who are infected when the mother acquires acute infection during pregnancy and transmits the infection transplacentally or in people who are immunocompromised by HIV or other causes.
Acute infection is usually asymptomatic in immunocompetent patients, but 10 to 20% have manifestations, similar to those of mononucleosis, including lymphadenopathy.
Immunocompromised patients typically present with encephalitis and have ring-enhancing intracranial mass lesions, seen on MRI or CT with contrast.
To diagnose, use serologic tests (for IgG and IgM antibodies), histopathology, or polymerase chain reaction.
Treatment is indicated mainly for congenitally infected neonates, pregnant women with acute infection, and immunocompromised patients.
Toxoplasma gondii life cycle The only known definitive hosts for T gondii are members of family Felidae (domestic cats and their relatives).
Use pyrimethamine and sulfadiazine plus leucovorin or, if the patient is allergic to sulfonamides or sulfadiazine is not tolerated, pyrimethamine and clindamycin.
Pyrimethamine is a potent teratogen and should not be used during the 1st and early 2nd trimester of pregnancy; spiramycin is recommended then for maternal infection.
Antiretroviral therapy should be optimized in patients with AIDS; suppressive treatment is continued until patients are asymptomatic and CD4 cell counts are > 200 / mcL for > 6 months.
Centers for Disease Control and Prevention (CDC): Resources for Health Professionals: Toxoplasmosis AIDSinfo: Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents
Oocysts are shed in the cat's feces.
Large numbers are shed, but usually only for 1 - 2 weeks.
Symptoms range from none to benign lymphadenopathy, a mononucleosis-like illness, to life-threatening central nervous system (CNS) disease or involvement of other organs in immunocompromised people.
Oocysts take 1 - 5 days to sporulate and become infective.
Cats become reinfected by ingesting sporulated oocysts.
Soil, water, plant material, or cat litter becomes contaminated with oocysts.
Intermediate hosts in nature (eg, birds, rodents, wild game, animals bred for human consumption) become infected after ingesting infective materials.
Oocysts develop into tachyzoites shortly after ingestion.
Tachyzoites spread throughout the body and form tissue cysts in neural, eye, and muscle tissue.
Cats become infected after consuming intermediate hosts containing tissue cysts.
Humans can become infected by ingesting undercooked meat containing tissue cysts.
Humans can become infected by ingesting food or water contaminated with cat feces or other feces-contaminated materials (eg, soil) or contact with a pet cat's litter.
Rarely, human infection results from blood transfusion or organ transplantation.
Rarely, transplacental transmission from mother to fetus occurs.
Retinochoroiditis, seizures, and intellectual disability occur in congenital infection.
In the human host, parasites form tissue cysts, most commonly in skeletal muscle, myocardium, the brain, and the eyes; these cysts may remain throughout the life of the host and can reactivate if the host becomes immunocompromised.
Infection can occur by Ingestion of oocysts Ingestion of tissue cysts Transplacental transmission Blood transfusion or organ transplantation Ingestion of oocysts in food or water contaminated with cat feces is the most common mode of oral infection.
Infection can also occur by eating raw or undercooked meat containing tissue cysts, most commonly lamb, pork, or rarely beef.
After ingestion of oocysts or tissue cysts, tachyzoites are released and spread throughout the body.
This acute infection is followed by the development of protective immune responses and the formation of tissue cysts in many organs.
The cysts can reactivate causing disease, primarily in immunocompromised patients.
Toxoplasmosis reactivates in 30 to 40% of AIDS patients who are not taking antibiotic prophylaxis, but the widespread use of trimethoprim / sulfamethoxazole for Pneumocystis prophylaxis has dramatically reduced the incidence.
Toxoplasmosis can be transmitted transplacentally if the mother becomes infected during pregnancy or if immunosuppression reactivates a prior infection.
Transmission of Toxoplasma to a fetus is extraordinarily rare in immunocompetent mothers who were infected with Toxoplasma and developed immunity prior to pregnancy.
Diagnosis is by serologic tests, histopathology, or polymerase chain reaction (PCR).
Transmission may occur via transfusion of whole blood or white blood cells or via transplantation of an organ from a seropositive donor.
In otherwise healthy people, congenital or acquired infection can reactivate in the eyes.
Nonocular reactivation is very rare in healthy people.
Past infection confers resistance to reinfection.
Symptoms and Signs of Toxoplasmosis Infections may manifest in several ways: Acute toxoplasmosis Central nervous system (CNS) toxoplasmosis Congenital toxoplasmosis Ocular toxoplasmosis Disseminated or non-CNS disease in immunocompromised patients Acute toxoplasmosis Acute infection is usually asymptomatic, but 10 to 20% of patients develop bilateral, nontender cervical or axillary lymphadenopathy.
A few of these also have a mild flu-like syndrome of fever, malaise, myalgia, hepatosplenomegaly, and less commonly, pharyngitis, which can mimic infectious mononucleosis and include lymphadenitis.
Atypical lymphocytosis, mild anemia, leukopenia, and slightly elevated liver enzymes are common.
The syndrome may persist for weeks but is almost always self-limited.
CNS toxoplasmosis Most patients with AIDS or other immunocompromised patients who develop toxoplasmosis present with encephalitis and ring-enhancing intracranial mass lesions seen on CT or MRI scans, both with contrast.
Risk is greatest among those with CD4 counts of < 50 / mcL; toxoplasmic encephalitis is rare when CD4 counts are > 200 / mcL.
Treatment is most often with pyrimethamine plus either sulfadiazine or clindamycin.
These patients typically have headache, altered mental status, seizures, coma, fever, and sometimes focal neurologic deficits, such as motor or sensory loss, cranial nerve palsies, visual abnormalities, and focal seizures.
Congenital toxoplasmosis Congenital toxoplasmosis results from a primary, often asymptomatic infection acquired by the mother during pregnancy.
Women infected before conception ordinarily do not transmit toxoplasmosis to the fetus unless the infection is reactivated during pregnancy by immunosuppression.
Spontaneous abortion, stillbirth, or birth defects may occur.
The percentage of surviving fetuses born with toxoplasmosis depends on when maternal infection is acquired; it increases from 15% during the 1st trimester to 30% during the 2nd to 60% during the 3rd.
The severity of congenital diseases decreases if the mother becomes infected later in pregnancy.
Disease in neonates may be severe, particularly if acquired early in pregnancy; symptoms include jaundice, rash, hepatosplenomegaly, and the characteristic tetrad of abnormalities: Bilateral retinochoroiditis Cerebral calcifications Hydrocephalus or microcephaly Psychomotor retardation Prognosis is poor.
Many children with less severe infections and most infants born to mothers infected during the 3rd trimester appear healthy at birth but are at high risk of seizures, intellectual disability, retinochoroiditis, or other symptoms developing months or even years later.
Ocular toxoplasmosis This type usually results from congenital infection that is reactivated, often during the teens and 20s, but rarely, it occurs with acquired infections.
Focal necrotizing retinitis and a secondary granulomatous inflammation of the choroid occur and may cause ocular pain, blurred vision, and sometimes blindness.
Relapses are common.
Disseminated infection and non-CNS involvement Disease outside the eye and CNS is much less common and occurs primarily in severely immunocompromised patients.
They may present with pneumonitis, myocarditis, polymyositis, diffuse maculopapular rash, high fevers, chills, and prostration.
In toxoplasmic pneumonitis, diffuse interstitial infiltrates may progress rapidly to consolidation and cause respiratory failure, whereas endarteritis may lead to infarction of small lung segments.
Untreated disseminated infections are usually fatal.
Diagnosis of Toxoplasmosis Serologic testing For central nervous system involvement, CT or MRI and lumbar puncture Histopathologic evaluation of biopsies Polymerase chain reaction-based assays of blood, cerebrospinal fluid, tissue, or, during pregnancy, amniotic fluid Toxoplasmosis is usually diagnosed serologically using an indirect fluorescent antibody (IFA) test or enzyme immunoassay (EIA) for IgG and IgM antibodies (see table).
Specific IgM antibodies appear during the first 2 weeks of acute illness, peak within 4 to 8 weeks, and eventually become undetectable, but they may be present for as long as 18 months after acute infection.
IgG antibodies arise more slowly, peak in 1 to 2 months, and may remain high and stable for months to years.
Assays for Toxoplasma IgM lack specificity.
Human exposure to toxoplasmosis is common wherever cats are found.
Table The diagnosis of acute toxoplasmosis during pregnancy and in the fetus or neonate can be difficult, and consultation with an expert is recommended.
If the patient is pregnant and IgG and IgM are positive, an IgG avidity test should be done.
High avidity antibodies in the first 12 to 16 weeks of pregnancy essentially rules out an infection acquired during gestation.
But a low IgG avidity result cannot be interpreted as indicating recent infection because some patients have persistent low IgG avidity for many months after infection.
Suspected recent infection in a pregnant woman should be confirmed before intervention by having samples tested at a toxoplasmosis reference laboratory.
If the patient has clinical illness compatible with toxoplasmosis but the IgG titer is low, a follow-up titer 2 to 3 weeks later should show an increase in antibody titer if the illness is due to acute toxoplasmosis, unless the host is severely immunocompromised.
In general, detection of specific IgM antibody in neonates suggests congenital infection.
Maternal IgG crosses the placenta, but IgM does not.
Detection of Toxoplasma - specific IgA antibodies is more sensitive than IgM in congenitally infected infants, but it is available only at special reference facilities (eg, Toxoplasma Serology Laboratory, Palo Alto Research Institute, Palo Alto, CA).
An expert should be consulted when fetal or congenital infection is suspected.
An estimated 11% of residents ≥ 6 years in the US are seropositive, which indicates that they have been infected, and more than 60% of some populations in other regions have been infected (see Centers for Disease Control and Prevention: Epidemiology & Risk Factors).
Toxoplasma are occasionally demonstrated histologically.
Tachyzoites, which are present during acute infection, take up Giemsa or Wright stain but may be difficult to find in routine tissue sections.
Tissue cysts do not distinguish acute from chronic infection.
Toxoplasma must be distinguished from other intracellular organisms, such as Histoplasma, Trypanosoma cruzi, and Leishmania.
Polymerase chain reaction (PCR) tests for parasite DNA in blood, cerebrospinal fluid (CSF), or amniotic fluid are available at several reference laboratories.
PCR-based analysis of amniotic fluid is the preferred method to diagnose toxoplasmosis during pregnancy.
If central nervous system (CNS) toxoplasmosis is suspected, patients should have head CT with contrast or MRI with contrast, or both plus a lumbar puncture if there are no signs of increased intracranial pressure.
Although these lesions are not pathognomonic, their presence in patients with AIDS and CNS symptoms warrants a trial of chemotherapy for T gondii.
CSF may be positive for lymphocytic pleocytosis, and the protein level may be elevated.
Approach to the Neurologic Patient By Michael C Levin, MD, College of Medicine, University of Saskatchewan Reviewed / Revised Jul 2021 | Modified Sep 2022 View Patient Education History Physical Examination and Testing Patients with neurologic symptoms are approached in a stepwise manner termed the neurologic method, which consists of the following: Identifying the anatomic location of the lesion or lesions causing symptoms Identifying the pathophysiology involved Generating a differential diagnosis Selecting specific, appropriate tests Identifying the anatomy and pathophysiology of the lesion through careful history taking and an accurate neurologic examination markedly narrows the differential diagnosis and thus the number of tests needed.
Usually, a clinician can quickly determine whether a reliable history is forthcoming or whether a family member should be interviewed instead.
History of present illness should include the following: Specific questions clarify the quality, intensity, distribution, duration, and frequency of each symptom.
What aggravates and attenuates the symptom and whether past treatment was effective should be determined.
Asking the patient to describe the order in which symptoms occur can help identify the cause.
Specific disabilities should be described quantitatively (eg, walks at most 25 feet before stopping to rest), and their effect on the patient's daily routine noted.
Past medical history and a complete review of systems are essential because neurologic complications are common in other disorders, especially alcoholism, diabetes, cancer, vascular disorders, and HIV infection.
Family history is important because migraine and many metabolic, muscle, nerve, and neurodegenerative disorders are inherited.
Social, occupational, and travel history provides information about unusual infections and exposure to toxins and parasites.
Sometimes neurologic symptoms and signs are functional or hysterical, reflecting a psychiatric disorder.
Typically, such symptoms and signs do not conform to the rules of anatomy and physiology, and the patient is often depressed or unusually frightened.
This approach should not be replaced by reflex ordering of CT, MRI, and other laboratory testing; doing so leads to error and unnecessary cost.
However, functional and physical disorders sometimes coexist, and distinguishing them can be challenging.
Physical Examination and Testing A physical examination to evaluate all body systems is done, but the focus is on the nervous system (neurologic examination).
The neurologic examination, discussed in detail elsewhere in T he M anual, includes the following: Mental status Cranial nerves Motor system Muscle strength Gait, stance, and coordination Sensation Reflexes Autonomic nervous system In many situations, a cerebrovascular examination also is done.
Diagnostic tests may be needed to confirm a diagnosis or exclude other possible disorders.
To identify the anatomic location, the examiner considers questions such as Is the lesion in one or multiple locations?
Is the lesion confined to the nervous system, or is it part of a systemic disorder?
What part of the nervous system is affected?
Specific parts of the nervous system to be considered include the cerebral cortex, subcortical white matter, basal ganglia, thalamus, cerebellum, brain stem, spinal cord, brachial or lumbosacral plexus, peripheral nerves, neuromuscular junction, and muscle.
Once the location of the lesion is identified, categories of pathophysiologic causes are considered; they include Vascular Infectious Neoplastic Degenerative Traumatic Toxic-metabolic Immune-mediated When appropriately applied, the neurologic method provides an orderly approach to even the most complex case, and clinicians are far less likely to be fooled by neurologic mimicry—eg, when symptoms of an acute stroke are actually due to a brain tumor or when rapidly ascending paralysis suggesting Guillain-Barré syndrome is actually due to spinal cord compression.
History The history is the most important part of the neurologic evaluation.
Patients should be put at ease and allowed to tell their story in their own words.
Benign Paroxysmal Positional Vertigo (Benign Positional Vertigo; Benign Postural Vertigo; BPPV) By Mickie Hamiter, MD, New York Presbyterian Columbia Reviewed / Revised May 2023 View Patient Education Etiology Symptoms and Signs Diagnosis Treatment Key Points Topic Resources Inside the Ear Epley maneuver: A Simple... In benign paroxysmal positional vertigo, short (< 60 seconds) episodes of vertigo occur with certain head positions.
This displaced material stimulates hair cells most commonly in the posterior semicircular canal, occasionally in the lateral semicircular canal, and rarely in the superior semicircular canal, creating the illusion of motion.
Etiologic factors include Spontaneous degeneration of the utricular otolithic membranes Labyrinthine concussion Otitis media Ear surgery Recent viral infection (eg, viral neuronitis) Head trauma Prolonged anesthesia or bed rest Previous vestibular disorders (eg, Meniere disease) Occlusion of the anterior vestibular artery Inside the Ear Symptoms and Signs of Benign Paroxysmal Positional Vertigo Vertigo is triggered when the patient's head moves (eg, when rolling over in bed or bending over to pick up something).
Acute paroxysms of vertigo last only a few seconds to minutes; episodes tend to peak in the morning and abate throughout the day.
Nausea and vomiting may occur, but hearing loss and tinnitus do not.
Diagnosis of Benign Paroxysmal Positional Vertigo Clinical evaluation Gadolinium-enhanced MRI if findings suggest central nervous system (CNS) lesion The diagnosis of BPPV is based on characteristic symptoms, nystagmus elicited by the Dix-Hallpike maneuver (also called the Barany maneuver), and the absence of other abnormalities noted during neurologic examination.
Such patients require no further testing.
Unlike the positional nystagmus caused by BPPV, positional nystagmus caused by a CNS lesion has the following characteristics: Lacks latency, fatigability, and severe subjective sensation May continue for as long as the position is maintained May be vertical or change direction If rotary, is likely to be in an unexpected direction If patients have nystagmus suggesting a CNS lesion, gadolinium-enhanced MRI of the brain and internal auditory canal is performed.
Treatment of Benign Paroxysmal Positional Vertigo Provocative maneuvers to fatigue symptoms Canalith repositioning maneuvers BPPV usually subsides spontaneously in several weeks or months but may continue for months or years.
Because brief episodes can recur over a long period of time, medications (such as those used in Meniere disease) are not recommended.
Often, the adverse effects of medications worsen dysequilibrium.
Nausea and nystagmus develop.
Because BPPV is fatigable, one therapeutic approach is to have the patient perform provocative maneuvers early in the day in a safe environment.
Symptoms are then minimal for the rest of the day.
Canalith repositioning maneuvers (most commonly the Epley maneuver or, less commonly, the Semont, maneuver or Brandt-Daroff exercises) involve moving the head through a series of specific positions intended to return the errant canalith to the utricle.
After the Epley or Semont maneuver is done, the patient should try to avoid neck flexion or extension for 1 to 2 days.
These maneuvers can be repeated as necessary.
The Brandt-Daroff exercises are done 5 times in a row, 3 times / day, for about 2 weeks or until there is no vertigo with the exercise.
For the Semont maneuver, the patient is seated upright in the middle of an examination table.
The patient's head is rotated toward the unaffected ear; this rotation is maintained throughout the maneuver.
Next, the torso is lowered laterally onto the examination table so that the patient is lying on the side of the affected ear with the nose pointed up.
After 3 minutes in this position, the patient is quickly moved through the upright position without straightening the head and is lowered laterally to the other side now with the nose pointed down.
After 3 minutes in this position, the patient is slowly returned to the upright position, and the head is rotated back to normal.
The patient sits upright, then lies on one side with the nose pointed up at a 45-degree angle.
The patient remains in this position for about 30 seconds or until the vertigo subsides and then moves back to the seated position.
The same motion is repeated on the opposite side.
This cycle is repeated 5 times in a row, 3 times / day, for about 2 weeks, or until there is no more vertigo with the exercise.
Key Points In BPPV, vertigo is caused by displacement of otoconial crystals into a semicircular canal; symptoms are triggered by head movement.
Nausea and vomiting may also occur, but not tinnitus or hearing loss.
Treatment involves canalith repositioning maneuvers.
Diagnosis is clinical, but some patients require MRI to rule out other conditions.
Treat with canalith-repositioning maneuvers.
Medications rarely help and may worsen symptoms.
Benign paroxysmal positional vertigo (BPPV) is the most common cause of relapsing otogenic vertigo.
It affects people increasingly as they age and can severely affect balance in older adults, leading to potentially injurious falls.
Etiology of Benign Paroxysmal Positional Vertigo BPPV is thought to be caused by displacement of otoconial crystals (calcium carbonate crystals normally embedded in the saccule and utricle).
Goodpasture Syndrome (Goodpasture's Syndrome; Anti-GBM Antibody Disease) By Joyce Lee, MD, MAS, University of Colorado School of Medicine Reviewed / Revised Sep 2021 | Modified Sep 2022 View Patient Education Pathophysiology Symptoms and Signs Diagnosis Prognosis Treatment Key Points Topic Resources Alveolar Hemorrhage (Goodpasture... Goodpasture syndrome, a subtype of pulmonary-renal syndrome, is an autoimmune syndrome consisting of alveolar hemorrhage and glomerulonephritis caused by circulating anti-glomerular basement membrane (anti-GBM) antibodies.
Men are affected more often than women.
Anti-GBM antibodies are directed against the noncollagenous (NC-1) domain of the alpha3 chain of type IV collagen, which occurs in highest concentration in the basement membranes of renal and pulmonary capillaries.
Environmental exposures—cigarette smoking most commonly, and viral respiratory infection and hydrocarbon solvent inhalation less commonly—expose alveolar capillary antigens to circulating antibody in genetically susceptible people, most notably those with HLA-DRw15, - DR4, and - DRB1 alleles.
Circulating anti-GBM antibodies bind to basement membranes, fix complement, and trigger a cell-mediated inflammatory response, causing glomerulonephritis, pulmonary capillaritis, or both.
Symptoms and Signs of Goodpasture Syndrome Hemoptysis is the most prominent symptom; however, hemoptysis may not occur in patients with alveolar hemorrhage, and patients may present with only chest x-ray infiltrates or with infiltrates and respiratory distress, respiratory failure, or both.
Other common symptoms include Cough Dyspnea Fatigue Fever Hematuria Weight loss Up to 40% of patients have gross hematuria, although pulmonary hemorrhage may precede renal manifestations by weeks to years.
Signs vary over time and range from clear lungs on auscultation to crackles and rhonchi.
Some patients have peripheral edema due to renal failure and pallor due to anemia.
Diagnosis of Goodpasture Syndrome Serum anti-GBM antibody tests Sometimes renal biopsy Patients are tested for serum anti-GBM antibodies by indirect immunofluorescence testing or, when available, direct enzyme-linked immunosorbent assay (ELISA) with recombinant or human NC-1 alpha3.
Presence of these antibodies confirms the diagnosis.
Goodpasture syndrome most often develops in genetically susceptible people who smoke cigarettes, but hydrocarbon inhalation exposure and viral respiratory infections are additional possible triggers.
Antineutrophil cytoplasmic antibodies (ANCA) testing is positive (in a peripheral pattern) in only 25% of patients with Goodpasture syndrome.
If anti-GBM antibodies are absent and patients have evidence of glomerulonephritis (hematuria, proteinuria, red cell casts detected with urinalysis, renal insufficiency, or a combination of these findings), renal biopsy is indicated to confirm the diagnosis.
A rapidly progressive focal segmental necrotizing glomerulonephritis with crescent formation is found in biopsy specimens in patients with Goodpasture syndrome and all other causes of pulmonary-renal syndrome.
Immunofluorescence staining of renal or lung tissue classically shows linear IgG deposition along the glomerular or alveolar capillaries.
IgG deposition also occurs in the kidneys of patients with diabetes or with fibrillary glomerulonephritis (a rare disorder causing the pulmonary-renal syndrome), but glomerular basement membrane binding of antibodies in these disorders is nonspecific and does not occur in linear patterns.
Prognosis of Goodpasture Syndrome Goodpasture syndrome is often rapidly progressive and can be fatal if prompt recognition and treatment are delayed.
Prognosis is good when treatment begins before onset of respiratory or renal failure.
Long-term morbidity is related to the degree of renal impairment at diagnosis.
Patients requiring urgent dialysis and those with > 50% crescents in the biopsy specimen (who often will require dialysis) usually survive for < 2 years unless kidney transplantation is done.
Hemoptysis may be a good prognostic sign because it leads to earlier detection; the minority of patients who are ANCA-positive respond better to treatment.
Symptoms are dyspnea, cough, fatigue, hemoptysis, and hematuria.
Relapse occurs in a small number and is linked to continued tobacco use and respiratory infection.
In patients with end-stage renal disease who receive kidney transplantation, disease can recur in the graft.
Treatment of Goodpasture Syndrome Plasma exchange Corticosteroids and cyclophosphamide Immediate survival in patients with pulmonary hemorrhage and respiratory failure is linked to airway control; endotracheal intubation and mechanical ventilation are recommended for patients with borderline arterial blood gas measurements (ABGs) and impending respiratory failure.
Patients with significant renal impairment may require dialysis or kidney transplantation.
Treatment is daily or every-other-day plasma exchange for 2 to 3 weeks using 4-L exchanges to remove anti-GBM antibodies, combined with corticosteroids (usually methylprednisolone 1 g IV over 20 minutes once a day or every other day for 3 doses followed by prednisone (1 mg / kg orally once a day for 3 weeks, then titrated down to 20 mg orally once a day for 6 to 12 months) and cyclophosphamide (2 mg / kg orally or IV once a day for 6 to 12 months) to prevent formation of new antibodies.
Therapy can be tapered when pulmonary and renal function stop improving.
Rituximab could be used in some patients who have severe adverse effects due to cyclophosphamide or refuse cyclophosphamide as treatment, but it has not been studied in patients with Goodpasture syndrome.
Key Points Patients with Goodpasture syndrome may have both pulmonary hemorrhage and glomerulonephritis or either one separately.
Pulmonary findings can be mild or nonspecific.
Test serum for anti-glomerular basement membrane antibodies.
Goodpasture syndrome is suspected in patients with hemoptysis or hematuria and is confirmed by the presence of anti-GBM antibodies in the blood or in a renal biopsy specimen.
Do a renal biopsy if patients have glomerulonephritis.
Diagnose and treat Goodpasture syndrome before organ failure develops whenever possible.
Treat using plasma exchange, a corticosteroid, and cyclophosphamide.
Prognosis is good when treatment is begun before onset of respiratory or renal failure.
Treatment includes plasma exchange, corticosteroids, and immunosuppressants, such as cyclophosphamide.
(See also Pulmonary-Renal Syndrome.)
Pathophysiology of Goodpasture Syndrome Goodpasture syndrome is the combination of glomerulonephritis with alveolar hemorrhage and anti-GBM antibodies.
Goodpasture syndrome most often manifests as diffuse alveolar hemorrhage and glomerulonephritis together but can occasionally cause glomerulonephritis (10 to 20%) or pulmonary disease (10%) alone.
Progressive Supranuclear Palsy (PSP) (Steele-Richardson-Olszewski Syndrome) By Hector A Gonzalez-Usigli, MD, HE UMAE Centro Médico Nacional de Occidente Reviewed / Revised Feb 2022 | Modified Sep 2022 View Patient Education Symptoms and Signs Diagnosis Treatment Key Points Progressive supranuclear palsy is a rare, degenerative central nervous system disorder that progressively impairs voluntary eye movements and causes bradykinesia, muscular rigidity with progressive axial dystonia, pseudobulbar palsy, and dementia.
Patients tend to fall backward.
Dysphagia, dysarthria with emotional lability (pseudobulbar palsy), depression, and disordered sleep are common.
Resting tremor may develop.
Dementia eventually occurs.
Many patients become incapacitated within about 5 years and die within about 10 years.
Progressive supranuclear palsy has several different clinical types based on the predominant symptoms or signs (1): Richardson syndrome: Classic progressive supranuclear palsy with progressive supranuclear ophthalmoplegia and severe balance problems (the most common form, in ≥ 70% of cases) PSP-P: Parkinsonian type of progressive supranuclear palsy, which responds to levodopa, resulting in transient, slight improvement PSP-PAFG: Characterized by pure akinesia with freezing of gait PSP-PGF: Characterized by progressive gait freezing PSP-PNFA (PSP-SL): Characterized by progressive nonfluent aphasia or speech or language disorders PSP-AOS: Characterized by apraxia of speech PSP-FTLD (PSP-F): Characterized by frontotemporal degeneration PSP-CBS: Characterized by corticobasal syndrome, causing profound asymmetric symptoms PSP-MN (PSP-PLS): Characterized by motoneuron symptoms related to primary lateral sclerosis Other possible forms include PSP-C: Characterized by cerebellar signs PSP-PI: Characterized by postural instability In forms other than Richardson syndrome (nonclassical forms [called atypical parkinsonism]), ophthalmoplegia may be delayed by years.
The different clinical types of progressive supranuclear palsy have different characteristics (eg, parkinsonian features, corticobasal syndrome, speech problems, frontotemporal degenerative signs, akinesia, freezing of gait).
Diagnosis of PSP Clinical evaluation Diagnosis of progressive supranuclear palsy is clinical.
MRI is usually done to exclude other disorders.
In advanced cases, MRI shows a characteristic decrease in midbrain size that is best seen on midsagittal views and that causes the midbrain to be shaped like a hummingbird or emperor penguin.
On axial views, the midbrain may resemble a morning glory (2).
Occasionally, levodopa and / or amantadine partially relieve rigidity.
Physical and occupational therapy may help improve mobility and function and reduce the risk of falls.
Treatment focuses on relieving symptoms.
Because PSP is fatal, patients should be encouraged to prepare advance directives soon after the disorder is diagnosed.
These directives should indicate what kind of medical care people want at the end of life.
Key Points The first symptom of classic progressive supranuclear palsy may be difficulty looking up or down without moving the neck or difficulty climbing up and down stairs.
Focus on relieving symptoms; consider levodopa and / or amantadine to relieve rigidity, and prescribe physical and occupational therapy.
The cause of progressive supranuclear palsy is unknown.
Neurons in the basal ganglia and brain stem degenerate; neurofibrillary tangles containing an abnormally phosphorylated tau protein are also present.
Symptoms and Signs of PSP Symptoms of progressive supranuclear palsy usually begin in late middle age.
The first symptom may be Difficulty looking up or down without moving the neck or difficulty climbing up and down stairs Voluntary eye movements, particularly downward gaze, become difficult, but vertical reflex eye movements triggered by passive head movement (neck flexion, extension) are unaffected.
Movements are slowed, muscles become rigid, and axial dystonia develops.
Pathophysiology of Acute Bacterial Meningitis Most commonly, bacteria reach the subarachnoid space and meninges via hematogenous spread.
When stopped, the PCO2 should be gradually increased to normal because a sudden increase may cause a significant increase in ICP.
Usually, adults are given mannitol 1 g / kg IV bolus over 30 minutes, repeated as needed every 3 to 4 hours or 0.25 g / kg every 2 to 3 hours, and children are given 0.5 to 2.0 g / kg over 30 minutes, repeated as needed.
Additional measures can include IV fluids Antiseizure drugs Treatment of concomitant infections Treatment of specific complications (eg, corticosteroids for Waterhouse-Friderichsen syndrome, surgical drainage for subdural empyema) Prevention of Acute Bacterial Meningitis Use of vaccines for H influenzae type B and, to a lesser extent, for N meningitidis and S pneumoniae has reduced the incidence of bacterial meningitis.
Physical measures Keeping patients in respiratory isolation (using droplet precautions) for the first 24 hours of therapy can help prevent meningitis from spreading.
A conjugatedpneumococcal vaccine effective against 13 serotypes, including > 80% of organisms that cause meningitis, is recommended for all children (see table).
Routine vaccination against H influenzae type b is highly effective and begins at age 2 months.
A quadrivalent meningococcal vaccine is given to Children who are 2 to 10 years if they have an immunodeficiency or functional asplenia All children at age 11 to 12 years with a booster dose at age 16 Older children, college students living in dormitories, and military recruits who have not had the vaccine previously Travelers to or residents of endemic areas Laboratory personnel who routinely handle meningococcal specimens During a meningitis epidemic, the population at risk (eg, college students, a small town) must be identified, and its size must be determined before proceeding to mass vaccination.
The effort is expensive and requires public education and support, but it saves lives and reduces morbidity.
Bacteria may also reach the meninges from nearby infected structures or through a congenital or acquired defect in the skull or spine (see Route of entry).
The meningococcal vaccine does not protect against serotype B meningococcal meningitis; this information should kept in mind when a vaccinated patient presents with symptoms of meningitis.
Chemoprophylaxis Anyone who has prolonged face-to-face contact with a patient who has meningitis (eg, household or day care contacts, medical personnel and other people who are exposed to the patient's oral secretions) should be given postexposure chemoprophylaxis.
For meningococcal meningitis, chemoprophylaxis consists of one of the following: Rifampin 600 mg (for children > 1 month, 10 mg / kg; for children < 1 month, 5 mg / kg) orally every 12 hours for 4 doses Ceftriaxone 250 mg (for children < 15 years, 125 mg) IM for 1 dose For adults, a fluoroquinolone (ciprofloxacin or levofloxacin 500 mg or ofloxacin 400 mg) orally for 1 dose For meningitis due to H influenzae type b, chemoprophylaxis is rifampin 20 mg / kg orally once a day (maximum: 600 mg / day) for 4 days.
There is no consensus on whether children < 2 years require prophylaxis for exposure at day care.
Chemoprophylaxis is not usually needed for contacts of patients with other types of bacterial meningitis.
Key Points Common causes of acute bacterial meningitis include N meningitidis and S pneumoniae in children and adults and Listeria species in infants and older adults; S aureus occasionally causes meningitis in people of all ages.
Typical features may be absent or subtle in infants, patients with alcohol use disorder, older patients, immunocompromised patients, and patients who develop meningitis after a neurosurgical procedure.
If patients have focal neurologic deficits, obtundation, seizures, or papilledema (suggesting increased ICP or an intracranial mass effect), defer lumbar puncture pending results of neuroimaging.
Treat acute bacterial meningitis as soon as possible, even before the diagnosis is confirmed.
Common empirically chosen antibiotic regimens often include 3rd-generation cephalosporins (for S pneumoniae and N meningitidis), ampicillin (for L monocytogenes), and vancomycin (for penicillin-resistant strains of S pneumoniae and for S aureus).
Because white blood cells (WBCs), immunoglobulins, and complement are normally sparse or absent from cerebrospinal fluid (CSF), bacteria initially multiply without causing inflammation.
Routine vaccination for H influenza, S pneumoniae, and N meningitidis and chemoprophylaxis against N meningitidis help prevent meningitis.
Practice Guidelines for the Management of Bacterial Meningitis: This article reviews the recommendations for the diagnosis and management of bacterial meningitis, including the initial approach, indications for CT before lumbar puncture, tests to distinguish viral from bacterial meningitis, specific tests to identify the causative bacteria, timing of antimicrobial drugs for suspected meningitis, specific drugs to be used to treat suspected or confirmed bacterial meningitis, and the role of dexamethasone.
2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis: This article reviews the literature, evaluates the evidence, and presents recommendations.
It specifically discusses the approach to infections associated with cerebrospinal fluid shunts, cerebrospinal fluid drains, intrathecal drugs (eg, baclofen), deep brain stimulation hardware, neurosurgery, and head trauma.
Later, bacteria release endotoxins, teichoic acid, and other substances that trigger an inflammatory response with mediators such as WBCs and tumor necrosis factor (TNF).
Typically in CSF, levels of protein increase, and because bacteria consume glucose and because less glucose is transported into the CSF, glucose levels decrease.
Brain parenchyma is typically affected in acute bacterial meningitis.
Inflammation in the subarachnoid space is accompanied by cortical encephalitis and ventriculitis.
Complications of bacterial meningitis are common and may include Hydrocephalus (in some patients) Arterial or venous infarcts due to inflammation and thrombosis of arteries and veins in superficial and sometimes deep areas of brain Abducens palsy due to compression or inflammation of the 6th cranial nerve Deafness due to inflammation of the 8th cranial nerve or structures in the middle ear Subdural empyema Increased intracranial pressure (ICP) due to cerebral edema Brain abscess (if the infection penetrates into brain parenchyma) Brain herniation (the most common cause of death during the acute stages) Systemic complications (which are sometimes fatal), such as septic shock, disseminated intravascular coagulation (DIC), or hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion (SIADH) Etiology of Acute Bacterial Meningitis Likely causes of bacterial meningitis depend on Patient age Route of entry Immune status of the patient Age In neonates and young infants, the most common causes of bacterial meningitis are Group B streptococci, particularly Streptococcus agalactiae Escherichia (E) coli and other gram-negative bacteria Listeria monocytogenes In older infants, children, and young adults, the most common causes of bacterial meningitis are Neisseria meningitidis Streptococcus pneumoniae N meningitidis meningitis occasionally causes death within hours.
Sepsis caused by N meningitidis sometimes results in coagulopathy and bilateral adrenal hemorrhagic infarction (Waterhouse-Friderichsen syndrome).
Haemophilus influenzae type B, previously the most common cause of meningitis in children < 6 years and overall, is now a rare cause in the US and Western Europe, where the H influenzae vaccine is widely used.
However, in areas where the vaccine is not widely used, H influenzae is still a common cause, particularly in children aged 2 months to 6 years.
In middle-aged and in older adults, the most common cause of bacterial meningitis is S pneumoniae Less commonly, N meningitidis causes meningitis in middle-aged and older adults.
As host defenses decline with age, patients may develop meningitis due to L monocytogenes or gram-negative bacteria.
Table Route of entry Routes of entry include the following: By hematogenous spread (the most common route) From infected structures in or around the head (eg, sinuses, middle ear, mastoid process), sometimes associated with a CSF leak Through a penetrating head wound After a neurosurgical procedure (eg, if a ventricular shunt becomes infected) Through congenital or acquired defects in the skull or spine Having any of the above conditions increases the risk of acquiring meningitis.
Table Immune status Overall, the most common causes of bacterial meningitis in immunocompromised patients are S pneumoniae L monocytogenes Pseudomonas aeruginosa Mycobacterium tuberculosis N meningitidis Gram-negative bacteria But the most likely bacteria depend on the type of immune deficiency: Defects in cell-mediated immunity (eg, in AIDS, Hodgkin lymphoma, or drug-induced immunosuppression): L monocytogenes or mycobacteria Defects in humoral immunity or splenectomy: S pneumoniae or, less frequently, N meningitidis (both can cause fulminant meningitis) Neutropenia: P aeruginosa or gram-negative enteric bacteria In very young infants (particularly preterm infants) and older adults, T-cell immunity may be weak; thus, these age groups are at risk of meningitis due to L monocytogenes.
Symptoms and Signs of Acute Bacterial Meningitis In most cases, bacterial meningitis begins with 3 to 5 days of insidiously progressive nonspecific symptoms including malaise, fever, irritability, and vomiting.
However, meningitis may be more rapid in onset and can be fulminant, making bacterial meningitis one of the few disorders in which a previously healthy young person may go to sleep with mild symptoms and never awaken.
Typical symptoms and signs of meningitis include Fever Tachycardia Headache Photophobia Changes in mental status (eg, lethargy, obtundation) Nuchal rigidity (although not all patients report it) Back pain (less intense than and overshadowed by headache) However, fever, headache, and nuchal rigidity may be absent in neonates and infants (see Neonatal Bacterial Meningitis).
So-called paradoxical irritability, in which cuddling and consoling by a parent irritates rather than comforts the neonate, suggests bacterial meningitis.
If meningitis becomes severe in neonates and infants, skull fontanelles may bulge because of increased intracranial pressure.
Seizures occur early in up to 40% of children with acute bacterial meningitis and may occur in adults.
Up to 12% of patients present in coma.
Severe meningitis increases intracranial pressure (ICP) and typically causes papilledema, but papilledema may be absent early or be attenuated because of age-related or other factors.
Accompanying systemic infection by the organism may cause Rashes, petechiae, or purpura (which suggest meningococcemia) Pulmonary consolidation (often in meningitis due to S pneumoniae) Heart murmurs (which suggest endocarditis—eg, often caused by S aureus or S pneumoniae) Atypical presentations in adults Fever and nuchal rigidity may be absent or mild in immunocompromised or older patients and in patients with alcohol use disorder.
Often, in older patients, the only sign is confusion in those who were previously alert or altered responsiveness in those who have dementia.
In such patients, as in neonates, the threshold for doing lumbar puncture should be low.
Brain imaging (MRI or, less optimally, CT) should be done if focal neurologic deficits are present or increased ICP is suspected.
If bacterial meningitis develops after a neurosurgical procedure, symptoms often take days to develop.
Diagnosis of Acute Bacterial Meningitis Cerebrospinal fluid (CSF) analysis As soon as acute bacterial meningitis is suspected, blood cultures and lumbar puncture for CSF analysis (unless contraindicated) are done.
Blood should be analysed when lumbar puncture is done so that blood glucose levels can be compared with CSF glucose levels.
Treatment should be started as follows: If bacterial meningitis is suspected and the patient is very ill, antibiotics and corticosteroids are given immediately, even before lumbar puncture.
If bacterial meningitis is suspected and lumbar puncture will be delayed pending CT or MRI, antibiotics and corticosteroids should be started after blood cultures but before neuroimaging is done; the need for confirmation should not delay treatment.
Clinicians should suspect bacterial meningitis in patients with typical symptoms and signs, usually fever, changes in mental status, and nuchal rigidity.
However, clinicians must be aware that symptoms and signs are different in neonates and infants and may be absent or initially mild in older patients, patients with alcoholic use disorder, and immunocompromised patients.
Diagnosis can be challenging in the following patients: Those who have had a neurosurgical procedure because such procedures can also cause changes in mental status and neck stiffness Older patients and patients with alcohol use disorder because changes in mental status may be due to metabolic encephalopathy (which may have multiple causes) or to falls and subdural hematomas Focal seizures or focal neurologic deficits may indicate a focal lesion such as a brain abscess.
Because untreated bacterial meningitis is lethal, tests should be done if there is even a small chance of meningitis.
Testing is particularly helpful in infants, older patients, patients with alcohol use disorder, immunocompromised patients, and patients who had neurosurgical procedure because symptoms may be atypical.
Pearls & Pitfalls Do a lumbar puncture even if clinical findings are not specific for meningitis, particularly in infants, older patients, patients with alcohol use disorder, immunocompromised patients, and patients who have had neurosurgery.
If findings suggest acute bacterial meningitis, routine tests include CSF analysis Complete blood count and differential Metabolic panel Blood cultures plus polymerase chain reaction (PCR), if available Lumbar puncture Unless contraindicated, lumbar puncture (see also How To Do Lumbar Puncture) is done immediately to obtain CSF for analysis, the mainstay of diagnosis.
Contraindications to immediate lumbar puncture are signs suggesting markedly increased intracranial pressure (ICP) or an intracranial mass effect (eg, due to edema, hemorrhage, or tumor).
Thus, lumbar puncture should be considered high risk with any of the following: Papilledema Focal neurologic deficits Focal seizures A known central nervous system mass lesion Large stroke Suspected central nervosus system focal infection In such cases, lumbar puncture may cause brain herniation and thus is deferred until neuroimaging (typically CT or MRI) is done to check for increased ICP or a mass effect.
When lumbar puncture is deferred, treatment is best begun immediately (after blood sampling for culture and before neuroimaging).
After ICP, if increased, has been lowered or if no mass effect or obstructive hydrocephalus is detected, lumbar puncture can be done.
CSF should be sent for analysis: cell count, protein, glucose, Gram staining, culture, PCR, and other tests as indicated clinically.
A multiplex film-array PCR panel can provide rapid screening for multiple bacteria and viruses plus Cryptococcus neoformans in a CSF sample.
This test, which is not always available, is used to supplement, not replace, culture and traditional tests.
CSF cell count should be determined as soon as possible because white blood cells (WBCs) may adhere to the walls of the collecting tube, resulting in a falsely low cell count; in extremely purulent CSF, WBCs may lyse.
Typical CSF findings in bacterial meningitis include the following (see table): Increased pressure Fluid that is often turbid A high WBC count (consisting predominantly of polymorphonuclear neutrophils) Elevated protein A low CSF: blood glucose ratio A CSF: blood glucose level of < 50% suggests possible meningitis.
Findings typically include headache, fever, and nuchal rigidity.
A CSF glucose level of ≤ 18 mg / dL or a CSF: blood glucose ratio of < 0.23 strongly suggests bacterial meningitis.
However, changes in CSF glucose may lag 30 to 120 minutes behind changes in blood glucose.
In acute bacterial meningitis, an elevated protein level (usually 100 to 500 mg / dL) indicates blood-brain barrier injury.
CSF cell count and protein and glucose levels in patients with acute bacterial meningitis are not always typical.
Table Identification of the causative bacteria in CSF involves Gram staining, culture, and, when available, PCR.
Gram staining provides information rapidly, but the information is limited.
For bacteria to be reliably detected with Gram stain, about 10 5 bacteria / mL must be present.
Results may be falsely negative if any of the following occur: CSF is handled carelessly.
Bacteria are not adequately resuspended after CSF has been allowed to settle.
Diagnosis is by cerebrospinal fluid (CSF) analysis.
Errors in decolorization or reading of the slide occur.
If clinicians suspect an anaerobic infection or other unusual bacteria, they should tell the laboratory before samples are plated for cultures.
Prior antibiotic therapy can reduce the yield from Gram staining and culture.
PCR, if available, and latex agglutination tests to detect bacterial antigens may be a useful adjunctive tests, especially in patients who have already received antibiotics.
Determination of antibiotic sensitivity requires bacterial culture.
Until the cause of meningitis is confirmed, other tests using samples of CSF or blood may be done to check for other causes of meningitis, such as viruses (particularly herpes simplex), fungi, and cancer cells.
Other tests Samples from other sites suspected of being infected (eg, urinary or respiratory tract) should also be cultured.
Prognosis for Acute Bacterial Meningitis With antibiotic treatment, the mortality rate for children < 19 years may be as low as 3% but is often higher; survivors may be deaf and neuropsychologically impaired.
The mortality rate, even with antibiotic treatment, is about 17% for adults < 60 years but up to 37% in those > 60.
Community-acquired meningitis due to S aureus has a mortality rate in the range of 43%.
In general, mortality rate correlates with depth of obtundation or coma.
Factors associated with a poor prognosis include Age > 60 years Coexisting debilitating disorders A low Glasgow coma score at admission (see tables and) Focal neurologic deficits A low CSF cell count Increased CSF pressure (particularly) Seizures and a low CSF: serum glucose ratio may also indicate a poor prognosis.
Treatment of Acute Bacterial Meningitis Antibiotics Corticosteroids to decrease cerebral inflammation and edema Antibiotics are the mainstay of therapy for acute bacterial meningitis.
In addition to antibiotics, treatment includes measures to decrease brain and cranial nerve inflammation and increased intracranial pressure (ICP).
Most patients are admitted to an intensive care unit (ICU).
Antibiotics Antibiotics must be bactericidal for the causative bacteria and must be able to penetrate the blood-brain barrier.
If patients appear ill and findings suggest meningitis, antibiotics (see table) and corticosteroids are started as soon as blood cultures are drawn and even before lumbar puncture.
Also, if lumbar puncture is delayed pending neuroimaging results, antibiotic and corticosteroid treatment begins before neuroimaging.
Pearls & Pitfalls If patients appear ill and acute meningitis is suspected, treat them with antibiotics and corticosteroids as soon as blood for cultures is drawn.
Appropriate empiric antibiotics depend on the patient's age and immune status and route of infection (see table).
(See also Overview of Meningitis and Neonatal Bacterial Meningitis.)
In general, clinicians should use antibiotics that are effective against S pneumoniae, N meningitidis, and S aureus.
In pregnant women, neonates, older patients, and immunocompromised patients, Listeria meningitis is possible; it requires specific antibiotic treatment, usually ampicillin.
Herpes simplex encephalitis can clinically mimic early bacterial meningitis; thus, acyclovir is added.
Antibiotic therapy may need to be modified based on results of culture and sensitivity testing.
Commonly used antibiotics include 3rd-generation cephalosporins for S pneumoniae and N meningitidis Ampicillin for L monocytogenes Vancomycin for penicillin-resistant strains of S pneumoniae and for S aureus Table Table Table Corticosteroids Dexamethasone is used to decrease cerebral and cranial nerve inflammation and edema; it should be given when therapy is started.
Adults are given 10 mg IV; children are given 0.15 mg / kg IV.
Dexamethasone is given immediately before or with the initial dose of antibiotics and every 6 hours for 4 days.
Use of dexamethasone is best-established for patients with pneumococcal meningitis.
Patients presenting with papilledema or signs of impending brain herniation are treated for increased ICP with the following: Elevation of the head of the bed to 30˚ Hyperventilation to a PCO2 of 27 to 30 mm Hg for not more than 24 hours to cause intracranial vasoconstriction Osmotic diuresis with IV mannitol Hyperventilation is used until other measures become effective and is not used for more than 24 hours.
Treatment of Anemia By Evan M Braunstein, MD, PhD, Johns Hopkins University School of Medicine Reviewed / Revised Jul 2022 | Modified Sep 2022 View Patient Education If identified, the cause of the anemia is treated.
When the hemoglobin (Hb) falls dangerously low (eg, < 7 g / dL [< 70 g / L] for patients without cardiopulmonary insufficiency or higher for patients with it), red blood cell (RBC) transfusion temporarily increases oxygen-carrying capacity.
RBC transfusion should be reserved for patients With or at high risk of cardiopulmonary symptoms With active, uncontrollable blood loss With some form of hypoxic or ischemic end-organ failure (eg, neurologic ischemic symptoms, angina, tachycardia in patients with underlying heart failure or severe chronic obstructive pulmonary disease) Transfusion procedures and blood components are discussed elsewhere, as is the evaluation of anemia.
Anemia of Renal Disease By Gloria F Gerber, MD, Johns Hopkins School of Medicine, Division of Hematology Reviewed / Revised Jun 2023 View Patient Education Diagnosis Treatment Anemia of renal disease is a hypoproliferative anemia resulting primarily from deficient erythropoietin (EPO) or a diminished response to it; it tends to be normocytic and normochromic.
The bone marrow may show erythroid hypoplasia.
RBC fragmentation identified on the peripheral smear, particularly if there is thrombocytopenia, suggests microangiopathic hemolytic anemia and warrants additional investigation and treatment.
Treatment of Anemia of Renal Disease Treatment of underlying renal disease Sometimes, recombinant erythropoietin and iron supplements Treatment of anemia of renal disease is directed at Improving renal function Increasing RBC production If renal function returns to normal, anemia is slowly corrected.
Recombinant EPO improves anemia and reduces transfusion needs in patients with chronic kidney disease and is generally initiated when hemoglobin is < 10 g / dL (< 100 g / dL).
In patients receiving long-term dialysis, recombinant erythropoietin (eg, epoetin alfa or darbepoetin alfa) along with iron supplements is the treatment of choice.
However, because there is both reduced production of EPO and marrow resistance to EPO, the recombinant EPO dose may need to be higher.
The goal is a hemoglobin of 10 to 11.5 g / dL (100 to 115 g / L).
Careful monitoring of hemoglobin response is needed because adverse effects (eg, venous thromboembolism, myocardial infarction, death) may occur when hemoglobin rises to > 12 to 13 g / dL (> 120 to 130 g / L).
Treatment includes measures to correct the underlying disorder and supplementation with EPO and sometimes iron.
In addition, adequate repletion of iron stores is required to ensure an adequate response to recombinant EPO, and concurrent iron supplementation is often needed.
In almost all cases, maximum increases in RBCs are reached by 8 to 12 weeks.
(See also Overview of Decreased Erythropoiesis.)
Anemia in chronic renal disease is multifactorial.
The most common mechanism is Hypoproliferation due to decreased erythropoietin (EPO) production Lack of EPO leads to loss of erythroferrone production, causing loss of hepcidin suppression and increased iron sequestration (as observed in the anemia of chronic disease — 1).
Renal glomerular lesions (eg, due to amyloidosis, diabetic nephropathy) generally result in the most severe anemia for their degree of renal excretory failure.
Sickle Cell Disease (Hb S Disease) By Evan M Braunstein, MD, PhD, Johns Hopkins University School of Medicine Reviewed / Revised Jun 2022 | Modified Sep 2022 View Patient Education Pathophysiology Symptoms and Signs Diagnosis Prognosis Treatment Key Points More Information Topic Resources Sickle Cells Sickle cell disease (a hemoglobinopathy) causes a chronic hemolytic anemia occurring almost exclusively in people with African ancestry.
Complications are treated supportively.
No effective in vivo anti-sickling drug is available.
Splenectomy is valueless.
Indications for hospitalization include suspected serious (including systemic) infection, aplastic crisis, acute chest syndrome, and, often, intractable pain or the need for transfusion.
Fever alone may not be a reason to hospitalize.
However, patients who appear acutely ill and have a temperature > 38 ° C should be admitted so that cultures can be obtained and IV antibiotics can be given.
Antibiotics Patients with suspected serious bacterial infections or acute chest syndrome require broad-spectrum antibiotics immediately.
Analgesics Painful crises are managed with liberal administration of analgesics, usually opioids.
IV morphine (continuous or bolus) is effective and safe; meperidine is avoided.
During crises, pain and fever may persist for as long as 5 days.
Hemoglobinopathies are genetic disorders affecting the hemoglobin molecule.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are often useful in reducing opioid requirements; however, they must be used cautiously in patients with renal disease.
Intravenous hydration Although dehydration contributes to sickling and may precipitate crises, it is unclear whether vigorous hydration is helpful during crises.
Nevertheless, maintaining normal intravascular volume has been a mainstay of therapy.
Oxygen Oxygen is given if needed to treat hypoxia.
Transfusion Transfusion is given in many situations in which its efficacy has not been demonstrated.
However, chronic transfusion therapy is indicated for prevention of recurrent cerebral thrombosis, especially in children, in an effort to maintain the Hb S percentage less than 30%.
In the acute setting, specific indications for transfusion include Acute splenic sequestration Aplastic crises Cardiopulmonary symptoms or signs (eg, high-output heart failure, hypoxemia with PO2 < 65 mm Hg) Preoperative use Priapism Life-threatening events that would benefit from improved oxygen delivery (eg, sepsis, severe infection, acute chest syndrome, stroke, acute organ ischemia) Sometimes pregnancy Transfusion is not helpful during an uncomplicated painful crisis.
Simple transfusion can be done when the goal is to correct anemia, such as during aplastic crisis or splenic or hepatic sequestration.
Exchange transfusion is done during severe acute events such as the acute chest syndrome or stroke in order to decrease the Hb S percentage and prevent ischemia.
It can be done with modern apheresis machines.
Hemoglobin S was the first abnormal hemoglobin to be identified.
If the initial hemoglobin is low (< 7 g / dL [< 70 g / L]), this process cannot be initiated before first transfusing red cells.
Partial exchange transfusion minimizes iron accumulation and hyperviscosity.
Curative treatments Hematopoietic stem cell transplantation remains the only curative treatment for sickle cell disease.
Given the risks associated with this therapy, it is generally restricted to patients with advanced disease complications.
Gene therapy or gene editing techniques that reduce the amount of Hb S are currently in clinical trials.
This field is rapidly evolving and use of stem cell therapy to treat sickle cell disease will likely expand in the near future.
Health maintenance For long-term management the following interventions have reduced mortality, particularly during childhood: Pneumococcal, Haemophilus influenzae influenza (inactivated, not live), and meningococcal vaccines Early identification and treatment of serious bacterial infections Prophylactic antibiotics, including continuous prophylaxis with oral penicillin from age 4 months to 6 year Use of hydroxyurea and folate supplementation Supplemental folic acid, 1 mg orally once a day, is usually prescribed.
Hydroxyurea, by increasing Hb F and thereby reducing sickling, decreases painful crises (by 50%) and decreases acute chest syndrome and transfusion requirements.
It is indicated in patients with recurrent pain crises or other complications.
The dose of hydroxyurea is variable and is adjusted based on blood counts and adverse effects.
Homozygotes (about 0.3% of people with African ancestry in the United States) have sickle cell anemia; heterozygotes (8 to 13% of people with African ancestry in the United States) are typically not anemic but have a risk of other complications.
Hydroxyurea causes neutropenia and thrombocytopenia.
It is also a teratogen and should not be given to females of child-bearing age.
Three additional drugs are available to treat sickle cell disease.
Both L-glutamine and crizanlizumab target vaso-occlusion and were found to decrease pain crises in controlled, randomized studies (1, 2).
L-glutamine is thought to reduce oxidative stress in sickle erythrocytes, while crizanlizumab inhibits P-selectin, which contributes to adhesion of sickle erythrocytes to the vascular endothelium.
Voxelotor inhibits polymerization of Hb S, stabilizes oxygenated hemoglobin, and was shown to increase hemoglobin levels in a randomized, controlled trial (3.
While these drugs are currently being incorporated into treatment regimens for sickle cell patients, data on their efficacy remain limited.
Transcranial Doppler flow studies in children can help predict risk of stroke, and many experts recommend annual screening for children from age 2 to 16 years.
Children at high risk appear to benefit from prophylactic, chronic exchange transfusions to keep Hb S at < 30% of total hemoglobin; iron overload is common and must be screened for and treated.
For patients receiving frequent red cell transfusions, chelation therapy to prevent or delay complications due to iron overload should be considered.
Pathophysiology of Sickle Cell Disease Hemoglobin (Hb) molecules consist of polypeptide chains whose chemical structure is genetically controlled.
N Engl J Med 381 (6): 509 - 519, 2019. doi: 10.1056/NEJMoa1903212 Key Points Patients homozygous for hemoglobin S have an abnormal beta chain, resulting in fragile, relatively inflexible red blood cells that can plug capillaries, causing tissue infarction and are prone to hemolysis, causing anemia.
Patients have various acute exacerbations including painful crisis, sequestration crisis, aplastic crisis, and acute chest syndrome.
Long-term consequences include pulmonary hypertension, chronic kidney disease, stroke, aseptic necrosis, and increased risk of infection.
For acute crises, give opioid analgesics for pain, check for worsening anemia (suggesting aplastic or sequestration crisis) and signs of acute chest syndrome or infection, restore normal intravascular volume using 0.9% saline and then give maintenance fluids.
Prevent infection by using vaccinations and prophylactic antibiotics; limit painful crises and risk of disease complications by giving hydroxyurea.
Normal adult blood also contains ≤ 2.5% hemoglobin A2 (composed of alpha and delta chains) and < 1.4% hemoglobin F (fetal hemoglobin), which has gamma chains in the place of beta chains (see also Hemoglobinopathies in Pregnancy).
Hemoglobin F predominates during gestation and gradually decreases, particularly in the first months of life; its concentration increases in certain disorders of hemoglobin synthesis and in aplastic anemia, other bone marrow failure disorders, and myeloproliferative neoplasms.
It is caused by homozygous inheritance of genes for hemoglobin (Hb) S Sickle-shaped red blood cells cause vaso-occlusion and are prone to hemolysis, leading to severe pain crises, organ ischemia, and other systemic complications.
Different hemoglobins (Hbs), as distinguished by electrophoretic mobility, are alphabetically designated in order of discovery (eg, A, B, C), although the first abnormal hemoglobin, sickle cell hemoglobin, was designated Hb S Structurally different hemoglobins with the same electrophoretic mobility are named for the city or location in which they were discovered (eg, Hb S Memphis, Hb C Harlem).
In the US, common anemias include those caused by genetic mutations resulting in Hb S or Hb C disease, and the thalassemias.
In hemoglobin S, valine is substituted for glutamic acid in the 6th amino acid of the beta chain.
Distorted, inflexible RBCs adhere to vascular endothelium and plug small arterioles and capillaries, which leads to infarction.
Vaso-occlusion also causes endothelial injury, which results in inflammation and can lead to thromboses.
Because sickled RBCs are fragile, the mechanical trauma of circulation causes hemolysis (see Overview of Hemolytic Anemia).
Chronic compensatory marrow hyperactivity deforms the bones.
Acute exacerbations (crises) may develop frequently.
Acute exacerbations Acute exacerbations (crises) occur intermittently, often for no known reason.
In some cases, crisis appears to be precipitated by Fever Viral infection Local trauma Vaso-occlusive crisis (pain crisis) is the most common type; it is caused by tissue hypoxia and leads to ischemia and infarction, typically in the bones, but also in the spleen, lungs, or kidneys.
Aplastic crisis occurs when bone marrow erythropoiesis slows during acute infection due to human parvovirus, during which an acute erythroblastopenia may occur.
Acute chest syndrome results from pulmonary microvascular occlusion and is a common cause of death, with mortality rates of up to 10%.
It occurs in all age groups but is most common in childhood.
Repeated episodes predispose to chronic pulmonary hypertension.
Sequestration crisis typically occurs in children whose spleen has not yet become fibrotic due to repeated splenic infarction.
Acute sequestration of sickled cells in the spleen exacerbates anemia.
Hepatic sequestration may occur in children or adults, causing right upper quadrant pain.
Rapid enlargement of the liver can occur and may be accompanied by intrahepatic cholestasis and renal failure.
Infection, bone marrow aplasia, or lung involvement (acute chest syndrome) can develop acutely and be fatal.
Priapism, a serious complication that can cause erectile dysfunction, is most common in young men.
Complications Chronic spleen damage can lead to autoinfarction and increases susceptibility to infection, particularly pneumococcal and Salmonella infections (including Salmonella osteomyelitis).
These infections are especially common in early childhood and can be fatal.
Recurrent ischemia and infarction can cause chronic dysfunction of multiple different organ systems.
Complications include ischemic stroke, seizures, avascular necrosis of the hips, renal concentrating defects, renal papillary necrosis, chronic kidney disease, heart failure, pulmonary hypertension, pulmonary fibrosis, and retinopathy.
Heterozygotes Patients who are heterozygous (Hb AS) do not experience hemolysis or painful crises.
However, they do have an increased risk of chronic kidney disease and pulmonary embolism.
In addition, rhabdomyolysis and sudden death may occur during sustained, exhausting exercise.
Impaired ability to concentrate urine (hyposthenuria) is common.
Unilateral hematuria (by unknown mechanisms and usually from the left kidney) can occur but is self-limited. Typical renal papillary necrosis can occur but is less common than among homozygous patients, and there is an association with the extremely rare medullary carcinoma of the kidney.
Anemia is present, and sickle cells are usually evident on the peripheral smear.
Symptoms and Signs of Sickle Cell Disease Most symptoms occur only in patients who are homozygous and result from Anemia Vaso-occlusive events resulting in tissue ischemia and infarction Anemia is usually severe but varies among patients and is usually compensated; mild jaundice and pallor are common.
Hepatosplenomegaly is common in children, but because of repeated infarctions and subsequent fibrosis (autosplenectomy), the spleen in adults is commonly atrophied.
Cardiomegaly and systolic ejection (flow) murmurs are common.
Cholelithiasis and chronic punched-out skin ulcers around the ankles are common.
Painful vaso-occlusive crisis causes severe pain in long bones, the hands and feet, back, and joints.
Hip pain may result from avascular necrosis of the femoral head.
Severe abdominal pain, which may be due to hepatic vein thrombosis, may develop with or without vomiting and is usually accompanied by back and joint pain.
Acute chest syndrome is characterized by sudden onset of fever, chest pain, and pulmonary infiltrates.
It may follow bacterial pneumonia.
Hypoxemia may develop rapidly, causing dyspnea.
Diagnosis of Sickle Cell Disease DNA testing (prenatal diagnosis) Peripheral smear Solubility testing Hemoglobin electrophoresis (or thin-layer isoelectric focusing) The type of testing done depends on the age of the patient.
DNA testing can be used for prenatal diagnosis or to confirm a diagnosis of the sickle cell genotype.
Screening of neonates is available in most US states and involves hemoglobin electrophoresis.
Screening and diagnosis in children and adults involve examination of the peripheral smear, hemoglobin solubility testing, and hemoglobin electrophoresis.
Prenatal screening The sensitivity of prenatal diagnosis has been greatly improved with the availability of PCR (polymerase chain reaction) technology.
It is recommended for families at risk for sickle cell (eg, couples with medical or family histories of anemia or of suggestive ethnic background).
DNA samples can be obtained by chorionic villus sampling at 10 to 12 weeks' gestation.
Amniotic fluid can also be tested at 14 to 16 weeks.
Diagnosis is important for genetic counseling.
Painful crises are treated with analgesics and other supportive measures.
Newborn screening Universal testing is currently recommended and is frequently one of a battery of newborn screening tests.
To distinguish between hemoglobin (Hb) F, S, A, and C, the recommended tests are hemoglobin electrophoresis using cellulose acetate or acid citrate agar, thin-layer isoelectric focusing, or hemoglobin fractionation by high performance liquid chromatography (HPLC).
Repeat testing at age 3 to 6 months may be necessary for confirmation.
Solubility testing for Hb S is unreliable during the first few months of life.
Screening and diagnosis of children and adults Patients with a family history of sickle cell disease or trait should be screened with peripheral smear, hemoglobin (Hb) solubility testing, and hemoglobin electrophoresis.
Patients with symptoms or signs suggesting the disorder or its complications (eg, poor growth, acute and unexplained bone pain, particularly in the fingers, aseptic necrosis of the femoral head, unexplained hematuria), and patients with African ancestry with normocytic anemia (particularly if hemolysis is present) require laboratory tests for hemolytic anemia, hemoglobin electrophoresis, and examination of RBCs for sickling.
If sickle cell disease is present, the red blood cell count is usually between 2 and 3 million / microL (2 and 3 x 10 12 / L) with hemoglobin reduced proportionately; cells are normocytic (microcytosis suggests a concomitant alpha or beta thalassemia).
Nucleated RBCs frequently appear in the peripheral blood, and reticulocytosis ≥ 10% is common.
Transfusions are occasionally required.
Hb S must be distinguished from other hemoglobin types with a similar electrophoretic pattern by showing the pathognomonic RBC morphology.
Bone marrow examination is not used for diagnosis.
If it is done to differentiate other anemias, it shows hyperplasia, with normoblasts predominating; bone marrow may become aplastic during sickling or severe infections.
The erythrocyte sedimentation rate, if done to exclude other disorders (eg, juvenile rheumatoid arthritis causing hand and foot pain), is low.
Incidental findings on skeletal x-rays may include widening of the diploic spaces of the skull and a sun-ray appearance of the diploic trabeculations.
The long bones often show cortical thinning, irregular densities, and new bone formation within the medullary canal.
Unexplained hematuria, even among patients not suspected of having sickle cell disease, should prompt consideration of sickle cell trait.
Evaluation of exacerbations If patients with known sickle cell disease have acute exacerbations, including pain, fever, or other symptoms of infection, aplastic crisis is considered and a complete blood count and reticulocyte count are done.
A reticulocyte count < 1% suggests aplastic crisis, particularly when hemoglobin decreases below the patient's usual level.
In a painful crisis without aplasia, the white blood cell count rises, often with a shift to the left, particularly during bacterial infection.
Vaccines against bacterial infections, prophylactic antibiotics, and aggressive treatment of infections prolong survival.
The platelet count is usually increased but can fall with the acute chest syndrome.
If measured, serum bilirubin is usually elevated (eg, 2 to 4 mg / dL [34 to 68 micromol / L]), and urine may contain urobilinogen.
In patients with chest pain or difficulty breathing, acute chest syndrome and pulmonary embolism are considered; chest x-ray and pulse oximetry are necessary.
Because acute chest syndrome is the leading cause of death in sickle cell disease, early recognition and treatment are critical.
Hypoxemia or pulmonary parenchymal infiltrates on chest x-ray suggest acute chest syndrome or pneumonia.
Hypoxemia without pulmonary infiltrates suggests pulmonary embolism.
In patients with fever, infection and acute chest syndrome are considered; cultures, chest x-ray, and other appropriate diagnostic tests are done.
Prognosis for Sickle Cell Disease The life span of homozygous patients has steadily increased to > 50 years.
Common causes of death are acute chest syndrome, intercurrent infections, pulmonary emboli, infarction of a vital organ, pulmonary hypertension, and chronic kidney disease.
Treatment of Sickle Cell Disease Broad-spectrum antibiotics (for infection) Analgesics and IV hydration (for vaso-occlusive pain crisis) Oxygen (for hypoxia) Sometimes transfusions Immunizations, folic acid supplementation, and hydroxyurea (for health maintenance) Stem cell transplantation (for advanced complications) Treatment includes regular health maintenance measures as well as specific treatment of the complications as they arise.
Hemosiderosis By James Peter Adam Hamilton, MD, Johns Hopkins University School of Medicine Reviewed / Revised Sep 2022 View Patient Education Hemosiderosis is focal deposition of iron that does not typically cause tissue damage.
Another common site of accumulation is the kidneys, where hemosiderosis can result from extensive intravascular hemolysis.
Free hemoglobin is filtered at the glomerulus, resulting in iron deposition in the kidneys.
The renal parenchyma is not damaged, but severe hemosiderinuria may result in iron deficiency.
Focal hemosiderosis can result from hemorrhage within an organ.
Iron liberated from extravasated red blood cells is deposited within that organ, and significant hemosiderin deposits may eventually develop.
Iron loss due to hemorrhage can still occur and cause iron deficiency anemia because iron stored in nonhematopoietic tissues cannot be reused.
Chronic inflammatory syndromes, such as nonalcoholic fatty liver disease and the metabolic syndrome, can also lead to hemosiderosis.
In affected patients, abdominal MRI may show excess iron in the liver and spleen.
When the lungs are affected, the cause usually is recurrent pulmonary hemorrhage, either idiopathic (eg, Goodpasture syndrome) or due to chronic pulmonary hypertension (eg, as a result of primary pulmonary hypertension, pulmonary fibrosis, or severe mitral stenosis).
Perioral Dermatitis By Jonette E Keri, MD, PhD, University of Miami, Miller School of Medicine Reviewed / Revised Feb 2022 | Modified Sep 2022 View Patient Education Diagnosis Treatment Topic Resources Perioral Dermatitis Perioral dermatitis is an erythematous, papulopustular facial eruption that resembles acne and / or rosacea but typically starts around the mouth.
Biopsy, which is generally not clinically necessary, shows spongiosis and a lymphohistiocytic infiltrate affecting vellus hair follicles.
In the lupoid variant, granulomas may be present.
Treatment of Perioral Dermatitis Avoidance of fluorinated dental products and topical corticosteroids Topical or sometimes oral antibiotics Perioral dermatitis treatment is to stop fluorinated dental products and topical corticosteroids (if being used) and then use topical antibiotics (eg, erythromycin 2% or metronidazole 0.75% gel or cream 2 times a day).
If there is no response, oral doxycycline or minocycline 50 to 100 mg 2 times a day or oral tetracycline 250 to 500 mg 2 times a day (between meals) may be given for 4 weeks and then tapered to the lowest effective dose.
In contrast to acne, antibiotics can usually be stopped.
Topical pimecrolimus (for people > age 2 years) also reduces disease severity.
Isotretinoin has been successfully used to treat granulomatous perioral dermatitis.
Treatment includes avoidance of causes, and topical and sometimes oral antibiotics.
A variety of causes of perioral dermatitis have been proposed, including exposure to topical corticosteroids and / or fluoride in water and toothpaste, but the etiology of perioral dermatitis is unknown.
Despite its name, perioral dermatitis is not a true dermatitis.
The eruption classically starts at the nasolabial folds and spreads periorally, sparing a zone around the vermilion border of the lips.
But the eruption can also spread periorbitally and to the forehead.
Diagnosis of Perioral Dermatitis Clinical evaluation Diagnosis of perioral dermatitis is by appearance; perioral dermatitis is distinguished from acne by the absence of comedones and from rosacea by the latter's lack of lesions around the mouth and eyes.
Pityriasis Rosea By Shinjita Das, MD, Harvard Medical School Reviewed / Revised Aug 2021 | Modified Sep 2022 View Patient Education Symptoms and Signs Diagnosis Treatment Key Points Topic Resources Pityriasis Rosea (Herald... Pityriasis Rosea Pityriasis Rosea (Head and... Pityriasis Rosea (Back) Pityriasis Rosea on the Groin Pityriasis rosea is a self-limited, inflammatory disease characterized by diffuse, scaling papules or plaques.
Most patients itch, occasionally severely.
Papules may dominate with little or no scaling in children and pregnant women.
The rose or fawn color is not as evident in patients with darker skin; children more commonly have inverse pityriasis rosea (lesions in the axillae or groin that spread centrifugally).
Manifestations of Pityriasis Rosea Pityriasis Rosea (Herald Patch) Initially, most people develop one large scaly patch (herald patch; arrow), and within 1 to 2 weeks, smaller pink patches can occur on the trunk, arms, and legs.
Pityriasis Rosea Pityriasis rosea is characterized by an initial 2 - to 10-cm herald patch followed by centripetal eruption of oval papules and plaques with a slightly raised border, typically appearing along skin lines.
Image provided by Thomas Habif, MD. Pityriasis Rosea (Head and Torso) This image shows erythematous and violaceous, ovoid, scaly papules coalescing into patches on the head and torso of a patient with pityriasis rosea.
Pityriasis Rosea (Back) This image shows violaceous, scaly plaques on the back and arms of a patient with pityriasis rosea.
Patches that appear more pink in patients with lighter skin appear violaceous and / or hyperpigmented in patients with darker skin.
Pityriasis Rosea on the Groin This photo shows atypical (inverse) pityriasis rosea characterized by oval scaly plaques in the inguinal creases.
Image provided by E Laurie Tolman, MD.
Classically, lesions orient along skin lines, giving pityriasis rosea a Christmas tree-like distribution when multiple lesions appear on the back.
A prodrome of malaise, headache, and sometimes arthralgia precedes the lesions in a minority of patients.
Diagnosis of Pityriasis Rosea Clinical evaluation Diagnosis of pityriasis rosea is based on clinical appearance and distribution.
Differential diagnosis includes Tinea corporis Tinea versicolor Drug eruptions Psoriasis Parapsoriasis Pityriasis lichenoides chronica Lichen planus Secondary syphilis Serologic testing for syphilis is indicated when the palms or soles are affected, when a herald patch is not seen, or when lesions occur in an unusual sequence or distribution.
Treatment of Pityriasis Rosea Antipruritic therapy No specific treatment is necessary because the eruption usually remits within 5 weeks and recurrence is rare.
Pityriasis rosea most commonly occurs between ages 10 and 35.
Antipruritic therapy such as topical corticosteroids, oral antihistamines, or topical measures may be used as needed.
Some data suggest that acyclovir 800 mg orally 5 times a day for 7 days may be helpful in patients who present early and have widespread disease, or present with flu-like symptoms.
Of note, pityriasis rosea during pregnancy (especially during the first 15 weeks of gestation) is associated with premature birth or fetal demise.
Pregnant women should be offered acyclovir; however, antiviral therapy has not proved to reduce obstetric complications.
Key Points Pityriasis rosea is a self-limited, inflammatory disorder of the skin possibly caused by human herpesvirus types 6, 7, or 8 or drugs.
An initial 2 - to 10-cm herald patch is followed by centripetal eruption of oval papules and plaques with a slightly raised and scaly border, typically appearing along skin lines.
Diagnose based on clinical appearance and distribution.
Pityriasis rosea during the first 15 weeks of pregnancy is associated with premature birth or fetal demise.
Pregnant women should be offered antiviral therapy, even though this has not proved to reduce obstetric complications.
The cause of pityriasis rosea may be viral infection (some research has implicated human herpesviruses 6, 7, and 8).
Drugs may cause a pityriasis rosea-like reaction.
Symptoms and Signs of Pityriasis Rosea The condition classically begins with a single, primary, 2 - to 10-cm herald patch that appears on the trunk or proximal limbs.
A general centripetal eruption of 0.5 - to 2-cm rose - or fawn-colored oval papules and plaques follows within 7 to 14 days.
The lesions have a scaly, slightly raised border (collarette) and resemble ringworm (tinea corporis).
Overview of Dental Emergencies By Michael N Wajdowicz, DDS, Veterans Administration Reviewed / Revised Oct 2022 View Patient Education Emergency dental treatment by a physician is sometimes required when a dentist is unavailable to treat the following conditions: Fractured and avulsed teeth Mandibular dislocation Postextraction problems (eg, bleeding, swelling and pain, alveolitis and osteomyelitis, and osteonecrosis of the jaw [ONJ]) Analgesia and treatment of infection Oral analgesics effective for most dental problems include acetaminophen 650 to 1000 mg every 6 hours and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400 to 800 mg every 6 hours.
For those who cannot tolerate penicillins, alternatives include cephalexin 2 g, azithromycin or clarithromycin 500 mg, or doxycycline 100 mg. All of these alternatives are also given once orally 30 to 60 minutes before the procedure.
Clindamycin is no longer recommended for prophylaxis.
Ibuprofen and acetaminophen also can be used together for a brief period, alternating the drugs every 3 hours.
For severe pain, these drugs may be combined with opioids such as codeine 60 mg; hydrocodone 5 mg, 7.5 mg, or 10 mg; or oxycodone 5 mg.
Antibiotics for dental infections include amoxicillin 500 mg orally every 8 hours for 3 to 7 days, or penicillin VK 500 mg orally every 6 hours for 3 to 7 days.
In patients who are sensitive or allergic to penicillin or its analogs, azithromycin 250 mg is recommended with an initial loading dose of 500 mg followed by 4 days of 250 mg. Alternatively, clindamycin 300 mg orally every 6 hours for 3 to 7 days may be prescribed.
Patients should be monitored for possible resistance to azithromycin and increased risk of Clostridium difficile infection with clindamycin.
Patients who fail to respond to amoxicillin or penicillin can be switched to amoxicillin clavulanate 500/125 mg 3 times a day for 7 days; those with allergy to penicillins can be given metronidazole 500 mg 3 times a day for 7 days along with their initial regimen (1).
Prophylactic antibiotics For prevention of infective endocarditis, the 2021 American Dental Association guidelines (2), as well as the American Heart Association (3), recommend prophylactic antibiotics in patients undergoing dental procedures only for patients with Prosthetic cardiac valves, including transcatheter-implanted prostheses or with prosthetic material used for valve repair Previous infective endocarditis Specific congenital heart diseases Cardiac transplant recipients with heart valve problems (valvulopathy) For patients with prosthetic joint implants, the American Dental Association 2021guidelines (2) state that prophylactic antibiotics are not typically recommended but may be considered for patients with Immunocompromised state Uncontrolled diabetes Past joint infection Recent joint placement Dental procedures requiring prophylaxis are those that require manipulation or perforation of gingival or oral mucosa or that involve the root end area of the teeth (ie, those most likely to cause bacteremia).
The preferred drug is amoxicillin 2 g once orally 30 to 60 minutes before the procedure.
Tropical Sprue By Zubair Malik, MD, Lewis Katz School of Medicine at Temple University Reviewed / Revised Mar 2023 View Patient Education Etiology Symptoms and Signs Diagnosis Treatment Tropical sprue is a rare acquired disease, probably of infectious etiology, characterized by malabsorption and megaloblastic anemia.
Symptoms and Signs of Tropical Sprue Patients commonly have acute diarrhea with fever and malaise.
A chronic phase of milder diarrhea, nausea, anorexia, abdominal cramps, and fatigue follows.
Steatorrhea (foul-smelling, pale, bulky, and greasy stools) is common.
Nutritional deficiencies, especially of folate and vitamin B12, eventually develop after several months to years.
The patient may also have weight loss, glossitis, stomatitis, and peripheral edema.
Diagnosis of Tropical Sprue Endoscopy with small-bowel biopsy Blood tests to screen for consequences of malabsorption Tropical sprue is suspected in people who live in or have visited areas where the disease is endemic and who have megaloblastic anemia and symptoms of malabsorption.
The test of choice is upper gastrointestinal endoscopy with small-bowel biopsy.
Characteristic histologic changes (see table) usually involve the entire small bowel and include blunting of the villi with infiltration of chronic inflammatory cells in the epithelium and lamina propria.
Unlike in celiac disease, anti-tissue transglutaminase antibody (tTG) and anti-endomysial antibody (EMA) are negative in patients with tropical sprue.
Diagnosis is clinical and by small-bowel biopsy.
Additional laboratory studies (eg, complete blood count; albumin; calcium; prothrombin time; iron, folate, and B12 levels) help evaluate nutritional status.
Barium small-bowel follow-through may show segmentation of the barium, dilation of the lumen, and thickening of the mucosal folds.
D-xylose absorption is abnormal in > 90% of cases.
However, these tests are not specific or essential for diagnosis of tropical sprue.
Treatment of Tropical Sprue Long-term tetracycline Treatment of tropical sprue is tetracycline 250 mg orally 4 times a day for 1 or 2 months, then 3 times a day for up to 6 months, depending on disease severity and response to treatment.
Doxycycline 100 mg orally 2 times a day can be used instead of tetracycline.
Folate 5 to 10 mg orally once / day should be given for the first month along with vitamin B12 1 mg IM weekly for several weeks.
Megaloblastic anemia promptly abates, and the clinical response is dramatic.
Other nutritional replacements are given as needed.
Failure to respond after 4 weeks of therapy suggests another condition.
Tropical sprue is a malabsorption syndrome.
Etiology of Tropical Sprue Tropical sprue occurs chiefly in the Caribbean, southern India, and Southeast Asia, affecting both natives and visitors.
The illness is rare in visitors spending < 1 month in areas where the disease is endemic.
Although etiology is unclear, tropical sprue is thought to result from chronic infection of the small bowel by toxigenic strains of coliform bacteria.
Malabsorption of folate and vitamin B12 deficiency results in megaloblastic anemia.
Tropical sprue has rarely been reported in the United States, and the incidence worldwide has been decreasing in recent decades, perhaps because of increasing use of antibiotics for acute traveler's diarrhea.
Intestinal Lymphangiectasia By Zubair Malik, MD, Lewis Katz School of Medicine at Temple University Reviewed / Revised Mar 2023 View Patient Education Symptoms and Signs Diagnosis Treatment Intestinal lymphangiectasia is a rare disorder characterized by obstruction or malformation of the intramucosal lymphatics of the small bowel.
In acquired cases, the defect may be secondary to retroperitoneal fibrosis, constrictive pericarditis, pancreatitis, neoplastic tumors, and infiltrative disorders that block the lymphatics.
Impaired lymphatic drainage leads to increased pressure and leakage of lymph into the intestinal lumen.
Impairment of chylomicron and lipoprotein absorption results in malabsorption of fats and protein.
Because carbohydrates are not absorbed through the lymphatic system, their uptake is not impaired.
Symptoms and Signs of Intestinal Lymphangiectasia Early manifestations of intestinal lymphangiectasia include massive and often asymmetric peripheral edema, intermittent diarrhea, nausea, vomiting, and abdominal pain.
Some patients have mild to moderate steatorrhea (foul-smelling, pale, bulky, and greasy stools).
Chylous pleural effusions (chylothorax) and chylous ascites may be present.
Growth is retarded if onset is in the first decade of life.
Diagnosis of Intestinal Lymphangiectasia Endoscopic small-bowel biopsy Sometimes contrast lymphangiography Diagnosis of intestinal lymphangiectasia usually requires endoscopic small-bowel biopsy, which shows marked dilation and ectasia of the mucosal and submucosal lymphatic vessels at the tips of the villi.
Alternatively, contrast lymphangiography (injection of contrast material via the pedal lymphatics) can show abnormal intestinal lymphatics.
Laboratory abnormalities include lymphocytopenia and low levels of serum albumin, cholesterol, IgA, IgM, IgG, transferrin, and ceruloplasmin.
Barium studies may show thickened, nodular mucosal folds that resemble stacked coins.
D-xylose absorption is normal.
Intestinal protein loss can be shown by using chromium - 51-labeled albumin.
Treatment of Intestinal Lymphangiectasia Supportive care Sometimes surgical resection or repair Abnormal lymphatics cannot be corrected.
Supportive treatment of intestinal lymphangiectasia includes a low-fat (< 30 g / day), high-protein diet containing medium-chain triglyceride supplements.
Supplemental calcium and fat-soluble vitamins are given.
Intestinal resection or anastomosis of the abnormal lymphatics to the venous channels may be beneficial.
Pleural effusions should be drained by thoracentesis.
Symptoms include those of malabsorption, with edema and growth retardation.
Intestinal lymphangiectasia is a malabsorption disorder.
Malformation of the lymphatic system is congenital or acquired.
Congenital cases usually manifest in children (typically diagnosed before age 3 years) and less frequently in adolescents or young adults.
Males and females are equally affected.
Levator Syndrome By Parswa Ansari, MD, Hofstra Northwell-Lenox Hill Hospital, New York Reviewed / Revised Jan 2023 View Patient Education Symptoms and Signs Diagnosis Treatment Levator syndrome is episodic rectal pain caused by spasm of the levator ani muscle.
In severe cases, the pain can persist for many hours and recur frequently.
The patient may have undergone various rectal operations for these symptoms, with no benefit.
Diagnosis of Levator Syndrome Clinical evaluation Physical examination can exclude other painful rectal conditions (eg, thrombosed hemorrhoids, fissures, abscesses).
Physical examination is often normal, although tenderness or tightness of the levator muscle, usually on the left, may be present.
Occasional cases are caused by low back or prostate disorders.
Other causes of pelvic pain (eg, cancer) must be ruled out.
In most cases, a distinct cause of levator syndrome is not identified.
Treatment of Levator Syndrome Analgesics, sitz baths Sometimes electrogalvanic stimulation Treatment of levator syndrome consists of explanations to the patient of the benign nature of the condition.
An acute episode may be relieved by the passage of gas or a bowel movement, by a sitz bath, or by a mild analgesic.
When the symptoms are more intense, physical therapy may be effective.
Skeletal muscle relaxants or anal sphincter massage under local or regional anesthesia can be tried, but the benefit is unclear.
Treatment includes analgesics and sitz baths and sometimes physical therapy.
Proctalgia fugax (fleeting pain in the rectum) and coccydynia (pain in the coccygeal region) are variants of levator syndrome.
Symptoms and Signs of Levator Syndrome Rectal spasm causes pain, typically unrelated to defecation, usually lasting < 20 minutes.
It may occur spontaneously or with sitting and can waken the patient from sleep.
The pain may feel as if it would be relieved by the passage of gas or a bowel movement.
Dysphagia Lusoria By Kristle Lee Lynch, MD, Perelman School of Medicine at The University of Pennsylvania Reviewed / Revised Mar 2022 | Modified Sep 2022 View Patient Education Dysphagia lusoria is caused by compression of the esophagus from any of several congenital vascular abnormalities.
The vascular abnormality is usually an aberrant right subclavian artery arising from the left side of the aortic arch, a double aortic arch, or a right aortic arch with left ligamentum arteriosum.
The dysphagia may develop in childhood or later in life as a result of arteriosclerotic changes in the aberrant vessel.
Barium swallow shows the extrinsic compression, but arteriography is necessary for absolute diagnosis.
Most patients require no treatment, but surgical repair is sometimes done after careful weighing of risks and benefits.
Wiskott-Aldrich Syndrome By James Fernandez, MD, PhD, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University Reviewed / Revised Jan 2023 View Patient Education Symptoms and Signs Diagnosis Treatment Wiskott-Aldrich syndrome is an immunodeficiency disorder that involves a combined B - and T-cell defect and is characterized by recurrent infection, eczema, and thrombocytopenia.
Br J Haematol 106 (4): 875 - 883, 1999. doi: 10.1046 / j.1365 - 2141.1999.01637.x Symptoms and Signs of Wiskott-Aldrich Syndrome The first manifestations are often hemorrhagic (usually bloody diarrhea), followed by recurrent respiratory infections, eczema, and thrombocytopenia.
Cancers, especially B-cell lymphomas (EBV+) and acute lymphocytic leukemia, develop in about 10% of patients > 10 years.
Diagnosis of Wiskott-Aldrich Syndrome Immunoglobulin levels Platelet count and volume assessment White blood cell function tests (eg, neutrophil chemotaxis, T-cell function) Diagnosis of Wiskott-Aldrich syndrome is based on the following: Decreased T-cell count and function Elevated IgE and IgA levels Low IgM levels Low or normal IgG levels Decreased natural killer cell cytotoxicity Impaired neutrophil chemotaxis Antibodies to polysaccharide antigens (eg, blood group antigens A and B) may be selectively deficient; quantitative immunoglobulin response to polysaccharide vaccines (eg, pneumococcal vaccine) is usually measured.
Platelets are small and defective, and splenic destruction of platelets is increased, causing thrombocytopenia.
Mutation analysis may be used to confirm the diagnosis if there is clinical and laboratory evidence of Wiskott-Aldrich syndrome.
Genetic testing is recommended for 1st-degree relatives.
Because risk of lymphoma and leukemia is increased, a complete blood count with differential is usually done every 6 months.
Acute changes in symptoms related to B-cell dysfunction require more in-depth evaluations.
Treatment of Wiskott-Aldrich Syndrome Supportive care using prophylactic immune globulin, antibiotics, and acyclovir For symptomatic thrombocytopenia, platelet transfusion and rarely splenectomy Hematopoietic stem cell transplantation Gene therapy Treatment of Wiskott-Aldrich syndrome is prophylactic antibiotics and immune globulin to prevent recurrent bacterial infections, acyclovir to prevent severe herpes simplex virus infections, and platelet transfusions to treat hemorrhage.
If thrombocytopenia is severe, splenectomy can be done, but it is usually avoided because it increases risk of septicemia.
The most well-established cure is hematopoietic stem cell transplantation, but gene therapy is under study.
A recent small study of lentiviral hematopoietic stem / progenitor cell gene therapy in 8 patients with Wiskott-Aldrich syndrome followed for up to 7.6 years demonstrated resolution of severe infections and eczema and a decrease in autoimmune and bleeding disorders in all of the patients (1).
Without aggressive intervention with transplantation or gene therapy, most patients die by age 15; however, some patients survive into adulthood.
Wiskott-Aldrich syndrome is a primary immunodeficiency disorder that involves combined humoral and cellular immunity deficiencies.
Inheritance is X-linked recessive.
Wiskott-Aldrich syndrome is caused by mutations in the gene that encodes the Wiskott-Aldrich syndrome protein (WASP), a cytoplasmic protein necessary for normal B - and T-cell signaling.
Thrombocytopenia likely occurs due to various reasons, including increased platelet clearance, ineffective thrombocytopoiesis, and / or decreased platelet survival (1).
Because B - and T-cell functions are impaired, infections with pyogenic bacteria and opportunistic organisms, particularly viruses and Pneumocystis jirovecii, develop.
Infections with varicella zoster virus and herpes simplex virus are common.
Common Variable Immunodeficiency (CVID) By James Fernandez, MD, PhD, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University Reviewed / Revised Jan 2023 View Patient Education Symptoms and Signs Diagnosis Treatment Common variable immunodeficiency (acquired or adult-onset hypogammaglobulinemia) is characterized by low immunoglobulin (Ig) levels with phenotypically normal B cells that can proliferate but do not develop into Ig-producing cells.
Impaired T-cell immunity also may be present in some patients.
Autoimmune disorders can occur, including autoimmune thrombocytopenia, autoimmune hemolytic anemia or pernicious anemia, systemic lupus erythematosus, Addison disease, thyroiditis, rheumatoid arthritis, and alopecia areata.
Patients also may develop malabsorption, nodular lymphoid hyperplasia of the gastrointestinal tract, systemic granulomatous inflammation, lymphocytic interstitial pneumonia, splenomegaly, and / or bronchiectasis.
Gastric carcinoma or lymphoma occurs in 10% of patients.
Symptoms and Signs of CVID Patients with CVID have recurrent sinopulmonary infections causing sinus congestion and pressure, cough, shortness of breath, chest pain, mucus production, fevers, chills, and / or lymphadenopathy.
Diagnosis of CVID Measurement of serum immunoglobulin (Ig) and antibody titers Flow cytometry for T-cell and B-cell subsets Serum protein electrophoresis Diagnosis of common variable immunodeficiency is suggested by recurrent sinopulmonary infections and requires all of the following: Low (at least 2 standard deviations below the mean) levels of IgG Low levels of IgA, IgM, or both Impaired response to immunizations (usually both protein and polysaccharide vaccines) Exclusion of other immunodeficiency disorders Antibody or autoantibody levels should not be measured if patients have been treated with IV immune globulin (IVIG) within the previous 6 months because any detected antibodies may be from the IVIG.
B-cell and T-cell quantification by flow cytometry is done to exclude other immunodeficiency disorders and to distinguish CVID from X-linked agammaglobulinemia, multiple myeloma, and chronic lymphocytic leukemia; findings may include low numbers of class-switched memory B cells or CD21+ cells.
Serum protein electrophoresis is done to screen for monoclonal gammopathies (eg, myeloma), which may be associated with reduced levels of other immunoglobulin isotypes.
Spirometry, complete blood count, liver tests, and a basic metabolic panel are recommended yearly to check for associated disorders.
If lung function changes, CT should be done.
Patients have recurrent sinopulmonary infections.
Because mutations are usually sporadic, screening relatives is not recommended unless there is a significant family history of CVID.
Treatment of CVID Prophylactic immune globulin (IgG) replacement therapy Antibiotics for infections Disease-specific treatment for comorbid immunodeficiency disorders such as granulomatous lung disease or associated autoimmune disease Treatment of CVID consists of immune globulin and antibiotics as needed to treat infection.
Rituximab, vedolizumab, tumor necrosis factor (TNF) - alpha inhibitors (eg, etanercept, infliximab), corticosteroids, and / or other treatments may be required to treat complications such as autoimmune disorders, immune enteropathy, lymphoid interstitial pneumonia, and granulomatous inflammation.
Diagnosis is based mainly on serum Ig levels.
Treatment includes prophylactic IgG replacement therapy and antibiotics for infection.
Common variable immunodeficiency (CVID) is a primary immunodeficiency disorder that involves humoral immunity deficiencies.
It includes several different known molecular defects, but in most patients, the molecular defect is unknown.
Mutations are sporadic in > 90% of cases.
CVID is clinically similar to X-linked agammaglobulinemia in the types of infections that develop, but onset tends to be later (typically between ages 20 and 40).
Early Repolarization Syndrome By L Brent Mitchell, MD, Libin Cardiovascular Institute of Alberta, University of Calgary Reviewed / Revised Jan 2023 View Patient Education Diagnosis Treatment Early repolarization syndrome is a genetic disorder of cardiomyocyte ion channel function (channelopathy).
The risk of arrhythmia is higher when the early repolarization pattern is in the inferior leads, the lateral leads, or both.
Early repolarization syndrome appears to result from mutations that produce a Gain of function of outward potassium current channels OR Loss of function of inward sodium or calcium current channels These ion channel changes magnify the normal small transmural voltage gradients during the plateau phase of the action potential.
These gradients produce a J-wave and J-point elevation on the ECG and predispose to polymorphic ventricular tachycardia which can degenerate into ventricular fibrillation.
Prior to the VT / VF the early repolarization pattern may become more exaggerated and the VT / VF may be precipitated by an episode of myocardial ischemia.
The polymorphic VT is often initiated by a short-long-short RR interval sequence (although this sequence is not specific for early repolarization syndrome): The first short RR interval is between a baseline beat (usually a normal beat) and a premature beat (usually a premature ventricular beat).
The long RR interval is the post-extra-systolic pause and ends with a baseline beat (usually a normal beat).
This pause is followed by a short RR interval when the VT begins.
Early repolarization syndrome appears to be inheritable, but disease-specific gene mutations are rarely identified, suggesting that the disorder is often polygenic.
The ventricular arrhythmias may cause palpitations, and / or cardiac arrest.
Syncope may occur but is uncommon because VT that occurs with early repolarization syndrome rarely self-terminates (unlike with some other disorders that cause VT in which syncope is more common).
Patients are predisposed to polymorphic ventricular tachycardia (VT) and ventricular fibrillation (VF).
Diagnosis of Early Repolarization Syndrome Characteristic clinical and ECG manifestations Clinical screening of first-degree family members Diagnosis should be considered in patients who have had polymorphic ventricular tachycardia, ventricular fibrillation, or sudden cardiac arrest (or a family history of those events in the absence of structural heart disease) and who also have ECG changes showing an inferior and / or lateral early repolarization pattern.
The typical ECG finding of early repolarization is J-point elevation of ≥ 1 mm (≥ 0.1 mV) followed by ST segment elevation in two or more contiguous inferior and / or lateral leads.
Because specific gene defects are seldom identified, genetic testing is not typically recommended for patients or family members.
However, first-degree family members should be evaluated clinically and with an ECG.
Treatment of Early Repolarization Syndrome Implantable cardioverter-defibrillator (ICD) if symptomatic For asymptomatic patients with the early repolarization ECG pattern and no family history of sudden death, no treatment is recommended because such patients are at very low risk.
Patients who have had cardiac arrest or who have demonstrated VF or polymorphic VT are at high risk and should have an ICD placed.
An ICD should be considered for certain patients with the early repolarization ECG pattern and certain other high-risk features (1).
When frequent ICD discharges need to be suppressed, quinidine, which blocks the outward potassium current that may be increased in early repolarization syndrome, may be efficacious.
IV isoproterenol may be useful in patients who have multiple episodes of ventricular arrhythmias in quick succession (electrical storm).
Some patients require an implantable cardioverter defibrillator (ICD).
Early repolarization refers to ECG findings typically including J-point elevation ≥ 0.1 mV, often with a slurred or notched appearance, followed by ST-segment elevation in 2 or more contiguous leads.
This ECG pattern is not uncommon, as it occurs in about 5% to 10% of the population, especially in men, younger patients, and athletes.
Most people with this early repolarization ECG pattern do not manifest arrhythmias.
However, early repolarization is substantially more common in survivors of apparently idiopathic ventricular fibrillation (VF), and early repolarization syndrome refers to people with early repolarization on ECG who also have had symptomatic ventricular arrhythmias.
Cor Pulmonale By Nowell M Fine, MD, SM, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary Reviewed / Revised Sep 2022 View Patient Education Pathophysiology Etiology Symptoms and Signs Diagnosis Treatment Key Points Topic Resources Cor Pulmonale (Echocardiogram) Causes of Cor Pulmonale Cor pulmonale is right ventricular (RV) enlargement secondary to a lung disorder that causes pulmonary artery hypertension.
Demands on the RV may be intensified by increased blood viscosity due to hypoxia-induced polycythemia.
Rarely, RV failure affects the LV if a dysfunctional septum bulges into the LV, interfering with filling and thus causing diastolic dysfunction.
Etiology of Cor Pulmonale Acute cor pulmonale has few causes.
Chronic cor pulmonale is usually caused by COPD, but there are several less common causes (see table).
In patients with COPD, an acute exacerbation or pulmonary infection may trigger RV overload.
Table Symptoms and Signs of Cor Pulmonale Initially, cor pulmonale is asymptomatic, although patients usually have significant symptoms (eg, dyspnea, exertional fatigue) due to the underlying lung disorder.
Later, as RV pressures increase, physical signs commonly include a left parasternal systolic lift, a loud pulmonic component of the 2nd heart sound (S2), and murmurs of functional tricuspid and pulmonic insufficiency (regurgitation).
Later, an RV gallop rhythm (3rd [S3] and 4th [S4] heart sounds) augmented during inspiration, distended jugular veins (with a dominant a wave unless tricuspid regurgitation is present), hepatomegaly, and lower-extremity edema may occur.
Diagnosis of Cor Pulmonale Clinical suspicion Echocardiography Cor pulmonale should be suspected in all patients with one of its causes.
Chest x-ray shows RV and proximal pulmonary artery enlargement with distal arterial attenuation.
ECG evidence of RV hypertrophy (eg, right axis deviation, QR wave in lead V1, and dominant R wave in leads V1 to V3) correlates well with degree of pulmonary hypertension.
However, because pulmonary hyperinflation and bullae in COPD cause realignment of the heart, physical examination, x-rays, and ECG may be relatively insensitive.
Echocardiography or radionuclide imaging is done to evaluate LV and RV function; echocardiography can assess RV systolic pressure but is often technically limited by the lung disorder; cardiac MRI may be helpful in some patients to assess cardiac chambers and function.
Right heart catheterization may be required for confirmation.
Treatment of Cor Pulmonale Treatment of cause Treatment of cor pulmonale is difficult; it focuses on the cause (see table), particularly alleviation or moderation of hypoxia.
Early identification and treatment are important before structural changes become irreversible.
If peripheral edema is present, diuretics may seem appropriate, but they are helpful only if LV failure and pulmonary fluid overload are also present.
Diuretics should be used cautiously because small decreases in preload often worsen cor pulmonale.
Pulmonary vasodilators (eg, hydralazine, calcium channel blockers, nitrous oxide, prostacyclin, phosphodiesterase inhibitors), although beneficial in primary pulmonary hypertension, are not effective.
Findings include peripheral edema, neck vein distention, hepatomegaly, and a parasternal lift.
Bosentan, an endothelin receptor blocker, also may benefit patients with primary pulmonary hypertension, but its use is not well studied in cor pulmonale.
Digoxin is effective only if patients have concomitant LV dysfunction; caution is required because patients with COPD are sensitive to digoxin 's effects.
Phlebotomy during hypoxic cor pulmonale has been suggested, but the benefits of decreasing blood viscosity are not likely to offset the harm of reducing oxygen-carrying capacity unless significant polycythemia is present.
For patients with chronic cor pulmonale, long-term anticoagulants reduce risk of venous thromboembolism.
Key Points Cor pulmonale is RV enlargement and eventually failure secondary to a lung disorder that causes pulmonary artery hypertension.
Cor pulmonale itself is usually asymptomatic but common physical findings include a left parasternal systolic lift, a loud pulmonic component of S2, functional tricuspid and pulmonic regurgitation murmurs, and later, distended jugular veins, hepatomegaly, and lower-extremity edema.
Diagnosis usually requires echocardiography or radionuclide imaging, and sometimes right heart catheterization.
Early identification and treatment of the cause are important before cardiac structural changes become irreversible.
Although patients may have significant peripheral edema, diuretics are not helpful and may be harmful; small decreases in preload often worsen cor pulmonale.
Diagnosis is clinical and by echocardiography.
Cor pulmonale is usually chronic but may be acute and reversible.
Primary pulmonary hypertension (ie, not caused by a pulmonary or cardiac disorder) is discussed elsewhere.
Pathophysiology of Cor Pulmonale Lung disorders cause pulmonary hypertension that can lead to cor pulmonale by several mechanisms: Loss of capillary beds (eg, due to bullous changes in COPD [chronic obstructive pulmonary disease] or thrombosis in pulmonary embolism) Vasoconstriction caused by hypoxia, hypercapnia, or both Increased alveolar pressure (eg, in COPD, during mechanical ventilation) Medial hypertrophy in arterioles (often a response to pulmonary hypertension due to other mechanisms) Pulmonary hypertension increases afterload on the RV, resulting in a cascade of events that is similar to what occurs in LV failure, including elevated end-diastolic and central venous pressure and ventricular hypertrophy and dilation.
In VF, synchronization of a shock to the QRS complex is neither necessary nor possible.
A DC shock applied without synchronization to a QRS complex is DC defibrillation.
Direct current (DC) cardioversion or defibrillation can be delivered as Monophasic current Biphasic current Monophasic current travels in one direction between the two electrodes.
In biphasic devices, the current reverses direction part way through the shock waveform.
The biphasic device requires lower energy and has been shown to lead to higher rates of return of spontaneous circulation (ROSC).
However, survival outcomes are similar in both devices (1).
Most manual and automated external defibrillators (AEDs) are now biphasic because of increased efficiency at restoring sinus rhythm.
Biphasic devices are also smaller in size (making the devices more portable).
Procedure for DC cardioversion When DC cardioversion is elective, patients should fast for 6 to 8 hours to avoid the possibility of aspiration.
Because the procedure is frightening and painful, brief general anesthesia or IV analgesia and sedation (eg, fentanyl 1 mcg / kg, then midazolam 1 to 2 mg every 2 minutes to a maximum of 5 mg) is necessary.
Equipment and personnel to maintain the airways must be present.
After synchronization to the QRS complex is confirmed on the monitor, a shock is given.
The most appropriate energy level varies with the tachyarrhythmia being treated.
For defibrillation of ventricular fibrillation or pulseless ventricular tachycardia, the energy level for the first shock is 120 to 200 joules for biphasic devices (or according to manufacturer specification) although many practitioners use the maximum device output in this setting 360 joules for monophasic devices (or according to manufacturer specification) Subsequent shocks are at the same or higher energy level for biphasic devices and are at the same level for monophasic devices.
For synchronized cardioversion of atrial fibrillation, the energy level for the first shock is 100 to 200 joules for biphasic devices (or depending on manufacturer specification) 200 joules for monophasic devices (or according to manufacturer specification) Subsequent shocks are at the same or higher energy level for both biphasic and monophasic devices.
DC cardioversion-defibrillation can also be applied directly to the heart during a thoracotomy or through use of an intracardiac electrode catheter; then, much lower energy levels are required.
Less commonly, but more likely if patients have marginal left ventricular function or multiple shocks are used, cardioversion precipitates myocyte damage and electromechanical dissociation.
If necessary, direct antiarrhythmic therapy, including antiarrhythmic drugs, direct current (DC) cardioversion-defibrillation, implantable cardioverter-defibrillators (ICDs), pacemakers (and a special form of pacing, cardiac resynchronization therapy), catheter ablation, surgery, or a combination, is used.
A transthoracic DC shock of sufficient magnitude depolarizes the entire myocardium, rendering the entire heart momentarily refractory to repeat depolarization.
Thereafter, the most rapid intrinsic pacemaker, usually the sinoatrial (SA) node, reassumes control of heart rhythm.
However, it is less effective for terminating tachyarrhythmias that result from automaticity because the return rhythm is likely to be the automatic tachyarrhythmia.
In the remaining 20% of patients with Raynaud symptoms, a causative underlying disease (eg, systemic sclerosis) will be evident at initial presentation or diagnosed subsequently.
Secondary Raynaud syndrome accompanies various disorders and conditions, mostly connective tissue disorders (see table Causes of Secondary Raynaud Syndrome).
Table Nicotine commonly contributes to secondary Raynaud syndrome but is often overlooked.
Raynaud syndrome may accompany migraine headaches, variant angina, and pulmonary hypertension, suggesting that these disorders share a common vasospastic mechanism.
Symptoms and Signs of Raynaud Syndrome Sensations of coldness, burning pain, paresthesias, or intermittent color changes of one or more digits are precipitated by exposure to cold, emotional stress, or vibration.
Rewarming the hands accelerates restoration of normal color and sensation.
Color changes are clearly demarcated across the digit.
They may be triphasic (pallor, followed by cyanosis and after warming by erythema due to reactive hyperemia), biphasic (cyanosis, erythema), or uniphasic (pallor or cyanosis only).
Changes are often symmetric.
Raynaud syndrome does not occur proximal to the metacarpophalangeal joints; it most commonly affects the middle 3 fingers and rarely affects the thumb.
Vasospasm may last minutes to hours but is rarely severe enough to cause tissue loss in primary Raynaud syndrome.
Raynaud syndrome secondary to a connective tissue disorder may progress to painful digital gangrene; Raynaud syndrome secondary to systemic sclerosis tends to cause extremely painful, infected ulcers on the fingertips.
Manifestations of Raynaud Syndrome Raynaud Syndrome With Cyanosis Multiple fingertips are cyanotic.
© Springer Science+Business Media Raynaud Syndrome With Pallor Pallor develops irregularly in the fingers.
© Springer Science+Business Media Raynaud Syndrome With Digital Gangrene Ulceration and gangrene affect the 2nd finger in this patient who had Raynaud syndrome secondary to systemic sclerosis.
© Springer Science+Business Media Diagnosis of Raynaud Syndrome Clinical criteria Examination and testing for underlying disorder Raynaud syndrome itself is diagnosed clinically.
Acrocyanosis also causes color change of the digits in response to cold but differs from Raynaud syndrome in that it is persistent, not easily reversed, and does not cause trophic changes, ulcers, or pain.
Primary and secondary forms are distinguished clinically, supported by vascular laboratory studies and blood testing.
Clinical findings A thorough history and physical examination directed at identifying a causative disorder are helpful but rarely diagnostic.
Occasionally, other acral parts (eg, nose, tongue) are affected.
Findings suggesting primary Raynaud syndrome are the following: Age at onset < 40 (in two thirds of cases) Mild symmetric attacks affecting both hands No tissue necrosis or gangrene No history or physical findings suggesting another cause Findings suggesting secondary Raynaud syndrome are the following: Age at onset > 30 Severe painful attacks that may be asymmetric and unilateral Ischemic lesions History and findings suggesting an accompanying disorder Laboratory testing Vascular laboratory testing includes measuring digital pulse wave forms and pressures.
The main blood tests are to diagnose collagen vascular diseases (eg, measurement of erythrocyte sedimentation rate [ESR] or C-reactive protein, antinuclear and anti-DNA antibodies, rheumatoid factor, anticentromere antibody, anti-cyclic citrullinated peptide [CCP] antibodies, anti-scleroderma [SCL] 70 antibody).
Treatment of Raynaud Syndrome Trigger avoidance Smoking cessation Calcium channel blockers or prazosin Treatment of primary Raynaud syndrome involves avoidance of cold, smoking cessation, and, if stress is a triggering factor, relaxation techniques (eg, biofeedback) or counseling.
Drugs are used more often than behavioral treatments because of convenience.
Vasodilating calcium channel blockers (eg, extended-release nifedipine 60 to 90 mg orally once a day, amlodipine 5 to 20 mg orally once a day, felodipine 2.5 to 10 mg orally twice a day, or isradipine 2.5 to 5 mg orally twice a day) are most effective, followed by prazosin 1 to 5 mg orally once a day or twice a day.
Topical nitroglycerine paste, pentoxifylline 400 mg orally twice or 3 times a day with meals, or both may be effective, but no evidence supports routine use.
Beta-blockers, clonidine, and ergot preparations are contraindicated because they cause vasoconstriction and may trigger or worsen symptoms.
Treatment of secondary Raynaud syndrome focuses on the underlying disorder.
Calcium channel blockers or prazosin is also indicated, given as above for primary Raynaud syndrome.
Antibiotics, analgesics, and, occasionally, surgical debridement may be necessary for ischemic ulcers.
The disorder may be primary or secondary.
Low-dose aspirin may prevent thrombosis but theoretically may worsen vasospasm via prostaglandin inhibition.
IV prostaglandins (alprostadil, epoprostenol, iloprost) appear to be effective and may be an option for patients with ischemic digits.
However, these drugs are not widely available, and their role is yet to be defined.
Cervical or local sympathectomy is controversial; it is reserved for patients with progressive disability unresponsive to all other measures, including treatment of underlying disorders.
Sympathectomy often abolishes the symptoms, but relief may last only 1 to 2 years.
Key Points Raynaud syndrome is reversible vasospasm of parts of the hand in response to cold or emotional stress.
Raynaud syndrome may be primary or secondary to another disorder, typically one affecting connective tissue.
Primary Raynaud syndrome, unlike the secondary form, rarely causes gangrene or tissue loss.
Diagnose clinically but consider testing to diagnose a suspected cause.
Avoid cold, smoking, and any other triggers.
Diagnosis is clinical; testing focuses on distinguishing primary from secondary disease.
Give a vasodilating calcium channel blocker or prazosin.
Treatment of uncomplicated cases includes avoidance of cold, biofeedback, smoking cessation, and, as needed, vasodilating calcium channel blockers (eg, nifedipine) or prazosin.
Overall prevalence is about 3 to 5%; women are affected more than men, and younger people are affected more than older people.
Raynaud syndrome is probably due to an exaggerated alpha-2 adrenergic response that triggers vasospasm; the mechanism is not defined.
Primary Raynaud syndrome is much more common (> 80% of cases) than secondary; it occurs without symptoms or signs of other disorders.
Revascularization for Acute Coronary Syndromes By Ranya N Sweis, MD, MS, Northwestern University Feinberg School of Medicine; Arif Jivan, MD, PhD, Northwestern University Feinberg School of Medicine Reviewed / Revised Jun 2022 | Modified Sep 2022 View Patient Education Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction ST-Segment Elevation Myocardial Infarction Topic Resources Thrombolysis in Myocardial... Fibrinolytic Therapy for STEMI Revascularization is the restoration of blood supply to ischemic myocardium in an effort to limit ongoing damage, reduce ventricular irritability, and improve short-term and long-term outcomes in patients with acute coronary syndromes.
ST-Segment Elevation Myocardial Infarction Emergency PCI is the preferred treatment of ST-segment elevation myocardial infarction (STEMI) when available in a timely fashion (door to balloon-inflation time < 90 minutes) by an experienced operator (1).
Indications for urgent PCI later in the course of STEMI include hemodynamic instability, malignant arrhythmias requiring transvenous pacing or repeated cardioversion, and age > 75.
If the lesions necessitate CABG, there is about 4 to 12% mortality and a 20 to 43% morbidity rate.
If there is likely to be a significant delay in availability of PCI, thrombolysis should be done for STEMI patients meeting criteria (see table Fibrinolytic Therapy for STEMI).
Used with aspirin, fibrinolytics reduce hospital mortality rate by 30 to 50% and improve ventricular function.
Modes of revascularization include: Thrombolysis with fibrinolytic drugs Percutaneous coronary intervention (PCI), with or without stent placement Coronary artery bypass grafting (CABG) The use, timing, and modality of revascularization depend on which acute coronary syndrome (ACS) is present, timing of presentation, extent and location of anatomic lesions, and availability of personnel and facilities (see figure — 1).
Prehospital use of fibrinolytics by trained paramedics can significantly reduce time to treatment and should be considered in situations in which PCI within 90 minutes is not possible, particularly in patients presenting within 3 hours of symptom onset.
Regardless, most patients who undergo thrombolysis will ultimately require transfer to a PCI-capable facility for elective angiography and PCI as necessary before discharge.
PCI should be considered after fibrinolytics if chest pain or ST-segment elevation persists ≥ 60 minutes after initiation of fibrinolytics or if pain and ST-segment elevation recur, but only if PCI can be initiated < 90 minutes after onset of recurrence.
If PCI is unavailable, fibrinolytics can be repeated.
Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction Immediate reperfusion is not as urgent in patients with uncomplicated non-ST-segment elevation myocardial infarction (NSTEMI), in whom a completely occluded infarct-related artery at presentation is uncommon, or in patients with unstable angina who respond to medical therapy.
A noninterventional approach and a trial of medical management are used for patients in whom angiography demonstrates Only a small area of myocardium at risk Lesion morphology not amenable to PCI Anatomically insignificant disease (< 50% coronary stenosis) Significant left main disease in patients who are candidates for CABG Further, angiography or PCI should be deferred in favor of medical management for patients with a high risk of procedure-related morbidity or mortality.
By contrast, patients with persistent chest pain despite maximal medical therapy or complications (eg, markedly elevated cardiac markers, presence of cardiogenic shock, acute mitral regurgitation, ventricular septal defect, unstable arrhythmias) should proceed directly to the cardiac catheterization laboratory to identify coronary lesions requiring PCI or CABG.
As in patients with stable angina, CABG has historically been preferred over PCI for patients with left main or left main equivalent disease (although the data supporting this practice are changing) and for those with left ventricular dysfunction or diabetes.
CABG must also be considered when PCI is unsuccessful, cannot be used (eg, in lesions that are long or near bifurcation points), or causes acute coronary artery dissection.
Fibrinolytics are not indicated for unstable angina or NSTEMI.
Lumbar Herniated Nucleus Pulposus (Herniated Lumbar Disk; Ruptured Lumbar Disk; Prolapsed Intervertebral Disk) By Peter J Moley, MD, Hospital for Special Surgery Reviewed / Revised Oct 2022 View Patient Education Symptoms and Signs Diagnosis Treatment Key Points Topic Resources Herniated Nucleus Pulposus Herniated Disk (MRI Scan) Herniated nucleus pulposus is prolapse of an intervertebral disk through a tear in the surrounding annulus fibrosus.
Posterior protrusion may compress the cord in the cervical, thoracic, or upper lumbar spine or the cauda equina, especially in a congenitally narrow spinal canal (spinal stenosis).
In the lumbar area, > 80% of disk ruptures affect L5 or S1 nerve roots.
Herniated disks are common.
Symptoms and Signs of Lumbar Herniated Nucleus Pulposus Herniated disks often cause no symptoms, or they may cause symptoms and signs in the distribution of affected nerve roots.
Pain usually develops suddenly, and back pain is typically relieved by rest and activity modification.
In contrast, nerve root pain caused by an epidural tumor or abscess begins more insidiously, and back pain is worse at night while in bed.
Cauda equina compression often results in urine retention or incontinence due to loss of sphincter function.
In patients with lumbosacral herniation, coughing, sneezing, and activities such as sitting and bending forward increase the pain.
Diagnosis of Lumbar Herniated Nucleus Pulposus MRI or CT Diagnosis is usually suspected during a history and physical examination and confirmed by MRI or CT.
The physical examination should include the an evaluation of strength, sensation, and reflexes.
The tear causes pain due to irritation of sensory nerves in the disk, and when the disk impinges on an adjacent nerve root, a segmental radiculopathy with paresthesias and weakness in the distribution of the affected root results.
Tests for dural tension should also be done.
On examination, with the patient in supine with legs extended, raising the leg may cause pain to radiate down the posterior thigh to below the knee (straight leg-raising test).
Straightening the knee while sitting can produce similar pain (sitting straight-leg raising test).
A variation of this test in which straightening the knee with the patient sitting and bending forward at the waist with the foot dorsiflexed is called the slump test.
In upper lumbar disc herniation (L1 - 2, L2 - 3), extending the leg at the hip with the patient prone can cause pain radiating into the anterior thigh (femoral stretch test).
Achilles tendon and patellar reflexes may be diminished or absent.
MRI or CT can identify the cause and precise level of the lesion.
Rarely (ie, when MRI is contraindicated and CT is inconclusive), CT myelography is necessary.
Electrodiagnostic testing may help identify the involved root.
Diagnosis is usually confirmed by MRI or CT.
Because an asymptomatic herniated disk is common, the clinician must carefully correlate symptoms with MRI abnormalities before invasive procedures are considered.
Treatment of Lumbar Herniated Nucleus Pulposus Conservative treatment initially Invasive procedures, sometimes including surgery, if neurologic deficits are progressive or severe Because a herniated disk desiccates and shrinks over time, symptoms tend to abate regardless of treatment.
Up to 85% of patients with back pain—regardless of cause—recover without surgery within 6 weeks.
Conservative treatment Treatment of a herniated disk should be conservative unless neurologic deficits are progressive or severe.
Heavy or vigorous physical activity is restricted, but ambulation and light activity (eg, lifting objects < 2.5 to 5 kg [about 5 to 10 lb] using correct techniques) are permitted as tolerated; prolonged bed rest and traction are no longer indicated.
Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), or other analgesics should be used as needed to relieve pain.
Oral methylprednisolone may be given, tapered over 6 days, starting with 24 mg daily and decreased by 4 mg a day.
In selected patients, gabapentin and amitriptyline are often used for refractory neuropathic pain.
Physical therapy and home exercises can improve posture and strengthen back muscles and thus reduce spinal movements that further irritate or compress the nerve root.
Treatment of mild cases is with analgesics, activity modification, and physical therapy.
Percutaneous approaches to remove bulging disk material are still being evaluated.
Dissolving herniated disk material with local injections of the enzyme chymopapain is not recommended.
Lesions acutely compressing the spinal cord or cauda equina (eg, causing urine retention or incontinence) require immediate surgical evaluation (see diagnosis of spinal cord compression).
Key Points Herniated lumbar disks are common and usually affect nerve roots at L5 or S1.
If symptoms develop suddenly and back pain is relieved with rest, suspect a herniated disk rather than an epidural tumor or abscess.
Recommend analgesics, light activity as tolerated, and exercises to improve posture and strength; however, if pain or deficits are severe or worsening, consider invasive procedures.
Bed rest is rarely indicated.
Patients with progressive or severe neurologic deficits, intractable pain, conservative treatment failure, myelopathy, or cauda equina syndrome with associated sphincter dysfunction may require immediate or later elective surgery (eg, diskectomy, laminectomy).
Spinal vertebrae are separated by fibrocartilaginous disks consisting of an outer annulus fibrosus and an inner nucleus pulposus.
When degenerative changes (with or without trauma) result in protrusion or rupture of the nucleus through the annulus fibrosus in the lumbosacral or cervical area, the nucleus is displaced posterolaterally or posteriorly into the extradural space.
Radiculopathy occurs when the herniated nucleus compresses or irritates the nerve root.
Tibialis Posterior Tendinosis and Tibialis Posterior Tenosynovitis (Posterior Tibial Tendon Dysfunction) By Kendrick Alan Whitney, DPM, Temple University School of Podiatric Medicine Reviewed / Revised Oct 2021 | Modified Sep 2022 View Patient Education Symptoms and Signs Diagnosis Treatment Topic Resources How to Examine the Foot How To Examine the Ankle Tibialis posterior tendinosis, which is degeneration of the tibialis posterior tendon, and tibialis posterior tenosynovitis are the most common causes of pain behind the medial malleolus.
If the tendon ruptures (eg, with chronic tendinosis), the foot may acutely flatten (arch collapse) and pain may extend into the sole.
In tenosynovitis, pain is typically more acute and the tendon may feel thick and swollen as it courses around the medial malleolus.
Diagnosis MRI Tibialis posterior tendinosis and tenosynovitis are diagnosed clinically.
Palpation of the tendon with the foot in an inverted plantar flexed position with applied resistance is usually painful.
Standing on the toes is usually painful and may not be possible if the tendon is ruptured or severely dysfunctional.
Pain and swelling with tenderness of the tibialis posterior tendon behind the medial malleolus is suggestive of tenosynovitis.
Unilateral arch collapse with medial ankle bulging and forefoot abduction (too many toes sign) is particularly suggestive of advanced tendon pathology and warrants testing for tendon rupture.
MRI or ultrasonography can confirm a fluid collection around the tendon (indicating tenosynovitis) or the extent of chronic degradation or tearing to the tendon with associated tendinosis.
How to Examine the Foot VIDEO How To Examine the Ankle VIDEO Treatment Orthotics and braces or surgery Complete rupture of the tibialis posterior tendon requires surgery if normal function is the goal.
Surgery is especially important in young active patients with acute tears.
The posterior tibial tendon lies immediately behind the medial malleolus.
Conservative therapy consists of mechanically off-loading the tendon by using custom-molded ankle braces or orthotics modified with a deepened heel cup and appropriate medial wedging or posting.
Corticosteroid injections exacerbate the degenerative process (see Considerations for using corticosteroid injections).
For tenosynovitis, rest and aggressive anti-inflammatory therapy are warranted.
Degeneration results from long-standing biomechanical problems, such as excessive pronation (often in obese people) or chronic tenosynovitis.
Tenosynovitis of the tendon sheath begins with acute inflammation.
The tendon can be involved by primary inflammatory disorders, such as rheumatoid arthritis or gout.
Symptoms and Signs Early on, patients experience occasional pain behind the medial malleolus.
Over time, the pain becomes severe, with painful swelling behind the medial malleolus.
Normal standing, walking, and standing on the toes become difficult.
Posterior Achilles Tendon Bursitis By Kendrick Alan Whitney, DPM, Temple University School of Podiatric Medicine Reviewed / Revised Oct 2021 | Modified Sep 2022 View Patient Education Symptoms and Signs Diagnosis Treatment Topic Resources How to Examine the Foot How To Examine the Ankle Posterior Achilles tendon bursitis is inflammation of a bursa that forms in response to shoe pressure and is located at the top edge of the posterior shoe counter between the skin and Achilles tendon.
Early symptoms may be limited to redness, pain, and warmth.
Later, superficial skin erosion may occur.
After months or longer, a fluctuant, tender, cystic nodule 1 - to 3-cm in diameter develops.
It is red or skin-colored.
In chronic cases, the bursa becomes fibrotic and calcified.
Diagnosis Symptoms and a small, tender, and skin-colored or red nodule The presence of the small, tender, and skin-colored or red nodule in a patient with symptoms consistent with posterior Achilles tendon bursitis is diagnostic.
Rarely, an Achilles tendon xanthoma develops at the top edge of the posterior shoe counter but tends to be pink and asymptomatic.
Achilles tendon enthesopathy causes pain mainly at the tendon's insertion but may also cause pain at the top edge of the posterior shoe counter.
Enthesopathy is differentiated by the absence of a soft-tissue lesion.
How to Examine the Foot VIDEO How To Examine the Ankle VIDEO Treatment Modification of footwear Properly fitting shoes with low heels are essential for people with posterior Achilles tendon bursitis.
A foam rubber or felt heel pad may be needed to lift the heel high enough so that the bursa does not contact the shoe counter.
Protective gel wraps, padding around the bursa, or the wearing of a backless shoe until inflammation subsides is indicated.
Foot orthotics may enhance rear foot stability and help reduce irritating motion on the posterior calcaneus while walking.
Warm or cool compresses, nonsteroidal anti-inflammatory drugs (NSAIDs), and intrabursal injection of a local anesthetic / corticosteroid solution offer temporary relief; the Achilles tendon itself must not be injected (see Considerations for using corticosteroid injections).
Surgical removal of a portion of the underlying bone may rarely be necessary to reduce soft-tissue impingement.
Treatment is footwear modification.
Posterior Achilles tendon bursitis occurs mainly in young women.
Wearing high-heeled shoes is a risk factor.
Another risk factor is a bony prominence (Haglund deformity) on the calcaneus.
This deformity predisposes to bursa formation if repeatedly irritated by the shoe counter.
Symptoms and Signs Symptoms and signs of posterior Achilles tendon bursitis develop at the top edge of the posterior shoe counter.
The rate of conversion to open surgery was 3, 9%.
Average time of removing chest tube after surgery (n=74) was 2, 84±0, 89 days (2 - 6 days).
Average time of hospitalization after surgery (n=74) was 5, 57±1, 14 days (3 - 8 days).
Complication rate of thoracoscopic surgery 1, 3% (grade I complication).
Proportion of followed patients was 76/77 (98, 7%).
The average follow-up time: 31, 95 ± 26, 23 months (1 - 80 months); Accounting for 85, 52% good results, accounting for 9, 21% average.
1 recurrent tumor accounted for 1.32% cases and three cases of myasthenia gravis but also decreased treatment dosage.
Quality of life after surgery were evaluated patients were satisfied or very satisfied with the proportion accounted for 94, 74% complained postoperative decreases with time to a doctor.
Clinical, image diagnostic and labo features of mediastinal tumor group were treated with thoracoscopic surgery The incidence of clinical manifestations took 68, 83% of which symptoms of chest pain, cough and dyspnea were most common; average lasting time of symptoms before hospital admission was 5, 82 ± 7, 69 month (0, 5 - 36 months).
Percentage of tumor was discovered on the radiographs was 88, 31%; 100% mediastinal tumor was discovered by CT-scaner with anterior mediastinal tumor and superior-anterior mediastinal tumor rate 59, 74%; midle mediastinal tumor rate 18, 18% and posterior mediastinal tumor rate 22, 08%.
The average tumor size on CT-scaner was 5, 58 ± 1, 89 cm (2, 3 - 12, 3 cm).
Biopsy rate via CT-scaner for preoperative diagnosis is increased.
All neurinomas located at posterior mediastinum were hyperintensity on the MRI and no related to spinal canal.
No found abnormal about result of immune markers tests in blood at teratomas group and respiratory functions in thymus tumor group.
Indication and results of mediastinal tumor group were treated with thoracoscopic surgery Solid mediastinal tumor with size under 10 cm, not invade adjacent organs and mediastinal cystic designated thoracoscopic surgery had successful rate was 96, 1% with averate time (n = 74) was 116, 28 ± 29, 32 minutes (40 - 180 minutes).
TNB+ and TNB - are majority seen in younger group, pre-menopausal status, risk moderate and high.
TNB+ accounts for higher percentage in stage I, II; in contrast, TNB - is more common in stage II, III.
HER2 is majority seen in younger group, lower 60 Y-O, stage II & III, and risk moderate and high.
LAHH and LBHH are only seen in risk moderate and high.
Pathology: Luminal type: account for the high percentage in NPI low and moderate; in which, LUMA is more common in NPI low, ≤2 cm in sise, grade I and low nodal status; in contrast, LUMB is more common in NPI moderate, >2 - 5 cm in size, and grade II.
TNB+ and TNB - are commonly seen in NPI moderate and high, higher grade, up 3 metastazed nodes.
TNB - accounts for the higher percentage than TNB+ in grade III, metastazed node, NPI high and >5 cm in size.
HER2 type is the most common in >2 - 5 cm in size and metastazed node; it accounts for the high percentage grade III, NPI moderate and high.
LAHH and LBHH types: are commonly seen in NPI low and moderate, grade III.
LAHH type is more common in ≤2 cm in sise, while LBHH accounts for the high percentage in 2 - 5 cm in size.
Le Dinh Roanh Training Facility: Hanoi Medical University BRIEF OF NEW CONCLUSION OF THE DOCTORAL THESIS: Using IHC method for surrogating gene analysis to define molecular types in breast cancer with standards of Bhagarva-2010.
By researching 495 breast cancers, we conclude as following: (1) Molecular types are more common as: LUMA, HER2, TNB+ and LUMB; molecular types are less common as: LBHH, TNB - và LAHH.
In which, luminal type account for the higher percentage in Ki67 low, p53 (-) and p53-Bcl2+; in which, LUMA is almost more common than LUMB.
TNB+ and TNB - are expressed in Ki67 high, p53 (+) 3 point, p53+Bcl2 - group and less expression in Bcl2.
HER2 is similar to TNB+ and TNB - types, but accounts for less rate.
LAHH and LBHH are majority expressed in Ki67 moderate or high, p53 (+) 2 - 3 point and p53+Bcl2+ group.
(2) Regarding the relationship between molecular type with clinico-pathological characteristics: LUMA accounts for the higher percentage in elder group, stage I, risk low and moderate, while LUMB is more common in stage II, risk moderate and high.
Established technical process and successfully produced for the first time in Vietnam and around the world polyvalent F (ab') 2 antivenom of two snakes species Bungarus multicinctus (B M) and Bungarus candidus (B C).
The product has been standardized according to National Standards, Vietnam Pharmacopoeia IV, 2009 (top) of anti snake venom serum for human consumption and as recommended by the World Health Organization (WHO guidelines, 2008).
Refined methods are highly effective in focusing concentration and purification of fragments F (ab') 2, an element necessary to neutralize venom toxins, with the globulin concentration reaches 97.2% in which F (ab') 2 accounts for 95.6%, the amount of albumin was removed almost completely (only 2.8%).
(BC+ BM) antivenom polyvalent F (ab') 2 from horses confirmed the safety and effectiveness of the results of laboratory Quality Assurance and Accreditation grassroots country 's National Institute for Control of Vaccines and medical Biologicals, Ministry of health Vietnam.
Products certified hit all the targets (8/8) safety (general safety, thermal media elements, and the standard sterile rationalization: pH, merthiolat concentration, NaCl concentration, concentration of protein) and 267.5 LD50 / vial titre (5ml), 620µg neutralizing (BC+BM) venom: Certificate answers testing results of the National Institute for control of Vaccines and Biologicals, Ministry of health Vietnam, No: 00610/SPDT-NC, December 1, 2010.
Astrocytoma can have cysts.
Medulloblastoma and ependymoma can metastasize in the spinal cord and invade the brain stem.
All medulloblastomas are classified as malignant grade IV, low-grade astrocytomas (grade I and II) took 92.9% and the percentage of low-grade ependymoma is 64.7%.
The outcomes of cerebellar cancer treatment are not good in a histopathological manner.
The majority of patients died within the first year (78.3% of death cases).
The survival rate after 5 years estimated by Kaplan-Meier curve was 38% in general, specifically, this proportion of medulloblastoma and astrocytoma was 27% and 60% relatively, and most ependymoma patients died before the observation end (5 years).
After finding the results, here are some recommendations: It is essential to diagnose and treat early, combining treatment therapies is needed.
We need an organization managing and studying a compatible treatment therapy and a caring procedure to promote the survivability of children with cerebrum and cerebellar tumors.
Clinical manifestations including headaches, vomiting, staggering, apraxia are prominent symptoms of cerebellar tumors in general and both medulloblastoma, astrocytoma; in the case of ependymoma headaches and vomiting signs are significantly lower.
Determining the incidence rates of medulloblastoma, astrocytoma, ependymoma and other types which are 49.2%; 33.9%; 13.7% and 3.2% respectively.
MRI images of locations of histopathological tumors show that medulloblastoma and ependymoma are mainly found in vermis, the lodgement of astrocytoma is in both vermis and cerebellar hemisphere.
Name of the Thesis: Role of percutaneous CT-guided vertebral biopsy in diagnosis vertebral column diseases Code: 62720166.
- In cases where there are many types of lesions (osteosclerosis, osteolytic, osteonecrosis), biopsy should be performed at the site of soft tissue lesions with better diagnostic value (adequacy 100% versus 95, 1%).
Specialization: Radiology.
PhD Student: Pham Manh Cuong.
- For suspected spinal tuberculosis cases, a histopathological examination, specimen culture and TB PCR testing should be combined to achieve the highest specific diagnostic rate.
Name of the thesis: Applied research sentinel lymph node biopsy in the treatment of the early stage breast cancer.
SLNB should be applied routinely for early-stage breast cancer with non-palpable lymph nodes.
Sentinel node accurately reflected the state of axillary lymph node metastasis of breast cancer patients, with the following indices of extemporary biopsy: sensitivity 88.9%, specificity 100%, accuracy 98.7%, and false negative rate of 11.1%.
In our trial, factors such as age patients, site of tumor, size of tumor and grading tumor do not relate to the ability of lymph node metastasis in early breast cancer.
Assessments of sentinel node biopsy methods outcomes: the average follow-up of 33.24 months reported that patients with pain, swelling and numbness arm in the group of sentinel lymph node biopsy (SLNB) only were significant lower than the group of SLNB and completion axillary lymph node dissection, P <0.001.
3-year Kaplan Meier estimates for overall survival were 98.7% and 3-year Kaplan Meier estimates for disease-free survival was 98.3%.
There were 2.4% local recurrences in the group of breast conserving treatment and no cases ipsilateral axillary recurrences.
Our studies showed that SLNB method using blue methylene in the surgical treatment of early stage breast cancer is safe and effective, especially at breast surgery centers which do not access to radioisotopes facilities.
The study has provided a large data on the application of results of gene mutation analysis in treatment: switching successfully from insulin to oral sulfonylureas in the largest number of patients in Vietnam, follow-up on stopping treatment for 9 patients with transient neonatal diabetes.
Publisher comprehensive treatment results for a large number of patients with neonatal diabetes at a single center: blood glucose control, HbA1C, psychomental development.
Results of sulfonylurea treatment in patients with neonatal diabetes mellitus were confirmed.
M D, PhD Training Institution: Hanoi Medical University New conclusions of the thesis: 1.
First comprehensive study on identifying mutations of over 20 genes and disorder of imprinting on chromosome 6 for a largest cohort of Vietnam patients with neonatal diabetes mellitus.
33/40 (82.5%) patients with neonatal diabetes mellitus have identified mutations in specific gene.
First published data on gene mutations causing neonatal diabetes in Vietnamese.
Spectrum of mutations in 6 genes and the proportion of patients with mutations in each gene were ABCC8 (33.3%), KCNJ11 (27.3%), INS (18.2%); abnormal of 6q24 (15.2%), EIF2AK3 (1 case) và FOXP3 (1 case).
Prof, MD Training institution: Department of Surgery - Hanoi Medical University New conclusions of the thesis: - Research has evaluated the clinical characteristics and diagnostic imaging of pilocytic astrocytoma at different sites: cerebellum, brain stem, chiasma and cerebral hemisphere - Given the success rate of microsurgery as well as the disconcordance between the contrast of tumor in the MRI and the bleeding in the operation - There are several factors that affect the results of micro-surgery treatment: age, preoperative condition, location of tumor in the brain, and the resection.
Name of the thesis: Study of morphology of abdominal trauma on dead victim from road traffic accident by forensic examination
Code: 62.72.01.05; Major: Pathology - Forensic Medicine
The new conclusions of the thesis: On the basis of forensic examination at Viet Duc Hospital for fatalities caused by road traffic accidents occurred in some northern provinces between January 1, 2011 and December 31, 2015, the thesis has identified a number of factors related to road traffic accidents such as the popularity of the type of means of transport, the time of the accident, the condition and the complexity of the trauma, the duration of the life after the accident, in order to alert people when taking part in traffic and provide scientifically valid evidence of road traffic accidents for the authorities to develop and implement more effective preventive measures.
The thesis focuses on external and internal trauma patterns of particular importance in the field of forensic examination.
External trauma make it possible for assessors to identify the mechanism of traumatic injury, the mode and the circumstances in which the vehicles cause the traumas, to facilitate the investigation of civil or criminal liability.
Study of internal traumas allows for the assessment of the location of traumatic organs, traumatic injuries, and associated traumas, in order to prevent them from being overlooked in emergency or treatment for the victim.
By studying the mechanism for causing the type of traumas corresponding to the trauma statistics and descriptions, the forensic examiner can estimate the morphology and extent of the internal trauma in the most likely way, in cases where relatives may not allow the agency to operate the dead body.
These understandings are the basis for the diagnosis and treatment of victims of road traffic accidents.
Thesis: Current state of oral diseases and effectiveness of oral intervention for the older people in Dak Lak Code: 62720601 Speciality: Odonto Stomatology Ph D Student: Le Nguyen Ba Thu Scientific instructor: 1.
This is a suitable method for aging dental physiology in the elderly.
Medical Assoc.
Ph D.Truong Manh Dung 2.
This cross-sectional study is a part of the ministry-level research project Research on the condition of oral diseases of Vietnamese older people which is a review of oral health conditions, treatment demands, and some related factors using World Health Organization questionnaire and clinical report in 1997 forms, supplemented in 2013 and the first national oral health survey in 1990, the second one in 2000.
By some simple, easy-to-implement measures (health education and treatment of cavities and periodontitis) the study has shown good interventions in only a short time: low incidence rates of tooth decay and recurring, high success rate of tooth filling, reduced percentage of elderly people needing to treat periodontal disease, changes of knowledge, attitudes and practice of oral health care in a positive way.
Tittle: Study on ductus venosus Doppler indices in normal fetuses from 22 to 37 weeks of age to establish the centile chart and clinical application.
Le Hoang.
The number of patients going for surgery and surgical procedures was more and more raising responding to 9378 and 4356 cases in 1995 and 11645 and 4868 cases in 2012.
The capacity of using hospital beds felt from 66.2% in 1995 to 11.3% in 2012.
The times for examination of doctors was not high, the average time for examination per day is 3.4 in 1995 and 3.5 in 2012.
Subclinical examination intended to rise in 1995 (4.0) and 2012 (4.8).
Intervention study on management at Cham Pa Sac hospital was the first study carried out in Laos.
The study results had indicated some problems in planning and reporting activities of the hospital.
Therefore, some of solutions to management in the hospital were come up such as setting up operation plan, statistic report.
Those interventions had initially obtained encouraging results.
For the first time in Laos, a study on disease patterns was carried out in the hospital of Cham Pa Sac. From 1995 to 2012, the disease patterns of inpatients that belong to the transmitted diseases group making up the highest percentage.
In particular, there was improvement in both quantity and quality in terms of planning, reporting, monitoring and evaluating.
This result contributed to enhancing the quality of examination and treatment at Cham Pa Sac hospital and expanding the interventions on management at other provincial hospitals of Laos. At the same time, it also contributed to the quality of patient care and health care of people in general.
Noncommunicable diseases tended to increase, especially traffic accidents.
The percentages of infectious diseases, Noncommunicable ones and poisonous accidents in 1995 were 49.6%; 38.4%; and 11.9%; respectively and in 2012 were 37.1%; 42.8% and 20.1%, respectively.
The number of patients taken to the hospital accounted for the highest rate between June and August annually.
Name of thesis: Longitudinal study of Cranio-facial and dental arch growth in a group of Hanoi students aged 11 to 13 years old Specialization: Odonto-Stomatology Code: 62720601 PhD Student: Pham Cao Phong, Course 33 - Specialization in Odonto-Stomatology Instructors: 1.
The work identified 48 craniofaciodental, 7 dental arch sizes of each jaw; described the growth pattern of head and face, dental arch of 122 students from 11 to 13 years old to see the development principles of Vietnamese craniofacial structures.
These were the basic datapublished in first time in Vietnam, made the basis for the diagnosis and planning treatment for patients with orthodontics, as well as for the references in future research.
Currently in Vietnam, although there are some studies on craniofacial anthropometry, the standard measurements for each age, including the age from 11 to 13 years old is not enough, this age is one with high requirement for dental correction.
As a result, the physicians must be familiar with the craniofacial index of each age, understand deeply on the craniofacial and dental arch growth to diagnose and make the treatment plan for children.
With the method of measuring and analyzing on the distal lateral cephalometric radiographs and the gypsum samples of dental arches from 122 students aged 11 to 13 years old at three different measuring times, the Autocad software was used to film-drawing to ensure the accuracy in the technique of cephalometricradiograph overlapping, the method that has not been used by growth-studyingworks in Vietnam.
62.1% of patients have syringomyelia accompanied.
The average degree of tonsillar herniation is 13.2 mm.
The average time of diagnosis is 49.8 months.
29.3% of patients are diagnosed with different diseases and receive long internal medicine treatment before surgery.
MRI scan of skull and / or cervical spine is the main method of diagnosis, clearly showing 100% of patients with CM-I with herniation of cerebellar tonsil through foramen magnum to cervical canal.
100% of images show that large pool of CSF in posterior fossa is compressed or disappears.
The size of posterior cranial fossa is narrowed with funnel shape, the length of petroclival groove and the height of occipital bone are reduced, and Boogard's angle is expanded.
The average degree of tonsillar herniation is 13.2 mm; 58.7% of patients have herniation of more than 10 mm.
36 patients (62.1%) have syringomyelia accompanied.
6 patients (10.3%) have kyphosis / scoliosis.
6 patients (10.3%) have ventricular dilatation.
Surgical Treatment All patients have manifestation of clinical symptoms, and tonsillar herniation through foramen magnum from 3 mm and up shown on MRI images.
Decompression of posterior cranial fossa and cutting of posterior arch of C1 along with duraplasty using musculoaponeurotic tissue are effective methods to re-establish the flow of CSF through craniocervical junction region. There are 11 patients (18.97%) who have syrinx drained to subarachnoid space and 24 cases (41.38%) using bioadhesive to cover the patch on dura mater.
Results of surgical treatment 91.4% of patients are monitored and re-examined after surgery; time of monitoring after surgery is 1 - 50 months. Among them, 84.9% of patients have good clinical results, 13.2% have no changes and 1.9% have bad results.
MRI scan of skull and / or cervical spine for re-examination after surgery is done with 66% of patients, in which 19 cases have good results, 10 cases have syrinx size reduced, 5 cases still have syrinx and 1 case still has ventricular dilatation.
There is no case of bleeding during and after surgery.
There is no patient's death during the period of monitoring after surgery.
Diagnosis 89.7% of cases show signs of suboccipital headache, the pain spreads up to the top of the head, down to the neck and both shoulders.
69% of patients have numbness of hand and feet.
Valsalva maneuver is performed with 46.6% and 84.5% cases of over 18 years old.
The average age is 33.5 years old.
The ratio of females / males is 3/1.
Title: Study on the variability and value of LH in the prognosis of polycystic ovary hyperstimulation in clomiphene citrate alone and in combination with FSH
Single-variable regression revealed a statistically significant association between LH levels and FSH levels, estrogen expressed in the following equations: [LH] = 0, 09 x [oestrogen] + 10, 06 R2 =0, 094 [LH] = 1, 35 x [FSH] + 6, 31 R2 =0, 148
There is a linear relationship between LH levels and the probability of not responding to treatment through the following equation: Ln (= - 0, 881 + 0, 017 x LH = e - 0, 881 + 0, 017xLH hay odd = e - 0, 881 + 0, 017xLH
There is a statistically significant decrease in LH when patients respond to ovulatory stimulation (with ovulation).
In contrast, if the response is not satisfactory, LH levels are almost unchanged before and after treatment.
Specialized: Obstetrics and Gynecology
New findings of thesis:
The mean LH level of infertile patients with polycystic ovaries was 14.48 ± 5.32 and LH ≥ 10 accounted for 81.4%.
Average LH levels are much higher than those of other races but are comparable to that of other studies in Vietnam and in Asia.
The mean LH level of the group of patients with polycystic ovaries (13.78 ± 5.76) was lower than that of the normal ovary group (15, 45) ± 4.5)
There is a inverse relationship between LH and weight: LH = 22, 83 - 0, 167 x weight (kg) R = 0, 223 R2 = 0, 050
There is late puberty in patients with polycystic ovaries that do not respond to CC, the mean age of onset of menstrual periods is: 14, 51 ± 1, 75 (years old)
Patients with polycystic ovaries that do not respond to CC have normal BMI
Ass.
Prof Lê Văn Quảng Training facility: Hanoi Medical University New conclusions of the thesis: - This is the first study in Vietnam, using Methylene Blue to detect sentinel lymph node in thyroid cancer, to help determine the exact occult lymph node metastasis, thereby giving a strategy the cervical lymph node dissection with the same time reasonable thyroidectomy.
- The rate of sentinel lymph node detection with Methylene Blue is very high: 98.2%; Most lymph nodes are in the pre-tracheal group (group 6): 90.4%.
- There is no relationship between factors: age, sex, position of tumor in the lobe, tumor size, stage T and the multifocality with the result of the sentinel lymph node biopsy by Methylene blue.
- Percentage of non-metastatic lymph nodes on pathology: 55.7%; metastasis on pathology: 44.3%, the rate of occult cervical lymph node metastasis is very high: 51.5%.
- Sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy and false negative rate of the method are: 86%, 100%, 100%, 87, 1%, 92.8% and 14% respectively.
Because using these two sequences does not increase the diagnostic values compared to single sequence HASTE diffusion.
The combination of these sequences include HASTE diffusion does not enhance the diagnostic values.
Prof Dr Pham Minh Thong 2.
Asso.
Prof Dr Doan Thi Hong Hoa Education institution: Hanoi Medical University New contributions of the thesis: - MR imaging has high values in diagnosis of recurrent middle ear cholesteatoma.
It can detect recurrent middle ear cholesteatoma which has to be timely operated to prevent complications.
MRI helps to reduce the number of second-look surgeries in terms of checking if there is recurrent cholesteatoma.
- T1W and T2W sequences are not specific in diagnosis of recurrent cholesteatoma.
- HASTE Diffusion is the best sequence to detect recurrent middle ear cholesteatoma with sensitivity (Sn) = 84.8%; specificity (Sp) = 100%; positive predictive value (PPV) = 100%; negative predictive value (NPV) = 70.6%; Accuracy (Ac) = 88.9%.
- The EPI diffusion and DPI (Delayed Post-gadolinium Imaging, 30 - 45 minutes after injection of gadolinium T1W) which are not necessary to be performed, lead to reduce the examination time, contrast medium expense and the allergic risk.
Risk factor for postoperative complication: Age, meatus location, chordee degree, urethral defect length, penile skin cover were not obviously related to the outcome of surgery with HOSE and complications of hypospadias repair.
Age was obviously related to the uroflowmetry at 6 months after surgery, but was not obviously related at 12 months after surgery.
Co-operate was obviously related to the uroflowmetry at 6 months and 12 months after surgery.
For surgical repair of penile hypospadias use transverse pedicled preputial island flap, based on the method of Duckett with improvement.
Apply HOSE scoring system to assess the outcome of hypospadias repair: Successful in 83, 7%; failure 16, 3% 3.
The thesis is both humane and practical and scientific high level.
Serum creatinine after 6 months were: 115.58 ± 25.06 μmol / l, after 1 year: 122.8 ± 33.1 μmol / l. The result works well after kidney transplantation reached 3 years: 89.48%.
The research results have opened up a new direction for the supply of transplant organs, and more specifically the choice for chronic renal failure patients indicated compound.
The purpose of the thesis aims to evaluate a model or rather a process of taking, preserving kidney transplant from a brain-dead at the hospital Viet Duc.
In the short period from 5/2010 to 12/2013 the number of 20 brain-dead organ donor patients and 38 cases of renal transplantation, this thesis contributes the following informations: The thesis has contributed to the standardization process took multiple organs, and kidney transplantation from brain dead people.
The standards provide adequate research, specifically the updated scientific research facilities modern international standards.
The thesis shows the results obtained objectively monitor meticulous detail from results close to the long-term results.
This is good material for the transplant center in the country of reference.
Renal get good results achieved 97.37%.
Renal function restores soon 35/38 kidney transplant: 92.10%.
The follow-up outcomes period was short as 3 months, at most 43 months.
The study indicated exactly the distribution of HPV genotype at genital cancerous tissue.
HPV16 infection accounted for the highest rate, 43.5%, followed by HPV18 - 23%, HPV16, 18 co-infection accounted for 16.2%.
HPV52 infection only accounted for 4.2%.
Of 94% (94/100) HPV16 infection cases was lineage European; sublineage Asian accounted for the highest percentage, 80% (80/100); European prototype - 14%, Asian-American a - 5% and African 2 - 1%.
Epithelial carcinoma accounts for 99.5% (213/214) of genital cancer cases, in which, squamous cell carcinoma accounts for the highest proportion (79.8% - 170/213).
Sublineage Asian of HPV16 appeared in all types of cancer cells and at the squamous cell carcinoma accounts for 90%.
Squamous cell carcinoma infected all sublineage of HPV16, Asian sublineage alone accounted for 78.3%.
Tumor resection was 85, 2%.
Wide tumor resection with margin over 1 cm was 52, 8%.
The incidence of lymphoedema following adjuvant radiotherapy was 23, 2%.
Acute radiation skin toxicities were mostly mild (grade 1) accounted for 59, 2%.
Late radiation skin toxicities were 45, 1% with mostly grade 1 37, 4%.
Joint stiffness were rare by 7, 8%.
Extremity edema met 18, 1%.
Five year overall survival rates were 63, 2%.
Five-year disease free survival rates were 54, 5%.
Five-year recurrent rates were 28, 8%.
This is the first study in Vietnam with a sample size large enough to reach the most complete results on the effectiveness of limb sparing surgery combined with adjuvant radiotherapy in extremity soft tissue sarcoma.
Factors affecting five year overall survival rates were tumor size, tumor depth and histologic grade.
Tumor size, tumor depth, histologic grade and surgical procedures that affect the five-year recurrent rates
The results from the study show that: The most common tumor location in the thigh is 59, 2%.
Undifferentiated pleomorphic sarcoma were 21, 2%.
Grade 3 was highest with 52, 1%.
Prof Mai Trong Khoa Assoc.
79.3% of patients had surgery, in which 67.8% had radical surgery and 12.6% underwent anal sphincter-preserving surgery.
- Radiotherapy using a linear accelerator to deliver a dose of 46Gy combined with a preoperative Capecitabine regimen for low locally advanced rectal cancer was safe, acceptable and resulted in stable toxicities: hematological, hepatic-renal system, gastrointestinal, urinary tract and skin complications were mostly level 1, 2.
- HLA-B * 15: 02 was the most common HLA-B allele in Vietnamese patients (Kinh ethnicity) with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).
HLA-B * 51: 02 allele may play an important role in the pathogenesis of the traditional medicine-induced SJS / TEN.
There may possibly have a link between HLA-B alleles and causative drugs of SJS / TEN.
The HLA-B genotypes may be useful for suggesting the causative drugs in some cases and preventing SJS / TEN.
- Serum granulysin levels were significantly higher in SJS / TEN patients than in erythema multiforme (EM) patients.
After the onset of SJS / TEN, serum granulysin levels were not associated with the severity of the diseases.
- In SJS / TEN patients, serum levels of GM-CSF, TNF-α, IFN -, IL-6 and IL-12 were significantly higher than those in EM patients.
At the day of re-epithelialization, serum levels of GM-CSF, TNF-α, IFN -, IL-1β, IL-5, IL-6 and IL-12 were significantly lower than those at the day of hospitalization.
Serum level of IFN - may be a good biomarker to differentiate SJS / TEN from EM as well as to evaluate the progress and the severity of SJS / TEN.
Through the study of cervical cancer screening for 8, 000 women who are in the age of 21 - 65 years old and had sexual intercourse in 24 rural communes of Vu Thu and Kien Xuong districts of Thai Binh province, we have conclusions as follows: 1.
Effect of detecting precancerous cervical lesions in the community by VIA and its related factors: The positive rate of VIA was 6.89%, cytological abnormalities were 0.3375%, colposcopic and pathological abnormalities were 27/27 (in which: 26 LSIL, 01 HSIL).
Some factors related to the VIA (+) results in our study were: age group 40 - 49; education levels from college to university; a history of abortion ≥ 3 times; birth numbers ≥ 3 times; a history of infection; association with smoking; intercourse ≤ 18 years old.
Research results have contributed to proving that VIA is an effective, appropriate and widely accepted method of cervical cancer screening at the primary health care level, helping to detect early cervical lesions among women at childbearing age.
Evaluate the results of CO2 laser treatment for precancerous cervical lesions: The cure rate after one treatment was 96.6%; The cure rate in the first 3 months was 96.6% and after 6 months is 100%; The average cure time according to the lesion diameter was 70.9 ± 21.6 days; Average mucus-secreting time was 7.32 ± 3.14 days; Complications after treatment was 4.96%.
The results of our study show that CO2 laser treatment is an effective and reliable treatment for precancerous lesions of the cervix.
The method has advantages such as ease of implementation, low cost, effectiveness and safety, and preservation of female reproductive function.
This is the first doctoral thesis in Vietnam about treatment of cerebral arteriovenous malformation with combination of embolization and surgery.
We conclude: Combination of embolization and microsurgery indicated for high grade cerebral arteriovenous malformations (Spetzler-Martin III, IV) Purposes of pre-operative embolization include: 1.
Partial embolization of nidus, 2.
Advantages of combining embolization and microsurgery: reducing intraoperative bleeding (average blood loss 393, 75ml), high rate of total resection (100%) Favorable outcomes: good (mRS 0 - 2) 79, 17%, moderate (mRS 3 - 4) 16, 67%, poor (mRS 5 - 6) 4, 16%
Through a study of 109 transfusion-dependent pediatric thalassemia patients who were assessed iron overload and received deferiprone chelation therapy and followed in 1 year, we would give conclusions as follow: - It is possible to use many methods to assess iron overload at the same time: assessment by serum ferritin index showed that 97, 2% of thalassemia patients with iron overload; new technique T2 * magnetic resonance imaging has been used to measure liver T2 * relaxation time - LIC and heart T2 * relaxation time accurately and estimates the level of iron overload in the liver and heart: there were 99, 1% of patients having liver iron overload and 12, 8% had cardiac iron overload.
- There were correlations between LIC, cardiac MRI T2 * and serum ferritin index, therefore, in facilities that do not have appropriate conditions to use the MRI T2 * technique to assess tissue iron status or in pediatric patients with contraindications or inability to cooperate to perform this technique, we can still assess the patient's iron status by serum ferritin index in order to recommending an appropriate chelation treatment regimen.
- Deferiprone DFP is effective and safe in the treatment of hepatic and cardiac iron overload and reduction of serum ferritin levels in pediatric thalassemia patients with periodic blood transfusions: serum ferritin decreased 459 ng / ml, LIC decreased 4.7 mg / g dry liver, heart T2 * time increased 8.1 ms - The results obtained from the thesis have made a practical contribution to the assessment of iron burden as well as monitoring the effectiveness of deferiprone chelation therapy for pediatric thalassemia patients.
- First successful step in isolating, proliferating and differentiating human embryonic neural stem cells into dopaminergic neurons. - The study was elaborately conducted on a large number of sample to isolating, culturing and differentiating rat and human neural stem cells, serving as a premise for experimental studies on the treatment of Parkinson's disease by stem cells in animals as well as for volunteers in the future.
- For the first time in Vietnam, traumatic macular hole has been examined and evaluated comprehensively and in detail about anatomical characteristics such as apical hole diameter, basal hole diameter, photoreceptor inner segment - outer segment junction... - By OCT, we accurately and objectively measured and evaluated the anatomical changes of traumatic macular hole before and after vitrectomy.
These results have contributed to confirm the role and effectiveness of vitrectomy, internal limitant membrane peeling and gas tamponade in the treatment of traumatic macular hole.
- This study has shown that the MHI and HFF are valuable in predicting the surgical success.
Some other factors such as intraretinal cyst, subretinal fluid, central subfield thickness, central average thickness, EZ defect... are also related to the results of surgery.
- The induction time with propofol TCI effect site concentration combined with ketamine 0, 3 mg / kg is longer than induction with etomidat but shorter and lower dose than induction with propofol TCI set plasma concentration.
- Induction and intubation with propofol TCI effect site concentration combined with ketamine 0, 3 mg / kg had less effect on heart rate and blood pressure than propofol TCI set plasma concentration and induction by etomidate.
- Eligble time for extubation of the method of anesthesia with propofol TCI combined with ketamin is shorter than that of anesthesia with etomidat combined with sevofluran.
Stimulation rate; vomiting, nausea; Post-anesthesia hallucinations of these methods have a low rate and no difference.
The prevalence of rheumatoid arthritis associated interstitial lung disease was 31.6%.
The rate of clinical complaints due to rheumatoid arthritis associated interstitial lung disease were low with: dry cough: 17.9%, sputum cough: 4.5%, dyspnea on exertion: 4, 5%. 14.9% of patients had crackles rales on lung examination.
Lesions on High Resolution Computed Tomography (HRCT) with 32.8% of patients with reticulation; 67.2% of patients have ground glass opacity; 1.5% of patients had honeycombing and 14.9% of patients had traction bronchiectasis.
There are 26.9% patients with mild restrictive ventilatory defect.
In this study, we found a relationship between age, stage of rheumatoid arthritis, serum RF levels, serum anti-CCP levels, smoking in rheumatoid arthritis patients with interstitial lung disease
- This is a study based on a large sample size in Vietnam on a group of patients with poor responder prognosis to ovarian stimulation in IVF treatment with 2 flare-up and antagonist regimens.
On the other hand, high clinical pregnancy rates, shorter duration of use and significantly less total FSH dose were maintained.
- Criteria for selecting patients with poor prognosis is the new standard.
+ AMH ≤ 1, 25ng / ml and / or + AFC less than 5 cysts.
- The research design was a comparative study aiming at determination of effectiveness between 2 ovarian stimulation protocols.
To conduct the study requires the highest similarity between the two regimens, especially with a large sample size.
This study aimed at evaluation of the treatment effectiveness of 2 flare-up and antagonist regimens on patients with poor responder prognosis to ovarian stimulation.
The flare-up regimen and the antagonist regimen noted similarity in endometrial thickness and morphology and the cancellation rate during ovarian stimulation.
Oocyte quality, fertilization rate, implantation rate and clinical pregnancy rate were also similar between the two regimens.
The antagonist regimen is more cost-effective than the flare-up regimen.
Suject: Evaluation the spinal anesthesia and combined spinal epidural anesthesia for cesarean delivry in pregnancies complicated by severe preeclampsia Speciality: Anesthesiology.
Nguyễn Quốc Tuấn Establishment: HaNoi Medical University The new conclusions of thesis: - Spinal anesthesia or combined spinal epidural anesthesia is better than general anesthesia for cesarean delivry in pregnancies complicated by severe preeclampsia: good quality of anesthesia peroperation and good analgesia post - operation, stability of hemodynamic, minor side effects and not newborn baby depressed.
- Its probable to apply spinal anesthesia or combined spinal epidural anesthesia (in the modern obstetric and gynecology hospital) instead of general anesthesia for cesarean delivry in pregnancies complicated by severe preeclampsia if normal hemostase and platelete > 100 G / l.
Scientists first posed this question in the mid-1990s, after researchers came upon a chemical agent that in rodents seemed to reproduce many of caloric restriction's benefits.
No compound that would safely achieve the same feat in people has been found yet, but the search has been informative and has fanned the hope that caloric-restriction (CR) mimetics can indeed be developed eventually.
The hunt for CR mimetics grew out of a desire to better understand caloric restriction's many effects on the body.
Scientists first recognized the value of the practice more than 60 years ago, when they found that rats fed a low-calorie diet lived longer on average than free-feeding rats and also had a reduced incidence of conditions that become increasingly common in old age.
What is more, some of the treated animals survived longer than the oldest-living animals in the control group, which means that the maximum lifespan (the oldest attainable age), not merely the normal lifespan, increased.
Various interventions, such as infection-fighting drugs, can increase a population's average survival time, but only approaches that slow the body's rate of aging will increase the maximum lifespan.
The rat findings have been replicated many times and extended to creatures ranging from yeast to fruit flies, worms, fish, spiders, mice and hamsters.
Until fairly recently, the studies were limited short-lived creatures genetically distant from humans.
But caloric-restriction projects underway in two species more closely related to humans - rhesus and squirrel monkeys - have scientists optimistic that CR mimetics could help people.
The monkey projects demonstrate that compared with control animals that eat normally caloric-restricted monkeys have lower body temperatures and levels of the pancreatic hormone insulin, and they retain more youthful levels of certain hormones that tend to fall with age.
Studies of caloric restriction are showing the way.
The caloric-restricted animals also look better on indicators of risk for age-related diseases.
For example, they have lower blood pressure and triglyceride levels (signifying a decreased likelihood of heart disease) and they have more normal blood glucose levels (pointing to a reduced risk for diabetes, which is marked by unusually high blood glucose levels).
Further, it has recently been shown that rhesus monkeys kept on caloric-restricted diets for an extended time (nearly 15 years) have less chronic disease.
They and the other monkeys must be followed still longer, however, to know whether low-calorie intake can increase both average and maximum lifespans in monkeys.
Unlike the multitude of elixirs being touted as the latest anti-aging cure, CR mimetics would alter fundamental processes that underlie aging.
We aim to develop compounds that fool cells into activating maintenance and repair.
The best-studied candidate for a caloric-restriction mimetic, 2DG (2-deoxy-D-glucose), works by interfering with the way cells process glucose, it has proved toxic at some doses in animals and so cannot be used in humans.
But it has demonstrated that chemicals can replicate the effects of caloric restriction; the trick is finding the right one.
By limiting food intake, caloric restriction minimizes the amount of glucose entering cells and decreases ATP generation.
As researchers on aging noted recently, no treatment on the market today has been proved to slow human aging - the build-up of molecular and cellular damage that increases vulnerability to infirmity as we grow older.
When 2DG is administered to animals that eat normally, glucose reaches cells in abundance but the drug prevents most of it from being processed and thus reduces ATP synthesis.
Researchers have proposed several explanations for why interruption of glucose processing and ATP production might retard aging.
One possibility relates to the ATP-making machinery's emission of free radicals, which are thought to contribute to aging and such age-related diseases as cancer by damaging cells.
Reduced operation of the machinery should limit their production and thereby constrain the damage.
Another hypothesis suggests that decreased processing of glucose could indicate to cells that food is scarce (even if it isn't) and induce them to shift into an anti-aging mode that emphasizes preservation of the organism over such 'luxuries' as growth and reproduction.
But one intervention, consumption of a low-calorie * yet nutritionally balanced diet, works incredibly well in a broad range of animals, increasing longevity and prolonging good health.
Those findings suggest that caloric restriction could delay aging and increase longevity in humans, too.
Unfortunately, for maximum benefit, people would probably have to reduce their caloric intake by roughly thirty percent, equivalent to dropping from 2, 500 calories a day to 1, 750.
Few mortals could stick to that harsh regimen, especially for years on end.
But what if someone could create a pill that mimicked the physiological effects of eating less without actually forcing people to eat less?
Could such a 'caloric-restriction mimetic', as we call it, enable people to stay healthy longer, postponing age-related disorders (such as diabetes, arteriosclerosis, heart disease and cancer) until very late in life?
This action widens the airway in the back of the throat and the snoring noise stops immediately.
Like anything else, some of these appliances are inferior solutions.
For example, some mouthpieces force the jaw into a closed position and, as a result, can feel uncomfortable and unnatural while sleeping.
Some of them also require you to soften the material inside stiff trays by boiling them in water, and require a near-perfect bite impression for the proper fit.
MRDs are frequently made by dentists for their patients and can cost several hundred dollars for the appliance, plus the cost of the dentist visits for fitting.
Thats why experts in the field of snoring are so excited about the new Living HingeZQuiet mouthpiece.
The ZQuiet mouthpiece offers several fundamental advances over traditional snoring prevention mouthpieces: - Comfort - The companys patent pending Living Hinge makes this mouthpiece remarkably comfortable.
-Immediate Fit - ZQuiet has developed a universal sizing system for their product so that it fits immediately no boiling and molding process is required.
-Effectiveness - The ZQuiet mouthpiece is already being used successfully by thousands of people and, unlike most other snoring mouthpieces offered online, this one is FDA cleared to treat snoring.
Most of us do it to some degree and, generally speaking, the older we get, the worse the condition gets.
-Value - Perhaps the most innovative thing about the ZQuiet mouthpiece is the companys commitment to providing its customers with a great value.
The ZQuiet mouthpiece sells for less than $60.
Snoring can put a huge strain on our most important relationship in life, as the person with whom one shares their bed often suffers chronically as a result of their partner's snoring.
Thats because its the leading symptom of Obstructive Sleep Apnea * which left untreated can lead to chronic fatigue, high blood pressure, weight gain, and even heart failure and stroke.
So, treating snoring can make a huge difference in a person's long term health not to mention the more immediate benefits of a solid night's sleep every night and the pleasure of waking rested and ready to handle the day.
Unfortunately, effective treatments for snoring have been highly intrusive and expensive.
They include procedures like surgery, in which a doctor cuts away or shrinks tissue in the back of the throat, or an expensive and often-times uncomfortable CPAP face mask which forces air into the lungs keeping the air passages open while you sleep.
One of the more popular treatments for snoring is whats known as a Mandibular Repositioning Device (MRD), which is worn as a dental mouthpiece and works by adjusting the position of the lower jaw while you sleep.
Mung beans help in detoxing the body as they are a sweet and cooling food, according to the herbalist Nguyen Cong Duc of the Ho Chi Minh City University of Medicine and Pharmacy Đậu xanh (mung beans) are a common ingredient in Vietnamese cuisine.
Cook on a high flame with a liter of water for 30 minutes.
Simmer and stir until the mixture achieves a porridge-like consistency.
Add the 100g sliced pork liver and cook until the meat is browned through.
- To prevent and fight sunstroke, cook 50g mung beans, 50g rice and two bowls of water on a high flame for 20 minutes until it becomes like porridge.
- To cool the body, to treat fever and to stop nosebleeds, try this sweet soup.
Cook 50g mung beans and 200g lotus root with two bowls of water on a high flame for 30 minutes until the beans and lotus root become soft.
Season with sugar.
- To detox after a bout of food poisoning, boil 120g mung beans, 60g cam thảo (fresh licorice) and two bowls of water on a high flame for 30 minutes.
Mung beans are added to rice dishes, used in soups (especially in chè sweet soup), and ground into flour to make cakes.
Have this soup right after food poisoning for a complete detox.
- To remove toxins such as mercury and arsenic from your system, have mung beans with egg whites.
Mix 50g mung bean powder with 100g egg whites and cook on a medium flame until the egg is cooked through.
- To treat digestive disorders and relieve measles rash, make a sweet soup of red and green mung beans.
Boil equal portions of red and green mung beans in water for 30 minutes or until soft.
- To treat hangovers, wash a handful of mung beans in boiling hot water.
Pound the beans in a mortar.
In a cup, take a spoonful of the pounded beans and add boiling water.
When cool, drink the filtered bean water.
But the humble mung beanshave some surprisingly nutritious tricks up their sleeves.
Alternatively, boil crushed mung beans with a pinch of tea leaves in water for 10 minutes.
Let the mixture cool before drinking it slowly.
- To control diabetes, boil 200g mung beans, two sliced pears, 250g củ cải (turnip) in three bowls of water for 45 minutes until cooked through.
Regular consumption of the dish helps regulate blood sugar levels.
- To stop nausea, cook 16g mung beans and 16g đường phèn (rock sugar) with two bowls of water on a high flame for 20 minutes.
Filter and drink the bean soup.
Alternatively, grind 100 mung beans with ten peppercorns in a food processor.
Take a spoonful of the powder and add hot water to make an anti-nausea drink.
According to the herbalist Nguyen Cong Duc of the Ho Chi Minh City University of Medicine and Pharmacy, mung beans are a sweet and cooling food.
They help in detoxing the body.
Mung beans act as a diuretic, help fortify the stomach, and decrease fat.
The beans are rich in potassium and sodium, so they lower blood pressure.
Herbalist Duc suggests incorporating mung beans into your diet with these recipes: - To fight aging and fortify the skin, try the mung bean and pork liver porridge.
In a pot, take 100g mung beans and 100g rice.
Alzheimer's Disease Dementia is a brain disorder that seriously affects a person's memory, thinking, and reasoning skills. People with dementia often have trouble thinking and speaking clearly, remembering recent events, and learning new things.
Alzheimer's disease is named after Dr Alois Alzheimer, a German doctor.
In 1906, Dr Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness.
He found abnormal clumps and tangled bundles of fibers.
The clumps are now called amyloid plaques and the tangles are called neurofibrillary tangles.
Today, these plaques and tangles in the brain are considered signs of Alzheimer's disease.
Scientists also have found other brain changes in people with Alzheimer's disease.
There is a loss of nerve cells and pathways in areas of the brain that are vital to memory and other mental abilities.
There also are lower levels of some of the chemicals in the brain that carry complex messages back and forth between nerve cells. Alzheimer's disease may disrupt normal thinking and memory by blocking these messages between nerve cells.
Over time, it becomes hard for them to handle everyday activities and take care of themselves.
There are many causes of dementia, but Alzheimer's disease is the most common cause of dementia in older persons.
Scientists think that up to 4.5 million people in the United States suffer from Alzheimer's disease.
The disease usually begins after age 65 and risk goes up with age.
While younger people also may get Alzheimer's disease, it is much less common.
About 5 percent of men and women ages 65 to 74 have Alzheimer's disease, and nearly half of those age 85 and older may have the disease.
It is important to note, however, that Alzheimer's disease is not a normal part of aging.
How To Get Good Posture - Để có dáng đi tốt Understanding exactly what correct posture consists of is something that is critically important, however something many people dont quite get.
Shoulder Positioning Going up the body, you also want your shoulders to be pulled back, thinking of squeezing at the shoulder blades while opening up the chest as best as possible.
As you do this, youll likely feel your entire upper body shift slightly, and you might even notice you increase in height.
Neck Positioning The next factor to consider about correct posture is neck positioning.
The neck should always be in a relaxed neutral position with the shoulders pressed down.
Many of us get into the position of sticking the neck out too forward while shrugging at the shoulders (due to stress).
Take a second during your day to press the shoulders down and make sure the neck is relaxed.
Foot Positioning Finally, while some people do have a naturally turned out foot position, for the most part youll want your feet to be facing directly forward, about shoulder width apart.
This is important so that you dont start to suffer from knee or lower back pain as you walk.
When the feet are not placed properly, there can be tension forces acting on the knee ligaments, which can become very problematic over the long term.
So, make sure you have a good idea what correct posture is and then put that into action.
This is unfortunate because using correct posture is going to impact many areas of your life such as your self-confidence, how thin you look, your risk for injuries, and how much energy you have on a day to day basis.
Make a conscious effort everyday to monitor your posture and make sure youre not slipping up.
Here is what you need to know about what correct posture is.
Hip Positioning When trying to obtain correct posture, your hip positioning should be upwards, with the glutes squeezed.
Do your best to pull the hips upwards to prevent this from occurring.
By looking sideways into a mirror you can easily see exactly what position your hips are in.
Abdominal Positioning Moving on, while you lift up your hips, at the same time this should cause you to squeeze the stomach slightly.
This will enable you to adopt a firmer stomach position, instantly making you look thinner.
BRAIN IN LOVE I and my colleagues Art Aron and Lucy Brown and others, have put 37 people who are madly in love into a functional MRI brain scanner.
So, he built a temple in her honor, facing his.
And every spring and autumn, exactly at the equinox, the sun rises behind his temple, and perfectly bathes her temple with his shadow.
And as the sun sets behind her temple in the afternoon, it perfectly bathes his temple with her shadow.
After 1, 300 years, these two lovers still touch and kiss from their tomb.
17 who were happily in love, 15 who had just been dumped, and we're just starting our third experiment: studying people who report that they're still in love after 10 to 25 years of marriage.
So, this is the short story of that research.
In the jungles of Guatemala, in Tikal, stands a temple.
It was built by the grandest Sun King, of the grandest city state, of the grandest civilization of the Americas, the Mayas.
His name was Jasaw Chan K'awiil.
He lived into his 80s, and he was buried beneath this monument in 720 AD.
And Mayan inscriptions proclaim that he was deeply in love with his wife.
Fetal education The guidance in the fetal sensory function and action should be instantly performed step by step in a planned way to promote the development of infantile intelligence and behavior during the best developmental period of the function of the fetal sensory system.
Therefore, the pregnant woman should avoid bad stimulations like obscene and evil things, violence, killing and ugliness so as not to affect the fetal development.
Fetal / prenatal education in 4th month Important work is taking place in babys brain.
This month, his / her nerve cells will increase rapidly, especially in the front of the brain, where thinking takes place.
Fatty sheaths, which act like insulators on electrical wires to speed messages as they travel, have begun to form around the nerve of the spinal cord.
Also during this month, the babys senses continue to awaken.
The baby has begun to develop his / her ear from inside out.
He / she can not only hear the sounds of the mothers heart beating and blood, but also discern my voices.
According to these changes, I changed my fetal education practice a little bit.
During this month, I decide to do the following things for him / her: 1.
Strive for tranquility; establish the security and support I need to cultivate the peace of mind.
For example, 13 weeks after the gestation, planned speaking and recitation of poems are kept for the fetus; singing songs and playing tapes may be arranged to let the fetus listen to the melodious and beautiful music or songs.
Try to stay away from people and things that make me anxious, angry, depressed, or sad.
Listen to simple, soothing and beautiful music once a day.
The music is neither loud nor noisy, and I only listen to it no more than 20 minuets each time.
Name my baby a nickname and have loving conversations with my baby.
Every day when I get up, brush my teeth, have the breakfast / lunch / supper, or begin to work, I call my baby by this nickname and tell him / her what I am doing.
And I also encourage babys daddy to do the same, although his conversation is much simpler.
Poor daddy, or hi, baby, daddy is back.
Apart from these, the mother's sounds of talking and laughing with others, the bird's singing, the insect's singing and the murmuring stream in a forest are all the good information to promote the development of the fetal auditognosis and nervous system.
How are you today?
Continue to create a calm, loving, peaceful internal environment.
Give the baby more detailed and vivid descriptions of my daily activities.
I not only just tell baby what I do everyday, but also get him / her involved, asking him / her questions or opinions like a real conversation.
At the same time, I aslo encourage babys daddy M to speak to him / her whenever he gets time, let him rub or pat my tummy gently when he talks to the baby, and tell him / her who he is, say hello to him / her, show how much he loves him / her, and etc.
We both treat the baby as a real family member, show him / her our love, tell him / her how happy and how eager we want to see him / her in months.
Researches have found that if the pregnant woman often listens to lively and sweet music, the fetus will be less restless and grow and develop well; if the pregnant woman is usually exposed to the noisy and deafening rock and roll music, the fetus will be more restless.
Begin to read short poems or children stories to baby.
Once or twice a week, I read an ancient poem to baby.
I choose a very simple poem and keep repeating the same one to him / her.
The poem I read to baby descibes a poor peasant working under the scorching sun of the noon, with big drops of sweat falling into the ground.
The poem asks who knows that every grain of rice in our bowl is produced with every drop of sweat of peasants.
After reading the poem to my baby, I also explained to him / her its moral meanings, and wished he / she would respect other peoples hard work and learn to be frugal in the future.
Again, the purpose of reading poems or stories to the baby is not to make him / her remember those poems or stories, nor to influence him / her to become a literature lover, but to let the baby get used to our voices, show our care and love, and build a compassionate parent-baby relationship.
Regulating the diet The pregnant woman's diet should be fresh, bland, nutritious, light, and moderate in amount.
First trimester of pregnancy (three months since conception): Small amount of fine diet is advisable due to the slow fetal development as well as the reaction of pregnancy.
Every night before bed time, lying in the bed, the pregnant woman put her hands on her abdomen and strokes the fetus to promote the fetal movement.
The pregnant woman may select the food suitable for her taste and slightly sour orectic food, fresh vegetables and fruits being the best ones.
However, the fishy, pungent and irritative foods should be contraindicated to avoid aggravating the vomiting of pregnancy.
Second trimester of pregnancy: The fetus grows fast.
Ingestion of food rich in protein, calcium and phosphorus is advisable for the pregnant woman.
Paddy, beans, meat, fish and eggs contain rich proteins.
Calcium exits in yolk, milk, dried small shrimps, animal skeletons and green leafy vegetables; phosphorus in soybean, chicken and mutton.
Eating these foods can promote tissue growth, strengthen the bone, benefit marrow, tonify the brain to promote the fetal development.
Third trimester of pregnancy (eight to ten months in pregnancy): The fetal growth and development accelerate.
This is the crucial period for the cerebral development.
Thus, more nutrients should be stored.
This can arouse the initiative of fetal movement to let the fetus receive earlier training in standing and walking than the untrained fetus.
The pregnant woman should eat more fine proteins, pay attention to proper proportion of animal protein and vegetable protein, eat less salt and basic food to prevent edema.
The pregnant woman should avoid irritative foods like hot pepper, sensitized foods like crab meat, and river deer and hare.
It is advisable for her to give up smoking, drinking spirit and strong tea in case abortion, premature labor, dead fetus, monster and congenital diseases should occur.
Living a normal daily life After conception, exogenous pathogenic factors easily invade the pregnant woman, giving rise to various fetal diseases, even abortion.
Thus, the pregnant woman should live a normal daily life with caution and arrange the daily schedule scientifically.
She should rise early and go to bed early, and work, study and live regularly.
Besides, she should modify her clothing to prevent cold and summer heat in conformity to seasonal variations.
The strenuous exercise is not advisable for the pregnant woman.
The pregnant woman should not climb high, walk fast, sit in a lateral position, bend over, limp along, lean against something, take an object from a high place, defecate and urinate in the out of the way places, stand, sit and lie long, expose herself to cold and heat.
The pregnant woman should be cautious not to hit the abdomen, avoid being exposed to noxious substances like lead, mercury, benzol and arsenic as well as radioactive rays.
This method is advisable for regular use and it is more important during the gestational period.
It is not advisable for her to visit public places often to prevent infectious diseases causing the fetal injury or abortion.
The pregnant woman should maintain smooth defecation and urination.
In the case of constipation without remission or dysuria, she should go to see a doctor in time.
But it is contraindicated in the pregnant woman with early uterine contraction.
Avoiding evil things Frequent contact with beautiful things may beautify the fetus.
Millennium Development Goals on health 'will not be met' By Jane Dreaper Health correspondent, BBC News The under-five death rate remains too high in the developing world Researchers say just nine of 137 developing countries will achieve ambitious targets to improve the health of women and children.
Intervention strategies There were 273, 500 maternal deaths, of which 56, 100 were related to HIV.
In 1990, an estimated 409, 100 women died during pregnancy or childbirth.
The highest level of maternal death is seen in Eritrea, Liberia and Afghanistan.
The lowest is in Iceland and Austria.
Countries making slower progress on the infant death target include Nigeria and Ethiopia.
The authors said 23 countries in sub-Saharan Africa were unlikely at the present pace to achieve MDG4 before 2040.
Many aspects of health systems limit the scale-up of child and maternal interventions, they said.
Nevertheless, some intervention strategies can be delivered without a health system that has the capacity for referral and emergency management.
These include vaccination, distributing insecticide-treated bed nets, vitamin A supplementation and deworming.
They praised India for promising and substantial progress in reducing maternal mortality during the past five years.
The analysis in The Lancet updates previous estimates of progress on the fourth and fifth Millennium Development Goals (MDGs).
The authors concluded: The MDG targets have helped rally donors to recognise the urgent need for further investment.
Even with major accelerated efforts, most countries are unlikely to achieve both targets.
Although some might see this as a failure of global health action, it is perhaps more important to keep track of whether the pace of progress for children and mothers has improved.
A year ago, governments around the world pledged 25bn to reinvigorate efforts on both targets.
But the Lancet paper says the potential for delivering the aid is unclear, because aid money for health has been growing at a slower pace in recent years.
Midwife training The authors acknowledge estimating the death rates is contentious, and that their work has triggered a vigorous academic debate on measurement strategies.
In an accompanying comment, global health experts Peter Byass and Wendy Graham said: Numerical assessments against the MDGs are inevitably processes that are plagued by poor and missing data.
It is self-evident that the greatest numbers of avoidable deaths happen in some of the world's largest countries.
A report by the Partnership for Maternal, Newborn and Child Health (PMNCH) - also released on Tuesday - says some of the world's poorest countries have pledged 7bn of their own resources to try to reduce the death rates.
Bangladesh has committed to train 3, 000 midwives by 2015, while Congo has promised to provide free obstetric care, including Caesarean sections.
The experts predict that no country in sub-Saharan Africa will meet the goals to dramatically reduce deaths by 2015.
But they say progress is speeding up in most countries.
The targets were set by world leaders in 2000.
MDG4 aims to reduce the death rate for children aged under five by two-thirds between 1990 and 2015.
MDG5 states an ambition to cut deaths among pregnant women and new mothers by three-quarters during the same timescale.
The researchers from Seattle estimate there were 7.2 m infant deaths around the world in the past year - compared with 11.6 m in 1990.
China, Rwanda and Botswana were praised for substantial acceleration in tackling child mortality in the past decade.