Knowledge, practices in public health service utilization among health insurance card’s holders and influencing factors in Vientiane, Lao
Describe knowledge, practices in public health service utilization among health insurance card's holders and influencing factors in Vientiane, Lao PDR, 2017.
Methodology: A cross sectional study was used among 928 adult health insurance card's holders in Phone Hong and Keo Oudom districts, Vientiane province.
Results: Percentage of card's holders who knew the finance-free utilization of the first registered public health services was 44.5% and being provided health insurance information was 34.8%.
Percentage of card's holders who went to the first registered public health services was 61.8%.
Percentage of card's holders who went to public health services to receive medicines for their relatives / others people was 20.1%.
The determinants of knowledge and practices in public health service utilization among health insurance card's holders were distance and time taken to health services, time of health insurance and health insurance information provided.
Conclusions: Knowledge and practices in public health service utilization among health insurance card's holders were still limited.
It's necessary to provide health insurance communication and education for people who live in remote areas and participate interupted health insurance.
Studying the method of quantification of diclofenac sodium in traditional herbal medicines used for treatment or support osteoarthritis by high performance liquid chromatography
In order to contribute to the detection of banned substances in traditional herbal medicines, we conducted a study on the method of quantification of diclofenac sodium in traditional herbal medicines which are used for treatment or support for osteoarthritis by high performance liquid chromatography (HPLC).
After precipating, diclofenac sodium was eluted by HPLC using a reverse-phase column (C8, 150 mm x 4.6 mm, 5 μm), mobile phase contains methanol / phosphat buffer (70: 30 v / v, pH 2.5), at a flow rate of 1.0 ml / min, and a wavelength detection at 275 nm.
Therefor, the method was appropriately formulated to determine diclofenac sodium in herbal medicines.
Research for clinical characteristics and plasma dopamine concentrations in schizophrenic patients
The purpose of this study was to evaluate the effects of a mixture extract of C chrysantha and G pentaphyllum on weight loss and lowering lipid blood levels in obese Swiss mice.
Swiss mice were randomly allocated into 5 groups with 8 animals in each group.
Group 1: non-obese mice.
With the remaining 4 groups, the mice were induced to become obese for 8 weeks.
mice were fed with distilled water (group 2) mixture extract at a dose of 12g / kg / day (group 3), 24g / kg / day (group 4) and atorvastatin at a dose of 15mg / kg / day (group 5).
The feeding time period was 14 days.
Mice in each group was assessed for weight weekly and the levels of Total Cholesterol (CT), HDLCholesterol (HDL-C), LDL-Cholesterol (LDL-C) and Triglyceride (TC) was recorded at initial time (after obesity was induced for 8 weeks) and 1 hour after taking the extracted mixtures on the last day.
The results showed that the mixture extract of C chrysantha and G pentaphyllum at doses of 12 g / kg / day and 24 g / kg / day, atorvastatin at a dose of 15 mg / kg / day (group 3, 4, 5) induced weight loss and decreased TC, CT, LDL-C levels compared with group 2 (p < 0.05) and the difference was not statistically significant between groups 3, 4, 5 (p > 0.05).
Research characteristics of clinical, paraclinical peripheral nerve damage in newly diagnosed type 2 diabetes patients
A cross-sectional descriptive study was implemented to assess fluor contaminated teeth among children aged 12 years of Thai ethnic group in Con Cuong district, Nghe An province.
The study was completed in May 2015 with 476 children aged 12 years at 9 secondary schools, applying the methodology of investigation and classification of WHO-2013 with the Dean's fluorosis index.
Research results showed that: The rate of 12-year-old children with fluor contaminated teeth including the suspicion level was 13.2%.
The rate of 12-year-old children with fluor contaminated teeth without suspicion level was 7.1%.
Mostly suspected and very mild, there was no case of severe fluor contaminated teeth. There was only one case of moderate fluor contaminated teeth.
The Dean's index of community fluor contaminated teeth in 12-year-old children was 0.13. This was a community without fluor contaminated teeth according to the 2013 classification of the World Health Organization.
Characteristics of dry eye in patients with primary Sjögren syndrome
To investigate the reasonableness of using proton pump inhibitors (PPI) at 120 Military Hospital in Tien Giang province.
Unreasonable prescriptions in PPI used mainly gastritis.
Subjects and methods: Cross-sectional descriptive study on 4532 outpatient prescriptions of patients who were prescribed drugs by doctors from July 1st, 2020 to July 30th, 2020 at clinics of the examination department - Military Hospital 120.
Results: Prescribing unsafe proton pump inhibitors accounted for 12.13%.
Percentage of prescriptions without instructions for use of proton pump inhibitors (0.79%).
The proportion of prescription drugs with drug interactions was 52.14%, clopidogrel was the most interactive drug commonly used with PPIs (48.3%).
The proportion of proton pump inhibitors indicated unreasonable was 9.76%.
The proportion of prescriptions with proton pump inhibitors for gastritis treatment accounted for 66.14% of the total number of prescriptions with proton pump inhibitors that were not reasonable.
Conclusion: The proportion of proton pump inhibitors was not safe and reasonable and the proportion of prescription drugs with no instructions on how long to use proton pump inhibitors were low.
The proportion of prescription interacting drugs accounted for a high proportion, clopidogrel was the most interactive drug commonly used with PPIs.
Evaluation of compliance with vancomycin therapy before and after the participation of clinical pharmacists at the department of intensive care medicine - anti toxicology, Nguyen Tri Phuong hospital
Primary spontaneous pneumothorax is a common disease in young people with a recurrence rate.
Currently, indications of video-assisted thoracoscopic surgery (VATS) in the routine treatment of primary spontaneous pneumothorax and it is recommended to perform early in the first episode of pneumothorax.
Methods: Cross-sectional study; The research results were recorded in the following variables: age, sex; operative indications; operative time... The data were recorded in the research medical record for each patient and processed by the SPSS 20.0.
Results: From January 2018 to April 2021 at Cardiovascular and Thoracic Center - Viet Duc University Hospital, 38 patients underwent video-assisted thoracoscopic surgery for primary spontaneous pneumothorax.
Indications of VATS: Recurrent preumothorax 44, 74%; Prolonged preumothorax 21, 05%; bullae 21, 05%; preumothorax-hemothorax 10, 52%; bilateral spontaneous pneumothorax 2, 63%.
There were no complications nor death.
Follow-up from 1 month to 24 months, no cases of recurrence.
Outcomes of therapeutic penetrating keratoplasty for treating microsporidial keratitis
By means of direct interviews with 156 primary caregivers for stroke patients who were treated at the hospital and are currently living in Ha Dong district in Hanoi, on rehabilitation care knowledge for patients at home, findings reveal: Percentage of primary carer full knowledge of the content of each patient care was limited: only 2 out of 8 contents reaching over 50%, which are eating care (70.6%) and occlusion preventive care (55.8%).
The remaining content ratio care primary caregivers full knowledge was low: skin care (46.2%), urinary tract care, bladder (46.2%), constipation preventive care (13.5%), respiratory care (30.8%), standing care (46.9%), care practice, athletes (34.6%).
Percentage of primary care-givers pass all 8 contents of rehabilitation care at home for patients with stroke accounted for only 25.0%.
Deep anterior lamellar keratoplasty to treat corneal perforation and descemetocele from microbial keratitis
TAFRO syndrome was first reported in 2010 in Japan. It is characterized by a constellation of symptoms: Thrombocytopenia, Anasarca, reticulin Fibrosis of the bone marrow, Renal dysfunction and Organomegaly (TAFRO).
TAFRO syndrome often occurs in the middle-aged and the elderly, and is rarely seen in adolescents.
Here we report the first child case diagnosed with TAFRO syndrome, and successfully treated with Cyclosporin A in the national children hospital.
He was diagnosed with TAFRO syndrome, treated by prednisone 1mg / kg / day combined with cyclosporin A 4mg / kg / day for 2 weeks. Improvement seen with no fever, no edema, increased platelets, and improved kidney function.
C-met expression in gastric adenocarcinoma
To describe clinical characteristics of periodontitis patients at Thanh Nhan Hospital, Hanoi.
Subjects and method: 103 patients who were examined at Odonto - Stomatology department, Thanh Nhan hospital.
Descriptive cross-sectional study.
Results and conclusion: Periodontal pocket depth (PPD) was 3, 25 ± 1, 36 mm.
Periodontal pocket depth (PPD) and clinical attachment loss (CAL) were the same at upper and lower teeth and increased by age.
Gingival index (GI) score and Oral Hygiene Index-Simplified (OHI-S) increased by age and the mean probing pocket depth (PPD).
Surgical Treatment of Urethral Stricture After Hypospadias Repair: Experience on 49 Patients
In this study, the Folin-Ciocalteu method was applied to determine the total polyphenol contents (referred to milligrams gallic acid mass equivalence or GAE) in tea products (one oolong and three ancient teas, including red, green, and white) based on ISO 14502 - 1: 2005 with some modifications, typically ultrasonic-assisted single extraction using methanol: water (7: 3 v / v) as an extraction solvent at 70oC with the extraction ratio of 0.200: 10.00 (g: mL).
The analytical method was validated using Shimadzu 1800 UV-Vis instrument with favorable linearity of R2 > 0.995, linear range of 10 - 70 mg GAE L-1, acceptable repeatability, reproducibility (% RSDs were 0.79 and 1.2 for intra-day and inter-day, respectively), and high recoveries (higher than 98% for spiked samples).
The total polyphenol contents (mean values, mg GAE g-1 dried weight, in brackets) performed a descending order of white (206.62) ~ green (201.33) > red (167.42) > oolong (139.18) teas due to the variation in the oxidation levels during the fermentation, particularly for red and oolong teas.
Higher polyphenol contents released in tea infusions were observed regarding the increasing brewing temperature, except for oolong tea with its specific fluctuation, maybe due to its "wrap-curled" structure, leading to longer brewing durations for polyphenol to be extracted stably and completely.
This study contributes to enriching data for Vietnamese tea products in the context of high production and export.
Factors affecting the working motivation of health workers at the Ho Chi Minh City 115 Emergency Center in 2020
To report the clinical and radiological outcomes after corrective osteotomy in ankylosing spondylitis patients.
The mean SRS-22 score increased significantly from 9.2 ± 1.4 preoperative to 22.8 ± 1.7 at the 3 month postoperative moment.
There were 28 surgery-related complications in 12 patients (17.3%).
Conclusion: Corrective osteotomy is an effective method for treating a fixed kyphotic deformity occurring in ankylosing spondylitis, resulting in satisfactory outcomes with acceptable complications.
Subject and method: We prospectively analyzed 69 ankylosing spondylitis patients who underwent corrective osteotomy between 2010 and 2022.
Results: A total of 91 corrective osteotomies were performed in 69 patients with a mean follow-up of 30.1 months (range, 3 to 68 months).
The mean correction angles were 24 0 ± 200 (range, - 140 to 710).
The mean ODI preoperative score was 50 ± 15%, (range, 31.7% to 88.3%) and postoperative ODI was 22.5 ± 6% (range, 16.7% to 46.6%).
Preliminary screening of phytochemical constituents and bioactivities in vitro of Jasminanthes Tuyetanhiae T.B. Tran & Rodda, apocynaceae
Describe clinical and subclinical characteristics and treatment results of 02 patients with myocarditis after vaccination with Pfizer's COVID-19 vaccine.
Conclusion: We recorded 2 cases of myocarditis after vaccination with the Pfize-COVID-19 vaccine, occurring in the second bolus.
It is necessary to monitor and treat promptly to avoid sequelae.
Methods: Report on clinical cases of myocarditis patients after vaccination with Pfizer's COVID-19 vaccine, treated at Department of cardiology at Duc Giang general hospital, December 2021 Results: 02 young male patients aged 16 and 17, 02 days after vaccination with Pfizer's COVID-19 vaccine showed symptoms: palpitations, left chest pain and fatigue.
The ECG of the 17-year-old patient clearly shows pericarditis: isotropic ST elevation in the precordial leads.
Both patients had elevated hs-cTnI: 9686.56 pg / ml and 2069.94pg/ml.
No shreds of evidence of damage in echocardiogram: LV function is normal, no pericardial fluid.
The patients have treated: Anti-inflammatory with Aspirin 800mg per day, Analgesic: Ibuprofen 200mg - 400mg per day.
The hospital discharge times of 02 cases were different: Patient with higher hs-cTnI and ECG changes had a treatment time of 14 days longer than patient without EKG changes, with a lower elevation of hs-cTnI.
Both patients were discharged from the hospital without any abnormal cardiac sequelae: hs-cTpI lower than the threshold value, ECG bounds back to normal. Echocardiogram is normal.
The correlation between bone density and some clinical and subclinical factors in the patients with dialysis chronic kidney disease
Describe the status of compliance with the process of removing protective equipment by medical staff in caring for Covid-19 patients and some related factors at Duc Giang General Hospital in 2022.
Subjects and methods: A cross-sectional description, on all 176 medical staff with 521 observations and satisfying the selection criteria, conducted from January to March 2022 at Duc Giang General Hospital.
Results: The percentage of healthcare workers who followed the removal of personal protective equipment was 72%.
Some factors such as gender, job title and working position are related to the compliance with the procedure of removing personal protective equipment of medical staff taking care of patients with COVID - 19 (p<0.05).
Conclusion: The compliance rate of medical staff with the process of removing personal protective equipment in the care for COVID - 19 patients at Duc Giang General Hospital is quite high.
The hospital continues to maintain monitoring and evaluation in order to improve the compliance rate with the removal of personal protective equipment, thereby contributing to preventing the spread of COVID - 19.
Surgical results of medullary thyroid cancer
Describe clinical, magnetic resonance, and anatomical characteristics of femoral muscle disease patients with polymyositis and autoimmune dermatomyositis at the Department of Musculoskeletal - Bach Mai Hospital.
Find the relationship between clinical, magnetic resonance, and anatomical femoral myopathy in patients with polymyositis and autoimmune dermatomyositis at the Department of Musculoskeletal - Bach Mai Hospital in the researched patients.
Subjects and research methods: A prospective, cross-sectional study was performed on patients diagnosed with polymyositis and dermatomyositis according to Bohan and Peter's criteria in 1975.
The patients were examined for clinical examination, hematology, biochemistry, pathology, femoral magnetic resonance, and electromyography.
Research results: 1) Clinical characteristics of muscle damage: mean muscle strength is 58.68 ± 7.30, mean muscle pain VAS is 5.38 ± 1.66, and average muscle inflammation accounts for the proportion. 46.6% high, and the main symptom of muscle weakness was 96.9%.
2) Characteristics of subclinical lesions: muscle edema is the primary lesion detected on MRI images of the thigh muscle at 65.6%, the late stage has muscle atrophy at 15.6%, and fat degeneration at 9.4%.
Regarding muscle histopathology, the most common injury characteristics are inflammatory cell invasion, degeneration, regeneration, and proliferation, with 62.5%, 81.3%, 68.8%, and 78.1%, respectively.
The rate of detection of muscle damage on MRI images of the thigh muscle correlates with increased CK concentration.
Patient evaluation of healthcare providers’ communication: a survey at outpatient ward of Thai Nguyen National hospital in 2022
To determine the rate of reopening of the ductus arteriosus after successful PDA prophylaxis with intravenous paracetamol in premature infants ≤ 27 weeks associated with RDS receiving surfactant therapy.
During the hospital stay, there were 7 (22.6%) cases of re-opening of the ducts requiring PDA closure, the mean time of PDA reopening was 14 days postnatal age, the incompletely PDA closure, and female gender were two factors that increase the rate of PDA reopening.
Conclusions: The ductus arteriosus reopened in at least 22.6% of infants after successful PDA prophylaxis with intravenous paracetamol.
Therefore, PDA should be monitored by clinical assessment and cardiac ultrasound for early detection of symptomatic PDA requiring intervention, especially during the first 2 weeks of postnatal age in incompletely PDA closure patients.
Evaluation of changes on echocardiography after 3 months of treatment in patients with acute pulmonary embolism
Assessing the level of knowledge of nursing students about the prevention of varicose veins of the lower extremities.
It is necessary to have early intervention measures to prevent the progression and limit the complications of varicose veins of the lower extremities for nursing students with early signs of varicose veins of the lower extremities and ensure health and safety and improve the quality of life for nursing students and medical staffs in the future.
Identifying the percentage of students with early signs of varicose veins of the lower extremities.
Subjects and research Methods.
A descriptive cross-sectional study on 341 nursing students was conducted in the 2nd, 3rd, and 4th years at the Faculty of Nursing - Medical Technology, University of Medicine and Pharmacy at Ho Chi Minh City during the period of time from March, 2021 to August, 2021 ".
The rate of students achieving general knowledge level on prevention of varicose veins of the lower extremities on average level was 61.6% and 31.1% of students had a good level of knowledge.
The percentage of nursing students with early signs of varicose veins of the lower extremities was 26.7%.
Most students report that early signs of varicose veins of the lower extremities are leg fatigue and microvascular swelling under the skin, calf pain, cramps (nocturnal cramps), stinging and itching sensations.
Clinical characteristics of sleep quality in elderly patients with hypertension
Patients who came to the examination rooms of the Out-Patient Examination Department of Nhat Tan hospital with hypertension that the doctor thought about the white coat effect during 8 months from October 1, 2020 to May 31, 2021.
Conclusion: Our study shows that OPB30 reduces the effect of White Coat Effect about 20.2% of cases with identified office hypertension. Thereby, treating hypertensive patients and monitoring White Coat Effect patients will be more effective as well as reducing costs and side effects for them.
The number of patients with OBP30 measured was 163 including records with at least 8 readings.
Results: A total of 163 patients were recorded with full OBP30, of which 93 were female, accounting for 57%. Age 14 to 86.
When measuring OBP and someone showing signs of hypertension, the doctor thought that 107 people should be treated (65.6%).
After getting the results of OBP30, the doctor only prescribed antihypertensive treatment for 74 people (45.4%), reduced 33 people, and the rate of reduction in hypertension treatment was 20.2%.
Barriers to treatment compliance in children with HIV/AIDS and some related factors at the Vietnam national children’s hospital
In Vietnam, according to a report from the research results "Burden of Disease and Injury" under the VINE project (2011), mental health problems account for 18% of the total burden of disease.
The General Report of Vietnam's Health Sector in 2014 indicates that mental disorders are one of the five groups of diseases that account for a large proportion of the total disease burden caused by non-communicable diseases.
The objective of the study was to determine the prevalence of anxiety, stress and depression and the factors related to the rate of anxiety, stress and depression among health workers working at the examination department of the Hanoi Obstetrics and Gynecology Hospital.
A cross-sectional descriptive study on 224 health workers from September 2021 to June 2022.
The results show that the percentage of medical staff participating in COVID-19 prevention and control at some participating hospitals has symptoms of depression. emotion, anxiety and stress are 17.86%, 28.57%, 16.96% respectively.
The rate of depression is related to: gender and education level (p<0.05).
Research helps managers have policies to improve the mental health status of healthcare workers.
Prevalence of pulmonary hemorrhage in very preterm neonates at children’s hospital 1
Diabetes mellitus and periodontitis are common diseases, there is a two-way relationship between oral health and systemic disease.
Periodontal treatment improves glycosylatedhemoglobin.In
Aim: The aim of the study was to evaluate the long-term results of periodontal treatment on clinical features and HbA1c in type 2 diabetes patients.
Materials and Methods: A clinical trials study on 76 type 2 diabetes patients with mild and moderate periodontitis.
Periodontal index and HbA1c were recorded at baseline and six month after treatment.
Results: After 6 months, significant changes in periodontal index (p0.05).
Clinical characteristics and prognostic biomarker of Covid-19 patients
Evaluating the safety and efficacy of transcatheter closure of large atrial septal defect under intracardiac echocardiography guidance.
Conclusion: Our study has shown that the percutaneous closure of large secondary atrial septal defects in the 20 - 37 mm diameter range under intracardiac echocardiography guidance can be performed safely and effectively.
Subjectives and method: 55 patients with large atrial septal defect were treated at the cardiovascular centre, Cho Ray Hospital.
The prospective, open label, non-randomized, longitudinal study.
Result: 55 patients had mean age of 41.78 ± 11.64 years old (23 - 62 years), female 85.45%.
The mean diameters of the atrial septal defect were 24.14 ± 3.42 mm (transesophageal echocardiography) and 27.89 ± 4.27 mm (intracardiac echocardiography) with P<0.001.
After a 3-month follow-up period, we recorded patients with improved dyspnea according to NYHA class as well as the right ventricular diameter and pulmonary artery pressure on echocardiography.
Palliative care need of cancer patients at the oncology center, thai nguyen central hospital and related fators
Gastric cancer is the fifth most common malignancy worldwide, and the fourth cause among all malignancy in Vietnam.
Postoperative results: adenocarcinoma, highly differentiated, at the small curvature of the stomach, pT1aM0N0.
After surgery, the patient was stable, without complications and was discharged from the hospital.
Conclusion: Endoscopy and biopsy play an important role in early detection of gastric cancer.
However, the majority of patients arriving at the hospital are in the late stage.
We present the clinical, endoscopic, histopathological and treatment characteristics of 01 patient with early gastric cancer. Case presentation: Female patient, 56 years old.
From 09/2020 - 09/2021, the patient had upper GI endoscopy (06 times) and biopsies (06 times).
Endoscopy results: small curvilinear ulcer, size 1 cm, surface is not smooth.
Histopathological results: 1/6 biopsies, we found cancer cells (last biopsy: 09/2021).
There were 3/6 times (50%) with gastric dysplasia.
The patient underwent laparoscopic surgery.
Chronic pain in older people with primary knee osteoarthritis
Describe the status of response to antiretroviral therapy and identify some factors related to the treatment response of patients at two HIV / AIDS treatment facilities in Yen Bai province in 2021.
Subjects and methods. A cross-sectional descriptive study was produced from January 1, 2021 to August 31, 2021 among 399 HIV-infected patients over 18 years old, managed and received ART at the HIV / AIDS care and treatment facility - Nghia Lo area general hospital and Yen Bai city health center, Yen Bai province.
Of the total number of HIV-infected patients managed and received antiretroviral therapy (ART), 96.2% of patients responded to ART, in which 100% of patients using second-line regimens respond to treatment.
Factors related to treatment response include: high school education level (aOR= 11; 95% CI: 2.6 - 46.9), duration of ART (aOR=1.3; 95% CI: 1.06 - 1.6) and treatment adherence (aOR=5.6; 95% CI: 1.4 - 22.6).
It is necessary to strengthen management, treatment support and counseling to improve treatment adherence, thereby helping patients have a better treatment response to ART.
Factors Affecting Consumer’s Intentions in Buying Organic Foods in Long Bien District, Hanoi
The purpose of this research was to identify the factors affecting customer purchase intentions toward organic food in Long Bien district, Hanoi.
The study used the factors (Subjective Norm (SN), Perceived Behavioral Control) in the model Theory of Planned Behavior (TPB) and use some other factors, based on the previous studies on the same subjects.
The findings showed that there were 4 factors affecting customer purchase intentions toward organic food: SN, health consciousness, consumer knowledge, sensation about price (SPr) positively.
The study has supported the inclusion of new constructs in the TPB as it has improved the predictive power of the proposed framework in determining consumer's intention to purchase organic food.
Parental knowledge analysis of mothers treatment at the hospital of hospital Nam Dinh treasury
To assess knowledge of mothers have child with acute intussusception disease at Nam Dinh General Hospital.
Results: The mean score of knowledge of the mother was 8.3 ± 4.2 (total 20 points).
In it, 36.1% understood what was the acute intussusception; 37.7% were aware of the cause; 18% were not aware of signs of acute intussusception, 42.6% were not aware of necrotic intestinal complications if late.
54.1% of mothers were aware of the treatment and 57.3% of the control responded correctly when children showed signs of acute intussusception.
The study also showed that three factors significantly affected maternal knowledge of residence; education and health education reception.
Preliminary results of AI-assissted colonoscopy application in proximal colon polyp detection
Chromosomal mosaicism in prenatal diagnosis is a complex problem that confuses the perception of true mosaicism or pseudomosaicismand often causes difficulties in genetic counseling.
In this study, the authors reported 5 cases of chromosomal mosaicism in prenatal karyotype diagnosis and compared them with the corresponding karyotype results of children after birth.
Amniotic fluid and peripheral blood cells were prepared chromosomal metaphase by culture method and chromosomal analysis according to ISCN 2016 standards.
Samples were collected and analysed at Hanoi Medical University Hospital from 2017 to 2020.
There were 3 cases of abnormal prenatal chromosomal mosaicism, but the postnatal results were normal, two cases of abnormal prenatal chromosome mosaicism, but had abnormal peripheral blood postnatal chromosome results.
These results, together with discussion, will provide more valuable information for the prognosis of chromosome mosaicism cases in prenatal diagnosis and give better genetic counseling for the patients.
Bioactivity and toxicity evaluation of nutraceuticals using in vitro cell-based models: A review
HER2-neu targeted therapy in combination with chemotherapy has been the standard treatment for HER2-neu positive cancer in the world.
In Vietnam, Trastuzumab has been used since 2016 while Pertuzumab has just recently been used.
This is a descriptive cohort study evaluating the efficacy of neoadjuvant Trastuzumab and Pertuzumab in combination with chemotherapy for HER2-neu positive breast cancer at K hospital from 01/2018 to 04/2021.
The results on 20 patients showed that the clinical overall response rate was 95.0%, with only one patient progressed.
Total pathological complete response (tpCR) rate was 80.0%.
There were no associations between tpCR and age, tumor and nodal stage, histological type and grade, ER, PR, Ki67 status and chemotherapy regimen.
The regimens were well tolerated and no patients had treatment delay or interruption due to toxicities.
Iron chelation with deferasirox in thalassemia patients at Vietnam national institute of hematology and blood transfusion during 5 year’s follow–up from 2016 to 2020
Anemia status is related to zinc and vitamin A defciency status in children of elementary schools.
Therefore, future prevention should be implemented simultaneously and in coordination with the improvement of micronutrients defciency.
Evaluate the results of veno- arterial extracorporeal membrane oxygenation for cardiogenic shock patient
This is a cross-sectional description of 33 surgeries performed between October 2019 and December 2021.
Among patients undergoing open heart surgery, congenital heart disease in adults accounts for nearly 22.3%.
The two most common malformations were bicuspid aortic valve defect (14 cases, 42.4%) and atrial septal defect (10 cases, 30.3%).
Many patients have surgery when there have been serious complications due disease progression over an extended time period: severe heart failure, increased pulmonary arterial pressure, enlarged aorta, dilatation of the descending aorta. In addition to the classic open heart surgery, minimally invasive surgeries have been successful to cases where the pathology is not too complex and does not have severe complications.
Nutritional status of the children under 5 years of age in hanoi, 2019
Peritonitis is one of the major complications of continuous ambulatory peritoneal dialysis (CAPD).
Clinical manifestations of tuberculous peritonitis typically are usually indistinguishable from bacterial peritonitis.
We report a case of a 17-year-old boy who suffered from end-stage renal disease with a history of 3 times of peritonitis with negative peritoneal effluent cultures.
He was treated with antibiotics for grampositive, gram-negative coverage and fungal for 7 days but his symptoms remained unchanged.
The outcome of using cryopreserved vein graft for lengthening renal vein in living donor kidney transplantation in Viet Duc hospital
In Vietnam, Gomphrena celosioides Mart.
(Amaranthaceae) is a popular herb. The aim of this study was evaluate the analgesic and sedative effects of its extract to clarify the pharmacological effects of Gomphrena celosioides.
The extract was concentrated at a temperature of 70 °C.
Results show that at dosage of 300mg / kg and 600mg / kg, aqueous and ethanol extracts, perspectively, weren't found to increase the reaction time of the mice in tail immersion method (p>0, 05) However, aqueous and ethanol extracts reduced the number of writhing movements of the mice (p<0, 05) in peripheral antinociceptive method. Ethanol extract shortened the stay time on the rotating cylinder at dosage 600mg / kg (p<0, 01).
Determination of the median levels of serum biomarkers in the first trimester screening program in pregnant women of University Medical center hospital
Describe the current status of knowledge and care practices of mothers whose children under 5 years of age have acute diarrhea at Nghe An Obstetrics and Gynecology Hospital in 2021.
Methods: A cross-sectional descriptive study with analysis was conducted in 94 mothers at the Department of Gastroenterology, Nghe An Obstetrics and Gynecology Hospital, to investigate the knowledge and care practices of mothers whose children under 5 years of age had acute diarrhea.
Results: 42.6% of mothers had knowledge that the route of transmission was from eating or drinking contaminated food.
54.3% of mothers practice washing hands with soap before preparing food.
56.4% of mothers did not practice correctly about the diet during the child's acute diarrhea; 39.4% of mothers did not pass Oresol and only 33% of mothers gave Oresol to their children according to the doctor's instructions.
Mothers still lack knowledge and practice in the process of caring for children with acute diarrhea.
Conclusion: The study showed that the knowledge and practice of caring baby of mothers with children under 5 years of age with acute diarrhea was still low.
Results of 1,5-volume plasma exchange therapy in acute liver failure due to acute poisoning
Treatment of hypertension is a continuous and long-term work, so the management and treatment of hypertensive patients is essential.
Objectives: Evaluation of the results of management and treatment of hypertension patients and analysis of some factors affecting the results of treatment and management of hypertension at Go Cong Tay District Medical Center from 2019 to 2020.
Methods: A cross-sectional descriptive study combining quantitative and qualitative based on information collection from management software, in-depth interviews with medical staff and group discussion of hypertensive patients managed at the Go Cong Tay district health center from April to October 2021.Results: The number of people with high blood pressure being examined and treated is increasing every year, the rate of patients coming back for follow-up examination on schedule is 63.6%.
The rate of patients taking the correct dose was 89.3%.
As a result of treatment, 28.9% of subjects reached the target blood pressure.
Policies and regulations on management and treatment of hypertension, shortage of human resources, limitations on equipment, facilities and drugs of CHS, no operating funding, and personal factors of patients are factors affecting the management of hypertension treatment. Conclusion: The percentage of patients reaching the target blood pressure is still quite low, there are many factors from the medical facilities and the patients that affect the management and treatment of hypertension.
α-glucosidase inhibitory activity of three green seaweeds collected in the coast of Khanh Hoa province
One of the effective therapeutic approaches in the management of type 2 diabetes is inhibition of α-glucosidase.
This study investigated α-glucosidase inhibitory activity of three green seaweeds (Halimeda macroloba, Ulva reticulate and Ulva lactuca) and the results indicated that the inhibitory effect (IC50 values) of H macroloba, U reticulata and U lactuca and were 3.98, 4.76 and 5.21 mg / ml, respectively.
The suitable extraction time and extraction temperature for extracting high activity α-glucosidase inhibitors from green seaweed H macroloba were found to be 60 min and 60 C, respectively.
Among the extract fractions, ethyl acetate showed the highest α-glucosidase inhibitory activity (IC50 value of 2.45 mg / ml), followed by n-hexane, butanol and water with IC50 values of 2.79, 4.11 and 4.91 mg / ml, respectively.
Phytochemical screening showed phenolic, flavonoids and terpenoid were present in the ethyl acetate fraction of green seaweed H macroloba.
Botanical characteristics, and pharmacological properties of Alangium salviifolium (L.f.) Wang.: A review
Clinical and subclinical characteristics of rectal cancer patients at K Hospital from 06/2018 to 10/2021.
Adenocarcinoma accounts for 100%, mucinous form accounts for 14.8%.
Stage T3 accounted for 61.8%, T4 accounted for 29.1%.
After treatment, the tumor circumference decreased by 70.9%.
Rate of lowering stage 64.1%.
The rate of radical surgery is 100%, in which low rectal cancer preserves the sphincter 16.4%.
Response on MBH accounts for 90.9%.
Conclusion: The average age is 58.6.
Ratio male / female: 1.4.
Time of disease detection ≤ 6 months accounted for 84.9%.
Common functional symptoms: bloody stools, accounting for 87.2%.
Evaluation of the results of preoperative radio-chemotherapy for rectal cancer by Volumetric Modulation Arc Therapy (VMAT) combined with oral capecitabine.
Partial mobility accounts for 74.5%.
Stage T3 accounted for 64.8%, T4 accounted for 35.2%.
Tumors less than 6 cm from the anal margin account for 72.6%.
Lower the overall period 64.1%.
Increase the rate of radical surgery by 100% and anal sphincter-conserving surgery to 16.4%.
The general histopathological response was 90.9%.
In which complete response is 10.9%.
Toxicity only encountered grade 1, grade 2 with a low rate.
Subjects and research methods: Non-controlled clinical intervention study, convenient sample size.
Results: Mean age was 58.6 years old.
The common age is from 51 to 70, accounting for 76.6%.
Common symptoms in colorectal cancer include bloody stools 87.2%.
Partially mobile tumors accounted for 65.5%.
Acute blood pressure levels recorded at admission and long-term outcome
The average length of stay in the hospital was 7.75 ± 3.8 days.
Conclusion: Children infected with Covid - 19 have a common symptom of fever.
Common laboratory tests have increased CRP, LDH and lung lesions on X-ray.
Most children with Covid-19 have a mild form.
Research objectives: Clinical, subclinical characteristics and treatment results of children infected with Covid-19 from 2 months to 5 years of age treated at Duc Giang General Hospital.
Subjects and research methods: A prospective study describing a series of cases including 52 patients diagnosed with Covid-19 who were treated at the Pediatric Covid-19 unit of Duc Giang General Hospital from January 1, 2022 to October 10, 2022.
Results: The mean age of the disease was 21.0 ± 15.4 months (2 - 62 months), in which 59.6% of cases were under two years old.
The ratio of boys to girls is 2.1: 1.
Blood tests showed an increase in white blood cell counts, CRP, D-dimer, ferritin and LDH by 5.8%, 28.8%, 19.2%, 7.7% and 88.5%, respectively.
The rate of children having chest x-ray with lesions accounted for 63.5%.
Results of conserving breast surgery using round block oncoplastic technique in department of breast surgery
Evaluate the effects of abdominal acupuncture combined with movement therapy on recovering upper limb functions in patients with hemiplegia due to cerebral infarction after acute phase at Phu Tho Provincial General Hospital from 2021 to 2022.
Methods: Clinical trial study, comparison before and after treatment's result and compare with control group.
60 patients were divided into two group: the study group used abdominal acupuncture combined with movement therapy, the control group used movement therapy.
Results: After 6 weeks of the treatment, the patients in the study group improved movement of the paralyzed arm according to the Fugl - Meyer scale, improved dexterity function of the paralyzed hand and improved average Barthel score better than the control group, statistical significance with p < 0.05.
Conclusion: Abdominal acupuncture combined with movement therapy improved upper limb functions in patients with hemiplegia due to cerebral infarction after the acute phase.
Acute toxicity study of submerged-fermentation of phellinus linteus biomass powder
To survey the prevalence of dyslipidemia and the relationship between dyslipidemia and some clinical and subclinical indexs among the elderly patients with hypertension who were treated at 115 General Hospital - Nghe An.
Methods: This was a cross-sectional study conducted on 150 the ederly patients with hypertension who were treated at 115 General Hospital - Nghe An.
Results: (1) The prevalence of dyslipidemia among the elderly with hypertension was 88, 0%; (2) There is the relation between dyslipidemia with: fatty liver status, BMI, waist circumference, duration of hypertension, alcohol abuse and physical inactivity; (3) No relationship has been found between dyslipidemia with: age group (≥ 70 years old compared to 60 - 69 years old), sex, family history of dyslipidemia.
Conclusion: Dyslipidemia account for a very high proportion among the elderly patients with hypertension, especially in patients with other associated cardiovascular risk factors such as overweight, obesity, alcohol abuse and physical inactivity.
A case report: Bosma arhinia microphthalmia syndrome at Cho Ray hospital
To determine the changes in biochemical and hematological parameters of pre-eclampsia patients.
Subjects and methods: A cross-sectional study on 60 pre-eclampsia pregnancy women and 60 healthy pregnancy women.
The assays are determined by means of enzyme colorimetric, enzyme kinetics, indirect selective electrode.
Results: Plasma Uric acid, Urea, Creatinine, AST, ALT levels were significantly higher in pre-eclampsia group than control group, sequence: 469, 73 ± 124, 99 μmol / L versus 267, 96 ± 47, 96 μmol / L (p<0, 05); 6, 75 ± 3, 34 mmol / L versus 2, 65 ± 0, 59 mmol / L (p<0, 05); 71, 73 ± 17, 98 μmol / L versus 54, 04 ± 4, 56 μmol / L (p<0, 05); 31, 20 ± 22, 28 U / L versus 21, 09 ± 5, 01 U / L (p<0, 05); 22, 53 ± 19, 18 U / L versus 14, 29 ± 7, 55 U/L (p<0, 05).
Total platelet count and Protein, Albumin levels were significantly lower in pre-eclampsia group than control group.
Conclusion: There was a marked change in some biochemical indicators related to liver and kidney function, a significant increase in uric acid concentration and a decrease in platelet count of pre-eclampsia patients.
Assessing the results of gynecological laparoscopic surgeries
CRISPR / Cas9 is a new technique developed in the recent time.
Beginning with the discovery of the mysterious palindromic repeating sequence of DNA in E Coli in 1987, scientists began investigating the function of this seemingly outrageous phenomenon.
This natural curiosity developed a whole new way to modify DNA: CRISPR / Cas9.
The system developed as a self-defense against bacteria is an essential way to self-vaccinate against invading viruses and plasmids.
The paper presents the basic mechanisms of how the CRISPR / Cas9 system works and some possibilities that the CRISPR / Cas9 system can apply practically (act on sleeping genes - Knock) - out genes, genomic editing without the use of DNA vectors, temporarily inactivating genes...) to almost all species.
Drug - Induced Dyslipidemia
To assess the relationship between collateral circulation on Multiphase Computed Tomography Angiography (CTA) with some clinical features and outcome in patients with acute ischemic stroke.
Subject and method: 136 consecutive patients with acute ischemic stroke who had multiphase CTA in the first 7 days from onset and were received routine treatment regimen at Military Hospital 103 from November 2021 to July 2022.
Assessment some clinical features, outcome based on Glasgow Coma Scale (GCS), Medical Research Council UK (MRC), National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS).
Result: Average age: 66.2 ± 12.2, male / female ratio: 1.52/1.
The level of collateral circulation on multiphase CTA: Good 76.4%, average 19.1%, poor 1.5%.
GCS, MRC, and NIHSS were significantly lower in the group of good collateral circulation at all: admission, after 24 hours and discharge.
Good recovery at hospital discharge (mRS 0 - 2) was significantly higher in the group of good collateral than in the moderate - poor group (53.7% vs 4.4%; p < 0.05).
Conclusion: Collateral circulation on multiphase CTA has a value of prognosis of outcome in patients with acute ischemic stroke.
Classification of eye behavior based on electrooculogram signals using labview tools
A longitudinal, descriptive and analytical study was performed on 173 patients with cirrhosis admitted to the Department of Gastroenterology, Soc Trang General Hospital from 11/2020 to 4/2021 with the aims to: (1) Describe the clinical characteristics of patients with cirrhosis; (2) Evaluate care outcomes and analyze some related factors of care outcomes.
Therefore, not only caring cirrhosis, but also need to guide patient how to care comorbidities and persuade patients to quit drinking (alcoholism patients) to improve care and treatment outcomes.
The study showed: The mean age of patients was 58.6 ± 14.1 (56.1% male and 43.9% female).
The majority of patients live in rural areas (85.5%); low education level (22.0% are illiterate; 45.7% have primary school level).
History: alcoholism (40.5%), viral hepatitis (19.7%).
Common clinical features: fatigue (99.4%); anorexia, poor appetite (97.1%); collateral circulation (35.8%); ascites (56.6%); 19.7% of patients had gastrointestinal bleeding complications.
Rate of Child-Pugh A, B, c is 18.5%, 52.0% and 29.5%.
Through assessment: Good care (78.0%), bad care (22.0%).
There was a relationship between disease history, comorbidities, nursing care, treatment results with outcome of care (p < 0.05).
Magnetic resonance imaging features of lingual thyroglossal duct cyst
Assess the patient's satisfaction with nursing care provided by clinical departments in Hue University of Medicine and Pharmacy Hospital in 2019.
Subject and method: A cross-sectional study on 600 inpatients at Hue University of Medicine and Pharmacy Hospital.
Results: The general proportion of patient satisfaction was 71.4%%.
Patients were satisfied more with mental health services (77.8%), nursing care skills (75.5%) and the relationship with nurses (70.2%), consulting health education services (73.6%). Patient were less satisfied with hospital hygiene (61.5%).
Conclusion: overall, more patient show enthusiasm with the medical care provided by nurse (71.4%).
However, the patient's satisfaction with hospital hygiene stood at only 61.5%.
Surgical repair for peripheral facial nerve injury in patient with facial trauma
To evaluate of the prediction factors for the success of Heated and humidified high-flow nasal cannula (HHFNC) in patients with exacerbation of chronic obstructive pulmonary disease (COPD).
Methods: Pre and post - intervention study on 32 patients with COPD exacerbation used HHFNC support.
Results: the success rate with HHFNC was 65.6%.
In the successful group, vital signs (heart rate, respiratory rate, SpO2 and blood pressure) and arterial blood gas (pH, PaO2, PaO2/FiO2) improved gradually (p<0.001). In the failure group, the pH decreased and PaCO2 increased significantly (p<0.05).
Mechanical ventilation parameters (Flow, FiO2) decreased in the successful group and increased in the failure group during study period (p<0.001; p<0.05).
PaCO2 with cut-off ≥ 62 mmHg (area under ROC curve, AUC = 0.8247), HACOR with cut-off ≥ 4 (AUC = 0.8636), ROX with cut-off ≥ 7, 98 (AUC = 0.8030) provided high sensitivity, specificity, positive predictive value and negative predictive value.
Conclusion: The successful prediction factors for HHFNC were PaCO2, HACOR and ROX at the initiation of the non-invasive ventilation for patients with the acute exacerbation of COPD
The role of simulation in pediatric nursing practice to self-efficacy of full-time bachelor nursing student in the practice of intravenous injection skills for children
Describe clinical, investigations and treatment results of hookworm infections with severe hypoproteinemia.
Conclusion: Although hookworm infection is a common disease in developing countries, severe complications of hookworm such as protein-losing enteropathy are rare, so prompt diagnosis and treatment is required to avoid life-threatening.
Subjects and methods: Report a case of severe complications of hookworm at the Department of Emergency and Poison Control, National Children's Hospital.
Results: A 20-month-old girl from the Muong ethnic was admitted because of lethargy and diarrhea.
Initial tests showed that the child had severe anemia, with elevated eosinophils and severe hypoproteinemia.
The patient was treated for the emergency condition and investigated common causes of hypoproteinemia. Patients were excluded: malnutrition, liver and kidney diseases,... Based on epidemiological factors and symptoms, we prescribed tests for parasites including worm eggs and quantified alpha 1 antitrypsin (A1AT) level in the stool.
The child's stool showed a lot of hookworm eggs (+++) and increased A1AT concentration (106.2 mg / dL).
The patient was confirmed with protein-losing enteropathy (PLE) due to hookworm infection and was treated with albendazole for 3 days.
After 16 days of diagnosis and treatment, the patient had normal bowel movements, no edema, no reduction in serum protein and was discharged.
Evaluating nursing care for mucositis induced by chemoradiation for the treatment of head and neck cancer at National cancer hospital
In recent years, Vietnam has witnessed an increase in cardiovascular disease morbidity and mortality.
This has given impetus to the current cross-sectional study to collect data on risk factors of cardiovascular disease through the 2016 annual physical exam result of 269 staff members aged from 20 to 64 from a Hanoi-based university.
The prevalence of overweight - obesity, hypertension and dyslipidemia was 43.8%, 12.3% and 29.0%, respectively.
Men were more at risk than women.
Compared with wider community, the prevalence of hypertension and dyslipidemia among the staff was considerably lower.
There was an association between gender and these risk factors, while age generally affected hypertension (p < 0.001).
ASSESSMENT OF THE EFFECTIVENESS OF NERVE PAIN TREATMENT CAUSED BY HERNIATED DISC WITH GUNA COLLAGEN INJECTION
To evaluate prevalence 6 weeks postpartum diabetes and relative with some factors in women with gestational diabetes Subject and method: A cross-sectional and follow up to 6 weeks postpartum on 93 pregnant women with GDM from 7/2018 to 7/2019 at National Hospital of Endocrinology.
Conclusion: Prevalence 6 weeks postpartum diabetes is 11.8%.
Overweight / obesity pre-pregnancy increased risk type 2 diabetes postpartum.
BMI pre-pregnancy level 22.2 kg / m2 predict type 2 diabetes mellitus with highest sensitve and specificity.
Result: Prevalence type 2 diabetes 6 weeks postpartum was 11.8%; prediabetes 47.3%, normal glucose tolerance 40.9%.
BMI pre-pregnancy level 22.2 kg / m2 predict postpartum type 2 diabetes mellitus with highest sensitve (90.9%) and specificity (70.7%), AUC = 0.803 (p=0.002).
BMI pre-pregnancy ≥ 22.2 kg / m2 increased risk type 2 diabetes postpartum 6.95 fold (p<0.01).
BMI at diagnosed gestational diabetes ≥ 25.2 kg / m2 increase risk of type 2 diabetes postpartum 5.21 fold (p<0.05).
Wrapping technique of ascending aorta in hybrid procedure for complex aortic arch disease
Surgery is the most important treatment method, with high efficiency and fewer complications.
Results: benign / malignant ratio is 1, 31, female / male ratio is 1, 05/1, painless mass at gland is the most common symptom.
Tumor size 2 - 4 cm 72, 6%, right / left is 1, 1/1, hypoechoic 89%.
With benign tumors, the commonest histopathology is pleomorphic adenoma, Among the malignant tumors, adenoid cystic carcinoma was the commonest tumor 34, 37%, followed by mucoepidermoid carcinoma 25%.
With benign tumors, surgery removed the tumor 35, 7%, removed the whole gland+tumor 64, 3%, 96, 9% of cancer underwent surgery to remove the entire gland, 53, 1% lymph node dissection.
Common complications are early paresis of the marginal branch of the facial nerve 10, 8%, recover after 6 months, lingual nerve paresis, hematoma are uncommon.
Conclusions: Histopathology of submandibular tumor is diversity.
Clinical and subclinical features can guide diagnosis and treatment prognosis.
Green synthesis and study on antibacterial activity of silver and gold nanoparticles obtained from callisia fragrans leaf extract
Descriptive, cross-sectional study of 97 ethnic minority patients diagnosed with hypertension by interview, measurement of anthropometric indicators according to a set of survey questionnaires.1 Results: Awareness, attitude of patients about hypertension: 19.59% have not heard about hypertension; Periodical checking BP 7.21%, when having symptoms 24.74%, not checking 68.04%; subjects who not fully knew about complications with regard to hypertension accounted for 26.81%; BP increased proportionally with BMI, p<0.01; The average waist circumference of women was higher than that of men (89.83 ± 5.50 cm compared with 87.27 ± 5.59 cm), p<0.05, there was a positive, moderate correlation with BP (rHATTr = 0.44, rHATT = 0.56).
Conclusions: Awareness and attitudes of ethnic minorities about hypertension are still limited compared to plains and cities.
The waist circumference of ethnic people tends to be higher than that of Kinh people.
Hypertension has a positive correlation with waist circumference and BMI.
Study of microbial agents causing low genital tract infections in women gynecological examination and related factors
Evaluating the effectiveness of urea clearance in hemodialysis by the spKt / V indicator is necessary for treating patients with end-stage chronic kidney disease (ESRD). Multiple evaluation methods could support the specialists in choosing the best treatment methods for this disease.
This study was conducted to evaluate the effectiveness of hemodialysis by comparing the spKt / V indicator in direct measurement on the machine to the calculation method according to the Daugridas formula.
The cross-sectional descriptive study on 175 patients with ESRD undergoing hemodialysis at Cho Ray Hospital from January to June 2022 used the Willcoxon Signrank Test to compare the average spKt / V calculated by the two methods above.
The results show that the average spKt / V calculated by the direct measurement on the machine (1.77 (1.5 - 2.06)) and the Daugridas formula (1.6 (1.36) - 1.82)) were all within the recommended value.
The Willcoxon Signrank Test illustrates a statistically significant difference in spKt / V in the two methods, while the Linear regression model shows a strong correlation with correlation coefficients R = 0.65 and R2 = 0.423 (p<0.001).
Therefore, experts need to consider choosing an optimal method of measuring directly on the machine to evaluate and adjust parameters during the hemodialysis process in their professional interest to effectively treat the disease.
Building a scale of knowledge, attitudes, behavior of consuming functional foods at pharmacies in Ho Chi Minh city
This research recruited all bronchiolitis inpatients in Vinmec Timescity International Hospital from Jan 2022 to Dec 2022.
The reason of antibiotic application was analysed based on clinical symptoms, complete blood count, CRP, nasopharyngeal test for virus and bacteria.
Result: There were 68 inpateints acquiring bronchiolitis, with mean age 9, 2 ± 5, 4 months and male / female ratio was 1, 5.
Conclusion: The rate of administering antibiotics in bronchiolitis treatment in Vinmec Timescity International Hospital was 51.5%. The justification forantibiotic using was clinical symptome, elevated inflammatory biomarkers, positive nasopharyngeal culture and X-ray.
Isolation of escherichia coli bacteriophage from water environment by lysis method
To evaluate the effectiveness of pain treatment of auricular electrical stimulation in patients with hip lumbar syndrome due to degeneration spine and comment some factors related to treatment outcome.
Subjects: 60 patients diagnosed with hip lumbar syndrome due to degeneration spinr divided into study group and control group, treated at Rehabilitation - Traditional Medicine Department, Hoe Nhai General Hospital from September 2021 to July 2022.
Research method: controlled clinical intervention, comparison before and after treatment.
Results: after 20 days of treatment, the mean VAS score of the study group decreased from 6.43 ± 0.82 to 0, 83 ± 0.65 with p < 0.05; this result was statistically significant compared to the control group (VAS decreased from 6.13 ± 0.90 to 1, 27 ± 0.79) with p < 0.05, the mean score of daily living function after treatment of the study group (4.77 ± 1.46) improved over the control group (5.57 ± 1.48) with p < 0.05.
Conclusion: auricular electrical stimulation combined with electro-acupuncture and acupressure has pain relieving effect, improving daily living function in patients with hip lumbar syndrome due to degeneration spine.
The current situation of drugs usage to treat basedow on inpatients
To develop an analytical methodology to simultaneously determine naringin and two preservatives (sodium benzoate and potassium sorbate) in extract of young pomelo.
Subjects and methods: Naringin, sodium benzoate and potassium sorbate in young pomelo extract were determined by HPLC method.
Results: Chromatographic separation was made with C18 column using acetonitrile - acetic acid 0.1% (20: 80) as the mobile phase at 1, 0 ml / min and detected at 235 nm.
The process was validated the system suitsability; selectivity; linearity range of naringin (10.0 - 500.0 (ppm); y = 9902.5x; R2 = 1.0000), potassium sorbate (0.4 - 20.0 (ppm); y = 34597x; R2 = 1.0000), and sodium benzoate (0.4 - 20.0 (ppm); y = 35395x; R2 = 1.0000); precision of both three compounds with RSD < 2.0%; and accuracy with recovery ratio in 98 - 102 (%).
Conclusion: The process could be applied to determine the content of marker and preservatives in young pomelo extract.
Clinical and laboratory characteristics of copd patients after exacerbation at the respiratory center in Bach Mai hospital in 2018
Describe the clinical and laboratory features of patients with chronic obstructive pulmonary disease after their exacerbations.
Method: A cross-sectional study was conducted on 122 patients with Chronic Obstructive Pulmonary Disease (COPD) after the exacerbations by the Respiratory center at Bach Mai Hospital in 2018.
In terms of physical manifestations, 63, 9% COPD patients reduced vesicular breath sounds; 31, 2% had coarse crackles and fine crackles; 76, 25 had a high pulmonary artery pressure and 50, 8% patients had the P pulmonale in ECG.
The effects of particulate matter on inpatient elderly people with stroke in five hospitals, Danang, 2019
To determine the physical exam and diagnostic testing in patients who suffer from obstructive sleep apnea syndrome aged over 65 years old in Bach mai Hospital.
Methods: Forty-five patients who suffer from obstructive sleep apnea syndrome aged more than 65 years old agreed to participate in our study and performed polysomnography, from 9/2020 to 7/2021.
The most common nocturnal symptom is loud snoring when sleeping, reach to 92.5%, and waking up many times during the night, reach to 75%.
97.6% of patients had Mallampati grade 3 - 4 (n=42) with an average apnea index of both sexes of 32.63 (n=45).
Of which 73.3% of patients have moderate to severe AHI.
Patients with obstructive sleep apnea syndrome have Epworth score > 10 and morning headache symptoms only accounted for 20% (n=40).
Conclusion: Subjects over 65 years of age with OSA presented with daytime drowsiness, headache, and low morning irritability.
Snoring is the most common nocturnal symptom in patients over 65 years of age with obstructive sleep apnea with moderate to severe AHI.
Work motivation of clinical nursing and associated factors at Tay Ninh general hospital in 2019
Colon cancer is a common disease in Vietnam, ranking second after gastric cancer in gastrointestinal cancers.
The mean operativetime was 168.7 ± 31.4 minutes. The mean duration of hospitalization was 10.8 ± 4.9 days.
Conclusion: Laparoscopic surgery for colon cancer is a safe and effective surgical technique with less postoperative pain and a low rate of postoperative complications.
Treatment of colon cancer is mainly based on surgery to excise the colon with tumor and adjuvant chemotherapy.
Laparoscopic surgery for colon cancer increasingly shows its effectiveness and is widely used.
A prospective, descriptive study was conductedon 35 patients with colon cancer who were treated by laparoscopicsurgery at the Hue Central Hospital - Branch 2 from January 2019 to June 2021.
The mean age was 62.4 ± 17.8 (34 - 82); the male / female ratio was 1.2.
The sites of cancer were: right colon 31.4%; transverse colon 11.5%; left colon 25.7%; sigma colon 31.4%.
Protrusive tumors were accounted for 82.9% by diagnostic colonoscopy.
Elevation of CEA serum level wasfound in 42.9% preoperatively.
TNM stage of II and III were the most 80%.
Study on hematological characteristics and beta globin gene mutations of beta thalassemia carriers at the National Institute of Hematology and Blood Transfusion from 2015 to 2022
Evaluation of the association between single nucleotide polymorphisms rs1128503, rs2032582, rs1045642 of the ABCB1 gene and rs2234918, rs581111, rs529520 of the OPRD gene and methadone substitution therapy in patients with opioid addiction.
Material and methods: 400 opiate-addicted patients receiving methadone treatment were identified for single nucleotide polymorphisms by Sanger gene sequencing.
Results: Individuals carrying CT genotype of single nucleotide polymorphism rs1045642 of the ABCB1 gene required high dose group (≥ 90mg / day) 1.59 times higher than CC genotype (OR=1, 59, p=0.03).
For the single nucleotide polymorphism rs2234918 of the OPRD1 gene, individuals carrying the CC genotype required high-dose group therapy (≥ 90mg / day) has higher 2 times more than TT genotype (OR = 2, p=0.049).
Individuals carrying the CT-CC genotype (rs1045642 ABCB1 gene - rs2234918 OPRD1 gene) requiring high dose group treatment (≥ 90mg / day) has higher 4, 00 times more than wild-type CC - TT genotype (OR = 4, 00, p=0.02).
Conclusion: There is an association between genetic variant of single nucleotide polymorphism rs2032582 of the ABCB1 gene and rs2234918 of the OPRD1 gene and methadone substitution therapy in patients with opioid addiction.
Positive blood culture sepsis in covid-19 patients
Skin cancers are increasingly on the rise with a series of change agents disrupting cell division inducing unlimited proliferation and cell differentiation disorders; however, the body has mechanisms to protect against skin cancer.
One of the main factors is P53 protein encoded by the TP53 gene.
When this gene is mutated, there is loss of function triggering tumor cells development.
Research of TP53 gene mutations in skin cancer tissue will contribute to understanding the mechanism causing cancer and support clinicians to plan for treatments especially radiotherapy.
By gene sequencing of skin cancer of 63 patients initially, we identified mutation in gene TP53 in different forms; mutation in the exons held 27%, transformation in the intron segments accounted for 95.2%.
We identified 52 transformation positions in gene TP53, of which 10 mutations were found in the exons and 42 changes in the intron segments.
Direct costs for inpatient treatment of patients with ischemic stroke at neurology center Bach Mai hospital, in 2021
Osteoporosis is a common disease in the elderly.
Conclusion: Bone density should be routinely measured in women over the age of 60 to determine osteoporosis.
Many studies show that women aged 60 years or more, about 20% osteoporosis and in men the same age on the incidence is about 10%.
Osteoporosis is a silent disease, patients are less interested but progress to serious consequences as fractures, fracture location is common femoral neck and spine.
Currently, to diagnose osteoporosis, measurements of bone mineral density measurements by adsorption dual energy xrays are considered the standard method.
Methodology: A cross-sectional study.
Conducting research on bone mineral density by DEXA method of women aged 40 to measure bone mineral density at the Hue Central Hospital.
Plug-assisted retrograde transvenous obliteration for the treatment of gastric variceal hemorrhage
This research was performed to investigate the clinical, subclinical features and correlation of peripheral vascular disease and pulmonary arterial hypertension in patients with systemic sclerosis.
Systolic pulmonary artery pressure was not too elevated and most patients had only mild symptoms.
There was no correlation between pulmonary arterial hypertension and peripheral vascular diseases.
This was a cross-sectional study of 71 patients with systemic sclerosis.
100% of patients had nailfold microvascular impairment on capillaroscopy and most were in the early stage, accounting for 47.9%; the total capillaroscopy score was 3.3 ± 1.2.
98.6% of patients had Raynaud's phenomenon and the average process duration of Raynaud's phenomenon was 38.0 ± 37.2 months and the average Raynaud's condition score was 3.9 ± 1.5 points; 6 patients accounting for 8.5% had active digital ulcers; the average quantity of digital pitting scars was 1.1 ± 1.4.
The mean systolic pulmonary artery pressure was 40.2 ± 5.1 mmHg.
The majority of patients with WHO functional classification belonged to group II, accounting for 53.5%.
The WHO functional classification mean was 2.0 ± 0.7.
There was no correlation between pulmonary arterial pressure value and RCS, number of active digital ulcers and semi-quantitative nailfold capillaroscopic score of loss of capillaries with p>0.05.
All patients had peripheral vascular disease on subclinical and nearly all showed clinical symptoms.
Study on transfer of antibiotic-resistance characteristic from probiotics to other bacterial species in vitro
ABO blood types are based on two methods (direct and indirect method) at the same time and is only confirmed if having similar results.
In clinical practice, we recorded some difficult cases of blood group determination.
In the following case, we used many supporting techniques such as antibody adsorption in cold temperature and pedigree analysis in order to determine ABO blood group.
The result of this patient was B weak with B antibody.
ASSESSMENT THE CLINICAL AND SUBCLINICAL IN PATIENTS WHO UNDERWENT MICHANICAL MITRL VALVE REPLACEMENT WITH POSTERIOR LEAFLET PRESERVATION AT HUE CENTER HOSPITAL
To determine the HPV infection rate and the relationship between the HPV infection rate and the epidemiological characteristics of women visiting Hai Phong Obstetrics and Gynecology Hospital.
Methods: A cross-sectional descriptive study, 800 sexually active women aged 18 to 69 who came to Hai Phong Obstetrics and Gynecology Hospital agreed to participate in the study and had HPV DNA testing. cervix from December 1, 2018 to April 1, 2019.
Results and conclusions: The rate of HPV positive is 12.75%.
There is a statistically significant relationship between the prevalence of HPV infection with geographical characteristics.
No association was found between clinical manifestations and Thinpap Test results of research subjects with the rate of HPV infection.
Determination of total flavonoid, anthocyanin content and antioxidant activity of the fractions extract from butterfly pea (Clitoria ternatea) flowers
Describe some clinical characteristics of patients with palmar and plantar hyperhidrosis and evaluate the results of HB herbal medication formular for treating palmar and plantar hyperhidrosis.
Methods: use randomized clinical trial and compare results before-after treatment on 50 patients with palmar and plantar hyperhidrosis.
Results: The average age was 24.02 - 7.59 (years old), females were more likely to develop hyperhidrosis than males, the onset age of the disease at under 12 years old accounted for the majority of the studied patients (76%).
After 1 month of treatment, the percentage of patients who had hyperhidrosis quite frequently decreased from 40.0% to 16.0% and the proportion of the ones who had hyperhidrosis fairly frequently declined from 54.0% to 18.0% (p < 0.05).
The percentage of patients who developed level 3 (50%) and level 4 (16%) of hyperhidrosis underwent a drop to 12.0% and 4.0%, respectively (p < 0.05).
The quality of life effect of hyperhidrosis: 16.0% of patients decreased 80% of the total symptoms and 58.0% of patients decreased 50% of the total symptoms.
Conclusions: HB herbal medication formular improved clinical symptoms patients with palmar and plantar hyperhidrosis.
Clinical and laboratory testing of oral anticoagulation therapy vitamin k antagonists at the emergency department of hanoi heart hospital
Arteriovenous malformations of the scalp are rare vascular malformations but constitute a high proportion in arteriovenous malformations of the head and neck.
We retrospectively assessed the outcome after treatment of scalp arteriovenous malformations by thePlastic and Maxillofacial Surgery Department at Viet Duc university hospital between January 2009 and December 2018.
Patients were treated by embolization and resection.
The small lesions have the highest rate of successful treatment.
The large and diffuse lesions, especially those with connection with the intracranial vessels are big challenges to manage and require collaboration between the plastic - maxillofacial team and the neurosurgical team.
Some factors related to treatment compliance of patients with type 2 diabetes
he pandemic not only upsets people's lives, but also shields countries from economic, political and social instability.
At this time, each country considers the role of health and preventive medicine (preventive medicine) very important.
And Vietnam is also a country that is not outside of this problem.
This article will mention some limitations in state budget spending on preventive medicine and make recommendations to increase the efficiency of state budget spending on preventive medicine in particular and state budget spending on health in general.
Study on the situation of prescribing on elderly patients apply the STOPP/START criteria at Bac Lieu hospital in 2021
Pulmonary embolism is a fierce emergency and requires early and accurate management.
The treatment of pulmonary thromboembolism becomes increasingly difficult in patients at high bleeding risk.
We reported a case of successful embolectomy in a high-risk patient with acute pulmonary thromboembolism on the background of traumatic brain injury, as well as a reviewed of the literature on similar patients.
The value of mri for determining meniscal tears in patients with injured knee
Common symptoms were nasal congestion, post nasal discharge, headache, tinnitus, scratchy throat.
Conclusion: After 3 months of surgery, most of functional symptoms improved compared to before surgery.
Adenoid hypertrophy was considered uncommon in adults.
Because of various causes, the adenoid is hypertrophic in adults.
Less may become cancer cell.
Objectives: To describe the clinical features, subclinical characteristíc and asscess the result of adenoidectomy by microdebrider.
Materials and methods: Descriptive crosssectionalstudy and prospective design with patients (from 15 years old) who sufferfrom hypertrophy adenoid, were treated with microdebrider under nasal endoscopic at Can Tho Ear Nose Throat Hospital.
Results: Of 102 cases, 55 were males and 47 were females. Patients aged between 15 - 59 years.
Most of them had the grade II hypertrophy adenoid with 60.8%.
Prevalence of depressive symptoms in women with intrauterine growth restriction at hung vuong hospital
The study aimed to determine the factors affecting the quality of life of patients with type 2 diabetes treated as outpatients at Tra Vinh University Hospital in 2021.
The crosssectional study includes data from over 200 people with type 2 diabetes who are being treated as outpatients at Tra Vinh University Hospital.
The study used direct interviews to collect data.
The study managed and analyzed data using SPSS 20.0 software and the Kruskal Wallis and MannWhitney test to identify factors affecting the life quality of patients with type 2 diabetes.
The results show that the overall quality of life score of diabetic patients is 62.10 ± 7.31, equivalent to the average quality of life of patients with diabetes.
The results also show that the average quality of life score for participants are connected with factors including age groups, occupation, duration of disease, other comorbidities, and complications in patients.
This difference is statistically significant with p < 0.001, p = 0.001, p = 0.039, p = 0.007, p = 0.008, respectively.
In addition, the study did not find any difference in the mean quality of life scores by gender, education level, marital status, health insurance, household economy, people living with, BMI, glycemic index, and treatment methods.
5 years cosmetic outcome after intensity modulated radiation therapy followed conservative surgery of breast cancer stage I-II at K hospital
Streptomyces is the microorganism that has capable of producing antibiotics.
The current study aimed to screen and to select a strain that had the highest antibacterial activity from 59 available soilderived Streptomyces strains based on the perpendicular culture method on 5 indicator pathogenic bacteria, including Bacillus cereus, Escherichia coli, Salmonella typhi, Staphylococcus aureus và Pseudomonas aeruginosa.
Fourteen strains exhibited their antibacterial activity at various levels, the remaining did not have that activity.
The strain that had the highest antibacterial ability was HĐM3.2 against 4/5 indicator microorganisms, including B cerius, S aureus, S typhi and E coli with inhibitory areas were 9.5, 10.5, 16.5, and 14.5 mm respectively.
Strain HĐM3.2 was identified as strain Streptomyces sp.
based on a phylogenetic tree built on the 16S rRNA gene sequences.
Suitable conditions that made the strain HĐM3.2 showed the highest antibacterial activity were investigated based on agar well diffusion assay.
The medium of International Streptomyces Project 2 with pH 8, the ambient temperature at 28oC were suitable conditions for Streptomyces sp.
HĐM3.2 produced the highest inhibitory areas against B cereus, E coli, S typhi, S aureus.
Effect evaluation of recombinant lumbrokinase on acute brain infarction mice model
The purpose of this study was to describe the characteristics and progression of lung lesions on chest X-ray and CT scans in COVID-19 patients with pneumonia treated at National Hospital of Tropical Diseases.
Materials and methodes: Design of a cross-sectional descriptive study performed in 200 patients with COVID-19 who were treated at National Hospital of Tropical Diseases from January 2020 to May 2021.
Results: 91.5% of patients had no lesions on chest X-ray, while lung lesions detected on chest CT were 53% of patients. Characteristics of lung lesions on chest X-ray: 64.7% of patients had lesions in 2 lungs, 41.2% had lesions in the lower third, and 35.3% had diffuse lesions.
The lesion morphology included: opacities (70.6%), interstitial thickening (17.6%), frosted glass (11.8%). Characteristics of lesions on chest CT: lesions are mainly located in the periphery of the lung (57.5%), both central and peripheral (38.7%).
Distribution of lesions in multiple lobes of 2 lungs (68%).
The most common lesions are: frosted glass (91.5%), solidified (22.6%), interstitial thickening (14.2%).
Progression of lesions on chest CT: after 15 days of treatment, 68% of patients' lesions tend to decrease or return to normal, 2.8% of patients tend to remain unchanged, 6.6% of patients aggravated, the lesion tends to worsen.
A case report of renal leiomyoma and review literature
To investigate the globin gene mutation causing thalassemia in patients with hypochromic microcytic anemia without iron deficiency at Bach Mai Hospital from 2019 to 2021 and to find out the relationship between some indicators of red blood cell characteristics demand for genotypes.
MCH was lowest in genotype - -SEA / -4.2α; highest in genotype - - SEA/αα.
With genotype beta globin Hb lowest in genotype Cd17 / β, highest in genotypes Cd71/72 / β and Cd26/β.
Subjects: 82 subjects had small red blood cells, no iron deficiency and were screened for globin mutations.
Method: A cross-sectional descriptive study, combining retrospective and prospective.
Results: Detecting alpha globin mutations - SEA, α2 cd142, - 3.7, - 4.2.
Genotype - SEA heterozygous accounted for the highest rate 51.8%.
Detection of beta globin mutations Cd26, Cd17, Cd71/72, IVS1.1, Cd95.
The heterozygous Cd26 genotype accounted for the highest rate (21.9%).
With the alpha globin genotype, Hb was lowest in the - SEA / α2 cd142 genotype (73.2 g / l).
MCV was lowest in genotype - -SEA / -3.7α; highest in genotype - - SEA / α2 cd142α2 cd142.
Study on ultrasonic and cytology characteristics of the thyroid nodules in patients with euthyroid Grave’s disease
Conclusion: Tumor can invade middle cranial fossa and cavernous sinus through natural fissure and foramen, most commonly is superior orbital fissure.
Due to high risk of complications and recurrence, the extensive tumor should be treated by a multidisciplinary team and modern techniques.
Objective: The article review clinical symptoms, radiological images and outcomes of surgical approach to remove JNA tumors with middle cranial fossa and cavernous sinus extension.
Methods: The study is a case series to review 05 patients (ages 13 to 28) diagnosed with JNA tumor with intracranial extension from 2018 - 2021.
Results: All 5 patients with JNA was diagnosed with stage III.
Endoscopic surgery was used as additional technique.
Follow up was 2 years.
Survey on anxiety disorder among 4th year students at Nam Dinh university of nursing
The results of the study showed a relatively high percentage of non-anxiety students with 59.7%.
Over 69% of the participants had an understanding of anxiety through self-evaluation. 88.3% of students know how to find activities to reduce anxiety and stress.
Factors influencing anxiety in the 4th year students of NamDinh University of Nursing are diverse. Learning activities and job opportunity after graduation are the main factors contributing to students' anxiety and stress.
Primary outcome evaluation of interstitial brachytherapy stage I-III mobile tongue cancer treatment
Congenital airway stenosis (tracheobronchial stenosis) in children is rare, difficult to treat and become more complex when associated with congenital heart defects.
Study on preparation of “Luc vi dia hoang” capsules
To evaluate clinical features, imaging and factors related to surgical treatment results of epidermoid cysts in the cerebellopontine angle.
Microsurgery to remove the entire tumor is the ideal treatment to increase the rate of symptom improvement.
However, if tumors are adherent to surrounding important structures, surgeon can actively leave this part in order to preserve function after surgery.
Methods: A cross-sectional descriptive study of 34 cases of CPA epidermoid cysts diagnosed and treated with microsurgery at the Neurosurgery Department - Cho Ray Hospital from February 2018 to February 2021.
Results: The mean age of the research group was 41, 1 ± 8, 7, male / female ratio is approximately 0, 4/1.
The most common hospital admission symptoms were headache (29, 4%), V neuralgia (26, 5%) and tinnitus (20, 6%).
Total tumor removal reached 41, 2%.
After 6 months of postoperative follow - up, the most improved symptoms were hemiparesis (100%), facial hemispasm (75%) and V neuralgia (72, 2%).
New neurological deficits at 6 months were 14, 7%, of which cerebellar syndrome accounted for 5, 9%, paralysis of the VI, VII and VIII nerves each equivalent to 2, 9%.
Complications after surgery were all less than 10%, cerebellar contusion and hemorrhage accounted for the highest rate of 8, 8%.
Conclusion: CPA epidermoid cysts with diverse clinical manifestations.
Extraction and testing of active ingredients resisting some types of bacteria of blumea balsamifera oil
Determine the relationship between stress, anxiety, depression in patients with type 2 diabetes and related factors.
Conclusion: There is a strong and positive correlation between stress, anxiety and depression.
There are associations between stress, anxiety, depression with social factors, patient health information and patient's type 2 diabetes pathology factors.
Subjects and methods research: Cross-sectional descriptive analysis on 133 patients who visited the outpatient clinic at the Ho Chi Minh City University of Medicine and Pharmacy Hospital from April 2022 to September 2022.
The research tool is the DASS - 21 scale.
Statistical analysis by T-test, ANOVA, Mann-Whitney, Kruskal-Wallis, Pearson.
Results: The rates of stress, anxiety and depression of patients according to the DASS-21 scale were 6.77%, 37.6%, and 10.52%.
There is a positive and strong correlation between stress, anxiety and depression and this is statistically significant with the correlation coefficient r 0.75 and p < 0.001.
There was a relationship between stress and: religion, medical expenses, frequency of blood sugar checks, duration of diabetes, number of insulin injections per day, knowledge of insulin pens, hypertension, blood sugar fasting, with p < 0.05.
There is a relationship between anxiety and: age of the patient, knowledge of insulin pens, fasting blood sugar, p < 0.05.
There is an association between depression with: medical expenses, frequency of blood glucose testing, duration of diabetes 2, number of insulin injections per day, knowledge of insulin pens, hypertension, fasting blood sugar, p < 0.05.
Outcome of cementless total hip arthroplasty for osteonecrosis of the hip in Tam Anh hospital
Virus-caused Acute Respiratory Tract Infections (ARTIs) are among the most frequent diseases worldwide, with a high fatality rate.
The worldwide influenza and covid-19 pandemics have had a serious impact on humanity because the viral mutations develop at a rate quicker than human ability to discover, manufacture, and distribute vaccines, as well as immunisation.
Furthermore, the widespread use of antibiotics to treat respiratory co-infection bacteria without a doctor's prescription contributes to an increase in antibiotic resistance.
In view of this situation, many scientists around the world have researched and developed probiotics, also known as beneficial bacteria, to support the treatment and prevention ofARTIs because this is a safe and potentially effective approach.
Recently, LiveSpo® Pharma successfully created LiveSpo® Navax, a physiological saline suspension containing 5-billion beneficial Bacillus spores for ear, nose, and throat spraying administration.
In this paper, we review some of the research findings including (i) clinical trials on the efficacy of LiveSpo® Navax delivered through nasal spray in the treatment and prevention ofARTIs in children infected with RSV and influenza, and (ii) two case studies on the efficacy ofLiveSpo® Navax in the treatment of symptomatic Covid-19 infection in two families of individuals with moderate and mild symptoms.
Application of the PREMISE score to predict early death prognosis and outcome in the 30th day of patients with acute ischemic stroke
This study investigated the symptoms of traditional medicine related to Liver, Spleen, and Stomach in patients with gastroesophageal reflux disease.
Pulse and tongue symptoms are very common, traditional medicine symptoms play an important role in the diagnosis of the clinical traditional medicine patterns in gastroesophageal reflux disease
Method: A cross-sectional study was performed on 384 patients with gastroesophageal reflux disease at the Gastroenterology clinic - University Medical Center Ho Chi Minh City from 11/2021 to 05/2022, to survey 40 traditional medicine symptoms based on the PIGERD questionnaire.
Results: Females accounted for a higher proportion than males, the average age was concentrated in middle age, the duration of the disease was mainly from 1 - 18 months.
The most common symptoms were severe fatigue (76.6%), belching (75.3%) and easy stomach bloating (72.9%).
The typical symptoms of gastroesophageal reflux disease also accounted for a fairly high proportion such as burping up sour taste (60.4%), heartburn (50.5%), heat behind the sternum (45.3%).
Symptoms of abdominal distension (6.3%) and cramping (10.1%) accounted for the lowest rate.
Among the tradiontional medicine signs, red tongue (47.9%) and thin white tongue moss (35.4%) were the most common types of tongue and tongue moss.
The string-like pulse (44.3%) was the most common, and the rapid pulse (14.8%) was the least common.
Conclusion: The symptoms of traditional medicine are very diverse, revolving mainly around the organs of the liver, spleen, and stomach.
Evaluation of therapeutic of effectiveness of lactulose enema in hepatic encephalopathy
Assessment of knowledge and attitudes related to pain management for post-operative patients at the Orthopedic Unit, Viet Duc University Hospital.
Cross-sectional descriptive study on 135 nurses working at the Orthopedic Unit, Viet Duc University Hospital.
The Nurse's Knowledge and Attitudes Survey Regarding Pain (NKASRP) has been revised and adapted to be appropriate for pain management and treatment in Vietnam, which were used to measure the nurse's knowledge and attitudes in the study.
Results: Research results showed that the number of nurses with knowledge reached 9, accounting for only 6.6%, only one nurse with good knowledge.
Most nurses participating in the study answered correctly questions of pain management with medication.
The proportion of nurses with a positive attitude related to the perception of pain in the patient is still low.
Numbers of nurses with positive attitudes were 30 (22.2%); Most of the nurses participating in the study (77.8%) did not have a positive attitude about pain management.
Conclusion: Knowledge and attitudes about pain management for patients after surgery of the nurses at the Orthopedic Unit are still lacking.
Hospitals should pay attention to strengthen training for nurses on pain management for patients.
Cytotoxic effect of ethanol extract of ficus pumila leaves on mcf7 breast cancer cells
To study clinical characteristics and treatment response rates to concurrent chemoradiotherapy of neuroendocrine tumors of the uterine cervix (NTUC) at K Hospital from 2018 to 2020.
Subject and method: Non-controlled clinical intervention study, we included patients whose tumors were described in the original pathology as NTUC, FIGO IB-IIIC, at K Hospital, from 2018 - 2020. Patients were treated by definitive chemoradiotherapy using EP regimen.
Result: 40 patients were enrolled in the study, the mean age was 45.8, the small cell subtype accounted for the largest (80%), the rate of FIGO stage I, II, III were 17.5%, 35% and 47.5%, respectively.
30/40 patients had complete response (75%), 4/40 patients had partial response (10%) and 6/40 had progressive disease (15%).
Conclusion: NTUC was rare disease with poor prognosis, the rate of advanced disease was high.
Concurrent chemoradiotherapy using EP was effective for patients with NTUC, however, longer follow-up time is needed to evaluate survival outcome.
Simultaneous determination of some illegal antihypertensive and diuretic drugs in traditional herbal preparations by HPLC-DAD
Medical workers are directly exposed to high levels of negative emotions that appear to increase the risk of long-term consequences such as secondary stress, depressive symptoms or burnout occupation with adverse outcomes for health care quality.
Objectives: To assess the stress level of medical workers and its related factors at some hospitals treating COVID-19 patients in Ho Chi Minh City in 2021.
Methods: A cross sectional study was conducted on 244 medical workers in 12 hospitals and frontline medical units treating COVID-19 patients in Ho Chi Minh City from September 13 to 20, 2021.
Using the stress component of the 21-item Depression, Anxiety and Stress Scale (DASS-21) to assess the level of stress among healthcare workers.
Results: A total of 244 medical workers, 80.3% experienced stress. The prevalence of stress was found to be in the range of mild (17.6%), moderate (22.5%), severe (29.7%), of extremely severe (12.3%).
Multivariable logistic regression model showed that directly treating COVID-19 patients (OR=2.14, 95% CI: 1.01 - 4.53; p<0.05) and often under pressure from superiors at work (OR = 7.05; 95% CI: 1.55 - 31.9; p<0.05) were associated with stress.
Success rate of percutaneous coronary intervention for chronic total occlusion
Conclusions: This study revealed the feasibility in a novel approach to estimate MSM population size in light of the development of social network and mobile application.
This study provides valuable information on MSM population sizes in HCMC which is very helpful in program planning and resource allocation.
Objective: This study aimed to estimate the size of the MSM population in HCMC and compare based on three different data sources.
Methods: This study used the social app multiplier method to estimate the size of MSM populations in HCMC.
The count of users on a popular social app among MSM in HCMC was used as the first data source.
Results: 26% (95% CI 14 - 38) of MSM in HCMC surveyed used the Blued social app in the last two weeks from 17/7/2020 - 31/7/2020.
Percutaneous treatment of liver abscess with diameter larger than 5cm
Image-enhanced endoscopy (IEE) plays a vital role in detecting and evaluating endoscopic lesions. However, these techniques are only implemented in advanced, high-cost endoscopic systems.
Results: Compared to the senior doctors' group, the junior doctors' group assessed that image evaluation was more difficult (52.1% of images were considered hard to evaluate compared to 25.8% in the expert group).
The rates of accurate evaluation in the junior group and the expert group were 54.7% and 52.7%, respectively.
Ihe level of accurate evaluation between junior and senior doctors was similar.
Conclusion: The preliminary results suggested the possibility of applying this software in clinical practice to improve lesions detection in medical units with limited resources.
In Vietnam, there have been preliminary results in the application of artificial intelligence (AI) in endoscopy.
Objective: To evaluate the feasibility of utilizing AI to simulate enhanced mode images for esophageal endoscopic images.
Methods: We built an evaluation set of 240 endoscopic images at the Z-line: 60 FICE images, 60 FICE-simulation images, 60 LCI images, and 60 LCI-simulation images.
The FICE and LCI simulation images were generated from the white light images using the CycleGAN network.
Each subset of images had 30 normal Z-line images and 30 images with reflux injury.
The evaluation set was then shuffled and sent to five junior endoscopists (<5 years of experience) and five senior endoscopists (≥5 years of experience) for evaluation.
The doctors were informed that there were simulated images generated by an AI algorithm in the image set and were asked to determine which images were IEE or AI-simulated images.
Factors related to the needs of palliative care among patients after colorectalcancer surgery at Vietnam national cancer hospital in 2018
In the psychologic domain, cancer patients ages above 60 years reporting lower levels of unmet need than those ages under 60 years, females reporting higher levels of unmet need than males, stage I and II lower levels of unmet need than those cancer stage III and IV.
In the medical information domain, cancer patient ages above 60 years reporting higher levels of unmet need than those age under60 years, over secondary lower levels of unmet need than those level of education under secondary.
In the physical and daily living, females reporting higher levels of unmet need than males, married group reporting lower levels of unmet need than lower than single / unmarried group, the self-moving group was lower than the non-self-moving group.
In the sexual domain, females reporting lower levels of unmet need than males, single / unmarried reporting lower than married group.
Outcomes of recurrent epithelial ovarian cancer patients treated with paclitaxel regimen at k hospital
COVID-19 affects both physical and mental health of patients seriously. Understanding the impact of COVID-19 on patients' health related quality of life is an important key to developing policies and community intervention programs.
A cross-sectional study was conducted among 324 inpatient COVID-19 patients at Pham Ngoc Thach hospital; at the time of discharge, in november 2021, the Vietnamese version of the EQ-5D-5L quality of life scale was used for the survey.
Health related quality of life score and standard deviation of all 324 study subjects were 0.874 ± 0.216, respectively.
More than one-third (33.3%) of participants with COVID-19 had anxiety / melancholy.
After multivariate analysis and controlling for potential confounding factors, the study showed that female patients had a higher quality of life than male patients; as age peaks, the quality of life decreased; p revalence of diabetes and / or former pulmonary / extra pulmonary tuberculosis were factors that reduce quality of life among patients with COVID-19.
Moreover, screening for mental disorders among hospitalized COVID-19 patients should be done for all patients to identify the problems as the early stage.
Predictive factors of recurrence after liver resection for hepatocellular carcinoma
In order to provide data on clinical characteristics and the etiology of STIs at Hanoi Medical University Hospital, we conducted a retrospective observational study on 1251 men with confirmed STI.
Therefore, sex education and propaganda about safe sexual intercourse and faithfulness are very important to prevent and reduce the rate of sexually transmitted diseases.
Our results showed that patients with STIs were predominantly in the 20 - 30 age group representing 41.6% of all patients.
82.4% of the subjects did not use condoms when having sex with their partners and 71.8% of patients had oral sex.
The majority of patients was infected with Chlamydia, constituting 30.46%, followed by Gardnerella (20.14%), Neisseria gonorrhoeae (17.9%), Mycoplasma genitalium (15.03%) and Ureaplasma parvum (13.43%).
60.9% had multiple co-infection.
Adverse effects of chemoradiation therapy on stage III adenocarcinoma lung cancer by cisplatin in combination with etoposide or pemetrexed
Adequate vaccination has been shown to protect the community against COVID-19, the most important tool to prevent the COVID-19 pandemic.
Objective: Investigation of anti-SARS-CoV-2 antibody levels after two doses of COVID-19 vaccine.
Subjects and Methods: A descriptive cross-sectional study performed the first quantitative test for anti-SARS-CoV-2 antibodies in 332 and second in 196 adult volunteers.
Comparison of antibody levels at 2 - 8 weeks and 8 - 14 weeks after vaccination with two vaccines AZD1222 or BNT162b2.
Results: The antibody levels of AZD1222, BNT162b2, mix-and-match group and the total at 2 - 8 weeks after the second dose were 989 (476 - 1945), 1955 (1327 - 3245), 4368 (2066 - 6716) and 1622 (684 - 3741) BAU / mL; at 8 - 14 weeks were 796 (385 - 1460), 1080 (848 - 1985), 1714 (1058 - 2647) and 1014 (490-1892) BAU/mL.
There was no correlation between antibody levels with age, gender, weight and BMI in the studied groups.
Conclusions: Vaccines AZD1222, BNT162b2 and mixed injection produce good antibodies.
Antibody levels decreased significantly at 8 - 14 weeks compared with 2 - 8 weeks after the second dose.
Knowledge, attitude and practicalnurser in routine hand washing of nurses at Thai Binh children’s hospital in 2020
The purpose of this study is to describe the incidence of anaphylactic reactions after Oxford / AstraZeneca vaccination and management of such reactions.
AstraZeneca vaccination is safe and anaphylactic reaction management is successful.
87.5% of anaphylactic reactions happened within the first 24 hours with 45.2% happened within the first 30 minutes.
One case of grade 3 anaphylaxis and two cases of grade 2 anaphylaxis all occurred within 30 minutes of vaccination.
Clinical and subclinical characteristics of pulmonary tuberculosis in patients with diabetes at Thai Nguyen tuberculosis and lung disease hospital
At Thai Nguyen Tuberculosis and Lung Disease Hospital, there has not been much research on this issue, so we conducted this study with the aim of describing the clinical and subclinical characteristics of pulmonary tuberculosis in patients Type 2 diabetes with research methods that describe cross-sectional designs, combining retrospective and prospective studies.
The study results showed that the mean age ± SD of patients with tuberculosis with diabetes was 58 ± 13 years older than patients with simple tuberculosis (42.27 ± 18) (p = 0.001).
Mild fever in the afternoon, hiss, snoring rale was more common in patients with pulmonary tuberculosis with diabetes (p <0.05), but more weight loss was seen in the pulmonary tuberculosis group (p <0.05).
Cave lesions and mediastinal lesions on X-ray were more common in patients with tuberculosis with diabetes (27.9% and 62.8%, respectively) compared with patients with pulmonary tuberculosis (6.5% and 43.5%, respectively).
Evaluation of risk of malignancy of operated thyroid nodules classified as bethesda III/ IV
We aimed to evaluate the left ventricular function before and after implantation of cardiac resynchronization therapy (CRT) device by using tissue Doppler echocardiography.
Methods: A prospective longitudinal follow-up in 33 patients with severe heart failure (left ventricular ejection fraction ≤ 35%) and QRS duration ≥ 120 ms, who underwent a CRT device implantation in Vietnam National Heart Institute - Bach Mai Hospital.
Results: The mean age was 60 years old and the proportion of males was 84, 8%.
The pre-implantation baseline QRS duration was 133.9 ms At the time of discharge, 1 month and 3 months follow-up after implantation, the QRS duration was 124.4 ms; 115.6 ms; 111.8 ms, respectively.
The severity of mitral regurgitation was improved and the systolic pulmonary artery pressure was decreased significantly after CRT implantation and during follow-up (p<0.05).
The diastolic left ventricular function improved significantly from 1 month follow-up after CRT implantation with a decrease in the E / e' index, and e', a' and s' indices were increased (p<0.05).
The left ventricular global longitudinal strain was improved significantly from 1 month follow-up after CRT implantation.
Conclusions: Patients, who underwent CRT implantation, had a reduction of the QRS duration from 133.9 ms to 111.8 ms after 3 months follow-up.
Evaluation of the result of intracranial aneurysm microsurgical treatment by clipping
Three genes p53, rarα1, wnt and liver of Medaka fish tissue were selected to study the toxicity of DDT to fish embryo (8 days old) and adult Medaka fish (3 months old).
TEM and real-time PCR methods were used to examine changes in structure of liver tissue and genetic expression.
The TEM results recorded a clear difference between the control and the experimental sample.
Adult Medaka fish exposed to 1 μg / L DDT for 24 hours has a distorted liver cell nucleus with many hollow lipid particles, and the sinus-shaped meshes are clustered, interrupted; lysosome is not intact with many degenerative bubbles.
The results of real-time PCR analysis showed that DDT affects the development, different and proliferation of cells in the embryonic stage and gene expression in adult stage.
All three genes p53, rarα1 and wnt in fish embryos changed strongly and tended to be inhibited when exposuring with 1700 μg / L DDT, the values were recorded respectively 0.9; 4.9 and 5.4 times compared to the control sample (1 times).
For adult fish, gene expression was lower than fish embryos with real-time PCR analysis values for the three genes p53, rarα1 and wnt respectively 0.9 and 0.5; 0.36 and 0.09; 0.53 and 0.09 times after exposure to 1500 and 1700 μg / L DDT.
These results demonstrated that gene expression is dependent on the developmental stage of the cell as well as on the dose of the chemical exposed.
The development, cell differentiation / proliferation in the embryonic and adulthood stages affected differently to the cell gene expression.
Preventive factors for hypertension in persons 30 years and older in Hai Chau district, Da Nang city
Objective: To describe the clinical and subclinical characteristics of patients with persistent mass at Hanoi Obstetrics and Gynecology Hospital in 2020 - 2021.
Method: this is a cross-sectional study.
Results: 32 cases of persistent mass included.
100% of patients suffered anemia, the persistent mass is less than 4 cm accounting for 75%.
Myometrial thickness > 2 m accounting for 75% of cases.
Conclusion: persistent mass leads to prolonged vaginal haemorrhage mainly, small size less than 4 cm and myometrial thickness > 2 mm is the main feature of the mass.
Factors related to walking rehabilitation for patients with hemiplegia due to ischemic stroke
Prophylaxis treatment of bleeding in patients with hemophilia A (HA) helps limit bleeding, prevent and minimize complications.
Emicizumab is a prophylactic drug for HA, used in the European Union, the US, Japan and many countries around the world [10] with proven effectiveness and safety by many clinical studies [5].
However, the high cost of the drug is a huge barrier against wider application.
Thus, it is necessary to evaluate the feasibility of drug using in clinical practice based on a cost-effectiveness analysis, in which the first important step is to build up a specific model for Vietnamese patient population.
Using modelling methods combined with literature review and consultation with clinical experts, the study builds a cost-effectiveness analysis model based on Microsoft Excel 2016 with a model structure factoring in the particular clinical settings of Vietnam.
Treatment effects of first-line chemotherapy with paclitaxel – carboplatin regimen on patients with stage IV non-small cell lung cancer
The study involved 171 consecutive patients scheduled for elective coronary surgery at Hanoi Heart Hospital from 6/2016 - 8/2018.
Main results: Mean age 65, 05 ± 7, 41 years; 78, 4% male.
The occurrence of hemodynamic instability (n=45, 26, 3%) was associated with a longer preoperative QRS duration.
The QRS duration was also longer (QRS ≥ 90 miligiây) in patients who developed acute heart failure need inotropic drugs (36, 4% vs15, 7%; p< 0, 05).
Conclusions: The intraventricular conduction delay, or QRS duration, was associated with a higher risk of postoperative hemodynamic instability following coronary surgery.
Effectiveness of health education intervention on adherence to non - pharmacological treatment among patients with hypertensive at Nam Dinh general hospital
To describe the situation, change practice the behavior of some measures to control non-pharmacological blood pressure after health education intervention in hypertensive patients on outpatient treatment at Nam Dinh General Hospital in 2016.
Method: The subjects of the study were patients with hypertension over 40 years old who were outpatient treatment at Nam Dinh General Hospital.
The 8-week pre-and post intervention study was conducted with 118 patients using available questionnaires about a number of non-pharmacological measures of blood pressure control such as alcohol restriction, tobacco / pipe tobacco use, Sports mode, blood pressure monitoring mode.
Results: The status of non-smoking / pipe tobacco compliance 93, 2%, alcohol and alcohol restriction 89, 8%, exercise and exercise 39, 8%, blood pressure monitoring 8, 5%.
After the intervention, the compliance with non-smoking compliance improved 94, 9%, alcohol restriction 96, 6%, exercise and exercise 54, 2%, follow-up blood pressure 39, 8%.
Identifying genetic mutations causing thalassemia in children at Haiphong children’s hospital
Evaluate the current state of the quality of insured outpatient services (clinical time, patient satisfaction) and evaluate the effectiveness of the LSS improvement in some steps in the process.
Result: 32 causes of ineffective activities were identified in two screening procedures.
The goal of improving survey process timing and patient satisfaction is 20%.
After improvements in the Lean Six Sigma model, positive results on the timing of the two procedures were obtained, including the expected length of the registration process (<40 minutes) was improved by 13.8%, the expected length of dosage regimen (<20 minutes) was improved by 22.9%, and the satisfaction level of patients was improved by 11.5%.
Study the plasma folic acid levels in patients with alcoholic liver cirrhosis
Colon diseases are increasingly detected due to the development of colonoscopic techniques, especially colorectal cancer.
Annually, the hospital of Can Tho University of Medicine and Pharmacy has many patients coming for examination, treatment, and colonoscopy.
Therefore, we want to build a disease model of colon diseases in patients who come for examination and colonoscopy at Can Tho University of Medicine and Pharmacy hospital.
Objectives: To describe the clinical characteristics, the incidence of colon diseases, and the relationship between clinical and endoscopic images in patients who come to Can Tho University of Medicine and Pharmacy hospital.
Materials and methods: A cross-sectional descriptive study on 722 patients who came to Can Tho University of Medicine and Pharmacy Hospital for examination and endoscopy in the first six months of 2021.
Results: The rate of colonic disease through colonoscopy was 35.4% normal, 31.3% polyps, 10% ulcerative colitis, 6.1% colon tumors and 4% diverticula.
The relationships between the symptoms of abdominal pain, bowel disorders, stool disorders, ulcerative colitis, colon tumors, age group, and polyps, colon tumors with p<0, 05.
Conclusion: Colonoscopy is necessary for patients ≥40 years old with bowel disorders and stool disorders to detect colon diseases early.
Evaluation of the results of patient's early eating after hepatectomy for hepatocellular carcinoma
The quality of the test makes a very important contribution to the diagnosis, especially the diseases of cancer, endocrinology, thyroid gland,... [3], so the good implementation and monitoring of the test quality at the hospitals have been required by the Ministry of Health, which must monitor and evaluate monthly through external quality assessment to overcome and develop measures to improve testing quality [1], [7].
This study analyzed the 2021 external quality assessment results for immunoassays and found that: immunoassays are prone to errors at low concentrations; the errors of the tests of the cancer marker group and the thyroid group were relatively higher than the other groups; quality control chemicals / reactants degraded, instrument calibration should be focused on more.
Tracheal diverticulum - in one case
To evaluate the efficacy of miniscrews for whole arch distalization from researchs in the past 20 years.
Occlusion plane rotates counterclockwise during maxillary whole arch distalization and anticlockwise during mandibular whole arch distalization.
Upper lip retracts up to 2.5 mm, lower lip retracts up to 2.0 mm.
Conclusion: Miniscrews are effective in whole arch distalization.
The most obvious clinical signs of total dentition distalization are incisor retraction and molar distal movement, statistically significant difference proved.
Other movement such as tipping, extrusion, intrusion of incisors and molars, rotation of occlusion plane, lips retraction are somewhat showed in the results but not many articles have statistically significant difference.
Materials and methods: Systematic review.
Results: 08 artilces were included in the systematic review.
Miniscrew used in whole arch distalization are 1.5 mm - 2 mm in diameter, 6 mm - 14 mm in length for maxillary and are 1, 5 mm in diameter, 6 mm - 7.1 mm in length for mandibular.
Upper incisors retract 0.49 mm - 4.6 mm (p<0.05 in 4/6 articles).
Upper first molar move distally 1.29 mm - 4 mm (p<0.05 in 5/6 articles).
Lower incisors retract 1.69 mm - 3.2 mm (p<0.05 in 2/3 articles).
Lower first molar move distally 1.88 mm - 3.4 mm (p<0.05 in 2/3 articles).
Mid-term outcomes of video-assisted thoracoscopic anatomical lung resection for non-small cell lung cancer with clinical stage I and prognostic factors
Evaluation the value of frozen biopsy and results of combination frozen biopsy with operation in treatment of Hirschsprung's disease.
Methods: Serial retrospective description Results: There were 34 cases included in this research.
Mean operation time was 168, 5 ± 71, 9 minutes, mean refeeding time was 2, 6 ± 1, 4 days, and mean hospitalization was 10, 2 days.
Mean follow-up time was 11, 1 ± 8, 3 months, including 2 (5, 9%) cases was reported fecal incontinence and 6 (17, 6%) cases was enterocolitis, no cases was reported constipation.
No patient was required re-operation.
The results of frozen biopsy were correspondence with total biopsy in all cases.
Conclusions: The accuracy of frozen biopsy in Hirschsprung's disease is very high.
Combination frozen biosy with operation in treatment Hirschsprung's disease shows good results with low complication rates.
Value of the electrocardiogram in localizing the occlusion site in the coronary artery in the patients with ST-segment elevation acute myocardial infarction
The outcome of STEMI patients depends mainly on the occlusion site of coronary artery.
The ST↑in DII, DIII, aVF and ST↑in DIII > ST↑in DII predicted RCA occlusion with 83, 72% sens, 96, 49% spec, 94, 72% PV+ and 88, 70% PV - (p <0, 001).
The ECG was high valuable to predict the occlusion site of coronary artery in STEMI.
Accordingly, the presumptive prediction of a culprit artery based on the electrocardiogram (ECG) recorded at admission is an important clinical sign.
Materials and methods: a descriptive study of 100-patients with STEMI admitted to the An Giang heart hospital.
The ECG patterns pronounced ST-segment deviation before initiation of reperfusion therapy were evaluated and correlated with the exact occlusion site as determined by coronary angiography.
Results: The ST↑ (two contiguous leads) in V1 to V6 strongly predicted LAD occlusion with 56, 14% sens, 97, 67% spec, 96, 97% PV+ and 62, 68% PV - (p <0, 001).
The ST↑in V2 to V4 and ST↑in V1 > 2, 5 mm predicted LADI occlusion with 65, 21% sens, 96, 10% spec, 83, 33% PV+ and 90, 24% PV - (p=0, 005).
The ST↑in V2 to V4 and ST↓ở aVL predicted LADII-III occlusion with 84, 21% sens, 98, 76% spec, 94, 11% PV+ and 96, 38% PV - (p=0, 024).
The ST↑in DII, DIII, aVF and ST↑in DII > ST↑in DIII and ST↓in aVR ≥ 1 mm predicted LCX occlusion with 60% sens, 100% spec, 100% PV+ and 97, 73% PV - (p <0, 001).
Evaluating the results of breast cancer patients treated with breast conserving surgery and sentinel lymph node biopsy at K hospital
Psoriasis affects an estimated 2% of the world's population.. E-PSORA contains PHA, jojoba oil, and vitamin E with antioxidant, anti-inflammatory and moisturizing propertie which have potential benefits in topical psoriasis treatment.
Objectives: evaluate results of topical treatment of plaque psoriasis at Can Tho Dermato-Venereology Hospital and Can Tho University of Medicine and Pharmacy Hospital in 2019 - 2021.
Materials and methods: A descriptive cross-sectional study was conducted on 155 mild and moderate plaque psoriasis, treatment duration with E-PSORA for 6 weeks.
Results: very good results had level 3.9%, good had level 32.9%, quite had level 38.1%, medium had level 20.0% and poor results had level 5.2%.
Side effects only recorded 5.8% itching and 7.1% skin redness in the first week, which disappeared in the next 5 weeks of treatment.
Conclusion: E-PSORA is an effective topical therapy in reducing psoriatic lesions with few side effects
Analysis of causes and proposal of solutions to reduce accident at work when using the handling machine
However, when using lifting equipment, accidents for operators, incidents that cause economic losses, production interruptions and accidents for the surrounding people can also occur.
To ensure safety, prevent incidents and accidents when using lifting equipment, the operator must master the technical profile of the equipment, structure, structure, utility, operating procedure, and rules and regulations.
The paper analyzes the causes and proposes measures to minimize occupational accidents when using handling machines
Study therapeutic efficacy in generalized anxiety disorder
Describe the knowledge, regimen, and implementation of COVID-19 infection prevention among health workers at Duc Giang General Hospital in 2021.
Subjects and methods: Model A cross-sectional description was performed on 762 health workers working at Duc Giang General Hospital from January to December 2021.
Results: 87.5% of health workers had acceptable knowledge about COVID-19.
The majority of health workers are active in the prevention of COVID-19 disease (accounting for 83.0%).
The practice of wearing masks in health workers achieved (4.1 ± 1.0) points on the scale of 5, while hand hygiene before and after contact with patients reached (3.9 ± 1.1) points.
The health workers with better knowledge and active activities show an exceeding performance compared to those who lack knowledge and awareness, with p < 0.05.
Conclusion: The knowledge gained and active activities of health workers will determine the performance of health workers in the prevention of COVID-19 infection.
Clinical outcomes and safety in Covid -19 patients treated with remdesivir in Vinmec international hospital
The distribution system plays an important role in all business activities from goals to development strategies and creates competitive advantages among enterprises, including pharmaceutical enterprises.
Hasan - Dermapharm is a pharmaceutical manufacturing and distribution company in a joint venture with Dermapharm AG, Federal Republic of Germany.
The study was conducted to analyze the current situation of the pharmaceutical distribution organization of Hasan-Dermapharm Co, Ltd in the period 2016 - 2020, thereby proposing practical and timely solutions to improve the distribution system.
The study was carried out by cross-sectional descriptive method based on retrospective data collected at the company's head office during the period 2016 - 2020 on the characteristics of the distribution system including market coverage, distribution channel depth, and response.
Thus, the company has quite a high market coverage, focusing a lot of human resources on the distribution business.
Factors related to nutritional knowledge among mothers of 6-24 month babies with acute respiratory at Nam Dinh children’s hospital in 2020
To describe the real situation of nutritional caring and to identify factors related to nutritional caring of women who have 6 - 24 months children treated acute respiratory infections (ARI) at Children's Hospital in Nam Dinh.
Method: The study subjects include 75 women who have children aged 6 - 24 months of treatment for ARIs at Nam Dinh Children's Hospital.
A descriptive study is conducted on 75 women.
Results: The research showed that the average score of breastfeeding knowledge for children 6 - 24 months is 0, 5 ± 0, 7, this score for children 6 - 24 months with complementary feeding is 6, 5 ± 1, 8, the medium score of breastfeeding knowledge for children with ARIs is 1, 1 ± 0, 5, this score for children with ARIs with complementary feeding is 0, 4 ± 0, 6, the average of women knowledge about ARIs is 3, 5 ± 1, 1, the average of the general knowledge of women is 13, 0 ± 4, 7.
There are still 42, 7% of mothers who have not enough knowledge.
There is a correlation between mother's knowledge and education and the number of children in the mother. The research reveals that women's nutritional knowledge is not good, therefore requires health education interventions to improve nutritional caring knowledge for women, especially when the children are ill.
Study on grafting collagen of catfish skin on hydroxyapatite from catfish bone
Knee osteoarthritis is a continuous disease.
The average follow-up time: 11.6 ± 6.4 months.
The mean pre‐ and KS (knee score) post‐op were 49.3 ± 8.4 and 74.4 ± 5.8 respectively (p < 0.05).
The mean pre‐ and KFS (knee function score) post‐op were 37.7 ± 7.4 and 78.1 ± 3.6 respectively (p < 0.05).
The average flexion post-op was 120.70 ± 9.4.
83.6% of cases were very satisfied with the result of surgery.
Conclusion: The results of total knee replacement for severe osteoarthritis of knees are good.
Total knee replacement reduces pain, improves motor function of the knee, helps to move more stable and brings the quality of life to patients with severely damaged joints.
The disease is very common and it is one of the main causes of decreased and loss the motor functions.
Total knee replacement is indicated for severe knee osteoarthritis.
Objectives: To evaluate total knee replacement surgery results treating severe knee osteoarthritis at the Can Tho University of Medicine and Pharmacy Hospital.
Results: The average age is 64.8 ± 6.9 years old (youngest 50, oldest 82).
There were 11 men (16.7%), 55 women (83.3%).
24 left knees and 42 right knees were operated on, 8 patients both knees replaced.
Knowledge, attitude and practices on dengue prevention of people in dong xuyen ward, Long Xuyen city, An Giang province in 2021
Describe the current of need and meeting palliative care needs of cancer patients treated at Nam Dinh General Hospital in 2020.
A descriptive study performed on 350 cancer patients being treated at the Department of Oncology - Nam Dinh General Hospital from 12/2019 to 8/2020 meeting the inclusion criteria.
Information was gathered in the form by direct interviews with patients through pre-designed questionnaires.
For each question, the patient chose one of two options "Yes" or "No", depending on whether the patient had the need or not and if the need was met or not.
Results: The rate of patients who needed the health information support was highest, accounting for 77, 7%; the rate of patients needed physical and daily activities assistance was 77, 4% while the need of psychological assistance accounted for 70, 3%.
The rates of meeting patients needs of health information, of physical and daily activities as well as of psychology were 79, 7%; 74, 6% and 69, 7% respectively.
Conclusion: Cancer patients have different needs, the highest need is for disease diagnosis (82, 9%); the lowest is the need to participate in activities to reduce feelings of depression (62, 3%).
Meeting the needs is highest for needs of disease diagnosis (84, 3%) and lowest for personal hygiene care (60, 3%).
Care must be based on the needs of the patient; Therefore, it is necessary to properly assess the needs of each patient in order to offer appropriate and effective care.
Overview of indication for thyroid lobectomy in papillary thyroid microcarcinoma
Report the surgical outcomes of some lumbar spinal diseases by single portal full endoscopic technique.
Methods: We retrospectively reviewed patients who had undergone full endoscopic lumbar surgery between October 2019 and May 2022 at spine unit of Saint Paul general hospital in Hanoi.
Results: Of 200 patients with a follow-up duration of > 1 month, mean age is 53 years old.
Etiologies are included: Lumbar disc herniation, lumbar spinal stenosis, tumor, facet cyst, spondylodiscitis, Sacral iliac joint pain, epidural hematoma.
Day of hospitalization is 1.3 ± 1 days.
During the following up time, there were two patients had residual discs, 6 patients had dural tear or nerve root injury, 2 patients received spinal fusion surgery due to segmental instability after 1 year.
Conclusion: Full endoscopic lumbar spine surgery is a safe and effective option for lumbar spinal disease with advantages of minimal invasive technique.
Evaluation of medicine list used at general Thai Binh hospital for the period 2018-2019
Aortic disease is diverse and carries a high risk of sudden death if the patient has symptoms.
The aortic arch disease may be aneurysm, dissection, artherosclerotic ulcer, pseudoaneurysm, coracrtation.
The most common cause is hypertension, others are infection, connective tissue disease, trauma, congenital.
Surgical treatment is the clasic method, but it has high risks for the patients who were recurrent operation, severe comorbidity diseases. The operative risks compose of severe bleeding, sternal infection, complications relate to long time of anesthesia.
Result of pulling impacted teeth into occlusion with support of CBCT films
The study was carried out to find out factors affecting the choice of using medical services at public and private health facilities in the Northern Midlands and Mountainous region.
Logistic regression model and cross-sectional data from the 2020 Vietnam Household Living Standards Survey (VHLSS) were used.
The outcome shows that most of the variables are influential and statistically significant, such as Age of household head; Household with elderly people, children; Household size; Education status of household head; Total number of outpatient and inpatient medical examination and treatment; Participation in health insurance; Household income and Area of residence (In this article, decimal numbers are formed under international standard).
Analysis the role of qsofa, sofa in prospects of personal performance bacteremia and bacterial infection emergenry department accessories
The author presents a case of silicosis in a 34-year-old male patient who has worked as a rock driller for 4 years with dry cough and shortness of breath.
The patient was admitted to the hospital in the case of chronic silicosis.
Chest X-ray and CT scan of the chest showed suggestions such as diffuse nodular lesions in both lungs, multiple mediastinal lymphadenopathy, bilateral hilum with calcified lymph nodes.
There are multiple cervical lymph nodes on both sides.
Diagnosis is confirmed by lung biopsy and neck dissection to make the histology with characteristic images of silicosis.
Series cases report: Laparoscopic harvest of latissimus dorsi flap in immediate breast reconstruction
Describe the satisfaction of patients who ate nutritious meals about the service attitude of staff of the Department of Nutrition, Describe the satisfaction of patients who ate nutritious meals on time of delivery, Description patient satisfaction with nutritious meals on meals.
Method: Cross-describe 1000 patients inpatient treatment at clinical departments in the hospital according to the information collection form and meals provided by the Nutrition Department.
Results: Percentage of patients most satisfied with the price of food with 96%; satisfied staff with the rate of 89.2%; satisfied with the meal is 78.9%; satisfied with cleaning the tray is 77.8%; 75.9% of patients continue to use the service; 73% of patients are satisfied with the food; 68.2% of patients are satisfied with the delivery time.
Conclusion: Most patients are satisfied with the food supply provided by the Department of Nutrition.
Hospitals should continue to promote increasing patient satisfaction with reasonable diets, especially in terms of time to deliver meals, dishes and cleaning trays.
Overview of the treatment of bleeding peptic ulcers
COVID-19 associated pulmonary Aspergillosis (CAPA) is a new disease characterized by secondary Aspergillus mold infection in patients with COVID-19.
It primarily affects COVID-19 patients in critical state requiring care in intensive care units and has a high mortality rate.
We report a case of an 11-yearold girl with a healthy history and mild COVID-19 infection, who was admitted to the hospital with a fever lasting 1.5 months since the onset of COVID-19.
The child was excluded from other causes of persistent fever and diagnosed with suspected case of CAPA.
The child responded well to treatment with voriconazole.
Conclusion: CAPA has non-specific clinical symptoms.
In children with persistent fever after COVID-19 infection, the possibility of invasive fungal infection should be evaluated, including in children with mild COVID-19 who have a completely normal immune system and no risk factors.
Evaluating the results of endoscopic microsurgery for benign lesions of the larynx at the Department of Surgery and Treatment on Request - 108 Military Central Hospital
Community based Fieldwork is a compulsory subject at Hanoi Medical University, held for 1 - 2 weeks locally.
A cross-sectional descriptive study was conducted on 232 students participating in the fieldwork to describe the students' feedback on the fieldwork process at Binh Luc - Ha Nam and some related factors in the academic year 2021 - 2022.
The research results show that the student feedback on the fieldwork is very positive, with the lowest cost clearly informed score of 3.09 and the highest part-time faculty support score of 3.49.
Regarding the field study program, students highly appreciated the content, methods of organization and teaching and communication of health education, the value in career development, (GPA from 3.11 to 3, 26).
There is a correlation between student's grade and good feedback on fieldwork (OR = 0.58, 95% CI = 0.32 - 0.97).
Continue to implement the real community learning program in the same way that the teaching organization has implemented and consider better adjusting to living conditions.
Clinical and subclinical characteristics of liver injury treated conservatively
To describe the current quality of life of patients with chronic kidney hemodialysis at Nam Dinh General Hospital 2021.
Method: A cross-sectional study was conducted on 53 patients with chronic kidney hemodialysis at Nam Dinh General Hospital in the period from April to September 2021.
Results: The mean score of SF36 quality of life was 31.45 ± 9.86 (total score: 100).
The mean score of kidney problems was 45.92 ± 7.98 (total score: 100).
Overall quality of life score was 38.68 ± 7.57 (total score: 100).
Conclusion: The quality of life of patients in the study area is relatively low.
Pherochromocytomas in children - Genotypic and phenotype
Assessing patient's satisfaction is a central and cross-cutting task that is concrete evidence of the hospital's quality.
Objectives: description outpatients's atisfaction at the Department of Dermatology, Tien Giang Central General Hospital in 2021.
Results: The study on 260 patients recorded: the overall satisfaction rate of patients was 74.2%, the average point of overall satisfaction of patients was 4.15 (SD = ± 0.25).
The satisfaction rate by aspect is: tangible aspect (79.2%), reliability aspect (84.6%), responsiveness aspect (79.6%), assurance aspect security (80.8%), empathy aspect (84.2%).
Conclusions: The satisfaction level of patients is quite high, however, it is necessary to implement some solutions to improve the service quality.
Assessment of the result of primary and microdissection thinning anterolateral thigh flap in plastic surgery
Pheochromocytoma (PCC) and Paraganglioma (PLG) are neuroendocrine tumors.
The patients were determined as having hypertension accompanied with abdominal mass.
Definitive diagnosis was Pheochromocytoma.
One in two patients was identified as carrying mutation of gene encoded succinate dehydrogenase complex iron sulfur subunit B (SDHB).
Tumors derived from adrenal medulla secreting catecholamines, called Pheochromocytoma.
Tumors with extra adrenal origin, which either secrete cathecholamines or are nonfunctional termed Paraganglioma.
Because of similar clinical manifestations and treatment therapies of Phechromocytoma and catecholaminessecreting Paraganglioma, clinicians use the term "pheochromocytoma" to refer to both of tumors.
Pherochromocytomas is a rare disease in children with the estimated incidence is about 1 per 50.000 to 100.000 children.
This disorder could be sporadic or sometimes it could present as a part of inherit syndromes, such as von Hippel-Lindau syndrome, Neurofibromatosis type 1, heteditary Pheochromocytoma / Paraganglioma.
In children, 60% to 80% of cases result from heteditary causes.
Malignant hypertension is a common symptom which can lead to variety of severe complications.
We report 2 cases presenting sudden headache, nausea, abdominal pain and seizure.
Initial experiences of Halo-gravity traction in treatment of extremely severe adult idiopathic scoliosis
Hypertension is one of the chronic diseases mainly examined in outpatient at general hospital in Vietnam.
The PDD / DDD rate was difference betwen antihypertensive classes.
To prescribe an appropriate regimen treatment and average prescribed daily doses (PDD) not only helps to control blood pressure well, but also reduces hospitalization.
The aim of this study is to analyze the prescription pattern and PDD in hypertensive outpatients in a general hospital.
Materials and methods: Retrospective prescriptions of outpatient at the Pharmacy Departmen of the 108 military central Hospital, using cross-sectional descriptive methods.
Results: Polytherapy (78%) was leading trend of antihypertensive therapy for outpatients and average cost was 364.688 VND.
The most frequent of antihypertensive class to be prescribe were combine ARB + BB + CCB.
In monotherapy, ramipril was highest prescribed.
The average PĐ / DDD ratio of CCB and ARB was approximately 1, in accordance with the recomendation while ACE-I was not.
Conclusion: Most of the prescription in our study was polytherapy.
Outcomes of autologous bone marrow mononuclear cell administration in combination with neurological rehabilitation for traumatic brain injury patient
Evaluating the effectiveness of relieving pain and improving shoulder extension by using ear acupuncture combined with acupressure massage and therapeutic ultrasound in periarthritis humeroscapularis patients.
Subjects: 30 patients were diagnosed with periarthritis humeroscapularis tendinitis and treated at the Public Security Hospital of Traditional Medicine, from September 2021 to September 2022.
Methods: progressive, evaluating the results before and after treatment.
Results: after 15 days of treatment, the average VAS score decreased from 5, 17 ± 0, 99 to 0, 67 ± 0, 71 points with p <0.05; average EFA score increased 7, 50 ± 1, 09 to 16, 30 ± 1, 09 (p <0.05).
Conclusion: Ear acupuncture combined with acupressure massage and therapeutic ultrasound is effective and safe for treating periarthritis humeroscapularis tendinitis.
Serum procalcitonin concentration and relationship with blood culture results at Ninh Thuan province general hospital 2021
Breast cancer today is not the same as it was 20 years ago.
Breast cancer survival rates have increased thanks to higher awareness, better detection, and improved treatment.
According to the World Health Organization (WHO), about 2.3 million people are diagnosed with breast cancer each year, but the outlook is very good for them.
IgG4 RELATED SIALANDENITIS IN CHILDREN: A CASE REPORT
Ohtahara syndrome is one of the earliest and most severe forms of developmental and epileptic encephalopathy.
Over the last decade, the rapid advances in molecular techniques, especially in high-throughput sequencing (HTS), have revealed that a majority of Ohtahara patients have genetic etiology.
About 20 genes have been found to be related to this syndrome so far, and Next Generation Sequencing (NGS) technique is now an important genetic test for this syndrome.
This study was conducted on 4 patients with Ohtahara syndrome referred to Children's Hospital 2, Ho Chi Minh City.
Whole-exome sequencing (WES) following targeted analysis on 283 epileptic encephalopathy-related genes was performed to identify disease-causing variants of the patients.
Following multi-step bioinformatics analysis, trio-based Sanger sequencing confirmation, and variant classification according to standards of The American College of Medical Genetics and Genomics - 2015, we have identified 2 pathogenic mutations in 2 patients: OH3 (KCNQ2, c.868G>A, p G290S) and OH4 (SCN2A, c.788C>T, p A263V).
This study also confirms that NGS in general and WES, in particular, are reliable and useful in detecting genetic causes of Ohtahara syndrome, thereby, assisting in diagnosis and treatment of this syndrome.
The zinc deficiency and serum vitamin A status in women of reproductive-aged in low-income communes in Thuan Chau district, Son La province, in 2018
Peutz-Jeghers Syndrome (PJS) is a rare disease, characterized by hamartomatous polyposis of the gastro-intestinal (GI) tract and pigmentation around lips, eyelids and macules on the buccal mucosa.
The objective of the study was to describe one case of colorectal adenocarcinoma in a patient with Peutz-Jeghers Syndrome.
A case study report was applied.
Imaging showed smallbowel intussusception in the pelvic region, along with colorectal polyps; the largest polyp in the high rectum measuring 38 x 37 mm was lobulated.
Pathological results showed that the large polyp in the rectum is adenocarcinoma invading the smooth muscle layer; other polyps are typical Peutz-Jeghers polyps, with low-grade dysplasia.
The patient was diagnosed with a moderately differentiated adenocarcinoma invading the smooth muscle layer / Peutz-Jeghers syndrome.
The clinical and subclinical characteristics of gastrointestinal non- hodgkin lymphoma
Assess of treatment effect of post-herpetic neuralgia with lidocaine patch 5% in combination with pregabalin at National Hospital of Dermatology and Venereology.
Subjects and methods: Clinical research, randomized controlled trials (RCTs) of 120 patients with post-herpetic neuralgia at National Hospital of Dermatology and Venereology from July 2020 to May 2021.Results: Mean age of research and control group were 66.43 ± 8.67 and 66, 57 ± 8, 66, repecstively.
After 8 weeks, NRS score did not show difference between two groups, average NRS score was 0.68.
After two weeks, 41.7% of the patients in the study group has significant pain relief in compared with only 1.7% of the control group.
After 8 weeks, 75% of the study group had complete pain relief in compared with 64.7% of the control group.
Dry mouth was the most common side effect in both study and control group with the ratio were 96.7% and 93.3%, repectivesly.
Efficacy of micropulse transscleral cyclophotocoagulation in glaucoma
Doxorubicin (DBC) is one of the most common chemotherapy drugs used to treat cancers of microbial origin.
Based on theoretical computational modeling, molecular docking techniques, and predictive pharmacokinetic properties (ADME), DBC derivatives were evaluated for their ability to inhibit target proteins and potential use as a cancer treatment drug.
The results indicate that 1−C2H−DBC, 2−C2H−DBC, and 2−F−DBC derivatives have relatively favorable interaction energies with ERα, Aromatase, CCL18, and PR enzymes.
The interaction properties of these derivatives with the target protein were comparable to those of the reference standard, DBC.
In addition to compare the ADME pharmacokinetic parameters with the reference standard, the druglikeness index and drugscore of these derivatives were also investigated.
Survey relationship between weather conditions and pain intensity based on the vas scale and traditional medicine properties in patient with osteoarthritis at An Hoa ward, Hue city
To summary and critically appraisal the quality of model-based economic evaluations of mental health promotion and prevention interventions.
Conclusion: The quality and modelling methods varied significantly among studies, making it challenging to synthesize and interpret the results.
The quality of the studies needs to be improved in the future, especially the validation of the model's structure and assumptions.
Method: A systematic review was conducted following guidelines in conducting systematic review of Cochrane Collaboration to identify all relevant model-based economic evaluations published ever until the end of 2020.
The quality of included studies was assessed using the Philips Checklist. Two researchers independently carried the selection process and quality appraisal.
Most of the studies were published after 2010 (39 studies).
Most of them were cost-utility analysis with the primary outcome measurement of Quality-adjusted life year (QALY) and employing a societal perspective.
The quality of the studies varied greatly. There was significant heterogeneity in time horizon, model cycle, model assumptions, etc.
The practice of validating model structure and model assumptions was very poor.
Surgical treatment of left – sided infective endocarditis in hanoi heart hospital
The aims of this study were to find out the comorbidities in critcal patients with COVID-19 in Duc Giang General hospital.
Methods: The design of this study was a retrospective descriptive method.
Results: A total of 91 critical patients were included of this study: 74 (81.3%) patients death due to COVID-19; 47.3% male and 52.7% female.
The highest critical patient rate occurred in the age group ≥60 years (81.3%).
The prevalent comorbidity was hypertension (50.5%), diabetes (37.4%), cardiovascular disease (28.6%), stroke (11%), chronic liver disease (7.7%), nervous system diseases (4.4%), COPD and lung diseases (3.3%), Down syndrome (1.1%); 51.7% patients reported having two or more comorbidities, and 22% only has one comorbidity.
There are relationships between rate of mortality rate and comorbidities of hypertension, diabetes; and number of the comorbidities (p<0.05).
Conclusions: Hypertension, cardiovascular disease, and diabetes were the most common comorbidity in critical patients with COVID-19. More than half of the patients had two or more comorbidities.
Assessment of molecular biological response after 3 months of treatment in patients with newly diagnosed chronic myeloid leukemia
To describe some clinical characteristics and care of patients with cirrhosis of the liver.
Basic care and monitoring activities accounted for the largest proportion, which is the implementation and monitoring of epidemics and drugs under medical orders 97.12%; tracking needle injection site 96.40%; activities accounted for the rate of performing tests only 82.73%.
Conclusion: Patients admitted to the hospital in a state of high decompensated cirrhosis, nutritional care helps to improve their physical condition, and correct general care activities account for 89.93%.
Subject and method: A prospective, cross-sectional study was carried out on 139 cirrhosis patients who were cared for and treated at the Institute of Gastroenterology and Hepatology, 108 Military Central Hospital, from February 2021 to December 12/2021.
Result: Male accounted for 83.45%, male / female ratio was 5.05/1.
The middle age group accounted for the highest percentage, the average age was 60.65 ± 11.14 years.
The biggest cause leading to cirrhosis was alcohol, accounting for 55.40%; followed by the cause of hepatitis B accounted for 28.06%.
Typical clinical signs such as jaundice, yellow eyes accounted for 91.36%, abdominal distension 81.29%, gastrointestinal bleeding 76.25%.
Cirrhosis admitted to the hospital according to Child-Pugh's classification at grade B (moderate) accounted for the highest rate of 52.52%.
The majority of patients ate a combination of oral and gastric tube, accounting for 99.28%, 84.89% of patients did not see any eating abnormalities.
100% of patients were monitored for blood transfusion; The process of monitoring vomit and feces daily accounted for only 92.45%.
Heart failure management according to european society of cardiology’s 2016 guideline
To evaluate the predictive value and the relationship between FOUR, Glasgow coma scale and the outcome of patients with primary hemorrhagic stroke.
Methods: We conducted a prospective descriptive study of 139 primary cerebral hemorrhage patients, hospitalized in the Neurology Department of Bach Mai Hospital within one week from the onset during March 2016 to June 2016.
Results: The mortality rate was 24, 5%, the rate of favorable outcome was 20, 1%, and moderate to severe disabled patients accounted for 55.4%.
There was a strict relationship between the FOUR, Glasgow coma scale and the clinical outcome of patients with primary hemorrhagic stroke (OR = 1.87, CI: 1.36 - 2.58, p < 0, 01, r = - 0.76; OR = 1.53, CI: 1.16 - 2.03, p < 0, 01, r = - 0.74, respectively).
Conclusions: The FOUR and GCS scales had strict relationship with clinical outcome at 30 days according to modified Rankin scale.
More studies are needed to consolidate the role of FOUR scale in practice.
Study right ventricular function in patients with aortic valve severe stenosis
This randomized controlled trial determined the quality of bowel cleansing when combining with simethicone.
Patients who would undergo total colonoscopy on the same day of checkup were randomly assigned to intervention (with simethicone) or control arm (without simethicone) and quality of bowel cleansing was assessed by the McNally scale.
Among 380 participants, 192 were assigned to the intervention arm.
The proportion of patients who completed the regimen for bowel preparation with the instructed duration (2 - 3 hours) was higher in the intervention arm than in the control carm (53.7% vs 41.5%, p=0.04).
The proportion of self-report clean bowel preparation was higher in the intervention arm (99% vs 91%, p=0.03).
The proportion of good bowel cleansing in the intervention arm (100%) was higher in the control arm (around 40%) in all three colon segments.
In this trial, adding simethicone to bowel preparation improved the effectiveness of bowel preparation.
IDH1/2 mutations in adult patients with diffuse gliomas
To compare a popular nutritional screening tool with the new Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria in elderly hospitalized COVID-19 patients.
Nutritional status should be determined by NRS-2002 in elderly patients with COVID-19 at hospital admission.
Methods: 182 elderly COVID-19 patients admitted to the critical care ward, Infectious Field Hospital No. 5G were evaluated consecutively upon admission using the nutritional risk screening tool 2002 (NRS-2002), undernutrition according to GLIM criteria, and assess the risk of sarcopenia by SARC-F tool. Results: Malnutrition rate 46.7% according to GLIM criteria.
The sensitivity and specificity of NRS-2002 in detecting malnutrition were 98.8% and 56.7%, respectively.
The concordance with the GLIM criteria was 54.0%.
NRS-2002 was a moderate-value screening tool for the diagnosis of malnutrition.
Patients at nutritional risk according to the NRS-2002 were more likely to present with sarcopenia than patients at low risk (OR: 4.04; 95% CI: 1.31 - 12.4).
Conclusion: NRS-2002 is valuable in detecting malnutrition in hospitalized elderly COVID-19 patients diagnosed by new GLIM criteria.
Furthermore, elderly COVID-19 patients at high risk of malnutrition according to NRS-2002 are at increased risk of present with sarcopenia.
Situation of use of prophylactic antibiotic in endovascular intervention
Anaphylactic shock is a severe allergic condition that can be life-threatening if it is not diagnosed and treated promptly.
The rate of sequelae is 1.8%.
The length of stay in the Pediatric Intensive Care Unit is seven days, with the need for mechanical ventilation lasting up to 24 hours. Conclusion: Almost all of the patients admitted to the Pediatric Intensive Care Unit were grade III anaphylaxis, high rate of this group failed to repeat IM adrenalin and needed to combine adrenalin with other vasopressors or inotropes.
The survival rate was 95.5%, of which 1.8% of patients had sequelae.
This study aimed to evaluate the outcome of anaphylaxis in children at the Pediatric Intensive Care Unit, Vietnam National Children's Hospital.
All of patients were given intramuscular injections of epinephrine before admission to the PICU. The proportion of patients who had received the correct treatment was 44.5%.
The survival rate is 95.5%, and the death rate is 4.5%.
Hyperglycemia and dyslipidemia of male mice generated obesity model by a high-fat diet
A cross-sectional descriptive study was performed to assess the hearing status of armored tank soldiers.
The study was carried out on 315 soldiers.
The results showed that, out of 315 soldiers who were tested for hearing, 17.7% had hearing loss in one ear, 45.08% had hearing loss in both ears.
Most soldiers with hearing loss in one ear had mild hearing loss (92.8%).
Among soldiers with binaural hearing loss, 90.8% had mild receptive hearing loss; 9.2% of moderate, severe and profound hearing loss who had a high-frequency lesion pattern typical of noise-induced hearing loss after many years of exposure.
The results show that there were many soldiers in need of intervention to reduce sound exposure to prevent permanent severe hearing loss due to noise.
Research on the relationship between arterial stiffness by pulse wave velocity with some risk factors in patients with chronic ischemic heart disease
This study proposes a theoretical model based on Technology Acceptance Model (TAM) with two new independent variables namely Personal Innovativeness in Information technology (IT) and Trust to understand intentions as well as behaviors of the consumer which leads to the further decision of utilizing mobile healthcare applications in Vietnam.
The result shows that Trust is the most important factor impacting on the consumers mobile healthcare application usage behavior in Vietnam.
The efficacy of pembrolizumab plus chemotherappy in patients with stage iv non small cell lung cancer
A combination of antibiotic therapy and implant-conserving surgery is a good treatment approach to save infected buttock implants.
Although this method is effective in treating the infections, it leaves a significant psychological impact on the patient.
We report a case that was successfully treated with antibiotic therapy in combination with silicone implant-conserving surgery.
A 29-year-old female patient was diagnosed with an infection of the implant pocket 10 days after gluteal augmentation surgery.
The patient was treated with antibiotic therapy and operated to irrigate the silicone implant and the pockets, and then the implants were reinserted into the pockets after irrigation.
The relationship between lymph node metastasis and overall survival after thoracoscopic surgery for non-small cell lung cancer
Evaluate the effectiveness of Educational Intervention to improve the knowledge and practice of endotracheal suctioning among ICU nurses in Hue Central Hospital, Viet Nam.
Method and subject: This study was quasi-experimental research, two groups, the pre-test and post-test design to an evaluation of 126 nurses who were work at three departments where are Intensive Care Unit, Department of Anesthesiology and Critical Care and Stroke Center at Hue Central Hospital.
Results: The participants in the intervention group who received the education program had statistically significant higher mean scores of knowledge and practice than before and those in the control group who did not receive the education program (all p < 0.05).
Conclusion: The Educational Intervention on knowledge and practice of endotracheal suctioning improve the knowledge and practice of ICU Nurses.
This education program should be approached to provide all ICU Nurse to take care of the endotracheal patient better.
Assessment of the treatment effects of two regimens TDF/3TC/LPV/r and TDF/3TC/DTG in HIV/AIDS patients at Quang Ninh provincial hospital 2020-2022
Morphological characteristics of frontal lobe on MRI in patients with alcohol use disorder.
Subject and methods: Descriptive research, cross-section in 30 inpatients with alcohol use disorder at the Psychiatric Department, 103 Military Hospital from April 2021 to March 2022, and 21 healthy controls.
Results: The total gray matter volume of the frontal lobe in the group of patients decreased compared to the control group (91, 83 ± 1, 35 cm3 versus 97, 29 ± 1, 62 cm3, with p<0, 05).
The volume of the right orbital gyrus gray matter and the left precentral gyrus volume in the patient group decreased compared to the control group (5, 96 ± 0, 1 cm3 and 4, 85 ± 0, 11 cm3 versus 6, 24 ± 0, 13 cm3 and 5, 20 ± 0, 13 cm3, with p<0, 05).
The thickness of superior frontal gyrus gray matter in the patient group decreased compared to the control group (2, 55 ± 0, 04 mm versus 2, 68 ± 0, 03 mm, with p<0, 05).
The volume of the superior frontal gyrus white matter, the medial frontal gyrus, the inferior frontal gyrus, and the precentral gyrus in the patient group decreased compared to the control group (34, 27 ± 0, 75 cm3; 37, 16 ± 0, 69 cm3; 14, 01 ± 0, 32 cm3 and 26, 35 ± 0, 48 cm3 versus 37, 54 ± 0, 90 cm3; 40, 54 ± 0, 83 cm3; 15, 68 ± 0, 38 cm3 and 30, 08 ± 0, 57 cm3, with p<0, 05).
Conclusion: The total gray matter volume of the frontal lobe, white matter volume of superior frontal gyrus, medial frontal gyrus, inferior frontal gyrus, and precentral gyrus decreased in the patient group compared to the control group.
Treatment results of pars plana vitrectomy combined scleral buckle for patients with rhegmatogenous retinal detachment
Students at HaNoi Medical University, Thanh Hoa Campus are at high risk of being infected with Hepatitis B virus through professional practice activities at the hospital.
They are not only the future health workers but also the people who will consult the community on how to prevent transmission and inform them of the consequences caused by infecting the hepatitis B virus.
A cross-sectional descriptive study was carried out on all full-time general practitioner students from the 1st to the 6th year at Thanh Hoa Campus.
Quality of life of HIV-infected people receiving ARV treatment in outpatient Clinic of Nha Trang Medical Center 2020 and some related factors
MELAS syndrome is a mitochondrial genetic disorder that affects many organs and systems of the body, especially the nervous system and muscles.
The disease is caused by mutations in mitochondrial DNA that alter proteins in the mitochondrial electron transport chain.
This study aims to apply genetic techniques to detect mitochondrial DNA mutations that cause MELAS syndrome.
Materials and methods: Genomic DNA of patients with suspected MELAS syndrome was extracted from peripheral blood samples.
PCR-RFLP and Sanger sequencing were performed to identify common mutations.
The two point mutations m.3243A>G and m.3697G>A were detected in patients with MELAS syndrome, in which m.3243A>G was detectable by PCR-RFLP.
Conclusion: The procedure for screening of mitochondrial DNA mutations in MELAS syndrome patients by application of PCR-RFLP and sequencing techniques was completely constituted.
Evaluation of long-term treatment outcomes over a 10-year period in patients with congenital hyperinsulinemia at Children’s hospital 2
Early stage head and neck cancer patients with poor performanced status couldn't ride out full course of 30 - 35 fractions of radiation therapy.
Most of OARs dose constraints were acceptable, though there were two cases inevitably received cochlea dose > 25Gy.
Post-treatment response rate was 89%, 2-year PFS and OS was 72% and 83%, respectively.
Only 1 patient suffered grad 3 mucositis, no severe late toxicities observed in the series.
Conclusion: Stereotactic body radiation therapy is a feasible treatment option for elderly patients with early stage H&N cancer but couldn't endure conventional fractionation radiotherapy or unresectable recurrent tumor.
Locally recurrence in previously irradiated head and neck tumors has been associated with poor outcomes.
Stereotactic body radiation therapy (SBRT) has emerged as a feasible and promising treatment option for these candidates.
Methods: We prospectively investigated a series of cases, consisted of 28 patients diagnosed with early H&N cancers or loco-regional recurrent diseases treated with fractionated stereotatic radiation therapy from January 2019 to Deccember 2021.
Results: Mean value of radiotherapy time was 5 days.
Evaluation of total and regional right ventricular function by echocardiographic markers of myocardial tissue in congenital heart patients with pulmonary hypertension
Evaluation of the long-term treatment outcomes over a 10-year period in patients with congenital hyperinsulinemia at Children's Hospital 2 from 2012 to 2022.
Epilepsy was seen in 24% of patients, of which one (16.67%) had abnormal brain MRI.
Conclusion: Assessing the long-term response to treatment is essential to prevent medical side effects, surgical complications, and neurological damages from prolonged hypoglycemia.
Method: Retrospective and prospective case series.
Results: From January 2012 to January 2022 at Children's Hospital 2 there were 36 cases diagnosed with congenital hyperinsulinemia (CHI).
Follow-up after an average of 4.4 ± 2.2 years (1.4 - 8 years), 63.89% of patients was treated by Diazoxide for the first line, of which 39.13% responded, 62.5% had mutations unrelated to the KATP channel.
88.89% of patients discontinued after 24, 44 ± 14, 01 months, 55.56% of patients had side effects including edema, fluid retention, hyperemia, eczema, mouth ulcers, agranulocytosis.
For Octreotide, there were 66.67% of patients responded to treatment, of which 55.56% discontinued after 24.08 ± 20.46 months, 22.22% had vomiting.
In the group of patients undergoing surgery, 22.22% had hypoglycemia, 66.67% had normal blood glucose, 11.11% lead to diabetes after 8 years.
For exocrine pancreatic function, 22.22% of patients had pancreatic enzyme deficiency (amylase, lipase) without clinical symptoms.
The rate of patients had neurodevelopmental problems is 60%.
Chronic periodontitis status of the first diagnosed patients at National Hospital of Odonto - Stomatology Hanoi 2018 - 2019
To survey the basic health care needs of small and medium enterprises.
Subjects and methods: The survey was carried out in 4 provinces of Hai Duong, Lam Dong, Dong Nai, Thua Thien-Hue at 40 small and medium production facilities with a total of 894 employees (565 men; 329 women). Results: showed that 591 people, accounting for 66.11%, were exposed to harmful factors in the working environment, in which the number of men exposed was nearly twice the number of women.
There are 32 production facilities that have records of occupational hygiene, 38 units have carried out monitoring of labor environment, of which 27 production facilities are monitored once a year.
Most of the respondents said that the production facilities have implemented a number of measures to reduce harmful factors, the highest of which is to improve lighting, ventilation and cooling by over 90%.
Conclusion: Based on the survey results, it is the basis for the authors to propose a package of basic occupational health care services for small and medium-sized production facilities and employees.
Impact of perception of corporate social responsibility on behavior through organizational commitment of health staff in Vietnam
To describe the clinical features, workup and treatment of patients with urinary tract infections (UTI) in Internal Medicine Department No3, Viet-Tiep Friendship hospital.
The most commonly selected antibiotics were of quinolone group (59.61%), followed by 3rd generation cephalosporin group (23.08%).
After treatment, 19.23% of UTI cases were cured.
The rate of patients with remission or relief of symptom (s) was 75%; 3 patients (5.77%) had complications.
Subjects and methods: The prospective descriptive study was performed on 52 patients with urinary tract infections treated at Internal Medicine Department No3 Viet-Tiep Friendship Hospital.
Results: Common age group is 60 years old and older, accounting for 65.4%, average age is 60.92±17.32, ranging from 19 to 90 years old.
Urinary infections are common in women, accounting for 90.4%.
Among the cases with positive urine culture, gram-negative bacteria accounted for 90.4%, with two common pathogens that were E coli (67.7%), P aeruginosa (12.9%). The rest are fungi and other bacteria.
Among 52 patients, 47 patients were treated with 1 antibiotic, accounting for 90.38%.
The remaining 5 patients (9.62%) were treated with 2 antibiotics.
Surgical outcomes of cerebellopontine angle tumors
To determine the effectiveness of BTL tea and giving medical advice in smoking cessation treatment and monitor methods' adverse reaction.
There are 200 patients in the 30-day treatment.
Results: The very good rate of smoking cessation cases were 38%, 25% of these were good and 37% of these were not effective.
Conclusions: BTL tea and medical advice is effective in smoking cessation, improving symptoms of withdrawal syndrome (shortness, irritability, insomnia, cravings...) and decreased levels of CO in the breath of patients after treatment.
Research on relationship between NT-proBNP levels and some clinical and paraclinical factors of the patients with acute stroke
This study was conducted with the aim of reviewing some clinicals and paraclinical characteristics of patients with stage I - II breast cancer after one-stage breast reconstruction surgery and to evaluate treatment results.
All patients with stage I, II breast cancer underwent radical mastectomy combined with one-stage implant placement from January 2016 to August 2022 at the Department of On-Demand Treatment A and Department of Breast Surgery - National Cancer Hospital satisfied the selection and exclusion criteria.
Data are retrospective secondary data from medical records.
Skin-sparing or nipple-sparing mastectomy combined with bag placement in patients with early breast cancer is a relatively safe surgery and achieves cosmetic results.
The disease-free survival (DFS) rate was high and varied from 24 - 36 months according to factors related to disease-free survival including age group, primary tumor status (T), regional lymph node status (N) and diagnose postoperative disease.
The future of virtual screening in drug discovery
To assess effects of Vietnam gree coffee bean extract to blood pressures in experimental animals.
Subjects and methods: 40 Swiss mice were divided randomly into 4 groups: group 1 (control) - animals were administrated vehicle at 0, 1ml/10g; groups 2, 3 and 4 (treatments) - animals were contributed green coffee bean extracts at doses 200mg / kg, 300mg / kg and 400mg / kg, respectively.
Animals were contributed vehicle or green coffee bean extracts daily for 3 continous weeks.
After then, animals were perfomed running tests in the treadmill system.
Blood presures of all animals were measured before and after the test 1 minute, 3 minutes, 5 minutes.
Results: All kinds of blood pressures in animals treated green coffee bean extracts at doses 400mg / kg and 300mg / kg were lower than these in control animals after the behavioral test.
Conclusion: Vietnam green coffee bean extract induced stability of blood presures in experimental animals.
Evaluation of treatment results in Burkholderia pseudomallei infected patients at the National hospital for tropical diseases from 2016-2021
The vertical compaction technique is an improvement to increase the fit in root canal fillings.
Currently, on the market, the EQ-EV heat compactor is being introduced by the manufacturer and being used by many clinics.
Objective: Evaluation of the effectiveness of sealing the root canals with the EQ - EV heat compactor Methods: A Non-controlled case study was conducted.
Results and conclusion: Through surveying the results of filling the canals of 30 teeth with the EQ-EV heat compactor, it shows that: there is the correlation between the volume of fillings and canals on X-ray film: 90% full - filling; excess filling rate: 6.7%; missing fillings: 3.3%.
The correlation between cementum and tooth apex shows that the rate of cement reflux in the apical region: is 10%; missing is 3.3%.
The correlation between GP and apex shows that the ratio of GP is moderate to the apex of 90%; rate over apex 3.3%; Missing in the apical 1/3 is 6.7%.
The homogeneity of the filling material by compaction is high 93.3%.
The adaptation of the root canal surface to the first third of the neck: 100%; middle third: 96.7%; apical 1/3 segment 96.7%.
Molecular diagnosis of adrenal hyperplasia congenita
Our study investigates the prevalence of human papillomaviruses infection and other factors among women of reproductive age in Hanoi.
Methods: This cross-sectional study selected 1176 married women of the age from 18 to 49 in Cau Giay and Dong Anh district of Hanoi.
Each participant had an interview and a gynecological examination including HPV detection tests.
Results: HPV was detected in 9, 27 percent of participants (type 16 was found in 63, 3%, type 18 was 22, 9% and both types were 13, 8%).
Multiple regression model showed potential risk factors for HPV infections: living in suburban (OR 2, 9), unqualified knowledge and practice of daily hygiene (OR 3, 6), history of induced abortion (2, 1), currently taking contraceptive drugs (OR 2, 7).
HPV infection rate was higher in group with cervical ectropion than group without cervical ectropion (38, 5% vs 25, 3%, p<0, 05).
Conclusion: The prevalence of HPV infection among married women of reproductive age in Cau Giay and Dong Anh district of Hanoi is 9, 27%.
High-risk factors of HPV infection are living in suburban, having unqualified knowledge and practice of daily hygiene, having history of induced abortion, currently taking contraceptive pills and cervical ectropion.
Study on the endometrium regeneration treatment using human injured uterine tissue model
To evaluate evaluate the change of some psycho-physiological indices of health care worker and epidemic prevention staffs in personal epidemic prevention clothes.
Objects and methods: 30 staff working with epidemic prevention clothing for 4 hours continuously measured some environmental factors (temperature, humidity, wind speed, CO2 - about every 60 minutes), compared the HI index (heat Index - recorded continuously every 5 minutes) inside and outside personal epidemic prevention clothes and evaluate the change of some psychophysiological indices (heart rate, blood pressure, core temperature, skin temperature, sweat (before - after working) before - after workshift.
Result: 97.1% of the time the inside temperature is higher than the outside temperature of the epidemic prevention clothes from 0.50C to 4.50C.
There was an increase in heart rate, blood pressure, skin temperature, under the tongue temperature, sweat in staff working in protective clothing after work compared to before work shift (p<0.05-p<0.001).
Conclusion: Working with epidemic prevention clothing is harmful effects on health.
Recommendation: It is necessary to have solutions to reduce side effects on the health care worker and epidemic prevention staffs in personal epidemic prevention clothes.
Mental healthcare for youth through mobile applications and websites: International experiences and recommendations for Vietnam
Malnutrition is associated with increased morbidity and mortality in patients with dementia (PWD).
Regular screening and assessment of nutritional status and prevention of the risk of malnutrition are essential for PWD to limit serious outcomes and mortality.
Our study aims to assess nutritional status and identify the correlation between the level of malnutrition and the severity of dementia of PWD at the National Geriatric Hospital in 2022.
The cross-sectional study was carried out on 63 PWD being treated at the National Geriatric Hospital from January to April 2022.
The research questionnaire included the Mini Mental State Examination (MMSE), Mini Nutrition Assessment (MNA), and anthropometric indicators.
Our findings revealed that 47, 7% of participants having moderate and severe dementia.
The mean weight and body fat percentage were 55, 5±8, 9 (kg) and 32, 4±7, 3 (%), respectively.
74, 6% of PWD had malnutrition / risk of malnutrition.
MMSE score and MNA score had a positive correlation with the correlated coefficient of r. =0, 3 (p-value<0, 05).
Malnutrition / risk of malnutrition is common in PWD.
Survey of renal failure complication at adult primary nephrotic syndrome
Epilepsy is a disease common in the nervous system.
The prevalence of epilepsy is estimated at 1% of the population.
Antiepileptic drugs (AEDs) provide good control of seizures, but some hypersensitivity reactions to AEDs have also been reported.
Side effects of AEDs include early manifestations (drowsiness, dizziness, gastrointestinal symptoms, even worsening of convulsions) and late manifestations (psychotic episodes, behavioral disturbances, depression, cognitive impairment, osteoporosis, leukopenia).
Cutaneous adverse reactions that fall under the category of early manifestations, ranging from mild reactions such as skin rashes (MPE), to severe cutaneous adverse reactions (SCARs) include Steven-Johnson Syndrome (SJS), toxic epidermal necrolysis). (TEN), symptomatic systemic drug reactions with eosinophilia (DRESS) and acute systemic pustular rash (AGEP).
The use of aromatic antiepileptic drugs such as Carbamazepine, Oxcarbazepine, Phenytoin, Phenobarbital, Lamotrigine, Primidone and Zonisamide are often associated with skin rash and other symptomsand signs of drug hypersensitivity.
Patients with allergic reactions or hypersensitivity to AEDs have a higher incidence cross-sensitization is high (40 - 80%), which suggests that chemically structer similar antiepileptic drugs should be avoided in high-risk populations.
VMAT - CST process at the truebeam machine in Ho Chi Minh city cancer hospital
Portal hypertension (PH) in children is caused by many causes.
It is necessary to detect and diagnose ASCVD early in patients with chronic liver disease in order to reduce the rate of complications and the risk of death.
Key words: Portal hypertension, esophageal varices, chronic liver disease.
In patients with chronic liver disease, PH is one of the poor prognostic factor.
Upper gastrointestinal endoscopy is not only considered as the gold standard to diagnosis PH, classify grade gastroesophageal varices, detect other lesions but also assess the risk of gastrointestinal bleeding, use interventional and prophylactic measures.
This is a cross-sectional study on 79 chronic liver disease who were diagnosed PH by endoscopy. The study was conducted at the National Children's Hospital from July 2019 to October 2020.
The results of the study showed 58.2% of chronic liver disease patients in the age 1 - 5 years had PH.
Common clinical symptoms include splenomegaly 98.7%, hepatomegaly 44.3%, thrombocytopenia 73.4%; anemia 60.8%, decrease in white blood cell count 15.2% and neutropenia 12.7% and abnormal liver function tests.
The esophageal varices on endoscopic examination at the time of diagnosis was mainly at grade I (26.5%) and grade II (46.8%), the rate of varices grade III (15.6%), grade IV (10, 2%).
Other combined lesions include gastric mucosal inflammation (92.4%), gastric varices (26.6%), duodenal ulcer 10.1%.
Treatment of foot drop after spinal anesthesia with intravenous lipid 20% emulsion: A case report
The aim of this article is to determine the prevalence in pulmonary tuberculosis patients at Dak Lak tuberculosis and lung disease hospital in 2021 and identify some related factors.
A facility-based, cross-sectional study conducted on 124 patients diagnosed with pulmonary tuberculosis.
Pre-tested semi-structured questionnaires were used for collecting demographic data, lifestyle habits and clinical data.
The rate of type 2 diabetes in patients with pulmonary tuberculosis is 39.5%.
Pulmonary TB patients with diabetes have a higher rate of hypertension than the group without diabetes.
In patients with pulmonary tuberculosis, the lesions recorded on X-ray were mainly in the middle and lower lobes and the tubercle, while in the non-diabetic group, the lesions were mainly in the upper lobes.
Introduction prevention of an announcement in Vietnamese people through MSCT survey of 640 brain blood vessel at Hoa Hao policlinic - Ho Chi Minh city
Describe the current status of professional awareness of regular general nursing students at Haiduong Medical Technical University.
Methods: A crosssectional descriptive study, using a questionnaire on the perception of nursing students about the profession on 131 first - and fourth-year full-time general nursing students at Hai Phong University of Medical Technology from October 2019 to March 2020.
Results and conclusions: The majority of students (83.2%) have a good awareness of the nursing profession, with an average score of 158.84 ± 21.07.
In which, 87.0% of students have a good perception of the competence of Nursing, the average score is 90.25 ± 12.1, 87.0% of students have a good perception of the quality of nursing. The average score is 39.48 ± 6.28 and 85.5% of the students have a good perception of the position of the nursing profession, the average score is 22.41 ± 3.7.
Some factors related to blood lipid metabolism disorders in the elderly people in Thai Binh rural area
Evaluation nutritional statusamong new cancer patients under 5 years old.
Results: There were 170 new cases with cancer under 5 years old. The prevanlence of underweight malnutrionwas 22.4% (moderate 20%, severe 2.4%).
The prevanlence of stunting malnutrion was 12.4% (moderate 11.8%, severe 0 .6%).
The prevanlence of wasting malnutrion was 17.6% (modarate 12.4%, severe 5.3%). The prevanlence of malnutrion according to middle upper arm circumference (MUAC) was 10.9%.
The prevanlence of overweight by weight / height index was 4.1%.
The prevanlence of malnutrion according to serum albumin was 29% and serum protein was 20%.
There was not any differences in underweight status between the cancer diseases.
Acute kidney injury in patients with sepsis and septic shock in the intensive care unit - Hue central hospital
Conclusion: Comply with loading dose anticoagulant recommendations, based on clinical and coagulation testing.
The indication for CRRT should be reconsidered in children with severe metabolic acidosis, with severe multi-organ dysfunction, and need to assess the prognosis of death before deciding to CRRT.
Objective: The aim of this study was to assess characteristics of continuous renal replacement therapy in children with sepsis shock at Pediatric Intensive Care and Toxicology Department 2 from January 1, 2015 to December 31, 2019.
Methods: This retrospective study included 77 cases of children with septic shock who underwent continuous renal replacement therapy at Pediatric Intensive Care and Toxicology Department at the Children's Hospital 2.
Results: The highest rate of indication was multi-organ dysfunction syndrome (31.2%).
The CRRT strategy used the most commonly was CVVHDF (96.1%).
The ultrafiltration rate was 46.7 ml / kg / hour.
The anticoagulant used was heparin, 100% of patients were not given the loading dose.
Membrane clotting was the most common complication (49.3%).
Colistin-resistant and Extended-Spectrum �-Lactamase producing Escherichia coli from healthy people and clinical specimens in Ho Chi Minh city
Postoperative pulmonary complications (PPCs) increase mortality, length of hospital stay, etc. Significantly, the chronic obstructive pulmonary disease (COPD) patients are easy to trigger exacerbations after surgery.
This descriptive cross-sectional retrospective combined prospective study was conducted to investigate the ratio of patients who triggered COPD exacerbation after gastrointestinal surgery under general anesthesia.
Thirty patients met the inclusion criteria; 100% were male, with 20% of patients having complications with the onset of postoperative exacerbations.
The spirometry in the complicated and uncomplicated groups was FEV1 = 48.2 ± 11.1 and 61.4 ± 13.8, respectively, which was no statically significant p = 0.0517.
The GOLD A / B / C / D subgroup at exacerbation was 0/3/1/2, respectively. The difference between the uncomplicated and complicated groups was statistically significant with p = 0.03.
Postoperative exacerbations are still high, so COPD patients need to be monitored more closely before surgery. v
Small intestine perforation due to a toothpick with non-specific clinical symptoms
Solitary Fibrous Tumor (SFT) is a rare disease, which can occur in many organs in the body.
Histopathology of SFT belongs to mesothelioma and has specific markers for immunohistochemical staining.
Most SFT are benign but can also present as malignancy.
In the thorax, SFT usually originates and occurs in the pleura.
Solitary Fibrous Tumor of the chest (SFTC) is very rare, and Malignant Lipomatous Solitary Fibrous Tumor of the chest (MLSFTC) is even rarer.
We introduce a case of malignant LSFTC with the goal of analyzing the pathological characteristics and chest computed tomography images, wishing to add to the bank of rare lung diseases, as reference for physicians to have the correct approach when encountering a similar case.
To study effct of treatment with I131 for basedow patients at Hue Central Hospital
Progression and short-term outcomes of mild traumatic brain injury in adults were studied.
Mortality rate was 0.65%.
Conclusion: Nonoperative treatment has yielded positive results.
Depending on patients's condition and specific circumstances, there will be different indications and treatment options.
Patients and methods: prospective, descriptive study on nonoperative mild traumatic brain injury in adults in Viet-Duc hospital from May 2020 to December 2020.
Glasgow outcome scale was used to evaluate treatment outcomes.
Results: 306 cases met inclusion criteria.
Mean age: 42.07±18; male (77.78%), female (22.22%).
Traffic accident was seen in most patients.
The mean number of CT scan was 1.93±0.4.
There were 6 cases (1.96%) witnessed clinical deterioration.
Good recovery with no disability accounted for 87.21% of all patients during the 3 - month follow up.
Profile of non-high-density lipoprotein cholesterol in patients with acute myocardial infarction
Conclusion: Goiter and thyroid volume were smaller after 3 months and 6 month treatment with I131 in Basedow patients than befor treatment statistical significance.
function of thyroid gland after 3 months and 6 months treating with I131 improving trend euthyroidism.
Objectives: To study figure and function of thyroid gland after 3 months and 6 months treating with I 131 in Basedow patients.
Subjects and method: 63 Basedow patients. This was a cross-sectional descriptive and prospective study.
Patiens were examined: figure of thyroid gland (goiter, thyroid volume) and function thyroid gland (I 131 concentrate at thyroid gland, concentration T3, T4, TSH, TRAb).
Results: After 3 months treatment Basedow with I131, goiter degree II was 39.29% and degree III was 7.14%; right lobe thyroid volume was 27, 22±15, 77 (ml) and left lobe was 25, 43±15, 18 (ml).
After 6 months treatment Basedow with I131, goiter degree II was 7.14%; right lobe thyroid volume was 16, 81±10, 92 (ml) and left lobe was 13, 85±83, 91 (ml)).
After 3 months treatment, rate hyperthyrodisum was 41.10%, euthyroidism was 35.52% and hypothyroidism 23.21%.
After 6 months treatment, rate hyperthyrodisum was 18.10%, euthyroidism was 51.85% and hypothyroidism 29.63%.
Morphological changes of eustachian tube function in patient with chronic rhinosinusitis
The risk of residual cardiovascular risk as recommended by ESC 2019 was 12.5%, and according to the AHA / ACC 2018 was 32.1%.
Patients in the group with high levels of non-HDL-C (≥ 85 mg / dL) had a significantly lower mean age and higher BMI compared to the group with low levels of non-HDL-C.
In the parameters of lipid, the level of total cholesterol, LDL-C and triglyceride was also significantly higher in the group with high levels of non-HDL-C.
Conclusions: Our study revealed that the rate of patients with acute myocardial infarction achieved nonHDL-C goals was low.
The residual cardiovascular risk in the study population was still relatively high.
Patients with high levels of non-HDL-C have a lower mean age, higher BMI, and lipid parameters such as total cholesterol, LDL-C and triglyceride had higher level than the group with low levels of non-HDL-C.
Objectives: To describe the profiles of non-HDL-C in patients with acute infarction myocardial and, to assess the proportion of patients with non-HDL-C levels achieving treatment goals according to current treatment recommendations.
Methods: A cross-sectional descriptive study of 297 consecutive patients with acute myocardial infarction admitted Cho Ray Hospital from January 2020 to July 2020.
Results: Among 297 patients, the mean age was 66.5 ± 12.5 years, and the male to female ratio was 1.3: 1.
The mean level of non-HDL-C and LDL-C were 144.5 mg / dL and 123.9 mg / dL, respectively.
Of these, 2.6% achieved LDL-C <55 mg / dL while 6.1% achieved non-HDL-C <85 mg/dL.
Of these, 9.4% achieved LDL-C < 70 mg / dL while 14.4% achieved non-HDL-C <100 mg/dL.
Surgical repair for congenital trachea stenosis at Vietnam national children’s hospital
The study aimed to monitor the management of medical solid waste contains rick of SARS-CoV-2 at treating COVID-19 patients hospitals in 2021.
Subject and methods: A description cross-sectional study was conducted at 4 hospitals in the North region (including: Thanh Nhan Hospital, Bac Ninh Provincial General Hospital, Bac Giang Provincial General Hospital, Hai Duong Province Hospital for Tropical Diseases) since September to December 2021.
Results and conclusion: Monitoring results showed that the volume of medical waste in hospitals has increased from 153% because all waste from the COVID-19 patients treatment area is considered infectious waste.
The increased amount of waste leads to an increase in the management cost of medical waste.
Because the management of medical waste has been carried out quite decently by hospitals in accordance with the provisions of Joint Circular No. 58/2015/TTLT-BYT-BTNMT and timely guidance on waste management and hygiene in COVID-19 prevention issued together with Decision No. 3455/QD-BCDDQG, hospitals did not face many surprises and difficulties in managing medical solid waste contains rick of SARS-CoV-2.
The study concludes that the common clinical manifestations of Henoch-Schonlein purpura are reddish-purple spots, digestive tract symptoms and high complete remission.
Keyword: Henoch-Schonlein nephritis, epidemic characteristics, clinical manifestations.
This study aims to describe the epidemic characteristics and clinical manifestations of HSP in children.
The study was conducted on 50 patients diagnosed with HSP at the Department of Pediatrics, Bach Mai Hospital from 2017 to 2018.
The common clinical manifestations were reddish-purple spots (90%), digestive tract symptoms (68%) and nephritis (18%).
At the end of the study period, 78% of the cases were completely recovered, 16% relapsed and 6% without remission.
Keywords: Non-communicable disease, village health worker, risk factor, communication, mountainous.
The study was conducted from 01/01/2015 to 30/09/2019 of 98 victims who died of brain damage.
The study results show that brain stamping at the affected place accounted for the highest percentage (76.5%), followed by fracture of skull (38.8%), opposing brain stamping on the opposite side (18.4%), cerebral suppression due to hernia (10.2%), cerebral suppression due to sudden increase and decrease in speed (4.1%), intermediate cerebral suppression (3.1%), and combined intracranial lesions accounted for 56.3%.
Keywords: Accident, road traffic accident, head injury, skull fracture, contrecoup fractures, forensic exam.
This descriptive study describes clinical and subclinical symptoms of neonatal pneumonia and evaluates the results of its treatment in Bac Ninh Obstetrics and Pediatrics Hospital.
The average duration of treatment was 8.6 ± 3.8 days.
The study concludes that neonatal pneumonia was more common in male children; the main clinical manifestations were coughing, rapid breathing, small granules; and a combination of antibiotics was effective in treating neonatal pneumonia.
Keywords: Neonatal pneumonia, tachypnea, apnea, use of antibiotics.
Among the patients, 57.0% were male; the male / female ratio was 1.33.
There were 67/200 (33.5%) patients aged 0 - 7 days with 13.5% of whom were preterm neonates.
In preterm infants, the most common clinical signs were cough (96.4%), tachypnea (42.9%), wheezing (89.3%), recessive (35.7%), scattered bibasilar rales (85.7%), cyanosis (32.1%), and apnea (21.4%).
In fullterm infants, the most common symptoms were cough (89.5%), cyanosis (6.9%), recessive (18.6%), and scattered bibasilar rales (77.9%).
There were 28.5% of the patients with unstable white blood cells; 26.0% of the children had increased CRP.
The most common antibiotic formula was Cefalosporin + Amikacin used in 30% of the cases.
121/200 cultured cases were positive, of which 35.5% was K pneumoniae, 27.3% was H influenzae, 21.5% was E coli, and 14.0% was S aureus.
The Trp64Arg (rs4994) polymorphism in codon 64 of ADRB3 (beta3-adrenergic receptor) gene is involved in the regulation of energy metabolism.
Keywords: ADRB3, rs4994, genotyping, RFLP.
This study optimizes the genotyping method of ADRB3 rs4994 polymorphism and determines the allele and genotype frequencies of this polymorphism in 3 - 5 years old children in Hanoi.
A cross-sectional study was conducted on 100 three-to-five-year-old Hanoi children, using DNA extraction method from cheek mucosa cells.
The genotyping of this polymorphism was performed by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) method.
The study optimized the method of genotyping of ADRB3 rs4994 polymorphism with Mval enzyme.
In 3 - 5 years old children in Hanoi, T / T genotype accounted for the highest proportion (78%), C / C genotype accounted for the lowest proportion (3%).
T and C allele frequencies were 0.785 and 0.125, respectively.
The genotypes observed were in agreement with those expected under Hardy-Weinberg equilibrium.
It is necessary to apply the genotyping method and genetic distribution for genotyping the ADRB3 rs4994 polymorphism in large-scale studies in Vietnam.
Objective: To evaluate serum vitamin D and IL-17 levels before and after treatment with oral Isotretinoin and Vitamin D, and analyze their relationships with clinical features in patients with moderate and severe acne vulgaris.
After treatment, serum vitamin D and IL-17 levels were significantly different from before treatment in both groups: Using oral isotretinoin in combination with Vit D and using isotretinoin alone. But there was no difference when comparing these 2 groups after treatment.
Conclusion: Serum Vit D and IL-17 levels in patients with moderate and severe acne vulgaris were significantly different from healthy controls.
There is a significant change in serum Vit D and IL-17 levels before and after treatment with oral isotretinoin and Vit D Keywords: Acne vulgaris, vitamin D, IL-17.
Objective: To evaluate the treatment outcome of disorders of serum sodium and postassium concentration in patients with chronic wounds.
Conclusion: Electrolyte disturbances in patients with chronic wounds were usually low serum Na+ and / or K+ concentration.
Na+ and K+ concentration in exudate were nearly equal to those in serum.
Electrolyte disturbances in patients with chronic wounds were easy to re-establish after treatment.
Keywords: Disorders of serum sodium and postassium, chronic wound, exudate.
Subject and method: A prospective descriptive study was performed on thirty patients who aged over 16 years old with chronic wounds and disorders of serum sodium (Na+) and postassium (K+) concentration within 24 hours after hospitalization at Wound Healing for electrolyte disorders (Na+ and K+).
We also determined the concentration of Na+ and K+ in wound exudate, which was obtained from Vacuum Assisted Closure (VAC).
Result: The patients with chronic wounds and electrolyte disorders who usually had low concentration of Na+ (50%), low K+ was 26.67%, Na+ and K+ were both low of 13.33%.
Objective: To assess the nutritional status of cancer patients when admitted to the hospital for treatment in the Department of Pain Management and Palliative Care.
Conclusion: Assessment of the nutritional status of cancer patients when admitted to the hospital for treatment in the Department of Pain management and Palliative Care revealed that 11% were in good nutritional status, 58% were in mild malnutrition or moderate malnutrition, 31% were in severe malnutrition Keywords: Nutritional status, cancer patients, PG-SGA, BMI, albumin.
Subject and method: 100 patients entering the Department of Pain management and Palliative Care for the first time were surveyed for a number of clinical indicators, tested and assessed on nutritional status in accordance with the PG-SGA (Scored Patient - Generated Subjective Global Assessment).
Result: 68% of patients were male; 63% of patients were ≥ 60 years old; 64% of patients were with gastrointestinal cancer; 82% of patients were in stage IV; 32% of patients had a combination of diseases; and 20% of patients had the systemic status ECOG at 3 points.
Assessed on BMI, 19% had light weight, 12% were moderately thin, and 9% were too thin.
Assessed on the level of albumin in blood, 21% were of slight decrease, 14% were of moderate and 3% were of severe decrease.
Among the 100 patients, 78% suffered from weight loss, 61% suffered from reduced appetite, 62% suffered from activity decrease, 100% suffered from an increase in nutritional requirements, 40% suffered from muscle impairment, fat impairment, and fluid excess.
The most common symptoms affecting eating and drinking were: Fatigue (65%), loss of appetite (60%), pain (28%), early satiety (25%).
Generally, 11% were in good nutritional status, 58% were in mild malnutrition or moderate malnutrition, 31% were in severe malnutrition.
The score group 0 - 1 accounted for 9%, the score group 2 - 3 accounted for 21%, the score group 4 - 8 accounted for 29% and the score group ≥ 9 accounted for 61%.
Objective: To investigate the prevalence and antibiotic resistance of bacteria causing catheter - associated urinary tract infections at the 108 Military Central Hospital from January to April 2022.
pneumoniae had a high rate of resistance to quinolone and third generation cephalosporins, the prevalence of resistance to imipenem was 9.4% and meropenem was 6.5%.
aeruginosa had a very high rate of resistance to most antibiotics, resistance to cefepime and amikacin were 36.7% and 22.7%, respectively.
Keywords: Catheter-associated urinary tract infections (CAUTI), antimicrobial resistance, urinary catheter.
Objective: To review the patients who were diagnosed with glycogenic acanthosis on upper gastrointestinal endoscopy and to describe the clinical symptoms, endoscopic and urlological features.
Clinically, mild glycogenic acanthosis was a common finding, in 55 (82.1%) cases.
Pathologically, benign squamous hyperplasia was 65 cases (97.0%), and with dysplasia squamous epithelium was 2 patients (3.0%).
Conclusion: The common clinical symptoms areabdominal pain, burning, bloating and belching.
Endoscopically, 81.2% of them with moderate degree of squamous cell hyperplasia.
The main accompanying endoscopic lesions are GERD and gastritis.
Histourlologically, most cases are benign squamous hyperplasia; squamous cell dysplasia is observed in 3% of cases.
Keywords: Squamous hyperplasia, glycogenic acanthosis, hyperplastic.
Patients with glycogenic acanthosis were aged 38 - 84 years, average 61.5 ± 9.3 years.
The most common symptoms were heartburn 53 (79.1%), belching and bloating 52 (77.6%), upper central abdominal pain 59 (88.1%).
The less common symptoms were chronic cough 18 (26.9%), difficulty swallowing 2 cases (3.0%).
Gastroesophageal reflux was detected in 57 cases (85.1%) with squamous hyperplasia, while hiatal hernia was detected in 3 (4.5%) cases.
Objective: To evaluate the prevalence and characteristics of hypertension in patients after kidney - transplant surgery and other related factors.
Conclusion: Hypertension after kidney transplant surgery was popular.
Keywords: Hypertension, kidney transplant, post-surgery.
Subject and method: Fifty-seven patients have performed kidney transplants at 108 Military Center Hospital from December 2016 to March 2020.
This was a retrospective and prospective study, blood pressure was measured daily before and early post - transplantation, and 10 days continuously.
Result: Mean blood pressure after surgery was 141/85 ± 14.6/10.3 mmHg.
The mean hypertension days was 7.1 ± 2.68 days.
Dialysis more than three years and inadequate blood pressure control before the operation were risk factors that increase the likelihood of post-surgery hypertension, with OR were 1.92 (1.10 - 3.51) and 2.03 (1.36 - 3.07), respectively.
Diastolic blood pressure had weak positive relationship to BMI (r = 0.219; p<0.001), but systolic blood pressure had no relationship to BMI.
Objective: To examine whether the dural cross-section area (DCSA) and anteroposterior diameter (APD) in axial loaded magnetic resonance imaging (MRI) correlates with the severity of clinical symptoms in patients with lumbar spinal canal stenosis (LSCS).
Keywords: Spinal canal, axial loaded magnetic resonance image, lumbar spinal canal stenosis.
The severity of symptoms was evaluated on the basis of the walking distance, visual analogue scale (VAS) of leg pain, back pain, Japanese Orthopaedic Association score and ODI (Oswestry Disability Index 2.0).
Result: 62 patients with LSCS (25 men and 37 women, 32 - 81 years, median age, 57.61 ± 9.6 years), VAS back pain: 6.0 ± 1.03, VAS leg pain: 6.64 ± 1.32, ODI: 69.23 ± 5.52.
Objective: To study clinical and subclinical characteristics in patients with type 2 diabetes who the first time to consult in Outpatient Department of Senior Officers.
Research the factors affecting type 2 diabetes patients.
Subject and method: All type 2 diabetes patients come to the clinic for the first time in Outpatient Department of Senior Officers from August 2018 to July 2019, descriptive, cross-sectional research method.
Objective: To evaluate the characteristics of changes in electromyography and its relationship with clinical characteristics and magnetic resonance imaging in patients with lumbar disc herniation.
Subject and method: Including 60 patients with confirmed diagnosis of lumbar disc herniation, inpatient treatment at 103 Military Hospital from 9/2020 to 3/2021.
Result: The age group 40 - 59 accounted for the highest rate of 48.3%; male / female ratio was 1.14/1. Location of disc herniation L4-L5 63.3%, L5-S1 30%, L4-L5 and L5-S1 6.7%, type of hernia right posterior deviation 41.6%, hernia posterior left deviation 55%; compound hole 3.4%.
Electromyography on the patient side: The percentage of patients with electromyography abnormalities was 50%, of which: L5 root damage 30%, roots S1 13.3%; L5 and S1 roots 6.7%, 90% of patients had spontaneous potential; 100% of patients had reduced aggregation and motor units of neurourly.
The rate of electromyographic abnormalities was higher in patients: Disease over 6 months, severe and very severe pain according to VAS scale, stage 3 disc herniation, severe disc herniation, degree of root compression III and severe spinal hepatomegaly, the difference was statistically significant with p<0.05.
Conclusion: There is a relationship between the percentage of patients with lumbar disc herniation with changes on electromyography with the clinical severity and the degree of injury on MRI of the lumbar spine.
Keywords: Lumbosacral disc herniation, radiculourly, magnetic resonance imaging (MRI), electrodiagnostic study (EDX).
Objective: To investigate the value of four circulating microRNAs (microRNA: microRNA-155, microRNA-147b, microRNA-223, microRNA-146 - 3p) in diagnosis of sepsis.
Subject and method: 71 sepsis patients treated in Viet-Tiep Hospital, Hai Phong and 108 Military Central Hospital, Ha Noi from November, 2014 to July, 2017 there are 31 Dengue haemorrhagic fever (DHF) patients and 32 healthy control (HC) were included in the control group.
Result and conclusion: The expression of 4 microRNAs: MicroRNA-146 - 3p, microRNA-147b, microRNA-155, microRNA-223 in sepsis group was significantly higher than that in healthy control and DHF group (p<0.05).
Keywords: Sepsis, microRNA 146 - 3p, microRNA 147b, microRNA-155, microRNA 223.
Objective: To survey on the patient safety awareness of medical staffs at 108 Military Central Hospital.
Subject and method: A cross-sectional description based on the questionnaire survey chart of patient safety of the American Health Research and Quality Agency. The survey was conducted with 661 medical staffs at 108 Military Central Hospital in 2020.
Among the components of patient safety, the teamwork was the most positive (94.3%) with an average score was 4.2, the human resources was the lowest positive (60.1%) average score was 3.6.
Conclusion: Patient safety awareness of medical staffs at 108 Military Central Hospital in 2020 was rather good.
More attention should be paid on human resources to ensure the patient safety quality.
Keywords: Patient safety, 108 Military Central Hospital.
Objective: To examination of some clinical features of Ota's nevus patients treated at 108 Military Central Hospital.
Subject and method: A cross-sectional descriptive study of Ota's nevus was conducted by reviewing the clinical characteristics and photographs of one hundred and seventy-six patients.
Statistical analysis was used to compare outcomes and determine contributing factors.
Result: 161 patients were in accordance with Tanino's classification (91.48%), in which there were cases of type I (30.7%), cases of type II (28.4%), of type III (24.27%), and of type IV (5.11%).
The remaining cases were not in line with Tanino's classification 15 (8.52%) .169 patients were in line with PUMCH's classification (96.02%), and 3.98% patients were not 7/176 (3.98%).
Conclusion: The clinical feature of Ota's nevus is so complicated, there are not any classifications covered all cases.
Keywords: Nevus of Ota, Tanino, PUMCH.
Objective: To compare serum copper and copper to ceruloplasmin ratio between the patients and the controls.
Females have higher levels of both serum copper and copper to ceruloplasmin ratio than males (p=0.017, p=0.039).
The older the patients get, the higher levels of serum copper they have (p=0.036, r = 0.26).
Patients who drink alcohol more than once a month had lower copper to ceruloplasmin ratio than those who do not drink (p=0.049).
Conclusion: There is no difference in serum copper level between the controls and the patients.
The patients have lower copper to ceruloplasmin ratio than the controls.
Serum copper raise as the patients get older.
Gender can affect serum copper level and copper to ceruloplasmin ratio in psoriasis patients.
Copper to ceruloplasmin is found to be relative to alcohol consumption.
Keywords: Plaque psoriasis, serum copper, copper to ceruloplasmin ratio.
To identify the relationship between serum copper, copper to ceruloplasmin ratio and clinical characteristics.
Subject and method: We designed a cross-sectional study with convenience sampling of 66 cases of psoriasis patients and 66 normal people at dermatology clinic of Ho Chi Minh City Hospital of Dermatology and Venereology during the period January 2021 to June 2021.
Result: Mean age was 44 years old.
15% of the patients had family history of psoriasis.
There was no significant difference in serum copper levels between the cases and the controls (mean 76.7µg / dL vs mean 75.4µg / dL, p=0.55).
Serum ceruloplasmin levels were significantly raised among the cases as compared with the controls (mean 41.2mg / dL vs mean 32.7mg / dL, p=0.001).
Serum copper to ceruloplasmin ratio were significantly low in the psoriasis group as compared with the controls (mean 2.1 vs mean 2.4, p=0.001).
Objective: To evaluate an innovative program to improve the knowledge of patients and their family members about care at the Department of Thoracic surgery, Bach Mai Hospital.
Keywords: Innovation, knowledge, patients and their family members, care.
Objective: To determine the proportion of anxiety, depression and the association with the duration of taking oral isotretinoin in patients with acne at Hospital of Dermato-Venereology, Ho Chi Minh city.
Subject and method: Prospective study, sixty-seven patients taking oral isotretinoin were evaluated by using the HAD scale from October 2018 to July 2019.
Result: The study showed that 50.75% had anxiety, 13.43% had depression, 1.43% had a combination of anxiety and depression symptoms.
No association found between the development of anxiety, depression for patients with acne and the duration of oral isotretinoin treatment.
Conclusion: The percentage of anxiety, depression in acne patients taking oral isotretinoin is very high.
Therefore, we need to pay attention to this issue during treatment and management of acne patients.
Keywords: Anxiety, depression, acne, isotretinoin.
Objective: To review some clinical and echocardiographic characteristics of mechanical valves replacement.
Clinical and echocardiographic based on the criteria of the Viet Nam National Heart Association and ACC / AHA guidelines.
Result: Anamnesis of rheumatic heart disease was 62.7% (no treatment was 16.4%), Hypertension was 35.8%, NYHA 2 and 3 were 100%, fainting was 26.9%, chest pain on exertion was 59.7%.
Echocardiography: Severe aortic stenosis valve was 97%, mean gradient pressure > 40 mmHg was 95.5%, left ventricular hypertrophy (308.7 ± 35.3g) but left ventricular systolic function is preserved.
Conclusion: Clinical symptoms of aortic stenosis were not obvious, chest pain on exertion was 59.7%, fainting was 26.9%.
Echocardiography: severe stenosis of the aortic valve by area accounted for 97% and according to mean gradient pressure was 95.5%.
Left ventricular hypertrophy with a mean muscle mass of 308.7 ± 35.3g.
Keywords: Aortic valve replacement, aortic valve stenosis (AS).
Background: Minimally invasive cardiac surgery has been worldwidely and powerfully developed in both quantity and quality.
No hospital death; 3.6% of postoperative bleeding needed re-operation.
In a 3 month follow-up, 73.6% were NYHA grade I - II; mean LVEF was 62.9 ± 3.7%; mean PAPs was 31.7 ± 3.7 mmHg; there were no re-operation needed and no mortality during the following time.
Conclusion: MIMVR surgery at Hue Central Hospital was safe and effective, significantly improved clinical symptoms as well as postoperative pain.
Keywords: Minimally invasive, surgery, mitral valve replacement, right thoracotomy.
In Vietnam, at Hue Central Hospital, we have recently performed minimally invasive surgical techniques in mitral valve replacement with promising outcomes.
Objective: To evaluate the early outcomes of minimally mitral valve replacement (MIMVR) surgery via the right thoracotomy in our department.
Subject and method: This is a descriptive study.
All patients were diagnosed as mitral stenosis and mitral regurgitation, and underwent MIMVR at Hue Central Hospital from December 2016 to December 2019.
Patients were postoperatively followed up and assessed by clinical examination and echocardiography within 3 months.
Result: 56 patients underwent MIMVR surgery, the male-female ratio was 1: 2.1; the mean age was 44.5 ± 12.5 years old; Preoperative functional symptom: NYHA grade I-II in 66.1%.
Mean MVA was 1 ± 0.6 cm2; mean LVEF was 63.2 ± 5.4%; mean PAPs was 43.3 ± 18.3 mmHg.
Mean aortic cross-clamping and mean CPB time time was 95.8 ± 16.6 minutes and 130.2 ± 27.9 minutes respectively; mean mechanical ventilation time was 3.4 ± 1.3 hours; mean ICU time was 5.9 ± 1.8 days.
Objective: To investigate the rate of multiple types of nosocomial infections and related factors at Department of Intensive Care, Vinh Phuc province Hospital.
Keywords: Mosocomial infections, ventilator-associated pneumonia, risk factors.
Objective: To identify the rate of severe pneumonia due to adenovirus and it's prognosis factors in children.
Subject and method: A cross-sectional study collected 100 children from 2 months to 5 years. All participants were confirmed adenovirus pneumonia by realtime PCR in the National Children's Hospital from June of 2018 to May of 2019.
Result: The prevalence of severe pneumonia caused by adenovirus was 64%.
The probability of developing severe pneumonia in the group with lobar pneumonia in chest X-ray were 7.74 times higher than that of the group without lobar damage (OR = 7.74, 95% CI: 3.45 - 26.39, p<0.05).
The risk of having severe pneumonia in children infected from family was lower than those infected in the hospital (OR = 0.2, 95% CI: 0.05 - 0.79, p<0.05).
Conclusion: Most of the children with pneumonia due to adenovirus were severe.
Lobar pneumonia in X-ray and infection from family members were associated with the severity of adenovirus pneumonia in children.
Objective: To compare the onset and duration of sensory and motor blocking effects, success and complications rates of two techniques.
Subject and method: 60 patients indicated for upper limb surgeries at 7A Military Hospital from May 2020 to September 2020 were randomly divided into two 20ml levobupivacaine 0.5% combined lidocaine 2% and 1/200.000 adrenaline.
Group II with nerve The procedure time (5.5 ± 2.68 vs 4.6 ± 1.72 min), time of onset of sensory suppression (5.03 ± 1.09 vs 9.6 ± 1.58 min) and time of onset of motor block (8.0 ± 1.98 vs 12.26 ± 2.27 min) in group I were significant shorter those in Group II (p<0.05).
The duration of sensory and motor block (335.15 ± 115.30 vs 312.30 ± 312.30 minutes and 285.13 ± 103.20 vs 225.40 ± 98.35 minutes, respectively) were significant longer in group I than in Group II (p<0.05).
Good numbness rate (96.66% vs 90%) and complications (3.3% vs 9.9%) were comparable between two groups.
Keywords: Brachial plexus block, ultrasound-guided.
Objective: To evaluate the outcome of the anterior debridement, decompression and autograft fusion by titanium plate in treatment for the lower cervical tuberculosis.
Conclusion: The anterior debridement, decompression, using iliac crest fusion and fixation by titanium plate was demonstrated to be a safe and effective method to treat lower cervical tuberculosis.
Keywords: Lower cervical spine, cervical spine tuberculosis, anterior approache, cervical plating.
From December 2013 to February 2019, 12 lower cervical tuberculosis (8 male; 4 female; average age 39.5 ± 17.3 years) who underwent surgical treatment at Neurosurgery Department of 108 Military Central Hospital.
Neurologic function of all the patients was evaluated by VAS, JOA score and ASIA grade.
Patients were followed up for 13.4 ± 4.5 months on average.
Result: Postoperatively neurologic function of all the patients using the VAS, JOA score and ASIA grade was improved significantly after surgery.
The cervical sagittal alignment was improved by C2 - 7 Cobb's angle change (- 4.8° ± 1.9° postoperative end - examination vs 14.3° ± 7.8° preoperative; p<0.05).
All patients had solid fusion and no major complications were observed in the follow-up period.
Objective: To describe the disease structure and some related factors of the patients in the Cardiovascular Intensive Care Unit (A2-D).
Keywords: Disease structure, cardiovascular intensive care unit, 108 Military Central Hospital.
Although most of the case have histourlological features of meningothelial meningioma, the diagnosis has remained challenging for clinicians, radiologists and as well as urlologist due to their rarity and vague clinical symptoms.
However, the histourlological images of small preoperative biopsy showed features of atypical fibrous histiocytoma: Monomorphic fibroblast-like and epithelioid shaped cells with delicate chromatin arranged in the whorl / curlicue pattern and CKAE1/AE3-negative staining; the tumor extended into the dermis and hypodermis.
The postoperative histourlological results confirmed cutaneous meningioma, type III based on the medical history, histourlology and immunohistochemistry.
Keywords: Cutaneous meningioma, post-traumatic cutaneous meningioma.
We pressent two case with hyperparathyroidism, treated with ultrasound-guided percutaneous RFA using moving-shot technique with positive result. Some discussions on dianogsis and techniques of RFA procedure were given.
There were no complications associated with RFA. Serum PTH, Calci-Ion, Phosphat level normalized after 2 months follow-up.
RFA is safe and effective in treatment of parathyroid adenoma in primary hyperparathyroidism.
Keywords: RFA, parathyroid, hyperparathyroidism.
Objective: To evaluate clinical characteristics, recurrence risk factors, and radioiodine treatment response in post-total thyroidectomy papillary thyroid micro-carcinoma patients.
Keywords: Papillary thyroid microcarcinoma, recurrence risk classification, radioiodine therapy.
The subgroup analysis showed that some clinical and histourlological characteristics were not significantly different; however, the recurrence risk and radioiodine therapy response classification were significantly different between the two groups.
Ganglioneuromas (GNs), benign tumors of symurletic neuvous systems arising from the neural crest tissue and are most commonly located in the posterior mediastinum and retroperitoneum.
Keywords: Ganglioneuroma, adrenal incidentaloma.
They are rarely found in the adrenal gland, asymptomatic and incidentaloma in almost cases.
Although GNs is benign but it can grow and cause compression, so surgery is the optimal treatment method.
It is complicated to diagnose exactly before surgering, difficult distinction with adrenal cortical carcinoma.
Postoperatively, there is no need for adjuvant therapy in patients with adrenal GNs and their progonist is excellent.
We report the clinical case describing adrenal ganglioneuroma, without exact diagnosis and the exception of adrenal cortical carcinoma.
Conclusion: Adrenal ganglioneuroma is benign, occurs rarely and preoperative diagnosis is difficult, thus surgery is the gold standard for the treatment and histourlological examination is the mainstay of diagnosis.
Paronychia and pyogenic granuloma-like lesions are among the most noticeably undesirable side effects on patients treated with epidermal growth factor receptor inhibitor (EGFR). These badly affect the patients' quality of life as well as their compliance with targeted therapies.
Keywords: Epidermal growth factor, paronychia adverse event, pyogenic granuloma, topical beta-blockers.
No F hepatica was detected in the present study.
Conclusion: F gigantica and intermediate form were identified in bovine and buffalo in the Northern Vietnam, whereas F hepatica was not detected.
dranhk61@gmail. com - Học viện Quân y Keywords: Fasciola, bovine, buffalo, PCR-RFLP, Northern Vietnam.
Result: The present results showed that, using PCR-RFLP based on the first internal transcribed spacers (ITS1) of the rDNA revealed that 95 out of 122 isolates (77.9%) were Fasciola gigantica type, whereas 27 isolates (22.1%) presented an intermediate Fasciola.
Objective: To evaluate the scientific evidence related to the tooth movement outcome of orthodontic treatment with clear aligners from 2010 to 2020.
Keywords: Tooth movements, clear aligners, systematic review, orthodontics.
Subject and method: An electronic searched for articles on the databases PubMed, ScienceDirect, Google Scholar published from January 2010 to the end of 2020 to identify all peer-reviewed articles potentially relevant to the review.
Data collected from each article included: author, year of publication, study design, sample size, intervention, comparison, and treatment outcome.
Methodological limitations were highlighted and the quality of articles was scored using tools such as: Risk of Bias In Non - randomized Studies of Interventions (ROBINS-I) for cohort studies and Cochrane Risk of Bias Tool for randomized controlled clinical trials.
Result: Twelve relevant articles were selected, one was a randomized controlled clinical trials, two were prospective cohort studies, and nine were retrospective cohort studies.
Sample sizes ranged from 16 to 75, with a total of 477 patients.
Most of the covered studies assessed predictability of tooth movement comparing post-treatment patient models to the predicted digital planned tooth movement models (ClinCheck, Vectra, Canfield Scientific).
Conclusion: Current studies have low to moderate evidence in the outcome of tooth movement when use clear aligners for some cases.
Most tooth movements are not equivalent to a specialized software-based treatment plan for clear aligners, except for small horizontal tooth movements.
Objective: To investigate the change of anti-SARS-CoV-2 IgG antibody levels in individuals after vaccination with AstraZeneca, Moderna, and Pfizer vaccines.
Keywords: SARS-CoV-2, COVID-19, COVID-19 vaccine, antibody.
Subject and method: 221 adult volunteers 108 Military Central Hospital during the period from 11/2021 to 2/2022 according to the injection procedure of the Ministry of Health.
Objective: To determine the cause of infection in kidney transplant patients in the first year after transplantation at 108 Military Central Hospital from 2016 to 2021.
Keywords: Kidney transplant, viruses.
Among 51 patients (71.8%) infected with at least 1 of 5 viruses, BKV and JCV (50.7% and 33.8%), CMV (60.6%), EBV (7.0%), The rate of virus infection at the 6th month after kidney transplant was significantly higher than that at the time of 1, 2 and 12 after kidney transplantation (Mc-Nemar test, p<0.05).
Objective: To determine the efficacy, short-term results of percutaneous transluminal angioplasty (PTA) in patients with chronic iliac diseases.
Despite many advances in imaging diagnostic and urlophysiology, some cases of SBO are still diagnosed late or lacking of inaccuracy, leading to increased morbidity and mortality.
Conclusion: The main complication of SBO is intestinal ischemia, computed tomography imaging is the modality of choice in this urlology because of its ability to assess the bowel wall, the supporting mesentery and peritoneal cavity all in one, signs of intestinal ischemia can be seen on computed tomography: abnormal enhancement of the intestinal wall, thickening of the intestinal wall that may increase density, signs of halo ring or target, localized fluid collection or bleeding in the mesentery, gas in the intestinal wall, portal vein in the late cases.
Keywords: Small bowel obstruction, intestinal ischemia, closed-loop obstruction.
Brackground: Pneumonia is an acute respiratory infection (ARI) with damage in the lungs.
The average duration of antibiotic treatment in patients with pneumonia (7.92 ± 1.79) and severe pneumonia (7.76 ± 1.60).
The rate of using one antibiotic is the highest at 51.21%, the rate of using two antibiotics is relatively high at 47.56%.
The treatment of pneumonia in the hospital is relatively effective, with an overall cure rate of 64.6%, leaving a large proportion of patients with 35.4% relief, meaning symptom reduction but still need treatment add with antibiotics after discharge.
Conclusion: The proportion of children who have used antibiotics before going to the hospital is less than that of children who have not used penicilline antibiotics in a large proportion, of which ampicilline antibiotic is used the most.
The average time of initial antibiotic use is about 8 days, and the duration of the alternative regimen is 5 days.
The overall cure rate was 64.6%, with the remaining 35.4% of patients getting better.
According to WHO, pneumonia is one of the five main causes of death in children especially children under 5 years old.
Up to the present time, there are many studies on pneumonia children under 5 years old, but there are not many studies on the treatment results of pneumonia in children in Nghe An province.
Four regimens for pneumonia have been used when the patient first arrived, including 2 antibiotic alone regimens and 2 antibiotic combination regimens.
Two doses of Ich Tri Vuong did not effect SGOT and SGPT, while Atorvastatin induced a significant in there liver enzymes.
Ich Tri Vuong 180 mg / kg / day and atorvastatin 5 mg / kg / day reduced the degree of liver steatosis in histological examination.
Keywords: Ich Tri Vuong, Non-alcoholicfatty liver disease.
The studies were designed to accessing the effect of Ich Tri Vuong on serum lipids level, SGOT, SGPT, and liver steatosis in histological examination in non-alcoholic fatty liver disease in cholesterol-fed rabbits.
Group 1: Oral administration (OA) with water 2ml / kg / day.
Group 2: OA cholesterol 0.5g / kg / day + water 2ml/kg.
Group 3: OA cholesterol 0.5g / kg / day + Atorvastatin 5mg / kg/day.
Group 4: OA cholesterol 0.5g / kg / day+ ITV 60mg / kg/day.
Group 5: OA cholesterol 0.5g / kg / ngày + Ich Tri Vuong 180mg / kg/day.
After 8 weeks, Ich Tri Vuong decreasing total cholesterol and LDL equivalent to Atorvastatin 5mg / kg / day group (p> 0.05).
Objective: "Describe the level of risk of some occupational risks of nurses at K Hospital in 2018".
The risk of being bullied by co-workers accidents while working, allergies / shocks when exposed to chemicals, and work stress are all more than 3 times higher than those of the less exposed group (p<0.05).
Conclusion: Early intervention measures are needed to address the occupational risks of nurses in the hospital.
Keywords: Occupational risks, nurses hospital.
Methods: Using the cross-sectional description method with the whole sample selection on 370 nurses of K hospital. The self - filled questionnaire is designed, content includes: Working environment (exposure with blood, chemicals, radiation, noise, dust patients...).
Risks encountered (sharp objects stabbed, colleagues pinched, lawsuits...).
The most recent way to handle risks.
Results: Groups working for 1 - 5 years, 5 - 10 years, 10 - 20 years, respectively, have 4.6, 3.4 and 2.8 times compared with the group over 20 years.
Internal medicine has a risk of 3 times higher, the subclinical department 2.06 times compared to the functional department (p<0.05).
The group with high exposure to chemicals is 2.3 times higher than the group with little exposure to and stress at work, and other injuries are 1.91 and 1.61 times higher respectively, than the group with little exposure (p<0.05).
Groups with overload of work and psychological pressure have a higher risk of 10 types of risk than the group with little exposure.
CLINICAL, SUBCLINICAL CHARACTERISTICS AND ITS RELATIONSHIP OF PENILE CANCER AT K HOSPITAL 2008 - 2014 Objectives: Study some clinical - subclinical and its relationship of penile cancer at K hospital 2008 - 2014.
Keywords: penile cancer.
Subjects and methods: A retrospective and prospective study on 106 patients were diagnosed by histopathology and were identified as penile cancer stage I, II, III were treated at K hospital from 2008 - 2014.
Results: median age 51.2 years, disease common in people ageing from 40 to 70 years old (68.9%), duration of illness over 6 months (72.3%).
The invasiveness of tumors in T2 and T3 is38.7% and 52.8%, respectively.
Histopathology of penile cancer is squamous cancer (100%).
The low grade G1, 2 (84%), high grade G3, 4 (16%), lymph node metastases (39.6%), stage I, II and III (8.5%, 40.6% and 50.9%, respectively).
The wider invasiveness of tumors is, the more frequent clinical consultation and the higher lymph node metastases are by histopathology.
Results: (1) The most common subtype is pre-T ALL (56.3%).
(2) 100% patients express cyCD3, but surface CD3 can be seen in only 25% cases.
Other common T-cell markers are: CD7 (68.8%), CD2 (56.2%), CD5 (50%).
SYSTOLIC AND DIASTOLIC LEFT VENTRICLE FUNCTION ASSESSMENT BY TISSUE DOPPLER ECHOCARDIOGRAPHY IN PATIENTS WITH PERFUSION DEFECTS IN SPECT STUDY Objective: Evaluating left ventricular function in the hypertensive disease with perfusion defects in SPECT by tissue Doppler echocardiographic.
Subjects and Methods: We evaluated 127 patients with traditional echocardiography and TDI; among them, 80 as normal control subjects and 47 patients with hypertension.
Conclusions: In the hypertensive disease with perfusion defects in SPECT had lower Sm, Em, Em / Am when compared with patients without perfusion defects in SPECT.
Keywords: Hypertension, Diastolic function, pulsed-wave tissue Doppler echocardiography
ASSESSMENT OF MAXILLARY SINUS WALL BROKEN TREATMENT IN MID-FACE FRACTURE BY REDUCTION - FOLEY BALLOON INTRASINUS FIXATION Objective: 1.
To give the description of clinical and X-ray of maxillary sinus fracture.
To assess the result of using Foley balloon as the role of intrasinus fixation device in sinus wall broken.
Cross section, descriptive study.
Result: 15/19 (78, 95%) patients were good and fair results in 4/19 (21, 05%) after 10 days of operation.
Meanwhile these ratios reached at 17/19 (89, 47%) and 2/19 (10, 53%) after 6 months of treatment Keywords: Maxillary sinus fracture, Foley balloon intrasinus fixation.
COMMENT ON TECHNIC OF AMNIOCENTESIS AND MANAGEMENT THE FETAL CHROMOSOMAL ABNORMALITIES IN NATIONAL OBSTETRIC GYNECOLOGY HOSPITAL AND IN HANOI OBSTETRIC GYNECOLOGY HOSPITAL FROM 1/2008 TO 6/2009 The descriptive study on 438 women amniocentesis and amniotic cell culture for detection of chromosomal abnormalities may cause fetal malformations in National Obstetric and Gynecology Hospital and in Hanoi Obstetric and Gynecology Hospital period from 1/1/2008 30/6/2009.
Results: the technique of amniocentesis are relatively safe, this technique is performed only once in 97.3% of women and 2.1% of pregnant women have to 2 pnction; 0.7% of pregnant women have rebooked to amniocentesis after 1 - 2 weeks, while the technical implementation in short time (5 minutes in 92.7% of women), length of hospital stay was 2 hours after amniocentesis; low complication rate (only 0.2%).
Results management of fetal chromosomal abnormalities: proportion of chromosomal abnormalities was 8.2%, including 6.4% to abortion; 1.8% referral for monitoring and further treatment.
Conclusion: the technique of amniocentesis to detect abnormal fetal chromosomes are relatively safe, low complication rate, the majority of cases have been diagnosed fetal chromosomal abnormalities often have to manage by abortion.
Keyword: amniocentesis, amniotic cell culture, management the fetal chromosomal abnormalities
BREAST AUGMENTATION WITH SILICONE - GEL IMPLANTS USING PERIAREOLAR INCISION WITH PURSE STRING SUTURE WITH LESS VISIBLE SCAR Objectives: three main approaches used in breast augmentation were inframammary, periareolar and axillary approach.
Keywords: breast augmentation, periareolar incision, purse - string suture
Scars after surgery always should be considered.
In this report, we evaluated our technique using periareolar approach with purse - string suture to hide the scars under the nipples in breast augmentation.
The surgical time was 1 hour and 45 minutes for both sides.
STUDYING CHARACTERISTIC PULSE DOPPLER ULTRASOUND AND CLINICAL OF CHRONIC VENOUS INSUFFICIENCY OF THE LOWER EXTREMITIES Purpose: Studying characteristic pulse Doppler ultrasound and clinical of chronic venous insufficiency of the lower extremities.
Conclusion: Patients with chronic venous insufficiency of the lower extremities have a high averange age, women get sick more, the common rick factors: relating to the profession, childbirth, obesity.
Doppler ultrasound parameters showed: varicose veins and appear reflux time >1 sec.
Keywords: Chronic venous insufficiency, Varicose veins, Pulse Doppler ultrasound.
Objects and methods: 70 patients with chronic venous insufficiency, clinical examination and Doppler ultrasound of the lower circuit.
Result: Female (81, 4%), the averangeage 40 - 60 (64, 3%).
Clinical calf strain (97, 2%), heavy legs (91, 5%), disturbancesof sensation inthe foot (90, 6%).
CEAP clinical classification: C1 (26, 5%), C2 (50, 9%), C3 (17.9%), C4 (3, 8%), C6 (0.9%). Ultrasound Doppler: great saphenous vein femoral vein into segments diameter: 7, 97 mm, great saphenous vein above-knee segment diameter: 4, 63 mm, great saphenous vein below-knee segmentdiameter: 4, 04 mm.
Cross vein sections below knee diameter: 2, 84 mm.
Reflux time in great saphenous vein, small saphenous vein, cross vein: 3, 3 - 4, 68sec.
BMI mean of faty liver diabetes group is 23, 15 ± 2, 73, those of nofaty liver diabetes group is 20, 86 ± 3, 02, in focus group is 20, 76 ± 1, 77 with significant defference in statistics p < 0, 01.
Cholesterol and Triglycerid concentration mean of faty liver diabetes are higher than those of nofaty liver diabetes group with significant defference in statistics.
SURVEY OF CLINICAL CHARACTERISTICS, LABORATORY FNDINGS AND CONTINUOUS RENAL REPLACEMENT THERAPY IN POSTPARTUMS WITH ACUTE KIDNEY INJURY Aim of survey is to study the clinical characterisitics, laboratory findings and initial evaluation of continuous renal replacement therapy in postpartum patients with acute renal injujy.
A case serie study of 61 patients admitted the Intnsive care unite, Cho Ray hospital from 01/12/2012 to 31/6/2014 were analyzed.
Glasgow score, SOFA and APACHE II was 9.69 ± 3.9, 13.64 ± 4.15 and 23.66 ± 7.32, respectively.
The rate of acute kidney injury degree 1 was 37.7%, degree 2 was 21.3% and degree 3 was 41.0%.
Rate of hyperurimia was 32.8%, oedema was 40.9%, hypotension was 54.1%.
CRRT with CVVH mode improved renal function but no evidence of improvement the hospital mortality.
Keywords: Postpartum, Acute kidney injury, Continuous renal replacement therapy.
STUDY OF THROMBOELASTOGRAPHY (TEG) INDICATORS IN ACUTE PROMYELOCYTIC LEUKEMIA Background: TEG is aglobal coagulation test, allowing hematologists to assess situation with DIC in APL patients.
Purpose: To study some TEG indicators in APL patients.
Patients and methods: Descriptive study was carried out on 51 APL patients treated in NIHBT from 1/2013 - 3/2014.
Results: (1) Observed coagulopathy due to DIC, showing in TEG indicators: in 74, 5% patients CI reduced; in 37, 3% R prolonged; in 49, 1% K prolonged; in 62, 7% α narrowed; in 68, 6% MA reduced.
(2) Observed relationship between TEG indicators and separate coagulation tests: (a) Positive correlation: Strong correlation between MA - TEG and platelet count; Significant correlation between: R - TEG and rAPTT; α - TEG and fibrinogen; Not significant correlation between MA - TEG and fibrinogen.
(b) Inverse correlation, significant inverse correlation between K - TEG and fibrinogen.
Keywords: Moyamoya disease, cerebral occlusive disease, bypass
Results: The authors treated a total of 33 patients undergoing 35 procedures (mean age 35, 9 ±12, 6).
The mean follow up 3, 8 years, reccurrent strokes were 6, 6%.
Overall, there was a significant improvement in quality of life in the corhort as measured in using the Modifyied Rankin Scale (p<0, 005).
Hemorrhagic strokes consist of a highest rate 86, 7% (26/30 patients), transient ischemic attack rate is 10% (3/30 patients), neurological deficits rate is 3, 3% (1/30 patients) Conclusions: Moyamoya disease is a chronic cerebrovascular occlusive disease with a long history carrying risk of either ischemic or haemorrhage events. Revascularization surgery in patients with Moyamoya disease and cerebrovascular occlusive disease carries a low risk, is effective at preventing future ischemic events, as well as furture strokes and improves quality of life.
EVALUATION EFFECTIVE TREATMENT SCLERODERMA SYSTEM WITH METHOTREXATE AT NATIONAL HOSPITAL OF DERMATOLOGY AND VENEREOLOGY Systemic sclerosis (SSc) is difficult to treated in autoimmune connective tissue diseases.
The study aimed to evaluation efficacy of methotrexate (MTX) in combination with oral prednisolon for treatment of systemic scleroderma.
69 SSc patients were divived into 2 groups: Combination of MTX and oral prednisolon were used in MTX-treated group, and alone oral prednisolon for control group.
The level of mouth open and arthralgia were significantly improved in MTX-treated group compared with control group. However, there were no different improvement in mRSS, extension fingers, the grip fingers in two groups.
Finger swelling, symptoms of Raynaud's, digital scars, difficulty breathing, diarrhea disorders were improved when compared to base line in both groups.
Otherwhile, there was not signifficantly difference between the 2 groups (p>0.05).
In conclusion, MTX have effects in treatment of SSc.
Keywords: Systemic sclerosis (Scleroderma), Methotrexate
KNOWLEDGE, ATTITUDES OF HEALTH CARE STAFF ABOUT NUTRITIONAL CARE IN TAN KY DISTRICT GENERAL HOSPITALS, NGHE AN IN 2014 Objective: Assess knowledge, attitudes of health care staff about nutritional care in Tan Ky district general hospitals, Nghe An province in 2014.
Method: cross-sectional surveys were conducted among all medical employees at Tan Ky Hospital.
Results: The rate of medical staff had adequate knowledge of malnutrition was 79.5%.
The proportion state that establishing nutritional department was essential was 95.2%.
Conclusions: The majority of health workers understood the concept, the major causes, consequences and the need of establishing the Nutritional Department at the district hospital.
DISEASE PATTERN OF PATIENTS IN KIEN HAI DISTRICT HOSPITAL, KIEN GIANG PROVINCE IN 2011 Nowadays, Viet Nam is in the stage of diseases transition with infectious diseases are still high, however, non-communicable diseases and injury are growing quickly.
A cross-sectional study was conducted. The study to describe the disease pattern of in-patients in Kien Hai district hospital in 2011.
The results indicated that patients in Kien Hai hospital was mainly in the group aged 16 - 49 (59.5%), mostly female patients (71.9%).
56.1% of in-patients entered hospital during the rainy season.
62.9% of patients suffered from non-infectious diseases, infectious diseases accounted at 29%; group of accident, injury and poisoning accounted at 8.1%.
The most common diseases were acute diarrhea (11%), followed by hypertension (10.2%), bronchitis (8%), and pharyngitis / tonsillitis (5.9%).
Keywords: disease pattern, non-communicable diseases (NCDs), district hospital
THE ASSESSMENT OF COMMUNICATION PROCESS OF HEALTH STAFF WITH PATIENTS AT REHABILITATION DEPARTMENT, HAI DUONG HOSPITAL Objectives: To assess the communication process of health staff with patients at Rehabilitation Department, Hai Duong Hospital.
There are not any behaviors or suggestions related to bribery.
75% and 20% of patients are very satisfied and satisfied to the communicative attitude of health staff.
Keywords: communication, health staff, rehabilitation department
Subjects and Method: A cross-sectional descriptive study on 60 patients who receive treatment over 5 days the Rehabilitation Department, Hai Duong hospital.
Results and Conclusion: 75% of patients are very satisfied and 20% are satisfied with the practice of communication procedure of health staff.
Attentive reception reaches 70% of very-satisfied and 28.3% of satisfied.
Attentive explanation about the administrative procedures, rules, hospital fees, medical insurrance is 88.3%.
Clear explanation about disease status and treatment method accounts for 83.3%.
About 91.6% of health staff provide explanation for patients before, in and after treatment procedure.
83.3% health staff often visit patients.
EVALUATE KNOWLEDGE AND PRACTICE OF HEALTH WORKERS IN THE COLLECTION, CLASSIFICATION, TRANSPORTATION AND DESTRUCTION OF MEDICAL WASTE IN HOSPITAL OF TRADITIONAL MEDICINE Objective: evaluate the status of knowledge and practice of health worker in the collection, sorting, transport and disposal of medical waste in Hospitals of traditional medicine.
Subject: health workers includes: nurses, nurse, nurses, doctors and pharmacists in all clinical and subclinical in 10 traditional medicine hospitals represent the province in the areas country.
Research methodology: The study was conducted by the method described cross-sectional analysis, interview health workers by content table to assess knowledge, practice in the management and handling of hazardous medical wastes of hospital.
Conclusion: the content is the most misunderstood distinguish 5 groups of medical waste and the collection, sorting errors still occur Keywords: Medical waste at Hospitals of traditional medicine
KNOWLEDGE AND PRACTICE TO PREVENT HAND FOOT AND MOUTH DISEASE AMONG MOTHERS WITH CHILDREN UNDER 5 YEARS OLD AT THANHSON COMMUNE This was a cross-sectional descriptive study conducted at Thanhson commune, Kimbang district in Hanam province about knowledge and practice of mothers on hand-foot and mouth disease prevention. Results showed that more than half of mothers (57.6%) knew the symptom of ulcers in mouth; 78.1% knew the symptom of blisters in palm and feet.
Only 68.8% of them knew the sensible age group for the disease as from 10 years and lower.
About more than half of mothers (57.3%) knew that the infected rout was digestive tract.
About 61.1% of mothers knew that it is necessary to clean hand before eating and 76.8% of them indicated that it is necessary to clean hand after toileting to prevent this disease.
However, only 56.6% of them did washing hand with soap before feeding children and 68.4% of them washed hand after helping children toileting.
Keywords: hand-foot and mouth disease, disease prevention, mother, children, Hanam
STATEMENT OF ADVERSE PREGNANCY OUTCOMES IN BIEN HOA, THANH KHE - DA NANG AND PHU CAT - BINH DINH Conducted cross-sectional survey in 1500 women aged 15 - 49 years old in 4 wards (Thac Gian, Chinh Gian, An Khe and Hoa Khe) in Thanh Khe - Da Nang, 1551 women in 5 wards (Tan Tien, Tan Phong, Tan Mai, Trung Dung, Thong Nhat) in Bien Hoa and 6600 women in Phu Cat - Binh Dinh, we found that: The rate of spontaneous abortionin in Thanh Khe - Da Nang is: 3.79%, in Bien Hoa is 6.58%, in Phu Cat - Binh Dinh is 4.45%.
The proportion of maternal with miscarriage in Thanh Khe - Da Nang is: 3.92%, in Bien Hoa is 8.09%, in Phu Cat - Binh Dinh is 9.58%.
The rate of stillbirth in Thanh Khe - Da Nang is: 1.59%, in Bien Hoa is 2.38%, in Phu Cat - Binh Dinh is 0.49%.
The proportion of maternal with stillbirth in Thanh Khe - Da Nang is: 1.64%, in Bien Hoa is 3.08%, in Phu Cat - Binh Dinh is 1.29%.
In Thanh Khe - Da Nang, the rate of birth defect is 1.76%, In Bien Hoa is 2.27%, Phu Cat - Binh Dinh is 1.83%.
In Phu Cat - Binh Dinh and in Bien Hoa, there is correlation between abnormal pregnancy and exposure to agent orange chemical (OR: 1.75 and 3.19).
Keywords: spontaneous abortion, stillbirth, birth defects, agent orange chemical, reproductive abnormalities.
CLINICAL EFFECTS OF EMBRYOS CULTURE IN LOW OXYGEN CONCENTRATION In this prospective randomized clinical study, 172 patients were divided into 2 groups: embryos cultured in 5% and 20% oxygen concentration. Objectives: compare pregnancy rate, live birth rate between 2 groups.
Live birth rate in 5% oxygen group was of 46, 51% higher than 40, 69% in 20% oxygen group 32, 55% but no significantly Conclussion: Clinical pregnancy rate on day 5 in 5% oxygen group was higher than that in 20% oxygen group.
Live birth rate in 5% oxygen group was higher than in 20% oxygen group but no significantly.
Keywords: pregnancy rate, live birth rate, low oxygen concentration in IVF
Method: using FSH to stimulate ovaries.
Fertilization by conventional IVF or ICSI.
On day 3, 3 - 5 embryos were selected to culture to day 5 in both group.
Results: No differences of characteristic, of ovarian reserve, ovarian stimulation and embryos transfer in both groups.
Clinical pregnancy rate in 5% oxygen group was of 56, 97%, significantly higher than 40, 69% in 20% oxygen group.
Purpose: To study the relationship between WBC and platelet count, hemoglobin concentration in CML.
Results: (1) Elevated WBC: (205, 1 ± 148, 4 x 109 / l); most patients were anemic (Hb: 101, 7 ± 23, 3 g / l); elevated platelet count (595, 3 ± 496, 1 x 109/l).
(2) Splenomegaly was more severe in patients with higher WBC.
SITUATION OF EXAMINATIONAND DRUG USE IN NGHIA TAN POLYCLINIC CAU GIAY DISTRICT, HANOI IN 2014 Polyclinics andcommunal health centers have an important role in primary health care program.
The number of drugs in the highest prescription was seven drugs, averaging 3.8 drugs / prescription.
Vitamins and minerals drugs accounted for 19.8%; accounting for 16.4% of antibiotics.
Traditional medicines were also used at high rate of 9.1%.
Keywords: examination, drug use, polyclinic
In Vietnam, a list of essential drugs was approved by the Ministry of Health as a basis for ensuring the basic treatment needs for primary health care program.
A cross-sectional study was conducted. The study to describe thesituation of examination and drug use in Nghia Tan polyclinic, Cau Giay District, Hanoi in 2014.
The results indicated that patients with one disease / illness was the highest proportion (59.2%).
Average rate was about 1.5 diseases / patient.
There were 53.2% of patients that assigned examination testing.
The most common diseases wereupper respiratory tract infection (17.0%), hypertension (11.2%), diabetes (8.5%) and dyslipidemia (8.9%).
The percentage of patients were prescribed treatment as outpatientwas highest (65.9%).
Results: Overall survival and disease-free survival after 5 years was 75.2%, 68%, respectively.
A number of factors affect survival after treatment.
Adjuvant chemotherapy had a role to improve survival of this patient group.
Conclusion: Survival after treatment depends on both prognostic factors and complementary therapies Keywords: Breast cancer, negative receptor, breast cancer survival 1 66
EVALUATION OF PAS SCORE IN THE DIAGNOSIS OF PEDIATRIC APPENDICITIS Aim: - To evaluate PAS score in the diagnosis of pediatric appendicitis at the National hospital of Pediatrics.
- To describe the factors affecting the accuracy of PAS in the diagnosis of appendicitis.
Patients 4 years old and above and did not use antibiotics and pain reliver prior to consultation gave a more accurate diagnosis by PAS score.
Conlcusion: PAS score is simple and easy to perform.
It is also effective in early diagnosis of pediatric appendicitis.
Keywords: appendicitis, pediatrics, PAS score (pediatric appendicitis score), specificity, sensitivity, affecting factors.
A SERVEY OF POSTOPERATIVE PAIN AND HEMORRHAGE AFTER COBLATION TONSILLECTOMY Purpose: evaluate the level of postoperative pain and ratio of hemorrhage after tonsillectomy with Coblator.
Conclusion: Coblation tonsillectomy have good postoperative analgesia compared with other methods, ratio of hemorrhage: 8%.
Keywords: Tonsillectomy, coblation tonsillectomy, Coblator.
Subjects and Methods: 50 patients were done tonsillectomy using Coblator in ENT National Hospital from 05/2014 to 04/2015.
Results: the level of postoperative pain over time: the most pain on 2 postoperative days: average pain score of 2.7 points on the second day.
Pain increases from the first day to the second day and decreasing to the fourteenth day, without severe pain.
The level of postoperative pain over age: Children often have severe pain at the beginning but decreasing faster than adults.
Times of using painkillers are usually 2 times / a day.
The average number of days using painkiller for both group 2.6, the number of days painkillers adult higher than child (3 days / 2.1 days).
Maximum using painkillers is 8 days, mimimum using painkiller is 1 day.
Postoperative bleeding: 4/50 delayed hemorrhage (8%), have no early hemorrhage, time of recovery: 7.8 days.
WATER PUMP PRESSURE CONTROL IN CONTEXTOF INTRAHEPATIC STONE DISEASE TREATED BY ENDOSCOPIC LITHOTRIPY Objectives: Evaluate the application results of the water pump pressure control in contextof intrahepatic stone disease treated by endoscopic lithotripsy.
Materials and methods: The intrahepatic stones patients, operated in Viet Duc hospital during 1/2011 - 12/2011 treated by endoscopiclithotripsy with the water pump pressure control.
The method is describing prospective.
Results: The satisfactory results for101 cases intrahepatic stones were operated withthe water pump pressure control by endoscopic lithotripsy procedure; no death rate, low complication rate (5, 94%), the rate of missing stone was improved (29, 9%), reduce the operation time (average 128 minutes), economize the electrohydraulic probe (average 0, 56 electrohydraulic probe for 1 patient). Conclusion: Application water pump pressure control in endoscopic lithotripsy electrohydraulic is the safe method, high stone evacuation effect, economize time and electrohydraulic probe.
Methods: In 28 patients having CABG with the GEA graft (mean 57 years, 22 men).
10 (35%) patients had acute myocardium infarction and 3 (10.7%) patients needed IABP support preoperatively.
22 (78.6%) patients had multivessel disease, 6 (24.1%) with left main coronary artery disease.
Mean EF 0.57±0.11, mean LVIDd 51.49 ± 6.04 mm.
The sites for GEA grafting were 16 (57.1%) posterior descending artery of RCA and 11 (42.9%) sequential to circumflex artery. The mean number of distal anastomoses was 3.5 ± 0.63, mean operating time 364 ±82 hours, mean volume blood loss 367 ± 262 ml.
All patients underwent CABG without using cardio-pulmonary bypass support.
Results: There were 22 cases operated. Among them, tumors located at cervico-thoracic region in 14 cases, intrathoracic but above the carina in 3, at carina and one bronchus in 4, and carina plus both bronchi in 1 case.
Mortality is 3 (13.6%), due to over missing of the tracheal tissue. One happened 5 days postoperatively, one after 3 weeks, and one after 4 months.
In one other case, the tumor recurred after 3 years due to the remnant tumor at the left main bronchus and died without surgical interference.
Others are still alive normally and assume to be successful in term of surgical interference.
Conclusion: Tracheal tumor resection and reconstruction surgery is feasible. Indication should reserves for tumors that invade less then one third of the trachea.
Complete resection of the tumor is the most importance for the successful of the surgery.
The diseases may cause airway obstruction requiring tumor resection and tracheal reconstruction.
Keywords: Tracheal tumor, tracheal reconstruction
At present, there is no any substitute material for tracheal tube, so careful considering indication and surgical technique could help improving theoutcome.
This study examines the feasibility of the surgical interference for this disease.
Methods: Retrospectively review tracheal tumor cases operated with resection and reconstruction at the Thoracic Department, Choray hospital during 6 years (2010 - 2015).
Patients received adjuvant chemo-radiation postoperatively and were followed-up with tracheal endoscopy and / or CT-scan for 1 month, 6 months, and annual postoperatively.
Size of tumors, locations, surgical accesses, reconstruction techniques, morbidity, and mortality are subjects to be examined.
EVALUATION OF MARKERS OF MYOCARDIAL PERFUSION DURING PRIMARY PERCUTANEOUS CORONARY INTERVENTION FOR ACUTE ST ELEVATION MYOCARDIAL INFARCTION Objective: Detection of abnormal myocardial perfusion is crucial to the prognosis of patients with acute ST elevation myocardial infarction (STEMI) after thay have undergone primary percutaneous coronary intervention (PCI).
Methods: Cross-sectional descriptive and 30-day follow-up prospective study of 215 consecutive STEMI patients treated with primary PCI.
Results: Post-interventional TIMI flow 2, 9±0, 4; TMP grade 2, 3±0, 9; ST segment resolution 2, 3±2, 8 mm.
Keywords: ST elevation myocardial infarction, percutaneous coronary intervention, myocardial perfusion
THE PROPORTION AND CHARASTERICTICS OF ANEMIA IN PATIENTS WITH MAINTENANCE HEMODIALYSIS TREATED BY RHU-EPO The purposes of this study were to survey the proportion of anemia and patients achieved treatment goal in comparison with guidelines for the management, some charasteristics related to anemia in patients with maintenance hemodialysis (HD).
Subjects and method: 175 patients with HD treated by rHu-EPO were to determine value of haematological tests and serum iron.
Results showed that: 93, 7% patients with anemia; moderate and severe degree of anemia is 86, 6%.
Patients not achieved treatments goal is 85, 7%.
Patients with anemia have reticulocyte index (RI) and reticulocyte production index (RPI) lower than patients havent's anemia.
Hemodialysis patients have decreasing serum ferritin and transferrin.
Conclusion: although was treated by rHu-EPO, hemodialysis patients with anemia and not achieved treatment goal have high percentage, reduced ability to reticulocyte production, decreased serum ferritin and transferrin.
Keywords: Maintenance hemodialysis, anemia, reticulocyte, serum iron.
24 HOUR AMBULATORY BLOOD PRESSURE CHARACTERISTICS IN HYPERTENSIVE PATIENTS WITH LEFT VENTRICULAR HYPERTROPHY Background: The relations between nocturnal hypertension and non-dipping with left ventricular hypertrophy (LVH) remain controversial.
Keywords: non-dipping, nocturnal hypertension, left ventricular hypertrophy
Objectives: To investigate24h ambulatory blood pressure (BP) characteristics and the relations between nocturnal hypertension and non-dipping with LVH in hypertensive patients.
Subjects and method: 87 hypertensive patients (54 with LVH and 33 without LVH) were enrolled.
24h BP characteristics were compared between patients with and without LVH.
Nocturnal hypertension was associated with LVH (OR = 5; 95% CI 1.96 - 12.73; p<0.01), meanwhile non-dipping was not associated with LVH (OR = 0.63; 95% CI 0.24 - 1.63; p>0.05).
Conclusions: All systolic BP parameters and only nocturnal diastolic BP were higher in patients with LVH than those without LVH.
Nocturnal hypertension but not non-dipping was associated with LVH in hypertensive patients.
SOME FACTORS AFECTING TREATMENT OUTCOME IN AMBLYOPIC CHILDREN OVER 7 YEARS OLD The study aimed to explore a number of factors affecting treatment outcomes in amblyopic children over 7 years old.
Prospective clinical interventional study in amblyopic patients 8 to 18 years, treated at the Vietnam National Institute of Ophthalmology (VNIO) in the period from January to July 2014.
Good treatment results achieved in 93.5% for mild amblyopic group, 19.6% for moderate amblyopic group and no cases in dense amblyopia group achieved this result.
Percentage of poor treatment results in combined causes groups was 37.5%, higher than the group due to refractive error alone (11.2%).
Percentage of good results in patients with anisometropia of less than 1.50D was 80% and for patients with anisometropia more than 1.50D was 15%.
The severity of amblyopia, the cause of amblyopia, as well as anisometropic level, treatment age significantly affects the outcome of treatment.
Unilateral or bilateral as well as type of refractive errors are not related to treatment outcome.
Keywords: Amblyopia, oclusion
RESEARCH ON IMAGES OF HISTOPATHOLOGY OF CUTANEOUS LESIONS IN DRUG ALLERGY Objective: It contributes to study images of histopathology of cutaneous lesions in a number of common clinical manifestations of drug allergy.
Research subjects and methods: By the described research method on images of histopathology of cutaneous lesions on 37 patients with skin allergy, in which, 18 patients with skin lesions without bullous skin lesions and 19 patients with bullous skin lesions.
Results: In the patient group without bullous skin lesions, spongiosis and liquid degeneration of the basal layer of epidermal lesions and availability of the penetration of inflammatory cells in the dermis account for 72.22%, 22.22% and 100%, respectively.
Conclusion: histopathology of cutaneous lesions in drug allergy in the patient group without bullous skin lesions, spongiosis, liquid degeneration of the basal layer and the penetration of inflammatory cells are common manifestations.
In the patient group with bullous skin lesions, necrosis in the epidermis, bullous skin lesions between the epidermis, spongiosis and the dermis and availability of penetration of inflammatory cells are common manifestations.
Keywords: Skin, histopathological lesions, drug allergy
From February 2004 to April 2005, 95 cases of bone tumors had fine needle aspiration cytology.
Results The patients range from 12 - 84 years of age.
Female sexual predilection (F / M = 1, 07/1).
The matching of cytological diagnosis was 87.9% compared with histopathology diagnosis: Osteosarcoma 92.3%, Giant cell tumor 88.9%, Bone metastasis of cancer 91.3%, Multiple myeloma 80.0%.
Sensitivity 94.3%, specificity 94.1%, positive predictive value 93.6%.
Background: International Standard Organization (ISO) has been widely used in many countries in the world, however, how well in services healthcare in current Cho Ray hospital was help increase productivity and satisfaction for medical staff.
Keywords: satisfaction, medical staff, ISO 9001: 2015
Objectives: To determine the customers' satisfaction and some factors affecting the satisfaction of health workers (HCWs) at Cho Ray Hospital with ISO 9001: 2015 after three years application.
Results: Survey of 287 health workers shows the satisfaction; In which, according to the 4 factors that show satisfaction rate is direct leadership, colleagues 271/287 (94.4%), followed by work, learning opportunities and advancement 268/287 (93.4%), internal regulations, salary and benefits 262/287 (91.3%) and the lowest satisfaction rate is the working environment 259/287 (90.2%); Rate the overall satisfaction rate of health workers is quite high at 207/287 (72.1%).
In which, age group under 35 years old having worked in the medical profession for less than 5 years, working in the hospital less than 5 years, having a professional background of university or less, they are less satisfied than the other groups (p <0.05).
Conclusion: The ISO 9001: 2015 application was suitable for current Cho Ray and meet the customer's demand.
Validity of capillary hematocrit in the sick newborns admitted in neonatal intensive care unit, children’s hospital 1, vietnam
Phương pháp nghiên cứu: Nghiên cứu hàng loạt ca được thực hiện từ tháng 4/2014 - 6/2014, chúng tôi thực hiện đo cùng lúc Hct ở tĩnh mạch và mao mạch trên 50 trẻ sơ sinh nhập khoa hồi sức sơ sinh bệnh viện Nhi Đồng 1, 4 trẻ bị loại ra khỏi lô nghiên cứu do không lấy được Hct tĩnh mạch.
Hct mao mạch và Hct tĩnh mạch có tính tương đồng cao trên trẻ sơ sinh bệnh lý; phương trình hồi quy đơn biến để dự đoán Hct mao mạch từ Hct tĩnh mạch: Hct mao mạch = 1, 779 + 1, 003 x Hct tĩnh mạch (r = 0, 965, p <0, 001); Hct mao mạch có tính tin cậy khi thay thế cho Hct tĩnh mạch (hệ số tin cậy R = 0, 93).
Study on hepatoprotective effect of turmeric (curcuma longa) extracts to prevent hepatocyte alcohol-induced lesion in hepg2 cell line
Objective: The aim of this work was to study on hepatoprotective effect of turmeric (Curcuma longa) to prevent alcohol-induced hepatocyte lesion in HepG2 cell line.
Conclusion: Turmeric rhizome was shown to prevent HepG2 cells injury induced by 100 mM ethanol in decreasing order: curcumin, ethyl acetate and 70% alcohol extracts.
This result suggested that curcumin could contribute to hepatoprotective effect of turmeric and that turmeric could be studied to develop drugs for prevention and / or treatment of alcoholic liver diseases.
Keywords: alcohol, hepatoprotective effect, HepG2 cell line, turmeric
Methods: HepG2 cells were cultured in EMEM supplemented with 10% FCS, 2 mM L-glutamine, 100 IU / ml penicillin and 100 µg / ml streptomycin.
Cells were treated to curcumin, ethyl acetate or 70% ethanolic extracts from turmeric rhizomes at concentrations corresponding to that of curcumin at 2.5, 5 and 10 µg / ml (NĐ1, NĐ2, NĐ3) alone or combined with 100 mM ethanol for 24h.
Hepatoprotective effect was evaluated through several assays including cell proliferation (MTT test), necrosis (LDH test), oxydant stress (cellular glutathione content) and apoptosis activation (AO / EB staining, DNA fragments assay, DNA agarose gel electrophoresis).
Results: Ethanol 100 mM reduced 45.1% of HepG2 cells viability.
Its antiproliferative effect was recovered in presence of CM at 3 tested concentrations, EN at NĐ1, NĐ2 and CN at NĐ1 with efficiency of 30 - 60%.
Alcohol decreased 26.4% GSH content in HepG2 cells; 3 tested concentrations of CM, EN, CN enhanced GSH levels with efficiency of 120 - 1900%.
Necrotic effect of 100 mM ethanol was decreased 40 - 170% in presence of CM, EN, CN at 3 tested concentrations.
Establishment of a method for carotenoids quantification in some commercial products using hplc method
Conclusion: We have succesfully established an HPLC protocol for qualification of carotenoid in commercial products.
The protocol has been validated and applied to determining the carotenoid contents of several different bacterial biomasses and some domestic and imported products.
Keywords: HPLC, carotenoid. Betacarotene, functional food
Materials and methods: In this work, we studied methods for extraction of carotenoid from bacteria and developed the carotenoid quantitative method for products containing carotenoid based on HPLC with Knauer Smarline 2500 system.
Results and disscussions: The result show that, cells breaking process by using ultrasonic bath and extract carotenoid with chloroform / methanol (2: 1) are the most effective with performance about 94, 82%.
The content of carotenoids from bacteria and other products were determined by HPLC method, that is rapid and high sensitivity with RP C18, at room temperature. The mobile phase is acetonitrile - methanol - dichloromethal (70: 20: 10, v / v / v) supplemented with ammonium acetate 10 mM, with flow 1ml / minute, inject volume 20 µl, UV detector at 450 nm.
The HPLC method is highly suitable with RSD of chromatography parameters were less than 2%.
The method was validated for the acceptable accuracy and precision with the recovery rate is 99.83%.
Prognostic mortality of the saps ii score in critically ill medical patients
Background: There is a need for a tool to accurately and rapidly predict critically ill patients, to prioritize and allocate resources to reduce mortality.
Keywords: prognostic model, mortality
Objective: To evaluate accuracy of the SAPS II in prognostic hospital mortality of critically ill medical patients.
Methods: Retrospective cohort on medical patients treated at ICU department in the Cho Ray Hospital from April 3, 2019 to December 31, 2019.
Results: 159 patients participated in the study.
Median age of the study sample was 57.0 years, the mortality rate was 46.5%.
The average SAPS II score was 58.3 ± 19.3 points.
The area under the curve of the SAPS II scale is 0.78 with a 95% confidence interval between 0.71 and 0.85, with a p-value <0.005.
The predicted and observed mortality are not significant differences by the Hosmer-Lemeshow test with χ2 = 13.7, df = 8, p-value = 0.09>0.05.
Conclusion: A New Simplified Acute Physiology Score (SAPS II) has good discrimination and calibration in predicting hospital mortality of critically ill medical patients in ICU.
Background - Objectives: Glimepiride sulfonamide (impurity B) and glimepiride urethane (impurity C) are impurities of glimepiride which arise from synthesis and during storage of glimepiride.
All the calculations concerning the quantitative analysis showed that several material glimepirides and its preparations in Vietnam market contained an amount of glimepiride impurities B and C that was within accepted limits according to USP 40.
Conclusion: Glimepiride impurities B and C were established reference standards with their HPLC purity over 99% on the basis.
Quality control of these impurities in material glimepiride and its preparations was carried out, using the established impurity B and C reference standards.
Keywords: Glimepiride sulfonamide, glimepiride urethane, glimepiride carbamate, glimepiride impurity B, glimepiride impurity C.
The presence of these impurities may influence on treatment efficacy and safety of glimepiride.
The BP 2017 and USP 40 require conducting the impurity test in material glimepiride and its preparations.
Glimepiride impurity B and C were successfully synthesized with their HPLC purity over 99% on the basis, using peak area normalization method.
There has been no publication for establishment of reference standard of impurities B and C so far.
Therefore, this study was carried out with the aim of establishment of reference standard and quality control of impurities B and C in material glimepiride and its preparations Method: The object of this study is 3-ethyl-4-methyl-2-oxo-N - [2 - (4-sulfamoylphenyl) ethyl] - 2, 3-dihydro-1H-pyrrol-1-carboxamid (glimepiride impurity B, glimepiride sulfonamide) and methyl [[4 - [2 - [[(3-ethyl-4-methyl-2-oxo-2, 3-dihydro-1H-pyrrol-l-yl) carbonyl] amino] ethyl] phenyl] sulfonyl] carbamat (glimepiride impurity C, glimepiride urethane, glimepiride carbamate).
Method: Establishment of reference standard of glimepiride impurities B and C, basing on ISO guide 34: 2009 and ISO 15328: 2005 guide; Quality control of these impurities in material glimepiride and its preparations, using the established impurity B and C reference standards.
Results: The results of evaluation and establishment of impurity B and C reference standards showed that these substances can be applied for registration of national reference standards. The HPLC purity of impurities B and C were 99.43% and 99.87% on the basis, respectively.
Knowledge, practice in hypertensive patients aged 40 or older in long thuan commune, ben cau district, tay ninh province.
Background: High blood pressure (THA) is a increasing disease.
Conclusion: Building an intervention program on health education communication to improve knowledge and practical lifestyle changes of patients about treating hypertension.
hypertensive may leads to many serious consequences.
Objectives: Determine the percentage of patients with hypertension 40 years old and over with the right knowledge, right practice in the treatment of hypertension in Long Thuan commune, Ben Cau district, Tay Ninh province in 2011.
Methods: This is a cross-sectional survey research about true knowledge and proper practice in treatment of hypertension on 360 people aged 40 or older interviewing people with hypertension directly according to the questionnaire were prepared.
76.1% of patients have a habit of eating hight salt diet.
60.3% patients have work which is less physical activity Correlation is statistically significant between age, education with knowledge about complications of the disease, hypertensive disease prevention knowledge.
Shape and dimensions of adult vietnamese' s tympanic membrane and auditory ossicles
In measuring 78 moulds of tympanic memebrane, 72 malleus, 73 incus and 69 stapes from 1995 to 2000 in Hochiminh City, we obtain the following measurements: - Tympanic membrane: Vertical diameter 8, 65 ± 0, 85 mm; Horizontal diameter 7, 72 ± 0, 52 mm; angle between tympanic membrane and antero-inferior wall of the external auditory canal 48, 08 ± 9, 380; angle between tympanic membrane and superior-posterior wall of the external auditory canal 157, 41 ± 7, 490; angle of the tympanic membrane umbo 142, 08 ± 9, 580; Depression of Tympanic membrane umbo 1, 79 ± 0, 40 mm.
- Length of malleus 7, 76 ± 0, 35 mm; length of maleus caput 4, 10 ± 0, 26 mm; length of malleus manubrium 4, 62 ± 0, 35 mm; Antero-posterior diameter of malleus manubrium 0, 65 ± 0, 06 mm; latero-medial diameter of malleus manubrium 1, 07 ± 0, 13 mm; angle between head - neck and handle of the malleus 120, 40 ± 12, 070, malleus mass 23, 62 ± 2, 73 mg. - Length of incus 6, 21 ± 0, 41 mm; Width of incus 4, 94 ± 0, 35 mm; angle between short limb and long limb of the incus 101, 8 ± 8, 880, incus mass 26, 68 ± 3, 02mg.
- Heigth of stapes 3, 33 ± 0, 21 mm; Longitunal dimension of foot plate 2, 95 ± 0, 19 mm; Transverse dimension of foot plate 1, 46 ± 0, 11 mm; stapes mass 3, 42 ± 0, 8 mg.
Salivary cortisol concentration, anxiety and pain in deviated lower third molar surgery
Background: In oral surgery, lower third molar surgery supposedly makes patient most anxious.
Result: Salivary cortisol concentration and anxiety levels of patients were correlated (p<0.05).
The correlation between these two variables was positive (Pearson +).
Patients with high dental anxiety had greater postoperative pain at 2 hours, 4 hours after the lip numb.
Salivary cortisol concentration and postoperative pain levels were not correlated.
Conclusion: Salivary cortisol concentration before deviated lower third molar surgery can suggest dental anxiety. However, it doesnt predict the level of postoperative pain.
Keywords: salivary cortisol, dental anxiety, pain after surgery, lower third molar surgery
To evaluate anxious level, using scale is subjective.
Finding an objective indicator to measure this problem is still controversial, in which salivary Cortisol is one of the suggested factors.
In addition, there was no consistency among studies on the relationship between anxiety measurement scales and the level of pain after deviated lower third molar surgery.
So, does there exist an objective predictive indicator that reflects the level of postoperative pain?
Does the change in salivary cortisol concentration affect the postoperative pain level?
Objective: The aim of this study was to investigate salivary cortisol concentration before deviated lower third molar surgery whether is an objective factor to evaluate anxious level and postoperative pain.
Methods: A descriptive cross - sectional study was performed of 95 patients who underwent lower third molar extractions from June 2018 to May 2019 at Oral Surgery Unit, Faculty of Odonto - Stomatology, The University of Medicine and Pharmacy at Ho Chi Minh city.
Dental anxiety was evaluated using the DASS-21, postoperative pain was assessed on VAS scale and we determined salivary cortisol concentration before surgery by ELISA with Elecsys Cortisol II Cobas.
Result of treatment of endometrisis by gnrh-agonists
Endometriosis a common disorder in women.
The treatment of endometriosis composes of laparoscopy and hormonal treatment.
30 patients who have endometriosis of moderate stage, after treated by laparoscopy, were divided into 2 groups: treated with Triptorelin or Goserelin in 3 months, then followed up in 12 months.
There were 4 in 16 infertiled women had pregnancy.
Background.
Among the 18 successful laparoscopic colectomies, there are 5 right colectomies (28%), 6 sigmoid colectomies (33%), 5 proctosigmoid resections (28%) and 2 abdominoperineal proctosigmoid resections (Miles procedure) (11%).
All the anastomoses were made extra-corporeally by suturing through a small incision in patients who got right colectomy or sigmoid colectomy.
Among 5 proctosigmoid resections, 2 patients had extra-corporeal suturing anastomosis, the other 3 had intra-corporeal anastomosis with Endo Stapler.
Mean operating time is 155 minutes.
There was no mortality and no anastomosis leakage.
Laparoscopic colectomy is technically feasible to experienced laparoscopic surgeons.
The operation is favorable in benign lesions or small tumors.
Laparoscopic colorectal sugery has become popular for benign and malignant lesions of the colon and rectum.
The preliminary results are good with unsignificant accidents and complications.
However, this procedure hasn't been domestically disseminated.
The aim of this study is to evaluate the safety, efficacy and determine proper indications for laparoscopic colorectal resection.
From October 2002 to January 2003, we performed 19 laparoscopic colectomies.
18 patients had colorectal cancer and 1 patient had a large tubular-villous adenoma polyp of the sigmoid colon.
Purposes: Accessment of retinoblastoma situation in the south of viet nam and early diagnosis strategy.
Methods: The longitudinal prospective study with the description of the cases without comparison. We studied over 61 patients from nov, 2003 to nov, 2005.
Results: Study of 61 case of retinoblastoma at Eye hospital of HCMC during 2003 - 2005 showed that: retinoblastoma was in 22 provinces of south of VietNam, in 5 popular races, with prevalence of 2patients/1million/2years.
There are about 40% hereditary retinoblastoma.
All patients were treated lately due to their parent.
Conclusion: Screen risk objects (patient, s brothers and sisters with family history, bilateral retinoblastoma, multitumor retinoblastoma, under 7 years old and their offsing) and communicate about retinoblastoma to people.
Study of the insulin resistance in human with impaired fasting glucose by homeostasis model assessment (homa ir)
Background: Impaired fasting glucose is the major factor of type 2 diabetes mellitus.
Objective: To evaluate insulin resistance in human with impaired fasting glucose.
Methods: A prospective descriptive cross section with comparisons.
Results: In this study, the mean age of 80 patients with impaired fasting glucose is 64.2 ± 11.1, the mean age of 80 healthy controls is 61.9 ± 11.9 and the gender distributions of two previous groups are equal.
The results of the study showed that: HOMA IR is higher in the impaired fasting glucose group than the control group.
The ratio of insulin resistance in the impaired fasting glucose group 45.0%.
Conclusion: The ratio of insulin resistance in human with impaired fasting glucose is high.
Evaluate of the clinical and urodynamic results of tension-free transobturator tape surgery for treatment of female stress urinary incontinences
Objective: To evaluate the results of tension-free transobturator tape surgery in treatment of femal stress urinary incontinence Methods: Between January 2011 and May 2012, 29 women underwent TOT procedures at Viet Duc University Hospital.
All the patients had stress urinary incontinence on both clinical examination and on cystometry preoperatively.
Results: Mean follow-up was 9 ± 1.7 months.
Conclusions: Our results suggest that the TOT procedure is an effective treatment for women with stress urinary incontinence.
Treatment for opened fracture of the tibial shaft by external fixation in baria hospital
Opened fracture accounts for one third of total fracture, and opened tibiashaft fractures are easily to see most.
From March 1998 to March 2005, 65 patients involving Gustilo grade II and III open fractures of the tibia shaft were treated by the external fixators at Ba Ria hospital.
The average time to follow a case up to 12 months with the followed results: - Bone healing: 82, 26%; - Malunion: 8, 06%; - Nonunion: 8, 06%; The time dor the bones to be healed often occupy 22, 5 weeks.
In which there are some implacations: - Secondary displacement: 17, 74%; - Infectious pin: 20, 96% This method frequently applied in Ba Ria hospital give good result and can be open to other hospitals.
The effectiveness of the addition of amphiregulin to the maturation medium
Background: Amphiregulin is a crucial mediated substance that affects directly on the maturation process of the oocyte.
The addition of AREG to the medium may have a positive effect on the oocyte maturation and embryo quality of the in-vitro maturation (IVM) technique.
Objective: To compare the embryology outcomes of the immature oocytes cultured in maturation medium that have or have not AREG added.
methods: This was a prospective cohort study conducted on patients who were diagnosed with PCOS, aged <37 years, had a minimum of 25 follicles (2 to 9 mm) on ultrasound and treated with CAPA-IVM.
Evaluation the effectiveness in improving the life quality of cancer patients by hairy antler product
Objective 1/To improve the life quality of cancer patient using hairy antler.
2/To improve the paraclinical factors.
Patient and method of study: Study design: clinical trial with control group (30 patients for each group: study and control group).
Result: 1 / Hairy antler has effect of improving the life quality of cancer patients.
2 / The cancer pathology reduces the blood cells (Hairy antler has the capacity of stopping this process, no effect on the tumor.
3 / The cancer pathology causes anemia, the modern medicine (operation-chemo-radiotherapy) also influenced the process of blood forming, such that the number of blood cells are reduced more and more (Hairy antler has the capacity of improving clearly the anemic state.
4 / No side effects are found in patients using Hairy antler.
Conclusion 1 / Hairy antler has the capacity of supplementary treatment for the cancer patients.
2 / Hairy antler has the capacity of improving the anemic syndrom.
The courses of the overloaded patients in the outpatient department at the tu du hospital
According to ICD10 diagnosis rate of screening pregnant patients is 25.7%, such as: cervical inflammation is 12.8%.
From check-in reason whether hospital because the hospital trust Tu Du 63.4%, not trust medical facilities 57.4%.
After exams are provided as a prescription treatment of 91.5%, that these patients can be treated at medical facilities such as: 78.9% of Ho Chi Minh City and 71.9% of provinces. Conclusions: Patient visits have too load outpatient at Tu Du hospital, especially the morning, are the common diseases accounted for 70.0% more reason to visit as well as according to ICD10.
Health facilities can treat 3/4 situations.
Hospital patients to private hospitals for 63.4% Tu Du.
Department of Health proposes to transfer a rotating advanced doctor with medical facilites, additional equipment sites; provide medical re-examination in the afternoon, Be collect enough expenses to have enough money and restrictive load exceeds the limit online
For samples that tooing patients choose to visit during business hours.
We choose calculateed form: n = Z2 (1-/2) x P x (1-P) / e2, we have > 384 patients.
Data are handled via software SPSS for Windows, 10.05Results: Research from 02/2009 to 8/2009 over 414 patients for outcome: Screening outpatient always exceeds the assigned targets.
Every day, each doctor visits 50 patient; staff working extra hours 2 - 3.
Patient visits in the morning 70.0%.
Patients from 18 - 60 years is 97.3%. Patients who live in the province to visit is 50.7%.
Effectiveness of hand - operated and rotary protaper(r) instruments in root canal preparation.
Background: cleaning and shaping root canals is an important step and has an essential pline-height: 1.75art to determine the success of endodontic therapy.
Data was statistically analysed using the Independent-samples T test, the Paired-samples t test and the Chi-square test. Results: rotary ProTaper (r) maintained the original canal curvature better than hand - operated ProTaper (r) (P<0.05).
There were no significant differences in maintaining initial working length (P>0.05) and shaping root canal at the apical third (P>0.05).
Conclusion: under the conditions of this in vitro study, both instruments were equally effective in preparing root canals and safe to use.
Rotary ProTaper (r) respected original canal curvature better than hand-operated ProTaper (r).
Objectives: this study was designed to compare in vitro hand-operated and rotary ProTaper (r) instruments in regard to 4 parameters of root canal preparation: the alteration of canal curvature, the change of working length, the shape of postoperative root canal cross - section in the apical third and the working time.
Materials and method: a total of 30 extracted mandibular premolars were randomly divided into 2 groups of 15 teeth each. Based on radiographs taken prior to instrumentation with the initial instrument inserted into the canal, the 2 groups were balanced with respect to the angle of canal curvature and working length.
The assessment of changes of canal cuvature and working length was based on radiographs taken prior and post instrumentation.
Postoperative root canals were cross - sectioned at 3 mm from the foramen for shape evaluation.
The time required for canal preparation was recorded for each specimen.
Knowledge of patients on nutrition disease pancreatitis
Background: Pancreatitis is a common disease, can recur many times and become cronic pancreatitis or arcute pancreatits on the cronic background.
Good knowledge of diet for pancreatitis is positively associated with rehopitalization with recrrent pancreatitis.
Objective: Understanding the knowledge of patients on nutrition disease pancreatitis.
Learn how the patients learn about the diet for pancreatits.
Methods: The study was investigated on 77 hospitalized patients with a diagnosis of pancreatitis (exclude pancreatitis due to stones) by cross-sectional description method.
Results: 68.83% know how to limit fat, 70.12% know how to limit fried food, 80.51% know how to limit alcohol, 62, 23% know how to give up smoking, 75.32% know to eat boiled, steamed foods, 58.44% know how to use dairy food, 55.84% know how to divide food into small meals.
But, 59.74% think that cereals are necessary for disease pancreatitis, 44.15% dont know whetherpancreatits should eat fiber.
20.79% patients who were advised by the medical staff, 41.55% patients who learn through media by themseft, 37.66% learn through experience of their friend.
Conclusion: Good knowledge of diet for pancreatitis is positively associated with rehopitalization with recrrent pancreatitis.
Serum tnf-alpha levels of the patients with psoriasis at hospital of dermato-venerology in ho chi minh city
Background: TNF - is considered to be a proinflammatory cytokine which has the potential for broad-reaching effects in the psoriasis inflamatory cascade.
Serum TNF-alpha levels might have clinical usefulness, particularly in evaluating the monitoring the clinical disease severity and monitoring therapeutic effects.
This study aims to improve the understanding of pathogenesis of psoriasis, resulting in better monitoring and treatment. Objective: To analyze the serum TNF-alpha levels in psoriatic patients to evaluate the concentrations, correlation with some clinical features.
Method: Performing a analyzed cross-sectional study in 40 healthy persons and 60 psoriatic patients.
Results: The median serum TNF-alpha levels of the patients were 6.61 + 5.00 pg / mL, significantly higher than those of healthy people (p = 0.004).
The median serum TNF-alpha levels of the plaque-type psoriatic patients and patients with psoriatic arthritis were not significantly differerent from those of healthy people (p = 0.748 and p=0.167).
The median serum TNF-alpha levels of the patients with erythroderma were 13.77 + 4, 2 pg / mL, significantly higher than those of healthy people (p = 0.000) and of the plaque-type psoriatic patients (0.000) and patients with psoriatic arthritis (0.000).
There was a significantly differerent between the median TNF-alpha serum levels and severity of psoriatic arthritis (p=0.01).
There was a linear positive correlation between the median serum TNF-alpha levels and clinical disease severity of the plaque-type psoriatic patients (R = 0.305, p = 0035) Conclusion: Serum TNF-alpha levels provide many useful information about pathogenesis of psoriasis.
Studying the morphology of 24 hour blood pressure in patients having primary hypertension and metabolic syndrome with complications
Background: The morphology of 24 hour blood pressure relating to complication in patients with primary hypertension.
However, there is a few studies in the morphology of 24 hour blood pressure in patients having primary hypertension and metabolic syndrome with complication. Objectives: Studying the variance of in patients having primary hypertension and metabolic syndrome (MS) with complication. Methods: Cross-sectional descriptive, analysis, prospective study. Results: In this study, 54 patients having hypertension with MS and 44 patients having hypertension without MS (control group) had the same age and took the blood pressure and 24 hour blood pressure by ABPM.
Taking diagnosis primary hypertension by JNC VII criteria (Joint National Committee) VII, taking metabolic syndrome by IDF criteria (IDF: International Diabetes Federation) applying for Asia Pacific (IDFA).
The results showed that: Hypertension group with MS has the proportion of non-dipper (63.0%) higher than the control group (52.0%), however, no statistical significance (p > 0.05).
In patients having hypertension and MS with cardiac complication have the proportion of non-dipper (66.7%) higher than in patient without that (61.6%), no statistical significance (p > 0.05).
In patients having hypertension and MS with eye complication have the proportion of non-dipper (79.2%) higher than in patient without that (50.0%) with p < 0.05.
In patients having hypertension and MS with renal complication have the proportion of non-dipper (83.3%) higher than in patient without that (52.9%) with p < 0.05.
In patients having hypertension and MS with brain complication have the proportion of non-dipper (73.4%) higher than in patient without that (59.0%) without statistical significance (p > 0.05). Conclusions: There is an variation in the morphology of 24 hour blood pressure and increasing the proportion of non-dipper in patients having primary hypertension and MS with complication (heart, eye, kidney, brain) compare with patients having primary hypertension and MS without complication with statistical significance (p < 0.05).
Background: Up to present Endoscopic Retrograde Cholangio Pancreatography (ERCP) plays an important role in diagnosis and treatment in carcinomas of the head of pancreas.
+ Complication of stenting is 6% due to bleeding (1%), inflammation of billiary tract (4%), pancreatitis (!%).
+ Obstruction of stent (30%) in first three months.
It seems to be better than other imaging facilities in diagnosis of some kinds of malignant tumors.
While the surgeon has so many difficulties in this disease, with Stents, it is really a major advance in treatment of malignant billiary tract obstruction.
Materials and methods: A retrospective study up to 31st May 2004 was done for 782 patients with carcinomas of biliary-pancreas performed at: + Binh Dan Hospital from 1993: 297 cases.
+ Medic Center from 1997: 315 cases.
We have checked all of severe epistaxis so far Results: Traumatic carotico - cavernous fistulas 3 cases (7.5%); Related carotid arteries 3 cases (7.5%): Carotid artery ligation; Internal maxillary aneurysms 13 cases (32.5%): Embolization; Related ethmoid artery 2 cases (5%): Ethmoid artery ligation; The bleeding sites have not been found clearly on DSA 19 cases (47.5%): 5 cases in of them have no longer bleeding after DSA & pulled pack out & 14 cases have been done successfully by endoscopic cauterization.
Survey about head injury due to traffic accident in ho chi minh city after helmet wearing's resolution has done
Objective: Rate of head injury in time when the resolution 32/2007/NQ-CP had done,
The level of brain injury of patents when this resolution had done.
Results: The surveillance of 658 head trauma patients cause of traffic jam, had or not protected hat in Emergency department of Nhan Dan Gia Dinh hospital for 12 months (1 - 12/2008) showed that almost patients are young patients (mean ages is 30.9 ± 14, 4 year) improved in 18 - 25 group, male was twice higher than female.
There were 20.3% patients hadn't wore protected hat, in cases had wore protected hat there were 26.2% the protected hat out of the head after accidents.
Rate of head injury in time - when the study has done decreased.
Almost patients in this study were mild head injury (81.7%), 18.2% had brain injury, dead was 2%.
When comparative analysis between the two groups had or not wear protected hat, there were identify different between them at level brain injury in the CT (OR = 1, 97; p < 0, 01).
Efficacy of media in raising awareness of knowledge, attitude and using emergency service 115 amongst population in ho chi minh city (2012-2013)
Background: To reduce mortality and complications due to limited first aid and improper delays, it is essential to improve awareness and using the emergency service 115 in Ho Chi Minh City, one of solutions is to intervene by media. Objectives: Determine the proportion of people in Ho Chi Minh who have knowledge, attitudes and use of emergency 115 before and after by media intervention.
When encountering an emergency situation, 10.51% and 35.04% would call 115 before and after intervention, respectively (p <0.001), performance indicators: 71.32%.
Total phone calls before and after intervention were 14.63 and 15.96 / day, respectively.
Average number of ambulance trips before and after intervention were 12.89 and 13.49 / day.
Amongst groups with different age, group 18 - 30 year-old is most aware of emergency service, has called and will call 115 when they encounter an emergency case.
Those people who have university degree, living in urban districts, professional, students are more aware of emergency service and 115, yet emergency usage frequency is not different from other groups.
Conclusion: The study has showed that intervention by media amongst population in Ho Chi Minh City has been remarkably effective in improving the understanding of the emergency service and 115.
However, although people may increase understanding of emergency aid, the attitude and using 115 service do not increase significantly.
More solutions are needed to enhance attitudes and behavior using the emergency 115 amongst people in Ho Chi Minh City, not merely by means of media. Keywords: emergency service, 115, media.
Learn a number of factors related to the knowledge, attitude and use of emergency 115 people in Ho Chi Minh City before and after the intervention.
Methods: Subjects: People living in Ho Chi Minh City in 2012 - 2013.
Result and Discussion: The 3D-pharmacophore model was built based on the ETA-binding pocket with 4 features.
The docking modelling were performed on the ETA-binding pocket (pocket A) and D-glucose binding pocket (pocket B) of MCR-1.
Conclusion: The in silico models for the MCR-1 inhibitors were successfully built and 4 hits were found by virtual screening.
The developed 3D pharmacophore model could used to virtual screening of larger databases. In vitro experiments should also be conducted to demonstrate the activity of hit compounds.
Keywords: MCR-1, colistin, 3D-pharmacophore, docking, virtual screening.
MCR-1 is a phosphoethanolamine transferase.
MCR-1 enzyme plays role in transfer of phosphoethanolamine to lipid A and in change the electrical charge of lipid A and reduce the affinity to colistin and related polymyxins, which leads to colistin resistance.
Colistin is considered the antibiotic against most gram-negative bacteria.
Therefore, developing an MCR-1 inhibitor to restore the efficacy of these drug against MCR-1 is in progess.
Materials and Methods: Target protein structure of this study is the crystal structure of the MCR-1.
Pharmacophore approach and molecular docking were applied to build in silico models for virtual screening of MCR-1 inhibitor.
The virtual sreening database is DrugBank Database.
Endoscope pneumatic dilation for treatment of esophageal achalasia
No complication and no mortality in this study.
Conclusion: Pneumatic dilation as a treatment of achalasia very reasonable, safe and easy technique.
Keywords: Achalasia, balloon dilatation, endoscopy, rigiflex
Aim: To assess the recently results of baloon dilation as a treatmentof achalasia in the Binh Dan Hospital Endoscopy Department during the period from 01/01/2016 to 31/10/2017.
Results: Male and female rates were 15/18.
Average age was 41 (20 - 67 age).
In total 38 times performed procedure use Rigiflex balloon dilation (1.1 time/1 patient).
Therapeutic features in children with anaphylactic shock at pediatric hospital no 1
Objective: Anaphylactic shock is an immediate reaction, threatening to children's life.
84.3% patients were only used alone IM / SC / IV Adrenaline.
62.6% patients were supported with oxygen, consisting of 7/83 (8.4%) patients with intubulation.
Almost patients were used Hydrocortisone (98.8%) and Antihistamine H1 (100%).
Results of treatment: 99% patient out of shock and alive, 81.9% patient out of shock after using 1 to 2 doses of IM / SC / IV Adrenaline (73.3% patients after 1 dose and 8.6% after 2 doses).
The rate of severe anaphylactic shock were 10.5% and the rate of death were 1%.
Conclusion: In treatment of anaphylactic shock, Adrenaline is the most important drug.
If patients were treated immediately and appropriately with Adrenaline, we could reduce the rate of severe anaphylactic shock and death.
Keywords: anaphylactic shock, therapeutic features, Adrenaline / Epinephrine.
Our study described therapeutic features in children with anaphylactic shock, contributing to help paediatric patients out of anaphylactic shock fastly, decreasing rate of severe and fetal anaphylactic shock.
Method: Cross-sectionnal, descriptive and analysis retrospective study for 105 paediatric patients with age of 1 months to 15 years old, diagnosed anaphylactic shock at pediatric hospital No 1 from June 1st 2006 to June 1st 2015.
Results: Tertiary health service: There were 28 anaphylactic shock cases in total 32 referral cases, 26 cases (92.9%) were treated with Adrenaline, in those 26 cases there were 5 cases (19.2%) treated with IM / SC / IV Adrenaline combined with continuous IV Adrenaline.
80.8% patients were used Adrenaline with appropriate doses according to recommendations.
IM / SC initial Adrenaline doses were 80.8%.
There were 25/28 (89.3%) cases out of shock after treatment.
Pediatric hospital No 1 (83 cases with anaphylactic shock): 100% patients were used Adrenaline with appropriate doses.
The platelet count/spleen diameter and right liver lobe diameter/albumin ratio in prediction of the presence of esophageal varices in cirrhotic patients
Background: To evaluate the platelet count / spleen diameter (PC / SD) and right liver lobe diameter / albumin (RLLD / ALB) ratio in prediction of the presence of esophageal varices (EV) in cirrhotic patients.
Methods: A total of 166 cirrhotic patients underwent biochemical tests, upper digestive endoscopy and abdominal ultrasono graphy.
The PC / SD and RLLD / ALB ratio were calculated.
We investigated the correlation between calculated ratios and the presence of EV and calculate the predictive values.
Results: Prevalence of EV was 55.42%.
At the cut-off value of 975, PC / SD ratio had 85.54% diagnostic accuracy for predicting the presence of EV, 93.45% sensitivity (sens), 75.58% specificity (spec), 82.69% positive predictive value (PPV), 90.32% negative predictive value (NPV).
At the cut-off value of 4.00, ELLD / ALB ratio had 83.13% diagnostic accuracy, 73.91% sens, 94.59% spec, 94.44% PPV, 74.47% NPV.
At the cut-off value of 2.24, "new variable" = - 0.003 (PC / SD) + 1.447 (RLLD / ALB) had 81.52% sens, 89.19% spec. Conclusion: The PC / SD, RLLD / ALB ratio and "new variable" were the useful non-invasive measures in prediction of the presence of EV in cirrhotic patients.
The study consisted of 110 infertile males experiencing clinical and laboratory examination at the andrology center
Objectives: This study was to 1) identify several causes of male infertility in Andrology centers, and 2) to describe associated factors related to sperm quality in male infertility.
Results: The leading cause belonged to sperm quality, in which azoospermie accounted for 50%.
Endocrine causes accounted for 46%.
Endocrine and Mumps were associated with sperm quality.
Conclusion: Male producibility was shown by sperm quality, and endocrine and mumps were associated with sperm quality.
Study on acute toxicity, in vivo anti-inflammatory and analgesic effects of 50% alcohol extract of hydnophytum formicarum jack. rhizomes
Results: There was no mortality detected or any signs of toxicity in mice at the maximum oral dose (Dmax) of 10 g extract / kg body weight corresponding to 32, 24 g plant powder/kg.
did exhibit acute anti-inflammatory effect, reduced the hind paw edema in mice from 3rd day.
The doses of 100 and 200 mg / kg decreased writhing in mice after 6th and 11th minute, respectively.
This analgesic effect of both doses was observed until 40th minute.
This extract did exhibit anti-inflammatory and analgesic effects at the oral dose of 100 and 200 mg / kg in mouse models.
rhizomes, acute toxicity, anti-inflammatory, analgesic
has been traditionally used to treat hepatitis, jaundice... Out of the 4 types of extracts (aqueous extract and three alcoholic extracts with 50%, 70% or 96% ethanol) from this medicinal plant, high extraction efficiency, high total polyphenol content and the highest antioxidant activity were noted for the extract with 50% ethanol.
Methods: Swiss albino mice aged 7 - 8 weeks weighing about 25 g were used.
After oral administration of single doses of 50% alcoholic extract, mortality and toxic signs in both sexes of mice were observed within 72 hours.
The situation of malaria detection and case management in some malaria endemic communes, easoup district, dak lak province
Background: The communal and village health system plays an important role in the malaria control programe.
The proportion of patients being examined malaria parasite 1 time and more than 2 times was 77.42% and 15.84% respectively.
Conclusion: The effectiveness of activities communal health and microscopic points still has some limitations.
Recommendations: The communal and village health and microscopic points should be supervised continuously to enhance their job performance.
Objectives: To describe the activities of communal health for malaria detection and cases management in some malaria endemic communes and to evaluate the situation of activities of microscopic points for malaria parasite examination in Ea Soup district, Dak Lak province.
Study method: Epidemiological descriptive study.
Results: The survey on the activities of communal health showed the proportion of availability month was 70.97%; 100% of people can access the service of malaria dectection and management.
The error proportion of malaria smear examination was 30%.
The microscopists answered the malaria smears before 2 hours at microscopic points and after 3 - 5 days for village health workers. The proportion of malaria patients who were not examined was 6.74%.
Background and study aims: Magnetic resonance pancreatography (MRCP) is a safe noninvasive imaging technique that can depict the biliary tract without use of contrast material.
This study was designed to evaluate the role of MRCP in diagnosis of the anatomic variants of the biliary tract. Patients and Methods: a retrospective study (from August 2004 to April 2006, at NDGĐ Hospital) was conducted in 147 MRCP.
Results: MRCP has the sensitivity of 85, 1%, the specificity of 92, 1%, the accuracy of 89, 2% for detecting of anatomic variant of biliary tract.
Nose foreign bodies removed at operating room of children hospital n.1 ent department in 2010
Background: Foreign bodies of the nose are popular at the treatment of ENT children diseases.
About time of staying in hospital, almost of them were discharged in the same day.
About time of removing, most of foreign bodies were removed during 5' to 20' (48 cases, 72.8%).
Conclusion: There were no severe complications, but don't put small toys in the reach of children.
Keywords: Button battery, inorganic pieces, organic substances.
In many cases children don't agree to be treated by removing foreign bodies.
Objective: 66 patients were sent to operating rooms in 2010.
Result: There were 66 foreign bodies of the nose, most of them were inorganic foreign bodies (51 cases, 77.2%), then organic foreign bodies (12 cases, 18.2%).
There were 7 button batteries that were dangerous foreign bodies, causing necrosis in the nose.
Intervention: Performing of the upper-air way endoscopy when drug-induced sleep.
Objective: to describe the epidemic, manifestation, laboratory test, complication and evaluate the response to treatment of nephrotic syndrome of children above age 10.
The second cause of the nephrotic syndrome is Lupus Erythromatous Systemic.. Conclusion: Screening the cause of nephrotic syndrome and using renal biopsy is nessessary for nephrotic syndrome of children above age 10.
Objective: Determine the prevalence of osteoporosis, its associated factors and the relationship between sex hormones and bone mineral density (BMD) in male patients 50 years old and over undergoing muscoskeletal diseases.
Keywords: osteoporosis, coticosteroid, hypocalcemia, sex hormones.
Method: 169 male patients 50 years old and over undergoing muscoskeletal diseaseswere included in prospective, cross-sectional study at Department of Rheumatology, Cho Ray hospital from August 2013 to April 2014.
Results: Prevalence of overall osteoporosis, lumbar spine and femoral neck was 47.3%; 40.2% and 31.4%; respectively.
Male aged 60 - 69 consistedthe highest ratio (34.4%), men reported smoking, drinking alcohol and long-term corticosteroid use were 42.6%; 55.6% and 24.9%; respectively.
Low level of total testosterone (< 2 ng / ml) and estradiol (< 20 pg / ml) showed positive correlation to bone mineral density at the femoral neck and lumbar spine.
In multivariate logistic regression analysis, long-term corticosteroid use (OR=6.33, 95% confidence interval [CI]: 2.96 - 13.51, p<0.001), hypocalcemia (OR=5.30, 95% CI: 2.48 - 11.33, p<0.001) and low level of total estradiol (OR=4.98, 95% CI: 1.22 - 20.23, p<0.05) were associated with osteoporosis.
Conclusion: The prevalence of osteoporosis in male patients 50 years old and over undergoing musculoskeletal disease is relatively high, especially patients with long-term corticosteroid use, hypocalcemia and low level of total estradiol.
Finding shows that plan of screening all associated factors to osteoporosis is neccesary and this can save the cost of osteoporosis treatment.
Objectives: Most elderly continuous ambulatory peritoneal dialysis (CAPD) patients need assistance to perform PD.
Meanwhile, assisted person had no time to perform at least 4 - 5 exchanges every day.
Case report: we reported four elderly patients on CAPD transferred to APD treatment for more than 6 months (11/2016 - 3/2018) in Thong Nhat hospital to compare the effectiveness of solute clearance, ultrafiltration control between CAPD and APD, and to evaluate the patient compliance, and consumable expenses of APD.
However, APD still was costly for Vietnamese patients in purchase machine and consumable expenses of APD.
Keywords: Automated Peritoneal Dialysis (APD), solute clearance, elderly.
Experience in applied biomedical statistics of postgraduate and resident students in hanoi medical university
Background: The application of statistics in biomedical studies is increasing and developing.
Conclusion: The ability in applied biomedical statistics of post graduated and resident students in Hanoi Medical University was limited.
There was an association between their reading experience, reference articles with the ability in applied statistics of the students (p < 0.05).
Keywords: Applied statistics, graduate students and resident students.
However, the quality of the application is still a problem that needs to pay attention.
It involves knowledge and experience of researchers in applied biomedical statistics.
Objectives: Describe the experience and the ability in applied biomedical statistics of graduate students and resident students in Hanoi Medical University school year 2012 - 2013.
Methods: A cross-sectional study was conducted with all graduate students of course 20thand resident students of course 35thin Hanoi Medical University.
Result: There were 270 students participated in the study, of whom 80.7% werepost-graduated students and 19.3% were resident students.
Over 50% of students had been trained in epidemiology and statistics.
The majority of participants agreed that statistics is important in making decisions, referencing articles as well as in medicine based on evidences with over 90%.
However, only 1.1% was confident to interpret the results of descriptive statistics, 6.0% could interpret p value, 3.7% was able to interpret test statistics, 2.2% could analyze data themselves and 0.7% could evaluate the statistical results.
Application of the sequential organ failure assessment score in predicting outcome in icu patients with severe sepsis
Mean age was 56 years old and the mortality rate was 46.5%.
The APACHE II score was 18.12 ± 6.78 points.
Objectives: The investigation of parasites in fresh vegetable at the supermarket in HCM city included: (1) Identifying parasitic prevalence in fresh vegetable. (2) Identifying all kinds of parasitic prevalence in fresh vegetable.
Significant difference between Ozone, tap - water and Vegy.
Vegetable samples total: 90 Results: Common parasitic prevalence in vegetable is 94.4%.
The infection is mainly in the form of cyst of amoeba; metazoa are egg of Toxocara and larva of nematode.
Parasitic prevalence 100% on basil, water cress, centella, wild lettuce; 80% in the rest of sample.
Case report: endoscopic extraction of a live fasciola gigantica from common bile duct at medic center.
A female patient, 19 years old, living in Thanh hoa had epigastric colicky pain in 5 days with fever ranging from 39 to 40 celsius degrees. No jaundice was noted.
We thought it a species of fasciola and sent it to parasitology department of HCM medical university.
She was treated with Emetin and symptoms improved later.
Although fasciolasis is not rare in Vietnam now and is increasingly detected with typical clinical features, US and CT findings, and Elisa test, it is the first case of endoscopic diagnosis and extraction of a live fasciola gigantica.
Lab test showed normal results.
We decided to make a small sphincterotomy to extract the foreign body with Dormia basket.
Knowledge - attitude - practice of street food seller in food safety, thap cham province, phan rang city, 2009
Objectives: To calculate the percentage of knowledge - attitude - practice in food safety of street food seller and processor living in Thap Cham province, Phan Rang city, 2009.
The percentage of subjects has appropriate practice of changing water frequently for washing food and process tool by 99.1%.
After reviewing the antiinfectious effects of antibiotics since a century, the author mentionned about the bacterial resistance to antibiotics and its prevalence on the world through many international seminars.
Gastrointestinal strongyloidiasis: report of three cases
All of patients were treated in many hospital but still not improved.
This report can warn all clinicians to pay attention on this nematode in their diagnosis of gastrointestinal diseases.
Chacteristics of pneumococcal meningtitis at children’s hospital 1
Background: Streptococcus pneumoniae is known as one of the major causes of meningitis in children leading to high mortality rate and severe neurologic sequelae.
The mortality rate was 10.9% (n = 6).
Conclusion: Streptococcus pneumonia is not only a main pathogen of pediatric meningitis but also the reason of numerousneurologic sequelae.
Pneumococcal meingititis is the burden of the healthcare sector.
Keywords: pneumococcal meningitis.
Objectives: This study determined the characteristics of pneumococcal meningitis in children.
Methods: pneumococcal meningtitis casesoccuring from January 2012 to March 2017 at Children's Hospital 1 were review retrospectively.
The records of all patients, including data on epidemiology, clinical fetures, laboratory and treatment informations, were obtained and analyzed.
Results: in total, the cases of 55 pediatric patients seen over a 5-year period were analyzed.
78.2% of these cases (n=43) had a cerebral spinal fluid culture positive with pneumococcus; 83.6% (n= 46) had a latex of cerebral spinal fluid positive with pneumococcus, and 61.8% had a blood culture positive with pneumococcus.
The common chief complaint was seizure (n=24; 43.6%), and fever (n=25; 45.5%).
The most common initial antibiotic treatments were ceftriaxone, vancomycin, and / or rifampicin. The treatment duration was 21 days.
Characteristics of epilepsy syndromes at children' s hospital 2 - hcmc
Objectives: The main aim of this research was to identify distribution rates of epidemiology, clinical manifestations, laboratory features and treatment options of different epilepsy syndromes. Material and method: Describe the cases series.
The study recruited epileptic patients diagnosed and treated at the Neurological Department at Children's Hospital 2 from 12/2001 to 2/2009.
Only 7 cases (1.8%) were classified as special syndromes. Conclusion: The 1989 International Classification of Epilepsies and Epileptic Syndromes of the International League Against Epilepsy are extremely helpful in evaluating prognosis as well as choosing appropriate treatment options.
We can have the widespread application of this classification system on clinical practice in order to improve the living standard of epileptic children.
He activities of psychology unit of the university of medicine and pharmacy at ho chi minh city
280 persons (265 children) who had the psychological probems went to Psychology Unit of the University of Medicine and Pharmacy at Ho Chi Minh City for the clinical psychological examination from 4/04 to 12/04.
72.5% of them were under 5 years old.
Their chief complaints were: loss of appetit (72 cases, 25.7%), troubles of comportment (35 cases, 12.5%), troubles of sleep (34 cases, 12.1%), troubles of language (26 cases, 9.3%), vomitting or OGR (24 cases, 8.6%).
Therapeutic methods include: assuring their family, stimulating the child, treatment of comportment, supporting their family, guiding their parents, understanding the child's demand,...
Clinical evaluation and video thoracoscopic surgery results of 34 cases primary mediastinal cysts
Background: Cystic lesions of the mediastinum are uncommon, comprising 12% to 18% of all primary mediastinal tumors.
The surgical approach was video-thoracoscopic surgery in 34 patients.
The mean tumor size was 14, 49 ± 2, 01 cm.
The mean operation time was 61.47 ± 28.61 minutes.
The mean blood loss was 40.73 ± 60.16 ml.
The mean length of post-operation stay was 5.41 ± 1.32 days.
The mean chest tube duration was 2.08 ± 0.28 days.
The mean pain score postoperative was 4.20 ± 1.06.
Conclusion: Video thoracoscopic Surgery for mediastinal cysts is associated with low morbidity and mortality rates and a very low recurrence rate.
It offers a definitive diagnosis and cure, avoiding the higher morbidity and mortality risks associated with conservative observation.
Unless they attain a large size and cause compressive symptoms, these tumors are generally asymptomatic and are discovered incidentally upon radiologic investigation of some other condition.
Keywords: Bronchogenic cyst, mediastinal cyst, Video thoracoscopic surgery - VTS, VATS
They are particularly significant because of the difficulty in making a differential diagnosis: they can simulate multiple lesions, both benign and malignant.
There is still no consensus on whether the best approach to treatment for mediastinal cysts is a conservative medical one (particularly in application to pericardial and bronchogenic cysts) or a surgical approach.
The purpose of this study was to analyze our experience with primary mediastinal cysts, emphasizing the clinical presentations and results of video thoracoscopic surgery.
Methods: case series, thirty-four patients with mediastinal cysts underwent video thoracoscopic surgery from July 2010 through July 2013 at the thoracic surgery department Cho Ray hospital.
The records of these patients were reviewed for age at presentation, sex, signs and symptoms at presentation, results of the imaging techniques, types of mediastinal cysts, location and size of cysts, types of surgical procedure, length of hospital stay, early postoperative complications, death, and other follow-up information.
Results: The 34 mediastinal cysts comprised 11 bronchogenic, 1 pericardial, 6 thymic, and 7 hydro-cysts, together with 9 cystic teratomas.
Overall, 24 of the 34 patients with mediastinal cysts were asymptomatic.
Relationship between antibiotic use and the presence of multidrug resistance gene- acase report of infection with klebsiella pneumonia mang genebla ndm-1
Introduction: In order to evaluate the relationship between antibiotic using and the development of antibiotic resistance genes, we follow up a case infected by Klebsiella pneumoniae carrying blaNDM-1.
The initial antibiotic used is not concordant with antibiogram.
Genotyping of Klebsiella pneumoniae isolated from wound showed the presence of gene blaNDM-1 and the augmentation of gene ESBL (blaTEM, blaSHV, blaCTX-M, blaVEB) during therapy.
Skin culture was still positive with Klebsiella pneumoniae even when the wound is recovered.
Conclusion: Further studies are required for better understanding about patients infected or colonised with Klebsiella pneumonia carrying geneblaNDM-1.
Antibiotic stewardship is necessary to reduce antibiotic resistance.
Keywords: antibiotic, resistance, Klebsiella pneumoniae, gene ESBL, gene blaNDM-1
Method: Case report.
Describe clinical aspects and evaluate the relationship between clinical symptoms, antibiogram and genotyping.
Results: A 59 year-old male, farmer, admitted with diagnosis wound infection after amputation of left thigh in patient with chronic venous stenosis due to thrombosis.
Patient was treated with many kinds of antibiotics including 3rdcephalosporins, aminoglycoside, trimethoprim.
Half-time disappearence of chromosome aberrations in peripheral blood lymphocytes of differentiated thyroid carcinoma patients after 131i therapy
Objective: Try to determine interval half-time disappearance of chromosome aberrations of dicentric and ring in peripheral blood lymphocytes (PBLs) of differentiated thyroid carcinoma patients after treatment different 131I doses to build optimum time between two treatment period.
Materials and methods: We analysed chromosomal aberration frequencies of 90, 450 metaphase cells in blood samples of 127 differentiated thyroid carcinoma patients (female: 104, male: 23), age of these patients ranged from 18 to 82 years at before and after treatment with 131I dose from 1.11 GBq to ≥ 22.20 GBq.
Study design: prospective, Cross - descriptively and comparison of before and after administration of 131I.
Results: Half-time disappearance of chromosome aberrations of dicentric and ring in peripheral blood lymphocytes of 5 groups of differentiated thyroid carcinoma patients after administration different 131I doses as 1.11 GBq, 3.70 GBq, 4.81 GBq, 6.66GBq and ≥ 22.20 GBq were 151, 148, 181 and 452 days, respectively.
Conclusion: Half-time disappearance of chromosome aberrations of dicentric and ring in peripheral blood lymphocytes of 5 groups of differentiated thyroid carcinoma patients after treatment from 5th to 15 th months and depends on cumulative dose of 131I treatments.
The interval between of two 131I treatments time is 5th to 15 months.
Subglottic stenosis in children in pediatric hospital 1
Objective: Laryngeal stenosis is one of the most difficult in treatment, it's take time to treat and it's a burden for patients and their family so we try to find out the effective tretment for our patients by assessing the efficacy of endoscopic laser incision with mitomicine - C insitu in managing laryngeal stenosis in children in ENT department of PH I on 14 patients in the last two years.
Results: There are total 14 patients, 9 boys and 5 girls. They are all get stenose of larynx because of leaving the endotracheal tube more than 7 days in the trachea.
Evaluating nutritional in caring the patient with nephrotic syndrome
Objective: To study the general characteristics and evaluate the results of nitrition in caring patient with nephrotic syndrome at Pediatrics of Hue Central Hospital.
Population and study methods A cross-sectional study implemented from March, 2011 to August, 2011.We conducted studies on 66 patients with nephrotic syndrome from 15 years of age, was treated at Pediatrics os Hue Central Hospital.
Results: Age of infection is mainly from 5 to 11 years of age account for 51.52%, morbidity more boy than girl.
Starting to the hospital: With 85.71% of patients with edema, with 77.14% of patients with abnormal proteinuria, with 57.14% of patients with abnormal blood proteins.
Removing the hospital: Has 94.29% of patients with no edema, 100% of patients had normal urine, 88.57% patients have yellow urine, 97.14% patients with normal urinary protein, have 74.29% patients with normal blood proteins, albumin 74.29% patients with normal blood.
Conclusion Through the above results, we see a very important role of nurses in the treatment and care of rheumatic heart patients to reduce the risks and serious complications of nephrontic syndrome.
However, health education to patients before to discharge from hospital has not been much attention.
Objective: 3-MCPD is a toxic chemical formed as a result of the reaction between a lipid (triglyceride) and a chlorine (Cl -) in foods (sodium chloride, acid chlohydric).
In this study, we investigated the acute, subchronic and chronic toxicity of 3-MCPD on micronucleus formation in blood peripheral erythrocyte. Method: mice were orally administered 3-MCPD at doses of 1 mg / kg, 10 mg / kg, 40 mg / kg or 100 mg/kg.
Blood was collected at acute phase (24 hours, 48 hours, 72 hours and 2 weeks), subchronic phase (3 months) and chronic phase (6 months).
The micronucleus test was performed on erythrocyte to investigate the ability of 3-MCPD to induce numerical or structural chromosomal damage. Results: 3-MCPD at doses experimented increased the micronucleus formation in erythrocyte at acute phases (dose of 100mg / kg) as well as at subchronic and chronic phase. Conclusion: 3-MCPD at doses of 1, 10, 40 and 100 mg / kg, administered in 6 months induced significant changes in genotoxicity, which may be a risk factor of carcinogenesis.
Evaluation of surgery for treatment cerebral hemorrhage due to vitamin k deficiency bleeding
Conclusion: Vitamin k deficiency bleeding is important cause of cerebral hemorrhage in infants.
Early diagnosis and surgical intervention in first 12 ours decrease mortality rate.
Keywords: Vitamin k deficiency bleeding, cerebral hemorrhage, surgical evacuation.
The most common general manifestations included pallor, respiratory distress.
Radiological findings varied from acute subdural hemorrhage (SDH) in 9 cases (60%), subdural hemorrhage and intracerebral hemorrhage in 5 cases (33%), subdural hemorrhageand subarachnoid hemorrhage in 1 case (6.6%).
11 cases (73.3%) was intervened before first 6 ours, 04 cases (26.7%) in first 6 - 12 ours.
Current status in waiting time and affect of waiting time on caregiver’s satisfaction at outpatient clinic, vietnam national children’s hospital in 2017
Objective: To describe waiting time and to find out the effect of waiting time on patient caregiver's satisfaction at Outpatient clinic, Vietnam National Children's Hospital in 2017.
Method: The study is carried out using cross-sectional and quantitative method.
Result:: 400 patient caregivers were seclected for interview, the study shows that: Mean of waiting time for registration was 10.43 ± 5.72 minutes, mean of waiting time for examination was 34.21 ± 10.82 minutes, mean of waiting time for taking samples was 37.84 ± 17.22 minutes, mean of waiting time for test results was 55.49 ± 20.18 minutes, waiting time for doctor's consultation was 27.62 ± 8.33 minutes, mean of waiting time for payment after discharge was 21.43 ± 11.22, mean of total time for examination was 187.47 ± 65.32 minutes.
Waiting time for registration, for examination, and for payment affected the caregiver's satisfaction (p < 0.05).
Conclusion: Average waiting time is 187.47 ± 65.32 minutes in which waiting for registration, for examination and waiting for payment affect the caregiver's satisfaction.
Keywords: Waiting time, satisfaction, patient caregiver's, Outpatient clinic.
Evaluation of blood count for donors plateletapheresis and the quality of platelets units separated from amicore platelet apheresis system
Objective: Evaluation of blood count for plateletapheresis donors and the quality of platelets units separated from Amicore machine.
Keywords: Donors, plateletpheresis, hematological indicator, platelet count
Methods: Plateletapheresis donors from Amicore machine at Hue Blood Transfusion Center.
Material and methods: Cross-sectional description study.
All donors were safe, adversed reactions mainly occur in mild citrate poisoning, feeling of numbness lips was 13.33%.
The average volume of platelets was 271.50 ± 25.41 ml.
The average platelet count was 310.30 ± 21.57 x 109 / a unit.
100% of platelet units achieve quality standards according to AABB standards, quality according to 26 Circular Ministry of Health in 2013.
Conclusion: All donors were safe and 100% of platelet units passed AABB quality standards and Ministry of Health quality of Viet Nam.
Type 2 diabetes management in trung vuong emergency hospital
Objectives: Determine the percentage achieving all three treatment goals: HbA1c <7%, blood pressure ≤ 130/80 mmHg and LDL-cholesterol <2.6 mmol / L outpatients with type 2 diabetes.
Metformin and gliclazide are the most popular.
Keywords: Type 2 diabetes mellitus, treatment goals.
Determining the structure of diabetes medication of outpatients with type 2 diabetes.
Subjects and methods: Cross-sectional descriptive study on 205 patients with type 2 diabetes treated at Outpatient Department at Trung Vuong Emergency Hospital.
Data collection includes HbA1c, blood pressure, blood lipid profile, adherence to exercise, diet, medication.
Results: The proportion of patients achieves all three targets (HbA1c <7%, blood pressure ≤ 130/80 mmHg and LDL-cholesterol reduction by 12.2%).
100% patients take medication to control blood sugar.
The rate of oral hypoglycemic agents, insulin and combination are 75.1%, 12.2% and 12.7%, respectively.
Conclusions: The proportion of patients with type 2 diabetes achieve all three treatment goals (HbA1c, blood pressure and LDL-cholesterol) is low.
25.4% of patients with type 2 diabetes use insulin to control blood sugar.
The results of surgical treatment of neck aneurysm clip in the treatment of cerebral aneurysm rupture khanh hoa provincial hospital
Objective: Describe clinical features, imaging studies and the results of surgical treatment of neck aneurysm clip in the treatment of cerebral aneurysm rupture Khanh Hoa provincial Hospital.
Which one aneurysm was 22 (95.7%), multiple aneurysms was 1 (4.3%); Common position aneurysm was anterior communicating artery (AcomA) 14 cases (58.3%); Pcomm: 4 cases (16.7%), MCA: 5 cases (20.8%), ICA 1 case (4.2%).
At the time of discharge patients: Phase 5 of 18 (78.2%), grade 4 2 (8.7%), grade 3 to 2 (8.7%), level 1 is 1 (4.3%).
There are 22 patients with cerebral angiography test after surgery, which accounted for 95.5% 21 cases of aneurysm neck is clamped completely and 1 case 4.5% residual aneurysm neck.
Conclusion: Microsurgical forceps neck aneurysm treatment is a safe and highly effective.
Keywords: aneurysm, microsurgery, subarachnoid hemorrhage
Introduction: Pregnant women infected with HIV / AIDS, they can infect their children. If not detected early and preventive treatment.
Status of hospital care at 90% good reviews.
Conclusion: We found that detection of HIV infection earlier in pregnant women has an important role in the care of pregnant.
They are participate in the program transmitted from mother to child soon, they are consulted on HIV knowledge They had time to prepare, they have the correct knowledge about HIV to baby care possible to avoid transmission to the baby after birth and in the postpartum period.
Caring role of health workers is important.
Keywords: Knowledge of HIV-infected pregnant women, care situation of pregnant women with HIV in Vietnam.
Problem infant infection from mother, it will become a psychological burden economic and social, family.
HIV-infected pregnant women, they have the correct knowledge about HIV, they are well cared for during pregnancy, birth and the postpartum period, and this will contribute to reducing the rate of mother-to-child transmission.
Objectives: Surveys assessment of HIV-infected pregnant women cares situation and knowledge of HIV-infected pregnant women program of mother to child transmission at Hung Vuong Hospital in Vietnam.
Methods: Cross-sectional descriptive, with 50 HIV-infected pregnant women delivering at Hung Vuong Hospital from March to June 2014, they were invited to answer a questionnaire.
Results: The percentage of women with correct knowledge about HIV is 90%.
Group of women detected HIV (+) in pregnancy: this group is participating mother to child transmission during pregnancy, 66.6% correct knowledge.
Group of women detected HIV (+) before pregnancy correct knowledge 96.9%.
Prognostic role of troponin i in subarachnoid hemorrhage
Objective: Investigating the relationship between elevated Troponin I (TnI) levels in serum and the following parameters: the severity of subarachnoid hemorrhage (SAH) at admission, functional outcome at discharge and 3 months after SAH.
Keywords: Subarachnoid hemorrhage, Troponin I, severity, outcome.
Methods: In a prospective study, 164 patients with spontaneous SAH had serum level of TnI measured at admission.
The severity of SAH was determined by the World Federation of Neurosurgery scale (WFNS).
Outcome of SAH patients was assessed with Glasgow Outcome Scale (GOS).
Although this elevated level was associated with poorer outcome at discharge (p = 0.002) and at 3 months after SAH (p = 0.004) in univariable regression, when we performed multivariable binary logistic regressions, these regressions did not identify TnI level as a significantly predictor of outcome at discharge (OR = 1.05; 95% CI: 0.3 - 3.73; p = 0.941) and at 3 months after SAH (OR = 0.71; 95% CI: 0.18 - 2.71; p = 0.61).
Conclusions: Elevated TnI level was associated with severity of SAH but was not an independent predictor of poorer functional recovery.
Applycating montgomery t tube in treatment of laryngotracheal stenosis at cho ray hospital from 2014 to 2019
Background: Laryngotracheal stenosis happens after prolonged intubattion, trauma or infection.
Stenosis is the most common locating of the neck (74.3%), followed by the subglottis (25.7%).
Classification by Myer-Cotton grade IV is most common (40%), followed by degree I (34.3%), degree III (20%), degree II (5.7%).
The length of narrow sections shorter than 2 cm (71.4%), from 2 cm-4 cm (25.7%), longer than 4 cm (2.9%).
Keywords: T-tube, tracheal stenosis
It is a complicated disease with high recurrent rate and very difficult to treat, not only affecting the airway but also the speech capacity.
Objective: To applycate Montgomery T tube in treatment of laryngotracheal stenosis.
Methods: Descriptive Study.
35 patients with laryngotracheal stenosis were given T-tube surgery at Cho Ray hospital from June 2014 to June 2019.
Result: The majority met in men 62.8%, females 34.3%.
The age group meeting the most is 15 - 30 years old, accounting for 34.3%.
Medical history of endotracheal time from 7 - 14 days accounted for 65.7%.
The majority of patients were done tracheostomy (80%).
Laparoscopic partial splenectomy: a report of 3 cases
Background: Splenic cysts is a relatively rare condition, with about 800 cases reported in literature.
True epidermal cyst is thought to be congenital while pseudocysts are reputedly post-traumatic.
Recognizing the importance of the spleen, along with the development of diagnostic imaging and surgical techniques have led to significant changes in the management of splenic cysts.
Objective: In this study, we focus on evaluation of the technical and the results of 3 cases of laparoscopic partial splenectomy in treatment of splenic cysts.
Methods: We described 3 cases laparoscopic partial splenectomy in our hospital.
Results: In our three cases, time surgery 150 - 170 minutes, blood loss during surgery 50 - 100 ml, no postoperative complications and length of stay in 5 - 6 days were recorded.
Conclusions: Laparoscopic partial splenectomy in treatment of splenic cyst can be done safely, shorter hospital stays, recovery soon.
Keywords: laparoscopic partial splenectomy, splenic cysts.
Background: Acoustic radiation force impulse (ARFI) imaging is a new elastography method for the evaluation of tissue stiffness, integrated into a conventional US sys - tem, able to non-invasively evaluate the stiffness of deep tissues.
On VTQ mode: the mean shear wave velocity of HCC was 2.7± 0.2m / s in this study.
Conclusions: ARFI is a simple, noninvasive and might become a useful diagnostic method for the differentiation between benign and malignant liver lesions.
Keywords: Elastography, Acoustic Radiation Force impulse imaging, Hepatocellular carcinoma.
So, this elastographic technique is suitable for solid liver lesions assessment.
This technique ultrasound has not been widely applied in Viet Nam today.
Therefore, the purpose of this study was to describe the characterictics of Hepatocellular carcinoma (HCC), the most common malignant liver tumor.
Obiectives: This study was conducted to describe the characteristics of HCC on ARFI elastography ultrasound and to assess the severe liver fibrosis.
Materials and methods: This is a cross-sectional descriptive study. A total of 55 patients with HCC lesions were included in the study, these HCC images were analyzed on Acusion S2000 with TVI and VTQ modes at University medical center Ho Chi Minh City.
The sensitivity and specificity of VTI mode for clear limit assessment were 70.2% and 25%, respectively.
Melioidosis from 1-2015 to 8-2017at children’s hopital 2
Objectives: Describe the epidemiological, clinical and treatment characteristics of melioidosis in CH2 from January 2015 to August 2017.
Conclusion: Melioidosis is a serious infection with wide range of clinical presentations, different from aldult and difficult in treatment.
Early diagnosis and treatment with appropriate antibiotics can improve the outcome.
Keywords: Melioidosis, Whitmore, Burkholderia pseudomallei, septicemia, severe pneumonia.
Methods: Retrospective description.
Results: 22 patients with positive cultures for Burkholderia pseudomallei.
The average age was 6 years old, male: female 1.44: 1, none had apparent predisposition to infectionand pre-existing conditions.
Hospitalized about 9.7 days after onset.
Fever is the most common symptom.
The most common clinical presentation was septicemia of 81.8%, and acute suppurative par otitis is a common site of infection 63.6%.
Ceftazidim or meropenem combined with surgical drainage in pus is preferred therapy. The mean duration of hospitalisation was 24 days and the mortality rate was 9.1%.
Anaesthesia for robot-assisted laparoscopic surgery in adults
Background: Robot-assisted surgery was first employed by the end of 1980s, and has since become popular in the U S, Europe, Japan, and South Korea for complex surgeries.
Methods: A retrospective, cross-sectional study of all the patients having indication of robot-assisted laparoscopic surgery in adults at Anesthesiology and critical care department in Cho Ray Hospital from Oct 1st, 2017 to Feb 28th, 2018.
Results: The ratio between male and female was approximately 2: 1 among all 36 inpatients.
The mean age was 51.5 ± 6.5 with the oldest at 76 and the youngest at 25 years old.
The mean body mass index (BMI) was 22.4 ± 0.39.
Average length of stay in hospitals was 15.6 ± 1.67 days, with the minimum 7 days and the maximum 38 days.
The mean time from induction to the end of surgery was 431± 65 minutes, with the minimum of 240 minutes (liver and pancreas) and the maximum of 630 minutes (urology department).
Over the past decade, robot-assisted surgery has become widespread in a variety of operations.
The average amount of blood loss was 432.7 ± 182 mL. Four patients received blood transfusion with a maximum of 4 packed red blood cells unit.
The mean of perioperative intravenous fluids was 2831.1, with the minimum of 1200 mL and the maximum of 4500 mL.
The surgical complications observed included no case of cognitive dysfunction, death, digit injury, head and neck edema (5.5%), conjunctival edema (16.7%), arrhythmia (bradycardia) or low pressure (55.5%), postoperative nausea and vomiting (8.3%), need for ICU (5.5%), need for vasopressor agents (5.5%).
Conclusion: Although the majority of patients generally tolerate robot-assisted surgery well and appreciate the benefits, anesthesiologists must consider the changes in the cardiopulmonary system that occur when patients are placed in Trendelenburg position, and when pneumoperitoneum is created.
Keywords: laparoscopic surgery, robot da Vinci, anesthesia
Basically, robotic surgery offers the benefits of laparoscopic surgery, such as improved cosmesis, reduced postoperative pain, and wound complications, and faster recoveries, with shorter hospital stays.
Several robotic systems have attempted to enter the field of robotic surgery.
Presently, the da Vinci system of Intuitive Surgical is the only commercially available robotic system, and is predominant in Vietnam.
Binh Dan hospital in Hochiminh city is the first in the country to perform robotic endoscope surgeries for adult patients.
The settings for robotic surgery require specific considerations that differ from conservative surgical techniques.
The modern anesthesiologist should keep abreast of these changes, and consider the impact on the anesthetic plan and patient safety.
Ho Chi Minh City-based Cho Ray Hospital puts into operation its newest robotic endoscopic surgery system on October 23rd.
Accuracy of the ultrasonography in disangosis of the polypoid lesions of gallbladder in comparison with the surgical and histopathologic results
Background: Polypoid lesions of the gallbladder encompass a wide variety of pathology.
Conclusions: The accuracy of sonography for diagnosing of polypoid lesions of the gallbladder was not so high.
Because of the likelihood of cholelithiasis and of the malignancy of the polypoid lesions greater than 1 cm, the findings of the study suggest that those polypoid lesions should undergo cholecystectomy.
Although most of these lesions are benign, some early carcinomas of the gallbladder do present as polypoid lesions.
The study aims at determining the accuracy of ultrasound-diagnosed polypoid lesions of the gallbladder. Methods: Data of 109 patients who had the ultrasound-diagnosed polypoid lesions of the gallbladder from February 2000 to August 2005 were analyzed.
The including criteria were the patients underwent cholecystectomies and had the histopathology results.
Results: Histopathology evaluation confirmed polyps in 50 patients (49.5%) categorized as having polypoid lesions of the gallbladder.
Most specimens from patients with the ultrasound reports suggesting small polyps manifested chronic cholecystitis with the embedded in the gallbladder wall (cholesterolosis) or cholelithiasis (55 patients or 46, 8%).
Urgical results of head injury at children hospital 2
Objectives: This study describes some epidemiologic characterization, causes and surgical results of children head trauma to assess the implication for prevention to decrease the deathMethods: A retrospective study of head injury children younger than 15 years of age who operated at CHILDREN HOSPITAL 2 from 8/2008 to 8/2009.
Early diagnostic and prompt operation has excellent results.
Data were collected to compute incidence rate by computerResults: A total of 43 cases of pediatric head trauma operated at Children's Hospital 2 from 8/2008 to 7/2009 were identified.
Children at the age from newborn to 6 years showed the highest incidence (50%).
Male / female = 2: 1.
Traffic accidents were the leading causes (60%).
Excellent surgical results: 88.4% (38 cases).
Complication: 7% (3cases).
Mortality rate: 4.6% (2 cases) Conclusions: Children at the age under 6 years showed the highest incidence.
Male: female = 2: 1.
Background: It's very important to diagnose exactly for suitable treatment to chest trauma.
Conclusions: The treatment was mostly on medicine in majority.
The indications for thoracotomy were in special cases.
The valuable signs for thoracotomy: hypovolemic shock syndrome, respiratory decompensation and acute pericadial compression.
Objectives: To study the indications for thoracotomy in treatment to chest trauma.
To search the valuable clinic and paraclinic signs for thoracotomy.
To choose the incisions and to ameliorate the quality for treatment.
Methods: This study was a prospective, descriptive and cross - sectional study.
Results and discussion: Prevalence was 78% men and 22% women in 98 patients.
The average age was 42 ± 3.4 (9 - 74 years old).
44% patients had hypovolemic shock syndrome accompanying with others injuries.
Predictors of poor outcome after ischemic stroke in patients with atrial fibrillation
Background: Awareness of the predictors of poor outcome after stroke can help us to prevent poor outcome.
Keywords: predictors, poor outcome, ischemic stroke, atrial fibrillation.
Independent predictors of 3-month outcome were determined by using univariable and binary logistic regression analyses.
Results: Most of the patients were over 65 and female outnumbered male (53.4% vs 46.6%).
True low risk patients were 2.1% while most of the others are high risk patients (59.7% or 81.4% according to CHADS2 or CHA2DS2-VASc). 40.4% of all patients were using oral anticoagulants before stroke onset and only 9.7% of all patients using OACs got target INR.
Age over 65, female, high heart rate, disorder of consciousness and NIHSS ≥ 11 on admission, valvular atrial fibrillation, large infarction, occlusion of major arteries, hemorrhagic infarctions and pneumonia were related with 3-month outcome in univariable analysis.
However, after binary logistic regression analysis, only female, NIHSS ≥ 11 on admission and pneumonia are independent predictors of poor outcome.
Conclusion: We can use female, NIHSS ≥ 11 on admission and pneumonia as predictors of poor outcome in stroke patients with atrial fibrillation.
Clinical and echocardiographic characteristics in diagnosis of atrial septal defect (in chợ rẫy hospital from 01/2010 to 09/2010)
Objective: to evaluate clinical characteristics and the value of echocardiography in diagnosis of atrial septal defect (ASD). Subjects and methods: a cross-sectional prospective study was carried out from January 2010 to September 2010.
72 patients were diagnosed Atrial Septal Defect (ASD) by echocardiography and treated by surgical closure at Open Heart Surgery Department, Cho Ray hospital. Results: the majority of ASD patients were late detected (only 18% < 16y. o).
Most of them were hospitalized with symptoms of fatigue (83.3%) and exercise dyspnea (70.8%).
Echocardiography found that 89% were secondary ASD with moderate aterial pulmonary hypertention (48.6%).
Compare with the results post surgery, there was the suitability with echocardiography about types and defect sizes. Conclusion: transthoracic echocardiography is an important method of diagnosing ASD, giving hemodynamic parameters and detecting asociated anomalies.
Depands on the results of echocardiology, surgeons can predict the outcomes of th eir patients.
Automated gun biopsy with free hand ultrasound guidance to diagnose some special kidney diseases
In these patients, the kidney biopsy was done carefully between 2 hemodialysis run without any complication even bleeding postbiopsy, mean of glomeruli per specimen was 11.
Conclusion: Percutaneous automated gun kidney biopsy under the guidance of ultrasound was a safe, effective procedure to diagnose complicated and severe kidney diseases
We got the kidney specimen each biopsy, however, only 66/69 (97.05%) specimens had enough glomeruli to make the diagnosis.
Median of glomeruli per specimen was 11.
No severe postbiopsy complication detected within 24h followed at Nephrology Department, and rescreened by renal ultrasound a day postbiopsy.
Three patients (4.41%) had mild complications (1 self limited macroscopic hematuria without blood transfusion, 1 hematoma và 1 pain at kidney biopsy place).
Fourteen severe acute kidney failure patients on hemodialysis were proceeded kidney biopsy, in which 10 rapid progressive renal failure, and 4 acute renal failure with long maintenance phase and normal bilateral kidney sizes.
Results of experimental studies in subtotal pancreas transplantation
Objectives: Build subtotal pancreas transplant procedures on experimental and assessment some results of experimental in subtotal pancreatic transplant from a living donor.
Object and method: Studies on pigs and experimental surgery subtotal pancreas transplant from living donor with models for the Center - Bladder.
Results: Subtotal pancreas transplant experiments have 04 different models, pancreas transplant live at the time 96 hour was 80%, post-transplant survival time was highest in model b is 100%, a common complication of partial pancreas transplant is embolism.
Conclusion: Subtotal pancreas transplant is surgery experimentally with high success rates and carefully study the vascular anatomy to identify appropriate models for transplantation.
Keywords: Subtotal pancreas transplant, vascular anatomy.
No any severe side effects were observed in both treatments.
There were a lot of methods of treat ment, but relapse rate of pityriasis versicolor are still high.
Objective: This study was designed to assess and compare the efficacy, safety of single doses of itraconazole (400mg) and fluconazole (450 mg) in the treatment of pityriasis versicolor in drug - addicts.
Method: The patients were divided into two groups in this open study. Clinical sympotms and signs, mycologic examinations (potassium hydroxide preparation) and Wood's light were performed before treatment, and at month 1, 2, 3, 4 and 6 after treatment.
Results: 72 patients were enrolled into this open, clinical trial, but 5 of them were drop-outs.
33 patients in itraconazole group (group 1) and 34 patients in fluconazole group (group 2).
72, 73% patients in group 1 and 73, 53% patients had negative Wood's lamp and KOH examiations at 6 months after treatment.
The relapse rate of group 1 and group 2 were 9, 06% và 8, 82% in respectively.
Conclusion: Both single oral doses of itraconazole and fluconazole were effective in the treatment of pityriasis versicolor.
The organisms causing spontaneous bacterial peritonitis in patients with liver cirrhosis
The ratio of positive blood culture is 25%.
Isolated Gram-negative organisms were resistant to third-generation cephalosporin in 50%, to ciprofloxacin in 32%, and 99% sensitive with Carbapenem.
Conclusion: The ratio of culture-positive ascites is 37%, Escherichia coli accounted for 19 cases (54%), isolated Gram-negative organisms were resistant to third-generation cephalosporin in 50%, to ciprofloxacin in 32%.
Objective: To define the ratio of positive culture ascites, isolated microorganisms, and the susceptibility tests of these microorganisms.
Methods: Retrospective descriptive study, examining adult hospitalized patients at Hospital for Tropical diseases from 7/2011 to 5/2012.
Followed by Aeromonas spp (6 cases, 17%).
Psychological adjustment and related factors in patients with ostomy
Objectives: Ostomy has become a common technique and is a life-saving method for patients with severe colorectal diseases such as colorectal cancer.
The score of psychological adjustment was 43.9 ± 6.7.
Male patients who had all support from others to take care of the ostomy had higher level of psychological adjustment.
Conclusion: Patients with ostomy had moderate level of psychological adjustment.
The results indicated a need for supporting programs for patients with ostomy so that patients can have better mental health.
This can help patients to have optimal treatment and quality of life.
Keywords: ostomy, psychological adjustment, related factors
Patients with ostomy can have psychological disorders.
However, study investigating psychological adjustment in this population is scarced.
Our study was to estimate the level of psychological adjustment and its correlates in patients with ostomy.
Patients were interviewed using the Ostomy Adjustment Inventory (OAI) which had language compatible to Vietnamese and high level of reliability through our pilot study.
Results: Nearly two thirds of patients were male; average age was 57.3 ± 14.6 years old.
About 20% of patients had permanent ostomy and 80% had temporary ostomy.
Only one third of patients could take care of their own ostomy.
Results of treatment of non - hodgkin's lymphoma at oncology department - hue central hospital
Between October 2003 and March 2005, 48 patients with non-Hodgkin's lymphoma were diagnosed and treated at the Oncology Dept. and Clinical Hematology Dept, Hue Central Hospital.
Males-and-females ratio was 1.5/1.
The age ranges of 31 - 40 and 51 - 60 were most seen.
Almost patients had lymph node enlargement, included 56.3% with neck involvement. Some rarely seen sites were reported: spinal column, maxillary sinus and orbit.
The major treatment modality was chemotherapy with CHOP regimen.
The overall response and complete response rate reached 87.2% and 55.3%, respectively.
Treatment failure rate remained high, 18.8% of patients died within 20 months
Retroperitoneal inflammatory liposarcoma: a case report
Retroperitoneal tumor diagnosis can be difficult.
Because tumors in this location can belong to many different histological types.
Therefore, beside of reported a case of retroperitoneal inflammatory liposarcoma, we review literature for some issues that affect the diagnostic of retroperitoneal liposarcoma.
Because of high recurrence and mortality, retroperitoneal liposarcoma need effective and aggressive treatment.
Surgery plays a major role in the treatment of retroperitoneal liposarcoma.
Keywords: retroperitoneal tumor, liposarcoma, inflammatory liposarcoma.
Impact of frailty on the short-term outcomes in very elderly patients with acute myocardial infarction
Background: The very elderly people constitute an increasingly important sector of patients admitted hospital with acute myocardial infarction (AMI).
The 6-month major adverse cardiovascular events (MACEs) did not significantly differ in frail and non-frail groups.
However, patients with severve / very severve frailty were asscociated with 6-month all-cause and cardiovascular mortality when compare to the mild / moderate frailty group (22.41% vs 1.79% p<0.001 and 15.52% vs 1.79%; p=0.007; respectively).
Conclusions: Patients with severve / very severve frailty were asscociated with an increase in all-cause mortality and cardiovascular mortality when compare to the mild / moderate frailty group at 6 months.
Therefore, an assessment of frailty was very nessessary to predict the short-term MACEs in such situation.
Keywords: frailty, very elderly patients, acute myocardial infarction, major adverse cardiac events (MACEs)
Frailty is a geriatric syndrome and its prevalence increased with age as well as cardiovascular disease, especially AMI.
However, the impact of frailty on clinical outcomes in the very elderly patients with AMI is uncertain.
Objective: To determine the relationship between frailty and major adverse cardiac events (all-cause death, cardiovascular death, myocardial infarction, stroke and major bleeding) in hospital and at 6 months in the very elderly patients with AMI.
Frailty was definied according to the Canada Study of Health and Aging Clinical Frailty Scale.
Results: Of 275 patients, 175 (62.55%) were considered frailty and rates of severve / very serverve frailty accounted for 67.44%.
Frailty was associated with in-hospital mortality and reinfarction MI (18.02% vs 4.85%; p=0.002 and 4.65% vs 0; p=0.022; respectively).
Introduction: Preparation of tablets from self-emulsions containing curcumin and comparison of tablet formations by freeze-drying and direct compression using adsorption agents.
Keywords: curcumin, selt-emulsion, mucoadhesive tablet.
Materials and methods: Self-emulsions containing curcumin were prepared with surfactants, co-surfactants, and oils.
By dispersing in the water, droplets of emulsion could improve dissolution rate and bioavailability of curcumin.
Fourier transform infrared spectroscopy and Powder X-Ray Diffraction as well as mucoadhesive time were also investigated to characterize the self-emulsion.
Results and discussion: Percentage of drug release in the stimulated gastric fluid indicated that self-emulsion could enhance dissolution rate of curcumin significantly.
Curcumin structure was changed from crystal to amorphous state.
Carbopol was effective in the role of a mucoadhesive agent in tablet formation.
However, it should be noted that mucoadhesive time was depended on the tableting method.
In addition, percentage of drug release was also affected by the method making tablets, i. e.
Characteristic of ventilator-associated pneumonia at intensive care unit, cho ray hospital
Background: Ventilator-Associated Pneumonia (VAP) is very popular in patients have hospital acquired pneumonia (HAP).
Isolated bacteria are A baumannii (61%), P aeruginosa (11.7%), S aureus (11.7%), Klebsiella sp (10.4%), E coli (5.2%).
Conclusions: Our study shows that VAP rate in ICU is low compared to six years ago because we have performed methods to prevent VAP according to Centers for Disease Control and Prevention (CDC).
However, isolated bacteria resistant rapidly to a lot of antibiotics and make treatment more difficult Keywords: hospital acquired pneumonia, ventilator-associated pneumonia, inappropriate initial antibiotic
VAP is associated with increase is mortality, hospital length of stay, and costs.
Although there have had methods to prevent VAP, but VAP is also developing complicatedly and makes treatment more difficult.
Objective: Determine clinical characteristics, risk factors and microbiological results between early onset and late onset VAP.
Methods: Prospective, descriptive study.
Results: There are 86 patients enrolled in the study with 51 males (59.3%) and 35 females (40.7%), mean age is 55.59 ± 22.37 years.
VAP rate is 21.2%.
Mean APACHE II score at hospitalized time is 19.28 ± 6.13.
Risk factors are serum albumin < 2.2 g / dl, H2 blockers ± antacids, > 4 units of blood products, mechanical ventilation > 7 days, reintubation, aerosolized bronchodilator use, inappropriate antibiotic.
Objectives: The presence of acute kidney injury in the setting of acute heart failure is very common occurrence and was termed cardiorenal syndrome 1 (CRS1).
Building the optimal regression model by the BMA (Bayesian Model Average) method with 2 variables NGAL and creatinin day 1: Odds Ratio= ey while y = - 2.39 + 0.0037 x NGAL + 0.17 x CreatininD1.
The nomogram is designed to predict the likelihood of CRS1 with AUC 0.79.
Conclusions: Plasma NGAL is quite good value in the diagnosis of CRS1 in patients with acute heart failure or ADHF.
Keywords: cardio-renal syndrome (CRS1) type 1, biomarkers
Neutrophil gelatinase-associated lipocalin (NGAL) in the blood and urine is one of the earliest biomarkers of acute kidney injury due to ischemia or renal toxicity.
This study was aimed: (1) to decribe clinical, subclinical characteristics, prevalence of CRS1; (2) to evaluate the diagnostic efficacy of NGAL in diagnosis of CRS1.
Method: there were 139 patients with acute heart failure or acute decompensated heart failure (ADHF) in the Department of Cardiovascular resuscitation and Interventional cardiology at 115 Ho Chi Minh City Peoples Hospital from November 2018 to May 2019.
This is a prospective cohort study.
Results: there were 48 cases (rate 34.5%) with CRS1, medium age 66.12 ± 15.77, men accounted for 50.4%.
There were no significant differences of vital signs on admission, diagnosis, phenotype of heart failure between CRS1 and Non-CRS1 groups.
The Urea, Creatinin N1 and N3, NT-proBNP levels were higher in the group with CRS1 than Non-CRS1, the difference was statistically significant p <0.05.
The optimal cut-off for diagnosing NGAL CRS1 is > 353.23 ng / ml, AUC is 0.732 (95% CI 0.65 - 0.80, p <0.001), sensitivity 74.47%, specificity 68.48%, positive predictive value 54.7%, negative predictive value 84%.
Supplement of No 4 - 2014: 141 - 145 On the occasion of two cases of congenital iliac artery aneurysms are detected and successful treatment at Children's Hospital 1 in the last 10 years; we present the ultrasound characteristics and surgical outcomes and review literature.
Keywords: congenital iliac artery aneurysms
Background: Frozen embryo transfer is a current trend in practice worldwide.
Keywords: natural cycle, artificial cycle, endometrial preparation, frozen embryo transfer, live birth rate
The natural and artificial cycle protocols are common endometrial preparation protocols in Vietnam.
There are currently no studies comparing the effectiveness of these two protocols for endometrial preparation.
Objectives: To compare the live birth rate of natural cycle and artificial cycle protocol in endometrial preparation for frozen embryo transfer.
Method: This retrospective cohort study was conducted in group of patients undergoing endometrial preparation for frozen embryo transfer with natural cycle or artificial cycle protocols at IVFMD, My Duc hospital, Ho Chi Minh City.
The primary outcome was live birth rate.
Result: From January 2018 to February 2021, a total number of 182 patients were included in this study.
Live birth rate was not different between the two protocols, natural cycles versus artificial cycle protocol (39.1% versus 34.4%, p=0.616).
Conclusion: The initial study found no impact of the endometrial preparation regimen on the outcome of cryopreserved embryo transfer in Vietnamese women.
Indication and evaluation of endoscopic, laparoscopic and surgical procedures for treatment of common bile duct stones associated gallstones
No mortality and intraoperative accident, complications included 3 cases (bleeding, pancreatitis and CBD leakage.
Minimally invasive endoscopic and surgical management helped to avoid wound infection and helped patients to recover faster.
The mean hospital stay was also shorter and for all stones removals.
The best choice of treatment depends not only on stone and CBD duct characteristics but also on equipments supply, experience of surgeons and experts and over all it must be safe for patient.
About sex: male 25.7% and female 74.3%.
CBD stone associated with gallstone 106 cases (75.7%), associated IHS 34 cases (24, 3%).
Diagnosis with preoperative abdomen US (126 cases - 90%), intraoperative US (8 cases - 5.7%) and intraoperative cholangiography (6 cases - 4.3%).
Tert promoter mutation in gliomas
Background and objectives: Mutations in TERT promoter are frequently found in gliomas and predict response to treatment.
Keywords: Glioma, gene mutation, TERT.
The mutation plays a role in identification of different prognostic groups as well as in selection of patients for suitable therapeutic strategies.
This study aimed to establish a procedure of DNA sequencing for detection of TERT promoter mutation from Vietnamese patients with glioma.
Methods: A descriptive cross-sectional study was conducted on 33 glioma samples.
DNA was extracted from tumor cells using Wizard® Genomic DNA Purification Kit.
The TERT promoter region was amplified with PCR and sequenced with Sanger technique.
Results: A specific primer pair was successfully designed for amplification and sequence analysis of TERT promoter region.
Conclusion: We successfully established a procedure for detection of mutation in the TERT promoter from glioma.
Pathological features of pleural mesothelioma
Opening: Malignant pleural mesotheliomas are frequently caused by exposure to asbestos.
In addition, immunohistochemical methods are also helpful in differential diagnosing with other types of carcinomas metastatic to the pleura, prognosis and treatment.
These tumors are difficult to diagnose, and often overlooked or misdiagnosed with cancer metastasis invasive to the pleura, especially bronchogenic adenocarcinoma.
Recently, basing on new markers of immunohistochemical methods have enabled the diagnosis of this tumor more convenient and more accurate.
Subjects & Methods: In our case series study of malignant pleural mesothelioma, we used 6 markers including CK, TTF-1, Surfactant Protein-A, Desmin, Calretinin and HBME-1 to diagnose this tumor and to exclude bronchogenic adenocarcinoma, a pleural invasive tumor.
Results & Discussion: 39 cases obtained in 3 years from 2008 to 2010 show that the diagnosis of malignant pleural mesothelioma needs suggestions on epidemiology, imaging studies, cytology and histology on routine HE staining to make immunohistochemical staining and finally, to make the diagnosis more accurate.
However, it is essential to have more researches and evaluations of this diagnostic techniques.
With the above six markers it has not really perfected to diagnose all of the elements in the malignant pleural mesothelioma, such as the diagnosis, prognosis and treatment of pleural metastatic carcinomas.
Conclusion: It is difficult to make a diagnosis of malignant mesothelioma.
The implementation of immunohistochemical staining of a variety of markers is necessary for accurate diagnoses.
Comparison of 2 toothbrushing methods for efficacy in plaque removal: the back and forth and the bass modified methods
Toothbrushing using the Bass modified method was found to remove significantly more plaque than brushing using the back and forth one (p<0.001).
- Upper part of ureter: 4 cases.
+ Causes: - Cancer of uterin cervix: 18 cases.
- Failure: 13 cases.
- Complications: + Hematoma: 1 case.
Conclusions: - Antegrade percutaneous stenting is safe and improves the quality of life.
- Causes of failure: + Pyonephrosis.
+ Severe ureteral stricture (corresponds to the grade of hydronephrosis)
Materials and methods: - During 2 years (from 01/2001 to 06/2003), we have 32 cases of antegrade percutaneous stenting including: + 8 males, 24 females.
+ Age 18 - 90.
+ Grade of hydronephrosis: - 1st grade: 4 cases.
- 2nd grade: 20 cases.
- 3rd grade: 8 cases.
+ Location: - Lower ureter: 28 cases.
Background: The previous reseaches had the differents results about the pathoanatomic correlations in PostStroke Depression.
Some reseachers reported that injury to specific brain areas appears to increase the risk of developing PSD: left hemisphere, thalamus, left basal ganglia..., the others reported that had no relationship between the position of injury of brain and PSD.
Objective: W e studied a series of 182 patients with stroke to found the relationship between PSD and lesion of left or right hemisphere, and the lesion location.
Methods: A desriptive, prospective and cross sectional study.
Efficacy of biolac in the treatment of acute diarrhea and antibiotic-associated diarrhea in children
Objective: To determine the efficacy of Biolac in the treatment of acute diarrhea and antibiotic-associated diarrhea in children.
Method Unblinded randomized controlled trial.
Setting Children's Hospital number 2.
Results: Biolac shortens the mean duration of diarrhea and the mean duration of treatment in acute diarrheal children (0.8 days and 0.4 days, respectively); stops diarrhea after 3 days better among the treatment group in both acute diarrhea (38% vs 20% of the control) and antibiotic-associated diarrhea (16% vs 8% of the control).
Conclusion: By shortening the duration of diarrhea, Biolac can help patients recover earlier, and reduce the risk of malnutrition following an acute diarrhea.
Cost-effectiveness analyses should be considered in delivering supplementary probiotic as a reventive measure of antibiotic-associated diarrhea.
Background: Pain is always a concern for patients when they have to undergo surgery.
Average pain at rest and when coughing is high in the first hours after surgery, then decreases over time.
No recorded cases of complications related to technical transversus abdominis plane block.
There were 3 cases of nausea and 2 cases of postoperative vomiting (7.3%).
Conclusion: The TAP block effectively relieves pain for the first 24 hours after laparoscopic colorectal surgery.
Keywords: TAP block, colorectal surgery
With the tendency to reduce the use of morphin analgesics because it slows bowel rehabilitation and increases the risk of postoperative nausea and vomiting.
This research was studied with aim of determining the total morphine dose, pain points at rest and when exercising at 2 hours, 6 hours, 12 hours, 24 hours after surgery, the rate of side effects related to morphine when performing transversus abdominis plane block in patients with laparoscopic colorectal surgery.
Methods: Describes a series of laparoscopic colorectomy surgeries with the program from September 2018 to March 2019 at the Department of Anesthesiology - Cho Ray Hospital.
Results: 68 cases were selected for the study.
Average age 54.0 ± 9.6 years old, more female than male patients.
The average BMI is 21.1 ± 2, 6 kg / m2.
Median surgery time was 182.5 minutes.
Average total morphine dose in 24 hours after surgery is 20.2 ± 3.8mg (99% CI, 18.9 - 21.4).
Objective: Necrotizing pneumonia (NP) is an serious complication of pneumonia in children and on an increasing trend.
The median value of CRP was 160 mg / L, and the CRP ≥ 80 mg / L accounted for 80.4% of children.
The most common lesion on chest X-ray was pleural effusion (56.6%), and a radiolucent lesion only accounted for 17%.
There was 73.6% necrotic lesions associated with pleural effusion and or pneumothorax on chest CT, most of them located in one lobe (60.4%) and in the right lung (47.2%).
Conclusion: It is necessary to increase the PCV 13 vaccination for children.
It is necessary to describe the epidemiological, clinical, laboratory characteristics of the disease for early diagnosis and appropriate treatment.
Method: 53 children with NP were described at the Respiratory Department, Childrens Hospital No2, Ho Chi Minh City from January, 2019 to May, 2021.
Results: The median age was 2 years old.
Only 20.8% of children received the pneumococcal conjugate vaccine.
The most common reasons for hospitalization were fever (75.5%), and shortness of breath (11.3%).
The median time of fever after admission was 7 days.
There was 75.5% of children with respiratory failure.
Clinical and imaging features of some patients with multilevels cervical spinal stenosis
Objective: To determine the proportion of cervical spinal stenosis based on the ages, sex, some clinical and imaging features.
Subjects and methods: A cross-sectional and propective study was done on 34 patients with cervical spinal stenosis at Neurosurgery Department, Cho Ray Hospital from February 2009 to June 2012.
Results: The cervical spinal stenosis mainly occurred in men with sex ratio of 5.8/1, mean ages was 50 ± 12.044 years.
Prevalence of depression in patients with hypertension at out patient department of nguyen tri phuong hospital
Objective: The study aims to Survey the depression condition and relevant factors in out-patients with hypertension at Nguyen Tri Phương hospital from March to May, 2010Methods: A Cross-sectional descriptive analysis study was conducted on 151 patients with hypertension at Nguyễn Tri Phương hospital's examination department.
Data were colleted using face-to-face interviews through structured questionnaire. Results: 26.5% patients with HTN had depression disorder, female is more depression than male, 15% male patient and 39.4% female patient suffered from depression (p= 0.002).
Depression disorder in group of age from 18 to 29 was 66.7%, and group of age over 70 was 50%, group of age from 30 - 49 was 22.2%, group of age from 50 - 70 was 26.1% (p = 0.002).
In 43.1% patient in primary education level, 10% patient in intermediate and university education level suffered from depression (p= 0.005).
80% patient with income under 10 million VND / year and 19.8% patient with income above 10 million VND / year suffered from depressionConclusion: 26.5% patients with HTN had depression disorder, there are the association between age, gender, education, income, and depression disorder.
Beside The relationship between duration of hypertension treatment, underlying disease, social support and depressive disorderThe assistance of nurses in taking care of the patient could help to detect depressive symptoms, as a meaningful contribution to the treatment period of the hypertensive.
Thyroglossal duct cyst: diagnosis and treatment
A retrospective study of 271 cases have diagnosed thyroglossal duct cyst and treated at Cancer Hospital in HCM City for 4.5 years.
Here are the results: + Thyroglossal duct cyst can occur in all ages, average 30 years old and 70% of patients hospitalizing over 20 years old.
Ratio of male / female = 1.1/1.
+ Diagnosis rely mainly on clinical manifestations and ultrasound images with sensitivity of 89.6% and positive diagnosis value of 95.5%.
Another diagnosis methods (CT scan, FNA..) are used in some cases when there is unclear diagnosis.
+ 3.8% of wrong diagnosis cause by cysts in rare locations: undermental, suprasternal... + Sistrunk method is used to treat this disease with low recurrent rates of 0.8%, low complication 7.2% and properly of mild complication involving in the heal.
Prevalance of hypertension and its risk behaviors at the population among 25-64 years old in ninh hai district, ninh thuan province, 2012
Background: The proportion of hypertension among out - and inpatients at Ninh Hai district health center has been increasing, however it does not reflect a true high prevalence of hypertension in community.
Most of the people did not eat vegetable, but used vegetable oil in food processing.
About ¾ used salty foods and only 40% had physical activity at high intensity.
Among the hypertensive group, the proportion of obesity was 19%, and other behavioral risk factors were still common such as smoking, binge drinking, physical inactivity, and low vegetable intake.
Conclusion: The proportion of hypertension among people aged 25 - 64 years at Ninh Hai district was high, and the prevalence of related behavioral risk factors among the hypertensive group is a challenge for the control of community hypertension problem.
Health education needs to be strengthened.
Keywords Hypertension, prevalence, behavioral risk factors
In addition, there has been no study on risk behaviors associated to hypertension among Ninh Hai people.
Objectives: To determine the prevalence of hypertension and related behavioral risk factors among people aged 25 - 64 years at Ninh Hai in 2012.
The STEPs survey questionnaire by the WHO was used to interview the study subjects about tobacco use, alcohol consumption, diet, and physical activity.
The survey commands of STATA version 11.0 software was used for data analyses.
Results: The prevalence of hypertension based on actual blood pressure measures was 15%, and was 20% if currently using antihypertensive subjects included.
The proportion of obesity, currently smoking, and alcohol consumption was 10%, 37%, and 44%, respectively.
Prevalence of post-partum urinary retention after vaginal delivery and the relationship between various obstetric parameters and post-partum urinary retention.
A cross-sectional survey of the vaginal delivery to investigate the prevalence of post-partum urinary retention and to research the relationship between various obstetric parameters and post-partum urinary retention was carried out at Tu Du hospital from September 2001 to June 2002.
The results show that the prevalence of post-partum urinary retention is 13, 5%.
The obstetric parameters commonly associated with urinary retention are nulliparity, instrumental delivery, protracted delivery.
Post-partum urinary retention is a common phenomenon that may be related to the process of partirution and associated with long-term bladder dysfunction.
Early diagnosis and intervention are required to prevent irreversible bladder damage.
Communication between medical staff and mothers after cesarean section in terms of health care quality and sympathy at the national hospital of obstetrics and gynecology in 2018
Objective: To describe mothers' feeling after cesarean section in terms of health care quality and sympathy of medical staff at the National Hospital of Obstetrics and Gynecology in 2018.
Methodology: This is a cross-sectional and quantitative study conducted on 120 mothers after cesarean section using SERVQUAL.
Result: Health care quality is evaluated by mothers, which has average point of 17.0 ± 2.0, in which excellent level accounts for 48.3%, good level accounts for 50.8%, average level accounts for 0.8%.
Mothers who feel sympathy of medical staff have average point of 20.3 ± 2.6, in which excellent level accounts for 40.8%, good level 58.3% and poor level 0.8%.
Conclusion: Most of the mothers feel qualified health care and medical staff's sympathy at excellent and goold level after cesarean section (99.1%).
Keywords: communication, mothers, cesarean, sympathy, health care quality.
Quality of life of people living in ninh kieu district, can tho city, 2011
Background: Quality of life is an important aspect which has been most considered by society and government.
In addition, there was a significant difference between gender, marriage status and the psychological aspect.
Conclusion: People living at Can Tho city had "good" and "average" level of quality of life.
In comparison with the quality of life at Ho Chi Minh city, while people living at Can Tho city had a lower score of social relationship than those living at Ho Chi Minh city, the score of physical, psychological and environment were higher than Ho Chi Minh city.
Study on quality of life at Can Tho city was conducted to have an in-depth vision and help government to make policies to improve quality of life of Can Tho people.
Objectives: to determine quality of life with its four aspects (physical, psychological, social relationship and environment) and some demographics information (age, gender, educational status, stable income status...) Method: a cross-sectional study was applied.
383 participants who was aged at 18 and over and living at 5 wards of Ninh Kieu district, Can Tho city, were interviewed from June to July, 2011.
Results: Of the total 383 participants, female (54.6%) was more prevalent than male, with a mean age of 40, 76 ± 16, 37.
Most respondents participating in this study graduated secondary school (24.0%), and was doing business (18.32%).
Moreover, 54.6% of participants self-assessed stable income.
Most participants satisfied their quality of life with "average" and "good" level (38.6% and 32.9%, respectively), as well as their health with high proportion (43.6%).
In terms of the correlation between four aspects of quality of life and some demographic characteristics, age, educational and stable economic status had a strong correlated with all four aspects.
Surveying patient’s health literacy at trung vuong hospital 2016
Background: Health literacy is the cognitive and social skills which determine the motivation and ability of inviduals to gain access understand and use information in ways which promote and maintain good health.
Conclusion: The determination of patient's health literacy in the hospital is the basis for the appropriate interventions, especially through communication channel, in specific patients in order to improve the effectiveness of patient's care and treatment.
Finally, we improve the patient safety, satisfaction, and quality of hospital care.
Keywords: Health literacy.
The determination of patient's health literacy in the hospital is the basis for the appropriate interventions in order to enhance the effectiveness of patient's care and treatment.
Objectives: To estimate the level of patient's health literacy in Trung Vuong hospital in 2016 using The Health Literacy Survey - Asia - Questionaire.
To estimate the relation between health literacy and the patient's characteristics, the factors about social-economic of the patient in Trung Vuong hospital.
Results: The average health literacy score of the patient was 25.32 (SD 6.73), the median was 25.53 [19.86 - 31.21].
Adequate health literacy was associated with occupation, getting information from television, internet and the income.
Background: Calcaneal fractures are quite common, accounting for 2% of all fractures and 60% of all ankle injuries.
At the same time, investigating the correlation between them with age, height, sex, position of the legs and between the calcaneal angles.
Results: The mean of Bohler angle is 33.80 ± 4.20, range from 260 to 430.
The mean of Gissane angle is 116.60 ± 5.30, range from 1010 to 1280.
The mean of the calcaneal compression angle is 32.90 ± 3.30, range from 250 to 430.
The mean of the facet inclination angle is 62.70 ± 5.70, range from 470 to 780.
There is no difference between the sexes, left and right, two age groups.
There was no correlation with height and age.
There is a positive correlation between the calcaneal angles representing the posterior facet.
Conclusions: The measurements of the calcaneal angles representing the posterior facet in each ethnic group are different.
At the same time, there is a statistically significant correlation between these angles, so clinicians will have more choices during diagnosis and treatment.
In which, posterior facet fractures of the calcaneus accounts for 75%.
Keywords: calcaneus, Bohler angle, Gissane angle, calcaneal compression angle, facet inclination angle
To support diagnosis, treatment, and prognosis results, the calcaneal angles on X-ray film representing the posterior facet have been described in the literature.
There are differences in the normal values ​​of the calcaneal angles between ethnic groups so each country needs its own indicators.
At the same time, it is necessary to determine the correlation between the angles to have more options for clinicians to treat.
Objective: Determine the measurements of the calcaneal angles representing the posterior facet in normal Vietnamese people and examine their correlation with each other.
Methods: Cross-sectional study.
We conducted 128 X-rays of the lateral calcaneus of the volunteers participating in the research at the Department of Diagnostic Imaging of the Hospital of Traumatic and Orthopedic in Ho Chi Minh city.
Then, measuring angles: Bohler, Gissane, calcaneal compression angle, facet inclination angle by efilm 3.1 software.
Analysis of the clinical, paraclinical and renal anatomopathological manifestations of type 2 diabetes patients with nephrotic syndrome
Introduction: The identification of the renal pathologic types is fundamental for differential diagnosis of diabetes associated with nephrotic syndrome or diabetes associated with primary glomerular disease.
Conclusion: Kidney biopsy is fundamental for establishing diagnosis, prognostic and treatment strategy in type 2 diabetes patients associated with nephrotic syndrome.
Objectives: Analysis of the clinical, paraclinical manifestations in type 2 diabetes patients and the relationship with the anatomopathological findings.
Patients and method: Prospective descriptive study on 38 patients with type 2 diabetes at 115 People's Hospital (since May 2009 to May 2011).
Results: The mean age is 60.11 ± 10.04 years old, Proteinuria 6.27± 3.78g/24h, Albuminemia 2.5 - 3.8g / dl, Protidemia 4.2 - 6.2 g / dl, 57.9% patients with high Cholesterolemia > 240 mg / dl, 84.2% with high, Triglyceridemia 150 - 499 mg / dl and 63.3% with high, LDL-C 130 - 189mg/dl.
94% patients presented poor control of glycemia (HbA1C >7%), 68.5% with renal failure (GFR <60 mL / min/1.73 m2).
The mean time from the detection of diabetes until the appearance of nephrotic syndrome was: 5 - 10 years on 14/35 patients (36.84%); >10 years on 17/35 patients (47.36%), < 5 years on 4/35 patients (15.78%).
The anatomopathological findings on 35 patients showed 6 minimal changes (17.1%), 12 proliferative glomerulonephritis (34.3%) and 17 glomerulosclerosis (48.6%) consistent with damage caused by diabetes.
Inappropriate damage caused by diabetes is minimal change lesion in 6/35 patients (17.1%).
Compared with two groups of patient with other histologic lesions, protinuria was significally higher (p=0.002) as well as protidemia and albuminemia were significally lower (p=0, 006) in the group of patient with minimal change.
Introduction: Related substance is an important criteria to evaluate drug's quality.
Were determined some conditions (1.88 g of phenol and 8 hours of reaction' time) for synthesis B2 to give the highest yield (30.7%).
From B2 and tert-butylamine was synthesized B'3, the yield of the process was 19.2%.
The purity of B2 and B'3 were checked by TLC and melting point.
Their purity, determined by HPLC using peak area normalization method were respectively 99.72% (B2) and 99.87% (B'3).
Chemical structure of B2 and B'3, elucidated from their IR, MS and NMR spectroscopic data, respectively were 2-chloro-1 - (4-hydroxyphenyl) ethanone (B2) and N - (tert-butyl) - 4-hydroxybenzamide (B'3).
Conclusion: Was synthesized and purified B2 with the purity of 99.72% and determined some conditions of reaction to give highest yield.
From B2 was synthesized B'3 with the purity of 99.87%.
Keywords: Salbutamol, synthesis, impurity B, 2-chloro-1 - (4-hydroxyphenyl) ethanone, N - (tert-butyl) - 4-hydroxybenzamide
Salbutamol is an essential drug.
In Vietnamese Pharmacopoeia IV (Supplement), Salbutamol Impurity B CRS is used for the related substances test, but it isn't available in the Standard Impurities Bank of Vietnam.
Objective: Synthesis of intermediate products B2 and B'3 of salbutamol impurity B.
Were studied the effects of phenol's amount and reaction time to the yield.
B'3 was synthesized and purified from B2 and tert-butylamine.
Purity of received products was tested by using TLC, melting point and HPLC.
Structure of B2 và B'3 was elucidated by UV-Vis, IR, MS and NMR analyses Results: From phenol and chloroacetyl chloride was synthesized and purified B2.
Characteristics and treatment of acute myeloidleukemia in children at pediatric hospital 2
Objective: To determine the epidemiological, clinical, paraclinical characteristics and evaluate the results of treatment in acute myeloid leukemia (AML) at Department of Hematology-Oncology, Children's Hospital 2 from January 2011 to May 2016.
After induction chemotherapy, the complete recovery rate of 7 - 3, BFM 98 and APL protocol (for M3) was 89.47%, 90.24% and 87.5% respectively.
The most common side effect is hair loss, vomiting - nausea, mouth ulcers.
Infection is common complication.
Overall survival rate after 3 years of 7 - 3, BFM 98 and APL (for M3) protocol was 21.1%, 41.9% and 87.5% respectively.
Conclusions: Acute myeloid leukemia is a malignant disease, with a high rate of recurrence. After chemotherapy, there are many complications, which can be fatal such as severe infection.
Therefore, we need to increase the knowledge of care for patient's family as well as care and support to extend the life of patients with acute myeloid leukemia.
Keywords: acute myeloid leukemia in children, 7 - 3 protocol, BFM 98 protocol, APL protocol.
The male / female ratio was 0.94 / 1.
The most common clinical symptoms are anemia, fever, hemorrhage, and hepatosplenomegaly.
One quarter of the cases (17 children) had white blood cells> 50, 000 / mm3, and peripheral blood was detected in 29 cases.
Severe anemia with Hb <8g / dL was found in half of the cases (34/68) and thrombocytopenia <20, 000 / mm3 in 13/68 of the cases (19%).
In AML patients, M2 was most common with 18/68 of the cases (26.5%), 8 cases with M3, one unclassified case and one biphenotype case.
Causes, clinical and subclinical features and results of surgical treatment in colonic perforation
The open technique was 55.6%, laparoscopic technique in 33.3%.
Conclusions: Diverticulitis and cancer were still the most common causes.
The disease was usually diagnosed before surgery with clinical peritonitis and image of intraperitoneal gas.
Diagnosis is improved by the ability of CT scan that detects pneumoperitoneum compared to radiology.
However, the disease is still worse prognosis because of high complications and mortality, Laparoscopic assisted surgery and primary anastomosis were indicated in appropriated patients.
Keywords: Non-traumatic colonic perforation.
Results: There were 90 patients including 54 males (60%) and 36 females (40%) with median age 52 ± 18 years.
Common causes included diverticulitis (46.1%), cancer (28.9%) and colitis (18.9%).
Noticeable clinical manifestations were: fever in 82.2%, abdominal pain (97.8%), sign of inflammatory peritoneum (97.8%).
Pneumoperitoneum was revealed by radiology in 26, 8% and by computed tomography scan in 47.3%.
Postoperative complication rate was 33.3%, postoperative mortality rate was 15.6%. The common surgical methods were Hartmann (25.6%), primary anastomosis (36.7%), suture of the perforation (27.8%).
Comparision outcomes of 6 versus 12 core prostate biopsy under transrectal ultrasound guide
Introduction: The prostate cancer detection rate in patients with elevated prostate specific antigen (PSA) increases with extended needle biopsy protocols.
There were 65 prostate cancer (PCa) patients (27.43%), 129 BPH patients (54.43%), 3 patients with BPH + high grade prostatic intracellular neoplasia (PIN) (1.27%) and 3 patients with BPH + prostatitis (16.88%).
Conclusions: Prostate biopsy under TRUS guide is valuable.
The biopsy results show that the prevalence of prostate cancer at Binh Dan hospital is not so high as of Western series and the mean age of PCa patients is also higher than Western population.
The overall cancer detection rate 12 core transrectal prostate biopsy is superior to 6 core biopsy but not statistically significant.
In Viet Nam, This topic is rarely reported.
We describe the results of 6 and 12 core transrectal biopsy.
Objectives: Comparision the overall cancer detection rate of 6 and 12 core biopsy.
Methods: Patients having an elevated PSA level (>4ng / ml) or abnormal digital rectal examination (DRE) (hard nodules) would be performed prostate biopsy.
Group 6 score (365 patients): Mean age of patients was 70.76 years (range 40 - 97).
There were 75 prostate cancer (PCa) patients (20.54%), 283 BPH patients (77.53%), 4 patients with BPH + high grade prostatic intracellular neoplasia (PIN) (1.09%) and 3 patients with BPH + prostatitis (0.84%).
Group 12 score (293 patients): Mean age of patients was 71, 75 years (range 34 - 99).
Background: Gallbladder carcinoma is a rare disease with a late diagnosis and poor prognosis.
Most of gallbladder carcinomas in the present series manifested as type 1 enhancement pattern (71%).
By using type 1 enhancement pattern as the predictor for malignancy, the sensitivity, specificity, and accuracy of CT scan for detection of malignancy was 71%, 96% and 91%, respectively.
Conclusion: MDCT is a reliable diagnostic method for differentiating between benign and malignant thickened gallbladder wall.
Focal, irregular wall thickening and discontinuous mucosal enhancement are three direct signs that most associated with malignancy.
Moreover, the one-layer heterogeneous enhancement of gallbladder wall is suggestive of malignancy.
Gallbladder wall thickening is one of the most common finding on radiologic examination, this finding is seen in approximately one-third of gallbladder carcinomas and in many other benign conditions.
An accurate differentiation between these two groups is very important for treatment planning.
Objective: To evaluate the value of CT findings in differentiation gallbladder carcinomas from other benign conditions in patients with thickened gallbladder wall.
Method: CT scan images of 75 patients including 28 gallbladder carcinomas and 47 other benign conditions were recorded from 1/2016 to 6/2020, at University Medical Center HCMC.
The CT features including direct, indirect findings and the wall enhancement pattern were analyzed. Differences in CT findings between benign and malignancy were evaluated and calculated.
Results: Among the direct CT findings, irregular, focal wall thickening and discontinuous mucosal enhancement offer the highest values for predicting malignancy.
All the indirect CT findings showed statistical significant differences between benignity and malignancy.
Urban heart in can tho and binh duong, vietnam, 2009-2010
Apart from Di An district, the incident of Dengue fever is the important public health problem.
Number of traffic accidents is quite high and proportion of agents has hygiene and safety foods are low in 4 districts.
Proportion of poor households in Thu Dau Mot and Thuan An is higher than two other ones.
The government spending allocated on health in Ben Cat is still low.
Proportion of population covered by health insurance is the interested matter. Conclusion: Response phase is the effective tools to help policy makers, local authorities, program managers in their policy making process to decide healthy policies.
Meanwhile in Binh Thuy, O Mon, Cai Rang district: infant mortality rate and under five mortality rate must be health priority.
In Binh Thuy, O Mon districts, there're some substantial problems in number of traffic accidents; and proportion of population using sanitation toilet is still low.
Number of food poisoning is still high in Ninh Kieu district.
Ninh Kieu and Binh Thuy districts have per capita GDP higher than two other ones.
Apart from O Mon district, three other ones have the government spending on health lower than requirement.
The situation and the factors results in drinking alcohol in students' the ben luc private high school, 2008
Background: Drinking alcohol is the important problem which is paid more attention to in Viet Nam, especially in high school students, as its consequence is more and more serious.
There are the differences between sex, the students' father's job, attitude about drinking alcohol behavior of someone and drinking alcohol. Conclusion: The results will help either the board of managers of the private high school Ben Luc or the local officials in Ben Luc district to give appropriate solutions in order to raise the students' awareness of drinking alcohol.
Objectives: To investigate the prevalence and the factors results in drinking alcohol in students' the Ben Luc private high school, and the relationship between drinking alcohol and its related factors.
Collecting data by structured questionnaire, of the Ben Luc private high school's 384 students, Ben Luc district, Long An province.
Results: drinking alcohol proportion is 32.8%.
Either reason of first-drinking alcohol or of second one is to communicate.
The majority of students say that drinking alcohol is not good (79.43%), and will cause traffic accidents and many diseases afterward (61.6% và 54.0%).
Frequency and related factors of dementia non- trauma coma
Background: Coma is a common clinical situations in clinical practice and is a manifestation of many different pathological.
Of which the most prominent risk groups are: age, habitat, history of diabetes, of Glasgow, time awakening, the pupillary light reflex and cerebral infarction, high blood sugar, low blood sugar, elevated triglycerides, blood creatinine increased, blood osmotic pressure increases and Doppler carotid - basilar spine The above related factors are associated with statistics significant dementia after non-trauma coma (p < 0.05).
Conclusion: The frequency of dementia after non-trauma coma is 77%.
Related factors of dementia after non-trauma coma are: age, habitat, history of diabetes street, Glasgow, wake time, pupillary light reflex, cerebral infarction, increased blood sugar, low blood sugar, elevated triglycerides, blood creatinine increased, blood osmotic pressure increased and carotid doppler spinal - basilar atherosclerosis or stenosis.
Coma caused by diversity and a very high mortality rate.
Dementia after coma is difficult to avoid, as much as the world's research on the world every 5 people are in a coma, there are 4 people with dementia.
In Vietnam no research on dementia after coma. Objective: Investigation of the frequency of dementia in patients with coma at the time of three months in a coma and the related factors of non-trauma dementia after coma.
Object and Methods: Prospective longitudinal describes study.
Performed in 356 patients over a coma alive after 3 months.
Assessed by MMSE scale and diagnosed according to DSM - IV criteria.
Results: 356 patients were include, the frequency of dementia after coma due to medical reasons is 77%.
Objectives: To define rate of causes in non-traumatic small bowel perforation.
Pneumoperitoneum was revealed by radiology in 48.98% and by computed tomography scan in 73.91%.
Postoperative complication rate was 60%, postoperative mortality rate was 26%.
Prognostic factors increasing risk of postoperative complications include: preoperative shock, rapid pusle, ASA ≥ III, MPI ≥ 26.
Prognostic factors increasing risk of postoperative mortality include: preoperative shock, ASA: IV, MPI ≥ 26 Conclusions: Intestinal tuberculosis, enteritis are still the most common cause, followed by foreign bodies.
Diagnosis is improved by the ability of CT scan that detects pneumoperitoneum compared to radiology.
However, the disease is still worse prognosis because of high complications and mortality, especially if present risk factors.
Keywords: non-traumatic small bowel perforation
To describe clinical and subclinical features and results of surgical treatment in non-traumatic small bowel perforation.
Methods: A retrospective review of all patients who underwent operative intervention for non-traumatic small bowel perforation at NDGD hospital from April in 2008 to March 31st, 2013 was performed.
Results: There were 50 patients including 26 males (52%) and 24 females (48%) with median age 52 ± 19 years.
Common causes included tuberculous intestinal perforation (28%), non-specific enteritis (24%) and foreign body (20%).
Noticeable clinical manifestations were: fever from 380C to 400C in 48%, pusle ≥ 100 beats / minute in 58%, abdominal pain (98%), abdominal tenderness (96%), muscular guarding (84%), abdominal distention (48%).
Pregnancy outcome of oligohydramnios of third trimester
We had prospectively examined the pregnancy outcome of 142 oligohydramnios patients at Huøng Vöông Hospital: 35% study subjects delivered abdominally in which 68% indicated for fetal distress. 98% patients got 5' Apgar score ≥ 7.
Applying the transconjunctival approach in zygomatico-maxillary fracture fixation
In facial plastic surgery, an adequate incision that can approach the fracture site without leaving a scar is now a demand in a developing society.
Objective: evaluate the result of using the transconjunctival approach in zygomatico-maxillary reconstructive surgery with miniplates and screws.
Material: patients having zygomatico-maxillary fractures being reconstructed by the transconjunctival approach at ENT department, Choray hospital 01/2011 - 12/2012.
Male / female=3, 5/1.
Causes: Traffic accidents 88, 9%.
Result: good scar 94, 4%; bad scar 5, 6%.
Patient's satisfaction: satisfied 64, 8%; moderately satisfied 33, 3%; Unsatisfied 1, 8% Conclusion: transconjunctival approach is cosmetic and can reach the fracture site in zygomatico-maxillary reconstructive surgery.
Keywords: zygomatico-maxillary fracture, transconjunctival approach, zygomatico-maxillary reconstructive surgery
Background: Arterial blood gas (ABG) is not only a useful but necessary tool in the department of emergency and resuscitation.
Keywords: venous blood gas, arterial blood gas, emergency and resuscitation
Repeated sampling for ABG is difficult to do and causes the risk of complications.
Objectives: To identify the correlation of pH, CO2, HCO3, and BE between venous blood gas (VBG) and ABG by different diseases.
Methods: A cross-sectional study was conducted in 151 patients with indications for ABG analysis at the Emergency and Resuscitation Unit, Pham Ngoc Thach Hospital.
Arterial and venous blood samples were collected simultaneously within 5 minutes in the same patient.
Results: The average differences (ABG - VBG) of pH, pCO2, HCO3 and BE values between arterial and venous samples were 0.039, - 5.7, - 0.9 and - 0.09, respectively.
The equations to estimate ABG values from VBG values by the linear regression model were as follows: pHa = 0.591 + 0.924 x pHv, pCO2a = 0.396 + 0.868 x pCO2v, HCO3a = 1.388 + 0.889 x HCO3v.
The Cohens Kappa coefficients of agreement between VBG and ABG for respiratory acidosis, metabolic acidosis, respiratory alkalosis, and metabolic alkalosis were 0.79, 0.82, 0.66, and 0.86, respectively.
Conclusion: VBG analysis can replace ABG in some clinical situations in the department of emergency and resuscitation.
Robotic-assisted laparoscopic prostatectomy extraperitoneal
Prostate cancer is a common cancer in men.
In the stage of non-invasive cancer, radical prostatectomy is the optimal treatment for patients.
Laparoscopic or robot-assisted laparoscopic have more benefits than the traditional operation.
Most of cases have been done in intraperitoneal.
We would like to present a case that is extraperitoneal robot-assisted laparoscopic radical prostatectomy.
Keywords: Prostate cancer, extraperitoneal robot-assisted laparoscopic.
Role of extracorporeal shockwave lithotripsy in treament proximal ureteral stones
Background and purpose: in order to evaluate the role of extracorporeal shockwave lithotripsy (ESWL) in treatment proximal ureteral stones.
Patients and methods: This is the prospective descriptive study187 cases of ESWL in treatment proximal ureteral stones from 12/2009 - 10/2010 at Binh Dan hospital.
Successful rate based on factors: stone burden (diameter <= 10 mm: 92.5%, >10 mm: 77.8%); radiographic level (strong: 75.0%, medium: 86.4%, poor: 90.5%), hydronephrosis level (I: 91.1%, II: 74.55%, III: 60.0%); uretal congestion degree (incomplete: 91.4%, complete: 79.3%); stone location (L2-L3: 86.5%, L3-L4: 86.6%, L4-L5: 77.8%); stone surface (smooth: 85.6%, rough: 86.7%), stone density (identical: 87.6%, unequal: 84.4%), release of bacteria after ESWL (urine culture positive 13.5% with 19/141 cases).
Complication rates: steinstrasse (2.1%), renal colic (4.3%), fever (3.7%), long-term macrohematuria (2.1%).
After ESWL, transient macrohematuria rate was 81.8%. Conclusion: we realized that ESWL in treatment proximal ureteral stones should be the first choice for ureteral stone treatment strategy in Viet Nam currently.
Pathological features and categorization of endometrial diseases
Background: The endometrium is a vital part of the mammalian uterus. It is vulnerable to many diseases such as acute inflammation, chronic inflammation, endometrial hyperplasia, endometrial cancer, etc.
The most common diseases are endometrial hyperplasia, which happens in 117 out of 152 cases (77%).
Endometrial hyperplasia is mostly found in the 40 to 59 year old age group, covering 97/117 cases (82.9%).
Keywords: Endometrium, endometrial hyperplasia (Endometrium proliferative)
Material and Method: We used the horizontal sampling method to analyze the pathological characteristics of 152 endometrial cases examined and treated at the Department of Obstetrics at the University of Medicine and Pharmacy Hospital, Branch 2, from January 2013 to November 2014.
; Correlation between diseases and age groups: Endometrial hyperplasia mostly happens among the 40 to 59 year old age group, including 97/117 cases (82.9%).
All typical complex endometrial hyperplasia happens on patients over 40 years old (7/7 cases).
4/5 non-typical complex endometrial hyperplasia cases are found on patients over 40 years old (80%) and 2/5 cases are on patients over 60 years old (40%).
Conclusion: Most of patients are from 30 to 59 year old (141 cases which cover 92.8% total number of cases).
Assassment of renal function in using radionuclide imaging after relief of upper urinary obstruction
Purpose: The aim of this study was using radionuclide imaging before and after relief the upper urinary obstruction for assessement of renal function.
This study was performed form 9/2006 to 7/2007 with 25 patients who were diagnosed upper urinary obstructions from many causes: Stone of the kidney-ureter: 72% (18TH).
Stricture of the ureter: 20% (5TH).
This is safe, effective and invasive.
Background: Sepsis and septic shock is the serious illness and mortality rate is high.
The changes of kinetic of PCT at group non response to antibiotic treatment: PCT1: 21.02 ng / ml (0.09 - 448.2) → PCT2: 19.61 ng / ml (0.11 - 310) → PCT3: 3.19 ng / ml (0.68 - 87.88) → PCT4: 4.12 ng / ml (0.82-92.35).
There are no differences in PCT levels between groups, (p>0.05).
Procalcitonin quantitative analysis by BRAHMS-PCT-LIA, Lumat LB 9507, Germany.
Results: Mean value of serum PCT in septic patients is 12.58ng / ml.
Initial assessment of surfactant effects in treatment of hyaline membrane disease in preterm neonates.
Background: Hyaline membrane disease (HMD) is very common disease in preterm neonates that is caused by the deficiency of surfactant substance in the alveoli.
Conclusions: Earlysurfactant management in preterm neonates with HMD improves lung function significantly, reduce severity and treatment time.
The surfactant supplement in HMD will reduce severity and mortality rate.
Objective: Initial assessment of the clinical condition and laboratory results improvement in surfactant treatment of HMD in preterm neonates in National Hospital of Pediatrics (NHP).
Results: Surfactant replacement reduces oxygen concentration supply requirement significantly (65.5 - 67.4% vs 28.9 - 36.3%), especially, 1 hour after supplement in both early and late groups.
Study on chemical components of luoc vang herbs(callisia fragrans lindl.)
Objectives: to determine the chemical components of the aerial part of Luoc vang (Callisia fragrans) Methods: repat column chromatography was used to isolate compounds and NMR spectrometry was used to identify the structure. Results: the aerial part of Luoc vang (Callisia fragrans) composes carotenoid, triterpenoid, flavonoid, polyphenol, organic acid, reduct compounds.
From 3.6 kg of air-dried materials, EtOH extract is fractionated by silica gel repeated column chromatography as described in the experimental, led to the isolation of LV-H2 (122, 6 mg).
Conclusions: LV-H2 is determined as a pentacyclic triterpenoid that has a skeleton of olean or taraxeran by spectrometry NMR 1H và DEPT
Modified early warning score values in emergency patients
Background: Modified Early Warning Score - Morgan 1997s revised early risk warning score is a leading tool for assessing a patients risk of early cardiac arrest based on five physiological parameters: blood pressure systolic, heart rate, respiratory rate, temperature and AVPU score of perception.
With a MEWS score of 3 points, the mortality rate of the NB group, graded in yellow, was 0.3%.
The mortality rate of the NB group classified into yellow with MEWS score from 4 points was 3%.
Conclusion: Use MEWS scores consistent with professional activities of the Emergency Department Keywords: MEWS, cardiac arrest risk warning
MEWS is a validated algorithm used clinically in emergency hospitalization to identify cardiac arrest, unnecessary hospital death.
Objectives: To determine the distribution of patients to the emergency department according to the MEWS, the duration of follow-up in the Emergency Department, the rate of patients admitted to the hospital, the rate of patients getting worse and the time of getting worse and dying according to the MEWS score of the emergency group of patients, graded in yellow.
Methods: Descriptive and vertical section studies of emergency patients with a yellow resolution at the Emergency Department of Emergency Department, Gia Dinh Peoples Hospital, TP.
Ho Chi Minh City from April to September 2020.
Results: The study was conducted with 327 patients admitted to the Emergency Department, distributed in the group of patients over 60 years old (46%), this is an age group with many background diseases, with a history of many inpatient hospital admissions (51.6%).
The proportion of patients with a high MEWS score of 4 points or more accounts for 6.7% of early admission, within 1 - 4 hours into ICU departments, coronary intervention units, external resuscitation, and other resuscitation of each clinical department.
The rate of patients getting worse in the first 24 hours is 1.8%.
The mortality rate of the NB group, graded 0 - 2 points in yellow, is 0.3%.
Problem: The safety of blood transfusions is always an issue that is of interest to the health community and general population.
Keywords: PDCA (Plan-Do-Check-Act), SOP (Standard Operating Procedure), WI (Work Instruction).
Objectives: To increase the rate of adherence to a standard procedure for classification of blood groups in supplying blood products at the Blood Laboratory in order to avoid mistakes of transfusing the wrong blood group.
Method: Use the PDCA quality improvement approach with a design based on research of the before and after time series. The trend ò quality indicators are reviewed every 3 week regularly.
Detection and quantitative the philadelphia chromosome by pcr technique in chronic myeloid leukemia patients
We also compare our results with other local and foreign researchers to confirm the accuracy of this technique.
The t (9; 22) (q34; q11) translocation associated with BCR-ABL leads to a cytogenesis aberration known as Philadelphia chromosome, and it could be detected by PCR technique.
Objective: To detect and quantitative analysis for fusion genes BCR-ABL including BCR-ABL b2a2 and BCR-ABL b3a2 transcripts to confirm the presentation of Philadelphia chromosome in CML patients.
Subjects: 60 cases of CML patients in chronic phase (CP) were confirmed by positive bone marrow smears that were undergoing treated in out patient department of Cho Ray hospital.
Results: Results show that the BCR-ABL fusion gene was found in 59 (98.33%) of these 60 blood samples. In these 59 positive cases, BCR-ABL b3a2 type has the highest rate of 44.07%, followed by BCR-ABL b2a2 type with 32.2%, and BCR-ABL b2a2 + b3a2 combinative type with 23, 73%.
Conclusion: These results indicate that PCR technique can be used to detect Philadelphia chromosome.
Background: Asthma is now a global health burden with significantly increasing prevalence.
Before intervention, all of cases in the study don't know to self-monitor of their children's symptoms with asthma diary and about the asthma action plan, but rate of self-monitoring of synmptoms with asthma diary is 82.5% and rate of parents knowing how to relief the asthma exacerbation by asthma action plan is 52.6%.
Conclusion: After of education of self-management with asthma action plan showed that rate of well-controlled asthma, rate of daily using of long-term control medications and rate of monitoring visit are high in children with asthma.
So that, it's necessary to applicate it in units having asthma management.
Keywords: asthma, asthma action plan, self-management of asthma.
Well-controlled asthma is goal of treatment.
Objective: To assess efficacy of asthma management with asthma action plan in children.
Patients and method: In prospective case series design, parents of inpatients 2 - <15 years old admitted to the General medicine Department 2 of the children's hospital 1 because of asthma exacerbation were educated about self-management of asthma with asthma action plan and followed - up within 3 months after discharge.
Resutls: Mean age is 143.9 ± 27.2 months, especially children <5 years old arein a majority (70%).
Among total of 101 children, rate of patients with past history of asthma are 46.5%.
This group has rate of well-controlled asthma is 73.3% and rate of monitoring visit is 93.3% after 3 months of intervention. Before intervention, rate of daily using of long-term control medications is 55.5% and is 93.7% after 3 month of intervention.
Rate of correct using of inhaler device is 43.5% before intervention and is 81.4% after 3 month of intervention.
Investigating characteristics and in-vitro resistance to bacteria causing community- acquired pneumonia in nguyen tri phuong hospital 2008.
Objective: Investigating characteristics and in-vitro resistance to bacteria causing community - acquired pneumonia in Nguyen Tri Phuong Hospital 2008.Methods: Adult community - acquired pneumonia patients admitted Nguyen Tri Phuong Hospital from January 2008 to December 2008, having positive sputum or BAL culture, including 186 patients with 117 males and 69 females. Results: Gram - negative bacteria (94.6%) are majority to gram - positive bacteria (5.4%).
The most popular strains are Pseudomonas spp.
; after that are Providencia spp.
, Moraxella catarrhalis, Proteus mirabilis, E coli, H influenza... Gram-negative bacteria are high resistance to a lot of antibiotics; only low resistance to 3rd - 4th generation Cephalosporin, Ticarcillin, Piperazin / Tazobactam, Amikacin and Quinolone. Bacteria caused CAP are multiform and high resistant antibiotics.
S pneumonia is totally resistance to oxacillin, so high resistance to  lactam.
Background: Hand hygiene compliance related to taking care of patient is currently one of the most important medical issues and attracted to many interests because of its direct involvement to the potential transmissions of microbial pathogens which cause healthcare associated infections, the challenge of the compliance among healthcare workers, and the quality of different disinfectants and technical procedures.
Keywords: Health care associated infection (HCAI), Hand hygiene, disinfectant, coverage rate.
Objectives: Evaluate the efficacy of the technical procedure of rapid hand sanitizer by the coverage rate (%) of disinfectants on the surface of hand skin.
Method: Empirical description, prospective; stratified random sampling method (n=410).
Results: The average coverage rate of fluorescence on the surface of hand skin: 88.02% (<50%: 1.7%; 50% - 75%: 9.7%; >75%: 88.6%).
The missing parts, which are the ones of the hand skin not covered by fluorescence were the dorsum of the hand: 60% (247); the nail and under-nail areas: 57% (236); the front and back sites of fingers: 55% (227); the both sides of fingers: 48% (198); and the palm of the hand: 3%.
Conclusions: In the situation of carrying simple medical practices at outpatient department and / or normal patient room, hand hygiene technique by alcohol-based rub (liquid or gel) still remains some particular limitations in term of technical.
Furthermore, such areas of dorsum of the hand, nail and under-nail areas, front and back sites of fingers, and between fingers are not easily exposed by antiseptic.
It is necessary to organize training, teaching courses efficiently in hand hygiene basing on good practice and visualization of the risk of microbial pathogen transmission via hand.
Cytomegalovirus after renal transplantation in cho ray hospital: difficulty in the therapy
BACKGROUND: Cytomegalovirus (CMV) is the subfamily of the Herpesvirus.
Characteristics of seromarkers in patients with cirrhosis and hepatocellular carcinoma infected by hepatitis b virus
Cirrhosis and Hepatocellular carcinoma (HCC) are two important complications of Chronic Hepatitis B virus (HBV).
Cross investigating 100 patients with HCC and 100 patients with cirrhosis infected by HBV in Cho Ray hospital, we found the prevalence of 5 HBV seromarkers as follows: HBsAg (+) in 87% patients with HCC and 74% in patients with cirrhosis; HBcAb (+) in 94% HCC patients and 93% cirrhotic patients.
Rates of HBe seroconversion were 58% and 45% in HCC group and cirrhotic group respectively.
However, 50% in the HCC group and 32% in the cirrhotic group were suggested to be involved with precore mutants.
Exceptionally, 23% patients with HCC and 17% patients with cirrhosis suggested to precore mutants were associated with ALT elevation.
Moreover, the HBs seroconversion occurred in HCC (10%) and even higher in cirrhosis (21%).
Conclusion: To investigate the role of HBV infection on HCC or cirrhosis, HBcAb is more reliable than HBsAg but it's better to use both seromarkers.
Precore mutants should be suggested in patients had HBe seroconversion and ALT elevation.
As the liver disease progressed to the state of HCC or cirrhosis, the HBs seroconversion could be occurred already.
Rapidly progressive glomerulonephritis in children’s hospital 1
Background: Rapidly progressive glomerulonephritis (RPGN) is an acute nephritic illness with rapid loss of kidney function and need to be urgent to diagnose and treat.
The extent of tubulointerstitial fibrosis in 4/6 patients with SLE progressing to end stage renal disease was over 20% while in others with remission, it was less than 15%.
12 patients (92%) received intravenous administration of methylprednisolone pulse therapy, 4 patients (30%) also received immunosuppressive therapy including prednisone and cyclophosphamide, 3 patients (23%) had to receive continuous renal replacement therapy according to their clinical situation and renal pathology.
Seven patients achieved clinical remission, five patients presented as chronic kidney disease and one died because of hospital acquired pneumonia.
Conclusion: Rapidly progressive glomerulonephritis is not common in children; most of them progress rapidly and severely.
It seems to be that the severity of renal failure at presentation, the proportion of glomeruli containing crescents and the extent of tubulointerstitial fibrosis were important prognostic signs.
Remission depends on the cause and the duration to start treatment.
We suggest that early recognition and prompt aggressive treatment might improve outcome.
Keywords: Rapidly progressive glomerulonephritis, crescentic glomerulonephritis, chronic kidney disease, crescent, children.
Studies in children are limited.
Objectives: To evaluate the clinical, laboratory features, renal pathology of rapidly progressive glomerulonephritis in children admitted to the Nephrology Department, Children's Hospital 1 from May 2008 to September 2011.
Method: Retrospective case series.
Results: Thirteen pediatric patients were diagnosed as having RPGN, including six patients with systemic lupus erythematosus (SLE), six with post infectious glomerulonepritis and one with Henoch Schönlein purpura.
Of patients with RPGN with an average age of 13.07 (9 - 15) years, 6 patients (46%) were male and 7 (54%) were female.
All patients had clinical evidence of renal involvement and presented with edema and proteinuria.
The majority of the patients (84.6%) had hypertension.
All 6 patients with SLE had severe renal pathology (WHO IV) and almost fibrous crescents while all 6 patients with post infectious glomerulonephritis had cellular crescents in their renal biopsies.
Preliminary study on chemical constituents and biological activities of purslane - portulaca oleracea
Background: Traffic accidents are a major problem of public health with high incidence, especially in adolescent students.
Conclusions: Percentage of students has the right knowledge and a positive attitude onusing helmet was rather high, however the rate of correct practice is very limited although regulation of usinghelmet for the children has beenin effect.
Besides education program on usinghelmet for the chidren, schools need to have intervention program forjuvenile grade levels as well as their family focusing on the content of the object such as the importance of using helmet when taking traffic to contribute to not only changingthe current situation in suburban districts in using helmet for the children, but also limiting locally traffic accidents.
Keywords: traffic accidents, helmets, knowledge, attitude, practices.
According to the National Traffic Safety Committee, Ho Chi Minh City is one of the few citieshaving high compliance rates in using helmet.
However the rate of children aged from 6 - 14 years using helmet only accounts for 60 - 70% and 50% of suburban kids do not use helmet by April 2015.
Regulation of using helmit for children can contribute to improving the situation.
Objectives: To determine the prevalence of students having the correct KAP about using helmet and relationship between knowledge, attitude, practice with the sample characteristics among the Tan Phu high school students in the Phu Trung ward, Cu Chi district, Ho Chi Minh City.
Materials and method: A cross-sectional studywas carried out on 347 students at Tan Phu high schoolin July 2015.
Structured questionnaire were self-administred by students Percentage of students has the correct KAP on using helmit wasreported and to determine the relationship between KAP and characteristics Chi-squaredtest was used at level of significance at 0.05.
Results: Percentage of students has the correct knowledge, attitude and practice is 84%, 86% 14%, respectively.
There were significant relationship between family economystatus and knowledge; grade and transported frequency by motorbike and positive attitude; and grade and practice.
Evaluated the result of emergent open repair of abdominal aortic aneurysm.
The early results after the emegent open repair of patients with imminent, contained and free ruptured abdominal aortic aneurysm (AAA) Objective: To evaluate the early results after the emegent open repair of patients with imminent, contained and free ruptured abdominal aortic aneurysm (AAA), to identify the mortality, the early complications and the predictors of early outcome.
Patients and methods: Retrospective review of forty-eight patients underwent emergent repair for AAA, during May 2008 to May 2010 in Cho Ray Hospital.
Demographic, preoperative, intraoperative, and postoperative data were recorded and statistically analysed to identify predictors for mortality Results: 14 imminent and 34 contained to free ruptured AAA patient were divided 2 groups.
The mortality was 20.8% (10/48); 20.6% in ruptured group and 21.4% in the other died by multiple organ failure, myocardial infarction, cerebral infarction, graft infection, ischaemic colitis, coagulopathy, inhalation pneumonia.
The results of this study suggest that a good postoperative survival rate can be expected in patients with a Glasgow Aneurysm Score <77 and Hardan < 1, age < 76.
Objectives: to assess the role of the tympanometry to diagnosis and follow-up of acute otitis media in children.. Study design: descriptive study as serial cases.
In 74 ears (79, 6%) with persistent middle ear effusion after an episode acute otitis media, there were 17 ears (23%) effusion persisting for less than 3 weeks, 50 ears (67, 6%) effusion persisting for 3 weeks to 3 months and 7 ears (9, 4%) effusion persisting for longer than 3 months. Conclusion: Tympanometry plays a important role to diagnosis and follow-up of acute otitis media in children.
Characteristics, imaging and surgical results of diverticulitis
Purpose: to describe clinical characteristics, sensitivity of ultrasound and CT scan, and to evaluate the results of surgical treament of colonic diverticulitis.
Diverticulectomy (with / without appendectomy) was performed in 31 patients (75.6%) without any mortality and morbidity.
Conclusion: The incidence of colonic diverticulitis was increasing, RD was predominant and usually misdiagnosed as appendicitis.
The ultrasound sensitivity was low, therefore, CT should be performed in case of suspected colonic diverticulitis due to its high sensitivity and accuracy.
Among various surgical procedures for colonic diverticulitis, diverticulectomy, which could be performed by laparoscopy in most cases, should be considered as a safe and adequate treatment.
Patients and methods: A retrospective review of 41 patients who underwent operations for colonic diverticulitis from January 2007 to December 2010 at Gia Dinh People Hospital was performed (all diagnosis were confirmed by anapathological results).
Result: Thirty-six patients had right diverticulitis (RD) and 5 patients had left diverticulitis (LD).
The mean age was 38.8 years (range, 15 - 80) and patients with RD were significantly younger (mean age 36.0 years vs 58.6 years).
The male: female ratio was 29: 12.
The ultrasound and CT sensitivity of colonic diverticulitis were 22.0% and 69.2% respectively.
Only 11 patients (26.8%) had accurate preoperative diagnosis.
Introduction: The tibial plateau fractures were treated by arthroscopic reduction and internal fixation (ARIF) with two or three screws at least.
Conclusion: Arthroscopically assisted treatment of tibial plateau fractures brought a good result at the early stage. This study needs to be done on more patients and a longer term follow-up.
However, we believe this method will bring the good result for the patients with tibial plateau fracture grade I-III as per Schatzker's clasification.
This technique had been introduced by many advantages: better visualisation, less traumatic surgery, reconstruction of accompanying injuries.
At the early stage we start applying this technique for patients of tibial fracture grade I, II and III as per Schatzker's clasification that we realised in our department.
The early results of bone healing, of function of leg were evaluated. Result: There are 3 patients treated by a tibial plateau fracture with accompanying injuries such as meniscal tear, medial collateral rupture, femoral cartilage articular damage.
Results were evaluated after 4 months, including bone healing, function of injuried member, knee stability... All had a good result.
Survey on characteristics of varicella in children at children's hospital 1
Objectives: To describe the epidemiology, clinical manifestations, laboratory findings, complications and treatments for varicella in children. Material and Method: Retrospective and descriptive study with an analysis for 203 cases of varicella at Children's Hospital 1 from Jan 01 2007 to Dec 31 2008.Results: The peak of the disease was in March.
The mean length of admission was 3.8 days.
The mean hospitalization cost was 444, 266 VND Conclusion: The most of varicella patients were under five years old.
The most common complication was the bacterial skin sur-infection, the severe was the meningoencephalitis.
98% have not been vaccinated against the varicella-zoster virus.
There was no death in the survey but the patients were hospitalized and have the risk of zona in the future.
Most children were aged less than 5 years (65.5%).
There were no varicella-related deaths.
Developing a quantitation method of amino acids from cerf velvet
Add 3.5 ml 50 mM Na2HPO4, pH 7.0: EtOH (1: 1), lắc rung 30 sec, filtered through a 0.45 µm filter.
+ Validated the SKLHNC method: the system compatibility, specificity, repeatability, linear range, accuracy were conformed (RSD < 2%).
+ Applied to assay three lots of Cerf velvet capsules: 010111, 020411 and 030711.
+ Other criteria: Characteristics; Mass uniformity; Loss of weight; Disintegration time; Microbiological contamination.
Traditional Medicine Institute of Ho Chi Minh city recently used Cerf velvet for production of Cerf velvet capsules.
- In-house specification is proposed such as: Characteristics; Mass uniformity: average mass ± 7.5%; Loss of weight ≤ 5%, Disintegration time ≤ 30 min; determine AA by CR, TLC and SKLHNC; Assay (mg / capsule): Ser ³ 0.33, Gly ³ 1.73, Ala ³ 1.43, Val ³ 0.38, Leu ³ 0.47 và Phe ³ 0.88; Microbiological contamination (Vietnamese Pharmacopoeria, 2009).
To improve product quality for registration of drugs and to meet the treatment needs at Institute, this study was done with the goal "Developing a quantitation method of amino acids from Cerf velvet".
Objectives: To determine the causes of fever and factors related to serious infections.
Conclusion: Fever in children under 3 months of age needs to be vigilant and could be at high risk of severe infection.
Keywords: Fever in infant aged 29 - 90 years day, risk of serious infections, low risk.
Methods: This is a cross-sectional study.
Results: The most frequent clinical manifestations were respiratory (67.41%) and gastrointestinal (61.28%) signs.
The main causes of fever were infections of lower respiratory tract (39.83%), viral infections (22.56%) and bacterial meningitis (13.37%).
Septicemia was found in 7.53% and severe infection was present in 69% of the cases.
The most commonly used antibiotics were 3th cephalosporins generation.
Severe infections were related to high fever >39°, the presence of respiratory clinical signs or the presence of both respiratory clinical manifestations and high fever.
Positive blood culture and CRP >15 mg / L were related with severe infection.
Guillain - Barré syndrome is almost a clinical diagnosis, demonstrated with acute inflammatory demyelinating polyradiculoneuropathies.
Clinical issues were improved in 23th day of disease onset for being on ventilator patient: motor recovery, improvement in cranial nerve functions and respiratory involvement.
The other patient also recovered in 21st day with remarkable clinical amelioration.
There was not any corticoides during treatment period.
Keywords: Guillain Barré syndrome, plasmapheresis, plasma exchange
The current treatment for this rare but severe autoimmune disease is using intravenous immunoglobulin (IVIG) and other supportive methods preventing compications.
Two patients were treated with 5 single Plasma Volume sessions of Plasma exchange per 24 hours, replacement solution was albumin 5%.
Thalassemia: diagnosis and treatment in the children's hospital no.1
This study included 84 children with thalassemia who were admitted to the Children's Hospital No. 1 in Ho Chi Minh City, from 1st June 2002 to 30th Dec 2002.
The mean duration of treatment was 8.73 + 8.4 days, and 70.2% cases needed less than 7 days to stay in hospital
The result showed that: Thalassemia is the most common type of heritable anemia in infants, the rate of beta-thalassemia - Hb E was 42.8%, and the rate of homozygous beta-thalassemia was 34.5%.
14.3% patients had the history of this disease in the family.
66.7% patients were diagnosed as anemia & were treated before hospitalizing.
Only 7.2% children were vaccinated against hepatitis B & meningitis.
Outstanding clinical symptoms were hemolytic anemia (100%), hepatomegaly (86.9%) & skull deformation (37.8%).
Review of regulations on functional foods management in vietnam
Keywords: functional foods, legal documents, management, Vietnam
Background: Postoperative care and postoperative pain management play an important role in accelerating the recovery of patients' general condition.
The prevalence of patients with severe pain in group P + D was statistically lower than that in group D (2% vs 14.9%, p = 0.023).
The result of logistic regression showed that, using combination of paracetamol and diclofenac helped reduce the rate of severe pain at 6 hours after administration in comparision with using diclofenac only (OR = 0.082, CI 95% 0.009 - 0.730, p = 0.025).
Conclusion: The combination of intravenous paracetamol and diclofenac suppository proved more significant effectiveness in pain severity reduction at 6 hours after administration in patients undergoing spinal anaesthesia for cesarean section when compared with diclofenac suppository alone. Keywords: cesarean section, paracetamol, diclofenac
Objective: To compare the effects of diclofenac suppository and diclofenac suppository combined with intravenous paracetamol on postoperative pain management in patients undergoing spinal anaesthesia for cesarean section at An Sinh Hospital, Ho Chi Minh city.
Materials and Methods: A cross - sectional study was conducted in patients undergoing spinal anaesthesia for cesarean section.
There were 2 groups of patients, of which group D patients (n = 47) received 100 mg diclofenac suppository, and group P + D patients (n = 49) received 100 mg diclofenac suppository combined with 1000 mg intravenous paracetamol.
The same spinal anaesthesia procedure was applied for all patients.
The primary outcome of this study was the difference in NRS pain scores at 2 and 6 hours after drug administration between the 2 groups.
Binary logistic regression model was used to determine the factors associated with severe pain of patients at 2 and 6 hours after drug administration.
Results: There was no statistically significant difference between the 2 groups regarding most of the baseline characteristics, excepted for the duration of surgery and the newborns' body weight.
Patients in the 2 groups had a significant improvement in pain scores at 2 and 6 hours after drug administration.
Comparison of impulse osillometry system and spirometry for diangosis of chronic obstructive pulmonary disease in elderly.
Background: Chronic obstructive pulmonary disease (COPD) is the global burden, especially in developing countries.
FVC, FEV1/FVC) and IOS measurements (R5, X5, R20) were recorded.
Synthesis and investigation of antioxidant activity of flavonoids
Background and objectives: Reactive oxygen species (ROS) have been implicated as a cause of degenerative diseases such as brain dysfunction, cancer, immune system depletion.
Conclusion: The application of the QSAR models to predict the antioxidant activity of the derivatives provides the basis for screening, design, selective synthesis and in vitro determination of antioxidant activity to identify powerful antioxidant novels.
Keywords: reactive oxygen species, antioxidant activity, flavonoids, QSAR
Flavonoids - a large group of common compounds in plants - have diverse biological effects such as anti-inflammatory, anti-allergy, anti-cancer and reduce the risk of cardiovascular disease. These biological activities are mainly related to the anti free radical potential of flavonoids.
This study was performed with the aims as follows: synthesis of flavonoid derivatives, identification of antioxidant activity and analysis of structure-activity relationships.
Materials and methods: A total of 213 compounds with ability to neutralize free radicals were collected form literatures.
The antioxidant activity was assessed by DPPH radical scavenging.
Results: In vitro assays indicated that F1 (quercetin), F2 and F3 (luteolin) are three good antioxidants and comparable to vitamin C and BHT (butylated hydroxytoluene).
The antioxidant capacity of the chalcone is quite low (F5, F6) or almost inactive.
Curcumin (F9) is resulted in a better antioxidant activity than that of tested chalcones.
Factors influencing pre-hospital time after onset acute ischemic stroke
Background: Prehospital time is one the important factors of thrombolysis therapy in patients with acute ischemic stroke.
Objective: Investigate factors associated with prehospital time after acute ischemic stroke.
Relationship between renal artery stenosis and hypertension in hypertensive patients with coronary disease
This study was performed to investigate the relationship between RAS and hypertension in hypertensive patients with coronary disease. Methods.
RAS was seen in 62 patients (48%), 98% were atherosclerotic.
There was no relationship between the severity of renal artery stenosis and degree of hypertension (p= 0.205).
However, bilateral RAS significantly correlated to the severity of hypertension (p = 0.028) Conclusions.
The prevalence of RAS was high among hypertensive patients with coronary disease.
Scoring systems in severe community – acquired pneumonia
Objective: The aim of this study was to compare the ability of SMART-COP, ATS / IDSA 2007 and SCAP systems to evaluate severe community - acquired pneumonia (CAP), predict the need for intensive respiratory and vasopressor support (IRVS) and 30-day mortality in CAP.
Keywords: Community-acquired pneumonia, intensive respiratory and vasopressor support (IRVS), severity score.
Methods: We included 156cases with community - acquired pneumonia.
The scores were calculated at admission and associated with the need for intensive respiratory and vasopressor support and 30-day mortality.
Results: The mean age of patients was 61.87±17.85 years old.
The 30-day mortality level for CAP was 7.1%.
33/156 patients (21%) with CAP were followed in ICU.
The area under curve (AUC) values of the three systems (SMART-COP, ATS / IDSA 2007 and SCAP) for the need for IRVS were 0.575, 0.672 and 0.738 and for 30-day mortality were 0.664, 0.712 and 0.772, respectively.
Conclusion: In comparison with ATS / IDSA 2007 and SMART-COP, SCAP score system had a lot of advantages: more practical in predicting ICU admission, cost-effective, accessible, and useful in taking quick decision for ICU admission.
However, clinical assessments were still crucial to predict the requirement for IRVS and mortality in CAP.
Level of physical actnity - difficulty of actnities' daily lning among the elderly at thanh phu commune, ben luc district long an province in 2004.
The object of this cross - sectional study is all of the elderly, be examined to identify some commonly existing chronic health conditions and interviewed the level of physical activity, the dificulty of actioities'dailp living, the low cognitive condition.
The prevalence of the elderly having difficulty of activities'daily living was found at 7, 7% and 19, 4% of them do not engage in the physical activity.
The economic condition is the only social factor associating with the activities.
Health problems relating to the difficulty in activities are low cognitive condition (OR = 27, 13; CI 95% 10, 05 - 73, 22) and Body Mass Index - under weight (OR = 2, 08).
At the level of physical activity, academic standard, cardiovascular disease (OR = 1, 7; CI95% 1, 13 - 2, 54), low cognitive condition (OR =17, 69; CI95% 5, 74 - 54, 4) and Body Mass Index - under weight (OR = 1, 73) are the related factors.
Two variables grow paralle showing that the dificulty of actioities'dailu living (objective factor) joints to the level of physical activity (subjective factor) and that suggests for taking care about the elderly health mission.
Investigating the bone mineral density by dual energy x-ray absorptiometry in patients using long-term inhaled corticosteroids
Background: The proportion of osteoporosis in patients with asthma and chronic obstructive pulmonary disease (COPD) using long-term inhaled corticosteroids (ICS) in Viet Nam has not been investigated.
Objective: To estimate the proportion of osteoporosis in patients with asthma and COPD using long-term ICS.
Subjects and method: cross-sectional and observational study.
The bone mineral density (BMD) at lumbar spine of 85 patients with asthma and COPD using ICS for more than or equal to 6 months at University Medical Center at Ho Chi Minh City was measured by dual energy X-ray absorptiometry (DXA).
The criteria of diagnosis of osteoporosis was T-score  2.5.Result: 34% (29/85) patients with asthma and COPD using long-term ICS were suffered from osteoporosis.
This proportion increased to 66% in group of  60 years old, 52% in group of menopausal women, 64% in group of BMI < 18.5 kg / m2, 65% in group of COPD with stages III and IV, and 61% in group of using short-term courses of systemic corticosteroids (SCS) for exacerbations.
The proportion of osteoporosis correlated with advancing age, menopause, low weight, and short-term courses of SCS (P < 0.05), but did not correlated with daily cumulative mean of ICS dose (P > 0.05).
Conclusion: The proportion of osteoporosis in patients with asthma and COPD using long-term ICS was higher than in normal subjects.
Advancing age, menopause, low BMI, severe COPD, and using short-term courses of SCS partly contributed to the increase of this proportion.
Primary evaluation of the middle ear risk index prognostic factors on the success of tympanoplasty
Objectives: To evaluate the value of middle ear risk index (MERI) prognostic factors on the success of tympanoplasty.
The distribution of colorectal adenomas according to their sizes and
Aim: Analyze the distribution of colorectal adenomas according to their sizes and locations. Methods: A prespective, cross-sectional study was conducted at the University Medical Center on patients who underwent colonoscopy with polypectomy from November 2006 to June 2007.
The rates of high risk adenomas (adenoma with villous component or with dysplasia) were 7%, 26.2%, 85.2% and 87.5% in polyps with diameter £5 mm, 6 - 10 mm, 11 - 20 mm and > 20 mm, respectively.
All polyps in the proximal colon and in patients who is older than 50 are adenomas. Non-neoplastic polyps were only found in sigmoid-rectal region. Conclusion: Analyze the distribution of colorectal adenomas according to their sizes and locations provides useful information for endoscopic management strategy.
Surgical treatment of spondylolisthesis grade v by robert gaines technique: a case report
The authors present a 25-year-old male, who underwent a Robert Gaines procedure for symptomatic L5 spondyloptosis at the Central Military 108 Hospital.
Permanent spinal traction was applied between the two stages.
At the 1.5-year follow-up, the patients symptoms were fully resolved, as demonstrated by successful fusion and a full return to activities by the patient.
The early results of radical resection for hilar cholangiocarcinoma
No deaths until now.
Conclusion: Radical resection is a safe, and could improve survival of patients.
Keywords: Hilar cholangiocarcinoma, Klatskin's tumor.
The objective of this study was to evaluate the early results of the radical resection for treatment hilar cholangiocarcinoma.
Materials and methods: Prospective study of cases series.
Results: From 08/2016 to 10/2017 at Binh Dan Hospital, a total of 8 cases.
The average age is 58, 5 males, 3 females.
The mean operative time was 190 - 270 minutes.
The mean blood loss was 350 ml, no blood transfusions in operating.
Complication rate was 50%, Two cases were reoperated: 1 postoperative bleeding (12.5%), 1 wound dehiscence (12.5%), and 2 bile leakage treated conservatively.
Results: 11 cases: Clinical findings are the chronic sinusitis, especially one side. The diagnosis was delayed and complications (exophthalmos,..: 36, 6%).
Most of tumor are benign (63, 6%).
Treament of this benign tumors are the endoscopic surgery (85, 7%).
The recurrent is unpreditable.
Conclusion: neoplasms of the nose and paranasal sinuses in children are benign. The endocopic surgery is feasible to remove this benign tumor.
Diagnosing intracranial aneurysms with mr angiography
Objective: The purpose of this study was to investigate the sensitivity, specificity, positive predictive value and negative predictive value of 3D-time-of-flight (3D-TOF) magnetic resonance angiography (MRA) in the detection of cerebral aneurysms with the use of conventional digital subtraction angiography (DSA) as the gold standard.
The rapidly improving spatial and temporal resolution of 3D-TOF MRA make it becoming a safe, non-invasive and very efficient method for screening of intracranial aneurysms.
Keywords: 3D-TOF MRA, cerebral aneurysms
Methods: 3D-TOF MRA was performed in 114 patients with clinical dignosis suggested cerebral aneurysms. Each patient underwent conventional digital subtraction angiography (DSA) for the definite diagnosis.
Results: 114 patients underwent DSA and 3D-TOF MRA. 130 aneurysms of 102 patients were detected by DSA.
126 aneurysms were detected by 3D-TOF MRA.
3D-TOF MRA had a sensitivity of 96.9%, specificity of 92.3%, positive predictive value of 99, 2% and negative predictive value of 75.0% in detection of aneurysms with the average size measuring 5, 9 mm.
And strength of agreement between 3D-TOF MRA and DSA was good (Kappa, k=0.81).
Conclusions: This study indicates the good capability for detection of aneurysms by 3D-TOF MRA.
- In the patients with angina pectoris, the rate of LV wall dyskinesis in patients with typical angina was higher than that in whom with atypical angina.
- In the patients with angina pectoris, the rate of wall diskinesis in patients with myocardial infarction was higher than that in whom without myocardial infarction. Conclusions: There was an increase LV dimension and the rate of LV hypertrophy in angina patients.
The patients with typical angina have higher rate of wall dyskinesis than patients with atypical angina. The patients with myocardial infarction also have higher wall dyskinesis than patients without myocardial infarction.
Prequency of antigens of some red blood cell systems in patients receiving phenotyped blood at cho ray hospital
Objective: "Studying frequency of antigens of some red cell blood groups to choose phenotype blood unit which is matched with patient."
Method: Retrospective and cross sectional descriptive study.
Results: From June, 2011 to June, 2012, we studied on 44 patients at Cho Ray Hospital.
As a result, we detected that the frequency of antigens of some red cell blood groups are the following: Rh system: D: 100%, C: 97, 7%, c: 43, 1%, E: 31, 8% and e: 95, 5%; Kidd system: Jka: 63, 6%, Jkb: 70, 5%; Duffy system: Fya: 90, 9%, Fyb: 6, 8%; MNSs system: M: 86, 6%, N: 20, 5%, S: 9, 1%, s: 100%; Lewis system: Lea: 9, 1%, Leb: 72, 7%; P system: P1: 27, 3%.
Conclusion: Phenotyped blood units are used to reduce the immunological risk of transfusion
Keywords: Antigens, phenotype red cell
Predictive values of computerized tomography in the diagnosis of gallbladder carcinoma
Objectives: Our aim was to describe characteristics of gallbladder carcinoma images on computerized tomography (CT) and determine the value of helical CT in the diagnosis of T stage gallbladder carcinoma, compared with pathology and surgery.
Conclusions: Gallbladder carcinoma was commonly located in the body and bottom positions.
The medium size of tumor was 25 mm.
Imaging appearances of gallbladder carcinoma could be categorized into three main groups.
The sensitivity, specificity and accuracy diagnosis of T stage gallbladder carcinoma was high.
Methods: A Cross sectionnal description study was implemented at Cho Ray Hospital and the University Medical Center Ho Chi Minh City.
Inclusion criteria: Patients with computerized tomography contrast, cholecystectomy surgery or surgical biopsy surveillance, and pathology results were identified as gallbladder carcinoma.
The medium size of tumor was 25 ± 11.7 mm.
Images of gallbladder carcinoma could be categorized into three main groups: gallbladder wall thickening 43.5% (20/46), polypoid intralumina 28.3% (13/46), and a large mass within the gallbladder 28.3% (13/46).
After injection of contrast, respondents in the portal vein, the gallbladder wall enhancement in two patterns: The two-layer pattern with a strongly enhancing thick inner layer and a weakly enhancing or nonenhancing outer layer were 80% (16/20), and the one-layer pattern with a heterogeneously enhancing thick layer was 20% (4/20).
Background: Perioperative fasting guidelines recommend oral carbohydrates 2 hours before procedures requiring anesthesia.
Conclusions: Administration of maltodextrin 12.5% 2 hours prior anaesthesia does not cause an increase in gastric volume, even reduces gastric volume lower than volume at 8 hours after fasting.
Keywords: cross-sectional area of the antrum, CSA, fasting, maltodextrin, gastric volume, gastric volume per body weight, maltodextrin, ultrasound
Intaking carbohydrates 2 hours prior to anesthesia caused an increase in gastric volume remains unclear.
We aimed to compare gastric volume in children using ultrasound before and after drinking carbohydrate fluids.
The ratio of residual gastric volume and weight greater than 1.5 ml / kg was also recorded.
Results: The ratio of gastric volume and weight of all 88 patients at 2 hours after intaking maltodextrin 12.5% is 0.6 ± 0.2 ml / kg, lower than after 8 hours of fasting by 0.7 ± 0.2 ml / kg (p <0.001, mean difference 0.06 ml / kg, 95% confidence interval 0.03 - 0.1 ml/kg).
No children had the ratio of residual gastric volume and weight greater than 1.5 ml / kg.
Prevalence of intra-abdominal hypertension in critically ill patients
Objective: To identify the prevalence of intra-abdominal hypertention (IAH) and its risk factors in a mixed population of intensive care patients.
Keywords: Intra-abdominal pressure (IAP), Intra-abdominal hypertension (IAH), Abdominal compartment syndrome (ACS).
Methods: Prospective study - non interventions.
Patients admitted for more than 24 h to ICU or SICU during the 2 years study period.
Intra-abdominal pressure (IAP) was measured three times (every 8 h) by the bladder pressure method.
Data included the demographics, medical or surgical type of admission, SOFA score, etiological factors (such as abdominal surgery, haemoperitoneum, abdominal infection, massive fluid resuscitation) and predisposing conditions (such as hypothermia, acidosis, polytransfusion, coagulopathy, sepsis, liver dysfunction, pneumonia and bacteraemia).
Results: We enrolled 384 patients with the mean age of 61.6 ± 20.6 years, SOFA score of 6.1 ± 3.7.
Mean IAP was 10, 4 ± 4, 8 mmHg (maximum 25 mmHg).
The prevalence of IAH (defined as IAP 12 mmHg or more) was 51% and 3.4% of patients had abdominal compartment syndrome (defined as IAP 20 mmHg or more and organ dysfunction).
Conclusion: This study showed that the prevalence of IAH is quite high. Therefore, IAP needs to be measured routinely in critically ill patients to get valid information about IAH.
Characteristics of candidemia of neonate in childrens hospital 1 from june 2014 to june 2019
Objectives: To determine prevalence of characteristics of pathogen, clinical and laboratory features, treatment outcome of neonatal candidemia in hospital children 1 from June 2014 to June 2019.
Common clinical symptoms were: lethargy (72.2%), poor feeding (52.2%), vomiting (28.9%), tympanites (27.8%), abnormal apnea (27.8%), low temperature (17.8%).
Laboratory abnormalities were leukopenia (18.9%), thrombocytopenia (51.1%), C-reactive protein acceleration (23.3%).
Of the total, 100% were sensitive to Amphotericin B; 92.3% were sensitive to Fluconazole. All fluconazole-resistant cases belonged to the C non-albicans group.
The mortality rate of candida septicemia was 26.7%, in which the mortality rate of C albicans was higher (41.7%) in comparison with that of the C non-albicans group.
Conclusion: C non-albicans species have been the dominant pathogen which increases over time and resistant to anti-fungal agents.
Amphotericin B is more likely to the preferable choice for suspected cases of neonatal candidemia.
Keys word: Candidemia
Methods: Neonates with candidemia diagnosis in hospital children 1 from June 2014 to June 2019.
Retrospective case series study.
Results: There were 90 neonates with candidal septicemia admitted to the Children 1 Hospital from June 2014 to June 2019.
The positivity rate was 5.1% of 1.765 blood cultures.
The number of cases infected with C non-albicans species was higher than those with C albicans (72.2% vs 27.8%).
Of C albicans patients, 87.7% were born preterm (30% preterm; 34.4% very preterm and 23.3% extremely preterm), 80% were low birth weight (29% low birth weight, 29% very low birth weight, and 22% extremely low birth weight).
Risk factors include use of two antibiotics or more (97.8%), administration of parenteral nutrition (90%), central venous catheters (67.8%), endotracheal intubation (55.6%), parenteral nutrition with lipid (38.9%), abdominal operations (28.9%), use of H2 inhibitor (15.5%).
The C non-albicans group had a higher rate of central catheter insertion and a longer time of CVC duration, prolonged duration of parenteral nutrition, a longer time of antibiotics use, longer hospital stay as compared to those of the C albicans group.
A study of her2 heterogeneity in gastric cancer
Introduction: Human epidermal growth factor receptor 2 (HER2) related to the pathogenesis and poor outcome of numerous types of carcinomas, including gastric carcinoma.
No relation was found between HER2 heterogeneity and clinicopathologic parameters.
Keywords: Protein HER2, gastric cancer, immunohistochemistry, gene amplification, fluorescence in situ hybridisation (FISH), silver in situ hybridisation (Dual ISH), Intratumoral heterogeneity
Results and Conclusions: 15.9% (33/208) and 24.5% (51/208) of gastric cancers showed HER2 gene amplification and protein overexpression, respectively.
Intratumoral heterogeneity showed high frequency in diffuse histologic type and in IHC-2+ positive cases.
A case report of thrombotic thrombocytopenic purpura - hemolytic uremic syndrome in adult
Thrombotic thrombocytopenic purpura-hemolytic uremic (TTP) syndrome is rare, 4.5 cases/1000000 per year.
In the past, 93% patients died after having had exact diagnosis.
Nowadays, prognosis of TTP has been improved significant due to positive treatement with plasma exchange, 90% patients being survived.
Biliary stone extraction via t-tube tract using fiber optic choledochoscope
Background: Retained biliary stones remain a common clinical problem in patients after surgery and a challenge for hepatobiliary surgeons.
The most common factors responsible for failure are small, angulated intrahepatic bile ducts and biliary strictures.
Biliary strictures were noticed in 56 patients (28%).
There were no major accidents and complications.
The mean hospital stay was 7 days (6, 97 + 5, 32).
Conclusions: Biliary stone extraction via T-tube tract with electrohydraulic lithotripsy is a safe and efficient procedure for retained biliary stones and intra-hepatic stones with a high complete clearance rate and no major complications.
This is the method of choice for treatment of retained biliary stones in patients with a T-tube in situ.
Objectives: The aim of this study is to evaluate the efficacy of biliary stone extraction via T-tube tract using a flexible fiber optic choledochoscope and electrohydraulic lithotripsy.
Methods: This is a prospective, interventional case series study.
From January 2004 to December 2005, biliary stone extraction via T-tube tract was performed 614 times on 200 patients with retained biliary stones at the University Medical Center of Ho Chi Minh City.
A 5 mm flexible fiber optic choledochoscope was used in accompanied with electrohydraulic lithotripsy.
Results: All of the patients had intrahepatic stones, among them, 62 patients had common bile duct stones.
Each patient had 3, 07 times of stone extraction on average (from 1 to 9 times).
Electrohydraulic lithotripsy was necessary in 135 patients (67, 5%) because of large or impacted stones.
Acute kidney failure in the elderly
Two cases were postrenal azotemia, one due to cervical cancer invading bilateral ureters, and another secondary to chronic hypotonic bladder.
The last four cases were intrarenal failure, including three cases due to toxic (1 fish bile, 1 wasp venom, 1 unknown drug nephrotoxicity), and one case of rapid progressive glomerulonephritis.
The aging kidneys are very sensitive to acute renal failure due to dehydration, changing blood pressure, urinary tract obstruction, drug and toxic agents.
To describe the clinical and laboratory characteristics, the course of acute renal failure in 10 elderly patients (over 60) who were successfully diagnosed and treated in the Nephrology Ward, Cho Ray Hospital.
Case series.
In 10 patients with acute renal failure, only 3 had oliguria while other 7 non-oliguria.
Four of 10 patients had history of chronic kidney disease with chronic kidney failure.
Background: Dyslipidemia, a kind of metabolism disease, is a main risk factor of arteriosclerotic cardiovascular disease.
These patients must have one of these criterions: Total Cholesterol ≥ 200mg / dl (5.2 mmol / l), LDL-c: 100 - 189mg / dL (2.6 - 4.9 mmol / L), Triglycerid 150 - 500mg / dL (1.7 - 5.7 mmol/L).
The study monitored and evaluated these values: total cholesterol, Triglycerid, LDL-c, HDL-c, SGOT, SGPT, Bun, Creatinin after 6 weeks of treatment to identify the capsule's safety and lipidemia lowering effect.
Results: The "Bo Khi hoat huyet" hard capsule was showed safe and well tolerated on healthy people.
Appropriate dose for patients is 4 - 12 capsules per day.
No side effects recorded.
Conclusion: The "Bo khi hoat huyet" hard capsule has the effects of reducing total cholesterol, LDL-c after 6 weeks of treatment and can be used safely.
Keywords: "Bo khi hoat huyet" hard capsule, lipidemia lowering effect.
Many researches presented that lipidemia lowering medicines help decreasing the risk of coronary heart disease, the mortality rate of cardiovascular disease, and contribute into atherosclerosis regression.
A number of researches have proved lipidemia modulating effect of medicinal plants.
This study is to define the safety and lipid lowering effect in normal and lipidemia patients.
Aims of the study: To determine the lipidemia lowering effect of the "Bo khi hoat huyet" hard capsule.
Phase 2: clinical trial with control group, randomized distribution.
Depending on the appropriate dose and safety of capsule determined in phase 1, phase 2 was performed on 51 volunteer - dyslipidemia patients; including 26 patients in studying group treated with "Bo khi hoat huyet" capsule accompanied with the diet and exercise, 25 patients in control group treated with diet and exercise only.
Objective: 4 different risk categories of minimal residual disease (MRD) in acute leukemias mainly rely on the immunophenotypic aberrancies or leukemia-associated phenotypes (LAP) observed at diagnosing and following time point. Method: Cohort - descriptive research.
From April to December 2010, we used many fluorescence monoclonal antibodies and 4 - 5 immunostaining combinations to analyse 59 samples after induction treatment on FACS Canto II with Diva software at Blood Transfusion and Hematology Hospital.
Results: Based on 4 MRD levels, of 43 patients with B-ALL: 48, 8% at the low risk (0, 01% - <0, 1% cells), 41, 9% at the intermediate risk (0, 1% - <1% cells) and 3 pateints relapsed after 4 follow-up months; of 16 pateints with AML: 68.8% at intermediate risk.
Common LAPs are cross-lineage and asynchronous antigen expressions. Conclusion: Flow cytometry can distinguish the malignant from regeneration of the normal blasts in bone marrow samples which morphology can't detect.
Introduction: Disseminated strongyloidiasis is a common manifestation in patients on immunosuppressive drugs.
Results: Stool examination and serology analysis are possitive for Strongyloides stercoralis.
The remission after treatment of Strongyloides infection strongly suggests the diagnosis of disseminated strongyloidiasis in this patient.
Conclusions: Untreated Strongyloidiasis is a contraindication for immunosuppressive drugs to prevent the complication of disseminated strongyloidiasis.
Research the diagnosis value of ultrasound, doppler and bio-chemical makers in ovarian cancer
Objective: To determine the value of ultrasound, Doppler and bio-chemical makers in diagnosis ovarian cancer. Method: A descriptive cross-sectional study 209 patients with ovarian mass including 26 patients with ovarian cancer and 183 patients with benign ovarian tumor. Result: The tumor papillary projection was worth prediction ovarian cancer than the septal structure.
The sensitivity and specificity of Tokyo classification of ovarian ultrasound were 85.6% and 92.9%.
The ovarian tumor with high vascularity had high risk of malignancy, OR = 50, 8.
PI < 1.01, the sensitivity was 91.3%, the sepecificity was 87, 5%.
CA 125 > 60 UI / mL was a worth bio-chemical makers to predict ovarian cancer, the sensitivity was 96.2%, the specificity was 94.0%. Conclusion: Combine ultrasound, Doppler with bio-chemical maker to increase the accurate diagnosis of ovarian cancer.
The diagnosis and the treatment of intestinal tuberculosisin pulmonary tuberculosis patients
Objective: to determine the diagnosis and treatment of internal tuberculosis in pulmonary tuberculosis patients Method: analytical crossed sectional study Results: From 01/2003 to 12/2006, 48 cases of intestinal tuberculosis in pulmonary tuberculosis patients (41 male and 7 female patients).
There were 9.09% of positive AFB smear and 40.91% of positive BK culture in faece.
Alternatively, 48 cases had lesions on the chest X-rays, especially in nodullar infiltration (77.08%), unilateral lung more than bilateral lung (70.83% versus 29.17%).
Positive AFB sputum smear was low (12.5%); 81.25% of cases had positive tuberculin test; WBC level was high (56.25%); and the sedimentation increased in average level.
After a 6 - 9 month antituberculosis therapy, all of cases had been successful.
Conclusion: Determination of diagnosis of internal tuberculosis was correctlly and early due to treat antituberculosis drugs timely in pulmonary tuberculosis patients
The average age was 40.3 (range, 27 to 63).
Most of them had the incident time over 1 month (89.58%), and had been treated many times in surgical wards or intestinal wards previously.
All cases had digestive troubles (abdominal pain, diarrhea, and / or constipation); 64.58% of palpable massess in the right iliac fossa; 87.5% of positive Koenig's signs; and 5 cases of fistula in the right iliac fossa.
Many cases had respiratory symptoms (chest pain, cough...).
On the orther hand, there were mainly tuberculous lesions in ileocecal area (87.5%) on the colonic radiography with barium, often Stierlin's sign, lumen stenosis and ulcerative form.
Abdominal echo also showed ileocecal hypertrophy, mass in the right iliac fossa, and adenopathy (87.5%; 70.33% và 35.42%).
On gross pathologic examination, they were the ulcerative forms (31.25%); fibrous hypertrophic forms (35.42%) and ulcerohypertrophic forms (33.33%).
About pathologic results of biopsies, they were tuberculous lesions (58.33%).
Early results of spinal infection treatment at neurosurgery department – nguyen tri phuong hospital
Background: Spinal infections are rare pathology but are an important clinical problem that often require aggressive medical therapy, and sometimes even surgery.
The most common bacterium isolated was Staphylococcus aureus (S aureus).
The first choice of antibiotics was ceftazidim and vancomycin.
The mean duration of antibiotic perfusions was 28.7 days.
Conclusion: Antibiotic therapy is required effectively and appropriate durations.
aureus is common bacterium isolated.
Most cases were managed medically.
Some cases were operated with indications of spinal decompression or failed medical treatments.
Known risk factors are advanced age, diabetes mellitus, immunosuppression, previous surgical procedures involving or adjacent to the intervertebral disc space.
The most common level of involvement is at the lumbar spine, followed by the thoracic, cervical and sacral levels: lesions at the thoracic spine tend to lead more frequently to neurological symptoms.
Objectives: To analyze the bacteriology, clinical manifestations, management and images of spinal infections.
Methods: Retrospective review of 41 patients who had spinal infections and were managed medically and surgically from Mar. 2011 - Dec. 2015.
Experience managing some cases having placenta percreta with bladder invasion and previous cesarean section
Objective: To withdraw key experiences when caring for pre-operations and management in operations in old incision patients having placenta percreta with bladder invasion for reducing blood loss, lowering complication rate and mortality mother. Methodology: Retrospective, clusters described study in 5 years (1/2006 - 12/2010). Results: the study showed that the average times of cesarean section was 1.25; second cesarean section was 25%, vaginal bleeding and hematuria were 50%.
Most massive blood loss met at the time of removing the placenta (5000ml and 7500ml), 100% were having old incision and placenta previa, a case of stillbirth, gestational age over 35 weeks accounted for 100%, good Apgar scores, good birth weight 87.50%, maternal deaths 0%. Conclusion: carefully evaluation and fully preparation in pre-operation, multidiscipline consultations at intervention of termination of pregnancy as well as appropriate surgical techniques are the most important steps to reduce blood loss during surgery, to reduce complications and maternal mortality.
Objectives: Herbal products are widely used in Vietnam. Most of them have been approved in prevention and treatment of diseases by traditional experiences.
Conclusions: Two herbal products were found to have the hypnotic activity.
The intermediate (3 years) and short term outcomes of percutateous coronary intervention as opposed to medical approaches in the treatment of acute myocardal infarction in patients ≥ and < 65 years old
Background: Elderly patients with myocardial infarction (AMI) often have co-morbid conditions and therefore are treated with conservatively medical approach more frequently than non-elderly patients.
The overall mortality of the research patients after discharge is 12%.
Of these, the group treated with PCI had the mortality of 3.1% (n=6), much less than group only treated medically (18.4%, n=50), p<0.001.
When comparing the only-treated-medically approach and PCI in 2 groups, we observed that group < 65 years old when treated with medical approach and PCI had the mortality of 13.1% and 1.04% respectively (p<0.001); the group ≥ 65 years old when treated with the medical approach and PCI had the motility of 19.9% and 6.1% respectively, p<0.001.
The patients <65 years old and treated with PCI had a decrease in mortality of 82% compared with those <65 years old and treated medically with HR=0.18; 95% CI (0.08 - 0.41), p<0.001.
The patients ≥65 years old and only treated medically have fatal risk 2.64 times greater than the patients <65 years old and only treated medically, p=0.03.
The patients ≥ 65 years old and treated with PCI had a decrease in mortality of 53% compared with those < 65 years old and only treated medically, p=0.29.
When following up after 36 months, the mortality in group ≥ 65 years old is higher than group < 65 years old with mortality at 6 months (18.8% compared with 0% respectively), at 12 months (11.1% compared with 2.9%), 24 months (14.7% compared with 2.2%), and 36 months (19.7% compared with 7.4%).
Conclusions: The short term and intermediate term mortality of the group of patients ≥ 65 years old with AMI treated with a conservatively medical approach was higher than those < 65 years old.
The PCI approach decreased the risk of death compared with the medical approach in both the groups ≥ 65 years old and < 65 years old.
Reperfusion via PCI can be performed with elderly patients.
Whether there is any difference in mortality between percutaneous coronary intervention (PCI) and medical approach in patients ≥ and < 65 years old is still not clear.
Keywords: Short term and intermediate term outcome, AMI, PCI, conservatively medical approach, elderly.
Objective: To assess the short term and intermediate term (3 years) outcomes of invasive reperfusion (PCI) and conservatively medical approaches in AMI treatment of 2 patient groups, those ≥ and those < 65 years old.
Subjects and research method: From February 2009 to July 2012, we enrolled 467 in-patients with AMI treated at Cardiovascular ICU and Interventional Unit of Ho Chi Minh city's Thong Nhat Hospital.
The patients were categorized into 2 groups: the group ≥ 65 years old (elderly group) comprised 310 patients (66.38%), group < 65 years old (non-elderly group) comprised 157 patients (33.62%).
This is the cohort, prospective research.
Results: Patients in group ≥ 65 years old received the conservatively medical approach much more frequently than the group < 65 years old (48.1% compared with 22.9%, p<0.001).
Conversely, patients in group < 65 years old had the PCI more frequently than group ≥ 65 years old (71.4% compared with 49.3%, p<0.001).
In addition, Coronary artery bypass grafting (CABG) rate in the group < 65 years old was also higher than those in group ≥ 65 years old (5.7% compared with 2.6%, p=0.15).
Research of the wound infection at the general surgery department of university medical center
Introduction: Surgical wound infection was one of common complications at all hospitals.
Conclusion: Surgical wound infection rate at the General Departmet was 3% in general.
The wound infection rates was related to: open surgery or laparoscopic surgery, diabetes group, clean or clean-cantaminated operations, type of gauze.
The rate of wound infection in diabetes group was 21%. and without diabetes was 2%, group patients cared in hospitals 10%, nursing Health Center 1%, or at their home by a nurse 11%. The rate of wound infection in patients using sterile gauze and Urgo steril was orderly 6% and 0%.
The incidence and related factors of surgical site infection following cesarean section at tu du hospital
Background: In the Centers for Disease Control (CDC) definition, surgical site infection (SSI) is an infection at or near the incision that occurs within 30 days after surgery.
Average time of SSI was 7 ± 2.3 days, 46.2% of SSI was detected during hospitalization and 53.8% of SSI occurred after discharge.
Factors associated with SSI included: rupture of membranes over 12 hours, (OR = 21.7, 95% CI 4.56 - 9.14, p <0.05); Operation duration was 60 minutes or more, (OR = 3.7, 95% CI 3.25 - 11.4, p <0.05); previous caesarean section was adhesive (OR = 13.4, 95% CI 2.57 - 8.34, p <0.05); Blood loss ≥ 1000ml during surgery (OR = 6.6, 95% CI 4.7 - 23.5, p <0.05).
Conclusion: Surgical site infection following caesarean section is common.
Identification of risk factors for SSI after CS is important for targeted implementation of quality improvement measures and infection control interventions.
Keywords: cesarean section; surgical site infection
Every year, there are about 28, 000 cases of caesarean section in Tu Du hospital, the statistical reports of hospitals so far only counted cases of SSI occurred during hospitalization, so this is only the floating of the iceberg because there are cases of SSI occurred after discharge but not yet statistics.
Therefore, we conducted the topic "The incidence and related factors of surgical site infection following cesarean section at Tu Du hospital" to properly receive the SSI situation, contributing to prevention strategies of SSI for women post CS.
Objective: This study was conducted with the aim to determine the incidence and risk factor associated with surgical site infection (SSI) following cesarean section.
Method: This was a prospective cohort study in women undergoing CD in the studied period.
SSIs were defined by Centers for Disease Control (CDC) criteria.
The follow-up lasted 30 days to evaluate clinical data of infection.
Patients' socio-demographic, clinical data and incidence of SSI following the CS were noted using a standardized data collection form.
Ec-ic bypass
Objective: Moyamoya disease (MMD) is a rare cerebrovascular disease mainly described in the Asian literature. To address a lack of data on clinical characteristics and long-term outcomes in the treatment of MMD in Vietnam.
Conclusion: Revascularization surgery in patients with MMD carries a low risk, is effective at preventing future ischemic events, as well as future strokes and improves quality of life.
Patients in whom symptomatic MMD is diagnosed should be offered revascularization surgery.
MMD (Moyamoya disease), EC-IC bypass (Extracranial-Intracranial bypass) Keywords: MMD (Moyamoya disease), EC-IC bypass (Extracranial-Intracranial bypass).
The authors analyzed their experience at Cho Ray hospital, Hochiminh city, Vietnam.
They report on a consecutive series of patients treated for MMD and detail their demographics, clinical characteristics, and long-term surgical outcomes.
Methods: Data obtained in consecutive series of 12 patients with MMD treated microsurgical between 2009 and 2012 were analyzed.
Demographic, clinical, and surgical data were prospectively gathered and neurological outcomes assessed in postoperative follow-up.
Results: The author treated a total of 12 adult patients undergoing 12 procedures (mean age 39.6 years). Direct revascularization technique was used in 100% of adults.
In 12 patients undergoing 12 procedures (mean follow-up 1.8 years), the surgical morbidity and mortality rate was 0%. The cumulative 4-year risk of perioperative or subsequent stroke or death was 0%.
Overall, there was a significant improvement in quality of life.
Some factors leading to customers’ word violence to nurses at clinical departments, vietnam national children’s hospital
Objective: To investigate some factors affecting customers' word violence to nurses at clinical departments, Vietnam National Children's Hosptal in 2017.
Methodology: A cross-sectional study is conducted on 300 nurses of clinical departments.
Conclusion: Features of nurses including working experience, qualification, department, not on duty, bad relationship with customers are risk factors of customers' word violence to nurses.
Keywords: Factors affecting, word violence, customers, nurses.
The application of endoscopic surgery in the management of sinonasal diseases in baoloc hospital
Most of the patients have got complete symptomatic relief.
After operating 3 month we met 4.3% refractory rhinosinusitis and 2.9% recurrent polyps in the nose.
Conclusion: It was concluded that endoscopic surgery has provided a safe and efficient method for dealing with different sinonasal disease and can be performed with high success rate for alleviation of symptoms with negligible morbidity.
Keywords: endoscopic surgery, sinonasal diseases
The main technique of surgery applied minimum functional endoscopic sinus surgery (miniFESS) and functional endoscopic sinus surgery (FESS).
Although there were 18.4% bleeding that we had to pause operating for hemostatic, but no case was fatally serious because of bleeding.
No major complications like CSF leak, retro orbital hemorrhage, diplopia and blindness were noted.
Objectives: Recently, overweight and obesity prevalence has increased dramatically due to economic development and urbanization.
The prevalences of nine traditional medicine patern are Phlegm-dampness (27.08%), Qi-deficiency (24.31%), Yin-deficiency (18.75%), Qi-depression (11.81%), Yang-deficiency (8.68%), Blood-stasis (6.94%), Inherited-special (1.74%), Dampness-heat (0.69%) and Neutral (0%).
Conclusion: Among overweight and obese patients at Dong Thap Traditional Medicine Hospital, hypertension (86.81%) and stroke (59.72%) are most common comorbidities.
Phlegm-dampness (27.08%) and Qi-deficiency (24.38%) are the majority in traditional medicine parterns.
Keywords: overweight, obesity, traditional medicine parterns, chronic diseases
In Vietnam, 25% of adults are overweight or obese.
Obesity is the leading preventable cause of death worldwide, which is related to multiple chronic diseases such as cardiovascular diseases, diabetes, certain types of cancer and osteoarthritis.
However, in Traditional Chinese Medicine, such conditions were not well debribed. In this study, we aim to examin the traditional medicine paterns of overweight and obesity for guiding diagnosis and treatment.
The present study was conducted to determine the proportion of comorbidities and nine tradional medicine paterns observed in patients with overweight or obese at Dong Thap Traditional Medicine Hospital.
Materials and Methods: 288 patients aged over 18 years having overweight - obese and other chronic diseases at Dong Thap Traditional Medicine Hospital were examined.
The parterns were classified by the CCMQ table (by China Association for Traditional Chinese Medicine).
Objectives: Total parenteral nutrition (TPN) as a traditional mode of treatment in severe acute pancreatitis was still used widely in clinical work.
Total complications (infection, local or systemic complication of pancreas, death) and laboratory findings (CRP, serum lipase) were no difference in the outcome measures.
The cost of nutritional support and hospitalized day were lower and shorter in patients who received nasogastric feeding.
Conclusion: This study suggests that early nasogasrtic feeding should be used preferentially in patients with severe acute pancreatitis.
Keywords: severe acute pancreatitis, nasogastric feeding, total parenteral nutrition.
In addition, enteral nutrition treatment methods have developed; early gastric feeding has already been highlighted for severe acute pancreatitis, but the therapeutic risks versus benefits need to be studied.
A semi-elemental diet is infused by gravity nutrition bag with 10 - 50 drops per minute.
Safety was assessed by condition ofabdominal pain, and tolerance, laboratory findings (CRP, serum Lipase) and incidence of complications.
Efficacy was determined by improvement of clinical course.
Background: Kidney transplantaion is a efficate procedure and recovered the qualitiy of life for the ESRD patients.
ED on 18 pts The Immunosupression therapy and ED is nonsignificant (p>0.05).
The sex-hormone level is nondifferent between two group (p>0.05).
Results of 25 photographs of the erectile penis taken by 25 pts themseves showed 21/25 penis (84%) were straight, 2 (8%) right offset, 2 (8%) left offset, but all of angles were not higher than 30 degrees.
All of patients have declared that their erectile penis can introduce in the vagina. Dicussions and conclusions: Kidney transplantation improve the erectile function.
The ED were 33% of patient after transplantation.
The end to end anastomosis of the graft artery and hypogastric artery is an easier skill but we have to suture and cut the hypogatric artery.
The objective of this report is evaluate the ED and the curvature of penis on patient who has got a hypogatric anastomosis in kidney transplantaion.
Patients and Methods: A csross section study.
Inclusion criteria: patients (pts) with a kidneytransplantaion using a hypogastric arterial anastomosis, agread cooperative with the research.
Situations and sohetions for medical students who don't want to accede the youth hochiminh communist
The Communist youth union in HCM Universities play an important role in helping the staffs manage the political and mental education in students, keep security in Universities and dormitories, and are the volunteers in learning and teaching, artistical and physical movemcnts, social works and in introducing good menbers of the Union to the communist party.
Some young students in University of Medical sciences and other universities; however, haven't had any favor being a youth menber aspecially in open economy period; therefore; the main aim of this topic is finding the cause and the solution of the problem involving students' reluctancy to join the youth union.
Therapeutic effect of oral zinc supplementation in children with persistent diarrhea hospitalized in children hospital n2
The objective of the study is to evaluate the benefit of zinc supplementation in treatment of persistent diarrhea.
In conclusion, oral zinc supplementation for subgroup of persistent diarrheal children with low serum zinc level, or with wasted situation significantly reduces duration of illness and increases the weight gain.
A randomized controlled study was carried out on 71 children with persistent diarrhea hospitalized in Children Hospital N2 from 3/1999 to 3/2001.
Thirty - five children recruited in the zinc supplement group were given zinc gluconate (3mg / kg / day zinc element) and 36 children in control group.
The two groups were similar at baseline with regards to characteristics of the severity, the duration, the age, the nutrition status, serum zinc, plasma protein.
Supplemented children had a significant improvement in serum zinc levels in comparison with controls (p<0.001).
There was no difference in weight gain and duration of illness between supplemented and controls.
Among the subset of children with serum zinc levels <60 m g / dl at admission, supplemented children had a better weight gain (p<0.05) and shorter duration of treatment (p<0.01) as compared to controls.
Among the wasted children, there was a significant reduction in the duration of treatment (p<0.05).
The increase in serum zinc levels after treatment were negatively correlated with serum zinc levels at admission.
Objective: The goal of this study was to define the epidemiology of head injury in pediatric.
Keywords: Pediatric head trauma, traffic accident, abuse.
Methods: Descriptive research in 341 children, who was addmitted with head injury diagnosis at Children Hospital 2, from April 01, 2015 to July, 2016.
Results: Incidence of head injury was 58% in < 6 year old.
Boy was 58.7% and girl was 41.3%.
Fall was 48.97%, traffic accident was 44.87%.
Incidence of surgery was 22.3%, uncomplicated incidence was 94.1%, mobidity rate was 3, 2%.
Motarlity rate was 2.6%.
Sarcopenia prevalence and related factors in hospitalized elderly with cardiovascular disease
Background: Sarcopenia is a condition characterized by loss of skeletal muscle mass and function, which is a high risk predisposition for health disabilities such as falls, disability, increased hospitalizations and even death.
> 80 years, chronic kidney disease, diabetes, and BMI < 19 were factors associated with higher sarcopenia rate.
Dyslipidemia was associated with lower sarcopenia rate.
Keywords: sarcopenia, elderly, cardiovascular disease, hospitalization
However, research on this syndrome with cardiovascular disease has not been done in Vietnam.
Objectives: To survey sarcopenia prevalence and related factors in the hospitalized elderly with cardiovascular disease (including heart failure, coronary artery disease, post cardiac surgery such as coronary artery bypass graft, mitral and aortic valve replacement) in Thong Nhat Hospital, Ho Chi Minh City.
Results: The overall sarcopenia prevalence was 33.3%, with average age 73.6 ± 8.3 years.
The prevalence rates of sarcopenia across diagnostic categories were as follows: heart failure, 43.6%; coronary artery disease 30.3% and post - cardiac surgery 22.2%.
Factors were associated with higher sarcopenia include: diabetes (OR=3.1; CI 95%: 1.3 - 7.1; p < 0.01), chronic kidney disease (OR = 4.3; CI 95%: 1.4 - 13.1; p = 0.011), > 80 years (OR = 3.1; CI 95%: 1.3 - 7.5; p = 0.01) and BMI < 19 (OR = 12.9; CI 95%: 3.3 - 50.4; p < 0.01).
Meanwhile dyslipidemia was associated with lower sarcopenia rate (OR = 0.4; CI 95%: 0.15 - 0.8; p=0.017).
Conclusions: Sarcopenia prevalence in elderly patients with cardiovascular disease was 33.3%.
Investigation of the chemical components of thespesia populnea l. leaves
Objective: The aim of the study was to isolate some main compounds from Thespesia populnea leaves for using in control purposes of medicinal plants and in bioassays.
The compounds were isolated from the ethyl acetate fraction using vacuum liquid chromatography and normal column chromatography.
Structure elucidations of isolated compounds were based on data of UV, MS and NMR spectra.
Results: Four phenolic compounds (TH1, TH2, TH3 and TH4) were isolated from the ethyl acetate extract.
The isolated compounds were identified to be luteolin-7-O-bD-glucopyranoside (cynaroside, 78.45 mg), epicatechin (51.08 mg), luteolin (3.76 mg), and trans-tiliroside (4.62 mg), respectively.
Conclusion: The isolated compounds can be standardised for using as standard references for qualitative and quantitative analyses of Thespesia populnea leaves and for bioassays.
Keywords: luteolin, luteolin-7-O-bD-glucopyranoside, cynaroside, epicatechin, trans-tiliroside
Characteristics of chldren with portal hypertension at childrens hospital 2
Objectives: Describe demographic, clinical and laboratory characteristics, treatment, causes of portal hypertension in children.
Conclusion: Variceal bleeding is the commonest complications of portal hypertension.
Prophylaxis of variceal bleeding include pharmacologic treatment, endoscopy and surgery.
Methods: Case series study.
Results: A total of 68 cases had criteria enough to participate the study.
Most of cases aged ≥2 years old (42.6%).
Clinical findings: splenomegaly (92.6%), dilated abdominal veins (61.8%), ascites (52.9%), upper gastrointestinal bleeding (41.2%).
Laboratory findings: 42.6% thrombocytopenia; 63.3% abnormal liver function tests, gastrointestinal endoscopy show esophageal varices 17.6%.
Prehepatic causes (19.1%) include 13 cases extrahepatic portal venous obstruction.
Intrahepatic were the most common causes (77.9%) with 53 cases cirrhosis.
Magnetic resonance imaging of spinal cord arteriovenous malformation
Background: Spinal arteriovenous malformations are rate disorders.
Mean age 38.46 years, male: female= 3: 1, thoracic level predominated 422.55%.
MRI finding included: Flow voidds 100%, Nidus 31.91%, blood vessel dilated 85.11%, swelling 87.23%, spinal cord expansion 44.68%, haemorrhage 21.28%.
Flow voids was noted in 47 patients (100%), Nidus was most predominant in type 2 - 3 (76.47%) (p<0.01).
Evaluation with TWIST: There were 14 patients with TWIST, the feeding artery was seen in 9 patients (64.29%) and there was only singel feeding artery.
TWIST identified amount of the feeding artery in 5/9 patients (55.56%), the level of the feeding artery in 6/9 patients (60%) with a 1 level difference on DSA (r: 0.934, p<0.01).
Conclusions: there are significant difference in the clinico - radiological distinguishing features in various types of AVMs: Age, spinal cord expansion, haemorrhage, Nidus sign.
If not detected and treated, these lesions cause myelopathy.
Objective: To identify radiological features of spinal arteriovenous malformations (AVMs).
Materials and Methods: Retrospective studies described case series of patients confirmed AVMs by MRI (Magnetic resonance imaging) and DSA (Digital subtraction angiography) in university medical center, Chợ Rẫy hospital between January 2011 and March 2018.
Efficacy and safety of endoscopic mucosal resection in treatment of non-pedunculated gastric and colorectal polyps
Objectives: To assess the initial results of endoscopic mucosal resection (EMR) in treatment of non-pedunculated gastric and colorectal polyps.
Method: This is a case series study of 43 patients.
Results: There were 12 males and 31 females with mean age 51.
Of them, there were 4 cases of hyperplastic polyps, 29 cases of tubular polyps, 10 cases of low grade dysplasia in the stomach and colorectum.
Mean time of healing ulcer after EMR was 9.8 ± 3.5 days.
There were no complications such as perforation or bleeding and no remained polyps during 4 weeks follow-up.
Conclusion: Our study shows that EMR can be used effective and safe in treatment of non-pedunculated polyps and early cancers of stomach and colorectum.
Keywords: Endoscopic mucosal resection (EMR), non-pedunculated gastrointestinal polyp, gastric polyp, colorectal polyp.
Clinical findings and treatment primary malignant tumors of the appendix
Background: Primary malignant tumors of the appendix are very rare, found in 0.5% of appendicitis.
There were two recurrent mucinous adenocarcinoma cases need re-operation.
There was only one case had postoperative chemotherapy.
Conclusions: Primary malignant tumors of the appendix are rare, and almost are diagnosed by anapathological result.
My study specially emphasizes in early diagnosis, adequate treatment, and postoperative re-examination.
They are usually diagnosed at the time of appendectomy or based on anapathological result, and sometimes they can perforate, lead to localized abscess.
In Vietnam, there are a few studies of this disease.
The aim of the study: to report our early results in diagnosis and treatment of primary malignant tumors of the appendix.
All were confirmed by anapathological results.
Fifty percent of cases were mucinous adenocarcinoma and 50% were adenocarcinoma.
Study on payment ability of medical cost of people in district 2, district 4 and tan phu district, ho chi minh city
Background: Evaluation ability to pay medical expenses of people is essential to help health managers have information to determine the cost of health care services.
Objectives: To identify payment ability of medical cost of people in district 2, district 4 and Tan Phu district, Ho Chi Minh city for the year of 2015 Methods: Qualitative study was conducted deep interviews and focus group discussion sessions based on the semi-structural questionnaire with purposely selected sample.
Results: Most of the participants involved in the research said that the cost of health care is relatively consistent.
The patient can afford to pay the cost of health care catastrophe from several thousand Vietnam dong to 2 million Vietnam dong per course of treatment.
The cost treatment of patients with health insurance are often much lower than patients used service.
Conclusion: The need of using household doctor services is quite large and the hospitals need to communicate to people so that they have opportunities to better health care and contribute to limit overcrowding problem in hospitals.
Keywords: affordability, medical costs, health economics
Evaluation of autonomic dysfunction in patients with parkinson’s disease
Results: Abnormal autonomic function tests were found in the range of 8.3% - 55%, the highest frequency of abnormality was observed in blood pressure response to isometric exercise.
The severity of autonomic dysfunction showed significant correlation with Hoen & Yahr stage (p = 0.001) and part III of UPDRS (Pearson's correlation coefficient = 0.537, p < 0.001).
Conclusions: The results of this study showed mild abnormalities of both sympathetic and parasympathetic function in patients with Parkinson's disease.
Autonomic dysfunction increased in severity with disease progression.
Keywords: Parkinson's disease, autonomic function test, sympathetic function, parasympathetic function.
Objective: To characterise the frequency and severity of autonomic dysfunction in patients with Parkinson's disease; to find the correlation between the degree of autonomic deficits and the severity of Parkinson's disease.
Methods: This was a cross-sectional study, including 60 patients with Parkinson's disease in International Neurosurgery Hospital, from Sep 2013 to Jun 2014.
The diagnosis of Parkinson's disease was verified using the UK Parkinson's Disease Society Brain Bank clinical criteria.
In this study, parasympathetic autonomic function was evaluated by the heart rate response to standing (30: 15 ratio) and heart rate variability with deep breathing.
Sympathetic autonomic function was evaluated by the sympathetic skin response, blood pressure response to standing, blood pressure response to isometric exercise (sustained handgrip) and cold pressor test.
Percutaneous nephrolithotomy for recurrent renal stones
Keywords: Percutaneous nephrolithotomy (PNL), Recurrent renal stones, Second look
Clinical and laboratory characters of 57 chronic pleural effusions with tuberculosis and cancer diagnoseđ by fibrotic thoracoscopy
Among 57 cases of chronic pleural effusion (18 tuberculous cases and 39 all kinds of cancer) had been diagnosed by fiber thoracoscopy biopsy, we had detected some different clinical features between tuberculous and malignant pleural effusions: the malignant pleural effusions usually occurred in over 40-year-old patients with mediastinal syndromes and clubing fingers (Se=8-l0%, SP=100%).
Keywords: pleural effusion, tuberculosis, cancer, thoracoscopy
Background: Stress, anxiety, depression are common mental illnesses in life.
Keywords: stress, anxiety, depression, DASS-21, Hau Giang
Some previous researches in Vietnam and around the world showed that those disorders among students are relatively high.
Therefore, it is essential to determine all students mental health status at Vi Thanh high school for the gifted. Based on that, we can offer the most suitable backup solutions.
Characteristics of epidemiology, clinical history, laboratory on the hemophilia and von willebrand patients at blood transfusion hematology hospital in ho chi minh city
Data showed that almost patients had moderate severity (63.51% of Hemophilia A and 61.54% of Hemophilia B).
The most complication were damage to joints and muscles if not be diagnosed and treated appropriately. Therefore, it is necessary to understand the characteristics of Hemophilia and Von Willebrand for early diagnosis and treatment so that the patients' quality of life can be improved.
Keywords: Hemophilia, von Willebrand, epidemiology, clinical history, laboratory.
Results: There were 174 Hemophilia patients (98.86%) and 2 Von Willebrand patients (1.14%).
Most of patients admitted to hospital were over 16 years old (55.75%), (Hemophilia A and B accounted for 52.7% and 73.07%).
Hemophilia A was more common than Hemophilia B (85.05% compared to 14.95%).
The distribution of Hemophilia patients was broad, including most provinces of Central Coast, Central Highlands and Southern regions.
Ho Chi Minh city had the highest number of patients (37.35%).
Proportion of cases with family history of Hemophilia was 54.55%.
Most of bleeding episodes occurred spontaneously (62.84% in Hemophila A, 61.54% in Hemophila B and 100% in Von Willebrand).
Objective: Compare effect of ventilation and stableness about hemokinesis indexes between methods PLMA and tracheal tube.
Methods: Prospective and compare with control.
Sample size were 114 patients from 18 years old and over, and following standard of ASA I, II.
Sample size divided randomly into two groups: PLMA and endotracheal tube (group PLMA used size 3 or 4 and group endotracheal tube used size 7 - 7.5).
Data collection comprised of pulses, systolic blood pressure, and diastolic blood pressure, air way pressure, SpO2 and ETCO2 complications within and after anaesthetize.
Results: The parameters about ventilation and hemokinesis indexes within anaesthetize between PLMA and endotracheal tube included SpO2 were 99.94 ± 0.22% and 99.98 ± 0.13%;
Conclusion: There was no difference about ventilation and stableness of hemokinesis indexes as well as complications between group PLMA and endotracheal tube.
A study on anatomy of the left cỉrcumflex artery
Introduction: The coronary arteries disease (CAD) is one of the major causes of death in developed countries and is increasing in developing countries.
Conclusion: The LC xusually originates from the LMCA, somtimes from the Aorte.
It mightend at the anterior surface of the left ventricular, at the left margin, between the left margin and the Crux, or at the Crux.
It gave the branches to left ventricular and left atrium, such as the anterior left ventricular branches, the left marginal branches, the posterior left ventricular branches, the posterior interventricular branches, the posterior right ventricular branches, the left atrial branches.
Keywords: main left coronary artery, circumflex artery, anterior interventricular artery, left marginal branch, Crux.
The knowledge of anatomy of coronary arteries is essential in the diagnostic and treatment procedures of CAD.
Objective: To study the anatomical characteristics of the Left Circumflex Artery (LCx).
Materials and methods: 125 hearts of 125 cadavers preseved in formalin solution in department of Anatomy, the University of Medicine and Pharmacy at HCM city.
Results: In 125 specimens studied, the LCx was absent in 4 specimens, accouting to 3.2%.
Most LCx originate from the Left Main Coronary Artery (LMCA), only 0.8% originate from the Aorta.
The mean outer diameter at the origin of the LCx was 3.33±0.67 mm.
The LC xended at the left boder in 46.28% of the specimens; between the left border and the Crux in 45.46%; at the anterior surface of the left ventricular in 4.13%, and at the Crux in 4.13% of thespecimens.
97.52% of the specimens had the anterior left ventricular branches; 100% had the left marginal branches; 20.66% had the posterior left ventricular; 4.13% had the posterior interventricular branch; and 0.83% had the posterior right ventricular branhces.
Evaluation of twelve years of postoperative pain management in pediatric hospital 2
Objectives: Evaluate the efficacy and safety of the pain managements performed at the Pediatric Hospital 2 over 12 years.
Conclusion: The analgesic combination with Morphine and the combination of epidural and GA were significant and safe for children undergoing major surgeries.
To have the effective pain management, pain assessment, early pain control, maintenance of a quality continous formation and developement of pain department are the goals in progress.
Methods: retrospective, descriptive and analystic study Results: From Jun 1996 to Oct 2007 we performed 8 studies of postoperative pain management in 961 children ASA I - III.
Nalbuphine or Morphine was used for infants older than 6 months, IV or infusion in 48 hours.
Regional anesthesia, caudal or continous epidural in 24 - 48 hours were performed for infants older than 1 month with Bupivacaine alone either added to Morphine, or Fentanyl or Clonidine.
The side effects of epidural technique and drugs: pierced epidural, nausea - vomiting, prurity, and hypotension were much fewer than in literature.
There were no cases of respiratory distress or catheter infection.
Postoperative care for treatment of penile carcinoma in can tho general central hospital
We observed as following: Penectomy associated with bilateral inguinal lymphadenectomy were principle surgical treatment 27 cases (75%), YOUNG's operation 04 cases (11, 1%) and simple penectomy 05 cases (13, 9%) of old age and chronic deseases. In general, postoperative complication rate is 50%, including hemorrhage 2, 7%, woud infection 5, 6%, skin flap necrosis 13, 7%, wound broken 19, 7%, lymph accumulation 5, 6%, scrotal and leg edema 2, 7%.
The good postoperative nursing care has a greatly important role, decreasing complication rate and helping the patients to reintegrate back early to the normal life
The early results of longo procedure in the treatment of the elder patients with hemorrhoids
This study was carried out to evaluate the clinical outcome of Longo procedure in the elderly patients at Thong Nhat hospital.
Methods: a sample of 145 patients with symptomatic third - and fourth-degree hemorrhoids underwent Longo procedure from Jan 2009 to Oct 2011.
They were evaluated for postoperative morbidity and analgesic requirement.
Results: 75.9% percent were males and the mean age was 70.9 (range 65 - 96) years.
The mean operative time was 37.8 (20 - 70) min.
All patients received oral analgesic alone after 72h.
Conclusion: Longo procedure was found safe, well tolerated by patients with minimal parenteral analgesic use and early discharge from the hospital in elder patients.
Study the peritonitis of appendix: laparoscopic and opened operation
Background: Many studies in our country and in the foreigners are practiced for peritonitis of appendix.
The diagnosis based on the abdominal pain, tenderness of RLQ with high WBC.
Laparoscopy 3 holes (10 mm, 10 mm, 5 mm) and laparotomy 4 - 7 cm on the right iliac fossa: remove the appendix, suture the base, lavage of the right iliac fossa, and drainage.
Recovery and post op are the same.
Results: During this time, we operated 897 cases (36.15%) of peritonitis of appendix/2481 cases appendicitis, LA 743 cases (82.83%; conversion 93 cases, 12.51%), OA 154 cases (18.74%).
Male / female is the same, the middle age 35 for male, 37 for female.
Variabilities LA OA p Time of procedure (minute) 70.38 (30 - 100) 65 (30 - 140) 0.08 Morbidity 3.09% (23/743) 4.54% (7/154) 0.36 Reoperation 0.26% (2/743) 1.29% (2/154) 0.08 Pain post-op using to antalgic injection 2.2 days (1 - 3) 3.3 days (2 - 4) 0.09 Middle time of hospital stay in post-op.
Clinical and pathological chracteristics of lip cancers
For the tumor grading, grade 1 is 64%; grade 2 is 28%; grade 3 is 8% and grade 4 is 0%.
Patients and Methods: Retrospective study on 60 patients with lip cancers who have been diagnosed and treatment in K Hospital - Hanoi from 1/2002 to 12/2008.
Results and Conclusions: Ages are ranged from 13 to 84; mean age is 65.17; the group of more than 50 years old counted for 90%.
There were 88.3% of patients come to hospital due to the tumor on his / her lips.
Average time from getting disease to be diagnosed is 19.4 months.
The rates of squamous cell carcinoma is 83.3%; basal cell carcinoma is 10%; adenoma carcinoma is 5% and malignant melanoma is 1.7%.
ABSTRA CTBackground: school violence is a priority in Vietnam; many serious cases of violence have occured recently. Objectives: the study aims to indentify the percentage of pupils performed violence, the percentage of pupils having correct knowledge and right attitude on school violence and the relationship between violent behaviours of pupils with pupils' situation of family, school and neighbourhood. Methods: A cross-sectional study was conducted on 493 pupils in Le Lai junior high school in April 2010.
Data was collected by face-to-face interviewed using structured questionnaires. Results: the percentage of pupils participating in fighting in the last six months was 13.2%, bringing weapons to class was 5.9%, and insulting and cursing was 36.9%.
The percentage of pupils having correct knowledge on school violence was low, ranging from 3 - 8.7%.
Personal characteristics, situation of family, school and neighbourhood were related to violent behaviours of pupils.
The percentage of pupils being performed violence, having relatives who perform violence, or having friends who perform violence was 1.9, 1.4 and 2.1 times higher than that of those being not performed violence, having relatives who do not perform violence, or having friends who do not perform violence, respectively. Conclusion: The percentage of pupils performed violence in Le Lai junior high school was high and there were relationship between pupils' situation of family, school and neibourhood with violent behaviours of pupils.
Initial results of endovascular intervention of brain arteriovenous malformations in cho ray hospital
Purposes: A brain arteriovenous malformations (AVM) is an abnormal connection between the arteries and veins in the brain.
Keywords: Brain arteriovenous malformation, complete obliteration, endovascular intervention
The annual risk of bleeding up to 4% if untreated, our purpose is to report the initial experiences for treating brain arteriovenous malformations (AVMs) by endovascular intervention.
Materials and methods: All the patients treated by endovascular intervention for AVMs at Cho Ray hospital from June 2014 to December 2016, 30 patients with brain AVMs were treated by endovascular intervention. The techniques for treatment of AVMs include cerebral angiography diagnosis, transarterial approach to the nidus of AVMs by a microcatheter, embolization was performed with Onyx, n-BCA, PHIL or coils.
The efficacy and safety were evaluated by variants: complete occlusion, partial embolization rates, procedural success rate, clinical improvement, procedural complication.
Results: In 30 patients were performed with 55 feeding pedicles embolized, ranging from 1 to 3 per patient Average estimated size reduction was 73%.
Total obliteration was achieved in 11 patients (36.7%), the average diameter of large AVMs were decreased less than 3 cm with 76.7% and partial embolization was followed by surgery and by radiosurgery.
Complications occurred in 2 patients with neurological deficit in 1 patient (3.3%), cerebral hemorrhage after embolization in 1 patient (3.3%), mortality (0%).
The result of arteriovenous graft with ptfe prothesis for hemodialysis at the people’s hospital 115
Background: Patients with end stage renal disease is increasing in community.
100% cases followed by an upper arm straight graft (Brachial artery - basilic vein) with synthetic material polytetrafluoroethylene (PTFE), majority of patients under local anesthesia.
The mean time operation: 94.85 minutes (75 - 125 m).
100% patients has good flow and good quality.
1 patient with 9 months to use, 2 patients with 2 years to use, other patients used good now.
This is a method easy to use.
Treatment with hemodialysis is common now in Vietnam.
Reason of fail with classic AVF is sclerosed veins and thrombus.
During the past 10 years, paediatric regional blocks have been used increasingly because of the appreciation that children do feel pain.
Caudal anesthesia is the most commonly applied locoregional technique in paediatric surgery, due to it is easy to perform, safe and effective.
From 02/2002 to 11/2002, we applied 72 cases for paediatric orthopaedic surgery and received satisfactory success. This technique may be to perform in the province hospitals.
The satisfaction of clients with examining and treating process of the department of examination in the hospital of tropical diseases in hochiminh city in 2010
Introduction: One of the criterions for assessing the hospital quality is according to the satisfaction of patients.
That will promote hospital quality services to patients basing on their real requirements. Objective: The study aims to surveys the rate of patient satisfaction with examining and treating process of the Department of Examination in the Hospital of Tropical diseases in HCM city in 2010.Method: A cross-sectional study was conducted on 355 clients.
The information on demographic and satisfaction of patients were collected by face to face interviewed using a structured questionaire. Results: There were approximately 98% of participants satisfied with the hospital, in general.
The percentage of clients satisfied with the treating counter was the highest with 94.9% and with reception counter was the lowest with 72.4%. Conclusions: The percentage of clients' satisfaction with examining and treating process of the Department of Examination in the Hospital of Tropical diseases was rather high, mainly with medical staff's attitude.
However, the way to organize work stages and the layout of functional rooms was not suitable and favourable to patients along with medical staff.
Objectives: To identify acute / severe malnutrition ratio of in-patient in hospital Nhi dong 2, ratio of exact height / length measurement, exact and completed malnutrition screening form perform, nutritional intake information record, exact and completed dietary code fulfill.
Conclusions: Ratio of completed in-patient malnutrition screening in 2020 was high but not exact enough.
It is necessary to train and control of malnutrition screening and to implement nutrition supports for in-patients.
It is necessary to have preparation on human resoure, equipments for in-patient nutritional support demanding.
Keywords: in-patient malnutrition screening, in-patient malnutrition
Methods: Analysis cross sectional study based on 935 pediatric patients admitted to Internal general departments, Internal special departments or Surgegy departments of Childrens Hospital 2 in 2020, at least 48 hours.
Results: An analysis cross sectional study was developed, based on 935 pediatric patients admitted to Internal general departments, Internal special departments or Surgegy departments of Childrens Hospital 2 in 2020, at least 48 hours.
Ratio of exact height / length measurement is 47.5%.
Only 33% of them had performed exact full 5 criteria in malnutrition screening form.
There were 79.4% of them in risk of acute malnutrion and highest ratio was in Internal special departments (93%).
There were 10.5% of them in risk of severe acute malnutrion and highest ratio was in Internal special departments too (20.5%).
Surgical treatment for perforated choledochal cyst with bile peritonitis: one-staged versus two-staged procedure.
Objective: In management of perforated choledochal cyst with bile peritonitis (PCC), selection between two-staged procedure and one-staged definitive repair is still controversial.
Mean size of the choledochal cysts was 54± 49 mm (range: 15 to 180 mm).
Before February 2008, the one-staged procedure was performed in only 1/5 cases (20%), but after that all 14/14 cases (100%) were treated with the one-staged definitive repair.
There was no significant difference between the one-staged and the two-staged group regarding patients' characteristics, duration of symptoms, clinical presentations and cystic size.
The mean post-operative hospital stay for the one-staged group was 8.0±2.8 days.
There was no anastomotic leakage, no death and all patients were discharged in good health.
Conclusions: One-staged definitive repair of perforated choledochal cyst with bile peritonitis is safe, feasible, with good results and should be preferred in experienced centers.
The aim of this study is to report the authors' results in management of PCC with special emphasis on the one-staged procedure. Methods: Medical records of all patients undergoing surgery for PCC at National Children's Hospital, Hanoi, Vietnam from May, 2005 to April, 2011 were reviewed.
The clinical presentations, diagnosis, operative procedures and results were analyzed.
The choice of the operative procedure was according to the surgeon preference.
In the two staged procedure, firstly biliary drainage was performed by putting a drain into the gall bladder or the choledochal cyst, peritoneal lavage and drainage were also carried out. Definitive repair was scheduled 1 - 2 months later, consisting of total excision of the cyst and Roux-en Y hepaticojejunostomy.
In the one staged procedure, definitive repair was performed with peritoneal lavage and drainage at once, without any biliary drain. Results: There were 19 patients, with mean age 2.6±2.9 years (ranged from 2 month to 9 years) and female dominance (73.7%).
The clinical manifestations were abdominal pain and distention in 94.7%, vomiting 89.5%, fever 68.4%, jaundice 26.3 and acholic stool 26.3%, abdominal tenderness 100%, peritoneal signs 73.7%, palpable mass 21.1%.
Duration of the acute symptoms ranged from 1 to 30 days (mean 5.4±6.5 days).
The effectiveness of hemofiltration on tranfusion need in cardiac surgery with cardiopulmonary bypass
Background: Ultrafiltration is effective in limiting hemodilution and reducing other adverse effects of cardiopulmonary bypass. It is used routinely in pediatric open heart surgery.
Mean of length of hospital stay decrease (ultrafiltration group: 19.3 days, control: 21.8 days, p = 0.03).
There are no difference on blood loss, transfusion postoperative, complications and mortality rate.
Conclusion: Using of ultrafiltration during cardiac surgery with cardiopulmonary bypass is effective in reduction of transfusion need during operation, length of hospital stay decrease.
Keywords: Open heart surgery, Cardiopulmonary bypass, Ultrafiltration, Transfusion.
This study aims to evaluate the effectiveness of ultrafiltration on the need of transfusion in patients undergoing open heart surgery.
Methods: A prospective study of experimental clinical control.
213 adult patients (≥18 years old), Euroscore ≤ 5, NYHA II, III, undergoing selective open heart surgery from December 2013 to March 2016 in Cho Ray hospital were divided into two groups: 105 in ultrafiltration's group; 108 in controlled group.
Cardiopulmonary bypass performed with heart lung machine HL 20, membrane oxygenator, hemofiltration HPH 400.
Primary outcome measurement: Rate of transfusion peroperation.
Secondary outcome measurements: length of hospital stay, rate of transfusion postoperation; complications, mortality rate.
Results: Transfusion rate peroperation of ultrafiltration group is lower (ultrafiltration group: 33.3% vs control group 68.5%, p < 0.001).
Management of cholecystolithiasis with laparoscopic cholecystectomy as a day surgery procedure
Objectives: To determine feasibility and safety of laparoscopic cholecystectomy (LC) as a day surgery procedure in management of cholecystolithiasis.
14 patients (56%) had return of bowel function before discharge.
Only 1 patient (4%) readmitted because of pain and subhepatic collection which well responded with conservative treatment.
24 patients (96%) were satisfied with the care they received.
Conclusion: In strictly selected patients, LC can be performed as a safe and effective day surgery procedure.
Methods: This is a prospective study in 1 year (July 2005 to June 2006) at Hoan My hospital.
The study selected patients who had symptomatic cholecystolithiasis, age of under 70 years, low anaesthetic risks (ASA 1 and 2).
LCs were performed using a three-trocar technique.
There were no common bile duct exploration and subhepatic drainage.
Results: There were 25 patients including 22 females and 3 males with mean age of 48 years (range 32 - 68).
Mean time from admission to operation was 4.7 hours (range 1 - 10 hours).
Mean operative time was 52 minutes (range 35 - 100 minutes).
Mean hospital stay after surgery was 14 hours.
Urethral complication at group hypoplastic spongiosum "poorly-developed" is 16.1%, it's higher than group hypoplastic spongiosum "well-developed" 1.5% (p=0.005).
Conclusions: Spongioplasty supports adding cover for neourethra, restoring approximate normal anatomy of urethra.
Result is quite good with lower complication of urethral fistula.
We conclude that hypoplastic spongiosum has effiency for prevention urethral fistula after hypospadias surgery.
Keywords: hypospadias, hypoplastic spongiosum, spongioplasty
Urethroplasty followed Duplay, s procedure (when urethral plate has slit-shape) or Snodgrass's procedure (when urethral plate has plate-shape).
Technique for urethroplasty: Duplay, s procedure was 60 cases (49.2%), Snodgrass, s procedure was 62 cases (50.8%).
Group has small gland (42 cases-34.4%), group has normal gland (80 cases - 65.6%).
In all cases, hypoplastic spongiosum was been confirmed: group has hypoplastic spongiosum "well developed" (66 case-54.1%), group has hypoplastic spongiosum "poorly developed" (56 case - 45.9%).
Group with small gland has hypoplastic spongiosum "poorly-developed" 85.7%, it's higher than group with normal gland has hypoplastic spongiosum "well-developed" 20.5%, (p=0.0001).
Average of following up time was 17 months (6 - 28 months).
Common complications 8.2%: urethral fistula 6.6%, meatal regression 1.6%.
Evaluating bladder funtion in treatment of spinal cord injury with adipose cultured autologous mesenchymal stem cells
Keywords: spinal cord injury, stem cell, neurogenic bladder
Results: The number of involuntary contraction in treatment group (0.4 ± 0.221) was lower than that of the control group (2.3 ± 0.300); this difference was insignificant (p<0.05).
There were no significant improvement in Pdetmax, MCC and compliance at 6 months after stem cell transplantation (p > 0.05).
At 3 months after transplantation, the rate of patients with Pdetmax<40 cmH2O was higher than at 6 months after transplantation, but the difference was insignificant (p > 0.05).
This finding showed that the poor management of neurogenic bladder after transplantation caused no improvement in urodynamic parameters of the treatment group compared to the control group.
Genotypic resistant profile of hiv-1 in arv-naïve patient in ho chi minh city
Background: The drug-resistant HIV-1 strains appear in patients who are treated with ARV drug firstly, creating the phenomenon of acquired drug resistance (ADR), then they have the ability to infect into new persons, creating naïve drug resistance (TDR = Transmitted Drug Resistance).
The frequency of NRTI mutations is 20 cases (9.2%), of NNRTI is 10 (7.8%), and of PI is 7 (3.3%).
NRTI-resistant mutations detected are M184V, T69NL74I, M184V / I, K219Q, T69N / S, T215D; NNRTI - resistant mutations are Y181C, V106I, K103N / T, E138A, Y181C, G190A, V106I; PI-resistant mutations are M46I, M36I, H69K.
Conclusion: The rate of ARV drug-resistant HIV-1 mutations is increasing not only in the term of quantity of virus but also of number of mutant strains.
Keywords: HIV-1, naïve, ADR, TDR, NRTIs, NNRTIs, Pis.
TDR rate is growing in new HIV-1 infections, trigger the high risk for treatment failure.
Methods: The study was designed according to the descriptive and prospective method, performed at HCMC Hospital for Tropical Diseases from 1/2010 to 12/2011.
Sample size: 250.
Criteria for screening: naïve patients were diagnosed with HIV infection following Vietnam Ministry of Health 2009 Guildelines for diagnosing and treatment HIV / AIDS (10).
Total whole blood samples were extracted RNA from plasma, synthesized cDNA, amplified and sequenced reverse transcriptase and protease gene. Then, we analysed sequences and found out the drug-resistant mutations, basing on drug resistance database Stanford (USA) and the ANRS AC11 group (France).
Results: Among 216 successful samples, there are 44 individuals (20.37%) carrying at least one drug-resistant mutation type; in which 6 individuals (2.78%) carrying two drug-resitant mutations.
Hypothesis: The FESS technique changes from recurrent sinusitis to chronic sinusitis for managing inflammatory lesions properly.
Result: Recurrent sinusitis: CT Scan, surgical observation and histopathology reveal that lesions are more severe at OMC than other sinuses, expand from OMC to adjacent cells in A-P direction.
Chronic sinusistis: CT Scan, surgical observation and histopathology reveal that lesions are more severe than in the first one, and diffuse at OMC as well as at anterior ethmoids and posterior sinuses.
Conclusion: In recurrent sinusitis: FESS is the technique of choices.
Preoperative staging of gastric cancer: the role of computed tomography
Background: Gastric cancer is one of the most frequent causes of cancer-related deaths worldwide.
The early detection and accurate preoperative staging of gastric cancer is critical.
Objectives: We perform this study to evaluate feasibility of computed tomography for preoperative staging of gastric cancer.
The overall accuracy for lymph node staging was 44.4%.
Overall accuracy in assessment of metastases was 72.2%.
Conclusions: Maybe computed tomography cannot evaluate accurately preoperative staging of gastric cancer.
A retrospective study of 86 cases of phyllodes tumor diagnosed by histology and / or by was conducted cytology in Cancer Center - HCMC, from January, 2003 to December, 2004. The results show that sensitivity: 59.7% including 52.3% had typical cytological appearance and 6.5% had hypocellularity in stromal fragments.
Positive predictive value: 83.6%, false positive rates: 10.5%, false negative rates: 36%.
Endocrine disorders in patients with adrenal tumors before surgery
Background: In south Viet Nam management of endocrine disorders of adrenal tumors is still controversial.
Among subgroup of patients with pheochromocytoma, only 45.5% of cases had 24-urine catecholamine equal or greater than 2 upper limit of reference range. Conclusion: In this study hormone-secreting adrenal tumors were frequent (54.9%).
Proportion of adrenal incidentaloma was 52.9%.
There is a need to study hormonal dysfunctions in these patients, in order to improve management of adrenal tumors. Objectives: to assess hormonal dysfunctions in patients with adrenal tumors before surgery.
Method: retrospective case series report. Participants: Patients with adrenal tumors admitted to hospital and had adrenalectomy from April 2002 to March 2006.Results: 102 patients (60 female), female to male ratio was 1.4/1.
Median age was 43 (15 - 74).
54/102 patients had adrenal incidentaloma.
Common manifestations were hypertension (43.1%) and flank pain (44.1%).
Preliminary results of laparo-endoscopic single site (less)
Over the world, laparo-endoscopic has been developed rapidly.
There are many different development ways, such as NOTES (natural orifice translumental endoscopic surgery), but LESS (laparo-endoscopic single site) is a new surgical technique.
Objective: to evaluate preliminary results of laparo-endoscopic single site (LESS) through 5 cases of cholecystectomy. Method: A case series study. Subject: Patients who were diagnosed, accepted LESS and were selected for cholecystectomy, at Hepato-Pancreato-Biliary surgery department of Binh Dan Hospital, Ho Chi Minh city. Results: In this study, the average age of this group is 37.4 years old.
The mean of operative time is 60 minutes, it is long because of deficiency of specialized stool.
Duration of paint released drug usage after surgery is 24 hours.
No patient has complication.
The period of hospitalization is 1 day.
Study on culture conditions for coq10 production from pseudomonas palustris -a pruple non-sulfur phototrophic bacteria
Objective: Coenzym Q10 (CoQ10) function in the mitochondrial respiratory chain and serves as a lipophic antioxidant.
Keywords: Ubiquinon Q-10, culture conditions, Rhodopseudomonas palustris
There is an increasing interest in the use of CoQ10 as a nutritional supplement and cosmetic ingredient.
It is known that CoQ10 is produced in a wide variety of organisms, from microorganisms such as bacteria and yeast, to higher animals and plant.
Economical production of CoQ10 by microbes will become more important due to the growing demands of the pharmaceutical industry.
Method: Optimimization of cultural conditions such as carbon source, vitamins, carrot juice and tomato juice in order to improved the production of CoQ10 from the bacteria strains Rhodopeudomonas palustris PN16, PN21 and PN31 - purple non-sulfur phototrophic bacteria isolated in VietNam produced CoQ10.
Results: Optimal the supplements in our experiment including mannitol, peptone, 0, 75 g / l yeast extract and 5 mg / l vitamin E were added to the original culture to enhance production of Q10.
The method selected for CoQ10 extraction had been demonstrated that it is a highly effective protocol for extracting CoQ10 from bacteria Bacteria can produce CoQ10 reached 399, 8 mg / g dry cell weight after 72 hours.
Background - Objectives: Follow-up of CABG graft patency is very important, especially when a new CABG strategy is being adapted.
It is an appropriate method for following-up patients after CABG.
Keywords: 64-slice computed tomography, CABG, patency rates
Selective angiography remains the gold standard but it has its disadvantages.
We aimed at evaluating the role of 64-slice computed tomography in following - up post CABG T-graft patency rates.
Method:. The case series study included 35 patients aged from 35 to 75 with T-graft bilateral mamary artery bypasses operated at University Hospital of Ho Chi Minh City from Jan 2008 to Dec 2011.
101 of those were on LAD and LCx systems where as 28 on RCA system.
Mean follow-up was 22 ± 17 months.
114 bypasses were functional, 3 occluded and 3 with string-signs.
Conclusions: 64-slice computed tomography is a noninvasive investigation which can provide good asessment of bypasses.
A case report of an acute glomerulonephritis associated to methicilline resistant staphylococcus aureus in a lupus nephritis man
We reported a case of acute glomerulonephritis associated to methicilline resistant Staphylococcus aureus (MRSA) infection in a 22 yo man, who was diagnosed systemic lupus erythematosus with arthritis manifestations in joints, myocarditis and glomerulonephritis.
MRSA infection started from a cellulitis in the right arm, then widespreaded to pneumonia, pericardial effusion with cardiac tamponade and sepsis.
The pericardiac tamponade was managed by surgical drainage and antibiotics, mainly vancomycine.
With acute glomerulonephritis manifested by oliguric acute renal failure, hemodialysis was indicated.
Renal biopsy was performed to differentiate the cause of acute glomerulonephritis. It showed severe acute glomerulonephritis due to infection with infiltration of neutrophils in the glomeruli, endo - and extracapillary proliferative with cellular crescentic formation and damaging the Bowmann's capsule.
Immunoflourescent staining showed IgG, IgA, Fibrinogen, C3, C1q granular deposits in the mesangial region.
Conclusion: Although MRSA infection was finally controlled but the acute renal failure was not recovered and patient required long term hemodialysis.
Treament multiple myeloma with bortezomib at hematology and blood transfusion hospital
Objective: Evaluations effective of Bortezomib in multiple myeloma.
Method: Patients were diagnosed as multiple myeloma from August 2007 to August 2009 at the Blood transfusion and Hematology hospital of HCMC, with retrospective study.
Conclusions: Preliminary results showed that regimens with Bortezomib are well effective in Myeloma patients.
Survey methodology qualitative and quantitative active ingredient cefaclor
Objectives: Sustained release formulation is desirable for cefaclor, as it s half-life is very short.
The current Vietnam pharmaceutical market has circulated no home-made preparations of cefaclor in sustained release form, but foreign ones at high prices.
Material and method: This study was designed to investigate qualitative, quantitative determination of cefaclor by HPLC method and UV-VIS spectrophotometry.
Results: The linearity, detection limit of HPLC method and UV-VIS spectrophotometry were R = 0.99623 and 0.17 - 0.40 mg / ml; R2= 0.9987 and 8.75 - 45.0 ụg / ml, respectively.
Conclusion: The formulation of sustained release cefaclor tablet is being examined.
Keywords: Qualitative and quantitative, cefaclor.
Primary evaluation the effect of sufentanil in the balance anesthesia for general surgery
Objects: Evaluate the primary effect of sufentanil in the balance anesthesia for the general surgery.
Study design: prospective, descriptive, cross-sectional study.
Patients and methods: 29 ASA physical status I-II patients, average 46.90 ± 1.79yr, who underwent elective general surgery at University Medical Center, from June to October 2007.esults: Introduced anesthesia dose of 0, 02 mcg / kg Sufentanil, averaged overal dose of 0.42 ± 0.08 mcg / kg Sufentanil, 5 mcg / ml concentration, slow intravenous were no significant change in heart rate and mean blood pressure at several time of surgery (p<0.05).
There was not respiratory depression arter 3 minutes injection and postoperation.
There was one case be depressed respiration and had to use Naloxone to control depression (0.16mg). ten cases were cough after injection (34.48%).
Other adverse reactions were not (nause, vomiting, puritus...) Conclusions: Using 0.02 mcg / kg i. v Sufentanil, 0.42 ± 0.08 mcg / kg overal dose was achieved hemodynamic stability, no respiratory depression, safety, efficacy and little adverse reaction.
However, it is important to dilute and ensure enough time for onset before practice some stimulations (introduced tube, surgery stimulations...)
Objectives: Optimizaion of detection protocols for JAK2 and CALR mutation.
Keywords: MPNs, CALR, JAK2
Arthroscopic repairs for partial and full-thickness rotator cuff tears: a comparison of two groups with minimum follow-up one year
There were no significant differences of constant score (P=0.5131) or of UCLA score (P=0.6054) between the 2 groups.
The results showed that 92% of the total patients showed good to excellent results and 8% fair results.
Conclusions: Arthroscopic rotator cuff repair could be a good technique for all partial and full-thickness rotator cuff tears.
There are many reports about the results of rotator cuff repairs but few of them have compared the results of two groups of partial and full-thickness rotator cuff repairs.
Of 75 consecutive patients who were treated with arthroscopic rotator cuff repair, 25 patients who were followed-up for 17.3 months (min 13 months, max 25 months) were enrolled in study.
The average age of the patients was 53, 2. years, and the mean duration of follow-up was 17.3+ / -3.5 months.
The FTRCT group showed changes from average 65.7 + / -4.0 points to 94.0+ / -7.6 points (min 70, max 100) and attained 32.9+ / -2.8 points of UCLA score (min 26, max 35).
Background: Cases of severe alcohol poisoning and dangers are due to poisoning other alcohol such as methanol - an industrial alcohol, which cause high mortality.
Duration of treatment (days): 2.33 ± 1.21.
100% of patients had been added Bicarbonate, 66.7% of patients with ventilator and continuous dialysis. There was 1 case (16.7%) who taken vasopressin.
Results of treatment: mortality of rate was 33.3%.
Conclusion: Alcohol poisoning is a emergency and had a high mortality rate (33.3%).
Patients with disorders of consciousness, decreasing of vision and respiratory distress acounted 66.7%. Characters of laboratory showed severe metabolic acidosis and increased anion gap.
Added Bicarbonate and continuous dialysis to perform early.
The diagnosis and treatment of alcohol intoxication are difficult, especially Methanol.
Objective: Define the features of clinical and laboratory of alcohol poisoning.
Result: From 05/2011 to 9/2014, there were 06 cases of severe alcohol toxic.
All of them were male, aged 30 - 64 years old.
66.7% of patients with disorders of consciousness, respiratory failure and decreased vision.
Oliguria accounted 50% (3 cases).
Hypotension and nausea accounted 33.3% (2 cases) and nobody had convulsions.
Evaluation clinical of features and anesthesia in acute head injury operation
Objectives: Assessment the effects of treatment of head injury to establish a protocol for treatment and anesthesia in emergency neurosurgical head injury patients.
Method: Prospective, descriptive, cross-sectional study.
Results: This prospective, cross-sectional study of 275 patients of emergency neurosurgical head injury at People 115 Hospital in HCM city, from July 2005 to March 2006.
All of them were postoperatively confirmed as acute intracranial hematoma effect in head injury.
The most common cause of head injury is traffic accident 82.818%, the mean age is 33, 32±13, 01 (range 7 to 74), male / female=6/1, severe head injury: 33.82% with emergency endotracheal intubation: 77.41%, 98.18% were infused at preoperation period, operation in "Golden time": 49.82%, used ventilation post operative more than 12 hours: 63.64%, Midazolam plus Fentanyl as sedation and analgesia for assisted ventilation patients: 54.55%, 25, 81% abnormal first blood gas result, 25, 09% ionogram abnormal, 83.16% CVP abnormal and mortality rate: 9.45%.
Conclusions: Patient with brain injury must be immediately manage for stable blood circulation and respiration, prevent secondary lesions, suitable anesthesia and resuscitation, artificial ventilation at post operation period, balance of homeostasis, electrolytes and alkaloid - acid,... to reduce the morbidity and mortality rate as well as the sequelae.
Assessment of chloroquin efficacy regime in the treatment for uncomplicated vivax malaria, 2009
Background: Malaria is a communicable disease and to be a leading killer of the developing countries in tropic and subtrropic areas, especially in Africa.
Laparoscopic surgery for hirschsprung disease: experiences of hue central hospital
Objectives: To evaluate the results of laparoscopic surgical techniques combined transanal one-stage endorectal pull-through, the treatment of Hirschsprung's disease (HD) in children.
Methods: Including 17 patients of HD (10 males, 7 females) with distal colon aganglionosis were considered candidates for laparoscopic techniques combined transanal one-stage endorectal pull-through from 1/2012 to 6/2017.
Prospective studies with follow-up and re-examination of postoperative anal dilatation.
Results: Average age 6.7 ± 1.3 months (2 - 65), male / female 1.4/1, 100% preoperative barium enema with long aganglionic segment.
Intraoperative aganglionic location: sigmoid-rectum joint 5.9%, sigmoid colon 29.4%, descending-sigmoid colon joint 17.6%, descending colon 41.2%, splenic flexure 5.9%, without total aganglionic colon.
Average length of aganglionic segment 23.2 ± 4.3 cm, the average length of the surgical procedure was 162.2 ± 15.5 minutes, the length of hospital stays of 5.8 ± 3.2 days (4 - 9).
Follow-up time of 37.3 ± 2.6 months with 17.6% enteritis, successful medical treatment, 11.8% anastigmatic stenosis of successful dilatation, without other complications, all children have been well now.
Conclusions: Laparoscopic surgical techniques combined transanal one-stage endorectal pull-through, the treatment of Hirschsprung's disease is safe and effective, can solve all very high and can be alternative for assisted laparotomy.
Keywords: Hirschsprung's disease, transanal one-stage endorectal pull-through.
Primary nocturnal enuresis in outpatient at children’s hospital 1
Objective: The aims of this study were to determine the characteristic of enuretic children and investigate the factors associated with nocturnal enuresis at Children Hospital Number 1.
The prevalence of severe enuretic children was 84.7%.
After 1 month of treatment, 87.9% children responsed with treatment.
Small bladder and nocturnal polyuria were recognized in severe enuretic children.
Deep sleep was associated in children with severe enuresis with p=0.05.
Conclusion: Almost enuretic children who admitted at nephrology outpatient clinic were severe (more than 3 wet nights per week).
Boys and girls have the same prevalence of enuresis, the most common age was 8.
Subject and methods: All enuretic children over 5 years old who admitted at nephrology outpatient clinic of Children Hospital Number 1 were included in the research.
We recorded the information in the questionnaires and bladder diaries, include: age, gender, family history, neurologic disorder, history of upper airway obstruction, deep sleep, constipation, expected bladder capacity, maximum voided volume, nocturnal urine volume, fluid intake and fluid intake after 17 hour.
We determine factors associated based on the severity of enuresis.
Data was calculated by SPSS 16.0 and the associted factors for the severity of enuresis were investigated by Chi-square and t-test with p ≤ 0.05.
Results: The study group was composed of 59 children aged between 5 and 15 years.
The propotion of boys: girls was 1: 1, the most common age was 8.
The prevalence of enuretic chidren had constipation, upper airway obstruction, caffeine based drinks and deep sleep was 14%, 26%, 70% and 66% alternatively.
Experience trong the treatment cuûa horseshoes-kidney stones at the general hospital cuûa binh dinh
At exploration the transperitoneal approach is more satisfactory for vascular control and permits better visualization of abnormal anatomy.
Prevalence of diabetes in chronic obstruction pulmonary disease
Objective: To determine the prevalence of diabetes mellitus (DM) and prediabetes in chronic obstructive pulmonary disease (COPD) patients and related factors.
Methods: Cross-sectional study. 91 COPD patients were recruited from University Medical Center HCMC.
Results: The prevalence of diabetes mellitus was 17.6%, prediabetes was 49.5%.
Abdominal obesity, hypertension, dyslipidemia were significantly associated with diabetes and prediabetes in COPD patients.
Lung function impairment was not associated with an increased risk of diabetes and prediabetes in COPD patient.
Conclusion: In COPD patients, the prevalence of DM and prediabetes were 17.5% and 49.5% respectively, nearly double the prevalence of DM and prediabetes in the community.
Keywords: diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD).
Background: Adenosine acts directly to stimulate lipid synthesis.
Conclusion: Determination of adenosine deaminase activity may help to early detect patients with lipid disorders and prevent possible complications.
Keywords: adenosine deaminase, lipid disorders, lipid profile, dyslipidemia
Removal of endogenous adenosine by adenosine deaminase resulted in an immediate rise in lipolytic activity.
Objectives: To determine the activity of adenosine deaminase enzyme in patients with lipid metabolic disorder with normal people without lipid metabolic disorders.
Comparison of adenosine deaminase enzyme activity with triglyceride, cholesterol, HDL-C, and LDL-C concentration in patients with lipid metabolic disorders.
Determination of sensitivity, specificity, area under ROC curve, ADA cut point in patients with lipid metabolic disorders.
Results: The level of the adenosine deaminase activity of patients with dyslipidemia was higher than the control group.
There was a positive correlation of adenosine deaminase activity with blood triglyceride, cholesterol, LDL-c levels, abdominal circumference and negative correlation of adenosine deaminase activity with HDL-C levels.
A case report: gastric volvulus in newborn
Introduce: Gastric volvulus israre that often in patients over 50yo.
He can be breast fed on 5th day postoperation and discharge hospital on14th day post operation.
Conclusion: Newborn gastric volvulusis very rare, symtoms and signs is not clearly, Borchard's trisign is not fully. Let's remenbergastric volvulus when our patients was obtructed or par-obtructed at stomach: Undigestive, prolonged vomitting, stomach protrudes highly on abdominal wall, spherical distention of stomach, stomach lies horizontally.
Keywords: gastric volvulus, newborn
Gastric volvulus in newborn is very rare therefore it was usually forgot and miss diagnosis that will effect cristically to patient's life.
Opposite, result of treatment will be very good ifgastric volvulus is detected and operated early before gastric necrosis.
Case report: During 25 years run of Dongnai children's hospital, this is the first time when we have detected and operated on timely a newborn gastric volvulus who has special symtoms and signs: Newborn is male, 2 hours age, malnutrition, vomitte old milk, no digestion.
Gastric distention, stomach protrudes highly on abdominal wall.
Abdominal Xray: spherical distention of stomach.
Background: The regular implementation review of prescription regulations, prescribing indicators based on e-prescribing systems is required to ensure safe and rational use of drugs.
Objectives: Evaluate the implementation of prescription regulations, prescribing indicators of outpatients at University Medical Center Ho Chi Minh City Branch 2.
Methods: Cross-sectional description with stratified random sampling method, used MS Excel 2010 and the IBM SPSS statistic 20.0 software to survey 400 outpatient prescriptions in June 2015.
Results: Prescriptions to comply with regulations are 92.5%.
The number of drugs per prescription was found to be more than the WHO optimal value (4.35 vs ⩽2) respectively.
According to other studies, this indicator is 3.33 in Malaysia; 4.13 (Referral Hospital) in Thailand.
Introduction: Rhabdomyolysis is a rare event of rapid destruction of skeletal muscle cells.
An elevated plasma creatine kinase level is the most sensitive laboratory finding pertaining to muscle injury.
The management of the condition includes prompt and aggressive fluid resuscitation, elimination of the causative agents and prevention of complications.
The range of trigger mechanisms is wide and span from mechanical injury, ischemia, infections, and genetic alterations to drugs and toxins.
Rhabdomyolysis is a well-known clinical syndrome of muscle injury associated with myoglobinuria, electrolyte abnormalities, and often-acute kidney injury (AKI).
Case presentation: A 26-year-old man was admitted to Nhan dan Gia Dinh hospital, HCMC from August 07 to September 07, 2017.
The patient was diagnosed with acute kidney injury due to rhabdomyolysis.
Plasma creatine kinase (CK) levels are markedly elevated, and myoglobinuria is present.
Blood analysis revealed acute kidney injury and increased muscular enzymes.
Conclusions: Rhabdomyolysis is exhibited by a triad of symptoms including myalgia, weakness, and myoglobinuria.
Acute kidney injury combined with myoglobinuria is the most serious complication of rhabdomyolysis, and can be life threatening.
Objectives: Analyzing the clinicoradilogical characteristics and surgical results of cerebral aneurysms in young adults.
Conclusions: Cerebral aneurysms in young adults is not frequent.
Clinical condition is good.
Aneurysmal size is often <5 mm, AcomAo is most frequent.
Surgical results are favorable.
Keywords: Aneurysms, microsurgical
Methods: Retrospective study of 91 patients <40 y. o underwent surgery for cerebral aneurysm from 1.2009 to 8.2014 at Viet Duc and Bach Mai hospital.
Results: 91/612 (14, 9%) aneurysms <40y. o.
Mean age 31, 2 (15 - 39).
M: F 2: 1.
Good clinical grade 45, 1%.
Acom Ao 45, 1%, MCA 29, 3%.
Vascular anomalies: ACA complex 19, 8%, MCA 7, 7%.
Good surgical results 79, 7%.
Establishment of the panel cells system for antibody screening and antibody identification to ensure the safety of blood transfusion in chợ rẫy hospital
Background: Blood transfusion is daily going on with a mass of quantities. The times of blood transfusion seem to be rising.
To detect and confirm the irregular antibodies to choose the units of blood matched with the patients on immunology, we have to establish the panel cells system with the presence of the antigens different from of ABO blood group system. Methods: We identified the antigens different from ABO blood group systemResults: In March 2006, from 42 blood samples collected from medical officers at Cho Ray Hospital by the great assistant of Dr Oytip Nathalang.
Since then, we had established the panel cells system for antibody screening and antibody identification. Conclusion: These issues will lead to the unexpected result that there will have the presence of immunological antibodies in the blood recipients.
The value of vaporesection for managing benign prostatic hyperplasia using a thulium 2-µm continuous-wave laser
Introduction: The potential of a new continuous-wave 2-µm Thulium-doped Yttrium Aluminium Garnet (Tm: YAG) laser for the endoscopic treatment of benign prostatic hyperplasia (BPH) is investigated.
The mean catheter time was 2.21 ± 0.86 days.
Average Qmax after 1st, 6th, 12th month surgery were 14.66 ± 3.37; 16.99 ± 3.12; 17.61 ± 2.98 mL / s.
Score IPSS decreased from 30.06 ± 3.58 after 1st, 6th, 12th month surgery were 12.03 ± 1.80; 11.23 ± 2.69; 9.27 ± 2.33 mL / s.
Conclusion: Vaporesection using the 2 μm continuouswave laser for the treatment of obstructive BPH is a safe and effective ablative procedure.
Keywords: laser surgery, Tm: YAG, vaporesection, benign prostatic hyperplasia.
Purpose: The simultaneous combination of vaporisation and resection of prostatic tissue in a retrograde fashion is the main characteristic of this new laser technique.
The mean age of the patients was 72.77 ± 9.09 years.
The mean prostatic volume was 58.97 ± 28.48 mL.
The following variables were assessed before and after vaporesection: maximum urinary flow rate (Qmax), postvoiding residual urine volume (PVR), International Prostate Symptom Score (IPSS), Quality of Life Index (QoL) and 1 - 6 - 12-months follow-up.
Results: vaporesection time was 56.61 ± 20.38 min.
Characters of injured inferior rectus muscle in orbital floor fractures
Clinical features of the eye movement included orthophoria in 83.4%, up - deviation in 10.0%, down-deviation in 6.6%, upgaze restriction in 86.7% with an average degree being - 2.2 and downgaze restriction in 40.0% with an average degree being - 0.8.
The muscle entrapment which appeared only in the fractures with a width less than 10 mm had down-deviation and positive forced duction test as characteristic clinical features.
The muscle capsule adherence had upgaze restriction, orthophoria and normal downgaze movement.
A muscle tear had partial downgaze restriction, and up-deviation or orthophoria.
Studying corelation of renal and coronary artery stenosis in the coronary artery disease
Introduction: Treating early hypertensive patients with renal artery stenosis (RAS) help reduce the risk of coronary artery disease (CAD).
Conclusions: The frequence of RAS increased with the number of stenosis coronary segments.
So, it is reasonable to perform sreening renal arteriography at the time of coronary arteriography.
Conversely, CAD patients with treated RAS reduce secondary complications.
Therefore, our objectives are valuating corelation of renal and coronary artery stenosis.
Methods: Studying 149 CAD patients with or without significant renal artery stenosis (RAS) indicated for renal arteriography at the time of coronary arteriography. Results: The prevalence RAS of CAD patients 44.30 percent and interrelate hypertension is 87 percent.
Corelation of renal and coronary artery stenosis: One stenosis coronary segment interrelates with. unilateral - RAS group 22.92% and bilateral RAS 16.67%.
Gastroduodenogram with water - soluble contrast media can diagnose the perforated and sealed - perforated gastroduodenal ulcer Objectives: To initially evaluate the effect of the method of gastroduodenogram with water - soluble contrast media to diagnose the perforated gastroduodenal ulcer.
Method: Descriptive, prospective study.
Consist of perforated gastroduodenal ulcer patients done gastroduodenogram with water - soluble contrast media Results: the early result from 26 patients with the sensitivity 100% and the speciality 62.5% Conclusion: It's essential to continue studying and to improve the technique to do gastroduodenogram with water - soluble contrast media in the perforated gastroduodenal ulcer.
Situation of malnutrition in children in nursery school in my tho city, tien giang province in 2013 - 2014
Objectives: Determine the ratio malnutrition of children in nursery school in My Tho city.
Results: The ratio of children were underweight was 2.5%, underweight malnutrition are at medium level.
Stunting rate is 4.6%, stunting average rate of 3.9% and 0.7% severe.
Conclusion: The rate of malnutrition in children is not too high.
The effect of health education methods on controlling enterobiasis in kindergaten children in cu chi district, ho chi minh city school year 2008 – 2009
The rate of correct knowledge and practice after intervention relates each other (OR =1.89 (1.51 - 2.37)) and is influenced strongly by original cognition and behavior, the center or branch of school, career of parents and people who directly take care of children (p <0.01).
However, this study has not yet demonstrated the relationship between health education methods and the rate of correct knowledge and practice (p>0.05).
Conclusion & suggestion: Using flyers or direct communication improved equally on knowledge and practice of parents of kindergarten children in Cu Chi district.
Subjects & method: this community intervention study was carried out among 1576 parents of children belonging to 6 kindergartens that were randomly selected from 28 kindergartens in Cu Chi district, HCM City.
The studied subjects were randomly divided into two groups: group A received direct health education & flyers, just flyers for group B.
Distributing flyers and remind-letters was done after one month and two months, respectively, from first health education.
Using the questionaire to collect data on administration, knowledge and practice of parents.
The rates of knowledge and practice were assessed before and after intervention.
Data was analysed by Stata 10.0.
Results: The rates of correct knowledge and practice before intervention are 53.31% and 48.18% in group A; 63.13% and 49.38% in group B, respectively.
After three times of health education in 2 months, the rate of incorrect knowledge and practice decreased in both groups: RR = 0.57 (0.45 - 0.70) and 0.74 (0.60 - 0.91) in group A; RR = 0.58 (0.44 - 0.78) and 0.43 (0.31 - 0.58) in group B.
Growth of mandible from 8 to 18 years old in relation to cervical vertebral bone age: study on cephalometric films
Objectives: The purpose of this study was to evaluate the development madibular based on Cervical Vertebral Bone Age) Method: The subjects included 78 children (47 boys and 31 girls) had 4 - 5 stages of cervical vertebral bone age, selected from longitudual study group of craniofacial morphology of Faculty of Odonto-Stomatology from 1996 to 2010.
(An aquation that estimates the cervical vertebrae bone age: CVBA=1.92+ 0.04 * α2 + 0.03 * α4 - 1.12 * AB3/CB3 + 3.17 * h4 / w4).
Total 508 cephalometric films of 78 children were taken and traced.
The mandibular dimensions and growth rates were measured and analyzed.
Results: (1) Mandibular dimensions increase from CVBA I to CVBA V and the mean madibular lengths were consistently larger for boys than for girls (p< 0.01 hoặc p< 0.001).
(2) Growth rates of mandible were no significant between sexes (except CVBA III).
(3) Mandibular growth peak was noted during the interval CVBA II (2.55 ≤ CVBA < 3.33) in females and CVBA II-III (2.55 ≤ CVBA < 4.36) in males.
Conclusions: To evaluate the development madibular based on Cervical Vertebral Bone Age to determine the optimal time for interceptive orthodontic treatment.
Keywords: growth, mandible, cervical vertebral bone age (CVBA), cephalometric film.
Evaluation of the microscopic diagnostic system in the national malaria control programme in viet nam
The study problem: An evaluation on the microscopic system in malaria cases detection was carried out with the objective of the study: to review the current status, the quality of activities and the impact of the microscopic system to the National Malaria Control Programme in Viet Nam.
The approach to the communal microscopic point of the local population when they get ill or fever is around 75%, this proportion is highest in high malaria endemic areas.
The conclusion: In general, the activities, the inputs and outcomes of the microscopic system in detection and diagnostic for malaria was insufficient as requirement, however, the system was considered a good impact for the National Malaria Control Programme.
The object and methods of the study: The communal microscopic points in 30 representative districts of the country were random selected for the cross-sectional survey and a retrospective study of the microscopic system by utilization of the national and surveillance reports for the period 2006 - 2010 and 2011 also was done at the same time.
The annual number of blood slides examined is >10%, of which 50% belongs to communal microscopic points.
The proportion of microscopic point sending slides for checking quality is 100%.
The lack of supplies and equipment was met at almost microscopic points at communal level except Giemsa solution, glass slides... the number of microscopy with good and bad quality is 74% and 15%.
The proportion of microscopes participated training course for malaria is 89% and number of microscopic have good and normal skill level in reading blood slides is 52% and 48%.
Dyslipidemia in hiv/aids patients treated by the second line arvs in the hospital for tropicaldiseases
Background: The treatment of HIV / AIDS patients lasts a lifetime, so several undesirable side effects may occur, including dyslipidemia.
Objective: To examine dyslipidemia in HIV / AIDS patients under the second line ARVs in the Hospital for Tropical Diseases.
Methods: Prospective, cross-sectional descriptive.
Conclusion: The HIV / AIDS patients in the Hospital for Tropical Diseases of Ho Chi Minh City treated by the second line ARVs presented the dyslipidemia but the mechanism of these disorders, the change of lipid profiles during the treatment, the management of the abnormalities were not mentioned in this study.
Keywords: dyslipidemia, HIV / AIDS.
The percentage of households with clean water did not achieve the proposed target of the Program.
For example, this percentage of Tra Vinh Province is the lowest, reaching only 43.7%, followed by Bac Lieu (49.5%), Ca Mau Province (78.4%), Hau Giang Province (82.6%), Kien Giang Province (83.3%) and Long An Province (89.9%).
The proportion of households with sanitary toilet in all supervised provinces was under 50%.
Moreover, the percentage of medical stations with clean water did not achieve the proposed target of the Program.
The percentage of the medical stations with sanitary toile was 85%, in which no data was collected from Kien Giang province.
Conclusion: 100% of the provinces supervised have established the Leading Board for implementation of National Target Program for Clean Water and Rural Environmental Sanitation in the Rural Areas in the 2012 - 2015 period and carried out planning procedures for the national target program of clean water and environmental sanitation in the rural areas.
Of 06 supervised provinces, only Long An Province achieved the percentage of households with clean water in accordance with NTP3 Program.
All the supervised provinces had the percentage of households with sanitary toilet below 65%.
The percentage of rural medical stations with clean water and sanitary toilet did not achieve the target of NTP3 Program.
Keywords: NTP3 Program, clean water and environmental sanitary
Objectives: To evaluate the planning and organization of implementing activities of the local health system in the National Target Program for Clean Water and Environmental Sanitation in the Rural Areas in 2013. Method: This study was conducted by retrospective and actual survey.
Results: All provinces have established the Leading Board for National Target Program for Clean Water and Rural Environmental Sanitation in the Rural Areas in the 2012 - 2015 period, in which, the Deputy Laeding Board is the representative of the health sector.
The Agencies have carried out the implementation of related activities such as the construction of sanitary toilets for households and commune medical stations, the supervision of water quality and training to enhance capability and communication.
Endoscopic pictures of the normal middle ear and some disease of the middle ear
Objective: collecting endoscopic pictures of the normal middle ear as well as some disease of the middle ear.
Method: descriptive study sa serial case.
Results: many endoscopic pictures, including the pictures of endoscopic anatomy of the middle ear, some pictures of the disease of the middle ear, were collected.
Conclussion: these pictures fill the essential gap in anatomic middle ear and show great variations in physical appearance of some disease of the middle ear.
The abnormally of vessels (2 or 3 renal arteries) were not the criteria of side choosing.
The RPLDN were started with 3 trocars, the kidney were removed through an incision of 8 cm between 2 posterior trocars.
The warm ischemia time were respected, the washing and preservation of the kidney were done with Euro-Collins solution at 4 Celcius degree.
Conclusion: Our 106 RPLDN were performed successfully on donors and recipients.
Keywords: Kidney Transplanstation, Laparoscopic Nephrectomy, Living Donor
Since Gaur had introduced the retroperitoneal laparoscpic techniques, many Asian authors reported the efficacy of it in LLDN that is RPLDN.
In Việt Nam, RPLDN was the first time done in Cho Ray Hospital at 8/2005.
The aim of this report is introdution of our experience of RPLDN on the first series in Viet Nam.
The role of left lateral hepatectomy for hepatocellular carcinoma treatment
Background: Laparoscopic left lateral hepatectomy is relatively simple, with no need of reconstruction, can be applied popularly.
Mean postoperation stage is 6.32 ± 1.79 days (4 - 17).
89.3% patients have 7-day postoperation stage.
Conclusions: Laparoscopic left lateral hepatectomy for hepatocellular carcinoma treatment is relatively simple with high successful rate, low rate of intraoperative and postoperative morbidity, short postoperation stage and soon recovery.
We need more researches evaluating the feasibility, safety and effects of this procedure.
Objects: Determining the rates of success, morbidity, operation time, blood loss and postoporation stage of laparoscopic left lateral hepatectomy.
Methods: Cross sectional survey of 57 cases of laparoscopic left lateral hepatectomy for hepatocellular carcinoma treatment at HCMC University Medical Center from September 2005 to August 2012.
Results: Sex ratio is 2: 1, mean age is 57 ± 13.88 years old (16 - 79).
92.1% patients have got hepatitis B or C 100% patients' liver function is Child Pugh A (5 points).
Successful rate is 100%, with low rate of intraoporation hemorrhage 1.8% (1 case, no need of blood transfusion), low rate of postoperation morbidity 3.5% (1 case of liver failure, 1 case of small intestinal perforation and need of reoperation).
Mean operation time is 98.84 ± 34.29 minutes (40 - 180).
Mean blood loss is 105.93 ± 104.62ml (0 - 500), median is 75ml.
Parasagittal meningioma: diagnosis and surgical results at viet duc hospital
Objectives: Evaluation of clinical and diagnostic imaging, surgical methods and result of parasagittal meningioma. Methods: Study on patients with parasagittal meningioma at Viet Duc Hospital from 01 - 2010 to 06 - 2011.
Diagnosis is based on the MRI and DSA.
Surgical treatment have good result.
Results: There were 61 patients in the study, including 27 males, 34 females, ratio Male / Female is 1/1, 54, the oldest is 81 years old, the youngest is 20 years old, average age is 54.1 ± 11.79.
Headache (80.3%), hemiplegia (59%) and seizures (41%) are the most common symptoms.
Clinical symptoms: at most admission perception slight decline GCS score: 15 - 14 points 87.2%, Stroke severity at admission mild and moderate majority: 44% NIHSS 0 - 4 points, 41% NIHSS 5 - 14 points.
Dizziness 74.4%, vomiting 59%, headache 53.8%, 74.4% ataxia, speech 76.9%, 41% choke swallow, nystagmus 28.2%.
These symptoms related good outcomes of cerebellar infraction.
Recovery in activity without the help (mRS ≤ 3), at the time of hospital discharge was 53.8%, and a month after discharge 64.1%.
Adverse outcomes irreversible, absolutely need assistance in daily life, bedridden or death, was 46.2% at discharge and a month after discharge was 35.9%.
Conclusion: Higher admission GCS scale, lower NIHSS scale rehabilitation a month after discharge as possible.
Cerebellar infarction group no choke swallowing result possible rehabilitation at a month after discharge.
However, specific lesion location, lesion types may have prognostic factors separately.
Objectives: Describe clinical characteristics, sub-clinical and outcomes of cerebellar infarction patients.
Surveying the association between epidemiology, vascular risk factors, clinical, imaging and cerebellar infarction outcomes at a month after discharge.
Method: Descriptive case series of patients with cerebellar infarction, at Nhan Dan 115 hospital from 01/2016 115 to 07/2016.
Statistical analysis is done with the software SPSS 16.0 for window. Results: Total 39 patients, mean age was 66.79 years, male ratio was 64%.
The risk factors: hypertension rate was 87%, diabetes rate was 31%, smoking rate was 35.9%, history of stroke or transient ischemic attack rate was 18%, hyperlipidemia rate was 53.8%, 2.6% of heart valve disease; 10.3% of atrial fibrillation; AV block III of 2.6%.
Objectives: The objective of this study determine the reliability and correlation between the angular and linear measurements the sagittal skeletal relationship between maxilla and mandible.
Materials and method: 138 pre-treatment lateral cephalograms were divided into 3 groups (class I, II, III skeletal pattern, 23 males and 23 females for each group) according to ANB angle and Wits measurement.
Angular measurements (FABA, Beta, W, ACoGn, NSBa+SBaMe), AF-BF linear measurement and CoGn / CoA ratio were determined.
Mean and standard deviation of all variables were calculated; the difference among 3 groups, the correlation between each pair of variables and the reliability in differentiating skeletal patterns of each variable were determined.
Results and conclusions: There was significant difference of the mean values among 3 groups, significant correlations between each pair of variables and remarkable reliability in differentiating skeletal patterns.
Keywords: angular measurement, linear measurement, sagittal skeletal pattern, cephalometric analysis.
The primary results of intersphincteric resection in patients with ultralow rectal cancer
Objectives: Low rectal cancer was a indication of Miles's procedure.
In recent years, intersphincteric resection with coloanal anastomosis has been proposed to avoid permanent colostomy for low rectal cancer.
Methods: This is cross-study on 8 low rectal cancer patients at UMC.
Results: All of patients had safe margin.
After 1 year follow-up, there was no recurrence case.
The anorectal functions were impaired and recovered gradually.
Conclusion: The intersphincteric resection with coloanal anastomosis had showed the good results of oncology and anorectal function.
This is a option for very low rectal cancer.
Study anti-inflammatory effect of gth capsule in experimental animals.
Aims: The study was designed to evaluate acute anti-inflammatory effect of GTH capsules, a functional food supported patients to treat gout, hyperuricemia, arthritis and degenerative joints disease.
Material and Methods: Swiss albino male mice, 25 ± 2 g, provided by Pasteur Institute, Ho Chi Minh City.
Results: GTH capsules dose of 0.9 g / kg mouse and 0.6 g / kg mouse both showed anti-inflammatory effect.
The dose of 0.9 g GTH / kg mouse showed an equivalent anti-inflammatory activity as Meloxicam Conclusion: GTH capsules showed an acute anti-inflammatory effect in carrageenan-induced acute inflammation on mice.
Keywords: anti-inflammatory effect, carrageenan, GTH, Homalomena occulta, Curcuma longa, Black beans, Eleutherine subaphylla, Achyranthes aspera
Assess levels of estradiol in female patients with epilepsy
Objective: Quantitative, comparable levels of estradiol (E2), free estradiol (FE2), the concentration of sex hormone binding globulin (SHBG) and albumin in female patients with epilepsy compared with the controls group.
SHBG concentrations follicular phase was 66.80 ng / ml ± 5.76, luteal phase was 70.76 ng / ml ± 6.08.
Albumine concentration was 43.42 g / l ± 0.63.
No correlation of estradiol levels with age of onset, duration of illness of female patients with epilepsy; There is no difference in estradiol levels between different types of seizures, frequency of seizures, causes of epilepsy and between the treatment of epilepsy in women.
Conclusion: estradiol and free estradiol were lower, whereas SHBG levels were higher in the epilepsy patients than in the controls.
However, estradiol, free estradiol and SHBG levels were not different between groups of patients categorized according to SFS, causes of epilepsy and between the treatment of epilepsy in women.
The relationship between the concentration of estradiol to SHBG and albumine in female patients with epilepsy.
Evaluate the relationship between blood levels of Estradiol of female patients with epilepsy with some clinical characteristics of epilepsy.
Methods: cross-sectional study, prospective with, the control group, performed in 31 women, aged 16 to 45 with epilepsy and 30 normal women.
Concentrations of estradiol, SHBG and albumin was determined between the follicular phase and between the luteal phase.
Results: There is a positive correlation between age and time of onset and duration of illness; negative correlation between age of onset of disease and duration of disease.
27.8% of female patients the onset of epilepsy at puberty.
Follicular phase estradiol concentration was 126.92 pmol / l ± 10.11, luteal phase is 291.24 pmol / l ± 48.72.
Free estradiol concentrations follicular phase was 0.71 pmol / l ± 0.22, luteal phase is 1.42 pmol / l ± 0.34.
Introduction: Basket plant is commonly used as a traditional remedy to cure a range of diseases including sore throat, arthritis, and gastritis, prevent oxidization and improve the immune system.
Background: Extracorporeal Shock Wave Lithotripsy (ESWL) is non-invasive of urinary stones by breaks them, by using externally applied, focused, high intensity acoustic pulse, into smaller pieces so that they can pass easily through ureter.
Keywords: Extracorporeal Shock Wave Lithotripsy (ESWL), kidney stone.
The aim of this study was to evaluate the effectiveness and safety of ESWL in kidney stone by electromagnectic lithotriptor at Thong Nhat Hospital.
Methods: All patients with renal stones having a diameter up to 2 cm were included in the study.
Basic evaluation such as history, examination, ultrasound and excretory urography were performed.
Electromagnectic lithotrypsy was done and data were collected from 1st October 2013 to 30th March 2015 at Thong Nhat Hospital, HoChiMinh city.
Results: Out of a total of 81 patients 58 were male and 23 were female.
The stone free rate was 80.2%.
Conclusion: ESWL is a safe and effective way of treating kidney stones.
Effects of problem based learning on basic anesthesia and analgesia teaching at university of medicine and pharmacy at hcm city
Objectives: PBL instead of the lecture-based course (LBL) was used in Basic Anesthesia and Analgesia 1.
Results: Analysis of the results of both groups revealed statistically significant higher scores, favor to PBL students in all the categories of the questionnaire.
Conclusions: PBL is an effective learning method. It can get students' interest.
Keywords: Problem, problem based learning, skill.
- The development of students' problem solving skill.
Methods: A prospective cohort study was conducted to determine the effects of this intervention.
Forty students were randomly assigned to either PBL (n = 20), with tutorial groups of up to ten students, or to the traditional, lecture-based course (n = 20).
A questionnaire consists 14 questions in 5 categories was used to investigate the effect of either PBL or LBL on students by getting the student's perception about the method.
Reseach of application of the autologous peripheral blood stem cell transplantation by cryopreservation at -1960c in acute myelogenous leukemia at the blood transfusion & hematology hospital in ho chi minh city
The mobilization regimen was high dose Cyclophosphamide and G-CSF (Neupogen).
The conditioning regimen was BuCy (Busulfan and Cyclophosphamide).
The median mononucleocyte count was 10.5 ± 2.1 x 108 / kg and CD34+ cell count was 4.2 ± 0.8 x 106/kg.
High-grade B-cell lymphoma with MYC and BCL2 and / or BCL6 rearrangements is an aggressive mature B-cell lymphoma with rearrangements of MYC and BCL2 or BCL6 ("double hit" lymphomas) or both BCL2 and BCL6 ("tripple hit" lymphomas) detected by conventional cytogenetics or fluorescence in situ hybridisation.
These lymphomas are the new entities in the 2016 revision of the World Health Organization classification for lymphoma, which occur in less than 10% of cases of diffuse large B-cell lymphoma.
Double hit or tripple hit lymphomas have a poor prognosis when treated with standard chemoimmunotherapy, and have increased risk of central nervous system involvement and progression.
In this manuscript, we review the pathological characteristics, immunohistochemistry and translocation of MYC, BCL2 and BCL6 in high-grade B-cell lymphoma.
Keywords: high-grade B-cell lymphoma; translocation of MYC, BCL2 and BCL6; rearrangements; double hit lymphomas; tripple hit lymphomas
Objectives: The aim of this study was to investigate the influences of several factors on the quality of life in patients with end stage renal disease before renal replacement therapy.
Keywords: Quality of life, End Stage Renal Disease.
Methods: A prospective study conducted in end-stage renal disease patients, who were treated at the Nephro-urology Department, Bach Mai Hospital, and Hanoi, Vietnam from January to October 2013.
Results: The study included 148 patients, male were 58.8% and female were 41.2%, the mean age of patients was 43.3 ± 15.3 (16 - 78 years old).
Patients lived in urban and rural areas (52% and 48%, respectively). Patients graduated from secondary school diploma (31.7%) and high school diploma (42.6%).
Patients with health insurance were 87.2%.
There was the association of kidney disease symptoms and the quality of life in patients with end stage renal disease (p<0.05) and no association of SF - 36 scores with gender, age, education level, health insurance... However, most of the problems of kidney diseases were correlated with the quality of life of end stage renal disease patients with p<0.05.
Conclusions: There was the association of kidney disease symptoms and the quality of life in patients with end stage renal disease (p<0.05).
Evaluation of urinary tract infection from testing renal pelvic urine samples done by percutaneous nephrolithotomy
Objective: Evaluating renal pelvis urine samples during surgery provides valuable information about bacteriology, supports the treatment of urinary tract infections, and minimizes serious complications such as sepsis and septic shock.
There was one case of sepsis, no septic shock or death recorded in our study.
Conclusions: Gram stain and renal pelvic urine culture are highly useful techniques to evaluate urinary tract infection when performing percutaneous nephrolithotomy.
Keywords: urinary tract infection, percutaneous nephrolithotomy, renal pelvic urine gram stain, renal pelvic urine culture
Methods: A total of 69 patients that met the criteria were retrospective studied.
All patients had renal pelvic urine samples collected at 2 time points: puncturing and after lithotripsy approximately 15 to 30 minutes.
These urine samples were evaluated by urinalysis, gram stain, culture and antibiogram.
Results: The rate of urinary tract infection in renal pelvic urine samples was 31.88%, in which gram - negative bacteria accounted for 76.19%.
The most common isolated bacterial spp. was E coli (46.15%), followed by Enterobacter cloacae, Proteus mirabilis, Staphylococcus aureus, Enterococcus faecalis and fungi.
Computed tomography findings in renal cell carcinoma
Conclusion: We can distinguish between light renal cell carcinomas and papillary renal cell carcinoma based on computed tomography.
Objective: Survey characteristics tomography images from renal cell carcinoma.
Methods: We conducted retrospective and describes all cases of computer tomography, have surgery, surgical results as RCC patients in surgical urinary Cho Ray hospital from 01/2008 to 12/2010.
Results: 59 cases of RCC in this research.
95% of patients with a tumor, tumors located at the kidney accounted for 84.7% and the distribution in the shell accounts for 47% advantage.
Calcification in the tumor in 20% of cases and 83% in case of tumor necrosis.
100% tumor with low attenuation in the film is not injected, tumors usually powerful drugs on the medullary shell accounts for 83.05% of cases.
Tumor size was 6.8 ± 3.3 cm.
Clear renal cell carcinoma are often calcified and larger size compared with papillary renal cell carcinoma.
Laparoscopic left colic interposition for esophageal reconstruction for treatment of caustic esophageal stricture. experiences in 02 cases
Background: Colon interposition using the left colon is a treatment of esophageal strictures.
Keywords: esophageal caustic stricture, retrosternal canal, colon interposition
With development of laparoscopic surgery, we used total laparoscopy for mobilizing colon, creating retrosternal canal in left colic reconstruction.
Objectives: To evaluate first technical outcomes of total laparoscopic colon interposition using the left colon in treatment of esophageal caustic strictures.
Methods: Cases report, 02 cases of total laparoscopic colon interposition using the left colon at the Department of Digestive Surgery in Cho Ray hospital.
Results: On October and November 2021, we performed 02 cases of total laparoscopic colon reconstruction for esophageal caustic strictures.
Both cases used the left colic graft and the cervical esophageal anastomosis.
There were no anastomosis leakage and stricture so far.
Swallowing was improved after surgery.
The total flavonoid level was determined using various quantitative methods including weighing and UV-Vis spectrophotometry based on the quercitrin standard.
The antibacterial potential was examined using the well diffusion agar method.
Results: The extraction proficiency was 15, 59%.
The contents of flavonoid dry weights were 2, 35% and 13, 67% in the raw materials and in the extract, respectively.
Risk factors for aspirin resistance after percutaneous coronary intervention in the elderly patient
Objectives: To determine the association betweenaspirinresistancewiththerisk factors such as: age, sex, smoking, obesity, basic tests, medicaltreatmentin elderly patients withcoronary artery diseaseafterpercutaneous coronaryintervention Design: cross - sectional study Method: 150patients ≥60years old underwent percutaneous coronary intervention (PCI) from01 Octobor, 2013to30 April, 2014at Heart Institute - HCMC.
Patientsweretreated withaspirin200 mg / dayandwere tested forplatelet functionanalysisinthe time of48 hoursafterintervention.
Results: Aspirinresistance occured in female than male gender (30.6% versus 25%), no found the associationbetweenage, gender, smoking, obesity, fasting glucoselevels, HbA1C, LDL-cholesterol, andhypertensiondisease, dyslipidemia, diabetes, cerebralvascular accident, and thegroupACE inhibitors / ARBs, diuretics, beta blockers, calciumchannel blockers, statins, nitrates, hightriglyceridelevels, heart failure. Chronic kidney disease (p =0.04, OR=2.19, 95% CI1.02 to 4.67) andpatientstreated withproton pump inhibitors (p =0.04, OR= 2.26, 95% CI 1.0 to 5.0) were thehigh riskofaspirinresistance.
Conclusions: Elderly patientswith chronic kidney diseaseortreated withproton pump inhibitorshouldbe testedforplateletfunction.
Keywords: Elderly, aspirin resistance, percutaneous coronary intervention.
Prevalence and correlates of zinc deficiency in pregnant vietnamese women in ho chi minh city
Objectives: This study explores the prevalence of zinc deficiency and possible correlates in pregnant Vietnamese women in Ho Chi Minh City.
Further academic and clinical input is needed to confirm the scale of this neglected issue.
Keywords: Zinc, deficiency, dietary supplement, pregnant women, Vietnam.
Methods: This was a cross-sectional study conducted at a general hospital in Ho Chi Minh City, Vietnam.
Results and discussion: In total, 254 pregnant women were invited and 107 (42%) participated.
The mean age of participants was 29 years, and mean gestational age was 10 weeks.
Median zinc concentration in serum was 13.6 mmol / L, and the prevalence of zinc deficiency was 29% (95% confidence interval (CI) 21% - 39%).
The daily intake of a milk product supplement was the only significant correlate of zinc deficiency of the items investigated (adjusted odds ratio=0.40, 95% CI=0.16 - 0.99, p=0.049).
Objectives: The role of bilevel positive airway pressure (BiPAP) ventilation in the treatment of acute cardiogenic pulmonary edema. Methods: We studies postpectively 42 patients with acute cardiogenic pulmonary edema, who were treated with bilevel positive airway pressure ventilation and all patients also received standard therapy according to the Advanced Cardiac Life Support Protocol.
We also accessed relation between vital signs and blood arterial gases from patients entering ED to patients recovering. Result: A total of 42 patients (mean [±SD] age: 72, 45 ±9.28; female sex 52, 38%); were ventilating time (mean [±SD] 321, 3 ±15.79 minute); and success 97% (41/42), failure: 2.38% (1/42).
Analysis of clinical, paraclinical features and diagnotic patterns of tuberculosis in tb/hiv patients at dong thap province
Objective: to analyse clinical, paraclinical features and diagnostic patterns of tuberculosis (TB) in TB / HIV patients at Dong Thap province.
Physical symptoms had no significant difference among two groups (p>0.05).
Rate of positive sputum smear at level ³ (2+) was higher than rate of positive sputum smear at level ≤ (1+) (59.2% vesus 40.9%) and occurred more in pts with early phase HIV infection (p>0.05).
94.4% cases had lesion on chest X-rays, including infiltration lesion (74.6%), lung interstitial lesion (39.8%), mediastinal and hilar adenopathy (29.7%), pleural effusion (28.8%),... and cavity lesion (20.3%), occurred more in pts with late phase HIV infection (p>0.05).
Most of TB / HIV patients with late phase HIV infection had number of leukocytes under 4, 000 / mm3, number of lymphocytes under 1, 200 / mm3, number of lymphocyte T CD4+ under 200 / mm3, low Hb, high VS, and high transaminases significantly (p < 0.05).
Rate of new TB incidence, rate of extrapulmonary disease, rate of negative pulmonary TB and rate of combined TB in TB / HIV patients with late phase HIV infection were higher than in TB / HIV patients with early phase HIV infection (in turn, 92.1%; 20.2%; 32.4%; and 43, 8% vesus 88.9%; 16.7%; 23.3% and 41.7%) (p>0.05).
Conclusions: TB / HIV patients with late phase HIV infection showed clinical, paraclinical features without typical, more complicative, more severe and extrapulmonary TB occurred more than in TB / HIV patients with early phase HIV infection.
Results: From 1/2010 to 12/2011, there were 125 TB / HIV patients (pts) (divided into two groups: 36 pts with early phase HIV infection and 89 pts with late phase HIV infection).
Ratio of male pts and female was 1.66: 1.
Most of them were from 15 - 45 years old (86.4) and the average age was 32.9 ± 10.2.
74.4% cases lived in the countryside of Dong Thap province.
76% cases had low quality of education (under level of high school), 88.8% had no job or subsisted on manual labour and 57.6% shot heroin.
52% cases had the incubation period between 3 and 8 weeks.
The most common symptoms were fever, diarrhea, loss over 10% of body weight, dyspnea, cough, fatigue, weakness... and disorders of skin that were mainly showed in pts with late phase HIV infection (p<0.05).
Background: Panax stipuleanatus, a rare medicinal plant with health-promoting and anti-cancer effects, is in danger of extinction.
Results: Callus 4 weeks after subculture was 17 - 20 µm in size, with embryogenic characteristics, and created embryos after 24 weeks on 0.5 mg / L NAA medium Conclusions: 26 week-old callus, at 4 weeks after subculture with cells with average size 17 - 20 µm capable of forming embryos.
Keywords: embryo, callus
Gross total resection was achieved in 38 patients (77.8%).
One death occurred (1.8%).
98 percents of patients had good outcome (post-operation GOS was 4 or 5).
Conclusions: Endonasal endoscopic transsphenoidal surgery is an effective treatment method for patients with pituitary adenomas, which results in high rates of resection and low rate of complications and death. The advent of the endonasal endoscopic transsphenoidal surgery has provided a wider and more close-up panoramic view that has made more detailed, delicate procedures feasible and safer.
Keywords: Pituitary adenoma, endonasal endoscopic transsphenoidal surgery.
The male: female ratio was 1: 3.6.
Percentages of macroadenoma and microadenoma wererespectively 83.3 and 16.7%. There were 12 patients with prolactinoma (22.2%), 9 patients with growth hormone - secreting pituitary adenoma (16.7%), 2 patients with ACTH-secreting pituitary adenoma (3.7%).
Result of buccal mucosal 1-stage urethroplasty for anterior urethral strictures caused by balanitis xerotica obliterans (bxo)
Patients and methods: Between January 3008 and June 2013, 33 patients underwent buccal mucosal 1-stage urethroplasty for anterior urethral strictures caused by BXO at Department of Urology A, Binh Dan hospital.
Results: At a mean follow-up of 24.03 months (range 2 to 57 months), 26/33 patients have no recurrent stricture (successful rate 78, 8%), 2 strictures were treated with visual urethrotomy, 5 strictures were reoperated with buccal mucosal urethroplasty.
Conclusions: Using buccal mucosal membrane for urethroplasty, urethral stricture caused by BXO, is a first option.
Keywords: balanitis xerotica obliterans (BXO)
Objectives: To assess the initial results of endoscopic retrograde cholangiopancreatography (ERCP) in treatment of acute obstructive suppurative cholangitis and edematous pancreatitis caused by common bile duct (CBD) and common hepatic duct (CHD) stones.
Keywords: Endoscopic retrograde cholangiopancreatography (ERCP), extrahepatic stone, common bile duct (CBD) stone, common hepatic duct (CHD) stone, septic shock caused by CBD stone, acute obstructive suppurative cholangitis, acute edematous pancreatitis.
These patients were treated by emergency ERCP from Jan 2014 to July 2015 in the endoscopy department, University Medical Center of HCM city.
Results: There were 32 males and 43 females with mean age 48.3.
Of them, there were 9 cases of septic shock caused by CBD stones (4 male and 5 female patients), 6 cases of acute obstructive suppurative cholangitis combined with acute edematous pancreatitits by CBD stones (2 male and 4 female patients), 20 cases of acute edematous pancreatitis caused by CBD stones (8 male and 12 female patients) and 46 cases of acute obstructive suppurative cholangitis caused by CBD and CHD stones (18 male and 28 female patients).
Conclusion: Our study shows that emergency ERCP can be used effective and safe in treatment of acute obstructive suppurative cholangitis and edematous pancreatitis caused by CBD and CHD stones.
Preliminary report about the efficacy of early switchfrom intravenous to oral antibiotic in post-appendectomy patients with peritonitis complication
Objective: To preliminarily evaluate the efficacy and antibiotic cost of early switching from IV to oral antibiotic in post-appendectomy patients with peritonitis complication. Methods: A 3-month prospective, cross-sectional study.
We compared the efficacy, length of hospital stay and antibiotic cost among 3 groups of appendicitis-induced peritonitis patients: control (IV antibiotic only), early switching (PO antibiotic after 3-day IV) and late switching (PO antibiotic after more than 4-day IV). Results: 86 patients included in this study were divided into 3 groups: control (31 patients), early switching (30 patients) and late switching (25 patients).
We did not find any difference in therapeutic efficacy among the 3 groups (p = 0.692).
Although the length of hospital stay did not significantly change (p = 0.468), the antibiotic cost was markedly reduced in the early switching group compared to that of the control group (p = 0.004) as well as the late switching group (p = 0.001).
Conclusions: Early switching from IV to oral antibiotic is a best choice for post-operative patients as this method can ensure the therapeutic efficacy with reduced antibiotic cost, and therefore reduced therapeutic cost
Background: Hospital wastewater is one of the concerns for protecting environment and community health at hospitals.
If not being treated in compliance with current regulations, it will pose a severe pollution source and be a direct disease transmission source to human.
In recent years, with the attention from Ho Chi Minh City People's Committee, Department of Health has invested in building wastewater treatment facilities for district hospitals.
However, the current state of reception, operation and post-investment management are issues of concern to improve the efficiency of wastewater treatment facilities at the district hospitals in Ho Chi Minh City.
Objectives: To assess the management and treatment of district hospitals' wastewater in Ho Chi Minh City.
Objectives: To describes the characteristics of pre-operative and post-operative endocrine disorder of sellar area tumors.
Methods: Case-series study.
All pediatric patients diagnosed with sellar turcia tumors undergo surgery at Childrens Hospital 2 from January 2012 to May 2020.
Results: Before surgery, there were 81.4% of patients with endocrine disorders, of which, the majority of patients had 1 to 2 disorders, accounting for 1/3 of those cases.
95.3% of patients had endocrine disorders, of which, the majority of patients have 3 disorders (hypothyroidism, adrenal insufficiency and central diabetes insipidus).
Conclusion: Sellar and parasellar tumors often occured endocrine disorders, this rate was higher after surgery.
Keywords: pituitary tumors, surgery, endocrine disorder
Objectives: To determine the ratio of success and complications of transcatheter arterial embolization (TAE) in treatment for rebleeding postoperative hepatic trauma.
Keywords: Transcatheter arterial embolization, rebleeding.
Methods: This is a retrospective study including 44 patients (38 males, 6 females; mean age 30.7 years), who had liver trauma in 5 years (01/04/2007 - 31/12/2012) at Cho ray Hospital.
Results: 44 patients were treated by transcatheter arterial embolization with a success rate of 97, 7%. The failure rate of TAE was 1 case (2.3%) due to hepatic arteriovenous fistulas after postoperative hepatic trauma.
Complication rates were 13 cases (29.54%), 4 cases (9.1%) required reoperation for early complications, non - reoperative management were 9 cases (20.5%).
No patient rebleeding after TAE.
6 severe cases died related to severe complex trauma.
Conclusions: Transcatheter arterial embolization (TAE) in treatment for rebleeding postoperative hepatic trauma had high success rate.
However, long time study should be done to confirm.
Levels of patient satisfy about health services at ben luc hospital - ben luc district - long an province, 05/2005.
This is a descriptive cross sectional study aiming to identify patients' satisfaction on the health services of Ben Luc hospital in Long An province, 2005.
The specific objectives of the reseach is to identify the levels of satisfaction aiming to support manager in improving hospital operation.
The purpose of the research is to improve the quality of hospital health care.
We carried out the survey with 220 patients visited to the hospital within 13th May and 3rd June.
The result showed that there were 90% of patients satisfy with the hospital in general, 94, 5% satisfy with diagnosing phase, 91, 8% satisfy with treatment and care phare, 74, 5% satisfy with consultant phase, 70% satisfy with food and drink support, 61, 8% satisfy with sanitation, 60, 9% satisfy with recovery room.
Study of clinical characteristic and risk factors for deep vein thrombosis (dvt) of the lower extremities in patients with chronic heart failure
Purpose: Determine the incidence and clinical, morphologic characteristic of Deep Venous Thrombosis (DVT) of the lower limbs in patients hospitalized with heart failure. Determine risk factors and the relationship with the heart failure grade of Deep Venous Thrombosis (DVT) of the lower limbs in patients hospitalized with chronic heart failure.
The incidence of DVT is similar in the right and the left legs (65.5% and 67.2%, respectively).
Research by using Doppler ultrasound the lower limbs' veins from the ankles to the inguinal folds in both legs.
The average age is 74 (74.1 ± 11.4).
Women are 67.2%.
Pelvic exenteration
There are 5 males, 7 females with average age 54.58.
As clinical picture, there are 12 large painful pelvic tumors with 5 dysuria, 5 difficult defecation, 3 vaginal bleeding or hematuria.
Mean operative time were 153 mn, mean blood loss 500ml.
Objective: A study of indication, of surgical technique and of results of pelvic exenteration. Patients and Method: A retrospective study of pelvic exenteration of all patients operated at Binh Dan hospital from 2001 to 2008.
All the charts are analyzed to know the original cancer, the surgical indication, the surgical techniques and the results.\ Results: During 8 years, the pelvic exenteration was performed for 12 patients.
Establish a protocol used to obtain mesenchymal stem cells from rabbit adipose tissue
Background: Mesenchymal stem cells from adipose tissue are increasingly interested in research and application in tissue technology and regenerative medicine because of their superior features and great potential that these cells bring.
Conclusion: With the results achieved, we have isolated and cultured mesenchymal stem cells from rabbit adipose tissue.
They will be a suitable source of cells for later animal modeling experiments.
Keywords: mesenchymal stem cells, rabbit adipose tissue, differentiation, mesenchymal stem cell markers
Therefore, an efficient protocol is required to obtain mesenchymal stem cells from these adipose tissues for testing in animal models before human application.
Objectives: Establish procedures for the acquisition and identification of mesenchymal stem cells from rabbit adipose tissue used for testing on animal models.
Methods: The research method is a descriptive experiment.
Rabbit adipose tissue is collected under aseptic conditions and isolated stem cells by a mixture of enzymes collagenase-dispase.
The identification criteria for mesenchymal stem cells are on the surface adhesion of flasks, the differentiation ability, and the expression of mesenchymal stem cell-specific markers.
Results: The cells of the third passages were used to identify as mesenchymal stem cells.
The change of calcium ion concentration on kidney-stone patients with renal insufficiency
Introduction and Purpose: To study the change of serum calcium ion concentration and the relation between calcium ion concentration and creatinin clearance rate (using Cockcroft-Gault formula) on kidney-stone patients with renal insufficiency.
Results: As renal insufficiency was progressive, serum calcium concentration of 42/58 pts (69.73%) remained within the normal range, meanwhile it of 16/58 other pts (28.55%) decreased; the differences of serum calcium concentration between renal failure stage I and II, stage II and III were significant statistically (with p < 0, 001 and p < 0, 05).
There was a positive correlation between of serum calcium ion and creatinin clearance rate (r = 0.17).
Conclusion: The concentration of serum calcium ion changed along with renal failure stages.
There was a positive correlation between of serum calcium ion and creatinin clearance rate (using Cockcroft-Gault formula).
Keywords: Serum calcium concentration, kidney stone, renal insufficiency.
The needs of communication and education about reproductive health of youth 15 - 24 years old in tan phu district, hcmc
Background: Today, the puberty of adolescents and the average age of first sexual intercourse significantly decreased.
It can be say that teenagers have sex but lack of knowledge about the function of reproduction and measures to safe sex.
Laparoscopic splenectomy using ligasure in children with immune thrombocytopenic purpura
Objective: Assess the results of surgical splenectomy used LigaSure in young thrombocytopenia Method: We records of all pediatric patients with ITP undergoing LS using LigaSure at Viet Duc Hospital.
Conclusion: We believe that LigSure is safe for vascular control in LS and can provide less blood loss, reduces operating time.
Keywords: Laparoscopic splenectomy, thrombocytopenia, LigaSure.
Study on clinical features and electrocardiogram (ecg) in patients with heart failure at tien giang central general hospital
Objectives: To descried clinical featears and laboratory findings and ECG in patients with heart failure and study the relationship between ECG and other clinical featears, laboratory findings in heart failure.
EF falls below 55% share of 84%.
High level of NT-ProBNP percentage of 92%.
ECG: Myocardial ischemia (42.7%), sinus tachycardia (24%), atrial fibrillation (21.3%), lelf ventricular systolic strain (13.3%) and normal ECG (9.3%).
Conclusions: ECG is usually abnormal in heart failure.
Abnormal ECG supports prognosis heart failure.
Collected samples were patients with clinically diagnosed heart failure according to Framingham.
Results: There were totally 75 respondents.
The common clinical symptoms of heart failure were platypnea (84%) and dyspnea on drdinary exertion (73.3%).
Most patients had NYHA III (81.3%).
Shadow images large heart was 78.7%.
Assessment of the situation, improvement and evalutation of the analysis of disease pattern by the method of defined daily dose (ddd) at the hospital of district 11 in 2017
Background: According to Circular 21/2013/TT-BYT, there is method used for the identification of disease pattern which is DDD (Defined Daily Dose) analysis.
Keywords: the disease patterns, ATC, DDD
Because of this, the Department of Pharmacy has utilised these measures to re-identify the disease pattern.
Methods: The list of medications used at the hospital in 2017.
The retrospective study was conducted with data of drug consumption in 2017 by DDD analyzing tools.
Results: The number of drugs prescribed in 90% of presciptions had the% DDD of 89.74%, they belonged to the class of antidiabetic and antihypertensive drugs. The total cost of drug classes have the highest use respectively class of cardiovascular drugs (29.32%), class of antidiabetic drugs (20.76%), class of antibiotics drugs (19.06%).
Disease patterns at the hospital of dictrict 11 mainly diabetes, cardiovascular and bacteriosis disease.
Conclusion: The study has supported the Faculty of Pharmacy in setting a plan to make a priority in procurement of major classes of drugs, including cardiovascular, antidiabetic and antibiotic drugs.
In addition, the cost of DDD-followed drug use is determined to convert the treatment regimen to the most cost-effective and effective drugs so that it can provide advice for the Drug and Therapeutics Committee.
The prevalence and associated factprs of azoospermia among men having examination at department of infertility, tu du hospital
Introduction: Azoospermia is reported in about 5% worldwide.
Associated factors of azoospermia included exposure to toxic chemical, history of testicular trauma, history of orchitis after mumps post-puberty, bilateral testicular atrophy, and cryptorchidism.
Keywords: azoospermia, testis, orchitis, testicular trauma, mump
There is no report on the prevalence and associated factors of azoospermia among vietnamese men.
Objective: To investigate the prevalence and associated factors of azoospermia among men having examination at Department of Infertility, Tu Du Hospital.
Method: A cross-sectional study with a sample size of 1825 men was performed at Department of Infertility, Tu Du Hospital from November 2017 to May 2018.
All male patients performed semen analysis and physical examination.
Results: The prevalence of azoospermia was 10.5% (95% CI: 9.1 - 11.9%).
Factors that associated with azoospermia included exposure to toxic chemical, history of testicular trauma, history of orchitis after mumps post-puberty, bilateral testicular atrophy, cryptorchidism (increasing risks of 4, 9, 8, 4 and 6 times, respectively).
Three subgroups as pretesticular, testicular and posttesticular azoospermia had distinctly different features about secondary sex characteristics, testicular volumes, ejaculatory duct obstruction and hormonal levels.
Conclusion: The prevalence of azoospermia is 10.5%.
Correlation between fluorescein angiography and optical coherence tomography in detection of cystoid macular edema
Aims: To find the correlation between FA and OCT in CME patients.
OCT demonstrated greater sensitivity than FA in detecting CME, particularly those associated with RVO, DR and age-related macular degeneration.
Keywords: cystic macular edema, fluorescein angiography, OCT.
Methods: Cross-sectional study.
168 eyes who had FA and OCT performed on the same day.
FA and OCT images were evaluated for the evidences associated with CME and other structural changes of macula.
Main outcome measure was the correlation between FA and OCT findings of macula in patients with CME.
Results: The common causes of CME in our study were diabetic retinopathy (DR; 30, 95%), retinal vein occlusion (RVO; 27, 38%) and age-related macular degeneration (23, 81%).
The sensitivity for detection of definite CME was higher for OCT (92, 86%, 156/168 cases) than for FA (84, 52%, 142/168 cases).
OCT gave earlier CME diagnosis than FA in 14 (8, 33%) eyes.
The strong correlation between CME's image in FA with CME's image and site in OCT, between classification of CME in FA and OCT.
Results of laparoscopic surgery in treatment central bile duct stones
Objective: Determine the feasibility of laparoscopic surgery in removing central bile duct (CBD) stones.
Evaluate the efficacy, morbidity rate, complications of surgery.
Subjects and Methods: Combined retrospective cross-sectional descriptive prospective in 66 patients who is indicated laparpscopic surgery open CBD to remove the stones at Cho Ray hospital in Ho Chi Minh City from 01/2010 to 2/2012. These patients had CBD stones confirmed preoperation by ultrasound, computerized tomography or radiography retrograde bile.
Results: Performed laparoscopic surgery to remove CBD stones on 66 patients, of which 39.4% (26/66) patients had CBD stone alone, 61.6% (40/66) combined common hepatic duct stones or gallbladder stones.
Laparoscopic surgery is successful 97% (64/66), switch open surgery 3% (2/66), complications is 3% (2/66) due to gallbladder lesions when dissecting adhesion, early complications is 15% (10/66) which is stable medical therapy.
Remnant stone rate is 13.6% (9/66), no deaths.
Conclusions: performing laparoscopic surgery to remove the CBD stones has the advantages: less postoperative pain, early recovery, cosmetic incisions, early discharge, a high percentage of clean stone, low complications and morbidity rate, no deaths.
Background: The suture technique of rotator cuff repair is based on the anatomic study of rotator cuff's insertion.
The relationship between the length of arm and the width of superior facet, middle facet, SSP, ISP, the width from medial to lateral, superior to inferior of SC were calculated by linear regression with respective r 0.085, 0.06, 0.25, 0.16, 0.04 và 0.001.Conclusions: the medial to lateral width of the vietnamese SSP, ISP is smaller than the width in others anatomic studies.
There isn't relationship between the length of arm and the dimention of rotator cuff footprint. Clinical relevance: This anatomic study can be served for the evaluation of rotator cuff tears, the choice of suture technique of rotator cuff repair.
The anterior to posterior width of the superior, midle facet, the width from biceps groove to the superior of the sulcus or bare zone, the medial to lateral width of the supraspinatus (SSP), infraspinatus (ISP), the superior to inferior and medial to lateral width of the subscapularis (SC) were measured with millimeter measuring tape.
The length of arm was measured from greater tuberosity to lateral epicondyle. Results: The anterior to posterior width of the superior facet is 19, 66± 2, 82 mm with min 14 mm and max 25 mm.
Retroperitoneal laparoendoscopic single-site ureterolithotomy and pyelolithotomy: one centre initial experience
Objective: To report and to assess the feasibility, the safety of the Retroperitoneal Laparoendoscopic single-site ureterolithotomy and pyelolithotomy initially performed at Binh Dan hospital. Materials and methods: We report 10 cases of retroperitoneal laparoendoscopic single-site ureterolithotomy and pyelolithotomy performed at the Department of Urology of Binh Dan hospital fro May 2014 to April 2015.
Incision of ureter using the electrical hook, stone leverage, placement of a ureteral stent, and ureteral closure using a running suture.
Ten patients having 11 stones with one patient having 2 stones.
Ureterolithotomy: 7/10 (Left side: 5/7, Right side: 2/7), Pyelolithotomy 3/10 (Left side: 2/3, Right side: 1/3).
Mean stone size: 19 mm (range 15 - 32).
Ureteral stenting: 9/10 cases, in one case placement of ureteral stent was impossible due to mild distal ureteric stricture.
Conclusion: Retroperitoneal Laparoendoscopic Single-site ureterolithotomy and pyelolithotomy in our center had initial encouraging outcomes without any complications.
Keywords: Laparoendoscopic Single-Site Surgery - LESS, Retroperitoneal Laparoscopy, Ureterolithotomy, Pyelolithotomy
Skin incision of 1.5 cm at the tip or right below the tip of the 12th rib in the posterior axillary line, and a minilumbotomy performed.
Objective: The aim of this study was to assess the relation between risk factors and IAH and ACS. This study also evaluated the effects of IAH and ACS on morbidity and mortality.
Independent predictors for IAH included obesity (OR 4.86; CI 95%, (1.75 - 13.44); p= <0.01), previous abdominal surgery (OR 2.18; CI 95%, (1.42 - 3.33); P= 0.001), ileus (OR 5.02; CI 95%, (2.84 - 8.85); p<0.001) and sepsis (OR 2.27; CI 95%, (1.25 - 4.14); p= 0.006).
Among them, BMI was a risk factor with statistically signigficant (p < 0.001).
ACS group had high mortality (p < 0.001).
Conclusions: The occurrence of IAH during the intensive care unit stay is an independent predictor of organ dysfunction and mortality.
ACS group has high mortality.
The risk factor for developing IAH and ACS include obesity, previous abdominal surgery, ileus and sepsis.
Keywords: Iintraabdominal pressure (IAP); Intraabdominal hypertension (IAH); Abdominal compartment syndrome (ACS).
Methods: Descriptive prospective study.
Total of 384 consecutive patients admitted two intensive care units in Nhan Dan Gia Dinh hospital for >24 hrs during the 2 year study period were included in the study.
Intraabdominal pressure (IAP) was measured daily via the bladder.
Results: There were 384 patients (pts) met inclusive criteria.
The mean IAP was 10 ± 4.8 mmHg.
Of 384 pts, 196 (51%) had IAH and 14 (3.4%) had ACS.
Synthesis of isoxazolo[4,3-c]quinolon-4-on
3-Acetyl-4-hydroxy-2-quinolones are obtained by hydrolytic ring opening annd subsequent decarboxylation from the corresponding pyrano [3, 2-c] quinolin-2, 5-diones, reacted with sodium azide to the 4-azido-3-acetyl-2-quinolones which cyclized on thermolysis to yield the ISOXAZOLO [4, 3-c] QUINOLON-4-ON.
The level of hs-troponin i in heart failure patients at soc trang hospital
The concentration of hs-troponin I has a median value of 14.9ng / L.
There was a weak uphill (positive) linear relationship with r = 0.164 and statistically significant (p = 0.034) between troponin I and age.
It have also been found to a weak downhill (negative) linear relationship of troponin I and ejection fraction, r = - 0.262, p = 0.001.
Conclusion: Hs-troponin I can be used in prognosis and follow-up therapy for patients with heart failure.
Keywords: hs-troponin I, heart failure, Soc Trang hospital.
Aim: Survey on the level of hs-troponin I in patients with heart failure at Soc Trang Hospital. Sample and method: Cross-sectional study.
There were 168 patients ≥18 years old, diagnosed with acute and chronic heart failure, were treated at Department of Internal Cardiology; Soc Trang Hospital participated in the study.
The concentration of hs-troponin I was investigated and correlated with the sample characteristics.
There were no patients with grade I heart failure, mostly with grade II heart failure (48.8%).
Objectives: The aim of this study was to determine the effect of an essential oil containing mouthrinse on salivary Streptococcus mutans levels in patients with fixed orthodontic appliances.
Conclusion: Essential oil containing mouthrinse was found effectiveness in reducing the amount of S mutans in saliva in patients with fixed orthodontic appliances.
Adding essential oil containing mouthrinse to the standard oral hygiene regimen may be beneficial for orthodontic patients in maintaining proper oral health.
Keywords: essential oil containing mouthrinse, Streptococcus mutans
Method: A single-blind, randomized controlled trial with two parallel groups design was conducted in 29 orthodontic patients with fixed appliances at Faculty of Odonto-Stomatology, University of Medicine and Pharmacy at Ho Chi Minh City.
On-stimulated salivary samples were collected at baseline and after 4 weeks.
Colony-forming units per ml (CFU / ml) of Streptococcus mutans colonies on MSB Agar (Mitis Salivarius Bacitracin) were counted after 5 days of anaerobic incubation.
Results: There was no statistically significant difference in mean of S mutans CFU between the two groups at baseline (p>0.05).
The control group showed an increase of 2.54% in the S mutans CFU with no statistical significance (p>0.05).
In vitro germ cells differentiation of mouse testicular tis
Objective: To identify in vitro germ cells differentiation of mouse testicular tissues to mature sperms Method: Testis tissues derived from mouse adult testis is used for isolation germ cells.
Germ cells and some of different cells such as Sertoli are co-cultured in vitro in medium GAMETE-100, plus with FSH and Testosterone.
However, combination of FSH and testosterone can resulted in maturation of germ cells better than if using only FSH or testosterone.
Background: Ulcerative colitis (UC) is a long-lasting inflammation and ulceration in the large intestine (colon). It is treated by internal medicine or surgery.
The compared group used sulfasalazin 100 mg / kg.
Parameters for UC evaluation of Monika Schneider include clinical score (weight loss, stool consistency, blood in stool, average weight) and mortality.
Results: Determined Dmax =26.67g / kg.
In the UC model induced by dextran sodium sulfate 3% for10 days, the dose 6.67 mg / kg (1/4 Dmax) showed significant reduction in clinical score parameters about 4.48 points (p=0.07), weight recovery (p = 0.01), decreased liquid stool and blood in stool.
In the UC model induced by dextran sodium sulfate 3% for15 days, the dose 6.67 mg / kg reduced clinical score parameters about 2.23 points (p=0.11), decreased liquid stool, blood in stool and reduced the death rate.
From this fact, the study of traditional medicine with fewer unwanted effect and improvement of disease is essential.
Many studies have demonstrated that Shen-Ling-Bai-Zhu (SLBZ) was effective in treating UC.
However, in Vietnam, there are no studies on experimental models that show the effect of SLBZ.
Aims of study: Evaluate the effect of SLBZ extract on the ulcerative colitis model induced by dextran sodium sulfate 3% in mice during 10 days and 15 days.
Method: Evaluate the effect of SLBZ dose 6.67g / kg (1/4 Dmax) on the ulcerative colitis model induced by dextran sodium sulfate 3% in mice, orally, during 10 days and 15 days.
To evaluate ventilation function of the eustachian tube in patients with suffering from the endoscopic sinus surgery
Objective: To evaluate ventilation function of the Eustachian tube in patients with suffering from the endoscopic sinus surgery.
According to the number of Eustachian tubes: After 7 months, only 6 Eustachian tubes (2.8%) are still obstructed (p<0.05).
There is relationship between Eustachian tube function and ear fullness before surgery (p<0.05) and improvement of symtoms of ear through followed stages (p<0.05).
Conclusion: The cases with obstructed Eustachian tubes are at the high rate in patients with suffering from the chronic sinusitis.
The endoscopic sinus surgery improves the Eustachian tube function considerably.
However after the surgery, there is a small rate of obstructed Eustachian tubes.
Subjects and methods: The prospetive study includes 106 patients aged from 20 to 70. They were diagnosed with chronic sinusitis, but their medical treatment has been failed and they suffered from the endoscopic sinus surgery at the ENT department of the Trưng Vương Emergency Hospital in the period from 10 / 2010 to 7 / 2012.
Results: + Before surgery: The cases with the obstructed Eustachian tube function are 64 (60.4%) and the cases with normal Eustachian tube function are 42 (39.6%).
According to the number of Eustachian tubes: obstructed Eustachian tubes are 85 (40.1%) and normal Eustachian tubes are 127 (59.9%) on the right side and the left side.
+ After surgery: These patients are followed after 1 month - 4 months - 7 months. * In the obstructed Eustachian tube group: After 7 months, the cases whose Eustachian tubes have been still obstructed are 16 (15.1%) (p<0.05).
According to the number of Eustachian tubes: obstructed Eustachian tubes are 13 (6.1%) (p<0.05).
Evaluate the change of blood pressure in patients with non-funtioning kidney nephrectomy
Objectives: To identify the change between preoperative and postoperative blood pressure in patients with non-functioning kidney nephrectomy. Materials and methods: Prospective description in patients who underwent non-functioning kidney nephrectomy from May 2010 to May 2011 at Cantho General Hospital. Results: 17 patients underwent retroperitoneal nephrectomy.
11 hypertensive patients had their mean blood pressures reduced from 151.4/87 mmHg to 128.2/73.2 mmHg after surgery (p<0.05).
The mean preoperative blood pressures of 6 patients without hypertension was 118.2/73.2 mmHg and the mean postoperative blood pressures was 115.8/70 mmHg. Conclusion: Nephrectomy can improve blood pressure control in patients with hypertension especially nephrogenic hypertension.
Evaluation the early results of thulium yag laser transurethral resection of non – muscle invasive bladder cancer
Introduction and objective: To evaluate the early results of Thulium YAG laser transurethral resection of non - muscle invasive bladder cancer combined with intravesical six doses of mitomycin C after operation.
Recurrence patients after 09 follow - up months was 2/16cases.
Conclusion: Thulium YAG laser transurethral resection of non - muscle invasive bladder cancer is good early results, safe, easy to implement and almost no complications.
Keywords: Non - muscle invasive bladder cancer, Thulium YAG laser, mitomycin C.
Materials and methods: Prospective cases study was realized on 19 cases of non - muscle invasive bladder cancer to treat at Binh Dan hospital from 06/2012 to 03/2013.
Patients were resected endoscopically bladder tumors by Thulium YAG laser, then injected intravesical the six doses of 40mg mitomycin C after operation once a week.
To evaluate the early results and follow - up the patients every 3 months.
Results: Mean age: 64.42 ± 16.4 years.
Common age: 61 - 80 years (42.11%).
The rate of male / female: 3.75/1.
The average time of operation: 25.4 ± 8.9 minutes.
The early results: good evaluation was the highest (89.47%).
62/73 (85%) E Coli isolates carry genes producing ESBL; among them, number of isolates carrying one gene CTX-M is 26 (35.6%), TEM is 1 (1.4%); carrying TEM+CTX-M genes is 34 (46.5%) and SHV+CTX-M is 1 (1.4%).
Conclusion: Prevalence of ESBL Enterobacteriacae genes: carrying one CTX-M gene, TEM, SHV, TEM+CTX-M, SHV+CTX-M and SHV+TEM+CTX-M are 28.3%, 3.5%, 1%; 33.6%, 6.2% and 2.7% respectively.
Prevalence of AmpC Enterobacteriacae genes: carrying one DHA gene, CYM and FOX+CYM are respectively 8.6%, 2.9% and 8.6%.
Keywords: GenotypesESBL; AmpC; healthy population.
Of studied 148 isolates of β-lactamase producing Enterobacteriacae, there were 85 E coli isolates; 61 Klebsiella spp.
isolates and 2 Citrobacter isolates.
The isolates were examined genotypes of ESBL and AmpC by using multiplex-PCR technique.
Result: 148 β-lactamase producing Enterobacteriaceae iolates, phenotypes of ESBL is 113 (76.4%) and AmpC is 35 (23.6%).
The rate of genotypes compare with phenotypes of ESBL is 85/113 (85%) and of AmpC 7/35 (20%).
Results of postoperative radiotherapy for astrocytoma by linear accelerators at cho ray cancer center
Objectives: Determining the results of postoperative radiotherapy in astrocytoma treated by Linear Accelerators at Cho Ray Cancer Center Methods: Retrospective study of 101 postoperative astrocytoma patients treated by 3D radiotherapy at Cho Ray Cancer Center from 01.01.2010 to 31.12.2010..
Median survival time in different grades of the tumor were: grade 1: 19, 9 months; grade 2: 19.9 months; grade 3: 14.5 months; grade 4: 10.5 months.
This difference wasn't statistically significant with p = 0.00001 (p<0.05).
The independent prognosis factors affect survival time included age and grade of histology.
The best survival time in group which age was < 50 year old and grades 1 and 2 of astrocytoma.
Keywords: Astrocytoma, radiotherapy, survival time
Most patients was under 50 years old (72%).
The sites of tumor mostly are in supratentorium region (82.1%) in which the temporal lobe was 29.7%.
Grade 2 of histology was most common, 45.5%.
The median survival time in age group > 50 was 12.3 months but in age group ≤ 50 was 18.55 months.
This difference was statistically significant with p = 0.00018 (p<0.05).
The survival time in different sites of the tumor were not statistically significant, with p=0125 (p>0.05).
Co-infection with hbv, hcv and hiv among drug addicts at thanh đa withdrawal centre, hcm city
The study aims to determine the prevalence of co-infection with HBV, HCV, HIV and the risk factors for transmission of these agents in 271 drug addicts at Thanh Đa withdrawal Centre, HCM city, from June to July 2004.
Results: Prevalence of HBV, HCV and HIV were 11.1%, 41.5% (56.3% for IDUs), and 22.9% (33.7% for IDUs), respectively.
Rate of HCV / HIV co-infection was 17%.
The percentages of injection drug users (IDUs) were 62.4%, in which 24.1% used to share needle, especially 13.6% IDUs used to share needle over 5 times.
The number of tattooers accounted for 40.6%.
Report on 6 cases using technique of t.v.t. (tension-free vaginal tape) for treatment of stress urinary incontinence in women.
T V.T
Since the end of the year 2002, we have applied this technique to treat 6 women who were suffered from stress urinary incontinence for long time (2 - 30 years) and have got 6/6 of successful incidence.
The author presents his preliminary experiences on this new method in Binh Dan hospital.
Design of small-molecules binding into interleukin-1β
Background and Objectives: Interleukin (IL) - 1β is a member of the IL-1 family of cytokines which is an important mediator of inflammatory response and immune response.
Conclusion: The in silico models of IL-1β inhibitors were built successfully.
These models could be developed to screen larger databases. The screening results would be continually evaluated by molecular dynamics simulation or / and in vitro assays to find bioactive compounds.
Keywords: Interleukin-1β, Interleukin-1β inhibitors, 3D-Pharmacophore, Molecular docking.
There are three approved protein structure-based drugs inhibiting IL-1β.
This study aimed at discovering small-molecule inhibitors impeding IL-1β activity.
Methods: The crystal structure of IL-1β was collected from Protein Data Bank with PDB code 9ilb.
3D-pharmacophore modelling and molecular docking were used to screen a DrugBank database containing 7.616 compounds. The hit compounds were evaluated functional score to select the most potential compounds for IL-1β inhibitory activity.
Results: Two 3D-pharmacophore models of IL-1β binders were established including 33 and 70 of which were found to bind to site A and site B, respectively.
Several compounds potentially inhibiting IL-1β activity namely DB07710, DB08957, DB01014 were demonstrated.
Relation of clinical symptons and obstructive sleep apnea
Objective: Description of common clinical symptoms of obstructive sleep apnea and determining the factors relate to obstructive sleep apnea at Cho Ray Hospital. Methods: During the period from March 2010 to December 2014 in the Department of Respiratory, Cho Ray Hospital, we studied cross sectional and analyzed 189 patients with sleep disorders.
Conclusion: The factors which are the age, male, BMI, necklace, waist, sleep apnea, daytime sleepiness, Epworth ≥ 7, morning headaches and sleepiness while driving vehicles have related to obstructive sleep apnea.
Keywords: obstructive sleep apnea (OSA), clinical symptoms.
The patients were examined common clinical symptoms and polygraphs test.
Results: one hundred and forty four patients had AHI ≥ 5 and forty five patients had AHI < 5.
The age is 49.3 ± 14.8 and male / female is 2.6/1.
Through ENT examination, no findings abnormal nose and palate, Friedman stage 2 has 91.2%; stage 3 has 8.8% and no finding Friedman stage 1.
The symptoms were loud snoring (87.8%), sleep apnea (73%), daytime sleepiness (63.5%), Epworth has 7, morning headaches (23.3%), sleepiness while driving vehicles (20.1%), traffic accidents due to sleepiness (1.6%), poor concentration at work (21.2%) and habit drinking before bedtime (3.7%).
When analyzing the age, male, BMI, necklace, waist, sleep apnea, daytime sleepiness, Epworth ≥ 7, morning headaches and sleepiness while driving vehicles related to obstructive sleep apnea.
The proportion of malaria parasite infection, the situation of bednets and the usage of the bednets at the community of ea lop commune, ea soup district, dak lak province 2011
Background: In order to achieve the targets of reducing malaria mortality and morbidity, sleeping under bednets for malaria control is one of the top priorities.
The proportion of well-preserved bednets was 42.11%.
Conclusion: Increasing rates of bed-net usage and proper bed-net maintenance through health information, communication and education to enhance the effectiveness of malaria control.
The evaluation of bednet status and people's bednet usage will be helpful for making malaria control plans.
Objectives: To identify the proportion of malaria parasite infection in the community residing in Ea Lop commune, Ea Soup district, Dak Lak province in 2011 and to evaluate the bednet situation and usage of the people for malaria control.
Methods: Cross-sectional descriptive study, investigating malaria parasite infection rate, surveying bednet situation and usage of the populations in Ea Lop commune, Ea Soup district, Dak Lak province in 2011.
Result: The proportion of malaria parasite infection in Ea Lop commune was 6.15%; of which P falciparum infection dominated with 79.17%.
The proportion of person / bednet in the study commune was 2, 3.
The bednets treated with insecticides accounted for 97.37%.
The rates of inhabitants sleeping under bednets and sleeping without bednets were 88.46% and 11.54%, respectively.
The torn bednets occupied 50%.
Application of jaws-only intensity modulated radiotherapy in cancer treatment at nuclear medicine & oncology department, bachmai hospital
Objectives: Primary access the role of intensity modulated radiotherapy in cancer treatment at nuclear medicine & oncology department, bachmai hospital.
Patients and methods: Restrospective study of 21 cancer patients treated by JO-IMRT at nuclear medicine & oncology department, bachmai hospital.
Treatment time for a fraction is from 10 to 15 minutes with 2.25 Gy for CTV1 per day.
Discrepancies of doses were below 3% (0.15 to 2.84%) between planning and practice.
In clinical, almost patients had good respond, acounting for 90% whereas side effects were quite less than conventional radiotherapy.
Conclusions: JO - IMRT is a high technique, better than conventional radiotherapy and suitable for Vietnamese cancer patients.
Self-learning activitives of the first year medical students of university of medicine and pharmacy – hcmc in 2015
Background: In the time of media explosion, beside the guide of teachers, students should be improving their ability in self-learning, especially in proffesional skills of a medical doctor.
Researching the self-leaning of the first year medical students can provide to University of Medicine and Pharmacy - HCMC the solution in increasing the quality of medical doctor skills.
Keywords: self-learning, self-learning activitives, academic evaluation.
Characteristics of pericarditis in children at children's hospital 1 - ho chi minh city
Objectives: To determine the rate of epidemiologic, clinical, paraclinical characteristics, etiologies, treatment and outcomes of pericarditis and the cause of purulent pericarditis in children who were treated and followed up at the cardiovascular department - Children, s Hospital 1.Methods: case series reportResults: In 9 years (from 6 - 2000 to 6 - 2009) 73 children, average age 7 (from 3 months to 15.4 years old), with acute pericarditis admitted to the Children's hospital 1, were studied retrospectively and prospectively for etiology, presentation, management, and outcome.
The etiologies of pericardial effusion were: purulent or bacterial pericarditis (51.4%), viral pericarditis (11.1%), post-cardiac surgery (9.7%), collagen vascular disease (4.2%), and rheumatic fever (2.8%).
The treatment include pericardial drainage 21.9%, antibiotic therapy 80.8%, the mean duration of antibiotic therapy was 15.21 ± 11.93 days, (purulent pericarditis 23.95±9.67 days).
Corticosteroid was used in 46.6%, the mean duration was 12.47±6.22 days.
Corticosteroid did not improve neither the outcome of constrictive pericarditis nor decrease the mortality of purulent pericarditis.
It was only helpful in post-pericardiotomy syndrome.
Complications included tamponade 21.9%, constrictive pericarditis 2.73%, recurrent pericarditis 1.37%.
The most common causative organism was S aureus (50%), then Acinetobacter 18.75%, Staphylococcus coagulase (-), Klebsiella, Pseudomonas and E coli 12.5%, the other causes were 6.25% include H influenzae, Morganella, S pneumoniae và Proteus.
The most common preceding or concurrent infections were pneumonia and pleural effusion (80%). Conclusion: Pericarditis is uncommon disease however it can results in high mortality unless it is early diagnosis and management.
Patients usually have various non-specific symptoms and misdiagnosed with other cardiac diseases.
Most cases are caused by bacteria, especially S aureus.
Antibiotic therapy and surgery intervention help improve the outcome.
Inflammatory reactions were very high in almost cases presented by increasing ESR and CRP.
The positive blood culture was 24% and the positive pericardial fluid culture was 25.6%.
The electrocardiogram showed low voltage in 32 patient (51.9%) and changes of ST-T segment in 32 patients (61.53%).
Chest X-rays showed cardiomegaly in 86%, pneumonia 53% and pleural effusion 54.8%.
Background: Eosinophilia meningitis can be the result of noninfectious causes and infectious agents.
Keywords: Eosinophilic meningitis, Angiostrongylus cantonensis, children.
Among the infectious agents, Angiostrongylus cantonensis is the most common.
Objectives: To describe the epidemiology, clinical features, and laboratory findings of eosinophilic meningitis in pediatrics.
Methods: A case-series study of children with eosinophilic meningitis at the Infectious Diseases Department of Children's Hospital N01 from September 2013 to July 2014.
Results: 27 cases were described, the median age was 7 years old and 89% of them came from provinces. The incidence was remarkably high (74%) from September to December.
Common clinical presentations were headache (96.3%) and fever (63%); the patients with meningeal signs 26%, lower limb weakness 7%, and 6th cranial nerve palsy 7%.
Assess the effectiveness of non-surgical treatment of peri-implantitis.
Key words: Non-surgical treatment, peri-implantitis
Objectives: The aim is to evaluate the effectiveness of non-surgical treatment of peri-implantitis.
Materials and methods: Descriptive, prospective study design of clinical trial without control group.
The sample included 38 patients with 40 single restorations on the implant with mild peri-implantitis.
The patients received oral hygiene instructions, management of screw loosening and cleaning of the implant surface.
Data collection included gingival bleeding index (BOP), plaque index (PlI), gingival index (GI), pocket depth (PD), and bone loss (BL) in intraoral periapical X-rays recorded at baseline.
Three months and six months after treatment, the indices of gingival bleeding (BOP), pocket depth (PD), bone loss (BL) were recorded.
Study on prognosis of serum acid uric in acute ischemic stroke.
Background: Current evidence shows that uric acid is a potent antioxidant whose serum concentration increases rapidly after acute ischemic stroke (AIS).
We aimed to describe the prognostic significance of SUA in AIS.
Methods: We studied 84 patients with AIS admitted to the cardiology, Hue Central Hospital from May, 2015 to October 2016.
Acid uric concentration was measured at hospital arrival, day 3 and day 7.
Correlated equation was constructed to analyze the association of SUA with functional outcome as assessed by the modified Rankin scale (mRS) at 30-day follow-up.
Mid-term outcome of perforated duodenal ulcer repair using single-port laparoscopic surgery.
Background: Single-port laparoscopic surgery (SPLS) is increasingly used in surgery and in the treatment of perforated duodenal ulcer.
There was one case (1.4%) in which one additional trocar was required.
Average length of hospital stay was 5.7 ± 1.2 (4 - 12) days.
Post-operative complications rate was 2.8%.
There was no leakage from the repair site, no port-site hernia and no post-operative mortality.
There was one case (2.2%) diagnosed with recurrent duodenal ulcer perforation at 5 months after the repair of the first perforation.
On gastroduodenoscopy, recurrent duodenal ulcer was seen in 8.9% of cases.
The aim of this study was to evaluate mid-term outcome of perforated duodenal ulcer repair using SPLS.
Conclusions: SPLS is a safe method for the treatment of perforated duodenal ulcer.
Conversion rate was 1.4%.
Key words: perforated duodenal ulcer, single port laparoscopic repair, single port laparoscopy
Methods: A prospective study on 72 consecutive patients diagnosed with perforated duodenal ulcer and treated with SPLS at Hue University Hospital and Hue Central Hospital from January 2012 to Mars 2016.
Results: The mean age was 48.8 ± 14.0 (17 - 79) years.
Male / female ratio was 17.0.
Four patients (5.6%) with history of abdominal surgery were successfully treated by pure SPLS.
Patients were classified as ASA 1, ASA 2 and ASA 3 in 86.1%, 12.5%, and 1.4% of cases, respectively.
Using Boey scoring system, there were 86.1% and 12.5% of cases classified as Boey 0 and Boey 1 while there were no Boey 2 and 3 cases.
The average size of perforation was 4.1 ± 2.6 (1.5 - 22) mm.
A study on the quality decrease of amoxicillin, aspirin ph8 and vitamin c drugs by time under the effects of temperature and humidity at different areas in hue province.
Background: A preliminary research about the relation of drug quality decrease through period of stored time by temperature and humidity at different geographic areas was carried on Aspirin pH8 intestine-disolved coated tablets, Vitamin C film coated tablets and Amoxcycillin capsules.
Materials and method: Pharmaceuticals possessing same manufacture batch and date expire longer than experimental period preserved at Thuan An coastal area, Nam Dong mountainous region, flat country of Hue Province and Hue Drug Quality Control Centre, Vietnam. The change of temperature and humidity at drug stored pharmacies was recorded contineuosly.
Monthly, these drugs were examed quality following Standards of Vietnam Pharmacopie Volumn III, edition 2002 and in-home Standards.
Results: The decrease of drug quality happened earliest and strongest at Than An, then Nam Dong, sustained a severe elimate condition yearly.
Especially, effect of humidity element on the drug decomposition was serious than temperature.
The decrease of drug quality was also happened at Hue city but in gentle degree, while all drugs were still in good quality under the standard store condition at Drug Quality Control Centre (25oC, 60%).
Studying serum uric acid concentration in essential ypertensive patients.
Background: Evaluation of serum uric acid concentration contribute to understanding the complications of hypertension on the kidney as well as determination the relationship between levels of uric acid in the blood with a number of factors involved in essential hypertensives.
Purposes: (1) Determination of serum uric acid concentration in essential hypertension. (2) Survey a number of involved factors hypertensives with serum uric acid concentration.
Materials and method: 82 patients, the mean age: 62, 24 ± 2, 30 years old, was diagnosed with essential hypertension is based on the criteria and classified of WHO / ISH (2004), blood pressure measurement, ECG, quantitative serum uric acid concentration, serum lipid profile, renal function.
Results: The results showed that serum uric acid concentration in hypertensives was 382, 2 ± 24, 5 m mol / l which is 404, 7 ± 27, 3 m mol / l in men, and emales 330, 8 ± 48, 0 m mol / l in women.
There were significant correlation between blood levels of uric acid with hypertensive levels (r = 0, 23, n = 82, p <0, 05) with time detection of hypertension (r = 0, 21, n = 82; p <0, 05), with renal function (r = 0, 35, n = 82, p <0, 01), with body mass index (r = 0, 42, n = 82, p <0.001), with triglyceride and cholesterol (r=0, 51 and 0, 38, respectively) also reverse correlated with HDL - cholesterol (r = - 0.47, p <0, 001).
Conclusion: The concentration of serum uric acid closely related with hypertensive levels and a number of factors involved in hypertensive patients.
Key words: serum uric acid concentration, essential hypertension.
Clinical haracteristics of latent-onset type-2 diabetes mellitus (lada).
Objective: to determine clinical characteristics of LADA in non overweight and obesity population of diabetic patients.
Materials and methods: A cross-sectional study in 156 non overweight and obesity population of diabetic patients.
Clinical data were obtained and a blood sample taken to measure autoantibodies glutamic acid decarboxylase antibodies (GADAb).
Results: There were 30 patients who were diagnosed LADA in 156 non overweight and obesity diabetic case.
LADA patients have certain clinical characteristics such as earlier age of onset, lower BMI, tablets response time is shorter, insulin dependency rate is higher than the group of type 2 diabetes.
Conclusion: In clinical practice we may use characteristics such lean diabetes, short-term Oral Hypoglycemic Agent Responsiveness, as a criterion for screening high-risk subjects for anti-GAD antibody testing, to diagnose Latent-onset type-2 diabetes mellitus (LADA) in patients with type 2 diabetes mellitus.
Key words: Latent-onset type-2 diabetes mellitus (LADA)
The study on arterial blood gas in patients with acute stroke.
Objectives: 1) To investigate the variation in arterial blood gas in patients with acute stroke according to ischemic stroke and hemorrhagic stroke.
HCO3 - correlated with Glasgow (r=0.323; p<0.01) and NIHSS (r=-0.274; p<0.05).
At the time of 24 hours, there was a negative correlation between PO2 (r=-0.375, p=0.001) and SaO2 (r =-0.39, p<0.01) with NIHSS.
There was a negative correlation between PO2 (r=-0.435) and SaO2 (r=-0.457) with damage volume (p <0.0001).
At the time of 48 hours, there was a negative correlation between PCO2, PO2 and SaO2 with NIHSS (r=-0.312, p<0.01, r=-0.35, p=0.01 and r=-0.0270, p<0.05).
PCO2 was positively correlated with Glasgow (r = 0.260, p <0.05).
There was a negative correlation between PO2 (r = - 0.391, p = 0.001) and SaO2 (r = - 0.421, p <0.001) with damage volume.
Conclusions: In stroke patients, disturbances on ABG they are surfered from (acid-base disorders, hypoxemia) affect directly or indirectly on brain cells.
Secondary brain damages could be well prevented if these disturbances is diagnosed and treated promptly.
Key words: Stroke, arterial blood gas, Glasgow scale score, NIHSS
2) To determine the correlation and relevance between arterial blood gas and Glasgow scale score, NIHSS, volume of brain damage on computed tomography imaging.
Subjects and methods: A cross-sectional study was done in 70 patients with acute stroke.
Results: Reduced rates of PCO2, PO2, SaO2 at the time of admission were 56.2%, 25%, 18.8% in ischemic stroke and 44.4%, 72.2%, 63% in hemorrhagic stroke.
At the time of 24 hours, these rates were 75%, 56.2%, 50% in ischemic stroke and 50%, 79.6%, 70.4% in hemorrhagic stroke.
At the time of 48 hours, these rates were 68.7%, 50%, 18.8% in ischemic stroke and 53.7%, 59.3%, 44.4% in hemorrhagic stroke.
Respiratory acidosis was only present at hemorrhagic stroke.
Respiratory alkalosis was in both stroke style and had the highest proportion.
At the time of admission, SaO2 was negatively correlated with damage volume (r= - 0.264, p<0.05).
Preoperative assessment of thyroid nodules: role of ultrasound and fine needle aspiration (fna).
Background: Each type of thyroid nodules is managed differently, hence preoperative diagnosis plays an important role.
The rates of colloid nodule, adenoma, and carcinoma w 39%, 23%, 31% respectively.
Conclusions: In this study, thyroid tumors were more common in females, a common clinical presentation was a lump or protrusion, the adult was the most dominant.
The preoperatively diagnostic value of ultrasound and FNA in thyroid tumors were reliable.
Hence, a combination of clinical signs, ultrasound, and FNA can improve the accuracy of preoperative diagnosis.
Key words: Thyroid ultrasound, fine needle aspiration (FNA), thyroid nodule, preoperative assessment
To answer the question: "The role of ultrasound and FNA in preoperative assessment of thyroid nodules", we conducted this study to evaluate the value of ultrasound and fine-needle aspiration in the diagnosis of thyroid tumors and to describe clinical characteristics of the sample.
Materials and Methods: This descriptive study included 100 patients diagnosed with thyroid nodules at Hue University of Medicine and Pharmacy Hospital from June 2017 to June 2018, having preoperative results of the ultrasound, FNA, thyroid functions, and postoperative pathology.
Results: Of the 100 cases analyzed, sensitivity, specificity, and accuracy of ultrasound were 80.6%, 79.7%, 80% correspondingly, while these of FNA were 58%, 82.6%, 75% respectively. The sign of microcalcification on ultrasound had Se 71%, Sp 95.7% respectively.
A study on clinical features of ent cancers at hue university hospital and hue central hospital.
Background: The study made to determine the epidemiologic and clinical features of cancers in ENT.
- Squamous cell carcinoma (88.4%) is most common.
Conclusion: ENT cancers in Hue having epidemiologic and clinical features similar to those of other regions in the country.
Result of treatment will be better if cancers are diagnosed early and treated properly.
Patients and method: Study 103 patients of ENT cancers by cross-sectional and descriptive methods.
Results: - Male patients (78.6%) are more numerous than female patients (21.4%).
Adults (98.1%) are more numerous than children (1.9%).
- Age range more than 45 years (73.8%), living in rural and mountainous area (70.9%), urban area (29.1%), manual labor profession (48.6%).
- The percentage of smokers (69.9%) and alcoholics (57.3%).
- Hospitalization in the first 6 months of disease (75.8%), diseased time more than 1 year (2.8%).
- Reasons of hospitalization following in order: Pain at tumor area (47.5%), dysphagy (44.7%), laryngeal syndrome (41.8%), headache (37.9%), otologic syndrome (31.1%), nasosinusal syndrome (29.1%), cervical nodes (25.2%)... - Order of ENT cancers: nasopharyngeal cancer (33.0%), laryngeal cancer (24.3%), hypopharyngeal cancer (19.4%), nasosinusal cancer (11.7%), tonsillar cancer (9, 7%), otologic cancer (1.9%).
- Metastasis to lymphatic nodes of superior carotide group (28.2%) is most frequent.
Study on the heart dysrhythm by 24 hours ecg holter in patients with mitral stenosis.
Objectives: Mitral stenosis is a common disease accounting for 40.3% of population of cardiovascular disease.
The results showed that: cardiac arrhythmias accounted for 53.33%, in which ventricular premature beats: 88.89%, atrial premature beats: 4.44%, sinus bradycardia: 6.67%, sinus tachycardia: 46.67%, sinus arrest: 11.11%, atrial fibrillation: 55.56%, supraventricular arrhythmias: 2.22%.
The more severe mitral stenosis is, the more often heart dysrhythms appear: mitral stenosis severity I, II, III has the rate of heart dysrhythm of 6.67%, 15.56%, 31.10%, respectively.
There was an inverse correlation between the severity of mitral stenosis and atrial fibrillation (r=-0.410, p<0.05); inverse correlation between the pulmonary artery pressure and degree of mitral stenosis (r=0, 7361, p<0, 05).
There was a proportional correlation between the pulmonary hypertension and atrial fibrillation (r=0.43, p<0.05).
Conclusion: ECG Holter is helpful in diagnosis, follow-up, prognosis of mitral stenosis. It is also valuable in detecting complications of mitral stenosis, aiding in treatment and improving patient's quality of life.
Cardiac arrhythmia is a common complication of this disease.
Determine the rate of cardiac arrhythmias and their classification in mitral valve disease throughout ECG Holter.
Find out the correlation between cardiac arrhythmia and mitral stenosis severity.
Materials and methods: 45 patients (the youngest was 22, the oldest was 73 and average age: 43.84 ± 12.97) were diagnosed with affirmation mitral stenosis based on clinical features, X-ray, and echocardiography. ECG Holter then was recorded and analyzed in the terms of the rate and classification of cardiac arrhythmias.
The effectiveness of electrohydraulic lithotripsy in the management of re-operatived biliary lithiasis.
Objective: To evaluate the effectiveness of electrohydraulic lithotripsy in the treatment of re-perated biliary lithiasis.
Jaundice 42.86%, hepatomegaly 19.44%, fever 66.6%, white blood cell uper 10.000 / ml 61.12%, hyperbilirubinemia 88.89%, hight transaminase level 47, 28%.
Intraoperative complications 19.44%, common post-operative complications 26.8% and not operative mortality.
Conclusion: Electrohydraulic lithotripsy in the the treatment of re-perated biliary lithiasis is highly effective and safe with less complication.
Noninvasive assessment of hepatic fibrosis.
Staging of hepatic fibrosis is crucial for prognosis, surveillance and treatment decision in patients with chronic liver diseases in clinical practice.
Liver biopsy has still the gold standard for assessment of hepatic fibrosis, but it has some limitations.
To overcome this, non-invasive methods were developed.
The methods of noninvasive assessment of liver fibrosis were divided into two main groups: serum biomarkers and techniques measuring liver stiffness.
Each method has its own advantages and limits.
Some studies suggest that the effectiveness of noninvasive methods for assessing liver fibrosis may increase when they are combined.
The aim of this article is to review and update the different non invasive methods for assessment of hepatic fibrosis, their advantages, disadvantages, diagnostic accuracy and their applications in clinical practice.
Key words: hepatic fibrosis, liver stiffness, chronic liver disease
The role of the gut microbiome in human health.
All of them, some of the most noticeable diseases are Clostridium difficile infection, inflammatory bowel disease, celiac disease and obesity.
Key words: gut microbiome, dysbiosis, Clostridium difficile infection, inflammatory bowel, celiac disease, obesity.
Clinical features and coagulation abnormalities in children with sepsis at danang hospital for women and children.
Objective: To determine the relationship between coagulation abnormalities and main clinical features, and hematologic tests.
Conclusion: Children with sepsis, especially septic shock were at high risk of coagulation dysfunction and coagulation abnormalities showed the correlation with hemorrhage and the mortality of sepsis.
Key words: coagulation abnormalities, sepsis, children
Methods: A descriptive cross-sectional study was conducted in 65 children with sepsis at the PICU, Da Nang Hospital for Women and Children from April 2012 to June 2013.
Results: The frequency of internal hemorrhage in septic shock children was significantly higher than in children with sepsis (p < 0.001).
The rate of thrombocytopenia was 30.8%, in which 10.8% of the children had severe thrombocytopenia (<50 x 109 / l).
Hypofibrinogenemia was observed in 30.8% of the patients, in which severe hypofibrinogenemia (≤ 1 g / l) was observed in 16.9% of the children.
The frequency of reduced prothrombin ratio was 40%, in which 23.1% of the patients had prothrombin ratio < 50%.
Positive D-dimer and DIC were observed in 53.8% and 20% of the patients, respectively.
Hemostatic changes showed the significant relationship with hemorrhage and the mortality of sepsis.
The roll of generic drugs– quality and economic aspect in treatment.
Generic drugs have an important role in ensuring the efficacy, safety, and especially the economic aspect of drug use.
A generic drug is a pharmaceutical product, usually intended to be interchangeable with an innovator product manufactured without a licence from the innovator company and marketed after the expiry date of the patent or other exclusive rights.
At present, unlikely FDA's regulations, Vietnam's law does not require all generic drugs launching in the market to prove the bioequivalence, the same efficient and safe as innovator drugs.
Because of the rapid growth of the domestic pharmaceutical market, the standard and quality of generic drugs compared with innovator drugs have to be consolidated and proved through trials of bioequivalence, then building the faith of professionals and patients in using generic drugs.
Thus the expansion of number and improving quality of the bioequivalence assessment centers become an important task of Vietnam pharmaceutical industry in the context of integration with the global pharmaceutical industry.
Key words: generic drugs, innovator drugs, patent, bioequivalence, treatment.
A case study of the diastematomyelia in hue university hospital.
Diastematomyelia is a rare congenital malformation anomaly that results in the splitting of the spinal cord in a longitudinal direction.
It is caused by the presence of the septum of bone, the cartilage or the fibers in spinal canal.
In the case of complete separation that isn't consolidated until the terminal filum and that is called the duplicated spinal cord.
Key words: Diastematomyelia, splitting, congenital malformation, duplicated spinal cord.
Power doppler ultrasound featuresof wrist joints in rheumatoid arthritis.
Background and aims: Assessments of disease activity in rheumatoid arthritis plays an important role in determining treatment plans and patient response to treatment.
Conclusions: Power Doppler ultrasound of wrist joints could be used as a non-invasive and feasible method to assessing disease activity in patients with rheumatoid arthritis.
Key words: rheumatoid arthritis, power Doppler ultrasound
The aims of this study was to describe the power Doppler ultrasound features of wrist joints in patients with rheumatoid arthritis and evaluate role of power Doppler ultrasoundin assessing disease activity in patients withrheumatoid arthritis.
Material and method: This present study included 30patients diagnosed with rheumatoid arthritis according to the 2010 ACR / EULAR classification criteria, who were admitted in the period July 2017 to April 2018 in Department of Nephrology and Rheumatology, Hue Central Hospital.
All patients were physical examination, laboratory investigations, assessment disease activity score in 28 joints using CRP (DAS28-CRP), clinical disease activity index (CDAI), simplified disease activity index (SDAI).
Power Doppler was graded using a validated semiquantitative scroring system, which consists of scale of 0 - 3.
Result: Twenty-seven wrist joints (45.0%) had synovitis in grey scale ultrasound.
Thirty-seven wrist joints (61.7%) had a power doppler signal, 18.3% had grade 1 (low), 21.7% had grade 2 (moderate) and 21.7% had grade 3 (high).
Biochemical, virological and the fibrosis responses to tenofovir disoproxil fumarate in patients with hbv-related compensated cirrhosis.
Background: Preliminary studies showed anti HBV nucleoside analogues treatment might improve the histopathology and improve the survival of the cirrhotic patients.
Data about efficacy of anti-HBV treatment in Vietnamese cirrhotic patients was still very limited.
This study was aimed at assessing the biochemical, virological and the fibrosis responses to Tenofovir disoproxil fumarate (Tenofovir DF) in patients with HBVrelated compensated cirrhosis.
Patients and methods: 48 patients of HBV-related compensated cirrhosis, diagnosed by Acoustic radiation Forced Imaging (ARFI), were enrolled.
Especially, 15 patients (31.2%) have obtained a remarkable improvement of fibrosis from F4 down to F3 or even F2.
Evaluation of longo’s hemorrhoidectomy at hue university hospital.
Conclusion: Our present study shows that Stapled Hemorrhoidectomy is a safe, reduced postoperative pain, shorter hospital stay and a faster return to unrestricted daily activity
Several studies have shown it to be a safe, effective and relative complication free procedure.
The aim of this study was to determine the suitability of (SH) as a day cas procedure at Hue University Hospital.
Methods: From Decembre 2009 to April 2012, 384 patients with third - degree and fourth-degree hemorrhoids who underwent Stapled Hemorrhoidectomy were included in this study.
Parameters recorded included postoperative complications, analegic requirements, duration of hospital stay and patient satisfaction. Follow-up was performed at 1 month and 3 months post-operative.
Results: Of the 384 patients that underwent a Stapled Hemorrhoidectomy 252 (65, 7%) were male and 132 (34, 3%) were female.
Echocardiogrpahy study on systolic function of right ventricle in normal adults.
Background: The ASE and ESC have recently published (2010) a guidline to assess the function of the right ventricle.
Results: Fractional area change 49, 76 ± 7, 328%; Tricuspid annular plane systolic excursion (TAPSE) 22, 5 ± 2, 597 mm; TDI velocity at the tricuspide annulus (S) 13, 8 ± 2, 138 cm / s; Tissue Doppler MPI (Tei index) 0, 47 ± 0, 049.
A moderate correlation between S velocity and TAPSE (r = 0, 38 p<0, 01); Tei index and TAPSE (r = - 0, 31 p < 0, 01); ICT, IRT and age (r=0, 29 p<0, 01).
Conclusion: the received parameters are all in the normal range of the guideline of ASE and ESC.
Key words: right ventricular function, TAPSE.
Analysis of clinical features in primary cutaneous t cell lymphoma.
Background: Primary cutaneous T cell lymphoma is a diverse and rare group of diseases with clinical manifestations that, if not biopsied, are easily confused with benign skin diseases.
Conclusion: The study documented the frequence and clinical characteristics of each subtype of primary cutaneous T cell lymphoma.
The most common were subcutaneous panniculitis-like T cell lymphoma and mycosis fungoides.
Although the morphology and location of skin lesions in the subtypes overlap, they still aid in the diagnosis of skin lymphoma.
Key words: T-cell lymphoma, primary, cutaneous.
Objective: To determine some clinical features of primary cutaneous T cell lymphomas and classify them according to the 2018 update of World Health Organization and European Organisation for Research and Treatment of Cancer classification.
Results: Median age at diagnosis is 59 years old.
Male: Female ratio is 1: 2.3.
In order of frequency, diagnoses were: subcutaneous panniculitis-like T cell lymphoma (35.8%), mycosis fungoides (28.2%), primary cutaneous anaplastic large cell lymphoma (15.4%), peripheral T cell lymphoma not otherwise specified (7.7%), extranodal NK / T cell lymphoma, nasal type (7.7%), primary cutaneous CD4+ small / medium T cell lymphoproliferative disorder (2.6%) and primary cutaneous CD8+ aggressive epidermotropic T - cell lymphoma (2.6%).
Subcutaneous panniculitis-like T cell lymphoma always presents as subcutaneous nodule-tumor (100%); the most common site is lower extremities (71.4%).
Mycosis fungoides has various appearance of skin lesions (36.4%) including patch-plaque (100%), and usually involves in trunk (90.9%).
Extranodal NK / T cell lymphoma, nasal type always has skin ulcer (100%).
Evaluation of risk factors for threatened preterm labour.
Objectives: To study the risk factors for threatened preterm labour.
BMI < 18.5 and ≥ 23 had 9.8 and 4.4 times higher at risk of TPL, 95% CI (1.1 - 82.5); (1.6 - 11.9) respectively.
History of stillbirth, abortion, and miscarriage increased the risk by 6.9 times 95% CI (1.5 - 22.4).
History of previous preterm birth, threatened preterm labour increased 9.1 times higher at risk with 95% CI (2.0 - 41.7).
The gap between two pregnancies < 12 months increased risk by 4.9 (1.0 - 23.9) times.
Conclusion: Detecting the risk factors of threatened preterm labour for preventing early and monitoring pregnant women to avoid the threatened preterm labour occur was essential.
Key words: Threatened preterm labour, pregnant women, risk factors
Medthods: The comparative crosssectional study.
Including 73 patients diagnosed with threatened preterm labour were monitored and treated at Hue Central Hospital's Obstetrics and Gynecology Department from June 2018 to August 2019.
Results: Multiple pregnancies increased risk of threatened preterm labour (TPL) 8.8 times higher in comparison with a single birth 95% CI (1.2 - 82.7), polyhydramnios was 4.9 times higher at risk 95% CI (1.1 - 23.9).
The length of cervix < 25 mm was also associated with 4.2 times higher 95% CI (1.3 - 13.1).
Low genital tract infection increased the risk by 2.6 times (1.3 - 13.1) p < 0.05.
Maternal age ≤ 20 or > 35 was 9.5 and 3.7 times higher at risk 95% CI (1.1 - 80.1) and (1.4 - 7.5) respectively.
Study on some clinical, biochemical characteristics and outcome of bacterial meningitis due to streptococcus suis at hue central hospital 2011-2012.
Objectives: Bacterial meningitis is a very severe infectious disease in Vietnam.
55% of patients have over 1000 cells / mm3 CSF, 47.5% of patients have CSF protein 3.0 - - 5.0 g/L.
In the result: 100% patients recovered, 40% had complications.
Conclusions: 45% of patients had contact to pig or used pigs products.
The majority of patients have headache (97.5%), vomiting (85%), Kernig's sign (72.5%), Brudzinsky's sign (52.5%).
Key words: Meningitis, Streptococcus suis
Studies about bacterial meningitis in our country in the last 10 years show that the most isolated causing bacteria is Streptococcus suis.
Materials and methods: Prospective study.
All the patients over 15 years old with diagnosis bacterial meningitis due to S suis treated in Hue Central Hospital from May, 2011 to April, 2012 were recruited in this study.
Results: 40 patients were enrolled in this study (male: 82.5%, female: 17.5%).
Mean age 46.5 ± 17.72.
45% of patients had contact to pig or used pigs products.
The value of narrow band imaging endoscopy in diagnosis of hypopharyngeal and laryngeal cancer and following - up post treatment.
Background: To evaluate the value of narrow band imaging (NBI) endosocopy in diagnosis of hypopharyngeal and laryngeal cancer and following - up post treatment.
Conclusion: NBI endoscopy is an useful tool for diagnosing of hypopharyngeal and laryngeal cancer and following - up post treatment.
Key words: narrow band imaging endoscopy, hypopharyngeal cancer, laryngeal cancer
Material and methods: A total of 75 patients included 36 patients with hypopharyngeal cancer and 39 patients with laryngeal cancer who had diagnosed at Department of Otoloryngology - Hue Central Hospital from 5/2017 to 5/2018.
Results: The age group 51 - 60 years occurred most often, 33.3%, the mean age was 62.1 ± 13.4.
The UICC stage III was 65.3%.
Tumor was in ulcerlarative and infiltrate form (89.4%), edema and inflammation of magrin tumor (41.3%), invasive (58.7%).
The tumor with IPCL type V-n had strong enhancement (51.3%) and moderate enhancement (44.4%) after contrast medium injection on CT scan.
One month after treatment, there were 33.3% of tumor - free, 53.7% of mucosal edema and 13% tumor size-decreasing on NBI image.
Direct observation of counseling activities of otc drugs in community pharmacies at hue city.
Background: This study aimed to characterize counseling activities of drug use at community pharmacies at Hue City.
Key words: pharmacists; community pharmacy; counseling; OTC drugs; Hue city
Methods: researchers observed directly customers buying OTC drugs during 63 hours in 21 pharmacies.
Results: Of 269 interactions between pharmacy staff and customers, 61.0% of cases received counseling.
Pharmacists asked question about whom the drugs were bought for (52.4%), disease symptoms (63.4%).
Pharmacists counseled on drug indications (51.2%), dosage and duration of drug use (61.0%).
Only 0.6% lasted more than 5 minutes.
Conclusions: Drug counseling activities in community pharmacies were still limited in term of quantity and quality of interactions between pharmacists and patients.
The treatment effect of infliximab on spondyarthritis patients.
Background: Biologic drugs, especially anti TNF-α drugs, are revolutionary in the treatment of Spondyloarthritis when the conventional DMARDs have proved ineffective.
Research objective: To evaluate the effectiveness of Infliximab treatment on Spondyloarthritis patients.
Materials and method: Longitudinal follow-up study with Infliximab treatment on 27 patients with Spondyloarthritis.
Results: The effectiveness of Infliximab on patients with Spondyloarthritis is demonstrated by clinical indicators; inflammatory markers: CRP, ESR in the first hour and the disease activity level according to ASDAS-CRP and ASDAS-ESR in the first hour at the time of T2, T6 compared to T0 were statistically significant (p < 0.05)).
After excluding the data of 2 patients with flare at T14, all the above-mentioned indicators improved, the difference was statistically significant with p < 0.05.
Conclusion: Infliximab is effective in improving clinical symptoms, inflammatory markers and disease activity score in patients with Spondyloarthritis.
Key words: spondyloarthritis, Infliximab.
Survey of the gingival zenith position and papilla proportion in the maxillary anterior dentition.
Background: Gingival morphology and contour play an essential role in creating a beautiful smile.
Mean mesial and distal papilla proportion for maxillary anterior dentition were 43.37% and 44.42% respectively.
Conclusions: All maxillary anterior teeth showed distal displacement of GZPs from the VBM.
The GZPs of maxillary lateral incisors were more coronal to the gingival lines.
Papilla proportions were approximately 43, 9% for all tooth groups.
Key words: Gingival zenith, vertical bisected midline, papilla height, papilla proportion
Understanding and establishing these characteristics are prerequisites during treatment planning for maxillary anterior dentition.
The aim of study was to evalute the position of gingival zeniths and to quantify papilla proportion in relation to clinical crown length in maxillary anterior region.
Methods: Descriptive cross-sectional study was conducted on 123 students from faculty of Odonto-Stomatology.
Results: Central incisors, lateral incisors and canines showed distal displacement from VBM with a mean average of 0.96 mm, 0.46 mm and 0.26 mm respectively.
The GZs of maxillary lateral incisors were more coronal to the gingival lines by approximately 0.77 mm.
Comparing the effectiveness of hyflex rotary and hand – operated instruments in preparing mesio-buccal root canals of mandibular permanent first molars.
Objectives: To compare the effectiveness of Hyflex rotary and NiTiflex hand-operated instruments in regard to 4 parameters of root canal preparation: the working time, the alteration of canal curvature and working length, obturating efficacy.
Postoperative teeth were examined clinically and radiographically after 1 week and 3 months.
Research design was prospective clinical trials, group comparison.
Data was statistically analysed using the SPSS 16.0 software.
Results: Rotary Hyflex files prepared significantly faster and maintained the original canal curvature better than hand - operated Nitiflex files (p < 0.05).
There was no significant differences in maintaining initial working length of two groups (p > 0.05) and both hand NiTiflex and rotary Hyflex instruments showed 1 case of ledge formation for each, 1 NiTiflex file separation and no perforation or apical transportion.
Three-month clinical results were equal: in rotary Hyflex group, 90% teeth of successful result, 10% teeth in suspect; in NiTiflex hand-operated group, 80% ratio of successfully - treated teeth, 10% suspect and 10% failing result.
Conclusions: Under the conditions of this clinical study, both instruments were safe to use, showed equally efficacy in preparing root canals and endodontic clinical results.
However, rotary Hyflex significantly reduced working time and respected original canal curvature better than hand-operated NiTiflex files, with higher treatment cost from 9 to 10 times.
Key words: cleaning, shaping, root canals, rotary, canal curvature
The assessment of changes of canal curvature and working length was based on radiographs taken prior and post instrumentation.
Current status of primary dental caries among 2 - 4 year-old children in some kindergartens in ngu hanh son district, danang city in 2022.
Background: Early childhood caries is defined as the presence of one or more carious lesions, tooth loss or decay on any primary tooth in a child ≤ 71 months of age.
Key words: primary dental caries, kindergarten children, dmf index, risk factor, protective factor.
This study aims to investigate the state of primary dental caries and its relationship with some factors in 2 - 4 year old kindergarten children in Ngu Hanh Son district, Da Nang city in 2022.
Methods: A cross-sectional descriptive study was conducted on 423 children aged 2 - 4 years old in 2 kindergartens, in Ngu Hanh Son district, Da Nang city, during March-April 2022.
The state of caries was assessed according to the dmf index, distributed by age, gender and related factors.
Results: There were 75.9% with dmf index was 6.15 ± 5.80, which increased with age, no difference between two genders and most common in the maxillary middle incisors and the mandibular molars.
Risk factors are associated with rates of caries, while protective factors did not significantly affect the rate of caries.
Conclusion: The state of primary dental caries in Ngu Hanh Son district, Da Nang city is still high.
Protective factors did not significantly affect the rate of caries.
Therefore, it is necessary to consider implementing early and more appropriate preventive measures for childhood caries.
Clinical characteristics and treatment outcome of laryngeal cancer in hue.
Conclusions: Laryngeal cancer is one of the most common cancers in Vietnam, good treatment results will be achieved with examination and treatment in early stage.
Surgery and chemoradiation therapy is still the best treatment solution for laryngeal cancer patients.
Key words: laryngeal cancer, laryngectomy, chemoradiation therapy
Patients and methods: 36 patients were diagnosed and treated laryngeal cancer in ENT Department and Oncology Center of Hue Central Hospital from 03/2018 to 05/2019 by prospective, obsertive, descriptive method with clinical intervention.
Results: Patients having the most common age range was 51 - 70 occupied 66.6%, the mean age was 61.1 ± 9.8, ranging from 39 to 83.
Male occupied 94.4% (34/36), females 5.6% (2/36).
The most common functional symptom was hoarseness with 80.6%.
Tumors in stage T3 N0 M0 took 33.3%.
Laryngectomy combined chemoradiation therapy was the treatment solution mostly used with 69.4%.
Patients having postoperative complications occupied 43.8% (7/16).
Patients had complete response to the treatment occupied 95.5%.
Research imaging characteristics of chest radiograph and computed tomographic scanning of blunt chest trauma.
Purposes: Describe imaging characteristics of chest radiograph, computed tomographic scanning and dissect additional value of computed tomographic scanning for radiograph of blunt chest trauma.
Key words: Chest radiograph, blunt chest trauma, computerized tomography
Materials and methods: There are 72 consecutive patients with blunt chest trauma on chest radiograph and computed tomographic scanning in Radiology department of Hue center hospital.
The main reason is due to traffic accidents (79.2%).
The proportion of blunt chest trauma injury on chest radiograph images and computerized tomography respectively: rib fractured 62.5% and 89.9%, clavicle fractured 25% and 26.4%, scapula fractures 5.6% and 11.1%, subcutaneous emphysema 23.6% and 41.7%, hemothorax 37.5% and 59.7%, pneumothorax 34, 7% and 51.4%, pulmonary contusion 33.3% and 45.8%, pulmonary laceration 0% and 11.1%, pneumomediastinum 4.2% and 8.3%.
Detected 08 cases of pulmonary laceration and 01 case sternum fractures were only detected on CT without detectable on chest radiographs.
Conclusion: Rib fracture is the most common ijnury of blunt chest trauma, followed by hemothorax, pneumothorax and pulmonary contusion.
CT findings more injury not visible on radiographs.
Clinical characteristics, laboratory tests and treatment outcome in patients with acute respiratory failure requiring invasive mechanical ventilator in intensive care unit at hue university of medicine and pharmacy hospital.
Ojectives: 1.
The mortality rate was 33.3%.
The variables associated with treatment failure were age ≥ 70 tuổi (RR = 2.7; p < 0.05), history of chronic kidney disease (RR = 2.9; p < 0.05), sepsis as a cause of mechanical ventilation (RR = 2.5; p < 0.05), ventilator-associated pneumonia (RR = 2.4; p < 0.05) and renal dysfunction during treatment (RR =2.4; p < 0.05).
Conclusion: The clinical characteristics of ARF patients requiring IMV were various and the mortality rate remained high. Risk factors for treatment failure included age ≥ 70, history of chronic kidney disease, sepsis as a cause of mechanical ventilation, ventilator-associated pneumonia and renal dysfunction during treatment.
Key words: acute respiratory failure, invasive ventilation, invasive mechanical ventilation
To describe the clinical and subclinical characteristics of patients with acute respiratory failure requiring invasive ventilation.
To evaluate the outcome of acute respiratory failure treatment with invasive ventilation and factors related to treatment failure.
Results: The mean age was 69.6 ± 16.4.
Tachypnea and agitation were the most common sign (51%).
The mean APACHE II score was 20.2 ± 3.3.
Propofol infusion for sedated upper gastrointestinal endoscopic ultrasound: a comparison of propofol alone versus propofol-fentanyl or propofol-midazolam.
Background: Gastrointestinal (GI) endoscopic untrasound is the major technique for diagnosis of GI disease and treatment.
Results: The average propofol consumption was 283.8 ± 113 mg in Group 1 and 230 ± 76.3 mg in Group 2 and 231.8 ± 76.3 mg in Group 3 (p < 0.05).
Overall, the other results were similar in 3 groups.
Conclusion: Both propofol / fentanyl and propofol / midazolam combinations provided appropriate hypnosis and analgesia during upper gastrointestinal endoscopy.
However, propofol consumption was significantly lower and greater endoscopist satisfaction in group using the propofol / fentanyl combination.
Key words: sedation, upper gastrointestinal endoscopy, propofol, fentanyl, midazolam
Various sedation and analgesia regimens such as midazolam, fentanyl, and propofol can be used during GI endoscopy.
The purpose of the study was to compare propofol alone and propofol combine with midazolam or fentanyl in moderate sedation for GI endoscopy.
Each patient was administered 1 mg / kg propofol for induction.
Early outcome after aortic valve replacement on patients with reduced left ventricular ejection fraction.
Background: Patients with aortic valve disease with severe left ventricular dysfunction usually have poor prognosis, postoperative mortality and morbidity are higher compared to those with normal left pump function.
Operative mortality was 0%.
Conclusion: Aortic valve replacement in patients with severe left ventricular dysfunction, although contains higher risk of mortality and morbidity, this is a method of choice which helps improve symtomps and LV function, and reduce mortality due to conventional therapy.
Keyword: Aortic valve replacement; reduced left ventricular ejection fraction
It is controversial in which state is too late for surgical indication on such patients with reduced left ventricular ejection fraction.
Methods: From January 2012 to December 2013, 17 patients with aortic valve replacement with LVEF ≤ 40% were included.
Results: Mean age was 27.29 ± 11.485 yrs.
All AR patients were in severe regurgitation (≥ 3/4).
All patients with AS had AR ≥ 2.5/4, severe stenosis with transvalvular gradient around 80 mmHg.
64.70% NYHA class III-IV.
100% patients with mechanical valve replacement.
ICU stay 7.29 days.
Association between the viscera syndromes according to traditional medicine and the clinical symptoms in patients with type 2 diabetes mellitus.
Background: Diabetes mellitus (DM) has become a common disease worldwide.
The syndromes of low rate are Stomach-Heat syndrome and Stomach-Yin deficiency syndrome.
The viscera syndromes are significantly associated with the Western medicine symptoms.
Key words: Frequency, type 2 diabetes mellitus, viscera syndrome, traditional medicine.
The treatment with Traditional medicine (TM) depends on the clinical form as well as the specific viscera syndrome.
According to the strategy of developing TM from 2014 to 2023 of the World Health Organization, the safe and effective use of TM in the national health system needs to be focused and strengthened.
Objectives: To investigate the viscera syndromes according to TM and the association with the clinical symptoms in patients with type 2 DM.
Materials and Method: A cross-sectional study was carried out in 97 patients with type 2 DM at Hue University of Medicine and Pharmacy Hospital and Hue Central Hospital from 07/2019 to 03/2020.
Results: Mean of age was 66.1 ± 11.3.
The proportion of patients with the viscera syndromes was 91.8%, in which 30.9% Kidney-Yin deficiency syndrome, 25.8% Spleen-Qi deficiency syndrome, 17.5% Kiney-Yin and Yang deficiency syndrome, 17.5% Liver-Yin deficiency syndrome, 16.5% Liver-Blood deficiency syndrome, 13.4% Lung-Dryness syndrome, 4.1% Stomach-Heat syndrome and 2.1% Stomach-Yin deficiency syndrome.
There was association between TM viscera syndromes and the clinical symptoms of type 2 DM according to Western medicine (p < 0.05).
Conclusion: The syndromes of high rate are Kidney-Yin syndrome and Spleen-Qi deficiency syndrome.
Retroperitoneals single incision laparoscopic nephrectomy: mini-invasive technical, safety and cosmetic.
Objective: Outcome of 45 retroperitoneal single incision laparoscopic nephrectomy of benigns nonfunction kidneys at Hue Central Hospital.
Results: Success: 42/45 patients.
Mean operating time 87.5mins (50 - 155 mins), postoperative hospital stay 5 - 7 days.
Conclusion: This is a mini-invasive technical, safety and cosmetic Key words: retroperitoneal single incision laparoscopic nephrectomy, single port nephrectomy
Assessment of surgical treatment for infected preauricular sinus at hue central hospital and hue university hospital.
Background: This study aims to research clinical characteristics and to evaluate the results of early surgical treatment of infected preauricular sinus.
Stages of the infected preauricular sinus: inflammation 71.7%, abcess 48.5%.
Surgical procedures: hot 69.6%, warm 30.4%.
Average inpatient time: 8.5 ± 3.1 days.
Recurrence after surgery 3 months having 1 ear, accounted for 2.2%.
Results after surgery 3 months: good 91.3%, moderate 6.5%, bad 2.2%.
Conclusions: Infected preauricular sinus were most common in children, combined defects were rare, having the role of family factors.
Majority of postoperative results were good.
Key words: Preauricular sinus
Subjects and methods: Studied 46 patients (46 ears) sufferring from infected preauricular sinus surgically treated, by the method of descriptive observative prospective study with clinical intervention.
Results: Age group of ≤ 15 years old accounted for the highest percentage with 71.8%.
Combined defects accounted for 2.2%.
Number of patients having familial factors accounted for 60.9%.
Location of preauricular sinus: classic position 91.3%, posterior to classic position 8.7%.
Positive bacteria culture with the proportion of 38.5%.
Most bacteria were sensitive to antibiotics.
Design an “in-house” software for calculting the risk of trisomy 21 and open neural tube defects in the gestational age 15 – 22 weeks.
Objectives: Design an "in-house" software for calculating the risk of fetus has Down syndrome, Edwards syndrome and open neural tube defects in prenatal screening at the gestational age 15 - 22.
Methods: Based on the Excel program of Microsoft Office and the articles with the Excel of Microsoft Office and the related articles have been published.
Results: In cases have the risk of trisomy 21 with the range from 1/251 to 1/350: the risk tends to be lower than Prisca (83.7%).
In cases of trisomy 18 with the risks are lower than 1/150: there are statistical significant differences between the two softwares (P <0.05).
The cases have the threshold lower than 1.50 MoM AFP: Where the disability screening of neural tube openings with thresholds lower than 1.5 MoM AFP: there are no statistical significant differences between the two softwares (P >0.05).
Knowledge, attitude on prevention from human papilloma virus infection (hpv) and related factors among parents of male students at junior high schools in hue city.
Introduction: Human Papilloma Virus (HPV) is a common sexually transmitted virus.
Relations with son, educational level of parents, defect / chronic disease of son and knowledge of parents were significantly associated with their attitude toward HPV infection prevention (p < 0.05).
Conclusions: This study highlighted that knowledge, attitude on HPV infection prevention of the parents of male students in Hue city was still low.
The health sector needs to implement comprehensive health education and communication programs to improve knowledge, attitude about prevention of HPV infection for people, especially males.
Key words: knowledge, attitude, human papilloma virus, HPV, parents, male students
HPV causes many diseases and the risk for many types of cancer which has been reported in both sexes, not just cervical cancer in females.
However, the prevention of HPV infection is quite limited among males in Vietnam.
The study is to evaluate knowledge, attitude on prevention of HPV infection among parents of male students at some junior high schools in Hue city and explore some related factors.
Methods: A cross-sectional study was conducted among 785 parents of male students at four junior high schools in Hue city.
Data were collected by direct interviews with structured questionnaire.
Results: Participants who got good knowledge and positive attitude of HPV infection prevention accounted for 18.9% and 15.2%, respectively.
Occupation, educational level of parents, number of sons and family history of HPV related diseases influenced on knowledge about HPV infection prevention.
Evaluation of the efects of embedding therapy and electronic acupuncture combined with “doc hoat tang ky sinh” remedy in the treatment of low back pain by osteoarthritis.
Background: Low back pain by osteoarthristis is one of the most common diseases in the world as well as in Vietnam, estimated 70 - 85% people in the world have low back pain sometime in their lives.
Obiectives: To evaluate the effects of embedding therapy and electronic acupuncture combined with "Doc hoat tang ky sinh" remedy in the treatment of low back pain by spondylosis.
Materials and methods: 72 patients diagnosed of low back pain by spondylosis, were examined and treated at Phu Yen Traditional Medicine Hospital, divided equally into 2 groups (group 1 and group 2).
Results: In group 1: Effective treatment at good and fair good level accounted for 41.7% and 41.7%.
In group 2: Good level occupied 33.3% and fair good level occupied 55.6%.
Conclusion: The ratios of good and fair good in 2 groups were equal (p >0.05) Key words: Low back pain, spondylosis, embedding therapy, electronic acupuncture
Research findings infection fascioliasis by technical enzymes linked immunosorbent (elisa).
Introduce: Fascioliasis is an infection common in animals, particularly sheep and cattle, and is widespread around the world.
The disease can be transmitted through food to Humans where it affects the liver.
It is also known as "common liver fluke infection".
Material and method: Include 326 person with suspected infection of fasciolasis, and recived ELISA from 4/2012 to 6/2013 at Hue Central Hospital.
Result: The rate of ELISA positive liver for 31.3%, men 24.4%, women 38.3%, rural areas accounted for 36.8%, Farmer group 36.2%.
Conclusion: Prevalence of Fasciolisis with symptoms suggestive in clinically is 31.3%.
Main source of contamination due to people eating aquatic plants.
Key words: Fascioliasis, ELISA
Serum folate receptor alpha levels in patients of epithelial ovarian carcinoma.
High expression of FRA is observed in malignant epithelial ovarian tumors.
This study is aimed to determine of serum folate receptor alpha levels in patients of epithelial ovarian carcinoma and to investigate the relationship between serum folate receptor alpha levels and serum CA125 levels and histopathological characteristics in patients of epithelial ovarian carcinoma.
Materials and methods: Cross-sectional study was conducted on 26 patients with epithelial ovarian carcinoma and 56 patients with benign ovarian tumors.
Factors related to the results of surgical treatment of zygomatic fractures with miniplates.
Background: Fracture of the zygomatic complex is one of the most common facial injuries in maxillofacial trauma and mainly caused by traffic accidents.
The objective of this study was to investigate the factors related to the results of surgical treatment of zygomatic fractures with miniplates.
Subjects and Methods: 46 patients (average age 34.24 ± 15.16) were diagnosed with zygomatic fractures. All of patients were operated and treated with titanium miniplates.
This study also investigated the factors related to the results of surgical treatment of zygomatic fractures with miniplates.
Results: Factors associated with post-operative results include: Clinical manifestations: restricted mouth opening, maxillary sinus fracture (p<0.05) X-ray: number of fracture lines (≥ 4 lines) and type IV fracture (p<0.01); overlapping fracture; comminuted fracture; depressed fracture (p<0.05); number of miniplates used: ≥ 2 (p<0.05).
Conclusions: Evaluating factors related to surgical results helps clinicians evaluate and make prognosis in order to develop treatment plan in time and minimize complications after surgery.
Key words: Fracture of the zygomatic complex; Affecting factors; Internal fixation with miniplates
To evaluate the outcome of the external ear trauma treatment at hue central hospital and hue university hospital.
Background: The external ear trauma is the most common in emergencies.
Cartilage auditory canal trauma were more common with 57.1%.
The most common type of injuries were skin lacerations revealed cartilage, bone (43.3%).
Minor injuries were the most common with 52.2%.
The mainly treatment was excision, suture (55.2%).
The time for healing with <7 dayswas the most (65.7%).
The majority of the external ear trauma without complications (91%).
Most of the symptoms improved after 1 week and 1 month of treatment.
Good results were the most common after 1 week of treatment (65.7%), and increased after 1 month of treatment (77.6%).
Conclusions: The more minor of the injuries and the earlier treatment of the external ear trauma lead to the better outcome of 1 month treatment.
Key words: The external ear trauma, the auricular trauma, the external auditory canal trauma
Early diagnosis and treatment lead to the better outcome.
Aim: To evaluate the outcome of the external ear trauma treatment.
Patients and methods: A prospective descriptive study on 64 patients with 67 ears diagnosed with the external ear trauma by clinical intervention.
Results: Ages 16 - 30 accounted for 46.9% majority.
Males (84.4%) more than females (15.6%).
Most of patients wereearly treated ≤ 6 hours (76.6%).
Auricular trauma (68.7%) were more common than external auditory canal trauma (31.3%).
The most common sites of auricular trauma were the upper haft of auricular (43.5%).
1 INTRODUCTION Horseshoe anal fistula (HAF) is one of the rare and complex fistulas, accounting for about 4.4% of anal fistula cases.
- Patients does not agree to participate in the study, the records are not enough information according to the research criteria.
METHODS 2.2.1.
Research design and sample size - Prospective descriptive study, with longitudinal follow-up - Convenient template selection 2.2.2.
The method of data collection 2.2.3.
MRI procedure 2.2.3.2.
The advent of MRI has increased the possibility of diagnosing and treating rectal prolapse.
Surgery procedure - Prepare patients, prepare surgical tools and equipment - Spinal anesthesia.
The patient is placed in the obstetric position - Steps to perform surgery + Assess the lesion, determine the external hole, the internal hole and the direction of the fistula, classify the anal fistula according to the sphincter system + Treatment of fistula: Can use a single method or a combination of many methods.
Research targets 2.2.4.1.
Objectives 1: Clinical features, the value of MRI in the diagnosis of HAF a.
Clinical features - Patient's age, gender, occupation, surgical, medical history - Disease duration, physical symptoms - Examination of external fistula: Number, location, distance to the anus margin b.
Value of MRI in the diagnosis of HAF - Classification of anal fistula according to sphincter system (according to Park) - The rate of matching diagnosis and classification of the fistula tract through MRI and surgery (%), the rate of finding internal fistula, number and location on MRI - The appropriate rate, sensitivity, and specificity of MRI when determining internal fistula (yes or not), compared with intraoperative assessment.
9 - The appropriate rate, sensitivity, and specificity of MRI when determining the specific location of the internal fistula, compared with intraoperative assessment.
Studies show that MRI is very valuable when identifying internal fistulas (with a detection rate of 90 - 97%), sensitivity 95.5 - 96%, specificity 80%, assessing the degree of involvement. The relationship of the fistula to the sphincter system (accuracy reached 70 - 91%).
The criteria for the 2nd objective: Evaluation of the results of surgery to treat the HAF a.
Results intraoperative - Method of finding internal, number and location of internal - Classification of the fistula tract according to Parks - Method of fistula treatment, the relationship between the surgery method and classification of fistula according to Parks.
- Operative times b.
Short-term outcomes: - Pain duration and pain assessment after surgery sau - Early complications: Bleeding, urinary retention,... - Assess the status of anal incontinence according to the Parks scale at the time of hospital discharge.
c. Long-term outcomes: Patient re-examination at 1 month, 6 months, 1 year after surgery and at the end of the study (December 2020).
Clinical features and value of MRI in the diagnosis of HAF 3.1.1.
- Comorbidities: 30.4% hemorrhoids, 3.6% diabetic patients.
- Disease duration: average 4.1 ± 6 months.
Value of MRI in the diagnosis of HAF 3.1.2.1.
Fistula tract Table 3.7.
Thereby helping to orient the treatment strategy in cases of HAF, avoiding damage to many sphincters and reducing the recurrence rate.
Evaluation of internal fistula - The rate of detecting internal fistula on MRI before magnetic surgery is 62.5%.
- Sensitivity, specificity and diagnostic value of MRI when detecting internal compared with the evaluation at surgery is 100%.
- Value of MRI when locating internal compared to surgery: Sensitivity 100%, specificity 0%, Positive predictive value 85.7% 3.2.
Evaluation of the results of surgery to treat the HAF 3.2.1.
Results intraoperative - Assessment of damage + 35 patients found fistula during surgery, accounting for 62.5%.
+ 35 / 35 cases (100%) found 01 internal fistula + The way to determine the internal fistula is mainly using stylet and hydrogen peroxide, accounting for 57.1% + 78.2% of internal fistulas were found at the 6 o'clock position 12 Table 3.14.
The combination of preoperative MRI and surgery techniques has contributed to improving the effectiveness of treatment of HAF.
Classification of the fistula according to Parks Classification of the fistula on MRI according to Parks Number of patients (n = 56) Ratio (%) Intersphincteric 30 53.6 Transsphincteric 12 21.4 Suprasphincteric 13 23.2 Extrasphincteric 1 1.8 Comment: Intersphincteric fistula accounted for the majority with 53.6% Bảng 3.1.
Surgery methods Surgery methods Number of patients (n = 56) Ratio (%) Fistulotomy 15 26.8 Fistulectomy 4 7.1 Fistulotomy and put drainege 29 51.8 Combined opening + put seton and drainege the fistula 8 14.3 Comment: 51.8% of the cases were fistulotomy and put drainege, 26.8% fistulotomy. - Intersphincteric fistulas were mainly treated by the method of fistulotomy and put drainege, accounting for 51.8% and fistulotomy 26.8%.
- The cases of suprasphincteric and extrasphincteric fistula were fistulotomy and put drainege.
7/13 suprasphincteric fistulas (53.9%) were combined opening + put seton and drainege the fistula - Operative time average 55.3 ± 16.2 minutes (30 - 120 minutes) 3.2.2.
Short-term outcomes 3.2.2.1.
Time and severity of pain after surgery - Pain after surgery on average 4.2 ± 1.7 days (2 - 6 days) 13 - The pain level according to the VAS scale gradually decreased from the first day to the third day.
Early complications Bảng 3.2.
However, due to the diversity in lesion characteristics and treatment methods, the results of anal fistula surgery in studies around the world still fluctuate with success rates from 88 to 94.4%, recurrence rate 2.2 - 21% In Vietnam, the diagnosis and treatment of HAF are still challenging and not yet agreed upon.
Early complications Early complications Number of patients (n = 56) Ratio (%) Bleeding 2 3.6 Difficulty urinating 1 1.8 Urinary retention 4 7.2 Total 7 12.6 Comment: Early complications 12.6% 3.2.2.3.
Relation to recurrence and disease duration Group Number of patients Disease duration (months) Mean Min Max No recurrence 49 4.05 ± 5.18 0.07 6 Recurrence 7 7.16 ± 8.07 4 24 p = 0, 008 Comment: The time of disease before surgery in recurrence group was longer than in the no recurrence group (p < 0.05) - The rate of recurrence was higher in the group of patients who had a history of surgery for abscess / anal drainage (20.0%) higher than those who had never had surgery (3.8%) (p = 0.0001 < 0.05) - The rate of recurrence was higher in the group of patients with no internal fistula found (23.8%) than in the patients with 1 internal fistula (5.7%) (p = 0.004 < 0.05) Table 3.31.
There have been many studies on HAF, but no study has fully evaluated the value of MRI in identifying HAF, relating the fistula to the sphincteric system, thereby determining direction and selection of surgical methods to increase the success rate and avoid complications of anal incontinence.
Relation to recurrence and classification of primary fistula Classification of primary fistula Group Total No recurrence Recurrence Intersphincteric (n = 30) 30 (100%) 0 (0%) 30 (100%) Transsphincteric (n = 12) 11 (91.7%) 1 (8.3%) 12 (100%) Suprasphincteric (n = 13) 8 (61.5%) 5 (38.5%) 13 (100%) Extrasphincteric (n = 1) 0 (0%) 1 (100%) 1 (100%) Total (n = 56) 49 (87.5%) 7 (12.5%) 56 (100%) p = 0.031 15 Comment: The observed significance level p < 0.05 - > There is a difference in recurrence rate between groups of patients with different classification of primary fistula.
The recurrence rates in the extrasphincter, suprasphincter and transsphincter fistula groups were 100%, 38.5% and 8.3%.
- There was no difference in the recurrence rate between the groups of patients applying different surgical methods (p > 0.05) - At the time of follow-up, the majority of patients were satisfied with the treatment results, accounting for 60.7%, 78.6%, 89.3% and 100%.
Chapter 4 DISCUSSIONS 4.1.
Clinical features and value of MRI in the diagnosis of HAF 4.1.1.
Age, gender The study results showed that the mean age of the patients was 38.3 ± 11.3 (16 - 65 years), male accounted for 89.3%.
Similar to other HAF studies, the mean age of the patients is about 35 - 50.3 years, the majority of male patients are from 59.9 to 82.7%.
For the above reasons, we conducted the topic: Research on diagnosis and surgical treatment of horseshoe anal fistula with two objectives: 1.
Comorbidities The comorbidities of the patient group in the study included: 30.4% hemorrhoids, 5.4% anorectal polyps and 3.6% type II diabetes.
Similar to other authors.
Duration of disease The mean duration of disease in the study was 4.1 ± 6.0 months (3 days - 24 months).
Similar to the study of Nguyen Xuan Hung, Inceoglu R and Browder L K.
Physical symptoms In the study, patients showed swelling and pain in the anus area, accounting for 64.3%.
Describe clinical features, determine the value of MRI in the diagnosis of horseshoe anal fistula.
Symptoms of discharge, purulent discharge near the anus were found with 41.1%; The anus is painful, accompanied by itching 17.9%.
Depending on the stage of the disease, the patient's symptoms on admission may vary.
4.1.2.
Value of MRI in the diagnosis of HAF 4.1.2.1.
Fistula tract Result of fistula MRI in our study: intersphincteric fistula accounted for 50%; transsphincter fistula 19.6%; Sphincter fistula 19.6% and extrasphincter fistula 10.8%.
The accuracy of MRI compared with intraoperative assessment of intersphincteric fistula was the highest with 93.3%, transsphincteric fistula 91.7%, suprasphincteric fistula 84.6%, accuracy of MRI when diagnosis of extrasphincter fistula was lowest (16.7%) The study of Rosa G MRI showed 38.7% intersphincter fistula, 52.6% transsphincter fistula, 2.6% suprasphincter fistula, 4% extrasphincter fistula.
According to Singh K, the ability of MRI to detect fistula with sensitivity 95.5%, specificity 80%, accuracy is 94%.
17 4.1.2.2.
Evaluation of internal fistula The study results showed that: MRI scan detected 35 patients with internal fistula, accounting for 62.5%.
Similarly, the rate of finding an internal fistula on MRI of Nguyen Ngoc Anh is 67.5%.
The study showed that: 35 cases of internal fistula detected by MRI, when compared with the surgical results, also gave the same results.
Thus, MRI can detect internal fistula with sensitivity and specificity of 100%, positive predictive value of 85.7%.
Similarly Singh K MRI has a sensitivity of 87.5%, a specificity of 95.2%, a positive diagnostic value of 77.8% and a negative diagnostic value of 97.6% in detection the exact location of the internal fistula.
Evaluation of the results of surgery to treat the HAF 4.2.1.
Results intraoperative 4.2.1.1.
Evaluation of internal fistula Accurate determination of the location of the internal fistula is especially important to help assess the entire fistula lesion prior to initiating surgery.
The results of the study showed that 62.5% of patients found fistula during surgery and 37.5% did not find it.
The method of determining the internal fistula was mainly using a combination of stylet and hydrogen peroxide, accounting for 57.1%, 2 patients (5.7%) using only stylet, 10 patients (28.6%) using only stylet.
Evaluation of surgical results of horseshoe anal fistula.
Most of the authors have the same opinion that the method of finding the internal fistula in the direction of MRI combined with hydrogen peroxide pump and stylet from the external fistula gives good efficiency.
18 4.2.1.2.
Number and location of internal fistula Intraoperative assessment found that 100% of patients had an internal fistula.
Regarding the distribution of hole positions, 78.2% were found at the 6 o'clock position.
The results are similar to other studies, the authors suggest that most cases of anal discharge start from the deep posterior anal cavity located in the posterior half of the anus and drain to the anal tract at 6 o'clock.
Pankaj Gar sees the hole in mid lane after 85.1%, mid lane before 8.5% 4.2.1.3.
Leakage classification according to Parks Classification of intrasphincteric fistula: intersphincter fistula found 53.6%, transsphincter fistula 21.4%, suprasphincter fistula 23.2% and 1 extrasphincter fistula accounted for 1.8%.
Similarly, Falih Noori found the rate of intersphincter fistula is 45%, transsphincter fistula 30%, suprasphincter fistula 20%, extrasphincter fistula 5%.
Pankaj found HAF to be intersphincter in 57.4%, transsphincter in 4.3%, and in both midmuscular and transsphincter in 38.3%.
2 THE NEW MAIN SCIENTIFIC CONTRIBUTION OF THE THESIS The study was conducted on 56 patients diagnose HAF and treated in Viet Duc hospital from January 2016 to April 2019. - Diagnosis HAF: Patients with external accounted for 51.8%.
Surgery methods - Fistulotomy (Lay - open) In our study, 15 patients (26.8%) had surgery to completely open the fistula.
The rate of fistulotomy in the group of patients had an intersphincteric fistula 41.4%, a transsphincter fistula 23.1%, there were no cases of fistula on the suprasphincter and extrasphincteric.
According to the authors, the indication for opening is applicable to most transsphincteric, intersphincteric fistulas, even with some transsphincteric horseshoe fistulas IIa or IIb.
- Fistulectomy The results of the study had 4 patients with fistulectomy, accounting for 7.1%.
In which, intersphincter 6.9%, transsphincter 15.4%.
19 - Fistulotomy and put drainege In the study, 51.8% of patients had partial fistula opening and drainage placed.
Indications for two-stage surgery in transsphincter fistulas (fissures with many nooks and crannies, widespread necrotizing inflammation), fistulas on the sphincter.
In case of transsphincteric fistula, the fistula is small, a single line, without nooks and crannies, after removing all the fistulas, cleanly cut, sew and close the internal fistula and part of the sphincter.
- Combined opening + put seton and drainege the fistula This is a modification of the Hanley surgery but in this case the primary fistula resection was performed using Seton.
Here, the deep posterior anal space is accessed for cleaning and drainage through the opening of the external fistula.
The superficial external sphincteric bundle is dissected along its fibers in the deep posterior anal space and a Seton is placed for ostomy to medial ossium in the posterior midline to progressively resect the fistula, or to mark the fistula if perform two-stage surgery.
In our study, there were 8 patient (14.3%) who had surgery to partially open the fistula + seton and drain, in which 1 case of high transsphincteric fistula and 7 cases of supramuscular fistula.
The authors recommend this method as a suitable option for high horseshoe-shaped abscesses.
Seton has both drainage effect and gradually cuts off the sphincter, thereby minimizing the risk of loss of anal control after surgery.
Operative time: 20 The results of the study showed that the average operative time was 55.3 ± 16.2 minutes (30 - 120 minutes).
The distance from the external to the anal margin averaged 2.6 cm.
Short-term outcomes 4.2.2.1.
Time and severity of pain after surgery The study found that the average time to use analgesia after surgery was 4.2 ± 1.7 days, the shortest was 2 days, the longest was 6 days.
The pain level according to the VAS scale gradually decreased from the first day to the third day.
Early complications We met 2 patients with bleeding, accounting for 3.6%, who were treated with hemostatic dressings.
In addition, 7.2% of patients with urinary retention required catheterization and the catheter was removed after 24 hours.
MRI has a high value in diagnosing HAF with an internal fistula finding rate of 62.5%, sensitivity and specificity of 100%.
Evaluation of anal autonomy function at the time of hospital discharge At the time of discharge, 35.7% of patients did not have anal incontinence, 57.1% had grade I incontinence (didn't actively control gas but still kept loose and solid stools) and 7.2% grade II autonomic disorder.
73.3% of patients in the completely open group did not have anal incontinence.
4 patients with grade II incontinence were in the group of surgery to open a part of the fistula in combination with seton and drainage.
Long-term outcomes 4.2.3.1.
Wound healing time The study found that the average wound healing time was 10.2 ± 3.7 weeks, the shortest was 5 weeks, the longest was 20 weeks.
The group of patients who underwent fully open surgery combined with seton placement and fistula drainage had the longest healing time 21 with an average of 13.6 ± 4.5 weeks (p < 0.05).
Similarly, the wound healing time in Nguyen Ngoc Anh's study was 11.25 ± 6 weeks.
Inceoglu R is 12 ± 3 weeks.
The diagnostic matching rate of MRI and surgery in the forms of intersphincteric fistula, transsphincter fistula, suprasphincter fistula and extrasphincter fistula were 93.3%, 91.7%, 84, 6% and 16.7%.
Evaluation of anal autonomy function at the time of follow-up The study results showed: Anal sphincter function improved gradually at the time of follow-up.
The rate of normal anal autonomy (grade 0) gradually increased over time from 1 to 12 months was 60.7%, 85.7% and 92.9%, respectively.
At the end of the study, 100% of patients had normal anal autonomy.
No patient had autonomic dysfunction.
Recurrence The study had 7 patients with recurrence after surgery, accounting for 12.5%.
In which 1 patient recurrence after 3 months, 4 patients recurrence after 6 months and 2 patient recurrence after 12 months.
Factors associated with recurrence include: long duration of disease (p=0.008), history of surgery for abscess / anal drainage (p=0.0001), no internal fistula found (p=0.004)), superior and extrasphincter fistulas (p=0.031)..
- Treatment results: 51.8% of the cases were fistulotomy and put drainege, 26.8% fistulotomy, 7.1% fistulectomy, 14.3% combined opening + put seton and drainege the fistula.
The research of Browder L K.
and Pezim M E.
reported the recurrence rate after the horseshoe repair from 9 to 21%.
In 2021, Asami Usui studied 139 patients with a HAF, the average follow-up time was 25.1 months with 12 patients with recurrence (9.1%).
Falih Noori I showed a recurrence rate of 10.7% in patients with suprasphincteric fistula and diabetes.
Patient satisfaction Our study found that at the time of follow-up, the majority of patients felt satisfied with the treatment results, accounting for 60.7%, 78.6%, 89.3% and 100%, respectively.
The proportion of patients who 22 were not satisfied with the treatment results at 1 month, 6 months and 12 months were 3.6%, 7.1% and 3.6%, respectively, due to recurrent or spontaneous disorders.
Early complications 12.6%.
Clinical features and value of MRI in the diagnosis of HAF Clinical features Mean patient's age: 38.3 ± 11.3 years.
Value of MRI in the diagnosis of HAF The accuracy of MRI in diagnosis horseshoe anal fistula in intersphincteric, transsphincteric, suprasphincteric and extrasphincteric fistulas were 93.3%, 91.7%, 84.6% and 16.7%.
MRI found internal fistula in 62.5% of cases, the diagnosis rate of horseshoe anal fistula by MRI with sensitivity and specificity was 100%.
Evaluation of the results of surgery to treat the HAF Results intraoperative 62.5% found an internal fistula.
Of which 78.2% of internal is at the 6 o'clock position.
The the mean time of wound healing was 10.2 weeks.
Anal sphincter function gradually improved, at the end of the study, 100% of patients with anal autonomy were normal.
Factors associated with recurrence: Long disease duration, history of anal abscess / fissure surgery, no internal fistula found, fistula above and outside the sphincter.
24 RECOMMENDATION 1.
It is necessary to develop a diagnostic procedure and select the appropriate surgical method for the lesion: + Preoperative anorectal MRI should be performed to assess lesions in patients clinically diagnosed with horseshoe anal fistula.
Recurrence 12.5%.
+ For patients with confirmed diagnosis of horseshoe anal fistula, they should be treated surgically at the hospital level with a team of specialized anorectal surgeons.
Continue to evaluate the results of treatment after surgery, especially to find out the cause of recurrence and the relationship, with a longer study period: 5, 10 and 20 years
Factors associated with recurrence: Long disease duration, history of anal abscess / fissure surgery, no internal fistula found, fistula above and outside the sphincter.
At the end of the study, 100% of patients were very satisfied with the treatment results, there were no cases of recurrence or loss of anal incontinence.
These contributions are realistic and contribute to emphasizing the role of MRI in the diagnosis and evaluation of horseshoe anal fistula.
Thereby orienting the selection of appropriate treatment methods to help reduce the rate of recurrence and complications after surgical to treat horseshoe anal fistula.
3 Chapter 1 LITERATURE REVIEW 1.1.
Anatomy - Physiology of the anorectal region 1.1.1.
Shape and structure 1.1.1.2.
Annual holes 1.1.1.3.
Hermann and Desfosses gland 1.1.1.4.
Lines that limit the anorectal region 1.1.1.5.
The cavity around the anus rectum 1.1.1.6.
Anorectal sphincter system 1.1.2.
Physiology of the autonomous function of the anus 1.1.2.1.
Mechanical factors 1.1.2.2.
Sphincter factor 1.1.2.5.
Horseshoe anal fistula 1.2.1.
Etiology and pathogenesis Horseshoe anal fistula is a complex fistula in which fistulas arise from a deep posterior anal cavity abscess extending into the rectal fossa with unilateral or bilateral extension branches of the fistula tract forming a horseshoe-shaped fistula or abscess.
Acute stage (abscess): Manifestation: Swollen, hot, red, painful mass near the anus or spreading to the buttocks or perineum 4 1.2.1.2.
Fistula stage: Abscess spontaneously ruptures or is incompletely incision made to create a fistula that drains fluid from the fistula tract to the skin near the anus.
Subclinical 1.2.3.1.
X-ray of the fistula with contrast 1.2.3.2.
Endorectal Ultrasound 1.2.3.3.
Research on the value of MRI in the diagnosis of HAF In recent years, the advent of anorectal MRI has increased the diagnostic and treatment capabilities of HAF.
Studies show that MRI is very valuable when identifying internal fistulas (with a detection rate of 90 - 97%), sensitivity 95.5 - 96%, specificity 80%, assessing the degree of involvement. The relationship of the fistula to the sphincter system (accuracy reached 70 - 91%).
A study by the American Society of Anorectal Surgery in 2005 found the ability of MRI to detect fistulas with a sensitivity of 95.5%, a specificity of 80%, and an accuracy of 94%.
Currently, MRI is increasingly used in the diagnosis and evaluation of HAF.
Classification of anal fistula 1.2.4.1.
Classification of abscesses near the anus 1.2.4.2.
Classification of anal fistula * Classification according to Parks: Intersphincteric fistula (type I), transsphincter fistula (type II), suprasphincteric fistula (type III), extrasphincter fistula (type IV) * Classify St James's by MRI into 5 grades: I, II, III, IV, V 1.3.
Treatment of horseshoe anal fistula 1.3.1.
History 5 1.3.2.
Surgery to treat horseshoe anal fistula Principle: Identify and treat the internal fistula, open or drain the fistula well, ensuring the anal sphincter function.
Fistula stage - Fistulotomy or Lay - open: An incision opens the fistula vertically from the external fistula to the internal fistula.
- Fistulectomy: The cure rate is high with removal of all lesions, however this surgery is still considered in each case due to the high rate of anal incontinence.
- Seton placement: For the purpose of draining fluid (drainage seton) or cutting the fistula gradual (cutting seton) so that the fistula heals while preserving sphincter function.
- Modified Hanley and Hanley techniques Deep drainage of the posterior anal space, fistula resection was performed only in the main branch and the lateral branches were left to heal on their own.
Today, there are some modifications to Hanley's process, which use a seton to slowly cut the primary fistula tract.
- Transfer of rectal mucosal flap: Surgery to remove part of the fistula, then transfer the flap to cover the internal fistula.
- Ligation of the intersphincteric fistula (LIFT): Ligation and removal of the fistula in the intersphincter space without cutting the sphincter.
- Video-assisted anal fistula treatment (VAAFT): Using a laparoscope inserted into the fistula through the external opening, clean and remove the dirt in the fistula with endoscopic pliers, then close the internal fistula.
6 1.4.
Research on the results of surgery to treat HAF 1.4.1.
In the world Today, the combination of MRI preoperative assessment as well as the development of surgical methods have contributed to improving the effectiveness of treatment of HAF.
However, due to the diversity in lesion characteristics and treatment methods, the results of surgery to treat HAF in studies around the world are still quite variable with success rate, recurrence rate and incontinence after surgery,... Koehler A with 42 patients with HAF showed that the success rate was 88%, recurrence was 12%.
Falih N surgery 28 HAF patients with improved Hayley method followed up after 6 months with results: recurrence rate 10.7%.
In Viet Nam In 2018, Nguyen Ngoc Anh studied 40 HAF patients: healing time 11.25 weeks, there was 1 patient with grade 2 anal incontinence, recurrence 17.5%.
Pham Thi Thanh Huyen had 5.1% postoperative bleeding complications, 100% of patients had good control of anal autonomic function according to CCIS scale, recurrence was 5.5% 7 Chapter 2 OBJECTIVES AND METHODS 2.1.
However, hepatectomy remains the most fundamental and effect ive treatment.
The results of these studies showed that Takasaki technique had many advantages compared with other methods as in the studies of Yamshita (2007), Chinburen (2015), Karamakovic (2016)... 1.5.2.
Vietnam Some authors have mentioned the Takasaki technique of Glissonean pedicle approach including Tran Cong Duy Long, Nguyen Hoang Bac (2018), Ninh Viet Khai (2018); Most studies focused on the results of this technique, but there has been no studies on the application of this technique in hepatectomy for hepatocellular carcinoma.
CHAPTER II RESEARCH SUBJECTS AND METHO DS 2.1.
RESEARCH SUBJECTS Including 106 patients diagnosed with HCC, treated with hepatectomy using Takasaki Glissonean pedicle approach at 108 Cent ral Military Hospital, from May 2015 to June 2018.
Inclusion criteria - Patients underwent hepatectomy using Takasaki Glissonean pedicle approach - Hepatocellular carcinoma was confirmed by postoperative pathologic results.
- Preoperative liver function classified as Child-Pugh A.
- Disease classified as stage I to IIIA according to the TNM classificat ion of AJCC (2017) by CTscan prior to surgery.
In 1888, Lagenbach performed successfully the first hepatectomy on a patient with a liver tumor.
RESEARCH METHO DS 2.2.1.
Study design: A prospective, non-controlled, interventional study.
Equipments - Routinely used laboratory machines, modern imaging facilit ies, open abdominal surgery instrument sets, CUSA excel+ ultrasonic aspiration system, Harmonic Scalpel, Valley-Lab diathermy, monopolar and bipolar diathermies, vascular clips, hemostatic agents (Surgicel), pan balance for surgical compress balance after surgery.
O perative protocol 2.2.4.1.
Indications and contraindications * Indications: - Localized single or multiple tumors without size limitation.
- No major vacular invasion - No distant metastasis - Remnant liver tissue is normal or mildly fibrotic - Disease stage according to TNM classificat ion: stage I, II, IIIA * Contraindications: - Extrahepatic metastases - Tumors in two lobes or more - Portal venous invasion - Thrombosis of the main portal veins, hepatic veins, or inferior vena cava - Hilar tumor 2.2.4.2.
In 1952, Lortat-Jacob presented the planned right hepatectomy by ligat ing the artery, portal vein and bile duct separately at the liver hilum prior to parenchymal transection.
Operative steps Step 1: Abdominal incision: using J-shaped, T-shaped or upper midline incision.
Step 2: Abdominal exploration hilar lymph node, liver, macroscopic characteristics of tumors (size, locat ion, number).
Ste p 3: Liver mobilization Ste p 4: Gl issonean pedicle control - Cholecystectomy - Hilar dissection to control Glissonean pedicles to control right and left branches, anterior and posterior sectional branches and segmmental branches.
Ste p 5: Liver transection - Glissionean pedicle clamping: to clearly delineate the margin between ischemic liver tissue (darker color) and normal perfused liver tissue.
Demarcation line marked.
- The Glissonean pedicle was transected prior to parenchymal transection in segmentectomy.
- Parenchymal transection: using Kelly clamp, Harmonic scalpel, Ligasure or CUSA.
- After completing parenchymal transection and clear exposure of the Glissonean pedicle achieved, the pedicle was clamped and transected (vascular stapler can be used).
In 1963, Ton That Tung proposed a method of planned hepatectomy, called technique of hepatectomy by intrahepatic Glissonean pedicle transection.
Hepatic veins and their major branches were oversewn or transected using vascular stapler.
Step 6: Peritoneal lavage (if necessary), drainage near the transection surface, abdominal closure.
Research contents 2.2.5.1.
General characteristics - Age: further classified into groups of <40 years old, 40 - 59 years old and ≥ 60 years old - Gender: Male / Female - Risk factors 2.2.5.2.
Clinical characteristics: Signs and symptoms 2.2.5.3.
Paraclinical characteristics - Hematologic tests, biochemistry tests, hepatitis tests.
In 1982, Bismuth introduced a combined Ton That Tung - Jacob Lortat hepatectomy technique.
- Serum AFP level: further divided int o 3 groups: AFP <20 ng / ml, AFP 20 - 400 ng / ml, AFP> 400 ng / ml - Child-Pugh classificat ion of liver funct ion * Dynamic abdominal CT scan - Tumor characteristics: location, size and number of tumors - Associated lesions.
* Biopsy results * Disease staging using Barcelona and AJCC grading system.
- Gallbladder management - Types of Glissonean pedicle control: right, left, anterior section, posterior section or segmental.
Complications of pedicle control.
- Glissonean pedicle transection - Liver parenchymal transection - Hemostasis of transection surface - Bile leakage control - Transection surface coverage - Abdominal drainage and closure 2.2.5.5.
Intraoperative characteristics - Glissonean pedicle approach time (minutes): from the beginning until complete pedicle control achieved.
- Type of hepatectomy: right hepatectomy, left hepatectomy, extended right hepatectomy, extended left hepatectomy, central hepatectomy, anterior sectionectomy, posterior sectionectomy, left lateral sectionectomy, segmentectomy.
- Parenchymal transection time (minutes): from the beginning until hemostasis of transection surface completed.
In 1986, Takasaki (Japan) introduced a hepatectomy technique using Glissonean pedicle approach at the liver hilum. This method showed multiple advantages in hepatectomy for HCC including accurate identification of parenchymal transection plane, allowing safe anatomic hepatic resection, reduct ion of ischemia of the remnant liver, reduct ion of blood loss and avoidance of tumor cell spreading to adjacent liver tissue during surgery.
- Operative time (minutes): from the beginning of abdominal incision to the end of abdominal closure.
- Volume of blood lost (ml): calculated by the amount of blood aspirated into the container and surgical compress weigh at the end of the operation. - Blood transfusion rat e - Blood transfusion volume: calculated by the volume of packed red blood cells transfused (ml) 2.2.5.6.
Early outcomes - Results of complete blood count, blood biochemistry tests and Prothrombin time on postoperative days 1, 3, 5.
- Complications: liver failure, bleeding, residual abscess, bile leakage, pleural effusion, ascites, wound infect ion.
- Duration of hospital stay: calculated from the time of surgery until discharge.
- Pathologic results 2.2.5.7.
Late outcomes - Periodical follow-up after surgery: every three months in the first year, every six months from the second year.
- At the end of the study * Recurrence and mortality rates * Mean survival time and survival rates at one, two and three years.
+ Overall survival time: the length of time from the date of surgery until the end of the study.
+ Disease free survival time: the length of time from the date of surgery to the date of recurrence or metastasis diagnosis.
* Evaluation of seveeral factors associated with survival time: AFP level, tumor size, number of tumors, degree of differentiat ion.
Data analysis Data were inputed and analysed by SPSS 20.0.
RESULTS 3.1.
Age and gender: The mean age was 52.16 ± 11.06 (28 - 73) years.
Age group 40 - 59 years was the most common, accounting for 56.6% of cases.
Risk factors: The most common risk factor of HCC in the study group was hepat itis B (52.8%).
CLINICAL AND PARACLINICAL CHARACTERISTICS 3.2.1.
Time from symptom onset to admission 48.1% of patients admitted to the hospital in less than one month from the onset of symptoms 3.2.1.2.
Paraclinical characteristics 3.2.2.1.
Blood te sts - Complete blood count and prothrombin ratio: erythrocyte count and hemoglobin level were within normal limits.
The mean prothrombin ratio was 97.85 ± 12.61%.
- Biochemistry tests: liver enzymes slightly increased in preoperative biochemistry tests.
- Alpha-fetoprotein: Mean AFP level was 335.93 ± 638.07 (1.42 - 2479.34) ng / ml.
Patients with AFP <20ng / ml accounted for the majority of cases (51.9%).
Liver function: 100% of patients had liver function classified as Child-Pugh A 3.2.2.3.
Liver biopsy: 28.3% of patients underwent preoperative liver biopsy.
3.2.1.4.
Staging * BCLC classification: 93.4% of patients were classified as stage A.
* TNM classification: The majority of patients were classified as stage I (69.8%).
TECHNICAL CHARACTERISTICS 3.3.1.
Type of incision: J-shaped abdominal incision was used in the majority of cases, account ing for 64.1%.
Thesis summary * Thesis layout The thesis was presented in 121 pages: introduction (02 pages), literature review (35 pages), subjects and methods (24 pages), discussion (33 pages), conclusion (02 pages), and recommendations (01 page).
- Posterior section was the most common tumor location on Ctscan and abdominal exploration, accounting for 24.5% and 28.3% of cases, respect ively.
10.4% of patients had multiple tumors.
There were 30 tables, 31 images and 21 diagrams.
- Management of pedicle stump: In 55.7% of patients, Glissonean pedicle was transected after parenchymal transection.
Parenchymal transection - The most common instruments used for transection were the combination of Kelly clamp with Harmonic scalpel and / or Valley - Lab diathermy (53.8%).
He mostasis, bile leakage control and coverage of transection surface - Hemostasis control: bipolar alone or in combination with suture was used for hemostasis in most cases (97.2%).
The thesis had 138 references (20 in Vietnamese and 118 in English).
O UTCO MES 3.4.1.
Intraoperative characteristics 3.4.1.1.
The majority were minor hepatetomies (79.3%), in which posterior sectionectomy was the most common type of hepatectomy performed (16%).
* New contributions of the thesis This is the fulfill study in Vietnam on the application of Glissonean pedicle approach using Takasaki technique in hepatectomy for HCC.
Blood loss Mean blood loss volume was 238.96 ± 206.71 ml.
Number of patients requiring blood transfusion and mean blood transfusion volume: There were 13 (12.27%) patients requiring blood transfusion.
Mean blood volume transfused was 634.62 ± 224.43 ml 3.4.2.
Early outcomes 3.4.2.1.
This is a technique of anatomic hepatectomy which can not only be used in major hepatectomy but also in sectionectomy or segmentectomy, and is not possible with other techniques.
Postoperative laboratory tests - Liver enzymes: GOT, GPT usually increased on day one, then gradually decreased on day 5.
Postoperative hospital stay Mean postoperative hospital stay was 10.7 ± 3.4 (5 - 22) days.
Therefore, it faciliates complete removal of intrahepatic micro-metastasis, reduct ion of recurrence rate, at the same time limit ischemia of remnant liver, reduct ion of blood loss during parenchymal transection and and avoidance of intestinal venous stasis.
Late outcomes 106 (100%) patients were followed periodically during 9 - 36 months postoperatively.
Recurrence and mortality rates At the end of the study, the recurrence was 16% (17 patients) and the mortality rate was 10.4% (11 patients).
Survival time Overall survival time - The mean overall survival time calculated by Kaplan-Meier method was 33 ± 0.8 months.
- The survival rates at 1, 2, 3 years were 96.9%, 86.2% and 80.5%, respect ively.
Disease-free survival time - The mean Kaplan-Meier disease-free survival time was 28.56 ± 1.2 months.
- The disease-free survival rates at 1, 2, 3 years were 86.0%, 66.3% and 66.3% respect ively.
Factors associated with overall survival time There was no association between AFP level, tumor size, number of tumors and degree of differentiation to the overall survival time with p> 0.05.
The research provided concrete evidences demonstrating the safety and effectiveness of the technique and identified a number of associated factors, giving surgeons more options in the treatment of HCC.
Factors associated with disease-free survival time There was an association between the number of tumors and the disease-free survival time with p = 0.021.
CHAPTER IV.
GENERAL CHARACTERISTICS 4.1.1.
Age and gender The mean age of patients was 52.16 ± 11.06 (28 - 73 years).
The male / female ratio in the study of Duong Huynh Thien was 8.3/1, and in the study of Yamashita (2007) was 5.28/1.
CLINICAL AND PARACLLINICAL CHARACTERISTICS 4.2.1.
Clinical characteristics The most common time from symptom onset to admission was ≤ 1 month (48.1%), followed by 1 - 3 months (27.4%) and ≥ 3 months (24.5%).
Nguyen Cuong Thinh's study showed that most patient presented after 1 - 3 months from the time of symptom onset (68.8%).
LITERATURE REVIEW 1.1.
Paraclinical characteristics 4.2.2.1.
Blood te sts In the current study, the results of preoperative complete blood count and coagulation panel were in normal range.
The mean serum AFP level was 335.93 ± 638.07 (1.42 - 2479.34) ng / ml.
Patients with AFP <20ng / ml accounted for the majority of cases (51.9%), followed by AFP of 20 - 400 ng / ml group (28.3%), and AFP of > 400 ng / ml group (19.8%).
Similar results were reported by Yamazaki (2010), with AFP ≤ 20 ng / ml was noted in 62.2% of patients.
Liver function The results showed that 100% of patients having liver function classified as Child-Pugh A, which was similar to the results of Chinburen (2015), and Duong Huynh Thien (2016).
Liver biopsy According to current guidelines of the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, as well as the National Comprehensive Cancer Network, the diagnosis of HCC can be made based on imaging.
Liver biopsy is only indicated in case of atypical MRI or CT scan images.
Staging Most patients were in early stages: BCLC stage A accounted for 93.4% of cases.
Using TNM classification, stage I accounted for the majority of cases (69.8%), followed by stage II (25.5%), and stage IIIA (4.7%).
Liver anatomy and applications Anglo-American authors, represented by Healey & Schroy (1953), divided the liver into segments based on the bile duct system.
The results were similar to those of Le Van Thanh (2013); but different from the study by Chinburen (2015): stage II (20%), stage III (71.1%), and stage IV (8.9%).
TECHNICAL CHARACTERISTICS 4.3.1.
Types of incision Depending on the location, size, number of tumors and the type of hepatectomy, different incision type can be choosen, including upper midline incision, right J-shaped incision, inverted T-shaped incision, bilateral subcostal incision with midline extension towards the xiphoid process (Mercedes incision).
Abdominal exploration Although there has been significant development of diagnostic imaging which allows quite accurate preoperative assessment of lesions, abdominal exploration during the operation remained very important, which help surgeons make the final decission of the surgical procedures.
The results of abdominal explorat ion showed that 78.3% of patients had liver fibrosis, 3.8% of patients had liver atrophy.
French authors, represented by C Couinaud (1957) divided the liver int o segments based on the portal vein.
Tumors in segments 5 and 8, segments 2 and 3, right and left liver accounted for 24.5%, 16%, 1.9%, 1.9% and 21%, and 7%, 13.2%, 6.6%, 5.7%, on CT scan and intraoperative exploration, respectively.
Le Van Thanh (2013) showed that posterior section and right liver were the most common tumor location on CT scan and intraoperative exploration, accounting for 30.2%, 17.7% and 30.2%, 18.8%, respectively.
In a study of Nguyen Dinh Song Huy (2016) on 2480 cases of hepatectomy in Cho Ray Hospital in the period 2010 - 2015, tumor > 5 cm in size accounted for the majority of cases (80.4%).
Liver mobilization Good liver mobilizat ion helps the surgeon easily manipulate and access the lesions, facilitating parenchymal transection and handling of any complicat ions, if necessary.
In our study, 66% of patients had part ial right liver mobilization and only 8.5% of patients had complete right liver mobilization.
In 93.4% of patients, liver mobilization was done before parenchymal transection.
Vietnamese authors, represented by Ton That Tung (1962), divided the liver based on the bile duct system and proposed a nomenclature to unify French and Anglo-American nomenclatures of hepat ic divisions.
The most common complications during liver mobilization were adrenal injury (2.8%), diaphragmatic laceration (2.8%) and tumor rupture (1.9%).
In the studies of Bai Ji (2012), Giordano (2010), Mouly (2013): cholecystectomy was done for 100% of cases.
Glissonean pedicle approach is considered successful when complete exposure and active control of the whole Glissonean pedicle can be achieved.
The success rate in our study was 100%.
We performed the Glissonean pedicle approach for posterior section pedicle (74 cases - 69.8%), right primary pedicle (71 cases - 67%), segmental pedicle (60 cases - 56.6%).
Complications occurred in two (1.9%) patients in which the posterior face of the right portal vein was injured during dissect ion.
Takasaki (1998) study reported a 100% success rat e of pedicle control and no complications.
Figueras (2003) show that extended clamping to the left pedicle was noted in 20% of cases. This might be due to the fact that the right pedicle is shorter and larger than the left pedicle.
* Gl issonean pedicle stump management In our study, the pedicle was transected prior to parenchymal transection in 44.3% of patients, while in 55.7% of patients, it was done after.
Transection of the right pedicle was performed in 1.9% of cases. Seperate transection of the anterior and posterior sectional pedicle was performed in right hepatectomy or extended right hepatectomy (5.7%).
100% of the transected stump were closed with continuous or figure of 8 suture or ligation, like Takasaki (2007), Yamamoto (2001).
Parenchymal transection The parenchyma was transected at the demarcation line between the darkened ischemic liver tissue and the normal liver tissue.
Applications The hepatic division nomenclature helps the surgeon quickly locate a specific anatomic position within the liver.
Hemostasis, bile leakage control and coverage of transection surface In this study, bipolar alone or in combination with suture were used for hemostasis of transection surface (97.2%), and monopolar diathermy was used in only 2.8% of cases.
In most cases, the transection surface was covered by Surgicel (87.8%), followed by the combination of Surgicel and greater omentum (7.5%).
Foreign authors such as Bai Ji (2012), Kramakovic (2016)... often used bio-glue to cover the transection surface.
In surgery, it is used in anatomic hepatectomy.
O UTCO MES 4.4.1.
Intraoperative results 4.4.1.1.
Gl issonean pedicle dissection time The dissect ion time for segmental pedicle was the longest: 11, 30 ± 5, 64 (3 - 25) mins; followed by the right, left primary pedicles, posterior pedicle: 4.79 ± 3.24 (1 - 20) mins, 2.75 ± 1.04 (2 - 5) mins and 1.95 ± 2.31 (1 - 11) mins, respectively. The dissect ion time of the anterior sectional pedicle was the shortest, of 1.72 ± 0.88 (1 - 5 mins).
In liver transplantation, a split liver transplantation or living donor transplantation can be performed based on the anatomic division of the liver.
Types of he patectomy Select ion of the type of hepatectomy was based on patient condition, tumor location, size, liver function... In this study, minor hepatectomies accounted for the majority of cases (79.3%), in which posterior sectionectomy being the most common procedure (16%).
Major hepatectomies (20.7%) included left hepatectomy (7.5%), right hepatectomy (7.5%).
Bai Ji's (2012), together with other authors, demonstrated the advantage of the Takasaki pedicle approach of accurat e anatomic liver resection.
O perative and parenchymal transection time Operative and parenchymal transection time depended on the experience of each surgeon, the instrements used (Kelly clamp, Harmonic scalpel, CUSA..).
The mean transection time was 32.9 ± 12.50 mins and the mean operative time was 118.31 ± 38.84 mins.
Of these, the mean transection and operative time were longest for central hepatectomy: 45.17 ± 18.03 mins and 152.50 ± 45.47 mins, respectively.
The results were similar to those of Karamarkovic (2016).
Karamarkovic (2016) reported the mean blood loss volume for minor hepatectomy of 350.8 ± 100.5 ml, and for major hepatectomy of 485.4 + / - 250.2 ml.
13 (12.27%) patients required blood transfusion. The mean blood volume transfused was 634.62 ± 224.43 ml.
Early outcomes 4.4.2.1.
Complications According to Steven (2018), the prevalence of postoperative complications was approximately 40% in patients without liver cirrhosis, and was higher in patients with cirrhosis.
In the current study, postoperative complication rate was 23.6%, including pleural effusion (17%), ascites (3.8%), bile leakage (1.9%), wound infection (0.9%).
Anatomy of the liver pedicle and its applications In the hepatic pedicle, the bile duct, hepatic artery, portal vein, lymphatic vessels and nerves run seperately components while they were all covered by a common Glisson membrane and accompanied into the liver parenchyma.
This result was similar to Yamashita (2007) - 22% but lower than that of Yamazaki (2010) - 46%.
Blood te sts GOT, GPT increased in the first 24 hours postoperatively and then returned to normal values on day 3 and 5.
Prothrombin ratio usually decreased on day one and gradually returned to normal range on day 3 and 5 after surgery; The postoperative mean total bilirubin was higher than before surgery, highest on day 1 and decreased on day 3 and day 5 aft er surgery.
Hospital stay Our mean hospital stay after surgery was 10.7 ± 3.4 (5 - 22) days.
This results were similar to the mean hospital stay reported by the Vietnamese and foreign authors.
At the hilum, the Glisson capsule was thickened and covers the hilar plate, gallbladder bed, umbilical fissure, and venous fissure.
Late outcomes 4.4.3.1.
Recurrence and mortality rates In recent years, the recurrence and mortality rates following hepatectomy has been improved significantly. At the end of the study, recurrence and mortality rates were 16% and 10.4% respectively.
In the study of Tabrizian (2015), National Comprehensive Cancer Network (NCCN) (2018), the five-year recurrence rat e of HCC was 60%.
Survival time The mean overall survival time was 33 ± 0.8 months.
The overall survival rate at 1, 2, and 3 years were 96.9%, 86.2% and 80.5%, respectively.
The mean disease-free survival time was 28.56 ± 1.2 months.
The disease-free survival rates at 1, 2 and 3 years was 86%, 66.3% and 66.3%, respectively.
The upper anterior margin of the liver plate can be released from the liver parenchyma without damaging the blood vessels.
Factors associated with overall survival time In this study, we found that AFP levels, tumor size, tumor number, and tumor degree of differentiation were not associated with overall survival time.
Factors associated with disease-free survival time When we explored factors associated with disease-free survival t ime, we found that the number of tumors was associated with the disease-free survival time.
CO NCLUSION From the study of 106 patients with hepatocellular carcinoma, treated by hepatectomy using Takasaki Glissonean pedicle approach at 108 Central Military Hospital from May 2015 to June 2018, we had the following conclusions: 1.
Technical characteristics of Takasaki Glissonean pedicle approach in hepatectomy for hepatocellular carcinoma Types of incsion: right J-shaped, T-shaped, upper midline incisions accounted for 64.1%, 23.6% and 12.3% of cases, respectively.
Abdominal exploration: high rate of liver cirrhosis of 78.3%.
Single tumor (58.5%).
Mean tumor size: 5.11 ± 2.5 cm.
Liver mobilization: right liver mobilization: partial (66%), total (8.5%); left liver mobilization: partial (19.8%), total (7.5%); Mobilization usually preceded parenchymal transection (93.4%).
Complication rate: 7.5%.
Glissonean pedicle approach: Success rate: 100%.
Cholecystectomy in 87.7%.
Complication rate: 1.9%.
Hepatectomy: Type of pedicle approach: right (67%), anterior sectional (62.3%), posterior sectional (69.8%), segmental (56.6%).
Glissonean pedicle stump suture (100%).
HEPATEC TO MY FO R HEPATOC ELLULAR CARCINOMA 1.2.1.
Instruments used for transection: Harmonic scalpel (39.6%), Kelly clamp in combination with Harmonic scalpel and / or Valley-Lab diathermy (53.8%).
Hemostasis of transection surface with bipolar energy (65.1%).
Bile leakage control by white compresses (99.1%), intraoperative detection of bile leakage (8.5%).
Outcomes of hepatectomy for hepatocellular carcinoma using Takasaki Gl issonean pedicle approach Intraoperative results Glissonean pedicle dissect ion time: right (4.79 ± 3.24 mins), left (2.75 ± 1.04 mins), anterior section (1.72 ± 0.88 mins), posterior section (95 ± 2.31 mins), segmental (11.30 ± 5.64 mins).
Type of hepatectomy: minor hepatectomy (79.3%), major hepatectomy (20.7%).
Mean parenchymal transection time: 32.9 ± 12.5 mins Mean operative time: 118.4 ± 38.84 mins.
Mean blood loss volume: 238.96 ± 206.71 ml.
Number of patients requiring transfusion: 12.27%, mean blood volume transfused: 634.62 ± 224.43 ml Early outcomes Rate of complicat ions: 23.6%.
Hi story Liver resect ion dated back to more than 100 years and was init ially used to treat blunt or open abdominal injuries.
Pleural effusion (17%), bile leakage (1.9%), ascites (3.8%), wound infection (0.9%).
Mean postoperative hospital stay: 10.7 ± 3.4 days.
Late outcomes Mean overall survival time: 33 ± 0.8 months.
Overall survival rates at 1, 2 and 3 years of 96.9%, 86.2% and 80.5%, respectively.
Mean disease-free survival time was 28.56 ± 1.2 months.
Disease-free survival rates at 1, 2 and 3 years of 86%, 66.3% and 66.3%, respectively.
The number of tumors was associated with disease-free survival time.
Hepatectomy using Takasaki Glissonean pedicle approach for hepatocellular carcinoma should be widely applied in central hospitals.
Further research on the late outcomes and related factors are required.
In 1888, Langenbuch was the first to perform a successful liver transplants.
Ton That Tung: In 1963, Ton That Tung a presented hepatectomy technique using intrahepatic control and suture-ligation of Glissionean pedicle combined with temporary intermittent inflow occlusion.
Bismuth: In 1982, Bismuth proposed a hepatectomy technique which combined the two methods of Lortat-Jacob and Ton That Tung.
Belghiti: In 2002, Belghiti proposed the hanging maneuver in hepatectomy.
HEPATEC TO MY USING TAKASAKI GLISSONEAN PEDICLE APPRO ACH 1.3.1.
Techniques At the liver hilum, the main Glissonean pedicle divides into the left and right Glissonean pedicles. The right pedicle further divides into the the anterior and posterior section pedicles.
These Glissonean pedicles continue to divide into smaller terminal branches when they enter into the parenchyma peripherally.
At the liver hilum, Glisson capsule is thicker and covers the hilum, gallbladder bed, umbilical and venous fissure.
Thanks to this feature, we can dissect the anterosuperior margin of the hepatic pedicle from the liver parenchyma to control the main Glissonean pedicles.
Control of the right or left Glissonean pedicles (primary branches): Right Glissonean pedicle: running from the liver hilum to the right, measured about 1 cm and dividing into two secondary branches for anterior and posterior section at the beginning of the umbilical fissure, anterior to the caudate process.
Left Glissonean pedicle: four times longer than the right pedicle, runing anteriorly to the lobe of Spiegel.
The left branch has three lateral branches: branche (s) for segment 4 on the right of the round ligament and branches to segments 2 and 3.
Control of sectional Glissionean pedicle (secondary branches): After controlling the right Glissonean pedicle, the parenchyma can be opened along the right pedicle, exposing the anterior and posterior section pedicles.
Anterior section pedicle is large and measured at least 1 cm in length.
This pedicle run initially upward, perpendicularly to the under surface of the liver, and gives branches for segment 5 and then runs abruptly posteriorly and terminates into two branches for segment 8.
Control of segmental Glissonean pedicles: After controlling the main Glissonean pedicles, the segmental pedicles can be found by dissect ing along the main Glissonean pedicles.
Advantages and disadvantages Advantages: Takasaki Glissonean pedicle approach helps clearly define the transection plane and enable anatomic liver resect ion not only in right or left hepatetomy but also in sectionectomy or segmentectomy.
Disadvantages: This approach may not be sucessful if there is history of surgery in the hilar region or tumors located at the hilum.
STUDY O N THE TECHNIQUE O F TAKASAKI GLISSONEAN PEDICLE APPROACH IN HEPATECTO MY FO R HEPATO CELLULAR CARCINOMA 1.4.1.
In the world In 2001, Yamamoto studied the control of Glissonean pedicle at the hilum in patients with small liver cancers (<5 cm) in 204 patients.
The authors concluded that the Glissonean pedicles and the liver parenchyma were connected by a thin layer of connective tissue which can be easily separated without compromising liver tissue, thus facilitat ing the control of Glissonean pedicles.
In 2010, Giordano studied the Takasaki technique of controlling Glissonean pedicle for major hepatectomy in 89 patients and for minor hepatectomy in 103 patients.
The author proposed a four-step surgical procedure: liver mobilizat ion, hilar dissect ion, parenchymal transection, bleeding control of the transection plane.
The author noted that there was a 'safe' space between the Glissonean pedicle and the liver parenchyma.
Dissection of this space was almost bloodless and helped avoid parenchymal lesions.
Currently, there are many treatments for HCC.
In 2013, Mouly conducted a study to evaluate the feasibility of Glissonean pedicle control and identify factors associated with failure of this approach.
He reported a success rate of 75% and a failure rate of 25%.
To explain the reasons of failure, the author argueed that 19% of failed cases resulted from abnormalities of the portal vein.
The mean angle between the left portal and the main portal veins was 56.50.
STUDY O N THE RESULTS O F TAKASAKI GLISSONEAN PEDICLE APPROACH IN HEPATECTO MY FO R HEPATO CELLULAR CARCINOMA 1.5.1.
In the world There have been numerous studies on hepatectomy using Takasaki Glissonean pedicle approach, as well as studies which compared different surgical methods in the treatment of HCC.
Microbiological and physiochemical contamination in packaged products in the market of Tay Nguyen.
English summary: There were 1074 food samples with 5 foods groups (bottles drinking water, natural mineral water, soft drinks, alcoholic beverages, powder milk), which have been circulated in the market at Tay Nguyen provinces were inspected for food quality from May 2014 to Dec 2015.
The results showed that 17.2% food samples failed to meet the food hygiene standards and the groups had a highest contamination rate were bottled drinking water and alcoholic beverages.
The cause of contamination was due to total Coliforms, E coli, Pseu.
aeroginosa, Clostridia, Streptococci fecal, nitrate (No3 -), and aldehyde, methanol.
The microbiological criteria physiochemical standards of natural mineral water, soft drink, powder milk are within permissible limit.
Keyword: Microbiological, physiochemical, contamination.
File attachments:
Determination of methanol content in white alcohol circulated in several provinces of northern region in 2017 - 2018.
Keyword: Methanol, gas chromatography, flame ionization detection, alcohol File attachments:
English summary: Objective: to determine methanol content in 268 unlabelled alcohol samples in 9 provinces of north region from 2017 to 2018.
Method: Samples were collected at retailed stores in downtown areas.
Methanol in the samples was detected by using gas chromatography with flame ionization detection (FID).
Result: There were 129 in 268 samples containing methanol (48.1%).
The concentration of methanol ranged from 7.0 to 651.3 mg / litter of ethanol 1000.
There were eight samples which exceeded TCVN 7043: 2013.
Our study provided the food administrators with more information to enhance solution to ensure food safety and prevent poisoning of spirit containing methanol.
Nutritional status and diet of cancer patients with chemotherapy in central obstetrics hospital in 2019 - 2020.
Tỷ lệ bệnh nhân có khẩu phần ăn không đáp ứng đủ nhu cầu khuyến nghị về sắt, canxi, phốt pho, vitamin C, A, B1, B2, PP, B12 là 93%, 95%, 48%, 45%, 77%, 55%, Lần lượt là 89%, 63%, 86%.
Chế độ ăn thực tế của bệnh nhân ung thư phụ khoa hầu hết không đáp ứng được yêu cầu về năng lượng và chất dinh dưỡng theo khuyến nghị.
Keyword: Nutritional status, diet, gynecological cancer with chemical treatment.
Nutritional status and related factors of patients with gastrointestinal cancer receiving chemotherapy in Hanoi medical university hospital.
Patients with gastric cancer were at higher risk of becoming malnourished than patients with colorectal cancer (OR = 2.2, p<0.05).
Keyword: Nutrition status, GI cancer, chemotherapy, BMI, PG-SGA.
English summary: Malnutrition is common in patients with gastrointestinal cancer, making treatment less effective and poor respond to chemotherapy.
Objectives: (1) To assess the nutritional status of patients with gastrointestinal cancer receiving chemotherapy.
Method: A cross-sectional study in 164 patients with gastrointestinal cancer receiving chemotherapy in Hanoi medical university hospital.
Results and conclusion: the prevalence of patients with BMI <18.5 was 26.2%; normal (18.5≤ BMI < 25) was 70.1% and overweight (BMI ³ 25) was 3.7%.
In this study, female patients had higher risk of malnutrition than male patients (OR = 2.4, p<0.05).
Effectiveness of multi-nutrient supplementation on improved nutritional status of pregnant women in Yen The district, Bac Giang province.
English summary: Community-based controlled nutrition intervention trial was conducted on pregnant women at 8 - 12 gestational age to evaluate the effectiveness of multi-nutrient supplementation on improved nutritional status (weight gain and nutritional anemia) of the subjects.
Methods: intervention group received 1 multi-nutrient supplement tablet a day from admission to 1 month after delivery, controlled group received 1 iron / folic acid tablet a day from admission to 1 month after delivery.
Results: in intervention group, weight gain at 36th week of gestation was 8.6 kg compared to admission while this gain was 8.2 kg in controlled group.
At week 12, 24 and 36 of gestation, weight gain of intervention group tended to be higher than controlled group, but not significantly (p>0.05).
Average Hb content of intervention group at 36th week of gestation was significantly higher than that of controlled group (p<0.05) Keyword: Intervention, multi-nutrient supplementation, iron / folic acid, pregnant women, weight gain, Hb.
Computerized data management and analysis in child malnutrition control program in Da Nang city.
Author: Ngo Van Quang, Nguyen Hoang Chau, Le Thi Quy, Nguyen Thi Thu, Pham Thu Huong Tạp chí DD&TP / Journal of Food and Nutrition Sciences - Tập 2 - Số 3 + 4 - Tháng 11 / Vol. 2 - No. 3 + 4 - November - Năm 2006 / Year 2006.
English summary: This study aimed to evaluate the effectiveness and lessons learned from the application of Excel software into the weighing program for children under 5 at the communal level and using Epi Info in analyzing nutritional data at the provincial level in the national malnutrition control program in Da Nang city from January 2004 to July 2006.After three years of implementing the program, all 56 communes in Da Nang (100%) have had their children's weight lists computerized, among which 32 communes (57.1%) are able to enter and manage the data themselves.
Besides, all 56 communes (100%) have also had their data analyzed on anthropometric data by the provincial program manager using Epi Info version 3.3 to classify child nutritional status. Applying informatics technology into data management and analysis has helped to improve the quality of nutritional data, to save time and human resource, and to sustainably enhance capacity for health staff at the communal and provincial levels.
Keyword: Computerized, data management and analysis, child malnutrition control program.
Nutrition and cancer.
Author: Le Thi Hop, Ha Huy Khoi Tạp chí DD&TP / Journal of Food and Nutrition Sciences - Tập 5 - Số 2 - Tháng 8 / Vol. 5 - No. 2 - August - Năm 2009 / Year 2009.
English summary: The authors overview recent knowledge on the relation between nutrition and cancer, in - cluding the history, theories, nutrition and the initiation of cancer, inhibitors and enhancements of cancer in diet.
Community based intervention to improve the nutrition status of children in Ho Chi Minh city first 1000 days of life.
The prevalence of underweight among children under five years in HCMC has dramatically declined over the past years and to date it has remained the lowest rate in the country in all three types of underweight, stunting and wasting (4.4%; 6.8%; 11.8% respectively in 2017).
Some severe micronutrient deficiencies have been eradicated.
Key components of these achievements include: Community based intervention, proper nutrition solutions particularly nutrition communication and educations, a widespread nutrition network, investing for nutrition activities of HCMC people committee, socialization and multi-sectoral coordination in nutrition activities, the pivotal role of a specialized nutrition unit as Nutrition Center.
Keyword: Nutritional status, malnutrition, 1000 fist day, nutrition strategies, Ho Chi Minh children.
Impedance index, standard anthropometric measurements, and variable for predicting fat-free mass in sick children.
Conclusions: Impedance index is a more significant predictor of FFM than other anthropometric measurements.
Keyword: Bioelectrical impedance analysis, body composition, body weight, dual energy X-ray absorptiometry, predictive value.
English summary: Objective: To compare the predictive value of impedance index (ZI, height2 / impedance) with anthropometric measurements for estimating fat-free mass (FFM).
Design: FFM of 120 white pediatric children (46 males, 74 females), aged 2.5 - 18 y was measured by using dual energy X-ray absorptiometry.
Weight, height, mid-upper arm circumference (MUAC), skinfold thickness (biceps, triceps, subscapular, suprailiac), and bioelectrical impedance were also obtained.
Stepwise multiple regression analysis and residual plots were performed to determine the most significant variables to predict FFM.
Results: The single best predictor of FFM was ZI, which explained 96.2% of the variance in FFM (r = 0.981, SEE = 2.15 kg).
Addition of weight to the model containing ZI increased the explained variance of FFM to 96.6% (r = 0.983, SEE = 2.03 kg).
BMI and MUAC were the poorest predictors of FFM: r = 0.422, SEE = 10.2 kg and r = 0.621, SEE = 8.93 kg, respectively.
The nutritional status of patients with cyclic dialysis chronic kidney disease in Lam Dong hospital in 2020 to 2021.
Keyword: Nutritional status, chronic kidney disease, SGA-DMS, Lam Dong general hospital.
English summary: Objectives: To assess the nutritional status of patients with cyclic dialysis chronic kidney patients at Lam Dong general hospital in 2020 - 2021.
Study to evaluate nutritional status, using body mass index classification (BMI), and the subjective global assessment - dialysis malnutrition score (SGA-DMS).
Subjects: Cross-sectional descriptive was conducted in 151 patients with chronic kidney dialysis cycle, 3 times / week at Lam Dong general hospital, of which male accounted for 43.1%, and female accounted for 56.9%.
When using SGA-DMS dialysis nutrition scores, 24.5% was normal (7 - 10), 71.5% was mild to moderate malnutrition (11 - 21), and 3.97% was severely malnourished (22 - 35).
Conclusion: The relatively high rate of malnutrition among CKD patients with cyclic dialysis is a big challenge for the health sector, and a public health issue.
Determine glycemic index of some vietnamese foods.
Author: Tran Quoc Cuong, Ta Thi Lan, Tran Thi Bich Van, Nguyen Thi Anh Van, Do Thi Ngoc Diep Tạp chí DD&TP / Journal of Food and Nutrition Sciences - Tập 8 - Số 3 - Tháng 7 / Vol. 8 - No. 3 - July - Năm 2012 / Year 2012.
Method: Experimental study on 12 healthy volunteers aged 22 - 31 years.
The participants have been provided glucose or test foods contain 50gram carbohydrate and tested for blood glucose by using personal blood glucose-meter at minutes 0, 15, 30, 45, 60, 90 and 120.
The glycemic index of each test food have been calculated by using area under the curve of test foods in 120 minutes devided to area under the curve of glucose.
Results: Steamed thin rice pancake, rice vermicelli and broken rice have low GI; bread, brown rice cook with low and medium amount of water and brown sticky rice have medium GI; white rice IR64, Taiwanese specie (VD20) and sticky rice Ngong, sticky rice Hoa Vang, red rice (Huyet Rong) and brown rice cook with high amount of water have high GI.
Conclusion: rice vermicelli, steamed thin rice pancake could use in menu of obesity and diabetes.
Brown rice has better GI than white rice and the amount of water will influent the GI of rice.
The level of customer satisfaction with public administration services at Binh Duong food hygiene and safety departments in 2015.
English summary: A survey on customer satisfaction of administrative services in the field of food hygiene and safety is necessary for determining the practical effectiveness.
None of the respondents expressed any degree of dissatisfaction.
8.4% of the respondents gave rating of "normal" for administrative procedures.
Over 50% of the respondents suggested a more convenient parking lot and more options for information provision as ways for better access to administrative procedures.
The situation of malnutrition in children 0 - 36 months of age in some coastal plain districts of Khanh Hoa province in 2011.
These results indicated thateducation and communication on infant feeding for mother should be continued to increase the rate of exclusive breastfeeding, and to delay the early initiation of complementary feeding aiming to prevent of malnutrition in children, particularly children under 36 months of age.
Keyword: Malnutrition, underweight, stunting, breastfeeding. File attachments:
English summary: A cross-sectional study was conducted from March to July 2011 among 810 children 0 - 36 months old and their mothers in three communes in 3 coastal plain districts of Khanh Hoa province to explore the situation of child malnutrition and some key indicators of child nutrition care practices of mother.
Results: The prevalence of underweight, stunting, wasting, and obesity was 10.1%, 18.4%, 3.6% and 2.6%, respectively.
There was no difference between genders in the three malnutrition types (underweight, stunting and wasting).
There were major differences in stunting rates among age groups.
Evaluation of nitrite and nitrate concentration of drinking water in southern and central province of Vietnam, 2015.
Author: Nguyen Thanh Huong, Tran Thanh Son, Bui Quang Dat, Hoang Thi Thu Huong, Nguyen Duy Anh Tạp chí DD&TP / Journal of Food and Nutrition Sciences - Tập 12 - Số 6 (1) - Tháng 11 / Vol. 12 - No. 6 (1) - November - Năm 2016 / Year 2016.
The results showed that the substandard water sample rate in raw water was 14.6% (267/1829 samples) and in treated water was 4.84% (117/2614 samples).
pH and concentrations of Nitrate was in a reverse relation.
The effects of water pollution were related to acute and chronic illnesses, cancer..., which are on the rise.
The EPA (United States Environmental Protection Agency) standards that are specifically designed to protect infants from methemoglobinemia are 10 ppm nitrate and 1 ppm nitrite in drinking water.
Food safety situation of collective kitchen and restaurants in Bac Giang province.
English summary: Results of the study on all food services in Bac Giang province showed that: Percentage of collective kitchens and restaurants that did not meet food safety conditions regulations by the Ministry of Health was accounted for 72.5%; Proportion of collective kitchen in primary schools / boarding schools did not meet food safety conditions was accounted for 90%. Proportion of collective kitchens in kindergarten did not meet food safety conditions was accounted for 70%; Percentage of restaurants did not meet food safety conditions was 60.0%.
there were 40.0% of the samples of raw meat having E coli contamination exceeding permissible limits; 7.5% of the samples of preliminarily processed but not heat treated meat having E coli contaminations exceeding permissible limits; 17.5% of the hands of food cooks and processing utensils and containers (knives, chopping board) were detected with E coli.
Keyword: Food services, collective kitchens, restaurants, food safety.
Nutritional status of workers in Thainguyen steel laminating and refining factory and related factors.
English summary: With the aim of study is to evaluate current nutritional status of workers in Thai Nguyen Steel Factory and related factors, a cross - sectional and retrospective study was carried out.
The results showed that: The rate of overweight and obesity is high (43.67%).
The rate of cardiovascular diseases and diabetes is also high (41.67%).
Overweight and obese are related to the present of cardiovascular diseases and diabetes (p< 0.01 - 0.001), the level of physical labor (p< 0.01), eating more meat (p< 0.001), game (p< 0.001).
It is recommended that primary health care should be planned for all workers.
Prevention of diseases related to nutrition should be taken.
Keyword: Nutritional status, related factors, factory worker.
Nutritional status of children <5 years with diarrhea hospitalized in Vinh Phuc obstetric and pediatric hospital in 2016.
Author: Nguyen Viet Son, Pham Thi Dung, Hoang Nang Trong, Ngo Thanh Binh.
Tạp chí DD&TP / Journal of Food and Nutrition Sciences - Tập 13 - Số 3 - Tháng 5 / Vol. 13 - No. 3 - May - Năm 2017 / Year 2017.
English summary: A cross-sectional study of 220 children under 5 with diarrhea administered for inpatient treatment at Vinh Phuc Hospital for Obstetrics and Pediatrics in 2016 found that: At the time of admission, 25% of the children were wasted; 24.5% of children were stunted; 15% of children were underweight and 2.3% of children had combined malnutrition.
At the time of discharge from hospital, the rate of malnutrition was higher with 35% of wasting; 21.4% of underweight; 4.1% of combined malnutrition.
Keyword: Malnutrition, diarrhea, children under 5 years old, Vinh Phuc obstetric and pediatric hospital.
Evaluation of norovirus contamination of pacific oysters with real-time RT - PCR.
Keyword: Norovirus, oysters, Real-time RT-PCR, food safety.
Author: La Thi Quynh Nhu, Phan Thi Thanh Ha, Le Quang Hoa Tạp chí DD&TP / Journal of Food and Nutrition Sciences - Tập 11 - Số 4 - Tháng 9 / Vol. 11 - No. 4 - September - Năm 2015 / Year 2015.
Due to limited data on the occurrence of this pathogen in foods in Vietnam, the objective of this study was to investigate the contamination prevalence of Norovirus in Pacific oysters (Crassostrea gigas) collected in markets in Hanoi.
In order to achieve this objective, 60 oyster samples were collected at local and super markets in Hanoi during the period from August 2013 to May 2014 and analyzed for the contamination of Norovirus in accordance with ISO / TS 15216 - 2: 2013 method.
After optimization of Real-time RT-PCR and determination of assay sensitivity, we applied the optimized procedure to the oyster samples and found 8/60 samples (13.3%) positive with Norovirus GII.
Feeding situation in children suffering from diarrhea and respiratory infection in the national hospital of pediatrics.
Keyword: Feeding, diarrhea, respiratory, infection File attachments:
Author: Hoang Thi Mai Dung, Nguyen Gia Khanh Tạp chí DD&TP / Journal of Food and Nutrition Sciences - Tập 2 - Số 3 + 4 - Tháng 11 / Vol. 2 - No. 3 + 4 - November - Năm 2006 / Year 2006.
The study aimed to assess actual dietary intake of children having diarrhea and respiratory infection and to identify related factors.
Method: A cross-sectional study in 200 patients from 1 - 4 years old in the Gastroenterlogy Department and Respiratory Department of the National hospital of pediatrics was conducted in 2005.
Results: Children from 1 to 3 years old met only 67% of energy intake and 83% of protein intake compared to the recommend nutrition allowance.
These percentages for 4 years old children were 67% and 90%, respectively.
Iron and vitamin A intake of all groups did not meet three recommend allowance.
The study knowledge and practice status of the patients, food supplies, parental education level, nutrition knowledge and practice and family income were related to diet of patients.
Household dietary changes after 6 years (1999 - 2005) in 6 communes of Dong Anh district Hanoi.
Proportion of energy from protein, lipid and glucid is more balance after 6 years, protein energy provided 14% and lipid 24%.
Keyword: Dietary intake, Household.
To assess the change on Hanoi outskirt citizens' diets, a study "Household dietary changes after 6 years (1999 - 2005) in 6 communes of Dong anh district, Hanoi" was conducted in May and June, 2005 and compared with data in 1999.
The results showed that after 6 years the amount of rice intake decreased by 85 gr, animal food intake increased such as meat by 15 times, egg / milk by 3 folders, oil 2 folders, fruit and sugar 20 folders. Fish / aquatic product consumption was nearly unchanged and vegetable decreased.
English summary: The target to improve the quality of health services in Ho Chi Minh City puts many challenges to hospitals within the City.
Prevention and treatment of hospital malnutrition in acute care setting are among effective solutions to improve quality of patient care, recovery, cost of treatment, length of hospital stay and mortalities.
Hospital malnutrition is not only caused by medical problems and treatment themselves (personal causes) but also by nutritional care of health care facilities (institutional causes).
Therefore, for effective malnutrition control of hospitalized patients, solutions should focus on both these group of causes particular food services in hospital.
Keyword: Malnutrition, hospital, nutrition care.
Determination of dissociation constant of DNA aptamer immunoglobuline using fluorescence anisotropy and capillary electrophoresis.
English summary: The dissociation constant is commonly used to describe the affinity between a protein and a ligand.
In this study, the dissociation constant of aptamer-IgE complex was accurately determined to be 59.6 ± 20.5 nM and 91.8 ± 10.3 nM using fluorescence anisotropy and capillary electrophoresis respectively.
The results of this study open up possibilities to develop the aptamer-based biossay for detection of IgE levels in blood serum, which is very useful for allergy diagnostics.
Keyword: ADN aptamer, ImmunoglobulinE, dissociation constant, fluorescence anisotropy, capillary, electrophoresis.
Dupuytren Contracture (Palmar Fibromatosis) By David R Steinberg, MD, Perelman School of Medicine at the University of Pennsylvania Reviewed / Revised Apr 2022 | Modified Sep 2022 View Patient Education Symptoms and Signs Treatment Topic Resources Dupuytren Contracture of... Dupuytren contracture is progressive contracture of the palmar fascial bands, causing flexion deformities of the fingers.
The disease is occasionally associated with fibrous thickening of the dorsum of the proximal interphalangeal (PIP) joints (Garrod pads), Peyronie disease (penile fibromatosis) in about 7 to 10% of patients, and rarely nodules on the plantar surface of the feet (plantar fibromatosis).
Other types of flexion deformities of the fingers can also occur in diabetes, locked trigger fingers, an ulnar claw hand, systemic sclerosis, and chronic reflex sympathetic dystrophy, which need to be differentiated.
Treatment of Dupuytren Contracture Corticosteroid injection (before contractures develop) Surgery for disabling contractures Injection of clostridial collagenase for certain contractures Injection of a corticosteroid suspension into the nodule may relieve local tenderness if begun before contractures develop.
However, this tenderness is self-limiting and often resolves with no intervention.
If the hand cannot be placed flat on a table or, especially, when significant contracture develops at the proximal interphalangeal (PIP) joints, surgery is usually indicated.
Surgical options include percutaneous needle fasciotomy, temporary application of a dynamic external fixator for PIP joint contractures, and open palmar / digital fasciectomy.
For severe disease with multiple finger involvement, open surgery with excision of the diseased fascia is the best treatment; excision must be meticulous because the tissue surrounds neurovascular bundles and tendons.
Incomplete excision or new disease results in recurrent contracture, especially in patients who are young at disease onset or who have a family history, Garrod pads, Peyronie disease, or plantar foot involvement.
Injectable collagenase may reverse some contractures (1, 2), particularly those at the MCP joint.
Collagenase injections and surgical fasciectomy result in similar improvements at the MCP joint, but injections lead to more rapid recovery with fewer early complications (3).
Treatment is with corticosteroid injection, surgery, or injections of clostridial collagenase.
(See also Overview and Evaluation of Hand Disorders.)
Dupuytren contracture is one of the more common hand deformities; the incidence is higher among men and increases after age 45.
This autosomal dominant condition with variable penetrance may occur more commonly among patients with diabetes, alcoholism, or epilepsy.
However, the specific factors that cause the palmar fascia to thicken and contract are unknown.
Symptoms and Signs of Dupuytren Contracture The earliest manifestation is usually a tender nodule in the palm, most often near the little or ring finger; it gradually becomes painless.
Next, a superficial cord forms and contracts and ultimately flexes the metacarpophalangeal (MCP) joints and interphalangeal joints of the fingers.
The hand eventually becomes arched.
Infected Bite Wounds of the Hand By David R Steinberg, MD, Perelman School of Medicine at the University of Pennsylvania Reviewed / Revised Apr 2022 | Modified Sep 2022 View Patient Education Diagnosis Treatment Topic Resources Splint in the functional... A small puncture wound, particularly from a human or cat bite, may involve significant injury to the tendon, joint capsule, or articular cartilage.
Pain worsening significantly with motion suggests infection of a joint or tendon sheath.
Although the diagnosis of infected bite wounds of the hand is clinical, x-rays should be taken to detect fracture or teeth or other foreign bodies that could be a nidus of continuing infection.
Treatment of Infected Bite Wounds Debridement Antibiotics Treatment of infected bite wounds of the hand includes surgical debridement, with the wound left open, and antibiotics.
Empiric antibiotics for outpatient treatment usually include monotherapy with amoxicillin / clavulanate 500 mg orally 3 times a day or combined therapy with penicillin 500 mg orally 4 times a day (for E corrodens, P multocida, streptococci, and anaerobes) plus either a cephalosporin (eg, cephalexin 500 mg orally 4 times a day) or semisynthetic penicillin (eg, dicloxacillin 500 mg orally 4 times a day) for staphylococci.
In areas where MRSA is prevalent, trimethoprim / sulfamethoxazole, clindamycin, doxycycline, or linezolid should be used instead of a cephalosporin.
If the patient is allergic to penicillin, clindamycin 300 mg orally every 6 hours can be used.
The hand should be splinted in the functional position and elevated.
Splint in the functional position (20-degree wrist extension, 60-degree metacarpophalangeal joint flexion, slight interphalangeal joint flexion) Noninfected bite wounds may require surgical debridement and prophylaxis with 50% of the dose of antibiotic used to treat infected wounds.
The most common cause of human bites is a tooth-induced injury to the metacarpophalangeal joint as a result of a punch to the mouth (clenched fist injury).
The oral flora of humans includes Eikenella corrodens, staphylococci, streptococci, and anaerobes.
Patients with clenched fist injuries tend to wait hours or days after the wound occurs before seeking medical attention, which increases the severity of the infection.
Animal bites usually contain multiple potential pathogens, including Pasteurella multocida (particularly in cat bites), staphylococci, streptococci, and anaerobes.
Serious complications include infectious arthritis and osteomyelitis.
Diagnosis of Infected Bite Wounds Clinical evaluation Usually x-rays Usually wound cultures Erythema and pain localized to the bite suggest infection.
Tenderness along the course of a tendon suggests spread to the tendon sheath.
Overview of Evaluation of the Older Adult By Richard G Stefanacci, DO, MGH, MBA, Thomas Jefferson University, Jefferson College of Population Health Reviewed / Revised May 2022 | Modified Sep 2022 View Patient Education Topic Resources Disorders More Common Among... Evaluation of older adults usually differs from a standard medical evaluation.
Multiple disorders complicate diagnosis and treatment, and effects of the disorders are magnified by social disadvantage (eg, isolation) and poverty (as patients outlive their resources and supportive peers) and by functional and financial problems.
Clinicians should also pay particular attention to certain common geriatric symptoms (eg, delirium, dizziness, syncope, falling, mobility problems, weight or appetite loss, urinary incontinence) because they may result from disorders of multiple organ systems.
If patients have multiple disorders, treatments (eg, bed rest, surgery, drugs) must be well-integrated; treating one disorder without treating associated disorders may accelerate decline.
Also, careful monitoring is needed to avoid iatrogenic consequences.
For example, with complete bed rest, older patients can lose 1 to 3% of muscle mass and strength each day (causing sarcopenia and sharply reduced mobility), and effects of bed rest alone can ultimately result in death.
Missed or delayed diagnosis Disorders that are common among older adults are frequently missed, or the diagnosis is delayed.
Clinicians should use the history, physical examination, and simple laboratory tests to actively screen for disorders that occur only or more commonly in older patients (see table); when diagnosed early, these disorders can often be more easily treated.
Early diagnosis frequently depends on the clinician's familiarity with the patient's behavior and history, including mental status.
Commonly, the first signs of a physical disorder are behavioral, mental, or emotional.
If clinicians are unaware of this possibility and attribute these signs to dementia, diagnosis and treatment can be delayed.
Table Polypharmacy Patients' prescription, over-the-counter, and recreational drugs (including marijuana) should be reviewed frequently, particularly to look for drug interactions and use of drugs considered inappropriate for older patients.
This review is especially important during care transitions when reconciliation of drugs is required to eliminate duplication, missed drugs, and errors in dosage and to identify drugs that may be no longer be needed.
Caregiver problems Occasionally, problems of older patients are related to neglect or abuse by their caregiver.
Clinicians should consider the possibility of patient abuse and drug abuse by the caregiver if circumstances and findings suggest it.
Certain injury patterns or patient behaviors are particularly suggestive, including Frequent bruising, especially in difficult-to-reach areas (eg, middle of the back) Grip bruises of the upper arms Bruises of the genitals Peculiar burns Unexplained fearfulness of a caregiver in the patient
For older patients, especially those who are very old or frail, history-taking and physical examination may have to be done at different times, and physical examination may require 2 sessions because patients become fatigued.
(For screening recommendations in older people, see Prevention of Disease in Older Adults.)
Older adults also have different, often more complicated health care problems, such as multiple disorders, which may require use of many drugs (sometimes called polypharmacy) and thus greater likelihood of a high-risk drug being prescribed (see table).
Early detection of problems can result in early intervention, which can prevent deterioration and improve quality of life, often through relatively minor, inexpensive interventions (eg, lifestyle changes).
Thus, some older patients, particularly the frail or chronically ill, are best evaluated using a comprehensive geriatric assessment, which includes evaluation of function and quality of life, best administered by an interdisciplinary team.
Multiple disorders On average, older patients have 6 diagnosable disorders.
A disorder in one organ system can weaken another system, exacerbating the deterioration of both and leading to disability, dependence, and, without intervention, death.
Self-Neglect in Older Adults By Daniel B Kaplan, PhD, LICSW, Adelphi University School of Social Work Reviewed / Revised Apr 2023 View Patient Education Self-neglect is the inability or unwillingness of vulnerable adults to meet their basic needs themselves, thereby compromising the adult's well-being.
It can include ignoring personal hygiene, not paying bills, not maintaining the integrity or cleanliness of the home, not obtaining or preparing food (leading to undernutrition), not seeking medical care for potentially serious symptoms, not filling prescriptions, not taking medications (prescription or over-the-counter) incorrectly, and skipping follow-up visits.
Risk factors for self-neglect in older adults include Social isolation Disorders that impair memory or judgment (eg, dementia) The presence of multiple chronic disorders Substance misuse or abuse Severe depression Warning signs of self-neglect include lack of a caregiver plus any of the following: Rapid weight loss, undernutrition, dehydration Unaddressed health conditions Hypothermia or heat exhaustion Unsanitary home or unkempt clothing Lack of adequate food in the home Disconnected utilities Decubitus ulcers, poor hygiene, or unpleasant body odor Not taking medications Delirium Differentiating between self-neglect and simply choosing to live in a way that others find undesirable can be difficult.
Social workers are often in the best position to make this determination.
In the United States, Adult Protective Services or the state unit on aging (whose numbers are available through the Eldercare Locator at 800 - 677 - 1116) can help by coordinating in-home safety assessments and helping older people obtain counseling services, emergency response systems, referrals to additional support services, and, if necessary, hospitalization.
Ovulatory Dysfunction By Robert W Rebar, MD, Western Michigan University Homer Stryker M D.
However, this method is often inaccurate.
More accurate methods include Home testing kits, which detect an increase in urinary luteinizing hormone (LH) excretion 24 to 36 hours before ovulation (requiring daily testing for several days around midcycle, usually beginning about or after cycle day 9) Pelvic ultrasonography, which is used to monitor increases in ovarian follicle diameter and collapse of the follicle (monitoring should begin in the late follicular phase) Measurement of serum progesterone or urinary pregnanediol glucuronide (a urinary metabolite of progesterone) Serum progesterone levels of ≥ 3 ng / mL (≥ 9.75 nmol / L) or elevated levels of pregnanediol glucuronide in urine (measured, if possible, 1 week before onset of the next menstrual period) indicate that ovulation has occurred.
Intermittent or absent ovulation should prompt evaluation for disorders of the pituitary, hypothalamus, or ovaries (especially PCOS).
Treatment of Ovulatory Dysfunction Treatment of the underlying disorder Clomiphene or letrozole Possibly metformin if body mass index is ≥ 35 kg / m2 Gonadotropins if clomiphene is ineffective Ovulation is induced with hormonal or metabolic medications.
Clomiphene Commonly, chronic anovulation that is not due to hyperprolactinemia is initially treated with the antiestrogen clomiphene citrate.
Clomiphene 50 mg orally once a day is started between the 3rd and 5th day after bleeding begins; bleeding may have occurred spontaneously or have been induced (eg, by progestin withdrawal).
Ovulation usually occurs 5 to 10 days (mean 7 days) after the last day of clomiphene; if ovulation occurs, menses follows within 35 days of the induced bleeding episode.
If menses does not occur, a pregnancy test is done.
School of Medicine Reviewed / Revised Sep 2022 View Patient Education Etiology Symptoms and Signs Diagnosis Treatment Key Points Ovulatory dysfunction is abnormal, irregular (with ≤ 9 menses / year), or absent ovulation.
The daily dose can be increased by up to 50 mg every cycle to a maximum of 200 mg / dose as needed to induce ovulation.
Treatment is continued as needed for up to 4 ovulatory cycles.
Most women who become pregnant do so by the fourth cycle in which ovulation occurs.
Ovulation occurs in 75 to 80% of women treated with clomiphene, but the pregnancy rate is at most 40 to 50%.
Adverse effects of clomiphene include vasomotor flushes (10%), abdominal distention (6%), breast tenderness (2%), nausea (3%), visual symptoms (1 to 2%), and headaches (1 to 2%).
Multifetal pregnancy (primarily twins) occurs in about 5%, and ovarian hyperstimulation syndrome occurs in ≤ 1%.
Ovarian cysts are common.
A previously suggested association between clomiphene taken for > 12 cycles and ovarian cancer has not been confirmed.
Clomiphene should not be given to women who are pregnant because, theoretically, it may cause genital birth defects.
Menses are often irregular or absent.
Letrozole Letrozole is an aromatase inhibitor that may be used instead of clomiphene.
Evidence indicates that in obese women with PCOS, letrozole (an aromatase inhibitor) is more likely to induce ovulation than clomiphene (1).
Data indicate that this effect may also occur in thin women with PCOS.
No evidence indicates that letrozole is more effective than clomiphene for causes of anovulation other than PCOS.
Letrozole, like clomiphene, is started between the 3rd and 5th day after menstrual bleeding begins.
Initially, women are given 2.5 mg orally once a day for 5 days.
If ovulation does not occur, the dose can be increased by 2.5 mg every cycle to a maximum of 7.5 mg / dose.
The most common adverse effects of letrozole are fatigue and dizziness.
Letrozole should not be given to women who are pregnant because theoretically, it may cause genital birth defects.
Diagnosis is often possible by menstrual history or can be confirmed by measurement of hormone levels or serial pelvic ultrasonography.
Metformin For women with PCOS, metformin (750 to 1000 mg orally twice a day) may be a useful adjunct in inducing ovulation, particularly if the patient is insulin - resistant, as many patients with PCOS are.
However, clomiphene alone is more effective than metformin alone and is just as effective as metformin and clomiphene together (2).
Metformin is not first-line therapy for women who have PCOS and want to become pregnant.
Metformin may be useful for women with a body mass index > 35 kg / m2 and should be considered for women with PCOS and glucose intolerance.
Exogenous gonadotropins For all women with ovulatory dysfunction that does not respond to clomiphene (or letrozole, when used), human gonadotropins (ie, preparations that contain purified or recombinant follicle-stimulating hormone [FSH] and variable amounts of luteinizing hormone [LH]) can be used.
Several IM and subcutaneous preparations with similar efficacy are available; they typically contain 75 IU of FSH activity with or without LH activity.
They are usually given once a day, beginning on the 3rd to 5th day after induced or spontaneous bleeding; ideally, they stimulate maturation of 1 to 3 follicles, determined ultrasonographically, within 7 to 14 days.
Ovulation is typically triggered with human chorionic gonadotropin (hCG) 5, 000 to 10, 000 IU IM after follicle maturation; criteria for using hCG may vary, but typically, at least one follicle should be > 16 mm in diameter.
Alternatively, a gonadotropin-releasing hormone (GnRH) agonist can be used to trigger ovulation, especially in women at high risk of ovarian hyperstimulation syndrome.
Although risk of ovarian hyperstimulation syndrome in women at high risk is lower when a GnRH agonist is used to trigger ovulation, it is safer to not trigger ovulation if women are at high risk of ovarian hyperstimulation syndrome or multifetal pregnancy.
Treatment is usually induction of ovulation with clomiphene or other drugs.
Risk factors for these problems include Presence of > 3 follicles > 16 mm in diameter Preovulatory serum estradiol levels > 1500 pg / mL (or possibly > 1000 pg / mL) in women with several small ovarian follicles When exogenous gonadotropins are used appropriately, > 95% of women treated with them ovulate, but the pregnancy rate is only 50 to 75%.
After gonadotropin therapy, 10 to 30% of successful pregnancies are multiple.
Ovarian hyperstimulation syndrome occurs in 10 to 20% of patients; ovaries can become massively enlarged, and intravascular fluid volume shifts into the peritoneal space, causing potentially life-threatening ascites and hypovolemia.
(See also the American Society for Reproductive Medicine guideline Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: A guideline.)
Treatment of the underlying disorder Underlying disorders (eg, hyperprolactinemia) are treated.
If the cause is functional hypothalamic amenorrhea, gonadorelin acetate, a synthetic GnRH agonist given as a pulsatile IV infusion, can induce ovulation.
Doses of 2.5 - to 5.0-mcg boluses (pulse doses) regularly every 60 to 90 minutes are most effective.
Gonadorelin acetate is unlikely to cause multifetal pregnancy.
N Engl J Med 356 (6): 551 - 566, 2007. doi: 10.1056/NEJMoa063971 Key Points The most common cause of ovulatory dysfunction in premenopausal women is PCOS; other causes include hypothalamic and pituitary dysfunction.
Diagnose ovulatory dysfunction based on menstrual history, results of pelvic ultrasonography, and / or measurement of serum progesterone and urinary pregnanediol glucuronide.
Induce ovulation in most women, usually with clomiphene citrate or letrozole.
Etiology of Ovulatory Dysfunction Chronic ovulatory dysfunction in premenopausal women is most commonly caused by Polycystic ovary syndrome (PCOS) But it has many other causes, including Hyperprolactinemia Hypothalamic-pituitary dysfunction (most commonly, functional hypothalamic amenorrhea) Other conditions that can cause anovulation (eg, diabetes, clinical depression, certain antidepressants, obesity, excessive exercise, excessive weight loss, use of drugs that contain estrogens or progestins) Symptoms and Signs of Ovulatory Dysfunction In women with ovulatory dysfunction, menses may be absent, irregular, or not preceded by symptoms (collectively termed molimina), such as breast tenderness, lower abdominal bloating, fatigue, headache, or moodiness.
Diagnosis of Ovulatory Dysfunction Menstrual history Sometimes basal body temperature monitoring Home ovulation testing kits Measurement of urinary or serum hormones or ultrasonography Anovulation is often apparent based on the menstrual history.
Measuring daily morning body temperature can help determine whether and when ovulation is occurring.
Spontaneous Abortion (Miscarriage; Pregnancy Loss) By Antonette T Dulay, MD, Main Line Health System Reviewed / Revised Oct 2022 View Patient Education Etiology Symptoms and Signs Diagnosis Treatment Key Points Topic Resources Classification of Abortion Characteristic Symptoms and... Spontaneous abortion is pregnancy loss before 20 weeks gestation.
As many as 25% of all pregnancies end in a spontaneous abortion during the first 12 weeks of pregnancy.
Incidence in all pregnancies is probably higher because some very early abortions are mistaken for a late menstrual period.
BMJ 364: l869, 2019. doi: 10.1136 / bmj. l869 Etiology of Spontaneous Abortion Early spontaneous abortion is often caused by chromosomal abnormalities.
Maternal reproductive tract abnormalities (eg, bicornuate uterus, fibroids, adhesions) may also cause pregnancy loss through 20 weeks gestation.
Isolated spontaneous abortions may result from certain viruses—most notably cytomegalovirus, herpesvirus, parvovirus, and rubella virus.
Other causes include immunologic abnormalities and major trauma.
Most often, the cause is unknown.
Risk factors for spontaneous abortion include Age > 35 History of spontaneous abortion Cigarette smoking Use of certain drugs (eg, cocaine, alcohol) A poorly controlled chronic disorder (eg, diabetes, hypertension, overt thyroid disorders) in the mother Subclinical thyroid disorders, a retroverted uterus, and minor trauma have not been shown to cause spontaneous abortions.
Threatened abortion is vaginal bleeding without cervical dilation before 20 weeks in a confirmed viable intrauterine pregnancy.
Symptoms and Signs of Spontaneous Abortion Symptoms of spontaneous abortion include crampy pelvic pain, uterine bleeding, and eventually expulsion of tissue.
Late spontaneous abortion may begin with a gush of fluid when the membranes rupture.
Hemorrhage is rarely massive.
A dilated cervix indicates that abortion is inevitable.
If products of conception remain in the uterus after spontaneous abortion, uterine bleeding may occur, sometimes after a delay of hours to days.
Infection may also develop, causing fever, pain, and sometimes sepsis (called septic abortion).
Diagnosis of Spontaneous Abortion Usually ultrasonography and quantitative beta subunit of human chorionic gonadotropin (beta-hCG) Pelvic examination Pregnancy is diagnosed with a urine or blood beta-hCG test.
Ultrasonography is done to confirm intrauterine pregnancy and check for fetal cardiac activity, which is usually detectable after 5.5 to 6 weeks gestation.
However, gestational age is often somewhat uncertain, and serial ultrasonography may be required.
If cardiac activity is absent and had been detected previously during this pregnancy, fetal death is diagnosed.
Diagnosis is by pelvic examination, measurement of beta subunit of human chorionic gonadotropin, and ultrasonography.
Alternatively, serial beta-hCG levels that decrease across ≤ 3 measurements are consistent with a failed pregnancy.
Assessment is also done to determine the status of the abortion process as follows: Threatened abortion: Patients have uterine bleeding and it is too early to assess whether the fetus is alive and viable and the cervix is closed.
Potentially, the pregnancy may continue without complications.
Inevitable abortion: The cervix is dilated.
If the cervix is dilated, the volume of bleeding should be evaluated because it is sometimes significant.
Incomplete abortion: The products of conception are partially expelled.
Complete abortion: The products of conception have passed and the cervix is closed (see table Characteristic Symptoms and Signs in Spontaneous Abortions).
Table Missed abortion is suspected if the uterus does not progressively enlarge or if quantitative beta - hCG is low for gestational age or does not double within 48 to 72 hours.
Missed abortion is confirmed if ultrasonography shows any of the following: Disappearance of previously detected embryonic cardiac activity Absence of such activity when the fetal crown-rump length is > 7 mm Absence of a fetal pole (determined by transvaginal ultrasonography) when the mean sac diameter (average of diameters measured in 3 orthogonal planes) is > 25 mm An anembryonic pregnancy refers to a gestational sac with no yolk sac or embryo, seen on ultrasound, in a nonviable pregnancy.
For recurrent pregnancy loss, testing to determine the cause of abortion is necessary.
Treatment is usually expectant observation for threatened abortion and, if spontaneous abortion has occurred or appears unavoidable, observation or uterine evacuation.
Treatment of Spontaneous Abortion For threatened abortion, observation For inevitable, incomplete, or missed abortions, observation or surgical or medical uterine evacuation If the mother is Rh-negative, Rho (D) immune globulin Sometimes pain medication Emotional support For threatened abortion, treatment is observation, but health care practitioners may periodically evaluate the woman's symptoms or do ultrasonography.
No evidence suggests that bed rest decreases risk of subsequent completed abortion.
For inevitable, incomplete, or missed abortions, treatment is uterine evacuation or waiting for spontaneous passage of the products of conception.
For patients managed expectantly, evacuation is done if excessive bleeding or infection occur or if the products of conception do not pass after about 2 to 4 weeks.
At < 12 weeks, evacuation may be done with suction curettage or medical management.
For medical evacuation, misoprostol (800 mcg intravaginally) is given; if there is no response to the first dose, one additional dose may be given at least 3 hours after first dose and typically within 7 days (1).
A dose of mifepristone (200 mg orally) 24 hours before misoprostol administration should be considered if available.
Evacuation is typically done with dilation and evacuation at 12 to 23 weeks or medication induction at > 16 to 23 weeks (eg, with misoprostol or mifepristone).
For dilation and evacuation, the later the gestational age, the greater the likelihood of placental bleeding, uterine perforation by long bones of the fetus, and difficulty dilating the cervix.
These complications are reduced by preoperative use of osmotic cervical dilators (eg, laminaria) or by medical induction.
Spontaneous abortion, by definition, is death of the fetus.
If complete abortion is suspected, uterine evacuation is not done routinely.
Uterine evacuation can be done if bleeding occurs and / or if other signs indicate that products of conception may be retained.
Pain medications should be given, as appropriate.
Rho (D) immune globulin is given if the mother is Rh-negative.
After a spontaneous abortion, parents may feel grief or guilt.
They should be given emotional support and, in most cases of spontaneous abortions, reassured that their actions were not the cause.
Formal counseling or support groups may be made available if appropriate.
About 20 to 30% of women with confirmed pregnancies bleed during the first 20 weeks of pregnancy; half of these women spontaneously abort.
Spontaneous abortion is often caused by chromosomal abnormalities or maternal reproductive tract abnormalities (eg, bicornuate uterus, fibroids), but etiology in an individual case is usually not confirmed.
Confirm spontaneous abortion and determine pregnancy status with quantitative beta-hCG, ultrasonography, and pelvic examination; a dilated cervix means that abortion is inevitable.
Treat with expectant management (observe for passage of products of conception) or surgical or medication (with misoprostol or sometimes mifepristone) uterine evacuation.
Often, uterine evacuation is not needed for threatened and complete abortions.
Provide emotional support to the parents.
Thus, incidence of spontaneous abortion is up to about 20% in confirmed pregnancies.
Fetal death and early delivery are classified as follows: Spontaneous abortion: Death of the fetus, sometimes with passage of products of conception (fetus and placenta), before 20 weeks gestation Fetal demise (stillbirth): Fetal death at ≥ 20 weeks Preterm delivery: Delivery of a live fetus between 20 weeks and 36 weeks/6 days Abortions may be classified as follows (see table Classification of Abortion): Early or late Spontaneous or induced Threatened or inevitable Incomplete or complete Missed Recurrent (also called recurrent pregnancy loss) Septic Table About 10 to 15% of confirmed pregnancies spontaneously abort (1).
Pedophilic Disorder (Pedophilia) By George R Brown, MD, East Tennessee State University Reviewed / Revised Apr 2021 | Modified Sep 2022 View Patient Education Diagnosis Treatment Pedophilic disorder is characterized by recurrent, intense sexually arousing fantasies, urges, or behaviors involving prepubescent or young adolescents (usually ≤ 13 years); it is diagnosed only when people are ≥ 16 years and ≥ 5 years older than the child who is the target of the fantasies or behaviors.
Attraction may be to young boys, girls, or both.
But pedophiles prefer opposite-sex to same-sex children 2: 1.
In most cases, the adult is known to the child and may be a family member, stepparent, or a person with authority (eg, a teacher, a coach).
Looking or touching seems more prevalent than genital contact.
Pedophiles may be attracted only to children (exclusive form) or also adults (nonexclusive form); some are attracted only to children who are related to them (incest).
Predatory pedophiles, many of whom have antisocial personality disorder, may use force and threaten to physically harm the child or the child's pets if the abuse is disclosed.
The course of pedophilia is chronic, and perpetrators often have or develop substance use disorders or dependence and depression.
Pervasive family dysfunction, a personal history of sexual abuse, and marital conflict are common.
Other comorbid disorders include attention-deficit / hyperactivity disorder, anxiety disorders, and posttraumatic stress disorder.
Diagnosis of Pedophilic Disorders Clinical evaluation Extensive use of child pornography is a reliable marker of sexual attraction to children and may be the only indicator of the disorder.
(See also Overview of Paraphilic Disorders and Sexual abuse.)
However, use of child pornography by itself does not meet criteria for pedophilic disorder, although it is typically illegal.
If a patient denies sexual attraction to children but circumstances suggest otherwise, certain diagnostic tools can help confirm such attraction.
Tools include penile plethysmography (men), vaginal photoplethysmography (women), and viewing time of standardized erotic materials; however, possession of such material, even for diagnostic purposes, may be illegal in certain jurisdictions.
Clinical criteria for diagnosis (based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5]) of pedophilic disorder are Recurrent, intense sexually arousing fantasies, urges, or behaviors involving a prepubescent child or children (usually ≤ 13 years) have been present for ≥ 6 months.
The person has acted on the urges or is greatly distressed or impaired by the urges and fantasies.
The experience of distress about these urges or behaviors is not a requirement for the diagnosis.
The person is ≥ 16 years and ≥ 5 years older than the child who is the target of the fantasies or behaviors (but excluding an older adolescent who is in an ongoing relationship with a 12 - or 13-year-old).
Identifying a patient as a potential pedophile sometimes poses an ethical crisis for health care practitioners.
However, health care practitioners have a responsibility to protect the community of children.
Practitioners should know the reporting requirements in their state.
Pedophilia is a form of paraphilia that causes harm to others and is thus considered a paraphilic disorder.
If practitioners have reasonable suspicion of child sexual or physical abuse, the law requires that it be reported to authorities.
Reporting requirements vary by state (see Child Welfare Information Gateway).
Treatment of Pedophilic Disorders Psychotherapy Treatment of comorbid disorders Drug treatment (eg, antiandrogens, selective serotonin reuptake inhibitors [SSRIs]) Long-term individual or group psychotherapy is usually necessary and may be especially helpful when it is part of multimodal treatment that includes social skills training, treatment of comorbid physical and mental disorders, and drug treatment.
Treatment of pedophilia is less effective when court ordered, although many adjudicated sex offenders have benefited from treatments, such as group psychotherapy plus antiandrogens.
Some pedophiles who are committed to treatment and monitoring can refrain from pedophilic activity and can be reintegrated into society.
These results are more likely when no other psychiatric disorders, particularly personality disorders, are present.
Drugs In the US, the treatment of choice for pedophilia is IM medroxyprogesterone acetate By blocking pituitary production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), medroxyprogesterone reduces testosterone production and thus reduces libido.
Typical doses are medroxyprogesterone 200 mg IM 2 to 3 times a week for 2 weeks, followed by 200 mg 1 to 2 times a week for 4 weeks, then 200 mg every 2 to 4 weeks.
The gonadotropin-releasing hormone (GnRH) agonist leuprolide, which reduces pituitary production of LH and FSH and thus reduces testosterone production, is also an option and requires less frequent IM injections (at 1 - to 6 month - intervals) than medroxyprogesterone.
Sexual offenses against children constitute a significant proportion of reported criminal sexual acts.
Cyproterone acetate, which blocks testosterone receptors, is used in Europe.
Serum testosterone should be monitored and maintained in the normal female range (< 62 ng / dL [2.15 nmol / L]) in male patients.
Treatment is usually long-term because deviant fantasies usually recur weeks to months after treatment is stopped.
Liver function tests should be done, and blood pressure, bone mineral density, and complete blood count should be monitored as required.
The usefulness of antiandrogens in female pedophiles is less well established.
In addition to antiandrogens, SSRIs (eg, high-dose fluoxetine 60 to 80 mg once a day or fluvoxamine 200 to 300 mg orally once a day) may be useful.
Drugs are most effective when used as part of a multimodal treatment program.
For older adolescents (ie, 17 to 18 years old), ongoing sexual interest or involvement with a 12 - or 13-year-old may not meet the clinical criteria for a disorder.
However, legal criteria may be different from psychiatric criteria.
For example, sexual activity between a 19-year-old and a 16-year-old may be a crime and not a pedophilic disorder, depending on the jurisdiction.
Diagnostic age guidelines apply to Western cultures and not to the many cultures that accept sexual activity, marriage, and childbearing at much younger ages and accept much greater age differences between sex partners than Western cultures do.
Most pedophiles are male.
How To Do Femoral Vein Cannulation By Paula Ferrada, MD, VCU Health System Reviewed / Revised Jun 2020 | Modified 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 Vascular Anatomy of the Femoral... Percutaneous Cannulation... Percutaneous cannulation of the femoral vein uses anatomic landmarks to guide venipuncture and a Seldinger technique to thread a central venous catheter through the femoral vein and into the inferior vena cava.
They should be exchanged for lines above the diaphragm as soon as possible.
Maintain your grasp on the guidewire at all times during the insertion.
Then, in increments of several centimeters and using a corkscrew motion as necessary, stepwise advance the entire length of the femoral catheter.
* For transvenous cardiac pacing and pulmonary arterial monitoring, a right internal jugular cannulation or a left subclavian vein cannulation typically is preferred.
Contraindications to Femoral Vein Cannulation Absolute contraindications Intra-abdominal hemorrhage or regional trauma Femoral vein thrombosis Local infection at the insertion site Antibiotic-impregnated catheter in an allergic patient For intra-abdominal hemorrhage or regional trauma, sites that drain into the superior vena cava should be used.
Aftercare for Femoral Vein Cannulation If needed (eg, if the femoral catheter is malfunctioning), do a chest x-ray to confirm that the tip of the catheter lies in the inferior vena cava distal to the right atrium.
Warnings and Common Errors for Femoral Vein Cannulation Never lose grasp of the guidewire. During cardiopulmonary arrest, or even low blood pressure and hypoxia, arterial blood may be dark and not pulsatile and may be mistaken for venous blood.
Tips and Tricks for Femoral Vein Cannulation Femoral lines are usually used only as provisional access because they have a high risk of infection.
Relative contraindications Coagulopathy, including therapeutic anticoagulation * Local anatomic distortion (traumatic or congenital), or gross obesity History of prior catheterization of the intended central vein Uncooperative patient (should be sedated if necessary) Ambulatory patient * Therapeutic anticoagulation (eg, for pulmonary embolism) increases the risk of bleeding with femoral vein cannulation, but this must be balanced against the increased risk of thrombosis (eg, stroke) if anticoagulation is reversed.
Femoral vein cannulation may be preferred for coagulopathic patients because, unlike the subclavian or internal jugular sites, the femoral triangle is readily compressible and vital structures (airway, pleural dome, mediastinum, blood vessels to brain) are distant from the venipuncture site.
Complications of Femoral Vein Cannulation (See also Complications of central venous catheterization.)
Complications include Infection Thrombosis Arterial puncture Hematoma Retroperitoneal bleeding Damage to the vein Air embolism Catheter misplacement * Nerve damage Bladder or bowel perforation (rare) * Rare complications due to femoral catheter misplacement include arterial catheterization and retroperitoneal infusion.
Femoral venous cannulation has the procedural advantages of a relatively superficial and easily accessed vein.
Equipment for Femoral Vein Cannulation Sterile procedure, barrier protection Antiseptic solution (eg, chlorhexidine - alcohol, chlorhexidine, povidone iodine, alcohol) Sterile drapes (large), towels Sterile head caps, masks, gowns, gloves Face shields Seldinger (catheter-over-guidewire) technique Cardiac monitor Local anesthetic (eg, 1% lidocaine without epinephrine, about 5 mL) Small anesthetic needle (eg, 25 to 27 gauge, about 1 inches [3 cm] long) Large anesthetic / finder * needle (22 gauge, about 1.5 inches [4 cm] long) Introducer needle (eg, thin-walled, 18 or 16 gauge, with internally beveled hub, about 2.5 inches [6 cm] long) 3 - and 5-mL syringes (use slip-tip syringes for the finder and introducer needles) Guidewire, J-tipped Scalpel (#11 blade) Dilator Central venous catheter (adult: 8 French or larger, minimum length for femoral catheter is 24 cm) Sterile gauze (eg, 4 × 4 inch [10 × 10 cm] squares) Sterile saline for flushing catheter port or ports Nonabsorbable nylon or silk suture (eg, 3 - 0 or 4 - 0) Chlorhexidine patch, transparent occlusive dressing * A finder needle is a thinner needle used for locating the vein before inserting the introducer needle.
It is not typically used but is optional (eg, in obese patients) for femoral vein cannulation.
Additional Considerations for Femoral Vein Cannulation Cannulation attempts sometimes fail.
If the femoral artery is errantly cannulated by either the tissue dilator or the CVC, leave the dilator or catheter in place and obtain surgical consultation for possible surgical removal.
Relevant Anatomy for Femoral Vein Cannulation The femoral vein and artery are accessible within the femoral triangle, which is defined by the inguinal ligament superiorly, the adductor longus muscle medially, and the sartorius muscle laterally.
The inguinal ligament spans between the symphysis pubis and the anterior superior iliac spine.
The femoral artery is palpated inferior to the inguinal ligament, typically at or just medial to its midpoint.
In addition, the nearby anatomy lacks the complexity and vital structures of the jugular and subclavian regions.
In the absence of a palpable femoral pulse, the femoral artery is presumed to lie in this region.
The femoral vein lies medially adjacent to the femoral artery.
The desired point of femoral vein puncture is 1 to 2 cm inferior to the inguinal ligament.
Bleeding due to a vascular impalement here can be controlled by externally compressing the vessels against the femoral head.
The retroperitoneal space lies superior to the inguinal ligament.
Bleeding due to a vascular impalement here causes retroperitoneal bleeding, and external compression of the vessels may be impossible.
Positioning for Femoral Vein Cannulation Raise the bed to a comfortable height for you (ie, so you may stand straight while doing the procedure).
Place the patient supine or in slight reverse Trendelenburg position (bed tilted with the head up) to distend the femoral vein.
However, femoral central venous catheters (CVCs) have higher risks of infection and thrombosis and are appropriate only for bedridden patients.
Retract a pannus or a urethral catheter away from the inguinal area using tape (or an assistant if needed).
Ultrasonographic guidance for placement of femoral lines increases the likelihood of successful cannulation and reduces the risk of complications.
When flushing a central line, use a 10-mL syringe (or one of equal or greater volume) and do not push too hard to avoid rupturing the line.
Establish the needle insertion path Gently palpate the femoral arterial pulse using 2 or 3 fingers.
Palpate gently so as not to compress the adjacent femoral vein (a compressed venous lumen is difficult to access).
The needle insertion path: Insert procedural needles (local anesthetic, finder, and introducer needles) 2 to 4 cm inferior to the inguinal ligament, 1 cm medial to the femoral artery, at a 45 to 60° angle into the skin, and aim toward the umbilicus.
When ultrasonographic guidance and trained personnel are available, this method of placement is preferred.
Maintain femoral artery palpation during needle insertions and keep the needle medial to the artery to avoid impaling the artery.
Percutaneous Cannulation of the Femoral Vein VIDEO Anesthetize the cannulation site Place a wheal of anesthetic at the needle entry site and then inject anesthetic into the skin and soft tissues along the anticipated needle insertion path.
Insert the introducer needle (or finder needle, optional) Insert the introducer needle (or, optionally, finder needle), with the bevel facing up, along the needle insertion path.
(See also Vascular Access: Central Venous Catheterization and How To Do Femoral Vein Cannulation, Ultrasound-Guided)
If no flash of blood appears in the barrel after 2 to 4 cm of insertion, withdraw the needle slowly.
Remove the needle and use 4 × 4 gauze squares for 10 minutes to hold external pressure on the area and to help prevent bleeding and hematoma.
Indications for Femoral Vein Cannulation Secure or long-term venous access that is not available using other sites Inability to obtain peripheral venous access or intraosseous infusion IV infusion of fluids and drugs for patients in cardiac arrest IV infusion of concentrated or irritating fluids IV infusion of high flows or large fluid volumes if placement of large-bore (eg, 18 or 16 gauge) peripheral venous catheters or other CVCs is not feasible Hemodialysis or plasmapheresis Transvenous cardiac pacing (see video How to Insert a Transvenous Pacemaker) or pulmonary arterial monitoring (Swan-Ganz catheter) * Placement of inferior vena cava filter Need for central venous access in patients with superior vena cava syndrome Central venous access above the diaphragm, unless contraindicated, is generally preferred to femoral venous access in patients who require central venous access.
Optional: Use the finder needle to guide insertion of the introducer needle If up to this point you have been inserting a finder needle (or an anesthetic needle that found the vein), now you will use this needle to guide insertion of the introducer needle.
Hold the introducer syringe with the needle bevel facing up.
Use one of two insertion methods: Either remove the finder needle and immediately insert the introducer needle along the same path, or keep the finder needle in place and insert the introducer needle underneath and roughly parallel to it (at a slightly shallower angle to the skin).
Insert the J-curved end of the guidewire into the introducer needle, with the J curve facing up.
Femoral lines are usually used only as provisional access because they have a high risk of infection.
Advance the wire 20 to 30 cm.
How To Do Diagnostic Peritoneal Lavage (DPL) By Dorothy Habrat, DO, University of New Mexico School of Medicine Reviewed / Revised Mar 2021 | Modified Sep 2022 View Patient Education Indications Contraindications Complications Equipment Additional Considerations Positioning Relevant Anatomy Step-by-Step Description of Procedure Aftercare Warnings and Common Errors Tips and Tricks Diagnostic peritoneal lavage (DPL) is an invasive emergency procedure used to detect hemoperitoneum and help determine the need for laparotomy following abdominal trauma.
Contraindications Absolute contraindications Obvious clinical indications for laparotomy (eg, gunshot wound to the abdomen or flank, other penetrating abdominal injury with shock, evisceration, impalement) Relative contraindications Availability of appropriate imaging (eg, E-FAST, CT) Pelvic fracture * Inability to place a urethral catheter * Pregnancy (2nd or 3rd trimester) * Previous abdominal surgery† Morbid obesity‡ * Supraumbilical open DPL is needed, to avoid an anteriorly spreading retroperitoneal bleed, distended bladder, or gravid uterine fundus, respectively.
† Adhesions from previous surgery make uniform distribution of fluid in the abdomen difficult and increase the risk of perforated viscus.
Open DPL is done, making the incision distant from the surgical incision site (elsewhere on the midline if possible or in the left lower quadrant).
‡ Infraumbilical semi-open or open DPL is done to more safely and accurately access the peritoneal space through thick subcutaneous fat.
Complications Complications of DPL include Herniation of bowel through the incision Injury to organs and / or vessels by needle or catheter Infection Cutaneous bleeding and / or hematoma Non-complication problems include inadequate fluid return.
Prior to DPL, place a urethral catheter and gastric tube to decompress the bladder and stomach and thereby avoid injury by the needle, guidewire, or catheter insertions.
Before attempting urethral catheterization, suspected urethral trauma (eg, as suggested by meatal blood or perineal bruising or hematoma) should be excluded by retrograde urethrography.
A catheter is inserted into the peritoneal cavity, followed by aspiration of intraperitoneal contents, often after their dilution with crystalloid.
Prophylactic antibiotics are not needed for DPL.
Positioning The patient is supine.
Relevant Anatomy The catheter is inserted on the longitudinal midline 2 cm inferior to the umbilicus.
This site is distant from both the stomach and omentum, and the underlying fascia (linea alba) is not very vascular.
The semi-open technique is an alternative (eg, for patients with thick abdominal fat).
Prepare the patient Insert a nasogastric tube (see How To Insert a Nasogastric Tube) Insert a urinary catheter (see How To Do Urethral Catheterization in a Female or How To Do Urethral Catheterization in a Male) If semi-open DPL is anticipated, shave a broad area about the anticipated incision site.
Swab a broad area of skin about the site * with antiseptic solution and allow to dry.
Place sterile towels about the site.
For semi-open technique, place large sterile drapes to establish a bigger sterile field.
DPL is rarely done for the detection of intraabdominal bleeding in the developed world because it has been replaced with Extended Focused Assessment with Sonography in Trauma (E-FAST).
Inject anesthetic at and around the needle entry point, covering the length of any anticipated incision (for semi-open technique) and down to the fascia.
* Standard entry site is midline, 2 cm inferior to the umbilicus.
Access the peritoneal cavity Closed technique Insert the introducer needle in the midline of the abdomen 2 cm inferior to the umbilicus angled at 45 degrees to the skin and directed inferoposteriorly toward the pelvis.
Advance the needle until you feel it pop through the fascia and the peritoneal membrane and then continue another 2 to 3 mm.
Hold the needle motionless and gently aspirate: If > 10 mL of blood is aspirated, hemoperitoneum is diagnosed and the procedure is ended.
This test result is also positive if there is free aspiration of gastrointestinal contents or bile.
If no blood is aspirated, insert the J-curve end of the guidewire into the needle, with the curve pointing in the same direction as the needle bevel, to steer the guidewire into the right or left pelvic gutter.
Advance the guidewire until it stops or until the length of wire protruding from the needle hub remains slightly longer than the peritoneal catheter.
If you feel resistance or if the patient experiences pain as you advance the guidewire, stop the procedure and withdraw the needle and guidewire together as a unit (to prevent the needle tip from shearing through the guidewire within the patient).
Reinsert the needle at a slightly different site, but still on the midline.
DPL has low specificity, identifying many lesions that cause bleeding but do not require operative repair, and results in a high negative laparotomy rate.
Hold the end of the guidewire and withdraw the needle until the point just exits the skin.
Grasp the guidewire at the skin surface and slide the needle off the wire.
Use the scalpel to make a small incision where the guidewire enters the epidermis, to permit passage of the catheter.
Thread the catheter over the guidewire and slide the catheter down to your fingers, grasping the guidewire at the skin.
The end of the guidewire should now be protruding from the end of the catheter hub; if it is not, slowly retract the guidewire out of the abdomen until the end protrudes.
Grasp and control the guidewire where it protrudes from the catheter hub and advance the catheter over the wire, using a corkscrew motion as necessary, until the catheter is fully inserted.
Remove the guidewire and begin the lavage.
Semi-open technique (alternative) An assistant is useful, particularly if the patient is obese.
Make a 4 to 6 cm vertical, midline incision down to the fascia starting just below the umbilicus.
Stop any bleeding using electrocautery or sutures.
DPL is invasive and risks iatrogenic damage to abdominal organs during the procedure.
Grasp the fascia with hemostats to stabilize it and insert the introducer needle directly through the fascia.
Do the peritoneal lavage Connect the bag of warmed lavage solution to the catheter with IV tubing and allow the fluid to flow into the peritoneal cavity.
Once fluid is instilled, lower the nearly empty solution bag well below the level of the abdomen and allow the fluid to return into the bag.
Recover as much fluid as possible, but as little as 250 mL is adequate.
Send fluid for analysis.
The lavage is positive if there are > 100, 000 red blood cells / mL, > 500 white blood cells / mL, or a positive Gram stain test.
A negative test does not exclude other solid organ injury, viscus perforation, diaphragmatic tears, or retroperitoneal injury.
Remove the catheter.
DPL also misses retroperitoneal injuries.
Close any skin incision with sutures or staples and dress the site.
Aftercare Remove the urethral catheter and nasogastric tube if these are not otherwise needed.
After a negative DPL, most clinicians consider additional diagnostic testing and admit the patient to hospital for observation and serial abdominal examinations.
Keep the patient NPO initially but introduce liquid and then food, depending on clinical status.
Warnings and Common Errors Not achieving cutaneous hemostasis during a semi-open procedure risks allowing blood from skin vessels to enter the abdomen and falsely elevate the red blood cell count During a semi-open procedure, inadvertently dissecting through the fascia and entering the abdomen Tips and Tricks If the flow of fluid is weak, the omentum may be blocking the catheter holes.
Abdominal palpation, repositioning the patient to allow the lavage fluid to move, or slight repositioning of the catheter may improve the flow.
However, DPL is more sensitive than E-FAST for mesenteric, diaphragmatic, and hollow viscus injury because these injuries (and the lesser volume of hemorrhage they produce) are more difficult to visualize on imaging.
The most common DPL techniques are Closed: Percutaneous needle insertion into the peritoneal cavity followed by catheter-over-wire (Seldinger technique) Semi-open: Dissection down to (and sometimes through) the rectus fascia followed by needle and catheter-over-wire technique into the peritoneal cavity An open technique (mini-laparotomy) in which the operator dissects into the abdominal cavity to directly visualize the peritoneum and incise it to insert the catheter in a more directed fashion is less often done and is not discussed here.
Indications DPL is indicated if imaging is not available and intraabdominal injury possibly requiring surgery is suspected, typically based on Blunt abdominal trauma with hemodynamic instability Stab wound to the abdomen penetrating the fascia (ie, seen on local wound exploration), or with other concerns for intraabdominal entry (eg, from instrument used, clinical findings) Multiple trauma with shock of unclear etiology, especially in patients with an unreliable physical examination of the abdomen (eg, due to altered mental status from head injury, intoxication, spinal cord injury, or other distracting painful injuries) Rarely, DPL is indicated when imaging is available, such as in hypotension plus an unclear E-FAST examination result or imaging that shows free pelvic fluid but no apparent solid organ injury (eg, ascites).
Human and Mammal Bites By Robert A Barish, MD, MBA, University of Illinois at Chicago; Thomas Arnold, MD, Department of Emergency Medicine, LSU Health Sciences Center Shreveport Reviewed / Revised Jan 2022 | Modified Sep 2022 View Patient Education Diagnosis Treatment Key Points Topic Resources Antimicrobials for Bite Wounds How To Clean, Debride, and... Human and other mammal bites (mostly dog and cat bites, but also squirrel, gerbil, rabbit, guinea pig, and monkey bites) are common and occasionally cause significant morbidity and disability.
Monkey bites, usually restricted in the US to animal laboratory workers, carry a small risk of herpes simian B virus (Herpesvirus simiae) infection, which causes vesicular skin lesions at the inoculation site and can progress to encephalitis, which is often fatal.
Bites to the hand carry a higher risk of infection than bites to other sites.
Specific infections include Cellulitis Tenosynovitis Infectious arthritis Osteomyelitis A fight bite is the most common human bite wound.
It results from a clenched-fist strike to the mouth and is a particular risk for infection.
In fight bites, the skin wound moves away from the underlying damaged structures when the hand is opened, trapping bacteria inside.
Patients often delay seeking treatment, allowing bacteria to multiply.
Cat bites to the hand also have a high risk of infection because cats' long, slender teeth often penetrate deep structures, such as joints and tendons, and the small punctures are then sealed off.
Human bites to sites other than the hand have not been proved to carry a greater risk of infection than bites from other mammals.
Diagnosis of Human and Mammal Bites Evaluation of hand bites while the hand is in the same position as when the bite was inflicted Assessment for damage to underlying nerve, tendon, bone, and vasculature and for presence of foreign bodies Human bites sustained in an altercation are often attributed to other or vague causes to avoid involvement of the authorities or to ensure insurance coverage.
Domestic violence is often denied.
The hands, extremities, and face are most frequently affected, although human bites can occasionally involve breasts and genitals.
Pearls & Pitfalls For any dorsal hand wound near the metacarpophalangeal joint, consider a human bite, particularly if the history is vague.
Wounds are evaluated for damage to underlying structures (eg, nerves, vasculature, tendons, bone) and for foreign bodies.
Evaluation should focus on careful assessment of function and the extent of the bite.
Wounds over or near joints should be examined while the injured area is held in the same position as when the bite was inflicted (eg, with fist clenched).
Wounds are explored under sterile conditions to assess tendon, bone, and joint involvement and to detect retained foreign bodies.
If a retained foreign body is a possibility, imaging (eg, x-ray for radiopaque foreign bodies, such as most teeth) may be done.
Wounds inflicted by chomping may appear to be minor abrasions but should be examined to rule out deep injury.
Culturing fresh wounds is not valuable for targeting antimicrobial therapy, but infected wounds should be cultured.
For patients with human bites, screening for hepatitis or HIV is recommended only if the attacker is known or suspected to be seropositive.
Bites by large animals sometimes cause significant tissue trauma; about 10 to 20 people in the US, mostly children, die from dog bites each year.
Treatment of Human and Mammal Bites Meticulous wound care Selective wound closure Selective use of prophylactic antibiotics Hospitalization is indicated if complications from a bite mandate very close monitoring, particularly when patient characteristics predict a high risk of nonadherence with outpatient follow-up.
Hospitalization should be considered in the following circumstances: When a human bite is infected (including clenched-fist injuries) When a nonhuman bite is moderately or severely infected When loss of function is evident When the wound threatens or has damaged deep structures When a wound is disabling or difficult to care for at home (eg, significant wounds to both hands or both feet, hand wounds that require continuous elevation) Priorities of treatment include wound cleaning, debridement, closure, and infection prophylaxis, including for tetanus (see table).
Wound care Bite wounds should first be cleaned with a mild antibacterial soap and water (tap water is sufficient), then pressure irrigated with copious volumes of saline solution using a syringe and IV catheter.
A local anesthetic should be used as needed.
Dead and devitalized tissue should be debrided, taking particular care in wounds involving the face or the hand.
How To Clean, Debride, and Dress Lacerations VIDEO Wound closure is done only for select wounds (ie, that have minimal damage and can be cleansed effectively).
Many wounds should initially be left open, including the following: Puncture wounds Wounds to the hands, feet, perineum, or genitals Wounds more than several hours old Wounds that are heavily contaminated Wounds that are markedly edematous Wounds that show signs of inflammation Wounds that involve deeper structures (eg, tendon, cartilage, bone) Wounds due to human bites Wounds sustained in a contaminated environment (eg, marine, field, sewers) In addition, in immunocompromised patients, wound healing may be better with delayed closure.
Other wounds (ie, fresh, cutaneous lacerations) can usually be closed after appropriate wound hygiene.
Results with delayed primary closure are comparable to those with primary closure, so little is lost by leaving the wound open initially if there is any question.
Hand bites should be wrapped in sterile gauze, splinted in position of function (slight wrist extension, metacarpophalangeal and both interphalangeal joints in flexion).
If wounds are moderate or severe, the hand should be continuously elevated (eg, hanging from an IV pole).
Facial bites may require reconstructive surgery given the cosmetic sensitivity of the area and the potential for scarring.
Primary closure of dog bites of the face in children has shown good results, but consultation with a plastic surgeon may be indicated.
Infected wounds may require debridement, suture removal, soaking, splinting, elevation, and IV antibiotics, depending on the specific infection and clinical scenario.
Joint infections and osteomyelitis require prolonged IV antibiotic therapy and orthopedic consultation.
Antimicrobials Thorough wound cleansing is the most effective and essential way to prevent infection and often suffices.
There is no consensus on indications for prophylactic antibiotics.
Studies have not confirmed a definite benefit, and widespread use of prophylactic antibiotics has the potential to select resistant organisms.
Drugs do not prevent infection in heavily contaminated or inadequately cleaned wounds.
However, many practitioners prescribe prophylactic antibiotics for bites to the hand and some other bites (eg, cat bites, monkey bites).
(See also Rat-Bite Fever.)
Infections are treated with antimicrobials initially chosen based on animal species (see table).
Culture results, when available, guide subsequent therapy.
Patients with human bites that cause bleeding or exposure to the biter's blood should receive postexposure prophylaxis for viral hepatitis and HIV as indicated by patient and attacker serostatus.
If status is unknown, prophylaxis is not indicated.
Table Key Points Infectious risk is high for hand wounds, particularly clenched-fist injuries.
Evaluate hand wounds with the hand in the position it was when the wound was inflicted.
Evaluate wounds for damage to nerve, tendon, bone, and vasculature and for the presence of foreign bodies.
Close only wounds that have minimal damage and can be cleansed effectively.
Decrease risk of infection by thorough mechanical cleaning, debridement, and sometimes antimicrobial prophylaxis.
Infection In addition to tissue trauma, infection due to the biting organism's oral flora is a major concern.
Human bites can theoretically transmit viral hepatitis and HIV.
However, HIV transmission is unlikely because the concentration of HIV in saliva is much lower than in blood and salivary inhibitors render the virus ineffective.
Rabies is a risk with certain mammal bites.
Contact lenses can be painful when The corneal epithelium is abraded (see Corneal Abrasions and Foreign Bodies); the eye becomes red, and the cornea stains with fluorescein.
The lenses fit poorly (eg, too tight, too loose, poorly centered).
There is too little moisture to keep the lens floating above the cornea.
The lenses are worn in a nonideal environment (eg, oxygen-poor, smoky, windy).
A lens is improperly inserted or removed.
A small foreign particle (eg, soot, dust) becomes trapped between the lens and the cornea.
The lenses are worn for a long time (overwear syndrome).
Overwear syndrome causes redness, photophobia, and tearing.
Spontaneous healing may occur in a day or so if lenses are not worn.
In some cases, active treatment is required (eg, topical antibiotic eye drops or ointments).
Toric soft contact lenses (which have different curvatures molded onto the front lens surface) or rigid lenses are used to correct significant astigmatism; they are satisfactory in many cases but require expert fitting.
Dilating the eye with mydriatic drops can ease photophobia.
Mydriatics work by temporarily paralyzing the muscles of the iris and ciliary body (movement of the inflamed muscles causes pain).
In overwear syndrome or any other condition in which pain does not quickly resolve when lenses are removed, an ophthalmologist or optometrist should be consulted before lenses are worn again.
Risk factors for contact lens-related corneal infection (keratitis) include the following: Poor lens hygiene Overnight or extended wear Use of tap water in the cleaning regimen Eyes with a compromised ocular surface (eg, dryness, poor corneal sensation) Infections require prompt treatment by an ophthalmologist.
Corneal ulcer A corneal ulcer, which is a potentially vision-threatening infection of the cornea, is suspected when a contact lens wearer has intense eye pain (both foreign body sensation and ache), decreased vision, redness, photophobia, and tearing.
The risk increases about 15 times if contact lenses are worn overnight.
Corneal ulcers can be caused by bacteria, viruses, fungi, or amebas.
Diagnosis is by slit-lamp examination and fluorescein staining.
A corneal epithelial defect (which stains with fluorescein) and a corneal infiltrate (collection of white blood cells in the corneal stroma) are present.
Contact lenses are also used to correct presbyopia.
At times, the corneal defect is large and dense enough to be seen with handheld magnification or even with the naked eye as a white spot on the cornea.
Microbiologic analysis of cultures and smears of the corneal infiltrate, contact lens, and contact lens case are indicated.
Contact lens use is stopped.
Antibiotic eye drops are given empirically for possible bacterial infection.
Initial therapy is broad-spectrum, using a fluoroquinolone antibiotic eye drop every 15 to 60 minutes around the clock for the first 24 to 72 hours, then at gradually longer intervals.
Additional antibiotic eye drops, such as cefazolin, vancomycin, or concentrated tobramycin, are used if the ulcer is large, deep, or close to the visual axis.
The antibiotic may be changed or stopped later based on culture results.
Neglected cases may respond poorly or not at all to treatment, and severe vision loss may result.
Rigid Corneal Contact Lenses A rigid lens is able to revise the natural shape of the cornea into a new, better refracting surface than a soft lens and thus tends to provide more consistent improvement in refraction for people who have astigmatism or an irregular corneal surface.
Older polymethyl methacrylate rigid contact lenses have been replaced by gas-permeable contact lenses (GPCLs) made of fluorocarbon and polymethyl methacrylate admixtures.
In one approach, termed monovision, the nondominant eye is corrected for near vision (reading) and the dominant eye is corrected for distant vision.
GPCLs are 6.5 to 10 mm in diameter and cover part of the cornea, floating on the tear layer overlying it.
Rigid contact lenses can improve vision in people with myopia, hyperopia, and astigmatism.
Rigid contact lenses can also correct corneal irregularities, such as keratoconus.
In most cases, patients with keratoconus see better with rigid contact lenses than glasses.
GPCLs can be designed to fit the eye exactly.
For complete wearing comfort, they require an adaptation period, typically about 4 to 7 days.
During this time, the wearer gradually increases the number of hours the lenses are worn each day.
Importantly, no pain should occur at any time.
Pain is a sign of an ill-fitting contact lens or corneal irritation.
Wearers may have temporary (< 2 hours) blurred vision (spectacle blur) when wearing eyeglasses after removing rigid contact lenses.
Rigid and soft bifocal and multifocal contact lenses can also be successful, but the fitting procedure is time-consuming because precise alignment is essential.
Soft Hydrophilic Contact Lenses Soft contact lenses are made of poly-2-hydroxyethyl methacrylate and other flexible plastics (such as silicone hydrogels) and are 30 to 79% water.
They are 13 to 15 mm in diameter and cover the entire cornea.
Soft contact lenses are often replaced daily (disposable single-use), every 2 weeks, or monthly.
Soft contact lenses can improve vision in people with myopia and hyperopia.
Because soft contact lenses mold to the existing corneal curvature, anything greater than minimal astigmatism cannot be treated unless a special toric lens, which has different curvatures molded onto the front lens surface, is used.
Weighting the lower aspect of the toric lens maintains its orientation by reducing lens spinning.
Soft contact lenses are also prescribed for treatment of corneal abrasion, recurrent erosions, or other corneal disorders (called bandage or therapeutic contact lenses).
Prophylactic antibiotic eye drops (eg, fluoroquinolone 4 times a day) may be advisable with a bandage lens.
Extended wearing of soft contact lenses, especially in aphakia after cataract surgery, is practical, but an ophthalmologist or optometrist should examine the patient regularly.
The patient should clean the lenses once a week.
Neither rigid nor soft contact lenses offer the eyes the protection against blunt or sharp injury that eyeglasses do.
Because of their larger size, soft contact lenses are not as likely as rigid contact lenses to eject spontaneously and are less likely to allow foreign bodies to lodge beneath them.
Soft contact lenses have a higher incidence of corneal infections than GPCLs, particularly when soft lenses are worn overnight.
When dry, soft contact lenses are brittle and break easily.
They absorb a certain amount of moisture (based on the water content) from the tear film to retain adequate shape and pliability.
Therefore, patients with dry eye are usually more comfortable wearing lenses that have a low water content.
Care and Complications of Contact Lenses Instructions for hygiene and handling lenses must be strictly observed.
Contact lenses occasionally cause painless superficial corneal changes.
Central Retinal Artery Occlusion and Branch Retinal Artery Occlusion (Retinal Artery Occlusion) By Sonia Mehta, MD, Vitreoretinal Diseases and Surgery Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University Reviewed / Revised Apr 2022 | Modified Sep 2022 View Patient Education Etiology Symptoms and Signs Diagnosis Prognosis Treatment Key Points Topic Resources Central Retinal Artery Occlusion Central retinal artery occlusion occurs when the central retinal artery becomes blocked, usually due to an embolus.
Risk of stroke is increased after retinal artery occlusion, particularly in the first weeks.
Symptoms and Signs Retinal artery occlusion causes sudden, painless, severe vision loss or visual field defect, usually unilaterally.
The pupil may respond poorly to direct light but constricts briskly when the other eye is illuminated (relative afferent pupillary defect).
In acute cases, funduscopy shows a pale, opaque fundus with a red fovea (cherry-red spot).
Typically, the arteries are attenuated and may even appear bloodless.
An embolus (eg, a cholesterol embolus, called a Hollenhorst plaque) is sometimes visible.
If a major branch is occluded rather than the entire artery, fundus abnormalities and vision loss are limited to that sector of the retina.
Patients who have giant cell arteritis are 55 or older and may have a headache, a tender and palpable temporal artery, jaw claudication, fatigue, or a combination.
Diagnosis Clinical evaluation Sometimes, color fundus photography and fluorescein angiography The diagnosis is suspected when a patient has acute, painless, severe vision loss.
It causes sudden, painless, unilateral, and usually severe vision loss.
Fluorescein angiography is often done and shows absence of perfusion in the affected artery.
However, if patients present with acute transient monocular vision loss thought to be due to a thromboembolic event, imaging tests take unnecessary time and should be deferred if the diagnosis is clear.
Once the diagnosis is made, carotid Doppler ultrasonography and echocardiography should be done to identify an embolic source so that further embolization can be prevented.
If giant cell arteritis is suspected, erythrocyte sedimentation rate (ESR), C-reactive protein, and platelet count should be done immediately.
These tests may not be necessary if an embolic plaque is visible in the central retinal artery.
Because risk of stroke is increased, some centers rapidly evaluate patients similarly to those who have had stroke or transient ischemic attack.
Prognosis Patients with a branch artery occlusion may maintain good to fair vision, but with central artery occlusion, vision loss is often profound, even with treatment.
Once retinal infarction occurs (as quickly as 90 minutes after the occlusion), vision loss is permanent.
If underlying giant cell arteritis is diagnosed and treated promptly, the vision in the uninvolved eye can often be protected and some vision may be recovered in the affected eye.
Treatment Reduction of intraocular pressure Pearls & Pitfalls Consider immediate measures to reduce intraocular pressure in patients who have sudden, painless, severe loss of vision.
If acute thromboembolism is suspected, the patient should be referred immediately to a specialized stroke center because there is an increased risk of other cerebrovascular events.
Immediate treatment is indicated if occlusion occurred within 24 hours of presentation.
Ocular massage with intermittent pressure on the closed eye or reduction of intraocular pressure with ocular hypotensive drugs (eg, topical timolol 0.5%, acetazolamide 500 mg IV or orally) may dislodge an embolus and allow it to enter a smaller branch of the artery, thus reducing the area of retinal ischemia.
Anterior chamber paracentesis is sometimes used to reduce intraocular pressure and increase perfusion.
Some centers have tried infusing thrombolytics into the carotid artery to dissolve the obstructing clot.
Multiple case series have suggested hyperbaric oxygen may improve visual outcome in central retinal artery occlusion.
Nonetheless, treatments for retinal artery occlusions rarely improve visual acuity.
Surgical or laser-mediated embolectomy is available but not commonly done.
These treatments are sometimes shown to be effective in small case series, but none have strong evidence to support efficacy.
Intraocular pressure can be decreased within the first 24 hours of occlusion to attempt to dislodge the embolus.
Patients with occlusion secondary to giant cell arteritis should receive high-dose systemic corticosteroids.
Key Points Central or branch retinal artery occlusion can be caused by an embolus (eg, due to atherosclerosis or endocarditis), thrombosis, or giant cell arteritis.
Painless, severe loss of vision affects part or all of the visual field.
Confirm the diagnosis by doing funduscopy (typically showing a pale, opaque fundus with a red fovea and arterial attenuation).
Immediately refer patients with acute thromboembolic events to a specialized stroke center.
Reserve color fundus photography and fluorescein angiography and search for an embolic source by doing Doppler ultrasonography and echocardiography for subacute cases.
Treat immediately if possible with ocular hypotensive drugs (eg, topical timolol or IV or oral acetazolamide), intermittent digital massage over the closed eyelid, anterior chamber paracentesis, or hyperbaric oxygen if available.
If patients present within the first few hours of occlusion, some centers catheterize the carotid / ophthalmic artery and selectively inject thrombolytic drugs.
Etiology Retinal artery occlusion may be due to embolism or thrombosis.
Emboli may come from any of the following: Atherosclerotic plaques Endocarditis Fat Atrial myxoma Thrombosis is a less common cause of retinal artery occlusion but can be seen with systemic vasculitis such as systemic lupus erythematosus (SLE) and giant cell arteritis, which is an important cause of arterial occlusion that requires prompt diagnosis and treatment.
Occlusion can affect a branch of the retinal artery as well as the central retinal artery.
Neovascularization (abnormal new vessel formation) of the retina or iris (rubeosis iridis) with secondary (neovascular) glaucoma occurs in about 20% of patients within weeks to months after occlusion.
Hypoglycemia By Erika F Brutsaert, MD, New York Medical College Reviewed / Revised Sep 2022 View Patient Education Etiology Symptoms and Signs Diagnosis Treatment Key Points Hypoglycemia, or low plasma glucose level can result in sympathetic nervous system stimulation, and central nervous system dysfunction.
Cortisol and growth hormone levels also increase acutely and are important in the recovery from prolonged hypoglycemia.
The threshold for release of these hormones is usually above that for hypoglycemic symptoms.
Hereditary or congenital syndromes that cause hypoglycemia in infancy and childhood are not discussed here.
Etiology of Hypoglycemia Hypoglycemia in patients without diabetes is rare.
It can occur in the fasting and / or postprandial state and can be classified as insulin - mediated or non - insulin - mediated.
A helpful practical classification is based on clinical status: whether hypoglycemia occurs in patients who appear healthy or ill.
In well-appearing adults without diabetes, the differential diagnosis includes insulin - mediated and non - insulin - mediated disorders.
Insulin - mediated causes include Exogenous insulin Insulin secretagogue (sulfonylurea) use Insulinoma Non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) Post-bariatric surgery hypoglycemia Insulin autoimmune hypoglycemia Insulinoma is a rare neuroendocrine tumor of insulin - producing beta cells.
Post-bariatric surgery hypoglycemia is a hyperinsulinemic hypoglycemia that develops sometimes years after bariatric (especially roux-en-Y gastric bypass) surgery.
In patients with diabetes who take insulin or antihyperglycemic treatment, hypoglycemia is common and is defined as a glucose level of ≤ 70 mg / dL.
It is rare, but the true frequency is not known and pathology specimens show nesidioblastosis (hypertrophy of pancreatic beta cells).
Hypoglycemia is typically postprandial.
NIPHS is a rare condition in which patients have hyperinsulinemic hypoglycemia with negative localizing imaging studies and no history of bariatric surgery.
Hypoglycemia is usually postprandial and surgical specimens demonstrate features of nesidioblastosis.
Insulin autoimmune hypoglycemia is a condition that most often occurs in patients with other autoimmune conditions such as systemic lupus erythematosus.
Autoantibodies bind to insulin or the receptor and dissociate.
Circulating insulin becomes available to bind to the receptor upon dissociation from the antibodies causing hypoglycemia.
Treatment is corticosteroids or immunosuppressants.
Non - insulin - mediated causes include Adrenal insufficiency Use of drugs other than insulin or a sulfonylurea (eg, quinine, gatifloxicin, pentamidine, alcohol) In ill patients, the differential diagnosis also includes insulin - mediated and non - insulin - mediated disorders.
Insulin - mediated disorders include Exogenous insulin Insulin secretagogue (sulfonylurea) use Non - insulin - mediated disorders include Malnutrition or starvation Cirrhosis Sepsis End-stage renal disease Heart failure, if advanced Adrenal insufficiency Non-islet cell tumor hypoglycemia Use of drugs other than insulin or a sulfonylurea In ill, hospitalized patients, spontaneous hypoglycemia that is not caused by drugs portends a poor prognosis and can occur when poor nutrition is combined with advanced organ failure (especially liver, kidney, or heart failure) and / or sepsis.
In contrast, hypoglycemia unrelated to exogenous insulin therapy is an uncommon clinical syndrome caused by various disorders or drugs.
Non-islet cell tumor hypoglycemia is a rare condition caused by production of large amounts of aberrant forms of insulin - like growth factor 2 (IGF-2) by a tumor.
The aberrant form of IGF-2 binds to the insulin receptor and causes hypoglycemia.
By the time hypoglycemia develops, the tumor is usually advanced.
Pseudohypoglycemia occurs when processing of blood specimens in untreated test tubes is delayed and cells, such as red blood cells and leukocytes (especially if increased, as in leukemia or polycythemia), consume glucose.
Poor circulation to the digits can also cause erroneously low fingerstick glucose measurements.
Factitious hypoglycemia is true hypoglycemia induced by nontherapeutic administration of sulfonylureas or insulin.
Symptoms and Signs of Hypoglycemia The surge in autonomic activity in response to low plasma glucose causes sweating, nausea, warmth, anxiety, tremulousness, palpitations, and possibly hunger and paresthesias.
Insufficient glucose supply to the brain causes headache, blurred or double vision, confusion, agitation, seizures, and coma.
Patients with diabetes mellitus of long duration may be unaware of hypoglycemic episodes because they no longer experience autonomic symptoms (hypoglycemia unawareness).
In research studies under controlled conditions, autonomic symptoms begin at or beneath a plasma glucose level of about 60 mg / dL (3.3 mmol / L), whereas central nervous system symptoms occur at or below a glucose level of about 50 mg / dL (2.8 mmol/L).
However, symptoms suggestive of hypoglycemia are far more common than the condition itself.
In contrast, people with glucose levels at these thresholds may have no symptoms, while people with symptoms suggestive of hypoglycemia can have normal glucose concentrations.
Diagnosis of Hypoglycemia Measurement of blood glucose level In patients with diabetes who are taking insulin or antihyperglycemic medications, a blood glucose level < 70 mg / dL (3.8 mmol / L) correlated with clinical findings is consistent with hypoglycemia.
The severity of hypoglycemia in patients with diabetes is based on blood glucose levels and need for assistance Level 1 (mild) hypoglycemia: blood glucose < 70 mg / dL (< 3.8 mmol / L) but ≥ 54 mg / dL (≥ 3 mmol / L) Level 2 (moderate) hypoglycemia: blood glucose < 54mg / dL Level 3 (severe) hypoglycemia: hypoglycemia requiring assistance from another person due to change in mental or physical status In patients not receiving diabetes treatment, diagnosis of a hypoglycemic disorder requires confirmation of Whipple's triad or confirmation of low blood glucose during a fast.
Whipple's triad includes Symptoms of hypoglycemia Low plasma glucose level (< 55 mg / dL) that occurs at the time symptoms occur Decrease in symptoms when dextrose or other sugar is given If a practitioner is present when symptoms occur, blood should be sent for glucose testing in a tube containing a glycolytic inhibitor.
If glucose is normal, hypoglycemia is ruled out and other causes of symptoms should be considered.
If glucose is abnormally low, and no cause can be identified from history (eg, drugs, adrenal insufficiency, severe malnutrition, organ failure or sepsis), serum insulin, insulin antibodies, and sulfonylurea level should be checked.
C-peptide, and proinsulin measured from the same tube can distinguish insulin - mediated from non - insulin - mediated and factitious from physiologic hypoglycemia and can obviate the need for further testing.
In practice, however, it is unusual that practitioners are present when patients experience symptoms suggestive of hypoglycemia.
Diagnosis requires blood tests done at the time of symptoms or during a 72-hour fast.
Home glucose meters are unreliable for quantifying hypoglycemia, and there are no clear glycosylated hemoglobin (HbA1C) thresholds that distinguish long-term hypoglycemia from normoglycemia.
So the need for more extensive diagnostic testing is based on the probability that an underlying disorder that could cause hypoglycemia exists given a patient's clinical appearance and coexisting illnesses.
To differentiate between insulin - mediated and non - insulin - mediated hypoglycemia and to determine the etiology of hypoglycemia, a 48 - or 72-hour fast may be required.
A 72-hour fast done in a controlled setting is the standard for diagnosis.
However, in almost all patients with a hypoglycemic disorder, a 48-hour fast is adequate to detect hypoglycemia and a full 72-hour fast may not be necessary.
Patients drink only noncaloric, noncaffeinated beverages, and plasma glucose is measured at baseline, whenever symptoms occur, and every 4 to 6 hours or every 1 to 2 hours if glucose falls below 70 mg / dL (3.8 mmol / L).
Serum insulin, C-peptide, and proinsulin should be measured when a simultaneous plasma glucose is < 55 mg / dL to distinguish endogenous from exogenous (factitious) hypoglycemia.
The fast is terminated at 72 hours if the patient has experienced no symptoms and glucose remains normal, sooner if glucose decreases to ≤ 45 mg / dL (≤ 2.5 mmol / L) in the presence of hypoglycemic symptoms.
End-of-fast measurements include beta-hydroxybutyrate (which should be low if the cause is an insulinoma), serum sulfonylurea to detect drug-induced hypoglycemia, and plasma glucose after IV glucagon injection to detect an increase characteristic of insulinoma.
Sensitivity, specificity, and predictive values for detecting hypoglycemia by this protocol have not been reported.
Treatment of hypoglycemia is provision of glucose combined with treatment of the underlying disorder.
There is no definitive lower limit of glucose that unequivocally defines pathologic hypoglycemia during a monitored fast.
Normal women tend to have lower fasting glucose levels than men and may have glucose levels as low as 50 mg / dL (2.8 mmol / L) without symptoms.
If symptomatic hypoglycemia has not occurred by 48 to 72 hours, the patient should exercise vigorously for about 30 minutes.
If hypoglycemia still does not occur, insulinoma is essentially excluded and further testing is generally not indicated.
In patients with postprandial hyperglycemia, fingerstick glucose measurement with laboratory testing after triggering foods can be done.
Treatment of Hypoglycemia Oral sugar or IV dextrose Sometimes parenteral glucagon Treatment in patients taking antihyperglycemic drugs Immediate treatment of hypoglycemia involves provision of glucose.
Individuals at risk for hypoglycemia should have glucagon or dasiglucagon at home and elsewhere, and household members and trusted others should be instructed on management of hypoglycemic emergencies.
In patients treated with glucose-lowering drugs (insulin or sulfonylureas), a plasma glucose level < 70 mg / dL (< 3.8 mmol / L) is considered hypoglycemia and should be treated to avoid further decreases in blood glucose and consequences of hypoglycemia.
Patients able to eat or drink can drink juices, sucrose water, or glucose solutions; eat candy or other foods; or chew on glucose tablets when symptoms occur.
The rule of 15s should be followed for treatment of hypoglycemia.
Most commonly, symptomatic hypoglycemia is a complication of drug treatment of diabetes mellitus with oral antihyperglycemics (especially sulfonylureas) and insulin.
Typically, 15 g of glucose or sucrose should be ingested.
Patients should check their glucose levels 15 minutes after glucose or sucrose ingestion and ingest an additional 15 g if their glucose level is not > 80 mg / dL (> 4.4 mmol / L).
After glucose levels improve to > 80 mg / dL, a snack containing a complex carbohydrate and protein may be ingested to prevent the glucose level from dropping again.
Adults and children unable to eat or drink can be given glucagon 0.5 mg (< 25 kg body weight) or 1 mg (≥ 25 kg) subcutaneously or intramuscularly.
Glucagon nasal spray, 3 mg or subcutaneous dasiglucagon, 0.6 mg subcutaneously (available in an autoinjector) may also be used.
For hypoglycemia management in the hospital setting, infants and younger children may be given 10% dextrose solution 2 to 3 mL / kg IV bolus.
Adults or older children can be treated with 50% dextrose 50 to 100 mL IV bolus, with or without a continuous infusion of 5 to 10% dextrose solution sufficient to resolve symptoms.
The efficacy of glucagon depends on the size of hepatic glycogen stores; glucagon has little effect on plasma glucose in patients who have been fasting or who are hypoglycemic for long periods.
Hyperglycemia may follow hypoglycemia either because too much sugar was ingested or because hypoglycemia caused a surge in counter-regulatory hormones (glucagon, epinephrine, cortisol, growth hormone).
Treatment in patients not taking antihyperglycemic drugs Hypoglycemia in patients not taking insulin or a sulfonylurea should also be corrected with oral sugar, IV dextrose or glucagon.
Symptomatic hypoglycemia unrelated to treatment of diabetes mellitus is relatively rare, in part because the body has extensive counter-regulatory mechanisms to compensate for low blood glucose levels.
Underlying disorders causing hypoglycemia must also be treated.
Islet cell and non-islet cell tumors must first be localized, then removed by enucleation or partial pancreatectomy; about 6% recur within 10 years.
Diazoxide and octreotide can be used to control symptoms while the patient is awaiting surgery or when a patient refuses or is not a candidate for a procedure.
Non-insulinoma pancreatogenous hypoglycemia syndrome (NIPH) is most often a diagnosis of exclusion after an islet cell tumor is sought but not identified.
Diazoxide or octreotide have been used, and partial pancreatectomy may be required for refractory cases.
Patients with hypoglycemia following gastric bypass can sometimes be treated with frequent low carbohydrate meals, but other treatments such as acarbose or diazoxide may be needed.
Drugs that cause hypoglycemia, including alcohol, must be stopped.
Treatment of hereditary and endocrine disorders, liver failure, renal failure, heart failure, and sepsis are described elsewhere.
Key Points In patients on drug treatment for diabetes, hypoglycemia is a plasma glucose level < 70 mg / dL.
Most hypoglycemia is caused by drugs used to treat diabetes mellitus (including surreptitious use); insulin - secreting tumors are rare causes.
Glucagon and epinephrine levels surge in response to acute hypoglycemia and appear to be the first line of defense.
To diagnose a hypoglycemic disorder not due to diabetes treatment requires a low plasma glucose level (< 55 mg / dL [< 3 mmol / L]) plus simultaneous hypoglycemic symptoms that reverse with dextrose administration.
If the etiology of hypoglycemia is unclear, do a 48 - or 72-hour fast with measurement of plasma glucose at regular intervals and whenever symptoms occur.
Measure serum insulin, C-peptide, and proinsulin at times of hypoglycemia to distinguish endogenous from exogenous (factitious) hypoglycemia.
Treat patients with hypoglycemia due to insulin or antihyperglycemic drugs with oral or parenteral glucose and glucagon, depending upon clinical severity.
In patients with hypoglycemia not due to insulin or other antihyperglycemic medications, give glucose and glucagon and treat underlying cause.
Toxic and Nutritional Optic Neuropathies (Toxic Optic Amblyopia; Nutritional Optic Amblyopia) By John J Chen, MD, PhD, Mayo Clinic Reviewed / Revised Oct 2022 View Patient Education Etiology Symptoms and Signs Diagnosis Prognosis Treatment Key Points Toxic and nutritional optic neuropathies result in reduced visual acuity that is believed to be the result of a destructive reaction in the orbital portion (papillomacular bundle) of the optic nerve.
Lead, methanol, chloramphenicol, digoxin, ethambutol, and many other chemicals can damage the optic nerve.
Deficiencies of protein and antioxidants are likely risk factors.
Curr Treat Options Neurol 21 (1): 5, 2019. doi: 10.1007 / s11940 - 019 - 0542 - 9 Symptoms and Signs In patients with toxic or nutritional optic neuropathy, vision blurring and dimness typically develop over days to weeks.
An initially small central or pericentral scotoma slowly enlarges, typically involving both the fixation and the blind spot (centrocecal scotoma), and progressively interferes with vision.
Color vision may be lost out of proportion to the loss of visual acuity.
Total blindness may occur in methanol ingestion, but other nutritional causes typically cause significant central vision loss but not usually complete loss of vision.
Retinal abnormalities do not usually occur, but temporal disk pallor may develop late.
Diagnosis Mainly clinical evaluation A history of undernutrition, bariatric surgery, or toxic or chemical exposure combined with typical bilateral cecocentral scotomata (caused by involvement of the optic disc and papillomacular fibers) on visual field testing justifies treatment.
It can be caused by various toxic and nutritional factors and probably unknown factors.
Laboratory testing for lead, methanol, suspected nutritional deficiencies, and other suspected toxins is done.
Once the optic nerve has atrophied, vision usually does not recover.
Treatment Treat the cause of the optic neuropathy Low-vision aids The cause of the patient's optic neuropathy is treated.
Exposure to toxic substances should stop immediately.
Alcohol and other potentially causative chemicals or drugs should be avoided.
Chelation therapy is indicated in lead poisoning.
Dialysis, fomepizole, ethanol, or a combination is used for methanol poisoning.
Treatment with oral or parenteral B vitamins and / or folate before vision loss becomes severe may reverse the condition when undernutrition is the presumed cause.
Their use could be justified on a theoretic basis; however, there is no proof of efficacy, and the at-risk population that should receive such supplements has not been defined.
Key Points Toxic or nutritional optic neuropathy is reduced visual acuity caused most often by drugs or toxins or nutritional deficiencies, particularly in people with alcohol use disorder or in those who have undergone bariatric surgery.
Vision loss is usually gradual and partial, involving central vision.
Diagnosis is mainly clinical (eg, bilateral cecocentral scotomata, suggestive history).
Treat the cause (eg, stopping exposure to a drug or toxin, improving nutrition).
Diagnosis is by history and visual field examination.
Treatment is avoiding suspected toxic agents and / or improving nutrition.
Etiology Toxic or nutritional optic neuropathy is usually bilateral and symmetric.
Undernutrition and vitamin deficiencies (eg, vitamins B1 or B12 or folate) may be the cause, particularly in patients who have had bariatric surgery (1) and those with alcohol use disorder.
True tobacco-induced optic neuropathy is rare.
Nutritional optic neuropathy may occur with other nutritional disorders, such as Strachan syndrome (polyneuropathy and orogenital dermatitis).
Genotype 1 is more common than genotypes 2, 3, 4, 5, and 6; it accounts for 70 to 80% of cases of chronic hepatitis C in the US.
Acute hepatitis C becomes chronic in about 75% of patients.
The Centers of Disease Control and Prevention (CDC) estimates that, from 2013 to 2016, about 2.4 million people in the US have chronic hepatitis C infection (1).
Worldwide, 71 million people are estimated to have chronic hepatitis C (2).
Chronic hepatitis C progresses to cirrhosis in 20 to 30% of patients; cirrhosis often takes decades to appear.
Hepatocellular carcinoma can result from HCV-induced cirrhosis but results only rarely from chronic infection without cirrhosis (unlike in chronic HBV infection).
Up to 20% of patients with alcohol-related liver disease harbor HCV.
Often, the first findings are signs of cirrhosis (eg, splenomegaly, spider nevi, palmar erythema) or complications of cirrhosis (eg, portal hypertension, ascites, encephalopathy).
Chronic hepatitis C is occasionally associated with lichen planus, mucocutaneous vasculitis, glomerulonephritis, porphyria cutanea tarda, mixed cryoglobulinemia, and, perhaps, non-Hodgkin B-cell lymphoma.
Symptoms of cryoglobulinemia include fatigue, myalgias, arthralgias, neuropathy, glomerulonephritis, and rashes (urticaria, purpura, leukocytoclastic vasculitis); asymptomatic cryoglobulinemia is more common.
Screening for Chronic Hepatitis C One-time, routine screening is recommended for all people ≥ 18 years old, regardless of risk factors.
The diagnosis of chronic hepatitis C is suspected in patients with any of the following: Suggestive symptoms and signs Incidentally noted elevations in aminotransferase levels Previously diagnosed acute hepatitis Diagnosis is confirmed by finding positive anti-HCV and positive HCV RNA ≥ 6 months after initial infection (see table Hepatitis C Serology).
Table Liver biopsy is rarely used in hepatitis C and has been supplanted by noninvasive imaging (eg, ultrasound elastography, magnetic resonance elastography) and serum markers of fibrosis, as well as scoring systems for fibrosis based on serologic markers.
HCV genotype is determined before treatment because genotype influences the course, duration, and success of treatment.
It is often asymptomatic until manifestations of chronic liver disease occur.
HCV RNA detection and quantification is used to help diagnose hepatitis C and to evaluate treatment response during and after treatment.
For most currently available quantitative HCV RNA assays, the lower limit of detection is about < 12 to 15 IU / mL, depending on the assay.
If a quantitative assay does not have that level of sensitivity, a qualitative assay can be used.
Qualitative assays can detect very low levels of HCV RNA, often as low as < 10 IU / mL, and provide results as positive or negative.
Qualitative tests can be used to confirm a diagnosis of hepatitis C or a sustained virologic response (SVR), defined as no detectable HCV RNA at 12 weeks after completion of treatment.
Other tests should be done to evaluate liver function; they include serum albumin, bilirubin, platelet count, and prothrombin time / international normalized ratio (PT / INR).
Patients should be tested for HIV and hepatitis B infection because transmission of these infections is similar.
If symptoms or signs of cryoglobulinemia develop during chronic hepatitis C, cryoglobulin levels and rheumatoid factor should be measured; high levels of rheumatoid factor and low levels of complement suggest cryoglobulinemia.
Screening for complications Patients with chronic HCV infection and advanced fibrosis or cirrhosis should be screened every 6 months for hepatocellular cancer with ultrasonography and serum alpha-fetoprotein measurement, although the cost-effectiveness of this practice, particularly serum alpha-fetoprotein measurement, is debated.
Diagnosis is confirmed by finding positive anti-HCV and positive HCV RNA ≥ 6 months after initial infection.
Prognosis for Chronic Hepatitis C Prognosis depends on whether patients have a sustained virologic response (SVR), ie, no detectable HCV-RNA at 12 weeks after completion of treatment.
Patients who have an SVR have a > 99% chance of remaining HCV RNA-negative and are typically considered cured.
Nearly 95% of patients with an SVR have improved histologic findings, including fibrosis and histologic activity index; in addition, risk of progression to cirrhosis, hepatic failure, and liver-related death is reduced.
In patients who have cirrhosis and portal hypertension and who were treated with interferon-based regimens, an SVR has been shown to reduce portal pressures and significantly reduce risk of hepatic decompensation, liver-related death, all-cause mortality, and hepatocellular carcinoma (1).
For chronic hepatitis C, treatment is recommended for all patients, except those with a short life expectancy due to comorbid conditions that cannot be remediated by HCV therapy, liver transplantation, or another directed therapy.
The goal of treatment is permanent elimination of HCV RNA (ie, SVR), which is associated with permanent normalization of aminotransferase levels and cessation of histologic progression.
Treatment results are more favorable in patients with less fibrosis than in patients with cirrhosis.
Treatment is with direct-acting antiviral drugs; permanent elimination of detectable viral RNA is possible.
Until late 2013, all genotypes were treated with pegylated interferon alfa plus ribavirin.
Now, interferon-based treatment regimens are no longer used, and ribavirin is no longer considered first-line and is used only in certain alternative regimens.
Currently, all patients are treated with direct-acting antivirals (DAAs) that affect specific HCV targets, such as proteases or polymerases (see also HCV genotype 1 and HCV genotypes 2, 3, 4, 5, and 6).
See tables Direct Acting Antivirals to Treat HCV and DAA Combination Therapies for the Treatment of HCV.
Pearls & Pitfalls Interferon-based treatment regimens are no longer used to treat chronic hepatitis C, and ribavirin is used only in certain alternative regimens.
Table DAAs are not used as single drugs but are used in specific combinations to maximize efficacy.
Table Current recommendations for HCV treatment are evolving rapidly.
Hepatitis C Guidance 2019 Update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection available online, are updated frequently.
Decompensated cirrhosis due to hepatitis C is the most common indication for liver transplantation in the US.
HCV recurs almost universally in the graft.
(See also Causes of Hepatitis, Overview of Chronic Hepatitis, and Acute Hepatitis C)
Before the use of DAAs, patient and graft survival was less favorable than when transplantation is done for other indications.
However, when DAAs are used, the SVR rate in patients who have had a liver transplant exceeds 95% whether they have cirrhosis or not.
Because SVR rates are so high, transplantation of hepatitis C-positive organs is being done increasingly, particularly among recipients who are also hepatitis C-positive, thus expanding the pool of potential donors.
If the recipient and donor are hepatitis C-positive, treatment can be postponed until after transplantation.
As a result, an unnecessary pretransplantation course of treatment can be avoided.
Regimens of sofosbuvir / velpatasvir, elbasvir / grazoprevir, or glecaprevir / pibrentasvir are now considered to have a good safety profile and are effective in patients with end-stage kidney disease, including dialysis patients.
Treatment of hepatitis C in patients with decompensated cirrhosis should be done in consultation with hepatologists, ideally in a liver transplant center.
HCV regimens that include protease inhibitors (those drugs with the ending of - previr) should not be used in patients with decompensated cirrhosis because levels of protease inhibitors are increased in patients with hepatic dysfunction.
Hepatitis B reactivation resulting in liver failure and death has been reported during or after HCV treatment with DAAs.
Therefore, all patients with hepatitis C being treated with DAAs should be checked for evidence of chronic or prior hepatitis B; tests should include all of the following: Hepatitis B surface antigen (HBsAg) Hepatitis B surface antibody (anti-HBs) IgG antibody to hepatitis B core (IgG anti-HBc) Patients with chronic hepatitis B or evidence of prior hepatitis B should be monitored for reactivation during and after HCV treatment, and HBV antiviral therapy should be considered during the course of HCV treatment.
HCV genotype 1 Genotype 1 is more resistant to traditional treatment with dual therapy with pegylated interferon-alpha plus ribavirin than other genotypes.
However, now with the use of interferon-free regimens of direct-acting antivirals (DAAs), the rate of SVR has increased from < 50% to ≥ 95%.
First-line regimens for HCV genotype 1 include Ledipasvir / sofosbuvir Elbasvir / grazoprevir Velpatasvir / sofosbuvir Glecaprevir / pibrentasvir Fixed-dose combination of ledipasvir 90 mg / sofosbuvir 400 mg is given orally once a day for 8 to 12 weeks depending on history of prior treatment, pretreatment viral load, and degree of liver fibrosis.
Fixed-dose combination of elbasvir 50 mg / grazoprevir 100 mg is given orally once a day, with or without ribavirin 500 to 600 mg orally twice a day, for 12 to 16 weeks depending on history of prior treatment, degree of liver fibrosis, and, in patients with genotype 1a, the presence or absence of baseline NS5A resistance-associated variants to elbasvir.
Fixed-dose combination of velpatasvir 100 mg / sofosbuvir 400 mg is given orally once a day for 12 weeks.
Fixed-dose combination of glecaprevir 300 mg / pibrentasvir 120 mg is given orally once a day for 8 to 16 weeks, depending on history of prior treatment and degree of liver fibrosis.
Ribavirin is usually well-tolerated but commonly causes anemia due to hemolysis; dosage should be decreased if hemoglobin decreases to < 10 g / dL (100 g / L).
Ribavirin is teratogenic in both men and women, requiring contraception during treatment and for 6 months after treatment is completed.
There are 6 major genotypes of hepatitis C virus (HCV), which vary in their response to treatment.
Clin Gastroenterol Hepatol 16 (3): 417 - 426, 2018. doi: 10.1016 / j. cgh.2017.09.027 Key Points Chronic hepatitis C infection develops in 75% of patients with acute infection and leads to cirrhosis in 20 to 30%; some patients with cirrhosis develop hepatocellular carcinoma.
Diagnosis is confirmed by finding positive anti-HCV and positive HCV RNA.
Treatment varies by genotype but includes use of one or more direct-acting antiviral drugs, sometimes with ribavirin.
Pegylated interferon is no longer recommended for treatment of chronic hepatitis C New treatments can permanently eliminate HCV RNA in > 95% of patients.
Patients with decompensated cirrhosis should be treated by hepatologists, and regimens containing protease inhibitors should not be used.
Jointly issued guidance from the American Association for the Study of Liver Disease (AASLD) and the Infectious Disease Society of America (IDSA): Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection: Up-to-date, peer-reviewed, unbiased, evidence-based When and In Whom To Initiate HCV Therapy: Exploration of the clinical benefits of curing hepatitis C and of treating fibrosis early, the importance of pretreatment assessment, and considerations in specific populations; overview of cost, reimbursement, and cost-effectiveness for hepatitis C treatment regimens Hepatitis C Virus Infection in Adolescents and Adults Screening: Exploration of the importance of screening, assessment of risk, use of screening tests including intervals, and treatment; supporting evidence provided
Septo-Optic Dysplasia (de Morsier Syndrome) By Stephen J Falchek, MD, Nemours / Alfred I duPont Hospital for Children Reviewed / Revised Dec 2018 | Modified Sep 2022 View Patient Education Diagnosis Treatment Topic Resources Polymicrogyria with Septo-Optic... Septo-optic dysplasia is a malformation of the front of the brain that occurs toward the end of the first month of gestation and includes optic nerve hypoplasia, absence of the septum pellucidum (the membrane that separates the front of the 2 lateral ventricles), and pituitary deficiencies.
Although the cause may be multiple, abnormalities of one particular gene (HESX1) have been found in some children with septo-optic dysplasia.
Symptoms of septo-optic dysplasia may include decreased visual acuity in one or both eyes, nystagmus, strabismus, and endocrine dysfunction (including growth hormone deficiency, hypothyroidism, adrenal insufficiency, diabetes insipidus, and hypogonadism).
Although some children have normal intelligence, many have learning disabilities, intellectual disability, cerebral palsy, or other developmental delay.
Diagnosis of Septo-Optic Dysplasia MRI Diagnosis of septo-optic dysplasia is by MRI.
All children diagnosed with this anomaly should be screened for pituitary endocrine abnormalities and developmental dysfunction.
The increasing use of fetal ultrasonography, which can detect absence of the septum pellucidum and increased ventricular size, followed by fetal MRI, add to the early detection of this malformation.
Treatment of Septo-Optic Dysplasia Supportive care Pituitary hormone replacement Treatment of septo-optic dysplasia is supportive, including replacement of any deficient pituitary hormones.
Urinary Tract Infection (UTI) in Children By Geoffrey A Weinberg, MD, Golisano Children's Hospital Reviewed / Revised Sep 2021 | Modified Sep 2022 View Patient Education Etiology Symptoms and Signs Diagnosis Prognosis Treatment Key Points More Information Topic Resources Grades of Vesicoureteral... Urinary tract infection (UTI) is defined by ≥ 5 × 10 4 colonies / mL in a catheterized urine specimen or, in older children, by repeated voided specimens with ≥ 10 5 colonies/mL.
(For adults, see Introduction to Urinary Tract Infections.)
Antibiotics are begun presumptively in all toxic-appearing children and in nontoxic children with a probable UTI (positive leukocyte esterase, nitrites, or pyuria).
Others can await the results of the urine culture, which are important for both confirming the diagnosis of UTI and yielding antimicrobial susceptibility results (1).
In infants and children > 2 months of age with toxicity, dehydration, or inability to retain oral intake, parenteral antibiotics are used, typically a 3rd-generation cephalosporin (eg, ceftriaxone 75 mg / kg IV / IM every 24 hours, cefotaxime 50 mg / kg IV every 6 or 8 hours).
A 1st-generation cephalosporin (eg, cefazolin) may be used if typical local pathogens are known to be sensitive.
Aminoglycosides (eg, gentamicin), although potentially nephrotoxic, may be useful in complex UTIs (eg, urinary tract abnormalities, presence of indwelling catheters, recurrent UTIs) to treat potentially resistant gram-negative bacilli such as Pseudomonas.
If blood cultures are negative and clinical response is good, an appropriate oral antibiotic (eg, cefixime, cephalexin, trimethoprim / sulfamethoxazole [TMP / SMX], amoxicillin / clavulanic acid, or, for selected children such as those > 1 year with complicated UTI caused by multidrug-resistant E coli, P aeruginosa, or other gram-negative bacteria, a fluoroquinolone) selected on the basis of antimicrobial sensitivities can be used to complete a 7 - to 10-day course.
A poor clinical response (eg, fever persisting > 72 hours) suggests a resistant organism or an obstructive lesion and warrants urgent evaluation with ultrasonography and repeat urine culture.
In nontoxic, nondehydrated infants and children who are able to retain oral intake, oral antibiotics may be given initially.
The drug of choice is TMP / SMX 5 to 6 mg / kg (of TMP component) 2 times a day.
Alternatives include cephalosporins such as cefixime 8 mg / kg once a day, cephalexin 25 mg / kg 4 times a day, or amoxicillin / clavulanic acid 15 mg / kg 3 times a day. Therapy is changed based on the results of cultures and antimicrobial sensitivities.
Etiology of UTI in Children By age 6 years, 3 to 7% of girls and 1 to 2% of boys have had a urinary tract infection.
Treatment is typically for 7 to 10 days, although shorter treatment courses are being evaluated.
Treatment may be given for up to 14 days if pyelonephritis is thought to be present and clinical response is slow.
Routine repeated urinalysis or urine culture is not necessary unless efficacy is not clinically apparent.
Vesicoureteral reflux It has long been thought that antibiotic prophylaxis reduces UTI recurrences and prevents kidney damage and should be started after a first or second febrile UTI in children with VUR.
However, this conclusion was not based on long-term, placebo-controlled trials (important because it has been observed that much VUR abates with time as children mature).
A large, controlled trial, the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial (2), did show that antibiotic prophylaxis using TMP / SMX reduced UTI recurrences by 50% (from about 25% to 13%) compared to placebo but did not show a difference in the rate of renal scarring at 2 years (8% in each group).
Also, the children in the trial who did develop UTI while taking prophylactic antibiotics were 3 times as likely to be infected with resistant organisms.
However, because the 2-year follow-up period is likely too short to draw firm conclusions regarding prevention of renal scarring, additional study may show that antibiotic prophylaxis does provide some renal protection but at the risk of more antibiotic-resistant infections.
Thus, the optimal strategy remains somewhat uncertain.
The peak age of UTI is bimodal, with one peak in infancy and the other peak between ages 2 years to 4 years (at the time of toilet training for many children).
Nonetheless, for children with grade IV or V VUR, open repair or endoscopic injection of polymeric bulking agents is usually recommended, often along with antibiotic prophylaxis until repair is completed.
For children with lesser grades of VUR, further research is required.
Because renal complications are probably unlikely after only one or two UTIs, pending further research one acceptable strategy may be to closely monitor children for UTIs, treat them as they occur, and then reconsider antimicrobial prophylaxis in those children with recurrent infections (especially for those with recurrent febrile UTIs, more severe VUR, or bowel or bladder dysfunction).
The female: male ratio ranges from 1: 1 to 1: 4 in the first 2 months of life (estimates vary, likely because of different proportions of uncircumcised males in study groups and the exclusion of infants with urologic anomalies now more commonly diagnosed in utero by prenatal ultrasonography).
Pediatrics 137 (4): e20152490, 2016. doi: 10.1542 / peds.2015 - 2490 Key Points UTIs in children are frequently associated with urinary tract abnormalities such as obstruction, neurogenic bladder, and ureteral duplication.
The peak age of UTI is bimodal, one peak in infancy and the other peak usually at the time of toilet training for many children.
E coli causes most UTIs in all pediatric age groups; the remaining causes are usually gram-negative enterobacteria (eg, Klebsiella, P mirabilis, P aeruginosa); frequently implicated gram-positive organisms are enterococci and coagulase-negative staphylococci (eg, S saprophyticus).
Neonates and children < 2 years with nonspecific symptoms and signs (eg, poor feeding, diarrhea, failure to thrive, vomiting) may have a UTI; children > 2 years usually present with the symptoms and signs of cystitis or pyelonephritis.
Antibiotics are initiated presumptively in all toxic-appearing children and in nontoxic children with evidence of positive leukocyte esterase nitrites, or pyuria.
For children with high-grade vesicoureteral reflux (VUR), antibiotic prophylaxis is given until surgical correction is done; with lesser grades of VUR, the benefit of prophylactic antibiotics is unclear and close monitoring for recurrent UTI may be an acceptable management strategy for individual children.
The female: male ratio quickly rises with age, being about 2: 1 between 2 months to 1 year, 4: 1 during the 2nd year, and > 5: 1 after 4 years.
In girls, infections usually are ascending and less often cause bacteremia.
The marked female preponderance beyond infancy is attributed both to the shorter female urethra and male circumcision.
Predisposing factors in younger children include Malformations and obstructions of the urinary tract Prematurity Indwelling urinary catheters In boys, lack of circumcision High-grade vesicoureteral reflux Other predisposing factors in younger children include bladder and bowel dysfunction, including constipation and Hirschsprung disease.
Predisposing factors in older children include Diabetes Trauma In females, sexual intercourse Urinary tract abnormalities in children Urinary tract infections in children are a marker of possible urinary tract abnormalities (eg, obstruction, neurogenic bladder, ureteral duplication); these abnormalities are particularly likely to result in recurrent infection if vesicoureteral reflux (VUR) is present.
About 20 to 30% of infants and children age 12 to 36 months with UTI have VUR.
In younger children, UTIs are frequently associated with anatomic abnormalities.
The younger the child at the first UTI, the higher the likelihood of VUR.
VUR is classified by grade (see Table: Grades of Vesicoureteral Reflux *).
Recurrent UTI is clearly associated with VUR, especially VUR of higher grades.
This association is likely due to two factors—that VUR predisposes to infection and recurrent infections can worsen VUR.
The relative contribution of each factor in children with recurrent UTI is unclear.
Children with more severe reflux may have higher risk of developing hypertension and renal failure (caused by repeated infection and chronic pyelonephritis), but the evidence is not definitive (see treatment of VUR).
Table Grades of Vesicoureteral Reflux * Grade Characteristics I Only the ureters are involved, but not the renal pelvis.
II Reflux reaches the renal pelvis, but the calyces are not dilated.
III The ureter and renal pelvis are dilated, with minimal or no blunting of calyces.
IV Dilation increases, and the sharp angle of the calyceal fornices is obliterated.
UTI may cause fever, failure to thrive, flank pain, and signs of sepsis, especially in young children.
V The ureter, pelvis, and calices are grossly dilated.
Papillary impressions frequently are absent.
* As defined by the International Reflux Study Committee.
Organisms Many organisms cause urinary tract infection in anatomically abnormal urinary tracts.
In relatively normal urinary tracts, the most common pathogens are Strains of Escherichia coli with specific attachment factors for transitional epithelium of the bladder and ureters E coli causes > 80 to 90% of UTIs in all pediatric age groups.
The remaining causes are other gram-negative enterobacteria, especially Klebsiella, Proteus mirabilis, and Pseudomonas aeruginosa.
Enterococci and coagulase-negative staphylococci (eg, Staphylococcus saprophyticus) are the most frequently implicated gram-positive organisms.
Fungi and mycobacteria are rare causes, occurring in immunocompromised hosts.
Adenoviruses rarely cause UTIs, and when they do, the disorder is predominantly hemorrhagic cystitis among immunocompromised hosts.
Symptoms and Signs of UTI in Children In neonates, symptoms and signs of urinary tract infection are nonspecific and include poor feeding, diarrhea, failure to thrive, vomiting, mild jaundice (which is usually direct bilirubin elevation), lethargy, fever, and hypothermia.
Neonatal sepsis may develop.
Infants and children < 2 years with UTI may also present with poorly localizing signs, such as fever, gastrointestinal symptoms (eg, vomiting, diarrhea, abdominal pain), or foul-smelling urine.
About 4 to 10% of febrile infants without localizing signs have UTI.
In children > 2 years, the more classic picture of cystitis or pyelonephritis can occur.
Symptoms of cystitis include dysuria, frequency, hematuria, urinary retention, suprapubic pain, urgency, pruritus, incontinence, foul-smelling urine, and enuresis.
Symptoms of pyelonephritis include high fever, chills, and costovertebral pain and tenderness.
Physical findings suggesting associated urinary tract abnormalities include abdominal masses, enlarged kidneys, abnormality of the urethral orifice, and signs of lower spinal malformations.
Diminished force of the urinary stream may be the only clue to obstruction or neurogenic bladder.
Diagnosis of UTI in Children Urine analysis and culture Often urinary tract imaging (See also the American Academy of Pediatrics' 2011 and 2016 practice guidelines for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months.)
Urine tests A reliable diagnosis of urinary tract infection requires the presence of pyuria on urinalysis and positive bacterial culture in properly collected urine, before an antimicrobial is given.
Follow-up imaging studies of the urinary tract are done.
A diagnosis of probable UTI may be made by the presence of pyuria on urinalysis, while culture results are pending.
Most clinicians obtain urine by transurethral catheterization in infants and young children, reserving suprapubic aspiration of the bladder for boys with moderate to severe phimosis.
Both procedures require technical expertise, but catheterization is less invasive, slightly safer, and has sensitivity of 95% and specificity of 99% compared with suprapubic aspiration.
Bagged specimens are unreliable and should not be used for diagnosis.
Urine culture results are interpreted based on colony counts.
If urine is obtained by catheterization or suprapubic aspiration, ≥ 5 × 10 4 colonies / mL commonly defines UTI.
Clean-catch, midstream-voided specimens are significant when colony counts of a single pathogen (ie, not the total count of mixed flora) are ≥ 10 5 colonies / mL.
However, at times symptomatic children may have UTI despite lower colony counts on urine cultures.
Urine should be examined by urinalysis and cultured as soon as possible or stored at 4 ° C if a delay of > 10 minutes is expected.
Occasionally, UTI may be present despite colony counts lower than the described guidelines, possibly because of prior antibiotic therapy, very dilute urine (specific gravity < 1.003), or obstruction to the flow of grossly infected urine.
Urinary tract infection (UTI) may involve the kidneys, bladder, or both.
Sterile cultures generally rule out UTI unless the child is receiving antibiotics or the urine is contaminated with antibacterial skin-cleaning agents.
Microscopic examination of urine is very useful but not definitive.
Pyuria (> 5 white blood cells (WBCs) / high-power field in spun urine sediment) is about 96% sensitive for UTI and 91% specific.
Raising the threshold of pyuria to > 10 WBCs / high-power field in spun urine sediment decreases the sensitivity to 81% but is more specific (97%).
A WBC count (using a hemocytometer) > 10 / mcL (0.01 × 10 9 / L) in unspun urine has greater sensitivity (90%) but is not used by many laboratories.
Presence of bacteria on urinalysis of spun or unspun fresh urine is about 80 to 90% sensitive but only 66% specific; Gram stain of the urine to detect the presence of bacteria is about 80% sensitive and 80% specific.
How to Catheterize the Urethra of a Male Infant or Small Child VIDEO Dipstick tests on urine to detect gram-negative bacteria (nitrite test) or WBC (leukocyte esterase test) are typically done together; if both are positive, the diagnostic sensitivity for UTI is about 93 to 97% and the specificity is about 72 to 93%.
Sensitivity is lower for each individual test, especially for the nitrite test (about 50% sensitivity), because it may take several hours for bacterial metabolism to produce nitrites, and frequent voiding by children may preclude nitrite detection.
The specificity of the nitrite test is quite high (about 98%); a positive result on a freshly voided specimen is highly predictive of UTI.
Sensitivity of the leukocyte esterase test is 83 to 96% and specificity is 78 to 90%.
Sexually transmitted infections of the urethra (eg, gonococcal or chlamydial urethritis), although involving the urinary tract, are not typically termed UTI.
In a recent multicenter analysis of infants with fever, the aggregate urinalysis findings of pyuria, positive leukocyte esterase, or presence of nitrites was 90 to 95% sensitive and 91% specific for UTI; in the study population, this yielded a positive predictive value of 40% and a negative predictive value of 100% (1).
Differentiating an upper UTI from a lower UTI can be difficult.
High fever, costovertebral angle tenderness, and gross pyuria with casts indicate pyelonephritis; an elevated C-reactive protein level also tends to be associated with pyelonephritis.
However, many children without these symptoms and signs have an upper UTI.
Pediatrics 141 (2): e20173068, 2018. doi: 10.1542 / peds.2017 - 3068 Blood tests A complete blood count and tests for inflammation (eg, erythrocyte sedimentation rate, C-reactive protein) may help diagnose infection in children with borderline urine findings.
Some authorities measure serum blood urea nitrogen and creatinine during a first UTI.
Blood cultures are appropriate for infants with UTIs and for children > 1 to 2 years who appear toxic.
Mechanisms that maintain the normal sterility of the urinary tract include urine acidity and free flow, a normal emptying mechanism, intact ureterovesical and urethral sphincters, and immunologic and mucosal barriers.
Urinary tract imaging Many major renal or urologic anomalies now are diagnosed in utero by routine prenatal ultrasonography, but a normal result does not completely exclude the possibility of anatomic anomalies.
Thus, renal and bladder ultrasound imaging is typically done in children < 3 years of age after their first febrile urinary tract infection.
Some clinicians do imaging on children up to 7 years of age or older.
Renal and bladder ultrasonography helps exclude obstruction and hydronephrosis in children with febrile UTIs and is typically done within a week of diagnosing UTI in infants.
Ultrasonography is done within 48 hours if infants do not respond quickly to antimicrobials or if their illness is unusually severe.
Beyond infancy, ultrasonography may be done in the few weeks after the UTI diagnosis.
Voiding cystourethrography (VCUG) and radionuclide cystography (RNC) are better than ultrasonography for detecting vesicoureteral reflux and anatomic abnormalities and previously were recommended for most children after a first urinary tract infection.
However, VCUG and RNC both involve use of radiation and are more uncomfortable than ultrasonography.
Also, the role VUR plays in the development of chronic renal disease is undergoing reevaluation, making the immediate diagnosis of VUR less urgent.
Thus, VCUG is no longer routinely recommended after the first UTI in children, especially if ultrasonography is normal and if children respond quickly to antibiotic therapy.
Abnormality of any of these mechanisms predisposes to UTI.
VCUG is reserved for children with the following: Ultrasonographic abnormalities (eg, scarring, significant hydronephrosis, evidence of obstructive uropathy or suggestion of VUR) Complex UTI (ie, persistent high fever, organism other than E coli) Recurrent febrile UTIs If VCUG is to be done, it is done at the earliest convenient time after clinical response, typically toward the end of therapy, when bladder reactivity has resolved and urine sterility has been regained.
If imaging is not scheduled until after therapy is due to be completed, children should continue antibiotics at prophylactic doses until VUR is excluded.
Radionuclide scanning is now used mainly to detect evidence of renal scarring.
It is done using technetium-99m-labeled dimercaptosuccinic acid (DMSA), which images the renal parenchyma.
DMSA scanning is not a routine test, but it may be done if children have risk factors such as abnormal ultrasound results, high fever, and organisms other than E coli.
Prognosis for UTI in Children Properly managed children rarely progress to renal failure unless they have uncorrectable urinary tract abnormalities.
However, repeated infection, particularly in the presence of VUR, is thought (but not proved) to cause renal scarring, which may lead to hypertension and end-stage renal disease.
In children with high-grade VUR, long-term scarring is detected at a 4 - to 6-fold greater rate than in children with low-grade VUR and at an 8 - to 10-fold greater rate than in children without VUR.
The risk of scarring after recurrent UTI (≥ 2 febrile episodes) is as high as 25%, or 10 - to 15-fold greater than that in children with only 1 febrile UTI; however, few children will have recurrent febrile UTI.
Treatment of UTI in Children Antibiotics For severe VUR, sometimes antibiotic prophylaxis and surgical repair Treatment of urinary tract infection is aimed at eliminating the acute infection, preventing urosepsis, and preserving renal parenchymal function.
Close contacts are defined more explicitly than for meningococcal prophylaxis because caretakers who spend time in the household but do not live there may nevertheless have become colonized with H influenzae type b.
Thus for this organism, household contacts are defined as the following: People who live with the index patient People who have spent ≥ 4 hours with the index patient for ≥ 5 of the 7 days preceding the index patient's hospital admission Chemoprophylaxis is then recommended for each member of a household, as just defined, if that household also has At least 1 contact < 4 years who is incompletely immunized or unimmunized A child < 12 months who has not completed the primary Hib conjugate immunization series An immunocompromised child (regardless of previous immunization status) Complete immunization against H influenzae type b is defined as having had at least 1 dose of Hib conjugate vaccine at age ≥ 15 months, or 2 doses between 12 months and 14 months, or the 2 - or 3-dose primary series for children < 12 months with a booster dose at ≥ 12 months.
In addition, if a preschool or child care center has had ≥ 2 cases of invasive Hib disease within 60 days among its attendees, many experts recommend chemoprophylaxis for all attendees and staff to eliminate asymptomatic nasal carriage regardless of immunization status.
Close contacts most at risk of secondary infection are children < 4 years who are incompletely immunized against H influenzae type b. Chemoprophylaxis should be given < 24 hours after identification of the index patient; chemoprophylaxis given > 2 weeks after exposure is likely of little to no value.
Oral rifampin or injectable ceftriaxone is preferred, and ciprofloxacin is acceptable for older contacts (see Table: Recommended Chemoprophylaxis for High-Risk Contacts * of Children With Meningococcal or Haemophilus influenzae Type b Meningitis).
Table Recommended Chemoprophylaxis for High-Risk Contacts * of Children With Meningococcal or Haemophilus influenzae Type b Meningitis Drug and Indication Age Dosage Duration Rifampin † (for Neisseria meningitidis) < 1 month 5 mg / kg IV or orally every 12 hours 2 days ≥ 1 month 10 mg / kg IV or orally every 12 hours (maximum 600 mg orally every 12 hours) 2 days Rifampin † (for H influenzae) < 1 month 10 mg / kg IV or orally once a day 4 days ≥ 1 month 20 mg / kg IV or orally once a day (maximum 600 mg orally once a day) 4 days Ceftriaxone (for either pathogen) < 15 years 125 mg IM Single dose ≥ 15 years 250 mg IM Single dose Ciprofloxacin ‡ (for either pathogen) > 1 month 20 mg / kg orally (maximum 500 mg) Single dose * See text for definitions of high-risk close contacts.
† Rifampin is not recommended for pregnant women.
‡ Ciprofloxacin is not routinely recommended for children < 18 years; however, it may be used for certain children > 1 month if risks and benefits have been assessed.
If fluoroquinolone-resistant strains of meningococci have been identified in a community, ciprofloxacin should not be used for chemoprophylaxis.
Key Points Infants with bacterial meningitis may first present with nonspecific symptoms and signs (eg, of upper respiratory or gastrointestinal illness) but then decompensate rapidly.
The most common bacterial causes of meningitis are Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b.
If meningitis is suspected, do lumbar puncture (unless contraindication exists) and give empiric antimicrobial therapy (and possibly dexamethasone) as soon as possible.
Empiric antimicrobial therapy in infants > 3 months is with cefotaxime or ceftriaxone, plus vancomycin.
In infants who have not received routine immunizations, common causes of bacterial meningitis include S pneumoniae (many serotypes; particularly in infants with no record of S pneumoniae conjugate vaccination) Neisseria meningitidis (especially serogroup B, but occasionally groups A, C, Y, or W135) H influenzae type b (particularly in infants with no record of H influenzae type b conjugate vaccination) Other etiologies of bacterial meningitis in infants and children > 3 months of age have been reported but are very rare.
Listeria monocytogenes, Streptococcus agalactiae, and Escherichia coli cause disease in infants < 3 months of age; they rarely are the etiology in extremely premature infants who have survived to become > 3 months of age.
Symptoms and Signs of Bacterial Meningitis in Infants The younger the patient, the less specific are the symptoms and signs of meningitis.
The initial manifestations of bacterial meningitis may be an acute febrile illness with respiratory or gastrointestinal symptoms followed only later by signs of serious illness.
About 33 to 50% of neonates have a bulging anterior fontanelle, but only rarely do they have nuchal rigidity or other classic meningeal signs (eg, Kernig sign or Brudzinski sign) typically present in older children.
In children < 12 months, the absence of nuchal rigidity must not be used to exclude meningitis.
Pearls & Pitfalls In children < 12 months, the absence of nuchal rigidity must not be used to exclude meningitis.
However, if present, nuchal rigidity should not be ignored.
As bacterial meningitis progresses, children develop central nervous system (CNS) manifestations, sometimes very rapidly.
The degree of CNS derangement ranges from irritability to coma.
As many as 15% of children who have bacterial meningitis are comatose or semicomatose at the time of hospitalization.
Seizures sometimes occur with bacterial meningitis but in only about 20% of children—typically those who are already toxic, obtunded, or comatose.
Infants who are alert and appear normal after a brief, non-focal seizure with fever are unlikely to have bacterial meningitis (see also Febrile Seizures).
Papilledema is very uncommon in children of any age with bacterial meningitis.
When papilledema is present, other causes of papilledema should be sought; bacterial meningitis progresses so quickly that there is usually insufficient time for papilledema to develop.
Diagnosis of Bacterial Meningitis in Infants Cerebrospinal fluid (CSF) analysis In general, lumbar puncture should be done whenever the diagnosis of meningitis is known or suspected in an infant.
However, lumbar puncture may be delayed for the following reasons: Clinically important cardiorespiratory compromise (most often in young infants) Signs of significantly increased intracranial pressure, including retinal changes; altered pupillary responses; hypertension, bradycardia, and respiratory depression (Cushing triad); and focal neurologic signs Suspected intracranial injury, including presence of visible injuries, particularly to the head, or history suggestive of nonaccidental injury Infection at the site of lumbar puncture Suspicion or history of bleeding disorders (eg, hemophilia, severe thrombocytopenia) In these circumstances, blood cultures should be done and antibiotics should be given empirically without doing the lumbar puncture.
In cases of suspected increased intracranial pressure, arrangements should be made for a neuroimaging study (eg, cranial CT with and without contrast enhancement, cranial ultrasonography) during or immediately after antibiotics administration.
Infants may present with nonspecific symptoms and signs (eg, lethargy, irritability, poor feeding, fever or hypothermia).
If the results of the imaging study suggest it is safe, lumbar puncture may be done.
However, it is not necessary to routinely do CT before lumbar puncture in young children with suspected meningitis; herniation of the brain is rare in young children with bacterial meningitis, even though all patients with meningitis have some degree of increased intracranial pressure.
CSF is sent for analysis, typically cell count, protein, glucose, Gram stain, culture, and, in selected infants, polymerase chain reaction (PCR) tests for enteroviruses (eg, in infants with meningitis during the late summer and autumn months in the US), herpes simplex virus, or parechovirus.
Simultaneously, a blood sample should be drawn and sent to have the CSF: blood glucose ratio determined.
Typical CSF findings in bacterial meningitis include High white blood cell (WBC) count (> 500 / mcL [0.5 × 10 9 / L] often to as high as 10, 000 WBC / mcL [10 × 10 9 / L], with a predominance of polymorphonuclear leukocytes [> 80%]) Elevated protein (> 100 mg / dL [1 gm / L]) Low glucose (< 40 mg / dL [2.2 mmol / L], often < 10 mg / dL [0.56 mmol / L], and CSF: blood glucose ratio typically < 0.33) Gram stain often shows organisms in the CSF in bacterial meningitis.
Although findings may vary somewhat, infants who have bacterial meningitis very rarely have completely normal CSF at examination.
Infants also should have 2 sets of blood cultures (if possible; minimum 1 set of aerobic and anaerobic culture bottles), serum electrolytes, complete blood count and differential, and a urinalysis and urine culture.
Differential diagnosis Symptoms and signs of bacterial meningitis may also be caused by other CNS infections, including viral meningitis (typically enteroviral or, in young infants, parechoviral), neonatal HSV infection (almost exclusively in the infant < 1 month of age), pediatric HSV encephalitis, and brain abscess.
Other causes of CNS infections that affect older children and adults (eg, Lyme neuroborreliosis; fungal meningitis; tuberculous meningitis; Bartonella infection; chemical meningitis resulting from use of nonsteroidal anti-inflammatory drugs, trimethoprim / sulfamethoxazole, or IV immune globulin; cancer) rarely occur in children < 12 months and should be distinguishable based on history, physical examination, and examination of the CSF.
In these other causes of meningitis, CSF findings most often include < 500 WBC / mcL (0.5 × 10 9 / L) with < 50% polymorphonuclear leukocytes, protein < 100 mg / dL (1 g / L), normal glucose, and a negative Gram stain for organisms.
Diagnosis is by cerebrospinal fluid analysis.
Prognosis for Bacterial Meningitis in Infants Among older infants and children, the mortality rate with bacterial meningitis is about 5 to 10%, and neurologic morbidity (eg, sensorineural hearing loss, intellectual disability, spasticity and paresis, seizure disorder) occurs in 15 to 25%.
Sensorineural deafness is most common after pneumococcal meningitis.
In older infants and children, mortality rates vary from 3 to 5% when the cause is H influenzae type b, 5 to 10% when the cause is N meningitidis, and 10 to 20% when the cause is S pneumoniae.
Treatment of Bacterial Meningitis in Infants Antimicrobial therapy As soon as bacterial meningitis is diagnosed (actually or presumptively), IV access should be secured and appropriate antimicrobial drugs (and possibly corticosteroids) should be given.
Empiric antimicrobial therapy for infants > 3 months is directed at the common pathogens: pneumococci, meningococci, and H influenzae type b.
A typical drug regimen includes Ceftriaxone or cefotaxime plus Vancomycin Cefotaxime and ceftriaxone are extremely effective against the organisms that usually cause bacterial meningitis in infants > 3 months.
The major difference between these drugs is that ceftriaxone has a much longer serum half-life than cefotaxime.
Vancomycin is given because some pneumococcal strains in certain areas are not susceptible to 3rd-generation cephalosporins.
In areas (and institutions) where most pneumococci are susceptible to penicillin, vancomycin may not be necessary, particularly if no gram-positive cocci are seen on the CSF Gram stain; decision to withhold vancomycin should typically be made in consultation with an infectious disease specialist.
Once the infecting organism is identified, more specifically targeted drugs are used; for example, vancomycin may no longer be required.
Treatment is with antimicrobials and, for selected infants, dexamethasone.
Organism-specific antimicrobial therapy After immediate empiric antimicrobial drugs have been started, results of CSF and / or blood cultures are used to select a more specifically targeted drug while waiting for microbial identification and susceptibility test results.
(See table Specific Therapy for Bacterial Meningitis in Infants Over 3 Months of Age Once Identification and Susceptibility Results Are Known and see table Recommended Dosages of Antimicrobial Drugs for Infants and Children With Bacterial Meningitis.)
If S pneumoniae is suspected (eg, because gram-positive cocci in pairs are seen on a Gram stain of the CSF), the empiric vancomycin should be continued until susceptibility test results are available.
Vancomycin is stopped if the isolate is susceptible to penicillin or the 3rd-generation cephalosporins; if the isolate is not susceptible, vancomycin is continued (and some clinicians add rifampin).
Because dexamethasone can decrease the CSF penetrance (and thus effectiveness) of vancomycin, some experts advise that either dexamethasone should not be given or, if given, that rifampin be added concurrently.
Disease caused by N meningitidis is treated reliably with penicillin G or ampicillin at high doses, or alternatively by a 3rd-generation cephalosporin.
If penicillin or ampicillin therapy is used, it is followed by a 2-day course of twice-daily rifampin to clear the carrier state and prevent relapse (rifampin is not necessary if a 3rd-generation cephalosporin is used to complete therapy).
If H influenzae type b is suspected or proved, disease may be treated reliably with either ceftriaxone or cefotaxime; ampicillin may be used only if the isolate is proved susceptible.
If ampicillin therapy is used, it is followed by a 4-day course of once-daily rifampin to clear the carrier state and prevent relapse (rifampin is not necessary if a 3rd-generation cephalosporin is used to complete therapy).
Specific antimicrobial therapy for other rare infections (eg, S agalactiae, E coli, L monocytogenes, S aureus) should be selected in consultation with an infectious disease specialist.
For an overview of meningitis, see Overview of Meningitis.
Table Specific Therapy for Bacterial Meningitis in Infants Over 3 Months of Age Once Identification and Susceptibility Results Are Known Pathogen Therapy Streptococcus pneumoniae Penicillin MIC ≤ 0.06 mcg / mL and ceftriaxone or cefotaxime MIC ≤ 0.5 mcg / mL: Penicillin G or ampicillin for 10 - 14 days; ceftriaxone or cefotaxime also acceptable Penicillin MIC ≥ 0.12 mcg / mL and ceftriaxone or cefotaxime MIC ≤ 0.5 mcg / mL: Ceftriaxone or cefotaxime for 10 - 14 days Penicillin MIC ≥ 0.12 mcg / mL and ceftriaxone or cefotaxime MIC ≥ 1.0 mcg / mL: Ceftriaxone or cefotaxime, plus vancomycin with or without rifampin for 10 - 14 days Neisseria meningitidis Penicillin G or ampicillin for 7 days (must be followed by rifampin to eliminate carrier state) Alternatives: Ceftriaxone or cefotaxime Haemophilus influenzae type b Ceftriaxone or cefotaxime for 10 days Alternative: Ampicillin if isolate is susceptible (must be followed by rifampin to eliminate carrier state) MIC = minimum inhibitory concentration.
Table Recommended Dosages of Antimicrobial Drugs for Infants and Children With Bacterial Meningitis Drug Infants and Children Ampicillin 50 - 75 mg / kg every 6 hours Cefotaxime 50 - 75 mg / kg every 6 hours Ceftriaxone 40 - 50 mg / kg every 12 hours or 80 - 100 mg / kg every 24 hours Penicillin G 50, 000 - 66, 667 units / kg every 4 hours or 75, 000 - 100, 000 units / kg every 6 hours Rifampin 10 mg / kg every 12 hours Vancomycin 10 - 15 mg / kg every 6 hours Corticosteroids for bacterial meningitis The use of corticosteroids (eg, dexamethasone) as adjunctive therapy in bacterial meningitis has been studied for decades and continues to be controversial.
The beneficial effects of corticosteroids in reducing neurologic morbidity appear to vary with the age of the patient (child or adult), the specific bacterial etiology, and even whether the patient lives in an industrialized country or in the developing world.
At present, evidence suggests that dexamethasone reduces hearing impairment in infants and children living in industrialized countries who have bacterial meningitis caused by H influenzae type b.
The effectiveness of dexamethasone in meningitis caused by other organisms remains unproved, although some studies of adults in industrialized countries with meningitis caused by S pneumoniae report improved neurologic outcomes and reduced mortality.
Dexamethasone does not appear to benefit children or adults with bacterial meningitis who live in developing countries, nor does it seem to benefit neonates with meningitis.
Thus, dexamethasone 0.15 mg / kg IV should be given before, or within 1 hour after, antimicrobial therapy in children > 6 weeks of age with meningitis caused by H influenzae type b.
The drug is continued every 6 hours for 4 days in confirmed H influenzae type b meningitis.
Some experts also recommend using this same dexamethasone regimen in children with pneumococcal meningitis who are > 6 weeks of age.
For optimal efficacy, dexamethasone must be started at the time of diagnosis; this is not always possible, unless the Gram stain of the fluid or epidemiologic factors (eg, disease contact history) can yield an immediate etiologic diagnosis.
For acute bacterial meningitis in older children and adults, see Acute Bacterial Meningitis, and in children < 3 months see Neonatal Bacterial Meningitis.
In regions where children have been given routine H influenzae type b and pneumococcal conjugate vaccines, bacterial meningitis caused by these organisms will be rare.
For these reasons, along with the conflicting evidence regarding the benefits of dexamethasone therapy, many pediatric infectious disease experts no longer routinely give corticosteroids to infants with meningitis.
Prevention of Bacterial Meningitis in Infants Prevention of bacterial meningitis involves vaccination and sometimes chemoprophylaxis.
Vaccination A conjugatepneumococcal vaccine effective against 13 serotypes, including > 90% of the pneumococcal serotypes that cause meningitis in infants, is recommended for all children beginning at 2 months of age (see Table: Recommended Immunization Schedule for Ages 0 - 6 Years).
For further information, see current Advisory Committee on Immunization Practices (ACIP) pneumococcal vaccine recommendations and the Centers for Disease Control and Prevention's child and adolescent immunization schedule for ages 18 years or younger, United States, 2021.
Routine vaccination with an H influenzae type b conjugate vaccine also is highly effective and begins at age 2 months.
For further information, see current ACIP Haemophilus influenzae vaccine recommendations.
The ACIP recommends that infants > 6 weeks who are at high risk of meningococcal disease receive a meningococcal conjugate vaccine.
For infants not at high risk, routine meningococcal conjugate vaccination is recommended at age 11 or 12 years (see Table: Recommended Immunization Schedule for Ages 7 - 18 Years).
High-risk infants include those who Have HIV infection Have functional or anatomic asplenia (including patients with sickle cell disease) Have persistent complement component pathway deficiencies Complement inhibitor use (eg, eculizumab, ravulizumab) Are traveling to or reside in a high-risk area (eg, sub-Saharan Africa, Saudi Arabia, or during the Hajj) Exposure to an outbreak attributable to a vaccine serogroup Two serogroup B meningococcal vaccines have been approved by the ACIP for use in children ≥ 10 years of age who are at high risk of meningococcal group B disease (same categories as above); routine meningococcal B vaccination is not yet currently given.
For viral meningitis, including in infants and children, see Viral Meningitis.
For further information, see current ACIP meningococcal vaccine recommendations.
Chemoprophylaxis for meningitis Antimicrobial chemoprophylaxis is necessary for N meningitidis meningitis: All close contacts H influenzae meningitis: Selected close contacts Contacts of children who have meningitis caused by other bacteria do not require chemoprophylaxis.
For meningococcal meningitis, close contacts have a risk of infection that may be 25 to 500 times higher than that of the general population.
Close contacts are defined as Household members, especially children < 2 years of age Child care center contacts exposed in the 7 days before symptom onset Anyone directly exposed to the patient's oral secretions (eg, through kissing, sharing toothbrushes or utensils, mouth-to-mouth resuscitation, endotracheal intubation, endotracheal tube management) in the 7 days before symptom onset Not every health care practitioner who has cared for an infant with meningitis is considered a close contact.
Health care personnel should receive chemoprophylaxis only if they were managing the patient's airway or were directly exposed to the patient's respiratory secretions.
Chemoprophylaxis should be given as soon as possible (ideally within 24 hours of identification of the index patient); chemoprophylaxis given > 2 weeks after exposure is likely of little to no value.
Rifampin, ceftriaxone, and ciprofloxacin are appropriate drugs depending on the age of the contact (see Table: Recommended Chemoprophylaxis for High-Risk Contacts * of Children With Meningococcal or Haemophilus influenzae Type b Meningitis).
For young children, oral rifampin or injectable ceftriaxone is preferred.
For H influenzae type b meningitis, the risk of infection in contacts is lower than with meningococcal disease but can be substantial in young, unvaccinated infant or toddler contacts residing in the household of an index patient.
Also, household contacts may be asymptomatic carriers of H influenzae type b.
Bright Futures / American Academy of Pediatrics (AAP): Recommendations for Preventive Pediatric Health Care (2022): A resource providing links to the periodicity schedule, to the Bright Futures Guidelines (4th Edition), and to summary links of all updates to the schedule since 2017 Bright Futures / AAP: Periodicity schedule chart: Recommendations for preventive pediatric health care for infants through 21 years of age (2022) Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition Centers for Disease Control and Prevention (CDC): Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2023 Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R / F) AAP: Media and children communication toolkit
In addition to physical examination, clinicians should evaluate the child's motor, cognitive, and social development and parent-child interactions.
Both physical examination and screening are important parts of preventive health care in infants and children.
Most parameters, such as weight, are included for all children; others are applicable to selected patients, such as lead screening in 1 - and 2-year-olds.
Anticipatory guidance is also important to preventive health care.
Pediatrics 145 (1): e20193449, 2020. doi: 10.1542 / peds.2019 - 3449 Physical Examination Growth Length (crown-heel) or height (once children can stand) and weight should be measured at each visit.
Head circumference should be measured at each visit through 36 months.
Growth rate should be monitored using a growth curve with percentiles; deviations in these parameters should be evaluated (see Physical Growth of Infants and Children).
Growth Percentile Calculators Clinical Calculator Clinical Calculator Clinical Calculator Clinical Calculator Clinical Calculator Clinical Calculator Clinical Calculator Clinical Calculator Clinical Calculator Clinical Calculator Blood pressure (See also Hypertension in Children.) Starting at 3 years of age, blood pressure (BP) should be routinely checked by using an appropriate-size cuff.
The cuff should cover at least two thirds of the upper arm, and the bladder (inflatable bag inside the cuff) should encircle 80 to 100% of the circumference of the arm.
If no available cuff fits the criteria, using a larger cuff is better.
Systolic and diastolic BPs are considered normal if they are < 90th percentile; actual values for each percentile vary by sex, age, and size (as height percentile), so reference to published tables is essential (see tables for BP levels for the 50th to 95th percentiles for and, below).
Systolic and diastolic BP measurements between the 90th and 95th percentiles are considered elevated and should prompt continued observation and assessment of hypertensive risk factors.
Table Table Ears, eyes, and mouth The most common abnormality is fluid in the middle ear (otitis media with effusion), manifesting as a change in the appearance of the tympanic membrane and a loss of tympanic membrane mobility in response to air pressure (during pneumatic otoscopy).
Clinicians should screen for hearing deficits.
Eyes should be assessed at each visit.
Clinicians should check for all of the following: Esotropia or exotropia Abnormalities in globe size: Suggesting congenital glaucoma A difference in pupil size, iris color, or both: Suggesting Horner syndrome, trauma, or neuroblastoma (asymmetric pupils may be normal or represent an ocular, autonomic, or intracranial disorder) Absence or distortion of the red reflex: Suggesting cataract or retinoblastoma Ptosis and eyelid hemangioma obscure vision and require attention.
Infants born at < 32 weeks gestation should be assessed by an ophthalmologist for evidence of retinopathy of prematurity and for the development of refractive errors, which are more common among infants in this age group.
Vision screening is recommended at ages 4 and 5 years.
Children can be screened at 3 years as well if they are cooperative.
In addition to the well-child visits at 3 through 5 years of age, instrument-based screening may be used to assess risk at 12 and at 24 months of age.
Vision testing by Snellen charts or newer testing machines can be used.
E charts are better than pictures; visual acuity of < 20/30 should be evaluated by an ophthalmologist.
Detection of dental caries is important, and referral to a dentist should be made if cavities are present, even in children who have only deciduous teeth.
Brushing with fluoride toothpaste in the appropriate dosage for age should be recommended.
The chest wall is palpated for the apical impulse to check for cardiomegaly.
Femoral pulses are palpated; if they are diminished and associated with a discrepancy between upper and lower extremity blood pressure measurements, the child may have aortic coarctation.
Abdomen Palpation is repeated at every visit because many masses, particularly Wilms tumor and neuroblastoma, may be apparent only as children grow.
Stool is often palpable in the left lower quadrant.
Spine and extremities Children old enough to stand should be screened for scoliosis by observing posture, shoulder tip and scapular symmetry, torso list, and especially paraspinal asymmetry when children bend forward.
At each visit before children start to walk, evaluation for developmental dysplasia of the hip should be done.
The Barlow and Ortolani maneuvers are used until about age 4 months.
After that, dysplasia may be suggested by unequal leg length, adductor tightness, or asymmetry of abduction or leg creases.
Toeing-in can result from adduction of the forefoot, tibial torsion, or femoral torsion.
Only pronounced cases require therapy and referral to an orthopedist.
Asymmetric toeing (toeing-in on one side and toeing-out on the other—windswept appearance) typically requires orthopedic evaluation.
All sexually active adolescents and young adults should be screened annually for STIs.
In boys, testicular and inguinal evaluation should be done at every visit, specifically looking for undescended testes in infants and young boys, testicular masses in older adolescents, and inguinal hernia in boys of all ages.
Safety Recommendations for injury prevention vary by age.
Some examples follow.
For infants from birth to 6 months: Using a rear-facing car seat Reducing maximum home water temperature to < 49 ° C (< 120 ° F) Preventing falls Using sleeping precautions: Placing infants on their back, not sharing a bed, using a firm mattress, and not allowing stuffed animals, pillows, and blankets in the crib Avoiding foods and objects that children can aspirate For infants from 6 to 12 months: Continuing to use a rear-facing car seat Continuing to place infants on their back to sleep Not using baby walkers Using safety latches on cabinets Preventing falls from changing tables and around stairs Vigilantly supervising children when in bathtubs and while learning to walk For children aged 1 to 4 years: Using an age - and weight-appropriate car seat (infants and toddlers should use a rear-facing car seat until they exceed the rear-facing weight or height limits for their convertible child safety seat; most convertible car seats have limits that will allow children to ride rear-facing for ≥ 2 years) Reviewing automobile safety both as passenger and pedestrian Tying window cords Using safety caps and latches Installing outlet plug covers Preventing falls Removing handguns from the home For children ≥ 5 years: All of the recommendations for children aged 1 to 4 years Using a bicycle helmet and protective sports gear Instructing children about safe street crossing Closely supervising swimming and sometimes requiring the use of life jackets during swimming Nutrition Excessive caloric intake underlies the epidemic of obesity in children.
Recommendations for calorie intake vary by age; for children up to age 2 years, see Nutrition in Infants.
As children grow older, parents can allow them some discretion in food choices, while keeping the diet within healthy parameters.
Children should be guided away from frequent snacking and foods that are high in calories, salt, and sugar.
Soda and excessive fruit juice consumption have been implicated as major contributors to obesity.
Exercise Physical inactivity also underlies the epidemic of obesity in children, and the benefits of exercise in maintaining good physical and emotional health should induce parents to make sure their children develop good habits early in life.
During infancy and early childhood, children should be allowed to roam and explore in a safe environment under close supervision.
Outdoor play should be encouraged from infancy.
As children grow older, play becomes more complex, often evolving to formal school-based athletics.
Parents should set good examples and encourage both informal and formal play, always keeping safety issues in mind and promoting healthy attitudes about sportsmanship and competition.
Participation in sports and activities as a family provides children with exercise and has important psychologic and developmental benefits.
Screening of children before sports participation is recommended.
Limits to screen time (for example, television, video games, cell phones and other handheld devices, and noneducational computer time), which is linked directly to inactivity and obesity, should start at birth and be maintained throughout adolescence.
Nonadherence in Children By Bridgette L Jones, MD, MS, University of Missouri, Kansas City, School of Medicine, Children's Mercy, Kansas City, MO Reviewed / Revised Dec 2022 View Patient Education More Information Nonadherence with drug recommendations (see also Adherence to a Drug Regimen) may occur at any age because of Cost Painful or inconvenient administration The need for frequent doses, complex regimens, or both But many unique factors contribute to nonadherence in children.
Some try folk or herbal remedies initially.
Some have limited income and are forced to spend their money on other priorities, such as food; others have beliefs and attitudes that prevent them from giving children drugs.
To help minimize nonadherence, a prescribing practitioner can do the following: Ascertain whether the patient and parent / caregiver agrees with the diagnosis, perceives it as serious, and believes the treatment will work.
Correct misunderstandings and guide the patient and caregiver toward reliable sources of information.
Identify motivating factors for adherence.
Give written as well as oral instructions in a language the patient and caregiver can review and understand.
Make early follow-up telephone calls to families to answer residual questions.
Assess progress and remind the patient and caregiver of follow-up visits.
Review drug bottles at follow-up office visits for pill counts.
Educate the patient and caregiver about how to keep a daily symptom or drug diary.
Children < 6 years old may have difficulty swallowing pills and are more likely to resist taking forms of drugs that taste bad.
Adolescents in particular need to feel in control of their illness and treatment and should be encouraged to communicate freely and to take as much responsibility as is possible for their own treatment.
Regimens should be simplified (eg, synchronizing multiple drugs and minimizing the number of daily doses while maintaining efficacy) and matched to the patient's and caregivers' schedules.
Critical aspects of the treatment should be emphasized (eg, taking the full course of an antibiotic).
If lifestyle changes (eg, in diet or exercise) are also needed, such changes should be introduced incrementally over several visits, and realistic goals should be set so as not to overwhelm the patient or caregiver.
Success in achieving a goal should be reinforced with praise, and only then should the next goal be added.
For patients who require expensive long-term regimens, a list of pharmaceutical patient-assistance programs is available at NeedyMeds.
NeedyMeds: Online resource of programs that provide assistance to people who are unable to afford their drugs and health care costs
Older children often resist drugs or regimens (eg, insulin, metered-dose inhalers) that require them to leave their classes or activities or that make them appear different from their peers.
Adolescents may express rebellion and assert independence from parents by not taking their drugs.
They may also skip a dose of the drug without seeing any immediate adverse effects and then incorrectly reason they do not need the prescribed drug, thus becoming more and more nonadherent.
Adolescents want to be like their friends and to belong to and fit into their peer group.
They wear the same clothes, prefer the same sneakers, and eat the same foods to belong.
Having a chronic condition marks them as different from their peer group and they are often nonadherent so they will not be seen as different from or by their friends.
Parents / caregivers may only partially remember or understand the rationale and instructions for taking a drug, and their work schedules may preclude their being available to give children their scheduled doses.
Miscellaneous Surgical Emergencies in Neonates By William J Cochran, MD, Geisinger Clinic Reviewed / Revised Aug 2021 | Modified Sep 2022 View Patient Education Inguinal hernia in neonates Inguinal hernias develop most often in male neonates, particularly if they are premature (in which case the incidence is about 10%).
This disorder has a high mortality rate (25%), which is even greater in premature infants (60%).
Prognosis is usually good after surgical repair of the perforation.
Ileal perforation in neonates Ileal perforation is another uncommon disorder that is most common among very low-birth-weight infants (< 1500 g) and during the first 2 weeks of life.
It has been associated with chorioamnionitis, postnatal glucocorticoid use, and indomethacin therapy to close a patent ductus arteriosis.
The etiology of ileal perforation is uncertain but may be related to a muscular defect in the ileal wall or to a problem with nitric oxide synthase and local ischemia resulting from vasoconstriction.
Treatment of ileal perforation is stabilization with IV fluids and antibiotics, followed by surgical repair.
Mesenteric arterial occlusion in neonates Mural thrombi or emboli may occlude a mesenteric artery after high placement of an umbilical artery catheter.
Such an occurrence is extremely rare but can cause extensive intestinal infarction requiring surgery and intestinal resection.
The right side is affected most commonly, and about 10% of inguinal hernias are bilateral.
Because inguinal hernias can become incarcerated, repair should be done shortly after diagnosis.
For premature infants, repair typically is not done until they have reached a weight of 2 kg.
In contrast, umbilical hernias rarely become incarcerated, close spontaneously after several years, and do not ordinarily need surgical repair.
Gastric perforation in neonates In neonates, gastric perforations are often spontaneous and typically occur in the first week of life.
Although this is overall an uncommon occurrence, perforation is more common among premature than full-term infants.
The etiology of gastric perforation is uncertain, but the perforation may be due to a congenital defect in the stomach wall, usually along the greater curvature.
The abdomen suddenly becomes distended, infants develop respiratory distress, and massive pneumoperitoneum is seen on abdominal x-ray.
How To Catheterize the Bladder in a Female Child By Keara N DeCotiis, MD, Nemours / Alfred I duPont Hospital for Children Reviewed / Revised Dec 2020 | Modified 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 Urethral catheterization is insertion of a flexible catheter through the urethra into the urinary bladder.
Relevant Anatomy The pediatric female anatomy is similar to the adult's, with a difference in size.
The female urethral meatus is the first opening below the clitoris and is located above the vaginal opening.
It can be difficult to visualize if it appears closed.
Also, young girls may have labial adhesions, which can make visualization of the meatus more difficult.
The urethra is short and straight and thus easy to catheterize.
Positioning Place the patient in a supine, frog position (hips and knees partially flexed, heels on the bed, hips comfortably abducted).
An assistant should hold the legs or knees.
Allow one or both parents or caretakers to remain present to comfort the child.
Having them hold the child's hand, provide a stuffed animal for the child to play with, or engage in other distraction techniques can help.
Several types of catheters are available.
Occasionally sedation is needed.
Place all equipment within easy reach on an uncontaminated sterile field on a bedside tray.
Open the prepackaged kit, taking care not to contaminate the contents.
Place the absorbent underpad with the plastic side down beneath the buttocks.
Remove diaper if present and clean the area with a wet washcloth using soap and water.
Dry the area with a dry towel.
Apply the sterile lubricant to the end of the catheter and place on the sterile field.
Saturate the application sticks, cotton balls, or gauze with antiseptic solution (eg, povidone iodine).
If a catheter cannot be inserted, suprapubic aspiration of the bladder may be necessary.
Place the sterile fenestrated drape over the pelvis so that the vulva is exposed.
With your nondominant hand, separate the labia to expose the meatus.
Cleanse the area around the meatus with each application stick, gauze pad, or cotton ball saturated in povidone iodine.
Clean the area with an anterior-to-posterior motion.
Discard or set aside the newly contaminated application stick, gauze pad, or cotton balls.
If using povidone iodine, clean 3 times then allow the area to dry.
Hold the catheter in your dominant free hand.
Separate the labia with your nondominant hand.
If the meatus is difficult to see, gently pull the vaginal introitus mucosa downward.
Advance the catheter gently through the urethra just until urine is obtained.
(See also Bladder Catheterization, How To Do Urethral Catheterization in a Female, and Urinary Tract Infection in Children.)
Do not poke repeatedly or force the catheter.
If the catheter has entered the vagina, leave that catheter in place as a landmark and obtain another catheter.
Collect urine in the specimen container.
If the volume is insufficient, gently massage the lower abdomen over the bladder (suprapubic area).
Remove the catheter by pulling out gently.
Remove all remaining povidone iodine with a wet washcloth.
Aftercare Remove the drapes.
Warnings and Common Errors To prevent causing a UTI, maintain strict sterile technique during the procedure.
To prevent causing blind passages and urethral injury, do not use excessive force during insertion.
Tips and Tricks Do not proceed with continued attempts at catheter placement if significant resistance is met or if the catheter feels as if it is buckling inside and not advancing.
If the catheter appears to be in the correct position but urine does not return, lubricant may be obstructing the drainage of urine.
With the catheter held in the current position, flush the catheter with normal saline to dislodge the lubricant and see if urine returns prior to proceeding with the remaining steps.
If the catheter appears to be in the correct position but urine does not return and there is the possibility of anuria due to dehydration, consider providing hydration (appropriate to the patient's clinical condition) before the procedure is attempted again.
Consult a urologist for any issues with catheter placement or guidance on catheter size and style in select clinical scenarios.
In certain situations where a catheter cannot be placed, a suprapubic percutaneous aspiration may be indicated.
The main reason to insert a bladder catheter in female children is to Collect a sterile urine sample for testing in very young children who cannot void on command Less common reasons include Relief of acute or chronic urinary retention (obstructive uropathy) Intermittent catheterization of a neurogenic bladder Instillation of contrast agent for cystourethrography Bladder irrigation Instillation of a drug Monitoring of urine output in certain hospitalized patients (indwelling catheter; not discussed here) Contraindications Absolute contraindications Suspected lower urinary tract disruption from recent trauma In trauma patients, lower urinary tract disruption (suggested by perineal hematoma, bleeding from the meatus, or pelvic bone injury) should be ruled out by retrograde urethrography or vaginal examination (and sometimes cystoscopy) before doing bladder catheterization.
Relative contraindications Known major abnormalities of the lower urinary tract History of urethral strictures Prior urethral or bladder neck reconstruction History of difficult catheter placement Complications Complications include Superficial urethral or bladder injury with bleeding (common) Urinary tract infection (UTI; common) Creation of false passages Scarring and strictures Bladder perforation (rare) Equipment Sometimes prepackaged kits are available; if not, equipment required typically includes Sterile drapes and gloves An absorbent underpad Antiseptic solution (eg, povidone iodine, chlorhexidine) with application sticks, cotton balls, or gauze pads Sterile water-soluble lubricant (with or without 2% lidocaine) Sterile cup for collecting urine specimen Urethral catheter size varies with age: neonate (full term) to 6 months—5 to 6 French (Fr); infant or toddler—6 to 8 Fr; prepuberal child—10 to 12 Fr; adolescent—12 to 14 Fr Washcloth for removing antiseptic solution after the procedure Additional Considerations Sterile technique is necessary to prevent a lower UTI.
If doing multiple procedures, do bladder catheterization first, as the child may void during the other procedures.
Overview of Chromosomal Anomalies By Nina N Powell-Hamilton, MD, Sidney Kimmel Medical College at Thomas Jefferson University Reviewed / Revised Dec 2021 | Modified Sep 2022 View Patient Education Diagnosis Chromosomal anomalies cause various disorders.
Lymphocytes are typically used for chromosomal analysis, except prenatally, when amniocytes or cells from placental chorionic villi are used (see Amniocentesis and Chorionic Villus Sampling).
A karyotype analysis involves blocking cells in mitosis during metaphase and staining the condensed chromosomes.
Chromosomes from single cells are photographed, and their images are arranged, forming a karyotype.
Several techniques are used to better delineate the chromosomes: In classical banding (eg, G [Giemsa] -, Q [fluorescent] -, and C-banding), a dye is used to stain bands on the chromosomes.
High-resolution chromosome analysis uses special culture methods to obtain a high percentage of prophase and prometaphase spreads.
The chromosomes are less condensed than in routine metaphase analysis, and the number of identifiable bands is expanded, allowing a more sensitive karyotype analysis.
Spectral karyotyping analysis (also called chromosome painting) uses chromosome-specific multicolor fluorescent in situ hybridization (FISH) techniques that improve the visibility of certain defects, including translocations and inversions.
Chromosomal microarray analysis (CMA), also called array comparative genomic hybridization (aCGH), is a single-step technique that allows the entire genome to be scanned for chromosome dosage abnormalities, including increases (duplications) or decreases (deletions), which may also be suggestive of an unbalanced translocation.
Single nucleotide polymorphism (SNP) microarray analysis has the additional ability to detect regions of homozygosity, which may be seen in cases where parents share common ancestry (consanguinity), and also when there is uniparental disomy (ie, both copies of a chromosome, or part of a chromosome, are inherited from one parent, instead of 1 copy from the mother and 1 copy from the father).
It is important to note that CMA does not detect balanced rearrangements (eg, translocations, inversions), which are not associated with deletions or duplications.
Anomalies that affect autosomes (the 22 paired chromosomes that are alike in males and females) are more common than those that affect sex chromosomes (X and Y).
Screening Noninvasive prenatal screening (NIPS) methods are currently available.
For NIPS, cell-free fetal DNA sequences obtained from a maternal blood sample are used for prenatal screening, primarily for trisomy 21 (Down syndrome), trisomy 13, trisomy 18, and sex chromosome aneuploidy.
It is important to note that the sensitivity and specificity vary for different chromosomal anomalies.
The positive predictive value also varies because of the different incidence of each condition.
Positive predictive value has been found to be high for trisomy 21 but less for trisomy 18 and trisomy 13.
NIPS has been used as a screening test for common microdeletion syndromes (eg, 22q11 deletion); however, the sensitivity and specificity are still relatively low.
Therefore, it is recommended that any anomaly detected with NIPS should be confirmed with a diagnostic test.
Chromosomal abnormalities fit into several categories but broadly may be considered as numerical or structural.
Numerical abnormalities include Trisomy (an extra chromosome) Monosomy (a missing chromosome) Structural abnormalities include Translocations (anomalies in which a whole chromosome or segments of chromosomes inappropriately join with other chromosomes) Deletions and duplications of various parts of chromosomes Terminology Some specific terms from the field of genetics are important for describing chromosomal anomalies: Aneuploidy: The most common chromosomal abnormality caused by an extra or missing chromosome.
Karyotype: The full set of chromosomes in a person's cells.
Genotype: The genetic constitution determined by the karyotype.
Phenotype: The person's clinical findings including outward appearance—the biochemical, physiologic, and physical makeup as determined by the genotype and environmental factors (see Overview of Genetics).
Mosaicism: The presence of ≥ 2 cell lines differing in genotype in a person who has developed from a single fertilized egg.
Diagnosis of Chromosomal Anomalies Chromosomal analysis (karyotyping) Banding Fluorescent in situ hybridization (FISH) Chromosomal microarray analysis (array comparative genomic hybridization) (See also Next-generation sequencing technologies.)
Somatic Symptom and Related Disorders in Children By Josephine Elia, MD, Nemours / A I.
Illness anxiety disorder: Children are extremely afraid that they have or will acquire a serious disorder.
They are so preoccupied with the idea that they are or might become ill that their anxiety impairs daily functioning or causes significant distress.
Children may or may not have physical symptoms, but if they do, their concern is more about the possible implications of the symptoms than the symptoms themselves.
Somatic symptom disorder: Children may develop multiple somatic symptoms or only one severe symptom, typically pain.
Symptoms may be specific (eg, pain in the abdomen) or vague (eg, fatigue).
Any part of the body may be the focus of concern.
Somatic symptom and related disorders are equally common among young boys and young girls but are more common among adolescent girls than adolescent boys.
Symptoms and treatment of somatic symptom and related disorders are very similar to those of anxiety disorders.
The symptoms are not consciously fabricated, and children are actually experiencing the symptoms they describe.
duPont Hospital for Children Reviewed / Revised May 2023 View Patient Education Diagnosis Treatment Key Points Somatic symptom disorder and related disorders are characterized by persistent physical symptoms that are associated with excessive or maladaptive thoughts, feelings, and behaviors in response to these symptoms and associated health concerns.
Diagnosis Psychiatric assessment Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) criteria Sometimes tests to rule out other disorders Diagnosis of somatic symptom or a related disorder is based on criteria from the (DSM-5-TR).
Generally, for one of these disorders to be diagnosed, symptoms must cause significant distress and / or interfere with daily functioning, and children must be excessively concerned about their health and / or symptoms in thoughts and actions.
At first presentation, physicians take an extensive history (sometimes conferring with family members) and do a thorough examination and often testing to determine whether a physical disorder is the cause.
Because children with somatic symptom disorder may also develop physical disorders, appropriate examinations and tests should be done whenever symptoms change significantly or when objective signs develop.
However, extensive laboratory tests are generally avoided because they may further convince children that a physical problem exists and unnecessary diagnostic tests may themselves traumatize children.
If no physical problem can be identified, doctors may use standardized mental health tests to help determine whether symptoms are due to somatic symptom or a related disorder.
Doctors also talk to the children and family members to try to identify underlying psychologic problems or troubled family relationships.
Treatment Psychotherapy Sometimes medications to relieve symptoms Children, even when there is a satisfactory relationship with a primary physician, are commonly referred to a psychotherapist.
Children may balk at the idea of visiting a psychotherapist because they think their symptoms are purely physical.
However, individual and family psychotherapy, often using cognitive-behavioral techniques, can help children and family members recognize patterns of thought and behavior that perpetuate the symptoms.
These disorders are distressing and often impair functioning.
Therapists may use hypnosis, biofeedback, and relaxation therapy.
Psychotherapy is usually combined with a rehabilitation program that aims to help children get back into a normal routine.
It can include physical therapy, which has the following benefits: It may treat actual physical effects, such as reduced mobility or loss of muscle, caused by somatic symptom or a related disorder.
It makes children feel as if something concrete is being done to treat them.
It enables children to participate actively in their treatment.
Medications to treat concurrent psychiatric disorders (eg, depression, anxiety) may help; however, the primary intervention is psychotherapy.
Children also benefit from having a supportive relationship with a primary care physician, who coordinates all of their health care, offers symptomatic relief, sees them regularly, and protects them from unnecessary tests and procedures.
Key Points Children are preoccupied with and excessively worried about their health, physical symptoms, or the possibility of having or acquiring a serious illness.
Children may have multiple symptoms (eg, impaired coordination or balance, weakness, paralysis or loss of sensation, seizures, blindness, double vision, deafness) or one severe symptom, typically pain.
Do appropriate examinations and tests initially to rule out a physical disorder as the cause of symptoms and, if symptoms change significantly or objective signs develop, to check for a new physical disorder.
Treatment may involve psychotherapy, usually combined with a rehabilitation program that aims to help children get back into a normal routine.
Somatic symptom and related disorders include the following: Conversion disorder: Typically, symptoms involve apparent deficits in voluntary motor or sensory function but sometimes include shaking movements and impaired consciousness (suggesting seizures) and abnormal limb posturing (suggesting another neurologic or general physical disorder).
Children may present with impaired coordination or balance, weakness, paralysis of an arm or a leg, loss of sensation in a body part, seizures, unresponsiveness, blindness, double vision, deafness, aphonia, difficulty swallowing, sensation of a lump in the throat, or urinary retention.
Factitious disorder imposed on another (previously referred to as Munchausen syndrome by proxy): Caregivers (typically a parent) intentionally falsify or produce physical symptoms in a child.
For example, they may add blood or other substances to urine specimens to simulate a urine infection.
Depressive Disorders in Children and Adolescents By Josephine Elia, MD, Nemours / A I.
However, events and stressors that cause demoralization and grief can also precipitate a major depressive episode.
There was a nonsignificant trend toward an increase in suicidal ideation (1.2% vs 0.8%), self-harm (3.3% vs 2.6%), and suicide attempts (1.9% vs 1.2%).
There appear to have been some differences in risk between different medications; however, no direct head-to-head studies have been done, and it is difficult to control for severity of depression and other confounding risk factors.
Observational and epidemiologic studies (4, 5) have found no increase in the rate of suicide attempts or completed suicide in patients taking antidepressants.
Also, despite a decrease in prescriptions for antidepressants following the black-box warning, the adolescent suicide rate increased by 14% (6, 7).
Using data from commercial claims (8) and nationwide registers (9) to estimate risks and benefits of medications in relation to suicidal events, SSRIs were associated with significantly decreased suicidal events.
In general, although antidepressants have limited efficacy in children and adolescents, the benefits appear to outweigh risks.
The best approach seems to be combining treatment with medications with psychotherapy and minimizing risk by closely monitoring treatment.
Whether or not medications are used, suicide is always a concern in a child or adolescent with depression.
The following should be done to reduce risk: Parents and mental health care practitioners should discuss the issues in depth.
The child or adolescent should be supervised at an appropriate level.
The etiology of depression in children and adolescents is unknown but is similar to etiology in adults; it is believed to result from interactions of genetically determined risk factors and environmental stress (particularly early life stress such as abuse, injury, natural disaster, domestic violence, death of family member, and deprivation [1]).
Psychotherapy with regularly scheduled appointments should be included in the treatment plan.
Pearls & Pitfalls Suicide risk is always a concern in children or adolescents with depression whether they are taking antidepressants or not.
Major depressive disorder involves feeling sad or irritable or losing interest or pleasure in almost all activities for most of the day nearly every day during a 2-week period plus other specific symptoms.
Diagnose a depressive disorder based on specific clinical criteria, and do appropriate laboratory tests to exclude other disorders (eg, infectious mononucleosis, thyroid disorders, illicit drug use).
Involve the family and school while treating the child to enhance the child's continued functioning and provide appropriate educational accommodations.
For adolescents (as for adults), a combination of psychotherapy and antidepressants usually greatly outperforms either modality used alone; in younger children, most clinicians opt for psychotherapy although if needed, medications can be used (depending on the child's age).
duPont Hospital for Children Reviewed / Revised May 2023 View Patient Education Symptoms and Signs Diagnosis Treatment Key Points More Information Topic Resources Medications for Long-Term... Depressive disorders are characterized by sadness or irritability that is severe or persistent enough to interfere with functioning or cause considerable distress.
Eur Child Adolesc Psychiatry Jul 24; 1 - 11, 2021. doi: 10.1007 / s00787 - 021 - 01849 - 9 Symptoms and Signs Basic manifestations of depressive disorders in children and adolescents are similar to those in adults but are related to typical concerns of children, such as schoolwork and play.
Children may be unable to explain inner feelings or moods.
Depression should be considered when previously well-performing children do poorly in school, withdraw from society, or commit delinquent acts.
In some children with a depressive disorder, the predominant mood is irritability rather than sadness (an important difference between childhood and adult forms).
The irritability associated with childhood depression may manifest as overactivity and aggressive, antisocial behavior.
In children with intellectual disability, depressive or other mood disorders may manifest as somatic symptoms and behavioral disturbances.
Disruptive mood dysregulation disorder Disruptive mood dysregulation disorder involves persistent irritability and frequent episodes of behavior that is very out of control, with onset at age 6 to 10 years.
Many children also have other disorders, particularly oppositional defiant disorder, attention-deficit / hyperactivity disorder (ADHD), or an anxiety disorder.
Diagnosis is by clinical criteria.
The diagnosis is not made before age 6 years or after age 18 years.
As adults, patients may develop unipolar (rather than bipolar) depression or an anxiety disorder.
Manifestations include the presence of the following for ≥ 12 months (with no period of ≥ 3 months without all of them): Severe recurrent temper outbursts (eg, verbal rage and / or physical aggression toward people or property) that are grossly out of proportion to the situation and that occur ≥ 3 times / week on average Temper outbursts that are inconsistent with developmental level An irritable, angry mood present every day for most of the day and observed by others (eg, parents, teachers, peers) The outbursts and angry mood must occur in 2 of 3 settings (at home or school, with peers).
Major depressive disorder Major depressive disorder is a discrete depressive episode lasting ≥ 2 weeks.
It occurs in as many as 2% of children and 5% of adolescents.
Major depressive disorder can first occur at any age but is more common after puberty.
Untreated, major depression may remit in 6 to 12 months.
Risk of recurrence is higher in patients who have severe episodes, who are younger, or who have had multiple episodes.
Persistence of even mild depressive symptoms during remission is a strong predictor of recurrence.
For diagnosis, ≥ 1 of the following must be present for most of the day nearly every day during the same 2-week period: Feeling sad or being observed by others to be sad (eg, tearful) or irritable Loss of interest or pleasure in almost all activities (often expressed as profound boredom) In addition, ≥ 4 of the following must be present: Decrease in weight (in children, failure to make the expected weight gain) or decrease or increase in appetite Insomnia or hypersomnia Psychomotor agitation or retardation observed by others (not self-reported) Fatigue or loss of energy Decreased ability to think, concentrate, and make choices Recurrent thoughts of death (not just fear of dying) and / or suicidal ideation or plans Feelings of worthlessness (ie, feeling rejected and unloved) or excessive or inappropriate guilt Major depression in adolescents is a risk factor for academic failure, substance use, and suicidal behavior.
Treatment is with antidepressants, supportive and cognitive-behavioral therapy, or a combination of these modalities.
While depressed, children and adolescents tend to fall far behind academically and lose important peer relationships.
In very severe depression, psychotic symptoms may emerge.
Persistent depressive disorder (dysthymia) Dysthymia is a persistent depressed or irritable mood that lasts for most of the day for more days than not for ≥ 1 year plus ≥ 2 of the following: Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self-esteem Poor concentration Feelings of hopelessness Symptoms may be more or less intense than those of a major depressive disorder.
A major depressive episode may occur before the onset or during the first year (ie, before the duration criterion is met for persistent depressive disorder).
Diagnosis Psychiatric assessment Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5-TR) criteria Diagnosis of depressive disorders is based on symptoms and signs, including the criteria listed above.
Sources of information include an interview with the child or adolescent and information from parents and teachers.
Several brief questionnaires are available for screening.
They help identify some depressive symptoms but cannot be used alone for diagnosis.
Specific close-ended questions help determine whether patients have the symptoms required for diagnosis of major depression, based on DSM-5-TR criteria.
History should include causative factors such as domestic violence, sexual abuse and exploitation, and drug adverse effects.
(See also discussion of Depressive Disorders in adults.)
Questions about suicidal behavior (eg, ideation, gestures, attempts) should be asked.
A careful review of the history and appropriate laboratory tests are needed to exclude other disorders (eg, infectious mononucleosis, thyroid disorders, substance use disorders) that can cause similar symptoms.
Other psychiatric disorders that can increase the risk and / or modify the course of depressive symptoms (eg, anxiety and bipolar disorders) must be considered.
Some children who eventually develop a bipolar disorder or schizophrenia may present initially with major depression.
After depression is diagnosed, the family and social setting must be evaluated to identify stresses that may have precipitated depression.
Treatment Concurrent measures directed at the family and school For adolescents, usually antidepressants plus psychotherapy For preadolescents, psychotherapy followed, if needed, by antidepressants Appropriate measures directed at the family and school must accompany direct treatment of the child to enhance continued functioning and provide appropriate educational accommodations.
Brief hospitalization may be necessary in acute crises, especially when suicidal behavior is identified.
For adolescents (as for adults), a combination of psychotherapy and antidepressants usually greatly outperforms either modality used alone (1).
For preadolescents, the situation is much less clear.
Most clinicians opt for psychotherapy in younger children; however, medications can be used in younger children (fluoxetine can be used in children ≥ 8 years), especially when depression is severe or has not previously responded to psychotherapy.
Depressive disorders in children and adolescents include Disruptive mood dysregulation disorder Major depressive disorder Persistent depressive disorder (dysthymia) The term depression is often loosely used to describe the low or discouraged mood that results from disappointment (eg, serious illness) or loss (eg, death of a loved one).
Usually, a selective serotonin reuptake inhibitor (SSRI; see table Medications for Long-Term Treatment of Depression, Anxiety, and Related Disorders) is the first choice when an antidepressant is indicated (2).
Children should be closely monitored for the emergence of behavioral side effects (eg, disinhibition, behavioral activation), which are common but are usually mild to moderate.
Usually, decreasing the medication dose or changing to a different medication eliminates or reduces these effects.
Rarely, such effects are severe (eg, aggressiveness, increased suicidality).
Behavioral adverse effects are idiosyncratic and may occur with any antidepressant and at any time during treatment.
As a result, children and adolescents taking such drugs must be closely monitored.
Adult-based research has suggested that antidepressants that act on both the serotonergic and adrenergic / dopaminergic systems may be modestly more effective; however, such medications (eg, duloxetine, venlafaxine, mirtazapine; certain tricyclics, particularly clomipramine) also tend to have more adverse effects.
Such drugs may be especially useful in treatment-resistant cases.
Nonserotonergic antidepressants such as bupropion and desipramine may also be used with a selective serotonin reuptake inhibitor (SSRI) to enhance efficacy.
In very severe depression, psychotic and / or manic symptoms may require treatment with an antipsychotic medication (3, 4).
However, such low moods, unlike depression, occur in waves that tend to be tied to thoughts or reminders of the triggering event, resolve when circumstances or events improve, may be interspersed with periods of positive emotion and humor, and are not accompanied by pervasive feelings of worthlessness and self-loathing.
Transcranial magnetic stimulation—although not yet approved by the Food and Drug Administration (FDA) for use in youths—has been used, particularly when patients do not respond to or tolerate medications (5).
Preliminary studies of transcranial magnetic stimulation in adolescents show similar clinical effects and tolerability as in adults (5 - 8).
Larger ongoing studies will soon provide more data on noninvasive brain stimulation in adolescent depression (7).
As in adults, relapse and recurrence are common.
Children and adolescents should remain in treatment for at least 1 year after symptoms have remitted.
Most experts recommend that children who have experienced ≥ 2 episodes of major depression be treated indefinitely.
The low mood usually lasts days rather than weeks or months, and suicidal thoughts and prolonged loss of function are much less likely.
Such low moods are more appropriately called demoralization or grief.
In 2004, the US FDA did a meta-analysis of 23 previously conducted trials of 9 different antidepressants (2).
Although no patients completed suicide in these trials, a small but statistically significant increase in suicidal ideation was noted in children and adolescents taking an antidepressant (about 4% vs about 2%), leading to a black box warning on all classes of antidepressants (eg, tricyclic antidepressants, SSRIs, serotonin - norepinephrine reuptake inhibitors such as venlafaxine, and tetracyclic antidepressants such as mirtazapine).
In 2006, a meta-analysis (from the United Kingdom) of children and adolescents being treated for depression (3) found that compared with patients taking a placebo, those taking an antidepressant had a small increase in self-harm or suicide-related events (4.8% vs 3.0% of those treated with placebo).
However, whether the difference was statistically significant or not varied depending on the type of analysis (fixed-effects analysis or random-effects analysis).
Strabismus By Leila M Khazaeni, MD, Loma Linda University School of Medicine Reviewed / Revised Feb 2022 | Modified Sep 2022 View Patient Education Classification Etiology Symptoms and Signs Diagnosis Prognosis Treatment Key Points Topic Resources Ocular deviations in strabismus Strabismus (Esotropia) Strabismus is misalignment of the eyes, which causes deviation from the parallelism of normal gaze.
A phoria is a latent deviation, detectable only when one eye is covered so that vision is monocular.
The deviation in a phoria is latent because the brain, using the extraocular muscles, corrects the minor misalignment.
A comitant deviation has the same amplitude or degree of misalignment in all gaze directions.
An incomitant deviation varies in amplitude or degree of misalignment depending on gaze direction.
Ocular deviations in strabismus Strabismus involves both eyes; the left eye is shown here.
The direction of the deviation is designated by the prefixes eso -, exo -, hyper -, and hypo-.
When the deviation is visible, it is indicated by the suffixes - tropia and - phoria.
Etiology of Strabismus Most strabismus is caused by Refractive error Muscle imbalance Rare causes include retinoblastoma or other serious ocular defects and neurologic disease.
Strabismus may be infantile or acquired.
The term infantile rather than congenital is preferred because the presence of true strabismus at birth is uncommon, and the term infantile permits inclusion of varieties that develop within the first 6 months of life.
Diagnosis is clinical, including observation of the corneal light reflex and use of a cover test.
The term acquired includes varieties that develop after 6 months.
Risk factors for infantile strabismus include family history (1st - or 2nd-degree relative), genetic disorders (Down syndrome and Crouzon syndrome), prenatal drug exposure (including alcohol), prematurity or low birth weight, congenital eye defects, and cerebral palsy.
Acquired strabismus can develop acutely or gradually.
Causes of acquired strabismus include refractive error (high hyperopia), tumors (eg, retinoblastoma), head trauma, neurologic conditions (eg, cerebral palsy; spina bifida; palsy of the 3rd cranial nerve, 4th cranial nerve, or 6th cranial nerve), viral infections (eg, encephalitis, meningitis), and acquired eye defects.
Specific causes vary depending on the type of deviation.
Esotropia is commonly infantile.
Infantile esotropia is considered idiopathic, although an anomaly of fusion is the suspected cause.
Accommodative esotropia, a common variety of acquired esotropia, develops between 2 years and 4 years of age and is associated with hyperopia.
Sensory esotropia occurs when severe visual loss (due to conditions such as cataracts, optic nerve anomalies, or tumors) interferes with the brain's effort to maintain ocular alignment.
Esotropia can be paralytic, so designated because the cause is a 6th (abducens) cranial nerve palsy, but it is an uncommon cause.
Treatment may include correction of visual impairment with patching and corrective lenses, alignment by corrective lenses, and surgical repair.
Esotropia can also be a component of a syndrome.
Duane syndrome (congenital absence of the abducens nucleus with anomalous innervation of the lateral rectus extraocular muscle by the 3rd [oculomotor] cranial nerve) and Möbius syndrome (anomalies of multiple cranial nerves) are specific examples.
Exotropia is most often intermittent and idiopathic.
Less often, exotropia is constant and paralytic, as with infantile exotropia or 3rd (oculomotor) cranial nerve palsy.
Hypertropia can be paralytic, caused by 4th (trochlear) cranial nerve palsy that occurs congenitally or after head trauma or, less commonly, as a result of 3rd cranial nerve palsy.
Hypotropia can be restrictive, caused by mechanical restriction of full movement of the globe rather than neurologic interference with eye movement.
For example, restrictive hypotropia can result from a blowout fracture of the orbit floor or walls.
Less commonly, restrictive hypotropia can be caused by Graves ophthalmopathy (thyroid eye disease).
Third cranial nerve palsy and Brown syndrome (congenital or acquired tightness and restriction of the superior oblique muscle tendon) are other uncommon causes.
Symptoms and Signs of Strabismus Unless severe, phorias rarely cause symptoms of strabismus.
Strabismus occurs in about 3% of children.
If symptomatic, phorias typically cause asthenopia (eye strain).
Tropias sometimes result in symptoms.
For example, torticollis may develop to compensate for the brain's difficulty in fusing images from misaligned eyes and to reduce diplopia.
Some children with tropias have normal and equal visual acuity; however, amblyopia frequently develops with tropias and is due to cortical suppression of the image in the deviating eye to avoid confusion and diplopia.
Diagnosis of Strabismus Physical and neurologic examinations at well-child checkups Tests (eg, corneal light reflex, alternate cover, cover-uncover) Prisms Strabismus can be detected during well-child checkups through the history and eye examination.
Evaluation should include questions about family history of amblyopia or strabismus and, if family or caregivers have noticed deviation of gaze, questions about when the deviation began, when or how often it is present, and whether there is a preference for using one eye for fixation.
Physical examination should include an assessment of visual acuity, pupil reactivity, and the extent of extraocular movements.
Slit-lamp examination is done to detect signs of cataract, and funduscopic examination is done to detect signs of structural defects or pathology of disorders such as retinoblastoma.
Neurologic examination, particularly of the cranial nerves, is important.
The corneal light reflex test is a good screening test, but it is not very sensitive for detecting small deviations.
Left untreated, about 50% of children with strabismus have some visual loss due to amblyopia (functional reduction in visual acuity of an eye caused by disuse during visual development).
The child looks at a light and the light reflection (reflex) from the pupil is observed; normally, the reflex appears symmetric (ie, in the same location on each pupil).
The light reflex for an exotropic eye is nasal to the pupillary center, whereas the reflex for an esotropic eye is temporal to the pupillary center.
Vision screening devices such as photoscreeners may be used by trained lay personnel to identify children at risk.
When doing the cover test, the child is asked to fixate on an object.
One eye is then covered while the other is observed for movement.
No movement should be detected if the eyes are properly aligned, but manifest strabismus is present if the uncovered eye shifts to establish fixation once the other eye, which had fixed on the object, is covered.
The test is then repeated on the other eye.
In a variation of the cover test, called the alternate uncover test, the child is asked to fixate on an object while the examiner alternately covers one eye and then the other, back and forth.
An eye with a latent strabismus shifts position when it is uncovered.
In exotropia, the eye that was covered turns in to fixate when the cover is removed; in esotropia, it turns out to fixate when the cover is removed.
Classification of Strabismus Several varieties of strabismus have been described, based on direction of deviation, specific conditions under which deviation occurs, and whether deviation is constant or intermittent.
Deviations can be quantified by using prisms positioned such that the deviating eye does not need to move to fixate.
The power of the prism is used to quantify the deviation and provide a measurement of the magnitude of misalignment of the visual axes.
The unit of measurement used by ophthalmologists is the prism diopter.
One prism diopter is a deviation of the visual axes of 1 cm at 1 m. Strabismus should be distinguished from pseudostrabismus, which is the appearance of esotropia in a child with good visual acuity in both eyes but a wide nasal bridge or broad epicanthal folds that obscure much of the white sclera nasally when looking laterally.
The light reflex and cover tests are normal in a child with pseudostrabismus.
Neuroimaging may be necessary to identify the cause of acquired cranial nerve palsies.
In addition, genetics evaluation may be beneficial for certain ocular malformations.
Prognosis for Strabismus Strabismus should not be ignored on the assumption that it will be outgrown.
Permanent vision loss can occur if strabismus and its attendant amblyopia are not treated promptly; children treated later respond somewhat, but once the visual system has matured (typically by age 8), response is minimal.
As a result, all children should have periodic formal vision screenings during the preschool years.
Description of these varieties requires the definition of several terms: Eso: Nasal deviation Exo: Temporal deviation Hyper: Upward deviation Hypo: Downward deviation (See figure Ocular deviations in strabismus.)
Treatment of Strabismus Patching or atropine drops for attendant amblyopia Contact lenses or eyeglasses (for refractive error) Eye exercises (for convergence insufficiency only) Surgical alignment of the eyes Treatment of strabismus first aims to equalize vision (ie, correcting amblyopia) and then, once vision is optimized, to align the eyes.
Treatment of children with amblyopia requires measures to encourage use of the amblyopic eye, such as patching the better eye or administering atropine drops into the better eye to provide a visual advantage to the amblyopic eye; improved vision offers a better prognosis for development of binocular vision and for stability if surgery is done to treat the strabismus.
Patching is not, however, a treatment for strabismus.
Eyeglasses or contact lenses are sometimes used if the amount of refractive error is significant enough to interfere with fusion, especially in children with accommodative esotropia.
Orthoptic eye exercises can help correct intermittent exotropia with convergence insufficiency.
Surgical repair is generally done when nonsurgical methods are unsuccessful in aligning the eyes satisfactorily.
Surgical repair consists of loosening (recession) and tightening (resection) procedures, most often involving the horizontal rectus muscles, and is most often done bilaterally.
Surgical repair is typically done in an outpatient setting.
Rates for successful realignment can exceed 80% (1); about 20% need another surgical procedure.
The most common complications are overcorrection or undercorrection and recurrence of strabismus later in life.
A tropia is a manifest deviation, detectable with both eyes open (so that vision is binocular).
Rare complications include infection, excessive bleeding, and vision loss.
J AAPOS 13 (1): 4 - 7, 2009. doi: 10.1016 / j. jaapos.2008.06.001 Key Points Strabismus is misalignment of the eyes; it occurs in about 3% of children and causes some vision loss (amblyopia) in about half of them.
Most cases are caused by refractive error or muscle weakness but sometimes a serious disorder is involved (eg, retinoblastoma, cranial nerve palsy).
Physical examination can detect most strabismus.
Treatment depends on cause, but surgery of the extraocular muscles is sometimes necessary.
A tropia can be constant or intermittent and may involve one eye or both eyes.
Physical Examination of the Newborn By Deborah M Consolini, MD, Thomas Jefferson University Hospital Reviewed / Revised Sep 2021 View Patient Education Topic Resources Assessment of gestational... Low-Set Ears in an Infant... Erythema Toxicum A thorough physical examination should be done within 24 hours.
Many clinicians begin with examination of the heart and lungs, followed by a systematic head-to-toe examination, looking particularly for signs of birth trauma and congenital abnormalities.
Cardiorespiratory system (See also Congenital Cardiovascular Anomalies.)
The heart and lungs are evaluated when the infant is quiet.
The clinician should identify where the heart sounds are loudest to exclude dextrocardia.
Heart rate (normal: 100 to 160 beats / minute) and rhythm are checked.
Rhythm should be regular, although an irregular rhythm from premature atrial or ventricular contractions is not uncommon.
A murmur heard in the first 24 hours is most commonly caused by a patent ductus arteriosus.
Daily heart examination confirms the disappearance of this murmur, usually within 3 days.
Femoral pulses are checked and compared with brachial pulses.
Doing the examination with the mother and other family members present allows them to ask questions and the clinician to point out physical findings and provide anticipatory guidance.
A weak or delayed femoral pulse suggests aortic coarctation or other left ventricular outflow tract obstruction.
Central cyanosis suggests congenital heart disease, pulmonary disease, or sepsis.
The respiratory system is evaluated by counting respirations over a full minute because breathing in neonates is irregular; normal rate is 40 to 60 breaths / minute.
The chest wall should be examined for symmetry, and lung sounds should be equal throughout.
Grunting, nasal flaring, and retractions are signs of respiratory distress.
Head and neck In a vertex delivery, the head is commonly molded with overriding of the cranial bones at the sutures and some swelling and ecchymosis of the scalp (caput succedaneum).
In a breech delivery, the head has less molding, with swelling and ecchymosis occurring in the presenting part (ie, buttocks, genitals, or feet).
The fontanelles vary in diameter from a fingertip breadth to several centimeters.
A large anterior fontanelle and anything more than a fingertip breadth posterior fontanelle may be signs of hypothyroidism.
A cephalohematoma is a common finding; blood accumulates between the periosteum and the bone, producing a swelling that does not cross suture lines.
Routine screening tests to detect problems that cannot be seen during the physical examination are also done (see Screening Tests for Newborns).
It may occur over one or both parietal bones and occasionally over the occiput.
Cephalohematomas usually are not evident until soft-tissue edema subsides; they gradually disappear over several months.
Head size and shape are inspected to detect congenital hydrocephalus.
Numerous genetic syndromes cause craniofacial abnormalities.
The face is inspected for symmetry and normal development, particularly of the mandible, palate, pinnae, and external auditory canals.
The eyes may be easier to examine the day after birth because the birth process causes swelling around the eyelids.
Eyes should be examined for the red reflex; its absence may indicate glaucoma, cataracts, or retinoblastoma.
Subconjunctival hemorrhages are common and caused by forces exerted during delivery.
Low-set ears may indicate genetic anomalies, including trisomy 18 and trisomy 21 (Down syndrome).
Malformed ears, external auditory canals, or both may be present in many genetic syndromes.
Basic measurements include length, weight, and head circumference (see also Growth Parameters in Neonates).
Clinicians should look for external ear pits or tags, which are sometimes associated with hearing loss and kidney abnormalities.
The clinician should inspect and palpate the palate to check for soft or hard palate defects.
Orofacial clefts are among the most common congenital defects.
Some neonates are born with an epulis (a benign hamartoma of the gum), which, if large enough, can cause feeding difficulties and may obstruct the airway.
These lesions can be removed; they do not recur.
Some neonates are born with primary or natal teeth.
Natal teeth do not have roots and may need to be removed to prevent them from falling out and being aspirated.
Inclusion cysts called Epstein pearls may occur on the roof of the mouth.
When examining the neck, the clinician must lift the chin to look for abnormalities such as cystic hygromas, goiters, and branchial arch remnants.
Torticollis can be caused by a sternocleidomastoid hematoma due to birth trauma.
Length is measured from crown to heel; normal values are based on gestational age and should be plotted on a standard growth chart.
A scaphoid abdomen may indicate a diaphragmatic hernia, allowing the intestine to migrate through it to the chest cavity in utero; pulmonary hypoplasia and postnatal respiratory distress may result.
An asymmetric abdomen suggests an abdominal mass.
The splenic edge is palpable in about 30% of newborns.
Splenomegaly (splenic edge palpable > 2 cm below the left costal margin) suggests congenital infection or hemolytic anemia.
The kidneys may be palpable with deep palpation; the left is more easily palpated than the right.
Large kidneys may indicate obstruction, tumor, or cystic disease.
The liver is normally palpable 1 to 2 cm below the costal margin.
An umbilical hernia, due to a weakness of the umbilical ring musculature, is common but rarely significant.
The presence of a normally placed, patent anus should be confirmed.
In term boys, the testes should be in the scrotum (see Cryptorchidism).
Scrotal swelling may signify hydrocele, inguinal hernia, or, more rarely, testicular torsion.
With hydrocele, the scrotum transilluminates.
Torsion, a surgical emergency, causes ecchymosis and firmness.
In term girls, the labia are prominent.
Mucoid vaginal and serosanguineous secretions (pseudomenses) are normal; they result from exposure to maternal hormones in utero and withdrawal at birth.
A small tag of hymenal tissue at the posterior fourchette, believed to be due to maternal hormonal stimulation, is sometimes present but disappears over a few weeks.
Ambiguous genitals (intersex) may indicate several uncommon disorders (eg, congenital adrenal hyperplasia; 5-alpha-reductase deficiency; Klinefelter syndrome, Turner syndrome, or Swyer syndrome).
Referral to an endocrinologist is indicated for evaluation as is a discussion with the family about benefits and risks of immediate vs delayed sex assignment.
These methods are typically accurate to ± 2 weeks; however, in the sick neonate these methods are less reliable.
Musculoskeletal system The extremities are examined for deformities, amputations (incomplete or missing limbs), contractures, and maldevelopment.
Brachial nerve palsy due to birth trauma may manifest as limited or no spontaneous arm movement on the affected side, sometimes with adduction and internal rotation of the shoulder and pronation of the forearm.
The spine is inspected for signs of spina bifida, particularly exposure of the meninges, spinal cord, or both (meningomyelocele).
Orthopedic examination includes palpation of long bones for birth trauma (particularly clavicle fracture) but focuses on detection of hip dysplasia.
Risk factors for dysplasia include female sex, breech position in utero, twin gestation, and family history.
The Barlow and Ortolani maneuvers are used to check for dysplasia.
These maneuvers must be done when neonates are quiet.
The starting position is the same for both: Neonates are placed on their back with their hips and knees flexed to 90 ° (the feet will be off the bed), feet facing the clinician, who places an index finger on the greater trochanter and a thumb on the lesser trochanter.
For the Barlow maneuver, the clinician adducts the hip (ie, the knee is drawn across the body) while pushing the thigh posteriorly.
A felt but not heard clunk indicates that the head of the femur has moved out of the acetabulum; the Ortolani maneuver then relocates it and confirms the diagnosis.
For the Ortolani maneuver, the hip is returned to the starting position; then the hip being tested is abducted (ie, the knee is moved away from the midline toward the examining table into a frog-leg position) and gently pulled anteriorly.
A palpable clunk of the femoral head with abduction signifies movement of an already dislocated femoral head into the acetabulum and constitutes a positive test for hip dysplasia.
The maneuvers may be falsely negative in infants > 3 months because of tighter hip muscles and ligaments.
If the examination is equivocal or the infant is at high risk (eg, girls who were in the breech position), hip ultrasonography should be done at 4 to 6 weeks; some experts recommend screening ultrasonography at 4 to 6 weeks for all infants with risk factors.
Neurologic system The neonate's tone, level of alertness, movement of extremities, and reflexes are evaluated.
Typically, neonatal reflexes, including the Moro, suck, and rooting reflexes, are elicited: Moro reflex: The neonate's response to startle is elicited by pulling the arms slightly off the bed and releasing suddenly.
In response, the neonate extends the arms with fingers extended, flexes the hips, and cries.
Rooting reflex: Stroking the neonate's cheek or lateral lip prompts the neonate to turn the head toward the touch and open the mouth.
Suck reflex: A pacifier or gloved finger is used to elicit this reflex.
These reflexes are present for several months after birth and are markers of a normal peripheral nervous system.
Skin A neonate's skin is usually ruddy; cyanosis of fingers and toes is common in the first few hours.
Vernix caseosa covers most neonates > 24 weeks' gestation.
Dryness and peeling often develop within days, especially at wrist and ankle creases.
Petechiae may occur in areas traumatized during delivery, such as the face when the face is the presenting part; however, neonates with diffuse petechiae should be evaluated for thrombocytopenia.
Many neonates have erythema toxicum, a benign rash with an erythematous base and a white or yellow papule.
This rash, which usually appears 24 hours after birth, is scattered over the body and can last for up to 2 weeks.
Juvenile Idiopathic Arthritis (JIA) By Jay Mehta, MD, Perelman School of Medicine at The University of Pennsylvania Reviewed / Revised Apr 2022 | Modified Sep 2022 View Patient Education Classification Symptoms and Signs Diagnosis Prognosis Treatment Key Points Macrophage Activation Syndrome Symptoms and Signs Diagnosis Prognosis Treatment Topic Resources Nail Pits Caused by Psoriatic... Juvenile idiopathic arthritis is a group of rheumatic diseases that begins by age 16.
Some of the categories are subdivided into different forms.
Macrophage activation syndrome is a severe, overwhelming, and life-threatening cytokine storm syndrome caused by an uncontrolled macrophage and T lymphocyte expansion.
It occurs in 10% of children with systemic JIA.
Symptoms and Signs Features of macrophage activation syndrome include high, nonremitting fever, hepatosplenomegaly, generalized lymphadenopathy, rash, hemorrhagic manifestations, central nervous system dysfunction (including seizures and coma), and shock.
Diagnosis Features that help distinguish macrophage activation syndrome from systemic JIA include the constant fever (unlike the intermittent daily fevers of JIA), constant rash (unlike the transient rash of systemic JIA), hemorrhagic manifestations, seizures, coma, and shock.
Despite marked systemic inflammation, the erythrocyte sedimentation rate (ESR) is paradoxically depressed because of low fibrinogen levels.
Often, however, macrophage activation syndrome cannot be differentiated from active systemic JIA; discriminatory criteria have been developed and include ferritin > 684 ng / mL (> 684 mcg / L) plus any 2 of the following: Platelets ≤ 181, 000 / mcL (≤ 181 × 10 9 / L) Aspartate aminotransferase > 48 units / L (> 0.80 microkat / L) Triglycerides > 156 mg / dL (> 1.76 mmol / L) Fibrinogen ≤ 360 mg / dL (≤ 10.58 g / L) Prognosis Macrophage activation syndrome has a mortality rate of 8% because of multiorgan failure.
Treatment No consensus exists regarding specific treatment.
Macrophage activation syndrome may respond well to successful treatment of the underlying rheumatic disease.
Specific treatment of this syndrome in systemic JIA usually includes high-dose corticosteroids and may include other drugs (eg, cyclosporine, interleukin [IL] - 1 inhibitors, cyclophosphamide) and stem cell transplantation.
Categories include the following: Oligoarticular JIA (persistent or extended) Polyarticular JIA (rheumatoid factor [RF] negative or positive) Enthesitis-related arthritis Psoriatic JIA Undifferentiated JIA Systemic JIA Many of these categories likely include more than one disease but are useful to help group children with a similar prognosis and response to treatment.
Also, children sometimes move to different categories during the course of their illness.
Oligoarticular JIA is the most common form and typically affects young girls.
It is characterized by involvement of ≤ 4 joints during the first 6 months of disease.
Oligoarticular JIA is further divided into 2 types: persistent (always ≤ 4 joints involved) and extended (≥ 5 joints involved after the first 6 months of disease).
Polyarticular JIA is the second most common form.
It affects ≥ 5 joints at onset and is divided into 2 types: RF negative and RF positive.
Typically, young girls are RF negative and have a better prognosis.
The RF-positive type typically occurs in adolescent girls and is analogous to adult rheumatoid arthritis.
Arthritis, fever, rash, adenopathy, splenomegaly, and iridocyclitis are typical of some forms.
In both types, arthritis can be symmetric and frequently involves the small joints.
Enthesitis-related arthritis involves arthritis and enthesitis (painful inflammation at the insertion of tendons and ligaments).
It is more common among older boys, and these patients may subsequently develop arthritis of their axial skeleton (sacroiliac and lumbar spine).
Enthesitis-related arthritis tends to be in the lower extremities and asymmetric.
The human leukocyte antigen-B27 (HLA-B27) allele is more common in this form of JIA.
Psoriatic JIA has a bimodal age distribution.
One peak occurs in young girls, and the other peak occurs in older males and females (who are equally affected).
It is associated with psoriasis, dactylitis (swollen digits), nail pits, or a family history of psoriasis in a 1st-degree relative.
Arthritis is frequently oligoarticular.
Undifferentiated JIA is diagnosed when patients do not meet criteria for any one category or meet criteria for more than one.
Systemic JIA (Still disease) involves fever and systemic manifestations.
PMID: 14760812 Symptoms and Signs of JIA Manifestations involve the joints and sometimes the eyes and / or skin; systemic juvenile idiopathic arthritis may affect multiple organs.
Children typically have joint stiffness, swelling, effusion, pain, and tenderness, but some children have no pain.
Joint manifestations may be symmetric or asymmetric, and involve large and / or small joints.
Enthesitis typically causes tenderness of the iliac crest and spine, greater trochanter of the femur, patella, tibial tuberosity, Achilles insertion, or plantar fascia insertions.
Sometimes, JIA interferes with growth and development.
Micrognathia (receded chin) due to early closure of mandibular epiphyses or limb length inequality (usually the affected limb is longer) may occur.
Treatment involves intra-articular corticosteroids and disease-modifying antirheumatic drugs.
The most common comorbidity is iridocyclitis (inflammation of the anterior chamber and anterior vitreous) that is typically asymptomatic but sometimes causes blurring of vision and miosis.
Rarely, in enthesitis-related arthritis, there are also the more common uveitis manifestations of conjunctival injection, pain, and photophobia.
Iridocyclitis can result in scarring (synechia), cataracts, glaucoma, or band keratopathy.
Iridocyclitis is most common in oligoarticular JIA, developing in nearly 20% of patients, especially if patients are positive for antinuclear antibodies (ANA).
It may occur in the other forms but is exceedingly rare in polyarticular RF-positive JIA and systemic JIA.
Skin abnormalities are present mainly in psoriatic JIA, in which psoriatic skin lesions, dactylitis, and / or nail pits may be present, and in systemic JIA, in which a typical transient rash often appears with fever.
Rash in systemic JIA may be diffuse and migratory, with urticarial or macular lesions with central clearing.
Systemic abnormalities in systemic JIA include high fever, rash, splenomegaly, generalized adenopathy (especially of the axillary nodes), serositis with pericarditis or pleuritis, and lung disease.
These symptoms may precede the development of arthritis.
Fever occurs daily (quotidian) and is often highest in the afternoon or evening and may recur for weeks.
Juvenile idiopathic arthritis (JIA) is uncommon.
In 7 to 10% of patients, systemic JIA may be complicated by macrophage activation syndrome, a life-threatening cytokine storm syndrome.
Diagnosis of JIA Clinical evaluation Rheumatoid factor (RF), antinuclear antibodies (ANA), anticyclic citrullinated peptide (anti-CCP) antibodies, and HLA-B27 tests Juvenile idiopathic arthritis should be suspected in children with symptoms of arthritis, signs of iridocyclitis, generalized adenopathy, splenomegaly, or unexplained rash or prolonged fever, especially if quotidian.
Diagnosis of JIA is primarily clinical.
It is made when a chronic noninfectious arthritis lasting > 6 weeks has no other known cause.
Patients with JIA should be tested for RF, anti-CCP antibodies, ANA, and HLA-B27 because these tests may be helpful in distinguishing between forms.
The test for ANA should be done by immunofluorescence because other methods may result in false-negative results.
In systemic JIA, RF and ANA are usually absent.
In oligoarticular JIA, ANA are present in up to 75% of patients and RF is usually absent.
In polyarticular JIA, RF usually is negative, but in some patients, mostly adolescent girls, it can be positive.
HLA-B27 is present more commonly in enthesitis-related arthritis.
The cause of JIA is unknown, but there seems to be a genetic predisposition as well as autoimmune and autoinflammatory pathophysiology.
In systemic JIA, laboratory abnormalities suggestive of systemic inflammation, such as elevated erythrocyte sedimentation rate (ESR), ferritin, and C-reactive protein, along with leukocytosis, anemia, and thrombocytosis are almost always present at diagnosis.
To diagnose iridocyclitis, a slit-lamp examination should be done even in the absence of ocular symptoms.
A recently diagnosed patient with oligoarticular or polyarticular JIA should have an eye examination every 3 months if ANA test results are positive and every 6 months if ANA test results are negative.
Prognosis for JIA Remissions occur in 50 to 70% of treated patients.
Patients with RF-positive polyarticular JIA have a less favorable prognosis.
Treatment of JIA Drugs that slow disease progression (particularly methotrexate, tumor necrosis factor [TNF] inhibitors, and interleukin [IL] - 1 inhibitors) Intra-articular corticosteroid injections Sometimes nonsteroidal anti-inflammatory drugs (NSAIDs) for symptom relief Similar to the therapy of patients with adult rheumatoid arthritis, disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate and the biologic agents (eg, etanercept, anakinra, canakinumab, tocilizumab, abatacept), have dramatically changed the therapeutic approach (1, 2, 3).
Methotrexate is useful for oligoarticular, psoriatic, and polyarticular forms of JIA.
Bone marrow depression and hepatic toxicity are monitored with complete blood count, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and albumin.
Occasionally, sulfasalazine is used, especially in cases of suspected spondyloarthritis.
The vast majority of children with JIA have a disease that is distinct from adult rheumatoid arthritis (RA), but in 3 to 5% of children with JIA, the disease is analogous to adult RA.
Etanercept is used most commonly at doses of 0.8 mg / kg subcutaneously (up to 50 mg) once a week.
Adalimumab and infliximab are other TNF inhibitors that have been shown to be effective.
The IL-1 inhibitors anakinra and canakinumab are particularly effective for systemic JIA.
Tocilizumab, an IL-6 receptor antagonist, is also indicated for the treatment of systemic JIA and polyarticular JIA.
Abatacept, a T-cell costimulation inhibitor, and tofacitinib, a Janus kinase inhibitor, are also options for the treatment of polyarticular JIA.
Except for severe systemic disease, systemic corticosteroids can usually be avoided.
When necessary, the lowest possible dose is used (eg, range for oral prednisone, 0.0125 to 0.5 mg / kg 4 times a day, or the same daily dose given once or twice a day).
Growth retardation, osteoporosis, and osteonecrosis are the major hazards of prolonged corticosteroid use in children.
Intra-articular corticosteroid injections can be given.
Classification of JIA Juvenile idiopathic arthritis is not a single disease; the term applies to a number of chronic, noninfectious arthritides that occur in children and share certain features.
The dosage for children is adjusted based on weight.
Some children may need to be sedated for intra-articular injection, especially if multiple joints require injection.
Symptoms of juvenile idiopathic arthritis may be reduced with NSAIDs but they do not alter long-term joint disease or prevent complications.
NSAIDs are most useful for enthesitis.
Naproxen 5 to 10 mg / kg orally 2 times a day, ibuprofen 5 to 10 mg / kg orally 4 times a day, and indomethacin 0.5 to 1.0 mg / kg orally 3 times a day are among the most useful.
Iridocyclitis is treated with ophthalmic corticosteroid drops and mydriatics and may require systemic methotrexate and anti-TNF therapy, and, occasionally, surgery.
Physical therapy, exercises, splints, and other supportive measures may help prevent flexion contractures.
The current classification system, from the International League of Associations for Rheumatology, defines categories of disease based on clinical and laboratory findings (1).
J Pediatr 189: 31 - 39, 2017. doi: 10.1016 / j. jpeds.2017.06.041 Key Points Juvenile idiopathic arthritis (JIA) encompasses a number of different chronic, noninfectious arthritides in children that differ in clinical and laboratory manifestations.
Suspect JIA in children with symptoms of arthritis, signs of iridocyclitis, generalized adenopathy, splenomegaly, or unexplained rash or prolonged fever.
Diagnose JIA clinically; use laboratory testing (of RF, anti-CCP antibodies, ANA, and HLA-B27) mainly to distinguish between forms.
Slow disease progression with methotrexate and / or biologic drugs (eg, etanercept, anakinra, canakinumab, tocilizumab, abatacept, tofacitinib) and treat symptoms with intra-articular corticosteroid injections and / or NSAIDs.
Treat iridocyclitis with ophthalmic corticosteroid drops and mydriatics, or systemic therapy if refractory.
Macrophage Activation Syndrome Macrophage activation syndrome is hemophagocytic lymphohistiocytosis associated with juvenile idiopathic arthritis (JIA; particularly systemic JIA) and with several other rheumatic diseases (particularly adult-onset Still disease).
Chronic Pyelonephritis (Chronic Infective Tubulointerstitial Nephritis) By Talha H Imam, MD, University of Riverside School of Medicine Reviewed / Revised Jul 2021 | Modified Sep 2022 View Patient Education Symptoms and Signs Diagnosis Prognosis Treatment Key Points Chronic pyelonephritis is continuing pyogenic infection of the kidney that occurs almost exclusively in patients with major anatomic abnormalities.
Patients with chronic pyelonephritis may have residual foci of infection that may predispose to bacteremia or, among kidney transplant patients, seed the urinary tract and transplanted kidney.
Xanthogranulomatous pyelonephritis (XPN) is an unusual variant that appears to represent an abnormal inflammatory response to infection.
Giant cells, lipid-laden macrophages, and cholesterol clefts account for the yellow color of the infected tissue.
The kidney is enlarged, and perirenal fibrosis and adhesions to adjacent retroperitoneal structures are common.
The disorder is almost always unilateral and most often occurs in middle-aged women with a history of recurrent UTIs.
Long-term urinary tract obstruction (usually by a calculus) and infection increase risk.
The most common pathogens are Proteus mirabilis and Escherichia coli.
Symptoms and Signs Symptoms and signs are often vague and inconsistent.
Some patients have fever, flank or abdominal pain, malaise, or anorexia.
In xanthogranulomatous pyelonephritis, a unilateral mass can usually be palpated.
Symptoms may be absent or may include fever, malaise, and flank pain.
Diagnosis Urinalysis and urine culture Imaging Chronic pyelonephritis is suspected in patients with a history of recurrent urinary tract infections (UTIs) and acute pyelonephritis.
However, most patients, except for children with vesicoureteral reflux (VUR), do not have such a history.
Sometimes the diagnosis is suspected because typical findings are incidentally noted on an imaging study.
Symptoms, because they are vague and nonspecific, may not suggest the diagnosis.
Urinalysis and urine culture and usually imaging tests are done.
Urinary sediment is usually scant, but renal epithelial cells, granular casts, and occasionally white blood cell (WBC) casts are present.
Proteinuria is almost always present and can be in the nephrotic range if VUR causes extensive renal damage.
When both kidneys are involved, defects in concentrating ability and hyperchloremic acidosis may appear before significant azotemia occurs.
Urine culture may be sterile or positive, usually for gram-negative organisms.
Initial imaging is usually with ultrasonography, helical CT, or intravenous urography (IVU).
Diagnosis is with urinalysis, culture, and imaging tests.
The hallmark of chronic pyelonephritis (usually with reflux or obstruction) on imaging is classically a large, deep, segmental, coarse cortical scar usually extending to one or more of the renal calyces.
The upper pole is the most common site.
Renal cortex is lost, and the renal parenchyma thins.
Uninvolved renal tissue may hypertrophy locally with segmental enlargement.
Ureteral dilation may be present, reflecting the changes induced by chronic severe reflux.
Similar changes can occur with urinary tract tuberculosis.
In xanthogranulomatous pyelonephritis, urine cultures almost always grow P mirabilis or E coli.
CT imaging is done to detect calculi or other obstruction.
Imaging shows an avascular mass with a variable degree of extension around the kidney.
Sometimes, to differentiate cancer (eg, renal cell carcinoma), biopsy may be required, or tissue removed during nephrectomy can be examined.
Treatment is with antibiotics and correction of any structural disorders.
Prognosis The course of chronic pyelonephritis is extremely variable, but the disease typically progresses very slowly.
Most patients have adequate renal function for ≥ 20 years after onset.
Frequent exacerbations of acute pyelonephritis, although controlled, usually further deteriorate renal structure and function.
Continued obstruction predisposes to or perpetuates pyelonephritis and increases intrapelvic pressure, which damages the kidney directly.
Treatment Correction of the obstruction Long-term antibiotic therapy Sometimes nephrectomy, sometimes followed by renal transplantation If obstruction cannot be eliminated and recurrent urinary tract infections are common, long-term therapy with antibiotics (eg, trimethoprim / sulfamethoxazole, trimethoprim, a fluoroquinolone, nitrofurantoin) is useful and may be required indefinitely.
Complications of uremia or hypertension must be treated appropriately.
For xanthogranulomatous pyelonephritis, an initial course of antibiotics should be given to control local infection, followed by en bloc nephrectomy with removal of all involved tissue.
Patients undergoing renal transplantation who have chronic pyelonephritis may require nephrectomy before the transplant.
Key Points Chronic pyelonephritis usually affects patients predisposed to urinary reflux into the renal pelvis (eg, by VUR, obstructive uropathy, or struvite calculi).
Suspect chronic pyelonephritis if patients have recurrent acute pyelonephritis, but the diagnosis is often first suspected based on incidental findings on imaging.
Obtain an imaging study (ultrasonography, helical CT, or intravenous urography [IVU]).
If obstruction cannot be relieved, consider long-term antibiotic prophylaxis.
Reflux of infected urine into the renal pelvis is the usual mechanism.
Causes include obstructive uropathy, struvite calculi, and, most commonly, vesicoureteral reflux (VUR).
Pathologically, there is atrophy and calyceal deformity with overlying parenchymal scarring.
Chronic pyelonephritis may progress to chronic kidney disease.
Polyuria By Geetha Maddukuri, MD, Saint Louis University Reviewed / Revised Dec 2022 View Patient Education Pathophysiology Etiology Evaluation Treatment Key Points Topic Resources Some Causes of Polyuria Polyuria is urine output of > 3 L / day; it must be distinguished from urinary frequency, which is the need to urinate many times during the day or night but in normal or less-than-normal volumes.
Evaluation of Polyuria History History of present illness should include the amounts of fluid consumed and voided to distinguish between polyuria and urinary frequency.
If polyuria is present, patients should be asked about the age at onset, rate of onset (eg, abrupt vs gradual), and any recent clinical factors that may cause polyuria (eg, IV fluids, tube feedings, resolution of urinary obstruction, resolving acute kidney injury, stroke, head trauma, surgery).
Patients should be asked about their degree of thirst.
Review of systems should seek symptoms suggesting possible causes, including dry eyes and dry mouth (Sjögren syndrome) and weight loss and night sweats (cancer).
Past medical history should be reviewed for conditions associated with polyuria, including diabetes mellitus, psychiatric disorders, sickle cell disease, sarcoidosis, amyloidosis, and hyperparathyroidism.
A family history of polyuria and excessive water drinking should be noted.
Drug history should note use of any drugs associated with nephrogenic diabetes insipidus (see table Some Causes of Polyuria) and agents that increase urine output (eg, diuretics, alcohol, caffeinated beverages).
Physical examination The general examination should note signs of obesity (as a risk factor for type 2 diabetes mellitus) or undernutrition or cachexia that might reflect an underlying cancer or an eating disorder plus surreptitious diuretic use.
The head and neck examination should note dry eyes or dry mouth (Sjögren syndrome).
Skin examination should note the presence of any hyperpigmented or hypopigmented lesions, ulcers, or subcutaneous nodules that may suggest sarcoidosis.
Either problem can include nocturia.
Comprehensive neurologic examination should note any focal deficits that suggest an underlying neurologic insult and assess mental status for indications of a thought disorder.
Volume status should be assessed.
Extremities should be examined for edema.
Red flags The following findings are of particular concern: Abrupt onset Onset during the first few years of life Night sweats, cough, and weight loss, especially when there is an extensive smoking history Psychiatric disorder Interpretation of findings History can often distinguish polyuria from frequency, but rarely a 24-hour urine collection may be needed.
Clinical evaluation may suggest a cause (see table Some Causes of Polyuria), but testing is usually necessary.
Diabetes insipidus is suggested by a history of cancer or chronic granulomatous disease (due to hypercalcemia), use of certain drugs (lithium, cidofovir, foscarnet, ifosfamide), and less common conditions (eg, sickle cell disease, renal amyloidosis, sarcoidosis, Sjögren syndrome) that have manifestations that are often more prominent than and precede the polyuria.
Abrupt onset of polyuria at a precise time suggests central diabetes insipidus, as does preference for extremely cold or iced water.
Onset during the first few years of life is typically related to inherited central or nephrogenic diabetes insipidus or uncontrolled type 1 diabetes mellitus.
Polyuria caused by solute diuresis is suggested by a history of diabetes mellitus.
Psychogenic polydipsia is more common in patients with a history of a psychiatric disorder (primarily bipolar disorder, or schizophrenia) rather than as an initial manifestation.
Pathophysiology of Polyuria Water homeostasis is controlled by a complex balance of water intake (itself a matter of complex regulation), renal perfusion, glomerular filtration and tubular reabsorption of solutes, and reabsorption of water from the renal collecting ducts.
Testing Once excess urine output has been verified by history or measurements, serum or fingerstick glucose determination should be done to rule out uncontrolled diabetes.
If hyperglycemia is not present, then testing is required: Serum and urine chemistries (electrolytes, calcium) Serum and urine osmolality and sometimes plasma antidiuretic hormone (ADH) level These tests look for hypercalcemia, hypokalemia (due to surreptitious diuretic use), and hypernatremia or hyponatremia: Hypernatremia (sodium > 142 mEq / L [142 mmol / L]) suggests excess free water loss due to central or nephrogenic diabetes insipidus.
Hyponatremia (sodium < 137 mEq / L [137 mmol / L]) suggests excess free water intake secondary to polydipsia.
Urine osmolality is typically < 300 mOsm / kg (300 mmol / kg) with water diuresis and > 300 mOsm / kg (300 mmol / kg) with solute diuresis.
If the diagnosis remains unclear, then measurement of serum and urine sodium and osmolality in response to a water deprivation test and exogenous ADH administration should be done.
Because serious dehydration may result from this testing, the test should be done only while patients are under constant supervision; hospitalization is usually required.
Additionally, patients in whom psychogenic polydipsia is suspected must be observed to prevent surreptitious drinking.
Various protocols can be used in water deprivation tests.
Each protocol has some limitations.
Typically, the test is started in the morning by weighing the patient, obtaining venous blood to determine serum electrolyte concentrations and osmolality, and measuring urine osmolality.
When water intake increases, blood volume increases and blood osmolality decreases, decreasing release of antidiuretic hormone (ADH; also referred to as arginine vasopressin) from the hypothalamic-pituitary system.
Voided urine is collected hourly, and its osmolality is measured.
Dehydration is continued until orthostatic hypotension and postural tachycardia appear, ≥ 5% of the initial body weight has been lost, or the urinary concentration does not increase > 30 mOsm / kg (30 mmol / kg) in sequentially voided specimens.
Serum electrolytes and osmolality are again determined, and 5 units of aqueous vasopressin are injected subcutaneously.
Urine for osmolality measurement is collected one final time 60 minutes postinjection, and the test is terminated.
A normal response produces maximum urine osmolality after dehydration (> 700 mOsm / kg [700 mmol / kg]), and osmolality does not increase more than an additional 5% after injection of vasopressin.
In central diabetes insipidus, patients are typically unable to concentrate urine to greater than the plasma osmolality but are able to increase their urine osmolality after vasopressin administration.
The increase in urine osmolality is 50 to 100% in central diabetes insipidus vs 15 to 45% with partial central diabetes insipidus.
In nephrogenic diabetes insipidus, patients are unable to concentrate urine to greater than the plasma osmolality and show no additional response to vasopressin administration.
Occasionally in partial nephrogenic diabetes insipidus, the increase in urine osmolality can be up to 45%, but overall these numbers are much lower than those that occur in partial central diabetes insipidus (usually < 300 mOsm / kg [300 mmol / kg]).
In psychogenic polydipsia, urine osmolality is < 100 mOsm / kg (100 mmol / kg).
Because ADH promotes water reabsorption in the renal collecting ducts, decreased levels of ADH increase urine volume, allowing blood osmolality to return to normal.
Decreasing water intake gradually will lead to decreasing urine output, increasing plasma and urine osmolality and serum sodium concentration.
Measurement of circulating ADH is the most direct method of diagnosing central diabetes insipidus.
Levels at the end of the water deprivation test (before the vasopressin injection) are low in central diabetes insipidus and appropriately elevated in nephrogenic diabetes insipidus.
However, ADH levels are not routinely available.
In addition, water deprivation is so accurate that direct measurement of ADH is rarely necessary.
If measured, ADH levels should be checked at the beginning of the water deprivation test, when the patient is well-hydrated; ADH levels should increase as intravascular volume decreases.
Treatment of Polyuria Treatment varies by cause.
Troubling nocturia can be managed by measures such as reducing fluid intake before bedtime, the use of desmopressin, and / or improving sleep hygiene.
Key Points Use of diuretics and uncontrolled diabetes mellitus are common causes of polyuria.
In the absence of diabetes mellitus and diuretic use, the most common causes of chronic polyuria are primary polydipsia, central diabetes insipidus, and nephrogenic diabetes insipidus.
Additionally, high amounts of solutes within the renal tubules cause a passive osmotic diuresis (solute diuresis) and thus an increase in urine volume.
Hypernatremia can indicate central or nephrogenic diabetes insipidus.
Hyponatremia is more characteristic of polydipsia.
Abrupt onset of polyuria suggests central diabetes insipidus.
A water deprivation test can help with diagnosis but should only be done with the patient under close supervision.
The classic example of this process is the glucose-induced osmotic diuresis in uncontrolled diabetes mellitus, when high urinary glucose levels (> 250 mg / dL [13.88 mmol / L]) exceed tubular reabsorption capacity, leading to high glucose levels in the renal tubules; water follows passively, resulting in glucosuria and increased urine volume.
Glucose-induced osmotic diuresis in diabetes mellitus is further increased with use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) that lower plasma glucose levels by inhibiting renal glucose reabsorption and increasing renal glucose excretion.
Therefore, polyuria results from any process that involves one or more of the following: Sustained increase in water intake (polydipsia) Decreased ADH secretion (central diabetes insipidus) Decreased peripheral ADH sensitivity (nephrogenic diabetes insipidus) Solute diuresis Etiology of Polyuria The most common cause of polyuria in adults is Taking diuretics The most common cause of polyuria (see table Some Causes of Polyuria) in adults and children is Uncontrolled diabetes mellitus In the absence of diabetes mellitus, the most common causes are Primary polydipsia Central diabetes insipidus Nephrogenic diabetes insipidus Table Patients recovering from oliguric acute kidney injury can have an osmotic diuresis.
Asbestos-Related Pleural Disease By Abigail R Lara, MD, University of Colorado Reviewed / Revised May 2020 | Modified Sep 2022 View Patient Education Topic Resources Asbestos-Related Plaques Asbestos-Related Plaques... Pleural disease, a hallmark of asbestos exposure, includes formation of pleural plaques, calcification, thickening, rounded atelectasis, adhesions, effusion, and mesothelioma.
All pleural changes are diagnosed by chest x-ray or CT, though chest CT is more sensitive than chest x-ray for detecting pleural disorders.
Benign asbestos pleural effusions (BAPE) are typically unilateral and occur 15 to 45 years after initial asbestos exposure.
Unlike asbestosis, there is not a clear dose-response correlation to the amount of asbestos exposure.
CT of the chest confirms the diagnosis in a patient with a history of asbestos exposure.
Analysis of the pleural effusion demonstrates an exudative process and can be serous, serosanguinous, or overtly bloody.
The presence of pleural plaques increases the likelihood of mesothelioma, thus diagnostic evaluation should be undertaken to rule out malignancy.
BAPE can resolve overtime. BAPE alone does not predict risk of malignancy.
Discrete plaques, which occur in up to 60% of workers exposed to asbestos, typically affect the parietal pleura between the 5th and 9th ribs bilaterally and adjacent to the diaphragm.
The apices and costophrenic angles tend to be spared.
Plaque calcification is common and can lead to misdiagnosis of severe pulmonary disease when radiographically superimposed on lung fields.
Fat stripes may be mistaken for pleural plaques on chest x-ray.
CT can distinguish pleural disease from fat.
Diffuse thickening affects visceral as well as parietal pleurae.
It may be an extension of pulmonary fibrosis from parenchyma to the pleurae or a nonspecific reaction to pleural effusion.
With or without calcification, pleural thickening can cause a restrictive defect.
Rounded atelectasis is a benign manifestation of pleural thickening in which invagination of pleura into the parenchyma can entrap lung tissue, causing atelectasis.
On chest x-ray and CT, it typically appears as a curvilinear, scar-like mass, often in the lower lung zones, and can be confused with a pulmonary cancer.
Asbestos can cause pleural disease other than mesothelioma, including benign asbestos effusion and benign pleural plaques.
Such pleural disease causes effusion but few symptoms.
Asbestos-related pleural disease can cause restrictive lung disease and impairment in diffusing capacity of carbon monoxide, even without the presence of interstitial fibrosis.
Benign Prostatic Hyperplasia (BPH) (Benign Prostatic Hypertrophy) By Gerald L Andriole, MD, Johns Hopkins Medicine Reviewed / Revised Aug 2022 | Modified Sep 2022 View Patient Education Pathophysiology Symptoms and Signs Diagnosis Treatment Key Points Topic Resources Prostatism Symptom Score American Urological Association... Benign prostatic hyperplasia (BPH) is nonmalignant adenomatous overgrowth of the periurethral prostate gland.
As the lumen of the prostatic urethra narrows and lengthens, urine outflow is progressively obstructed.
Increased pressure associated with micturition and bladder distention can progress to hypertrophy of the bladder detrusor, trabeculation, cellule formation, and diverticula.
Incomplete bladder emptying causes stasis and predisposes to calculus formation and infection.
Prolonged urinary tract obstruction, even if incomplete, can cause hydronephrosis and compromise renal function.
Symptoms and Signs of BPH Lower urinary tract symptoms Symptoms of benign prostatic hyperplasia (BPH) include a constellation of symptoms that are often progressive, known collectively as lower urinary tract symptoms (LUTS): Urinary frequency Urgency Nocturia Hesitancy Intermittency Frequency, urgency, and nocturia are due to incomplete emptying and rapid refilling of the bladder.
Decreased size and force of the urinary stream cause hesitancy and intermittency.
Pain and dysuria are usually not present.
Sensations of incomplete emptying, terminal dribbling, overflow incontinence, or complete urinary retention may ensue.
Straining to void can cause congestion of superficial veins of the prostatic urethra and trigone, which may rupture and cause hematuria.
Straining also may acutely cause vasovagal syncope and, over the long term, may cause dilation of hemorrhoidal veins or inguinal hernias.
Symptoms are those of bladder outlet obstruction—weak stream, hesitancy, urinary frequency, urgency, nocturia, incomplete emptying, terminal dribbling, overflow or urge incontinence, and complete urinary retention.
Urinary retention Some patients present with sudden, complete urinary retention, with marked abdominal discomfort and bladder distention.
Retention may be precipitated by any of the following: Prolonged attempts to postpone voiding Immobilization Exposure to cold Use of anesthetics, anticholinergics, sympathomimetics, opioids, or alcohol Symptom scores Symptoms can be quantitated by scores, such as the 7-question American Urological Association Symptom Score (see table American Urological Association Symptom Score for Benign Prostatic Hyperplasia).
This score also allows doctors to monitor symptom progression: Mild symptoms: Scores 1 to 7 Moderate symptoms: Scores 8 to 19 Severe symptoms: Scores 20 to 35 Digital rectal examination On digital rectal examination, the prostate usually is enlarged and nontender, has a rubbery consistency, and in many cases has lost the median furrow.
However, prostate size as detected with digital rectal examination may be misleading; an apparently small prostate may cause obstruction.
If distended, the urinary bladder can be palpated or percussed during abdominal examination.
Firm or hard areas in the prostate may indicate prostate cancer.
Diagnosis of BPH Digital rectal examination Urinalysis and urine culture Prostate-specific antigen level Sometimes uroflowmetry and bladder ultrasonography The lower urinary tract symptoms of benign prostatic hyperplasia (BPH) can also be caused by other disorders, including infection, prostate cancer, and overactive bladder.
Although palpable prostate tenderness suggests infection, digital rectal examination findings in BPH and cancer often overlap.
Although cancer may cause a stony, hard, nodular, irregularly enlarged prostate, most patients with cancer, BPH, or both have a benign-feeling, enlarged prostate.
Diagnosis is based primarily on digital rectal examination and symptoms; cystoscopy, transrectal ultrasonography, urodynamics, or other imaging studies may also be needed.
Thus, testing should be considered for patients with symptoms or palpable prostatic abnormalities.
Typically, urinalysis and urine culture are done, and serum prostate-specific antigen (PSA) levels are measured.
Men with moderate or severe symptoms of obstruction may also have uroflowmetry (an objective test of urine volume and flow rate) with measurement of postvoid residual volume by bladder ultrasonography.
Flow rate < 15 mL / sec suggests obstruction, and postvoid residual volume > 100 mL suggests acute retention.
Prostate-specific antigen (PSA) levels Interpreting prostate-specific antigen (PSA) levels can be complex.
The PSA level is moderately elevated in 30 to 50% of patients with BPH, depending on prostate size and degree of obstruction, and is elevated in 25 to 92% of patients with prostate cancer, depending on the tumor volume.
In patients without cancer, serum PSA levels > 1.5 ng / mL (1.5 mcg / L) usually indicate a prostate volume ≥ 30 mL.
If the PSA level is > 4 ng / mL (4 mcg / L), further discussion / shared decision-making regarding other tests or biopsy is recommended.
For men < 50 or those at high risk of prostate cancer, a lower cutoff (PSA > 2.5 ng / mL [2.5 mcg / L]) may be used.
Other measures, including rate of PSA increase, free-to-bound PSA ratio, and other markers, may be useful.
Treatment options include 5 alpha-reductase inhibitors, alpha-blockers, tadalafil, and surgery.
(A full discussion of prostate cancer screening and diagnosis can be found elsewhere in THE MANUAL)
Other testing Transrectal biopsy is usually done with ultrasound guidance (to minimize risk of infection) and is usually indicated only if there is suspicion of prostate cancer.
Transrectal ultrasonography is an accurate way to measure prostate volume.
Clinical judgment must be used to evaluate the need for further testing.
Contrast imaging studies (eg, CT, intravenous urography [IVU]) are rarely necessary unless the patient has had a urinary tract infection (UTI) with fever or obstructive symptoms have been severe and prolonged.
Upper urinary tract abnormalities that usually result from bladder outlet obstruction include upward displacement of the terminal portions of the ureters (fish hooking), ureteral dilation, and hydronephrosis.
If an upper tract imaging study is warranted due to pain or elevated serum creatinine level, ultrasonography may be preferred because it avoids radiation and IV contrast exposure.
Alternatively, men whose PSA levels warrant testing can undergo multiparametric MRI, which is more sensitive (although less specific) than transrectal biopsy.
Restricting biopsies to areas found to be suspect on multiparametric MRI may reduce the number of prostate biopsies and diagnoses of clinically insignificant prostate cancers, as well as possibly increasing diagnoses of clinically significant prostate cancers (1).
Using the criteria of a prostate volume > 30 mL and a moderate or high American Urological Association Symptom Score (see table American Urological Association Symptom Score for Benign Prostatic Hyperplasia), the prevalence of BPH in men aged 55 to 74 without prostate cancer is 19%.
Lancet 389 (10071): 815 - 822, 2017. doi: 10.1016/S0140 - 6736 (16) 32401 - 1 Treatment of BPH Avoidance of anticholinergics, sympathomimetics, and opioids Use of alpha-adrenergic blockers (eg, terazosin, doxazosin, tamsulosin, alfuzosin, silodosin), 5 alpha-reductase inhibitors (finasteride, dutasteride), or the phosphodiesterase type 5 inhibitor tadalafil, especially if there is concomitant erectile dysfunction Transurethral resection of the prostate or an alternative bladder outlet procedure Urinary retention Significant urinary retention requires immediate decompression.
Passage of a standard urinary catheter is first attempted; if a standard catheter cannot be passed, a catheter with a coudé tip may be effective.
If this catheter cannot be passed, flexible cystoscopy or insertion of filiforms and followers (guides and dilators that progressively open the urinary passage) may be necessary.
(This procedure should usually be done by a urologist.)
Suprapubic percutaneous decompression of the bladder may be used if transurethral approaches are unsuccessful.
Drug therapy For partial obstruction with troublesome symptoms, all anticholinergics and sympathomimetics (many available in over-the-counter [OTC] preparations), and opioids should be stopped, and any infection should be treated with antibiotics.
For patients with mild to moderate obstructive symptoms, alpha-adrenergic blockers (eg, terazosin, doxazosin, tamsulosin, alfuzosin) may decrease voiding problems.
The 5 alpha-reductase inhibitors (finasteride, dutasteride) may reduce prostate size, decreasing voiding problems over months, especially in patients with larger (> 30 mL) glands.
But if voiding criteria of a maximal urinary flow rate < 10 mL / sec and a postvoid residual urine volume > 50 mL are included, the prevalence is only 4%.
A combination of both classes of drugs is superior to monotherapy.
For men with concomitant erectile dysfunction, daily tadalafil may help relieve both conditions.
Many OTC complementary and alternative agents are promoted for treatment of BPH, but none, including the thoroughly studied saw palmetto, has been shown to be more efficacious than placebo.
Surgery Surgery is done when patients do not respond to drug therapy or develop complications such as recurrent urinary tract infection, urinary calculi, severe bladder dysfunction, or upper tract dilation.
Transurethral resection of the prostate (TURP) is the standard (1, 2).
Erectile function and continence are usually retained, although about 5 to 10% of patients experience some acute postsurgical problems, most commonly retrograde ejaculation.
The incidence of erectile dysfunction after TURP is between 1 and 35%, and the incidence of incontinence is about 1 to 3%.
However, technical advances such as the use of a bipolar resectoscope, which allows use of saline irrigation, have greatly improved the safety of TURP by averting hemolysis and hyponatremia.
About 10% of men undergoing TURP need the procedure repeated within 10 years because the prostate continues to grow.
Various laser ablation techniques are being used as alternatives to TURP.
Based on autopsy studies, the prevalence of BPH increases from 8% in men aged 31 to 40 years to 40 to 50% in men aged 51 to 60 years and to > 80% in men > 80 years.
Larger prostates (usually > 75 grams) traditionally require open surgery via a suprapubic or retropubic approach (currently, most surgeons prefer laparoscopy or robotic laparoscopic assistance to open surgery), although some newer techniques such as the holmium laser enucleation of the prostate (HoLEP) can be done transurethrally.
All surgical methods require postoperative catheter drainage for 1 to 7 days.
Other procedures Alternatives to TURP include microwave thermotherapy, electrovaporization, various laser techniques, high-intensity focused ultrasonography, transurethral needle ablation, radiofrequency vaporization, pressurized heated water injection therapy, urethral lift, steam injection therapy, and intraurethral stents.
Prostatic artery embolization (PAE) is being evaluated for men with an enlarged prostate gland, particularly those with hematuria who are poor candidates for surgery (3).
The circumstances under which these procedures should be used have not been firmly established, but those done in the physician's office (eg, steam injection) are being more commonly used and do not require use of general or regional anesthesia.
Table The etiology is unknown but probably involves hormonal changes associated with aging.
Acute urinary retention can develop with exposure to cold, prolonged attempts to postpone voiding, immobilization, or use of anesthetics, anticholinergics, sympathomimetics, opioids, or alcohol.
Evaluate patients with a digital rectal examination and usually urinalysis, urine culture, and PSA.
In men with BPH, avoid use of anticholinergics, sympathomimetics, and opioids.
Consider relieving troublesome obstructive symptoms with alpha-adrenergic blockers (eg, terazosin, doxazosin, tamsulosin, alfuzosin), 5 alpha-reductase inhibitors (finasteride, dutasteride), or tadalafil, especially if there is concomitant erectile dysfunction.
Consider TURP or other ablation technique if BPH causes complications (eg, recurrent calculi or infection, bladder dysfunction, upper tract dilation) or if bothersome symptoms are drug resistant.
Pathophysiology of BPH Multiple fibroadenomatous nodules develop in the periurethral region of the prostate, probably originating within the periurethral glands rather than in the true fibromuscular prostate (surgical capsule), which is displaced peripherally by progressive growth of the nodules.
Urinary Retention By Patrick J Shenot, MD, Thomas Jefferson University Hospital Reviewed / Revised Oct 2021 | Modified Sep 2022 View Patient Education Diagnosis Treatment Key Points Urinary retention is incomplete emptying of the bladder or cessation of urination.
Diagnosis Measurement of postvoid residual volume Diagnosis is obvious in patients who cannot void.
In those who can void, incomplete bladder emptying is diagnosed by postvoid catheterization or ultrasonography showing an elevated residual urine volume.
A volume < 50 mL is normal; < 100 mL is usually acceptable in patients > 65 but abnormal in younger patients.
Other tests (eg, urinalysis, blood tests, ultrasonography, urodynamic testing, cystoscopy, cystography) are done based on clinical findings.
Treatment Urethral catheterization and treatment of cause Relief of acute urinary retention requires urethral catheterization.
In men with benign prostatic hyperplasia, drugs (usually alpha-adrenergic blockers or 5-alpha-reductase inhibitors) or surgery may help decrease bladder outlet resistance.
No treatment is effective for impaired bladder contractility; however, reducing outlet resistance with alpha-adrenergic blockers may increase bladder emptying.
Intermittent self-catheterization or indwelling catheterization is often required.
An indwelling suprapubic tube or urinary diversion is a last resort.
Urinary retention may be Acute Chronic Causes include impaired bladder contractility, bladder outlet obstruction, detrusor-sphincter dyssynergia (lack of coordination between bladder contraction and sphincter relaxation), or a combination.
Key Points Mechanisms include impaired bladder contractility, bladder outlet obstruction, and detrusor-sphincter dyssynergia.
Incomplete retention is diagnosed by a postvoid residual volume > 50 mL (> 100 mL in patients > 65).
Prescribe urethral catheterization and treat the cause of retention.
Retention is most common among men, in whom prostate abnormalities or urethral strictures cause outlet obstruction.
In either sex, retention may be due to drugs (particularly those with anticholinergic effects, including many over-the-counter drugs), severe fecal impaction (which increases pressure on the bladder trigone), or neurogenic bladder in patients with diabetes, multiple sclerosis, Parkinson disease, or prior pelvic surgery resulting in bladder denervation.
Urinary retention can be asymptomatic or cause urinary frequency, a sense of incomplete emptying, and urge or overflow incontinence.
It may cause abdominal distention and pain.
When retention develops slowly, pain may be absent.
Long-standing retention predisposes to UTI and can increase bladder pressure, causing obstructive uropathy.
Mupirocin By Brian J Werth, PharmD, University of Washington School of Pharmacy Reviewed / Revised May 2022 | Modified Sep 2022 View Patient Education Mupirocin inhibits bacterial RNA and protein synthesis.
It is available only as a 2% topical preparation, which is bactericidal against staphylococci and beta-hemolytic streptococci.
Systemic absorption of topical mupirocin is negligible.
Mupirocin is used for Impetigo Minor superficial secondarily infected skin lesions Eradication of Staphylococcus aureus nasal carriage, although relapse rates may be high Chronic therapy leads to mupirocin - resistant staphylococci.
Mupirocin is nontoxic but, when applied to denuded skin or mucous membranes, may cause itching and burning.
Trimethoprim and Sulfamethoxazole 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 Some Indications for TMP / SMX Trimethoprim is available as a single drug or in combination with sulfamethoxazole (a sulfonamide antibiotic).
TMP / SMX is not clinically effective for group A streptococcal pharyngitis and does not prevent sequelae such as rheumatic fever.
Table Some Indications for TMP / SMX Indication Comments Chronic bacterial prostatitis One of the few effective drugs, but cures < 1/2 of patients, even after 12 weeks Uncomplicated cystitis in women As effective as fluoroquinolones for empiric short-course (3-day) therapy if the rate of TMP / SMX resistance is < 15% Prophylaxis for recurrent urinary tract infections in women and recurrent urinary tract infections in children Use of 1/2 to 1 double-strength tablet every night or every other night or, for women with previous recurrences after coitus, after coitus Treatment of Pneumocystis jirovecii pneumonia and prophylaxis of this infection in patients with AIDS or cancer Drug of choice Intestinal infections due to various bacteria (eg, Shigella species, Vibrio species, Escherichia coli) and the protozoans Cystoisospora and Cyclospora species Usefulness limited by increasing prevalence of resistance Nocardia and Listeria monocytogenes infections — Community-associated methicillin-resistant Staphylococcus aureus infections Drug of choice for oral treatment of uncomplicated infections caused by community-associated methicillin-resistant S aureus TMP / SMX = trimethoprim / sulfamethoxazole.
TMP alone is used less often but may be useful for Chronic bacterial prostatitis Prophylaxis and treatment of urinary tract infection in patients allergic to sulfonamides Contraindications to TMP and SMX TMP / SMX is contraindicated in patients who have had an allergic reaction to either drug.
Relative contraindications include folate deficiency, liver dysfunction, and renal insufficiency.
Use During Pregnancy and Breastfeeding Animal reproduction studies with TMP / SMX show some risk (eg, birth defects).
However, use of TMP / SMX should be avoided during the 1st trimester (because neural tube defects are a risk) and near term.
If used during pregnancy or in neonates, TMP / SMX increases blood levels of unconjugated bilirubin and increases risk of kernicterus in the fetus or neonate.
If TMP / SMX cannot be avoided during the 1st trimester, folic acid supplementation (4 mg / day) is necessary.
Sulfonamides enter breast milk, and use during breastfeeding is usually discouraged.
The drugs act synergistically to block sequential steps in bacterial folate metabolism: Trimethoprim (TMP) prevents reduction of dihydrofolate to tetrahydrofolate.
Adverse Effects of TMP and SMX Adverse effects of TMP / SMX include Those associated with sulfonamides Folate deficiency Hyperkalemia Renal insufficiency Renal failure in patients with underlying renal insufficiency is probably secondary to interstitial nephritis or tubular necrosis.
Also, TMP competitively inhibits renal tubular creatinine secretion and may cause an artificial increase in serum creatinine, although glomerular filtration rate remains unchanged.
Increases in serum creatinine are more likely in patients with preexisting renal insufficiency and especially in those with diabetes mellitus.
Most adverse effects are the same as those of sulfonamides.
TMP has adverse effects identical to those of SMX, but they are less common.
Nausea, vomiting, and rash occur most often.
AIDS patients have a high incidence of adverse effects, especially fever, rash, and neutropenia.
Folate deficiency (resulting in macrocytic anemia) can also occur.
Use of folinic acid can prevent or treat macrocytic anemia, leukopenia, and thrombocytopenia, which sometimes occur with prolonged TMP / SMX use.
TMP can decrease renal tubular potassium excretion, leading to potentially life-threatening hyperkalemia.
Sulfamethoxazole (SMX) inhibits conversion of p - aminobenzoic acid to dihydropteroate.
Rarely, severe hepatic necrosis occurs.
The drug may also cause a syndrome resembling aseptic meningitis.
Dosing Considerations for TMP and SMX TMP / SMX may increase warfarin activity and levels of phenytoin, methotrexate, and rifampin.
This synergy results in maximal antibacterial activity, which is often bactericidal.
Trimethoprim / sulfamethoxazole (TMP / SMX) is available as a fixed combination consisting of a 1: 5 ratio (80 mg TMP plus 400 mg SMX or a double-strength tablet of 160 mg TMP plus 800 mg SMX).
Pharmacokinetics Both drugs are well absorbed orally and are excreted in the urine.
They have a serum half-life of about 11 hours in plasma and penetrate well into tissues and body fluids, including cerebrospinal fluid.
TMP is concentrated in prostatic tissue.
Indications for TMP and SMX TMP and TMP / SMX are active against A broad spectrum of gram-positive bacteria (including some strains of methicillin-resistant Staphylococcus aureus) A broad spectrum of gram-negative bacteria Protozoans Cystoisospora and Cyclospora species The fungus Pneumocystis jirovecii The combination is inactive against Anaerobes Treponema pallidum Mycobacterium tuberculosis Mycoplasma species Pseudomonas aeruginosa Enterococci, many Enterobacterales (formerly Enterobacteriaceae), and many Streptococcus pneumoniae strains are resistant.
Zika Virus (ZV) Infections By Thomas M Yuill, PhD, University of Wisconsin-Madison Reviewed / Revised Jun 2023 View Patient Education Epidemiology Transmission of Zika Virus Symptoms and Signs Diagnosis Treatment Prevention Key Points More Information Topic Resources Overview of Zika Virus Infection The Zika virus is a mosquito-borne flavivirus that is antigenically and structurally similar to the viruses that cause dengue, yellow fever, and West Nile virus.
Overview of Zika Virus Infection VIDEO The main vectors are A aegypti and A albopictus.
If traveling to such areas, pregnant women should talk with their obstetric clinician about risks of Zika virus infection and precautions to be taken to avoid mosquito bites during the trip.
There is currently no vaccine to prevent Zika virus infection.
Prevention of transmission via mosquitoes Prevention of Zika virus infection depends on control of Aedes mosquitoes and prevention of mosquito bites when traveling to countries with ongoing Zika virus transmission.
Control of A aegypti has been very difficult; however, 2 approaches are being field-tested currently: Release of genetically altered males or sterilized males that mate with wild females whose larval offspring then do not mature or whose eggs are infertile Release of female A aegypti mosquitoes infected with Wolbachia bacteria that block susceptibility to Zika virus in the infected mosquitoes and their offspring To prevent mosquito bites, the following precautions should be taken (see also the CDC's Protection against Mosquitoes and Zika virus: Prevention and Transmission): Wear long-sleeved shirts and long pants.
Stay in places that have air conditioning or that use window and door screens to keep mosquitoes out.
Sleep under a mosquito bed net in places that are not adequately screened or air-conditioned.
Use Environmental Protection Agency-registered insect repellents with ingredients such as DEET (diethyltoluamide) or other approved active ingredients on exposed skin surfaces.
In the United States, A aegypti is restricted to an area that extends from the deep South along the United States-Mexican border to southern California.
Treat clothing and gear with permethrin insecticide (do not apply directly to the skin).
For children, the following precautions are recommended: Do not use insect repellent on infants < 2 months.
Do not use products containing oil of lemon eucalyptus (para-menthane-diol) on children < 3 years.
For older children, adults should spray repellent on their hands and then apply it to the children's skin.
Dress children in clothing that covers their arms and legs, or cover the crib, stroller, or baby carrier with mosquito netting.
Do not apply insect repellent to the hands, eyes, mouth, or cut or irritated skin of children.
Prevention of sexual transmission RNA of the Zika virus has been detected in semen up to 281 days after the onset of symptoms (1).
However, detection of viral RNA does not necessarily indicate the presence of infectious virus.
In one study, infectious virus was detected in a few individuals 30 days after illness onset but, in general, shedding of infectious Zika virus appeared to become much less common with time and was limited mainly to the first few weeks after illness onset; however, there is still a possibility of later transmission.
Because Zika virus can be transmitted via semen, people should use condoms or practice abstinence if one or both partners live in or have traveled to an area with current or past Zika virus transmission.
A albopictus, which better adapted to colder climates, is present in a large part of the southeast up through the Upper Midwest and in southern California.
This recommendation applies whether or not people have symptoms because most Zika virus infections are asymptomatic, and when symptoms do develop, they are usually mild.
Man with pregnant partner: Abstain from sexual activity, or use condoms and avoid sharing sex toys for the duration of the pregnancy Man who traveled to area at risk of Zika with or without female partner: Abstain from sexual activity or use condoms for 3 months after return (or the start of symptoms) Woman who traveled to area at risk of Zika without male partner: Abstain from sexual activity or use condoms for 2 months after return (or the start of symptoms) If using condoms, they should be used from start to finish every time during vaginal, anal, and oral sex.
Although no cases of woman-to-woman sexual transmission have been reported, the CDC recommends that all pregnant women who have a female sex partner who has traveled to or resides in an area with Zika use barrier methods every time during vaginal, anal, and oral sex, or abstain from sex during the pregnancy, and avoid sharing sex toys.
N Engl J Med 378 (15): 1377 - 1385, 2018. doi: 10.1056/NEJMoa1711038 Key Points The Zika virus is transmitted primarily by Aedes mosquitoes.
Most Zika virus infections are asymptomatic; symptomatic infections are usually mild, causing fever, a maculopapular rash, conjunctivitis, joint pain, retro-orbital pain, headache, and muscle pain (myalgia).
Zika virus infection during pregnancy can cause a serious birth defect called microcephaly, ocular and other lesions within the congenital Zika syndrome spectrum.
Monitor brain development in all infants born to mothers infected with Zika virus, whether infants have microcephaly or ocular lesions or not, for ≥ 2 years.
A aegypti is considered to be the main vector for epidemic Zika virus infection; A albopictus is thought to be a secondary vector of epidemic Zika virus infection in the tropics, but whether it would do so in the more temperate climate of the United States is unclear.
Test pregnant women for Zika virus if they have traveled to or live in areas of ongoing Zika virus transmission using serologic testing (enzyme-linked immunosorbent assay for IgM, the plaque reduction neutralization test) or RT-PCR.
Treat supportively; treat fever with acetaminophen and avoid using aspirin or NSAIDs until dengue has been excluded.
Pregnant women should NOT travel to areas with ongoing Zika virus outbreaks.
Prevention of Zika virus infection depends on controlling Aedes mosquitoes and avoiding mosquito bites.
Because Zika virus can be transmitted sexually, men and women who live in or have traveled to an area of ongoing Zika virus transmission should abstain from sexual activity or consistently and correctly use barrier methods during sex while their partner is pregnant.
Epidemiology of Zika Virus Infections In 1947, the Zika virus was first isolated from monkeys in the Zika Forest of Uganda but was not considered an important human pathogen until the first large-scale outbreaks in the South Pacific islands in 2007.
In May 2015, local transmission was first reported in South America, then in Central America and in the Caribbean, reaching Mexico by late November 2015.
Local transmission of Zika virus has been reported in the following regions: South America Central America and Mexico Caribbean Islands (including Puerto Rico and the US Virgin Islands) Pacific Islands Cape Verde (a nation of islands off the northwest coast of Africa) South and Southeast Asia (sporadic cases) Africa Florida and Texas The Centers for Disease Control and Prevention (CDC) issues travel alerts for countries in these regions when outbreaks occur.
Although as of December 2019, there were no areas with CDC travel precautions due to Zika outbreaks, in early 2020 there were thousands of cases in some areas of Brazil and hundreds of cases in Colombia.
In 2016 and 2017, cases of locally transmitted Zika virus infection were reported in Miami-Dade County in southeastern Florida and Brownsville, Texas.
Zika virus infection is typically asymptomatic but can cause fever, rash, joint pain, or conjunctivitis; Zika virus infection during pregnancy can cause microcephaly (a serious birth defect), eye abnormalities, and a number of developmental impairments termed congenital Zika syndrome.
According to the CDC website, there is no current local transmission of Zika virus in the continental United States.
However, Zika virus infection has been reported in travelers returning to the United States after travel to countries where the virus is transmitted locally.
Predicting where the Zika virus will spread is difficult.
However, because the same mosquito that transmits Zika also transmits dengue and chikungunya, local transmission of Zika virus can be expected wherever dengue or chikungunya has been transmitted.
Dengue has been locally acquired most recently in Texas, Florida, and Hawaii; chikungunya has been locally acquired in Florida, Puerto Rico, and the US Virgin Islands.
Similarly, in areas of the United States where dengue is now endemic (Puerto Rico and the US Virgin Islands in the Caribbean; American Samoa, Guam, and the Northern Mariana Islands in the Pacific Ocean), Zika virus infection may also become endemic.
There was some serological evidence of Zika virus infection in nonhuman primates in Brazil at the end of the major outbreak in humans there.
However, it is unclear whether the virus is routinely sustained in animal populations the way that yellow fever virus is.
Transmission of Zika Virus During the first week of infection, the Zika virus is present in blood.
Mosquitoes can acquire the virus when they bite infected people; the mosquitoes can then transmit the virus to other people through bites.
Diagnosis is with enzyme-linked immunosorbent assay or reverse transcriptase-polymerase chain reaction (RT-PCR).
Travelers from areas of ongoing Zika virus transmission may have Zika virus in their blood when they return home, and if mosquito vectors are present locally, transmission of Zika virus is possible there.
However, because contact between Aedes mosquitoes and people is infrequent in most of the continental United States and Hawaii (because of mosquito control and people living and working in screened and in air-conditioned environments), local transmission of Zika virus is expected to be rare and limited.
Although the Zika virus is transmitted primarily by mosquitoes, other modes of transmission are possible.
Zika virus persists in semen much longer than in blood, vaginal fluids, and other body fluids.
Both male-to-female and male-to-male transmission during unprotected sexual activity (no condoms) has occurred (see also the CDC: Clinical Guidance for Healthcare Providers for Prevention of Sexual Transmission of Zika Virus).
Zika virus may also be transmitted by men or women to their sex partners when sex toys are shared, even when infected people have no symptoms.
Zika virus also persists in vaginal secretions after it disappears from blood and urine; female-to-male sexual transmission of Zika virus infection has been reported (2).
A study in Guatemala reported viral RNA shedding in vaginal secretions intermittently for up to 6 months.
However, detection of viral RNA does not prove presence of infectious virus, because polymerase chain reaction may detect one or more gene fragments, not necessarily infectious virus.
Transmission by blood transfusion has been reported in Brazil; however, at present, no cases of transmission by blood transfusion have been confirmed in the United States (see also the Zika and Blood & Tissue Safety).
Prevention involves avoiding mosquito bites, avoiding unprotected sex with a partner at risk of having Zika virus infection, and, for pregnant women and their partners, avoiding travel to areas with ongoing transmission.
Symptoms and Signs of Zika Virus Infections Most people who become infected have no symptoms.
Symptoms of Zika virus infection include fever, maculopapular rash, conjunctivitis (pinkeye), joint pain, retro-orbital pain, headache, and muscle pain.
Symptoms last 4 to 7 days.
Most infections are mild.
Severe infection requiring hospitalization is uncommon.
Rarely, Zika virus infection has caused encephalopathy in adults.
Death due to Zika virus infection is rare.
Very uncommonly, Guillain-Barré syndrome (GBS) develops after a Zika virus infection.
GBS is an acute, usually rapidly progressive but self-limited inflammatory polyneuropathy thought to be caused by an autoimmune reaction.
(See also Overview of Arbovirus, Arenavirus, and Filovirus Infections.)
GBS has also developed after dengue and chikungunya disease.
Congenital Zika virus infection Zika virus infection during pregnancy can cause microcephaly (a congenital disorder involving incomplete brain development and small head size), other severe fetal brain, ocular, and other defects that, together are termed congenital Zika syndrome (see also the CDC: Congenital Zika Syndrome & Other Birth Defects).
In the continental United States, several cases of microcephaly have been linked to the Zika virus; the mothers of these infants probably contracted the infection through travel to a country with endemic infection.
Cases are being monitored by the CDC and WHO (see CDC: Zika cases in the United States; WHO: Countries and territories with current or previous Zika virus transmission).
Infants infected in utero, whether they have microcephaly or not, may have ocular lesions or congenital contractures (eg, clubfoot).
Infants infected in utero and born without congenital Zika syndrome are at risk for neurodevelopmental delay.
However, clinical manifestations of Zika virus infection resemble those of many febrile tropical diseases (eg, dengue, malaria, leptospirosis, other arbovirus infections), and its geographic distribution resembles that of other arboviruses.
Zika virus (ZV), like the viruses that cause dengue, yellow fever, and chikungunya disease, is transmitted by Aedes mosquitoes, which breed in areas of stagnant water.
Virus-specific IgM and neutralizing antibodies typically develop toward the end of the first week of illness, but cross-reaction with related flaviviruses (eg, dengue and yellow fever viruses) is common.
The PRNT with acute and convalescent serum pairs measures virus-specific neutralizing antibodies and helps distinguish cross-reacting antibodies from closely related flaviviruses.
A fourfold or greater rise in PRNT antibodies is diagnostic.
Lancet Infect Dis 20 (12): 1446 - 1456, 2020. doi: 10.1016/S1473 - 3099 (19) 30708-X Treatment of Zika Virus Infections Supportive care No specific antiviral treatment is available for Zika virus infection.
Treatment is supportive; it includes the following: Rest Fluids to prevent dehydration Acetaminophen to relieve fever and pain Avoidance of aspirin and other NSAIDs (nonsteroidal anti-inflammatory drugs) Aspirin and other NSAIDs are not typically used during pregnancy and should specifically be avoided in all patients treated for Zika virus infection until dengue can be ruled out because hemorrhage is a risk.
Also, death and severe infection due to Zika virus has been related to immune thrombocytopenia and bleeding (1, 2).
If pregnant women have laboratory evidence of Zika virus in serum, urine or amniotic fluid, serial ultrasonography every 3 to 4 weeks should be considered to monitor fetal anatomy and growth.
Referral to a maternal-fetal medicine or infectious disease specialist with expertise in pregnancy management is recommended.
Brain development should be monitored for ≥ 2 years in all infants born to mothers infected with Zika virus, whether or not the infants have microcephaly, ocular lesions, or other manifestations suggestive of congenital Zika syndrome.
Cryptosporidiosis 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 Pathophysiology Epidemiology Symptoms and Signs Diagnosis Treatment Prevention Key Points More Information Topic Resources Cryptosporidium Life... Cryptosporidiosis is infection with the protozoan Cryptosporidium.
Two types of oocysts are produced: Thick-walled oocysts, which are commonly excreted from the host Thin-walled oocysts, which are primarily involved in autoinfection The thick-walled infective oocysts are shed into the lumen and passed in stool by the infected host; they are immediately infective and can be transmitted directly from person to person by the fecal-oral route.
Very few oocysts (eg, < 100) are required to cause disease, thus increasing risk of person-to-person transmission.
When the infective oocysts are ingested by humans or another vertebrate host, the cycle begins again.
Oocysts are resistant to harsh conditions, including chlorine at levels usually used in public water treatment systems and swimming pools despite adherence to recommended residual chlorine levels.
Epidemiology of Cryptosporidiosis Cryptosporidium species infect a wide range of animals.
Cryptosporidium parvum and C hominis (formerly C parvum genotype 1) are responsible for most human cases of cryptosporidiosis.
Infections by C felis, C meleagridis, C canis, and C muris have also been reported.
Ingesting even a relatively small number of oocyts can result in disease.
Infections result from the following: Ingestion of fecally contaminated food or water (often water in public and residential pools, hot tubs, water parks, lakes, or streams) Direct person-to-person contact Zoonotic spread The disease occurs worldwide.
The primary symptom is watery diarrhea, often with other signs of gastrointestinal distress.
Cryptosporidiosis is responsible for 0.6 to 7.3% of diarrheal illness in countries with modern sanitation systems and an even higher percentage in areas with poor sanitation.
In the US from 2009 to 2017, there were 444 reported cryptosporidiosis outbreaks resulting in 7, 465 cases in 40 states and Puerto Rico.
The number of reported outbreaks increased an average of 13% per year.
Leading causes include swallowing contaminated water in pools or water playgrounds, contact with infected cattle, and contact with infected persons in child care settings (1).
In Milwaukee, Wisconsin, > 400, 000 people were affected during a waterborne outbreak in 1993, when the city's water supply was contaminated by sewage during spring rains when the filtration system did not work correctly.
Children, travelers to foreign countries, immunocompromised patients, and medical personnel caring for patients with cryptosporidiosis are at increased risk.
Outbreaks have occurred in day care centers.
The small number of oocysts required to cause infection, the prolonged excretion of oocysts, the resistance of oocysts to chlorination, and their small size raise concern about swimming pools used by diapered children.
Illness is typically self-limited in immunocompetent patients but can be persistent and severe in patients with AIDS.
Symptoms and Signs of Cryptosporidiosis The incubation period for cryptosporidiosis is about 1 week, and clinical illness occurs in > 80% of infected people.
Onset is typically abrupt, with watery diarrhea, abdominal cramping, and, less commonly, nausea, anorexia, fever, and malaise.
Symptoms usually persist 2 to 3 weeks, rarely ≥ 1 month, and then abate.
Fecal excretion of oocysts may continue for several weeks after symptoms have subsided.
Asymptomatic shedding of oocysts is common among children in countries with poor sanitation.
Cryptosporidiosis is also associated with undernutrition in children living in these areas.
In the immunocompromised host, onset may be more gradual, but diarrhea can be more severe.
Unless the underlying immune defect is corrected, infection can persist, causing intractable diarrhea for life.
Diagnosis is by identification of the organism or antigen in stool.
Fluid losses of > 5 to 10 L / day have been reported in some AIDS patients.
The intestine is the most common site of infection in immunocompromised hosts; however, other organs (eg, biliary tract, pancreas, respiratory tract) may be involved.
Diagnosis of Cryptosporidiosis Enzyme immunoassay for fecal antigen or molecular probes for parasite DNA Microscopic examination of stool (special techniques required) Identifying the acid-fast oocysts in stool confirms the diagnosis of cryptosporidiosis, but conventional methods of stool examination (ie, routine "stool for ova and parasites" testing) are unreliable.
Oocyst excretion is intermittent, and multiple stool samples may be needed.
Several concentration techniques increase the yield.
Cryptosporidium oocysts can be identified by phase-contrast microscopy or by staining with modified Ziehl-Neelsen or Kinyoun techniques.
Immunofluorescence microscopy with fluorescein - labeled monoclonal antibodies allows for greater sensitivity and specificity.
Enzyme immunoassay for fecal Cryptosporidium antigen is more sensitive than microscopic examination for oocysts.
Sensitive and specific DNA-based assays for detection and speciation of C parvum and C hominis are available.
Intestinal biopsy can demonstrate Cryptosporidium within epithelial cells.
Treatment of immunocompetent people, when necessary, is with nitazoxanide.
Treatment of Cryptosporidiosis Nitazoxanide in patients without AIDS and with persistent infection Antiretroviral therapy (ART) in patients with AIDS; nitazoxanide may improve symptoms, but does not cure infection in patients with AIDS In immunocompetent people, cryptosporidiosis is self-limited.
For severe or persistent infections, oral nitazoxanide is used; the recommended doses, given for 3 days, are as follows: Age 1 to 3 years: 100 mg 2 times a day Age 4 to 11 years: 200 mg 2 times a day Age ≥ 12 years: 500 mg 2 times a day No drug has proven efficacy in immunosuppressed patients.
For HIV-infected patients, immune reconstitution with ART is key.
Nitazoxanide (500 to 1000 mg 2 times a day) for 14 days or longer has been effective in reducing symptoms in adults with CD4 counts > 50 / mcL.
Paromomycin, or a combination of paromomycin and azithromycin, may be tried to decrease diarrhea and recalcitrant malabsorption of antimicrobial drugs, which can occur with chronic cryptosporidiosis (1).
Supportive measures, oral or parenteral rehydration, and hyperalimentation may be needed for immunocompromised patients with severe disease.
Stools of patients with cryptosporidiosis are highly infectious; strict stool precautions should be observed.
For patients with AIDS, highly active antiretroviral therapy and supportive care are used; nitazoxanide may improve symptoms, but does not cure infection in persons with untreated AIDS.
Special biosafety guidelines have been developed for handling clinical specimens.
Boiling potentially contaminated water for 1 min (3 min at altitudes > 2000 m [6562 ft]) is the most reliable decontamination method; only filters with pore sizes ≤ 1 micrometer (specified as "absolute 1 micron" or certified under NSF / ANSI International Standard No.
53 or No.
58) remove Cryptosporidium cysts.
Key Points Cryptosporidiosis spreads easily because fecal excretion of oocysts persists for weeks after symptoms resolve, a very small number of oocysts are required for infection, and oocysts are difficult to remove by conventional water filtration and are resistant to chlorination.
Watery diarrhea with cramping is usually self-limited but can be severe and lifelong in patients with AIDS.
Diagnose using enzyme immunoassay for fecal Cryptosporidium antigen and microscopic stool examination; the latter is less sensitive and requires specialized techniques (eg, phase-contrast microscopy, acid-fast staining).
For people without AIDS, use nitazoxanide if symptoms persist.
Treat people with AIDS with ART; symptoms may abate when the immune system improves with ART.
Nitazoxanide can improve symptoms but does not cure infection in persons with AIDS.
US Department of Health and Human Services: Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children Centers for Disease Control and Prevention (CDC) Cryptosporidium Prevention & Control: Includes recommendations intended to help prevent and control cryptosporidiosis in the general public
Pathophysiology of Cryptosporidiosis Cryptosporidia are obligate, intracellular coccidian protozoa that replicate in small-bowel epithelial cells of a vertebrate host.
After Cryptosporidium oocysts are ingested, they excyst in the gastrointestinal tract and release sporozoites, which parasitize gastrointestinal epithelial cells.
Hookworm Infection (Ancylostomiasis) 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 Pathophysiology Symptoms and Signs Diagnosis Treatment Prevention Key Points Topic Resources Hookworm life cycle Cutaneous Larva Migrans (Foot) Ancylostomiasis is infection with the hookworm Ancylostoma duodenale or Necator americanus.
Only A duodenale occurs in the Middle East, North Africa, and southern Europe.
N americanus predominates in the Americas and Australia; it was once widely distributed in the southern United States and is still present in areas in that region where there is unsanitary disposal of human waste.
Hookworm remains endemic on islands of the Caribbean and in Central and South America.
Some strains of A ceylanicum, a hookworm of dogs, cats, and hamsters, also mature to adulthood in the human intestine.
Infections with A ceylanicum have been reported in residents of parts of Asia and some South Pacific islands.
Pathophysiology of Hookworm Infection The hookworm species that reach maturity in the human intestine have similar life cycles.
Eggs passed in the stool hatch in 1 to 2 days (if they are deposited in a warm, moist place on loose soil) and release rhabditiform larvae, which molt once to become slender filariform larvae in 5 to 10 days.
Filariform larvae penetrate human skin when people walk barefoot on or otherwise come into direct contact with infested soil.
The larvae reach the lungs via blood vessels, penetrate into pulmonary alveoli, ascend the bronchial tree to the epiglottis, and are swallowed.
Symptoms include rash at the site of larval entry and sometimes abdominal pain or other gastrointestinal symptoms during early infection.
The larvae develop into adults in the small bowel; there, they attach to the wall, feeding on blood.
Chronic blood loss leads to iron deficiency anemia.
Development of anemia depends on worm burden and the amount of absorbable iron in the diet.
Zoonotic (animal) hookworm infections Zoonotic hookworms infections include Cutaneous larva migrans Eosinophilic enterocolitis Ancylostoma braziliense and Ancylostoma caninum are hookworms that have cats and dogs as the primary hosts.
These hookworms cannot complete their life cycle in humans.
If their larvae penetrate human skin, they typically wander in the skin, causing cutaneous larva migrans, rather than migrate to the intestine.
Rarely, A caninum larvae migrate to the intestine, where they may cause eosinophilic enterocolitis.
However, they do not cause significant blood loss and anemia, and because they do not mature to full adulthood, they do not lay eggs (making diagnosis difficult).
Later, iron deficiency may develop because of chronic blood loss.
Symptoms and Signs of Hookworm Infection Hookworm infection is often asymptomatic.
However, a transient pruritic papulovesicular rash (ground itch) may develop at the site of larval penetration, usually on the feet.
Migration of large numbers of larvae through the lungs occasionally causes Löffler syndrome, with cough, wheezing, eosinophilia, and sometimes hemoptysis.
During the acute phase, adult worms in the intestine may cause colicky epigastric pain, anorexia, flatulence, diarrhea, and weight loss.
Chronic, heavy, intestinal infection can lead to iron deficiency anemia, causing pallor, dyspnea, weakness, tachycardia, lassitude, and peripheral edema.
A low-grade eosinophilia is often present.
In children, chronic blood loss may lead to severe anemia, heart failure, and anasarca and, in pregnant women, to growth retardation in the fetus.
Cutaneous larva migrans can occur when animal hookworms infect, but do not reach adulthood, in humans.
It is caused by larvae as they migrate through the skin and is characterized by itchy, erythematous, serpiginous skin lesions.
On rare occasion, A caninum larvae reach the human intestine where they cause eosinophilic enterocolitis with abdominal pain and associated symptoms.
Hookworms are a major cause of iron deficiency anemia in endemic regions.
Diagnosis of Hookworm Infection Microscopic examination of stool A duodenale, A ceylanicum, and N americanus produce thin-shelled oval eggs that are readily detected in fresh stool.
Concentration procedures are needed to diagnose light infections.
If the stool is not kept cold and examined within several hours, the eggs may hatch and release larvae that must be differentiated from those of Strongyloides stercoralis.
Although the three hookworm species that infect humans can be differentiated by molecular probes, the ova are indistinguishable, and a species-specific diagnosis is not made in clinical laboratories.
Eosinophilia is often present in people infected with hookworms.
During the prepatent period of infection (ie, the 5 to 9 weeks between penetration of larvae and appearance of eggs in the stool), eosinophilia may be the only laboratory abnormality.
Hookworm infestation is an important consideration in the differential diagnosis of eosinophilia in immigrants or travelers returning from endemic regions where sanitation is poor.
Nutritional status, anemia, and iron stores should be evaluated (see Diagnosis, Iron Deficiency Anemia).
Diagnosis of cutaneous larva migrans is based on the clinical manifestations.
Ova are not present in the stool.
Treatment of Hookworm Infection Anthelmintic drugs Intestinal hookworm infection Intestinal hookworm infection is treated with anthelminthic drugs.
One of the following drugs may be used: Albendazole 400 mg orally as a single dose Mebendazole 100 mg orally twice a day for 3 days or 500 mg as a single dose Pyrantel pamoate 11 mg / kg (maximum dose of 1 g) orally once a day for 3 days These drugs should only be used during pregnancy if benefits outweigh risks.
Ivermectin, a common anthelmintic, is not effective for intestinal hookworm infection.
General support and correction of iron deficiency anemia are needed if infection is heavy.
Cutaneous larva migrans Cutaneous larva migrans is a self-limited infection, but symptoms can last 5 to 6 weeks.
Treatment with albendazole 400 mg orally once a day for 3 or 7 days or ivermectin 200 mcg / kg as a single dose is curative.
Prevention of Hookworm Infection Preventing unhygienic defecation and avoiding direct skin contact with the soil (eg, wearing shoes, using barriers when seated on the ground) are effective in preventing hookworm infection but difficult to implement in many endemic areas.
Periodic mass treatment of susceptible populations at 3 - to 4-month intervals has been used in high-risk areas.
Risk of developing cutaneous larva migrans can be reduced by the following: Avoiding direct skin contact with potentially infested beach sand or other soil where dogs or cats have defecated.
Treating cats and dogs for hookworm Key Points Hookworm larvae penetrate the skin when people walk barefoot on or otherwise come into direct contact with infested soil.
In humans, larvae of the hookworms Ancylostoma duodenale or Necator americanus travel through the bloodstream to the lungs, penetrate the alveoli, ascend to the epiglottis, are swallowed, and then mature in the intestines.
Infection may be asymptomatic, but a pruritic rash may appear at the site of larval penetration, and pulmonary involvement may cause cough and wheezing.
Intestinal involvement may cause iron deficiency anemia.
Diagnose by microscopic examination of stool.
Treat with albendazole, mebendazole, or pyrantel pamoate.
The estimated worldwide prevalence of hookworm infection is 576 to 740 million, mostly in developing areas.
Both A duodenale and N americanus occur in Africa, Asia, and the Americas.
Spasmodic Dysphonia By Hayley L Born, MD, MS, Columbia University Reviewed / Revised Mar 2023 View Patient Education Treatment Spasmodic dysphonia (vocal cord spasms) is intermittent spasm of laryngeal muscles that causes an abnormal voice.
Because the effect of BoNT is temporary, injections must be repeated to maintain the improvement.
Selective laryngeal nerve section with reinnervation surgery is also an option in certain centers.
Laryngeal nerve section without reinnervation has been shown to result in synkinesis and is not the preferred approach to this condition.
For abductor spasmodic dysphonia, no known treatment permanently alleviates the disorder, but temporary improvement has been achieved with botulinum toxin delivered to the posterior cricoarytenoid muscle (sole vocal abductor, 1, 2).
Surgical medialization (shifting toward the midline by inserting an adjustable spacer laterally) of both vocal cords has some benefit for some patients (3).
Spasmodic dysphonia is an idiopathic dystonia that affects the muscles of the larynx during specific movements of the larynx.
As a localized form of movement disorder, spasmodic dysphonia has an onset between ages 30 and 50 years, and about 60% of patients are women.
There are 3 main forms: Adductor spasmodic dysphonia Abductor spasmodic dysphonia Mixed spasmodic dysphonia In adductor spasmodic dysphonia, a patient's voice sounds squeezed, effortful, or strained due to uncontrolled closure of the vocal folds during speech.
These spasmodic episodes usually occur when vowel sounds are being formed, particularly at the beginning of words.
In abductor spasmodic dysphonia, which is less common, sudden interruptions of sound caused by uncontrolled opening of the vocal cords are accompanied by an audible escape of air during connected speech.
Those with mixed spasmodic dysphonia may display features of both adductor and abductor spasmodic dysphonia to varying degrees and at different times.
(See also Overview of Laryngeal Disorders.)
Treatment of Spasmodic Dysphonia Botulinum toxin injection Selective laryngeal nerve section and reinnervation surgery For adductor spasmodic dysphonia, injection of botulinum toxin (BoNT) into vocal adductors has become the standard of care, with targeting injections achieving a normal voice in approximately 70% of patients for up to 3 months.
Complex Regional Pain Syndrome (CRPS) (Reflex Sympathetic Dystrophy and Causalgia) By James C Watson, MD, Mayo Clinic College of Medicine and Science Reviewed / Revised Mar 2022 | Modified Sep 2022 View Patient Education Etiology Pathophysiology Symptoms and Signs Diagnosis Prognosis Treatment Key Points More Information Complex regional pain syndrome (CRPS) is chronic neuropathic pain that follows soft-tissue or bone injury (type I) or nerve injury (type II) and lasts longer and is more severe than expected for the original tissue damage.
It commonly occurs after immobilization of the limb to treat the initial injury.
CRPS type II is similar to type I but involves overt damage to a peripheral nerve.
Pathophysiology of CRPS Pathophysiology is unclear, but peripheral nociceptor and central sensitization and release of neuropeptides (substance P, calcitonin gene-related peptide) help maintain pain and inflammation.
The sympathetic nervous system is more involved in CRPS than in other neuropathic pain syndromes.
Central sympathetic activity is increased, and peripheral nociceptors are sensitized to norepinephrine (a sympathetic neurotransmitter); these changes may lead to sweating abnormalities and poor blood flow due to vasoconstriction.
Nonetheless, only some patients respond to sympathetic manipulation (ie, central or peripheral sympathetic blockade).
Symptoms and Signs of CRPS Symptoms of complex regional pain syndrome vary greatly and do not follow a pattern; they may include sensory, focal autonomic (vasomotor or sudomotor), and motor abnormalities.
Symptoms are unilateral; bilateral symptoms at onset suggest a different diagnosis.
Pain—usually burning or aching—is a core diagnostic feature.
It does not follow the distribution of a single peripheral nerve; it is regional, even when caused by injury to a specific nerve, as occurs in CRPS type II.
Other manifestations include autonomic changes (eg, sweating, vasomotor abnormalities), motor changes (eg, weakness, dystonia), and trophic changes (eg, skin or bone atrophy, hair loss, joint contractures).
It may worsen with changes in the environment or emotional stress.
Allodynia and / or hyperalgesia are usually present, indicating central sensitization.
Pain often causes patients to limit use of an extremity.
Cutaneous vasomotor changes (eg, red, mottled, or ashen color; increased or decreased temperature) and sudomotor abnormalities (dry or hyperhidrotic skin) may be present.
Edema may be considerable and locally confined.
Other symptoms include trophic abnormalities (eg, shiny, atrophic skin; cracking or excess growth of nails; bone atrophy; hair loss) and motor abnormalities (weakness, tremors, spasm, dystonia with fingers fixed in flexion or equinovarus position of foot).
Range of motion is often limited, sometimes leading to joint contractures.
Symptoms may interfere with fitting a prosthesis after amputation.
Psychologic distress (eg, depression, anxiety, anger) is common, fostered by the poorly understood cause, lack of effective therapy, and prolonged course.
Diagnosis of CRPS Clinical evaluation Complex regional pain syndrome is diagnosed when the following are present: Patients have continuing pain beyond that explained by dysfunction of a single nerve and that is disproportionate to any original tissue damage.
Certain clinical criteria (Budapest criteria [1]) are met.
The Budapest criteria have four categories.
For CRPS to be diagnosed, the patient must report at least one symptom in three of the four categories, and the clinician must detect at least one sign in two of the same four categories (symptoms and signs overlap): Sensory: Hyperesthesia (as a sign, to pinprick) or allodynia (as a sign, to light touch, deep somatic pressure, and / or joint movement) Vasomotor: Temperature asymmetry (> 1° C as a sign) or asymmetric skin color changes Sudomotor or edema: Sweating changes, sweating asymmetry, or edema Motor or trophic: Trophic changes in skin, hair, or nails, decreased range of motion, or motor dysfunction (weakness, tremor, dystonia) Also, there must be no evidence of another disorder that could explain the symptoms.
If another disorder is present, CRPS should be considered possible or probable.
Bone changes (eg, demineralization on x-ray, increased uptake on a triple-phase radionuclide bone scan) may be detected and are usually evaluated only if the diagnosis is equivocal.
However, on imaging tests, bone may also look abnormal after trauma in patients without CRPS, making abnormalities detected by x-rays and bone scans nonspecific.
In one test of sympathetic involvement, a patient is given IV infusions of saline (placebo) or phentolamine 1 mg / kg over 10 minutes while pain scores are recorded; a decrease in pain after phentolamine but not placebo indicates sympathetically maintained pain.
Sympathetic nerve block (cervical stellate ganglion or lumbar) has been used for diagnosis (and is used for treatment).
However, false-positive and false-negative results are common because not all CRPS pain is sympathetically maintained and nerve block may also affect nonsympathetic fibers.
Diagnosis reference 1.
Treatment includes drugs, physical therapy, and sympathetic blockade.
Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR: Proposed new diagnostic criteria for complex regional pain syndrome.
Pain Med 8 (4): 326 - 331, 2007.
Prognosis for CRPS Prognosis varies and is difficult to predict.
CRPS may remit or remain stable for years; in a few patients, it progresses, spreading to other areas of the body.
Treatment of CRPS Multimodal therapy (eg, drugs, physical therapy, sympathetic blockade, psychologic treatments, neuromodulation, mirror therapy) The primary goal of all treatments for complex regional pain syndrome is to increase the mobility and use of the affected limb.
Treatment of CRPS is complex and often does not result in complete relief of symptoms, particularly if begun late.
It includes drugs, physical therapy, sympathetic blockade, psychologic treatments, and neuromodulation.
Few controlled trials have been done.
Many of the drugs used for neuropathic pain, including tricyclic antidepressants, antiseizure drugs, and corticosteroids, may be tried; none is known to be superior.
Long-term treatment with opioid analgesics may be useful for selected patients.
(See also Overview of Pain.)
Neuraxial infusion with opioids, anesthetics, ziconotide, and / or clonidine may help, and intrathecal baclofen may reduce dystonia.
The goals of physical therapy include desensitization, strengthening, increased range of motion, and vocational rehabilitation.
In some patients with sympathetically maintained pain, regional sympathetic blockade relieves pain, making physical therapy possible.
Oral analgesics (nonsteroidal anti-inflammatory drugs [NSAIDs], opioids, various adjuvant analgesics) may also relieve pain sufficiently to allow rehabilitation.
Desensitization of an allodynic limb involves first applying stimuli that are relatively nonirritating (eg, silk) and, then over time, increasing to more irritating stimuli (eg, denim).
Desensitization can also involve thermal contrast baths, in which the affected limb is placed in a cool water bath, then placed in a warm water bath.
Mirror therapy has been reported to benefit patients with CRPS type 1 due to phantom limb pain or stroke.
Patients straddle a large mirror between their legs.
The mirror reflects the image of the unaffected limb and hides the affected (painful or missing) limb, giving patients the impression that they have two normal limbs.
Patients are instructed to move the normal limb while viewing its reflected image in the mirror.
CRPS type I was previously known as reflex sympathetic dystrophy (see also Complex Regional Pain Syndrome: Treatment Guidelines), and type II was known as causalgia.
This exercise tricks the brain into thinking that the affected or absent limb is moving without pain.
Most patients who do this exercise for 30 minutes a day for 4 weeks report a substantial reduction in pain.
For neuromodulation, implanted spinal cord stimulators are commonly used; in severe cases with significant functional impairment, they should be considered early.
Dorsal root ganglion stimulation may target localized symptoms.
Transcutaneous electrical nerve stimulation (TENS), applied at multiple locations with different stimulation parameters, may be effective but requires a long trial.
In patients with complex regional pain syndrome, psychotherapy may be used to treat depression and anxiety; it may also help patients successfully improve function and their control over their life despite the chronic pain disorder.
Key Points Complex regional pain syndrome may follow injury (to soft tissue, bone, or nerve), amputation, acute myocardial infarction, stroke, or cancer or have no apparent precipitant.
Diagnose CRPS if patients have neuropathic pain, allodynia or hyperalgesia, and focal autonomic dysregulation when no other cause is identified.
Prognosis is unpredictable, and treatment is often unsatisfactory.
Both types occur most often in young adults and are 2 or 3 times more common among women.
Treat as early as possible using multiple modalities (eg, drugs used for neuropathic pain, physical therapy, sympathetic blockade, psychologic treatments, neuromodulation, mirror therapy).
More Information Complex Regional Pain Syndrome: Treatment Guidelines: This web site provides links to two guidelines: Harden RN, Oaklander AN, Burton AW, et al, Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 4th edition (2013) and The Royal College of Physicians, Complex Regional Pain Syndrome in Adults, 2nd edition (2018).
These guidelines aim to help health care practitioners effectively treat patients with complex regional pain syndrome and improve their ability to function.
Etiology of Complex Regional Pain Syndrome CRPS type I typically follows an injury (usually of a hand or foot), most commonly after crush injuries, especially in a lower limb.
It may follow amputation, acute myocardial infarction, stroke, or cancer (eg, lung, breast, ovary, central nervous system); no precipitant is apparent in about 10% of patients.
Overview of Cerebral Function By Juebin Huang, MD, PhD, Department of Neurology, University of Mississippi Medical Center Reviewed / Revised Oct 2021 | Modified Sep 2022 View Patient Education Pathophysiology Diagnosis Topic Resources Lobes of the brain Areas of the brain Homunculus The cerebrum is divided by a longitudinal fissure into 2 hemispheres, each containing 6 discrete lobes: Frontal Parietal Temporal Occipital Insula Limbic The frontal, temporal, parietal, and occipital lobes cover the brain's surface (see figure Lobes of the brain); the insula is hidden under the Sylvian fissure.
Olfactory pathways bypass the thalamus and go directly to specialized areas of the cortex.
Sensory stimuli are further processed in association areas that relate to one or more senses.
The primary motor cortex generates volitional body movements; motor association areas help plan and execute complex motor activity.
Each unimodal association area is adjacent to its corresponding primary sensory area and processes information from that area at a higher level than the primary sensory area.
Heteromodal association areas are not restricted to any single motor or sensory function but receive convergent information from multiple sensory and motor areas of the brain.
Heteromodal association areas in the frontal, temporal, and parietal lobes integrate sensory data, motor feedback, and other information with instinctual and acquired memories.
This integration facilitates learning and creates thought, expression, and behavior.
Frontal lobes The frontal lobes are anterior to the central sulcus.
They are essential for planning and executing learned and purposeful behaviors; they are also the site of many inhibitory functions.
There are several functionally distinct areas in the frontal lobes: The primary motor cortex is the most posterior part of the precentral gyrus.
The limbic lobe (limbic system) is a C-shaped area on the most medial edge of each cerebral hemisphere; it includes some parts of the adjacent lobes.
The primary motor cortex on one side controls all moving parts on the contralateral side of the body (shown on a spatial map called a homunculus—see figure Homunculus); 90% of motor fibers from each hemisphere cross the midline in the lower brain stem and upper cervical spinal cord.
Thus, damage to the motor cortex of one hemisphere causes weakness or paralysis mainly on the contralateral side of the body.
The medial frontal cortex (sometimes called the medial prefrontal area) is important in arousal and motivation.
If lesions in this area are large and extend to the most anterior part of the cortex (frontal pole), patients sometimes become abulic (apathetic, inattentive, and markedly slow to respond).
The orbital frontal cortex (sometimes called the orbital prefrontal area—see figure Areas of the brain) helps modulate social behaviors.
Patients with orbital frontal lesions can become emotionally labile, indifferent to the implications of their actions, or both.
They may be alternately euphoric, facetious, vulgar, and indifferent to social nuances.
Bilateral acute trauma to this area may make patients boisterously talkative, restless, and socially intrusive.
The disinhibition and abnormal behaviors that can occur with aging and in many types of dementia probably result from degeneration of the frontal lobe, particularly the orbital frontal cortex.
The left posteroinferior frontal cortex (sometimes called the Broca area or posteroinferior prefrontal area—see figure Areas of the brain) controls expressive language function.
Although specific functions are attributed to each lobe, most activities require coordination of multiple areas in both hemispheres.
Lesions in this area cause expressive aphasia (impaired expression of words).
The dorsolateral frontal cortex (sometimes called the dorsolateral prefrontal area) manipulates very recently acquired information—a function called working memory.
Lesions in this area can impair the ability to retain information and process it in real time (eg, to spell words backwards or to alternate between letters and numbers sequentially).
The amount of cortical space given to a body part varies; eg, the area of the cortex that controls the hand is larger than the area that controls the shoulder.
The map of these parts is called the homunculus ("little person").
Parietal lobes Several areas in the parietal lobes have specific functions.
The primary somatosensory cortex, located in the postrolandic area (postcentral gyrus) in the anterior parietal lobes, integrates somesthetic stimuli for recognition and recall of form, texture, and weight.
The primary somatosensory cortex on one side receives all somatosensory input from the contralateral side of the body (see figure Homunculus).
Lesions of the anterior parietal lobe can cause difficulty recognizing objects by touch (astereognosis).
Areas posterolateral to the postcentral gyrus generate visual-spatial relationships and integrate these perceptions with other sensations to create awareness of trajectories of moving objects.
These areas also mediate proprioception (awareness of the position of body parts in space).
Parts of the midparietal lobe of the dominant hemisphere are involved in abilities such as calculation, writing, left-right orientation, and finger recognition.
Lesions in the angular gyrus can cause deficits in writing, calculating, left-right disorientation, and finger-naming (Gerstmann syndrome).
The nondominant parietal lobe integrates the contralateral side of the body with its environment, enabling people to be aware of this environmental space, and is important for abilities such as drawing.
Acute injury to the nondominant parietal lobe may cause neglect of the contralateral side (usually the left), resulting in decreased awareness of that part of the body, its environment, and any associated injury to that side (anosognosia).
For example, patients with large right parietal lesions may deny the existence of left-sided paralysis.
Patients with smaller lesions may lose the ability to do learned motor tasks (eg, dressing, other well-learned activities) —a spatial-manual deficit called apraxia.
Temporal lobes The temporal lobes are integral to auditory perception, receptive components of language, visual memory, declarative (factual) memory, and emotion.
Patients with right temporal lobe lesions commonly lose the ability to interpret nonverbal auditory stimuli (eg, music).
Lobes of the brain Brain function is extensively lateralized.
Left temporal lobe lesions interfere greatly with the recognition, memory, and formation of language.
Occipital lobes The occipital lobes contain The primary visual cortex Visual association areas Lesions in the primary visual cortex lead to a form of cortical blindness; in one form, called Anton syndrome, patients become unable to recognize objects by sight and are generally unaware of their deficits, often confabulating descriptions of what they see.
Seizures involving the occipital lobe can cause visual hallucinations, often consisting of lines or meshes of color superimposed on the contralateral visual field.
Insula The insula integrates sensory and autonomic information from the viscera.
It plays a role in certain language functions, as evidenced by aphasia in patients with some insular lesions.
The insula processes aspects of pain and temperature sensation and possibly taste.
Limbic lobe The limbic lobe (limbic system) includes structures that receive inputs from diverse areas of the brain and that participate in complicated, interrelated behaviors (eg, memory, learning, emotion).
Lesions that affect the limbic system usually result in a variety of deficits.
Patients with epileptogenic foci in the medial limbic-emotional parts of the temporal lobe commonly have complex partial seizures, characterized by uncontrollable feelings and autonomic, cognitive, or emotional dysfunction.
Occasionally, such patients have personality changes, characterized by humorlessness, philosophic religiosity, and obsessiveness.
Visual, tactile, and motor activities of the left side of the body are directed predominantly by the right hemisphere and vice versa.
Patients may have olfactory hallucinations and hypergraphia (an overwhelming urge to write).
Pathophysiology of Cerebral Dysfunction Cerebral dysfunction may be focal or global.
Focal and global processes can manifest as deficits or become foci for seizure activity.
These processes may also affect subcortical systems, altering arousal (eg, causing stupor or coma) or integration of thought (eg, causing delirium).
Focal dysfunction usually results from Structural abnormalities (eg, tumors, abscesses, stroke, trauma, malformations, gliosis, demyelination) Manifestations depend on the lesion's location, size, and development rate.
Lesions that are < 2 cm in diameter or that develop very slowly may be asymptomatic.
Larger lesions, rapidly developing lesions (over weeks or months rather than years), and lesions that simultaneously affect both hemispheres are more likely to become symptomatic.
Focal lesions in white matter can interrupt the connectivity between brain areas and cause the disconnection syndrome (inability to do a task that requires coordinated activity of ≥ 2 brain regions, despite retention of basic functions of each region).
Global dysfunction is caused by Toxic-metabolic disorders, including hypoxia and ischemia (commonly) Diffuse inflammation Vasculopathy Major trauma Disseminated cancer Degenerative disorders Global dysfunction may also result from disorders that occur in a specific area of the brain (eg, abscesses, tumors, trauma) if they increase intracranial pressure or cause herniation.
These disorders affect multiple dimensions of cerebral function.
Certain complex functions involve both hemispheres but are directed predominantly by one (cerebral dominance).
Recovery Recovery from brain injury depends in part on the following characteristics of the brain: Plasticity of the remaining cerebrum Redundancy Plasticity (ability of an area of the brain to alter its function) of the cerebrum varies from person to person and is affected by age and general health.
Plasticity is most prominent in the developing brain.
For example, if the dominant hemisphere language areas are severely damaged before age 8 years, the opposite hemisphere can often assume near-normal language function.
Although capacity for recovery from brain injury is considerable after the first decade of life, severe damage more often results in permanent deficits.
Gross reorganization of brain function after injury in adults is uncommon, although plasticity remains operative in certain specific areas of the brain throughout life.
Redundancy refers to the ability of more than one area of the brain to perform the same function.
Cerebral dysfunction syndromes Specific syndromes include Agnosia Amnesia (including transient global amnesia) Aphasia Apraxia Psychiatric conditions (eg, depression, psychosis, anxiety disorders) sometimes include similar elements.
Dysarthria, a neuromotor disorder, may cause symptoms similar to those of aphasia.
Diagnosis of Cerebral Dysfunction Clinical evaluation Often neuropsychologic testing In general, diagnosis of cerebral dysfunction is clinical, often assisted by neuropsychologic testing.
This standardized testing provides information about the brain's structural and functional integrity.
For example, the left hemisphere is typically dominant for language, and the right is dominant for spatial attention.
It evaluates intelligence, executive function (eg, planning, abstraction, conceptualization), attention, memory, language, perception, sensorimotor functions, motivation, mood and emotion, quality of life, and personality.
Diagnosis of the cause usually requires laboratory tests (blood and sometimes analysis of cerebrospinal fluid) and brain imaging, either structural (CT, MRI) or functional (positron emission tomography [PET], single-photon emission CT).
The cerebral cortex (see figure Areas of the brain) contains The primary sensory areas The primary motor cortex Multiple association areas, including unimodal and heteromodal association areas Areas of the brain The primary sensory areas receive somesthetic, auditory, visual, and gustatory stimuli from the thalamus, which receives stimuli from specialized sensory organs and peripheral receptors.
Primary Myelofibrosis By Jane Liesveld, MD, James P Wilmot Cancer Institute, University of Rochester Medical Center Reviewed / Revised Jul 2022 | Modified Sep 2022 View Patient Education Pathophysiology Symptoms and Signs Diagnosis Prognosis Treatment Key Points Topic Resources Conditions Associated With... Primary myelofibrosis (PMF) is a chronic myeloproliferative neoplasm characterized by bone marrow fibrosis, splenomegaly, and anemia with nucleated and teardrop-shaped red blood cells.
Mutations of the Janus kinase 2 (JAK2) gene are present in a high proportion of cases of primary myelofibrosis.
JAK2 is a member of the class I type tyrosine kinase family of enzymes and is involved in signal transduction for erythropoietin, thrombopoietin, and granulocyte colony-stimulating factor (G-CSF) receptors among other entities.
Mutations of the thrombopoietin receptor gene (MPL) or the calreticulin (CALR) gene also may be the cause of primary myelofibrosis.
However, there are rare cases of primary myelofibrosis in which none of these three mutations are present (triple negative primary myelofibrosis).
Some of these patients have other uncommon MPL mutations, which can only be detected by next generation sequencing.
In primary myelofibrosis, nucleated red blood cells (normoblasts) and myelocytes are released into the circulation (leukoerythroblastosis) when there is extramedullary hematopoiesis (ie, non-marrow organs have taken over blood cell production because of the fibrosed marrow).
Bone marrow failure eventually occurs, with consequent anemia and thrombocytopenia.
Rapidly progressive, chemotherapy-incurable acute leukemia develops in about 30% of patients.
Malignant myelofibrosis (sometimes called acute myelofibrosis), is a rare variant of myelofibrosis characterized by pancytopenia, myeloblastosis, and marrow fibrosis that has a more rapidly progressive downhill course and is generally due to a type of acute leukemia called acute megakaryoblastic leukemia.
Diagnosis requires bone marrow aspirate and biopsy and exclusion of other conditions that can cause myelofibrosis (secondary myelofibrosis).
Table Symptoms and Signs of Primary Myelofibrosis In many patients, myelofibrosis is asymptomatic.
Other patients have anemia, splenomegaly, or, in later stages, general malaise, weight loss, fever, or splenic infarction.
Lymphadenopathy is rare.
Severe extramedullary hematopoiesis can disturb the function of organs in which it occurs, including the brain.
Diagnosis of Primary Myelofibrosis Complete blood count (CBC) and peripheral blood smear Bone marrow aspirate and biopsy Testing for JAK2, CALR, and MPL mutations Primary myelofibrosis should be suspected in patients with splenomegaly, splenic infarction, and anemia.
If the disorder is suspected, CBC should be done and peripheral blood morphology and a bone marrow biopsy should be examined.
If myelofibrosis is present on bone marrow aspirate and biopsy (as detected by reticulin staining or trichrome staining, indicating excess collagen and osteosclerosis), other disorders associated with myelofibrosis (see table Conditions Associated With Myelofibrosis) should be excluded by appropriate clinical and laboratory evaluation.
The diagnosis of primary myelofibrosis is confirmed by detecting a mutation in JAK2, CALR, or MPL.
In some cases, none of these mutations is expressed (triple-negative myelofibrosis).
Treatment is often supportive, but Janus kinase 2 (JAK2) inhibitors, such as ruxolitinib, fedratinib, or pacritnib, may decrease symptoms and stem cell transplantation may be curative.
A broader next-generation sequencing panel may detect gene mutations associated with increased risk of leukemic transformation and may therefore be useful for prognosis.
Anemia is typically present and usually increases over time.
Blood cell morphology is variable.
Reticulocytosis and polychromatophilia may be present; teardrop-shaped RBCs (dacryocytes) are characteristic morphologic features.
Nucleated RBCs and neutrophil precursors are typically present in peripheral blood.
White blood cell counts are usually increased but are highly variable.
In advanced stages, myeloblasts may be present, even in the absence of acute leukemia.
Platelet counts initially may be high, normal, or decreased; however, thrombocytopenia tends to supervene as the disorder progresses.
Prognosis for Primary Myelofibrosis The median survival in primary myelofibrosis is 5 years from onset, but variation is wide; some patients have a rapidly progressing disorder, including development of acute myeloid leukemia, with short survival, but most have a more indolent course.
Only allogeneic stem cell transplantation is curative.
Unfavorable prognostic markers include hemoglobin < 10 g / dL (< 100 g / L), a history of transfusions, leukocytosis, and a platelet count < 100, 000 / mcL (< 1000 × 10 9 / L).
Patients in the least favorable risk group usually survive < 1 year, but those with low-risk disease have a median survival of 10 years.
Several prognostic scoring systems are available to predict survival.
A number of useful risk stratification systems are available to aid prognosis and guide decisions to institute medical therapy or stem cell transplantation.
The The Dynamic International Prognostic Scoring System (DIPSS) for Myelodysplastic Syndromes can be used to predict progression or survival as the disease evolves (1).
Some scoring systems also incorporate cytogenetics and molecular markers (eg, DIPSS-Plus).
Validated symptom assessment tools (eg, Myelofibrosis Symptom Assessment Form) are also available for patients with myelofibrosis and can be useful to monitor therapeutic responses.
Pathophysiology of Primary Myelofibrosis Myelofibrosis is a reactive, reversible increase in bone marrow collagen often with extramedullary hematopoiesis (primarily in the spleen).
Leukemia 31 (12): 2726 - 2731, 2017. doi: 10.1038 / leu.2017.169 Treatment of Primary Myelofibrosis Symptomatic therapy Sometimes interferon Sometimes ruxolitinib, fedratinib, or pacritinib Sometimes allogeneic stem cell transplantation Treatment is directed at symptoms and complications.
Some patients can be observed without treatment.
In early primary myelofibrosis, pegylated interferon has been shown to reduce marrow fibrosis and spleen size and can be used for low-risk patients as defined by various prognostic scoring systems (1).
Currently, for advanced primary myelofibrosis, the nonspecific JAK pathway inhibitor ruxolitinib is the therapy of choice in patients with a platelet count > 50, 000 / mcL (50, 000 × 10 9 / L).
Ruxolitinib is effective whether or not a JAK2 mutation or splenomegaly is present.
The main adverse effects of ruxolitinib are anemia and thrombocytopenia.
Myelofibrosis may be Primary (more common) Secondary to a number of hematologic, malignant, and nonmalignant conditions (see table Conditions Associated With Myelofibrosis).
Care must be taken when stopping ruxolitinib because a withdrawal syndrome may occur, with significant worsening of symptoms in part due to splenic enlargement and a rebound in inflammatory cytokines.
Low-dose corticosteroids may be used short term for symptom control.
When splenomegaly is significant, ruxolitinib can precipitate tumor lysis syndrome.
Fedratinib, also a JAK-2 inhibitor, can be used when there is resistance or intolerance to ruxolitinib.
Some patients who develop intolerance to ruxolitinib may be able to tolerate it again after a period off the drug.
A third JAK-2 inhibitor, pacritinib is available for patients whose platelets counts are too low to initiate ruxolitinib.
For patients with advanced disease, allogeneic stem cell transplantation may be beneficial.
Nonmyeloablative allogeneic stem cell transplantation has been successfully used in older patients.
Androgens, erythropoietin, splenectomy, chemotherapy, thalidomide, lenalidomide, splenic embolization, and radiation therapy have been tried for palliation.
Of these, low-dose thalidomide and prednisone can be effective in controlling splenomegaly, anemia, thrombocytopenia, and circulating blast cells.
Primary myelofibrosis results from neoplastic transformation of a multipotent bone marrow stem cell.
Splenectomy should be avoided if possible; splenic irradiation has only a temporary effect and can cause severe neutropenia and infection.
Among agents that are under investigation for treatment of myelofibrosis is luspatercept, an activin receptor ligand trap.
Canc Res 82: 749 - 763, 2022. doi: 10.1158/0008 - 5472.CAN-21 - 2930 Key Points Myelofibrosis is excessive bone marrow fibrosis, often with loss of hematopoietic cells and consequent extramedullary hematopoiesis.
Myelofibrosis is often primary but may occur secondary to a number of hematologic, malignant, and nonmalignant disorders, including polycythemia vera and essential thrombocytosis.
Primary myelofibrosis is a clonal hematopoietic disorder and often involves JAK2, CALR, or MPL mutations.
Diagnose with blood count, examination of peripheral blood smear and bone marrow, and molecular testing for JAK2, MPL, and / or CALR mutations.
Some patients have an indolent course and do not require therapy immediately, but some patients have a rapidly progressive downhill course with short survival.
These primary myelofibrosis progeny cells stimulate bone marrow fibroblasts (which are not part of the neoplastic transformation) to secrete excessive collagen.
Ruxolitinib is the therapy of choice for control of symptoms; allogeneic stem cell transplantation is of benefit in selected cases.
The peak incidence of primary myelofibrosis is between 50 and 70 years and predominantly in males.
Cancer Diagnosis By Robert Peter Gale, MD, PhD, DSC (hc), Imperial College London Reviewed / Revised Sep 2022 View Patient Education History Physical examination Testing Staging A diagnosis of cancer may be suspected based on history and physical examination but requires confirmation by biopsy and histopathologic examination.
Testing Tests include imaging tests, biomarkers, and biopsies; one or more of which may be indicated in patients with a suggestive history or physical or laboratory findings.
Imaging tests include plain x-rays, ultrasonography, CT, positron emission tomography (PET), and MRI studies.
These tests assist in identifying abnormalities, determining qualities of a mass (solid or cystic), providing dimensions, and establishing relationship to surrounding structures, which may be important if surgery or biopsy is being considered.
Biomarkers may offer corroborating evidence in patients with findings suggestive of a specific cancer (see Tumor Immunodiagnosis).
Most are not used as routine screening tests, except in high-risk patients.
Useful examples include Alpha-fetoprotein (hepatocellular carcinoma, testicular carcinoma) Carcinoembryonic antigen (colon cancer) Beta - human chorionic gonadotropin (choriocarcinoma, testicular carcinoma) Serum immunoglobulins (multiple myeloma) Molecular tests (diverse cancers) CA 125 (ovarian cancer) CA 27 - 29 (breast cancer) PSA (prostate-specific antigen— prostate cancer) Some of these biomarkers may be most useful in monitoring the response to treatment rather than in tumor detection.
Biopsy to confirm the diagnosis and tissue of origin is almost always required when cancer is suspected.
The choice of biopsy site is usually determined by ease of access and degree of invasiveness.
If lymphadenopathy is present, fine-needle or core biopsy may reveal the cancer type.
Core biopsies or lymph node excision are recommended for diagnosis of lymphomas because preservation of nodal architecture is important for accurate histologic diagnosis.
Sometimes the first indication is an abnormal laboratory test result (eg, anemia resulting from colon cancer).
Sometimes an open biopsy is needed.
Other biopsy routes include bronchoscopy or mediastinoscopy for easily accessible mediastinal or central pulmonary tumors, percutaneous liver biopsy if liver lesions are present, and CT - or ultrasound-guided biopsy of lung or soft tissue masses.
Grading is a histologic measure of cancer aggressiveness and provides important prognostic information.
Grade is based on the morphologic appearance of cancer cells, including the appearance of the nuclei, cytoplasm, and nucleoli; frequency of mitoses; and amount of necrosis.
For many cancers, grading scales have been developed.
Molecular tests such as chromosomal analysis, fluorescent in situ hybridization (FISH), polymerase chain reaction (PCR), and cell surface antigen testing (eg, in lymphomas, leukemias, lung, and gastrointestinal cancers) help delineate the origin of metastatic cancers, particularly for cancers of unknown primary origin, and may be helpful in selecting therapy.
Staging Once a histologic diagnosis is made, staging (ie, determination of the extent of disease) helps in treatment decision-making and influences prognosis.
Clinical staging uses data from the history, physical examination, imaging tests, laboratory tests, and biopsy of bone marrow, lymph nodes, or other sites of suspected disease.
For staging of specific neoplasms, see details in the organ-relevant discussion.
A complete history and physical examination may reveal unexpected clues to early cancer.
Imaging tests Imaging tests, especially CT, PET, and MRI, can detect metastases to brain, lungs, or abdomen, including the adrenal glands, retroperitoneal lymph nodes, liver, and spleen.
MRI (with gadolinium contrast) is the procedure of choice for recognition and evaluation of brain cancers, primary and metastatic.
PET scanning is increasingly being used to determine the metabolic activity of a suspect lymph node, lung nodule, or other mass.
Integrated PET-CT can be valuable, especially in lung, head and neck, and breast cancer and in lymphoma.
Ultrasonography can be used to study breast, ovarian, orbital, thyroid, cardiac, pericardial, hepatic, pancreatic, renal, testicular, and retroperitoneal masses.
It may help guide percutaneous biopsies and differentiate fluid-filled cysts from solid masses.
Nuclear scans can identify several types of metastases (eg, thyroid cancer).
Bone scans identify abnormal bone growth (ie, osteoblastic activity) before it is visible on plain x-ray.
Thus, bone scans are useless in neoplasms that are purely lytic (eg, multiple myeloma); routine bone x-rays are the study of choice in such diseases.
Laboratory tests Serum chemistry and enzyme measurements may help staging.
(See also Overview of Cancer.)
Elevated liver enzyme (alkaline phosphatase, lactate dehydrogenase, alanine aminotransferase) levels and elevated bilirubin levels suggest liver metastases.
Elevated serum alkaline phosphatase and calcium may be the first evidence of bone metastases.
Elevated blood urea nitrogen or creatinine levels may indicate cancer involvement of the kidney, collecting system, or bladder.
Elevated uric acid levels often occur in patients with rapidly proliferating cancers and in those with myeloproliferative and lymphoproliferative disorders.
However, most people with an increased uric acid level do not have cancer.
Invasive tests Mediastinoscopy is especially valuable in the staging of non-small cell lung cancer.
When mediastinal lymph node involvement is found, patients may benefit from pre-surgery chemotherapy and / or radiation therapy.
Bone marrow aspiration and biopsy are especially useful in detecting involvement by leukemias, lymphomas, and plasma cell myeloma (multiple myeloma) and metastases from small cell lung, breast, and prostate cancers.
Bone marrow biopsy may be informative in patients with unexplained hematologic abnormalities (ie, anemia, thrombocytopenia, pancytopenia).
Biopsy of sentinel regional lymph nodes is part of the evaluation of many cancers, such as breast, thyroid, gastric, lung, and colon cancers and melanoma.
History Physicians must be aware of predisposing factors and must specifically ask about familial cancers, environmental exposures (including smoking history), and prior or present illnesses (eg, autoimmune disorders, previous immune-suppressing therapy, hepatitis B or hepatitis C infection, HIV infection, abnormal Papanicolaou test, human papillomavirus infection).
Removal of a sentinel lymph node (as defined by uptake of contrast or radioactivity injected into the cancer) may allow limited but definitive lymph node sampling in patients with these cancers.
Symptoms suggesting occult cancer can include Fatigue Weight loss Fevers Night sweats Cough Hemoptysis Hematemesis Hematochezia Change in bowel habits Persistent pain Other symptoms may be present depending on the site of cancer (eg, hoarseness in laryngeal cancer or abnormal vaginal bleeding in uterine cancer).
Physical examination Particular attention should be paid to skin, lymph nodes, lungs, breasts, abdomen, and testes.
Findings help direct further testing, including x-rays and biopsies.
Infantile Hemangiomas By Denise M Aaron, MD, Dartmouth Geisel School of Medicine Reviewed / Revised Jan 2022 | Modified Sep 2022 View Patient Education Symptoms and Signs Diagnosis Treatment Key Points Topic Resources Periocular Infantile Hemangioma Infantile hemangiomas are raised, red or purplish, hyperplastic vascular lesions appearing in the first year of life.
Lesions can bleed or ulcerate from minor trauma; ulcers may be painful.
Infantile hemangiomas in certain locations can interfere with function.
Lesions on the face or oropharynx may interfere with vision or obstruct the airway; those near the urethral meatus or anus may interfere with elimination.
A periocular hemangioma in an infant is considered an emergency and should be attended to promptly to avoid permanent visual defects.
Lumbosacral hemangiomas may be a sign of underlying neurologic or genitourinary anomalies.
Lesions slowly involute starting at 12 to 18 months, decreasing in size and vascularity.
Generally, infantile hemangiomas involute by 10% / year of age (eg, 50% by age 5, 60% by age 6), with maximal involution by age 10.
Involuted lesions commonly have a yellowish or telangiectatic color and a wrinkled or lax fibrofatty texture.
Residual changes are almost always proportional to the lesion's maximal size and vascularity.
Diagnosis of Infantile Hemangiomas Clinical evaluation Diagnosis of infantile hemangiomas is clinical; the extent can be evaluated by MRI if lesions appear to encroach on vital structures.
Most spontaneously involute; those obstructing vision, the airway, or other structures require treatment.
Treatment of Infantile Hemangiomas Individualized based on location, size, and severity of lesions For superficial or uncomplicated lesions that require treatment, possibly topical or intralesional corticosteroids or topical beta-blockers (1) For complicated or high-risk lesions requiring treatment, oral propranolol (2) General wound care for ulcerated lesions Usually avoidance of surgery There is no universal infantile hemangioma treatment recommendation.
Because most lesions resolve spontaneously, observation is usually indicated before initiating treatment.
Treatment should be considered for complicated or high-risk lesions, ie, those that Threaten life Threaten function (eg, vision) Involve large areas of the face Are distributed over the beard area Are ulcerated Are multiple Are lumbosacral Topical treatments and wound care are useful for ulcerated lesions and help prevent scarring, bleeding, and pain.
Compresses, topical mupirocin or metronidazole, barrier dressings (generally polyurethane film dressing or petrolatum-impregnated gauze), or barrier creams may be used to prevent infection and / or reduce colonization.
Unless complications are life threatening or vital organs are compromised, surgical excision or other destructive procedures should be avoided because they frequently cause more scarring than occurs with spontaneous involution.
Ideal treatment varies based on many patient-specific factors.
Pediatrics 128 (2): e259 - 266, 2011. doi: 10.1542 / peds.2010 - 0029 Key Points Infantile hemangiomas affect 10 to 12% of infants by age 1 year.
Lesions slowly involute starting at 12 to 18 months, with maximal involution by age 10 years.
Use topical treatments and wound care for ulcerated lesions and to help prevent scarring, bleeding, and pain.
Unless complications are life threatening or vital organs are compromised, avoid surgery.
Infantile hemangioma is the most common tumor of infancy, affecting 10 to 12% of infants by age 1 year.
Infantile hemangioma is present at birth in 10 to 20% of affected infants and almost always within the first several weeks of life; occasionally, deeper lesions may not be apparent until a few months after birth.
Size and vascularity increase rapidly, usually peaking at about age 1 year.
Infantile hemangiomas can be classified by general appearance (superficial, deep, or cavernous) or by other descriptive terms (eg, strawberry hemangioma).
However, because all of these lesions share a common pathophysiology and natural history, the inclusive term infantile hemangioma is preferred.
Symptoms and Signs of Infantile Hemangiomas Superficial lesions have a bright red appearance; deeper lesions have a bluish color.
Definition of Dermatitis (Eczema) By Thomas M Ruenger, MD, PhD, Georg-August University of Göttingen, Germany Reviewed / Revised Jan 2023 View Patient Education The meaning of the word "dermatitis" is inflammation of the skin.
Erythroderma can be caused by a dermatitis, but it can also be caused by nondermatitis skin disorders.
Symptoms and signs of dermatitis disorders result from their histologic features: Erythema (due to dermal inflammation and increased blood flow) Skin thickening (due to cellular epidermal infiltrate and edema) Scaling (due to hyperproliferation of the epidermis and hyperkeratosis) Pruritus (possibly due to histamine released during inflammation) Erosions and possibly oozing, crusting, and secondary infection, all resulting from pruritus-induced scratching The most prominent manifestations in the acute phase of dermatitis are erythema and scaling.
The most prominent manifestations in the chronic phase of dermatitis are skin thickening and lichenification.
However, in clinical dermatology, dermatitis is used to describe a variety of different skin conditions that share the same inflammatory reaction pattern with similar clinical manifestations.
Histologically, lymphocytes extravasate into the dermis and then migrate into the epidermis, triggering intercellular epidermal edema (spongiosis), hyperproliferation, thickening, and hyperkeratosis.
The dermatopathologic term for this process is spongiotic dermatitis or eczematous dermatitis.
Although different types of dermatitis may differ in some minor histologic features, they cannot be clearly differentiated by histologic features alone.
Eczema is synonymous with dermatitis but is often used, mainly by non-health care practitioners, to mean atopic dermatitis (a specific type of dermatitis).
Lichenoid dermatitis and interface dermatitis are histologic terms and do not indicate dermatitis clinically.
The term "exfoliative dermatitis" should no longer be used.
It was previously used to describe erythroderma.
Diagnostic Tests for Skin Disorders By Julia Benedetti, MD, Harvard Medical School Reviewed / Revised Dec 2021 | Modified Sep 2022 View Patient Education Topic Resources Tzanck Test Diagnostic tests are indicated when the cause of a skin lesion or disease is not obvious from history and physical examination alone.
For fungal infection, scale is taken from the border of the lesion and placed onto a microscope slide.
Then a drop of 10 to 20% potassium hydroxide is added.
Hyphae, budding yeast, or both confirm the diagnosis of tinea or candidiasis.
For scabies, scrapings are taken from suspected burrows and placed directly under a coverslip with mineral oil; findings of mites, feces, or eggs confirm the diagnosis.
However, a negative scraping does not rule out scabies.
Wood light A Wood light (black light) can help clinicians diagnose and define the extent of lesions (eg, borders of pigmented lesions before excision).
It can help distinguish hypopigmentation from depigmentation (depigmentation of vitiligo fluoresces ivory-white and hypopigmented lesions do not).
Erythrasma fluoresces a characteristic bright orange-red.
Tinea capitis caused by Microsporum canis and M audouinii fluoresces a light, bright green.
(NOTE: Most tinea capitis in the US is caused by Trichophyton species, which do not fluoresce.)
These include Patch testing Biopsy Scrapings Examination by Wood light Tzanck testing Diascopy (See also Evaluation of the Dermatologic Patient.)
The earliest clue to cutaneous Pseudomonas infection (eg, in burns) may be green fluorescence.
Tzanck testing Tzanck testing can be used to diagnose viral disease, such as herpes simplex and herpes zoster, and is done when active intact vesicles are present.
Tzanck testing cannot distinguish between herpes simplex and herpes zoster infections.
An intact blister is the preferred lesion for examination.
The blister roof is removed with a sharp blade, and the base of the unroofed vesicle is scraped with a #15 scalpel blade.
The scrapings are transferred to a slide and stained with Wright stain or Giemsa stain.
Multinucleated giant cells are a sign of herpes infection.
Diascopy Diascopy is used to determine whether erythema in a lesion is due to blood within superficial vessels (inflammatory or vascular lesions) or is due to hemorrhage (petechiae or purpura).
A microscope slide is pressed against a lesion (diascopy) to see whether it blanches.
Hemorrhagic lesions do not blanch; inflammatory and vascular lesions do.
Biopsy There are several types of skin biopsy: Punch Shave Wedge excision In a punch biopsy, a tubular punch (diameter usually 4 mm) is inserted into deep dermal or subcutaneous tissue to obtain a specimen, which is snipped off at its base.
Diascopy can also help identify sarcoid skin lesions, which, when tested, turn an apple jelly color.
Shaving with a scalpel or razor blade may be done for more superficial lesions.
Bleeding is controlled by aluminum chloride solution or electrodesiccation; large incisions are closed by sutures.
Wedge excision of skin using a scalpel can be done for larger or deeper biopsies.
Pigmented lesions are often excised for histologic evaluation of depth; if too superficial, definitive diagnosis may be impossible.
Diagnosis and cure can often be achieved simultaneously for most small tumors by complete excision that includes a small border of normal skin.
Scrapings Skin scrapings help diagnose fungal infections and scabies.
The lower part of the anal canal, below the dentate line, is lined by stratified squamous epithelium.
This epithelium has dense innervation by somatic nerve fibers and is quite sensitive.
Step-by-Step Description of Anoscopy Pull the buttocks apart and visually inspect the external area.
Insert a lubricated gloved finger to do a routine digital rectal exam (use topical anesthetic jelly if patient has severe anal pain and does not have an allergy).
If using a topical anesthetic jelly, wait 1 to 2 minutes to give the anesthetic time to take effect.
If there is no gross blood, test any stool obtained for fecal occult blood, if indicated, and change glove on this hand.
Lubricate the anoscope and the central guide plug.
After the anoscope is completely inserted, remove the central guide plug (keep the plug available because it may be needed again).
If using a nonslotted anoscope, slowly rotate it as you withdraw it and inspect the entire mucosa for masses, lesions, hemorrhoids, or fissures.
Any fecal material or blood can be removed with a cotton swab to aid visualization.
If indicated, biopsy any suspect mass but only if above the dentate line.
If indicated, hemorrhoid therapy can be done in the office.
Aftercare for Anoscopy Although no particular aftercare is needed, tell patients to contact their physician immediately if there is significant bleeding or pain after the procedure.
Warnings and Common Errors for Anoscopy Do not biopsy a hemorrhoid or any vascular tissue.
Do not rotate a slotted anoscope because doing so can pinch tissue.
Do not reinsert the guide plug while the anoscope is inside the patient because doing so can pinch or tear tissue.
Remove the anoscope completely, reinsert the guide plug, and then reinsert the anoscope.
Tips and Tricks of Anoscopy Inspection of the external perianal area may be adequate to diagnose causes of severe anal pain such as a fissure, thrombosed external hemorrhoid, or some abscesses; in these cases, digital exam and anoscopy may not be indicated.
If prolapse is suspected, a Valsalva maneuver may reveal prolapsing hemorrhoids or mucosa.
Asking the patient to bear down while inserting a finger for digital exam or the anoscope may make the insertion easier.
Keep one finger pressed on the guide plug (usually your thumb) to prevent it from falling out during insertion until you are ready to remove it.
The slotted anoscope should not be rotated; it is better for visualization and treatment of hemorrhoids.
Additional Considerations for Anoscopy No bowel prep is needed for anoscopy.
The American Heart Association no longer recommends endocarditis prophylaxis for patients having routine gastrointestinal endoscopy.
Positioning for Anoscopy Place the patient in the left lateral decubitus position with knees flexed toward the chest.
Other positions, such as lithotomy position, are acceptable if needed.
Relevant Anatomy for Anoscopy The anal canal is about 3 to 5 cm long and connects the distal rectum to the outside.
Benign Esophageal Tumors By Minhhuyen Nguyen, MD, Fox Chase Cancer Center, Temple University Reviewed / Revised Mar 2021 | Modified Sep 2022 View Patient Education There are many types of benign esophageal tumors; many are found incidentally, remain asymptomatic, and warrant only observation.
With treatment, this tumor usually has an excellent prognosis.
Esophageal papillomas and granular cell tumors, although rare, may become malignant and their complete endoscopic removal is recommended.
Some can cause swallowing symptoms and rarely ulceration or bleeding.
Evaluation typically is that of dysphagia (see Dysphagia), beginning with a barium esophagram or upper GI endoscopy (with or without endoscopic ultrasonography).
Once a lesion is visualized, tissue samples can be obtained with upper endoscopy.
Leiomyoma, the most common, may be multiple and can become large.
Depending on its size and location, the tumor can be excised or enucleated.
Endoscopic submucosal dissection and video-assisted thoracoscopic surgery (VATS) have increasingly replaced open thoracotomy in many cases, thus reducing operative morbidity.
Arrhythmogenic Right Ventricular Cardiomyopathy (Arrhythmogenic Right Ventricular Dysplasia) By L Brent Mitchell, MD, Libin Cardiovascular Institute of Alberta, University of Calgary Reviewed / Revised Jan 2023 View Patient Education Diagnosis Treatment Key Points Arrhythmogenic right ventricular cardiomyopathy (ARVC), also called arrhythmogenic right ventricular dysplasia (ARVD), is a genetic cardiac disorder affecting mainly the right ventricle and causing ventricular tachyarrhythmias and increased risk of sudden death.
When abnormal, these proteins are prone to damage by mechanical stress (eg, from increased cardiac workload as from prolonged exertion).
Healing of the damage leads to replacement of myocytes by fibrofatty tissue, predominantly in the triangle between the right ventricular outflow tract, the right ventricular inflow tract, and the right ventricular apex, but sometimes also involving the posterolateral left ventricle.
Disease manifestations are the result of both electrophysiologic and structural changes, initially manifesting as ventricular premature beats and ventricular tachyarrhythmias but eventually causing right ventricular structural abnormalities (eg, dilation and thinning), resulting in congestive right ventricular cardiomyopathy.
Most commonly, the mutations are inherited with an autosomal dominant pattern with variable penetrance; however, autosomal recessive mutations are known.
The incidence of ARVC has regional variation from 1 in 2000 to 1 in 5000.
It is thought that sustained, heavy exertion (eg, from endurance athletics) hastens onset and progression of disease.
Patients may be asymptomatic, but those who are symptomatic usually present first with ventricular tachycardia (VT), ventricular fibrillation (VF), or sudden death.
ARVC is responsible for approximately 10% of sudden deaths in young adults.
Ventricular tachyarrhythmias are particularly likely to occur during emotional or physical stress.
Atrial fibrillation and signs of right ventricular systolic failure (eg, dependent edema, ascites) are usually manifestations of advanced disease.
Symptoms include palpitations, syncope, and cardiac arrest, and with worsening disease, manifestations of right ventricular failure.
Diagnosis of ARVC ECG and signal-averaged ECG Cardiac imaging (eg, echocardiography, cardiac magnetic resonance imaging, right ventricular angiography) Sometimes right ventricular biopsy Genetic testing Screening of first-degree family members Diagnosis of arrhythmogenic right ventricular cardiomyopathy is difficult in the absence of advanced right ventricular systolic dysfunction, leading to historic under-recognition of the disorder.
ARVC should be suspected particularly in young patients with palpitations, cardiac syncope, documented ventricular tachyarrhythmias, or resuscitation from unexplained cardiac arrest in the absence of clinically evident structural heart disease.
The diagnosis of ARVC is often first suspected when it is recognized that the patient's ventricular arrhythmias are of right ventricular origin, typically indicated by a left bundle branch block-shaped QRS complex with a superior frontal plane axis (the latter helping to differentiate ARVC from the more benign idiopathic right ventricular outflow tract ventricular tachycardia, which usually has an inferior frontal plane QRS axis).
Patients should have ECG, signal-averaged ECG, echocardiography, and cardiac MRI.
If no spontaneous ventricular arrhythmia has been demonstrated, exercise testing, ambulatory ECG monitoring, and / or electrophysiologic testing may be required.
Right ventricular angiography is not routine but, if done, may reveal characteristic structural abnormalities and also allow biopsy of the right ventricle; however, biopsy findings are often nonspecific.
Because no single test is diagnostic, major and minor diagnostic criteria have been proposed by an international task force (1).
The criteria include Evidence of right ventricular disease on imaging studies Right ventricular biopsy showing replacement of myocytes by fibrous tissue, fatty tissue, or both ECG repolarization changes including right precordial T-wave inversion ECG depolarization changes including right precordial epsilon waves Signal-averaged ECG showing late potentials Documented ventricular arrhythmias originating from the right ventricle Family history of ARVC or sudden death Identification of a gene mutation associated with ARVC Genetic testing is usually done in patients suspected of having ARVC.
The yield of testing is about 60% when task force criteria are met.
First-degree family members of patients have a significant risk of disease.
Diagnosis includes ECG, cardiac imaging, and consensus criteria.
Starting at age 10 to 12 years and every 1 to 3 years thereafter, they should have clinical evaluation (ie, to detect symptoms suggestive of arrhythmia), ECG, ambulatory ECG monitoring, and echocardiography.
Family members without the index mutation are then freed of follow-up investigations.
Eur Heart J 31; 806 - 814, 2010. doi: 10.1093 / eurheartj / ehq025 Treatment of ARVC Moderation of physical activity Often an ICD Usually a beta-blocker Sometimes antiarrhythmic drugs (particularly sotalol or amiodarone) Heart failure therapy (including transplantation) as required Treatment of arrhythmogenic right ventricular cardiomyopathy focuses on prevention of sudden death and prevention of symptomatic ventricular tachyarrhythmias.
Patients should avoid endurance athletics because such activities foster both disease progression and occurrence of life-threatening arrhythmias.
These risks are higher in men and in patients with more advanced disease (as evidenced by more task force criteria).
Prevention of sudden death is by an ICD (see also table Indications for an ICD).
An ICD is recommended for patients with prior sustained VT or resuscitated cardiac arrest or severe right ventricular (or left ventricular) systolic dysfunction.
Treatment requires limitation of physical exertion, and usually a beta-blocker and an implantable cardioverter-defibrillator (ICD).
An ICD also may be useful for patients with any major risk factor for sudden death, including prior syncope, non-sustained ventricular tachycardia, or moderate right or left ventricular systolic dysfunction (class IIa indication).
A recent Heart Rhythm Society consensus statement also provided recommendations regarding ICD use in patients with ARVC and various combinations of moderate other risk factors (1).
A beta-blocker (eg, metoprolol) should be used in most patients.
Antiarrhythmic therapy with a class III drug, particularly sotalol or amiodarone, may reduce symptomatic ventricular tachyarrhythmias but is not a substitute for an ICD.
Heart Rhythm 16: e301-e372, 2019. doi: 10.1016 / j. hrthm.2019.05.007 Key Points Arrhythmogenic right ventricular cardiomyopathy is a genetic disorder in which myocytes are replaced by fibrofatty tissue, leading to arrhythmias and later right ventricular failure.
The disorder progresses quicker in patients who engage in endurance exercise.
Diagnosis is based on consensus criteria involving clinical and electrocardiographic factors, cardiac imaging, and genetic testing.
First-degree family members have a significant risk of disease and require initial screening and regular testing.
Treatment requires moderation of physical activity, beta blockade, and often an ICD.
A number of genetic mutations adversely affect the structure and function of the intercalated disk, the structure that connects cardiac myocytes.
Most commonly, the mutations affect the component of the disk known as the desmosome (the adhesive intercellular junction that tethers intermediate filaments to cell membranes).
Desmosomes help connect cells in tissues that undergo mechanical stress, such as cardiac myocytes.
The desmosomal proteins that may be affected include plakophilin, desmoplakin, and desmoglein.
Catecholaminergic Polymorphic Ventricular Tachycardia By L Brent Mitchell, MD, Libin Cardiovascular Institute of Alberta, University of Calgary Reviewed / Revised Jan 2023 View Patient Education Symptoms and Signs Diagnosis Treatment Catecholaminergic polymorphic ventricular tachycardia is a genetic disorder affecting intracellular calcium regulation in cardiac tissue.
The tachyarrhythmias are usually precipitated by the adrenergic stimulation of physical or emotional stress.
The most characteristic ventricular tachyarrhythmia is bidirectional ventricular tachycardia which appears on ECG as two QRS complexes of opposite polarity in an alternating pattern.
Nevertheless, any polymorphic ventricular tachycardia (VT), or ventricular fibrillation (VF) may occur.
The incidence of CPVT is about 1 in 10, 000 and is equally common in males and females.
It is usually inherited as an autosomal dominant mutation of the gene encoding the cardiac ryanodine receptor, but it may be inherited as an autosomal recessive mutation of cardiac calsequestrin (CASQ2).
Symptoms and Signs of CPVT Some patients are asymptomatic and identified only on family screening.
When symptoms occur, they usually develop at a young age (ie, childhood or adolescence).
The tachyarrhythmias may cause palpitations, syncope, or cardiac arrest.
Events are typically triggered by emotional or physical stress.
Diagnosis of CPVT Exercise testing Genetic testing Screening of first-degree family members Diagnosis should be considered in patients with unexplained cardiac arrest or syncope or a family history of such in the absence of structural heart disease.
Patients are predisposed to ventricular tachyarrhythmias (less commonly atrial tachyarrhythmias) and sudden cardiac death, particularly during increased adrenergic activity (eg, from exercise).
Resting ECG is normal.
Diagnosis is confirmed by exercise testing-induced polymorphic VT (especially bidirectional VT) that also reproduces the patient's symptoms.
Genetic testing should then be done; it has a yield of approximately 50%.
They should have clinical evaluation (ie, to detect symptoms suggestive of arrhythmia) and exercise testing performed every 1 to 3 years.
If the initial patient has a causative mutation identified, family members without the index mutation are then freed of the need follow-up investigations.
Treatment of CPVT Exercise restriction Beta blockade Sometimes an implantable cardioverter-defibrillator (ICD) Rarely left cardiac sympathetic denervation All patients are advised to avoid strenuous exercise (eg, competitive sports).
Particularly those who will not accept exercise restrictions should be counseled on the need for appropriate cautions (eg, availability of an automated external defibrillator during training and competition).
For patients who have had symptoms (eg, syncope, cardiac arrest) or who have demonstrated VF or sustained VT, the primary treatment is high doses of a long-acting beta-blocker, preferably one without intrinsic sympathomimetic activity (eg, nadolol, slow-release propranolol).
If beta blockade is ineffective, flecainide may be useful both for its sodium channel and ryanodine receptor blocking effects.
Diagnosis is by exercise testing.
Implantable cardioverter-defibrillators (ICDs) are used for patients with CPVT who survived cardiac arrest or who have VT despite antiarrhythmic drug therapy.
Refractory cases are treated with left cardiac sympathetic denervation and / or arrhythmia substrate ablation.
Follow-up typically involves repeated exercise testing, but the predictive value is only moderate.
Asymptomatic patients (including relatives identified by genetic testing) should also moderate their physical activity and receive beta-blocker therapy.
Treatment is exercise restriction, beta blockade, and sometimes an implantable cardioverter-defibrillator (ICD).
Catecholaminergic polymorphic ventricular tachycardia (CPVT) results from mutations affecting proteins related to intracellular calcium regulation (particularly upregulation of the sarcoplasmic reticulum ryanodine receptor) in the heart.
The abnormalities increase release of calcium from the sarcoplasmic reticulum in response to adrenergic stimulation.
The resulting myocyte calcium overload causes delayed after-depolarizations and a propensity to atrial and / or ventricular tachyarrhythmias.
Chest Wall Tumors By Robert L Keith, MD, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine Reviewed / Revised May 2023 View Patient Education Symptoms and Signs Diagnosis Treatment Prognosis Key Points Chest wall tumors are benign or malignant tumors that can interfere with pulmonary function.
Symptoms and Signs of Chest Wall Tumors Soft-tissue chest wall tumors often manifest as a localized mass without other symptoms.
Many chest wall tumors are detected incidentally when imaging studies are done for another clinical reason.
Some patients have fever.
Patients usually do not have pain until the tumor is advanced.
In contrast, primary cartilaginous and bone tumors are often painful.
Diagnosis of Chest Wall Tumors Imaging Biopsy Patients with chest wall tumors require chest x-ray, CT, MRI, and sometimes positron emission tomography (PET) - CT to determine the original site and extent of the tumor and whether it is a primary chest wall tumor or a metastasis.
Biopsy and histologic evaluation confirm the diagnosis.
Treatment of Chest Wall Tumors Surgery Sometimes combination chemotherapy, radiation therapy, and surgery Most chest wall tumors are treated with surgical resection and reconstruction.
Reconstruction often uses a combination of myocutaneous flaps and prosthetic materials.
The presence of a malignant pleural effusion is a contraindication to surgical resection.
Primary chest wall tumors account for 5% of all thoracic tumors and 1 to 2% of all primary tumors.
In cases of multiple myeloma or isolated plasmacytoma, chemotherapy and radiation therapy should be the primary therapy.
Small-cell malignant tumors such as Ewing sarcoma and Askin tumor should be treated with a multimodality approach, combining chemotherapy, radiation therapy, and surgery.
In cases of chest wall metastasis from distant tumors, a palliative chest wall resection is recommended only when nonsurgical options do not alleviate symptoms.
Key Points Almost half of chest wall tumors are benign.
Less than half of malignant chest wall tumors are primary.
Consider the diagnosis if patients have a chest mass or unexplained chest wall pain, with or without fever.
Diagnose chest wall tumors with imaging, followed by biopsy.
Treat most with surgical resection and reconstruction (unless malignant pleural effusion is present), and sometimes chemotherapy and / or radiation therapy.
The most common benign chest wall tumors are Osteochondroma Chondroma Fibrous dysplasia A wide range of malignant chest wall tumors exist.
Over half are metastases from distant organs or direct invasions from adjacent structures (breast, lung, pleura, mediastinum).
The most common malignant primary tumors arising from the chest wall are Sarcomas: About 45% originate from soft tissue, and 55% originate from cartilaginous tissue or bone Chondrosarcomas are the most common primary chest wall sarcoma and arise from the anterior tract of ribs and less commonly from the sternum, scapula, or clavicle.
Bone tumors include osteosarcoma and small-cell malignant tumors (eg, Ewing sarcoma, Askin tumor).
The most common soft-tissue primary malignant tumors are fibrosarcomas (desmoids, neurofibrosarcomas) and malignant fibrous histiocytomas.
Other primary tumors include chondroblastomas, osteoblastomas, melanomas, lymphomas, rhabdomyosarcomas, lymphangiosarcomas, multiple myeloma, and plasmacytomas.
Tricuspid Regurgitation (Tricuspid Insufficiency; Tricuspid Incompetence) By Guy P Armstrong, MD, Waitemata District Health Board and Waitemata Cardiology, Auckland Reviewed / Revised Jul 2022 | Modified Sep 2022 View Patient Education Etiology Symptoms and Signs Diagnosis Prognosis Treatment Key Points Tricuspid regurgitation (TR) is insufficiency of the tricuspid valve causing blood flow from the right ventricle to the right atrium during systole.
Long-standing severe TR may lead to RV dysfunction-induced heart failure and atrial fibrillation.
Symptoms and Signs of Tricuspid Regurgitation Tricuspid regurgitation usually causes no symptoms, but some patients experience neck pulsations due to elevated jugular pressures.
Symptoms of severe TR include peripheral edema, fatigue, abdominal bloating, ascites, and anorexia.
Patients may also develop symptoms of atrial fibrillation or atrial flutter.
Signs of moderate to severe tricuspid regurgitation include jugular venous distention, with a prominent merged c-v wave and a steep y descent, and sometimes enlarged liver and peripheral edema.
In severe TR, a right jugular venous thrill may be palpable, as may systolic hepatic pulsation and an RV impulse at the left lower sternal border.
Auscultation Holosystolic murmur heard best at the left middle or lower sternal border (frequently not heard) On auscultation, the 1st heart sound (S1) may be normal or barely audible if a tricuspid regurgitation murmur is present; the 2nd heart sound (S2) may be split (with a loud pulmonic component [P2] in pulmonary hypertension) or single because of prompt pulmonic valve closing with merger of P2 and the aortic component (A2).
An RV 3rd heart sound (S3) may be audible near the sternum with RV dysfunction-induced heart failure.
The murmur of tricuspid regurgitation is frequently not heard.
When evident, it is a holosystolic murmur heard best at the left middle or lower sternal border or at the epigastrium with the bell of the stethoscope when the patient is sitting upright or standing.
The most common cause is dilation of the right ventricle.
The murmur may be high-pitched if TR is trivial and due to pulmonary hypertension, or it may be medium-pitched if TR is severe and has other causes.
When the murmur is not present at all, the diagnosis is best made by the appearance of the jugular venous wave pattern and the presence of hepatic systolic pulsations.
The murmur varies with respiration, becoming louder with inspiration (Carvallo sign).
Diagnosis of Tricuspid Regurgitation Echocardiography Mild tricuspid regurgitation is most often detected on echocardiography done for other reasons.
More moderate or severe TR may be suggested by history and physical examination.
Confirmation is by echocardiography.
Severe TR is characterized echocardiographically by ≥ 1 of the following: 2-Dimensional failure of coaptation or flail Dense, triangular, early peaking, continuous wave Doppler of TR jet Large flow convergence zone proximal to the valve Large regurgitant jet on color Doppler (≥ 50% of right atrial area) Systolic flow reversal in the hepatic veins (specific for severe TR) Vena contracta width > 7 mm When TR is moderate or severe, the peak regurgitant velocity will underestimate pulmonary pressure.
Two-dimensional echocardiography detects the structural abnormalities present in primary TR.
Assessing RV systolic dysfunction is challenging and is suggested on echocardiography by tricuspid annular plane systolic excursion (TAPSE) < 16 mm or tricuspid annular systolic velocity < 10 cm / second.
Cardiac MRI is now the preferred method for evaluating RV size and function.
Symptoms and signs are usually absent, but severe TR can cause neck pulsations, a holosystolic murmur, and right ventricular-induced heart failure or atrial fibrillation.
An ECG and chest x-ray are often done.
ECG is usually normal but, in advanced cases, may show tall peaked P waves caused by right atrial enlargement, a tall R or QR wave in V1 characteristic of RV hypertrophy, or atrial fibrillation.
Chest x-ray is usually normal but, in advanced cases with RV hypertrophy or RV dysfunction-induced HF, may show an enlarged superior vena cava, an enlarged right atrial or RV silhouette (behind the upper sternum in the lateral projection), or pleural effusion.
Laboratory testing is not needed, but if done, may show hepatic dysfunction in patients with severe TR.
Cardiac catheterization is indicated for accurate measurement of pulmonary pressure when TR is severe and to evaluate coronary anatomy when surgery is planned. Catheterization findings include a prominent right atrial c-v pressure wave during ventricular systole.
Prognosis for Tricuspid Regurgitation Severe tricuspid regurgitation ultimately has a poor prognosis, even if it is initially well-tolerated for years.
As with left-sided valvular regurgitation, the volume-overloaded ventricle eventually decompensates irreversibly.
However, in contrast to left-sided valvular regurgitation, there is no robust way to discern when the RV is starting to decompensate.
Given this, patients are commonly referred late for surgery.
In the context of the significant risks of surgery the overall outcome is poor.
Treatment of Tricuspid Regurgitation Treatment of cause Sometimes annuloplasty or valve repair or replacement Very mild tricuspid regurgitation is a normal finding and requires no action.
Medical treatment of causes (eg, heart failure, endocarditis) is indicated.
Medical therapy with loop diuretics can relieve congestion.
Aldosterone antagonists may be of additive benefit, as they counter secondary hyperaldosteronism due to hepatic congestion.
Treating the etiology is important in secondary TR.
Timing of intervention for tricuspid regurgitation depends on the patient's symptoms and RV function.
Patients with severe tricuspid regurgitation should undergo operation as soon as symptoms are present despite medical treatment or when there is moderate, progressive RV enlargement or dysfunction.
Severe LV dysfunction or severe pulmonary hypertension may make the surgical risk prohibitive.
During surgery for left-sided heart lesions, patients with moderate or mild TR with dilated annulus > 40 mm can undergo tricuspid annuloplasty, slowing progression to severe TR.
TR is usually benign and does not require treatment, but some patients require annuloplasty or valve repair or replacement.
However, tricuspid annuloplasty increases risk of the need for permanent pacing five-fold.
The net clinical benefit is not certain and awaits long-term follow up of the randomized trial addressing this issue (1).
Surgical options include Annuloplasty Valve repair Valve replacement Annuloplasty, in which the tricuspid valve annulus is sutured to a prosthetic ring or a tailored reduction in annulus circumferential size is done, is indicated when TR is due to annular dilation.
Valve repair or replacement is indicated when TR is due to primary valve abnormalities or when annuloplasty is not technically feasible.
Tricuspid valve repair is generally preferred to replacement.
Tricuspid valve replacement is indicated when TR is due to carcinoid syndrome or Ebstein anomaly.
A bioprosthetic valve is used to reduce the risk of thromboembolism associated with the low pressures of the right heart; in the right heart, unlike the left heart, bioprosthetic valves last > 10 years.
A bioprosthetic valve requires temporary anticoagulation (see also Anticoagulation for patients with a prosthetic cardiac valve).
Progress is being made toward a percutaneous valve repair procedure.
This will fill an unmet need and allow a lower risk percutaneous repair much earlier in the natural history of severe TR.
N Engl J Med 386 (4): 327 - 339, 2022. doi: 10.1056/NEJMoa2115961 Key Points Tricuspid regurgitation (TR) usually occurs in a normal valve affected by right ventricular dilation; less often there is an intrinsic valve disorder (eg, due to infective endocarditis, carcinoid syndrome, certain drugs).
Jugular venous distention may occur; severe TR may cause abdominal distension, hepatic enlargement, and peripheral edema.
Heart sounds include a holosystolic murmur heard best at the left middle or lower sternal border or at the epigastrium when the patient is sitting upright or standing; the murmur becomes louder with inspiration.
TR is usually well tolerated, but severe cases may require annuloplasty, valve repair, or valve replacement.
Etiology of Tricuspid Regurgitation Tricuspid regurgitation may be Primary Secondary (most common) Primary tricuspid regurgitation is less common.
It can be due to Blunt chest trauma Carcinoid syndrome Congenital defects (eg, cleft tricuspid valve, endocardial cushion defects) Drugs (eg, ergotamine, fenfluramine, phentermine) Ebstein anomaly (downward displacement of a congenitally malformed tricuspid cusp into the right ventricle [RV]) Idiopathic myxomatous degeneration Marfan syndrome Rheumatic fever Valvular abnormalities caused by infective endocarditis in users of illicit IV drugs Iatrogenic causes include pacemaker leads that cross the tricuspid valve and valve damage sustained during RV endomyocardial biopsy.
Secondary tricuspid regurgitation is due to leaflet tethering, which is the result of reduced leaflet coaptation caused by annular dilation (typical of right atrial dilation caused by chronic atrial fibrillation) and / or papillary muscle displacement (most commonly as a result of left heart disease causing pulmonary hypertension and leading to RV dilation or geometric distortion).
Atrioventricular Block (AV Block) By L Brent Mitchell, MD, Libin Cardiovascular Institute of Alberta, University of Calgary Reviewed / Revised Jan 2023 View Patient Education Key Points Topic Resources First-degree atrioventricular... Mobitz type I second-degree... 4: 3 Mobitz Type I Second-Degree... Mobitz type II second-degree... Second-degree atrioventricular... Third-degree atrioventricular... Overview of Atrioventricular... Atrioventricular (AV) block is partial or complete interruption of impulse transmission from the atria to the ventricles.
All normal P waves are followed by QRS complexes, but the PR interval is longer than normal (> 0.2 second).
For third-degree block, there is no relationship between P waves and QRS complexes, and the P wave rate is greater than the QRS rate.
First-degree AV block may be physiologic in younger patients with high vagal tone and in well-trained athletes.
First-degree AV block is rarely symptomatic, and no treatment is required.
Further investigation may be indicated when first-degree AV block accompanies another heart disorder or appears to be caused by medication.
Second-degree AV block Some normal P waves are followed by QRS complexes, but some are not.
Mobitz type I second-degree atrioventricular block The PR interval progressively lengthens with each beat until the atrial impulse is not conducted and the QRS complex is dropped (Wenckebach phenomenon); AV nodal conduction resumes with the next beat, and the sequence is repeated.
Mobitz type I second-degree AV block may be physiologic in younger and more athletic patients.
The block occurs at the AV node in about 75% of patients with a narrow QRS complex and at infranodal sites (His bundle, bundle branches, or fascicles) in the rest.
The most common cause is idiopathic fibrosis and sclerosis of the conduction system.
If the block becomes complete, a reliable junctional escape rhythm typically develops.
Treatment is therefore unnecessary unless the block causes symptomatic bradycardia and transient or reversible causes have been excluded.
Treatment is pacemaker insertion, which may also benefit asymptomatic patients with Mobitz type I second-degree AV block at infranodal sites detected by electrophysiologic studies done for other reasons.
In Mobitz type II second-degree AV block, the PR interval remains constant.
Beats are intermittently nonconducted and QRS complexes dropped, usually in a repeating cycle of every 3rd (3: 1 block) or 4th (4: 1 block) P wave (see figure Mobitz type II 2nd-degree AV block).
Mobitz type II second-degree atrioventricular block The PR interval remains constant.
Beats are intermittently nonconducted, and QRS complexes dropped, usually in a repeating cycle of every 3rd (3: 1 block) or 4th (4: 1 block) P wave.
Mobitz type II second-degree AV block is always pathologic; the block occurs at the His bundle in 20% of patients and in the bundle branches in the rest.
Patients may be asymptomatic or experience light-headedness, presyncope, and syncope, depending on the ratio of conducted to blocked beats.
Patients are at risk of developing symptomatic high-grade or complete AV block, in which the escape rhythm is likely to be ventricular and thus too slow and unreliable to maintain systemic perfusion; therefore, a pacemaker is indicated.
Diagnosis is by electrocardiography; symptoms and treatment depend on degree of block, but treatment, when necessary, usually involves pacing.
Second-degree atrioventricular block (high grade) Every second P wave is blocked in this example of high-grade second-degree AV block.
In patients with high-grade second-degree AV block, the distinction between Mobitz type I AV block and Mobitz type II AV block is difficult to make because 2 P waves are never conducted in a row.
Risk of complete AV block is difficult to predict, and a pacemaker is usually indicated.
Patients with any form of second-degree AV block and a structural heart disorder should be considered candidates for permanent pacing unless there is a transient or reversible cause.
Third-degree AV block Heart block is complete in third-degree AV block (see figure Third-degree AV block).
Third-degree atrioventricular block There is no relationship between P waves and QRS complexes (AV dissociation) in third-degree AV block.
The P wave rate is greater than the QRS rate.
The underlying rhythm here is a junctional escape rhythm with narrow QRS complexes and a rate of approximately 65 beats / minute.
There is no electrical communication between the atria and ventricles and thus no relationship between P waves and QRS complexes (AV dissociation).
Cardiac function is maintained by an escape junctional or ventricular pacemaker.
Escape rhythms originating above the bifurcation of the His bundle produce narrow QRS complexes, relatively rapid (> 40 beats / minute) and reliable heart rates, and mild symptoms (eg, fatigue, postural light-headedness, effort intolerance).
Escape rhythms originating below the bifurcation produce wider QRS complexes, slower and unreliable heart rates, and more severe symptoms (eg, presyncope, syncope, heart failure).
Signs include those of AV dissociation, such as cannon a waves, blood pressure fluctuations, and variation in loudness of the 1st heart sound (S1).
Overview of Atrioventricular Block VIDEO Most patients require a pacemaker.
If the block is caused by antiarrhythmic drugs, stopping the drug may be effective, although temporary pacing may be needed.
A block caused by acute inferior myocardial infarction usually reflects atrioventricular nodal dysfunction and may respond to atropine or resolve spontaneously over several days.
A block caused by anterior myocardial infarction usually reflects extensive myocardial necrosis involving the His-Purkinje system and requires immediate transvenous pacemaker insertion with interim external pacing as necessary.
Spontaneous resolution may occur but warrants evaluation of AV nodal and infranodal conduction (eg, electrophysiologic study, exercise testing, 24-hour ECG).
Most patients with congenital 3rd-degree AV block have a junctional escape rhythm that maintains a reasonable rate, but they require a permanent pacemaker before they reach middle age.
Less commonly, patients with congenital AV block have a slow escape rhythm and require a permanent pacemaker at a young age, perhaps even during infancy.
Key Points There are 3 degrees of AV block: first, second, and third.
First - and second-degree blocks are partial and third-degree block is complete.
First-degree AV block is rarely symptomatic and no treatment is required.
Second-degree AV block Mobitz type I may be physiologic and if heart rate slows, a reliable junctional escape rhythm typically develops and treatment is therefore unnecessary unless symptomatic bradycardia occurs.
Second-degree AV block Mobitz type II and third-degree AV block are always pathologic and a pacemaker is typically required unless the cause is transient or reversible.
Third degree blocks are complete.
First-degree AV block All normal P waves are followed by QRS complexes, but the PR interval is longer than normal (> 0.20 second—see figure First-degree atrioventricular block).
First-degree atrioventricular block For first-degree block, conduction is slowed without skipped beats.
Diagnosis is by electrocardiography (ECG) and serologic markers.
Sensitivity and specificity for myocardial cell injury vary significantly among these markers, but the troponins (cTn) are the most sensitive and specific and are now the markers of choice.
Recently, several new, highly sensitive assays of cardiac troponin (hs-cTn) that are also very precise have become available.
These assays can reliably measure troponin levels (T or I) as low as 0.003 to 0.006 ng / mL (3 to 6 pg / mL); some research assays go as low as 0.001 ng / mL (1 pg/mL).
Previous, less sensitive cTn tests were unlikely to detect cTn except in patients who had an acute cardiac disorder.
Thus, a "positive" cTn test (ie, above the limit of detection) was very specific.
However, the newer hs-cTn tests can detect small amounts of cTn in many healthy people.
Thus, troponin levels detected with hs-cTn tests need to be referenced to the normal range, and are defined as "elevated" only when higher than 99% of the reference population.
Furthermore, although an elevated troponin level indicates myocardial cell injury, it does not indicate the cause of the damage (although any troponin elevation increases the risk of adverse outcomes in many disorders).
In addition to acute coronary syndromes, many other cardiac and non-cardiac disorders can elevate cTn levels (see table Causes of Elevated Troponin Levels); not all elevated levels detected with hs-cTn represent myocardial infarction, and not all myocardial necrosis results from an acute coronary syndrome event even when the etiology is ischemic.
Treatment is antiplatelet drugs, anticoagulants, nitrates, beta-blockers, and, for STEMI, emergency reperfusion via fibrinolytic drugs, percutaneous intervention, or, occasionally, coronary artery bypass graft surgery.
However, by detecting lower levels of troponin, hs-cTn assays enable earlier identification of MI than other assays, and have replaced other cardiac marker tests in many centers.
Patients suspected of having an ACS should have an hs-cTn assay done on presentation and again 2 to 3 hours later.
Troponin should be measured at 0 and 6 hours if a standard cTn assay is used.
An hs-cTn level must be interpreted based on the patient's pre-test probability of disease, which is estimated clinically based on Risk factors for ACS Symptoms ECG findings A high pre-test probability plus an elevated level detected with an hs-cTn assay is highly suggestive of ACS, whereas a low pre-test probability plus a normal hs-cTn assay result is unlikely to represent ACS.
Diagnosis is more challenging when test results are discordant with pre-test probability, in which case serial hs-cTn assays often help.
A patient with low pre-test probability and an initially slightly elevated troponin level detected with hs-cTn that remains stable on repeat testing probably has non-ACS cardiac disease (eg, heart failure, stable coronary artery disease).
However, if the repeat level rises significantly (ie, > 20 to 50%) the likelihood of ACS becomes much higher.
If a patient with high pre-test probability has a normal troponin level detected with hs-cTn and that rises > 50% on repeat testing, ACS is likely; continued normal levels (often including at 6 hours and beyond when suspicion is high) suggest need to pursue an alternate diagnosis.
Table Coronary angiography Coronary angiography most often combines diagnosis with percutaneous coronary intervention (PCI—ie, angioplasty, stent placement).
Angiography is obtained urgently for patients with STEMI, patients with persistent chest pain despite maximal medical therapy, and patients with complications (eg, markedly elevated cardiac markers, presence of cardiogenic shock, acute mitral regurgitation, ventricular septal defect, unstable arrhythmias).
Patients with uncomplicated NSTEMI or unstable angina whose symptoms have resolved typically undergo angiography within the first 24 to 48 hours of hospitalization to detect lesions that may require treatment.
Some experts also recommend that angiography be done before hospital discharge in patients with STEMI who have not yet had angiography who have inducible ischemia on stress imaging or an ejection fraction < 40%.
Other tests Routine laboratory tests are nondiagnostic but, if obtained, show nonspecific abnormalities compatible with tissue necrosis (eg, increased erythrocyte sedimentation rate, moderately elevated white blood cell count with a shift to the left).
A fasting lipid profile should be obtained within the first 24 hours for all patients hospitalized with ACS.
Myocardial imaging is not needed to make the diagnosis if cardiac markers or ECG is positive.
However, in patients with myocardial infarction, bedside echocardiography is invaluable for detecting mechanical complications.
Classification of Acute Coronary Syndromes Acute coronary syndromes include Unstable angina Non-ST-segment elevation myocardial infarction (NSTEMI) ST-segment elevation myocardial infarction (STEMI) These syndromes all involve acute coronary ischemia and are distinguished based on symptoms, ECG findings, and cardiac marker levels.
Before or shortly after discharge, patients with symptoms suggesting an ACS but with nondiagnostic ECGs and normal cardiac markers should have a stress imaging test (radionuclide or echocardiographic imaging with pharmacologic or exercise stress).
Imaging abnormalities in such patients indicate increased risk of complications in the next 3 to 6 months and suggest need for angiography, which should be done before discharge or soon thereafter, with PCI or CABG done as necessary.
Right heart catheterization using a balloon-tipped pulmonary artery catheter can be used to measure right heart, pulmonary artery, and pulmonary artery occlusion pressures and cardiac output.
This test is not routinely recommended and should be done only if patients have significant complications (eg, severe heart failure, hypoxia, hypotension) and by doctors experienced with catheter placement and management protocols.
Treatment of Acute Coronary Syndromes Prehospital care: Oxygen, aspirin, and nitrates and triage to an appropriate medical center Drug treatment: Antiplatelet drugs, antianginal drugs, anticoagulants, and in some cases other drugs Often, angiography to assess coronary artery anatomy Often, reperfusion therapy: Fibrinolytics, percutaneous coronary intervention or coronary artery bypass surgery Supportive care Post-discharge cardiac rehabilitation and chronic management of coronary artery disease Treatment, including drug treatment, is designed to relieve distress, interrupt thrombosis, reverse ischemia, limit infarct size, reduce cardiac workload, and prevent and treat complications.
An acute coronary syndrome is a medical emergency; outcome is greatly influenced by rapid diagnosis and treatment.
Treatment occurs simultaneously with diagnosis.
Contributing disorders (eg, anemia, heart failure) are aggressively treated.
Because the chest pain of myocardial infarction usually subsides within 12 to 24 hours, any chest pain that remains or recurs later is investigated.
It may indicate such complications as recurrent ischemia, pericarditis, pulmonary embolism, pneumonia, gastritis, or ulcer.
Prehospital interventions by emergency medical personnel—including ECG, chewed aspirin (325 mg), pain management with nitrates (see table Drugs for Coronary Artery Disease), early thrombolysis when indicated and possible, and triage to the appropriate hospital where primary PCI is available—can reduce risk of mortality and complications.
Early diagnostic data and response to treatment can help determine the need for and timing of revascularization when primary percutaneous coronary intervention is not possible.
Hospital admission Drug therapy with antiplatelet drugs, anticoagulants, and other drugs based on reperfusion strategy Risk-stratify patient and choose a reperfusion strategy (fibrinolytics or cardiac angiography with PCI or CABG for patients with STEMI and cardiac angiography with PCI or CABG for patients with unstable angina or NSTEMI) On arrival to the emergency room, the patient's diagnosis is confirmed.
Unstable angina (acute coronary insufficiency, preinfarction angina, intermediate syndrome) is defined as one or more of the following in patients whose cardiac markers do not meet criteria for myocardial infarction (MI): Rest angina that is prolonged (usually > 20 minutes) New-onset angina of at least class 3 severity in the Canadian Cardiovascular Society (CCS) classification (see table) Increasing angina, ie, previously diagnosed angina that has become distinctly more frequent, more severe, longer in duration, or lower in threshold (eg, increased by ≥ 1 CCS class or to at least CCS class 3) ECG changes such as ST-segment depression, ST-segment elevation, or T-wave inversion may occur during unstable angina but they are transient.
Drug therapy and choice of revascularization depend on the type of acute coronary syndrome as well as the clinical picture (see figure Approach to acute coronary syndromes).
Choice of drug therapy is discussed in Drugs for Acute Coronary Syndrome, and choice of reperfusion strategy is further discussed in Revascularization for Acute Coronary Syndromes.
Approach to acute coronary syndromes * Morphine should be used judiciously (eg, if nitroglycerin is contraindicated or if the patient has symptoms despite nitroglycerin therapy).
Data suggest that morphine attenuates activity of some P2Y12 receptor inhibitors and may contribute to worse patient outcomes (1, 2).
‡ Although some recent trials raise questions, CABG is still generally preferred to PCI for patients with the following: Left main or left main equivalent disease Left ventricular dysfunction Diabetes Also, lesions that are long or near bifurcation points are often not amenable to PCI.
CABG = coronary artery bypass grafting; GP = glycoprotein; LDL = low density lipoprotein; NSTEMI = non-ST-segment elevation MI; MI = myocardial infarction; PCI = percutaneous intervention; STEMI = ST-segment elevation MI.
When the diagnosis is unclear, bedside cardiac marker tests can help identify low-risk patients with a suspected ACS (eg, those with initially negative cardiac markers and nondiagnostic ECGs), who can be managed in 24-hour observation units or chest pain centers.
Higher-risk patients should be admitted to a monitored inpatient unit or critical care unit (CCU).
Of cardiac markers, CK is not elevated but cardiac troponin, particularly when measured using high-sensitivity troponin tests (hs-cTn), may be slightly increased.
Several validated tools can help stratify risk.
Thrombolysis in MI (TIMI) risk scores may be the most widely used.
Patients with suspected NSTEMI and intermediate or high risk should be admitted to an inpatient care unit or CCU.
Those with STEMI should be admitted to a CCU.
Only heart rate and rhythm recorded by single-lead ECG are consistently useful for routine, continuous monitoring.
However, some clinicians recommend routine multilead monitoring with continuous ST-segment recording to identify transient, recurrent ST-segment elevations or depressions.
Such findings, even in patients without symptoms, suggest ischemia and identify higher-risk patients who may require more aggressive evaluation and treatment.
Qualified nurses can interpret the ECG for arrhythmia and initiate protocols for its treatment.
All staff members should know how to do CPR (cardiopulmonary resuscitation).
Supportive care The care unit should be a quiet, calm, restful area.
Unstable angina is clinically unstable and often a prelude to myocardial infarction or arrhythmias or, less commonly, to sudden death.
Single rooms are preferred; privacy consistent with monitoring should be ensured.
Usually, visitors and telephone calls are restricted to family members during the first few days.
A wall clock, a calendar, and an outside window help orient the patient and prevent a sense of isolation, as can access to a radio, television, newspaper and / or digital devices.
On day 1, patients without complications (eg, hemodynamic instability, ongoing ischemia), including those in whom reperfusion with fibrinolytics or PCI is successful, can sit in a chair, begin passive exercises, and use a commode.
Walking to the bathroom and doing nonstressful paperwork are allowed shortly thereafter.
Patients with successful, uncomplicated primary PCI for acute MI may be ambulated quickly and be safely discharged in 2 to 4 days.
If reperfusion is not successful or complications are present, patients require longer bed rest, but they (particularly older patients) are mobilized as soon as possible.
Prolonged bed rest results in rapid physical deconditioning, with development of orthostatic hypotension, decreased work capacity, increased heart rate during exertion, and increased risk of deep venous thrombosis.
Prolonged bed rest also intensifies feelings of depression and helplessness.
Anxiety, mood changes, and denial are common. A mild tranquilizer (usually a benzodiazepine) is often given, but many experts believe such drugs are rarely needed.
Non-ST-segment elevation MI (NSTEMI, subendocardial MI) is myocardial necrosis (evidenced by cardiac markers in blood; troponin I or troponin T and CK will be elevated) without acute ST-segment elevation.
Reactive depression is common by the 3rd day of illness and is almost universal at some time during recovery.
After the acute phase of illness, the most important tasks are often management of depression, rehabilitation, and institution of long-term preventive programs.
Overemphasis on bed rest, inactivity, and the seriousness of the disorder reinforces anxiety and depressive tendencies, so patients are encouraged to sit up, get out of bed, and engage in appropriate activities as soon as possible.
The effects of the disorder, prognosis, and individualized rehabilitation program should be explained to the patient.
Maintaining normal bowel function with stool softeners (eg, docusate) to prevent straining is important.
Urinary retention is common among older patients, especially after several days of bed rest or if atropine was given.
A catheter may be required but can usually be removed when the patient can stand or sit to void.
Because smoking is prohibited, a hospital stay should be used to encourage smoking cessation.
All caregivers should devote considerable effort to making smoking cessation permanent.
Although acutely ill patients have little appetite, tasty food in modest amounts is good for morale.
Patients are usually offered a soft diet of 1500 to 1800 kcal / day with sodium reduction to 2 to 3 g. Sodium reduction is not required after the first 2 or 3 days if there is no evidence of heart failure.
Patients are given a diet low in cholesterol and saturated fats, which is used to teach healthy eating.
Eur Heart J 37 (3): 245 - 252, 2016. doi: 10.1093 / eurheartj / ehv547 Rehabilitation and Post-Discharge Treatment Functional evaluation Changes in lifestyle: Regular exercise, diet modification, weight loss, smoking cessation Drugs: Continuation of antiplatelet drugs, beta-blockers, ACE inhibitors, and statins Functional evaluation Patients who did not have coronary angiography during admission, have no high-risk features (eg, heart failure, recurrent angina, ventricular tachycardia or ventricular fibrillation after 24 hours, mechanical complications such as new murmurs, shock), and have an ejection fraction > 40% whether or not they received fibrinolytics usually should have stress testing of some sort before or shortly after discharge (see table Functional Evaluation After Myocardial Infarction).
Table Functional Evaluation After Myocardial Infarction Exercise Capacity If ECG Is Interpretable If ECG Is Not Interpretable Able to exercise Submaximal or symptom-limited stress ECG before or after discharge Exercise echocardiography or nuclear scanning Unable to exercise Pharmacologic stress testing (echocardiography or nuclear scanning) Pharmacologic stress testing (echocardiography or nuclear scanning) Activity Physical activity is gradually increased during the first 3 to 6 weeks after discharge.
ST-segment elevation MI (STEMI, transmural MI) is myocardial necrosis with ECG changes showing ST-segment elevation that is not quickly reversed by nitroglycerin or showing new left bundle branch block.
Resumption of sexual activity, often of great concern to the patient and partner, and other moderate physical activities may be encouraged.
If good cardiac function is maintained 6 weeks after acute myocardial infarction, most patients can return to all their normal activities.
A regular exercise program consistent with lifestyle, age, and cardiac status reduces risk of ischemic events and enhances general well-being.
Supervised cardiac rehabilitation programs decrease mortality after revascularization (1). Risk factor modification The acute illness and treatment of ACS should be used to strongly motivate the patient to modify risk factors.
Drugs Several drugs clearly reduce mortality risk post-MI and are used unless contraindicated or not tolerated: Aspirin and other antiplatelet drugs Beta blockers Angiotensin-converting enzyme (ACE) inhibitors Statins Aspirin and other antiplatelet drugs reduce mortality and reinfarction rates in patients after myocardial infarction.
Enteric-coated aspirin 81 mg once / day is recommended long-term.
Dual antiplatelet therapy with aspirin and a P2Y12 receptor blockers (eg, ticagrelor, clopidogrel) for up to 1 year is recommended (2, 3).
Beta-blockers are considered standard therapy.
Troponin I or troponin T and creatine kinase (CK) are elevated.
Most available beta-blockers (eg, acebutolol, atenolol, metoprolol, propranolol, timolol) reduce post-MI mortality rate by about 25% for at least 7 years.
ACE inhibitors are also considered standard therapy and are given to all post-MI patients if possible, particularly if ejection fraction post MI is < 40%.
These drugs may provide long-term cardioprotection by improving endothelial function.
If an ACE inhibitor is not tolerated because of cough or rash (but not angioedema or renal dysfunction), an angiotensin II receptor blocker (ARB) may be substituted.
Statins are also standard therapy and are routinely prescribed regardless of lipid levels.
Reducing cholesterol levels after MI reduces rates of recurrent ischemic events and mortality in patients with elevated or normal cholesterol levels.
Statins appear to benefit post-MI patients regardless of their initial cholesterol level.
Post-MI patients whose primary problem is a low HDL level or an elevated triglyceride level may benefit from a fibrate, but evidence of benefit is less clear.
The statin should be continued indefinitely, unless significant adverse effects occur, and dose should be increased to the maximally tolerated dose.
Both types of MI may or may not produce Q waves on the ECG (Q wave MI, non-Q wave MI).
N Engl J Med 361: 1045 - 1057, 2009. doi: 10.1056/NEJMoa0904327 Key Points Unstable angina, NSTEMI, and STEMI represent worsening degrees of myocardial ischemia and necrosis; the distinctions help differentiate prognosis and guide treatment.
Diagnosis is based on serial ECG and cardiac marker levels, particularly using new, highly sensitive troponin T tests.
Immediate medical treatment depends on the specific syndrome and patient characteristics but typically involves antiplatelet drugs, anticoagulants, beta-blockers, and nitrates as needed (eg, for chest pain, hypertension, pulmonary edema), and a statin to improve prognosis.
For unstable angina and NSTEMI, do angiography within 24 to 48 hours of hospitalization to identify coronary lesions requiring PCI or CABG; fibrinolysis is not helpful.
For STEMI, do emergency PCI when door to balloon-inflation time is < 90 minutes; do fibrinolysis if such timely PCI is not available.
Etiology of Acute Coronary Syndromes The most common cause of acute coronary syndromes is An acute thrombus in an atherosclerotic coronary artery Atheromatous plaque sometimes becomes unstable or inflamed, causing it to rupture or split, exposing thrombogenic material, which activates platelets and the coagulation cascade and produces an acute thrombus.
Following recovery, initiate or continue aspirin and other antiplatelet drugs, beta-blockers, ACE inhibitors, and statins in most cases unless contraindicated.
Platelet activation involves a conformational change in membrane glycoprotein (GP) IIb / IIIa receptors, allowing cross-linking (and thus aggregation) of platelets.
Even atheromas causing minimal obstruction can rupture and result in thrombosis; in > 50% of cases, pre-event stenosis is < 40%.
Thus, although the severity of stenosis helps predict symptoms, it does not always predict acute thrombotic events.
The resultant thrombus abruptly interferes with blood flow to parts of the myocardium.
Spontaneous thrombolysis occurs in about two thirds of patients; 24 hours later, thrombotic obstruction is found in only about 30%.
Rarer causes of acute coronary syndromes are Coronary artery embolism Coronary spasm Spontaneous coronary artery dissection Coronary arterial embolism can occur in mitral stenosis, aortic stenosis, infective endocarditis, marantic endocarditis, or atrial fibrillation.
Cocaine use and other causes of coronary spasm can sometimes result in myocardial infarction.
Spasm-induced MI may occur in normal or atherosclerotic coronary arteries.
Spontaneous coronary artery dissection is a non-traumatic tear in the coronary intima with creation of a false lumen.
Myocardial infarction in the absence of coronary artery disease (MINOCA) Myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) is found in about 5% to 6% of patients with acute MI who undergo coronary angiography (1).
Patients with MINOCA tend to be younger, women, and without dyslipidemia, and they have myocardial necrosis without significant coronary atherosclerosis.
Measurement of newer, more sensitive markers indicates that some cell necrosis probably occurs even in mild forms; thus, ischemic events occur on a continuum, and classification into subgroups, although useful, is somewhat arbitrary.
Myocardial dysfunction Ischemic (but not infarcted) tissue has impaired contractility and relaxation, resulting in hypokinetic or akinetic segments; these segments may expand or bulge during systole (called paradoxical motion).
The size of the affected area determines effects, which range from minimal to mild heart failure to cardiogenic shock; usually, large parts of myocardium must be ischemic to cause significant myocardial dysfunction.
Some degree of heart failure occurs in about two thirds of hospitalized patients with acute myocardial infarction.
It is termed ischemic cardiomyopathy if low cardiac output and heart failure persist.
Ischemia involving the papillary muscle may lead to mitral valve regurgitation.
Dysfunctional wall motion can allow mural thrombus formation.
Myocardial infarction (MI) Myocardial infarction is myocardial necrosis resulting from abrupt reduction in coronary blood flow to part of the myocardium.
Infarcted tissue is permanently dysfunctional; however, there is a zone of potentially reversible ischemia adjacent to infarcted tissue.
MI affects predominantly the left ventricle (LV), but damage may extend into the right ventricle (RV) or the atria.
Infarction may be Transmural: Transmural infarcts involve the whole thickness of myocardium from epicardium to endocardium and are usually characterized by abnormal Q waves on ECG.
Nontransmural (subendocardial): Nontransmural infarcts do not extend through the ventricular wall and cause only ST-segment and T-wave (ST-T) abnormalities.
Necrosis of a significant portion of the interventricular septum or ventricular wall may rupture, with dire consequences.
A ventricular aneurysm or pseudoaneurysm may form.
Electrical dysfunction Electrical dysfunction can be significant in any form of acute coronary syndrome.
Ischemic and necrotic cells are incapable of normal electrical activity, resulting in various ECG changes (predominantly ST-T abnormalities), arrhythmias, and conduction disturbances.
ST-T abnormalities of ischemia include ST-segment depression (often downsloping from the J point), T-wave inversion, ST-segment elevation (often referred to as injury current), and peaked T waves in the hyperacute phase of infarction.
Conduction disturbances can reflect damage to the sinus node, the atrioventricular (AV) node, or specialized conduction tissues.
Symptoms and Signs of Acute Coronary Syndromes Symptoms of acute coronary syndromes depend somewhat on the extent and location of obstruction and are quite variable.
Painful stimuli from thoracic organs, including the heart, can cause discomfort described as pressure, tearing, gas with the urge to eructate, indigestion, burning, aching, stabbing, and sometimes sharp needle-like pain.
Many patients deny they are having pain and insist it is merely "discomfort." Except when infarction is massive, recognizing the amount of ischemia by symptoms alone is difficult.
Symptoms of ACS are similar to those of angina and are discussed in more detail in sections on unstable angina and acute myocardial infarction.
Complications After the acute event, many complications can occur.
They usually involve Electrical dysfunction (eg, conduction defects, arrhythmias) Myocardial dysfunction (eg, heart failure, interventricular septum or free wall rupture, ventricular aneurysm, pseudoaneurysm, mural thrombus formation, cardiogenic shock) Valvular dysfunction (typically mitral regurgitation) Electrical dysfunction can be significant in any form of ACS, but usually, large parts of myocardium must be ischemic to cause significant myocardial dysfunction.
Pericarditis that occurs 2 to 10 weeks after an MI is known as post-MI syndrome, or Dressler syndrome.
Diagnosis of Acute Coronary Syndromes Serial ECGs Serial cardiac markers Immediate coronary angiography for patients with STEMI or complications (eg, persistent chest pain, hypotension, markedly elevated cardiac markers, unstable arrhythmias) Delayed angiography (24 to 48 hours) for patients with NSTEMI or unstable angina without complications noted above Acute coronary syndromes should be considered in men, usually > 30 years, and women usually > 40 years (younger in patients with diabetes), whose main symptom is chest pain or discomfort.
Pain must be differentiated from the pain of disorders such as pneumonia, pulmonary embolism, pericarditis, rib fracture, costochondral separation, esophageal spasm, acute aortic dissection, renal calculus, splenic infarction, or various abdominal disorders.
In patients with previously diagnosed hiatus hernia, peptic ulcer, or a gallbladder disorder, the clinician must be wary of attributing new symptoms to these disorders.
(For approach to diagnosis, see also Chest Pain.)
The approach is the same when any ACS is suspected: initial and serial ECG and serial cardiac marker measurements, which distinguish among unstable angina, NSTEMI, and STEMI.
Every emergency department should have a triage system to immediately identify patients with chest pain for rapid assessment and ECG.
Pulse oximetry and chest x-ray (particularly to look for mediastinal widening, which suggests aortic dissection) is also done.
Consequences depend on degree and location of obstruction and range from unstable angina to non-ST-segment elevation myocardial infarction (NSTEMI), ST-segment elevation myocardial infarction (STEMI), and sudden cardiac death.
ECG ECG is the most important test and should be done as soon as possible (eg, within 10 minutes of presentation).
It is the center of the decision pathway because fibrinolytics benefit patients with STEMI but may increase risk for those with NSTEMI.
Also, urgent cardiac catheterization is indicated for patients with acute STEMI but not for those with NSTEMI.
For STEMI, initial ECG is usually diagnostic, showing ST-segment elevation ≥ 1 mm in 2 or more contiguous leads subtending the damaged area (see figure Acute lateral left ventricular infarction).
If symptoms are characteristic, ST-segment elevation on ECG has a specificity of 90% and a sensitivity of 45% for diagnosing MI.
Serial tracings (obtained every 8 hours for 1 day, then daily) showing a gradual evolution toward a stable, more normal pattern or development of abnormal Q waves over a few days (see figure Inferior (diaphragmatic) left ventricular infarction) tends to confirm the diagnosis.
Symptoms are similar in each of these syndromes (except sudden death) and include chest discomfort with or without dyspnea, nausea, and diaphoresis.
Because nontransmural (non-Q wave) infarcts are usually in the subendocardial or midmyocardial layers, they do not produce diagnostic Q waves or distinct ST-segment elevation on the ECG.
Instead, they commonly produce only varying degrees of ST-T abnormalities that are less striking, variable, or nonspecific and sometimes difficult to interpret (NSTEMI).
If such abnormalities resolve (or worsen) on repeat ECGs, ischemia is very likely.
However, when repeat ECGs are unchanged, acute MI is unlikely and, if still suspected clinically, requires other evidence to make the diagnosis.
A normal ECG taken when a patient is pain free does not rule out unstable angina; a normal ECG taken during pain, although it does not rule out angina, suggests that the pain is not ischemic.
If right ventricular (RV) infarction is suspected, a 15-lead ECG is usually recorded; additional leads are placed at V4R, and, to detect posterior infarction, V8 and V9.
ECG diagnosis of myocardial infarction is more difficult when a left bundle branch block configuration is present because the ECG changes resemble changes due to STEMI (see figure Left bundle branch block).
Left bundle branch block Cardiac markers Cardiac markers (serum markers of myocardial cell injury) are Cardiac enzymes (eg, CK-MB [creatine kinase MB isoenzyme]) Cell contents (eg, troponin I, troponin T, myoglobin) These markers are released into the bloodstream after myocardial cell necrosis.
Some have predominately peripheral involvement.
Systemic corticosteroids, immunosuppressants, and most disease-modifying antirheumatic drugs (DMARDs) have no proven benefit in axial spondyloarthritides and should generally not be used.
For proper posture and joint motion, daily exercise and other supportive measures (eg, postural training, therapeutic exercise) are vital to strengthen muscle groups that oppose the direction of potential deformities (ie, the extensor rather than flexor muscles).
Reading while lying prone and pushing up on the elbows or pillows and thus extending the back may help keep the back flexible.
Because chest wall motion can be restricted, which impairs lung function, cigarette smoking, which also impairs lung function, is strongly discouraged.
Intra-articular depot corticosteroids may be beneficial, particularly when one or two peripheral joints are more severely inflamed than others, thereby compromising exercise and rehabilitation.
They may also help if systemic drugs are ineffective.
Imaging-guided corticosteroid injections into the sacroiliac joints may occasionally help severe sacroiliitis.
For acute uveitis, topical corticosteroids and mydriatics are usually adequate.
If severe hip arthritis develops, total hip arthroplasty may lessen pain and improve flexibility dramatically.
Key Points Ankylosing spondylitis is a systemic disorder that affects axial and peripheral joints and can cause constitutional symptoms, cardiac symptoms, and anterior uveitis.
Among those with axial involvement, some have no evidence of sacroiliitis on plain x-rays.
Initial manifestation is usually inflammatory back pain and stiffness sometimes along with peripheral joint symptoms and / or anterior uveitis.
Diagnose based on the results of lumbosacral spine imaging, sacroiliac joint imaging, pelvic MRI, blood tests (erythrocyte sedimentation rate, C-reactive protein, and complete blood count), and / or explicit clinical criteria.
Use nonsteroidal anti-inflammatory drugs to help reduce symptom severity and improve function.
Use sulfasalazine, methotrexate, tumor necrosis factor (TNF) - alpha antagonists, or interleukin-17 (IL-17) antagonists to relieve joint symptoms.
Thus, some experts have classified ankylosing spondylitis as follows: Axial ankylosing spondylitis: Has predominantly axial involvement and findings typical of bilateral sacroiliitis on imaging Nonradiographic ankylosing spondylitis: Clinically similar to axial ankylosing spondylitis but without findings typical of sacroiliitis on imaging Peripheral ankylosing spondylitis: Ankylosing spondylitis with predominantly peripheral involvement Symptoms and Signs of Ankylosing Spondylitis The most frequent manifestation of ankylosing spondylitis is inflammatory back pain, but disease can begin in peripheral joints, especially in children and women, and rarely with acute iridocyclitis (iritis, anterior uveitis).
Other early symptoms and signs are diminished chest expansion from diffuse costovertebral involvement, and occasionally fatigue, anorexia, weight loss, and anemia.
Back pain—often nocturnal and of varying intensity—eventually becomes recurrent.
Morning stiffness, typically relieved by activity, and paraspinal muscle spasm develop.
A flexed or bent-over posture eases back pain and paraspinal muscle spasm; thus, kyphosis is common in untreated patients.
Severe hip and shoulder arthritis can eventually develop and usually has a poor prognosis.
In late stages, the patient has accentuated kyphosis, loss of lumbar lordosis, and fixed bent-forward posturing, with compromised pulmonary function and inability to lie flat.
There may be peripheral potentially deforming joint involvement, sometimes involving isolated digits diffusely (dactylitis).
Diagnosis requires showing sacroiliitis on imaging Treatment is with nonsteroidal anti-inflammatory drugs and / or tumor necrosis factor antagonists or interleukin-17 (IL-17) antagonists and physical measures that maintain joint flexibility.
Achilles and patellar tendinitis can occur.
Systemic manifestations of ankylosing spondylitis occur in one third of patients.
Recurrent, acute anterior uveitis is common and usually responds to local therapy; less commonly it becomes protracted and severe enough to impair vision.
Neurologic signs occasionally result from compression radiculitis or sciatica, vertebral fracture or subluxation, or cauda equina syndrome.
Cardiovascular manifestations can include aortic insufficiency, aortitis, angina, pericarditis, and cardiac conduction abnormalities (which may be asymptomatic).
Dyspnea, cough, or hemoptysis can rarely result from nontuberculous fibrosis or cavitation of an upper lobe of the lung; cavitary lesions can become secondarily infected with Aspergillus.
Nonspecific colitis has been noted in 30% of patients with ankylosing spondylitis.
Subcutaneous nodules, like those in patients with rheumatoid arthritis, do not develop in patients with ankylosing spondylitis.
Diagnosis of Ankylosing Spondylitis Lumbosacral spine and sacroiliac joint radiography Blood tests (erythrocyte sedimentation rate, C-reactive protein, human leukocyte antigen B27 [HLA-B27], and complete blood count) or explicit clinical criteria (Assessment of SpondyloArthritis international Society criteria) Pelvic / spine MRI in select patients Ankylosing spondylitis should be suspected in patients, particularly young men, with nocturnal back pain plus prolonged morning stiffness and kyphosis, diminished chest expansion, Achilles or patellar tendinitis, or unexplained anterior uveitis.
A 1st-degree relative with ankylosing spondylitis should raise suspicion.
Ankylosing spondylitis is 3 times more frequent in men than in women and begins most often between ages 20 and 40.
Patients should generally be tested with erythrocyte sedimentation rate, C-reactive protein, and complete blood count.
Rheumatoid factor (RF) and antinuclear antibodies are needed only if peripheral arthritis suggests other diagnoses.
The HLA-B27 allele is present in 90% of White patients with ankylosing spondylitis, but it is also present in up to 10% of the general population depending on ethnicity.
No laboratory test is diagnostic, but results can increase suspicion for the disorder or rule out other disorders that can simulate ankylosing spondylitis.
If, after these tests, ankylosing spondylitis is still suspected, patients should undergo x-ray or MRI of the lumbosacral spine and sacroiliac joints; demonstration of sacroiliitis on x-ray strongly supports the diagnosis.
Some patients should undergo pelvic MRI to look for sacroiliitis that is not seen on x-rays.
In these patients, MRI shows osteitis or early erosions.
Although there are several existing diagnostic criteria for patients with suspected ankylosing spondylitis, the Assessment of SpondyloArthritis international Society (ASAS) criteria (1, 2, 3) are most often applied.
They are useful in diagnosing patients earlier in the disease process, particularly those without spondyloarthritis on imaging.
The ASAS criteria for axial spondyloarthritis are applied to patients who have had back pain for > 3 months and who are < 45 years of age at onset.
It is 10 to 20 times more common among 1st-degree relatives of patients with ankylosing spondylitis than in the general population.
Diagnosis can be done using ASAS imaging or clinical criteria.
To fulfill the imaging criteria, patients must have radiographic or MRI evidence of sacroiliitis plus at least 1 spondyloarthritis feature.
To fulfill the clinical criteria, patients must have HLA-B27 plus at least 2 separate spondyloarthritis features.
ASAS spondyloarthritis features include the following: Dactylitis Enthesitis of the heel Family history of spondyloarthritis History of inflammatory back pain Arthritis Psoriasis Inflammatory bowel disease Presence of HLA-B27 Uveitis Elevated C-reactive protein Good response to nonsteroidal anti-inflammatory drugs Historical features that distinguish inflammatory back pain from noninflammatory back pain include onset at ≤ 40 years, gradual onset, morning stiffness, improvement with activity, and duration ≥ 3 months before seeking medical attention.
Erythrocyte sedimentation rate and other acute-phase reactants (eg, C-reactive protein) are inconsistently elevated in patients with active ankylosing spondylitis.
Tests for RF and antinuclear antibodies are negative.
The HLA-B27 genetic marker is minimally helpful because positive and negative predictive values are low.
The earliest x-ray abnormalities are pseudo-widening caused by subchondral erosions, followed by sclerosis or later narrowing and eventually fusion in the sacroiliac joints.
Changes are symmetric.
Early changes in the spine are upper lumbar vertebral squaring with sclerosis at the corners (shiny corner sign), spotty ligamentous calcification, and one or two evolving syndesmophytes.
The human leukocyte antigen B27 (HLA-B27) allele is present in 90% of White patients with ankylosing spondylitis, but it is also present in up to 10% of the general population depending on ethnicity.
Late changes result in a "bamboo spine" appearance, resulting from prominent syndesmophytes, diffuse paraspinal ligamentous calcification, and osteoporosis; these changes develop in some patients on average over 10 years.
Changes typical of ankylosing spondylitis may not become visible on plain x-rays for years.
MRI shows changes earlier, but there is no consensus regarding its role in routine diagnosis given the lack of prospective, validated data in regard to its diagnostic utility.
Pelvic MRI should be done if the index of suspicion of spondyloarthritis is high or if there is a need to rule out other causes of the patient's symptoms.
MRI shows early inflammatory changes, bone marrow edema on T2-weighted images with fatty changes, and subtle structural abnormalities.
Lastly, routine monitoring of radiographic changes with serial spine x-rays is not recommended.
Differential diagnosis of ankylosing spondylitis Mechanical back pain: A herniated intervertebral disk can cause back pain and radiculopathy similar to ankylosing spondylitis, but the pain is limited to the spine and nerve roots, usually causes more sudden symptoms, and causes no systemic manifestations or laboratory test abnormalities.
If necessary, CT or MRI can differentiate it from ankylosing spondylitis.
Involvement of a single sacroiliac joint suggests a different spondyloarthropathy or possibly infection.
Tuberculous spondylitis can simulate ankylosing spondylitis (see tuberculosis of bones and joints).
The risk of ankylosing spondylitis in 1st-degree relatives with the HLA-B27 allele is about 20%.
Diffuse idiopathic skeletal hyperostosis (DISH): DISH occurs primarily in men > 50 years and may resemble ankylosing spondylitis clinically and on x-ray.
Patients uncommonly have spinal pain, stiffness, and insidious loss of motion.
X-ray findings in DISH include large ossifications anterior to spinal ligaments (the calcification appears as if someone poured candle wax in front and on the right side of the vertebrae), bridging several vertebrae (usually 4 vertebral bodies) and usually starting at the lower thoracic spine, eventually affecting the cervical and lumbar spine.
There is often subperiosteal bone growth along the pelvic brim and at insertion of tendons (such as the Achilles tendon insertion).
However, the anterior spinal ligament is intact and frequently bulging, and sacroiliac and spinal apophyseal joints are not eroded.
Additional differentiating features of DISH are stiffness that is usually not markedly accentuated in the morning and a normal erythrocyte sedimentation rate.
Osteitis condensans ilii: Generally, osteitis condensans ilii manifests as sclerotic triangles on the iliac side of lower third of the sacroiliac joint in young multiparous females without any bony erosions.
This radiographic finding does not require treatment.
In general, the HLA-B27 allele is not present in patients with osteitis condensans ilii.
Increased prevalence of HLA-B27 in White people or HLA-B7 in Black people supports a genetic predisposition.
Proper treatment in most patients results in minimal or no disability and in a full, productive life despite back stiffness.
Occasionally, the course is severe and progressive, resulting in pronounced incapacitating deformities.
Poor prognostic factors include persistently high erythrocyte sedimentation rate and C-reactive protein, hip involvement, poor response to NSAIDs, presence of anterior uveitis, or heart or pulmonary disease.
Treatment of Ankylosing Spondylitis Nonsteroidal anti-inflammatory drugs (NSAIDs) Sulfasalazine, methotrexate, tumor necrosis factor (TNF) - alpha antagonists, or interleukin-17 (IL-17) antagonists (eg, secukinumab, ixekizumab) Exercises and supportive measures The goals of treatment of ankylosing spondylitis are relieving pain, maintaining joint range of motion, and preventing end-organ damage.
However, the concordance rate in identical twins is only about 50%, suggesting that environmental factors contribute.
Because the condition may cause lung fibrosis, cigarette smoking is discouraged.
(See also 2019 Update of the American College of Rheumatology / Spondylitis Association of America / Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis.)
NSAIDs reduce pain and suppress joint inflammation and muscle spasm, thereby increasing range of motion, which facilitates exercise and prevents contractures.
Most NSAIDs work in ankylosing spondylitis, and tolerance and toxicity dictate drug choice.
The daily dose of NSAIDs should be as low as possible, but maximum doses may be needed with active disease.
Drug withdrawal should be attempted only slowly, after systemic and joint signs of active disease have been suppressed for several months.
Sulfasalazine may help reduce peripheral joint symptoms and laboratory markers of inflammation in some patients.
Dosage should be started at 500 mg / day and increased by 500 mg / day at 1-week intervals to 1 to 1.5 g 2 times a day maintenance; because acute neutropenia can occur, cell counts must be monitored when initiating therapy or increasing drug dose.
Peripheral joint symptoms may also abate with methotrexate, but spinal symptoms are usually not reduced.
Classification of Ankylosing Spondylitis Most patients have predominantly axial involvement (called axial ankylosing spondylitis).
TNF-alpha antagonists (eg, etanercept, infliximab, adalimumab, certolizumab, golimumab) are often strikingly effective treatments for inflammatory back pain.
Adalimumab or infliximab are preferred over etanercept for the treatment of ankylosing spondylitis in patients with recurrent uveitis.
For patients who fail TNF-alpha antagonists, switching to an IL-17 antagonist is preferred to switching to another TNF-alpha antagonist.
Secukinumab can be given at a dosage of 150 mg subcutaneously at weeks 0, 1, 2, 3, and 4 and every 4 weeks thereafter.
Without the loading (weekly) doses, secukinumab is 150 mg subcutaneously every 4 weeks.
Adverse effects include urticaria, upper respiratory infections, fungal infections due to Candida, diarrhea, herpes zoster, and worsening symptoms of inflammatory bowel disease.
Ixekizumab, another IL-17 inhibitor, can be given for active ankylosing spondylitis as an injection of 80 mg / mL for adult patients every 4 weeks after a loading dose of 160 mg (two 80-mg injections) at week 0, followed by 80 mg at weeks 2, 4, 6, 8, 10, and 12.
Discontinuation of biologics is not recommended due to the likelihood for symptom recurrence.
Autoimmune Myositis By Alana M Nevares, MD, The University of Vermont Medical Center Reviewed / Revised Oct 2022 View Patient Education Etiology Pathophysiology Classification Symptoms and Signs Diagnosis Prognosis Treatment Key Points Topic Resources Heliotrope Rash Gottron Papules Dermatomyositis (Hand Findings) Dermatomyositis (Neck) Mechanic's Hands Autoantibodies in Autoimmune... Autoimmune myositis is characterized by inflammatory and degenerative changes in the muscles (polymyositis, necrotizing immune-mediated myopathy) or in the skin and muscles (dermatomyositis).
Familial clustering occurs, and human leukocyte antigen (HLA) subtypes are associated with myositis.
As enzyme levels fall toward or reach normal in many patients in 6 to 12 weeks, followed later by improved muscle strength, the corticosteroid dose can be gradually decreased.
If muscle enzyme levels rise again, the corticosteroid dose is usually increased while awaiting the full effect of other medications.
The overall goal is to rapidly eliminate inflammation but minimize long-term corticosteroid exposure, which is why a second drug (typically methotrexate, tacrolimus, or azathioprine as first-line noncorticosteroid drugs) is started at the same time as corticosteroids or shortly after so that prednisone can be tapered to a maximum dose of 5 mg a day, ideally within about 6 months.
IV immune globulin is a good option for patients who do not respond rapidly to therapy, develop infectious complications with high-dose corticosteroids and other immunosuppressants, or who are undergoing chemotherapy.
Some experts may use a combination of all 3 therapies in severe cases or when corticosteroid toxicity is present.
Children require initial doses of prednisone of 30 to 60 mg / m 2 once a day.
Occasionally, patients treated chronically with high-dose corticosteroids become increasingly weak after the initial response because of a superimposed, painless corticosteroid myopathy.
In these patients, CK remains normal even though the patients are weaker.
Myositis associated with cancer is more refractory to corticosteroids.
Cancer-associated myositis may remit if the tumor is removed.
For example, the alleles of the 8.1 ancestral haplotype (HLA-DRB1 * 03-DQA1 * 05-DQB1 * 02) increase risk of polymyositis, dermatomyositis, and interstitial lung disease.
People with an autoimmune disorder are at higher risk of atherosclerosis and should be closely monitored.
Key Points Muscle weakness caused by myositis is most often proximal.
Heliotropic rash and Gottron papules are specific for dermatomyositis.
To establish the diagnosis, look for characteristic rash, muscle weakness, elevated creatine kinase level, and muscle changes on electromyography or MRI.
Unless patients have the characteristic skin findings, do a muscle biopsy to confirm the diagnosis.
Consider screening patients ≥ 40 years with dermatomyositis and patients ≥ 60 years with polymyositis for cancer.
Treat patients with corticosteroids and other immunosuppressants.
Possible inciting events include viral myositis and underlying cancer.
The association of cancer with dermatomyositis (less so with polymyositis) suggests that a tumor may incite myositis as the result of an autoimmune reaction against a common antigen in muscle and tumor.
Pathophysiology of Autoimmune Myositis Pathologic changes include cellular damage and atrophy, with variable degrees of inflammation.
Muscles in the hands, feet, and face are affected less than other skeletal muscles.
Involvement of muscles in the pharynx and upper esophagus and occasionally the heart can impair the functions of those organs.
Inflammation may occur in joints and lungs, especially in patients with antisynthetase antibodies.
Dermatomyositis is characterized by immune complex deposition in the vessels and is considered a complement-mediated vasculopathy.
In contrast, polymyositis is characterized by direct T cell-mediated muscle injury, and necrotizing immune-mediated myopathies are characterized by macrophage-predominant infiltrates and myophagocytosis.
Manifestations include symmetric weakness, occasionally tenderness, and fibrous replacement of muscle, sometimes with atrophy, principally of the proximal limb girdle muscles.
Classification of Autoimmune Myositis Autoimmune myositis can be classified into 4 groups, mainly based on histopathology and clinical presentation: Polymyositis Dermatomyositis Necrotizing immune-mediated myopathies Inclusion body myositis Dermatomyositis can be distinguished from polymyositis by the characteristic skin findings of dermatomyositis (see Symptoms and Signs).
Muscle histopathology also differs.
Dermatomyositis and polymyositis can manifest as pure muscle diseases or as part of antisynthetase syndrome, which can be associated with arthritis (usually nonerosive), fever, interstitial lung disease, hyperkeratosis of the radial aspect of the digits (mechanic's hands), and Raynaud syndrome.
Necrotizing immune-mediated myopathies most often include signal recognition particle (SRP) antibody-related myositis and statin-induced myositis, usually have an aggressive presentation, very elevated creatine kinase (CK) levels, and do not involve extramuscular organs (1).
Inclusion body myositis causes proximal leg muscle weakness, but frequently involves distal muscles (eg, hand and foot muscles) often with muscle wasting.
It develops at an older age, has a slower progression, and does not generally respond to immunosuppressive therapy.
Autoimmune myositis can also overlap with other autoimmune rheumatic disorders—eg, systemic lupus erythematosus, systemic sclerosis, mixed connective tissue disease.
These patients have symptoms and signs of the overlap disorders in addition to myositis (manifest as either dermatomyositis or polymyositis).
Diagnosis is by clinical findings and abnormalities on muscle tests, which may include creatine kinase test, MRI, electromyography, and muscle biopsy.
Polyarthralgias, Raynaud syndrome, dysphagia, pulmonary symptoms (eg, cough, dyspnea), and constitutional complaints (notably fever, fatigue, and weight loss) may also occur.
Severe disease is characterized by dysphagia, dysphonia, and / or diaphragmatic weakness.
Muscle weakness may progress over weeks to months.
However, it takes destruction of 50% of muscle fibers to cause symptomatic weakness (ie, muscle weakness indicates advanced myositis).
Patients may have difficulty raising their arms above their shoulders, climbing steps, or rising from a sitting position.
Sometimes muscle tenderness and atrophy develop.
Patients may require the use of a wheelchair or become bedridden because of weakness of pelvic and shoulder girdle muscles.
The flexors of the neck may be severely affected, causing an inability to raise the head from the pillow.
Several types of myositis have pulmonary and cardiac manifestations.
Involvement of pharyngeal and upper esophageal muscles may impair swallowing and predispose to aspiration.
Muscles of the hands, feet, and face are not involved except in inclusion body myositis, in which distal involvement, especially of the hands, is characteristic.
Limb contractures rarely develop.
Joint manifestations include polyarthralgia or polyarthritis with swelling and other characteristics of nondeforming arthritis.
They occur more often in a subset with Jo-1 or other antisynthetase antibodies.
Visceral involvement (except that of the pharynx and upper esophagus) is less common in autoimmune myositis than in some other rheumatic disorders (eg, systemic lupus erythematosus, systemic sclerosis).
Occasionally, and especially in patients with antisynthetase antibodies, interstitial lung disease (manifested by dyspnea and cough) is the most prominent manifestation.
Cardiac involvement, especially conduction disturbances and ventricular dysfunction, can occur.
Gastrointestinal symptoms, more common among children, are due to an associated vasculitis and may include abdominal pain, hematemesis, melena, and ischemic bowel perforation.
Skin changes, which occur in dermatomyositis, tend to be dusky and erythematous.
Treatment is with corticosteroids combined with immunosuppressants and / or IV immune globulin.
Photosensitivity and skin ulceration are visible.
Periorbital edema with a purplish appearance (heliotrope rash) is relatively specific for dermatomyositis.
Elsewhere, the rash may be slightly elevated and smooth or scaly; it may appear on the forehead, V of the neck and shoulders, chest and back, forearms and lower legs, lateral thighs, elbows and knees, medial malleoli, and dorsal aspects of the proximal interphalangeal and metacarpophalangeal joints (Gottron papules—a relatively specific finding).
The base and sides of the fingernails may be hyperemic or thickened.
Desquamating dermatitis with splitting of the skin may evolve over the radial aspects of the fingers.
Subcutaneous and muscle calcification may occur, particularly in children.
The primary skin lesions frequently fade completely but may be followed by secondary changes (eg, brownish pigmentation, atrophy, persistent neovascularization, scarring).
Rash on the scalp may appear psoriaform and be intensely pruritic.
Characteristic skin changes can occur in the absence of muscle disease, in which case the disease is called amyopathic dermatomyositis.
Skin Changes in Dermatomyositis Heliotrope Rash This photo shows violaceous rash around the eyes and in the nasolabial folds and chin in a patient with dermatomyositis.
Autoimmune myositis is more common in females than males by a 2: 1 ratio.
© Springer Science+Business Media Gottron Papules Gottron papules are scaly, erythematous to violaceous papules on extensor surfaces of proximal interphalangeal and metacarpophalangeal joints.
© Springer Science+Business Media Dermatomyositis (Hand Findings) This photo shows Gottron papules (on metacarpophalangeal joints), subcutaneous calcifications (on metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints), and periungual erythema and thickening.
© Springer Science+Business Media Dermatomyositis (Neck) This image shows dusky, erythematous skin changes resulting from dermatomyositis.
Mechanic's Hands This photo shows hyperkeratosis and fissuring of the fingers in a patient with antisynthetase syndrome.
© Springer Science+Business Media Diagnosis of Autoimmune Myositis Clinical criteria Muscle biopsy (definitive) Autoimmune myositis should be suspected in patients with proximal muscle weakness with or without muscle tenderness.
Dermatomyositis should be suspected in patients with symptoms of myositis and skin findings compatible with dermatomyositis.
Establishing the diagnosis of autoimmune myositis requires as many as possible of the following 5 criteria: Proximal muscle weakness Characteristic rash Elevated serum muscle enzymes (if creatine kinase [CK] is not elevated, aminotransferases or aldolase, which are far less specific than CK) Characteristic electromyographic or MRI muscle abnormalities Muscle biopsy changes (the definitive test) Biopsy findings can vary, but chronic inflammation with muscle degeneration and some regeneration is typical.
Polymyositis and dermatomyositis can often be distinguished by muscle biopsy.
A definite diagnosis made by muscle biopsy is recommended before treatment of polymyositis to exclude other muscle disorders, such as those due to missing or defective enzymes, necrotizing myositis, and postviral rhabdomyolysis.
The incidence is 3 to 4 times higher in Black people than in White people.
Muscle biopsy is not usually necessary when skin findings are characteristic for dermatomyositis.
There is no pathognomic skin finding for dermatomyositis on biopsy, but the absence of direct immunofluorescence helps distinguish the rash from the rash in patients with systemic lupus erythematosus.
Autoantibodies should be tested.
Antinuclear antibodies (ANA) are positive in up to 80% of patients with dermatomyositis and polymyositis.
If the ANA test is positive, further testing for specific types of antibodies is important in increasing the suspicion for an overlap syndrome.
Clinical course and manifestations are associated with particular antibodies as described in table.
The relationship between these autoantibodies and disease pathogenesis remains unclear, although antibody to Jo-1 is a significant marker for fibrosing alveolitis, pulmonary fibrosis, arthritis, and Raynaud syndrome.
Table Evidence for increased risk of cancer is relatively strong in dermatomyositis and less strong for polymyositis.
These disorders may appear at any age but occur most commonly from age 40 to 60 or, in children, from age 5 to 15.
Therefore, cancer screening should be considered for patients ≥ 40 years who have dermatomyositis or for patients ≥ 60 years who have polymyositis because these patients often have unsuspected cancers.
Screening should include at least a physical examination that includes the breasts, pelvis, and rectum (with occult blood testing); complete blood count (CBC); biochemical profile; mammogram; urinalysis; chest x-ray; and any other tests appropriate based on the patient's age.
Additional investigation should be based on history and physical examination findings.
Some authorities recommend CT of the chest, abdomen, and pelvis as well as colonoscopy, particularly in patients who have dermatomyositis.
Younger patients without symptoms of cancer need not undergo screening.
Prognosis for Autoimmune Myositis Long remissions (even apparent recovery) occur in up to 50% of treated patients within 5 years, more often in children.
Relapse, however, may still occur at any time.
Overall 5-year survival rate is 75% and is higher in children.
Death in adults is preceded by severe and progressive muscle weakness, dysphagia, undernutrition, aspiration pneumonia, or respiratory failure with superimposed pulmonary infection.
Death in children with dermatomyositis may be a result of bowel vasculitis.
Etiology of Autoimmune Myositis The cause of autoimmune myositis seems to be an autoimmune reaction to muscle tissue in genetically susceptible people.
Dermatomyositis and polymyositis have been linked to an increased cancer risk.
Treatment of Autoimmune Myositis Corticosteroids Immunosuppressants (eg, methotrexate, azathioprine, mycophenolate mofetil, rituximab, tacrolimus) IV immune globulin Physical activities should be modestly curtailed until the inflammation subsides.
For acute disease, adults receive oral prednisone 1 mg / kg (usually about 40 to 60 mg) once a day.
For severe disease with dysphagia or respiratory muscle weakness, treatment usually starts with high-dose corticosteroid therapy (eg, methylprednisolone 0.5 to 1 g IV once a day for 3 to 5 days).
Serial measurements of creatine kinase (CK) provide the best early guide of therapeutic effectiveness.
However, in patients with widespread muscle atrophy, levels are occasionally normal despite chronic, active myositis.
MRI findings of muscle edema or high CK levels generally differentiate a relapse of myositis from corticosteroid-induced myopathy.
Aldolase is an alternative, being less specific for muscle injury than CK, but can occasionally be positive in patients with myositis and normal CK levels.
Gout By Sarah F Keller, MD, MA, Cleveland Clinic, Department of Rheumatic and Immunologic Diseases Reviewed / Revised Jul 2022 | Modified Sep 2022 View Patient Education Pathophysiology Symptoms and Signs Diagnosis Prognosis Treatment Key Points Asymptomatic Hyperuricemia Topic Resources Podagra Tophaceous Gout in Fingers Tophi Gout Crystals Tophus with Erosion Gout of the Middle Toe Microscopic Examination of... Gout is a disorder caused by hyperuricemia (serum urate > 6.8 mg / dL [> 0.4 mmol / L]) that results in the precipitation of monosodium urate crystals in and around joints, most often causing recurrent acute or chronic arthritis.
Gout is rare in younger people but is often more severe in people who develop the disorder before age 30.
Treatment of acute flares Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in treating acute flares and are generally well-tolerated.
However, they can have adverse effects, including gastrointestinal upset or bleeding, hyperkalemia, increases in creatinine, and fluid retention.
Older and dehydrated patients are at particular risk, especially if there is a history of renal disease.
Virtually any NSAID used in anti-inflammatory (high) doses is effective and is likely to exert an analgesic effect beginning within a few hours.
Treatment should be continued for several days after the pain and signs of inflammation have resolved to prevent relapse.
Oral colchicine, a traditional therapy, produces a dramatic response in some patients if begun soon after the onset of symptoms; it is most effective if started within 12 to 24 hours of an acute flare.
A dose of 1.2 mg can be followed with 0.6 mg 1 hour later; joint pain tends to decrease after 12 to 24 hours and sometimes ceases within 3 to 7 days, but continued dosing is generally needed to achieve resolution, which may take time.
If colchicine is tolerated, 0.6 to 1.2 mg once a day can be continued as the flare subsides.
Renal insufficiency and drug interactions, especially with clarithromycin and some statins, may warrant reduction of dosage or use of other treatments.
Gastrointestinal upset and diarrhea are common adverse effects.
Gout often runs in families.
IV colchicine is no longer available in the US.
Corticosteroids are used to treat acute flares.
Aspiration of affected joints, followed by instillation of corticosteroid ester crystal suspension, is very effective, particularly for monarticular symptoms; prednisolone tebutate 4 to 40 mg or prednisolone acetate 5 to 25 mg can be used, with dose depending on the size of the affected joint.
Oral prednisone (about 0.5 mg / kg once a day), IM or IV corticosteroids, or single-dose adrenocorticotropic hormone (ACTH) 80 U IM is effective, particularly if multiple joints are involved.
As with NSAID therapy, corticosteroids should be continued for a few days after the flare fully resolves to prevent relapse.
If monotherapy is ineffective or doses (eg, of NSAIDs) are limited by toxicity, colchicine can be combined with NSAIDs or corticosteroids.
In addition to NSAIDs or corticosteroids, supplementary analgesics, rest, ice application, and splinting of the inflamed joint may be helpful.
If patients are taking urate-lowering drugs when an acute flare begins, the drugs should be continued at the same dose; dose adjustments are deferred until the flare has subsided.
There is no contraindication to initiating urate-lowering therapy during an acute flare if appropriate antiinflammatory therapy is being provided.
If corticosteroids, colchicine, and NSAIDs are contraindicated or ineffective, an IL-1 antagonist, such as anakinra, can be used.
Patients with metabolic syndrome are at increased risk of gout.
Anakinra may hasten resolution of a flare and shorten the hospital stay of a patient with multiple comorbidities that limit the use of the other drugs.
Anakinra is typically given as 100 mg subcutaneously once a day until symptoms resolve.
Anakinra has the advantage of not affecting glucose levels or renal function or causing fluid retention and can be used in a patient with an active infection that is being appropriately treated.
Due to practical considerations (eg, cost), anakinra is not typically used to treat acute gout flares in the outpatient setting.
Prevention of recurrent flares The frequency of acute flares is reduced by taking 0.6 mg of colchicine once or twice a day (maximum 1.2 mg per day depending on tolerance and renal function).
An extra two 0.6-mg tablets of colchicine taken at the first suggestion of a flare may abort flares.
If the patient is taking prophylactic doses of colchicine and has taken higher doses of colchicine to treat an acute flare within the past 2 weeks, an NSAID or corticosteroid should be used instead to try to abort the flare.
A (reversible) neuropathy and / or myopathy can develop during chronic colchicine ingestion.
This condition is more likely to occur in patients with renal insufficiency, and in patients also receiving certain statins or macrolides, but can rarely occur in patients with none of these risk factors.
Flare frequency can also be decreased with daily low-dose NSAIDs if renal function allows.
Pathophysiology of Gout The greater the degree and duration of hyperuricemia, the greater is the likelihood that gout will develop.
Chronic corticosteroid use is not an ideal prophylactic therapy because of its adverse effect potential.
Lowering the serum urate level Colchicine, NSAIDs, and corticosteroids do not retard the progressive joint damage caused by tophi, because they do not lower the serum urate level.
Joint damage can be prevented and, if present, may be reversed with urate-lowering drugs.
Tophaceous deposits are resorbed by lowering serum urate or dissolved with uricase replacement therapy.
Maintaining a serum urate level below the saturation point (target is usually < 6 mg / dL [< 0.35 mmol / L]) will ultimately decrease the frequency of acute arthritic flares as the deposits are dissolved.
This decrease is accomplished by Blocking urate production with xanthine oxidase inhibitors (XOI) (allopurinol or febuxostat) Increasing urate excretion with a uricosuric drug (probenecid or losartan) Using both types of drugs together in severe tophaceous gout or in patients intolerant of higher doses of a XOI Increasing urate excretion by converting urate to allantoin, which is more soluble and readily excreted, with uricase replacement therapy in patients such as those who have severe tophaceous gout or did not respond to other urate-lowering therapy Urate-lowering therapy is indicated for patients with Tophaceous deposits Evidence of joint damage due to gout on imaging studies Frequent or disabling flares (eg, > 2 flares times a year) of gouty arthritis Urolithiasis Patients with infrequent flares but whose serum uric acid level is > 9 mg / dL (> 0.5 mmol / L) or for whom having any flares poses particular hardship Multiple comorbidities (eg, peptic ulcer disease, chronic kidney disease) that are relative contraindications to the drugs used to treat recurrent acute flares (NSAIDs or corticosteroids) Hyperuricemia is not usually treated in the absence of gout flares or uric acid nephrolithiasis.
The goal of urate-lowering therapy is to lower the serum urate level.
If tophi are not present, a reasonable target level is < 6 mg / dL (< 0.35 mmol / L), which is below the level of saturation (> 6.8 mg / dL [0.4 mmol / L] at normal core body temperature and pH).
Compelling data demonstrate decreased frequency of flares when the serum urate level decreases to < 6 mg / dL with this treat-to-target strategy.
Two randomized controlled trials have established that significantly fewer patients with a serum urate level < 6 mg / dL experienced gout flares than those with a higher serum urate level.
Urate levels can be elevated because of Decreased renal (most common) or gastrointestinal excretion Increased production (rare) Increased purine intake (usually in combination with decreased excretion) Why only some people with elevated serum uric acid (urate) levels develop gout flares is not known.
The patients with the target serum urate (< 6 mg / dL) who did flare had fewer gout flares than patients who were above this serum urate threshold (1).
If palpable tophi are present or if there is marked disability from tophaceous deposits, a reasonable goal is to dissolve them more rapidly, and this requires an even lower target level.
The lower the serum urate level, the faster tophi resolve.
After presumed complete dissolution of deposits, the serum urate can be allowed to increase to a level < 6 mg / dL.
Drugs are effective in lowering serum urate; dietary restriction of purines is less effective, but high intake of high-purine food, alcohol (beer in particular), and nonalcoholic beer should be avoided.
Carbohydrate restriction (especially high-fructose corn syrup) and weight loss can lower serum urate level, particularly in patients with insulin resistance because high insulin levels suppress urate excretion.
Intake of low-fat dairy products should be encouraged.
Because acute flares tend to develop during the first months of urate-lowering therapy, such therapy should be started in conjunction with once or twice a day colchicine or NSAIDs.
Resolution of tophi may take many months even with maintenance of serum urate at low levels.
Serum urate should be measured periodically, usually monthly while determining required drug dosage and then at least yearly to confirm the effectiveness of therapy or more often if there are drug changes or weight gain.
Decreased renal excretion is by far the most common cause of hyperuricemia.
Urate-lowering therapy should not be stopped if a patient has a flare.
Allopurinol, a xanthine oxidase inhibitor of urate synthesis, is the most commonly prescribed and preferred initial urate-lowering therapy.
Uric acid stones or gravel may dissolve during allopurinol treatment.
Treatment usually begins with 50 to100 mg orally once a day and can be slowly dose escalated up to 800 mg orally once a day.
The dose can be split if single daily dosing causes gastrointestinal distress.
Some clinicians recommend decreasing the starting dose in patients with renal insufficiency (eg, 50 mg orally once a day if creatinine clearance is < 60 mL / min/1.73 m 2) to decrease the incidence of rare but severe systemic hypersensitivity reactions; however, data that confirm the effectiveness of this intervention are limited.
The final dose of allopurinol should be determined by the target serum urate level.
The most commonly used daily dose is 300 mg, but this dose is effective in lowering serum uric acid levels to < 6 mg / dL (< 0.35 mmol / L) in fewer than 40% of patients with gout.
Absorption of allopurinol may decrease at doses higher than 300 mg, so split dosing (eg, twice daily dosing) should be considered.
Adverse effects of allopurinol include mild gastrointestinal distress and rash, which can be a harbinger of Stevens-Johnson syndrome, life-threatening hepatitis, vasculitis, or leukopenia.
It may be hereditary (eg, due to variations in uric acid transporter efficiency) and also occurs in patients receiving diuretics and in those with diseases that decrease the glomerular filtration rate (GFR).
Adverse effects are more common among patients with renal dysfunction.
HLA-B * 5801 carriers are at higher risk of allopurinol reactions, and HLA-B * 5801 prevalence varies by race (2).
Therefore, the 2020 American College of Rheumatology Guideline for the Management of Gout recommends testing patients of Southeast Asian descent (eg, Han Chinese, Korean, Thai) and Black American patients for HLA B * 5801 and using an alternative drug if that genetic marker is present.
Allopurinol is contraindicated in patients taking azathioprine or mercaptopurine because it can decrease metabolism of these drugs and thus potentiate their immunosuppressive and cytolytic effects.
Hepatic transaminase levels can become elevated and should be measured periodically.
Febuxostat is a more costly (in the US) but potent xanthine oxidase inhibitor of urate synthesis.
It is especially useful in patients who do not tolerate allopurinol, who have contraindications to allopurinol, or in whom allopurinol does not sufficiently decrease urate levels.
Febuxostat appears to prevent acute flares as efficaciously as allopurinol (3).
Febuxostat is begun at 40 mg orally once a day and increased to 80 to 120 mg orally once a day if urate does not decrease to < 6 mg / dL (< 0.35 mmol / L).
Febuxostat (like allopurinol) is contraindicated in patients taking azathioprine or mercaptopurine because it can decrease metabolism of these drugs.
Ethanol increases purine catabolism in the liver and increases the formation of lactic acid, which blocks urate secretion by the renal tubules, and ethanol may also stimulate liver urate synthesis.
Compared with allopurinol, febuxostat increased the risk of mortality in one study of patients with known cardiovascular disease (4), but several additional studies have not confirmed this observation (5).
Transaminase levels can become elevated and should be measured periodically.
Uricase is an enzyme, absent in humans, that converts urate to allantoin, which is more soluble.
Pegloticase is expensive and is used primarily in patients with gout in whom other treatments have been unsuccessful in lowering the serum urate level.
Pegloticase can also be used in patients who have a high burden of tophaceous deposits that would not likely be dissolved in a reasonable time period by other urate-lowering therapies.
It is given IV every 2 to 3 weeks for many months (typically at least 6 to 9 months) to totally deplete the excess urate deposits; it often lowers the serum urate level to < 1 mg / dL (< 0.1 mmol / L).
Pegloticase is contraindicated in patients with G6PD deficiency because it can cause hemolysis and methemoglobinemia.
Pegloticase infusion can be associated with symptoms consistent with anaphylaxis.
The effectiveness of the currently available preparation is limited by a high rate of development of drug neutralizing antibodies.
Lead poisoning and cyclosporine, usually in the higher doses given to transplant patients, alter renal tubular function leading to urate retention.
Failure of urate levels to decrease to < 6 mg / dL (< 0.35 mmol / L) after a pegloticase infusion indicates the likely presence of antipolyethylene glycol (anti-PEG) antibodies and an increased risk of future allergic reactions; regular infusions are then stopped.
To prevent other urate-lowering drugs from masking ineffectiveness of pegloticase, other urate-lowering drugs should not be used together with pegloticase.
However, co-administration of immunosuppressants (eg, methotrexate) with pegloticase may prevent development of the neutralizing antibodies.
Uricosuric therapy is useful in patients who under excrete uric acid (the majority of patients with hyperuricemia), have normal renal function, and have not had renal stones.
Probenecid is the only uricosuric drug available in the US.
Probenecid can be used as monotherapy if both allopurinol and febuxostat are contraindicated or not tolerated.
Probenecid loses efficacy with declining renal function and is generally not as useful with a glomerular filtration rate < 50 mL / min/1.73 m 2.
Probenecid treatment begins with 250 mg orally 2 times a day, with doses increased as needed, to a maximum of 1 g orally 3 times a day.
It is also effective when added to a xanthine oxidase inhibitor.
The antihypertensive drug losartan and the triglyceride-lowering drug fenofibrate both have uricosuric effects and can be used to decrease uric acid in patients who have other reasons for taking these drugs.
Increased production of urate may be caused by increased nucleoprotein turnover in hematologic conditions (eg, lymphoma, leukemia, hemolytic anemia) and in conditions with increased rates of cellular proliferation and cell death (eg, psoriasis, cytotoxic cancer therapy, radiation therapy).
Low doses of salicylates may decrease uric acid excretion and worsen hyperuricemia, but only trivially, and should not be avoided if otherwise indicated as in secondary prevention of cardiovascular disease.
Other treatments Fluid intake ≥ 3 L per day is desirable for all patients, especially those who chronically pass urate gravel or stones.
Alkalinization of urine (with potassium citrate 20 to 40 mEq orally 2 times a day or acetazolamide 500 mg orally at bedtime) is also occasionally effective for patients with persistent uric acid urolithiasis despite hypouricemic therapy and adequate hydration.
However, excessive urine alkalinization may cause deposition of calcium phosphate and oxalate crystals.
Extracorporeal shock wave lithotripsy may be needed to disintegrate renal stones.
Increased urate production may also occur as a primary hereditary abnormality and in obesity, because urate production correlates with body surface area.
Lancet 396 (10264): 1745 - 1757, 2020. doi: 10.1016/S0140 - 6736 (20) 32234 - 0 Key Points Although increased purine intake and increased production can contribute to hyperuricemia, the most common cause of gout is decreased urate excretion secondary to kidney disorders or genetic variability in uric acid transporter efficiency.
In most cases, the cause of urate overproduction is unknown, but rarely can be attributable to enzyme abnormalities; deficiency of hypoxanthine-guanine phosphoribosyltransferase (complete deficiency is Lesch-Nyhan syndrome) is a possible cause, as is overactivity of phosphoribosylpyrophosphate synthetase.
Suspect gout in patients with sudden, unexplained acute monoarticular or oligoarticular arthritis, particularly if the great toe or midfoot is affected or there is a prior history of sudden, unexplained episodes of acute arthritis with spontaneous remission in 7 to 10 days.
Confirm the diagnosis by finding needle-shaped, strongly negatively birefringent urate crystals in joint fluid; or by dual-energy CT scans or ultrasound imaging.
Documentation of hyperuricemia is insufficient to confirm the diagnosis of gouty arthritis.
Treat acute flares of gout with oral colchicine, an NSAID, a corticosteroid, a combination of colchicine with an NSAID or a corticosteroid, or an interleukin-1 (IL-1) antagonist.
Decrease the risk of future flares by prescribing colchicine, an NSAID, and life-long use of drugs to decrease the serum urate level.
Give drugs that decrease serum urate levels if patients have tophi, > 2 flares of gout per year, urolithiasis, or multiple comorbidities that contraindicate the drugs used to relieve acute flares; individualize the use of urate-lowering ongoing therapy in other patients.
Decrease urate levels usually by prescribing allopurinol or febuxostat alone or in combination with a uricosuric drug.
Asymptomatic Hyperuricemia Asymptomatic hyperuricemia is elevation of serum urate > 7 mg / dL (> 0.4 mmol / L) in the absence of clinical gout.
Generally, treatment of asymptomatic hyperuricemia is not required.
Most patients with asymptomatic hyperuricemia with serum urate levels as high as 10 mg / dL (0.6 mmol / L) do not develop gout flares over 10 years.
Increased intake of purine-rich foods (eg, liver, kidney, anchovies, asparagus, consommé, herring, meat gravies and broths, mushrooms, mussels, sardines, sweetbreads) can contribute to hyperuricemia.
However, patients with overexcretion of urate and recurrent uric acid kidney stones despite urinary alkalinization and sufficient hydration may receive allopurinol.
Observational data suggested that hyperuricemia may contribute to the progression of chronic kidney disease, cardiovascular disease, and, in adolescents, primary hypertension.
Interventional studies, however, have not demonstrated that lowering the serum urate level reduces progression of renal disease.
Beer, including nonalcoholic beer, is particularly rich in guanosine, a purine nucleoside.
However, a strict low-purine diet lowers serum urate by only about 1 mg / dL (0.1 mmol / L) and thus is rarely sufficient therapy for patients with gout.
Urate precipitates as needle-shaped monosodium urate (MSU) crystals, which are deposited extracellularly in avascular tissues (eg, cartilage) or in relatively avascular tissues (eg, tendons, tendon sheaths, ligaments, walls of bursae) and skin around cooler distal joints and tissues (eg, ears, finger pads).
In severe, long-standing hyperuricemia, MSU crystals may be deposited in larger central joints and in the parenchyma of organs such as the kidney.
At the acid pH of urine, urate precipitates readily as small platelike or diamond-shaped uric acid crystals that may aggregate to form gravel or stones, which may obstruct urine outflow.
Tophi are MSU crystal aggregates that most often develop in joint and cutaneous tissue.
They are usually encased in a fibrous granulomatous matrix, which prevents them from causing acute inflammation.
Symptoms of gout include acute, severe pain, tenderness, warmth, redness, and swelling.
Acute gouty arthritis may be triggered by trauma, medical stress (eg, pneumonia or other infection), surgery, use of thiazide diuretics or drugs with hypouricemic effects (eg, allopurinol, febuxostat, probenecid, nitroglycerin), or indulgence in purine-rich food or alcohol.
Flares are often precipitated by a sudden increase or, more commonly, a sudden decrease in serum urate levels.
Why acute flares follow some of these precipitating conditions is unknown.
Tophi in and around joints can limit motion and cause deformities, called chronic tophaceous gouty arthritis.
Gout increases the risk of developing secondary osteoarthritis.
Symptoms and Signs of Gout Acute gouty arthritis usually begins with sudden onset of pain (often nocturnal).
The metatarsophalangeal joint of a great toe is most often involved (called podagra), but the instep, ankle, knee, wrist, and elbow are also common sites.
Rarely, the hip, shoulder, sacroiliac, sternoclavicular, or cervical spine joints are involved.
The pain becomes progressively more severe, usually over a few hours, and is often excruciating.
Swelling, warmth, redness, and exquisite tenderness may suggest infection.
Definite diagnosis requires identification of crystals in synovial fluid.
The overlying skin may become tense, warm, shiny, and red or purplish.
Fever, tachycardia, chills, and malaise sometimes occur.
Course The first few flares usually affect only a single joint and last only a few days.
Later flares may affect several joints simultaneously or sequentially and persist up to 3 weeks if untreated.
Subsequent flares develop after progressively shorter symptom-free intervals.
Eventually, multiple flares may occur each year.
If ongoing urate-lowering therapy is not initiated, patients can develop chronic deforming arthritis from tophaceous gout due to ongoing urate deposition.
Tophi Palpable tophi develop in patients with gout and can rarely occur in patients who have never had acute gouty arthritis.
They are usually firm yellow or white papules or nodules, single or multiple.
They can develop in various locations, commonly the fingers, hands, feet, and around the olecranon or Achilles tendon.
Treatment of acute flares is with anti-inflammatory drugs.
Tophi can also develop in the kidneys and other organs and under the skin on the ears.
Patients with osteoarthritic Heberden nodes may develop tophi in the nodes.
This development occurs most often in older women taking diuretics, and these can become dramatically inflamed and misdiagnosed as inflammatory osteoarthritis.
Normally painless, tophi, especially in the olecranon bursae, can become acutely inflamed and painful, often after mild or inapparent injury.
Tophi may erupt through the skin, discharging chalky masses of urate crystals.
These sinus tracts can become infected.
Tophi in and around joints may eventually cause deformities and secondary osteoarthritis.
Complications of gout Gouty arthritis can cause pain, deformity, and limited joint motion.
Inflammation can be flaring in some joints while subsiding in others.
Patients with gout may develop urolithiasis with uric acid stones or calcium oxalate stones.
The frequency of flares can be reduced by regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or both plus persistent lowering of the serum urate level below its saturation level (< 6.8 mg / dL [< 0.4 mmol / L) with allopurinol, febuxostat, or uricosuric drugs such as probenecid.
Complications of gout include renal obstruction and infection, with secondary tubulointerstitial disease.
Untreated progressive renal dysfunction, most often related to coexisting hypertension or, less often, some other cause of nephropathy, further impairs excretion of urate, accelerating crystal deposition in tissues.
Cardiovascular disease, obstructive sleep apnea, nonalcoholic fatty liver disease, and components of metabolic syndrome are common among patients with gout.
Diagnosis of Gout Clinical criteria Synovial fluid analysis The diagnosis of gout should be suspected in patients with acute monoarticular arthritis or oligoarticular arthritis, particularly older adults or those with other risk factors.
Podagra and recurrent instep inflammation are particularly suggestive.
Previous flares that began explosively and resolved spontaneously within 7 to 10 days are also characteristic.
Similar symptoms can result from the following: Acute calcium pyrophosphate arthritis (calcium pyrophosphate dihydrate (CPPD) crystal deposition disease) (however, calcium pyrophosphate deposition generally occurs in larger joints, is not associated with tophi, and its clinical course is often milder but protracted) Acute rheumatic fever with joint involvement and juvenile idiopathic arthritis (however, these disorders occur mostly in young people, who rarely get gout) Rheumatoid arthritis (RA) (however, RA tends to be symmetrical and persistent, with more affected joints during a flare, flares persisting for longer periods of time, and flares in all joints subsiding together; whereas in gout, inflammation is usually flaring in some joints while subsiding in others) Acute fracture in patients unable to provide a history of injury (particularly metatarsal stress fractures) Acute infectious arthritis or chronic infectious arthritis (differentiation requires synovial fluid analysis) Palindromic rheumatism Acute calcific periarthritis caused by basiccalcium phosphateor calcium oxalate crystal deposition disease Palindromic rheumatism is characterized by acute, recurrent flares of inflammation in or near one or occasionally several joints or tendon sheaths with spontaneous resolution; pain and erythema can be as severe as in gout.
Flares often subside spontaneously and completely in 1 to 3 days.
Such flares may herald the onset of RA, and rheumatoid factor tests can help in differentiation; they are positive in about 50% of patients (these tests are positive in 10% of gouty patients also).
Synovial fluid analysis If acute gouty arthritis is suspected, arthrocentesis and synovial fluid analysis should be done at the initial presentation.
A typical recurrence in a patient with previously documented gout does not mandate arthrocentesis, but it should be done if there is any question of the diagnosis or if the patient's risk factors or any clinical characteristics suggest infectious arthritis.
In some cases, a diagnosis of gout may be reasonably presumed based on the patient's history and clinical features or on imaging results in cases when joint fluid cannot be obtained; however, every attempt should be made to document the presence of MSU crystals in synovial fluid from an affected joint.
Synovial fluid analysis can confirm the diagnosis by identifying needle-shaped, strongly negatively birefringent urate crystals that are free in the fluid or engulfed by phagocytes.
Synovial fluid during flares has inflammatory characteristics (see table), usually 2, 000 to 100, 000 white blood cells / mcL, with > 80% polymorphonuclear white blood cells.
These findings overlap considerably with infectious arthritis, which must be excluded by Gram stain (which is insensitive) and culture.
Table Serum urate level An elevated serum urate level supports the diagnosis of gout but is neither specific nor sensitive; at least 30% of patients have a normal serum urate level during an acute flare in part due to the uricosuric properties of the proinflammatory cytokine interleukin-6 (IL-6) or because a sudden lowering of the serum urate precipitated the flare.
However, the baseline serum urate level between flares reflects the size of the extracellular miscible urate pool.
The level should be measured on 2 or 3 occasions in patients with newly proven gout to establish a baseline.
Quantitation of urinary uric acid excretion to differentiate between overproduction and underexcretion is no longer recommended; it does not predict a patient's response to allopurinol or febuxostat (both of which decrease uric acid production).
The serum urate level can be low after initiation of therapy, but flares can continue to occur as long as tissue deposits remain.
Gout is more common among men than women.
The dissolution of the urate deposits may take many months after initiating therapy.
Imaging X-rays of the affected joint may be taken to look for bony erosions or tophi, but they are unnecessary if the diagnosis of acute gout has been established by synovial fluid analysis and rarely show erosions at the time of first flares.
In calcium pyrophosphate arthritis, radiopaque deposits may sometimes be present in fibrocartilage, hyaline articular cartilage (particularly the knee), or both, but calcinosis can be seen in the absence of acute flares.
Ultrasonography is more sensitive (although operator-dependent) than plain x-rays for the diagnosis of gout.
Urate deposition over the articular cartilage (double-contour sign) and clinically inapparent tophi are characteristic changes.
These findings may be evident even before the first gout flare.
Dual-energy CT scans (DECTs) can also reveal uric acid deposits and can be useful if the diagnosis is unclear based on standard clinical evaluation and testing, particularly if synovial fluid aspiration and analysis cannot be done.
Diagnosis of chronic gouty arthritis Chronic gouty arthritis should be considered in patients with persistent unexplained joint disease or subcutaneous or bony tophi.
Plain x-rays of the 1st metatarsophalangeal joint or other affected joint may be useful.
These x-rays may show punched-out lesions of subchondral bone with overhanging bony margins, most commonly in the 1st metatarsophalangeal joint; lesions must be ≥ 5 mm in diameter to be visible on x-ray.
Usually, gout develops during middle age in men and after menopause in women.
Joint space is typically preserved until very late in the course of disease.
Synovial fluid findings from chronic effusions of affected joints are usually diagnostic.
Diagnostic ultrasonography is increasingly used to detect a typical double-contour sign suggesting urate crystal deposition, but sensitivity is operator-dependent and differentiation from calcium pyrophosphate crystal deposits may be more difficult to do conclusively.
Prognosis for Gout With early gout diagnosis, life-long urate-lowering therapy enables most patients to live a normal life.
For many patients with advanced disease, aggressive lowering of the serum urate level can resolve tophi and improve joint function.
Gout is generally more severe in patients whose initial symptoms appear before age 30 and whose baseline serum uric acid level is > 9 mg / dL (> 0.5 mmol / L).
The high prevalence of metabolic syndrome and cardiovascular disease probably increases mortality in patients with gout.
Some patients do not improve sufficiently with treatment.
The usual reasons include inadequate education provided to patients, nonadherence, alcoholism, and mainly undertreatment of the hyperuricemia by physicians.
Research of toxicity and effects to support type 2 diabetes treatment of Nhat duong linh capsules Speciality: Traditional Medicine Code: 62720201 Reasearch student: Tran Thi Phuong Linh Supervisors: 1.
Prof Tran Quoc Binh 2.
Prof Nguyen Tran Thi Giang Huong Training Facility: Ha noi Medical University Summary of new finding of the thesis 1.
Nhatduonglinh capsules has high safety, with effect to reduce glucose in experimental animals: - Maximum taking dose 625g / kg weight of mice has no acute toxic manifestation.
Dose of 4.8g / kg / day (equivalent to dose used on human being) and dose 24 g / kg / day (five times higher than dose used on human being), taking orally continuously in three months, there is no change on hematology index, hematology biochemical indexes and liver tissue disease of rabbits kidney.
Name of topic: Study of patient controlled and non-patient controlled epidural analgesia during labor.
Code: 62710121; Speciality: Anesthesiology PhD student: Đo Van Loi Sciencific supervisors: Professor.
Nguyen Thu Training facility: Ha Noi Medical University New findings of the thesis: Using solution 0.1% bupivacaine with fentanyl 2µg / ml for pain relief during labor.
- The intervention of the medical staff of the PCEA group with background dose of 4 ml / h was less than the PCEA group without or with background dose of 2ml / h, and CEI group.
- Satisfaction for women of PCEA groups with background doses of 2 - 4ml / h was higher than those without the background dose, and CEI group.
- Motor block of the PCEA method was less than the CEI method.
- CEI method caused prolong the time from birth until the first breastfeeding compared with PCEA method with or without background dose of 2 - 4ml / h.
Title: Illness, health care utilization and expenditure of people at several inner areas in Hanoi Specialty: Hygiene - Sociology and Health Organization; Code of specialty: 62720164 Full name: Le Thanh Tuan, Ph D. student in K31 cohort (according to Decision: 3719/QD-DHYHN issued on December 04 2012 of the Rector of Hanoi Medical University) Supervisor: 1.
Described and compared the financial burden due to health care expenditure (out-of-pocket expenditure, catastrophic expenditure and impoverishment) of households at two urban areas of four inner districts in Hanoi (Hoan Kiem, Ba Dinh, Dong Da and Hai Ba Trung), which can be used to propose support schemes to minimize the degrees of inequality / inequity in health care expenditure among the poor, women and older people living in urban areas with poor living conditions.
Especially, by using a longitudinal design that combined between epidemiology and health economics approaches, using data analysis methods intention-to-treatment, employing Generalized Estimation Equations (GEE) regression models, the thesis provides updated scientific evidence with high validity and reliability about the associations between illness, health care utilization and financial burden due to health care expenditure and some socio-economic factors among people living in two urban areas.
The dissertation provided evidence that people living in areas with poor living conditions did not have a higher morbidity rate but had lower rates of access to health services than those living in the area has guaranteed living conditions.
The thesis provides valuable scientific evidence that supports policy makers and managers to develop policies and interventions in order to improving health status; leading to the equity / equality in health care service access and utilization; and minimizing health care expenditure and financial burden due to health care of urban population in Vietnam, especially in urban areas with poor living conditions.
The thesis can be considered an example of the application of longitudinal design, which is an advanced study design, to inform highly accurate and reliable study results.
Associate Professor Hoang Van Minh; 2.
Vu Hong Cuong.
New contributions of thesis: 1.
Described and compared the prevalence of illness among people at two urban areas of four inner districts in Hanoi (Hoan Kiem, Ba Dinh, Dong Da and Hai Ba Trung) that contributes to developing policies and interventions for improving health status and leading to equality / equity in health care and protection in urban population in Vietnam, especially those vulnerable subjects living in urban areas with poor living conditions.
Described and compared the rates of health care utilization among people at two urban areas of four inner districts in Hanoi (Hoan Kiem, Ba Dinh, Dong Da and Hai Ba Trung) that contributes to developing policies and interventions for improving the current situation and leading to the equality / equity in accessing and utilizing health care services of urban population in Vietnam, especially those vulnerable subjects living in urban areas with poor living conditions.
Research title: Study of clinical, paraclinical characteristics and application of histopathology classification of adenonocarcinomas to Association for the study of lung cancer 2011.
Tumors were found in the peripheral of the thoracic cavity (69.4%), the central (30.6%), the average tumor size: 34.9 + 14.5 mm, the smallest 7.0 mm, the largest is 92 mm, the shape is smooth (19.6%), multiple (33.1%), fringed (47.3%), solid density (29.4%), semisolid (57.1%), necrotic tumors (12.2%), pure ground glass opacity (1.2%).
At stage IV (50.2%), (40.8%) had bronchoscopic lesions, bronchial mucosal infiltration (38.0%.
Histopathological classification of ADC according to the International Lung Cancer Association 2011 and EGFR mutation: (81.6%) were determined by HE and PAS staining, (18.4%) defined by immunohistochemical staining.
Histopathological classification: acinar (47.3%), papillary (15.5%), lepedic (11.8%), solid (10.2%), micropapillary (9.0%).
Variations: mucus (3.3%), colloid (1.6%), clear cells (0.8%), fetal (0.4%), no enteric adenocarcinoma variation.
Acinar, papillary, lepedic, solid, more characteristic peripheral and non-smooth appearance, and acinar, solid fragmentation, are common in men, with a history of smoking.
EGFR gene mutation (51.6%), in women (75.0%), men (36.8%), and non-smokers (71.8%).
Mutations in all types: acinar (47.7%), papillary (57.9%), lepedic (60.0%), micropapillary (57.1%).
There were no differences in age group, location, tumor margin, size, tumor metastasis, stage of disease.
Code: 62720144 Specialization: Respiratory specialty PhD candidate: Nuyen Van Tinh the 32 th course Science instructors: 1.
Prof Ngo Quy Chau, MD, PhD.
Clinical manifestation, paraclinical characteristics Average age: 60.2 + 10.4 years old, male / female ratio 2.1 / 1.
Chest pain (89.0%), weight loss (86.1%), dry cough (59.2%), fatigue (54.7%), fever (34.3%), cough blood (16.7%).
The applied laparosopic technique is very skillful for treatment of renal trauma and associated abdominal organ injuries.
Title of the thesis: Study on clinical and paraclinical characteristics and some risk factors for acute pulmonary embolism in patients with chronic obstructive pulmonary disease exacerbations.
Mean duration of disease (year) (X ± SD): 7.32 ± 3.7; 83.8% over 5 years.
Common findings: severe airway obstruction, COPD patients of D-group, many symptoms.
Less frequent exacerbations due to infection in the PE group.
Common co-morbidity: heart failure (35.1%), hypertension (37.8%), diabetes (27%).
Common clinical symptoms: chest pain (43.2%), hemotysis (18.9%), Immobilization > 3 days (70.3%), history of deep venous thrombosis (13.5%), cor-pulmonale.
(2) Paraclinical: chest radiograph: one lateral high diaphragm, teardrop-shaped heart, pneumonia-like lesions, emphysema, central pulmonary artery dilatation.
CT-PA: pulmonary artery thrombosis in right lung is more common than the left lung.
97.3% of segmental and lobes level.
97.3% have obstructive index <40%.
PESI score: 97.3% in group 1 and 2.
Code: 62720144; Specialization: Respirology of Internal Medicine Doctoral Fellow: Nguyen Quang Doi; The 32rd course Supervisors: 1.
Echocardiography: increased pulmonary artery pressure, right ventricular dilatation (37.8%).
Blood gas: pH >7.45 (OR: 2.16; p = 0.03).
PCO2 <35 mmHg (OR: 3.9; p = 0.001).
The concentration of D-dimer in the PE group is higher than that of the non-PE group.
Electrocardiography: common findings were pulmonale p-wave, right bundle branch block, S1Q3T3 sign.
Prevalence and risk factors for acute PE in patients with COPD exacerbations with D-dimer level ≥ 1 mg / l FEU: (1) Prevalence of PE: 17.6%.
(2) Independent risk factors: History of deep vein thrombosis, diagnosis of COPD > 5 years, pneumonia-like lesions, emphysema, severe airway obstruction, non-infectious COPD exacerbation, hypertension.
(3) Padua Scale ≥ 4: increased risk of PE with OR = 3.
The value of the D-dimer test, the Wells score, the revised Geneva score in diagnosis of acute PE in patients with COPD exacerbation with D-dimer level ≥ 1 mg / l FEU: (1) D-dimer test yield: The D-dimer test does not play a role in the positive diagnosis of PE.
However, when the combination of D-dimer results < 2.1mg / l FEU with the Wells score <5 or the revised Geneva score ≤ 6 is good value in excluding PE.
(2) The value of Wells and revised Geneva scores: The value of Wells and revised Geneva scores were similarly and played a good role in excluding PE.
The revised Geneva score is easy to apply, more objective and can replace Wells score in clinical practice, especially when combination with the D-dimer test in rule out PE.
Prof Hoang Hong Thai, Ph D; 2.
Prof Chu Thi Hanh, Ph D.Training facility: Hanoi Medical University New conclusions of the thesis: Clinical and paraclinical characteristics of acute pulmonary embolism (PE) in patients with chronic obstructive pulmonary disease (COPD) exacerbation with D-dimer level ≥ 1 mg / l FEU: (1) Clinical: Age, gender: common met patients > 60 years old and male common met more than women.
Smoking history (pack - years): (32.1 ± 6.1).
Rate of 59.4% smoking over 30 pack - years.
Mean number of exacerbations (X ± SD): 2.1 ± 1.1.
Title of the thesis: Study on the relationship between anti-nucleosome and anti-C1q antibodies with disease activity and kidney damage in pediatric systemic lupus erythematosus.
Anti-C1q antibody is still valuable in diagnosis of lupus nephritis in children.
That helps clinicians early appoint kidney biopsy, choose appropriate treatment regimen and enhance treatment outcome.
Code: 62720135 Specialty: Pediatrics PhD candidate: Bùi Song Hương Instructors: 1.
Trần Thị Chi Mai Training location: Ha Noi Medical University New conclusions of the thesis: For the first time, the anti-nucleosome and anti-C1q antibodies were investigated and quantified concentration in the systemic lupus erythematosus in Vietnamese children.
This study results can be used to compare with studies in the region and the world.
Anti-nucleosome and anti-C1q antibodies are identified to be associated with disease activity level so can be used to assess and monitor the disease activity in the systemic lupus erythematosus in children.
PFS rate at 6 months 81.7%, 1 year is 45.2%.
Median OS was 19.0 months, average: 22.4 ± 3.6 months (range 3.0 - 59.0).
OS rate: 1 year: 56.9%; 2 years: 27.6%.
- Multivariate analysis PFS and OS show that response to treatment and maintenance therapy with bevacizumab are good prognostic factors.
- Toxicities: most common toxicity was neutropenia and diarrhea.
Other side effects encountered in grade 1 and 2, have little effect on treatment.
Side effects of bevacizumab include hypertension only grade 1 and 2 (21.2%), bleeding was grade 1 and mild (15.4%).
There were no cases of delay or discontinuation of treatment due to bevacizumab-related side effects.
To conclude, bevacizumab combined with FOLFOX4 regimen for metastatic rectal cancer patients is safe and effective.
This is the first study in Vietnam evaluate the results of treatment with chemotherapy combined with monoclonal antibodies in metastatic rectal cancer.
Results from the study showed that: - The quality of life of patients was improved in most aspects: physical, active, emotional and social.
Global health, symptoms after treatment had been improved compare to previous treatment.
- Response: Post-treatment CEA levels were significantly lower than before treatment.
After 6 cycles, the complete response was 7.7%; partial response was 55.8%; progressive disease was 21.1%; the overall response rate after 3 cycles and 6 cycles is 63.5%; disease control rate after 6 cycles reached 78.8%.
The group of patients with liver metastases and baseline CEA<30 ng / ml had higher response rates, the difference was statistically significant with p <0.05.
- Survival: Median follow-up of 26.8 months: Median PFS was 11.5 months, average: 12.1 ± 2.8 months (minimum: 2.0; maximum: 36.0).
- 36 patients diagnosed with hip arthritis due to ankylosing spondylitis were included, showing that 42.6% of symptomatic patients were morbid more than 10 years, 52.8% of patients had bilateral hip injuries, 95.7% of whom experienced severe pain.
X-rays showed that the majority of patients were in bilateral sacroiliitis stage II (66.7%) and hip arthritis stage III-IV according to BASRI-h index (89.4%).
The hip joint function on the HARRIS scale at the last endpoint was 95.86 ± 0.85, displaying excellent results.
Moreover, the patient's quality of life improved significantly, more obviously from 12th month post-operative, and at the last follow-up, ASQoL questionnaire score fell to 1.09 ± 0.37 (very satisfied).
Identification of outstanding phosphorus and pathological traits on brain imaging CHT; for the first time in Vietnam, CHT scans diffuse tension to find a direct correlation between structural damage and the level of clinical motor function in children with spastic cerebral palsy.
Using Dysport at 20 units / kg of body weight on lower limb muscle groups for children with spastic cerebral palsy combined with rehabilitation to improve motor function better than the group Only rehabilitate children with spasticity in cerebral palsy.
The undesirable effects after injection are usually mild and go away on their own within 1 week.
Determining the level of gross motor function GMFCS before treatment, pyramidal tracts injury is related to the treatment effect for children with spastic cerebral palsy.
The results of the thesis have shown the following new contributions: - Results of clinical, subclinical and polymorphic characteristics of CYP2C9 * 3, VKORC1 - 1639G>A, 1173C>T in patients with mechanical heart valve replacement.
- Results of relationship between clinical, subclinical and polymorphic characteristics of CYP2C9 * 3, VKORC1 - 1639G>A, 1173C>T with acenocoumarol dose in mechanical heart valve replacement patients.
From these results, it is necessary to determine polymorphisms of CYP2C9 * 3, VKORC1 - 1639G>A, 1173C>T gene which help to select the right dose of acenocoumarol for each patient to achieve the effect treatment as well as limiting complications.
The success of the study open next research important direction on individualization in therapy.
Through the study of the introduction chemotherapy regimen with Paclitaxel + Carboplatin every 3 weeks x 2 cycles, in combination with concurrent chemotherapy - radiation therapy and the weekly Paclitaxel + Carboplatin regimen in patients with non-small cells lung cancer stage III, inoperable.
We draw from research results valuable, current conclusions about treatment response, recurrence, non-progression survival, overall survival and side effects.
The project has made new contributions that have made comments about the effectiveness of the regimen of Paclitaxel-Carboplatin combined with simultaneous chemoradiotherapy, especially the use of 2 cycles of Paclitaxel - Carboplatin chemotherapy pre Concomitant chemoradiotherapy has produced an initial response to the tumor and lymph nodes thereby increasing the effectiveness of subsequent concurrent chemoradiotherapy and reducing radiation-induced pulmonary toxicity.
In addition, the dissertation also raises the factors affecting treatment effectiveness such as disease stage, whole lung V20 Gy, whole lung MILD, number of white blood cells, response time.
The dissertation has helped the appointment of non-surgical, stage III non-small cell lung cancer in order to increase efficiency, reduce complications, and be valuable for the cancer specialty.
Non-communicable chronic diseases, including type 2 diabetes, are a major disease pattern in developed countries.
In the world, there are a number of studies on the prevalence of type 2 diabetes in workers as well as in those who work shifts, overtime and the results show that there is a relationship between occupational risk factors such as work shifts, overtime... Studies also show that this is an issue that needs to be further studied for this group of workers.
With a sample size of 1755 subjects can represent a community of workers working shifts or overtime; make practical contributions to ensuring health and improving working capacity for workers who work shifts and overtime.
Therefore, the study of this topic is current, necessary and of high practical significance.
The average indexes on dental arches and faces of Vietnamese Muong children from 12 to 14 years old are as follows: The indicators on dental arches: The research has found the average value of dental arch sizes. The average value of dental arch sizes varies between ethnic groups and races in the world, but the difference is at various levels.
Most of the face angles are decreased, in particular, there are some increased angles in women, but they are not statistically significant.
The distances between two lips to the aesthetic lines E and S for men have little change and for women, there is almost no change.
Facial indexes: The research has found the average value of face sizes of Vietnamese Muong children aged 12, 13 and 14 years old.
In terms of face proportions, the above-mentioned Muong male and Kinh male children have the same facial size ratio (except for the ratio of wide mouth / lower jaw width) and the facial size ratios in female between Muong and Kinh children are different (except for the ratio of wide nose / wide mouth).
The growth of dental arch and face * The growth of the dental arch: - The width of the dental arch in the period from 12 to 14 years of age is increased in the width of the maxillary and mandibular arches of men and women.
- The length of the dental arches in the period from 12 to 14 years old is increased in the length of the maxillary and mandibular arches in size, decreased in size, but the change was not statistically significant.
- The circumference of the upper dental arche and lower is decreased from 12 to 14 years old of age, but the circumference of the dental arch of the lower teeth is decreased more than the circumference of the dental arch of the upper teeth.
* The facial growth: Face sizes from 12 to 14 years of age are increased.
However, at the age of 12 to 13 and from the age of 13 to the age of 14, some sizes increase and decrease alternately at different stages.
In this study, a large sample size analysis was performed with 370 fetuses with congenital heart defects.
There were 41, 91% Trisomy 18; 17, 65% Trisomy 21; 3, 68% Trisomy 13; 2, 21% sex chromosome abnormalities; chromosomal deletion accounted for the rate high with 16, 18%.
BOBS technique detected 19 cases of DiGeorge syndrome (microdeletion 22q11.2) and other cases of microdeletion and duplication in which the Karyotype technique was normal.
The Karyotype technique noticed 12 cases with abnormalities in chromosome structure: inversion, translocation, and chromosomal polymorphism.
Which BOBS technique was normal.
The results determined the relationship between chromosomal abnormalities and groups of congenital heart defects.
Combining methods of diagnosing fetal chromosomes helps to accurately diagnose and avoid missing many cases of chromosomal abnormalities, assisting the doctors, pregnant women, and families to have timely treatment
The results identified the rate of common heart defects: ventricular septal defect accounted for the highest rate with 51.20%.
Other defects that accounted for a decreasing rate were tetralogy of Fallot (18.03%), atrioventricular septal defect (7.93%), transposition of the great arteries (5.05%), and hypoplastic heart syndrome (4.81%).
Diagnosis of fetal chromosomes by amniocentesis combined with Karyotyping and BOBS techniques.
Determining the rate of chromosomal abnormalities in fetuses with congenital heart defects is 36.76%.
In which, 66.91% abnormal number of chromosomes and 33.09% abnormality of chromosome structure.
A few years ago, in one of the most fascinating and disturbing experiments in behavioural psychology, Stanley Milgram of Yale University tested 40 subjects from all walks of life for their willingness to obey instructions given by a 'leader' in a situation in which the subjects might feel a personal distaste for the actions they were called upon to perform.
If the subject was still reluctant to proceed, Milgram said that it was important for the sake of the experiment that the procedure be followed through to the end.
His final argument was, 'You have no other choice.
You must go on. '
What Milgram was trying to discover was the number of teacher-subjects who would be willing to administer the highest levels of shock, even in the face of strong personal and moral revulsion against the rules and conditions of the experiment.
Prior to carrying out the experiment, Milgram explained his idea to a group of 39 psychiatrists and asked them to predict the average percentage of people in an ordinary population who would be willing to administer the highest shock level of 450 volts.
The overwhelming consensus was that virtually all the teacher-subjects would refuse to obey the experimenter.
The psychiatrists felt that 'most subjects would not go beyond 150 volts' and they further anticipated that only four per cent would go up to 300 volts.
Furthermore, they thought that only a lunatic fringe of about one in 1, 000 would give the highest shock of 450 volts.
What were the actual results?
Well, over 60 per cent of the teacher-subjects continued to obey Milgram up to the 450-volt limit!
Specifically, Milgram told each volunteer 'teacher-subject' that the experiment was in the noble cause of education, and was designed to test whether or not punishing pupils for their mistakes would have a positive effect on the pupils' ability to learn.
In repetitions of the experiment in other countries, the percentage of obedient teacher-subjects was even higher, reaching 85 per cent in one country.
How can we possibly account for this vast discrepancy between what calm, rational, knowledgeable people predict in the comfort of their study and what pressured, flustered, but cooperative teachers actually do in the laboratory of real life?
One's first inclination might be to argue that there must be some sort of built-in animal aggression instinct that was activated by the experiment, and that Milgram's teacher-subjects were just following a genetic need to discharge this pent-up primal urge onto the pupil by administering the electrical shock.
A modern hard-core sociobiologist might even go so far as to claim that this aggressive instinct evolved as an advantageous trait, having been of survival value to our ancestors in their struggle against the hardships of life on the plains and in the caves, ultimately finding its way into our genetic make-up as a remnant of our ancient animal ways.
An alternative to this notion of genetic programming is to see the teacher-subjects' actions as a result of the social environment under which the experiment was carried out.
As Milgram himself pointed out, 'Most subjects in the experiment see their behaviour in a larger context that is benevolent and useful to society - the pursuit of scientific truth.
The psychological laboratory has a strong claim to legitimacy and evokes trust and confidence in those who perform there.
An action such as shocking a victim, which in isolation appears evil, acquires a completely different meaning when placed in this setting. '
Thus, in this explanation the subject merges his unique personality and personal and moral code with that of larger institutional structures, surrendering individual properties like loyalty, self-sacrifice and discipline to the service of malevolent systems of authority.
Here we have two radically different explanations for why so many teacher-subjects were willing to forgo their sense of personal responsibility for the sake of an institutional authority figure.
Milgram's experimental set-up involved placing the teacher-subject before a panel of thirty switches with labels ranging from '15 volts of electricity (slight shock)' to '450 volts (danger - severe shock)' in steps of 15 volts each.
The problem for biologists, psychologists and anthropologists are to sort out which of these two polar explanations is more plausible.
This, in essence, is the problem of modern sociobiology - to discover the degree to which hard-wired genetic programming dictates, or at least strongly biases, the interaction of animals and humans with their environment, that is, their behaviour.
Put another way, sociobiology is concerned with elucidating the biological basis of all behaviour.
The teacher-subject was told that whenever the pupil gave the wrong answer to a question, a shock was to be administered, beginning at the lowest level and increasing in severity with each successive wrong answer.
The supposed 'pupil' was, in reality, an actor hired by Milgram to simulate receiving the shocks by emitting a spectrum of groans, screams, and writhings together with an assortment of statements and expletives denouncing both the experiment and the experimenter.
Milgram told the teacher-subject to ignore the reactions of the pupil, and to administer whatever level of shock was called for, as per the rule governing the experimental situation of the moment.
As the experiment unfolded, the pupil would deliberately give the wrong answers to questions posed by the teacher, thereby bringing on various electrical punishments, even up to the danger level of 300 volts and beyond.
Many of the teacher-subjects balked at administering the higher levels of punishment, and turned to Milgram with questioning looks and / or complaints about continuing the experiment.
In these situations, Milgram calmly explained that the teacher-subject was to ignore the pupil's cries for mercy and carry on with the experiment.
Here are some facts that you probably didnt know about diabetes.
Glucose is carried around the body in the blood and the glucose level is called glycaemia.
Glycaemia (blood sugar levels) in humans and animals must be neither too high nor too low, but just right.
The glucose running around in the blood stream now has to get out of the blood and into the body tissues.
This is where insulin enters the story.
Insulin is a hormone made by the pancreas, a gland sitting just below the stomach.
Insulin opens the doors that let glucose go from the blood to the body cells where energy is made.
In diabetes, the pancreas either cannot make insulin or the insulin it does make is not enough and cannot work properly.
Without insulin doing its job, the glucose channels are shut.
Glucose builds up in the blood leading to high blood glucose levels, which causes the health problems linked to diabetes.
It is the worlds fastest growing disease.
People refer to the disease as diabetes but there are actually two distinctive types of the disease.
Type 1 diabetes is a condition characterized by high blood glucose levels caused by a total lack of insulin.
It occurs when the bodys immune system attacks the insulin-producing beta cells in the pancreas and destroys them.
The pancreas then produces little or no insulin.
Type 1 diabetes develops most often in young people but can appear in adults.
Type 2 diabetes is the most common form of diabetes.
In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin.
Insulin is necessary for the body to be able to use sugar.
Sugar is the basic fuel for the cells in the body, and insulin takes the sugar from the blood into the cells.
The diagnosis of diabetes often depends on what type the patient is suffering from.
It is Australias 6th leading cause of death.
In Type 1 diabetes, symptoms are usually sudden and sometimes even life threatening - hyperglycaemia (high blood sugar levels) can lead to comas - and therefore it is mostly diagnosed quite quickly.
In Type 2 diabetes, many people have no symptoms at all, while other signs can go unnoticed, being seen as part of getting older.
Therefore, by the time symptoms are noticed, the blood glucose level for many people can be very high.
Common symptoms include: being more thirsty than usual, passing more urine, feeling lethargic, always feeling hungry, having cuts that heal slowly, itching, skin infections, bad breath, blurred vision, unexplained weight change, mood swings, headaches, feeling dizzy and leg cramps.
At present, there is no cure for diabetes, but there is a huge amount of research looking for a cure and to provide superior management techniques and products until a cure is found.
Whether its Type 1 or Type 2 diabetes, the aim of any diabetes treatment is to get your blood glucose levels as close to the non-diabetic range as often as possible.
For people with Type 1 diabetes, this will mean insulin injections every day plus leading a healthy lifestyle.
For people with Type 2 diabetes, healthy eating and regular physical activity may be all that is required at first: sometimes tablets and / or insulin may be needed later on.
Ideally, blood glucose levels are kept as close to the non-diabetic range as possible so frequent self-testing is a good idea.
This will help prevent the short-term effects of very low or very high blood glucose levels as well as the possible long-term problems.
Over 1 million Australians have it though 50% of those are as yet unaware.
If someone is dependent on insulin, it has to be injected into the body.
Insulin cannot be taken as a pill.
The insulin would be broken down during digestion just like the protein in food.
Insulin must be injected into the fat under your skin for it to get into your blood.
Diabetes can cause serious complications for patients.
When glucose builds up in the blood instead of going into cells, it can cause problems.
Short term problems are similar to the symptoms but long term high blood sugar levels can lead to heart attacks, strokes, kidney failure, amputations and blindness.
Having your blood pressure and cholesterol outside recommended ranges can also lead to problems like heart attack and stroke and in fact 2 out of 3 people with diabetes eventually die of these complications.
Young adults age 18 - 44 who get type 2 diabetes are 14 times more likely to suffer a heart attack, and are up to 30 times more likely to have a stroke than their peers without diabetes.
Young women account for almost all the increase in heart attack risk, while young men are twice as likely to suffer a stroke as young women.
Every 10 minutes someone is diagnosed with diabetes.
This means that huge numbers of people are going to get heart disease, heart attacks and strokes years, sometimes even decades, before they should.
So much for the facts but what exactly is diabetes?
Diabetes is the name given to a group of different conditions in which there is too much glucose in the blood.
Heres what happens: the body needs glucose as its main source of fuel or energy.
The body makes glucose from foods containing carbohydrate such as vegetables containing carbohydrate (like potatoes or corn) and cereal foods (like bread, pasta and rice) as well as fruit and milk.
An emerging discipline called neuroaesthetics is seeking to bring scientific objectivity to the study of art, and has already given us a better understanding of many masterpieces.
They then had to judge which they preferred.
A third of the paintings were given no captions, while many were labelled incorrectly - volunteers might think they were viewing a chimp's messy brushstrokes when they were actually seeing an acclaimed masterpiece.
In each set of trials, volunteers generally preferred the work of renowned artists, even when they believed it was by an animal or a child.
It seems that the viewer can sense the artist's vision in paintings, even if they can't explain why.
Robert Pepperell, an artist based at Cardiff University, creates ambiguous works that are neither entirely abstract nor clearly representational.
In one study, Pepperell and his collaborators asked volunteers to decide how 'powerful' they considered an artwork to be, and whether they saw anything familiar in the piece.
The longer they took to answer these questions, the more highly they rated the piece under scrutiny, and the greater their neural activity.
It would seem that the brain sees these images as puzzles, and the harder it is to decipher the meaning, the more rewarding is the moment of recognition.
And what about artists such as Mondrian, whose paintings consist exclusively of horizontal and vertical lines encasing blocks of colour?
Mondrian's works are deceptively simple, but eye-tracking studies confirm that they are meticulously composed, and that simply rotating a piece radically changes the way we view it.
The blurred imagery of Impressionist paintings seems to stimulate the brain's amygdala, for instance.
With the originals, volunteers'eyes tended to stay longer on certain places in the image, but with the altered versions, they would flit across a piece more rapidly.
As a result, the volunteers considered the altered versions less pleasurable when they later rated the work.
In a similar study, Oshin Vartanian of Toronto University asked volunteers to compare original paintings with ones which he had altered by moving objects around within the frame.
He found that almost everyone preferred the original, whether it was a Van Gogh still life or an abstract by Miro.
Vartanian also found that changing the composition of the paintings reduced activation in those brain areas linked with meaning and interpretation.
In another experiment, Alex Forsythe of the University of Liverpool analysed the visual intricacy of different pieces of art, and her results suggest that many artists use a key level of detail to please the brain.
Too little and the work is boring, but too much results in a kind of 'perceptual overload', according to Forsythe.
What's more, appealing pieces both abstract and representational, show signs of 'fractals' - repeated motifs recurring in different scales, fractals are common throughout nature, for example in the shapes of mountain peaks or the branches of trees.
It is possible that our visual system, which evolved in the great outdoors, finds it easier to process such patterns.
It is also intriguing that the brain appears to process movement when we see a handwritten letter, as if we are replaying the writer's moment of creation.
Since the amygdala plays a crucial role in our feelings, that finding might explain why many people find these pieces so moving.
This has led some to wonder whether Pollock's works feel so dynamic because the brain reconstructs the energetic actions the artist used as he painted.
This may be down to our brain's' mirror neurons', which are known to mimic others' actions.
The hypothesis will need to be thoroughly tested, however.
It might even be the case that we could use neuroaesthetic studies to understand the longevity of some pieces of artwork.
While the fashions of the time might shape what is currently popular, works that are best adapted to our visual system may be the most likely to linger once the trends of previous generations have been forgotten.
It's still early days for the field of neuroaesthetics - and these studies are probably only a taste of what is to come.
It would, however, be foolish to reduce art appreciation to a set of scientific laws.
We shouldn't underestimate the importance of the style of a particular artist, their place in history and the artistic environment of their time.
Abstract art offers both a challenge and the freedom to play with different interpretations.
In some ways, it's not so different to science, where we are constantly looking for systems and decoding meaning so that we can view and appreciate the world in a new way.
Could the same approach also shed light on abstract twentieth-century pieces, from Mondrian's geometrical blocks of colour, to Pollock's seemingly haphazard arrangements of splashed paint on canvas?
Sceptics believe that people claim to like such works simply because they are famous.
We certainly do have an inclination to follow the crowd.
When asked to make simple perceptual decisions such as matching a shape to its rotated image, for example, people often choose a definitively wrong answer if they see others doing the same.
It is easy to imagine that this mentality would have even more impact on a fuzzy concept like art appreciation, where there is no right or wrong answer.
Angelina Hawley-Dolan, of Boston College, Massachusetts, responded to this debate by asking volunteers to view pairs of paintings - either the creations of famous abstract artists or the doodles of infants, chimps and elephants.
Acne 2 - Women and Acne - Phụ nữ và Mụn trứng cá Most young women and men will have at least a few pimples over the course of their lives.
But you dont have to wait to outgrow acne or to let it run its course.
Today, almost every case of acne can be resolved.
Acne also can, sometimes, be prevented.
Talk with your doctor or dermatologist (a doctor who specializes in treating skin problems) about how you can help prevent acne and if treatment would help you.
Many things can trigger acne in women: * Hormone changes during puberty.
During puberty, girls have an increase in male sex hormones called androgens.
This increase causes the glands to get larger and make more sebum.
* Hormone changes as an adult.
The menstrual cycle is one of the most common acne triggers.
Acne lesions tend to form a few days before the cycle begins and go away after the cycle is completed.
But acne seems to affect men and women in different ways.
Other hormone changes, such as pregnancy and menopause, improve acne in some women.
But some women have worse acne during these times.
Stopping use of birth control pills can play a role as well.
* Medicines.
Certain medicines, such as those used to treat epilepsy and types of depression.
* Pressure or friction on the skin.
Friction caused by bike helmets or backpacks can make acne worse.
If other people in your family have acne, there is a greater chance you will have it.
Young men are more likely to have a more serious form of acne.
Research shows that these pills can clear acne by slowing down overactive oil glands in the skin.
Sometimes, birth control pills are used along with a drug called spironolactone to treat acne in adult females.
This medication lowers levels of the hormone androgen in the body.
Androgen stimulates the skins oil glands.
Spironolactone is not appropriate therapy for all patients.
Acne in young women tends to be more random and linked to hormone changes, such as the menstrual cycle.
As women get older, acne often gets better.
But some women have acne for many years.
Women may have feelings of depression, poor body image, or low self-esteem.
Autophagy — How Your Body Detoxifies and Repairs Itself by Dr Mercola March 11, 2016 While there are many different ways to rid your body of accumulated toxins, from detoxifying foods and chemical and / or natural detox agents to saunas, a biological process known as autophagy plays a key role.
And, in fact, exercise is one of the ways by which you boost autophagy.
As you probably know, exercising creates mild damage to your muscles and tissues that your body then repairs, and by so doing makes your body stronger.
Exercise also helps flush out toxins by sweating, and is helpful for just about any detox program.
In fact, many consider exercise a foundational aspect of effective detoxification.
Dr George Yu, for example, who has been involved with clinical trials to help detoxify people from the Gulf War, recommends using a combination of exercise, sauna, and niacin supplementation to maximize elimination of toxins through your skin.
Exercise is an important component as it also causes vasodilation and increased blood flow.
Beyond that, as noted in the featured article: One study looked at autophagosomes, structures that form around the pieces of cells that the body has decided to recycle.
After engineering mice to have glowing green autophagosomes... scientists found that the rate at which the mice were healthily demolishing their own cells drastically increased after they ran for 30 minutes on a treadmill.
The term autophagy means self-eating, and refers to the processes by which your body cleans out various debris, including toxins, and recycles damaged cell components.
The rate continued increasing until theyd been running for 80 minutes.
How Much Exercise Do You Need to Optimize Autophagy?
The amount of exercise required to stimulate autophagy in humans is still unknown, however it is believed that intense exercise is more effective than mild exercise, which certainly makes logical sense.
That said, other research has shown that the Goldilocks zone in which exercise produces the greatest benefit for longevity is between 150 to 450 minutes of moderate exercise per week, lowering your risk of early death by 31 and 39 percent respectively.
Spending at least 30 percent of your workout on high-intensity exercises has also been shown to further boost longevity by about 13 percent, compared to exercising at a consistently moderate pace all the time.
Following these general guidelines will likely put you in the most advantageous position for maximizing autophagy as well.
How to Radically Inhibit Autophagy One of the quickest ways to shut down autophagy is to eat large amounts of protein.
What this will do is stimulate IGF-1 and mTOR, which are potent inhibitors of autophagy.
That is why its best to limit your protein to about 40 to 70 grams per day, depending on your lean body mass.
The specific formula is one gram of protein for every kilogram of lean body mass, or one-half gram of protein per pound of lean body mass.
This video link provides a more in-depth biochemical review of the autophagy processes involved in health and disease.
Substantial amounts of protein can be found in meat, fish, eggs, dairy products, legumes, nuts, and seeds.
Some vegetables also contain generous amounts of protein — for example, broccoli.
Forty grams of protein is not a large amount of food — it's the equivalent of one six-ounce chicken breast.
To determine whether or not you're getting too much protein, simply calculate your body's requirement based on your lean body mass, and write down everything you eat for a few days.
Then calculate the amount of daily protein you've consumed from all sources.
If you're currently averaging a lot more than what is optimal, adjust downward accordingly.
The following provides a quick overview of how much protein is in various foods.
- Red meat, pork, poultry, and seafood average 6 to 9 grams of protein per ounce.
- An ideal amount for most people would be a 3-ounce serving of meat or seafood (not 9 - or 12-ounce steaks!
), which will provide about 18 to 27 grams of protein - Seeds and nuts contain on average 4 to 8 grams of protein per quarter cup - Cooked grains average 5 to 7 grams per cup - Eggs contain about 6 to 8 grams of protein per egg.
As explained in laymans terms by Greatist1 Your cells create membranes that hunt out scraps of dead, diseased, or worn-out cells; gobble them up; strip em for parts; and use the resulting molecules for energy or to make new cell parts.
Autophagy is one way to remove damaged mitochondria, but biogenesis is the process by which new healthy mitochondria can be duplicated.
Interestingly, exercise plays a dual role as it not only stimulates autophagy but is also one of the most potent stimulators of mitochondrial biogenesis.
It does this by increasing a signal in your body called AMPK, which in turn activates PGC-1 alpha.
By stimulating your mitochondria — the organelles in nearly every cell that produce ATP — to work harder, your mitochondria start making reactive oxygen species (ROS), which act as signaling molecules.
One of the functions they signal is to make more mitochondria.
In essence, the key to preventing disease — virtually eliminating the risk of cancer, heart disease, diabetes, many other diseases — and slowing down the aging process lies in optimizing mitochondrial function and increasing mitochondrial numbers.
Thankfully, exercise helps you do both.
Intermittent Fasting — Another Way to Boost Autophagy Fasting is another biological stressor that produces many beneficial results, including autophagy.
Dr Colin Champ, a board-certified radiation oncologist and assistant professor at the University of Pittsburgh Medical Center explains it thus: Think of it as our bodys innate recycling program.
In fact, some of the benefits associated with fasting — such as a reduced risk of diabetes and heart disease — can at least in part be attributed to this process.
While there are many different kinds of intermittent fasting schedules, if youre insulin resistant, my personal recommendation is to fast every day by scheduling all of your eating within a window of approximately 8 hours or less.
For example, you could restrict your eating to the hours of 11am and 7pm.
I used to recommend skipping breakfast, but Ive since realized that it probably doesnt matter which meal you skip — breakfast or dinner — as long as you skip one of them.
Some really struggle without breakfast, so play around with it and find out what works best for you.
Eating between the hours of 8 a. m. and 4 p m. may work better for some people, and this schedule actually has an added advantage, because youre now fasting for several hours before going to bed.
Im convinced that its best for most to avoid eating three hours prior to bed, as the last thing you need to be doing is producing energy when you dont need it.
Theres compelling evidence showing that when you supply fuel to your mitochondria at a time when they dont need it, they leak a large number of electrons that liberate reactive oxygen species as free radicals.
These free radicals damage your mitochondrial and eventually nuclear DNA.
Autophagy makes us more efficient machines to get rid of faulty parts, stop cancerous growths, and stop metabolic dysfunction like obesity and diabetes.
Theres also evidence indicating that cancer cells uniformly have damaged mitochondria, so eating too close to bedtime is not a good idea.
I personally strive for six hours of fasting before bedtime, but at bare minimum, avoid eating at least three hours before going to bed.
To Boost Autophagy, Switch to a High-Fat, Low-Carb Diet Nutritional ketogenesis is a third strategy that will help boost autophagy, and to accomplish that, you need to cut down on the non-fiber carbs and increase the amount of healthy fat in your diet, along with a moderate amount of protein.
(Many Americans tend to eat far more protein than they need, which will counteract your efforts to get into nutritional ketosis.)
According to Champ: 3 Ketogenesis is like an autophagy hack.
Most Americans consume harmful fats like processed vegetable oils, which will invariably make your health worse.
By boosting your bodys autophagy process, you dampen inflammation, slow down the aging process, and optimize biological function.
Not only is it processed, its very high in omega-6 oils, and excess omega-6 fats will integrate into the inner mitochondrial membrane and become highly susceptible to oxidative damage, causing your mitochondria to die prematurely.
It is best to keep omega-6 fats consumption to less than 4 to 5 percent of your total daily calories Replace the omega-6 fats with healthy fats - such as natural, unprocessed fat - found in real foods such as seeds, nuts, real butter, olives, avocado, or coconut oil.
Its also important to make the distinction about which carbs we're talking about when we say low-carb, as vegetables are carbs too.
However, fiber carbs (i. e. vegetables) will not push your metabolism in the wrong direction — only the non-fiber ones will (think sugars and anything that converts to sugar, such as soda, processed grains, pasta, bread and cookies, for example).
Even more importantly, the fiber is not broken down by sugar but travels down the digestion system, is consumed by bacteria in your intestine, and converted to short chain fats that actually improve your health.
If you look at the nutrition facts on a processed food package, it will list total carbs, and again, that's not what we're talking about.
To calculate the dangerous non-fiber carbs, simply subtract the grams of fiber from the grams of total carbohydrate in the food in question.
Remember, you do need carbs, but you need most all of them from vegetables, which are also high in fiber.
Autophagy Restores Function in Aging Muscle Stem Cells It has long been known that mesenchymal stem cells (MSCs) in skeletal muscle are an important part of the muscle repair process.
As noted by Fight Aging: 2 Greater autophagy taking place in tissue should mean fewer damaged and disarrayed cells at any given moment in time, which in turn should translate to a longer-lasting organism.
Previous research4 has shown that exercise affects the behavior of your muscle stem cells, and may help prevent or even restore age-related muscle loss.
MSCs in muscle are very responsive to mechanical strain, and these stem cells accumulate in muscle post-exercise.
And, while the MSCs do not directly contribute to building new muscle fibers, they do release growth factors, which encourage other cells to generate new muscle.
Its also known that people's muscles tend to become increasingly deficient in MSCs with age, and that autophagy efficiency declines as well.
As a result, metabolic waste starts to build up in your cells and tissues.
A recent Spanish study5reports that satellite cells — muscle stem cells responsible for tissue regeneration — rely on autophagy to prevent the arrest of the cell cycle, known as cellular senescence; a state in which stem cell activity significantly declines.
In short, to improve the regeneration of muscle tissue, you need to augment autophagy.
With efficient autophagy — your bodys internal cleaning mechanism — your stem cells retain the ability to maintain and repair your tissues.
Keep running, don't stop.
It is a vital component in hormesis, wherein causing a little damage leads to a lasting increase in autophagy and a net gain.
Stem cells spend much of their time in a state of quiescence, only springing into action when called upon.
This helps to preserve them for the long term.
In older tissues with greater levels of molecular damage, ever more stem cells slip from quiescence into an irreversible senescent state.
These senescent cells are no longer capable of generating new cells, and start to secrete all sorts of harmful signal molecules.
Health and Longevity Are Rooted in Mitochondrial Function The take-home message here is that your lifestyle determines your fate in terms of how long youll live and, ultimately, how healthy those years will be.
For optimal health and disease prevention, you need healthy mitochondria and efficient autophagy (cellular cleaning and recycling), and three key lifestyle factors that have a beneficial effect on both are: What you eat: A diet high in quality fats, moderate in protein, and low in non-fiber carbs.
[But] I still think that whereas people accept the harm that smoking causes, they accept the problems being overweight causes, there is still some issue about accepting the harm that alcohol causes.
I think that's still a message that we haven't got through in the guidelines.
n England there is a deafening silence where a substantive strategy should be Diane Abbott Shadow public health minister Even where people do accept the risks, the minister said, some still carry on regardless.
People do things that they know harm their health, so 22% of people still smoke, she told the committee.
We do have to look at why it is that people feel the need to go and get very, very drunk and harm their health.
Ms Milton said it was unclear whether price changes were really able to alter habits, particularly among problem drinkers, pointing out that 80% of alcohol was drunk by one-third of the population.
But she said the government's new alcohol strategy, expected later this year or early in 2012, will say more about what we are going to do on price, and measures taken already - raising the duty on strong beer and cutting it on weaker varieties - were having an effect.
Already, there has been a response from the industry, she said.
There is no doubt about it, price can manipulate the market, so increasing duty on high-strength alcohol is not a bad idea, because for every litre sold there is less alcohol in it, which is a move in the right direction.
Anne Milton said MPs were susceptible to problem drinking because of their working hours Many people still do not accept the harm that alcohol can do to their bodies, despite government warnings, the public health minister has said.
Scotland is planning to introduce a minimum price per unit for alcohol, but Ms Milton said the move was probably illegal under European trade laws and would be challenged.
However, Labour's shadow public health minister Diane Abbott said the government should be prepared to look at minimum pricing.
MPs' susceptible' A recent report predicted that binge-drinking will cost the NHS (National Health Sẻvice) 3.8 billion by 2015, with 1.5 million A&E (accident and emergency) admissions a year, she said.
In Scotland, Alex Salmond is pushing ahead with minimum pricing policies, and yet in England there is a deafening silence where a substantive strategy should be.
Anne Milton Anne Milton said there was no one magic bullet to solving the problem of alcohol abuse.
Ms Milton insisted she had an appropriate degree of cynicism about industry campaigns to promote responsible drinking, but she believed companies did not want their brands to be associated with crime, anti-social behaviour and people being paralytically drunk.
She said about 80% of the major drinks companies had agreed to introduce labelling with information about units and warnings for pregnant women.
She said there was no one magic bullet to solve alcohol abuse, and local alcohol campaigns were likely to have worked best because consumption patterns were so varied.
The minister also said MPs were susceptible to risky behaviour like excessive drinking because of their anti-social hours and the time they spent away from family.
But she said she did not believe some of Parliament's many bars should be shut down in a bid to make them more sober.
Anne Milton told MPs that was in contrast to the risks of smoking and obesity which were acknowledged.
She said the Department of Health was in ongoing discussions with the Treasury on how alcohol pricing could be used to encourage safer drinking.
But she said setting a minimum price per unit was probably illegal.
Ms Milton was giving evidence to the House of Commons science and technology committee, which is looking into the evidence base for current alcohol guidelines.
She said that despite the incidence of problem drinking, there was not currently any evidence available to justify altering the recommended safe limits.
And there was, she acknowledged, a difficulty with guidelines full stop because people were inclined to disbelieve any messages about what to do - and what not to do - that come from government.
'Very, very drunk' I think [the guidelines] have an impact in as much as we know that the first step in changing behaviour is people being aware of the harm it can cause, she said.
Develop and evaluate a number of effective intervention measures are overweight-obese children in Hanoi.
The time for physical activity increased from 36.2 minutes / day to 63.4 minutes / day after intervention.
The time expense fro watching television reduced from 79.3 minutes / day to 65.3 minutes / day after intervention.
The diet intake of the obesity subjects have significantly change: Total energy intake reduced from 2451 Kcal to 2153 Kcal, energy source fro lipid reduced from 25.7% to 21, 4%.
The knowledge of the parents on overweight and obesity increased.
After intervention 100% of parents understand about the affects of and the methods for prevent and control of overweight and obesity among children.
The pilot intervention based on the school approach in combination with familly and health sector can be apply for control overweight and obesity for school children.
The pilot intervention was implemented at 4 primary schools in 4 districts in Hanoi, which have highest prevalence of overweight and obesity. The intervention approach were including: Nutrition education for the parents of the subjects, the teachers, the kitchen service on the health affects of overweight and obesity and the management solution.
To setting up the menu for the school children by each age.
To guideline for the physical activity at the household and at school.
There was a changes of the food habits and habits of children.
The habit of fast eating, eat planty of food, eat snack in the evening have reduced significantly (p < 0001).