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Directed Acyclic Graphs: Alternative tool for causal inference in epidemiology and biostatistics research and teaching

Review
  • Tran Ngoc Dang, Khuong Quynh Long, Huynh Thi Hong Tram, Le Huynh Thi Cam Hong, Tuan Minh Vo,
  • Pages 12-16
  • 27/10/2018
  • 123
  • 292
  • Free

The issue of causation is one of the major challenges for epidemiologists who aim to understand the association between an exposure and an outcome to explain disease patterns and potentially provide a basis for intervention. Suitably designed experimental studies can offer robust evidence of the causal relationships. The experimental studies, however, are not popular, difficult or even unethical and impossible to conduct; it would be desirable if there is a methodology for reducing bias or strengthening the causal inferences drawn from observational studies. The traditional approach of estimating causal effects in such studies is to adjust for a set of variables judged to be confounders by including them in a multiple regression. However, which variables should be adjusted for as confounders in a regression model has long been a controversial issue in epidemiology. From my observation, the adjustments using only "statistical artifacts" methods such as the p-value<0.2 in univariate analysis, stepwise (forward/backward) are widely used in research and teaching in Epidemiology and Statistics but without appropriated notice on the biological or clinical relationships between exposure and outcome which may induce the bias in estimating causal effects. In this mini-review, we introduce an interesting method, namely Directed Acyclic Graphs (DAGs), which can be used to reduce the bias in estimating causal effects; it is also a good application for Epidemiology and Biostatistics teaching.

Graphical abstract

Pursuing a targeted dream specialty and a research career: Opinions and observations from a fifth-year medical student’s perspective

Letter to Editor
  • Gehad Mohamed Tawfik,
  • Pages 1-4

With our fast-pacing life, numerous learning and scientific sources and information are available and required for medical students to boost their skills since their early life to accommodate with the great knowledge they take. Medical students should re-elaborate what they studied and exploit knowledge clinically. A good doctor is a good observer, so eyes should be kept on while mentor managing patients in order to add more to our medical notions. A seed to become a great future doctor starts by searching for a specialty that fits your personality, to practice it as a volunteer, to gain its skills earlier. So when you graduate, you have more time to gain other learning experience. As long as you practice it, the more chance to become one of its experts. Managing your patient as a relative, not as a bag of money, is very important to be applied. Inability to diagnose a patient is not a shame, so never let a patient go home without referring him to another doctor who has more experience than you. Having a background in other medical specialties will help you recognize common signs of other related medical conditions that could lead you to refer him to right specialty doctor. Joining a research lab will keep you updated with new inventions, drugs, algorithms, and guidelines, which will help you become more acknowledged with medical problems that you were unaware of. Time management is the key to success as a researcher without affecting your daily life activities and study requirements.

Graphical abstract

Translation and cross-cultural adaptation of the Vietnamese version of the Diabetes Distress Scale

Original Research
  • Ong Phuc Thinh, Huynh Ngoc Van Anh, Do Thanh Tung, To Gia Kien,
  • Pages 5-11

Background: The Diabetes Distress Scale (DDS) is a valid instrument to measure diabetes distress included in American Diabetes Association and Canadian Diabetes Association guidelines but not available in Vietnamese. This study translated and culturally adapted the DDS to assess diabetes distress of Vietnamese type 2 diabetics and evaluated its internal consistency, face and content validity.

Methods: The translation process followed standard guidelines for adaptation of an instrument: forward translation, back translation, synthesis, evaluation by an expert panel and pretest. The expert panel included three English specialists as linguistic experts and six content experts in multidisciplinary areas relevant to the study. The pretest was conducted on a sample of 31 type 2 diabetics in the Endocrinology outpatient clinic at Trung Vuong hospital. Content validity was determined based on experts’ concurrence using content validity index for items (I-CVI). Face validity is assessed by participants in pretest. Internal consistency was measured using Cronbach’s alpha.

Results: Final version was equivalent with the original English version and easy to understand. I-CVI of 17 items were 1.00 in linguistic experts and greater than 0.83 in content experts. All 31 participants involved in the pretest commented that the items were very clear and acceptable regarding their socioeconomic background. Cronbach’s alpha coefficient was 0.76 – 0.93 for each subscale and 0.94 for the overall.

Conclusion: Vietnamese version of the DDS was reliable, face and content-valid to assess diabetes distress in type 2 diabetics among Vietnamese.

Graphical abstract

The medical physics education and training program of Nguyen Tat Thanh University - the first official medical physics training program in Vietnam

Original Research
  • Dang Thanh Luong, Pham Nhu Tuyen, Hoang Anh Tung, Cao Huu Vinh,
  • Pages 43-47

The paper aimed to present the introduction of the first official medical physics training program - a new health care profession in Vietnam. The detail studies and analyses of the current status of training in Medical Physics as well as the present and future demands of it were also reported. The main roles, responsibilities and the challenges of medical physicists in medicine were discussed and clarified as well.

Graphical abstract

A case report of hepatic perivascular epithelioid cell tumours (pecomas) and literature review

Case Study
  • Nguyen Duc Duy, Nguyen Phan Xuan Truong, Phan Dang Anh Thu, Ngo Quoc Dat,
  • Pages 39-42

Perivascular epithelioid cell tumours (PEComas) belongs to the family of mesenchymal neoplasms that can occur in many organs, but rarely found in liver. Preoperative diagnosis could be challenging due to unspecific and variable radiologic patterns, which can be clinically misdiagnosed with hepatocellular carcinoma and other benign tumors. This report aims to announce a case of hepatic PEComa with extramedullary hematopoiesis. A 44- year- old woman accidentally presented a nodular mass in the left hepatic segment on ultrasonography with normal liver function result. Abdominal enhanced CT Scan showed hypervascular lesion. Morphology exibits classical characteristics of PEComa with mature fat tissue predominance, thick-wall vessel; somewhat amount of extramedullary hematopoiesis was also recognized. Tumor cells are diffusely immunoreactive with HMB45. PEComa is a rare disease in liver, pathologists need to recognize three components of this tumor to avoid misdiagnosing with malignant conditions.

Graphical abstract

The difference in the timings of healthcare professionals’ shifts and sleep disturbances

Review
  • Mahmoud Dibas, Mohammad Rashidul Hashan,
  • Pages 32-34

Healthcare professionals (HCPs) bear a huge responsibility of taking care of patients 24 hours a day and for the whole week. Although HCPs help patients get over their sufferings, these workers endanger their lives and cause themselves health problems including sleep disturbances. Since most of these disturbances are related to the timing or the schedules of these workers, the aim of this mini-review is to shed the light on how these shift schedules are different and how they can affect the sleepness and/or wakefulness of the workers in the health sector.

Graphical abstract

Aspiring experience journey towards research: importance and essential skills

Case Study
  • Gehad Mohamed Tawfik, Peter Samuel Eid, Linh Tran, Le Huu Nhat Minh, Mohammad Rashidul Hashan, Muhammed Khaled Elfaituri, Ali Mahmoud Ahmed,
  • Pages 35-38

Research is the creative and systematic conversion of ideas into knowledge and the application of this knowledge in different life fields. The more you get involved in research, the more experiences and skills you can gain. The continuous decreasing number of medical students interested in research can affect the public health in future. Our aim is to encourage medical students to involve more in the research career and to highlight the importance and skills needed for being a successful researcher. Discipline, passion to gain the knowledge, the accuracy of data checking, team work and strict rules are the most important characteristics of a research team. A researcher should be passionate, hard-working, and patient. Teamwork is the golden key to doing research; you should be responsible for your team and develop their research skills along the study period. A researcher should be a self-learner to increase his skills to get an advanced level. From the most important skill that a researcher should gain it by time is the leadership. Being motivated along the study period is an obstacle that leaders always meet, so you should have solutions for it. Fairness is an important manner a leader should acquire. Contribution in a research lab from your youth to build your CV, personality and gain great publications by time.

Graphical abstract

Staphylococcus aureus nasal colonization among Vietnamese adults: prevalence, risk factors and antibiotic susceptibility profile

Original Research
  • Nguyen Khoi Phan, Hien Thu Thi Pham, Thuc Trong Nguyen, Hoai Thu Thi Nguyen,
  • Pages 21-31

Staphylococcus aureus (S. aureus) has long been recognized as an important human pathogen causing many severe diseases. It is also a part of human normal flora with its ecological niche in the human anterior nares. This study focused on screening S. aureus nasal carriage in community and its relationship to human physiological and pathological factors which have not been studied in Vietnam previously. Two hundred and five volunteers in Ho Chi Minh City from 18 to 35 and over 59 years old both male and female participated in the study. Result showed that the prevalence of S. aureus nasal carriage in southern Vietnamese community was relatively low, only 11.2% (23/205), much lower than that in other international reports on human S. aureus. In addition, nasal carriage of the older age group (> 59 years old, 13.7%) was higher than that of younger age (18-35 years old, 10.4%). Other potential risk factors such as gender, career, height, weight, history of antibiotic usage, daily nasal wash, use of nasal medication sprays, acne problems, smoking and nasal problems showed no significant impact on S. aureus carriage. The obtained S. aureus nasal isolates were all sensitive to vancomycin. Lincomycin and tetracycline had low resistance rate with 4.3 % and 17.4 %, respectively. However, the isolates showed particularly high rate of multidrug resistance (54.2%) In summary, our data provided researchers an overview on S. aureus nasal carriage and antibiotic susceptibility profile of the community- isolated S. aureus in Vietnam. This would serve as valuable information on assessing risk of community-acquired S. aureus infections.

Graphical abstract

Prevalence of Sick Building Syndrome - Related Factors among Hospital Workers at University Medical Center Ho Chi Minh City, Vietnam

Original Research
  • Hai Nguyen Duc, Thy Linh Le, Chanh Ngoc Dang,
  • Pages 1-4
  • 01/07/2018
  • 141
  • 1862
  • Free

Poor indoor air quality is one of the most important factor causing occupational health problems such as sick building syndrome (SBS). Most previous research on risk factors of SBS is evaluated in the office or school environments rather than in the hospital. The aim of this study is to investigate the prevalence of SBS and its related effect on hospital workers in poorly-ventilated and confined working environments through a set of the questionnaires completed from March to June of 2017. The relationship between SBS-Related symptoms, individual characteristics, work environment and conditions were analyzed using Poisson regression. The prevalence of sick building syndrome was 70.1%. The most common symptoms reported by hospital workers include fatigue, headache, and feeling heavy-headed. There was a significant relationship between the prevalence of syndrome and sex, overload of work, atopy as well as varying room temperature.

Graphical abstract

Predictive Model for Live Birth at 12 Months After Starting In-Vitro Fertilization Treatment

Original Research
  • Vu NA Ho, Toan D Pham, Tuong M Ho, Lan N Vuong,
  • Pages 5-20
  • 01/07/2018
  • 39
  • 1136
  • Free

IVF carries a considerable physical, emotional and financial burden. Therefore, it would be useful to be able to predict the likelihood of success for each couple. The aim of this retrospective cohort study was to develop a prediction model to estimate the probability of a live birth at 12 months after one completed IVF cycle (all fresh and frozen embryo transfers from the same oocyte retrieval). We analyzed data collected from 2600 women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) at a single center in Vietnam between April 2014 and December 2015. All patients received gonadotropin-releasing hormone (GnRH) antagonist stimulation, followed by fresh and/or frozen embryo transfer (FET) on Day 3. Using Cox regression analysis, five predictive factors were identified: female age, total dose of recombinant follicle stimulating hormone used, type of trigger, fresh or FET during the first transfer, and number of subsequent FET after the first transfer. The area under the receiver operating characteristics curve for the final model was 0.63 (95% confidence interval [CI] 0.60‒0.65) and 0.60 (95% CI 0.57‒0.63) for the validation cohort. There was no significant difference between the predicted and observed probabilities of live birth (Hosmer-Lemeshow test, p > 0.05). The model developed had similar discrimination to existing models and could be implemented in clinical practice.

Graphical abstract

Evidence-based medicine education improve clinical knowledge of 4th year medical students in the university of medicine and pharmacy at Ho Chi Minh City

Letter to Editor
  • Tuan Minh Vo, Thang Bui Quoc, Dat Van Truong,
  • Pages 17-19

Evidence based medicine (EBM) education is a modern method for medical students in clinical training based on the reasonable use of the best evidence in making decisions about individual patient’s treatment. EBM education syllabus teaches medical student how to integrate the clinical experience and patient examination with the simplest out-there analysis data for increasing the utilization of top quality clinical analysis in clinical deciding, this methodology requires new literature looking out and proof evaluating skills. Thus, replacing the recently educated method by EBM has more challenges, the new program ought to analysis fastidiously for evaluating the behavior changes, the development of clinical skills and analysis the ultimate examination score for evaluating the effectiveness of EBM program. The result show that active teaching proves to be statistically completely different and has robust impact toward the ultimate outcome. EBM educated method might improve clinical knowledge and application of PBL/EBM brings concerning higher scores compared to recently educated method.

Graphical abstract

Switching to Effective and Optimal Study Methods - A necessary tool for Educational Success

Case Study
  • Truong Hong Hieu, Le Huu Nhat Minh, Muhammad Usman Hashmi, Heba Hussien El Tanany,
  • Pages 14-16

The secret of educational success and splendid future with prosperous career lies in the constant hard work performed in a smart way. By that way, the change or modification in study methods, exam strategies, and learning techniques is necessity. Deriving from our own experience as medical students from some developing countries from all over the world, authors support some tips and methods to approach the medical field more productive.

Graphical abstract

Inter-Rater reliability of a professionalism OSCE developed in family medicine training University of Medicine and Pharmacy

Original Research
  • Pham Duong Uyen Binh, Pham Le An, Tran Diep Tuan, Jimmie Leppink,
  • Pages 20-24

A POSCE was developed and administered in 2015 to assess six professional attributes for the Family Medicine (FM) residents, University of Medicine and Pharmacy (UMP), Vietnam. This study aims at exploring inter-rater reliability in FM POSCE developed in this context when analytic rubrics were applied.

Background: Past POSCEs showed raters’ variability on applying the global marking items and holistic rating. Using analytic rubrics, unlike holistic type, will provide more rationale for assigning a certain score might influence raters’ variability. Nonetheless, it is little known to what extent switching to this rubric type might influence the inter-rater reliability of POSCE.  

Methods:  Before the FM professionalism module (pretest) and after this module (posttest), 36 and 42 FM residents took the POSCE respectively. The raters in the pretest included 12 teachers of FM training center. Four faculty members from different faculties were belatedly added to the post-test together with the 12 former raters.  Raters’ training occurred in two different times, the former took place only for the 12 FM raters before the pretest and the latter was before the posttest for the 4 belatedly-recruited. During the POSCE, one pair of raters observed all performances per station. Inter-rater reliability was measured by the differences in total scores between raters per pair using paired t-test and Pearson correlation coefficient.  

Results: In POSCE pretest, no significant difference was found between raters’ scores in most pairs of raters, contrasting with that in the posttest. Most differences were noticed in the pairs of raters, in which one of the raters was the belatedly-recruited. In the pretest, moderate to strong positive correlation between raters’ mean scores were found (r=0.55-0.85), similar range was seen in the post-test (r=0.47-0.87), however, the correlation slightly weakened.   

Discussion and conclusion: The FM POSCE has high inter-rater reliability on the utilization of analytic grading rubrics. An analytic rubric might help minimize the discrepancies among raters. Moreover, training raters might have been an alternative influential factor on the raters’ consensus.

Graphical abstract

The First Annual National Vietnam Medical Education Conference “Preparing the 21st Century Physician”

Editorial Letter
  • Tran Diep Tuan,
  • Pages 1-2

Assoc. Prof. Dr. Tran Diep Tuan

President of University of Medicine and Pharmacy at Ho Chi Minh City, Department of Pediatrics - UMP

We are delighted to introduce the Special Issue for the medical education derived from the 1st National Vietnam Medical Education Conference: “Preparing the 21st Century Physician”. The First Annual National Vietnam Medical Education Conference was held on 2-3 December, 2017, by the Vietnam Ministry of Health, University of Medicine and Pharmacy in Ho Chi Minh City, and the Improving Access, Curriculum and Teaching in Medical Education and Emerging Diseases (IMPACT-MED) Alliance, which is supported by United States Agency for International Development (USAID) and implemented by Partnership for Health Advancement Vietnam, a collaboration between Harvard Medical School, the Brigham & Women’s Hospital and the Beth Israel Deaconess Medical Center. It has attracted approximately 300 leaders in the medical education, faculties and students from Vietnam and around the world.

This conference comes at an exciting time in the socio-economic development of Vietnam. The Vietnamese health sector has made enormous strides in the control of communicable diseases, increasing the life expectancy and increasing access to the health care for its population over the past 40 years since the reunification of the country. In July 2017, Vietnam became a middle-income country, and with this new status comes new health challenges, which if not addressed, will impede the continued development of the country.  Non-communicable diseases, a rapidly aging population, emerge threats of pandemics, environmental pollution, and climate change are all at our doorstep. Additionally, an increasingly connected society that demands a high-quality healthcare, the government’s plan for Universal Health Care, and the desire for regional and an international integration all represent the challenges and opportunities that we must tackle. Addressing these challenges and opportunities starts with transforming the health workforce. There is an urgent need to update the country’s system of health education including university curricula and transforming approaches to teaching and learning to train health professionals who can adapt and react to the health challenges and realize the opportunities that are presented.

A comprehensive curriculum reform is difficult.  However, we can build upon the experience of previous, smaller-scale reform projects, and capitalize on the investments and support from the highest level of government to transform our health education system. We have built strong partnerships among the network of universities and colleges in Vietnam to support each other, and we also have support from international partners. Education reform is a necessity for Vietnam. The conversations and discussions that we have at this inaugural conference will pave the way towards the transformation of our health education system. The conference aims to provide a forum for sharing innovations and advances in the medical education, stimulate discussions among medical education leaders, inspire further innovations, and foster a community of medical educators invested in advancing medical education research and quality improvement.

This entire volume is devoted to select the manuscripts, which was generated from the conference. We hope that it will be productive, and you will be inspired, energized and motivated to continue the efforts towards health education reform for your university/college, and for the country of Vietnam.

Graphical abstract

How to overcome challenges related to English and academic writing skills when studying abroad

Case Study
  • Minh Cuong Duong,
  • Pages 3-5

Nowadays, pursuing postgraduate study abroad after completing a Medical Doctor (MD) degree in their home country is common among Vietnamese doctors. There are several challenges in studying overseas that international students need to overcome to ensure a favorable outcome of their learning journey. The presenting paper mainly discussed about the challenges related to English and academic writing skills and aimed to provide some tips for studying effectively in developed countries. Based on his own experiences as a postgraduate international student in Australia, the author found that a successful learning journey could be facilitated by (1) feeling free to ask, (2) making friends with the locals and other international students, (3) exploring the local life, (4) learning and using a reference management software, and (5) attending all free academic skills workshops and consultations provided by the university.

Graphical abstract

Content validity of a professionalism OSCE developed in family medicine training University of Medicine and Pharmacy at Ho Chi Minh city Vietnam

Original Research
  • Pham Duong Uyen Binh, Pham Le An, Tran Diep Tuan, Jimmie Leppink,
  • Pages 6-11

Background: Assessments of professional behaviors such as professionalism Mini clinical examination (PMEX) and OSCE (POSCE) are playing an important role in driving the practice professionalism in medical training. Simulation-based assessment or POSCE has been used to evaluate several professional attributes. However, few evidence of content validity proving that whether POSCE is really measuring specific professional attributes have been reported in medical education literature.

Methods:  The four-step process of developing FM POSCE was analyzed to highlight the validity evidence according framework of Downing (2003). Group of 5 independent FM experts from Vietnam, Boston University, US and Liege, Belgium evaluated the blueprints, scenarios and item lists on a scale (1-totally disagree to 5-totally agree) regarding to what extent test blueprint, cases and item lists were relevant to the content domains and cultural context. The results of their evaluation were considered as an evidence of content validity. The mean and standard deviation of the scores given by them were calculated using SPSS, 20.0.

Results: Important evidence of content validity were found in the process of developing POSCE. Content experts’ evaluation showed that all professional attributes represented medical professionalism. However, the adequacy of professional attributes to evaluate the broad construct of professionalism was controversial (M=3.75, SD=0.95). Cases are relevant to assess these professional attributes and culture. Only the cases of “Respecting the patient” and “Making altruistic decision” contained some inappropriate marking items (M=3.75, SD=0.95; M=3.00, SD=0.92).  

Discussion and conclusion: FM POSCE developed in Vietnamese context can assess six specific professional attributes. This study suggested a process of developing POSCE that has several features such as using both sources of expertise and medical literature to build up the content of POSCE to improve the content validity.

Graphical abstract

My Way of Becoming a Good ECG Reader

Letter to Editor
  • Van Buu Dan Do,
  • Pages 12-13

My first days of learning about ECG was during the summer of second year at the medical school. I went through the graduation test with very little knowledge about ECG. I started learning ECG by comparing the ECG tracings with the echocardiographic results. However, the echo could not help in case of arrhythmia. So I spent my time reading the “Marriott's Practical Electrocardiography” – kind of textbook of ECG. It was so boring and I quickly gave up the goal of finishing the book. Then I changed to another strategy. Every time I saw an arrhythmic case, I went back home reading a whole chapter about some entity. This strategy proved to be effective. Gradually my skill of interpreting an ECG was built up. From the point of reading an ECG superficially and making a quick diagnosis (which is erroneous most of the time), I became very tedious in finding subtle abnormal signs. When you work really hard, life always has some rewards. I had been selected to study abroad about cardiac electrophysiology.  Nowadays, being the Head of Cardiac Electrophysiology department in my hospital, my daily work is to deal with challenging arrhythmic cases. Interpreting elusive ECG tracings is always a passion for me.

Graphical abstract

Virtual Screening, Oriented-synthesis and Evaluation of Lipase Inhibitory Activity of Benzyl Amino Chalcone Derivatives

Original Research
  • Trang Hoang Minh Vu, Duy Duc Vu, Dat Van Truong, Phuong Thuy Viet Nguyen, Dao Thanh Tran,
  • Pages 26-36
  • 21/12/2017
  • 124
  • 997
  • Free

Nowadays, obesity has been becoming one of the most popular problems to the global health. Molecular design with the aid of computing method is an efficient and cost-saving solution in the initial research of new potential drugs for the treatment of obesity. This study focused on benzyl amino chalcone derivatives as they have a benzyl group that can mimic the hydrophobic effect of the long chain carbon of Orlistat, a drug used to treat obesity. Initially, 102 molecular structures were prepared and docked into the protein by using AutoDock Vina version 1.5.6. Fourteen structures having good docking scores were selected to synthesize using a Claisen-Schmidt reaction. Afterward, these synthesized chalcones were tested biological activity against pancreatic lipase by spectrophotometric determination at a wavelength of 405 nm, using p-nitro phenyl palmitate as the substrate. The co-crystallized ligand of pancreatic lipase enzyme was redocked into the enzyme and the RMSD was 1.4976 Å which showed the ligand and the protein preparation could regenerate the practical experiment. As the docking results, the binding affinities of top ten compounds varied from -8.6 and -10.2 kcal/mol. Biological testing resulted in 4 derivatives with IC50 >120 µM, 8 derivatives with 60 µM < IC50 < 120 µM and 2 derivatives with IC50 < 60 µM. In addition, the docking results also confirmed the key role of amino acid Ser152 in interacting with the ligands. The benzyl amino chalcone derivatives are required for further investigation to become a lead compound for anti-obesity drug discovery.

Graphical abstract

Evaluation of ESP Effectiveness in Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam

Original Research
  • Thao Nguyen Thi Phuong, Tien Nguyen Dong Phuong, Hai Nguyen Duc, Dat Van Truong,
  • Pages 37-45

Since 2011, English for Specific Purposes (ESP) curriculum in Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City (Vietnam) has been changed in accordance with pharmaceutical specialization orientation and did apply the active learning-learner centered teaching methods. Our study used three self-administered questionnaires to collect the feedbacks from sophomores, final-year and pharmacist graduating in 2016 in evaluating ESP course effectiveness. Data analyzed with STATA 13 indicated that English lecturers made efforts to organize the active learning activities in ESP class but their target has neither been effective nor met the required students’ needs in academic purposes as well as their occupational purposes. In addition, students’ passivity and lack of apparent motivation made it more difficult to apply the active learning method. Generally, final-year pharmacy students and newly graduated pharmacists, besides their moderate English competence, had a low frequency in using English. It is also found that there exists the relationship between final-year pharmacy students’ frequency of using English, their English competence and pharmaceutical specialization as well as that between English use frequency and occupation.

Graphical abstract

The Incidence and Characteristics of Gastrointestinal Intolerance on Mechanically Ventilated Patients with Continuous versus Intermittent Feeding Method in The Intensive Care Unit: A Randomized Controlled Trial

Original Research
  • Vo Thi Hong Nhan, Alison Merrill, Tran Thien Trung,
  • Pages 46-51
  • 21/12/2017
  • 120
  • 1214
  • Free

Background: Enteral nutrition therapy via nasogastric tube can be administered through continuous or intermittent feeding methods for critically ill patients. However, there has not been existing consensus on the superiority of either method for mechanically ventilated patients due to insufficient evidence comparing the effectiveness of the two methods. The present study aimed to compare the impact of continuous versus intermittent feeding methods on gastrointestinal intolerance in mechanically ventilated patients.

Methods: 41 mechanically ventilated patients in the intensive care unit, University Medical Center, Ho Chi Minh City, Vietnam from 3/2017 to 5/2017 were enrolled in a randomized controlled trial. They were randomly and equally assigned to the two study groups and monitored for 4 consecutive days on incidence of gastrointestinal intolerance including high gastric residual volume, abdominal distention, diarrhea, and tube occlusion.

Results: There was statistically significant difference when comparing the gastric residual volumes between two groups with a median at 0.93ml (0.09-1.93) versus 11.61ml (7.61-17.28) (p < 0.001). The mean number of abdominal distention episodes in the continuous group was significantly lower than in the intermittent group (2.8 ± 2.66 versus 8.29 ± 5.1 episodes, respectively, p < 0.001). The diarrhea scores were not significantly different (p < 0.05) and there were no cases of occlusion recorded in the two groups.

Conclusions: Continuous feeding method offered less gastrointestinal intolerance than intermittent feeding method by reducing gastric residual volumes and limiting abdominal distention. The feeding method did not increase the risk of tube obstruction if it was flushed regularly.

Graphical abstract

Phytochemical Screening and Total Phenolics and Flavonoids Contents of Hibiscus Rosa Sinensis. L Cultivated in Viet Nam

Original Research
  • Han Truong, Ly Le, Minh Tran,
  • Pages 52-57

Background: Phenolics and flavonoids are regarded as the highest potential of chemotherapeutic activities. This investigation was carried out to evaluate phytochemical and total phenolics content (TPC) and total flavonoids content (TFC) and Fourier-transform infrared spectroscopy (FTIR) spectral analysis of Hibiscus Rosa Sinensis L. extracts (crude extract, n-hexane extract, ethyl acetate extract, and methanol extract) for further applications in pharmaceutical development.

Method: Total phenolics were estimated by Folin-Ciocalteu method; while, Aluminum chloride was employed to quantify total flavonoids in the sample extracts. And, functional groups of Hibiscus Rosa Sinensis compound was determined using a FTIR-spectrophotometer.  

Result: Results showed the leaves extracts to encompass the high amount of total phenolic and total flavonoid content. TPC values for crude extract, methanol extract, ethyl acetate extract and n-hexane extract were 57.09 ± 0.35 mg/g, 70.98 ± 0.03 mg/g, 21.31 ± 0.01 mg/g, and 18.45 ± 0.003 mg/g as gallic acid equivalent, respectively. Crude extract, methanol extract, ethyl acetate extract and n-hexane extract showed total flavonoids 26.87 ± 0.01 mg/g, 21.08 ± 0.03 mg/g, 21.70 ± 0.001 mg/g, 14.95 ± 0.02 mg/g as rutin equivalent. FTIR spectra of four extracts were comparable and showed the presence of nitro compounds and ring aromatic compounds.  

Conclusion: Our results indicate the potential of exploiting Hibiscus Rosa Sinensis leaves as a source of chemotherapeutic compounds, and it is worthy doing further researches on isolated bioactive compounds for developing novel functional foods or new drugs.

 

Graphical abstract

Letter from President of UMP

Letter from President
  • Tran Diep Tuan,
  • Pages 1-1
  • 10/12/2017
  • 17
  • 2700
  • Free

Assoc. Prof. Dr. Tran Diep Tuan

President of University of Medicine and Pharmacy at Ho Chi Minh City, Department of Pediatrics - UMP

 

Since our founding in 1947, the University of Medicine and Pharmacy at Ho Chi Minh City (UMP) has consistently worked hard to be a well-established and highly ranked university in Vietnam and the region. We aspire to provide a healthy scientific environment for our students, faculty and researchers. UMP is committed to advance scientific research and innovation, providing our community with the necessary tools in order to achieve these aspirations.

The MedPharmRes journal represents a major step that UMP has undertaken to provide a stage for academics to spread, promote, discuss their ideas and research. MedPharmRes is an open-access, peer-reviewed journal that is dedicated to publishing cutting-edge research that will help and promote change in the practice of medicine. We believe that science should be available to everyone and to prevent any limitations in the publishing process, UMP will sponsor publication associated fees between 2017 and 2018. This will allow academics from all backgrounds to submit for publication in our Journal. MedPharmRes applies high standards towards the peer- review process to ensure strict standards in methodological design and valid results. We emphasize the accuracy of research methodology and high ethical standards.  Our live online, blinded review process will allow both reviewers and authors to discuss the manuscript which will allow fair and accurate review of the submission, ensuring that the journal’s high standards are met.

In this inaugural issue, we would like to thank all the editorial and peer reviewers for their efforts. We hope that academics from around the world will choose to publish their research in this Journal, in order to promote high quality research, contributing to the development and advancement of of medical practice in Vietnam and around the world.

 

Graphical abstract

Quantitative Hepatitis B Surface Antigen in Different Phases of Chronic HBV Infection in Vietnamese Patients: The Preliminary Study

Original Research
  • Nguyen Thi Cam Huong, Le Thi Thuy Hang, Tran Bao Nhu, Salma Fala, Ibrahim Radwan, Nguyen Tien Huy, Pham Thi Le Hoa,
  • Pages 2-8
  • 10/12/2017
  • 82
  • 1272
  • Free

Quantitative serum HBsAg has been considered as a marker that reflects the immune effect on clearance of HBV. The HBsAg level varies in different genotypes and phases of infection. Therefore, we aimed to investigate the serum HBsAg level and its correlation with HBV DNA in different phases of Vietnamese CHB patients, predominately infected with genotype B and C. 267 chronic HBV treatment naïve patients (156 genotype B and 61 genotype C) were recruited in this cross-sectional study. Patients were categorized to 5 groups: immune tolerance (IT), HBeAg positive chronic hepatitis B (CHBe+), inactive carrier (IC), viral reactivation (VR), HBeAg negative chronic hepatitis B (CHBe-). The serum HBsAg level was measured by ECLIA method. Correlations between HBsAg and HBV DNA were analyzed by Spearman's correlation. The median HBsAg values were different between groups of CHB 4.56 log10 IU/mL (IT), 3.85 log10 IU/mL (CHBe+), 2.72 log10 IU/mL (IC), 3.21 log10 IU/mL (VR) and 3.09 log10 IU/mL (CHBe-) (p= 0.001). The significant correlations between HBsAg levels and HBV DNA were found in all CHB groups (r = 0.3 to 0.5). The ratios of HBsAg/HBV DNA were distributed around 0.5. The wide distribution of HBsAg and the highest ratio of HBsAg/HBV DNA were found in the IC groups. Our study demonstrated that serum HBsAg levels were significantly different in natural stages of CHB.  Significant correlations between HBsAg and HBV DNA were found in all CHB phases. The wide distribution of HBsAg in the IC group raises the question on the existence of HBsAg integration in CHB patients.

Graphical abstract

The Vietnamese Version of the Health-related Quality of Life Measure for Children with Epilepsy (CHEQOL-25): Reliability

Original Research
  • Tri Huu Doan, Tran Diep Tuan, Han Bao Huu Nguyen,
  • Pages 9-14
  • 10/12/2017
  • 76
  • 1145
  • Free

Purpose: This study aimed to translate and culturally adapt the self-report and parent-proxy Health-Related Quality of Life Measure for Children with Epilepsy (CHEQOL-25) into Vietnamese and to evaluate their reliability.

Methods: Both English versions of the self-report and parent-proxy CHEQOL-25 were translated and culturally adapted into Vietnamese by using the Principles of Good Practice for the Translation and Cultural Adaptation Process. The Vietnamese versions were scored by 77 epileptic patients, who aged 8–15 years, and their parents/caregivers at neurology outpatient clinic of Children Hospital No. 2 – Ho Chi Minh City. Reliability of the questionnaires was determined by using Cronbach’s coefficient α and intra-class correlation coefficient (ICC).

Results: Both Vietnamese versions of the self-report and parent-proxy CHEQOL-25 were shown to be consistent with the English ones, easy to understand for Vietnamese children and parents. Thus, no further modification was required. Cronbach’s α coefficient for each subscale of the Vietnamese version of the self-report and parent-proxy CHEQOL-25 was 0.65 to 0.86 and 0.83 to 0.86, respectively. The ICC for each subscale of the self-report and parent-proxy CHEQOL-25 was in the range of 0.61 to 0.86 and 0.77 to 0.98, respectively.

Conclusion: The Vietnamese version of the self-report and parent-proxy CHEQOL-25 were the first questionnaires about quality of life of epileptic children in Vietnam. This Vietnamese version was shown to be reliable to assess the quality of life of children with epilepsy aged 8–15 years.

Graphical abstract

Synthesis, in vitro Acetylcholinesterase Inhibitory Activity Evaluation and Docking Investigation of Some Aromatic Chalcones

Original Research
  • Thanh-Dao Tran, Thai-Son Tran, Thi-Cam-Vi Nguyen, Minh-Tri Le, Khac-Minh Thai,
  • Pages 15-25

In this study, a total of twenty chalcones were synthesized via Claisen-Schmidt condensation reaction and evaluated for their in vitro acetylcholinesterase inhibitory activities using Ellman’s method. Molecular docking studies on acetylcholinesterase were performed to elucidate the interactions between these chalcone derivatives and acetylcholinesterase active site at the molecular level. From the series, six compounds (S1-5 and S17) exhibited strong acetylcholinesterase inhibitory activities with IC50 values below 100 µM compared to the parent unsubstituted chalcone. Compound S17 (4’-amino-2-chlorochalcone) showed the strongest acetylcholinesterase inhibitory activity in the investigated group with IC50 value of 36.10 µM. Molecular modeling studies were consistent with the results of in vitro acetylcholinesterase inhibitory activities, and chalcone S17 could be considered as a potential lead compound for the development of new acetylcholinesterase inhibitors.

Graphical abstract