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

Editorial Letter
  • Tran Diep Tuan,
  • Pages 1-2
  • 02/04/2018
  • 28
  • 1014
  • Free

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
  • 02/04/2018
  • 68
  • 1086
  • Free

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
  • 02/04/2018
  • 78
  • 1307
  • Free

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

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
  • 03/04/2018
  • 82
  • 1339
  • Free

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
  • 03/04/2018
  • 79
  • 1057
  • Free

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

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
  • 163
  • 2286
  • 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
  • 58
  • 1627
  • 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

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
  • 06/07/2018
  • 50
  • 1061
  • Free

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

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
  • 07/07/2018
  • 36
  • 1127
  • Free

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

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
  • 08/07/2018
  • 50
  • 1024
  • Free

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 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

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

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
  • 166
  • 787
  • 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

Endoscopic submucosal dissection by using Clutch cutter and IT knife 2 for early gastric cancer with severe submucosal fibrosis: a case report

Case Study
  • Le Quang Nhan, Mai Vien Phuong, Le Quang Nghia,
  • Pages 17-21

Introduction: Gastric cancer is one of the highly malignant gastrointestinal cancers and the third leading cause of cancer death. In the last decade, early gastric cancer (EGC) has been reported by using narrow-band imaging (NBI) magnifying endoscopy. Advances in endoscopic techniques, such as endoscopic submucosal dissection (ESD), have enabled the en bloc resection of these EGC. Although ESD is performed for early gastric cancer, there are still many difficult problems in technique of this procedure. The difficulty of gastric ESD depends on the size and location of a tumor, presence of severe submucosal fibrosis, presence of ulceration... We report a case of our successful ESD by using Clutch cutter and IT knife 2 in treatment of EGC with severe submucosal fibrosis.

Case presentation: A 62-year-old man felt an epigastric discomfort two months ago. The narrow-band imaging (NBI) magnifying endoscopy revealed a suspected early gastric cancer type 0 - IIa + IIc (Japanese classification of early gastrointestinal cancers) at the incisura angularis, the size of this lesion was 15 mm in diameter, and pathological result of endoscopic biopsy was a well-differentiated adenocarcinoma. ESD was performed and we found there was severe submucosal fibrosis which was dissected safer and faster by using Clutch cutter and IT knife 2. There were no complications such as severe bleeding and perforation. The size of resected specimen was 60 x 35 mm and the time of procedure was 150 minutes. After ESD, the pathological result was a well differentiated adenocarcinoma, pT1a, UL(-), LY(-), V(-), no cancer cell in vertical and horizontal margins. The healing time of ESD-induced ulcer was 5 weeks without local recurrence.

Conclusion: Through this case, we aim to emphasize the importance of using Clutch cutter and IT knife 2 as a modified technique which makes ESD a safe procedure in treatment of EGC with severe submucosal fibrosis.

Graphical abstract

Budd-Chiari syndrome due to segmental obstruction of the inferior vena cava successfully managed with endovascular stenting

Case Study
  • Vo Pham Phuong Uyen, Quach Trong Duc, Dang Minh Luan, Luu Hieu Thao, Nguyen Dinh Luan,
  • Pages 22-26

Budd–Chiari syndrome (BCS), a rare and life-threatening disorder due to hepatic venous outflow obstruction, is occasionally associated with hypoproteinemia. We herein report the first case of BCS with segmental obstruction of the intrahepatic portion of inferior vena cava (IVC) and hepatic veins (HVs) successfully treated by endovascular stenting in Vietnam. A 32-year-old female patient presented with a 2-month history of massive ascites and leg swelling. She refused history of oral contraceptives use. Hepatosplenomegaly without tenderness was noted. Laboratory data showed polycythemia, mild hypoalbuminemia and hypoproteinemia, slightly high total bilirubin and normal transaminase level. The serum ascites albumin gradient was 1.9 g/dL and ascitic protein level was 1.1 g/dL. The other data were normal. BCS was suspected because of the discrepancy between mild liver failure and massive ascites; and the presence of hepatosplenomegaly and polycythemia. On abdominal magnetic resonance imaging, the segmental obstruction of three HVs and IVC was 2-3 cm long without thrombus. Cavogram revealed the severe segmental stenosis of intrahepatic portion of IVC with no visualized HV and extensive collateral veins. A Protégé stent was deployed to IVC. Leg swelling and ascites were completely resolved within 3 days after stenting. During 1-year follow-up, edema was not recurred and repeated laboratory results were all normal.

Graphical abstract

Effect of fluid bolus triggers and their combination on fluid responsiveness in optimization phase of severe sepsis and septic shock resuscitation

Original Research
  • Le Huu Thien Bien, Huynh Quang Dai, Mai Anh Tuan, Phan Vu Anh Minh, Pham Thi Ngoc Thao, Do Quoc Huy, Tuan Minh Vo, Dang Van Phuoc,
  • Pages 27-32

Objectives: to evaluate the fluid responsiveness according to fluid bolus triggers and their combination in severe sepsis and septic shock.

Design: observational study.

Patients and Methods: patients with severe sepsis and septic shock who already received fluid after rescue phase of resuscitation. Fluid bolus (FB) was prescribed upon perceived hypovolemic manifestations: low central venous pressure (CVP), low blood pressure, tachycardia, low urine output (UOP), hyperlactatemia. FB was performed by Ringer lactate 500 ml/30 min and responsiveness was defined by increasing in stroke volume (SV) ≥15%.

Results: 84 patients were enrolled, among them 30 responded to FB (35.7%). Demographic and hemodynamic profile before fluid bolus were similar between responders and non-responders, except CVP was lower in responders (7.3 ± 3.4 mmHg vs 9.2 ± 3.6 mmHg) (p 0.018). Fluid response in low CVP, low blood pressure, tachycardia, low UOP, hyperlactatemia were 48.6%, 47.4%, 38.5%, 37.0%, 36.8% making the odd ratio (OR) of these triggers were 2.81 (1.09-7.27), 1.60 (0.54-4.78), 1.89 (0.58-6.18), 1.15 (0.41-3.27) and 1.27 (0.46-3.53) respectively. Although CVP < 8 mmHg had a higher response rate, the association was not consistent at lower cut-offs. The combination of these triggers appeared to raise fluid response but did not reach statistical significance: 26.7% (1 trigger), 31.0% (2 triggers), 35.7% (3 triggers), 55.6% (4 triggers), 100% (5 triggers).

Conclusions: fluid responsiveness was low in optimization phase of resuscitation. No fluid bolus trigger was superior to the others in term of providing a higher responsiveness, their combination did not improve fluid responsiveness as well.

Graphical abstract

Antitumor-Promoting Effect of Ethanolic Extract from Leaves of Perilla frutescens var. crispa (Benth.) In Mouse Skin

Original Research
  • Vuu Thanh Tu Quyen, Huynh Ngoc Thuy, Ha Minh Hien, Huynh Ngoc Trinh,
  • Pages 33-39

This study aimed to investigate the antitumor-promoting effects of total ethanolic extract from Perilla leaf (PLE) in a two-stage chemical carcinogenesis protocol in mice. Quantitative analysis active compounds in PLE were performed by thin layer chromatography with normal phase of silica gel F254 and HPLC-PDA with reversed phase of C18 column at UV 300 nm. The cutaneous tumors were initiated by a single application by 7,12-dimethylbenz[a]anthracene (DMBA) on the dorsal shaved skin, then promoted by repeated applications of croton oil during 20 weeks. PLE was topically applied daily until the end of the experiment. The results observed from thin layer chromatogram highlighted the presence of rosmarinic acid and luteolin in PLE. By means of HPLC-PDA analysis, the total content of rosmarinic acid and luteolin were found in amounts of 1.178 ± 0.011 % (w/w) and 0.105 ± 0.001 % (w/w), respectively. The PLE-treated group prolonged the latency period of tumor appearance up to 2 weeks and also significantly reduced tumor volume in dorsal skin of mice as compared to untreated group. In conclusion, the total ethanolic extract from leaves of Perilla frutescens demonstrated promising antitumor-promotion activity in mouse skin.

Graphical abstract

Roles of Reactive Oxygen Species in Diseases and Development of Novel Antioxidant Therapeutics

Review
  • Long Binh Vong, Nhu-Thuy Trinh, Dai-Nghiep Ngo,
  • Pages 1-6

Reactive oxygen species (ROS) or oxidative stress has been reported with strongly involving to pathogenesis of many diseases in human. On the other hand, ROS play a critical regulation as secondary signal to maintain intracellular redox equilibrium. Basically, the antioxidant defense systems in the body counteract with overproduced ROS. However, when the redox balance is broken under severe oxidative stress conditions, it leads to tissue injuries and numerous disorders. In this review, we briefly introduce the systems of ROS and antioxidants systems in the body and discuss the opposite roles of ROS in normal physiological conditions and diseases. For ROS-related diseases, conventional and currently developed antioxidant therapies are also described in this review.

Graphical abstract

Online training needs of Methadone Maintenance Treatment clinics in southern Vietnam

Original Research
  • To Gia Kien, Huynh Ngoc Van Anh, Vu Thi Tuong Vi, Vu Huy Hoang, Nguyen Song Chi Trung, Do Van Dung,
  • Pages 7-14

Introduction: Continuing Medical Education (CME) significantly improves the competency of healthcare workers in Methadone Maintenance Treatment (MMT) clinics. However, CME courses are very costly, and a few participants fully attended a course. Online training is an alternative approach to efficiently improve training outcomes. The study assessed needs and possibility of online training courses of MMT clinics in southern Vietnam.

Methods: A google form was designed to collect characteristics, man-powers, facilities, online activities and training needs of MMT clinics. E-mails were sent to all MMT clinics in southern Vietnam to ask for their participants. A representative of MMT clinics who satisfied the inclusion invited to complete the form.

Result: 93 MMT clinics completed the survey. The response rate was 62% (93/150). One MMT clinic had 3 doctors/assistant doctors, 3 pharmacists/drug dispensers, 2 consultants and 3 other professionals on average. The number of clients visiting the clinic in the last month was 150. About 94% (93/95) of MMT clinics provide other additional services. On average, 385 clients came to MMT for other services. All clinics had adequate devices for online and blended training.

Conclusion: MMT clinics had high training needs and were willing to attend online and blended training courses. Online and blended training were possible in MMT clinics.

Graphical abstract

Correlation of axial loaded magnetic resonance imaging with clinical symptoms in lumbar spinal canal stenosis patients

Original Research
  • Nguyen Van Son, Vi Truong Son, Luu Ngoc Hoat, Do Thi Thanh Toan,
  • Pages 15-19

There are cases when symptoms are available but no abnormal stenosis is found in MRI and vice versa. Axial-loaded MRI has been shown that it can demonstrate more accurately the real status of spinal canal stenosis than conventional MRI. This is the first time we applied a new system that we have recreated from the original loading frame system in order to fit with the demands of Vietnamese people. Sixty-two patients were selected from Phu Tho Hospital in Phu Tho Province, Vietnam, who fulfilled the inclusion criteria. The Anterior-posterior diameter (APD), Dura Cross-sectional Area (DSCA) in conventional MRI and axial loaded MRI, and changes in APD and DCSA were determined at the single most constricted intervertebral level. The APD and DCSA in axial loaded MRI had very good significant correlations with VAS for back pain (rs=0.83, 0.79), leg pain (rs=0.69, 0.57) and JOA score (rs=0.70, 0.65). APD and DCSA in axial loaded MRI significantly correlated with the severity of symptoms. Our axial loading MRI provides more valuable information than the conventional MRI for assessing patients with LSCS.

Graphical abstract

Commitment: A concept analysis in nursing field

Review
  • Nguyen Thi Nhan, Nguyen Thi Truong Xuan,
  • Pages 20-25

Aim: To clarify the meaning of commitment and to provide the empirical referents to measure the concept of commitment.

Method: By using the Walker and Avant (2011) methodology, data were analyzed with the focusing on critical attributes of concept, constructed cases, antecedents and consequences of the concept. Additionally, the empirical referents and implications for nursing knowledge are presented to further elucidate the concept of commitment.

Findings: The critical attributes of commitment derived from this analysis are 1) Promising to involve in an action; 2) Acceptance of responsibility for the action; and 3) Persistent involvement in an action. The process of analysis concept of commitment leads to a better understanding of the concept itself. Nurses can use the ideas of this analysis as conceptual tools to assess the level of commitment among patients/clients in their action toward the health promoting behavior.

Conclusion: This analysis proposes a definition with the critical attributes of the concept which can be considered to use in nursing practice. Nursing is a universal profession; hence, the definition was proposed from this concept analysis can be considered as a beginning point for the further study in nursing field of each country.

Graphical abstract

Gestational Diabetes Mellitus in Women with Polycystic Ovary Syndrome Undergoing Assisted Reproduction

Original Research
  • Tran Thi Minh Chau, Lan N Vuong,
  • Pages 26-31

Polycystic ovary syndrome (PCOS) is a common endocrine metabolic disorder in women of reproductive age. PCOS is often associated with insulin resistance and carries an increased risk of gestational diabetes mellitus (GDM). The aim of this study was to evaluate the risk of GDM in women with a history of PCOS. This was a retrospective cohort study conducted at a single center in Vietnam between January 2014 and December 2017. A total of 400 women who conceived through assisted reproductive technology (ART) were included, 200 who had been diagnosed with PCOS, and 200 without a PCOS diagnosis as controls. Multivariable logistic regression models were used to examine the association between risk of GDM and PCOS after adjusting for confounders. GDM was present in 37% of those with PCOS, compared with 26.5% in those without PCOS (RR 1.4, 95% CI 1.04–1.87, p=0.02). The prevalence of GDM did not differ significantly between PCOS phenotype groups (p=0.28). Women with PCOS undergoing ART had a higher risk of GDM after adjusting for differences in age, pre-pregnancy body mass index, type of infertility, ART indications, and type of ART (adjusted OR 2.04, 95% CI 1.06–3.92). First-trimester fasting plasma glucose (FPG) was also an independent predictor for GDM (adjusted OR 1.54, 95% CI 1.01–2.34). This study suggests that PCOS and first-trimester FPG are independent risk factors for the development of GDM.

Graphical abstract