Risk of venous thromboembolism and appropriateness of thromboprophylaxis in patients undergoing lower limb orthopedic surgery in a Vietnamese hospital

Original Research

Abstract

Introduction: Patients undergoing orthopedic surgery are at high risk of venous thromboembolism (VTE), but the prophylactic practices are suboptimal. We aim to investigate the risk of VTE, the appropriateness of VTE prophylaxis and its associated factors in patients undergoing lower limb orthopedic surgery.

Method: A cross-sectional study was conducted at Gia Dinh People’s Hospital. Data was collected from medical records of patients aged ≥18 years undergoing lower limb orthopedic surgery between March 1st 2020 and June 30th 2020. VTE risk was stratified using the Caprini Risk Assessment Model, contraindications to anticoagulation and the appropriateness of thromboprophylaxis were evaluated according to current guidelines. Multivariate logistic regression analysis was used to determine factors associated with the appropriateness of VTE prophylaxis.

Results: A total of 217 patients was included (median age 54, 57.6% male). There were 80.2% of patients at risk of VTE. Overall rate of appropriate VTE prophylaxis was 35.0%. Patients with age ≥41, BMI >25 kg/m2, surgical duration >45 minutes, plaster cast or screw splint were less likely to receive appropriate VTE prophylaxis; patients with hospital stay >4 days after surgery got more chances to have proper VTE prophylaxis (p <0.05).

Conclusions: The majority of patients undergoing lower limb orthopedic surgery were at risk of VTE, but the rate of appropriate VTE prophylaxis was low. Factors associated with the appropriateness of VTE prophylaxis were age, BMI, surgical duration, plaster cast or screw splint, and length of hospital stay after surgery. Interventions are needed to improve the appropriateness of VTE prophylaxis. 

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Acceptance and willingness to pay for COVID-19 vaccines available in Vietnam: an online study during the fourth epidemic wave

Original Research

Abstract

COVID-19 vaccines available in Vietnam have different prices, efficacies, and side effects. We studied acceptance and willingness to pay (WTP) for COVID-19 vaccines in Vietnam, using a self-designed online questionnaire. Respondents were 2093 unvaccinated adults. Multiple regression analyses identified factors associated with vaccine acceptance and WTP. Acceptance of free vaccines was around 90% for the three available in Vietnam (Astra Zeneca, SPUTNIK V, and Pfizer-BioNTech). WTP for the same vaccines was about 70%. Vaccine acceptance was associated with being female and/or chronically ill or undergoing COVID-19-related job changes. WTP was associated variously with family economic status, occupational changes due to COVID-19, chronic disease, and perceived risk of infection. Most respondents were willing to be vaccinated and many were willing to pay for it, depending on personal and family circumstances. Vietnam should budget for free vaccines to support those unable to pay. 

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The effects of auricular acupuncture at Lung, Shenmen, Endocrine, Adrenal points on adult eczema: a randomized trial

Original Research

Abstract

Background and Objectives: Adult eczema (AE) has been reported to have a poor quality of life (qoL). Auricular acupuncture (AA) is a method that has been studied a lot recently. Our study is to determine the effects of combining AA and modern medication in the relief of symptoms and the improvement in qoL in AE.

Methods: A single-blind randomized study on 65 AE at the University Medical Center Ho Chi Minh City Branch 3; was randomized into an auricular acupuncture (AA) group and a Sham acupuncture (SA) group. All AA group patients will receive AA at Lung, Shenmen, Endocrine, and Adrenal points. The score of scoring atopic dermatitis (SCORAD) and the score of dermatology life quality index (DLQI) were compared in two groups before and after treatments.

Results: There were 33 patients in the AA group and 32 patients in the SA group. After 2 weeks, in the SA group, the SCORAD score of 46.4 ± 1.3 decreased to 28.2 ± 1.2, compared with the AA group’s SCORAD score of 47.5 ± 1.5 decreased to 24 ± 1.3; the DLQI score of 14.7 decreased to 7.6, compared with the intervention group DLQI score of 15, reduced to 5.7. The difference in improving the SCORAD score and the DLQI score between the two groups was statistically significant. No patient had any adverse events during the study.

Conclusions: Combining auricular acupuncture Lung, Shenmen, Endocrine, Adrenal points, and modern medication treatment may relieve effectively symptoms and improve the QoL in AE. 

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Effect of gonadotropin-releasing hormone agonist treatment in Vietnamese children with central precocious puberty

Original Research

Abstract

Introduction: Gonadotropin-releasing hormone agonists (GnRHa) are generally indicated in central precocious puberty (CPP) patients. We aimed to analyze the auxological outcomes of GnRHa treatment on CPP children.

Methods: A cross-sectional study with observational data were collected from 143 CPP patients who finished GnRHa therapy in Children Hospital 2, Vietnam. Anthropometry and sexual maturity rating were assessed after 6 months and each year of the therapy. The Bayley-Pinneau method was used to estimate the predicted adult height (PAH).

Results: The mean calendar age and bone age at the start of the treatment were 8.0 ± 0.7 years and 10.5 ± 0.1 years, respectively. The mean treatment period was 2.4 ± 0.6 years. GnRHa led to the regression of pubertal symptoms after treatment. The pre-treatment PAH was 157.8 ± 0.6 cm (girls) and 172.3 ± 2.4 cm (boys). The PAH at treatment discontinuation (162.0 ± 0.5 cm in girls and 176.7 ± 2.3 cm in boys) was higher than the initial PAH (p<0.05). For girls with treatment before 6 years old, GnRHa results in a predicted average gain in adult height of 10.2 ± 3.2 cm, whereas the predicted height advancement in the 6-8 age group was 5.3 ± 0.7 cm. The predicted average height gain of girls aged over 8 years was 3.2 ± 0.6 cm.

Conclusion: GnRHa therapy was effective for CPP treatment with the improvement of predicted final height. Predicted height advancement was still documented in females who started the treatment after 8 years old. 

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CHROMagarTM Strep B for detecting group B Streptococcus in pregnant women at 35th to 37th of gestation

Original Research

Abstract

Introduction: Group B Streptococcus (GBS) is one of the common causes of neonatal sepsis spreading from mothers to newborns. A common method to isolate and identify GBS is using Blood agar which delivers results in at least 48 hours. Although chromogenic culture media including CHROMagarTM StrepB, can develop colored colonies for detecting pathogenic bacteria easily, there has not been approached GBS isolation in Vietnam. This study was conducted to find out the GBS infection ratio in pregnant women at the 35th – 37th week of gestation. Furthermore, this research evaluates the efficacy of CHROMagarTM StrepB media and Blood agar in GBS detection as well.

Method: In a cross-sectional survey, a total of 258 pregnant women at 35th to 37th of gestation screened for GBS at Thuan Kieu General Clinic from 04/2021 to 12/2021 were recruited. Rectovaginal swabs from these patients were cultured on Blood agar and CHROMagarTM StrepB. We performed data analysis using SPSS ver 20, p<0.05 was statistically significant.

Result: Overall, out of 258 participants, 52 (20.16%) were GBS carriers. CHROMagarTM StrepB has significantly higher sensitivity than blood agar if spending a similar time (1.52 fold, p-value < 0.001), or event training a shortened time (18 hours and 48 hours), CHROMagarTM StrepB media is still more sensitive than blood agar (1.16 fold, p-value 0.044).

Conclusion: In this study, the GBS infection ratio in pregnant women at 35-37 weeks of gestation at Thuan Kieu General Clinic is 20.16%. Culturing vaginal-rectal specimens on CHROMagarTM StrepB medium is higher sensitivity and rapidly than blood agar for GBS detection. CHROMagarTM StrepB should be used to get more effective in identifying GBS carriers in near-term pregnant women. 

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Transplant tourism: a literature review on development, ethical and law issues

Review

Abstract

Objectives: This study aims to narratively review the progression of ethical and legal issues related to transplant tourism.

Methods: PubMed search and Google search with keywords were used in March 2022 to identify relevant studies and law documentation.

Results: The progression of transplant tourism was classified into three main periods. Before 2000, the most popular destination country was India (1,308 cases), this period was characterized by the absence of laws and regulations worldwide. The period from 2000 to 2010 was the peak explosion of transplant tourism, China became the most popular destination of tourists (7,591 cases). This triggered alarms by World Health Organization (WHO) resolution in 2004 and Istanbul declaration in 2008 calling for regulations to prohibit transplant tourism. From 2010 till today, additional scientific publications reported several complications in overseas transplanted patients. Laws and regulations restricting transplant tourism were promulgated by many countries such as Israel, Taiwan, Spain and others.

Conclusions: Transplant tourism is considered as illegal worldwide. WHO and many developed countries announced laws and measures to prevent this activity. The incidence of transplant tourism is currently decreasing, continued efforts should persist to end this criminal act. 

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How Vietnamese healthcare students think of nurses: Students stereotypes about Nursing at University of Medicine and Pharmacy at Ho Chi Minh City

Original Research

Abstract

Introduction: Vietnam’s health system increasingly recognizes the importance of interprofessional collaboration and education. Understanding stereotypes and interprofessional attitude could foster successful collaboration. This study aimed to assess stereotypes about nursing amongst healthcare students at University of Medicine and Pharmacy at Ho Chi Minh City.

Method: We invited nursing, medical, pharmacy and rehabilitation therapy students to complete an online survey before an interprofessional education course in September 2020. Student Stereotypes Rating Questionnaire was used to assess student stereotypes about nursing. Univariate regression was used to analyze the association between stereotypes score and other factors including interprofessional attitude as measured by Readiness for Interprofessional Learning Scale.

Results: With 102 students invited, 90 students completed the survey. Students were 20-21 years old, 57% were female, and 9% from minor ethnicity. The total attitude score was 80.2 ± 7.2, which meant favorable interprofessional learning. The total stereotype score was 37.1 ± 4.0, considered as high. Stereotype rated in descending order were: Practical skills (4.4), Interpersonal skills (4.3), Ability to be a team player (4.3), Professional competence (4.2), and Confidence (4.2), Ability to make decisions (3.9), Ability to work independently (3.8) and Leadership skills (3.5). There was an association between stereotype and interprofessional attitude total score (Coefficient 0.25, 95%CI: 0.15; 0.36, p-value < 0.01).

Conclusion: Vietnamese students highly regarded nursing profession, yet stereotypes about nursing existed and students viewed nurses as a capable team player, almost a follower. We need to study how interprofessional education courses could improve students’ attitude and stereotypes in future research. 

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31-item Quality of Life in Epilepsy Inventory: Translation and validation in Vietnamese

Original Research

Abstract

Introduction: This study aimed to translate the 31-item Quality of Life in Epilepsy Inventory (QOLIE-31) into Vietnamese and validate the translation.

Methods: The inventory was translated through “forward – backward” translation, and culturally adapted for standardization. To ensure the reliability of the inventory, the internal consistency and the temporal consistency was determined. Clinical variables were tested for discriminant validity by comparing their scores.

Results: Cronbach’s alpha coefficient ranged from 0.91 to 0.57, with the lowest in the Overall quality of life subscale. Test-retest reliability showed high reproducibility with intra-class correlation coefficients ranging from 0.72 to 0.87 (p<0.001). The mean score of QOLIE-31 was 71.31. Further, the study used the statistical differences of QOLIE-31 scores in the drug-resistant group to show discriminant validity.

Conclusion: The Vietnamese QOLIE-31 is a reliable and valid instrument as proven by the statistical data and can be used to assess quality of life in people with epilepsy. 

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Gastroesophageal reflux in children with recurrent and chronic respiratory diseases: non-acid or acid?

Original Research

Abstract

Introduction: In some cases, gastroesophageal reflux (GER) may be accompanied by duodenogastric reflux, forming non-acid reflux, which has a certain influence on the clinical presentation and the response to anti-reflux therapy. The study aimed to determine the role of non-acid reflux in children with recurrent and chronic respiratory diseases (RCRD).

Methods: All children with RCRD, for unknown reason, poorly responding to respiratory-specific therapy, hospitalized for gastroesophageal reflux disease (GERD) screening, using dual pH-multichannel intraluminal impedance (pH-MII).

Results: The study was conducted in 42 children at the age Me – 2.75; IQR 1.08-9.42. The most common type of reflux was weakly acid reflux - 62.25 [36.425-121.225], then acid - 34.05 [12.875-71.65], alkaline - 1.75 [0 - 12.375] episodes per day (p <0.05). Non-acid reflux was more common in children with only respiratory symptoms - no esophageal manifestations of GERD. All types of refluxes were more often recorded in the upright compared to the supine position. In 70% patients, cough could be associated with reflux, while in 88% children reflux was non-acid (including 69% - weakly acid, 19% - alkaline), in 38% - acid.

Conclusions: Non-acid reflux is the main type of GER in children with RCRD refractory to standard therapy, which could be associated with cough in this patient population. 

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Cancer-related thrombosis among older patients in a hospital in Vietnam: A retrospective study

Original Research

Abstract

Introduction: Venous thromboembolism (VTE), a highly prevalent complication in cancer patients, causes prolonged hospitalization and mortality. This study aimed to investigate the characteristics of VTE in older patients with cancer.

Methods: This was a retrospective study. Data were extracted from electronic medical records at the Geriatrics-Palliative Care Department of University Medical Center Ho Chi Minh City. Inclusion criteria included: aged ≥ 60 years, confirmed or newly diagnosed with cancer, and new VTE diagnosis. Exclusion criteria included lacking any information on demographics, laboratories, or treatments. Pulmonary embolism (PE) was confirmed using chest computerized tomography scans, while deep vein thrombosis (DVT), and other types of venous thrombosis were confirmed based on a doppler or abdominal ultrasound. Data were analyzed using Stata 15.0, with p <0.05 signifying statistical significance.

Results: Data of 151 patients were extracted from 1170 medical records (median age: 67, range 60 to 89 years). The three most frequent types of VTE were portal vein thrombosis (48.3%), PE (30.5%), and DVT (29.1%). Stage IV cancer was found in 74.2% of VTE patients. Leg pain was presented in 59.1% of the patients with DVT, and dyspnea was confirmed in 80.4% of the patients with PE. Anticoagulant therapy was the most common treatment for VTE (33.8%) and no major bleeding was recorded.

Conclusions: VTE was highly common among older patients with advanced cancer. Leg pain was an indicator of DVT and dyspnea was a warning sign of PE in older patients with cancer. No major bleeding was recorded in those receiving anticoagulants. 

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