Eosinophilic gastrointestinal disorders presenting with multiple gastric and colonic ulcerative lesions: a case report

Case Study

Abstract

Eosinophilic gastrointestinal disorders are rare inflammatory conditions marked by eosinophilic infiltration of the gastrointestinal tract. Endoscopic manifestations vary from patient to patient. However, ulcerative lesion is a rare occurence. A 57-year-old patient presented with chronic diarrhea and significant peripheral blood eosinophilia. During endoscopy, multiple ulcers were discovered throughout the stomach, duodenum, and colon. Biopsies showed excess tissue eosinophilia suggestive of eosinophilic gastroenteritis and colitis. The patient responded dramatically with corticosteroid. However, he developed steroid dependency necessitating the use of azathioprine. In conclusion, a rare case of eosinophilic gastroenteritis and colitis presented with multiple ulcerative lesions was described. Physicians should be aware that eosinophilic gastroenteritis and colitis may be a cause of chronic diarrhea, particularly, in patients presented with peripheral blood eosinophilia. Corticosteroid is the mainstay of treatment. In steroid dependency case, azathioprine may be an option. 

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Multisystem inflammatory syndrome in children following SARS-CoV-2 infection: A case report

Case Study

Abstract

Introduction: COVID-19 in children has a diverse clinical presentation, most of which is asymptomatic or mildly symptomatic. In addition, after 2-6 weeks of being infected with COVID-19, children may have the multisystem inflammatory syndrome in children (MIS-C), which is rare but serious condition, death has also been reported despite active treatment. We describe a severe clinical case of MIS-C treated at our hospital in the early stage of the 4th wave of COVID-19 in Vietnam.

Case report: A six-year-old boy admitted to Thu Duc City Hospital on August 27th, 2021. He had a history of COVID-19, which was diagnosed by a positive RT-PCR SARS CoV-2 test on July 24th, 2021. He had no symptoms and was concentrated quarantine with his family. He was discharged on August 12th, 2021. Four weeks after SARS-CoV-2 infection, he had symptoms such as sustained fever (5 days), stomachache (6 days), erythema multiform (8 days), eye and lip swelling (7 days), edema of hands and feet (10 days), dyspnea (5 days), hepatomegaly and shock. After then, he was diagnosed with MIS-C and treated with intravenous methylprednisolone 2 mg/kg/day (3 days), then tapered 1 mg/kg/day (5 days), maintained with prednisone 1 mg/kg/day for 14 days. The patient had no clinical symptoms, was discharged after 14 days of treatment, and continued treatment with aspirin 3 mg/kg/day and prednisolone 1 mg/kg/day.

Conclusion: The MIS-C manifestation following SARS-CoV2 infection needs prompt attention and treatment. Intravenous immunoglobulin plays an important role in treatment. However, when intravenous immunoglobulin is not available where limited resources, early appropriate use of methylprednisolone may be beneficial. 

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Angiographic recognition and percutaneous intervention of an occluded anomalous circumflex coronary artery causing acute myocardial infarction: a case report

Case Study

Abstract

Coronary arteries with anomalous origin are unusual but can be responsible for myocardial infarction. Acute occlusion of an anomalous coronary artery is not only easily missed on angiography but also technically challenging for percutaneous intervention. In this report, we present our experience in a patient with an anomalous circumflex being the culprit vessel in acute myocardial infarction. We report a case of a 74-year-old male patient presented with sudden chest pain. The diagnosis of occluded anomalous circumflex coronary artery was made by invasive coronary angiography shortly after admission. The patient was stented with a 2.5 x 18mm bare metal stent and was discharged with intensive medical treatment and regular follow-up. Interventional cardiologists should keep in mind there are several anomalous origin, the most frequent anomaly being a circumflex artery with origin from the right coronary artery or the right sinus of Valsalva. 

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A 63–year–old female with bilateral renal artery stenosis – highlights on diagnosis and optimal medical treatment

Case Study

Abstract

Renal artery stenosis is responsible for approximately 75% of secondary hypertensive cases. A 63-year-old female patient with uncontrolled hypertension and other comorbidities including type 2 diabetes mellitus and knee osteoarthritis presented with drastically raised systolic blood pressure in this case report (220 mmHg). Bilateral abdominal bruits were detected upon of physical examination. Imaging investigation showed significant bilateral atherosclerotic renal artery stenosis. An optimal combination of antihypertensive agents mainly with an angiotensin converting enzyme inhibitor, other than interventional revascularization, was applied and resulted in controlled blood pressure. 

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Parvovirus B19 infection and anemia after kidney transplantation: a report of two cases

Case Study

Abstract

Post-transplantation anemia is common among renal transplant recipients (RTR). The most frequent causes are erythropoietin deficiency, acute allograft rejection, iron deficiency, hemolytic anemia, adverse effects of immunosuppressive therapy, and virus infection. Human parvovirus B19 (HPV B19) can cause persistent viremia and erythropoietin-resistant erythroid aplasia in immunosuppressed patients. This case report describes two male renal transplant recipients who infected HPV B19 after kidney transplantation with severe anemia. Rapid and severe anemia that did not respond to blood transfusion. Adjustment of immunosuppressive drugs and intravenous immunoglobulin treatment resolved severe anemia after two months. In conclusion, when anemia develops rapidly and severely in renal transplant recipients in the absence of rejection and hemolysis, parvovirus B19 infection should be considered. 

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A case report: extremely severe pulmonary artery hypertension as an initial presentation of systemic lupus erythematosus in pregnancy

Case Study

Abstract

A 33-year-old G2 P1001 female at 13 weeks of gestation presented with dyspnea, tachycardia, and hypotension. Initial assessment revealed cardiogenic shock and acute respiratory failure caused by extremely severe pulmonary artery hypertension (PAH). Multidisciplinary efforts led to the diagnosis of severe PAH as an initial manifestation of systemic lupus erythematosus (SLE). Team care included gestational termination via dilation and curettage (D&C), followed by corticosteroids and vasodilator therapy, with excellent clinical and hemodynamic outcomes. 

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Bullous systemic lupus erythematosus with nephrotic syndrome in an adolescent girl: a case report

Case Study

Abstract

Bullous systemic lupus erythematosus is an uncommon autoimmune subepidermal vesiculobullous disease occurring in less than 5% of patients with systemic lupus erythematosus. The diagnosis of bullous systemic lupus erythematosus is based on clinical picture, histopathological findings, direct immunofluorescence and other immunologic tests. Importantly, establishing the diagnosis of bullous systemic lupus erythematosus requires the occurrence of systemic lupus erythematosus according to the American College of Rheumatology criteria. We report a case of bullous systemic lupus erythematosus in a 16-year-old Vietnamese girl, who demonstrated an acquired vesiculobullous eruption associated with nephrotic syndrome and fulfilled the European League Against Rheumatism/ American College of Rheumatology 2019 classification criteria of systemic lupus erythematosus. Clinical examination showed numerous tense, clear fluid-filled vesicles and bullae affecting the whole body with the predilection for the face, neck, chest, abdomen and bilateral inner thigh areas. Erosions were observed on the tongue and the buccal mucosa. Histopathologic examination showed subepidermal vesicle containing abundant neutrophils and perivascular mixed inflammatory cell infiltration. Microabscesses at tips of dermal papillae and the features of a leukocytoclastic vasculitis were not seen. Direct immunofluorescence of perilesional skin biopsies demonstrated linear deposition of IgG, IgA, IgM and C3 in the basement membrane zone. Linear immunoglobulin deposition displayed a u-serrated pattern with the predominant staining intensity of IgG. Serologic tests showed positive antinuclear antibody. Complement components assay revealed low levels of C3 (66.5 mg/dL) and C4 (3,9mg/dL). Proteinuria level was increased to 3.5g/24 hours. The final diagnosis of bullous systemic lupus erythematosus with nephrotic syndrome was made. The patient was treated with a high-dose oral glucocorticoid scheme and showed significant clinical improvement. 

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Pseudomembranous colitis with negative Clostridium difficile PCR presenting with massive ascites: a case report and literature review

Case Study

Abstract

Pseudomembranous colitis (PMC) is characterized by the presence of an inflammatory pseudomembrane overlying the colonic mucosa, and is primarily caused by Clostridium difficile infection (CDI). PMC is often associated with the use of broad-spectrum antibiotics. Common symptoms include watery diarrhea, mucus in stool, abdominal cramps, and fever. We report a case of a 52-year-old female presenting with new abdominal distention, frequent bloody, mucoid, jelly-like diarrhea, and abdominal pain. Peritoneal fluid analysis showed neutrocytic ascites with low serum-ascites albumin gradient (SAAG). A diagnosis of pseudomembranous colitis was confirmed by flexible sigmoidoscopy. However, polymerase chain reaction (PCR) test for Clostridium difficile was negative. The patient was treated with metronidazole (500 mg IV q8h) and vancomycin (250 mg PO QID). Her symptoms resolved after several days of treatment with no ascites found by ultrasound. Neutrocytic ascites can be a complication of PMC. Physicians should also be aware that empirical treatment of Clostridium difficile may cause false negative diagnostic test result. 

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Health service use and associated factors among old Khmer people: a cross-sectional survey in Tri Ton District, An Giang Province

Original Research

Abstract

Background: The health status of ethnic minorities of all ages lags far behind that of the general population, particularly in the old. The old minor ethnic population is more likely to have chronic diseases but less likely to access health services. This study assesses the rate of health services use and associated factors in the old Khmer population.

Method: A cross-sectional study was conducted on 400 Khmer people aged 60+ year-old from March to May 2020. Eligible participants were randomly recruited from households of five clusters out of nine communes of Tri Ton District, An Giang province, Vietnam. A structured questionnaire was designed to collect data on socio-demography, health status, health service use and accessibility to health services and quality of life. Quality of life was measured using EQ-5D-5L. All eligible participants were face-to-face interviewed by a bilingual researcher.

Result: The rate of health services use was 63.3%. The EQ-5D-5L utility index mean score was 0.46 (SD=0.28) and EQ-VAS mean score was 49.01 (SD=16.19). The odds of using health services were higher in those reported to have problems in mobility (OR=2.56, 95%CI 1.43-4.61, p<0.01), self-care (OR=2.05, 95%CI 1.30-3.24, p<0.01), activity (OR=2.35, 95%CI 1.44-3.82, p<0.01), pain/discomfort (OR=2.63, 95%CI 1.22-5.67, p=0.01), and anxiety/depression (OR=2.07, 95%CI 1.00-4.29, p=0.05) in univariate but not in multivariable analysis. The multivariable logistic regression showed that the odds of using health services were lower in those who were currently working (aOR=0.48, 95%CI 0.30-0.79, p<0.01), accessible to health information (aOR=0.47, 95%CI 0.27-0.80, p<0.01), but higher in those using health insurance (aOR=5.09, 95%CI 3.19-8.14, p<0.01), and in health facilities used Khmer language (aOR=2.04, 95%CI 1.15-3.62, p=0.01).

Conclusion: This study suggested that Khmer people should be involved in all stages of planning and implementing health programs and services for Khmer communities to improve the accessibility and health equity. 

Graphical abstract

A study on traditional medicine body constitution types in residential community of District 4, Ho Chi Minh City

Original Research

Abstract

Introduction: Body constitution (BC) is widely applied in daily clinical practice by Traditional Chinese Medicine (TCM) practitioners. The BC is innate depending on the intrinsic properties of the human body and is influenced by the environment. The most common diagnostic tool of physiological BC types is the Constitution in Chinese Medicine Questionnaire (CCMQ). This study was conducted to determine the proportion of nine TCM constitution types and comorbidities observed in the community of District 4, Ho Chi Minh City.

Methods: A cross-sectional design was applied to collect data for this study. All the participants were classified as BC types by the CCMQ. The collected data were statistically analyzed with the SPSS 22.0 software.

Results: There were 436 participants aged from 18 (163 males; 273 females) enrolled in this study from 05/2021 – 06/2021 in District 4. Five comorbidities were observed including hypertension (23.6%), cardiovascular diseases (13.1%), diabetes (11.5%), hyperlipidemia (8.3%) and obesity (4.1%). In participants, the prevalence of nine BC types were Neutral (62.4%), Qi-deficiency (17.2%), Qi-depression (15.6%), Inherited-special (8.9%), Yang-deficiency (8.3%), Blood-stasis (8.0%), Yin-deficiency (7.6%), Phlegm-dampness (6.4%), and Dampness-heat (5.7%). The Qi-deficiency type was significantly associated with ages, genders, hypertension and cardiovascular diseases while the Dampness-heat one was related to gender.

Conclusions: Among the participants in District 4, Ho Chi Minh City, hypertension (23.6%) is the most common comorbidity. Neutral (62.4%) is the majority in BC types. The associations between BC types and ages, genders, jobs, five chronic diseases were different. 

Graphical abstract

Combination of Indocyanine green clearance test and remnant liver volume for safe major hepatectomy

Original Research

Abstract

Introduction: Indocyanine green (ICG) clearance and remnant liver volume (RLV) are the two important factors in predicting post-hepatectomy liver failure (PHLF) after major hepatectomy; however, the combination of these is still controversial. This study is to find a way to combine these to select candidates for safe major hepatectomy.

Methods: A prospective cohort study included 137 major hepatectomies. ICG clearance (through ICG remnant at 15 minutes: ICG-R15), liver function results and the ratio of remnant to standard liver volume (RLV/SLV) were analyzed to examine their relations to PHLF. These variables, gender and age were analyzed using multivariate logistic regression to establish a model to predict PHLF.

Results: PHLF rate after major hepatectomy was 16.8% with 5.8% for grade B-C. ICG-R15 and RLV/SLV were significantly associated with PHLF (p = 0.019 and 0.007 respectively). ICG-R15 was not significantly associated with the grade of PHLF while RLV/SLV was but the post-hoc analysis showed no significant difference. Group RLV/SLV < 40% tended to have higher rate and grade of PHLF than group RLV/SLV > 40% but the difference was not significant (p = 0.063 and 0.072 respectively). Based on gender, age, ICG-R15 and RLV/SLV, PHLF rate could be estimated with model performance of 77%.

Conclusion: ICG clearance and RLV were associated with PHLF after major hepatectomy. It was safe and feasible to perform major hepatectomy with RLV/SLV under 40% and good ICG-R15. It was possible to estimate PHLF rate based on the patients’ gender, age, ICG-R15 and RLV/SLV. 

Graphical abstract

Emergence of telemedicine during COVID-19 pandemic: drawing upon an underrated modality in Vietnam

Review

Abstract

In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a global pandemic. In Vietnam, the incidence rate started climbing in May 2021, reaching an all-time high of 9,000 cases per day, and is projected to increase even further. Direct patient contact, as has always been the case in conventional medical practice, now constitutes significant transmission risk during the height of COVID-19. Healthcare workers, while accounting for a minor proportion of the population, are two to three times more likely to contract COVID-19, especially those who provide outpatient care or home-based service. The pandemic has led to a significant increase in the adoption of telemedicine, as hospitals are overwhelmed with critically ill patients, demand for healthcare soars, and transmission risk remains serious. With appropriate attention and further advancement of Vietnam's telehealth infrastructure, telemedicine will become an indispensable weapon to combat COVID-19 and an important modality of medical care during and after the pandemic. 

Graphical abstract

Comparison of indocyanine green clearance test and Child-Pugh score in evaluation of pre-hepatectomy liver function

Original Research

Abstract

Introduction: Indocyanine green (ICG) clearance (through ICG retention rate at 15 minutes - ICG-R15) is proven to correlate with histological fibrosis stage. Child-Pugh score, although proven to have weaker correlation, is still one of pre-hepatectomy liver function assessments. This study is to compare ICG-R15 and Child-Pugh score in evaluation of histological fibrosis stage and predicting of post-hepatectomy liver failure (PHLF) and to create the model of staging estimation for fibrosis.

Methods: A prospective cohort study was conducted in 340 patients of hepatectomy. ICG-R15, Child-Pugh score and platelet count (PLT) were analyzed to examine their association with histological fibrosis stage and PHLF. Ordinal logistic regression was used to establish the model of staging estimation for fibrosis.

Results: Child-Pugh score showed no significant association with histological fibrosis stage (p = 0.257) while ICG-R15 had a weak correlation (r = 0.232, p < 0.001), INR had a weak correlation (r = 0.156, p = 0.004), PLT had a negative correlation (r = -0.378, p < 0.001). The histological fibrosis stage could be estimated based on gender, age, ICG-R15 and PLT with AUC of 0.68. ICG-R15 was shown to be related to PHLF (p = 0.039) in which non-PHLF group had 0.75 times lower ICG-R15 than PHLF group while Child-Pugh score was shown to be statistically insignificant.

Conclusion: ICG clearance test was better than Child-Pugh score in evaluation of pre-hepatectomy liver function and predicting of PHLF. It was possible to estimate the histological fibrosis stage based on gender, age, ICG-R15 and PLT. 

Graphical abstract

Complete genome sequences and phylogenetic analysis of dengue virus in Southern Vietnam during 2014-2015

Original Research

Abstract

Objective: Dengue is an infectious disease that causes a worldwide health and economic burden despite the efforts to eradicate the disease. From 2013 to 2015, dengue epidemic significantly increased from 33,626 to 50,205 cases in Vietnam. This study aims to determine the genotype variations of dengue virus (DENV) circulating in Southern Vietnam during 2014-2015.

Methods: C6/36 cells were infected with twenty-four strains of dengue virus isolated in 2014-2015 and kept frozen. The complete nucleotide sequence of dengue virus genomes was obtained by polymerase chain reaction (PCR). The genome was sequenced in the MiSeq system and analyzed by the basic local alignment search tool (BLAST) program. Data from GeneBank was used to create the phylogenetic trees.

Results: Among the 17 analyzed strains from 8 southern provinces, four (23.53%) were DENV-1, three (17.65%) were DENV-2, five (29.41%) were DENV-3, and five (29.41%) DENV-4 were isolated. Four DENV-1 isolates belong to Asia genotype. Three DENV-2 strains were concentrated in a subgroup of Asian 1 genotype. Five DENV-3 isolates were identified as belonged to Asian 2 genotype and five DENV-4 isolates were found as belong to Asia 1 genotype. There were no amino acid mutations and the transition capacity between the nucleotide among four types of DENV serotypes suggested that the probability of conversion from C to T was the highest conversion rate.

Conclusions: These DENV isolates were genetically close to other previous strains isolated from Vietnam and its neighboring countries, including Thailand, China, Cambodia, and Singapore, Brazil, Sri Lanka due to dynamic transmission. 

Graphical abstract

Antibiotic usage among the elderly in Tan Loi commune, Dong Hy district, Thai Nguyen province, Vietnam

Original Research

Abstract

Introduction: Antibiotic resistance has been determined as a global threat. Inappropriate use of antibiotics is a crucial driver of the evolution of resistance.

Methods: A cross-sectional study was conducted aiming to describe the antibiotic usage among the elderly (60 years old and above) in Tan Loi commune, Dong Hy district, Thai Nguyen province, Vietnam in 2020. The questionnaire survey was submitted to 370 participants.

Results: More than half of the participants were female. The proportion of the elderly who bought antibiotics using a prescription was 39.2%. The participants normally bought the medicines the same as the previous (53.0%), medicine seller’s advice (44.9%), and relatives/friends’ advice (15.4%). More than half of the participants bought antibiotics themselves (57.8%). Local private pharmacies and health centers/hospitals were common locations for buying antibiotics, 63.8%, and 34.1% respectively. The percentage of the participants who stopped taking antibiotics when the symptoms are gone was 54.1%. More than 50.0% of the participants would change to more expensive antibiotics in case of symptoms are not released after using antibiotics. Some factors significantly associated with prescription usage were education levels, ethnic, obtained information related to antibiotic uses, others helping to buy the antibiotics.

Conclusions: The proportion of the elderly using antibiotics with a prescription was low. Majority of the participants bought antibiotics from the local private pharmacies. The main source of information to buy antibiotics was as the last time and medicine sellers. Some factors significantly associated with prescription use were education level, ethnicity, obtained information related to antibiotic uses, individuals who buy the medicines. Interventions are needed to improve knowledge and practice in buying antibiotics not only for the elderly but also for health service providers, private pharmacies in particular. 

Graphical abstract

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