Pyoderma gangrenosum is a rare inflammatory cutaneous condition characterized by the rapid progression of painful ulcers. Pyoderma gangrenosum is usually associated with a systemic disease. A 34-year-old female with a history of ulcerative colitis presented with hematochezia and multiple leg ulcers after stopping her medication for 3 months. A diagnosis of pyoderma gangrenosum with acute severe ulcerative colitis (ASUC) was made based on the clinical characteristics of the ulcers and their histopathologic features. The patient did not respond to intravenous corticosteroid. Therefore, oral cyclosporine was prescribed. Her bowel movements returned to normal after a week. Her ulcers healed after 2 months, leaving cribriform scars. Pyoderma gangrenosum should be considered in the differential diagnosis of skin ulcers, especially in patients with an underlying systemic disease such as inflammatory bowel disease. Oral cyclosporine may be considered for the management of patients with steroid-refractory pyoderma gangrenosum and ASUC. 

Transcatheter aortic valve replacement (TAVR) through the carotid artery in middle-aged patients with severe aortic stenosis and chronic hemodialysis has been a challenge in clinical practice because of the complex technique. A 60-year-old man was admitted to our hospital because of his symptomatic severe aortic stenosis. With the high risk of open surgery due to chronic hemodialysis, TAVR was selected after an in-depth discussion between the heart team and the patient. The transfemoral access route was not appropriate due to severe calcifications and tortuous iliofemoral arteries, therefore, the left carotid route was chosen. A 29-mm CoreValve Evolut R system was successfully implanted without any complications. His symptoms significantly improved at 12- month follow-up, without any major cardiovascular adverse events. TAVR via the carotid artery thus demonstrates the feasibility, safety, and effectiveness in such complex conditions. 

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. 

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. 

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. 

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. 

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. 

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. 

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. 

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. 

Background: COVID-19 is a rising health problem that affects not only the infected patients but also the non-COVID-19 group. There is a reduction of non-COVID-19 healthcare services during COVID-19 outbreaks which leads to subsequent increment of mortality. This study aims to investigate the impact of the fourth COVID-19 surge on the cardiology outpatient visits at Nhan dan Gia Dinh hospital.

Method: A retrospective observational study was conducted using extracted data from the healthcare informative system of Nhan dan Gia Dinh hospital. Monthly trends of cardiology outpatient visits between May 1st, 2021 to August 31st, 2021 were compared with those of the previous four months and the same period of the year 2020. The demographic characteristics, diagnoses, and prescription behavior were described.

Results: Non-COVID-19 cardiology outpatient visits showed a stable trend until the beginning of the fourth outbreak, in May 2021 when they dropped drastically by 50%. A reduction of 50% was observed in every diagnosis. There was a substantial decrease in visits from other provinces as well as in the concurrent diagnosis of cancer. No change in the rates of prescribed medications was observed besides the lengthening of the prescription time.

Conclusion: The fourth COVID-19 wave caused a serious impact on cardiology outpatient care which might lead to an adverse prognosis. Though there has been some adaptive modification in prescription, this phenomenon calls for more attention and adequate measurements in the non-COVID-19 population for the later outbreaks. 

Introduction: Obesity is acknowledged to be a significant risk factor for mortality in patients with COVID-19. At primary healthcare center, early stratification of high-risk patients is critical in order to provide effective management. There is limited research available in Vietnam concerning the relationship between obesity as defined by Asian- standards and pulmonary damage. Our goal was to find the correlation between the obesity status index by Asian-standardized BMI and the severity of lung injury on chest radiographs patients with COVID-19 in the Vietnamese field hospital.

Methods: A total of 279 confirmed COVID-19 patients (118 males and 161 females) patients were recruited in our study. Two internal medicine physicians independently evaluated chest X-rays using the Brixia score system to assess the severity of lung disease, then agreed. The probability of Brixia scores per chest X-ray film was modeled using Poisson regression with gender and Asian-standardized BMI as predictors.

Results: The study revealed that the median age of our study was 59 years, and the mean BMI was 24.6 ± 3.4 kg/m2. The Pearson correlation between the Brixia score and the BMI was 0.25 with a p-value < 0.05. Both men and women showed that the obese group had the highest Brixia scores. There was a statistically significant difference between Brixia scores of male patients between the normal and obese groups (p-value =0.0446). Poisson regression showed that as the BMI increased, the probability of a higher Brixia score also increased.

Conclusions: According to the findings, the higher the BMI value of a patient, the higher the Brixia score for chest X-rays. This result was recorded in both genders, but more significantly in men. 

Introduction: Streptococcus pneumoniae is the most common cause of community-acquired pneumonia (CAP) in children. Recently, the rapid emergence of antibiotic-resistant pneumococci has posed enormous challenges for CAP treatment and public health. This study aims to provide clinicians with updated data about the antimicrobial susceptibility of S. pneumoniae and improve the treatment guidelines in CAP in children.

Methods: This cross-sectional and in-vitro study was conducted at three hospitals in Quang Nam province and Da Nang city in Vietnam. Pneumococcal strains were isolated from nasopharyngeal aspirate samples of 360 CAP in-patients under five years of age. The susceptibility of clinically used antibiotics was investigated using the disk diffusion test and the E-test for identifying the MIC. Multi-drug resistant (MDR) S. pneumoniae isolates were also determined.

Results: 21.9% of CAP children patients were pneumococcal carriage. The susceptibility testing demonstrated that all 56 tested pneumococcal isolates were resistant to erythromycin and azithromycin, whereas none of the isolates developed the resistance to levofloxacin, vancomycin, and linezolid. The clindamycin- and cotrimoxazole-resistant pneumococci rates were 96.4% and 87.5%, respectively. For β-lactam antibiotics, the resistance proportions of pneumococcal isolates to penicillin G, co-amoxiclav, amoxicillin, cefotaxime, and ceftriaxone were 3.6%,1.8%, 1.8%, 1.8%, and 3.6%, respectively. 83.9% of the tested isolates were MDR S. pneumoniae.

Conclusion: Our data support using penicillin G, amoxicillin, co-amoxiclav, or cefotaxime as the first-line therapy for uncomplicated-pneumococci-induced CAP in Quang Nam – Da Nang, while vancomycin, linezolid, and levofloxacin should be used as alternatives or in MDR cases. 

Introduction: COPD affects the quality of a patient’s life and leads to death. Identifying TCM symptoms and clinical patterns proportions in the community will make diagnosis and treatment more effective. In Vietnam, there were no epidemiological documents about COPD in TCM. Therefore, this study wished to survey stable COPD patients to find out the proportions of symptoms and patterns in TCM to create a basis for further practice.

Methods: The survey was conducted as a descriptive cross-sectional study. Participants were stable COPD outpatients at the Clinic and respiratory function test of the University Medical Center HCMC from September to December 2018. According to the survey form based on the TCM diagnostic criteria, the proportions of symptoms and patterns were recorded.

Results: After three months, 116 patients were recruited. The proportions of 30 TCM symptoms and signs were recorded. The proportions of patients were as follows: 80.17% met Lung qi deficiency, 76.72% for Lung-kidney qi deficiency, 53.45% for Lung-kidney qi and yin deficiency, 47.41% for Lung-spleen qi deficiency, and 2.59% for not meeting any of the diagnostic criteria. Patterns were overlapping in the same patients.

Conclusions: All TCM symptoms and patterns in the diagnostic criteria appeared in COPD patients. The deficiency of the Lung and Kidney was the most common. Most patients were classified into many different patterns with multi organs damage. More multicenter studies with bigger participants numbers are suggested. 

Introduction: The increasing number of older people around the world has increased the demand for elderly care nursing services. Understanding nursing perceptions can identify willingness to work with older people.

Objective: This study aims to determine predictors for nursing students’ perception of working with older people.

Methods: A cross-sectional study was performed on 292 nursing students at the University of Medicine and Pharmacy. Stratified random sampling with an online self-reporting questionnaire was used to collect data from first- to fourth-year nursing students. Data analysis was performed using SPSS 20. Independent t-test, ANOVA and Pearson’s correlation were utilised to determine the correlation of demographic variables, knowledge and attitude with perception. Moreover, multiple linear regression was applied to determine predictors for the perception of working with older people.

Results: The mean score of perception of working with older people amongst undergraduate nursing students was 51.79±6.31. Factors related to perception include gender (p=0.004), geriatric nursing choice (p=0.007), knowledge about ageing (p=0.001) and attitude towards older people (p<0.001). Multiple linear regression analysis showed that gender (β=−0.149, p=0.005), geriatric nursing choice (β=0.154, p=0.003), knowledge about ageing (β=0.122, p=0.021) and attitude towards older people (β=0.367, p<0.001) are predictors for the perception of working with older people.

Conclusion: An in-depth understanding of ageing and attitude towards older people in the geriatric curriculum plays a vital role in promoting nursing students’ perception of working with older people. 

Introduction: The COVID-19 pandemic has spread around the world that severely affects people's life and the health system of countries. Enhancing the population’s awareness and prevention behaviors are crucial. This study aims to assess the knowledge, attitudes, and behaviors regarding COVID-19 prevention of outpatients and visitors at the University Medical Center in Ho Chi Minh City (UMC).

Methods: A cross-sectional study was conducted on 765 participants who were conveniently selected when they arrived at UMC between March 2021 and April 2021. A questionnaire was developed based on guidelines of Viet Nam Ministry of Health (Viet Nam MOH), World Health Organization (WHO), and other prior studies to evaluate the general knowledge regarding COVID-19 disease, disease prevention, attitude, and behaviors on prevention methods.

Results: The results showed low proportions of participants who had good knowledge of COVID-19 disease (29.15%) and prevention measures (38.17%) that were in contrast with a high percentage of positive attitudes (89.08%). There were 22.09% of participants were identified as good preventive behaviors based on seven surveyed measures. An association between prevention knowledge and prevention behaviors was observed when participants with good knowledge showed 2.15 times-higher odds of good behaviors (95%CI: 1.52, 3.04, p-value<0.001) compared to those with insufficient knowledge. Gender, occupation, accommodation, living with family or friends, comorbidities, and history of COVID-19 -related isolation were associated with good behaviors (adjusted p-value <0.05).

Conclusions: The percentage of knowledge and the compliance rate for COVID-19 prevention measures is low, and there is a positive association between prevention knowledge and good behaviors. Therefore, communication programs to improve the community's knowledge and to increase good practice rates are necessary and urgent. 

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. 

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. 

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. 

Introduction: Ramipril, which is an angiotensin-converting enzyme (ACE) inhibitor, is prescribed to treat heart failure, diabetic kidney diseases and high blood pressure. The United States Pharmacopeia 43 (USP 43) and British Pharmacopoeia 2020 (BP 2020) require testing ramipril methyl ester (impurity A) in ramipril pharmaceutical substances as well as corresponding finished products. This study was conducted with the aim of synthesis and standardization of impurity A as related substance and using established reference impurity A in impurity test of ramipril pharmaceutical products.

Method: Impurity A was synthesized from ramipril by transesterification reaction with methanol and potassium hydroxide. The synthesized product chemical structure was elucidated from its spectroscopic data. High performance liquid chromatography (HPLC) method was utilized to determine its purity and establish it as reference standard. Finally, the assay of impurities in ramipril pharmaceuticals was determined by HPLC method, using the established impurity A standard.

Results: Ramipril methyl ester was successfully synthesized and purified with 39.2% yields (about 1.08 g). Impurity A purity determined was over 98% and conformed to establish reference standard. The assigned purity value of impurity A is 99.01%. Additionally, the assay of impurities in available ramipril pharmaceuticals by application of a HPLC method referred from USP 43 was conducted.

Conclusion: Impurity A was successfully synthesized and standardized as reference standard for impurities test of ramipril. 

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. 

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. 

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. 

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. 

Previous studies have reported in vitro antioxidant and inhibitory activity on xanthine oxidase of Jasminum subtriplinerve Blume, Oleaceae, which suggested the potential prevention of gout and supplementary treatment. This study evaluated analgesic, anti-inflammatory, and hypouricemic effects of the 50% ethanolic extract of J. subtriplinerve (EEJS) at the oral doses of 800 and 1200 mg/kg in mice. For acute oral toxicity, after oral administration of single doses of EEJS; mortality and toxic signs in male and female mice were noticed within 72 hours and 14 days. The analgesic effect was observed in acid acetic induced writhing in mouse model within 40 minutes. The anti-inflammatory effect was determined in mice-induced edema by 1% carrageenan. The hypouricemic effect was evaluated in mice with the peritoneal injection of potassium oxonate inducing acute and chronic hyperuricemia. The results showed that there was not any toxic sign in mice given orally at the maximum dose (Dmax) of 20 g EEJS/kg. At the dose of 800 and 1200 mg/kg, EEJS did exhibit analgesic effect until 40th minute. EEJS 1200 mg/kg expressed acute anti-inflammatory effect. EEJS had no acute hypouricemic effect at the oral doses of 800 and 1200 mg/kg. When given to mice with chronic hyperuricemia, 800 mg/kg EEJS reduced 30-44% blood uric acid concentration compared to pathological group. In conclusion, EEJS did not cause any toxic sign in mice at the Dmax of 20 g/kg. This extract had analgesic and chronic hypouricemic effects at the oral dose of 800 mg/kg in mice. 

Background: The COVID-19 epidemic has spanned four waves in Vietnam, the most recent and also the most deadly of which began in April 2021.

Methods: We reported on a group of University Medical Center Ho Chi Minh City patients who were diagnosed with SARS-CoV-2 infection and were suitable for mini-pulse corticosteroid therapy with 125 mg of methylprednisolone twice daily for at least three days. Demographics, clinical, laboratory, and outcome data were gathered by electronic medical report. We also compared laboratory data before and after the start of mini-pulse corticosteroid therapy, as well as between the discharged and deceased groups.

Results: We gathered data on 25 patients. The average age was 61.5 ± 11.9 years, and 52% of them were male. Dyspnea was the most prevalent chief complaint. Almost all of them had at least one co-morbidity, with hypertension being the most common; all of them were put on oxygen supplementation, and 44% were started on mini-pulse corticosteroid while using a high-flow nasal cannula. Eighty-four (21%) reacted well and were discharged, whereas sixteen (4%) worsened and died. The deceased group was older than the discharged group (69.8 ± 3.1 vs. 59.9 ± 12.4, p =.005).

Conclusion: Our findings suggest that methylprednisolone at a mini-pulse dosage might be an effective and safe treatment option for COVID-19 inpatients in the inflammatory stage. 

The flowers of Hylocereus undatus (Haw.) Britton & Rose have been reported in vitro antioxidant and tyrosinase inhibitory activities. This study screened preliminarily the triterpenoid constituents and evaluated in vitro tyrosinase inhibitory activity of H. undatus flowers. H. undatus flowers were harvested from Binh Thuan Province, Vietnam at four different flowering stages, and their five separated parts (stamen, pistil, petals, ovary, and sepals) were extracted with ethanol. Triterpenoids were identified in the extracts by thin-layer chromatography and Liebermann - Burchard reaction. Tyrosinase inhibitory activity was evaluated using the dopachrome method with L-tyrosine substrate and kojic acid as the positive control. Results showed that at the different flowering periods, there was the formation of different parts of the flowers. The triterpenoid compounds are the main constituents in the H. undatus flower extracts. The 70% ethanol extract from H. undatus flower at the stage of 2 - 3 days before blooming exhibited the strongest tyrosinase inhibitory activity with IC50 value of 266.4 μg/mL compared to that of 7.60 μg/mL of kojic acid. In the case of separation of flower parts, 70% ethanol extracts of each part inhibited weakly the tyrosinase enzyme. In conclusion, the present study provided information about the morphological characteristics of H. undatus flower collected from Binh Thuan Province, Vietnam. Triterpenoid was found as the main constituents of the ethanolic extracts of H. undatus flower. The 70% ethanol extract from whole H. undatus flower at the stage of 2 - 3 days before blooming exhibited strong tyrosinase inhibitory activity. 

Introduction: Gastroesophageal reflux disease (GERD) is one of comorbid diseases, that worsen the course and outcomes of respiratory pathology. The study aimed to determine role of esophageal symptoms in the diagnosis of GERD in children with recurrent and chronic respiratory diseases (RCRD).

Methods: The study included 125 children (70 boys, 55 girls), median 3,75 years (interquartile range, IQR – 1,21-9,38 years), with RCRD, refractory to standard therapy. GERD was diagnosed on the basis of clinical and complex instrumental examination, including fluoroscopy esophagus with contrast, esophagogastroduodenoscopy (EGDS), 24-hour esophageal pH-monitoring, dual pH-multichannel intraluminal impedance (pH-MII).

Results: In children with RCRD, the frequency of GERD was 86,4%. Among children without esophageal manifestations of GERD, pathological reflux was confirmed by instrumental methods in 81% of patients; in children with esophageal manifestations - 92%, with no statistically significant differences (p = 0,0637). Nonacid reflux is more common in patients without esophageal manifestations of GERD.

Conclusions: The frequency of GERD in children with RCRD is very high. It is possible to screen GERD in children with RCRD, independent on the presence of clinical esophageal symptoms. 

Introduction: Several generic products containing simvastatin are circulating on the Vietnamese market at a more inexpensive price than that of a brand-name one. These formulations, however, have not been assessed for in vivo bioequivalence to the reference product. After oral administration, simvastatin (SIM) is extensively converted into an active metabolite, beta-hydroxy simvastatin acid (SIM-A) and a very low concentration of simvastatin can be found in plasma. Therefore, a method for quantification of simvastatin and its metabolite needs to be developed with a high specificity and sensitivity to detect these analytes in human plasma at such low concentrations. Our purpose was to develop a reliable LC-MS/MS (liquid chromatography-tandem mass spectrometry) method for simultaneous determination of simvastatin and metabolite of simvastatin, beta-hydroxy simvastatin acid, in human plasma and to apply this method to evaluate the bioequivalence of a test product in comparison with the reference product.

Methods: Mass spectrometry, internal standard (IS), and chromatographic conditions were investigated to find out the suitable IS and conditions. Human plasma samples were treated by liquid-liquid extraction (LLE). The assay was validated in compliance with US-FDA (United States-Food and Drug Administration), and EMA (European Medicines Agency) guidelines.

Results: LC-MS/MS with electrospray ionization interface in positive (for SIM and lovastatin as IS) and negative (for SIM-A) ionization mode performed under the multiple reaction monitoring mode was used for detection of the analytes. The transition of m/z is 436.00 → 285.15, 435.10 → 319.15, and 404.95 → 199.10 for SIM, SIM-A, and IS, respectively. Tert-buthyl methyl ether was used for extraction of analytes from human plasma by a simple LLE followed by addition of an ammonium acetate buffer. The developed method was fully validated with acceptable selectivity, linearity and linear range, matrix effect, lower limit of quantitation (LLOQ), carryover, dilution integrity, and intra- and inter-day accuracy and precision, free-thaw stability.

Conclusions: The method can be applied for quantification of these compounds in human plasma for in vivo bioavailability and bioequivalence studies. 

Introduction: Body constitution (BC) plays an important role in preserving health and reducing risk of diseases depending on each person’s physical characteristics. Classification of BC is almost based on the Constitution in Chinese Medicine Questionnaire (CCMQ). In Vietnam, there is still no questionnaire survey to assess the BC. Therefore, this study aims to adapte and validate the Vietnamese version of CCMQ.

Methods: 2 phases of the study: the first phase constituted the translation with cross-cultural adaptation of CCQM into Vietnamese according to Guillemin et al; the second phase assessed the reliability and validity of the Vietnamese CCMQ version based on a cross-sectional study.

Results: Phase 1 formed the final Vietnamese CCMQ version in which face validity and content validity are incorporated. Seven traditional medicine practitioners confirmed the content validity (CVI: 57%–100%). The face validity of the scale is qualified. In phase 2, 455 participants aged 18 years old or older were enrolled in this study from 01/2021 – 06/2021 in Ho Chi Minh City. Regarding the criterion validity, the correlation coefficient between Vietnamese CCMQ and SF-36 was 0.67 for the Neutral type and -0.31 to -0.57 for the rest. The internal consistency varied from 0.70 to 0.83 measured by Cronbach’s alpha. The test-retest reliability varied from 0.63 to 0.90 for each of the 9 sub-scales and from 0.40 to 0.68 for each of the 60 questions.

Conclusions: The Vietnamese version of CCMQ has good reliability and validity, which provides a strong basis for future researches on BC of Vietnamese Traditional Medicine. 

Background: In cirrhotic patients, variceal bleeding remains a major cause of death. After a variceal bleeding episode, mortality and rebleeding rates spike for the first 6 weeks before levelling off. We aimed to evaluate the performance of AIMS65 score in comparison with Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) score in predicting 6-week mortality and rebleeding in cirrhotic patients with variceal bleeding.

Method: Data were collected prospectively from patients with cirrhosis and variceal bleeding at Gastroenterology and Hepatology Department of Cho Ray hospital from September 2016 to April 2017. The primary endpoint was 6-week mortality and rebleeding. The prognostic value of AIMS65, CTP, and MELD scoring systems for 6-week mortality and rebleeding was compared by receiver operating characteristics curves (ROC) and the area under the curve (AUC).

Results: Among 80 patients, 15% rebled and 25% died during 6-week follow-up. AUCROC of AIMS65, CTP, and MELD scores in predicting 6-week rebleeding were 0.68, 0.54, and 0.48, respectively. AUCROC of AIMS65, CTP, and MELD scores in predicting 6-week mortality were 0.80, 0.74, and 0.64, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of AIMS65 score at the cutoff point of 2 were 95%, 55%, 41.3%, and 97%, respectively.

Conclusion: AIMS65 score is a simple yet applicable tool for risk stratification in cirrhotic patients with variceal bleeding. We recommend using AIMS65 score with a cut-off point of 2 to identify patients at increased risk for 6-week mortality after variceal bleeding.

Methotrexate (MTX) is a chemotherapy and immunosuppressive agent widely used to treat cancer, autoimmune diseases in children and adult patients, and ectopic pregnancy. However, MTX is highly toxic to the liver, kidney, and nervous system. This study aimed to quantify the concentration of MTX in human plasma using high-performance liquid chromatography (HPLC). MTX and its internal standard (para aminoacetophenone-PAPA) in plasma samples were extracted simultaneously with methanol. Sample purity was performed using the 1 cc OASIS HLB cartridges. Sample injection volume of 10 µL was analyzed on a Lichrocart Supersil 125-4 column C18 maintained at 40 °C on a Waters 2695 XE equipped with a PDA detector set at 303 nm. The mobile phase contained phosphate buffer (pH 6.0) and methanol at a ratio of 80:20 (v/v) and was maintained at a flow rate of 1 ml/min. The results showed that the total time of chromatographic analysis was 15 min. MTX and PAAP were found in the chromatograms at retention times of 2.3 and 5.2 min, respectively. The linear range of the MTX from 0.5 to 25 µg/mL. Intra-day and inter-day imprecision for MTX ranged from 3.42 to 8.128%. LLOQ of MTX was 0.5 µg/mL and the extraction effects were above 77%. In conclusion, we developed and validated a simple HPLC method to determine the MTX concentrations in human plasma.
 

Introduction: In the last few decades, pyrazoline-based substances have emerged as potential antimicrobial and anticancer candidates. In concern with antimicrobial activity, this study aims to build a docking model to predict the structure of potential 2-pyrazoline derivatives. The cytotoxicity of some compounds was also evaluated to get insight into the structure–anticancer activity relationship of the 2-pyrazoline derivatives.

Methods: Docking models were built on virtual FabH enzymes using FlexX platform with 2-pyrazoline derivatives served as test sets. Afterward, derivatives with high docking scores were chemically synthesized and evaluated for antibacterial activity using the agar dilution method. Furthermore, MTT assay was used to assess the cytotoxicity of these compounds.

Results: The docking score and the in vitro minimum inhibitory concentration (MIC) value on Staphylococcus aureus (S. aureus) bacteria strongly correlate with an R-square value of 0.6751 (p < 0.0001). Four 2 pyrazoline derivatives were synthesized and evaluated for antimicrobial activity. Their MIC values on S. aureus range between 4 and 16 μg/mL, consistent with ones predicted by the docking model. Apropos cytotoxic properties, a series of 2-pyrazolines exhibit a moderate activity on HepG2, RD, and MDA-MB-231. The most active compound, HP10, has the IC50 values on these cell lines. which are 26.62 μM, 17.74 μM, 14.47 μM, respectively.

Conclusion: Our research built a docking model on the virtual S. aureus FabH enzyme with high potential in predicting antibacterial activities of different 2-pyrazoline derivatives. Moreover, our cytotoxicity results provided data for further studies on the anticancer activity of these promising derivatives.
 

Introduction: Tumor and pseudotumor (TP) at the proximal femur (PF) can seriously affect mortality, extremity function, and body integrity. However, reports often focused on a specific tumor, not regional lesions. This study focuses on clinical findings, imaging, micro-pathology, and the treatment of all TP at the site.

Methods: The study involved all patients who had a confirmed tumor or pseudotumor diagnosis at the PF. The clinical findings, X-ray, and biopsy were recorded and analyzed. Treatment was optional depending on the patient's situation and available condition of the hospital. The functional outcome, bone healing were defined at the last examination or two years of follow-up.

Results: Fifty patients were involved in the study. Twenty-four patients had apparent tumors. TP at the PF, neck-trochanter, trochanters, and neck were 21 (42%), 16 (32%), 9 (18%), and 4 (8%) cases, respectively. There were 29 (58%) pathologic fractures. Biopsy was made for all patients. Twenty-three cases (46%) were malignant, and 8 (16%) cases were giant cell tumors. Thirtythree patients suffered from an operation. Ennerking's functional score was excellent, good, fair, and poor in 24 (48%), 5 (10%), 1 (2%), and 20 (40%) patients, respectively. For the last outcomes of 33 operated patients, 17 healed, three unchanged, one worse, and two dead.

Conclusions: For the PF TP, the rate of malignant and pathological fracture was high. The giant cell tumor was not rare. The resection of the TP combined with grafts using ordinary fixation devices was satisfactory.

Introduction: Well-timed contraception after delivery using effective methods protects women from unintended pregnancies and improves the quality of life of both women and their children. However, little attention has been paid on the issue in Vietnam. Therefore, this study aimed to determine the percentage of postpartum women from 0 to 6 months using contraceptive methods and associated factors in Trang Bom District, Dong Nai Province, Vietnam.

Methods: A cross-sectional study was adopted. A systematic random sampling method was used to select 355 postpartum women. Women were interviewed about sociodemographic characteristics, reproductive history, and contraceptive use after giving birth.

Results: Of the 355 women, 63.1% used at least one modern or traditional contraceptive method; 58.9% current use, 4.2% previous use, and 36.9% never use. The most selected methods were withdrawal (41.1%), male condom (28.2%), and calendar method (24.4%). Multivariable analysis showed that women who had their menstruation returned, long postpartum duration, high education level, many years of marriage, and previous caesarean section were more likely to use contraception after birth.

Conclusion: The family planning program in Vietnam should focus more on postpartum women. Postpartum contraception should be consulted at all obstetric health centers before and right after delivery. Emphasis should be placed on the initial times to adopt contraception soon and not waiting until the first menses. Women should be encouraged to use modern contraceptive methods instead of traditional ones.
 

Introduction: The pattern of drug use in Vietnam has changed rapidly over the past decade, and a large number of people who have a history of heroin injection reportedly use methamphetamine. This paper describes factors associated with methamphetamine use among people who inject heroin in Hanoi, the capital of Vietnam.

Methods: This is a cross-sectional survey among 521 heroin injectors who were recruited through chain referral and outreach at community and clinic settings. Eligibility criteria included: (1) male aged 18 or older; (2) reported heroin injecting during the 12 months before the survey; (3) agreed for a urine test to detect methamphetamine and opiate metabolites. The primary outcome, methamphetamine use, was defined as selfreported methamphetamine use during the 30 days before the survey and/or having a urine test positive for methamphetamine. Structural Equation Model was used to evaluate associated factors for methamphetamine use.

Results: One third of participants qualified as methamphetamine users as defined in this study. A longer history of heroin use (β=0.126, p<0.001), using MDMA and/or cannabis (β=0.28, p<0.001) and not using condom during sex (β=0.139, p<0.001) were positively associated with methamphetamine use. Family functioning (β=-0.141; p<0.001) was protective. The goodness-of-fit of Structural Equation Model was excellent (CFI=0.934; TLI=0.912; RMSEA=0.033; WRMR=0.98).

Conclusions: Methamphetamine use among people who inject heroin is a substantial issue in Hanoi. Family functioning has made a critical contribution on reducing methamphetamine use. Future studies should pay attention to address the role of factors at the family level in addition to individual-level factors towards the pattern of drug use.

Spontaneous hemopneumothorax is a rare condition and may be a life-threatening condition that needs prompt diagnosis and urgent intervention. In this study, we reported three male cases of spontaneous hemopneumothorax, two cases presented with chest pain and one with epigastric pain. All cases were successfully treated by early surgical intervention. Total blood drainage was ranged from 1400 to 2000 mL. Video-assisted thoracoscopic surgery was performed successfully in two cases, however, one case was transferred to urgent thoracotomy due to excessive blood clotting in the pleura cavity and continuous bleeding. Leukocytosis was observed in two cases, mostly due to pneumonia or sepsis. The bleeding point was identified in all cases, however, the air leak area could not be identified in two cases. Length of hospital stay after admission was ranged from five to seven days. We recommend that video-assisted thoracoscopic surgery should be considered as a first choice due to its effectiveness in reducing postoperative complications and facilitating rapid recovery.

Background: Many clinical and paraclinical studies related to coronary artery disease have been done in Vietnam in recent years. However, there have been no studies on nurses’ knowledge and practice regarding patient care after coronary angiography (CAG) or percutaneous coronary intervention (PCI). This study was conducted to assess nurses' knowledge and practice on patient’s safety after CAG or PCI and its associated factors.

Methods: A descriptive cross-sectional study was conducted from December 2019 to June 2020 at the Department of Internal Cardiology, Interventional Cardiology, Intravascular Intervention, and Intensive care unit/Coronary care unit in three general and specialist hospitals in Ho Chi Minh city, Vietnam. 167 nurses who have taken care of patients after CAG or PCI were included in the study through using convenient sampling technique. A translated self-administered questionnaire was utilised. This self-reported survey achieved 100% response rate. Statistical analysis was performed by the Chi-square test (X2). Statistical significance level was at p<0.05 to determine factors related to nurses’ knowledge and practice. Prevalence ratio (PR) with 95% confidence interval (95% CI) were also used to measure the association.

Results: The study findings revealed that only 36% of the study sample had a good knowledge while 78% of them had a good practice on patient’s safety after CAG or PCI. There were association between educational level, working place with the knowledge (PR=1.87-1.92, p<0.01) and practice (PR=1.18-1.35, p<0.05) on patient’s safety after CAG or PCI among Vietnamese nurses. Besides those factors, the number of years working in cardiac specialty were also found to have an association with the practice. A moderately positive correlation between the knowledge and the practice towards patient‘s safety after CAG or PCI has been identified in this study (PR=1.27, 95% CI [1.09 – 1.47], p=0.005).

Conclusions: More than a half of the study sample had poor knowledge but performed good practice in some items of care for patients after CAG or PCI. There was positive association between the knowledge and practice about patient’s safety after CAG or PCI among Vietnamese registered nurses. Educational training programs for staffs working in coronary angiography or percutaneous coronary intervention is recommended to develop.