Screening for Hypertension in Adults of a Northern Delta Province in Vietnam.

BACKGROUND: The proportion of people with hypertension is increasing, and those affected are relatively younger. Worldwide, it is estimated that people with high blood pressure are more than 1.5 billion people. In Vietnam, from 2002 to 2008, according to a national survey on hypertension and its risk factors within the prevention and control of cardiovascular disease program, the prevalence of hypertension was 25.1%. This is alarming because high blood pressure can cause serious complications, including death. OBJECTIVE: The study aimed to explore the blood pressure characteristics and hypertension prevalence in adults in a northern delta province of Vietnam, and describe some risk factors in hypertensive subjects screened through the program. METHODS: This was a cross-sectional study collecting data from people aged 18 years or older in 10 cantons and the city of Nam Dinh from July 15th to July 31st, 2020. Using semi-automatic OMRON sphygmomanometers, sitting blood pressure was measured three times according to standardized methods specified by the Ministry of Health and two National Vascular Societies. RESULTS: Blood pressure screening of 183,632 adults included 84,438 males, which accounted for 45.98%, with an average age of 60.36 ± 13.18 years. The estimated prevalence of hypertension was 27.20% (95% CI: 27.00% - 27.41%). The older the age, the higher the rate of hypertension in both sexes; the prevalence of hypertension over 65 years was 45.36%. Hypertension grade 1 accounted for 17.14%, followed by hypertension at grade 2 at 6.69%, and grade 3 at 1.15%; notably, the percentage of prehypertension accounted for 49.64%. The percentage of treated hypertension in Nam Dinh province was 56.85%, but the percentage of uncontrolled hypertension was 85.63%. CONCLUSION: The prevalence of hypertension in Nam Dinh province was relatively high (27.20%), although the number of treated patients was also high (56.85%); moreover, the proportion of uncontrolled hypertension remained extremely high (85.63%). Local campaigns and suitable interventions are required to detect hypertension in the early stages and increase awareness for treatment in the population.

Implementation of point-of-care testing of C-reactive protein concentrations to improve antibiotic targeting in respiratory illness in Vietnamese primary care: a pragmatic cluster-randomised controlled trial.

BACKGROUND: In previous trials, point-of-care testing of C-reactive protein (CRP) concentrations safely reduced antibiotic use in non-severe acute respiratory infections in primary care. However, these trials were done in a research-oriented context with close support from research staff, which could have influenced prescribing practices. To better inform the potential for scaling up point-of-care testing of CRP in respiratory infections, we aimed to do a pragmatic trial of the intervention in a routine care setting. METHODS: We did a pragmatic, cluster-randomised controlled trial at 48 commune health centres in Viet Nam between June 1, 2020, and May 12, 2021. Eligible centres served populations of more than 3000 people, handled 10-40 respiratory infections per week, had licensed prescribers on site, and maintained electronic patient databases. Centres were randomly allocated (1:1) to provide point-of-care CRP testing plus routine care or routine care only. Randomisation was stratified by district and by baseline prescription level (ie, the proportion of patients with suspected acute respiratory infections to whom antibiotics were prescribed in 2019). Eligible patients were aged 1-65 years and visiting the commune health centre for a suspected acute respiratory infection with at least one focal sign or symptom and symptoms lasting less than 7 days. The primary endpoint was the proportion of patients prescribed an antibiotic at first attendance in the intention-to-treat population. The per-protocol analysis included only people who underwent CRP testing. Secondary safety outcomes included time to resolution of symptoms and frequency of hospitalisation. This trial is registered with ClinicalTrials.gov, NCT03855215. FINDINGS: 48 commune health centres were enrolled and randomly assigned, 24 to the intervention group (n=18 621 patients) and 24 to the control group (n=21 235). 17 345 (93·1%) patients in the intervention group were prescribed antibiotics, compared with 20 860 (98·2%) in the control group (adjusted relative risk 0·83 [95% CI 0·66-0·93]). Only 2606 (14%) of 18 621 patients in the intervention group underwent CRP testing and were included in the per-protocol analysis. When analyses were restricted to this population, larger reductions in prescribing were noted in the intervention group compared with the control group (adjusted relative risk 0·64 [95% CI 0·60-0·70]). Time to resolution of symptoms (hazard ratio 0·70 [95% CI 0·39-1·27]) and frequency of hospitalisation (nine in the intervention group vs 17 in the control group; adjusted relative risk 0·52 [95% CI 0·23-1·17]) did not differ between groups. INTERPRETATION: Use of point-of-care CRP testing efficaciously reduced prescription of antibiotics in patients with non-severe acute respiratory infections in primary health care in Viet Nam without compromising patient recovery. The low uptake of CRP testing suggests that barriers to implementation and compliance need to be addressed before scale-up of the intervention. FUNDING: Australian Government, UK Government, and the Foundation for Innovative New Diagnostics.

[Regulation of immunoglobulin production: role of the cellular receptors for the Fc portion of these molecules]. / Régulation de la production d'immunoglobulines: rôle des récepteurs cellulaires de la partie Fc de ces molécules.

The aim of this paper was to review the action of the receptors for the Fc portion of Ig on the polyclonal activation of human B lymphocytes. The IgG Fc fragments were shown to be digested by monocytes into peptides which triggered B-cell differentiation and the release of a T-cell replacing factor termed (Fc)TRF. In the presence of PWM and monocytes, unbound aggregated IgG suppressed B-cell differentiation into Ig-synthesizing cells. This suppression was not isotype-specific. After having bound aggregated IgG, T cells were able to display an isotype-restricted suppression of B-cell differentiation induced by PWM. Finally, soluble Fc gamma R released from T or B lymphocytes or neutrophils were found to inhibit both the synthesis of IgG and the maturation of B cells into IgM or Ig A-secreting cells.