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BACKGROUND AND PURPOSE: Hemodynamic factors significantly influence the onset, progression, and rupture of intracranial aneurysms (IAs). Current rupture risk prediction scores focus primarily on the clinical, anatomical and morphological aspects. This study aimed to investigate the hemodynamic characteristics differences between ruptured and unruptured IAs. MATERIALS AND METHODS: Conducted from July 2021 to July 2022, this prospective cohort study involved patients with ruptured and unruptured IAs undergoing digital subtraction angiography (DSA). Hemodynamic characteristics were assessed using the AneurysmFlow™ tool. Hemodynamic, clinical, anatomical and morphological parameters were compared between ruptured and unruptured IA groups. RESULTS: The study included 127 patients with 135 aneurysms (67 ruptured, 68 unruptured). Complex flow patterns (type 3 and 4) were observed more frequently in ruptured aneurysms compared to unruptured aneurysms (odds ratio [OR], 5.57; 95% confidence interval [CI], 2.49-12.45; P < 0.001) in univariate analysis, and were also more common in unruptured aneurysms associated with daughter sacs features (P = 0.015). The mean aneurysm flow amplitude (MAFA) was lower in ruptured aneurysms, and associated with lower flow velocity in the parent artery related to vasospasm. MAFA in the aneurysmal dome or any additional daughter sacs was lowest compared to other regions inside the aneurysms. The technical failure rate of AneurysmFlow™ measurements was 8.5% (12 out of 139 patients). Additionally, hypertension (OR, 0.42; 95% CI, 0.30-0.54; P < 0.001), bifurcation location (AcomA/ACA/MCA/PcomA/posterior circulation) (OR, 0.17; 95% CI, 0.05-0.29; P = 0.005), and irregular shape (OR, 0.19; 95% CI, 0.05-0.35; P = 0.012) were identified as independently associated with rupture. CONCLUSIONS: Complex flow patterns identified on the AneurysmFlow™ tool are significantly more common in ruptured and unruptured aneurysms associated with daughter sac features. The lowest MAFA in the aneurysmal dome and daughter sacs likely indicates specific pathophysiological changes within the aneurysm wall associated with rupture incidence. Hypertension, bifurcation location, and an irregular shape are independently associated with the risk of rupture. Further multicenter studies with larger sample sizes are needed to validate these findings. ABBREVIATIONS: ACA = anterior cerebral artery; AcomA = anterior communicating artery; IAs = intracranial aneurysms; ICA = internal carotid artery; MAFA = mean aneurysm flow amplitude; MCA = middle cerebral artery; PcomA = posterior communicating artery; RIAs = ruptured intracranial aneurysms; SAH = subarachnoid hemorrhage; UIAs = unruptured intracranial aneurysms.
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Women living with HIV/AIDS (WLHA) encounter numerous challenges, such as stigma and gender disparities, that hinder their access to care, especially in patriarchal societies like Vietnam. We developed a hybrid intervention with online and offline (in-person) components to empower WLHA in Vietnam. The intervention was pilot tested with 91 WLHA in Hanoi. During baseline and 4-month, study investigators delivered two in-person sessions, one Zoom session, and 15 weeks of Zalo (social media platform) discussions to enhance positive coping strategies, treatment utilization and adherence, and engagement of support from family and peers. The participants continued their Zalo discussions from 4-month to 6-month without investigators' involvement. Intervention outcomes, including active coping and perceived barriers to care, were evaluated at baseline, 4-, and 6-month surveys. Mixed-effects regression models showed that the participants' active coping significantly increased from baseline (50.5 ± 9.4) to 4-month (53.8 ± 6.2; p = 0.0001), although there was a slight decrease at 6-month (52.8 ± 7.2), the change from 4-month to 6-month was not significantly significant (p = 0.3256). There was a significant reduction in participants' perceived barriers to care, from 19.8 ± 5.2 at baseline to 17.4 ± 5.2 at 4-month (p < 0.0001), which remained stable at 17.8 ± 4.3 at 6-month (p < 0.0001 compared to baseline). This intervention presents a promising model to empower WLHA in Vietnam and potentially in similar global contexts. Future interventions could benefit from leveraging natural peer leaders and adopting a more person-centered approach to meet WLHA's varying needs.
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BACKGROUND: Delivering methadone treatment in community health facilities by primary care providers is a task-shifting strategy to expand access to drug use treatment, especially in rural mountainous areas. This study aims to investigate factors related to confidence in providing methadone treatment among primary care providers in Vietnam to inform good practice development. METHODS: We conducted a cross-sectional survey with 276 primary care providers who were physicians, physician assistants, nurses, pharmacists or dispensing staff from 67 communes in a mountainous province in Northern Vietnam. Using self-report scales, we measured providers' confidence in providing methadone treatment, beliefs in harm reduction, perceived work-related support, perceived stigma and risk in working with drug-using patients, and empathy towards this population. We used multiple linear regression analyses to explore factors associated with providers' confidence in providing methadone treatment in the whole sample and to compare two groups of providers who did and did not have experience providing methadone. Potential associated factors were measured at facility and provider levels. RESULT: 114 (41.3%) participants had previously experience in providing methadone treatment. Providers with methadone treatment experiences had higher confidence in and more accurate knowledge of methadone treatment, perceived less stigma of working with drug-using patients, and reported more work-related support than those without experiences. Higher medical education is associated with lower confidence in providing methadone treatment among providers without methadone experiences, but higher confidence among providers with methadone experiences. Better methadone knowledge was associated with greater confidence in providing methadone treatment among inexperienced providers but not among those with experiences. Receiving work-related support was associated with greater confidence in providing treatment in both groups, regardless of their past methadone experiences. CONCLUSION: In rural provinces where methadone treatment has been expanded to primary care clinics, interventions to improve primary care providers' confidence should benefit professionals with diverse experiences in providing methadone treatment. Continued training and support at work for providers is essential to ensuring quality in decentralized methadone treatment.
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Atitude do Pessoal de Saúde , Metadona , Tratamento de Substituição de Opiáceos , Atenção Primária à Saúde , Humanos , Metadona/uso terapêutico , Metadona/administração & dosagem , Vietnã , Estudos Transversais , Feminino , Masculino , Tratamento de Substituição de Opiáceos/métodos , Adulto , Pessoa de Meia-Idade , Pessoal de Saúde , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Estigma Social , Redução do Dano , Conhecimentos, Atitudes e Prática em SaúdeRESUMO
BackgroundLiterature has shown the integration of electronic alerts into patient care has the potential to improve clinicians' workflow by saving time, increasing efficiency, and improving patient safety. However, despite these possible benefits of alerts, studies have shown that alerts are often overridden by clinicians. Objective: The purpose of this study was to optimize the acceptance rates of medication point-of-prescribing alerts within the electronic medical record (EMR) of an ambulatory care organization. Methods: The study design evaluated the actions taken by clinicians when they were presented with medication point-of-prescribing alerts. These alerts were created by the clinical pharmacy informatics team to help promote cost-effective and safe prescribing. Alerts determined to be high value alerts were optimized to increase clinicians' likelihood of accepting each alert's recommended alternative. The primary objective was to increase acceptance rates of high value alerts. The exploratory objective was to identify the estimated annualized cost-savings when high value alerts were accepted, and a lower cost alternative prescription resulted. Results: The acceptance rate of the optimized point-of-prescribing alerts increased to 8.7%, compared to a 3.2% acceptance in the pre-modification period (P <.001). The lower cost alternative prescriptions that resulted from the accepted alerts translated into an estimated annualized cost-savings of over 2 million dollars. Conclusion: The use of point-of-prescribing alerts with optimized information and specific cost comparisons in an ambulatory setting led to an increase in the acceptance rates of the alerts and more cost-conscious prescribing.
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Prescrição Eletrônica , Humanos , Interações Medicamentosas , Custos de Cuidados de Saúde , Redução de Custos , Assistência Ambulatorial/métodosRESUMO
This study aimed to evaluate the encapsulation of pomelo (Citrus grandis (L.) Osbeck) essential oils using the spray drying technique. The parameters of the process include concentration of maltodextrin (20-35% by wt%/wt%), concentration of essential oil (1-2.5% by wt%/wt%), inlet temperature of spray drying (120-180 °C), and feed flow rates (120-240 mL/h) were soundly examined. The utilization of suitable parameters as the concentration of maltodextrin at 30% (by wt%/wt%), the concentration of essential oil at 1.5% (by wt%/wt%), the inlet temperature of 140 °C, and feed flow rate of 120 mL/h showed the highest drying yields (90.05%), microencapsulation yield (75.59%), and microencapsulation efficiency (89.44%). TGA and DSC results verified higher stability of Citrus grandis essential oil after encapsulation. The encapsulation of pomelo essential oils maintained most of the major components in comparison with the non-encapsulated essential oils without any significant changing in powder-obtained quality. Supplementary Information: The online version contains supplementary material available at 10.1007/s10068-022-01161-5.
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Background: Recent trials including DIRECT-MT, DEVT, and SKIP have found that direct mechanical thrombectomy (MT) is equally effective as the combination of MT and intravenous thrombolysis. However, the results of the other trials, namely MR-CLEAN NO-IV and the SWIFT-DIRECT trial have failed to confirm the non-inferiority of direct MT vs. the combination therapy. Aim: We aimed to identify prognostic factors of direct MT for anterior circulation large vessel occlusion within 4.5 h. Materials and Methods: Data from January 2018 to January 2022 were retrospectively collected and analyzed. Adult patients with confirmed anterior circulation large vessel occlusion within 4.5 h of onset with baseline NIHSS of ≥6 and baseline ASPECTS of ≥6 treated using direct MT within 6 h were recruited. Results: A total of 140 patients were enrolled in the study with a median age of 65.5 years [interquartile range (IQR), 59-76.5], median baseline NIHSS of 13.5 (IQR, 11-16), and median baseline ASPECTS of 8 (IQR, 7-8). Direct MT was feasible in all patients (100%). Successful reperfusion (mTICI 2b-3) was achieved in 124/140 patients (88.6%) with a low rate of complications (8/140, 5.7%). Any type of intracranial hemorrhage (ICH) and symptomatic ICH occurred in 44/140 (31.4%) and 5/140 (3.6%), respectively. Overall, a good outcome (mRS 0-2) was achieved in 93/140 (66.4%), and the mortality rate was 9.3% (13/140 patients). Using multivariate analysis, lower age [odds ratio (OR), 0.96; 95% CI, 0.92-1.00; P = 0.05], low baseline NIHSS (OR, 0.82; 95% CI, 0.74-0.92; P = 0.00), and absence of ICH (OR, 0.29; 95% CI, 0.10-0.81; P = 0.02) were independently associated with favorable outcome. Independent predictors of mortality were baseline NIHSS (OR, 1.21; 95% CI, 1.01-1.46; P = 0.04), successful reperfusion (OR, 0.02; 95% CI, 0.00-0.58; P = 0.02), and ICH (OR, 0.12; 95% CI, 0.02-0.75; P = 0.02). Further analysis showed that the median mRS at 90 days was significantly better in the MCA occlusion group compared to the ICA plus M1 occlusion group [1 (IQR 0-3) vs. 2 (IQR 1-4); P = 0.05]. Conclusions: Our findings suggest that direct thrombectomy may be an adequate clinical option for younger patients (≤70) experiencing proximal middle artery occlusion within 4.5 h and who have low baseline NIHSS (≤14).
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OBJECTIVES: The present study aims to investigate whether each coping style used by Vietnamese people living with infertility diagnosis is associated with specific types of infertility-related stress (IRS). METHODS: In this cross-sectional design study, 997 patients with primary infertility diagnosis from three hospitals and two clinics in three regions of Vietnam completed questionnaire that consisted of Fertility Problem Inventory, the Copenhagen Multi-Centre Psychosocial Infertility and other questions. Four different linear regression analyses were performed on four coping styles. The five types of IRS and covariates were included in these models. FINDINGS: The results show that participants who experience all five types of IRS reported the dominant use of active-avoidance coping, while having four types of IRS, except for social concern, was associated with higher use of meaning-based coping. Utilising active-confronting coping was reported to be the outcome of experiencing increasing need for parenthood and decreasing rejection of child-free lifestyle. Choice of passive-avoidance coping was more common among those with increasing social concern and need for parenthood. Age and educational level impacted infertile people's choice of avoidance coping strategies. CONCLUSIONS: The results provide evidence to understand the direct impact of each type of IRS on infertile people's choice of coping styles to better support them during their individual and family therapy.
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BACKGROUND: All types of movements involve the role of articular cartilage and bones. The presence of cartilage enables bones to move over one another smoothly. However, repetitive microtrauma and ischemia as well as genetic effects can cause an osteochondral lesion. Numerous treatment methods such as microfracture surgergy, autograft, and allograft, have been used, however, it possesses treatment challenges including prolonged recovery time after surgery and poses a financial burden on patients. Nowadays, various tissue engineering approaches have been developed to repair bone and osteochondral defects using biomaterial implants to induce the regeneration of stem cells. METHODS: In this study, a collagen (Col)/γ-polyglutamate acid (PGA)/hydroxyapatite (HA) composite scaffold was fabricated using a 3D printing technique. A Col/γ-PGA/HA 2D membrane was also fabricated for comparison. The scaffolds (four layers) were designed with the size of 8 mm in diameter and 1.2 mm in thickness. The first layer was HA/γ-PGA and the second to fourth layers were Col/γ-PGA. In addition, a 2D membrane was constructed from hydroxyapatite/γ-PGA and collagen/γ-PGA with a ratio of 1:3. The biocompatibility property and degradation activity were investigated for both scaffold and membrane samples. Rat bone marrow mesenchymal stem cells (rBMSCs) and human adipose-derived stem cells (hADSCs) were cultured on the samples and were tested in-vitro to evaluate cell attachment, proliferation, and differentiation. In-vivo experiments were performed in the rat and nude mice models. RESULTS: In-vitro and in-vivo results show that the developed scaffold is of well biodegradation and biocompatible properties, and the Col-HA scaffold enhances the mechanical properties for osteochondrogenesis in both in-vitro and animal trials. CONCLUSIONS: The composite would be a great biomaterial application for bone and osteochondral regeneration.
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Integration of substance use disorder (SUD) treatment and HIV care can increase antiretroviral therapy coverage among people with opioid use disorder (OUD). However, implementation of integrated treatment models remains limited. Stigma towards people with OUD poses a barrier to initiation of, and adherence to, HIV treatment. We sought to understand the extent of stigma towards SUD and HIV among people with OUD in Vietnam, and the effect of stigma on integrated OUD and HIV treatment services utilization. Between 2013 and 2015, we conducted in-depth interviews with 43 patients and 43 providers at 7 methadone clinics and 8 HIV clinics across 4 provinces in Vietnam. We used thematic analysis with a mixed deductive and inductive approach at the semantic level to analyze key topics. Two main themes were identified: (1) Confidentiality concerns about HIV status make patients reluctant to receive integrated care at HIV clinics, given the requirements for daily buprenorphine dosing at HIV clinics. (2) Provider stigma existed mostly toward people with OUD and seemed to center on the belief that substance use causes a deterioration in one's morals, and was most frequently manifested in the form of providers' apprehensive approach towards patients. Concerns regarding stigmatization may cause patients to feel reluctant to receive treatment for both OUD and HIV at a single integrated clinic. Interventions to reduce stigma at the clinic and policy levels may thus serve to improve initiation of and adherence to integrated care.
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BACKGROUND: DNA methylation on cytosine in the CpG dinucleotides is one of the most common epigenetic perturbations taking place during cancer initiation, progression, occurrence and resistance therapy. DNA methylation seems to be sufficiently stable epigenetic modification to be utilized as a cancer biomarker in in vitro diagnostic (IVD) settings. Nowadays, the SHOX2 methylation (mSHOX2) is one of the most valuable DNA methylation biomarkers of lung cancer that is the leading cause of cancer death. It is being continuously validated across ethnicities, lifestyles and lifespan. This study focused on characteristics of mSHOX2 in Vietnamese patients with lung cancer since a lack of investigation and evidence of its utility in this country. METHODS: The probe and primer sets were designed according to the MethyLight method for quantitative assessment of the mSHOX2 in 214 formalin-fixed paraffin-embedded (FFPE) lung tissues and 57 plasma samples. RESULTS: mSHOX2 in FFPE tissues allowed discriminating benign and malignant lung diseases with 60% (95% CI 50.7-68.8%) sensitivity and 90.4% (95% CI 82.6-95.5%) specificity. Importantly, based on mSHOX2 in plasma, lung cancer could be detected with 83.3% (95% CI 65.3-94.4%) sensitivity and 92.6% (95% CI 75.7-99.1%) specificity, respectively. There were insignificant associations between mSHOX2 with age, cancer stage, EGFR mutation and serum CEA, CYFRA21-1 concentrations except for that gender. CONCLUSION: Our study indicated that mSHOX2 was satisfactory for distinguishing malignant from benign lung tissue and noninvasively detecting lung cancer.
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Metilação de DNA , Proteínas de Homeodomínio , Neoplasias Pulmonares , Antígenos de Neoplasias , Povo Asiático , Biomarcadores Tumorais/genética , Proteínas de Homeodomínio/genética , Humanos , Queratina-19 , Neoplasias Pulmonares/patologiaRESUMO
BACKGROUND: Adolescent substance use is a leading risk factor of medical and social problems in adults. However, evidence-based interventions for substance use disorders (SUD) among youth in resource-limited countries are lacking. Treatnet Family (TF), developed by United Nations Office on Drugs and Crime (UNODC), aims to make youth SUD care more affordable and accessible in low- and middle-income countries. This study explores the suitability of TF in Vietnam. METHOD: Twenty interviews were conducted with eight adolescents and their family members who participated in TF, and four practitioners who delivered TF. Questions centred on their experiences with the intervention and suggestions for improvement. Thematic analysis was used to evaluate the data. RESULTS: All adolescents were male with an average age of 19.3. Seven of them had left school. Most caregivers were female. Both family members and adolescents expressed a great demand for support, and both groups appreciated the immediate improvement in parent-child communication. However, the impact of TF could be compromised due challenges in recruiting families, possibly arising from the novelty of a family-based intervention in Vietnam and drug-related stigma. The perception of drug use as an acute condition instead of a chronic disorder, and the lack of a continuing care system, also made it difficult to retain participants. CONCLUSION: Vietnamese adolescents with SUD and their family members were in great need of support and access to evidence-based interventions. Building a comprehensive, health-centred substance use disorder treatment and care system would enhance treatment impact.
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Late HIV treatment remains a global public health issue despite significant efforts. To better understand what shapes this issue, we interviewed 36 Vietnamese ART-naive patients who came to HIV treatment in 2017. Half of them had intake CD4 counts fewer than 100 cells/mm3, the others had intake CD4 counts of 350 cells/mm3 and above. Late diagnosis was the reason of late treatment in our sample. Most late presenters were not members of the key populations at increased risk of HIV (e.g., people who inject drugs, commercial sex workers, and men who have sex with men). Individual-level factors included low risk appraisal, habit of self-medication, and fear of stigma. Network and structural-level factors included challenges to access quality health care, normalization of HIV testing in key populations and inconsistent provider-initiated HIV testing practices. Structural interventions coupled with existing key population-targeted strategies would improve the issue of late HIV diagnosis.
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Infecções por HIV , Minorias Sexuais e de Gênero , Diagnóstico Tardio , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Masculino , VietnãRESUMO
Articular cartilage defects affect millions of people worldwide, including children, adolescents, and adults. Progressive wear and tear of articular cartilage can lead to progressive tissue loss, further exposing the bony ends and leaving them unprotected, which may ultimately cause osteoarthritis (degenerative joint disease). Unlike other self-repairing tissues, cartilage has a low regenerative capacity; once injured, the cartilage is much more difficult to heal. Consequently, developing methods to repair this defect remains a challenge in clinical practice. In recent years, tissue engineering applications have employed the use of three-dimensional (3D) porous scaffolds for growing cells to regenerate damaged cartilage. However, these scaffolds are mainly chemically synthesized polymers or are crosslinked using organic solvents. Utilizing 3D printing technologies to prepare biodegradable natural composite scaffolds could replace chemically synthesized polymers with more natural polymers or low-toxicity crosslinkers. In this study, collagen/oligomeric proanthocyanidin/oxidized hyaluronic acid composite scaffolds showing high biocompatibility and excellent mechanical properties were prepared. The compressive strengths of the scaffolds were between 0.25-0.55 MPa. Cell viability of the 3D scaffolds reached up to 90%, which indicates that they are favorable surfaces for the deposition of apatite. An in vivo test was performed using the Sprague Dawley (SD) rat skull model. Histological images revealed signs of angiogenesis and new bone formation. Therefore, 3D collagen-based scaffolds can be used as potential candidates for articular cartilage repair.
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The goal of this study is to understand the ability of a newly developed barrier membrane to enhance bone tissue regeneration. Here in this study we present the in vitro characterization of the barrier membrane made from type I collagen and crosslinked by oligomeric proanthocyanidins (OPCs). The effects of the membrane (P-C film) on cell cycle, proliferation, alkaline phosphatase activity, and mineralization were evaluated using the human osteoblast cell line MG-63, while the barrier ability was examined using MG-63 cells, as well as the human skin fibroblast cell line WS-1. The pore size is one of the factors that plays a key role in tissue regeneration, therefore, we evaluated the pore size of the membrane using a capillary flow porometer. Our results showed that the mean pore size of the P-C film was approximately 7-9 µm, the size known to inhibit cell migration across the membrane. The P-C film also demonstrated excellent cell viability and good biocompatibility, since the cell number increased with time, with MG-63 cells proliferating faster on the P-C film than in the cell culture flask. Furthermore, the P-C film promoted osteoblast differentiation, resulting in higher alkaline phosphatase activity and mineralization. Therefore, our results suggest that this P-C film has a great potential to be used in guided bone regeneration during periodontal regeneration and bone tissue engineering.
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Regeneração Tecidual Guiada , Proantocianidinas , Regeneração Óssea , Células Cultivadas , Colágeno , Humanos , Membranas Artificiais , Osteoblastos , Proantocianidinas/farmacologiaRESUMO
Left ventricular free wall rupture is a fatal complication of acute myocardial infarction. Emergency surgical repair is usually indicated to treat this condition. However, in very high surgical risk cohort, conservative treatment can also be considered. We report a case of left ventricle pseudoaneurysm that was successfully treated conservatively in a 4-year period.
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INTRODUCTION: Paroxetine is a selective serotonin reuptake inhibitor (SSRI) with several indications, one of which is for depression. We present a case of probable paroxetine-induced serotonin syndrome. CASE SUMMARY: A 21-year-old female with a history of generalized anxiety disorder and major depression presented with increased depressive symptoms over several months while taking fluoxetine 20 mg daily. Fluoxetine was discontinued without taper and replaced with paroxetine 10 mg daily, along with hydroxyzine 50 mg twice daily as needed for anxiety. Within a week of starting the paroxetine, the patient reported increased anxiety, insomnia, and constant shaking. The paroxetine continued to be uptitrated over a 3-week period to a dose 30 mg due to unremitting depressive symptoms. One month later, the patient presented with tachycardia, generalized body aches, extreme fatigue, weakness, uncontrollable twitching, tremor, and hyperreflexia. A widespread burning sensation accompanied by random hot flashes without diaphoresis was also noted. Serotonin syndrome was diagnosed using the Hunters criteria. Paroxetine was discontinued, and the patient's physical symptoms resolved within a week. DISCUSSION: To date, only 5 cases of serotonin syndrome have been reported in patients receiving SSRI monotherapy at recommended therapeutic doses.
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Transtorno Depressivo Maior/tratamento farmacológico , Paroxetina/administração & dosagem , Paroxetina/efeitos adversos , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagem , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Síndrome da Serotonina/induzido quimicamente , Ansiedade/tratamento farmacológico , Feminino , Fluoxetina/administração & dosagem , Humanos , Hidroxizina/administração & dosagem , Serotonina , Adulto JovemRESUMO
Mechanical thrombectomy (MT) has been demonstrated as an effective treatment for acute ischemic stroke (AIS), thanks to large vessel occlusion (LVO), especially in case of anterior cerebral artery with many randomized clinical trials (RCTs) every year. On the other hand, there is a limited number of basilar artery occlusion (BAO)-related studies which have been conducted. The fact prompts our range of case studies, which furnish BAO understanding with our experience, results and some prognosis factors of MT. This retrospective and single-center study was conducted on 22 patients who were diagnosed with BAO and underwent the treatment of MT from October 2012 to January 2018. Clinical feature such as radiological imaging, procedure complications, and intracranial hemorrhage were all documented and evaluated. All the studies' results based on performance using modified Rankin scale score (mRS) and mortality at 90 days. The results from these BAO patients study indicated that the posterior circulation Acute Stroke Prognosis Early CT Score (pcASPECTS) recorded before the intervention was 7.7 ± 1.6, while the admission National Institutes of Health Stroke Scale (NIHSS) was 17.5 ± 5.4. 15/22 cases achieved successful recanalization (TICI, Thrombolysis in Cerebral Infarction scale, of 2b-3), accounting for 68.2%. The results highlighted 50% of the favorable outcome (mRS 0-2) occupying 11 out of 22 patients in total and the overall mortality was 36.4%. The intracranial hemorrhagic complication was detected in three cases (13.6%). Placing in juxtaposition the poor-outcome group and the favorable-outcome group, we could witness statistically significant difference (P < 0.05) suggesting both good baseline image (pc-ASPECTS ≥ 7) and recanalization (TICI 2b-3) were two good prognosis factors. Our case series showed that MT would be an effective and feasible treatment for BAO. The pre-procedural pcASPECTS ≥ 7 and post-procedural good recanalization (TICI 2b-3) were two important prognosis factors for predicting good clinical outcome.
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Infarto Encefálico/terapia , Trombólise Mecânica/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Insuficiência Vertebrobasilar/terapia , Idoso , Idoso de 80 Anos ou mais , Infarto Encefálico/complicações , Infarto Encefálico/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/mortalidadeRESUMO
BACKGROUND: Minimally invasive mitral valve surgery is becoming a gold standard and provides many advantages for patients. A learning curve is required for a surgeon to become proficient, and the exact number to overcome this curve is controversial. Our study aimed to define this number for mitral valve surgery in general, for replacement and repair separately. METHODS: A total of 204 mitral valve surgeries were performed via the right minithoracotomy approach from October 2014 to January 2019 by a single surgeon who isexperienced in conventional mitral valve surgery. Learning curves were analysed based on the trend of important variables (cross-clamp time, CPB time, ventilation time, ICU time, composite technical failure) over time, and the number of operations required was calculated by CUSUM method. RESULTS: MIMVS provided an excellent outcome in the carefully selected patients, with low mortality of 0.5% and low rate of complications. The decreasing trend of the important variables were observed over the years and as the cumulative number of procedures increased. The number of operations required to overcome the learning curve was 75 to 100 cases. When considered separately, the quantity for mitral valve replacement was 60 cases, whereas valve repair necessitated at least 90 cases to have an acceptable technical complication rate. CONCLUSION: MIMVS is an excellent choice for mitral valve surgery. However, this approach required a long learning curve for a surgeon who is experienced in conventional mitral valve surgery. TRIAL REGISTRATION: The research was registered and approved by the ethical board of the University of Medicine and Pharmacy at Ho Chi Minh City, number 141/DHYD-HDDD, on April 11th 2018.
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Implante de Prótese de Valva Cardíaca/educação , Curva de Aprendizado , Insuficiência da Valva Mitral/cirurgia , Toracotomia/educação , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/educação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Toracotomia/métodos , Resultado do Tratamento , VietnãRESUMO
BACKGROUND: Methadone maintenance treatment, initially introduced in Vietnam for HIV harm reduction, has marked a significant switch in the country's drug policy - from addiction as a moral issue to addiction as a brain disease. After the some initial outstanding achievements, the programme is facing a high dropout rate that threatens both goals of HIV prevention and drug treatment. This sociological study, as part of an HIV intervention research project, explores the challenges and opportunities that individuals who use drugs are faced with in relation to addiction treatment. METHODS: A qualitative study among drug users with and without methadone maintenance treatment experiences recruited by peer outreach workers. We conducted 58 in-depth interviews and 2 focus groups between 2016 and 2017. RESULTS: The start of treatment brought about significant feelings of success as heroin use was no longer compulsive. However, being in treatment programmes is also challenging with respect to continuing the recovery process. Barriers to retention include a popular fear of methadone as another harmful drug, a feeling of dependence related to the current practices of methadone treatment programmes and a poor therapeutic relationship. In the face of such challenges, the two major motivations that keep patients in care come from the desire to completely break up with heroin and the pursuit of family happiness. CONCLUSION: The current practices of methadone programmes pose challenges to patients' recovery efforts from addiction and threaten treatment retention. Prompt interventions are needed to help Vietnam attain its objective of providing better care for larger vulnerable populations.
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Usuários de Drogas/psicologia , Acessibilidade aos Serviços de Saúde , Adulto , Estudos de Casos e Controles , Feminino , Grupos Focais , Dependência de Heroína/tratamento farmacológico , Humanos , Masculino , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Pesquisa Qualitativa , Vietnã , Adulto JovemRESUMO
Japanese encephalitis virus (JEV) is classified into 5 genotypes (GI, GII, GIII, GIV, and GV), and the GI and GIII strains are the most widely distributed in JE endemic areas. In recent years, GV JEV has been detected in China and Korea, suggesting that GV JEV may invade other JE endemic areas, including Vietnam, and that more attention should be paid to the JEV strains circulating in these areas. In this study, we investigated the neutralization ability of the sera collected from 22 Vietnamese patients with JE who lived in northern Vietnam against the GI and GV JEV strains. In most cases, the ratios of the titer against GV to that against GI (GV:GI) were equal to or less than 1:4. However, the titer against GV JEV was equivalent (1:1) to that against GI JEV in only a few cases, and no serum had a ratio higher than 1:1. Thus, our results did not show convincing evidence that GV JEV was emerging in northern Vietnam in 2014.