PROGNOSTIC VALUES OF NEUTROPHIL/LYMPHOCYTE RATIO IN SEVERE BURN PATIENTS.

The aim of this study was to evaluate the characteristics and prognostic value of the neutrophil/lymphocyte ratio (NLR) in patients with severe burns. A retrospective study was conducted on 245 burn patients over 18 years old without comorbidity or combined injury, burn extent ≥20% TBSA, hospitalized within 24 hours after burn. The collected criteria included patient characteristics, NLR on admission, 3rd and 7th day after burn, and outcome. The results showed that NLR was higher than the normal value at all collected times. In addition, compared to the survivor group, NLR on admission, 3rd and 7th day after burn was significantly higher in the mortality group (p <.01). Multivariate analysis found that the NLR on the 7th day postburn was an independent factor associated with mortality (p <.05), along with the increase in age, burn extent, and presence of inhalation injury (AUC = .85; cut off: 14.13; sensitivity: 75% and specificity: 83.43%). In conclusion, NLR on the 7th day post burn may be used as a predictive factor for mortality amongst severe burn patients.

Le but de cette étude est d'évaluer les valeurs et l'intérêt pronostique du rapport neutrophiles/lymphocytes (RNL) chez le patient gravement brûlé. Il s'agit d'une étude rétrospective conduite auprès de 245 adultes (> 18 ans) brûlés sur >20% SCT, sans inhalation de fumée ni comorbidité, hospitalisés dans les 24h suivant le traumatisme. Nous avons examiné les caractéristiques du patient, les RNL à J3 et J7 ainsi que le devenir. Les RNL étaient systématiquement élevés, significativement plus chez ceux destinés à mourir (p <0,01). En analyse multivariée, la valeur de RNL à J7 est significativement corrélée à la mortalité (p <0,05), comme l'âge, la surface brûlée et l'inhalation. Au seuil de 14,13 on obtient une sensibilité de 75%, une spécificité de 83,43% et une AUC/ROC de 0,85. Le RNL à J7 peut être utilisé comme paramètre prédictif de mortalité chez les patients gravement brûlés.

Cost Analysis and Influencing Factors Amongst Severe Burn Patients.

This study analyzed the structure and determined the factors affecting the cost of treatment of severe burns patients. The results showed that the average total costs for a patient was 3275.9 USD. The daily cost of hospitalization was 113.3 USD, the treatment cost for 1% burn surface area was 109.5 USD with the highest proportion for medication and consumable medical equipment (43.2%), followed by surgery and procedures (30.2%). The treatment costs increased with increasing age, burn extent and deep burn area (p < .05) and were significantly higher in the group of patients with inhalation injury, electrical burns and in non-survivors (p < .01). Multivariate regression analysis found that burn extent, deep burn area and inhalation injury independently influenced the treatment cost of burn patients.

Cette étude a analysé le coût global de la prise en charge d'un brûlé grave ainsi que les imputations et les paramètres associés aux dépenses. Le coût moyen est de 3 275,9$ (113,3$/ % SB/j). Les médicaments et les consommables représentent 43,2 % du total ; le coût des chirurgies 30,2 %. Le coût augmente avec l'âge, la surface brûlée et la profondeur (p < 0,05). Il est significativement plus élevé en cas d'inhalation de fumées, de brûlure électrothermique et en cas de brûlure fatale (p < 0,01). En analyse multivariée, la surface brûlée, la profondeur et l'inhalation de fumée sont des facteurs indépendants d'augmentation du coût de traitement.

Epidemiology And Risk Factors For Death Of Pediatric Burns In A Developing Country. An Experience From The National Burn Hospital.

This retrospective study investigated burn features and predicted factors for death of pediatric burn patients in Vietnam. The results showed that pediatric burn accounted for 48.1% of total admitted burn patients. Preschool children and boys were predominant, burns were mostly caused by scald (76.2%) and the majority of patients lived in a rural area (64.1%). In addition, 94.5% had burn size less than 30% total body surface area and deep burn injury was seen in 45.5% patients. Moreover, a significantly higher incidence of deep burn injury was recorded in preschool age, patients living in a rural area, and non-scald burn. Overall LA50 was 81.5% and a significantly higher mortality rate was seen in non-scald burns, older children, extensive burn and inhalation injury. Multivariate logistic analysis indicated that only burn extent and inhalation injury were independent risk factors for death. An increased 1% of burn extent resulted in a .7 probability unit of death (OR=1.08) and this was 2.16 in the case of inhalation injury (OR=8.67). This health issue should be highlighted in order to develop appropriate policies and intervention measures in developing countries.

Cette étude rétrospective s'est penchée sur les caractéristiques et les facteurs de risque de mortalité des brûlures de l'enfant au Vietnam. Ces brûlres représentent 48,1% des hospitalisations dans notre centre. Les garçons d'âge préscolaire sont la sous- population prédominante. Les ébouillantements sont majoritaires (76,2%), de même que l'origine ruale (64,1%). L'immense majorité (94,5%) des brûlures touche moins de 30% SCT et l'atteinte n'est profonde que dans 45,5% des cas. Les brûlures sont plus profondes chez les patients ruraux préscolaires non ébouillantés. La SL (Surface Létale) 50 était de 81,5% ; les facteurs de risque de mortalité étant l'âge et la surface plus élevés, l'inhalation de fumées et la brûlure non due à un liquide. En analyse multivariée, seules la surface et l'inhalation de fumée ressortaient. Ainsi, l'augmentation de 1% de SB la probabilté de décès de 0,7 (OR 1,08) quand l'inhalation de fumée l'augmente de 2,16 (OR 8,67). Ce problème de santé publique doit être mis en avant afin de développer une législation et des mesures de protection adaptées dans les pays en développement.

Intrinsic and tunable ferromagnetism in Bi0.5Na0.5TiO3 through CaFeO3-δ modification.

New (1-x)Bi0.5Na0.5TiO3 + xCaFeO3-δ solid solution compounds were fabricated using a sol-gel method. The CaFeO3-δ materials were mixed into host Bi0.5Na0.5TiO3 materials to form a solid solution that exhibited similar crystal symmetry to those of Bi0.5Na0.5TiO3 phases. The random distribution of Ca and Fe cations in the Bi0.5Na0.5TiO3 crystals resulted in a distorted structure. The optical band gaps decreased from 3.11 eV for the pure Bi0.5Na0.5TiO3 samples to 2.34 eV for the 9 mol% CaFeO3-δ-modified Bi0.5Na0.5TiO3 samples. Moreover, the Bi0.5Na0.5TiO3 samples exhibited weak photoluminescence because of the intrinsic defects and suppressed photoluminescence with increasing CaFeO3-δ concentration. Experimental and theoretical studies via density functional theory calculations showed that pure Bi0.5Na0.5TiO3 exhibited intrinsic ferromagnetism, which is associated with the possible presence of Bi, Na, and Ti vacancies and Ti3+-defect states. Further studies showed that such an induced magnetism by intrinsic defects can also be enhanced effectively with CaFeO3-δ addition. This study provides a basis for understanding the role of secondary phase as a solid solution in Bi0.5Na0.5TiO3 to facilitate the development of lead-free ferroelectric materials.

Longitudinal sampling is required to maximize detection of intrahost A/H3N2 virus variants.

Seasonal human influenza viruses continually change antigenically to escape from neutralizing antibodies. It remains unclear how genetic variation in the intrahost virus population and selection at the level of individual hosts translates to the fast-paced evolution observed at the global level because emerging intrahost antigenic variants are rarely detected. We tracked intrahost variants in the hemagglutinin and neuraminidase surface proteins using longitudinally collected samples from 52 patients infected by A/H3N2 influenza virus, mostly young children, who received oseltamivir treatment. We identified emerging putative antigenic variants and oseltamivir-resistant variants, most of which remained detectable in samples collected at subsequent days, and identified variants that emerged intrahost immediately prior to increases in global rates. In contrast to most putative antigenic variants, oseltamivir-resistant variants rapidly increased to high frequencies in the virus population. Importantly, the majority of putative antigenic variants and oseltamivir-resistant variants were first detectable four or more days after onset of symptoms or start of treatment, respectively. Our observations demonstrate that de novo variants emerge, and may be positively selected, during the course of infection. Additionally, based on the 4-7 days post-treatment delay in emergence of oseltamivir-resistant variants in six out of the eight individuals with such variants, we find that limiting sample collection for routine surveillance and diagnostic testing to early timepoints after onset of symptoms can potentially preclude detection of emerging, positively selected variants.

Influence of gender difference on outcomes of adult burn patients in a developing country.

The aim of this study was to investigate the impact of gender on outcomes among adult burn patients. A retrospective study was conducted on 5061 adult burn patients (16 - 64 years old) admitted to the Vietnam National Burn Hospital over a three-year period (2016 - 2018). Demographic data, burn features and outcome including complications, length of hospital stay and mortality of male and female groups were compared. Results indicated that male patients were predominant (72.8%), younger (35.5 vs. 37.2 years old; p < .001) and admitted sooner to hospital. A greater number of males suffered electrical and flame/heat direct contact injuries, whereas more females suffered scald injury (34.7% vs. 12.2%; p < .001). Burn extent was larger among males (14.9% vs. 12.1%; p < .001). In addition, a higher proportion of deep burn injuries (44.8% vs. 41.2%; p < .05) and number of surgeries (1.2 vs. 1; p < .05), and longer hospital stay (17.8 vs. 15.8 days; p < .001) was recorded among the male group. Post burn complication and overall mortality rate did not differ between the two groups. However, death rate was remarkably higher in the female group when burn extent was ≥ 50% TBSA (72.4% vs. 57.3%; p < .05). In conclusion, burn features and outcomes were not similar between the male and female group. Male patients appear to suffer more severe injury requiring more surgeries and longer hospital stay. However, more attention should be paid to the significantly higher mortality rate among females with extensive burn.

Le but de ce travail était d'étudier l'impact du sexe sur le devenir d'adultes brûlés. Cette étude rétrospective a été conduite sur 5 601 patients âgés de 16 à 64 ans admis dans le CTB national du Vietnam entre 2016 et 2018 inclus. Les données démographiques, celles concernant la brûlure, les complications, la durée d'hospitalisation et la mortalité ont été comparées selon le sexe des patients. Les hommes prédominent (72,8%), sont plus jeunes (35,5 VS 37,2 ans - p<0,001) et sont hospitalisés plus rapidement. Les ébouillantements sont plus fréquents chez les femmes (34,7 VS 12,2% - p <0,001), les autres causes (électriques, flammes, contact) étant donc plus habituelles chez les hommes. Les brûlures des hommes sont plus étendues (14,9 VS 12,1% SCB - p< 0,001), plus profondes (44,8% de profond VS 41,2% - p< 0,05 ; 1,2 séances chirurgicales VS 1 - p< 0,05) et leur durée de séjour est plus longue (17,8 VS 15,8 j - p< 0,001). Le nombre de complications et la mortalité sont comparables. Toutefois, la mortalité des femmes brûlées sur ≥ 50% SCT était nettement plus élevée que celle des hommes (72,4% VS 57,3% - p< 0,05). En conclusion, les hommes ont des brûlures plus sévères nécessitant plus d'interventions chirurgicales et une hospitalisation plus longue. Il faut cependant être attentifs à la mortalité élevée des femmes extensivement brûlées.

Electronic and Optical Properties of Single Wall Carbon Nanotubes.

In this article, we overview our recent theoretical works on electronic and optical properties of carbon nanotubes by going from the background to the perspectives. Electronic Raman spectra of metallic carbon nanotubes give a new picture of Raman processes. Thermoelectricity of semiconducting nanotubes gives a general concept of the confinement effect on the thermoelectric power factor. Selective excitation of only a single phonon mode is proposed by the pulsed train technique of coherent phonon spectroscopy. Occurrence of both two and four fold degeneracy in the carbon nanotube quantum dot is explained by difference group velocities and the intra/inter valley scattering near the hexagonal corner of the Brillouin zone.

Obesity is associated with increased risk of allergy in Vietnamese adolescents.

BACKGROUND: The prevalence of allergic diseases has remarkably increased in the last decades in tandem with the number of obese individuals. Results of studies on obesity and allergic diseases are controversial, and most of them are related to asthma and asthma-like symptoms. OBJECTIVE: In our study, we evaluated the association of several obesity indices and the prevalence of allergic diseases, including bronchial asthma, allergic rhino-conjunctivitis, atopic dermatitis and food allergy. DESIGN: Cross-sectional study. RESULTS: From a total of 1185 adolescents (49.3% boys) aged 12 to 17 y old, 19.3% reported a physician-diagnosed allergic disease, and 35.3% reported undiagnosed allergic symptoms. Logistic regression analysis revealed a higher risk of allergy in children of middle (OR = 2.02, CI: 1.12-3.64) and high (OR = 2.40, CI: 1.25-4.61) compared to low socioeconomic status, in subjects reporting industrial emissions in the neighborhood (OR = 2.19, CI: 1.40-3.41), and in adolescents with parental history of allergy (OR = 1.92, CI: 1.26-2.92). Body mass index (BMI) and percentage of body fat (%BF) were significantly related to allergy (OR = 1.16, CI: 1.01-1.34 for BMI; OR = 1.03, CI: 1.01-1.06 for %BF). After controlling for socioeconomic status, industrial emissions and parental history of allergy, only %BF remained statistically significant (OR = 1.03, CI: 1.01-1.06). Food allergy was not related to obesity in our study population, and when adolescents with food allergy were excluded from the analysis, the odds of having allergy increased 28% with each increase in SD of BMI (OR = 1.28, CI: 1.05-1.57) and 5% for each unit increase in the percentage of body fat (OR = 1.05, CI: 1.01-1.08). CONCLUSION: In conclusion, being overweight was associated with an increased risk of allergy in our study population. Our results point towards an association between being overweight and rhino-conjunctivitis, but not food allergy. No association was observed with other allergic diseases.

Liver histopathology and biological correlates in five cases of fatal dengue fever in Vietnamese children.

We studied five fatal cases of dengue haemorrhagic fever (DHF), confirmed using the reverse transcriptase-polymerase chain reaction (RT-PCR) method, in Vietnamese children. The liver seems to be a target for dengue virus, so postmortem examinations were performed to investigate elementary lesions, local recruitment of inflammatory cells and whether the virus was present in target cells of the liver. We detected severe, diffuse hepatitis with midzonal necrosis and steatosis in two patients, focal areas of necrosis in two patients, and normal histology in one patient. Dengue virus antigen was detected using immunohistochemistry in hepatocytes from necrotic areas in four cases. There was no recruitment of polymorphonuclear cells, and no lymphocytes were detected in the liver lesions of patients who died from DHF. Lymphocytic infiltration occurred in only one hepatitis B virus-positive patient, with no signs of chronic hepatitis. Kupffer cells had mostly been destroyed in cases with focal or severe necrosis. TUNEL tests were positive in necrotic areas, with positive cells forming clusters, suggesting that an apoptotic mechanism was involved. Thus, we suggest that the hepatocyte and Kupffer cells may be target cells supporting virus replication and that the councilman body is an apoptotic cell, as in the pathogenesis of yellow fever.

Clinical and neurophysiological study of the effects of multiple doses of artemisinin on brain-stem function in Vietnamese patients.

The qinghaosu (artemisinin) group of drugs is the most important new class of antimalarials developed in the last fifty years. Although there has been no clinical evidence of neurotoxicity, an unusual pattern of damage to specific brain-stem nuclei has been reported in experimental animals receiving high doses of arteether or artemether. Detailed clinical examinations, audiometry, and brain stem auditory evoked potentials (BSAEPs) were assessed in 242 Vietnamese subjects who had previously received up to 21 antimalarial treatment courses of artemisinin or artesunate alone and 108 controls from the same location who had not received these drugs. There was no evidence of a drug effect on the clinical or neurophysiological parameters assessed. In this population there was no clinical or neurophysiological evidence of brain-stem toxicity that could be attributed to exposure to artemisinin or artesunate.

Management of multiple drug-resistant malaria in Viet Nam.

Malaria is still the most common infectious cause of mortality and morbidity in Viet Nam as it is in many developing countries in the tropics. The presence of resistance to available antimalarials and compliance in the target population are factors that influence the choice of drugs and regimens. In order to develop an ideal treatment for malaria, we conducted several clinical trials in patients with the disease in different settings. The results of these trials suggest that a combination of single dose artemisinin (or its derivatives) and mefloquine is the most effective, safe and practical treatment for acute non-complicated malaria due to multidrug-resistant Plasmodium falciparum. Concerning severe and complicated malaria, parenteral or rectal multi-doses of artemisinin or analogues are recommended due to their rapid parasite clearance time and other possible anti-cytoadherence effects. With its rapid parasite clearance, very early treatment of uncomplicated cases with artemisinin (and derivatives), especially at a health post level may help to prevent the development of complications, consequently reducing the number of severe cases and the malaria mortality rate.

Nutritional status of middle-aged Vietnamese in Ho Chi Minh City.

OBJECTIVE: To investigate the nutritional status of middle-aged Vietnamese in Ho Chi Minh City. METHODS: A cross-sectional survey in 300 Vietnamese aged 40 to 59 years (113 men, 187 women) was conducted in an urban, suburban and rural area of Ho Chi Minh City based on interviews that included a 24-hour dietary recall, food frequency questionnaire, and a short socioeconomic questionnaire. Anthropometry and blood pressure were measured, and blood was collected for serum protein and lipid analysis. RESULTS: A high prevalence of underweight (BMI < 18.5) was observed in the rural and suburban populations (35% and 23%, respectively), and overweight (BMI > or = 25) was observed in the urban population (18%). A high percentage of serum total cholesterol (TC) below 150 mg/dL was observed in the rural and suburban areas (43% and 37%, respectively). By contrast, the prevalence of TC above 220 mg/dL was twofold higher in the urban and suburban residents (13% and 12%, respectively) than in rural residents (6%). More than 80% of urban residents were of medium or high-income status, whereas 61% of suburban residents were of medium-income status and 66% of rural residents were of low-income status. CONCLUSIONS: The nutritional status of middle-aged Vietnamese in Ho Chi Minh City was characterized by undernutrition in 35% of the low-income population and by overnutrition in 18% the high-income population. Undenutrition was still a public health problem in the rural area whereas overnutrition started to become a noteworthy problem in the urban area. The suburban area suffered from both under- and overnutrition problems. Low lipid intake was the most important problem related to undernutrition in middle-aged residents of Ho Chi Minh City.

Prevalence and risk factors for diabetes in Ho Chi Minh City, Vietnam.

AIMS: To determine the prevalence of diabetes and associated risk factors in Ho Chi Minh City, Vietnam. METHODS: A total of 2932 participants aged 15 and above in Ho Chi Minh City were screened for diabetes in a cross-sectional study. The study was conducted from March-May 2001. Demographic, occupation, anthropometry and blood pressure were recorded. Blood glucose was calculated on fasting capillary and venous blood. The classification of diabetes and impaired fasting glucose (IFG) was carried out according to WHO and American Diabetes Association criteria. RESULTS: The crude prevalence of diabetes and IFG were 6.6 and 3.2%, respectively. After age, sex-adjustment to the Vietnam population census, the prevalence was 3.8 and 2.5%, respectively; approximately 40% of cases were found to be newly diagnosed diabetes. The crude prevalence of diabetes in the urban area was approximately 2.8 times higher than that recorded in the 1993 study (6.9 vs. 2.5%, respectively). In this study, there was a positive association between diabetes and sex, age, overweight, waist hip ratio (WHR), and having a history of delivering large for gestational age child; there was a negative association between diabetes and physical activity and occupation. CONCLUSIONS: This study found that the age, sex-adjusted prevalence of diabetes and IFG in Ho Chi Minh City were 3.8 and 2.5%, respectively, a rapid increase in the recent decade. Our study also indicates that ageing, a high WHR level, overweight and a sedentary lifestyle may be important determinants of the increased prevalence of diabetes during this transition period in Vietnam.

Rapid diagnosis of Japanese encephalitis by using an immunoglobulin M dot enzyme immunoassay.

Japanese encephalitis (JE) occurs in rural settings in southern and eastern Asia, where diagnostic facilities are limited. For the diagnosis of JE virus (JEV) infection, we developed a nitrocellulose membrane-based immunoglobulin M (IgM) capture dot enzyme immunoassay (MAC DOT) that is rapid, simple to use, requires no specialized equipment, and can distinguish JEV from dengue infection. In a prospective field study in southern Vietnam, 155 cerebrospinal fluid (CSF) and 341 serum samples were collected from 111 children and 83 adults with suspected encephalitis. The JEV MAC DOT, performed on site, was scored visually from negative to strongly positive by two observers, and the results were compared subsequently with those of the standard IgM capture enzyme-linked immunosorbent assay. For the 179 patients with adequate specimens, the MAC DOT correctly identified 59 of 60 JEV-positive patients and 118 of 119 JEV-negative patients (sensitivity [95% confidence intervals], 98.3% [92.1 to 99.91%]; specificity, 99.2% [95.9 to 100.0%]; positive predictive value, 0.98; negative predictive value, 0.99). The MAC DOT also correctly identified three patients with dengue encephalopathy. Admission specimens were positive for 73% of JE patients. Interobserver agreement for MAC DOT diagnosis was excellent (kappa = 0.94). The JEV MAC DOT is a simple and reliable rapid diagnostic test for JE in rural hospitals.