Evaluation of screening algorithms to detect rectal colonization with carbapenemase-producing Enterobacterales in a resource-limited setting.

Objectives: To improve and rationalize the detection of carbapenemase-producing Enterobacterales (CPE) in rectal swabs in a high-prevalence and resource-constrained setting, addressing surveillance challenges typically encountered in laboratories with limited resources. Methods: A point prevalence survey (PPS) was conducted on 15 August 2022, in a provincial children's hospital in northern Vietnam. Rectal swab samples of all admitted children were collected and plated on a selective medium for carbapenem-resistant Enterobacterales (CRE). Species identification and antimicrobial susceptibility testing (AST) were performed by MALDI-TOF, and VITEK2 XL and interpreted according to CLSI breakpoints (2022). Carbapenemases were detected by the carbapenem inactivation method (CIM) and quantitative real-time PCR (qRT-PCR). Results: Rectal swab samples were obtained from 376 patients. Of 178 isolates growing on the CRE screening agar, 140 isolates were confirmed as Enterobacterales of which 118 (84.3%) isolates were resistant to meropenem and/or ertapenem. CIM and PCR showed that 90/118 (76.3%) were carbapenemase producers. Overall, 83/367 (22.6%) were colonized by CPE. Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae complex were the most common CPE detected, with NDM as the predominant carbapenemase (78/90; 86.7%). Phenotypic resistance to meropenem was the best predictor of CPE production (sensitivity 85.6%, specificity 100%) compared with ertapenem resistance (95.6% sensitivity, 36% specificity). CIM was 100% concordant with PCR in detecting carbapenemases. Conclusions: These findings underscore the effectiveness of meropenem resistance as a robust indicator of the production of carbapenemases and the reliability of the CIM method to detect such carbapenemases in resource-limited settings where the performance of molecular methods is not possible.

Impact of long COVID-19 on posttraumatic stress disorder as modified by health literacy: an observational study in Vietnam.

BACKGROUND: The prevalence of posttraumatic stress disorder (PTSD) has increased, particularly among individuals who have recovered from coronavirus disease 2019 (COVID-19) infection. Health literacy is considered a "social vaccine" that helps people respond effectively to the pandemic. We aimed to investigate the association between long COVID-19 and PTSD, and to examine the modifying role of health literacy in this association. METHODS: A cross-sectional study was conducted at 18 hospitals and health centers in Vietnam from December 2021 to October 2022. We recruited 4,463 individuals who had recovered from COVID-19 infection for at least 4 weeks. Participants provided information about their sociodemographics, clinical parameters, health-related behaviors, health literacy (using the 12-item short-form health literacy scale), long COVID-19 symptoms and PTSD (Impact Event Scale-Revised score of 33 or higher). Logistic regression models were used to examine associations and interactions. RESULTS: Out of the study sample, 55.9% had long COVID-19 symptoms, and 49.6% had PTSD. Individuals with long COVID-19 symptoms had a higher likelihood of PTSD (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.63-2.12; p<0.001). Higher health literacy was associated with a lower likelihood of PTSD (OR, 0.98; 95% CI, 0.97-0.99; p=0.001). Compared to those without long COVID-19 symptoms and the lowest health literacy score, those with long COVID-19 symptoms and a 1-point health literacy increment had a 3% lower likelihood of PTSD (OR, 0.97; 95% CI, 0.96-0.99; p=0.001). CONCLUSION: Health literacy was found to be a protective factor against PTSD and modified the negative impact of long COVID-19 symptoms on PTSD.

Strong Negative Association between Cesarean Delivery and Early Initiation of Breastfeeding Practices among Vietnamese Mothers-A Secondary Analysis of the Viet Nam Sustainable Development Goal Indicators on Children and Women Survey.

Early initiation of breastfeeding (EIBF) involves feeding a newborn with the mother's breast milk within the first hour of delivery. The prevalence of EIBF in Vietnam has recently shown a downward trend. The present study aimed to demonstrate the current prevalence of EIBF practices and identify factors associated with EIBF among Vietnamese mothers with children under 24 months of age. This study was a secondary analysis of data from the Viet Nam Sustainable Development Goal Indicators on Children and Women (SDGCW) survey 2020-2021. The study participants included 1495 mothers extracted from the SDGCW dataset. Descriptive statistics and logistic regression analyses were performed. The prevalence of EIBF practice was 25.5% among all mothers, 31.9% among vaginal-delivery mothers groups, and 9.0% among cesarean-section mothers groups. Factors negatively associated with EIBF were younger age (0.18 times), cesarean delivery (0.25 times), and absence of skin-to-skin contact with newborns immediately after birth (0.43 times). The prevalence of EIBF among Vietnamese mothers was found to be substantially low, especially among those who underwent cesarean delivery. EIBF should be promoted among younger mothers and those who underwent cesarean delivery.

The Asthma Control Test (ACT) as an alternative tool to Global Initiative for Asthma (GINA) guideline criteria for assessing asthma control in Vietnamese outpatients.

AIMS: To determine the reliability and validity of the Asthma Control Test (ACT) to detect Global Initiative for Asthma (GINA)-defined uncontrolled or partly controlled asthma, and to determine the agreement between ACT and GINA in classifying asthma control among Vietnamese patients. METHODS: A cross-sectional study was performed in 323 of 360 invited outpatients with asthma in Ho Chi Minh City to compare the ACT and GINA classification for asthma control. RESULTS: Internal consistency of the ACT (Cronbach's alpha) was 0.83. The kappa coefficient of 0.55, based on the ternary split, represents moderate agreement between the two rating systems with a correctly classified rate of 75%. The area under the receiver operating characteristics curve for the ACT score predicting GINA control was 0.85. To detect GINA-defined 'not controlled asthma', the ACT had a sensitivity of 70%, specificity of 93%, and a positive predictive value of 89%, with a cut-off point of 19. The validity of the ACT with regard to agreement with the GINA classification was consistent across both sexes, but less so in adolescents or younger adults. The ACT score was significantly correlated with the percentage predicted forced expiratory volume in 1 second (r=0.35, p<0.001) and percentage predicted peak expiratory flow (r=0.26, p<0.001). CONCLUSIONS: The Vietnamese ACT is useful for identifying outpatients with GINA-defined uncontrolled or partly controlled asthma.

Allergic rhinitis and its impact on asthma update (ARIA 2008)--western and Asian-Pacific perspective.

The prevalence of allergic diseases such as allergic rhinitis (AR) and asthma is markedly increasing worldwide as societies adopt western life styles. Allergic sensitization is an important risk factor for asthma and AR, and asthma often co-exists with AR. An estimated 300 million people worldwide have asthma, about 50% of whom live in developing countries and about 400 million people suffer from AR. Yet, AR is often under-diagnosed and under-treated due to a lack of appreciation of the disease burden and its impact on quality of life, as well as its social impact at school and at the workplace. However, AR with or without asthma is a huge economic burden. Thus, there was clearly a need for a global evidence-based document which would highlight the interactions between the upper and lower airways including diagnosis, epidemiology, common risk factors, management and prevention. The Allergic Rhinitis and its Impact on Asthma (ARIA) document was first published in 2001 as a state-of-the-art guideline for the specialist, the general practitioner and other health care professionals. Subsequent new evidence regarding the pathomechanisms, new drugs and increased knowledge have resulted in the publication of the ARIA 2008 update. The present review summarizes the ARIA update with particular emphasis on the current status of AR and asthma in the Asia-Pacific region and discusses the Western and Asian perspective.