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Transforaminal percutaneous endoscopic lumbar discectomy (TPELD) recently confirms its superiority compared to typical open discectomy in the treatment of very high-grade migrated disk herniation. In Vietnam, this technique has been applied in recent years; however; lack of reports and evidence. Objectives: In this study, the authors would like to share their surgical experience and report the initial results in their center, after successfully performing TPELD for very high-grade migrated disk herniation in 40 patients. Patients and methods: Forty patients, who underwent TPELD to remove the nucleus of very high-grade migrated disk herniation, were enrolled in this study. The study was carried out from April 2019 to April 2021. Preoperative and postoperative MRI were compared to demonstrate the removed disk. Postoperative visual analog score, oswestry disability index, and modified Macnab criteria were obtained after 1 month, 6 months, and 1 year and were compared. Results: There were no major complications related directly to this technique. Seven patients were operated at L3-4, 28 patients at L4-5, and 5 patients at l5-S1. Mean visual analog score for leg pain improved from 7.36±0.64 preoperatively to 1.22±1.16 at 6 months postoperatively and 1.34±1.47 at 1 year postoperatively (P<0.01). The mean preoperative oswestry disability index improved from 67.1±8.79 preoperatively to 12.1±13.48 at 1 year postoperatively (P<0.01). Excellent or good global outcomes were obtained in 95%. Conclusions: TPELD is a minimally invasive treatment with effective and safe results of very high-grade migrated disk herniation. Improvement of several pain scores can be observed in the 12-month follow-up after surgery.
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Performing microsurgery with the support of navigation in falcine meningioma management shows significant impacts in short and middle-time follow-up, including unilaterally skull opening with smallest and nearest skin incision, lessen the surgical duration, limit blood transfusion and prevent tumours from recurrence. Materials and methods: Sixty-two falcine meningioma patients treated by microoperation applying neuronavigation were enroled from July 2015 to March 2017. Patients are evaluated before and 1 year after surgery according to The Karnofsky Performance Scale (KPS) for comparison. Results: Histopathology: the most common was fibrous meningioma with 32.26%; meningothelial meningioma was 19.35% and transitional meningioma was 16.13%. KPS I before surgery was 6.45% and after was 83.87%. KPS III who needed assistance in activities preoperation was 64.52% and postoperation was 1.61%. After surgery, there was no disabled patient. All patients were followed up a year after surgery and received MRI to evaluate the recurrence. After 12 months, there were three recurrent cases, accounted for 4.84%. Conclusions: Microsurgery under neuronavigation help brings significant improvement in patient's functional abilities and low recurrence of falcine meningiomas within 1-year post-surgery. Further studies with large sample size and longer follow-up duration should be performed to reliably evaluate safety and effectiveness of microsurgical neuronavigation in the management of the disease.
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BACKGROUND: Increased neutrophil extracellular trap (NET) formation and abundant NET-associated proteins are frequently found in the inflamed colon of patients with inflammatory bowel disease. Peptidyl arginine deiminase 4 (PAD4) activation is essential for the generation of NET and NET-mediated pathogenesis. However, the role of PAD4-dependent NET formation in murine inflammatory bowel disease models and the molecular mechanisms responsible for the altered gut barrier function are unknown. METHODS: Wild-type and Pad4 knockout (Pad4-/-) mice were administrated 3% dextran sulfate sodium (DSS) in their drinking water. Caco-2 monolayers were used to test the effect of NETs on intestinal barrier function and cytotoxicity. Histones were intrarectally administrated to wild-type mice to determine their effects on intestinal barrier function and cytotoxicity in vivo. RESULTS: PAD4 deficiency reduced the severity of DSS-induced colitis with decreased intestinal NET formation and enhanced gut barrier function and integrity in mice. NETs disrupted the barrier function in intestinal epithelial Caco-2 monolayers through their protein, rather than DNA, components. Pretreatment of NETs with histone inhibitors abrogated the effects on epithelial permeability. Consistent with these observations, adding purified histone proteins to Caco-2 monolayers significantly damaged epithelial barrier function, which was associated with the abnormal distribution and integrity of tight junctions as well as with increased cell death. Furthermore, intrarectal administration of histones damaged the intestinal barrier integrity and induced cytotoxicity in the mouse colon epithelium. CONCLUSIONS: PAD4-mediated NET formation has a detrimental role in acute colitis. NET-associated histones directly inhibit intestinal barrier function, resulting in cytotoxicity in vitro and in vivo.
Peptidyl arginine deiminase 4dependent neutrophil extracellular trap formation is detrimental to intestinal barrier function in acute colitis. Neutrophil extracellular trapassociated histones altered the integrity of tight junction and adherens junction proteins as well as induced intestinal epithelial cell death that resulted in increased gut epithelium permeability.
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Colite , Armadilhas Extracelulares , Doenças Inflamatórias Intestinais , Humanos , Animais , Camundongos , Armadilhas Extracelulares/metabolismo , Histonas/metabolismo , Células CACO-2 , Colite/induzido quimicamente , Doenças Inflamatórias Intestinais/patologia , Permeabilidade , Mucosa Intestinal/patologia , Modelos Animais de Doenças , Camundongos Endogâmicos C57BLRESUMO
OBJECTIVE: To evaluate the efficacy of bee venom acupuncture in humeroscapularis (PHS) patients. METHODS: One hundred and twenty patients diagnosed with PHS were assigned into four groups: BV1 (0.01 mg/kg), BV2 (0.005 mg/kg), BV3 (0.0025 mg/kg), and control group (vitamin B1 plus novocain 3% injection) with 15 d of treatment. The outcomes of the study including visual analogue scale (VAS) score and ß-endorphin, inflammatory cytokines including interleukin-10 (IL-10), IL-1ß and tumor necrosis factor α (TNF-α) and shoulder function score were assessed at baseline, after 10 and 15 d of treatment. RESULTS: All four groups reported statistically significant improvement in VAS score, motion range, and shoulder function score ( < 0.01), only the BV3 group showed significant increase of anti-inflammatory (IL-10) and decrease of pro-inflammatory (IL-1ß, TNF-α) cytokines after treatment ( < 0.05). The BV3 group presented a significant difference between all outcomes compared to the control and other groups. CONCLUSION: BV3 groups showed better recovery including reduced pain, improved motor function and normalized inflammatory cytokines than current therapy used in Vietnam and other groups.
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Terapia por Acupuntura , Venenos de Abelha , Periartrite , Humanos , Periartrite/terapia , Interleucina-10 , Fator de Necrose Tumoral alfa , Venenos de Abelha/uso terapêutico , CitocinasRESUMO
Minimally invasive transforaminal lumbar interbody fusion has proven effectiveness in treating spondylolisthesis, but there were few reports applying the technique from scarce resourcing developing countries. In this study, the authors report the results and share our experience of minimally invasive spinal transforaminal lumbar interbody fusion in spondylolisthesis treatment in Vietnamese patients. Materials and methods: In this study, the authors enroled 92 patients diagnosed with single-level, grade I or grade II lumbar spondylolisthesis from January 2019 to October 2022. Results: The median age in our study was 47.79±12.61 (range 15-75), the male/female ratio was 1/2.3. The mean disease duration was 28.57 months. Conventional X-ray images showed that there were 74 patients (80.43%) with spondylolisthesis grade I, 18 patients (19.57%) with grade II. Spondylolisthesis occured mainly in L4-L5 with 53 patients (57.61%). The isthmic sign was recorded in 16 patients (31.4%). The mean blood loss was 149.46 ml. Patients walked on average of 3.22 days after surgery. VAS score reduced significantly in both back and leg. Spinal function improved significantly with a preoperative Owestry Disability Index of 48.18% decrease to 15.18% 12 months after surgery. The surgical results were good and excellent at 95.00% after 12 months of surgery according to Macnab scale. The fusion rate reached 97.50%. Conclusions: The results of this Macnab's classification study show that minimally invasive spinal transforaminal lumbar interbody fusion is an effective treatment for spondylolisthesis with less pain, less blood loss after surgery, and high fusion rate.
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Introduction and importance: Cronkhite-Canada syndrome (CCS) is an extremely rare non-inherited syndrome first described in 1955 with only about 500 more cases reported so far. Since the aetiology of the disease remains unknown, there were no specific treatments in consensus. In many countries, CCS is a completely new condition that may confuse physicians at first encounter. Lessons should be learned from these cases by gastrointestinal specialists to be aware of this condition in any circumstances. Case presentation: The authors reported a case study of a 45-year-old Vietnamese male with CCS diagnosis, which encountered at our centre for the first time. Clinical discussion: The definitive diagnosis was provided by combining clinical characteristics, and endoscopic and histopathologic features, after excluding other causes of gastrointestinal polyposis. The patient responds to corticosteroids, proton pump inhibitors, and nutritional support right after treatment. After 1 year of treatment, his symptoms ameliorated completely although colon polyps insignificantly reduced. Conclusion: Gastroenterologists should always be aware of patients with CCS with the following symptoms: gastrointestinal hamartomatous polyps, diarrhoea, and the dermatologic triad of alopecia, hyperpigmentation, and onychodystrophy.
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Introduction: Endogenous endophthalmitis-related Klebsiella pyogenic liver abscess is a rare complication of metastatic infection. In most cases, visual acuity results are often impaired, even blind, and even with aggressive treatment with topical antibiotics, the final results are unsatisfactory. The objective of this study is to retrospectively based on medical records to describe clinical features, risk factors, and visual outcomes of patients with endogenous endophthalmitis-related pyogenic liver abscesses. Methods: We reported a case series of 12 endogenous endophthalmitis-related pyogenic liver abscess patients from March 2021 to 2023. All cases of endogenous endophthalmitis were diagnosed at admission or during the hospital stay. Results: From the medical records of 588 pyogenic liver abscess patients, we found 12 cases of endogenous endophthalmitis with 2.0%. The result showed a mean age of 61.5 ± 12.0 (41-78), diabetes mellitus (7 of 12), right lobe (7 of 12), single abscess (9 of 12), and the mean largest abscess diameter of 5.8 ± 1.7 cm (3.3-9). All patients had ocular symptoms such as eye pain (9 of 12), pus discharge (3 of 12), hypopyon (1 of 12), swollen eyelids (2 of 12), and corneal edema (2 of 12), pyogenic liver abscess before endogenous endophthalmitis (10 of 12), the median interval between endogenous endophthalmitis and pyogenic liver abscess 6.1 ± 1.9 days, ocular symptoms before diagnosis endogenous endophthalmitis 4.4 ± 2.3 days. All affected eyes were injected intravitreously with ceftazidime, amikacin, and vancomycin. Two patients underwent evisceration. Conclusions: Endogenous endophthalmitis has permanent morbidity, reducing visual acuity, poor quality of life, and lacks the warning signs, so it is essential for early detection of symptoms and referral to ophthalmologists.
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Current WHO-recommended diagnostic tools for tuberculosis infection (TBI) have well-known limitations and viable alternatives are urgently needed. We compared the diagnostic performance and accuracy of the novel QIAreach QuantiFERON-TB assay (QIAreach; index) to the QuantiFERON-TB Gold Plus assay (QFT-Plus; reference). The sample included 261 adults (≥ 18 years) recruited at community-based TB case finding events. Of these, 226 underwent Tuberculin Skin Tests and 200 returned for interpretation (TST; comparator). QIAreach processing and TST reading were completed at lower-level healthcare facilities. We conducted matched-pair comparisons for QIAreach and TST with QFT-Plus, calculated sensitivity, specificity and area under a receiver-operating characteristic curve (AUC), and analyzed concordant-/discordant-pair interferon-gamma (IFN-γ) levels. QIAreach sensitivity and specificity were 98.5% and 72.3%, respectively, for an AUC of 0.85. TST sensitivity (53.2%) at a 5 mm induration threshold was significantly below QIAreach, while specificity (82.4%) was statistically equivalent. The corrected mean IFN-γ level of 0.08 IU/ml and corresponding empirical threshold (0.05) of false-positive QIAreach results were significantly lower than the manufacturer-recommended QFT-Plus threshold (≥ 0.35 IU/ml). Despite QIAreach's higher sensitivity at equivalent specificity to TST, the high number of false positive results and low specificity limit its utility and highlight the continued need to expand the diagnostic toolkit for TBI.
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Tuberculose Latente , Tuberculose , Adulto , Humanos , Teste Tuberculínico , Vietnã/epidemiologia , Tuberculose/diagnóstico , Tuberculose Latente/diagnóstico , Bioensaio , Interferon gamaRESUMO
Background: Neuronavigation has been applied in neurocenters to help neurosurgeons plan the way to resect tumor totally and decline the neuro-injuries. This study aims to initially evaluate the result of microsurgery applying neuronavigation in treating falcine meningioma, which has not been reported comprehensively in Vietnam. Materials and methods: This cross-sectional study enrolled 62 patients diagnosised with falcine meningioma and treated by applying neuronavigation in operation in Neurosurgery Department of Military Hospital 103 and Viet Duc University Hospital from July 2015 to March 2017. Patients were assessed complications as well as residual lesions. Evaluate surgical results when discharging from hospital according to Ojemann MD standard. Results: Mean tumor volume was 67.37 ± 66.61 cm³ (range 6-370 cm³). Unilateral access site was the most common with 85.48%. Mean surgery duration was 209.84 ± 70.86 min. There were 27 out of 62 patients (43.55%) need blood transfusion in surgery. Tumor volume had an impact on blood transfusion in operation with p = 0.002. 82.26% of patients had total resection (Simpson I,II). There were 4.84% of patients having haemorrhage and 3 patients (4.84%) had wound infection after operation. Short-term outcome was evaluated according to Ojemann MD standard: good outcome was 67.74%, medium 17.74%, and poor outcome 14.52%. Conclusions: The application of neuronavigation and microsurgery enables surgeons to access falcine meningiomasare exactly, lessen the surgery duration, limit blood transfusion and complications after operation.
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Background and Aims: Virtual magnifying chromoendoscopy with flexible spectral imaging color enhancement (FICE), image-enhanced endoscopy techniques, and dye-staining magnifying chromoendoscopy (with Indigo carmine and Crystal violet) have contributed to better visualization of the pit pattern and vascular structure of colorectal polyp. Therefore, magnifying chromoendoscopy is capable of predicting the histopathological results of colorectal polyp without biopsy and remains their diagnostic values over time, especially in scare-setting resources. This study compared the images of magnifying chromoendoscopy between FICE, Indigo carmine, and Crystal violet and then assessed their diagnostic values based on colorectal polyps' histopathology as a gold standard. Methods: A total of 332 polyps of 266 patients were endoscopically evaluated from June 2016 to September 2019. After identified by white light endoscopy, polyps continued to be evaluated by virtual magnifying chromoendoscopy (×50-150 times) with FICE. The capillary-vessel pattern was divided into 5 subtypes according to the number, morphology, and distribution of the fine blood vessels according to Teixeira classification. Next, they were stained with Indigo carmine 0.2% and then Crystal violet 0.05% and were classified according to Kudo's pit pattern classification. Finally, polyps were resected by endoscopy or surgery and biopsy and compared with histopathological results of either neoplastic or nonplastic polyp. Results: The number of neoplastic polyps was 278/332 with 231 adenoma polyps and 47 carcinoma polyps. Magnifying chromoendoscopy has high sensitivity and accuracy when compared with the histopathological results of colorectal polyps. The sensitivity, specificity, and accuracy of magnifying chromoendoscopy with Crystal violet are 97.2%, 72.2%, and 93.0%; with Indigo carmine are 96.0%, 72.2%, and 92.1%; and with FICE are 92.1%, 68.5%, and 88.3%. Conclusions: Among the three methods, Crystal violet has the highest sensitivity and accuracy in predicting histopathological results of colorectal polyps. FICE has shown its diagnostic value with reliable sensitivity and accuracy and should still be a reasonable endoscopic choice for physicians in scare-setting resources regardless its moderate specificity. Physicians should base on their facility and capability to determine an appropriate endoscopy technique.
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Background: Both free medial sural artery perforator flaps and pedicled medial sural artery perforator flaps have been being effectively used in treatment of body defects especially in head and neck region by plastic surgeons worldwide. However, there is a lack of comprehensive studies on the anatomy of perforating artery branches in Vietnam. This study aims to describe anatomical vascular pedicles of medial sural artery perforator flap in Vietnamese adults . Methods: A descriptive cross-sectional study, dissected 62 lower limbs of 41 Vietnamese adult cadavers preserved by formalin in Department of Anatomy, Hanoi Medical University and Ho Chi Minh Medicine and Pharmacy University. Results: Origin of medial sural artery was branched constantly from popliteal artery. Common stem of artery was 8.39 ± 3.5 cm in mean length. The diameter of common stem, which was measured from origin, was 2.88 ± 0.98 mm averagely. The common stem of artery, which did not have any branch (15%), divided in to 2 branches (15%), 3 branches (30%), 4 branches (40%) before entering muscle. Medial sural artery had 1 to 5 branches perforating to the skin. The distance from perforating branch to the knee joint (popliteal crease) was 10.12 ± 3.7 cm, the distance from perforator branch to middle posterior leg was 1.6 ± 0.96 cm. Conclusions: The medial sural artery constantly originates from popliteal artery, supplies blood for medial gastrocnemius muscle. The skin area covering this muscle is nourished by one of five perforators of the medial sural artery. The perforating flaps can be created using medial sural artery perforating branches.
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Background: Despite its well-known effectiveness in vertebral compression fractures (VCFs), kyphoplasty could also bring the risk of developing subsequent VCFs post-augmentation, especially at adjacent vertebrae, which has been rarely reported in Asian countries. Methods: In this cross-sectional study, we performed cement augmentation on 69 vertebrae in 65 patients at the Spine Surgery Department, Viet Duc University Hospital, from June 2019 to November 2020. Cement augmentation was performed on 69 vertebrae in 65 patients. They then were followed and assessed for subsequent VCFs every 3, 6, 9 months after surgery. Results: 69 vertebrae in 65 patients were treated by kyphoplasty, 2 patients had 2 vertebrae treated and only one patient had 3 vertebrae injected. The average age recorded was 72 ± 8 years old. The average amount of cement injected was 5.4 ± 1.4 ml per vertebrae. At the end of the study, 63 patients did not develop subsequent VCFs. Two patients (3.07%) had new VCFs post-augmentation within the first two-month period post-injection. Age, gender, history of steroid injection and number of vertebrae treated with kyphoplasty showed no significant difference between the two groups. Conclusions: Kyphoplasty is an effective pain-reliving treatment for patients with osteoporotic VCFs and would pose no threats to subsequent VCFs. For patients developing abnormal acute pain within the period of two months, further examinations and MRI scan should be performed to detect subsequent VCFs in time.
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Aim: To determine several clinical and laboratory features as well as the bacterial profile of spontaneous bacterial peritonitis (SBP) in 58 Vietnamese patients admitted to a single center due to liver cirrhosis. Methods: We retrospectively analyzed bacteriological, clinical and laboratory characteristics of patients with SBP admitted to the Gastroenterology and Hepatology Center from July 2019 to July 2020. Results: Out of a total 58 SBP patients, 41 (70.9%) had culture-negative neutrocytic ascites. The majority of patients experienced abdominal pain (93,1%) and large ascites (65,5%). Gram-negative bacteria formed the main pathogens (14/17). Escherichia coli (9/17) was the predominant cause followed by Burkholderia cepacia (2/17). Antibiotic sensitivity rate of E. coli for third generation cephalosporin was low but high for aminoglycoside and carbapenem antibiotics. The resistance of E. coli was significant against fluoroquinolones (100%). All 3 cases of gram-positive bacteria were sensitive to vancomycin. Conclusion: Our study reported the bacteriological and clinical characteristics of patients with SBP and compared these findings between two groups: positive ascitic fluid culture and negative fluid culture. Ascitic fluid culture can guide for the right antibiotic choice since resistance to commonly prescribed antibiotics is common in SBP patients.
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With the development of digital technology, Vietnam's education has been undergoing significant changes. This is considered one of the eight important fields of the National Digital Transformation, so it needs to take advantage of opportunities to be able to train high-quality human resources according to international standards. Beside, the Covid-19 pandemic has quickly put pressure on the previously predicted trends in education such as the "Future University". This paper shows the data of an investigation on the factors affecting the readiness of Vietnamese students for digital transformation in the above context. The data is built based on the TAM model and sociological investigation method to collect multidimensional information from many perspectives of different individuals to have a basis for assessing the level of influence. The survey includes the main questions corresponding to the independent variables in the model: Self-study ability, Attitude, Perceived Usefulness, Perceived Ease of Use, and Covid-19. The authors distributed the questionnaire online and collected 913 valid responses.
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INTRODUCTION: Neurogenic tumors in the mediastinum account for approximately 20-30% of all types of mediastinal tumors in adults. This pathology is usually benign and has no or very few symptoms. Schwannoma rarely involves the phrenic nerve. We report a unique case of schwannoma involvement of phrenic nerve. Case Presentation. The 43-year-old female patient has an annual check-up of computerized tomography to detect the mass in the right middle mediastinum, so the patient was admitted to the hospital. Chest computerized tomography image found a mass of the middle mediastinum with the size of 23 × 22.3 mm located between the right pulmonary artery and the pericardium with uniform margins and clear boundaries, not invading the surrounding organization. Very little contrast is absorbed after injection. She underwent a uniportal video-assisted thoracoscopic surgery, and this mass was found to be originating from the right phrenic nerve. Resection of the portion of phrenic nerve with mass was performed. Postoperatively, the patient was discharged from the hospital after 4 days of treatment in a clinical condition with no difficulty breathing and no chest pain; postoperative X-ray showed no abnormality, and the right diaphragm was unchanged. CONCLUSION: Although they are very rare, schwannomas of the phrenic nerve should be considered in the differential diagnosis of mediastinal tumors. Uniportal video-assisted thoracoscopic surgery is a preeminent option with properly sized tumors that deliver good results and have no postoperative complications associated with surgery.
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OBJECTIVE: Nonintubated uniportal video-assisted thoracoscopic surgery (VATS) is a recent controversial procedure in many countries. Hence, the authors would like to present the experience in performing this approach and evaluate its initial results in the treatment, particularly, of intrathoracic diseases in Vietnam. METHODS: A prospective, descriptive study was conducted on 17 patients with intrathoracic diseases treated with nonintubated uniportal VATS from February to July 2019. Preoperative, intraoperative, and postoperative parameters were gathered and analyzed by SPSS Statistics, Version 18.0. RESULTS: Patients had an average age of 49.2 ± 20.5 (range 6 to 71) years. Regarding operative indications and methods, there were 3 ground glass opacity (17.6%) and 1 bullous lung disease receiving wedge resection (5.9%); 8 mediastinal tumors (47.1%) having resection, and 5 non-small-cell lung cancers receiving lobectomy combined with node dissection (29.4%). The average operative time and pleural drainage time were 108.6 ± 28.17 min (range 60 to 160) and 3.7 ± 1.18 days (range 2 to 8), respectively. The average hospitalization time was 4.9 ± 1.76 (range 3 to 12) days. No mortalities or major complications were recorded postoperatively. CONCLUSIONS: Nonintubated uniportal VATS is a safe and considerable surgical choice for appropriate intrathoracic conditions.
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Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Adolescente , Adulto , Idoso , Criança , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Vietnã/epidemiologia , Adulto JovemRESUMO
The size, shape and structure of iron particles in iron electrode influence the electrochemical properties of Fe/air cells. In order to improve the electrochemical performance of Fe/air cells, an attempt has been made successfully to synthesize iron oxide particles with different surface morphologies and have been used as negative electrodes. Fe2O3 nanoparticles were synthesized by hydrothermal method, in which their different morphologies viz., hollow spheres, tubes and plates have been controlled by the concentration of precursors. All the results showed better cycleability, good discharge capacity of synthesized Fe2O3 exhibited improved performance compared to commercial Fe2O3. Among the synthesized Fe2O3, hollow sphere provided the highest discharge capacity.
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Epidural abscess after obstetric epidural anesthesia occurs infrequently and may result in severe morbidity. We report a clinical case of an epidural abscess in Vietnam. A 31-year-old woman who was in labor was admitted to our hospital and given epidural anesthesia indicated to relieve labor pain. After three hours of anesthesia, cesarean section was indicated for the patient due to signs of fetal failure, the epidural catheter was then used to relieve pain for the first 48 hours postoperatively. On post-partum day 5 she presented with high fever of 39-40°C, fatigue, stimulation, dyspnea, and lumbar pain. The patient then suffered from sepsis and lower limb paralysis. She was diagnosed with epidural abscess based on the MRI of the lumbar spine. The abscess was treated by surgery for draining and appropriate antibiotics with a satisfactory outcome as she completely recovered her motor function and stable health status.
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This study is aimed at examining the sociodemographic factors associated with the utilization of labor epidural analgesia at a large obstetric and gynecology hospital in Vietnam. This was a cross-sectional study of women who underwent vaginal delivery in September 2018 at the Hanoi Obstetrics and Gynecology Hospital. The utilization of epidural analgesia during labor was determined. Univariate and multivariate regression models were applied to evaluate the association between patient demographic and socioeconomic factors and request for labor epidural analgesia. A total of 417 women had vaginal deliveries during the study period. 207 women utilized epidural analgesia for pain relief during labor, and 210 did not. Parturients older than 35 years of age (OR 2.84, 95% CI 1.11-8.17), multiparous women (OR 2.8 95% CI 1.85-4.25), women living from an urban area, women with higher income (OR 6.47, 95% CI 2.59-19.23), and women with higher level of education were more likely to utilize labor epidurals. Factors related to a parturient request for epidural analgesia during labor at our tertiary obstetric hospital included age greater than 35 years, multiparity, and high income and education levels. Educational outreach to women about the benefits of epidural analgesia can target women who do not share these demographic characteristics.
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Analgesia Epidural/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Gravidez/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Paridade , Fatores Socioeconômicos , Vietnã/epidemiologia , Adulto JovemRESUMO
Although the endoscopic disconnection surgery for the hamartomas was previously shown as a safe and effective treatment strategy in eliminating gelastic epilepsy, to date, there was no convincing evidence with this procedure in the resource-scare settings. We discuss an unusual case of a 7-year-old child who suffered from pharmacoresistant gelastic seizures was surgically treated with the endoscopic disconnection of the hypothalamic hamartomas. The patient underwent endoscopic surgery through the left ventricle approach to disconnect the lesion of the hypothalamus. Immediately after surgery, the patient's clinical laughter was eliminated with no complications. From the initial experience at our center, successful outcome of this case contributes to supporting the solid evidence in choosing the right treatment approach for the hypothalamus in subsequent cases, towards not only Vietnam but also the countries having similar resource-scare conditions.