Development and validation of a new measurement instrument to assess internship experience of medical doctors in low-income and middle-income countries.

Routine surveys are used to understand the training quality and experiences of junior doctors but there are lack of tools designed to evaluate the training experiences of interns in low-income and middle-income countries (LMICs) where working conditions and resource constraints are challenging. We describe our process developing and validating a 'medical internship experience scale' to address this gap, work involving nine LMICs that varied in geographical locations, income-level and internship training models. We used a scoping review of existing tools, content validity discussions with target populations and an expert panel, back-and-forth translations into four language versions and cognitive interviews to develop and test the tool. Using data collected from 1646 interns and junior medical doctors, we assessed factor structure and assessed its reliability and validity. Fifty items about experiences of medical internship were retained from an initial pool of 102 items. These 50 items represent 6 major factors (constructs): (1) clinical learning and supervision, (2) patient safety, (3) job satisfaction, (4) stress and burnout, (5) mental well-being, and (6) fairness and discrimination. We reflect on the process of multicountry scale development and highlight some considerations for others who may use our scale, using preliminary analyses of the 1646 responses to illustrate that the tool may produce useful data to identify priorities for action. We suggest this tool could enable LMICs to assess key metrics regarding intern straining and initial work experiences and possibly allow comparison across countries and over time, to inform better internship planning and management.

Genetic diversity of the oipA gene among Helicobacter pylori isolates and clinical outcome in Vietnam.

Outer inflammatory protein A (OipA), which is encoded by the oipA gene, can induce interleukin-8 secretion in gastric epithelial cells. The functional status of the oipA gene is regulated by the slipped-strand mispairing mechanism based on the CT dinucleotide repeat number in the 5' region. This study aimed to investigate the oipA functional status ("on/off") of Helicobacter pylori (H. pylori) and its association with gastroduodenal diseases in southwestern Vietnam. The cross-sectional study was conducted on 173H. pylori isolates from 173 patients with gastroduodenal diseases. Sanger sequencing was used to determine the functional status of oipA. Multivariable logistic regression analysis was performed to identify the association between oipA status and gastroduodenal diseases. The oipA "on" status accounted for 96% of H. pylori isolates. Twenty-five CT repeat patterns of the oipA 5' signal region were observed, five of which were novel CT repeat patterns. The oipA "on" status was found in 100%, 97.8%, and 86.8% of H. pylori isolates from patients with peptic ulcer, precancerous lesions, and chronic gastritis, respectively (p < 0.01). The oipA "on" status was related to gastric precancerous lesions versus chronic gastritis (adjusted OR = 7.39, 95% CI: 1.35-40.59, p = 0.021) and peptic ulcers versus chronic gastritis (adjusted OR = 12.79, 95% CI: 1.19-1760.32, p = 0.033). Our data show a high prevalence of the oipA "on" status, which was associated with precancerous gastric lesions and peptic ulcers. Moreover, genetic diversity in the number and pattern of CT dinucleotide repeat of oipA among Vietnamese H. pylori strains was identified.

Residual feed intake as a feed efficiency selection tool and its relationship with feed intake, performance and nutrient utilization in Murrah buffalo calves.

Residual feed intake (RFI) is the difference between the actual and expected feed intake of an animal based on its body weight and growth rate over a specific period. The objective of this study was to determine the RFI of buffalo calves using residuals from appropriate linear regression models involving dry matter intake (DMI), average daily gain (ADG) and mid-test metabolic body weight. Eighteen male Murrah buffalo calves of 5-7 months were selected and fed individually. A feeding trial using ad libitum feeding of total mixed ration (TMR, concentrate/roughage = 40:60) was conducted for 52 days in which the daily DMI, weekly body weight (BW) and growth rate of the calves were monitored. RFI of calves ranged from -0.20 to +0.23 kg/day. Mean DMI (in grams per kilogram of BW(0.75)) during the feeding trial period was significantly (P < 0.05) lower in low RFI group (79.66 g/kg BW(0.75)) compared to high RFI (87.74 g/kg BW(0.75)). Average initial BW, final BW and mid-test BW(0.75) did not differ (P > 0.05) between low and high RFI groups. Over the course of a trial period, low RFI group animals consumed 10% less feed compared to high RFI group of animals, yet performed in a comparable manner in terms of growth rate. Metabolizable energy for maintenance (MEm) was found to be significantly (P < 0.05) lower in low RFI group (13.54 MJ/100 kg BW) as compared to that of high RFI group (15.56 MJ/100 kg BW). The present study indicates that RFI is a promising selection tool for the selection of buffaloes for increased feed efficiency.

A multi-center randomised controlled trial of gatifloxacin versus azithromycin for the treatment of uncomplicated typhoid fever in children and adults in Vietnam.

BACKGROUND: Drug resistant typhoid fever is a major clinical problem globally. Many of the first line antibiotics, including the older generation fluoroquinolones, ciprofloxacin and ofloxacin, are failing. OBJECTIVES: We performed a randomised controlled trial to compare the efficacy and safety of gatifloxacin (10 mg/kg/day) versus azithromycin (20 mg/kg/day) as a once daily oral dose for 7 days for the treatment of uncomplicated typhoid fever in children and adults in Vietnam. METHODS: An open-label multi-centre randomised trial with pre-specified per protocol analysis and intention to treat analysis was conducted. The primary outcome was fever clearance time, the secondary outcome was overall treatment failure (clinical or microbiological failure, development of typhoid fever-related complications, relapse or faecal carriage of S. typhi). PRINCIPAL FINDINGS: We enrolled 358 children and adults with suspected typhoid fever. There was no death in the study. 287 patients had blood culture confirmed typhoid fever, 145 patients received gatifloxacin and 142 patients received azithromycin. The median FCT was 106 hours in both treatment arms (95% Confidence Interval [CI]; 94-118 hours for gatifloxacin versus 88-112 hours for azithromycin), (logrank test p = 0.984, HR [95% CI] = 1.0 [0.80-1.26]). Overall treatment failure occurred in 13/145 (9%) patients in the gatifloxacin group and 13/140 (9.3%) patients in the azithromycin group, (logrank test p = 0.854, HR [95% CI] = 0.93 [0.43-2.0]). 96% (254/263) of the Salmonella enterica serovar Typhi isolates were resistant to nalidixic acid and 58% (153/263) were multidrug resistant. CONCLUSIONS: Both antibiotics showed an excellent efficacy and safety profile. Both gatifloxacin and azithromycin can be recommended for the treatment of typhoid fever particularly in regions with high rates of multidrug and nalidixic acid resistance. The cost of a 7-day treatment course of gatifloxacin is approximately one third of the cost of azithromycin in Vietnam. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN67946944.

Study on the prevalence of Campylobacter spp. from chicken meat in Hanoi, Vietnam.

Campylobacter spp. is considered to be the most common bacterial cause of human gastroenteritis worldwide. In developing countries, Campylobacter spp. diarrhea is an important cause of childhood morbidity. Chicken meat is known to be a major source of Campylobacteriosis infection in the world. The purpose of this study was to investigate the prevalence of Campylobacter spp. in chicken meat. A total of 100 samples from breast part of chicken carcass were collected from retail market in Hanoi. The samples were taken for bacteriological analysis following the ISO 10272 standards. Thirty one samples (31%) were found positive for Campylobacter spp. The most frequently isolated Campylobacter was Campylobacter jejuni (45.2%) followed by Campylobacter coli (25.8%). Due to high contamination rates of retail chicken products, special attention must be paid to good manufacturing practices of food processors and vendors. Further studies should be done to assess the risk factors of Campylobacter spp. contamination in the Vietnamese fowl production chain.

Influence of different diets on growth performance, meat quality, and disease resistance in pig crossbreeds (PIE x MC-local) and PIE (LW x MC-local).

The present study evaluated the effect of different dietary formulations on the growth rate in pigs and their resistance to infection with hog cholera. Results indicate that growth rates can be enhanced by certain formulations and that there is a correlation between this increased growth rate and increased resistance to infection with hog cholera.