Effects of Plasmapheresis on Serum Lithium Levels in an ICU Patient with Bipolar Disorder: A Case Study.

ABSTRACT: This is a case description of a patient with bipolar disorder undergoing lithium therapy who received plasmapheresis for neuromyelitis optica spectrum disorder. Plasmapheresis resulted in lower and subtherapeutic serum lithium levels. Using therapeutic drug monitoring, a dose escalation of 80% was necessary to maintain therapeutic serum lithium levels. This underscores the importance of individualized therapy through therapeutic drug monitoring.

Antimicrobial Resistance Pilot Surveillance of Pigs and Chickens in Vietnam, 2017-2019.

Antimicrobial use (AMU) and antimicrobial resistance (AMR) are a growing public health and economic threat in Vietnam. We conducted a pilot surveillance programme in five provinces of Vietnam, two in the south and three in the north, to identify antimicrobial resistance (AMR) in rectal swab samples from pigs and fecal samples from chickens at slaughter points during three different points in time from 2017 to 2019. Escherichia coli (E. coli) and non-typhoidal Salmonella (NTS) isolates were tested for antimicrobial susceptibility using disk diffusion assay for 19 antimicrobial agents belonging to nine antimicrobial classes and Etest for colistin (polymyxin). Almost all E. coli (99%; 1029/1042) and NTS (96%; 208/216) isolates were resistant to at least one antimicrobial agent; 94% (981/1042) of E. coli and 89% (193/216) of NTS isolates were multidrug-resistant (MDR). Higher proportions of E. coli and NTS isolated from chickens were resistant to all antimicrobial classes than those isolates from pigs. There was a significantly higher proportion of MDR NTS isolates from the southern provinces of Ho Chi Minh City and Long An (p = 0.008). Although there were increasing trends of NTS in proportion of resistance to fluoroquinolone over the three surveillance rounds, there was a significant decreasing trend of NTS in proportion of resistance to polymyxin (p = 0.002). It is important to establish an annual AMR surveillance program for livestock in Vietnam to assess the impact of interventions, observe trends and drive decision making that ultimately contributes to reducing AMR public health threat.

Factors controlling accumulation of organic carbon in a rift-lake, Oligocene Vietnam.

Understanding of the processes of petroleum source rock (SR) accumulation in lacustrine rift basins and the behavior of lake systems as long-term carbon sinks is fragmentary. Investigation of an 800 m thick (500 m core and ~ 300 m outcrop), deep-lacustrine, Oligocene section in Vietnam, provides a rare insight into the controls and deposition of organic carbon (OC) and SR formation in continental rift basins. A multidisciplinary dataset, combining elemental data, inorganic and organic geochemistry with sedimentology, shows that the richest alginite-prone, sapropelic SR developed during periods of relative tectonic quiescence characterized by moderate primary productivity in a mainly dysoxic lacustrine basin. Increased rift activity and further development of graben morphology intensified water column stratification and anoxia, which hindered nutrient recycling. Sapropelic organic matter (OM) continued to accumulate, but with increasing amorphous OM content and decreasing total OC values. Periods of increased seasonality were characterized by thermocline weakening, enhanced mixing of water columns, increased primary productivity and diatom blooming. The results suggest that a change from dysoxia towards anoxia or extreme primary productivity does not necessarily enhance OC burial and SR quality. External nutrient input from a phosphate-rich hinterland is sufficient for sapropel formation, whereas the main limiting factor is methanogenesis.

Retrospective seroepidemiological study of chikungunya infection in South Asia, Southeast Asia and the Pacific region.

Chikungunya virus (CHIKV) and Ross River virus (RRV) of the genus Alphavirus, family Togaviridae are mainly transmitted by Aedes mosquitoes and the symptoms they cause in patients are similar to dengue. A chikungunya (CHIK) outbreak re-emerged in several Asian countries during 2005-2006. This study aimed to clarify the prevalence of CHIKV infection in suspected dengue patients in six countries in South Asia and Southeast Asia. Seven hundred forty-eight serum samples were from dengue-suspected patients in South Asia and Southeast Asia, and 52 were from patients in Fiji. The samples were analysed by CHIKV IgM capture ELISA, CHIKV IgG indirect ELISA and focus reduction neutralization test against CHIKV or RRV. CHIK-confirmed cases in South Asia, particularly Myanmar and Sri Lanka, were 4·6%, and 6·1%, respectively; and in Southeast Asia, particularly Indonesia, the Philippines and Vietnam, were 27·4%, 26·8% and 25·0%, respectively. It suggests that CHIK was widely spread in these five countries in Asia. In Fiji, no CHIK cases were confirmed; however, RRV-confirmed cases represented 53·6% of suspected dengue cases. It suggests that RRV is being maintained or occasionally entering from neighbouring countries and should be considered when determining a causative agent for dengue-like illness in Fiji.

The molecular characterization of an Eimeria and Cryptosporidium detected in Asian seabass (Lates calcarifer) cultured in Vietnam.

An intestinal Eimeria was previously reported as a significant pathogen of Asian seabass (Lates calcarifer) in nurseries in Vietnam. In the present study, both Eimeria and Cryptosporidium were detected by sequence analyses of fragments of the 18S rRNA gene amplified from these Vietnamese L. calcarifer tissues. Based on these analyses, the Eimeria from the Vietnamese L. calcarifer formed clades with the Eimeria detected in L. calcarifer tissues from Australia, but clustered separately from other known Eimeria and Goussia species. The Cryptosporidium detected in L. calcarifer from Vietnam clustered closest with C. parvum and C. hominis. In situ hybridization using DIG-labeled DNA probes generated from 18S PCR products on the Vietnamese L. calcarifer wax block tissues showed that this method could not be used to distinguish between Eimeria and Cryptosporidium, due to the conserved nature of the 18S locus. A previously published study on the morphology of parasite developmental stages and oocysts in the Vietnamese L. calcarifer tissues showed only an intestinal Eimeria infection. The Cryptosporidium could be present at very low levels undetectable by microscopy in intestines, or being ubiquitous, was a possible contaminant from feed or water. While molecular analysis is a very useful tool in the study of disease and identification of aetiological agents, this study reiterates the importance of demonstrating organisms in situ in tissues.

An intestinal Eimeria infection in juvenile Asian seabass (Lates calcarifer) cultured in Vietnam--a first report.

This is the first report of an intestinal Eimeria infection in Asian seabass (Lates calcarifer) at the histopathological and ultrastructural levels. The Eimeria infection was often associated with severe pathology and significant mortality in the absence of other pathogens. This showed that it is an important disease of juvenile L. calcarifer in small scale nurseries in Vietnam. Heavy infection and high prevalence levels of the Eimeria infection are suspected to be linked to the low daily water exchange rates practised in these nurseries. Although systemic iridovirus infection was concurrently observed in some of the fish examined, it was not as consistently present in diseased fish as the Eimeria infection.

Comparison of Vietnamese and European pig breeds using microsatellites.

This study characterized autochthonous pig breeds of Vietnam and compared them with breeds from other regions. A total of 343 animals were considered from 5 indigenous pig breeds of Vietnam (Muong Khuong, Co, Meo, Tap Na, and Mong Cai), 2 exotic breeds kept in Vietnam (Landrace and Yorkshire), 3 European commercial breeds (German Land-race, Piétrain, and Large White), the Chinese breed Meishan, and the European Wild Boar. Each individual was genotyped for 20 selected polymorphic microsatellite loci. The Vietnamese autochthonous breeds showed higher degrees of polymorphism, allelic diversity, and heterozygosity than the other pig breeds. Also, large genetic diversity was observed across the area of distribution, with village-specific subpopulations, which led to significant inbreeding coefficients. As expected, genetic distances showed large differences among European-based, Chinese, and Vietnamese indigenous breeds and reflected the geographical distribution of breeds. In comparison with the European breeds, the Vietnamese indigenous pig breeds harbored a considerable amount of genetic diversity and, therefore, will be of significance for livestock bioconservation.

Comparative effect of dietary olive, safflower, and linseed oils on spontaneous liver tumorigenesis in C3H/He mice.

In male C3H/He mice, which frequently develop spontaneous liver tumorigenesis, 5 wk of age and weighing about 20 g, the comparative effects on liver tumor incidence from the feeding of olive oil (OLI), safflower oil (SAF), and linseed oil (LIS) diets for 50 wk, the concentrations of total cholesterol (T-CHOL), triacylglycerol (TG), lipid peroxides in the plasma and liver, and the activities of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the plasma were examined. The changes in body weight and liver weight were not different among dietary groups. The number of mice bearing liver adenoma was greater in the SAF group than in the OLI and LIS groups. Liver carcinoma was observed in the SAF group, but not in the OLI and LIS groups. The concentrations of T-CHOL in the plasma and liver were higher in the OLI group than in the other groups. TG levels in the plasma and liver were highest in the OLI group and followed in order by the SAF and LIS groups. The concentration of plasma lipid peroxide was higher in the LIS group than in the other groups. Liver lipid peroxide content was extremely high in the LIS group, medium in the SAF group, and low in the OLI group. The activity of AST was highest in the OLI group and followed in order by the SAF and LIS groups. ALT activity was higher in the OLI group than in the other groups. A positive relationship between spontaneous liver tumorigenesis and the concentrations of T-CHOL, TG, and lipid peroxide or AST and ALT activities was hardly observed. These results suggested that spontaneous tumorigenesis in the liver of male C3H/He mice bred for 50 wk was suppressed by being supplied with OLI and LIS, compared with SAF, which had no direct relation to the concentrations of T-CHOL, TG, and lipid peroxide in the plasma and liver and the activities of plasma AST and ALT.

Aroma-active compounds of miniature beefsteakplant (Mosla dianthera Maxim).

Volatile flavor compounds of miniature beefsteakplant (Mosla dianthera Maxim.) from Vietnam were analyzed through gas chromatography-mass spectrometry-olfactometry (GC-MS-O). Sixty-two compounds were identified by GC-MS. Of these, (+/-)-carvone and (+/-)-limonene were the most abundant, followed by (Z)-limonene oxide, beta-caryophyllene, and alpha-humulene. Twenty aroma-active compounds were detected by aroma extract dilution analysis conducted on two GC columns of different polarities (DB-5MS and DB-Wax). The most intense aroma-active compounds were linalool (floral/sweet/lemon), (-)-carvone (spearminty), and 1-octen-3-one (mushroom/earthy). Other predominant aroma-active compounds included (Z)-3-hexenol (grassy/leafy/metallic), (Z)-limonene oxide (lemon/floral), myrcene (plastic/sweet), (+)-limonene (orange/lemon), alpha-thujene (soy sauce/grassy), and (Z)-dihydrocarvone (spearminty/pepperminty). On the basis of the aroma characteristics and intensity, it was concluded that (-)-carvone was responsible for the characteristic aroma of miniature beefsteakplant.

Phase 1 and phase 2 studies of Salmonella enterica serovar paratyphi A O-specific polysaccharide-tetanus toxoid conjugates in adults, teenagers, and 2- to 4-year-old children in Vietnam.

Salmonella enterica serovar Paratyphi A O-specific polysaccharide (O-SP) was activated with 1-cyano-4-dimethylaminopyridinium tetrafluoroborate (CDAP) and bound to tetanus toxoid (TT) with adipic acid dihydrazide as a linker (SPA-TT(1)) or directly (SPA-TT(2)). In mice, these two conjugates elicited high levels of immunoglobulin G (IgG) anti-lipopolysaccharide (LPS) in serum with bactericidal activity (E. Konadu, J. Shiloach, D. A. Bryla, J. B. Robbins, and S. C. Szu, Infect. Immun. 64:2709-2715, 1996). The safety and immunogenicity of the two conjugates were then evaluated sequentially in Vietnamese adults, teenagers, and 2- to 4-year-old children. None of the vaccinees experienced significant side effects, and all had preexisting LPS antibodies. At 4 weeks after injection, there were significant increases of the geometric mean IgG and IgM anti-LPS levels in the adults and teenagers: both conjugates elicited a greater than fourfold rise in the IgG anti-LPS level in serum in >/=80% of the volunteers. SPA-TT(2) elicited slightly higher, though not statistically significantly, levels of IgG anti-LPS than did SPA-TT(1) in these age groups. Accordingly, only SPA-TT(2) was evaluated in the 2- to 4-year-old children. On a random basis, one or two injections were administered 6 weeks apart to the children. No significant side effects were observed, and the levels of preexisting anti-LPS in serum were similar in children of all ages. A significant rise in the IgG anti-LPS titer was elicited by the first injection (P = 0.0001); a second injection did not elicit a booster response. Representative sera from all groups had bactericidal activity that could be adsorbed by S. enterica serovar Paratyphi A LPS.

Safety and immunogenicity of Vi conjugate vaccines for typhoid fever in adults, teenagers, and 2- to 4-year-old children in Vietnam.

The capsular polysaccharide of Salmonella typhi, Vi, is an essential virulence factor and a protective vaccine for people older than 5 years. The safety and immunogenicity of two investigational Vi conjugate vaccines were evaluated in adults, 5- to 14-year-old children, and 2- to 4-year-old children in Vietnam. The conjugates were prepared with Pseudomonas aeruginosa recombinant exoprotein A (rEPA) as the carrier, using either N-succinimidyl-3-(2-pyridyldithio)-propionate (SPDP; Vi-rEPA(1)) or adipic acid dihydrazide (ADH; Vi-rEPA(2)) as linkers. None of the recipients experienced a temperature of >38.5 degrees C or significant local reactions. One injection of Vi-rEPA(2) into adults elicited a geometric mean (GM) increase in anti-Vi immunoglobulin G (IgG) from 9.62 enzyme-linked immunosorbent assay units/ml (EU) to 465 EU at 6 weeks; this level fell to 119 EU after 26 weeks. In the 5- to 14-year-old children, anti-Vi IgG levels at 6 weeks elicited by Vi-rEPA(2), Vi-rEPA(1), and Vi were 169, 22.8, and 18.9 EU, respectively (P = 0.0001 for Vi-rEPA(1) and Vi with respect to Vi-rEPA(2)). At 26 weeks, the anti-Vi IgG levels for recipients of Vi-rEPA(2), Vi-rEPA(1), and Vi were 30.0, 10.8, and 13.4 EU, respectively (P < 0.001 for Vi-rEPA(1) and Vi with respect to Vi-rEPA(2)); all were higher than the preinjection levels (P = 0. 0001). Vi-rEPA(2) also elicited the highest anti-Vi IgM and IgA levels of the three vaccines. In the 2- to 4-year-old children at 6 weeks following the first injection, Vi-rEPA(2) elicited an anti-Vi IgG level of 69.9 EU compared to 28.9 EU for Vi-rEPA(1) (P = 0.0001). Reinjection increased Vi antibody levels from 69.9 to 95.4 EU for Vi-rEPA(2) and from 28.9 to 83.0 EU for Vi-rEPA(1). At 26 weeks, anti-Vi IgG levels remained higher than those at preinjection (30.6 versus 0.18 for Vi-rEPA(2) and 12.8 versus 0.33 for Vi-rEPA(1); P = 0.0001 for both). Vi vaccine is recommended for individuals of 5 years of age or older. In the present study, the GM level of anti-Vi IgG elicited by two injections of Vi-rEPA(2) in the 2- to 4-year-old children was higher than that elicited by Vi in the 5- to 14-year-old children (30.6 versus 13.4; P = 0.0001). The safety and immunogenicity of the Vi-rEPA(2) conjugate warrant further investigation.

Predictors of visits to commercial sex workers by male attendees at sexually transmitted disease clinics in southern Vietnam.

OBJECTIVES: To determine the HIV/sexually transmitted disease (STD) status of male patients at STD clinics and factors associated with frequent visits to commercial sex workers (CSW) in southern Vietnam. DESIGN: Cross-sectional survey. METHODS: Confidential interviews and physical and laboratory evaluation of 804 male patients at STD clinics in two semi-rural provinces in the Mekong delta. RESULTS: HIV seroprevalence was 0.5%. The prevalence of urethritis syndrome was 19.3%, gonorrhea 10.2% (Gram-stain positive) and syphilis 2% (reactive rapid plasma reagin test). All the men had visited CSW in the past and 58% had their first sexual experience with a CSW; 73% had visited a CSW in the last 3 years. Married men were equally as likely as single men to have casual partners or to have visited a CSW. The men recruited CSW more from the streets (45%) than from brothels (38%). Factors independently associated with visiting a CSW in the last 3 years included being single [odds ratio (OR), 2.2], age under 20 years (OR, 1.9), having first sexual intercourse with a CSW (OR, 2.1), not having a current girlfriend (OR, 2.1), using alcohol before sex (OR, 2.7) and drug use (OR, 1.8). Only 7% of men used condoms consistently; 70% had never used them. Only 37% had used a condom last time they had intercourse with a CSW. CONCLUSIONS: Prevention programs for men in Vietnam, particularly those who are young or single, need to focus on reducing drug and alcohol consumption and improving condom use with CSWs.

HIV infection and risk factors among female sex workers in southern Vietnam.

OBJECTIVES: To determine the extent of HIV infection among female commercial sex workers (CSW), to identify risk factors, and to provide baseline data for developing and targeting prevention measures. SUBJECTS AND METHODS: A total of 968 female CSW were enrolled in a cross-sectional study from August 1995 to October 1996. Information was obtained from confidential face-to-face interview, physical examination, and laboratory testing. RESULTS: A total of 65.5% of female CSW reported inconsistent condom use. Overall seroprevalence was 5.2%. The highest seroprevalence (9.5%) was detected in An Giang province, a border area adjacent to Cambodia. Out of seven HIV isolates in An Giang province, six were characterized as Thai subtype E and one as subtype B. Multiple logistic regression analysis showed an independent significant association between HIV seroprevalence and the following: age < or = 30 years [odds ratio (OR), 5.1; 95% confidence interval (CI), 1.7-15.2]; high frequency of sex (> 20 times per week; OR, 13.5; 95% CI, 3.6-50.2); inconsistent condom use (OR, 2.8; 95% CI, 1.01-8.0; sign of genital ulcers (OR, 18.1; 95% CI, 1.8-182); venereal warts (OR, 9.0; 95% CI, 2.5-33.0); brothels as sex venue (OR, 7.0; 95% CI, 2.0-24.3); and working at the border area (OR, 5.1; 95% CI, 2.4-11.0). Brothels as work-sites were significantly related to inconsistent condom use and the socioeconomic background of clients. Only 0.5% of CSW reported injecting drug use. CONCLUSIONS: Female CSW at brothels who reported inconsistent condom use and ulcerous sexually transmitted disease, particularly in the border area with Cambodia, had greater risk of HIV infection. Brothels were more frequently used as sex venues in the border area and were more likely to be visited by occasional clients who were difficult to access. Drug use among female CSW in this region was rare. The development of prevention measures should be based on these results.

Human leptospirosis in the Mekong delta, Viet Nam.

To estimate the seroprevalence of human leptospirosis in the Mekong delta in Viet Nam, an epidemiological survey was conducted in the province of Tien Giang, which is representative of the socioeconomic activities of the region (rice growing and cattle breeding). A cross-sectional study included 35 clusters representing 1400 people randomly selected and aged 15-60 years. Sex, age, occupation, contact with animals, type of water supply, and individual habits were recorded. Leptospiral agglutinins were detected by the microagglutination test, with a battery of 22 live antigens representing the main pathogenic serogroups of Leptospira species and additional local strains. 263 sera (18.8%) gave positive results and 41 (2.9%) had a titre of agglutinins > or = 400, suggesting recent infection. No significant difference was found between females and males. The distribution of seroprevalence was homogeneous throughout the population studied, with the exception of the 15-25 years age group, in which leptospiral antibodies were less frequent. Fifteen serogroups were found, the most prevalent being Bataviae (21.7%), Panama (15.2%), Icterohaemorrhagiae (13.7%) and Australis (8.7%). No significant link between leptospiral seropositivity and professional activities or contacts with animals was found, indicating that leptospirosis in the Mekong delta may be considered as an environmentally linked disease. Leptospirosis is known to be endemic in south-east Asia, and these data demonstrated the high level of circulation of leptospires and the potential importance of leptospiral infections among the rural population in this area.

Sperm auto - antibodies and anti-nuclear antigen antibodies in chronic dioxin - exposed veterans.

The authors studied anti-nuclear antibodies (ANA) in 25 chronic dioxin - exposed veterans by IIF technics with Hep-2 cell line and sperm autoantibodies by agglutination test of Franklin-Dukes. The site of antibody binding on spermatozoon is detected by IIF test. The control group for ANA detection is 63 healthy persons of the same age as that of dioxin - exposed veterans and the control group for sperm autoantibodies is 36 healthy males of 28-63 years old, having 1-2 children. Obtained results show that the rate of ANA positive in veterans group is normal, and sperm auto-antibodies is also at normal range. The site of antibody binding on spermatozoon is predominantly head - head, rarely head - neck or tail - tail.