Determination of drug-related problems among type 2 diabetes outpatients in a hospital in Vietnam: A cross-sectional study.

INTRODUCTION: Drug-related problems (DRPs) are common in clinical practice and occur at all stages of the medication process. The major factor contributing to DRPs is prescription, although patients' poor adherence to treatment is also a significant factor. This study evaluated type 2 diabetes outpatients in a hospital in Vietnam for drug-related problems (DRPs) and related variables. METHODS: A cross-sectional descriptive study was conducted on 495 outpatients who met the criteria and 157 people agreed to participate in the interview. Medication order review and medication adherence review were used to identify DRPs. The types of DRP were based on the Pharmaceutical Care Network Europe (PCNE) categories version 9.0. The identification and assessment DRPs were carried out by clinical pharmacists and get agreed upon by physicians who had not directly prescribed patients who participated in the study. RESULTS: A total of 762 DRPs were identified via prescribing review process, the average number of DRP on each prescription was 1.54±1.07, while 412 DRPs were determined through patient interviewing. The most frequent DRPs were "ADR (Adverse Drug Reaction) occurring" (68.8%). The main causes were "patient is unable to understand instructions properly" or "patient is not properly instructed", "patient stores insulin inappropriately", "patient decides to use unnecessary drugs" and "patient intentionally uses/takes less drug than prescribed or does not take the drug at all for whatever reason" which accounted for 65.0%, 41.4%, 38.2%, and 28.7%, respectively. From the prescribing review, the most observed DRPs were "Inappropriate drug according to guidelines/formulary" and "No or incomplete drug treatment in spite of existing indication", accounting for 45.0% and 42.9%, respectively. There was a significant association between age (OR 3.38, 95% CI: 1.01-11.30), duration of diabetes (OR 3.61, 95%CI: 1.11-11.74), presence of comorbidity (OR 5.31, 95%CI: 1.97-14.30), polypharmacy (OR: 2.95, 95%CI: 1.01-8.72) and DRPs. In patients, poor knowledge of antidiabetic agents was the main reason to lack adherence and occurring ADR (OR 2.73, 95%CI: 1.32-5.66, p = 0.007 and OR 2.49, 95%CI: 1.54-4.03, p = 0.001 respectively). CONCLUSION: DRPs occurred in the prescribing stage and relating to patient's behavior of drug administration was high. Clear identification of DRPs and the associated factors are essential for building the intervention process to improve effectiveness and safety in the treatment of type 2 diabetes mellitus patients.

Leptospira infection among human-close-contact animals in different geographical areas in Vietnam.

Leptospirosis is a neglected disease in Vietnam. Only a few studies have evaluated the status of Leptospira infection in both humans and animals. To our knowledge, this is the first serological survey of Leptospira in both domestic and wild animals, which may act as reservoirs of this agent. This study aimed to evaluate the seroprevalence of Leptospira in animals that are in close contact with humans in different geographical areas in Vietnam. Sera were collected from 1205 individual animals of six species, including buffaloes, cattle, cats, dogs, swine, and rats. The microscopic agglutination test (MAT) against 25 serovars of Leptospira spp. has been employed to detect serovars of Leptospira among the studied population. Overall, 44.2% of buffaloes, 24.9% of cattle, 10.2% of swine, 32.9% of dogs, 12.2% of cats, and 16% of rats were seropositive. A total of 17 different serovars were detected, of which serovars Hebdomadis and Canicola circulated in all the studied animal species. Variability of the predominant serovars circulating in animal species and in different geographical areas of Vietnam has been noted. We conclude that this study showed a high prevalence of Leptospira circulating in animals that are in close contact with humans, raising an alert of the important sources of pathogenic leptospires transmission to humans in Vietnam. These findings prove an imperative need for effective measures for disease prevention.

Seroprevalence of leptospirosis and Japanese encephalitis in swine in ten provinces of Vietnam.

BACKGROUND: Leptospirosis is an important zoonotic disease with a global distribution, affecting a wide range of mammalian animals and humans. Japanese encephalitis (JE) virus is the major vector-borne zoonotic disease in the Asia-Pacific region. The main objective of this study was to evaluate the seroprevalence of serovar-specific Leptospira and JE in swine from 10 provinces in Vietnam. METHODS: Samples were initially collected for swine influenza surveillance from March to April 2017 at large-scale farms (with at least 50 sows and/or 250 fattening pigs) with pigs that tested positive for influenza in the previous surveillance period (2015-16). FINDINGS: A total of 2,000 sera samples were analyzed from 10 provinces. Overall, the seroprevalence of leptospirosis was 21.05% (95% CI: 19.28-22.90) using a cut-off titer of ≥ 1:100. The apparent prevalence of JE was 73.45% (95% CI: 71.46-75.37) while the true prevalence was slightly higher (74.46%, 95% credible interval: 73.73-86.41). We found a relatively high presence of leptospirosis and JE in pigs kept on large farms. Prevalence was comparable with other studies suggesting opportunistic testing of samples collected for other surveillance purposes can be a valuable tool to better understand and prevent the potential transmission of these zoonotic diseases from pigs to people in Vietnam. CONCLUSION: Our study provides evidence to veterinarians and animal health professionals for evidence-based practice such as diagnosis, vaccination and zoonotic control. Further investigation into the possible role of different domestic animals, wildlife species or environmental factors is needed to identify the potential risk factors and transmission routes in Vietnam.