Outcomes of pregnant women hospitalized with unrepaired congenital heart disease: Insights from a multidisciplinary center in Vietnam.

Background: In developing countries, fewer women have access to multidisciplinary congenital heart disease and reproductive programs staffed by experts. We report pregnancy outcomes of a multidisciplinary healthcare strategy utilizing an in-hospital teamwork approach in Vietnam. Methods: This retrospective cohort study included pregnant women with unrepaired congenital heart disease managed at a referral cardiovascular center. Results: Undiagnosed congenital heart disease before pregnancy, a lack of pre-pregnancy cardiology counseling, and modified World Health Organization class III/IV were common. Under the multispecialty healthcare strategy, although the rate of maternal death was 8.2% in the modified World Health Organization class IV group, no deaths occurred in any other group. Fetal/neonatal complications occurred in 54% of pregnancies, and 49.4% of neonates survived. Poor pregnancy outcomes were associated with admission during the first/seconde trimester for fetus/neonates, third trimester for mother, modified World Health Organization class III/IV, cyanosis, and heart failure. Conclusion: The outcomes of pregnant women with unrepaired congenital heart disease were poor but seemed to improve with a multidisciplinary in-hospital healthcare teamwork strategy.

Efficacy of obstructive sleep apnea treatment by antileukotriene receptor and surgery therapy in children with adenotonsillar hypertrophy: A descriptive and cohort study.

Background: Prevalence of obstructive sleep apnea (OSA) in children with adenotonsillar hypertrophy is high and related to the occlusion of the upper airway. The main treatments of OSA in these children is adenotonsillectomy. However, this intervention is an invasive method with a various success rate. Thus, the indications of tonsillectomy remain debatable and non-invasive treatment is still a potential choice in these patients. Methods: It was a cross-sectional and interventional study. This study included children aged from 2 to 12 years-old who were diagnosed with OSA by respiratory polygraphy and had tonsillar hypertrophy with/without adenoid hypertrophy. All main data including age, gender, height, weight, body mass index (BMI), clinical symptoms, and medical history were recorded for analysis. Physical examination and endoscopy were done to evaluate the size of tonsillar and adenoid hypertrophy by using Brodsky and Likert classifications, respectively. The severity of OSA was done by using the classification of AHI severity for children. Results: There were 114 patients (2-12 years old) with a mean age of 5.5 ± 2.1 years included in the present study. The main reasons for consultations were snoring (96.7%), a pause of breathing (57.1%), an effort to breathe (36.8%), unrefreshing sleep (32%), doziness (28.2%), and hyperactivity (26.3%). There were 36% of subjects with tonsillar hypertrophy grade 1-2, 48.2% with grade 3, and 15.8% with grade 4 (Brodsky classification); among them, there were 46.5% of subjects with grades 1-2 of adenoid hypertrophy, 45.6% with grade 3, and 7.0% with grade 4 (Likert classification). The mean AHI was 12.6 ± 11.2 event/h. There was a significant correlation between the mean AHI and the level of tonsillar and adenoid hypertrophy severity (r = 0.7601 and r = 0.7903; p < 0.05 and p < 0.05, respectively). The improvement of clinical symptoms of study subjects was found in both groups treated with ALR (antileukotriene receptor) or ST (surgery therapy). The symptoms related to OSA at night including snoring, struggle to breathe, sleeping with the mouth open, and stopping breathing during sleep were significantly improved after treatment with ATR and with ST (p < 0.001 and p = 0.001, respectively). The mean AHI was significantly reduced in comparison with before treatment in study subjects treated with ALR (0.9 ± 1.0 vs. 3.9 ± 2.7 events/h; p = 0.001) or with ST (3.5 ± 1.4 vs. 23.4 ± 13.1 events/h; p < 0.001). Conclusion: The treatment of OSA due to adeno-tonsillar hypertrophy with ALR for moderate OSA or surgery for severe OSA might reduce the symptoms related to OSA at night and during the day.

Subtotal Laryngectomy with Epiglottic Reconstruction for Glottic Carcinoma: A Single Institutional Experience.

Aim: Laryngeal cancer is a common form of head and neck cancer in Vietnam where the current treatment is surgery. Subtotal laryngectomy with epiglottic reconstruction, a conservative surgery, allows removal of anterior commissure including thyroid cartilage and paraglottic space and provides a maximum restoration of the anatomical structure of the larynx. Purpose: To evaluate the results, the safety and effectiveness of patients who were treated with subtotal laryngectomy with epiglottic reconstruction. Material and Method: From January 2012 to July 2017, 42 patients (41 male, 1 female, median age 55.6 years, range 38-75 years) were diagnosed with glottic carcinomas at Vietnam National ENT Hospital, where they underwent a subtotal laryngectomy with epiglottic reconstruction. Results: Thirty-one patients (73.8%) had T2 glottic carcinoma, 4 (9.5%) T3 glottic carcinoma, and 12 (25.6%) had neck dissection. The arytenoid cartilage on the tumor-bearing side was resected in 11 patients (26.2%). Functional ipsilateral neck dissection was performed in 30 patients. Positive lymph node of stage T2 was 1/31 (3.2%). Postoperative histopathologic examination showed a tumour free of resection margin in 41 patients (97.6%). Only one post-operative complication occurred with bleeding 24 hours after surgery. There was no mortality. The 3- and 5-year overall survival rates were 97.6% and 85.7%, respectively. The rate of local control was 92.9%. Conclusion: Subtotal laryngectomy with epiglottic reconstruction was performed mostly for T2 and certain T3 glottic carcinomas when there is difficult to safely remove the tumour with transoral laser microsurgery. This surgery appears to be effective for the overall survival and has potential in clinical practice for treating moderate glottic carcinoma.

Clinical malaria and sickle cell disease among multiple family members in Chicago, Illinois.

Malaria is a disease of global importance and accounts for up to 500 million cases per year. Nearly all malaria cases in the United States occur among persons who have traveled to areas with ongoing malaria transmission. Among the cases of malaria reported in the United States in 2000-2005, 695 were in US residents under the age of 18 years. The association of malaria with the sickle cell hemoglobin is well described in Africa but is a rare occurrence in the United States. Here we report 5 cases of Plasmodium falciparum malaria in siblings of a family who had traveled to Africa without taking chemoprophylaxis. Two of the children had sickle cell anemia, and 1 of them developed severe life-threatening malaria and hemolysis. The 3 other siblings had sickle cell trait, 2 of whom had complicated malaria. Patients who have sickle cell disease and are infected with malaria are prone to hyperhemolytic crisis; therefore, this complication should be anticipated. The patients we describe emphasize the significance of prompt recognition of malaria and comorbidities and institution of appropriate treatment. The importance of antimalarial prophylaxis should be communicated to parents of children who are traveling to endemic areas as part of routine child care.

Malaria surveillance--United States, 2004.

PROBLEM/CONDITION: Malaria in humans is caused by any of four species of intraerythrocytic protozoa of the genus Plasmodium (i.e., P. falciparum, P. vivax, P. ovale, or P. malariae). These parasites are transmitted by the bite of an infective female Anopheles sp. mosquito. The majority of malaria infections in the United States occur among persons who have traveled to areas with ongoing malaria transmission. In the United States, cases can occur through exposure to infected blood products, congenital transmission, or local mosquitoborne transmission. Malaria surveillance is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers. PERIOD COVERED: This report summarizes cases in persons with onset of illness in 2004 and summarizes trends during previous years. DESCRIPTION OF SYSTEM: Malaria cases confirmed by blood film are mandated to be reported to local and state health departments by health-care providers or laboratory staff. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System (NMSS). Data from NMSS serve as the basis for this report. RESULTS: CDC received reports of 1,324 cases of malaria, including four fatal cases, with an onset of symptoms in 2004 among persons in the United States or one of its territories. This number represents an increase of 3.6% from the 1,278 cases reported for 2003. P. falciparum, P. vivax, P. malariae, and P. ovale were identified in 49.6%, 23.8%, 3.6%, and 2.0% of cases, respectively. Seventeen patients (1.3% of total) were infected by two or more species. The infecting species was unreported or undetermined in 262 (19.8%) cases. Compared with 2003, the number of reported malaria cases acquired in the Americas (n = 173) increased 17.7%, whereas the number of cases acquired in Asia (n = 172) and Africa (n = 809) decreased 2.8% and 3.7%, respectively. Of 775 U.S. civilians who acquired malaria abroad, only 160 (20.6%) reported that they had followed a chemoprophylactic drug regimen recommended by CDC for the area to which they had traveled. Four patients became infected in the United States; three cases were attributed to congenital transmission and one to laboratory-related mosquitoborne transmission. Four deaths were attributed to malaria, including two caused by P. falciparum, one by P. vivax, and one by a mixed infection with P. falciparum and P. malariae. INTERPRETATION: The 3.6% increase in malaria cases in 2004, compared with 2003, resulted primarily from an increase in the number of cases acquired in the Americas but was offset by a decrease in the number of cases acquired in Africa and Asia. This limited increase might reflect local changes in disease transmission, increased travel to regions in which malaria is endemic, or fluctuations in reporting to state and local health departments. These changes likely reflect expected variation in annual reporting and should not be interpreted as indicating a longer-term trend. In the majority of reported cases, U.S. civilians who acquired infection abroad had not adhered to a chemoprophylaxis regimen that was appropriate for the country in which they acquired malaria. PUBLIC HEALTH ACTIONS: Additional investigations were conducted for the four fatal cases and four infections acquired in the United States. Persons traveling to a malarious area should take one of the recommended chemoprophylaxis regimens appropriate for the region of travel and use personal protection measures to prevent mosquito bites. Any person who has been to a malarious area and who subsequently has a fever or influenza-like symptoms should seek medical care immediately and report their travel history to the clinician; investigation should include a blood-film test for malaria. Malaria infections can be fatal if not diagnosed and treated promptly. Recommendations concerning malaria prevention can be obtained from CDC at http://www.cdc.gov/travel or by calling the Malaria Hotline at telephone 770-488-7788. Recommendations concerning malaria treatment can be obtained at http://www.cdc.gov/malaria/diagnosis_treatment/treatment.htm or by calling the Malaria Hotline.

Malaria surveillance--United States, 2003.

PROBLEM/CONDITION: Malaria in humans is caused by any of four species of intraerythrocytic protozoa of the genus Plasmodium (i.e., P. falciparum, P. vivax, P. ovale, or P. malariae). These parasites are transmitted by the bite of an infective female Anopheles sp. mosquito. The majority of malaria infections in the United States occur among persons who have traveled to areas with ongoing transmission. In the United States, cases can also occur through exposure to infected blood products, by congenital transmission, or by local mosquitoborne transmission. Malaria surveillance is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers. PERIOD COVERED: This report covers cases with onset of illness in 2003, and summarizes trends over previous years. DESCRIPTION OF SYSTEM: Malaria cases confirmed by blood film are mandated to be reported to local and state health departments by health-care providers or laboratory staff. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System (NMSS). Data from NMSS serve as the basis for this report. RESULTS: CDC received reports of 1,278 cases of malaria with an onset of symptoms in 2003, including seven fatal cases, among persons in the United States or one of its territories. This number represents a decrease of 4.4% from the 1,337 cases reported for 2002. P. falciparum, P. vivax, P. malariae, and P. ovale were identified in 53.3%, 22.9%, 3.6%, and 2.6% of cases, respectively. Twelve patients (0.9% of total) were infected by two or more species. The infecting species was unreported or undetermined in 212 (16.6%) cases. Compared with 2002, the number of reported malaria cases acquired in Asia (n = 177) and the Americas (n = 147) increased by 3.5% and 4.3% respectively, whereas the number of cases acquired in Africa (n = 840) decreased by 7.0%. Of 762 U.S. civilians who acquired malaria abroad, 132 (17.3%) reported that they had followed a chemoprophylactic drug regimen recommended by CDC for the area to which they had traveled. Ten patients became infected in the United States, including one probable transfusion-related, one in which epidemiologic investigations failed to identify any apparent mode of acquisition, and eight which were introduced cases as a result of local mosquitoborne transmission. Of the seven deaths attributed to malaria, five were caused by P. falciparum, and a species was not identified in the other two. INTERPRETATION: The 4.4% decrease in malaria cases in 2003, compared with 2002, resulted primarily from a decrease in cases acquired in Africa, but this decrease was offset by an increase in the number of cases acquired in the Americas and Asia. This small decrease probably represents year-to-year variation in malaria cases, but also could have resulted from local changes in disease transmission, decreased travel to malaria-endemic regions, or fluctuation in reporting to state and local health departments. In the majority of reported cases, U.S. civilians who acquired infection abroad were not on an appropriate chemoprophylaxis regimen for the country in which they acquired malaria. PUBLIC HEALTH ACTION: Additional information was obtained concerning the seven fatal cases and the 10 infections acquired in the United States. Persons traveling to a malarious area should take one of the recommended chemoprophylaxis regimens appropriate for the region of travel, and travelers should use personal protection measures to prevent mosquito bites. Any person who has been to a malarious area and who subsequently experiences a fever or influenza-like symptoms should seek medical care immediately and report their travel history to the clinician; investigation should include a blood-film test for malaria. Malaria infections can be fatal if not diagnosed and treated promptly. Recommendations concerning malaria prevention can be obtained from CDC by calling the Malaria Hotline at 770-488-7788 or by accessing CDC's Internet site at http://www.cdc.gov/travel. Recommendations concerning diagnosis of malaria and its treatment can be obtained by calling the Malaria Hotline or accessing CDC's Internet site at http://www.cdc.gov/malaria/diagnosis_treatment/treatment.htm.

Antimalarial activity of lactucin and lactucopicrin: sesquiterpene lactones isolated from Cichorium intybus L.

Folklore reports from Afghanistan prior to the wars described the use of aqueous root extracts of Cichorium intybus (L.) as a light-sensitive plant remedy for malaria. Preparative isolation and bioassay against HB3 clone of strain Honduras-1 of Plasmodium falciparum identified the previously known light-sensitive sesquiterpene lactones Lactucin and Lactucopicrin to be antimalarial compounds.

Prevalence of malaria parasitemia and accuracy of microscopic diagnosis in Haiti October 1995

In October 1995 the Ministry of Public Health and Population in Haiti surveyed 42 health facilities for the prevalence and distribution of malaria infection. They examined 1,803 peripheral blood smears from patients with suspected malaria; the overall slide positivity rate was 4.0 percent (range, 0.0 percent to 14.3 percent). The rate was lowest among 1-to 4-year-old children (1.6 percent) and highest among persons aged 15 and older (5.5 percent). Clinical and microscopic diagnoses of malaria were unreliable; the overall sensitivity of microscopic diagnosis was 83.6 percent, specificity was 88.6 percent, and the predictive value of a positive slide was 22.2 percent. Microscopic diagnoses need to be improved, and edequate surveillance must be reestablished to identify areas where transmission is most intense. The generally low level of malaria is encouraging and suggests that intensified control efforts (AU)

Prevalence of malaria parasitemia and accuracy of microscopic diagnosis in Haiti, October 1995 / Prevalencia de parasitemia por malaria y precisión del diagnóstico microscópico en Haití, octubre de 1995

In October 1995 the Ministry of Public Health and Population in Haiti surveyed 42 health facilities for the prevalence and distribution of malaria infection. They examined 1.083 peripheral blood smears from patients with suspected malaria; the overall slide positivity rate was 4.0 por cent (range, 0.0 por cent to 14.3 por cent). The rate was lowest among 1-to 4-year-old children (1.6 por cent) and highest among persons aged 15 and older (5.5 por cent). Clinical and microscopic diagnoses of malaria were unreliable; the overall sensitivity of microscopic diagnosis was 83.6 por cent, specificity was 88.6 por cent, and the predictive value of a positive slide was 22.2 por cent. Microscopic diagnoses need to be improved, and adequate surveillance must be reestablished to identify areas where transmission is most intense. The generally low level of malaria is encouraging and suggests that intensified control efforts targeted to the areas of highest prevalence could furhter diminish the effect of malaria in Haiti

En octubre de 1995 el Ministerio de Salud Pública y Población de Haití inspeccionó 42 establecimientos de salud para determinar la prevalencia y distribución de la infección por malaria. Se examinaron 1 803 frotis de sangre periférica obtenidos de pacientes con sospecha de tener esa enfermedad; la tasa general de positividad de los frotis fue de 4,0% (con un recorrido de 0,0 a 14,3%). La tasa más baja (1,6%) se observó en el grupo de niños de 1 a 4 años y la más alta en personas de 15 años de edad o mayores (5,5%). Los diagnósticos clínico y microscópico de la malaria fueron poco confiables; la sensibilidad general del diagnóstico microscópico fue de 83,6% y su especificidad de 88,6%, y el valor predictivo de un frotis positivo fue de 22,2%. Es preciso mejorar los diagnósticos microscópicos y reestablecer una vigilancia adecuada a fin de identificar las zonas donde la transmisión es más intensa. La frecuencia relativamente baja de la malaria es un dato alentador y sugiere que el refuerzo de las iniciativas de control dirigidas a las zonas de mayor prevalencia podría mitigar aun más el efecto de la malaria en Haití

Prevalence of malaria parasitemia and accuracy of microscopic diagnosis in Haiti, October 1995

In October 1995 the Ministry of Public Health and Population in Haiti surveyed 42 health facilities for the prevalence and distribution of malaria infection. They examined 1.083 peripheral blood smears from patients with suspected malaria; the overall slide positivity rate was 4.0 por cent (range, 0.0 por cent to 14.3 por cent). The rate was lowest among 1-to 4-year-old children (1.6 por cent) and highest among persons aged 15 and older (5.5 por cent). Clinical and microscopic diagnoses of malaria were unreliable; the overall sensitivity of microscopic diagnosis was 83.6 por cent, specificity was 88.6 por cent, and the predictive value of a positive slide was 22.2 por cent. Microscopic diagnoses need to be improved, and adequate surveillance must be reestablished to identify areas where transmission is most intense. The generally low level of malaria is encouraging and suggests that intensified control efforts targeted to the areas of highest prevalence could furhter diminish the effect of malaria in Haiti