RESUMO
Introduction: Infection with Plasmodium vivax is a recognized cause of severe malaria including deaths. The exact burden and patterns of severe P. vivax monoinfections is however still not well quantified, especially in P. vivax endemic regions. We examined the magnitude and patterns of severe malaria caused by monoinfections of P. vivax and associated predictors among patients admitted to a tertiary care center for malaria in Vietnam. Methods: A retrospective cohort study was conducted based on the patients' medical records at the Hospital for Tropical Diseases from January 2015 to December 2018. Extracted information included demographic, epidemiologic, clinical, laboratory and treatment characteristics. Results: Monoinfections with P. vivax were found in 153 (34.5, 95% CI 30.3-39.1%) patients of whom, uncomplicated and severe malaria were documented in 89.5% (137/153, 95% CI 83.7-93.5%) and 10.5% (16/153, 95% CI 6.5-16.3%), respectively. Patterns of severe malaria included jaundice (8 cases), hypoglycemia (3 cases), shock (2 cases), anemia (2 cases), and cerebral malaria (1 case). Among 153 patients, 73 (47.7%) had classic malaria paroxysm, 57 (37.3%) had >7 days of illness at the time of admission, and 40 (26.1%) were referred from other hospitals. A misdiagnosis as having other diseases from malaria cases coming from other hospitals was up to 32.5% (13/40). Being admitted to hospital after day 7th of illness (AOR = 6.33, 95% CI 1.14-35.30, p = 0.035) was a predictor of severe malaria. Severe malaria was statistically associated with longer hospital length of stay (p = 0.035). Early and late treatment failures and recrudescence were not recorded. All patients recovered completely. Discussion: This study confirms the emergence of severe vivax malaria in Vietnam which is associated with delayed hospital admission and increased hospital length of stay. Clinical manifestations of P. vivax infection can be misdiagnosed which results in delayed treatment. To meet the goal of malaria elimination by 2030, it is crucial that the non-tertiary hospitals have the capacity to quickly and correctly diagnose malaria and then provide treatment for malaria including P. vivax infections. More robust studies need to be conducted to fully elucidate the magnitude of severe P. vivax in Vietnam.
RESUMO
The objective of this study was to determine the prevalence of amphetamine-type stimulant use and associated factors among methadone maintenance treatment (MMT) patients. In 2018, a cross-sectional study was conducted on 967 MMT patients at two methadone clinics in Ho Chi Minh City that serve Vietnamese patients. Amphetamine-type stimulant use was assessed by rapid urine test and face-to-face interview using the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST) tool. The prevalence of amphetamine-type stimulant use assessed by urine test was 25.4%. According to ASSIST, the prevalence of moderate and high risk amphetamine-type stimulant use was 15.5% and 1.1%, respectively. Amphetamine-type stimulant use and hazardous use were more prevalent in younger patients, having a part-time job, drug injection, having a lower score of self-health assessment, treated with a higher dose of methadone and missing methadone dose in the past 3 months. By contrast, patients who were HIV positive were less likely to use amphetamine-type stimulants. Cannabis and heroin use were significantly associated with amphetamine-type stimulant use (OR = 1.46; 95% CI: 1.38-8.67; and OR = 1.50; CI: 1.04-2.18, respectively) and hazardous use (OR = 4.07; CI: 1.67-9.92; and OR = 2.38; CI: 1.56-3.63, respectively). Screening and interventions are needed to cope with this issue on time, particularly in young patients, having drug injection and concurrent drugs user groups.
Assuntos
Metadona , Tratamento de Substituição de Opiáceos , Anfetamina/efeitos adversos , Estudos Transversais , Humanos , Prevalência , Vietnã/epidemiologiaRESUMO
This study identified prevalence and correlates of HIV-associated dementia (HAD) among people living with HIV (PLWHA) in Ho Chi Minh City, Vietnam. Four hundred PLWHA completed a self-report questionnaire and were interviewed by a trained researcher to assess HAD using the International HIV Dementia Scale (IHDS). Clinical information concerning HIV treatment was also extracted from medical records. The results indicate the prevalence of probable HAD based on IHDS score <10.5 was 39.8% (95% confidence interval [CI]: 35.0%-44.5%). Probable HAD was significantly higher among female, older PLWHA and among those with low education level (≤ primary school), moderate level of adherence to HIV medication and HIV stage 3. Those PLWHA with depressive symptoms also had higher odds of having probable HAD (odds ratio = 3.23, 95% CI: 2.05-5.11). These findings underscore the importance of early HAD screening and appropriate referral for further assessment and management of PLWHA especially those with higher risk of HAD.
