Performance of contrast-enhanced mammography for detecting multifocal and multicentric breast cancer and evaluating tumour size, and implications for surgical management: Early experience in a tertiary centre.

INTRODUCTION: To compare diagnostic accuracy of contrast-enhanced mammography (CEM) with standard 2D digital mammography (equivalent to low-energy image; LEM) for detection of multifocal and multicentric breast cancer and evaluation of tumour size and disease extent for preoperative planning. METHODS: Biopsy proven breast cancer patients who underwent CEM preoperatively between January 2021 and January 2023 were included in this study. CEM and LEM images were independently reviewed by at least two blinded readers. Lesion location, number, size (maximal diameter) and extension across the midline and/or nipple invasion were recorded. Tumour number and size estimated on imaging were compared with final operative histology, which served as the gold standard. RESULTS: Forty-nine patients (48 females and 1 male) and 50 cases (one patient had bilateral breast lesions) were included in the analysis. Median patient age was 60 (IQR 51, 69). CEM had significantly higher lesion detection rate compared with LEM, with sensitivities of 78% for LEM and 92% for CEM for the index tumour and 15% for LEM and 100% for CEM for multicentric and multifocal cancer. We found no statistically significant difference in median tumour size measurements on CEM and final surgical specimen (P value = 0.97); however, a significant difference was identified in the tumour size measured on LEM and surgical specimen (P value < 0.001). CONCLUSION: CEM is superior to standard 2D digital mammography for detection of multifocal and multicentric breast cancer and is a reliable and more accurate method for estimating tumour size.

Effectiveness of Continuous Endotracheal Cuff Pressure Control for the Prevention of Ventilator-Associated Respiratory Infections: An Open-Label Randomized, Controlled Trial.

BACKGROUND: An endotracheal tube cuff pressure between 20 and 30 cmH2O is recommended to prevent ventilator-associated respiratory infection (VARI). We aimed to evaluate whether continuous cuff pressure control (CPC) was associated with reduced VARI incidence compared with intermittent CPC. METHODS: We conducted a multicenter open-label randomized controlled trial in intensive care unit (ICU) patients within 24 hours of intubation in Vietnam. Patients were randomly assigned 1:1 to receive either continuous CPC using an automated electronic device or intermittent CPC using a manually hand-held manometer. The primary endpoint was the occurrence of VARI, evaluated by an independent reviewer blinded to the CPC allocation. RESULTS: We randomized 600 patients; 597 received the intervention or control and were included in the intention to treat analysis. Compared with intermittent CPC, continuous CPC did not reduce the proportion of patients with at least one episode of VARI (74/296 [25%] vs 69/301 [23%]; odds ratio [OR] 1.13; 95% confidence interval [CI] .77-1.67]. There were no significant differences between continuous and intermittent CPC concerning the proportion of microbiologically confirmed VARI (OR 1.40; 95% CI .94-2.10), the proportion of intubated days without antimicrobials (relative proportion [RP] 0.99; 95% CI .87-1.12), rate of ICU discharge (cause-specific hazard ratio [HR] 0.95; 95% CI .78-1.16), cost of ICU stay (difference in transformed mean [DTM] 0.02; 95% CI -.05 to .08], cost of ICU antimicrobials (DTM 0.02; 95% CI -.25 to .28), cost of hospital stay (DTM 0.02; 95% CI -.04 to .08), and ICU mortality risk (OR 0.96; 95% CI .67-1.38). CONCLUSIONS: Maintaining CPC through an automated electronic device did not reduce VARI incidence. CLINICAL TRIAL REGISTRATION: NCT02966392.

Tobacco and Alcohol Use Among Ethnic Minorities in Vietnam.

This study investigates the prevalence of tobacco and alcohol uses and associated factors among 12 ethnic minorities in Vietnam in 2019. A cross-sectional survey was conducted among 5172 people aged ≥15 years. The prevalence of smoking and drinking was 19.7% and 29.9%, respectively, and significantly higher among men than women. These numbers were heterogeneous across ethnic minorities. Smoking prevalence was high among Ba Na (25.9%), Cham An Giang (22.3%), Khmer (23.5%), La Hu (26.3%), Ta Oi (30.7%), and Bru Van Kieu (29.6%) ethnicities whereas that of Gie Trieng and Mnong ethnicities was low (3.7% and 9.5%, respectively). Drinking prevalence ranged from 1.4% in Cham An Giang ethnicity to 68.6% in Ba Na ethnicity. A wide ethnic disparity on tobacco and alcohol use could be explained by the ethnic variation of lifestyles, social norms, and cultural features. Our findings suggest the need to develop ethnic-specific interventions to mitigate the smoking and drinking prevalence.

Number of People who Inject Drugs in Son La, Vietnam: Population Size Estimation Based on Official Records.

AIMS: Estimated population sizes of key populations are critical for resource allocation as well as for monitoring program performance to prevent HIV infection. In 2018, using official records we recruited and conducted a brief survey among People Who Use Drugs (PWUD) to estimate the population size of People Who Inject Drugs (PWID) in Son La Province, Vietnam. METHODS: In Son La, the authorities develop and maintain a master list of individuals who are suspected of using drugs. The list is updated quarterly and is used to monitor the drug use situation in the province. The list, however, does not distinguish injecting from non-injecting drug users. Individual lists from six districts, 24 communes, and 96 hamlets were selected from among those from 12 districts, 204 communes, and 3335 hamlets in the whole province. After reviewing the lists with the hamlet health workers, based on the length of the lists, a minimum of 20% of the total or five drug users in any hamlet with fewer than 25 PWUD were randomly selected for a brief assessment. In addition to basic demographics, the assessment included any drug use in the last 3 months, injection drug use in the last 3 months, and the last time injected. RESULTS: A total of 250 PWUD were interviewed by hamlet health workers. The total number of PWID across all 12 districts in Son La was estimated at 4475 [95% Confidence Interval (CI): 3379-5570] and the corresponding proportion of PWID among PWUD was 48.4% (95% CI: 36.6-60.4). CONCLUSION: The exercise provided an estimated number of PWID in Son La. For planning HIV prevention and care service needs among PWID, additional studies using different methods are needed to validate and improve the population size of PWID in the province of Son La.

Identification of Enterovirus C105 for the first time in New Zealand

In this report we describe a new approach in HIV sentinel surveillance that was piloted in Viet Nam in 2009 and is currently being rolled out in all provinces. It comprises a brief behavioural questionnaire added to the HIV sentinel surveillance surveys conducted routinely among people who inject drugs, female sex workers and men who have sex with men. Timely reporting of data from this system has resulted in improvements to HIV prevention efforts for most at-risk populations.

Study complication of aplastic anemia following chemotherapy of acute myelogenous leukemia

Background: Aplastic anemia following chemotherapy of acute leukemia is a common complication, which may lead to severe consequences. Objective: To study characteristics of aplastic anemia occurred in ccute myelogenous leukemia (AML) patients, following chemotherapy. Subjects and methods: A prospective study was carried out in 50 AML patients treated at National Institute of Hematology and Blood Transfusion from Aug 2005 to Dec 2006. These patients were treated by induction chemotherapy with "3+7" regime. Result: Aplastic anemia had been seen in 100% patients. Characteristics of this condition were poor marrow cells (average marrow cell count was 15.1\xb112.6 G/l) and strongly decreased counts of hemoglobin, white blood cells and platelets. Hemoglobin, white blood cell and platelet counts at the lowest level were 83.32 g/l; 0.96 G/l; 30.18 G/l; respectively. This situation prolonged for 3-4 weeks and changed into the most severe condition at the end of second week after chemotherapy. Infection frequency was 92%. Conclusion: Aplastic anemia following chemotherapy of AML patients is a common complication with severe consequences such as significant decrease of WBC and platelet counts, which may lead to opportunistic infection. Hence, this complication must be monitored, detected and treated promptly. \r\n', u'\r\n', u'

Some opinions of the clinical progress of the patients with chronic granular leukemia

The aim of this study is to examine the effectiveness of hydroxyurea in treating CML patients in chronic phase. The result of the research shows that the induction treatment with hydroxyurea (initial dose: 40-60mg/kg body weight daily) radically improved clinical condition for CML patients: the size of spleen was reduced in the majority of patients (91.7% and 63.9% patients have palpable spleen (P<0.05), 83.3% and 5.6% patients have enlarged spleen third and forth degree before and after induction treatment respectively, percentage of patients with symptoms of high viscosity syndrome decreased from 36.1% to 0% after treatment with P<0.001, symptoms of anemia were decreased in the majority of patients. The follow up during the time of induction treatment shows that main clinical symptoms (enlarged spleen, high viscosity syndrome, anemia) have improved gradually in accordance with the decrease of WBC

Investigating the clinical and hematological features of chronic myelogenous leukemia at early initial hospitalization

From January 1997 to January 1998, there were 21 patients with chronic myelogenous leukemia who admitted to the Clinical Department, National Institute of Hematology and Blood Transfusion, B¹ch Mai Hospital. Mean age of patients was 42.85 for men and 38.12 for women. Among these patients, splenomegaly was observed in 100% of patients. Hyperleukocytosis, hyperthrombocytemia, erythrocytopenia, and hyperuricemia all were measured. 94% of patients were positive with Philadelphia chromosome

Study the changes in clinical and in blood cell indices after hydroxyurea treatment for chronic myelo-granulocytic leukemia

Chronic myelogenous leukemia (CML) is a clonal myeloproliferative disorder of the primitive hematopoietic stem cell. The research is performed to examine the effectiveness of hydroxyurea in treating patients with CML in chronic stage. The results showed that hydroxyurea dramatically improved clinical and hematological condition. All patients reached complete or partial remission

Blood uric acid levels in patients with chronic granulocytic leukemia

The study aimed to investigate the changes in blood uric acid level. Participants were 61 patients with chronic granulocytic leukemia who were treated at the Central Institute of Hematology and Blood Transfusion between 9/1999 and 12/2000. Main findings: Blood uric acid level has increased in a significant percentage of patients: 35.9% of males and 36.4% of females have blood uric acid level of 529 and 423Mmol/l, respectively. Mean level of blood uric acid for whole group was 356 +/- 132Mmol/l for males and 281+/-129 Mmol/l for females. Blood uric acid level was not changed consistently with white blood cell count. However, there was a tendency of having higher blood uric acid level in the patients with higher WBC count. The symptoms of secondary gout were not observed in patients of this study

Cytological features of peripheral blood in patients with chronic myelo-granulocytic leukemia

The study was carried out on 61 chronic myelo-granulocytic leukemia (CML) patients aimed to investigate the cytological features of peripheral blood. The results showed that all patients had laboratory features of normocytic and normochromic anemia (RBC counts: 2.8T/L +/- SD 0.59). All patients have increased WBC and platelet counts (WBC count: 210.5G/L +/- SD 101.0, platelet count: 624.3G/L +/- SD 431.9). The differentiated white cells showed all types of granulocytic cell (myeloblast 1.5%, promyelocytes 4%, myelocytes 15.5%, metamyelocytes 14.8%, band forms 7.1%, segmented neutrophils 44.9%, basophils 3.3%, eosinophils 2.4%, lymphocytes 5.4%, monocytes 0.1%) with the increase on absolute number and percentage of basophil and eosinophil. However, there was no elevation in myelocyte count compared with metamyelocyte count

Hematological changes during the aggressive treatment of chronic myeloid leukemia (CML) in the chronic duration by hydroxyurea

The aim of this study is to examine the effectiveness of hydroxyurea in treating CML patients in chronic phase. The result of the research shows that the induction treatment with hydroxyurea with initial dose of 40-60mg/kg body weight daily radically improves hematological condition for CML patients in chronic phase. All patients (42 patients) reached hematological remission (33.3% patients reached complete remission), 66.7% patients reached partial remission WBC decrease from 193.9117.7 g/l to 10.16.0 g/l. Percentage of myeloblast, promyelocyte, myelocyte and metamyelocyte in peripheral blood decrease from 35.08.0% to 6.96.6%. Hemoglobin concentration increase from 86.119.0 g/l to 96.013.3 g/l, RBC increase from 2.90.7 T/l to 3.20.5 T/l. The follow up during the time of induction treatment shows that main hematological indicators have changed gradually when approaching normal physiological values

Mechanism and menifestation of the leucocytotic syndrome in the granuloid leukemia

A small proportion of cases of chronic granuloid leukemia is associated with an extraordinary concentration of leukocytes in the blood. As a result of the hyperleukocytic syndrome, these cases present special problems and complication that may seriously affect on patients’ life and the quality of life to the physicians. Leukapheresis is an effective method of therapy in these cases which can reverse the hyperleukocytic syndrome rapidly and decrease the tumor cell mass so as to minimize the extent of chemotherapeutic-induced cytolysis and the cytolysis- induced complications.

Primarily opinions of additive survival duration of the chronic myeloid leukemia patients with chronic granuliform treated by hydroxyurea

A retrospective study was carried out in 34 chronic myeloid leukemia patients, who were followed up from the beginning stage of the disease throughout natural history of the disease. The result shows the follows: the percentage of transformation into acute myeloid leukemia was 86.7%, the percentage of transformation into acute lymphocytic leukemia was 13.3%. The median length of chronic phase was 28.9 months. The median survival was 33.6 months (52.4% patients have survived more than 52 months). Main cause of death in chronic phase was emboli due to hyperleucocytic syndrome