Value of multidetector computed tomography angiography before bronchial artery embolization in hemoptysis management and early recurrence prediction: a prospective study.

BACKGROUND: Multidetector computed tomography (MDCT) angiography is a useful examination to detect the source of the bleeding in patients with hemoptysis. The aim of the study was to prospectively evaluate the role and clinical efficacy of MDCT angiography before bronchial artery embolization (BAE) for the management of hemoptysis, and to investigate the predictors of early recurrence. METHODS: It is a double-center study which included 57 hemoptysis patients undergoing MDCT angiography prior to BAE from August 2019 to July 2020. A prospective analysis of culprit arteries detected by MDCT angiography allowed an evaluation of the role of this technique. A follow-up was done to assess the efficacy of BAE with preprocedural MDCT angiography and to explore the risk factors of early recurrent hemoptysis. RESULTS: The accuracy of MDCT angiography in the identification of culprit arteries was as high as 97.5%. The average number of total culprit arteries per patient was 2.75 ± 1.73. Among which, the average numbers of culprit ectopic bronchial arteries (BAs) and non-bronchial systemic arteries (NBSAs) per patient were 0.21 ± 0.41 and 1.04 ± 1.57, respectively. The immediate clinical success rate, total hemoptysis recurrence rate, and early hemoptysis recurrence rate of BAE following MDCT angiography were 94.7, 18.5, 16.7%, respectively. Aspergilloma (HR = 6.63, 95% CI: 1.31-33.60, p = 0.022) was associated with an increase in the risk of early recurrence. CONCLUSIONS: MDCT angiography should be performed before BAE for the management of hemoptysis. Aspergilloma was an independent predictor for early recurrence.

Lung abnormalities on computed tomography of Vietnamese patients with COVID-19 and the association with medical variables.

Objectives: Patients with COVID-19 may experience a lung injury without presenting clinical symptoms. Early detection of lung injury in patients with COVID-19 is required to enhance prediction and prevent severe progression. Methods: Lung lesions in patients with COVID-19 were defined using the Fleischner Society terminology. Chest computed tomography lesions and their correlation with demographic characteristics and medical variables were identified. Results: Patients with mild and moderate COVID-19 had up to 45% lung injuries, whereas critical patients had 55%. However, patients with mild and moderate COVID-19 typically had low-level lung injuries. Ground-glass (68.1%), consolidation (48.8%), opacity (36.3%), and nodular (6.9%) lung lesions were the most prevalent in patients with COVID-19. Patients with COVID-19 infected with the Delta variant had worse lung injury than those infected with the Alpha and Omicron. People vaccinated with ≥2 doses showed a lower risk of lung injury than those vaccinated with <1 dose. Patients <18 years old were less likely to have a lung injury than patients >18 years old. The treatment outcomes were unaffected by the severity of the lung injury. Conclusion: Patients with mild COVID-19 had a similar risk of lung injury as patients with severe COVID-19. Thus, using chest computed tomography to detect lung injury can enhance the treatment outcomes and reduce the patient's risk of pulmonary complications.

Distribution of human papillomavirus among Vietnamese women with cervical cancer and unusual genetic variability of HPV16.

HPV16, with typical mutations that differ in geographical distribution and carcinogenic potency, has implications for cervical cancer screening, clinical diagnosis, and treatment. DNASTAR and MEGA were used to identify HPV16 variants and construct a phylogenetic tree. The most prevalent HPV genotypes were HPV16 (63.9%), HPV18 (26.7%), and other HPV (6.9%). HPV16 alterations were found in all E6, E7, and L1 genes, including 15 missense and 18 synonymous mutations. Missense mutations include R10G, Q14H, D25E, H78Y, L83V (E6); M29V, R35K, L78R, L95P (E7); H73Y, T176 N, N178T, T317P, T386S, L472F/I (L1). HPV16 sublineages include A1 (17.2%), A2 (0.9%), A3 (56.0%), A4 (19.0%), D1 (4.3%), and D3 (2.6%). Although several mutations in the oncoproteins E6, E7, and L1 have been detected, mutations known to be associated with cervical cancer risk, such as D25E and L83V, occur at a relatively low frequency. This suggests that HPV16 mutations are associated with cervical cancer through a complicated mechanism.

Clinical, Laboratory Characteristic, and Treatment of Human Toxocariasis in Northern Vietnam.

Background: We determined the occurrence frequency of Clinical signs, subclinical characteristics on positive anti-IgG Toxocara ELISA cases, and clinical response results after 1 month of albendazole-specific treatment. Methods: A number of 103 clinically treated patients were studied between 2018 and 2019 in two hospitals. Relevant data are collected from examination and medical records such as age, sex, job, resident, clinical and sub-clinical signs. Sera samples were subjected to anti-IgG Toxocara antigen using ELISA. Results: The median age of the patient was 43.6 ± 14.4 years. The most common symptom groups were the skin and mucosa (88.3%), followed by neurological symptoms (44%). There are 76.7% of patients with risk factors for contact with pet dogs and cats. The majority of eosinophils in the normal range (< 8%) accounted for 85.4%, the major results of the OD value of ELISA were in the group (≥ 0.3-< 1.5) accounted for 75.7%. The skin and mucosa lesions in toxocariasis patients related to IgE values were statistically significant (P <0.05). The effectiveness of anthelmintic treatment is low with nearly half of patients having no clinical symptoms after 1 month of post-treatment. It is statistically significant between exposure to dogs/cats and treatment outcomes on clinical symptoms (P < 0.05). Conclusion: Toxocara infections in Vietnamese people often have skin allergies and liver damage, rarely with severe neurological symptoms. The efficacy of albendazole treatment after one month is not clear. In the near future, research with a confirmatory test other than Anti-IgG Toxocara ELISA is needed to screen for inhospital diagnosis.

Clinical Features, Laboratory Characteristics and Prognostic Factors of Severity in Patients with Rickettsiaceae at Two Military Hospitals, Northern Vietnam.

INTRODUCTION: Rickettsioses are diseases caused by intracellular Gram-negative bacteria of the Rickettsiaceae family and transmitted through the bite of infected ticks or mites. AIM OF STUDY: To investigate the clinical and subclinical characteristics and prognostic severe factors of the disease caused by Rickettsiaceae. METHODS: A prospective, descriptive cross-sectional study was conducted at Department of Infectious Diseases of two military hospitals in Northern Vietnam from May 2013 to June 2019, in which 88 adult febrile patients caused by Orientia tsutsugamushi (50 patients) or Rickettsia spp. (38 patients) were enrolled. We recorded information regarding epidemiological characteristics (age, geography, residence, occupation), medical history, clinical and subclinical findings, life-threatening complications during treatment, outcomes and some factors predicting serious life-threatening complications in a case record form. RESULTS: Scrub typhus (ST) patients had eschar (70%), skin-conjunctiva congestion (60%) and lymphadenopathy (44%). Rickettsia patients had a higher rate of maculopapular rash (39.5%), no ulcers and no lymphadenopathy detected. The majority of patients had elevated PCT >0.05 ng/µL and increase in liver enzymes and thrombocytopenia. Major prognostic factors for severe complications included diffuse infiltrates on lung X-ray (OR: 19.5; p = 0.014), coarse crackles (OR: 18; p = 0.016), respiratory rate ≥25 cycles/minute (OR: 18; p = 0.016), shortness of breath (OR: 7.44; p = 0.003), pleural fluid (OR: 4.3; p = 0.035) and increase in AST ≥ 200 UI/l (OR: 4.42; p = 0.012). The PCT value is able to distinguish between the two groups with quite high reliability (the area under the ROC curve is 0.75). CONCLUSION: Eschar and peripheral lymphadenopathy were two valuable clinical symptoms for the diagnosis of scrub typhus and distinguishing 2 groups of diseases. Respiratory distress, increase in AST ≥ 200 UI/l and level of PCT were used as major prognostic factors in patients with Rickettsiaceae.