Clinical Efficacy of Cerebrolysin and Cerebrolysin plus Nootropics in the Treatment of Patients with Acute Ischemic Stroke in Vietnam.

AIMS: To investigate the efficacy and safety of Cerebrolysin and Cerebrolysin plus nootropics in the routine treatment of patients with acute ischemic stroke (AIS). BACKGROUND: Acute ischemic stroke (AIS) is a leading cause of disability with unmet treatment needs lacking effective drug therapy. Multimodal drugs modulating stroke pathophysiology as Cerebrolysin constitute a good therapeutic option. OBJECTIVE: In this study, we assessed the effects of Cerebrolysin and Cerebrolysin plus nootropics, in comparison with other nootropic drugs alone, on functional, neurological and cognitive recovery of patients with AIS in Vietnam. METHODS: This non-interventional, controlled, open-label, prospective and multicenter study included 398 AIS patients (234 males) treated with Cerebrolysin (n=190; 20 i.v. infusions of 10 ml), other nootropics (comparator group; n=86), or a combination of both (n=122). The study primary endpoint was the modified Ranking Scale (mRS) score on day 90. Secondary endpoints included study-period change in NIHSS score; percentage of well-recovered (mRS 0-2) patients, the proportion of good NIHSS response (≥6 points) cases, and MoCA scores at day 90; and safety indicators. RESULTS: Compared with other nootropics, both Cerebrolysin and combined therapy induced significant improvements (p<0.001) in: Functional recovery (mRS scores); percentage of well-recovered patients (Cerebrolysin: 81.6%; combination: 93.4%; comparator: 43.0%); neurological recovery (study- period NIHSS change); proportion of good NIHSS responders (Cerebrolysin: 77.5%; combination: 92.5%; comparator: 47.6%); and MoCA scores (Cerebrolysin: 23.3±4.8; combination: 23.7±4.1; comparator: 15.9±7.7). Compared to Cerebrolysin, combined therapy improved (p<0.01) mRS outcomes and NIHSS change, but not MoCA scores, in moderate-severe stroke (NIHSS>11) cases only. No drug-related adverse events were reported. CONCLUSION: Cerebrolysin alone or combined with other nootropics was effective and safe in routine AIS treatment, during both acute and recovery phases, which supports its use in daily clinical practice. Others: According to the results of this multicenter study, the importance of reducing differences in the treatment regimens of AIS in Vietnam should be further emphasized.

Clinical epidemiology and mortality on patients with acute respiratory distress syndrome (ARDS) in Vietnam.

BACKGROUND: The clinical epidemiology and disease prognosis in patients with acute respiratory distress syndrome (ARDS) have not yet been fully elucidated in Vietnam. METHODS: We conducted a retrospective observational study at a national tertiary hospital in Hanoi, Vietnam. Participants were adult patients (age ≥18 years) who were admitted and diagnosed with ARDS during 2015-2017. Data on patients' general and clinical conditions, radiographic findings, ventilator settings, gas exchange, and treatment methods were collected and compared between survivors and non-survivors. Risk factors for mortality were assessed using logistic regression analysis. RESULTS: Among 126 eligible patients with ARDS admitted to the central tertiary hospital in Vietnam, we observed high mortality (57.1%). Of the total patients, 91.3% were transferred from local hospitals with a diagnosis of severe pneumonia and then diagnosed with ARDS at the central hospital. At the time of admission, 53.2% of patients had severe ARDS, 37.3% had moderate ARDS, and 9.5% had mild ARDS. The mean (standard deviation) sequential organ failure assessment (SOFA) score was 9.5 (3.4) in non-survivors and 7.4 (3.4) in survivors (p = 0.002). Although there was no significant difference in PaO2/FiO2 on admission between non-survivors and survivors, that on day 3 after admission was significantly different (p = 0.002). Logistic regression revealed that PaO2/FiO2 on day 3 [odds ratio (OR), 1.010; 95% confidence interval (CI), 1.003-1.017], length of stay in a local hospital before admission to the central hospital (OR, 1.122; 95% CI, 1.042-1.210) due to stable condition, and SOFA score on Day 1 (OR, 0.842; 95% CI, 0.708-1.002) were independent factors in patient survival. CONCLUSIONS: Patients with ARDS admitted the central tertiary hospital had severe illness and high mortality. Most patients were transferred from local hospitals. Improvements in human, medical, and sociological resources in local will contribute to reducing the mortality of ARDS in Vietnam.

Assessment of sliding insulin use in the treatment of new onset hyperglycemia cause by stress in emergency patients without diabetes

Sliding scale insulin was often applied for emergency patients. However there is no study on this therapy in Viet Nam. We used this therapy for 51 new onset hyperglycemic patients (glycemia > 200 mg/dl ) from 6/1998 to 2/2003. Regular insulin was injected when blood glucose>200 mg/dl, then blood glucose level was monitored by finger stick sugar Q4h. If glucose 200-300mg/dl, given 5IU of insulin, glucose>300 mg/dl, given 10 U.The goal blood glucose < 200mg/dl. Results: The average time to lower the blood glucose level to the target level was about 46h. The result after 7 days showed that glycemia was controlled < 200mg/dl and <150 mg/dl in 92% and 62% patientss, respectively.There was no severe hypoglycemia documented during the study.

Effects of new onset hyperglycemia on plasma osmolarity and electrolyte disorders in emergency patients

99 patients aged 15 – 87 years old were hospitalized at Bach Mai Hospital from June 1998 to Feb.2003, among them 51 cases were diagnosed as sufferring from diabetes and in 48 other, diabetes were still not diagnosed. At admission, average blood level of glucose 18,97+/_8,1 mmol. In 35-50% of studied cases, plasma osmolarity >300 mOsmol/kg H2O during monitored time. There was no statistically significant difference between various groups in the variation of glucose plasma level .In 10-20% of cases, there was an increase of 145 mmol/l of natrium in plasma

Assessment of sliding insulin use in the treatment of new onset hyperglycemia in emergency patients

Insuline therapy was used on 99 over-15 years old patients of newly diagnosed diabetes first in internal emergency Department at Bach Mai Hospital from June1998 to Feb.2003 Subjects were divided into 2 groups: Group 1 included persons of the signs of high blood glucose level without diabetes; group 2 included patients sufferred from diabetes without confirmed diagnosis. In >92% of cases of group 1 and 74% of group 2, insuline therapy had effectiveness to control blood glucose level 62% of group 1 and <36% of group 2. There was no complication of hypoglycemia

Fluid complementation by isotonic saline and hypoisotonic saline (half concentration saline) solutions for treatment of hyperosmalar coma due to diabetes

Study on 22 nonketonic hyperosmolar coma patients (13 males and 9 females) at the B¹ch Mai hospital during the period from 6/98 to 5/99. Patients were followed a volume replacement protocol using a normal saline during 3 first hours and a half - strength saline solution after that until the plasma osmolatty restores a preset value ((320 mOsmol/kg). Results shown that 17 patients (77%) were treated successfully and discharged. 5 deaths (23%) were seen in study: 1 patient died within the first 12 hours, when he had been presenting an uncontrolled hyperosmolar condition; 4 others died from different causes (such as septic shock, cerebral infarction...). Conclusion: fluid challenge with normal saline and half - strength saline solutions in our study shown a high efficiency in management of nonketotic hyperosmolar coma of NIDDM and did not evoke any serious complications