Accreditation of medical education in Vietnam: From local to global excellence.

Medical education in Vietnam is going through a period of transformation. The number of medical schools is growing with increased enrollment of the students to meet the workforce needs of the country. Simultaneously, there is a need to ensure the quality of medical graduates and that there are mechanisms in place through relevant regulatory bodies. As part of general framework, accreditation of higher education institutions is already a requirement in Vietnam with individual programs and disciplines to be accredited by the professional organizations within Vietnam or externally where appropriate. However, accreditation of medical education programs is not established as a separate entity. No medical education program in Vietnam has undergone an external evaluation but there are ongoing discussions at various forums to initiate an independent process for medical education programs. There is a consensus among stakeholders that the accreditation of medical education programs will have a potential to drive quality improvement. In this paper, we present a brief overview of the trajectory of accreditation process in Vietnam with recommendations to move forward. The journey ahead will require a coordinated approach from all stakeholders to build an accreditation system, which ensures that quality healthcare, is offered by the workforce in Vietnam.

Antiviral Drug-Resistant Influenza B Viruses Carrying H134N Substitution in Neuraminidase, Laos, February 2016.

In February 2016, three influenza B/Victoria/2/87 lineage viruses exhibiting 4- to 158-fold reduced inhibition by neuraminidase inhibitors were detected in Laos. These viruses had an H134N substitution in the neuraminidase and replicated efficiently in vitro and in ferrets. Current antiviral drugs may be ineffective in controlling infections caused by viruses harboring this mutation.

Genome-wide association mapping for root traits in a panel of rice accessions from Vietnam.

BACKGROUND: Despite recent sequencing efforts, local genetic resources remain underexploited, even though they carry alleles that can bring agronomic benefits. Taking advantage of the recent genotyping with 22,000 single-nucleotide polymorphism markers of a core collection of 180 Vietnamese rice varieties originating from provinces from North to South Vietnam and from different agrosystems characterized by contrasted water regimes, we have performed a genome-wide association study for different root parameters. Roots contribute to water stress avoidance and are a still underexploited target for breeding purpose due to the difficulty to observe them. RESULTS: The panel of 180 rice varieties was phenotyped under greenhouse conditions for several root traits in an experimental design with 3 replicates. The phenotyping system consisted of long plastic bags that were filled with sand and supplemented with fertilizer. Root length, root mass in different layers, root thickness, and the number of crown roots, as well as several derived root parameters and shoot traits, were recorded. The results were submitted to association mapping using a mixed model involving structure and kinship to enable the identification of significant associations. The analyses were conducted successively on the whole panel and on its indica (115 accessions) and japonica (64 accessions) subcomponents. The two associations with the highest significance were for root thickness on chromosome 2 and for crown root number on chromosome 11. No common associations were detected between the indica and japonica subpanels, probably because of the polymorphism repartition between the subspecies. Based on orthology with Arabidopsis, the possible candidate genes underlying the quantitative trait loci are reviewed. CONCLUSIONS: Some of the major quantitative trait loci we detected through this genome-wide association study contain promising candidate genes encoding regulatory elements of known key regulators of root formation and development.

Exploring fungal diversity in Vietnam: A citizen science initiative.

Invasive fungal diseases are increasing globally, causing a large burden of disease in vulnerable populations. At the same time, antifungal resistance is rapidly emerging. Affordable nationwide and regional surveillance of fungal pathogens is needed. We have adapted a citizen-science methodology developed by a United Kingdom research group to study six key fungi in Vietnam, where there is no existing formal surveillance. These pathogens were ranked as high or critical in the World Health Organization fungal priority pathogens list and recognized as major disease-causing agents in Vietnam. Secondary school students (n = 90) in Hanoi were our citizen scientists, collecting soil (n = 90) and air (n = 90) samples for fungal identification and characterisation of drug-susceptibility in the laboratory. Pilot studies confirmed the effectiveness of our revised isolation procedure, which used selective culture media to improve the isolation of target fungi. Through active school and student involvement, optimized protocols, and our cost-effective sampling, the study could be scaled across Vietnam. We demonstrate an approach to fungal surveillance which also enhances science education, and awareness of fungal diseases. It addresses critical healthcare and education challenges in Vietnam while combating the growing issues of invasive fungal diseases and antifungal resistance.

Promising clinical and immunological efficacy of Bacillus clausii spore probiotics for supportive treatment of persistent diarrhea in children.

Persistent diarrhea is a severe gastroenteric disease with relatively high risk of pediatric mortality in developing countries. We conducted a randomized, double-blind, controlled clinical trial to evaluate the efficacy of liquid-form Bacillus clausii spore probiotics (LiveSpo CLAUSY; 2 billion CFU/5 mL ampoule) at high dosages of 4-6 ampoules a day in supporting treatment of children with persistent diarrhea. Our findings showed that B. clausii spores significantly improved treatment outcomes, resulting in a 2-day shorter recovery period (p < 0.05) and a 1.5-1.6 folds greater efficacy in reducing diarrhea symptoms, such as high frequency of bowel movement of ≥ 3 stools a day, presence of fecal mucus, and diapered infant stool scale types 4-5B. LiveSpo CLAUSY supportive treatment achieved 3 days (p < 0.0001) faster recovery from diarrhea disease, with 1.6-fold improved treatment efficacy. At day 5 of treatment, a significant decrease in blood levels of pro-inflammatory cytokines TNF-α, IL-17, and IL-23 by 3.24% (p = 0.0409), 29.76% (p = 0.0001), and 10.87% (p = 0.0036), respectively, was observed in the Clausy group. Simultaneously, there was a significant 37.97% decrease (p = 0.0326) in the excreted IgA in stool at day 5 in the Clausy group. Overall, the clinical study demonstrates the efficacy of B. clausii spores (LiveSpo CLAUSY) as an effective symptomatic treatment and immunomodulatory agent for persistent diarrhea in children.Trial registration: NCT05812820.

A new species of Hemiphyllodactylus (Reptilia: Gekkonidae) from northern Vietnam.

We describe a new species of the genus Hemiphyllodactylus on the basis of four specimens from Cao Bang Province, northern Vietnam. Hemiphyllodactylus zugi sp. nov. is distinguished from the remaining congeners by a combination of the following characters: a bisexual taxon; average SVL of adult males 41 mm, of adult female 46.6 mm; chin scales bordering mental and first infralabial distinctly enlarged; digital lamellae formulae 3-4-4-4 (forefoot) and 4-5-5-5 (hindfoot); femoral and precloacal pore series continuous, 18-21 in total in males, absent in female; cloacal spur single in males; dorsal trunk pattern of dark brown irregular transverse bands; dark lateral head stripe indistinct; upper zone of flank with a series of large light spots, edged above and below in dark grey; caecum and gonadal ducts unpigmented.

A commentary on the National Medical Licensing Examination in Vietnam: why, what, who and how.

As a result of increasing societal demands and economic development, the number of medical schools in Vietnam has increased significantly over the past decade. In order to ensure physician competency, it is imperative that medical training meets a minimal threshold before entering clinical practice. The prospects of the National Medical Licensing Exam (NMLE) have been discussed extensively and are expected to be instrumental in influencing curriculum reform, thus enhancing the quality of medical education. This paper discusses briefly why NMLE is necessary for Vietnam, what should be considered when establishing it, who could be the responsible organization, and how good practices can be learned and used as personal recommendations for educators and policymakers.

Integrated Educational Technology in Teaching Anatomy Using the ASIC Framework: A Case Study from VinUniversity.

The curriculum in teaching anatomy is under increasing pressure to transform from traditional to interdisciplinary integration, from cadaver-based to multimodal instruction with a system-based approach. Educational technologies are becoming critical and urged to be integrated into teaching medicine. At the College of Health Sciences, VinUniversity, the block of Human Body Structure and Function (HBSF) within the undergraduate medical training program was designed to teach anatomy with relevant basic medical sciences based on the principles of the system-based integrated structure. To support students in achieving the intended learning outcomes, multiple innovative technological platforms have been introduced into the curriculum using the moderation of the Adaptation - Standardization - Integration - Compliance (ASIC) framework over four key terms: adaptation, standardization, integration, and compliance. In this paper, the process for curriculum development is presented with an illustration of the selected technological platforms and the lessons learned using the ASIC model.

Echocardiography Recording in Awake Miniature Pigs.

Echocardiography uses ultrasonic waves to non-invasively assess cardiac structure and function and is the standard of care for cardiac assessment and monitoring. The miniature pig, or minipig, is increasingly being used as a model of cardiac disease in medical research. Pigs are notoriously difficult to restrain and handle safely, and, therefore, research echocardiography in this species is almost always performed under anesthesia or heavy sedation. Anesthetics and sedatives universally affect cardiovascular function and may cause the depression of cardiac output and blood pressure, increases or decreases in heart rate and systemic vascular resistance, changes in the electrical rhythm, and altered coronary blood flow. Therefore, sedated or anesthetized echocardiography may not accurately depict the progression of cardiac disease in large animal models, thereby limiting the translational value of these important studies. This paper describes a novel device that allows for standing awake echocardiography in minipigs. In addition, training techniques used to teach pigs to tolerate this painless and non-invasive procedure without the need for hemodynamic-altering anesthetics are described. Standing awake echocardiography represents a safe and feasible way to perform the most common cardiac monitoring test in minipigs for cardiovascular research.

Inhibitory Effects of Honokiol on Substantia Gelatinosa Neurons of the Trigeminal Subnucleus Caudalis in Juvenile Mice.

Inhibitory neurotransmitters such as gamma-aminobutyric acid (GABA) and glycine are known to be abundant in the substantia gelatinosa (SG) of the trigeminal subnucleus caudalis (Vc). Thus, it has been recognized as an initial synaptic site for regulating orofacial nociceptive stimuli. Honokiol, a principal active ingredient derived from the bark of Magnolia officinalis, has been exploited in traditional remedies with multiple biological effects, including anti-nociception on humans. However, the anti-nociceptive mechanism of honokiol on SG neurons of the Vc remains fully elusive. In this study, effects of honokiol on SG neurons of the Vc in mice were investigated using the whole-cell patch-clamp method. In a concentration-dependent manner, honokiol significantly enhanced frequencies of spontaneous postsynaptic currents (sPSCs) that were independent of action potential generation. Notably, honokiol-induced increase in the frequency of sPSCs was attributed to the release of inhibitory neurotransmitters through both glycinergic and GABAergic pre-synaptic terminals. Furthermore, higher concentration of honokiol induced inward currents that were noticeably attenuated in the presence of picrotoxin (a GABAA receptor antagonist) or strychnine (a glycine receptor antagonist). Honokiol also exhibited potentiation effect on glycine- and GABAA receptor-mediated responses. In inflammatory pain model, the increase in frequency of spontaneous firing on SG neurons induced by formalin was significantly inhibited by the application of honokiol. Altogether, these findings indicate that honokiol might directly affect SG neurons of the Vc to facilitate glycinergic and GABAergic neurotransmissions and modulate nociceptive synaptic transmission against pain. Consequently, the inhibitory effect of honokiol in the central nociceptive system contributes to orofacial pain management.

Are countries using global fund support to implement HIV drug resistance surveillance? A review of funded HIV grants.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is the largest funder of human immunodeficiency virus (HIV) prevention and treatment programs worldwide. Since 2002, the Global Fund has encouraged grant recipients to implement drug resistance surveillance (DRS) as part of treatment programs. We reviewed documentation of 147 grants funded in 2004-2008 (funding rounds 4-8) to assess grantees' use of funds to support HIV DRS. Overall, 94 grants (64%) described HIV DRS as part of the national treatment program. However, only 32 grants (22%) specifically documented DRS as a grant-funded activity. This review provides baseline information suggesting limited use by countries of Global Fund financing to support HIV DRS. Additional assessment is required to evaluate barriers to using Global Fund grants to support DRS.

How Protein Methylation Regulates Steroid Receptor Function.

Steroid receptors (SRs) are members of the nuclear hormonal receptor family, many of which are transcription factors regulated by ligand binding. SRs regulate various human physiological functions essential for maintenance of vital biological pathways, including development, reproduction, and metabolic homeostasis. In addition, aberrant expression of SRs or dysregulation of their signaling has been observed in a wide variety of pathologies. SR activity is tightly and finely controlled by post-translational modifications (PTMs) targeting the receptors and/or their coregulators. Whereas major attention has been focused on phosphorylation, growing evidence shows that methylation is also an important regulator of SRs. Interestingly, the protein methyltransferases depositing methyl marks are involved in many functions, from development to adult life. They have also been associated with pathologies such as inflammation, as well as cardiovascular and neuronal disorders, and cancer. This article provides an overview of SR methylation/demethylation events, along with their functional effects and biological consequences. An in-depth understanding of the landscape of these methylation events could provide new information on SR regulation in physiology, as well as promising perspectives for the development of new therapeutic strategies, illustrated by the specific inhibitors of protein methyltransferases that are currently available.

Willingness to pay for a quality-adjusted life year among advanced non-small cell lung cancer patients in Viet Nam, 2018.

To examine the willingness to pay (WTP) for a quality-adjusted life year (QALY) gained among advanced non-small cell lung cancer (NSCLC) patients in Viet Nam and to analyze the factors affecting an individual's WTP.A cross-sectional, contingent valuation study was conducted among 400 NSCLC patients across 6 national hospitals in Viet Nam. Self-reported information was recorded from patients regarding their socio-demographic status, EQ-5D (EuroQol-5 dimensions) utility, EQ-5D vas, and WTP for 1 QALY gained. To explore the factors related to the WTP, Gamma Generalized Linear Model and multiple logistic regression tools were applied to analyze data.The overall mean and median of WTP/QALY among the NSCLC patients were USD $11,301 and USD $8002, respectively. Strong association was recorded between WTP/QALY amount and the patient's education, economic status, comorbidity status, and health utility.Government and policymakers should consider providing financial supports to disadvantaged groups to improve their access to life saving cancer treatment.

Low temperature stress in maize (Zea mays L.) induces genes involved in photosynthesis and signal transduction as studied by suppression subtractive hybridization.

Unfavourable environmental conditions such as cold induce the transcription of a range of genes in plants in order to acclimate to these growth conditions. To better understand the cold acclimation of maize (Zea mays L.) it is important to identify components of the cold stress response. For this purpose, cold-induced genes were analysed using the PCR-select cDNA subtraction method. We identified several novel genes isolated from maize seedling exposed for 48h to 6 degrees C. Of 18 Zea mays cold-induced genes (ZmCOI genes) characterized, the majority share similarities with proteins with known function in signal transduction and photosynthesis regulation. RT-PCR was conducted for a selected group of genes, namely ZmCOI6.1, ZmACA1, ZmDREB2A and ZmERF3, confirming the induction by low temperature. In addition, it was found that their expression was strongly induced by other abiotic stresses such as drought and high salt concentration, by stress signalling molecules such as jasmonic acid, salicylic acid and abscisic acid, and by membrane rigidification. These results suggest that this group of genes is involved in a general response to abiotic stresses.

Self-medication practices among Vietnamese residents in highland provinces.

Background: Monitoring self-medication practice, which refers to individuals using medicine without instructions of physicians, is critical to control its harmful effects. However, in Vietnam, evidence about self-medication among individuals in highland areas is constrained. This study examined self-medication practice among residents living in highland areas in Vietnam and determined associated factors. Materials and methods: A cross-sectional study was performed in five highland provinces with 1000 individuals. Information about individual and household's socioeconomic status and self-medication practice in the last 12 months was surveyed. Multivariate logistic and Poisson regressions were used to identify associated factors with self-medication. Results: 83.3% reported self-medication in the last 12 months, with the mean times of self-medication being 4.5 times (SD=4.1). Female (OR=0.62, p<0.01), ethnic minorities, higher number of members having health insurance in family (OR=0.82, p<0.01) and higher annual household income (OR=0.78, p<0.05) were associated with the lower likelihood of "Only buy medicines at pharmacy stores when having illness in the last 12 month". Moreover, people who were females (OR=0.59, p<0.05), white-collar worker (OR=0.25, p<0.01) and had higher number of children in the family (OR=0.68, p<0.05) were less likely to practice self-medication. People who were ethnic minorities, white-collar worker (Coef.=-0.32, p<0.01) and higher number of members having health insurance in family had lower times of self-medication in the last 12 months compared to other groups. Meanwhile, individuals having higher number of members in the family (Coef.=0.07, p<0.01) and higher annual household income (Coef.=0.08, p<0.01) had highertimes of self-medication in the last 12 months. Conclusion: Residents in highland areas in Vietnam had a considerably high 12-month prevalence of self-medication. Medical products quality management and self-medication guideline are potential to maximize the effects of self-medication. Moreover, promoting the use of health insurance should also be concerned as a solution to address this issue.

Public Awareness about Antibiotic Use and Resistance among Residents in Highland Areas of Vietnam.

BACKGROUND: Antibiotic resistance (AR) remains a global crisis. However, the literature on public awareness about antibiotic use and AR in the highland provinces of Vietnam has been constrained. This study explores the awareness of antibiotic use and resistance among general people in highland provinces in Vietnam and detects associated factors. METHODS: A cross-sectional study was performed in five highland provinces with 1000 households. Information about socioeconomic status and awareness regarding prescription medicine use, antibiotic use, and AR was surveyed. Multivariate logistic regression was used to identify associated factors with awareness. RESULTS: 64.2% of people were aware of prescription drugs. More than two-thirds (67.4%) of participants were aware of antibiotic use, of whom only 55.8% were aware of AR. Higher age, education, and family income were positively associated with being aware of prescription medicine, antibiotic, and AR. Females had a lower likelihood of being aware of prescription medicine (OR=0.64; 95%CI=0.45-0.90) compared to male counterparts. Those being freelancers were more likely to be aware of antibiotic resistance (OR=2.30; 95%CI=1.13-4.67) compared to those working in agriculture/fishery/forestry sector. Compared to Kinh ethnic, most ethnic minorities were less likely to be aware of prescription medicine, antibiotic, and AR. CONCLUSIONS: This study showed a low awareness regarding prescription medicine, antibiotic use, and AR among public people in the highland provinces of Vietnam. Further systemic and didactic educational interventions targeting females, low education, low income, ethnic minorities, and those working in agriculture/fishery/forestry sector in this setting should be performed and evaluated to improve the awareness about antibiotic use and resistance.