Cloning and expression of gene FanC-2NT encoding K99-2NT fimbrial antigen of enterotoxigenic Escherichia coli from diarrheic post-weaning piglets

Background and Purpose: The K99 (F5) is one pilus adhesin that mediates the attachment of enterotoxigenic E. coli (ETEC) strains to small intestines to cause to diarrhea in piglets, lambs and newborn calves. In this work, we carried out cloning and expression of the mature peptide of FanC subunit, K99 fimbriae, one of the most common adhesive antigens in E. coli. Materials and Methods: E. coli 2NT strain was isolated from fecal samples of post-weaning piglets with diarrhea. The coding sequence of the mature peptide of K99-2NT subunit was isolated by PCR amplification and cloned into pGEM®-T Easy vector for sequencing using fluorescent dideoxy-terminator method. Expression of K99-2NT protein which was inserted into pET200/D-TOPO vector induced with IPTG. The PCR product and expression level of protein was examined by agarose gel electrophoresis and sodium dodecyl sulfate-polyacrylamide gel electrophoresis, respectively. Results and Conclusions: We cloned and expressed successfully the mature peptide of K99 subunit with molecular weight of approximately 17.5 kDa from E. coli 2NT strain (named K99-2NT). Nucleotide sequence of the K99-2NT subunit coding region of fanC-2NT gene is 477 bp in length and is 99% similarity with that of fanC gene (accession no: M35282). Highest expression level occurred after 12 h of induction with 0.75 mM IPTG at 37oC. This subunit antigen will be tested for immune response of rat in the next time

Experiência de aprendizagem de estudantes de enfermagem na prevenção e controlo de infeções associadas aos cuidados de saúde (PC-IACS) em países asiáticos: um estudo qualitativo exploratório

Background: Healthcare-associated infection prevention and control (HAI-PC) education programs in Asian countries seem limited and require improvement and support. Objective: This study explored students’ learning experiences with HAI-PC education programs in Asian countries (two Vietnamese and two Cambodian universities) to support a pedagogical model in HAI-PC. Method: A qualitative exploratory study design was employed, and inductive content analysis was conducted. Students were selected to participate in the focus group to investigate their experiences with HAI-PC using five structured questions. There were 48 nursing students in total from four universities, 28 from 2 universities in Cambodia, and 20 from two universities in Vietnam. Results: The summary results gained from the four universities were synthesized by grouping them into sub-categories and four primary categories, which were students’ HAI-PC competence, students’ current learning methods in HAI-PC Education, the HAI-PC teaching and learning environment, students’ capacity, and entrepreneurial skills in HAI-PC development. Conclusion: This study revealed evidence to improve nursing education in HAI-PC in Asian countries. The new learning method of the simulation scenario and the model fascinated the students; they were happy and more confident about their future careers in practicing HAI-PC skills in their clinical practicum and hospital practice. The current HAI-PC education faces issues related to education and healthcare systems in Asian countries, highlighting the need for improvement.Enquadramento: Os programas de educação em prevenção e controlo de infeções associadas aos cuidados de saúde (PC-IAS) em países asiáticos parecem ser limitados e necessitam de melhorias e apoio. Objetivo: Este estudo explorou as experiências de aprendizagem dos estudantes com programas de educação em PC-IAS em países asiáticos (duas universidades vietnamitas e duas universidades cambojanas) para apoiar um modelo pedagógico em PC-IAS. Método: Foi utilizado um desenho de estudo exploratório qualitativo, e foi realizada uma análise de conteúdo indutiva. Os estudantes foram selecionados para participar no grupo focal para investigar as suas experiências com PC-IAS usando cinco perguntas estruturadas. No total, participaram 48 estudantes de enfermagem de quatro universidades, sendo 28 de duas universidades no Camboja e 20 de duas universidades no Vietname. Resultados: Os resultados resumidos das quatro universidades foram sintetizados agrupando-os em subcategorias e quatro categorias principais, que eram competência dos estudantes em PC-IAS, métodos de aprendizagem atuais dos estudantes em Educação em PC-IAS, ambiente de ensino e aprendizagem em PC-IAS, capacidade dos estudantes e habilidades empreendedoras no desenvolvimento de PC-IAS. Conclusão: Este estudo revelou evidências para melhorar a educação em enfermagem em PC-IAS em países asiáticos. O novo método de aprendizagem do cenário de simulação e o modelo cativaram os estudantes; eles ficaram felizes e mais confiantes em relação às suas futuras carreiras na prática de habilidades em PC-IAS no estágio clínico e na prática hospitalar. A educação atual em PC-IAS enfrenta questões relacionadas aos sistemas de educação e saúde em países asiáticos, destacando a necessidade de melhorias

Simulação como método de ensino na formação em enfermagem na prevenção e controlo de infeções associadas aos cuidados de saúde em países asiáticos: um estudo qualitativo

Background: Applying simulation for nursing education, especially in healthcare-associated infection prevention and control (HAI-PC) in developing countries has limited evidence. The study was conducted to explore educators’ perceptions of simulation as a teaching method for nursing education in HAI-PC in two Vietnamese and two Cambodian universities. Methods: An exploratory qualitative design was applied. A focus group of 37 educators from four universities was conducted for data collection. Inductive and deductive qualitative content analysis was applied in analysing the data. Results: The core category was constructed to reflect educators’ perception of scenario-based simulation (SBS) as a teaching method for nursing education in HAI prevention and control. This main category included three subcategories: (i) enhancing nursing competence; (ii) preparing students for simulation; and [1] promoting simulation pedagogy competence. Conclusions: The findings identified the importance and benefits of applying simulation as a teaching method in nursing education. Additionally, it emphasized the necessity of enhancing knowledge associated with HAIs and providing additional training on simulation for educators to improve the quality of conducting simulations.Enquadramento: A aplicação da simulação no ensino de enfermagem, especialmente na prevenção e controlo de infeções associadas aos cuidados de saúde (IACS), em países em desenvolvimento, tem evidências limitadas. O estudo foi conduzido para explorar as perceções dos educadores sobre a simulação como método de ensino para a formação em enfermagem na prevenção e controlo de IACS em duas universidades vietnamitas e duas universidades cambojanas. Métodos: Foi aplicado um desenho qualitativo exploratório. Um grupo de discussão com 37 educadores de quatro universidades foi conduzido para a recolha de dados. A análise qualitativa de conteúdo indutiva e dedutiva foi aplicada na análise dos dados. Resultados: A categoria central foi construída para refletir a perceção dos educadores sobre a simulação baseada em cenários (SBC) como método de ensino para a formação em enfermagem na prevenção e controlo de IACS. Esta categoria principal incluiu três subcategorias: (i) aprimoramento da competência em enfermagem; (ii) preparação dos estudantes para a simulação; e [1] promoção da competência em pedagogia de simulação. Conclusões: Os resultados identificaram a importância e benefícios da aplicação da simulação como método de ensino na formação em enfermagem. Além disso, enfatizou a necessidade de aprimorar o conhecimento associado às ICACS e fornecer treinamento adicional sobre simulação para educadores, visando melhorar a qualidade da condução das simulações

Experiências do estudante de enfermagem na aprendizagem da prevenção e controlo de IACS em países asiáticos através do uso de simulação baseada em cenários: um estudo qualitativo exploratório

Background: Healthcare-associated infections (HAIs) have posed a major threat to both patients and to the safety healthcare personnel worldwide. According to the World Health Organization, 10% of hospitalized patients are affected by HAIs worldwide. Objective: The objective of this study was to explore the experiences of nursing students in learning HAIs prevention and control by the application of the scenario-based simulation pedagogy now in use in two Vietnamese and two Cambodian universities. Methods: A qualitative study was conducted among 160 nursing students from 2 Cambodian universities and 2 Vietnamese universities, and by using the purposive-sampling method. The data were collected through a focus group discussion and analyzed by the Graneheim and Lundman method (Graneheim & Lundman, 2004). Results: Two themes and six categories were generated. 1) First theme: factors for enhancing student learning on the prevention and control of HAIs by use of scenario-based simulation; and 2) Second theme: factors hindering students learning on HAI prevention and control by use of scenario-based simulation. Conclusion: The findings showed that SBS is an effective learning method for nursing students that can be applied to enhance the quality of nursing education in the Asian countries as SBS not only improves the clinical skills, but also the soft skills of nursing students. However, the effective outcomes and impacts can only be achieved in the context with the appropriate learning materials and equipment, simulation facilities and the instructors with pedagogical skills.Enquadramento: As infeções associadas a cuidados de saúde (IACS) têm representado uma grande ameaça tanto para os pacientes quanto para a segurança dos profissionais de saúde em todo o mundo. De acordo com a Organização Mundial da Saúde, 10% dos pacientes hospitalizados são afetados por IACS em todo o mundo. Objetivo: O objetivo deste estudo foi explorar as experiências dos estudantes de enfermagem na aprendizagem da prevenção e controlo de IACS através da aplicação da pedagogia de simulação baseada em cenários, atualmente em uso em duas universidades vietnamitas e duas universidades cambojanas. Métodos: Um estudo qualitativo foi conduzido entre 160 estudantes de enfermagem de duas universidades cambojanas e duas universidades vietnamitas, utilizando o método de amostragem propositada. Os dados foram recolhidos através de uma discussão em grupo focal e analisados pelo método de Graneheim e Lundman (Graneheim & Lundman, 2004). Resultados: Dois temas e seis categorias foram gerados. 1) Primeiro tema: fatores que contribuem para a aprendizagem dos estudantes na prevenção e controlo de IACS pelo uso de simulação baseada em cenários; e 2) Segundo tema: fatores que impedem a aprendizagem dos estudantes na prevenção e controlo de IACS pelo uso de simulação baseada em cenários (SBC). Conclusão: Os resultados demonstraram que a SBC é um método de aprendizagem eficaz para estudantes de enfermagem que pode ser aplicado para melhorar a qualidade da educação em enfermagem nos países asiáticos, uma vez que a SBC não só melhora as habilidades clínicas, mas também as habilidades interpessoais dos estudantes de enfermagem. No entanto, os resultados e impactos efetivos só podem ser alcançados no contexto com os materiais e equipamentos de aprendizagem apropriados, instalações de simulação e instrutores com habilidades pedagógicas

Rifampicin resistant 'Mycobacterium tuberculosis' in Vietnam, 2020–2022

Objective: We conducted a descriptive analysis of multi-drug resistant tuberculosis (MDR-TB) in Vietnam’s two largest cities, Hanoi and Ho Chi Minh city. Methods: All patients with rifampicin resistant tuberculosis were recruited from Hanoi and surrounding provinces between 2020 and 2022. Additional patients were recruited from Ho Chi Minh city over the same time period. Demographic data were recorded from all patients, and samples collected, cultured, whole genome sequenced and analysed for drug resistance mutations. Genomic susceptibility predictions were made on the basis of the World Health Organization’s catalogue of mutations in Mycobacterium tuberculosis associated with drug resistance, version 2. Comparisons were made against phenotypic drug susceptibility test results where these were available. Multivariable logistic regression was used to assess risk factors for previous episodes of tuberculosis. Results: 233/265 sequenced isolates were of sufficient quality for analysis, 146 (63 %) from Ho Chi Minh City and 87 (37 %) from Hanoi. 198 (85 %) were lineage 2, 20 (9 %) were lineage 4, and 15 (6 %) were lineage 1. 17/211 (8 %) for whom HIV status was known were infected, and 109/214 (51 %) patients had had a previous episode of tuberculosis. The main risk factor for a previous episode was HIV infection (odds ratio 5.1 (95 % confidence interval 1.3–20.0); p = 0.021). Sensitivity for predicting first-line drug resistance from whole genome sequencing data was over 90 %, with the exception of pyrazinamide (85 %). For moxifloxacin and amikacin it was 50 % or less. Among rifampicin-resistant isolates, prevalence of resistance to each non-first-line drug was < 20 %. Conclusions: Drug resistance among most MDR-TB strains in Vietnam’s two largest cities is confined largely to first-line drugs. Living with HIV is the main risk factor among patients with MDR-TB for having had a previous episode of tuberculosis

SIMULATION AS A TEACHING METHOD FOR NURSING EDUCATION IN HEALTHCARE-ASSOCIATED INFECTION PREVENTION AND CONTROL IN ASIAN COUNTRIES: A QUALITATIVE STUDY

BACKGROUND: Applying simulation for nursing education, especially in healthcare-associated infection prevention and control (HAI-PC) in developing countries has limited evidence. The study was conducted to explore educators’ perceptions of simulation as a teaching method for nursing education in HAI-PC in two Vietnamese and two Cambodian universities. METHODS: An exploratory qualitative design was applied. A focus group of 37 educators from four universities was conducted for data collection. Inductive and deductive qualitative content analysis was applied in analysing the data. RESULTS: The core category was constructed to reflect educators’ perception of scenario-based simulation (SBS) as a teaching method for nursing education in HAI prevention and control. This main category included three subcategories: (i) enhancing nursing competence; (ii) preparing students for simulation; and [1] promoting simulation pedagogy competence. CONCLUSIONS: The findings identified the importance and benefits of applying simulation as a teaching method in nursing education. Additionally, it emphasized the necessity of enhancing knowledge associated with HAIs and providing additional training on simulation for educators to improve the quality of conducting simulations

EXPERIENCES OF THE NURSING STUDENT IN LEARNING HAI PREVENTION AND CONTROL IN ASIAN COUNTRIES THROUGH THE USE OF SCENARIO-BASED SIMULATION: AN EXPLORATIVE QUALITATIVE STUDY

BACKGROUND: Healthcare-associated infections (HAIs) have posed a major threat to both patients and to the safety healthcare personnel worldwide. According to the World Health Organization, 10% of hospitalized patients are affected by HAIs worldwide. OBJECTIVE: The objective of this study was to explore the experiences of nursing students in learning HAIs prevention and control by the application of the scenario-based simulation pedagogy now in use in two Vietnamese and two Cambodian universities. METHODS: A qualitative study was conducted among 160 nursing students from 2 Cambodian universities and 2 Vietnamese universities, and by using the purposive-sampling method. The data were collected through a focus group discussion and analyzed by the Graneheim and Lundman method (Graneheim & Lundman, 2004). RESULTS: Two themes and six categories were generated. 1) First theme: factors for enhancing student learning on the prevention and control of HAIs by use of scenario-based simulation; and 2) Second theme: factors hindering students learning on HAI prevention and control by use of scenario-based simulation. CONCLUSION: The findings showed that SBS is an effective learning method for nursing students that can be applied to enhance the quality of nursing education in the Asian countries as SBS not only improves the clinical skills, but also the soft skills of nursing students. However, the effective outcomes and impacts can only be achieved in the context with the appropriate learning materials and equipment, simulation facilities and the instructors with pedagogical skills

Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology.

BACKGROUND: Ventilator-associated respiratory infection (VARI) is a significant problem in resource-restricted intensive care units (ICUs), but differences in casemix and etiology means VARI in resource-restricted ICUs may be different from that found in resource-rich units. Data from these settings are vital to plan preventative interventions and assess their cost-effectiveness, but few are available. METHODS: We conducted a prospective observational study in four Vietnamese ICUs to assess the incidence and impact of VARI. Patients ≥ 16 years old and expected to be mechanically ventilated > 48 h were enrolled in the study and followed daily for 28 days following ICU admission. RESULTS: Four hundred fifty eligible patients were enrolled over 24 months, and after exclusions, 374 patients' data were analyzed. A total of 92/374 cases of VARI (21.7/1000 ventilator days) were diagnosed; 37 (9.9%) of these met ventilator-associated pneumonia (VAP) criteria (8.7/1000 ventilator days). Patients with any VARI, VAP, or VARI without VAP experienced increased hospital and ICU stay, ICU cost, and antibiotic use (p < 0.01 for all). This was also true for all VARI (p < 0.01 for all) with/without tetanus. There was no increased risk of in-hospital death in patients with VARI compared to those without (VAP HR 1.58, 95% CI 0.75-3.33, p = 0.23; VARI without VAP HR 0.40, 95% CI 0.14-1.17, p = 0.09). In patients with positive endotracheal aspirate cultures, most VARI was caused by Gram-negative organisms; the most frequent were Acinetobacter baumannii (32/73, 43.8%) Klebsiella pneumoniae (26/73, 35.6%), and Pseudomonas aeruginosa (24/73, 32.9%). 40/68 (58.8%) patients with positive cultures for these had carbapenem-resistant isolates. Patients with carbapenem-resistant VARI had significantly greater ICU costs than patients with carbapenem-susceptible isolates (6053 USD (IQR 3806-7824) vs 3131 USD (IQR 2108-7551), p = 0.04) and after correction for adequacy of initial antibiotics and APACHE II score, showed a trend towards increased risk of in-hospital death (HR 2.82, 95% CI 0.75-6.75, p = 0.15). CONCLUSIONS: VARI in a resource-restricted setting has limited impact on mortality, but shows significant association with increased patient costs, length of stay, and antibiotic use, particularly when caused by carbapenem-resistant bacteria. Evidence-based interventions to reduce VARI in these settings are urgently needed

Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke