Predicting deterioration in dengue using a low cost wearable for continuous clinical monitoring

Close vital signs monitoring is crucial for the clinical management of patients with dengue. We investigated performance of a non-invasive wearable utilising photoplethysmography (PPG), to provide real-time risk prediction in hospitalised individuals. We performed a prospective observational clinical study in Vietnam between January 2020 and October 2022: 153 patients were included in analyses, providing 1353 h of PPG data. Using a multi-modal transformer approach, 10-min PPG waveform segments and basic clinical data (age, sex, clinical features on admission) were used as features to continuously forecast clinical state 2 h ahead. Prediction of low-risk states (17,939/80,843; 22.1%), defined by NEWS2 and mSOFA < 6, was associated with an area under the precision-recall curve of 0.67 and an area under the receiver operator curve of 0.83. Implementation of such interventions could provide cost-effective triage and clinical care in dengue, offering opportunities for safe ambulatory patient management

TextANIMAR: Text-based 3D Animal Fine-Grained Retrieval

3D object retrieval is an important yet challenging task, which has drawn more and more attention in recent years. While existing approaches have made strides in addressing this issue, they are often limited to restricted settings such as image and sketch queries, which are often unfriendly interactions for common users. In order to overcome these limitations, this paper presents a novel SHREC challenge track focusing on text-based fine-grained retrieval of 3D animal models. Unlike previous SHREC challenge tracks, the proposed task is considerably more challenging, requiring participants to develop innovative approaches to tackle the problem of text-based retrieval. Despite the increased difficulty, we believe that this task has the potential to drive useful applications in practice and facilitate more intuitive interactions with 3D objects. Five groups participated in our competition, submitting a total of 114 runs. While the results obtained in our competition are satisfactory, we note that the challenges presented by this task are far from being fully solved. As such, we provide insights into potential areas for future research and improvements. We believe that we can help push the boundaries of 3D object retrieval and facilitate more user-friendly interactions via vision-language technologies.Comment: arXiv admin note: text overlap with arXiv:2304.0573

A modified Sequential Organ Failure Assessment score for dengue: development, evaluation and proposal for use in clinical trials

Background Dengue is a neglected tropical disease, for which no therapeutic agents have shown clinical efficacy to date. Clinical trials have used strikingly variable clinical endpoints, which hampers reproducibility and comparability of findings. We investigated a delta modified Sequential Organ Failure Assessment (delta mSOFA) score as a uniform composite clinical endpoint for use in clinical trials investigating therapeutics for moderate and severe dengue. Methods We developed a modified SOFA score for dengue, measured and evaluated its performance at baseline and 48 h after enrolment in a prospective observational cohort of 124 adults admitted to a tertiary referral hospital in Vietnam with dengue shock. The modified SOFA score included pulse pressure in the cardiovascular component. Binary logistic regression, cox proportional hazard and linear regression models were used to estimate association between mSOFA, delta mSOFA and clinical outcomes. Results The analysis included 124 adults with dengue shock. 29 (23.4%) patients required ICU admission for organ support or due to persistent haemodynamic instability: 9/124 (7.3%) required mechanical ventilation, 8/124 (6.5%) required vasopressors, 6/124 (4.8%) required haemofiltration and 5/124 (4.0%) patients died. In univariate analyses, higher baseline and delta (48 h) mSOFA score for dengue were associated with admission to ICU, requirement for organ support and mortality, duration of ICU and hospital admission and IV fluid use. Conclusions The baseline and delta mSOFA scores for dengue performed well to discriminate patients with dengue shock by clinical outcomes, including duration of ICU and hospital admission, requirement for organ support and death. We plan to use delta mSOFA as the primary endpoint in an upcoming host-directed therapeutic trial and investigate the performance of this score in other phenotypes of severe dengue in adults and children

A Multi-Center Randomised Controlled Trial of Gatifloxacin versus Azithromycin for the Treatment of Uncomplicated Typhoid Fever in Children and Adults in Vietnam

BACKGROUND: Drug resistant typhoid fever is a major clinical problem globally. Many of the first line antibiotics, including the older generation fluoroquinolones, ciprofloxacin and ofloxacin, are failing. OBJECTIVES: We performed a randomised controlled trial to compare the efficacy and safety of gatifloxacin (10 mg/kg/day) versus azithromycin (20 mg/kg/day) as a once daily oral dose for 7 days for the treatment of uncomplicated typhoid fever in children and adults in Vietnam. METHODS: An open-label multi-centre randomised trial with pre-specified per protocol analysis and intention to treat analysis was conducted. The primary outcome was fever clearance time, the secondary outcome was overall treatment failure (clinical or microbiological failure, development of typhoid fever-related complications, relapse or faecal carriage of S. typhi). PRINCIPAL FINDINGS: We enrolled 358 children and adults with suspected typhoid fever. There was no death in the study. 287 patients had blood culture confirmed typhoid fever, 145 patients received gatifloxacin and 142 patients received azithromycin. The median FCT was 106 hours in both treatment arms (95% Confidence Interval [CI]; 94-118 hours for gatifloxacin versus 88-112 hours for azithromycin), (logrank test p = 0.984, HR [95% CI] = 1.0 [0.80-1.26]). Overall treatment failure occurred in 13/145 (9%) patients in the gatifloxacin group and 13/140 (9.3%) patients in the azithromycin group, (logrank test p = 0.854, HR [95% CI] = 0.93 [0.43-2.0]). 96% (254/263) of the Salmonella enterica serovar Typhi isolates were resistant to nalidixic acid and 58% (153/263) were multidrug resistant. CONCLUSIONS: Both antibiotics showed an excellent efficacy and safety profile. Both gatifloxacin and azithromycin can be recommended for the treatment of typhoid fever particularly in regions with high rates of multidrug and nalidixic acid resistance. The cost of a 7-day treatment course of gatifloxacin is approximately one third of the cost of azithromycin in Vietnam. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN67946944

Triple therapy with artemether-lumefantrine plus amodiaquine versus artemether-lumefantrine alone for artemisinin-resistant, uncomplicated falciparum malaria: an open-label, randomised, multicentre trial

Background: Late treatment failures after artemisinin-based combination therapies (ACTs) for falciparum malaria have increased in the Greater Mekong subregion in southeast Asia. Addition of amodiaquine to artemether-lumefantrine could provide an efficacious treatment for multidrug-resistant infections. Methods: We conducted an open-label, randomised trial at five hospitals or health centres in three locations (western Cambodia, eastern Cambodia, and Vietnam). Eligible participants were male and female patients aged 2-65 years with uncomplicated Plasmodium falciparum malaria. Patients were randomly allocated (1:1 in blocks of eight to 12) to either artemether-lumefantrine alone (dosed according to WHO guidelines) or artemether-lumefantrine plus amodiaquine (10 mg base per kg/day), both given orally as six doses over 3 days. All received a single dose of primaquine (0·25 mg/kg) 24 h after the start of study treatment to limit transmission of the parasite. Parasites were genotyped, identifying artemisinin resistance. The primary outcome was Kaplan-Meier 42-day PCR-corrected efficacy against recrudescence of the original parasite, assessed by intent-to-treat. Safety was a secondary outcome. This completed trial is registered at ClinicalTrials.gov (NCT03355664). Findings: Between March 18, 2018, and Jan 30, 2020, 310 patients received randomly allocated treatment; 154 received artemether-lumefantrine alone and 156 received artemether-lumefantrine plus amodiaquine. Parasites from 305 of these patients were genotyped. 42-day PCR-corrected treatment efficacy was noted in 151 (97%, 95% CI 92-99) of 156 patients with artemether-lumefantrine plus amodiaquine versus 146 (95%, 89-97) of 154 patients with artemether-lumefantrine alone; hazard ratio (HR) for recrudescence 0·6 (95% CI 0·2-1·9, p=0·38). Of the 13 recrudescences, 12 were in 174 (57%) of 305 infections with pfkelch13 mutations indicating artemisinin resistance, for which 42-day efficacy was noted in 89 (96%) of 93 infections with artemether-lumefantrine plus amodiaquine versus 73 (90%) of 81 infections with artemether-lumefantrine alone; HR for recrudescence 0·44 (95% CI 0·14-1·40, p=0·17). Artemether-lumefantrine plus amodiaquine was generally well tolerated, but the number of mild (grade 1-2) adverse events, mainly gastrointestinal, was greater in this group compared with artemether-lumefantrine alone (vomiting, 12 [8%] with artemether-lumefantrine plus amodiaquine vs three [2%] with artemether-lumefantrine alone, p=0·03; and nausea, 11 [7%] with artemether-lumefantrine plus amodiaquine vs three [2%] with artemether-lumefantrine alone, p=0·05). Early vomiting within 1 h of treatment, requiring retreatment, occurred in no patients of 154 with artemether-lumefantrine alone versus five (3%) of 156 with artemether-lumefantrine plus amodiaquine, p=0·06. Bradycardia (≤54 beats/min) of any grade was noted in 59 (38%) of 154 patients with artemether-lumefantrine alone and 95 (61%) of 156 with artemether-lumefantrine plus amodiaquine, p=0·0001. Interpretation: Artemether-lumefantrine plus amodiaquine provides an alternative to artemether-lumefantrine alone as first-line treatment for multidrug-resistant P falciparum malaria in the Greater Mekong subregion, and could prolong the therapeutic lifetime of artemether-lumefantrine in malaria-endemic populations

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

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

PHÂN LẬP CÁC CHỦNG VI KHUẨN HIẾU KHÍ CÓ KHẢ NĂNG PHÂN HỦY CHLORPYRIFOS TRONG ĐẤT TRỒNG RAU MÀU Ở TỈNH LÂM ĐỒNG

This study aims to isolate aerobic bacteria strains for decomposing chlorpyrifos in soil in Lam Dong.  The number of microorganisms for decomposing chlorpyrifos can be increased by incubating the soil samples in MSM medium supplemented with chlorpyrifos (20 mg/L) as the only carbon source. Three aerobic bacteria strains were isolated after the separating each bacterial strain and investigating the decomposition ability chlorpyrifos processing, which were further named as T1, W3 and B2, respectively.  In particular, T1, W3 and B2 strains removed 50.4%, 59.3% and 62.2% of chlorpyrifos after 14 days of culture in MSM medium in supplementation with 20 mg/L chlorpyrifos, respectively. Acinetobacter calcoaceticus, Bacillus megaterium and Sphingomonas pseudosanguinis were identified by 16S rRNA gene sequencing. The three strains of bacteria exhibit ability to degrade chlorpyrifos when added to the soil environment. These results suggested that the isolated bacteria strains can be applied to treat contaminated soil with pesticides and irritate the plant growing.Nghiên cứu này được thực hiện với mục đích phân lập được các chủng vi khuẩn hiếu khí có khả năng phân hủy dư lượng thuốc bảo vệ thực vật chlorpyrifos tồn dư trong đất tại Lâm Đồng. Tiến hành làm giàu dòng vi khuẩn hiếu khí bản địa tại Lâm Đồng có khả năng phân hủy chlorpyrifos bằng cách ủ dịch chiết các mẫu đất trong môi trường MSM bổ sung chlorpyrifos đạt nồng độ 20 mg/L làm nguồn cacbon duy nhất. Tách riêng từng dòng vi khuẩn và khảo sát khả năng phân hủy chlorpyrifos đã chọn ra được 3 dòng vi khuẩn hiếu khí kí hiệu là T1, W3 và B2. Kết quả thí nghiệm cho thấy cả 3 dòng này đều có khả năng phân hủy chlorpyrifos, lần lượt là 50,4%, 59,3% và 62,2% hàm lượng chlorpyrifos sau 14 ngày nuôi cấy trong môi trường MSM bổ sung 20 mg/L chlorpyrifos. Ba dòng vi khuẩn được định danh lần lượt là Acinetobacter calcoaceticus, Bacillus megaterium và Sphingomonas pseudosanguinis bằng phương pháp giải trình tự gen 16S rRNA. Cả ba dòng vi khuẩn này đều thể hiện khả năng phân hủy chlorpyrifos tốt khi bổ sung vào môi trường đất, từ đó cho thấy chúng có tiềm năng ứng dụng cao để sản xuất tạo ra các chế phẩm vi sinh giúp xử lý đất ô nhiễm

Monitoring fine root growth to identify optimal fertilization timing in a forest plantation: A case study in Northeast Vietnam.

Fertilizer is applied widely to improve the productivity of plantations. Traditionally, fertilization is conducted in spring and/or in the early rainy season, and it is believed to support the growth of planted trees in the growing season. Little attention to date has been paid on identification of the optimal timing of fertilization and fertilizer dose. In this study, application of the fine root monitoring technique in identifying optimal fertilization timing for an Acacia plantation in Vietnam is described. The study used two fertilizer doses (100 and 200 g NPK/tree) and three fertilization timings (in spring; in the early rainy season; and based on the fine root monitoring technique to identify when the fine roots reach their growth peak). As expected fertilization timings significantly affected growth and above-ground biomass (AGB) of the plantation. Fertilization based on the fine root monitoring technique resulted in the highest growths and AGB, followed by fertilization in the early rainy season and then in spring. Applying fertilizer at 200 g NPK/tree based on the fine root monitoring technique increased diameter at breast height (DBH) by 16%, stem height by 8%, crown diameter (Dc) by 16%, and AGB by 40% as compared to early rainy season fertilization. Increases of 32% DBH, 23% stem height, 44% Dc, and 87% AGB were found in fertilization based on fine root monitoring technique compared to spring fertilization. This study concluded that forest growers should use the fine root monitoring technique to identify optimal fertilization timing for higher productivity

Aboveground Net Primary Production at Acacia mangium Plantation in Northern Vietnam

Net primary production (NPP) is an important index for understanding carbon cycling in forest ecosystems. In this study, aboveground NPP at Acacia mangium plantation was estimated basing on allometry for aboveground biomass increment (ΔM) and litter trap technique for litterfall (Lf). The experiment was conducted in two plots of 300 m2 each (15 × 20 m), established at a 21-month old plantation. Data were collected five times of 3-month intervals in a total duration of 357 days. The results indicated that Lf and ΔM were seasonal-dependent. Litterfall was highest (4.06 g m-1 day-1) during Sep-Jan (late rainy season, early winter) and lowest (1.10 g m-1 day-1) during Mar-Jun (early rainy season, early summer). While, ΔM was highest (13.51 g m-1 day-1) during Jun-Sep (rainy season, summer) and lowest (3.10 g m-1 day-1) during Jan-Mar (dry season, winter). Total Lf in a duration of 357 days was 9.69 tons ha-1 and ΔM was 27.71 tons ha-1, leading to total aboveground NPP of the present study plantation of 37.40 tons ha-1. It is concluded that aboveground NPP of acacia plantation was much higher than other forests of different types and ages around the world. Such difference indicates the importance of acacia plantation in soil nutrient cycling through litterfall decomposition and carbon sequestration through aboveground biomass increment