Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents.

BACKGROUND: Dexamethasone has been shown to reduce mortality in patients with tuberculous meningitis but the long-term outcome of the disease is unknown. METHODS: Vietnamese adults and adolescents with tuberculous meningitis recruited to a randomised, double-blind, placebo-controlled trial of adjunctive dexamethasone were followed-up at five years, to determine the effect of dexamethasone on long-term survival and neurological disability. RESULTS: 545 patients were randomised to receive either dexamethasone (274 patients) or placebo (271 patients). 50 patients (9.2%) were lost to follow-up at five years. In all patients two-year survival, probabilities tended to be higher in the dexamethasone arm (0.63 versus 0.55; p = 0.07) but five-year survival rates were similar (0.54 versus 0.51, p = 0.51) in both groups. In patients with grade 1 TBM, but not with grade 2 or grade 3 TBM, the benefit of dexamethasone treatment tended to persist over time (five-year survival probabilities 0.69 versus 0.55, p = 0.07) but there was no conclusive evidence of treatment effect heterogeneity by TBM grade (p = 0.36). The dexamethasone group had a similar proportion of severely disabled patients among survivors at five years as the placebo group (17/128, 13.2% vs. 17/116, 14.7%) and there was no significant association between dexamethasone treatment and disability status at five years (p = 0.32). CONCLUSIONS: Adjunctive dexamethasone appears to improve the probability of survival in patients with TBM, until at least two years of follow-up. We could not demonstrate a five-year survival benefit of dexamethasone treatment which may be confined to patients with grade 1 TBM. TRIAL REGISTRATION: ClinicalTrials.gov NCT01317654

Case Report: I feel like a mother to other babies: experiences and perspectives on bereavement and breastmilk donation from Vietnam

There is a growing recognition globally that care regarding lactation following a perinatal death needs to potentially offer the opportunity for maternal donation. This article discusses this experience and perspectives from a human milk bank (HMB) in Vietnam. This is a descriptive exploratory case study that has a long tradition in both the social and health sciences. Triangulated data collection involved a review of video data, interview data with the donor, and data review for the Da Nang HMB, a Center for Excellence in Breastfeeding. We found that although it is common for mothers in Vietnam to donate breastmilk to HMBs, it is less common for this to occur following perinatal loss. We offer a descriptive case study of the maternal loss of twins and a subsequent choice to donate for approximately 1 month to the Da Nang HMB, the first HMB in Vietnam. We discuss four reasons derived from this case regarding donation following perinatal loss. (1) A strong motivation to donate breastmilk when aware of the service, (2) donating breastmilk helped her deal with grief, (3) family members supported her through this tough time and supported her decision, and (4) health staff supported her decision. While human milk sharing (e.g., wet nursing) has been practiced in Vietnam, breastmilk donation from bereaved mothers has neither been discussed nor well-researched. Because maternal grief is complex and individual, deciding to donate breastmilk is a personal decision that needs to be supported, without creating guilt for those who do not wish to donate

Agroforestry - The Most Resilient Farming System for the Hilly Northwest of Vietnam

Over 94% of the land of northwestern Vietnam is classified as sloping. Population growth has exerted pressure on local natural resources, with agricultural expansion on steep slopes resulting in forest degradation, landscape fragmentation and severe environmental consequences. Efforts to restore forest ecosystems have been made by the government, however, as the livelihoods of 80% of the population depend on agriculture, the reconversion of land to forest has proven to be an inappropriate solution. Agroforestry offers a potentially sustainable land-use solution, which could re-establish forests, restore ecosystem services, and stabilize local livelihoods. In this paper, we assess the potential of agroforestry development in the region based on the results of two interrelated surveys conducted in 21 representative villages in six districts of three northwestern provinces: 1) a farming system diagnosis implemented in 17 representative villages; and 2) an agroforestry adoption survey with 210 households practising agroforestry in 14 villages. The analysis was strengthened by four years’ experience in implementing an extensive agroforestry project in the region. The studies focussed on assessing key benefits and constraints of existing farming systems, including agroforestry practices, adopted by farmers and identifying the potential for agroforestry development in the region. The results showed that the dominant farming system in the north-western provinces was monoculture of staple crops on slopes, which provided relatively low economic returns. Soil erosion, land degradation, and water shortages resultant from intensive farming practices were the most significant environmental issues in the area. Tree-based farming systems were rare and mostly a result of spontaneous adoption by farmers. Given the mountainous landscape and the need for soil stabilization, agroforestry was seen by farmers as a viable approach. Improving the existing and adopting new, integrated agroforestry systems were identified as viable ways toward sustainable livelihoods in Northwestern Vietnam

Synthesis of new simplified hemiasterlin derivatives with α,β-unsaturated carbonyl moiety.

International audienceIn this Letter, we report a convenient and efficient method for the synthesis of new simplified derivatives of hemiasterlin in which the α,α-dimethylbenzylic moiety A is replaced by α,β-unsaturated aryl groups as Michael acceptor. Most of these derivatives have a strong cytotoxic activity on three human tumor cell lines (KB, Hep-G2 and MCF7). Analogs 17b and 17f showed a high cytotoxicity against KB and Hep-G2 cancer cell lines comparable to paclitaxel and ellipticine

Dexamethasone and Long-Term Outcome of Tuberculous Meningitis in Vietnamese Adults and Adolescents

BACKGROUND: Dexamethasone has been shown to reduce mortality in patients with tuberculous meningitis but the long-term outcome of the disease is unknown. METHODS: Vietnamese adults and adolescents with tuberculous meningitis recruited to a randomised, double-blind, placebo-controlled trial of adjunctive dexamethasone were followed-up at five years, to determine the effect of dexamethasone on long-term survival and neurological disability. RESULTS: 545 patients were randomised to receive either dexamethasone (274 patients) or placebo (271 patients). 50 patients (9.2%) were lost to follow-up at five years. In all patients two-year survival, probabilities tended to be higher in the dexamethasone arm (0.63 versus 0.55; p = 0.07) but five-year survival rates were similar (0.54 versus 0.51, p = 0.51) in both groups. In patients with grade 1 TBM, but not with grade 2 or grade 3 TBM, the benefit of dexamethasone treatment tended to persist over time (five-year survival probabilities 0.69 versus 0.55, p = 0.07) but there was no conclusive evidence of treatment effect heterogeneity by TBM grade (p = 0.36). The dexamethasone group had a similar proportion of severely disabled patients among survivors at five years as the placebo group (17/128, 13.2% vs. 17/116, 14.7%) and there was no significant association between dexamethasone treatment and disability status at five years (p = 0.32). CONCLUSIONS: Adjunctive dexamethasone appears to improve the probability of survival in patients with TBM, until at least two years of follow-up. We could not demonstrate a five-year survival benefit of dexamethasone treatment which may be confined to patients with grade 1 TBM. TRIAL REGISTRATION: ClinicalTrials.gov NCT01317654

Mapping for engagement: setting up a community based participatory research project to reach underserved communities at risk for Hepatitis C in Ho Chi Minh City, Vietnam

Background: Approximately 1. 07 million people in Vietnam are infected with hepatitis C virus (HCV). To address this epidemic, the South East Asian Research Collaborative in Hepatitis (SEARCH) launched a 600-patient cohort study and two clinical trials, both investigating shortened treatment strategies for chronic HCV infection with direct-acting antiviral drugs. We conducted ethnographic research with a subset of trial participants and found that the majority were aware of HCV infection and its implications and were motivated to seek treatment. However, people who inject drugs (PWID), and other groups at risk for HCV were under-represented, although injecting drug use is associated with high rates of HCV. Material and Methods: We designed a community-based participatory research (CBPR) study to engage in dialogues surrounding HCV and other community-prioritized health issues with underserved groups at risk for HCV in Ho Chi Minh City. The project consists of three phases: situation analysis, CBPR implementation, and dissemination. In this paper, we describe the results of the first phase (i.e., the situation analysis) in which we conducted desk research and organized stakeholder mapping meetings with representatives from local non-government and community-based organizations where we used participatory research methods to identify and analyze key stakeholders working with underserved populations. Results: Twenty six institutions or groups working with the key underserved populations were identified. Insights about the challenges and dynamics of underserved communities were also gathered. Two working groups made up of representatives from the NGO and CBO level were formed. Discussion: Using the information provided by local key stakeholders to shape the project has helped us to build solid relationships, give the groups a sense of ownership from the early stages, and made the project more context specific. These steps are not only important preliminary steps for participatory studies but also for other research that takes place within the communities

Alcohol Use, Risk Taking, Leisure Activities and Health Care Use Among Young People in Northern Vietnam

Alcohol consumption is associated with a wide range of health and social consequences. It is also associated with a number of risk taking behaviours. These include illicit drug use and unsafe sex.  Alcohol consumption appears to be increasing in Vietnam. The purpose of this paper is to examine the patterns of alcohol consumption and its relationship with a number of other risk taking behaviours amongst young people.  Information was also obtained concerning leisure activities and use of health care. The paper also sets out to examine possible gender differences in relation to alcohol consumption and risk behaviour and to propose the development and implementation of alcohol monitoring and prevention programs in Vietnam.  The study involved a cross-sectional, community survey using a standardised interview.  This was conducted during face-to-face interviews with 1,408 young people aged 10-19 years.  Respondents were recruited randomly through the lists of the households from 12 selected communes in three areas in Northern Vietnam. The findings presented here were part of a larger health risk behaviour survey.  Levels of alcohol use were low. Overall, 16.5% of participants were experienced drinkers, and only 4% of them were current drinkers. Males were significantly more likely than females to report drinking. This study also showed that rates of alcohol consumption were associated with age, education, geographical area, gender, tobacco smoking, involvement in violence, watching television, computer use and playing computer games, wearing safety helmets and use of health services. Alcohol consumption tended to increase with age for both males and females.  Alcohol and its effects on young people are clearly a growing public health issue in Vietnam.  Because of this, more detailed behavioral research should be conducted into the relationship between alcohol consumption and other risky behaviours amongst young people.  It is also recommended that alcohol harm reduction policies should be implemented and integrated into measures to reduce levels of other health problems such as HIV/AIDS and non communicable diseases. Such policies should ideally be evidence-based and evaluated

Human femur morphology and histology variation with ancestry and behaviour in an ancient sample from Vietnam

FUNDING STATEMENT This study was part of a research fellowship funded by the Australian Research Council (DE190100068). The College of Arts and Social Sciences at the Australian National University ANU) funded histology laboratory equipment used in the ANU Histology laboratory of the School of Archaeology and Anthropology. ACKNOWLEDGMENTS We are indebted to the Vietnamese Institute of Archaeology in Hanoi, Vietnam for permissions to conduct this study, collaboration, and facilitating data collection in Hanoi. We thank Hallie Buckley and Dave McGregor for research support, the School of Social Science at the University of Queensland for access to microscopy facilities, and feedback during peer review which has improved this article. Funding was received from the Australian Research Council (DE190100068 to JJM), and the College of Arts and Social Sciences at the Australian National University.Peer reviewedPostprin

Replacement of freshwater small-size fish by formulated feed in snakehead (Channa striata) aquaculture: Experimental and commercial-scale pond trials, with economic analysis

Traditional snakehead culture in Southeast Asia relies on use of small-size (trash) fish as food, an unsustainable practice. Following development of weaning methods and testing of formulated feed (FF) in laboratory experiments, we conducted feeding trials of FF vs. trash fish (TF) in experimental ponds at Can Tho University (CTU), followed by similar trials on commercial farms in two provinces in Vietnam. CTU pond trials consisted of five treatments (in triplicate), in which TF was replaced by FF in increasing percentages: 0 (control), 25, 50, 75, and 100% replacement of TF by FF (i.e., three treatments had mixed TF/FF diets). Although survival was significantly reduced in the 100% replacement treatment, and growth was significantly reduced in the 75% and 100% replacement treatments, the cost per kg of fish produced was 28–35% less in those high-replacement treatments compared to the 0% replacement treatment. On-farm trials were then conducted at two farms in An Giang and Dong Thap provinces for 6 months with snakehead fed TF only or FF only. At both farms, survival (73–80%) was not significantly different, but growth was significantly better on FF diet at both; however, FF-fed fish at the An Giang farm showed significantly higher levels of abnormal development. Overall production was about twice as high at the An Giang farm as at Dong Thap, but significantly greater production by FF-fed fish vs. TF-fed fish was only seen at Dong Thap. Sensory evaluation by a tasting panel found no difference in product quality between FF-fed fish, TF-fed fish, and a commercial sample bought in the market. Economic analysis indicated that profits were higher for FF-fed fish from both farms, although production costs and sales varied greatly, reflecting market differences in the two provinces

Effect of molar ratios in the crystallochemical structure of biomimetic nanostructured hydroxyapatite on the characteristics of the product

The results of the study of effects of molar ratios in the crystallochemical structure of biomimetic hydroxyapatite (BMHAP) on the physicochemical characteristics of the product are presented. With an increase in molar ratio in the range 1.50-1.67, there is an increase in the unit cell parameters a and c, while the average crystallite size increases from 7.52 to 70.30 n