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

Prevalence and Risk Factors of Dengue Infection in Khanh Hoa Province, Viet Nam: A Stratified Cluster Sampling Survey

Background: Dengue is a clinically important arthropod-borne viral disease with increasing global incidence. Here we aimed to estimate the prevalence of dengue infections in Khanh Hoa Province, central Viet Nam, and to identify risk factors for infection. Methods: We performed a stratified cluster sampling survey including residents of 3–60 years of age in Nha Trang City, Ninh Hoa District and Dien Khanh District, Khanh Hoa Province, in October 2011. Immunoglobulin G (IgG) and immunoglobulin M (IgM) against dengue were analyzed using a rapid test kit. Participants completed a questionnaire exploring clinical dengue incidence, socio-economic status, and individual behavior. A household checklist was used to examine environment, mosquito larvae presence, and exposure to public health interventions. Results: IgG positivity was 20.5% (urban, 16.3%; rural, 23.0%), IgM positivity was 6.7% (urban, 6.4%; rural, 6.9%), and incidence of clinically compatible dengue during the prior 3 months was 2.8 per 1,000 persons (urban, 1.7; rural, 3.4). For IgG positivity, the adjusted odds ratio (AOR) was 2.68 (95% confidence interval [CI], 1.24–5.81) for mosquito larvae presence in water pooled in old tires and was 3.09 (95% CI, 1.75–5.46) for proximity to a densely inhabited area. For IgM positivity, the AOR was 3.06 (95% CI, 1.50–6.23) for proximity to a densely inhabited area. Conclusions: Our results indicated rural penetration of dengue infections. Control measures should target densely inhabited areas, and may include clean-up of discarded tires and water-collecting waste

Prevalence, perception and factors associated with diabetes mellitus among the adult population in central Vietnam: a population-based, cross-sectional seroepidemiological survey

Abstract Background Diabetes Mellitus (DM) has rapidly become a major public health concern in Vietnam. Although the prevalence of DM has been studied in northern and southern Vietnam, little data are available for the central region. Therefore, the aims of this survey were to estimate the prevalence of DM and to identify the perception of and factors associated with DM among the adult population in central Vietnam. Methods We conducted a cross-sectional, population-based survey in Khánh Hòa Province, Vietnam in December 2014 using three-stage cluster sampling and probability proportional to size sampling in line with the World Health Organization STEPwise approach. Four hundred and eighty residents aged 20–70 years were selected from 30 villages in 10 wards/communes. After obtaining informed consent, all residents participated in interviews regarding lifestyle, medical history, and perception of DM and underwent physical measurements and blood examination for fasting blood glucose and glycated hemoglobin. Factors associated with DM were analyzed using a logistic regression model. Results A total of 376 residents were enrolled (response rate: 78.3%; females: 59%; rural residents: 61%). Among the participants, 14.3% and 18.9% of males and females, respectively, were classified as overweight/obese according to body mass index (BMI), 37.7% and 22.1%, respectively, had hypertension, and 36.4% and 11.7% had metabolic syndrome. The prevalence of DM in the entire population was 7.2% (27/376; 95% confidence interval [CI]: 4.6–9.8). Participants aged 60–70 years were more likely to have DM than those aged 30–39 years (adjusted odds ratio [aOR]: 8.7; 95%CI: 1.4–56.0), and participants classified as obese were more likely to have DM than those with normal or low BMI (aOR: 10.2; 95%CI: 2.2–50.2). Furthermore, more than two-thirds (254/376, 67.6%) of the participants either did not understand or had never heard of DM, and less than half of the DM cases (12/27, 44%) were aware of their history of DM. Conclusions The results of this study suggested that the prevalence of DM among the adult population in central Vietnam was slightly higher than that in other areas. Additional research is needed to further explore perceptions of and practices regarding DM

Transient introgression of <i>Wolbachia </i>into <i>Aedes aegypti</i> populations does not elicit an antibody response to <i>Wolbachia </i>surface protein in community members

Wolbachia is an endosymbiotic bacterium that can restrict the transmission of human pathogenic viruses by Aedes aegypti mosquitoes. Recent field trials have shown that dengue incidence is significantly reduced when Wolbachia is introgressed into the local Ae. aegypti population. Female Ae. aegypti are anautogenous and feed on human blood to produce viable eggs. Herein, we tested whether people who reside on Tri Nguyen Island (TNI), Vietnam developed antibodies to Wolbachia Surface Protein (WSP) following release of Wolbachia-infected Ae. aegypti, as a measure of exposure to Wolbachia. Paired blood samples were collected from 105 participants before and after mosquito releases and anti-WSP titres were measured by ELISA. We determined no change in anti-WSP titres after ~30 weeks of high levels of Wolbachia-Ae. aegypti on TNI. These data suggest that humans are not exposed to the major Wolbachia surface antigen, WSP, following introgression of Wolbachia-infected Ae. aegypti mosquitoes