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

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

Enhancing Competence in Preventing Childhood Diseases for Preschool Teachers in Vietnam

This study aims to evaluate the current competence of preschool teachers in preventing childhood diseases in Vietnam and provide recommendations for their development in effectively addressing these issues. The research employed consulting methods, including telephone and email consultations, as well as a Google Form questionnaire. The questionnaire utilized a 5-level rating scale (Good, Fair, Average, Weak, Poor). The study involved 25 administrators (Education and Training officers, Kindergarten Principals, and Vice Principals) and 118 preschool teachers from Lao Cai city, Lao Cai province. The research was conducted from April 2021 to November 2021. Results of the study revealed several limitations in the current ability of preschool teachers to prevent childhood diseases in the study area. These limitations included inadequate competence among certain members of the Board of Education and management staff, particularly the principals. Furthermore, there was incomplete awareness among some management staff and teachers regarding the significance of fostering skills in preventing contagious diseases among Kindergarten teachers. The training activities related to preventing contagious diseases in children for Kindergarten teachers in Lao Cai city and province were also found to be inadequate. The schools predominantly followed an experiential approach rather than a systematic one. Based on the research findings, the study team proposes recommendations for enhancing the competence of preschool teachers in preventing childhood diseases

Developing competence to prevent children's diseases for preschool teachers in Vietnam

Objective of the study: to assess the current situation of preschool teachers' competence in preventing childhood diseases, from this situation, suggesting a direction to develop the competence of preschool teachers to cope with childhood diseases in Vietnam. Method of the study: We use consulting methods through telephone, email and through questionnaire designed by Google Form. The rating scale is divided into 5 levels (Good, Fair, Average, Weak, Poor). The survey was conducted directly and online with 25 administrators (officers of Education and Training, the Principal, the Vice Principal of Kindergarten) and 118 preschool teachers in Lao Cai city, Lao Cai province. Conducting period: From April 2021 to November 2021. Result of the study: The current situation of preschool teachers' ability to prevent childhood diseases in the area of the study has some limitations, such as: the competence of some members of the Board of Education, the management staff, who is directly the principal, still have some limitations; the awareness of a part of management staff and teachers is not very complete about the importance of fostering skills in preventing contagious diseases in children for teachers of Kindergarten

Maternal antibody and viral factors in the pathogenesis of dengue virus in infants

The pathogenesis of dengue in infants is poorly understood. We postulated that dengue severity in infants would be positively associated with markers of viral burden and that maternally derived, neutralizing antidengue antibody would have decayed before the age at which infants with dengue presented to the hospital. In 75 Vietnamese infants with primary dengue, we found significant heterogeneity in viremia and NS1 antigenemia at hospital presentation, and these factors were independent of disease grade or continuous measures of disease severity. Neutralizing antibody titers, predicted in each infant at the time of their illness, suggested that the majority of infants (65%) experienced dengue hemorrhagic fever when the maternally derived neutralizing antibody titer had declined to < 1:20. Collectively, these data have important implications for dengue vaccine research because they suggest that viral burden may not solely explain severe dengue in infants and that neutralizing antibody is a reasonable but not absolute marker of protective immunity in infants