The Individual and Synergistic Indexes for Assessments of Heavy Metal Contamination in Global Rivers and Risk: a Review

This article provides an overview of heavy metal contamination in rivers and assessment methods of their contamination and effects. According to literature, rivers with heavy metal contamination in surface water are mainly found in developing countries in Asia, Africa, and Latin America and the Caribbean area, while rivers with heavy metal contamination in sediments are mostly found in Europe. The increase in heavy metal contamination in rivers has led to the adoption of individual and synergistic assessment methods. Individual methods are useful in assessing the contamination and effects for a single heavy metal, while synergistic methods assess the combined contamination and effects of several heavy metals present in surface water and sediments. These two approaches have been commonly used together in recent studies to overcome the limitations of each other and provide a more comprehensive assessment. The developments, equations, advantages, limitations, and future perspectives of these methods are discussed in this review. Calculating indexes are simple, easy-to-implement, and effective methods to provide early alerts for the environmental changes and the adverse impacts on ecosystems and human health. However, calculating indexes still have limitations due to the lack of background concentrations of heavy metals in the study area. Therefore, this issue should be addressed to overcome the limitations of these methods in the future. This review provides a useful reference for future studies on heavy metal contamination in global rivers and the assessment methods for heavy metal contamination and effects

Efect of maleated anhydride on mechanical properties of rice husk filler reinforced PLA Matrix Polymer Composite

Polylactic acid (PLA) formulated from corn starch has a bright potential to replace the non-renewable petroleum-based plastics. The combination of PLA and natural fbre has gained interest due to its unique performance, as reported in many researches and industries. Meanwhile, rice husk produced as the by-product of rice milling can be utilised, unless it is turned completely into waste. Therefore, in the present study, the rice husk powder (RHP) was used as a fller in the PLA, so to determine the infuence of the fller loading on the mechanical properties of the PLA composite. A coupling agent was selected for treatment from two options, i.e., maleic anhydride polypropylene (MAPP) and maleic anhydride polyethylene (MAPE), by applying the agents with various loading contents, such as 2, 4 and 6 wt%. The composite was fabricated by using the hot compression machine. Both the treated and untreated RHP–PLA composites were characterised via the tensile, fexural and impact strength tests. The increase in the RHP loading content led to the decrease in the tensile and fexural strengths. The applications of the coupling agents (MAPE and MAPP) did not improve the tensile and impact strengths, but the fexural strength was enhanced

Liver Angiosarcoma with Poor Prognosis in a 61-Year-Old Woman: A Case Report and Literature Review

Tran Manh Hung,1 Thi Phuong Thao Tran2 1Department of Surgery, Bach Mai Hospital, Hanoi, Vietnam; 2Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, VietnamCorrespondence: Tran Manh Hung, Department of Surgery, Bach Mai Hospital, Hanoi, Vietnam, Tel +84-912-157-095, Email [email protected]: Hepatic angiosarcoma is very rare malignancy and more common in men than in women. To date, only a few female cases of liver angiosarcoma have been reported. Here, we report a female case of liver angiosarcoma, first detected in Vietnam, with a high malignancy stage, rapid progression, and poor prognosis.Case Presentation: A 61-year-old woman was admitted to the Bach Mai Hospital with fatigue, anorexia, weight loss, and severe pain in the right upper quadrant for 2 weeks prior. Clinical examination detected a firm 4-cm hepatomegaly below the right costal margin and grade I splenomegaly. Abdominal ultrasonography and CT revealed diffuse lesions in the entire liver parenchyma, spreading to the spleen, while MRI showed signs of bone metastasis. Blood tests showed elevated transaminase enzymes, especially Gamma Glutamyl Transferase 501 U/L; thrombocytopenia; no anemia; and other tumor markers such as AFP, CEA, and CA19-9 were within normal limits. On CT images, the dots and nodules in the liver and spleen appeared hyperenhanced in the arterial phase and washout in the venous phase. The results of both histopathology and immunohistochemistry showed liver angiosarcoma. Surgery and radiation were not indicated due to the suspicion of bone metastasis. Chemotherapy with doxorubicin at a dose of 60 mg/m2 and intravenous infusion once every 21 days was administered. Unfortunately, during the first dose of chemotherapy with doxorubicin, side effects appeared. Since the disease developed continuously and uncontrollably, the patient was subsequently exhausted, anemic, presented peritoneal fluid, and eventually died of intra-abdominal bleeding.Conclusion: For the diagnosis of liver angiosarcoma, ultrasound-guided liver biopsy could be applied for safe and effective histopathology, and selective embolization of the hepatic artery is necessary to prevent bleeding complications. The disease has a very poor prognosis, and if chemotherapy does not respond, the patient can die within six months of diagnosis.Keywords: liver angiosarcoma, primary tumor, hepatectomy, case repor

Catastrophic health expenditure of Vietnamese patients with gallstone diseases – a case for health insurance policy revaluation

Bach Xuan Tran,1,2,* Tho Dinh Tran,3,* Nila Nathan,4 Chau Quy Ngo,5 Loi Thi Nguyen,6 Long Hoang Nguyen,7 Huong Lan Thi Nguyen,8 Cuong Tat Nguyen,8 Huyen Phuc Do,7 Trang Huyen Thi Nguyen,9 Tung Thanh Tran,9 Thao Phuong Thi Thai,10,11 Anh Kim Dang,8 Nam Ba Nguyen,7 Carl A Latkin,2 Cyrus SH Ho,12 Roger CM Ho7,13 1Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; 2Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 3Department of Hepatobiliary Surgery, Vietnam-Germany Hospital, Hanoi, Vietnam; 4University of California, Santa Barbara, Santa Barbara, CA, USA; 5Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam; 6Woolcock Institute of Medical Research Vietnam, Hanoi, Vietnam; 7Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam; 8Institute for Global Health Innovations, Duy Tan University, Danang, Vietnam; 9Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam; 10Department of General Planning, Friendship Hospital, Hanoi, Vietnam; 11Department of Cardiology, Friendship Hospital, Hanoi, Vietnam; 12Department of Psychological Medicine, National University Hospital, Singapore; 13Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore *These authors contributed equally to this work Purpose: Despite gallstone diseases (GSDs) being a major public health concern with both acute and chronic episodes, none of the studies in Vietnam has been conducted to investigate the household expenditure for the GSD treatment. The objective of this study was to estimate the costs of managing GSD and to explore the prevalence and determinants of catastrophic health expenditure (CHE) among Vietnamese patients.Materials and methods: A cross-sectional study was conducted from June 2016 to March 2017 in the Department of Hepatobiliary and Pancreatic Surgery, Viet Duc Hospital in Hanoi, Vietnam. A total of 206 patients were enrolled. Demographic and socioeconomic data, household income, and direct and indirect medical costs of patients seeking treatment for GSD were collected through face-to-face interview. Multivariate logistic regression was used to explore factors associated with CHE.Results: The prevalence of CHE in patients suffering from GSD was 35%. The percentage of patients who were covered by health insurance and at risk for CHE was 41.2%, significantly higher than that of those noninsured (15.8%). Proportions of patients with and without health insurance who sought outpatient treatment were 30.6% and 81.6%, respectively. Patients who were divorced or widowed and had intrahepatic gallstones were significantly more likely to experience CHE. Those who were outpatients, were women, had history of pharmacological treatment to parasitic infection, and belong to middle and highest monthly household income quantile were significantly less likely to experience CHE.Conclusion: The findings suggested that efforts to re-evaluate health insurance reimbursement capacity, especially for acute diseases and taking into account the varying preferences of people with different disease severity, should be conducted by health authority. Further studies concerning CHE of GSD in the context of ongoing health policy reform should consider utilizing WHO-recommended measures like the fairness in financial contribution index, as well as taking into consideration the behavioral aspects of health care spending. Keywords: catastrophic health expenditure, gallstone, health insurance, out-of-pocket payments, Vietnam &nbsp

Epidemiological features and risk factors of Salmonella gastroenteritis in children resident in Ho Chi Minh City, Vietnam.

Non-typhoidal Salmonella are an important but poorly characterized cause of paediatric diarrhoea in developing countries. We conducted a hospital-based case-control study in children aged 2 children (cases 20∙8%, controls 10∙2%; OR 2∙32, 95% CI 1∙2-4∙7). Our findings indicate that Salmonella are an important cause of paediatric gastroenteritis in this setting and we suggest that transmission may occur through direct human contact in the home

Adherence to antiretroviral therapy among HIV/AIDS patients in the context of early treatment initiation in Vietnam

Hue Thi Mai,1 Giang Minh Le,1,2 Bach Xuan Tran,1,3,4 Ha Ngoc Do,5 Carl A Latkin,3 Luong Thanh Nguyen,6 Thao Phuong Thi Thai,7,8 Huong Thi Le,9 Anh Toan Ngo,10 Cuong Tat Nguyen,11 Cyrus SH Ho,12 Roger CM Ho13 1Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; 2Center for Research and Training on HIV/AIDS (CREATA), Hanoi Medical University, Hanoi, Vietnam; 3Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 4Vietnam Young Physician Association, Hanoi, Vietnam; 5Youth Research Institute, Vietnam (YRI)-Ho Chi Minh Communist Youth Union, Hanoi, Vietnam; 6Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam; 7Department of General Planning, Friendship Hospital, Hanoi, Vietnam; 8Department of Cardiology, Friendship Hospital, Hanoi, Vietnam; 9Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam; 10National Hospital of Obstetrics and Gynecology, Hanoi, Vietnam; 11Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam; 12Department of Psychological Medicine, National University Hospital, Singapore, Singapore; 13Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Purpose: This study aimed to assess the antiretroviral therapy (ART) compliance among patients with HIV/AIDS and its associated factors in the context of universal ART initiation in Vietnam. Patients and methods: A cross-sectional survey was conducted in five ART clinics located in three provinces, such as Hanoi, Thanh Hoa, and Lao Cai, from July to September 2017. Overall, adherence to ART in the last month was measured using a 100-point Visual Analog Scale (VAS). Besides, information about forgetting doses in the last 4 days and delaying taking pills in the last 7 days was also reported. Results: Among 482 patients, the suboptimal adherence rate was 54.5%. Noncurrent smoking (coefficient =4.19, 95% CI 0.42–7.97), higher baseline CD4 count (coefficient =4.35, 95% CI 0.58–8.13), and no traveling difficulties (coefficient =6.17, 95% CI 2.27–10.06) were predictors of higher VAS adherence score. Suboptimal adherence was associated with mountainous residence (OR =5.34, 95% CI 2.81–10.16). Female respondents were less likely to delay taking pills in the last 7 days (OR =0.19, 95% CI 0.07–0.52). Conclusion: Our study embraced early ART initiation in Vietnam; however, this approach should be parallel with appropriate resource allocation and service delivery. Keywords: HIV/AIDS, antiretroviral therapy, ART adherence, Visual Analog Scale, VA

The Role of Maternally Acquired Antibody in Providing Protective Immunity Against Nontyphoidal Salmonella in Urban Vietnamese Infants: A Birth Cohort Study

Background: Nontyphoidal Salmonella (NTS) organisms are a major cause of gastroenteritis and bacteremia, but little is known about maternally acquired immunity and natural exposure in infant populations residing in areas where NTS disease is highly endemic. Methods: We recruited 503 pregnant mothers and their infants (following delivery) from urban areas in Vietnam and followed infants until they were 1 year old. Exposure to the dominant NTS serovars, Salmonella enterica serovars Typhimurium and Enteritidis, were assessed using lipopolysaccharide (LPS) O antigen-specific antibodies. Antibody dynamics, the role of maternally acquired antibodies, and NTS seroincidence rates were modeled using multivariate linear risk factor models and generalized additive mixed-effect models. Results: Transplacental transfer of NTS LPS-specific maternal antibodies to infants was highly efficient. Waning of transplacentally acquired NTS LPS-specific antibodies at 4 months of age left infants susceptible to Salmonella organisms, after which they began to seroconvert. High seroincidences of S. Typhimurium and S. Enteritidis LPS were observed, and infants born with higher anti-LPS titers had greater plasma bactericidal activity and longer protection from seroconversion. Conclusions: Although Vietnamese infants have extensive exposure to NTS, maternally acquired antibodies appear to play a protective role against NTS infections during early infancy. These findings suggest that prenatal immunization may be an appropriate strategy to protect vulnerable infants from NTS disease

A cohort study to define the age-specific incidence and risk factors of Shigella diarrhoeal infections in Vietnamese children: a study protocol

BACKGROUND: Shigella spp. are one of the most common causes of paediatric dysentery globally, responsible for a substantial proportion of diarrhoeal disease morbidity and mortality, particularly in industrialising regions. Alarming levels of antimicrobial resistance are now reported in S. flexneri and S. sonnei, hampering treatment options. Little is known, however, about the burden of infection and disease due to Shigella spp. in the community. METHODS/DESIGN: In order to estimate the incidence of this bacterial infection in the community in Ho Chi Minh City, Vietnam we have designed a longitudinal cohort to follow up approximately 700 children aged 12-60 months for two years with active and passive surveillance for diarrhoeal disease. Children will be seen at 6 month intervals for health checks where blood and stool samples will be collected. Families will also be contacted every two weeks for information on presence of diarrhoea in the child. Upon report of a diarrhoeal disease episode, study nurses will either travel to the family home to perform an evaluation or the family will attend a study hospital at a reduced cost, where a stool sample will also be collected. Case report forms collected at this time will detail information regarding disease history, risk factors and presence of disease in the household.Outcomes will include (i) age-specific incidence of Shigella spp. and other agents of diarrhoeal disease in the community, (ii) risk factors for identified aetiologies, (iii) rates of seroconversion to a host of gastrointestinal pathogens in the first few years of life. Further work regarding the longitudinal immune response to a variety of Shigella antigens, host genetics and candidate vaccine/diagnostic proteins will also be conducted. DISCUSSION: This is the largest longitudinal cohort with active surveillance designed specifically to investigate Shigella infection and disease. The study is strengthened by the active surveillance component, which will likely capture a substantial proportion of episodes not normally identified through passive or hospital-based surveillance. It is hoped that information from this study will aid in the design and implementation of Shigella vaccine trials in the future