Current medical product development for diagnosis, surgical planning and treatment in the areas of Neurosurgery, Orthopeadic and Dental-Cranio-Maxillofacial surgery in Vietnam

With the population of 86 million and good GDP growth in recent decades, the medical market in Vietnam is growing fast. However, most of the medical technology products are imported, and the number of locally manufactured ones is limited and they do not have the high competition capability in term of quality, quantity and types. In this paper, the current product development in Vietnam for diagnosis, surgical planning and treatment in the areas of Rehabilitation, Neurosurgery, Orthopeadic and Dental-Cranio-Maxillofacial surgery is presented. A roadmap for medical technology development in Vietnam is propose

COMPLETE REPAIR FOR TETRALOGY OF FALLOT IN CHILDREN: SHORT-TERM OUTCOME IN A SINGLE CENTER

Tetralogy of Fallot is a common cyanotic congenital heart disease. Early surgery treatment gives patients a chance to have normal physical and mental health due to preventing complications of cyanosis and even death as a natural history of tetralogy of Fallot. This study aimed to show short-term outcomes (including the time of postoperative hospital stay and 30 days after discharge) of tetralogy of Fallot complete repair at the Department of Pediatric Cardiac Surgery, Cho Ray Hospital. A retrospective study was performed on the data of medical documents of 38 patients, who underwent complete repair for tetralogy of Fallot with full sternotomy and cardiopulmonary bypass from March 2017 to December 2019, following a collection form. The results showed the average age and weight were 33.89±13.02 months and 11.77±2.48 kg. The cardiopulmonary bypass time was 147.74±12.48 mins, the aortic cross-clamp time 104.84±9.73 mins, the mechanical ventilation time 31.14±10.75 hours, the duration of stay in the intensive care unit 58.03±13.56 hours, the postoperative hospital stay time 10.12±1.5 days, and the mortality rate 2.6%. The study concludes that the short-term surgical outcome of complete repair for tetralogy of Fallot in lightweight children is safe and effective with a low mortality rate

Assessing the efficacy and safety of magnesium sulfate for management of autonomic nervous system dysregulation in Vietnamese children with severe hand foot and mouth disease.

BACKGROUND: Brainstem encephalitis is a serious complication of hand foot and mouth disease (HFMD) in children. Autonomic nervous system (ANS) dysregulation and hypertension may occur, sometimes progressing to cardiopulmonary failure and death. Vietnamese national guidelines recommend use of milrinone if ANS dysregulation with Stage 2 hypertension develops. We wished to investigate whether magnesium sulfate (MgSO4) improved outcomes in children with HFMD if used earlier in the evolution of the ANS dysregulation (Stage 1 hypertension). METHODS: During a regional epidemic we conducted a randomized, double-blind, placebo-controlled trial of MgSO4 in children with HFMD, ANS dysregulation and Stage 1 hypertension, at the Hospital for Tropical Diseases in Ho Chi Minh city. Study participants received an infusion of MgSO4 or matched placebo for 72 h. We also reviewed data from non-trial HFMD patients in whom milrinone failed to control hypertension, some of whom received MgSO4 as second line therapy. The primary outcome for both analyses was a composite of disease progression within 72 h - addition of milrinone (trial participants only), need for ventilation, shock, or death. RESULTS: Between June 2014 and September 2016, 14 and 12 participants received MgSO4 or placebo respectively, before the trial was stopped due to futility. Among 45 non-trial cases with poorly controlled hypertension despite high-dose milrinone, 33 received MgSO4 while 12 did not. There were no statistically significant differences in the composite outcome between the MgSO4 and the placebo/control groups in either study (adjusted relative risk (95%CI) of [6/14 (43%) vs. 6/12 (50%)], 0.84 (0.37, 1.92), p = 0.682 in the trial and [1/33 (3%) vs. 2/12 (17%)], 0.16 (0.01, 1.79), p = 0.132 in the observational cohort). The incidence of adverse events was similar between the groups. Potentially toxic magnesium levels occurred very rarely with the infusion regime used. CONCLUSION: Although we could not demonstrate efficacy in these studies, there were no safety signals associated with use of 30-50 mg/kg/hr. MgSO4 in severe HFMD. Intermittent outbreaks of HFMD are likely to continue across the region, and an adequately powered trial is still needed to evaluate use of MgSO4 in controlling hypertension in severe HFMD, potentially involving a higher dose regimen. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01940250 (Registered 22 AUG 2013). Trial sponsor: University of Oxford

A novel IGHMBP2 variant and clinical diversity in Vietnamese SMARD1 and CMT2S patients

BackgroundPathogenic variants in the IGHMBP2 gene are associated with two distinct autosomal recessive neuromuscular disorders: spinal muscular atrophy with respiratory distress type 1 (SMARD1; OMIM #604320) and Charcot–Marie–Tooth type 2S (CMT2S; OMIM #616155). SMARD1 is a severe and fatal condition characterized by infantile-onset respiratory distress, diaphragmatic palsy, and distal muscular weakness, while CMT2S follows a milder clinical course, with slowly progressive distal muscle weakness and sensory loss, without manifestations of respiratory disorder.MethodsWhole-exome sequencing of the IGHMBP2 gene was performed for eight Vietnamese patients with IGHMBP2-related neuromuscular disorders including five patients with SMARD1 and the others with CMT2S.ResultsWe identified one novel IGHMBP2 variant c.1574T > C (p.Leu525Pro) in a SMARD1 patient. Besides that, two patients shared the same pathogenic variants (c.1235 + 3A > G/c.1334A > C) but presented completely different clinical courses: one with SMARD1 who deceased at 8 months of age, the other with CMT2S was alive at 3 years old without any respiratory distress.ConclusionThis study is the first to report IGHMBP-2-related neuromuscular disorders in Vietnam. A novel IGHMBP2 variant c.1574T > C (p.Leu525Pro) expressing SMARD1 phenotype was detected. The presence of three patients with the same genotype but distinct clinical outcomes suggested the interaction of variants and other factors including relating modified genes in the mechanism of various phenotypes

Long-Lasting Insecticidal Hammocks for controlling forest malaria: a community-based trial in a rural area of central Vietnam.

BACKGROUND: In Vietnam, malaria remains a problem in some remote areas located along its international borders and in the central highlands, partly due to the bionomics of the local vector, mainly found in forested areas and less vulnerable to standard control measures. Long Lasting Insecticidal Hammocks (LLIH), a tailored and user-friendly tool for forest workers, may further contribute in reducing the malaria burden. Their effectiveness was tested in a large community-based intervention trial carried out in Ninh Thuan province in Central Vietnam. METHODS AND FINDINGS: Thirty villages (population 18,646) were assembled in 20 clusters (1,000 individuals per cluster) that were randomly allocated to either the intervention or control group (no LLIH) after stratification according to the pre-intervention P. falciparum antibody prevalence ( or =30%). LLIH were distributed to the intervention group in December 2004. For the following 2 years, the incidence of clinical malaria and the prevalence of infection were determined by passive case detection at community level and by bi-annual malariometric surveys. A 2-fold larger effect on malaria incidence in the intervention as compared to the control group was observed. Similarly, malaria prevalence decreased more substantially in the intervention (1.6-fold greater reduction) than in the control group. Both for incidence and prevalence, a stronger and earlier effect of the intervention was observed in the high endemicity stratum. The number of malaria cases and infections averted by the intervention overall was estimated at 10.5 per 1,000 persons and 5.6/100 individuals, respectively, for the last half of 2006. In the high endemicity stratum, the impact was much higher, i.e. 29/1000 malaria cases and 15.7 infections/100 individuals averted. CONCLUSIONS: LLIH reduced malaria incidence and prevalence in this remote and forested area of Central Vietnam. As the targets of the newly-launched Global Malaria Action Plan include the 75% reduction of the global malaria cases by 2015 and eventually the elimination/eradication of malaria in the long term, LLIH may represent an additional tool for reaching such objectives, particularly in high endemicity areas where standard control tools have a modest impact, such as in remote and forested areas of Southeast Asia and possibly South America. TRIAL REGISTRATION: ClinicalTrials.gov NCT00853281

CHẾ TẠO VÀ TÍNH CHẤT CỦA VẬT LIỆU TỔ HỢP GRAPHENE – ỐNG NANO CÁCBON – HẠT NANO VÀNG

In this work, a composite nanomaterial consisting of graphene (Gr), double-wall carbon nanotube (DWCNTs) and gold nanoparticles (AuNPs), designated as DWCNTs-AuNPs-Gr was synthesized via the thermal chemical vapour deposition technique. The morphology and electrical and electrochemical properties of the material were characteried by using field emission scanning electron microscopy, Raman spectroscopy, four-probe sheet resistance measurement, and cyclic voltammetry (CV). The average sheet resistance value of DWCNTs-AuNPs-Gr is 549 W/sq, 2.3 times lower than that of graphene. The current response of a DWCNTs-AuNPs-Gr-modified electrode in a 2 mM K3[Fe(CN)6]/K4[Fe(CN)6] solution with 0.1 M PBS is 15.79 µA, 1.48 times higher than that of a graphene-modified electrode and 2.57 times higher than that of a bare electrode. The DWCNTs-AuNPs-Gr material can be used for electrochemical biosensors to detect various bioelements.Trong công trình này, màng tổ hợp của vật liệu graphene (Gr) – ống nano cácbon hai tường (DWCNT) và hạt nano kim loại vàng (AuNPs) (DWCNT-AuNPs-Gr) đã được chế tạo bằng phương pháp lắng đọng pha hơi nhiệt hóa học (CVD). Hình thái học bề mặt và các tính chất điện, điện hóa của vật liệu tổ hợp đã được khảo sát thông qua kính hiển vi điện tử quét phát xạ trường, phổ Raman, điện trở bốn mũi dò và kỹ thuật quét thế vòng (CV). Với nồng độ DWCNTs 0,3 g/L và tốc độ quay phủ 4000 vòng/phút, vật liệu DWCNTs-AuNPs-Gr có điện trở bề mặt giảm 2,3 lần so với màng Gr và đạt khoảng 549 W/sq; dòng đỉnh đáp ứng trong dung dịch 2 mM K3[Fe(CN)6]/K4[Fe(CN)6] trong 0,1 M PBS đạt 15,79 µA tại 50 mV/s, cao gấp 1,48 lần so với điện cực biến tính màng Gr và gấp 2,57 lần so với điện cực trần. Vật liệu DWCNTs-AuNPs-Gr có tiềm năng ứng dụng trong cảm biến điện hóa để phát hiện các phần tử sinh học khác nhau

Antibiotic use and prescription and its effects on Enterobacteriaceae in the gut in children with mild respiratory infections in Ho Chi Minh City, Vietnam. A prospective observational outpatient study.

BACKGROUND AND OBJECTIVES: Treatment guidelines do not recommend antibiotic use for acute respiratory infections (ARI), except for streptococcal pharyngitis/tonsillitis and pneumonia. However, antibiotics are prescribed frequently for children with ARI, often in absence of evidence for bacterial infection. The objectives of this study were 1) to assess the appropriateness of antibiotic prescriptions for mild ARI in paediatric outpatients in relation to available guidelines and detected pathogens, 2) to assess antibiotic use on presentation using questionnaires and detection in urine 3) to assess the carriage rates and proportions of resistant intestinal Enterobacteriaceae before, during and after consultation. MATERIALS AND METHODS: Patients were prospectively enrolled in Children's Hospital 1, Ho Chi Minh City, Vietnam and diagnoses, prescribed therapy and outcome were recorded on first visit and on follow-up after 7 days. Respiratory bacterial and viral pathogens were detected using molecular assays. Antibiotic use before presentation was assessed using questionnaires and urine HPLC. The impact of antibiotic usage on intestinal Enterobacteriaceae was assessed with semi-quantitative culture on agar with and without antibiotics on presentation and after 7 and 28 days. RESULTS: A total of 563 patients were enrolled between February 2009 and February 2010. Antibiotics were prescribed for all except 2 of 563 patients. The majority were 2nd and 3rd generation oral cephalosporins and amoxicillin with or without clavulanic acid. Respiratory viruses were detected in respiratory specimens of 72.5% of patients. Antibiotic use was considered inappropriate in 90.1% and 67.5%, based on guidelines and detected pathogens, respectively. On presentation parents reported antibiotic use for 22% of patients, 41% of parents did not know and 37% denied antibiotic use. Among these three groups, six commonly used antibiotics were detected with HPLC in patients' urine in 49%, 40% and 14%, respectively. Temporary selection of 3rd generation cephalosporin resistant intestinal Enterobacteriaceae during antibiotic use was observed, with co-selection of resistance to aminoglycosides and fluoroquinolones. CONCLUSIONS: We report overuse and overprescription of antibiotics for uncomplicated ARI with selection of resistant intestinal Enterobacteriaceae, posing a risk for community transmission and persistence in a setting of a highly granular healthcare system and unrestricted access to antibiotics through private pharmacies. REGISTRATION: This study was registered at the International Standard Randomised Controlled Trials Number registry under number ISRCTN32862422: http://www.isrctn.com/ISRCTN32862422