Table of contents: 2021
The number of stroke cases has more than doubled worldwide over the past four decades, including in low- and middle-income countries. Therefore, understanding the present situation of acute ischemic stroke in Vietnam is an urgent theme. The number of stroke cases in Vietnam is correlated with and reflected in the number of thrombolysis and thrombectomies performed. To increase the effectiveness of stroke treatment, use of thrombolysis and thromboembolism alone are insufficient. New organizational models for emergency care and methodologies for identifying the first signs of stroke need to be developed. We conducted a retrospective study of reports from 29 clinics that used these two types of treatment in 2009-2017. In the 50 stroke units, departments, and stroke centers in Vietnam, about 640 beds are designed to potentially receive and treat a population of 93 million people. Among the 1145 patients who were treated with recombinant tissue plasminogen activator, they had a National Institutes of Health Stroke Score (NIHSS) medium score when admitted to the hospital: 14.1; modified Rankin Scale (mRS) post three months: mRS (0-1) was 52.2%, mRS (6 score) was 6.12%. Intracranial hemorrhage rate was 4.1%. Of the 269 patients treated with thrombectomy, the mean age was 62.14 ± 13.3; NIHSS medium score entreat admission to the hospital: 16.2 ± 7.85; complete recanalization after treatment (TICI score 2b-3) was 60.3%. The rate of functional independence (90 day mRS score of 0 - 2) was 34.6%; the death rate was 17.9%; intracranial hemorrhage and symptomatic hemorrhage rate was 22.5% and 10.1%, respectively. Thrombolysis and thrombectomy are important treatments that can reduce disability (not mortality) in some patients after acute ischemic stroke; however, it is necessary to introduce higher quality and safe services. For this purpose, a better integrated approach to stroke care in Vietnam needs to be developed.
An evaluation was made of analgesic efficacy and side effects of ultrasound - guided transversus abdominis plane (TAP block) in women undergoing intubation anesthesia for caesarean section in Hanoi Obstetrics and Gynecology hospital, Vietnam. This was a comparative randomized clinical trial; 120 women underwent caesarean delivery under general anesthesia: patients received a TAP block in both sides (TAPB group, n = 60) or no TAP block (control group, n = 60). Both groups received analgesia with intravenous morphine controlled by the woman during 72 hours after surgery. Pain scores at rest and activity, morphine consumption during 72 hours, side effects (sedation, nausea and vomiting) and satisfaction of women were recorded. The time to first analgesic request in the TAP block group was 817 ± 311 minutes (13.6 ± 5.2 hours). There was a reduction of VAS (visual analog scale) scores after surgery in the TAP block group. The total morphine consumption was reduced more than 62% in the TAPB group (16.03 mg) compared with the Control group (41.65 mg). The incidence of PONV (postoperative nausea and vomiting) (5%) and sedation (3.3%) was reduced in patients who had a TAP blockade. The patient satisfaction with regards to pain relief was greater in the TAPB group (95 vs 65%). There were no complications attributable to the TAP block. Ultrasound-guided TAP block provided a better analgesic effect after caesarean section, reduced morphine consumption during 72 hours, and reduced side effects.
Osteoporosis is a common pathology and a cause of disability and reduced quality of life invarious developing countries. An urgent issue in this context is the study of risk factors for osteoporosis, especially those that can be modified. We conducted a cross-sectional study in Vietnam. The study was conducted in the city of Vinh and involved 2065 respondents who were randomly selected for the study, of which over 2050 people were examined. The average age of the participants in years was 62.1 ± 10.3 (men) and 59.3 ± 10.1 (women). The age of all examined patients was over 40 years. It was found that among people aged 50 and over, approximately 40% of women and 37% of men suffered from osteoporosis. The rate of osteoporosis increases with advancing age. Underweight people had a higher risk of osteoporosis compared to normal and overweight people. The proportion of osteoporosis in urban areas was higher than in suburban areas. The proportion of osteoporosis in white-collar, housewives, and businessmen was higher than in other professions. The risk of osteoporosis in alcohol abuse and smoking groups was 1.5 to 1.6 times higher than in those who were not drinking or smoking. In individuals with low adherence to preventive control and physical activity recommendations, the risk of osteoporosis was 1.5 times higher than in those who adhered to regular examinations and maintained moderate physical activity. Our study lends support to the hypothesis that some lifestyle and metabolic factors are predictive factors for the development of osteoporosis. Calcium and vitamin D intake, moderate physical activity, pregnancies and breast feeding, use of progestogens, either alone or in addition to estrogens can be considered preventative factors for osteoporosis development.
We investigated independent predictors of acute ischemic stroke (AIS) in older elderly (>75 years) patients in comparison with those of the elderly (from 60-75 years) in Vietnam. Data are for 308 consecutive AIS patients aged ≥ 60 years (138 aged >75 years) admitted to the stroke unit of Phu Tho Hospital from (2014-2017). An assessment of symptoms was also carried out using the NIH Stroke Scale (NIHSS), symptoms, instrumental and laboratory parameters during hospitalization and complications of the underlying disease. The existing predictors of hospital death, trauma, and length of hospital stay were also taken into account. When evaluating the parameters, logistic regression was used. Risk profiles before and after age 75 were compared. Age is a proven, unmodifiable, universal predisposing risk factor for stroke. Poor outcomes were more frequent in the oldest (>75 years) compared to the younger patients (≤75 years). NIHSS score and clinical parameters of AIS severity, including need for oxygen, indwelling catheter, or nasogastric tube), disability incidents, and medical complications predicted most of the outcomes in both age groups. After age 75, AIS etiology and primary clinical signs and symptoms were additional independent determinants for most outcomes, along with age, sex, and pre-stroke functional and health statusThe key factors were mechanical ventilation and pneumonia, and pre-stroke signs during the first three days in the hospital for AIS in the oldest- old (>75 years); in patients ≤75 years, atrial fibrillation was associated with poor outcomes and death at discharge.
Nasopharyngeal carcinoma (NPC) is a rare cancer in the Western hemisphere (1 case per 100,000 individuals). Conversely there are some areas, such as Southern China, Southeast Asia (Vietnam), the Mediterranean basin and Alaska, where morbidity reaches 80 per 100,000 individuals. Detecting cervical lymph node metastasis is important because it helps recommend the radiation dose and the chemotherapy strategy. We compared the diagnostic value of hematoxylin-eosin (HE) staining and a immunohistochemistry technique to determine the pathological features of tumors, in 53 samples of cervical lymphadenopathy from 30 patients with NPC. With HE, metastasis was detected in 41 of 53 samples with NPC and cervical lymphopathy. In the remaining 12 slides, the HE staining did not show signs of metastasis. Staining with immunohistochemistry revealted that 10 of 12 “negative” diagnoses based on HE staining, were actually metastatic. This means that 20% of the patients would not receive correct treatment based on HE staining alone. We conclude that immunohistochemistry is a highly sensitivity technique that can detect metastases that are not diagnosed by HE staining.
Laryngeal cancer remains one of the most common head and neck tumors. In the treatment of this disease, it is important to assess the overall survival when using transoral СО2 laser microsurgery. The aim of the research was to make an evaluation of treatment of patients with laryngeal cancer undergoing CO2 laser transoral microsurgery. Fifty patients aged 40-82 years (average age 58.7 years) with early-stage laryngeal cancer were treated with СО2 laser transoral microsurgery at the National ENT hospital from January 2012 to August 2014.Tumors at the T1aN0M0 stage were detected in 68%, T1bN0M0 in 14%, T2N0M0 in 18%. Overall survival was 87.1 ± 2.3 months, and 5-year survival was 92%. The survival rate depending on the type of surgical intervention Type III, Type IV, Type Va, Type Vb, Type Vc was 93, 94, 100, 100, and 100%, respectively. The survival rate depending on the stage T1aN0M0 was 91%, on the stage T1bN0M0 was 100%, on the stage T2N0M0 was 88%. Transoral СО2 laser microsurgery shows excellent results in laryngeal tumors, especially in the T1aN0M0 stage, making it possible to perform surgery in more comfortable conditions; it provides high survival rates, excellent cosmetic and functional results compared to classical open access, without compromising immediate and long-term treatment results.
The study of the characteristics of non-eosinophilic and eosinophilic chronic polyposis rhinosinusitis (CRSwNP) is necessary to improve understanding of the pathophysiological mechanisms of this disease and determine the optimal treatment strategy. We studied the specific features of eosinophilic and non-eosinophilic CRSwNP in Vietnamese patients. Patients (48 male and 35 female) with a diagnosis of CRSwNP took part in the work. Patients were operated on at the National ENT Hospital from 9/2017 to 8/2018. Based on a study of the pathology of nasal polyps, CRSwNPs were classified as eosinophilic or non-eosinophilic. In men, 35% had eosinophilic CRSwNP and 65% had non- eosinophilic CRSwNP. In the subgroup of women, eosinophilic CRSwNP was observed in 31% and non-eosinophilic CRSwNP in 69%. In total, 34% of 83 people had eosinophilic CRSwNP. The average duration of eosinophilic CRSwNP disease was 45.0 ± 43.1 months; non-eosinophilic CRSwNP was 25.5 ± 20.5 months. In this cohort of patients, 8.4% suffered from bronchial asthma, and a high probability of this pathology was found in combination with the eosinophilic CRSwNP (OR = 5.76; 1.04-31.89 CI 95%; P = 0.045). The proportion of allergic rhinitis with eosinophilic CRSwNP was 39.3%, and with non-eosinophilic CRSwNP was 12.7%. The share of uni-and bilateral eosinophilic CRSwNPs was 10.7 and 89.3%, while non- eosinophilic CRSwNPs were 41.8 and 58.2%, respectively. Thus, CRSwNP is a complex heterogeneous inflammatory disease. Eosinophilia plays an important role in the pathogenesis of this disease and significantly worsens the clinical picture. There are significant differences in the duration of the pathological manifestations, the presence of allergic rhinitis, bronchial asthma and the severity of polyps in patients with eosinophilic and non-eosinophilic CRSwNP.
Migraine and vertigo are the most common nervous system disorders in the population; often both are observed in the same patient Despite numerous epidemiological studies showing a close relationship between migraine and vertigo, there are several contentious issues in relation to migraine as a separate disease. These include the question of terminology and the possibility of dealing with vertigo as the main and often the only manifestation of a migraine attack. The aim of our study was to determine the type of vertigo in patients with chronic migraine (CM) and episodic migraine (EM) and the possible pathophysiological mechanisms of the relationship between them. The study involved 113 patients with an established diagnosis of migraine headaches at Tam Anh Hospital and National Otolaryngology Hospital of Vietnam from October 2018 to December 2019. All patients underwent clinical and neurological examination, videonystagmography, and a video head impulse test. It was found that with an increase in the duration of headache (days), the percentage of patients with both systemic vertigo (SV) and non-systemic vertigo (NSV) increased. Based the neurological examination, it was found that a greater percentage of patients with SV noted an increase in symptoms with a change in head position: 61.5 vs. 29.7%, and had a history of hearing problems: 57.7 vs. 38.5%. Analysis of the remaining indicators of subjective otoneurological symptoms did not reveal significant differences. It was found that SV is more characteristic of patients with CM. A relationship between increased vertigo and a change in head position and a history of hearing loss was also identified. This may indicate a pathology of the structures of the inner ear in such patients. Thus, we can assume a mixed nature of SV, the pathophysiological mechanisms of which probably include central sensitization and peripheral vascular mechanisms.
Diabetes mellitus (DM) continues to be the epidemic of the century and has a major impact on mortality from all causes and from cardiovascular disease (CVD). The systemic inflammatory pathway provides the common pathogenetic link in this comorbidity. We examined serum high- sensitivity C-reactive protein (hs-CRP) levels, as a marker of systemic inflammation in patients with type 2 diabetes mellitus and related them to CVD. The study consisted of 118 subjects with type 2 diabetes. Anthropometric characteristics were measured, and blood was collected for the evaluation of fasting blood sugar (FBS), HbAlc, and hs-CRP levels. Several clinical and biochemical characteristics were significantly different in the study group: triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), compared to control levels. Mean age, body mass index (BMI) and waist circumference of subjects were 60.80 years, 35,2 kg/m2, and 109.8 cm, respectively. Increased Hs-CRP levels were positively correlated with increased BMI and HDL-C. No relationship was seen between Hs-CRP levels and systolic blood pressure, FBS level, HbAlc, Cholesterol, TG and LDL-C. Some cardiovascular risk factors (including gender, age, smoking, obesity, dyslipidemia, and hypertension) did not show correlation with serum hs-CRP levels, while proteinuria did. Participants with cholesterol target levels had significantly lower hs-CRP. An association between hs-CRP and high cardiovascular risk is unlikely to be causal; however, hs-CRP could be a predictor for incidence of CVD in diabetic patients with comorbid obesity.
To date, the only study to evaluate blood pressure control in Vietnam in accordance with Eighth Joint National Committee (JNC 8) recommendations has been Nguyen Van Tri's 2015 study, which included nearly 6,000 older people with hypertension. This study showed that the proportion of blood pressure control at that time was 21.9%. We examined the relationship between blood pressure control and functional status, associated chronic diseases, multiple diseases, and medication. This was a descriptive cross-sectional study using multivariate analysis. The subjects of the study were patients with arterial hypertension older than 60 years who underwent outpatient treatment at the clinic of the department of the senior headquarters of the 175 Military Hospital of the Ministry of Defense from October 2015 to March 2016. There were significant associations between blood pressure control and orthostatic hypotension (OR = 0.456, 0.26-0.81 95% CI, P < 0.007), daily activity (Activities of Daily Living, ADL) (OR = 0.127, 0.06-0.25 95% CI, P < 0.025), instrumental activities (Instrumental Activities of Daily Living, IADL) (OR = 0.270, 0.16-0.47, 95% CI, P < 0.007), dyslipidemia (OR = 0.534, 0.307-0.927 95% CI, P < 0.024), diabetes (OR = 0.293, 0.19-0.45 95% CI, P < 0.001), chronic kidney disease (CKD) (OR = 0.307, 0.181-0.522 95% CI, P < 0.001), cardiovascular diseases (OR = 0.389, 0.218-0.694 95% CI, P < 0.001) and multiple drug therapy (OR = 0.529, 0.332-0.844 95% CI, P < 0.007). The greatest association was with ADL/IADL, diabetes and CKD. It is imperative to increase control over blood pressure, especially for patients with such concomitant diseases as diabetes mellitus and chronic kidney disease.
Flavonoids are a group of natural polyphenols that are typically present in many higher plants as secondary metabolites with low molecular weight. Diosmin (3′,5,7-trihydroxy-4′-methoxyflavone-7-ramnoglucoside) is a naturally occurring flavonoid found in relatively large quantities in citrus fruits. We examined the cytotoxic, antiangiogenic and antimicrobial activity of diosmin. The cytotoxic effect was assessed by the WST-1 test. Cellular DNA fragmentation was determined by measuring BrdU-labeled DNA fragments. The mRNA and protein levels were assessed by qRT-PCR and Western blot. The minimal inhibitory concentrations (MIC) of diosmin for six Gram-positive and nine Gram-negative bacteria were determined by using a microdilution method. Diosmin significantly and selectively inhibited proliferation depending on concentration and exposure time. Following diosmin treatment of MDA-MB-231 cells, a concentration-dependent and time-dependent increase in the number of apoptotic BrdU-labeled DNA fragments was observed. Exposure of MDA-MB-231 breast cancer cells to diosmin for 24 h markedly increased the mRNA expression of Bax and caspase-3, whereas the expressions of Bcl-2 and Bcl-XL were decreased. Furthermore, Western blotting demonstrated that protein expression of Bcl-2 and Bcl-XL was downregulated, while the expression of Bax and caspase-3 proteins was upregulated. Based on the MICs, significant activity was only seen against Gram-positive bacteria. We conclude that diosmin is a potential candidate for use in the treatment of breast cancer and for controlling infection.
A possible strategy to increase grain yield in common beans (Phaseolus vulgaris) is to obtain lines with earlier flowering and a longer grain filling period, associated with a higher dry matter accumulation rate. We examined the genetic control of these traits to investigate whether it is possible to select lines with earlier flowering, a longer period of grain formation, and a higher dry matter accumulation rate in the grain. We also sought to determine whether it would be feasible to use these traits as an indirect selection strategy for grain yield. Ten lines belonging to the Andean and Mesoamerican gene pool were crossed in a diallel scheme in Lavras, MG. The hybrids together with the parents were evaluated in a randomized block design in three seasons, corresponding to generations F2, F3 and F4. The variables measured were number of days to flowering (NDF), grain dry matter (GDM), grain yield (YIELD), number of days to physiological maturity (NDPM) and dry matter accumulation rate (RATE). We found that for NDF, NDPM and RATE, the general combining ability (GCA) explained most of the variation. Both GCA and the specific combining ability were important for YIELD. However, for this trait, the estimate of heterosis was significant, but negative (-27.7%), when the crosses involved the Andean x Mesoamerican lines. The estimated values of correlation between NDPM x NDF were positive (0.72 **), and negative between NDF x RATE (-0.52 **) and NDPM x RATE (-0.43*). Consequently, none of the populations presented potential for obtaining new lines with high grain yield, based on indirect selection for early flowering and traits associated with grain filling.
Polynemidae, commonly known as threadfins, are important fishing and aquaculture species. This is a peculiar fish group that is morphologically characterized by long tactile filaments of the pectoral fins. Although inserted in the Percomorpha, its relationships with other groups of this clade are uncertain. Cytogenetic investigations have helped clarify various evolutionary aspects of marine fish groups, including stock delimitation, speciation, taxonomy, hybridization, phylogenetic relationship, sex chromosomes, and genome changes. However, the chromosomal characteristics of threadfins are still unknown. We investigated the chromosomal features of two cryptic species, Polydactylus virginicus and P. oligodon found in Northeast Brazilian coastal waters (Tropical Southwestern Atlantic region). Cytogenetic data were obtained by conventional staining (Giemsa and fluorochrome staining, C-banding and Ag-NORs techniques) and molecular cytogenetic analyses through fluorescent in situ hybridization using rDNA probes (18S and 5S rDNA). The two species have similar karyotypes at the macro and microstructural levels. An unexpected high diploid number was found, with 2n=58 acrocentric chromosomes, including four microchromosome pairs. The expanded karyotypes are a synapomorphy for these species, likely resulting from sharing at least five chromosome fissions from a basal karyotype with 2n=48. Besides the macrostructural karyotype similarities, the Ag-NOR/GC-rich/18S rDNA (chromosome 19) and 5S rDNA (chromosome 20) loci have an identical organization in apparently homeolog chromosomes of these species, suggesting the conservation of large syntenic chromosomal regions. We conclude that although chromosome fissions are very rare events among other Carangaria fish, they played an important disruptive role in the evolution of some species of Polynemidae.
Although environmental toxicity of high concentrations of nanoparticles (NP) is well reported in the literature, information about their effects on biological systems at environmentally relevant concentrations remains scarce. We investigated whether low ZnO-NP concentrations influence the dynamics of cell division processes, cause nuclear abnormalities and induce changes in the genomic DNA using Allium cepa root cells. Healthy A. cepa bulbs were exposed to environmentally relevant concentrations of ZnO-NP for 48 hours under four different environmental conditions, namely: optimistic, median, pessimistic and known toxic. Mitotic index (MI), chromosomal abnormalities (CAs) and genomic stability based on DNA markers were estimated. ZnO-NPs induced significant changes in MI and CAs, with clear dose-response effects, even at very low concentrations and short exposure times. This outcome is clear evidence of negative effects. In addition, we evidenced instability in the repair mechanism of DNA mutated due to low concentrations of ZnO NPs based on RAPD-PCR results. Therefore, even short-term exposure of eukaryotic cells to low concentrations of ZnO-NP can damage cells and, consequently, negatively affect their biological functioning.
Molecular characterization of genes is a tool used to understand gene function. Chitin is the most abundant nitrogenous organic compound in nature; it is basically inert, but it can be transformed by the action of chitinases to several derivatives, which are of great interest in various areas of industry. These enzymes are widely distributed in many organisms and can be potentially used in genetic engineering to add characteristics that increase its activity. We examined 10 chitenase genes from 10 different strains of Stenotrophomonas maltophilia native to Chiapas, Mexico that have different enzymatic activities. After sequencing of the gene, a bioinformatic analysis was performed, which revealed an average length of 2100 bp and 64.7% G+C content of the genes. The open reading frame consists of 699 amino acids, which corresponds to an average molecular mass of 72.4 kDa, and an isoelectric point of 6.66. The genes exhibited between 99.3 and 100% identity. Additionally, the 3D structure of the chitinolytic enzyme was predicted using the structure of a chitinase from Streptomyces thermoviolaceus as a template. Results suggested that the chitinase of S. maltophilia contains four characteristic domains of these enzymes, the Chia1_BD, Big_3_5, type III fibronectin (FN3), and GH18 domains. This study provides basic knowledge for enzyme design using genetic engineering.