Current issues

Table of contents: 2021

Research Article

Cervical cancer (CC) is the third most diagnosed malignancy among women in Latin America. CC control focuses on prevention methods: primary prevention is carried out to prevent Human Papillomavirus (HPV) infections, such as vaccination, while secondary prevention methods aim to detect and treat cervical premalignant lesions. In addition, cytology is used for triage, and many countries, including Brazil, still use it for this purpose. However, this method has significant limitations, such as low sensitivity and poor reproducibility. Some molecular assays are relevant, such as HPV testing. In this pilot study, a micro-costing analysis was done to compare cytology and HPV testing for cervical cancer screening in the Brazilian Unified Health System. For this assessment, a cross-sectional study was performed involving 500 women aged 18–55 years old without cervical precancer or cancer. The participants underwent cervical cytology and HPV testing. The overall prevalence of HPV infection was 25.2%. Among these HPV-infected women, 13.6% presented normal or inflammatory, cytology and were HPV positive by molecular assay. Most of these patients were infected with high-risk-HPV 16 and 18 and were asymptomatic. Oncotic cytology was the most cost-effective in the comparison between these two screening strategies. However, the molecular assay had a higher sensitivity and specificity when compared with cytology. HPV testing, despite the higher costs, may still be economically advantageous for CC control programs as it could reduce the cost of CC treatment in the public health system. In conclusion, although HPV testing is currently more expensive than cytology assay, its use would still be justified as it can reduce the economic and social impact due to cases not detected by cytology.

Genet. Mol. Res. 20(1): GMR18719
DOI: 10.4238/gmr18719
Research Article

Prognosis of sinonasal squamous cell carcinoma (SNSCC) depends on TNM (Tumor, Node, Metastasis) staging, histological manifestations, and activity of cell-surface receptors (p53, Ki67, EGFR − Epidermal Growth Factor Receptor (ErbB-1; Her1). EGFR is the best- studied transmembrane tyrosine kinase receptor. The intensity of tumor cells division and the rate of their metastasis depend on EGFR. It also regulates the processes of angiogenesis. All this determines the severity of the course of the disease and the ability to predict its outcome. Depending on the speed of EGFR expression, targeted therapy may or may not be prescribed. The clinical picture and prognosis of SNSCC depends on the rate of EGFR expression. We conducted a prospective case study on 32 SNSCC patients treated at the National Ear Nose and Throat Hospital during two years (2011-2012). Clinical presentations and computed tomography scan imaging were analyzed and biopsy samples were examined to investigate EGFR activity (Her1). A semi quantification technique was used. The level of EGFR expression was correlated with disease staging. The rate of positive EGFR expression in SNSCC was 17/32; 8/32 scored 3+. EGFR was positive in 16/32 stage III patients. The EGFR-positive rate was higher in exophytic, advanced stage cancer, with neurological deficits and lymphadenopathy of the neck. EGFR expression was increased in 17/32 of sinonasal squamous cell carcinoma samples. Patients with more severe manifestations, including neurological symptoms, facial deformities and exophytic tumor growth had a significantly higher EGFR expression rate.

Genet. Mol. Res. 20(1): GMR18749
DOI: 10.4238/gmr18749
Research Article

We evaluated the results of laparoscopic nephrectomy for the treatment of renal tumors in a provincial hospital. Subjects and methods: 30 patients were diagnosed with renal tumors and underwent laparoscopic nephrectomy at a General Hospital, in Vietnam.  The mean age was 53.23 years, the rate of incidental detection of tumors was 8/30. Average tumor size was 5.33cm. Angiomyolipoma was found int 7/30 and renal cell carcinoma (RCC) in 23/30. The transperitoneal approach was used in 13/30. Most (21/30) patients had one renal artery and one renal vein. The mean operative time was 116 minutes, the average blood loss 161 ml, the drainage time five days and the hospital stay six days. Operative complications: minor hemorrhage 2/30; major haemorrhage 1/30. Postoperative complications: 3/30. Conversion to open surgery 1/30. Most (18/30) patients were examined after six months; one case had liver metastases. Laparoscopic nephrectomy (LRN) in the treatment of renal tumors is a safe, effective method and can be done in provincial hospitals. However, in order to make a more accurate conclusion, there is a need for large-scale studies with a longer follow-up time.

Genet. Mol. Res. 20(1): GMR18748
DOI: 10.4238/gmr18748
Research Article

We evaluated the initial results of laparoscopic partial nephrectomy (LPN) in the treatment of renal tumors in Thanh Hoa General Hospital. During examination, 10 patients (6 females, 4 males) were diagnosed with renal tumors on CT scans. Later they underwent LPN at Thanh Hoa General Hospital from November 2016 to March 2018. The mean age was 54.5 years. Average tumor size was 3.5 cm. There were seven patients in the pT1a stage and 3 in the pT1b stage. The R.E.N.A.L. nephrometry scoring: two patients in 4a; two patients in 4p; three patients in 5a; two patients in 6p; and one patient in 8x. Average operative time was 125.6 minutes. Average warm-ischemic time was 29.4 minutes. Blood loss average was 85.2 mL. Hemorrhagic complication in one patient. Convert to laparoscopic radical nephrectomy in one patient. Patients were followed for one to three months without complications, metastases, or local recurrence.

Genet. Mol. Res. 20(1): GMR18747
DOI: 10.4238/gmr18747
Research Article

We evaluated the results of mini–percutaneous nephrolithotomy (mini-PCNL) under ultrasonic guidance for treatment of kidney stones at Thanh Hoa General Hospital. This descriptive study examined, from July 2016 to September 2018, 300 cases of kidney stones performed mini-PCNL under ultrasonic guidance. Nephrolithotripsy was done by 30 and 100w Homium lasers. The 300 patients included 63.3% men and 36.7% women.  The mean age was 42.13 ± 33.4 years. Recurrent stones were found in 15%, renal pelvis and one calyx stone in 51.7%. Hydronephrosis before surgery at level 1 was found in 46.7%. Stone average length was 3.11 ± 0.63cm and average area was 5.16 ± 2.41cm2. Tunnel position in the middle calyx was found in 68.3%. Average surgery time averaged 58.42 ± 27.8 minutes. Bleeding during surgery was reported for 15 patients, hematuria after surgery in two patients, and fever after surgery in 46 patients. The average hospitalization duration was 4.6 ± 2.3 days. Early stones clearance rate was 78.3%. Mini–PCNL under ultrasound guidance with a 30 – 100w Holmium Laser energy source is a useful method of treating kidney stones safely, achieving an early stone clearance efficiency of 82.4%,and a low rate of postoperative complications of 16.7%. This method can effectively replace open surgery for the treatment of kidney stones.

Genet. Mol. Res. 20(1): GMR18746
DOI: 10.4238/gmr18746
Research Article

We evaluated the results of arthroscopic rotator cuff repair. Thirty cases of rotator cuff tear were treated by arthroscopic rotator cuff repair at the Thong Nhat hospital from 1/3/2012 to 30/6/2016. All patients were over 18 years old, had positive rotator cuff tear tests, and underwent X-ray and magnetic resonance imaging. The arthroscopic images showed rotator cuff tears, with indication for repair. The functional status of each patient was evaluated using the Constant-Murley Scale and the criteria of the University of California at Los Angeles (UCLA). During postoperative rehabilitation, we applied Cohen's protocol. Seventeen patients were female and 13 were male. The median age was 54 years (21–83). Sixteen patients had partial thickness tears and 14 patients had full-thickness tears. Repair technique: single-row in 13 patients, suture-bridge in 15 patients, transosseous-equivalent in two patients. Four patients with SLAP lesions were treated by debridement labrum for type I, and labral repair for more serious lesions. Five patients with long head biceps tendon rupture were treated with tenodesis. After surgery, 100% of patients were subjected to fluid extravasation through the shoulder joint, but did not have any compartment syndrome; all incisions healed good without infection or neurapraxia. The mean UCLA score was 32.4 (14 patients had excellent results, 14 good, and two fair). The mean Constant score was 38.5; the mean postoperative Constant score was 88.77 (p = 0.001). Among the patients, 90% achieved 80% function compared to a normal shoulder. All patients gave their consent to the study and were prepared for the full course of treatment and arthroscopic surgery. Repair of the rotator cuff was for some participants the only effective treatment and a way to restore the shoulder. Postoperative reconstruction of the rotator cuff of the shoulder resulted in a significant improvement in the indicators of the functional state of the shoulder joint.

Genet. Mol. Res. 20(1): GMR18745
DOI: 10.4238/gmr18745
Research Article
Authors:

We assessed the effectiveness of Aclasta for osteoporosis in patients with femoral head fractures at Thong Nhat Hospital in Ho Chi Minh City. A total of 156 patients with femoral head fractures and osteoporosis in the orthopedic department at Thong Nhat in Ho Chi Minh City were assigned to a randomized controlled trial from 01 Jan 2013 to 01 Jan 2014, divided into two groups: 75 patients were treated with Aclasta; 81 patients received a placebo. Most of them were followed for at least one year for new bone fractures and T-score index before and one year after treatment. New fractures were found at a rate of about 8% in the Aclasta group and 13.6% in the placebo group, which was significantly different (P < 0.001). Vertebral fractures were different in Aclasta (1.3%) and Placebo groups (3.7%), and the incidence of femoral head fracture was 2.6 and 3.7%. T-score improved significantly after one year in the Aclasta group; the proportion of patients with a T-score in this group changed due to bone deficiency 33.3 and 8%, while in the placebo group, it was 7.4 and 0%; this difference was significant (p <0.001). Using Aclasta for treatment of osteoporosis after femoral head fracture surgery reduces the incidence of new fractures and gives T-score improvement in patients with femoral head fractures, especially in elderly patients.

Genet. Mol. Res. 20(1): GMR18744
DOI: 10.4238/gmr18744
Research Article
Authors:

We evaluated the results of treatment of meniscus tear injury by arthroscopy to determine the influence of age, gender and cause of injury in patients undergoing endoscopic suturing. This was a prospective study conducted from 7/2006 to 7/2013. We followed 90 patients, from 17 to 50 years old attended at Thong Nhat hospital (Ho Chi Minh City). All of them were diagnosed with a torn meniscus and were treated with arthroscopic meniscus suturing by outside-in, inside-out and all inside techniques. Early results, including evaluating the side effects during surgery and after surgery and results after 6 months were collected. Among the 90 patients in our study, men accounted for 62%, almost two times higher than percentage of women. The main reason was due to sports injuries, accounting for 65%. The most common age was between 21 and 30 (46.7%). Results after surgery: 32/90 were very good, 52/90 (good, 4/90 medium, and 2/90 bad. The indication of suturing meniscus tear due to trauma gives superior results for knee function for patients, reducing long-term complications such as osteoarthritis.

Genet. Mol. Res. 20(1): GMR18743
DOI: 10.4238/gmr18743
Research Article
Authors:

Stroke is one of the leading causes of death both globally and in Southeast Asia, which is confirmed by high values: 5 million and 500 thousand deaths annually, respectively. The situation in Vietnam is also critical. We have systematized and studied the risk factors in patients with ischemic stroke in Phu Tho Province General Hospital. This was a prospective cohort study of 192 patients. Transient ischemic attack was described in 13% of all cases, and the risk of progression to severe disease or death had an odds ratio (OR) = 5.2; 63.5% of all patients with hypertension had a risk of severe complications or death with OR 3.2. Previous cardiovascular events were found during the history of the disease in 28.1% of patients. Hyperlipidemia had a significant prevalence among the patients; the risk of exacerbation was OR = 2.6. Tobacco smoking and alcohol abuse also had a high prevalence among patients (72.6%). The risk of death among smokers and alcohol abusers was 2.4 times higher compared with patients without bad habits. Ischemic cerebrovascular accident is one of the most common health problems in Vietnam and needs more attention.

Genet. Mol. Res. 20(1): GMR18742
DOI: 10.4238/gmr18742
Research Article

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.

Genet. Mol. Res. 20(1): GMR18741
DOI: 10.4238/gmr18741
Research Article

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.

Genet. Mol. Res. 20(1): GMR18740
DOI: 10.4238/gmr18740
Research Article

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.

Genet. Mol. Res. 20(1): GMR18739
DOI: 10.4238/gmr18739
Research Article

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.

Genet. Mol. Res. 20(1): GMR18737
DOI: 10.4238/gmr18737
Research Article

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.

Genet. Mol. Res. 20(1): GMR18736
DOI: 10.4238/gmr18736
Research Article

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.

Genet. Mol. Res. 20(1): GMR18735
DOI: 10.4238/gmr18735

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