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@#Emphysematous Pyelonephritis (EPN) is an uncommon but life-threatening condition for which diabetic patients are at high risk. The most common chief complaint bringing patients to the hospital is upper urinary tract infection. Early clinical diagnosis with radiography is a key to reduce the complications and death due to emphysematous pyelonephritis. We present a case study of a 45-year old female patient who was presenting to the emergency room with left flank pain. Blood testing showed acute kidney injury, E. coli bacteremia, and the radiography demonstrated an abnormal image of the left kidney consistent with EPN. Symptomatic treatment and antibiotic were given, but no response and developed to heart failure and death at Emergency Room.
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Background@#Hypertension in children is one of major concerns in public health. However, there is no evidence within the Lao population. Therefore, we aimed to determine the prevalence of hypertension in children and adolescents aged 11-15 years old.@*Methodology@#A descriptive, cross-sectional study was conducted in children and adolescents aged 11-15 years old at secondary schools of Vientiane Capital, Lao PDR. Two secondary schools were purposively selected, Vientiane and Bornagnao schools. The data were collected using questionnaire form.@*Result@#A total of 365 students were included in the study of which 50.7% were male. The mean age was 13.7 years old (Min=11 and Max=15). The majority of students were of Lao Loum ethnicity (95.1%). Of 365 students, 140 (38.3%) had high blood pressure during the survey. Of these, 99 (27.1%) people were at pre-hypertension, 6.3% in stage 1 and 4.9% in stage 2. Most (74.5%) of included students had normal Body Mass Index (BMI). Students with overweight and obesity were significantly more likely to have hypertension than others (p<0.001).@*Conclusion@#We found a high prevalence of hypertension in secondary school students particularly in those overweight and obese. Therefore, it is important to provide appropriate education at school to reduce the risk factors as well as hypertensive screening.
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Background@#Acute glomerulonephritis (AGN) occurs in all age groups and any settings around the world. AGN is a major cause of illness and death in children. However, the signs and symptoms are not specific for the disease.@*Objective@#To study the treatment and outcome of Acute Glomerulonephritis in children, at Pediatric ward, Mahosot Hospital@*Methodology@#A retrospective study was conducted to review the medical records of inpatients admitted to the Pediatric Ward at Mahosot Hospital from January 2014 to January 2017. All patients aged 15 years old or younger with complete medical records were included in the study. The information on signs and symptoms, laboratory results, treatment and outcome of the patients with acute glomerulonephritis were descriptively analyzed and reported.@*Finding@#There were 3,528 patients admitted to the Pediatric Ward at Mahosot Hospital during the three years. Among these, 64 patients were diagnosed as having AGN (1.81%), but only 36 cases met the study inclusion criteria. The proportion of males was slightly higher than females (ratio 1.2:1) with the mean (SD) age of 9.6 (±2.7 years old) years old. More than a half (53.57%) of the patients reported a medical history of pharyngitis or tonsillitis. The most common presenting symptoms and signs were edema (94%), hematuria (25%), anuria (36%) and hypertensive emergency (17%). The key abnormally elevated renal function tests included BUN (44%) and creatinine (28%). The most common complications included hypertensive encephalopathy (25%) and congestive heart failure (8%).@*Conclusion@#AGN is the major cause of acute kidney injury, congestive cardiac failure and hypertensive encephalopathy, which require optimal treatment in order to have a good outcome.
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Background@#The prevalence of Autoimmune Hemolytic Anemia (AIHA) globally ranges from 5-30%, but relatively high in Asia, 22%. This condition is commonly found among patients with thalassemia. However, no data are available about this disease in Lao PDR.@*Objective@#To determine the proportion of AIHA among Lao children with thalassemia.@*Methodology@#A cross-sectional study was conducted from May to September 2018 in pediatric patients with thalassemia who received blood transfusion at the Children’s Hospital, Vientiane Capital. There were 338 patients included in the study. Data analysis was done using SPSS, and Pearson chi-square was used to compare the two proportions.@*Finding@#We found that the proportion of AIHA was 3.6% (12/336) amongst those with thalassemia with more males than females (3:1). The mean (SD) age was 11.5 ± 3 years old. The older age of patients was significantly associated with AIHA, p=0.001. We also found that patients with transfusion dependent thalassemia were more likely to have AIHA than those who were not. The mean reticulocyte count (%) was significantly higher in patients with AIHA than those without AIHA (8.61±10.57 versus 1.18±1.14, p<0.001). Other variables such as sex, type of thalassemia, age at diagnosis, the frequency of blood transfusion, age at first blood transfusion, blood group and hemoglobin before blood transfusion were not significantly associated with AIHA.@*Conclusion@#The proportion of AIHA remains low in Lao children with transfusion dependent thalassemia, but requires further attention to reduce its complications. There is a need to identify factors associated with AIHA among Lao patients with Transfusion Dependent Thalassemia
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Background and Rational@#Fever is a common illness in children. Fever accounts for about 30% of all chief complaints in children presenting at emergency ward of the Childrens’ Hospital, Vientiane.@*Objective@#To compare the efficacy of fever management using rectal paracetamol plus tepid sponge (Group 1) versus rectal paracetamol plus fever cooling sheet (Group 2) in children aged 2 months to 5 years.@*Methodology@#We conducted a randomized controlled trial at the emergency ward of the national Children Hospital, Vientiane Capital, Lao PDR. Fever was defined as axillary temperature of ≤38.5°C. The study was from 1st June to 1st September 2018. The doses of paracetamol used were 80 mg, 125 mg and 250 mg for children weighed 3-<6 kg, 6-10 kg and >10-<15 kg, respectively. Consent ethics@*Result@#One hundred children enrolled in the study, 50 children in Group 1 and 50 in Group 2. The most common febrile illness in our study was the common cold. There was no significant difference of proportion of common colds in both groups (45.8% vs 39.2% in Group 1 and Group 2, respectively). The average temperature prior to treatment was 38.69°C and 38.78 °C for Group 1 and Group 2, respectively. After 15 minutes of the treatment, the temperature reduced to 38.43°C and 38.67°C, reduced to 38.13°C and 38.55°C in 30 minutes and to 37.62°C and 38.41°C in 60 minutes later for Group 1 and Group 2, respectively. The temperature at 60 minutes after the treatment was significantly lower in Group 1 (p=0.021). The proportion of children with normal temperature ( ≥37.5°C) was significantly higher Group 2 than Group 1 (18.7% vs 0%, respectively; p=0.01). The side effect of the treatment (irritation) in 60 minutes later was significantly higher in Group 2 as compared to Group 1 (76.9% vs 23.1%, p=0.006).@*Conclusion@#Rectal paracetamol plus tepid sponge was more efficacious than rectal paracetamol plus fever cooling sheet in lowering the temperature in children. Therefore, tepid sponge should be highly recommended to avoid the side effects derived from fever cooling sheet.
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Background and rationale@#In the Lao PDR, shortage of blood for transfusion for use in hospitals is an important and challenging problem, which has not been adequately resolved. This is due to the very low number of voluntary blood donation by the general population. Many factors may contribute to the low number of voluntary blood donation of Lao people, which we do not all know and understand.@*Results@#Eight hundred and ninety-eight subjects were enrolled in the study and interviewed (449 cases and 449 controls). The median (range) age of the respondents was 26 years (17 – 40). Factors significantly associated with voluntary blood donation were males (OR = 1.71; 95% CI = 1.31-1.23, P= 0.001), being single (OR = 2.01; 95% CI = 1.52-2.65, P<0.001), having a positive attitude toward voluntary blood donation (OR = 3.17; 95% CI = 2.37-4.22, P<0.001), convenience in traveling to and short distance from home to blood donation centre (OR = 2.35; 95% CI = 1.73-3.20, P=0.01), (OR = 1.67; 95% CI = 1.25-2.22, P=0.001), respectively, and having received information on blood donation from any channels (OR = 1.88; 95%CI = 1.38-2.55, P<0.001). Another important but not statistically significant reinforcing factor for voluntary blood donation was blood donation during important occasion (birthday, marriage anniversary and valentine’s day).@*Conclusion@#This study suggested that (1) voluntary blood donation campaign should be carried out continuously and focus on young people at educational institutions and (2) it is very vital that mobile blood donation teams continue their activities regularly in order to ensure that blood demand in hospital can be achieved.
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Background and rationale@#Diabetes mellitus (DM) remains an important health problem worldwide, including in Laos. Most deaths among DM type-2 patients result from complications due to poor control of glycemia. Eating and drinking behaviors are vital factors for glycemia control in DM patients and study of their knowledge, attitude and practice for eating-drinking behavior may help us to understand the problem and plan engagement and how to promote appropriate changes in patients’ behavior.@*Methodology@#A descriptive, cross-sectional study was conducted to explore knowledge, attitude and practice on eating-drinking of DM type-2 patients who visited the Outpatient Department of Mahosot Hospital from February to March 2012. A questionnaire was designed and pre-tested before interviewing patients following their consent. Patients were selected into the study using systematic random sampling.@*Results@#Two hundred DM type-2 patients (60% females) were interviewed. The overall mean (SD) age of the patients was 58 (9.2) years; 35.5% of them had at least a family member with DM. The mean (SD) duration the patients knew that they had DM was 6.1 years (SD = ±5.8). On the day of interview, 42% and 32.5% of the patients had blood glucose levels that were high (130-180 mg/dL) and very high (>180 mg/dL), respectively. Twenty-two percent of the respondents had a good level of DM diet knowledge while 59% of them had a moderate level and the remainder (19%) had a low level. Most of interviewees (98.5%) had correct knowledge on food restriction (rice, flour, sugar, and lipid) and 93.5% knew that food control, exercise, and taking antidiabetics regularly are the best ways to control blood sugar. Less than 50% of the respondents knew that DM patients have to restrict the quantity of rice to eat and that patients with complications must control their diets strictly. Although 68.5% and 31.5% of the patients had a good and moderate level, respectively, of attitude on DM nutrition, some of them still had beliefs that are not medically recommended. For example, 15.5% of patients thought that they could stop their medication by themselves, 28% said that DM patients can live normally regardless of blood sugar control, and 49.5% believed that DM was a bad karma. Approximately 1/4 of the interviewees reported that they mostly did not eat on time, 30.5% did not restrict their food, 41% just ate what they needed and 41.5% said that they ate any fruits that they liked.@*Conclusion@#Although most of DM patients had correct knowledge on DM diets, some of them had attitudes and practice on food consumption, including poor blood sugar control, that are at odds with current medical advice. Engagement methods are needed to inform patients of optimal dietary practice in order to prevent DM complications.
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Background and rationale@#Intensive Care Units (ICU) are wards where very sick patients are admitted and they are usually connected to invasive devices such as respirator, urine catheter etc. Patients in ICU are more likely (5 – 10 times) to have hospital-acquired infections than those admitted to other wards of the same hospitals. Very little is known about hospital-acquired infections in Laos, including the species of bacterial contaminating ICU. Information on this issue is essential for a hospital to plan on how to manage the environment and set stricter measures to avoid nosocomial infections in the ICU.@*Methodology@#This was a research survey conducted to determine the types and quantity of bacterial contamination in ICUs of a hospital in Vientiane. Open plate technique was applied by placing 256 media plates in 8 rooms of paediatric (n=3) and adult (n=5) ICUs. Controls were closed plates. Plates were sent to and bacteria were identified at National Centre of Laboratory and Epidemiology, Vientiane, Laos.@*Results@#Eight pathogens were identified and the most predominant bacteria found was Coagulase negative Staphylococcus spp. (56.0%), followed by Bacillus spp. (19.7%), Acinetobacter spp. (12.5%), Micrococcus spp. (8.4%), Escherichia coli (1.9%), Klebsiella pneumoniae (0.8%), Providencia rettgeria (0.4%) and Proteus mirabilis (0.3%). Escherichia coli, Klebsiella pneumoniae and Providencia rettgeri were not found in adult ICUs and Proteus mirabilis was not found in paediatric ICUs. The overall mean (95%CI) colonies of pathogens found in paediatric and adults ICUs was 83.04 CFU/dm2 (43.21 - 149.42 CFU/dm2) and 48.54 CFU/dm2 (21.96 - 135.00 CFU/dm2), respectively.@*Conclusion@#This study suggested that there were many bacteria contaminated in the ICUs of this hospital with a considerable quantity. Therefore, the hospital should have a better strategic plan to manage its environment and improve sterilization in the ICUs in order to reduce hospital-acquired infections among patients.
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The echinostome metacercariae encysted in Cipangopaludina sp. snails that were purchased from a market in Vientiane Municipality, Lao PDR, were identified as Echinostoma macrorchis (Digenea: Echinostomatidae) through recovery of adult flukes after experimental infection to rats and a cat. The metacercariae were round, 113-128 (121)x113-125 (120) microm, having a thick cyst wall, a head collar armed with collar spines, and excretory granules. The adult flukes recovered from the rats and cat at day 14 and 30 post-infection, respectively, were elongated, ventrally curved, and 3.9-6.3x0.7-1.1 mm in size. The head collar was distinct, bearing 43-45 collar spines with 5 angle spines on each side. Two testes were large (as the name implies), tandem, and slightly constricted at the middle, with irregular margins. Eggs were operculated, ovoid to elliptical, and 88-95x56-60 microm. In scanning electron microscopy, the head collar was prominent, with 43-45 collar spines. Scale-like tegumental spines were densely distributed on the ventral surface between the oral and ventral suckers. Sensory papillae were distributed mainly on the tegument around the 2 suckers. It is confirmed that E. macrorchis is distributed in Lao PDR using Cipangopaludina sp. snails as the second intermediate host.
Subject(s)
Animals , Cats , Rats , Animal Experimentation , Animal Structures/anatomy & histology , Biometry , Echinostoma/anatomy & histology , Laos , Microscopy/methods , Parasitology/methods , Snails/parasitologyABSTRACT
Freshwater fish from Vientiane Municipality and Savannakhet Province, Lao PDR were examined by the muscle compression and artificial digestion methods to know the infection status with trematode metacercariae. In the fish from Savannakhet, 2 species of metacercariae, Opisthorchis viverrini and Haplorchis taichui, were detected. O. viverrini metacercariae were found in 6 species of fish, Puntius brevis, Hampala dispar, Esomus metallicus, Mystacoleucus marginatus, Puntioplites falcifer, and Cyclocheilichthys armatus. H. taichui metacercariae were detected in 3 species of fish, P. brevis, P. falcifer, and M. marginatus. In the fish from Vientiane, 4 species of metacercariae, O. viverrini, H. taichui, Haplorchis yokogawai, and Centrocestus formosanus, were detected. Among them, O. viverrini metacercariae were found in 7 species of fish, Onychostoma elongatum, C. armatus, H. dispar, P. brevis, Cyclocheilichthys repasson, Osteochilus hasseltii, and Hypsibarbus lagleri. The metacercariae of H. taichui were detected in 6 species of fish, C. repasson, O. elongatum, C. armatus, H. dispar, Labiobarbus leptocheila, and Cirrhinus molitorella. The metacercariae of H. yokogawai were found in 9 species of fish, C. repasson, O. elongatum, C. armatus, H. dispar, Labiobarbus leptocheila, O. hasseltii. C. molitorella, Hypsibarbus wetmorei, and H. lagleri. The metacercariae of C. formosanus were detected in 4 species of fish, C. repasson, P. brevis, O. hasseltii, and C. molitorella. From these results, it is confirmed that fishborne trematode metacercariae, i.e. O. viverrini, H. taichui, H. yokogawai and C. formosanus, are prevalent in various species of freshwater fish from Savannakhet Province and Vientiane Municipality, Lao PDR.