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BACKGROUND Pandrug-resistant (PDR) Klebsiella pneumoniae has been reported sporadically in many countries and remains rare in Brazil. OBJECTIVES This study unravelled the genetic determinants involved with the PDR background of a clinical ST11 K. pneumoniae recovered in the Brazilian Amazon Region, where K. pneumoniae genomic and epidemiological information is scarce. METHODS Kp196 was submitted to the antimicrobial susceptibility test by the disk-diffusion method and minimum inhibitory concentration (MIC) determination. The whole genome sequencing was obtained and the sequence type was determined by core genome multilocus sequence typing (cgMLST). Its intrinsic and acquired resistome was assessed by Comprehensive Antibiotic Resistance Database (CARD) and comparison with wild-type genes. FINDINGS The analyses revealed that Kp196 belonged to the pandemic ST11 and presented the PDR phenotype. Its acquired resistome was composed of a huge set of clinically relevant resistance determinants, including bla CTX-M-15 and bla NDM-1, all found in the vicinity of mobile platforms. Considering its intrinsic resistome, the multidrug resistance, especially to colistin, tigecycline and fluoroquinolones, was multifactorial and attributed to modifications (indels, missense mutations, and gene disruption) in several housekeeping genes (arnT/phoQ/mgrB/ramR/acrB/gyrA/parC/ompK35-36-37). The Kp196 intrinsic resistome was also observed in a ST11 environmental strain, although harbouring distinct acquired resistomes. CONCLUSIONS An accumulation of different resistance mechanisms regarding the intrinsic resistome accounts for a more stable resistome, strongly contributing to the Kp196 PDR phenotype.
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AIM:To explore the changes and influencing factors of macular retinal blood flow density in patients with proliferative diabetic retinopathy(PDR)after vitrectomy, and establish a predictive model.METHODS: The clinical data of 173 patients with 173 eyes in PDR who underwent vitrectomy in our hospital from June 2019 to June 2021 were analyzed retrospectively. According to the changes of macular retinal blood flow density after operation, the patients were divided into normal group(118 cases with 118 eyes)and descending group(55 cases with 55 eyes). The general data, preoperative laboratory examination index and intraoperative condition of the two groups were compared. Multivariate Logistic regression was used to analyze the factors affecting the changes of retinal blood flow density in macular area after operation. Construct the line chart prediction model and evaluate its prediction efficiency.RESULTS: The course of diabetes, proportion of patients with complicated maculopathy, serum TC, TG, LDL-C, HbA1c, vascular occlusion and hyperplastic retinal traction in the decreasing group were significantly higher than those in the normal group, while HDL-C was significantly lower than that in the normal group(P<0.05). Multivariate Logistic regression analysis showed that course of diabetes > 17a(OR=4.526), complicated maculopathy(OR=4.983), HbA1c > 6.25%(OR=4.283), vascular occlusion(OR=5.216)and hyperplastic retinal traction(OR=4.765)were all risk factors of the decrease of macular retinal blood flow density after operation(P<0.05). The line chart prediction model has good differentiation and accuracy, and has high prediction value. CONCLUSION: Course of diabetes, complicated maculopathy, HbA1c, vascular occlusion and proliferative retinal traction are all related to the decrease of macular retinal blood flow density after vitrectomy with PDR. Understanding the risk factors is beneficial to surgical decision-making.
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Background@#A key success to achieve the highest potential in the nursing profession is the clinical nurse leaders (CNL) who are likely to have key roles for improving quality of patient care, but nothing published about this topic in the Lao PDR.@*Objective@#To evaluate the duties, leadership roles and to develop nursing technical leadership roles in central hospitals, Vientiane Capital.@*Methodology@#The study is action research conducted between 12/2019 - 6/2020, with 3 phases (1) preparation phase, (2) implementation-1 phase, and (3) implementation-2 phase (development of CNL roles.@*Results@#One hundred and eleven clinical nurse leaders from five central hospitals in Vientiane Capital participated in the study of which 92% were female; aged between 30-39 years (50%), and most of them worked in the Internal Medicine departments and their working experience ranged from 10-19 years (40.5%). About thirty-nine percent of the participants were mid-level nurses. The overall performance score for CNL roles was moderate with a mean of 3.2/5. The performance score was significantly different between levels of education of the nurses (for example between those who were auxiliary nurses and those who held the bachelor degree by training) with p-value <0.05. @*Conclusion@#The role of clinical nurse leaders in central hospitals evaluated systematically, traditionally and as routine work was not really satisfactory. The overall CNL performance was moderate and there remain some roles that need to be promoted particularly the research role.
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Background@#Global guidelines from the World Health Organization on discharging patients diagnosed with COVID-19 changed in 2021 to a symptom-based rather than negative PCR-based approach. Studies have shown that shedding of viable virus continues for approximately eight days after symptom onset in most patients. In Vientiane, Laos, until now, patients diagnosed with asymptomatic or mild COVID-19 are hospitalised for 2 weeks and then, if they still test PCR positive for SARS-CoV-2, stay for a further week in a designated quarantine hotel before being discharged home.@*Objective@#The aim of this pilot study was to investigate the risk of transmission of SARS-CoV-2 to household contacts of discharged patients who are still PCR-positive following 2-3 weeks quarantine in Vientiane, Lao PDR.@*Methods@#Adult participants, who were resident in Vientiane Capital and who were about to be discharged from hospital (after 2 weeks hospitalisation), or from a quarantine hotel, following a further one-week quarantine, were screened to assess eligibility for the study. The household of each case was visited a maximum of 48 hours before or up to 24 hours after the participant was discharged and a nasopharyngeal swab was taken from all household members. Repeat nasopharyngeal swabs from cases and contacts were taken on day 7 and day 14 after discharge home of each case.@*Results@#Between 20th May 2021 and 27th August 2021, 55 cases and 84 contacts in 27 households were enrolled in the study. The median [range] age of all 139 included participants was 26.5 years [3 months to 83 years] and 83 (60%) were female. By household, the median [range] number of cases and contacts were 1 [1-6] and 3 [1-13] respectively. At discharge home 32/48 (67%) cases tested positive for SARS-CoV-2. By day 7-11 of 47 cases (23%) still tested positive for SARS-CoV-2 by PCR and by day 14 this number was 2/24 (8%). No contacts tested positive during follow up and the numbers tested at the time of discharge of the case, 7 days later and 2 weeks later were 56, 57 and 37 respectively. Loss to follow up at day 7 and day 14 ranged from 15-50% (participants not at home at the time of visits).@*Conclusion@#In this pilot study we found no evidence of onward transmission of SARS-CoV-2 to contacts of cases discharged home with a positive PCR result. This suggests the current discharge policy for mild to moderate COVID-19 case following 2 weeks in hospital in the Lao PDR is safe.
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Objective@#The aim of this paper is to assess the interactions between migration paths and HIV infection risks among and from the views of people living with HIV in Lao PDR.@*Methods@#Twenty-four in-depth interviews with eight interviewees were carried out by four trained members of the Association of People Living with HIV (APL+), in 2017. The qualitative analysis was done manually to explore the influence of social determinants through migratory paths on the evolution of individual lifestyles, working and living environments, access to information, prevention and healthcare that contribute to HIV infection risks.@*Results@#Low levels of economic and education lead to migration and also increase risky practices and vulnerability to HIV infection of migrant workers. Insufficient awareness and access to prevention against HIV/STIs in their home country increase risky behaviours during migration. Moreover, inadequate referral system for HIV treatment, stigma, and family relationships contribute to influence the life courses of migrants' post-HIV infection.@*Conclusions@#Raising awareness and providing access to information on HIV/STIs, both for internal and external migrant workers are crucial in order to diminish the prevalence of HIV infection among the target audience. A reinforcement of the existing collaborative health measures between Lao PDR and Thailand is needed to enhance migrants’ access to healthcare services.
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Background@#Outbreaks of vaccine preventable-disease control and elimination are impeded by impaired focal vaccination uptake. Therefore, we aimed at assessing vaccination uptake and comparing with passive surveillance (PS) report at village level.@*Methods@#A community-based cross-sectional survey was conducted in the villages covered by two health centers in Bolikhamxay province, including non-Hmong and Hmong ethnic groups. Data collection was conducted by interviewing mothers or caregivers of children aged 6 to 23 months. The vaccination status was identified by vaccination cards, and compared with PS report at village level, which was collected from health centers. The Pearson’s chi-square test was used to compare these proportions, and pairwise correlation was used for the correlation of observed vaccination coverage.@*Finding@#Sixteen villages were included, nine were from Luk52 health center area and 7 from Namkhou health center area. There was a significantly strong correlation for pentavalent pneumococcal conjugate vaccine, Japanese encephalitis, Measles and Rubella and full immunization coverage compared to others. This correlation was not observed in the non-Hmong population. Amongst non-Hmong, the recorded coverage was lower in PS than in the survey regardless of type of vaccine. In contrast, amongst Hmong most vaccines had higher recorded coverage in PS than in the survey except Bacillus Calmette–Guérin (BCG) and hepatitis B at birth dose. MR and JEV vaccine, commonly given at the same time, were the only one that did not have significantly different coverage between PS and the survey (p<0.334).@*Conclusion@#The mis-estimatation of immunization coverage from the PS reporting system highlights further research needed to determine a better indicator of village-level vaccination coverage, but measles could be an indicator of prioritizing the settings.
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Objective@#we aimed to investigate the possible causes of death among preterm and LBW infants admitted to the post-delivery ward and/or NICU at Mahosot Hospital, Lao PDR, and the possible factors that influence preterm and LBW infants’ survival.@*Methods@#A retrospective cross-sectional study was conducted between by reviewing the treatment and outcomes for preterm and LBW infants admitted July - November 2017 to Mahosot Hospital in Vientiane, Lao PDR.@*Results@#Of 3,500 births in 2017, 224 (6.4%) were preterm, 350 (9.4%) were LBW and 106 (30.2%) were term LBW; 98 preterm births (43.8%) and 21 (19.8%) term LBW babies were admitted to the NICU. Enrolment included 93 cases including 86 (92.5%) preterms and 7 term LBW neonates, of whom 47 (54.7%) and 2 were admitted to NICU, respectively. Enrollees were mostly male, Lao Loum, born vaginally at Mahosot Hospital; 3.2% were extreme preterm, 15.1% were very preterm, 74.2% moderate to late preterm and 7.5% term LBW; 2.2% were extremely LBW, 16.1% very LBW, 63.4% LBW and 18.3% normal birth weight. All 44 (47.3%) preterm or LBW babies admitted to the postnatal ward survived. Of the 49 (52.7%) admitted to the ICU, 18.4% died. All neonates who died were preterm of gestational age ranging 25-36 weeks and birth weight 730-2220g. Babies admitted to the NICU were mostly diagnosed with respiratory distress syndrome (RDS, 39.7%), neonatal infections (31.7%), asphyxia (9.5%) and congenital malformations (4.8%). Patient care. Antenatal: 5.9% of preterm births <32 weeks received magnesium sulfate, and 27% of births 24-34 weeks gestational age received antenatal steroids. Postnatal: 37.6% received skin-to-skin contact (SSC), and 15% maintained SCC until breastfeed completed, 68.8% received exclusive breastmilk as first feed and 24.5% kangaroo mother care. Only 7.5% were monitored for hypoxemia and 24.7% for hypothermia. Weights were not checked prior to discharge. Case management: Around two-thirds of babies with risk factors for sepsis received prophylactic antibiotics. Most (77.6%) babies during the NICU admission received antibiotics, all of whom had a CBC and blood culture; but half without a diagnosis of sepsis or risk factors. Most (79.6%) preterm and LBW babies admitted to the NICU were given oxygen. About one-quarter of babies with RDS died. Very LBW infants rarely received supplementation with vitamin D, phosphate, iron and calcium.@*Conclusions@#Most study participants were late preterm and LBW. Just under 10% died. Care can be improved, including antenatal administration of magnesium sulfate and antenatal steroids that needs to be vastly increased for eligible mother in preterm labor. Respiratory management needs further investigation for gaps. Feeding with breastmilk and checking vital signs appear to be strengths.
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@#Objective: we aimed to assess the knowledge, attitude and practice (KAP) of healthcare providers (HCP) towards cervical cancer (CC) screening and to identify possible factors associated with its low utilization among women presenting at gynaeco-obstetrics units in the Lao PDR. Methods: A cross-sectional study was conducted between March - June 2018 on a sample of 85 (HCP) at gynaecology units in two provincial and eleven district hospitals in Luang Prabang (LPB) and Salavan (SLV) Provinces. Results: Of the 85 HCP, 63.4% were from SLV and 36.6% from LPB. 81% were females and mean ager was 32 years. Only 7% of them had good knowledge, 18.8% had good CC screening attitudes and only 1.2% had good CC screening practices. 36.2% of female HCP had been screened for CC and 48.3% had not been screened because they thought only those who had symptoms and risk factors should go for. The most common reasons for not conducting routine CC screening of patients were: lack of medical equipment (53.7%), and incompetent techniques (43.3%). HCP graduates and post graduates had a higher knowledge score (aOR = 4.09, 95% CI: 1.43-11.66, P = 0.008), and attitude score (aOR = 5.54, 95% CI: 1.55-19.75, p=0.008). Those, who had been working for more than 10 years, were more likely to have higher attitude scores (aOR = 6.07, 95% CI: 1.36-27.15, p =0.018). Conclusions: CC screening knowledge among HCP is generally fair. However, CC screening attitudes are still poor. Re-orientation courses on CC screening for HCP are urgently needed in order to move forward to the next steps in CC screening programs.
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Background@#Diabetes Mellitus (DM) is a major public health concern, but with minimal data on how this affects the Lao population. @*Objective@#We aimed at predicting the impact of the burden of DM, and determine the effectiveness of DM screening techniques to reduce related mortality in Lao PDR.@*Methods@#A compartmentally deterministic model was created to reflect the demography in 2005 and 2015, and DM prevalence in 2015 of the Vientiane capital population. The parameters were retrieved from calibration and literature reviews. The model predicted demographic structure and DM in 2035. The effectiveness of DM screening tests, either Fasting Plasma Glucose (FPG) or glycated hemoglobin (HbA1c), was examined in term of mortality reduction.@*Results@#By 2035, the Vientiane population is expected to have annual grow of 0.89% with higher proportion of more elderly people; those aged 45 years old and older are expected to account for 39.3% in 2035. Overall prevalence of DM was expected to rise from 9.65% in 2015 to 13.4% in 2035 as a result of the aging population. The model predicts that the prevalence of DM would double (28.42%) in those aged >60 years old by 2035. The mortality rate is expected to increase more than double from 890 in 2015 to 1,808 deaths per 100,000 people in 2035, with the highest rate in those with undiagnosed diabetes and those older than 60 years. Screening by FPG test at an initial age of 35 years old is estimated to reduce mortality by 17.93%, and 16.80% for initial age screening at 45 years. Screening by HbA1c test would slightly increase the mortality reduction by approximately 1.20% at both initial screening ages.@*Conclusion@#This mathematical modeling projected the steadily increase of prevalence and death related to DM over 30 years of simulation. Early screening by glycemia would reduce the mortality.
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The increase in prevalence of diabetes in India is one of the leading causes of blindness due to micro vascular and macro vascular complications. The complications in retina and kidney are due to damage of small vessels. Studies have shown significant association between diabetic retinopathy and diabetic nephropathy. In our study, we are discussing the complications during intra and post-operative period and also both anatomical and functional outcome in these patients after vitrectomy for proliferative diabetic retinopathy. Both eye and kidney share same vascular pattern. One pre-existing condition can be followed by the other condition due to similar microvascular damage. We wanted to evaluate the outcome of vitrectomy in proliferative diabetic retinopathy patients associated with chronic kidney disease.METHODSThis is a retrospective study done at Sarojini Devi Eye Hospital, Telangana State, South India, over a two-year period from June 2017 to June 2019. Data was collected from old medical records of our institute, from patients who presented to Retina Dept. with various complaints. They were examined in detail, documented and treated based on clinical presentation after clearance from physician. Patients presented with different ocular manifestations like non-resolving vitreous haemorrhage, focal tractional retinal detachment, multi focal tractional retinal detachment like broad based, table top, combined retinal detachment and tractional maculopathy. Patients underwent pars plana vitrectomy with or without silicone oil endotamponade.RESULTSPrognosis in these patients was good only in cases of non-resolving vitreous haemorrhage and focal tractional retinal detachment (47.61%) whereas in cases like multifocal retinal detachment cases outcome was favourable (42.82%) but patients with combined retinal detachment (9.52%) had poor anatomical and visual outcome.CONCLUSIONSManagement of these patients is very difficult when there is severe proliferative diabetic retinopathy with multiple broad vitreo retinal adhesions. Outcome is very poor particularly in patients of severe proliferative diabetic retinopathy associated with chronic kidney disease and coronary artery disease due to intra operative complications
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Diabetic retinopathy (DR) is a major microvascular complication of diabetes. It is the most common cause of blindness in the working-age population in developed countries. We wanted to analyse the correlation between risk factors of blindness like duration of diabetes, dyslipidaemia, hypertension, HbA1c with severity of diabetic retinopathy in order to design appropriate strategies for prevention and treatment of diabetic retinopathy.METHODSThis was a retrospective study of all diabetic patients with diabetic retinopathy who presented to the eye OPD at KS Hegde Medical Academy from April 1st 2018 to March 31st 2019 that fulfilled the inclusion criteria. A dilated fundus examination was done to note the grade of diabetic retinopathy. The demographic data along with the duration of diabetes, HbA1c values, Cholesterol levels and Blood pressure were documented and correlated with the severity of diabetic retinopathy.RESULTSThe study included 92 patients, of which 63 were males and 29 were females with a mean age of 54.5±2.8 years. We found that there was statistically significant association between the duration of diabetes and HbA1c levels with severity of diabetic retinopathy (p= 0.022 and 0.034 association), whereas there was no statistically significant correlation between blood pressure and cholesterol levels with severity of diabetic retinopathy (p= 0.52 and 0.456 respectively)CONCLUSIONSDiabetic retinopathy showed a male preponderance, with risk factors like duration of diabetes and HbA1c levels having a significant association with the severity of diabetic retinopathy. Therefore, it is essential to have a good systemic control of diabetes with diet and suitable medications. Diabetic retinopathy is a preventable cause of blindness when diagnosed early and screening of diabetic retinopathy must be done in all diabetics to prevent the progression of the disease.
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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@#Laos has a high prevalence of hepatitis B infection, at about 8% of the population. Hepatocellular carcinoma (HCC) caused by this virus could be significantly reduced by the primary prevention and early treatment of patients with chronic hepatitis B.@*Objective@#To describe the levels of viral load in patients with chronic Hepatitis B before and after antiretroviral (ARV) treatment in Lao PDR.@*Methodology@#A retrospective descriptive study was conducted by reviewing the laboratory records of 135 patients with chronic hepatitis B registered from January 2010 to August 2013 at the Christrophe Merieux Infectiology Centre, Vientiane Capital, Lao PDR. Hepatitis B viral load (VL) was determined by PCR before and after treatment initiation among this population. Pearson chi-square and Wilcoxon tests were used to compare the proportions and geometric mean.@*Result@#Among 135 hepatitis B patients, most (88%) of the patients were from referral hospitals in Vientiane Capital. 65% were male, and 55% were given ARV without VL testing. Among these, Cycloferon (an immunomodulator) was the commonly used (57%), which is not yet recommended by the Asian Pacific Association for the Study of the Liver Guidelines (APASL). The VLs of patients treated with ARV and Immunomodulator were significantly reduced from the baseline after 4 months. Patients treated with ARV alone had significantly lower geometric mean VL [IC 95%] 4 months after treatment initiation than those treated with Immunomodulator (3.53 [2.81-4.2] versus 4.14 [2.99-5.29]; p<0.001), and those treated with a combination of ARV and Immunomodulator (Geometric mean of VL: 3.53 [2.81-4.2] versus 4.82[3.8-5.8]; p=0.035). Our study found that there was no significant difference in VL between Immunomodulator and ARV+ Immunomodulator (4.14 [3-5.2] versus 4.82 [3.8-5.8]; p=0.371).@*Conclusion@#ARV and Immunomodulator treatment is effective in reducing HBV VL, but ARV works more effectively than when used in combination with Immunomodulator and for Immunomodulator alone. There is an urgent need of developing Lao consensus hepatitis B treatment guidelines and good clinical practice implementation.
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Introduction@#Diarrhea is the most common disease of children particularly in those under 5 years old. In Lao PDR, diarrhea is responsible for 12% of all childhood deaths and the disease is increasing. Therefore, there is a need to study optimal disease management in Lao patients@*Methodology@#A retrospective study was carried out by reviewing medical records of patients admitted at the Pediatric Infectious Ward, Mahosot Hospital, Vientiane Capital from 01/01/2017 to 31/06/2018. We included those diagnosed with acute diarrhea aged 15 years old or younger.@*Finding@#Three hundred and seventy children with diarrhea were included in the analyses, with a higher proportion of males than females [230 (62.2%), 140 (37.6%)] with a ratio of 1.6:1. Mean (SD) age of the patients was 2.1±2.33 years old. The most common age group was those < 2 years old with 247 cases (66.8%), followed by the age group of 2-5 years old [92 cases (24.9%)], 5-10 years old [25 cases (6.8%)] and 10-15 years old [6 cases (1.6%)]. The management in patients without clinically-evident dehydration was ORS in 161 (98.7%), IV fluid in 115 (71.5%) and antibotics in 12 (7.4%). For patients with moderate dehydration, the management consisted of giving ORS in 370 (100%), IV fluid in 198 (96%) and antibotics in one (0.5%). One patient with severe dehydration was given ORS and IV fluid.@*Conclusion@#High proportion of diarrhea found in children under 5 years old. Management in patients without clinical dehydration were rehydration with ORS and IV fluid because patients refused to drink ORS.
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@#This is a policy brief article on the prediction of Covid-19 outbreak and its prevention and control for the possible second wave in the Lao PDR. Compartmental dynamic modeling was created to reflect the natural history of Covid-19. This included susceptible, symptomatic and asymptomatic states and recovery or death. The simulation was done for one year and with two scenarios: 1) high transmission level (R0=5.2) and 2) mid -transmission level (R0=2.0). The model output showed that the size of the outbreak depended on the transmission level, and could reach to 85% of the Lao population with high transmission scenario. However, disease burden was predicted to be smaller with the interventions. Among these, voluntary home quarantine was found to be the most effective, but the predication reverses in the mid-level transmission scenario. Social distancing is much more effective. If there are imported COVID-19 cases, a new wave could occur in two weeks to 2 months, depending on the size of pandemic and efficacy of the rest of interventions. Mid-level lockdown would result in new epidemic starting by July 2020, but the number of infected people would be less if travel bans and social distancing are maintaining. Only high-level lockdown would be able to stop community transmission in the country.
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Adult specimens of Echinochasmus caninus n. comb. (Verma, 1935) (Trematoda: Echinostomatidae) (syn. Episthmium caninum Yamaguti, 1958) were recovered from 11 riparian people who resided along the Mekong River in Khammouane Province, Lao PDR. In fecal examinations done by the Kato-Katz technique, the cases revealed eggs of Opisthorchis viverrini/minute intestinal flukes, hookworms, and in 2 cases echinostome eggs. To recover the adult helminths, praziquantel 30–40 mg/kg and pyrantel pamoate 10–15 mg/kg in a single dose were given and purged with magnesium salts. Various species of trematodes (including O. viverrini and Haplorchis spp.), cestodes, and nematodes were recovered from their diarrheic stools. Among the trematodes, small echinostome flukes (n=42; av. 3.8 specimens per case) of 0.7–1.2 mm in length are subjected in this study. They are morphologically characterized by having 24 collar spines interrupted dorsally and anterior extension of vitellaria from the cirrus sac or genital pore level to the posterior end of the body. Particularly based on this extensive distribution of vitellaria, the specific diagnosis was made as Echinochasmus caninus. The cases were co-infected with various other helminth parasites; thus, clinical manifestations specific for this echinostome infection were difficult to determine. The present paper describes for the first time human E. caninus infections in Lao PDR. Our cases marked the 4–14th human infections with this echinostome around the world following the 3 previous cases reported from Thailand.
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Adulto , Animais , Humanos , Ancylostomatoidea , Cestoides , Crista e Barbelas , Diagnóstico , Ovos , Helmintos , Magnésio , Opisthorchis , Óvulo , Parasitos , Praziquantel , Pamoato de Pirantel , Rios , Sais , Coluna Vertebral , Tailândia , TrematódeosRESUMO
We identified the echinostome metacercariae in Chinese mystery snails, Cipangopaludina chinensis malleata, from Xiengkhuang Province, Lao PDR with morphologies of adult worms recovered. Total 20 snails were examined with artificial digestion method and then the collected metacercariae were orally infected to a mouse and a rat. Adult worms recovered from experimental animals were observed with a light microscope and a SEM. The metacercariae were round, 125×123 μm in average size, with a moderately thick cyst wall, collar spines distributed in the head collar and excretory granules in 2 canals of excretory tube. Adult flukes (3-week-old in a rat) were elongated, ventrally curved and 5.310×1.023 mm in average size. Head collar distinct, bearing 43 collar spines with 5 end group ones on each side. Oral sucker subterminal, prepharynx very short, pharynx well developed, and esophagus relatively short. Cirrus sac well developed, with a saccular seminal vesicle, and ventral sucker very large. Ovary round and on the median line of the body. Testes tandom and elongated. Eggs operculated, elliptical and 90×57 μm in average size. In the SEM observation, the head crown prominent, with 43 collar spines resembled with horns of younger stag. Scale-like tegumental spines were densely distributed on the surface between the head collar and ventral sucker, and their densities were decreased posteriorly. Conclusively, the metacercariae detected in C. chinensis malleata from Lao PDR were identified as those of Echinostoma macrorchis based on the morphological characteristics of adult worms.