GALAD score and a proposal for GALADUS model for detecting hepatocellular carcinoma in Vietnamese patients with chronic liver disease.

OBJECTIVE: The GALAD score, a serum biomarker-based model, predicts the likelihood of hepatocellular carcinoma (HCC) in patients with chronic liver disease. We evaluated the performance of the GALAD score compared to that of liver ultrasound in detecting HCC. PATIENTS AND METHODS: This study recruited a group of 136 patients with HCC and a control group of 436 patients with cirrhosis or chronic hepatitis B or hepatitis C. The performance of the GALAD score and ultrasound in detecting HCC in these patients was analyzed using the area under the receiver operating characteristic curve (AUC). The sensitivity and specificity of the optimal GALAD score were compared to those of ultrasound. RESULTS: The AUC of the GALAD score for detecting HCC was 0.940 [95% confidence interval (CI) 0.92-0.96], higher than that of ultrasound [0.939 (0.91-0.96), p < 0.001]. At a threshold of 1.24, the GALAD score had a sensitivity of 91.2% and a specificity of 81.9% for detecting HCC. The AUC of the GALAD score for early HCC detection was 0.75 (95% CI 0.71-0.80, p < 0.001; threshold 1.13, sensitivity 87.5%, specificity 67.8%, p < 0.001). The combination of GALAD and ultrasound (GALADUS score) showed further improvement, achieving an AUC of 0.97 (95% CI 0.96-0.99; cut-off point 1.37, sensitivity 95.6%, specificity 89.2%, p < 0.001). CONCLUSIONS: In our study, the GALADUS score showed improved performance compared to the GALAD score. Therefore, we suggest that the performance of the GALAD score should be reconsidered and that it should be evaluated in combination with ultrasound for HCC detection.

A study survey on molnupiravir treatment in COVID-19 patients at home in Ninh Thuan province, Vietnam.

OBJECTIVE: Molnupiravir (MOV) is an oral antiviral drug that received use authorization in Vietnam for the treatment of mild COVID-19 (F0). There was a need to develop alternative approaches that allowed patients to access medication, decongest hospitals, clinics, and facilities, and protect people from infection. During the COVID-19 crisis, the Ninh Thuan Health Authorities implemented the home delivery of medication by community health workers. This study conducted in collaboration with two important Italian entities [the Aldo Moro University of Bari City and the 118 Department of Territorial Emergency System (118 SET) of Taranto City] aimed to evaluate the implementation of home delivery F0 treatment package assessing the rate of infection recovering during the coronavirus pandemic in Ninh Thuan province, Vietnam. PATIENTS AND METHODS: A convergent mixed methods research, based on a longitudinal study with quantitative research and qualitative assessments, evaluated four implementation outcomes: the feasibility, fidelity, coverage, sustainability, and effectiveness of the initiative. Data sources included routinely collected data, a telephonic survey of patients, an analysis of set-up and recurrent costs, as well as descriptive exploratory qualitative and quantitative analysis. RESULTS: After taking the MOV for 5 days, only 35 out of the initial 400 F0 patients remained positive, while 365 patients (91.2%) were negative (CT≥30). Whilst, the successful rate after using the drug during the course accounted for 99.85% and 100% after the entire treatment course, without any death. After 5 days of taking the drug, a positive test result (CT<30) was associated with age group ≥60 (OR=2.7) and comorbidities (OR=3.0) (p<0.05) compared to negative and positive results (CT≥30). Negative factors impacting F0 at home include a shortage of healthcare workers, inadequate supply of thermometers and SpO2 meters, and insufficient financial support for healthcare workers. CONCLUSIONS: MOV caused a reduction in the risk of hospitalization or death in mild COVID-19 patients, and molnupiravir was also found to be well tolerated and safe without any major adverse events during the administration period.

Relationship between PET/CT images and KRAS gene mutations in colorectal cancer in Vietnamese patients.

OBJECTIVE: We conducted this study to determine the relationship among standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) indexes of Flourine-18 fluorodeoxyglucose positron emission tomography/computed tomography18 (FDG-PET/CT) imaging and Kirsten rat sarcoma (KRAS) gene mutations in colorectal cancer (CRC). PATIENTS AND METHODS: This cross-sectional study was conducted in Bach Mai Hospital from 2020 to 2022. It included newly diagnosed CRC patients who underwent PET/CT examination prior to primary tumor resection. The maximum SUV (SUVmax - SUVmean), MTV, and TLG were considered. All pathologically confirmed CRC patients were accepted with further KRAS mutation status analysis. RESULTS: We enrolled 63 newly diagnosed CRC patients who underwent PET/CT examination prior to primary tumor resection. Among them, 31 (49.2%) patients had KRAS gene mutation. Patients with KRAS mutation status showed significantly different and higher SUVmax (p-value = 0.025), SUVmax t/b (p-value = 0.013), SUVmax t-b (p-value = 0.014), MTV (p-value = 0.023), and TLG (p-value = 0.011) than patients with WT KRAS. Other characteristics, including age, gender, tumor location, SUVb, SUVmean, SUVmax of lymph nodes, and SUVmax of liver metastasis, were insignificantly different between the two groups of patients with KRAS mutation status. Receiver operating curve analysis showed that the area under the curve was 0.672 for SUVmax (p-value = 0.019), SUVt/b (p-value = 0.045), and SUVt-b (p-value = 0.020). CONCLUSIONS: We observed a relationship, considering the quantitative parameters (SUVmax, SUVmax, SUVmax t-b, MTV, and TLG), between 18FDG-PET/CT images and the KRAS gene mutation in CRC by analyzing 63 patients prior to treatment.

Bisphosphonate therapy for children and adolescents with secondary osteoporosis.

BACKGROUND: Children with chronic illnesses are at increased risk for reductions in bone strength and subsequent fractures (osteoporosis), either due to the impact of the underlying condition on skeletal development or due to the osteotoxic effect of medications (e.g., glucocorticoids) used to treat the chronic illness. Bisphosphonates are being administered with increasing frequency to children with secondary osteoporosis; however, the efficacy and harm of these agents remains unclear. OBJECTIVES: To examine the efficacy and harm of bisphosphonate therapy in the treatment and prevention of secondary osteoporosis in children and adolescents. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (Issue 4, 2006), MEDLINE, EMBASE, CINAHL and ISI Web of Science (inception-December 2006). Further literature was identified through expert contact, key author searches, scanning reference lists of included studies, and contacting bisphosphonate manufacturers. SELECTION CRITERIA: Randomized, quasi-randomized, controlled clinical trials, cohort, and case controls of bisphosphonate(s) in children 0-18 years of age with at least one low-trauma fracture event or reductions in bone mineral density in the context of secondary osteoporosis. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed quality. Case series were used for supplemental harms-related data. MAIN RESULTS: Six RCTs, two CCTs, and one prospective cohort (n=281 children) were included and classified into osteoporosis due to: 1) neuromuscular conditions (one RCT) and 2) chronic illness (five RCTs, two CCTs, one cohort). Bisphosphonates examined were oral alendronate, clodronate, and intravenous (IV) pamidronate. Study quality varied. Harms data from 23 case series (n=241 children) were used. Heterogeneity precluded statistically combining the results. Percent change or Z-score change in lumbar spine areal BMD from baseline were consistently reported. Two studies carried out between-group analyses; one showed no significant difference (using oral alendronate in anorexia nervosa) while the other demonstrated a treatment effect on lumbar spine with IV pamidronate in burn patients. Frequently reported harms included the acute phase reaction, followed by gastrointestinal complaints, and bone/muscle pain. AUTHORS' CONCLUSIONS: The results justify further evaluation of bisphosphonates among children with secondary osteoporosis. However, the evidence does not support bisphosphonates as standard therapy. Short-term (3 years or less) bisphosphonate use appears to be well-tolerated. An accepted criterion for osteoporosis in children, a standardized approach to BMD reporting, and examining functional bone health outcomes (e.g., fracture rates) will allow for appropriate comparisons across studies.

Practice of using human excreta as fertilizer and implications for health in Nghean Province, Vietnam.

The ancient practice of applying latrine wastes to agricultural land has maintained soil fertility in Vietnam for several centuries but may be associated with health risks if the wastes are inadequately treated before usage. This study aimed at investigating the perceptions and handling practices using latrine wastes as fertilizers in a community in central Vietnam. Information was collected through structured questionnaire interviews administered to 75 farming households, focus group discussions, and key informant interviews. The majority (64%) of households had a single vault latrine, a possession that was associated with low income (chi2= 12.45; p < 0.05). Most households (85%) used latrine waste in agriculture that was composted before usage (98%). Households often mixed the composted excreta with kitchen ashes and powdered lime likely to increase pH and pathogen die-off. About 28% of households that were applying latrine waste as fertilizer composted three to six months, and only 11 (18%) households composted human excreta for more than the recommended six months. Households with double vault latrines were 7.8 (chi2= 9.4; p<0.05) times more likely to compost human excreta more than six months as compared with households having single vault latrine. Most farmers distributed the latrine wastes with bare hands (66%) because of convenience during application. Respondents with a high educational level used protective gloves more often when distributing latrine wastes in the fields compared to respondents with a low educational level (chi2 = 7.6; p<0.05). If any negative health impacts of latrine waste use in agriculture are to be reduced, then it is suggested that sustainable interventions should take into consideration farmers current excreta-use practices.

Ultrastructure of the major ampullate gland of the black widow spider, Latrodectus hesperus.

Silk production in the spider occurs within specialized glands that are capable of the synthesis of large fibrous proteins and the post-translational processing of those proteins to form an insoluble fiber. The major ampullate gland of Latrodectus hesperus (black widow) is similar in morphology to those found in the Araneid spiders. The tail domain of this gland is highly protein synthetic, giving rise to a core, fibrous protein product. In addition to a storage function, the ampulla region also synthesizes and exports an electron dense material that appears to form a 'coat' surrounding the silk generated within the tail. The duct of the gland consists of at least two distinct cell types: one type contains 'honeycomb' vesicles of unknown function, while the other possesses elaborate apical microvilli that may be involved in the reabsorption of water and subsequent dehydration of the silk. As the silk product transits through these various stages of assembly, it can been seen to undergo a condensation or concentration, possibly reflecting the influence of both the shear forces induced by movement into the duct and the dehydration that is thought to occur there.

Electrocardiographic monitoring in severe falciparum malaria.

Electrocardiographic monitoring over 24 h was performed with 53 patients with severe Plasmodium falciparum malaria (11 adults and 42 children) to assess the frequency of unrecognized cardiac arrhythmias. Nine patients (17%) died, 5 during the monitoring period and 4 afterwards. Pauses lasting 2-3 s were observed in 3 children, a single couplet in one, and a further child experienced frequent supraventricular ectopic beats which had not been detected clinically. In none of the patients who died could death be attributed to cardiac arrhythmia. Furthermore, no abnormality was detected which could have resulted from the often large doses of quinine, chloroquine or the artemisinin derivatives used for treatment. These results suggest that the heart is remarkably resilient even in the face of heavy parasite sequestration and other vital organ dysfunction, and that deaths from cardiac arrhythmias in severe malaria are rare. The need for routine cardiac monitoring of patients with severe and complicated P. falciparum malaria is questionable.