The influence of attributes on community preferences regarding antibiotic treatment: evidence from a discrete choice model.

Antibiotic resistance (AR) rates in Vietnam are among the highest in Asia, and recent infections due to multi-drug resistance in the country have caused thousands of deaths each year. This study investigated a Vietnamese community's preferences for antibiotic treatment and its knowledge and attitudes regarding antibiotics. A discrete choice experiment-based survey was developed and administered to the population of interest. The respondents were given sociodemographic-, knowledge- and attitude-related items and 17 pairs of choice tasks. Two hypothetical options were included in each choice task. Latent class analysis was conducted to determine the differences among the respondents' preferences. Among 1,014 respondents, 805 (79.4%) gave valid questionnaires. A three-latent-class model with four covariates (age, healthcare-related education or career, occupation, and attitude classifications) was used in the analysis. All five attributes significantly influenced the respondents' decisions. The majority, including young employed respondents with non-healthcare-related work or education, found treatment failure more important. Older respondents who had healthcare-related education/careers and/or appropriate antibiotic use- and antibiotics resistance-related attitudes, regarded contribution to antibiotic resistance as an important attribute in selecting antibiotic treatments. Unemployed individuals with correct knowledge identified the cost of antibiotic treatment as the most essential decision-making factor. Findings suggest minimal antibiotic impact on resistance; only 7.83% view it as amajor concern. The respondents exhibited substantial preference heterogeneity, and the general Vietnamese public had poor knowledge of and attitudes toward antibiotic use and antibiotic resistance. This study emphasizes the need for individual responsibility for antibiotic resistance and appropriate antibiotic use.

Retrospective Study of Claudin 18 Isoform 2 Prevalence and Prognostic Association in Gastric and Gastroesophageal Junction Adenocarcinoma.

PURPOSE: Claudin 18 isoform 2 (CLDN18.2) is an emerging biomarker and therapeutic target in gastric and gastroesophageal junction (G/GEJ) adenocarcinoma. This study aimed to obtain deeper understanding of CLDN18.2 positivity patterns, prognostic implications, and associations with various demographic, clinical, and molecular characteristics in G/GEJ adenocarcinoma. METHODS: Archived tumor tissue samples from 304 patients with G/GEJ adenocarcinoma in the United States were assessed for CLDN18.2 positivity by immunohistochemistry. CLDN18.2 positivity was defined as ≥50% or ≥75% of tumor cells with CLDN18 staining intensity ≥2+. CLDN18.2 positivity patterns were analyzed for association with prognosis and clinicopathologic/demographic characteristics. Where possible, CLDN18.2 positivity was analyzed for matched tissue samples to assess concordance between primary and metastatic tumors and concordance before and after chemotherapy. RESULTS: The overall prevalence of CLDN18.2-positive tumors (with ≥75% cutoff) was 44.4% (n = 135 of 304). CLDN18.2-positive tumors had a prevalence of 51.4% (n = 91 of 177) in gastric and 34.6% (n = 44 of 127) in GEJ adenocarcinoma. With a ≥50% cutoff, the prevalence of CLDN18.2-positive tumors was 64.4% (n = 114 of 177) in gastric adenocarcinoma and 44.9% (n = 57 of 127) in GEJ adenocarcinoma. There was no association between overall survival and CLDN18.2 positivity using either threshold. Statistically significant associations were noted between CLDN18.2 positivity and sex, histologic type of G/GEJ adenocarcinoma, and adenocarcinoma subtype (≥75% cutoff), and metastasis site and tumor grade (≥50% cutoff). The overall concordance of CLDN18.2 positivity (≥75% cutoff) was 73% (27 of 37) for matched primary versus metastatic tumor samples and 74% (29 of 39) for matched samples before and after chemotherapy. CONCLUSION: This study demonstrated that CLDN18.2 positivity did not correlate with survival in G/GEJ adenocarcinoma, consistent with published data. On the basis of matched sample analysis, CLDN18.2 appears to demonstrate >70% concordance as a biomarker. Observed correlations with certain patient/tumor characteristics warrant further study.

Microplastic Pollution in High Population Density Zones of Selected Rivers from Southeast Asia.

Southeast Asia (SEA) faces significant environmental challenges due to rapid population growth and economic activity. Rivers in the region are major sources of plastic waste in oceans. Concerns about their contribution have grown, but knowledge of microplastics in the area is still limited. This article compares microplastic levels in sediment and water from urban zones of three major rivers in SEA: Chao Phraya River (Thailand), Saigon River (Vietnam), and Citarum River (Indonesia). The study reveals that in all three rivers, microplastics were found, with the highest concentrations in Chao Phraya's water (80 ± 60 items/m3) and Saigon's sediment (9167 ± 4559 items/kg). The variations in microplastic sizes and concentrations among these rivers may be attributed to environmental factors and the exposure duration of plastic to the environment. Since these rivers are important water supply sources, rigorous land-use regulations and raising public awareness are crucial to mitigate plastic and microplastic pollution.

High Prevalence of Panton-Valentine Leukocidin Among Staphylococcus aureus Causing Acute Hematogenous Bone and Joint Infections From a Tertiary Children's Hospital in Vietnam.

BACKGROUND: We aimed to investigate the clinical features, antimicrobial susceptibility and pvl gene expression in Staphylococcus aureus causing acute hematogenous bone and joint infections (BJIs) in children in Vietnam. METHODS: In this prospective study, the demographics, microbiology and clinical outcomes of pediatric patients with acute hematogenous BJIs were collected from September 2022 to September 2023. Antimicrobial susceptibility profiles were determined using VITEK2 Compact system. The pvl gene encoding the Panton-Valentine leukocidin (PVL) toxin was detected by using polymerase chain reaction. Mann-Whitney, χ2 and Fisher test were used for statistical analysis. RESULTS: In total, 78 patients (46 boys) with S. aureus acute hematogenous BJIs were recruited at the National Children's Hospital, Hanoi, Vietnam. Of all S. aureus isolates, 84.6% were methicillin-resistant S. aureus. All S. aureus isolates were susceptible to vancomycin, ciprofloxacin and levofloxacin; 97% of methicillin-resistant S. aureus isolates was resistant to clindamycin (minimum inhibitory concentration ≥8 µg/mL). The pvl gene was detected in 83.3% of isolates, including 57 methicillin-resistant S. aureus isolates. Patients in the pvl-positive group had significantly higher C-reactive protein levels than those in the pvl-negative group (P = 0.04). In addition, all 8 children with septic shock were infected with pvl-positive S. aureus. CONCLUSIONS: PVL is a prevalent virulence factor of S. aureus in Vietnam. Furthermore, high inflammatory parameters (C-reactive protein) may be present at the time of diagnosis in PVL positivity-related acute hematogenous BJIs. Further research is necessary to enhance our understanding of the varying correlations between virulence factors and outcomes of S. aureus BJIs.

Reference Value Fibrin Monomer in Healthy Children: A Cross-Sectional Study.

The objective of this study is to determine the fibrin monomer reference intervals in healthy children. This cross-sectional study was conducted in the Hematology Department at Vietnam National Children's Hospital (April 2023 to March 2024). Children without prior history of clotting disorders or anticoagulants use hospitalized in preparation for orthopedic surgery or inguinal hernia surgery were enrolled in the study. The fibrin monomer test method was the quantitative fibrin monomer test on the STA-R system (Diagnostica Stago™, France). Eighty-six children (58 males and 28 females) were enrolled in the study. The median (interquartile range, 2.5th-97.5th) fibrin monomer value of the study subjects was 2.56 (0.11-5.93) µg/mL, with no statistically significant difference in fibrin monomer values among the age groups of 1 month to 3 years, 3 years to 13 years, and 13 years to 18 years. This is the first study conducted in Vietnam to determine reference values of fibrin monomer in children. This information can help in the diagnosis and treatment of early hypercoagulation stage and disseminated intravascular coagulation in children.

Nutritional status of Vietnamese infants assessed by Fenton growth chart and related factors: A cross-sectional study.

Importance: Nutritional status of infants, measured by birth weight and length, is an essential factor in neonatal development. Malnutrition in newborns may lead to a higher risk of mortality, neurological and cognitive impairment, and poor language development. Objective: This study aims to assess the nutritional status of infants and related factors regarding maternal anthropometric characteristics and medical history. Methods: A cross-sectional study was conducted at the National Hospital of Obstetrics and Gynecology, Vietnam from May 2021 to May 2022 on 340 infants and mothers. Low birth weight was defined following the Intergrowth-21 standards. Stunting was evaluated using the Fenton growth chart when the length was below the 10% percentile line of the gestational week. Multivariate regression models were applied to identify factors associated with the nutritional status of infants. Results: We found that 12.4% and 14.1% of infants in our study fell into stunted and underweight categories, respectively. Infants of mothers over 35 years old, having a height lower than 150 cm or experiencing anemia during pregnancy were more likely to be stunted or have low birth weight. Serum albumin deficiency during pregnancy was strongly associated with the infant being underweight (odds ratio [OR] = 2.8, 95% confidence interval [95%CI] 1.1-7.3). Newborns were more likely to be stunted if their mothers had a history of preterm birth (OR = 3.3, 95%CI 1.1-10.2). Interpretation: Maternal nutritional status is closely related to infant malnutrition, particularly in preterm infants. Improving the understanding of mothers regarding prenatal care, reproductive healthcare, adequate nutritional diet, and multi-micronutrient supplements during pregnancy is therefore important.

Microplastics and heavy metals in a tropical river: Understanding spatial and seasonal trends and developing response strategies using DPSIR framework.

Microplastics (MPs) have become an increasingly popular topic in recent years due to the growing concern about their impact on human health and the environment. Rivers in Southeast Asia are the dominant source of plastics and MPs into the environment; however, research on MPs in rivers from the region is insufficient. This study aims to investigate the impacts of spatial and seasonal variations on the distribution of MPs with heavy metals in one of the top 15 rivers releasing plastics into oceans (Chao Phraya, Thailand). Findings from this study are analyzed using the Driver-Pressure-State-Impact-Response (DPSIR) framework for proposing strategies to minimize plastic and MPs in this tropical river. Spatially, most MPs were detected in the urban zone, while the lowest was in the agricultural zone. Also, MP levels in the dry season are higher than at the end but lower than at the beginning of the rainy season. MPs with fragment morphology were mainly found in the river (70-78 %). Polypropylene was found with the highest percentage (54-59 %). MPs in the river were mostly detected in the size range of 0.05-0.3 mm (36-60 %). Heavy metals were also found in all MPs collected from the river. Higher metal concentrations were detected in the agricultural and estuary zones in the rainy season. Potential responses, including regulatory and policy instruments, environmental education, and environmental cleanups, were drawn from the DPSIR framework.

Anxiety and associated factors among Vietnamese students during COVID-19 pandemic: A cross-sectional study.

Mental health care for students in general, particularly anxiety, is a significant problem that needs more attention, especially during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to describe the prevalence of anxiety and examine the associated factors among students during the COVID-19 pandemic in Vietnam. A cross-sectional study was conducted from August to September 2021 among 5730 students. An online survey was used to collect sociodemographic information, and the generalized anxiety disorder questionnaire (GAD-7) was used to assess anxiety symptoms among Vietnamese students. Results showed that the prevalence of anxiety among study participants was 16.2% (95% confidence interval [CI]: 15.3%-17.2%). Factors related to anxiety among students were gender, type of housemate, COVID-19 exposure/infection status, vaccination status, health status, academic performance, and social relationships during the COVID-19 pandemic. A significant number of students experienced anxiety during COVID-19, and this rate was related to several factors. Psychological interventions are required to support students during and after the COVID-19 pandemic and other health crises. Further studies are required to confirm our findings.

Occurrence and spatial distribution of microplastic contaminated with heavy metals in a tropical river: Effect of land use and population density.

Microplastics are of concern due to their potential environmental risks. This research aims to find the effect of land use (agriculture, urban, and aquaculture) and population density on the abundance of microplastics contaminated with heavy metals in surface water and sediment of the Chao Phraya River in Thailand. Results indicated that population density is directly correlated with increased microplastic abundance. Most microplastics were found in the urban zone (water: 80 ± 38 items/m3 and sediment: 62 ± 11 items/kg) and were small fragments (0.05 to 0.3 mm). Polymer types of polypropylene and polyethylene were commonly found. Heavy metals of Cr, Cu, Cd, Pb, Zn, Ni, and Ti were detected in microplastics in water and sediment, with Cu, Pb, and Zn being the most dominant. Heavy metals in microplastics were highest in the agriculture zone. In general, the presence of metals on microplastics may potentially impact the ecosystem and human health.

First confirmed case of infant botulism caused by Clostridium botulinum type A(B) in a 10-month-old infant in Hanoi, Vietnam.

Infant botulism is a rare but sometimes life-threatening toxemia caused by ingestion of Clostridium botulinum spores. Although cases of infant botulism have probably occurred in Vietnam in the past, they have never been diagnosed and reported. Herein, we report the isolation of C. botulinum type A(B) from the stool of a 10-month-old infant during hospitalization.

The Germin-like protein OsGER4 is involved in promoting crown root development under exogenous jasmonic acid treatment in rice.

In rice (Oryza sativa L.), crown roots (CRs) have many important roles in processes such as root system expansion, water and mineral uptake, and adaptation to environmental stresses. Phytohormones such as auxin, cytokinin, and ethylene are known to control CR initiation and development in rice. However, the role of jasmonic acid (JA) in CR development remained elusive. Here, we report that JA promotes CR development by regulating OsGER4, a rice Germin-like protein. Root phenotyping analysis revealed that exogenous JA treatment induced an increase in CR number in a concentration-dependent manner. A subsequent genome-wide association study and gene expression analyses pinpointed a strong association between the Germin-like protein OsGER4 and the increase in CR number under exogenous JA treatment. The ProGER4::GUS reporter line showed that OsGER4 is a hormone-responsive gene involved in various stress responses, mainly confined to epidermal and vascular tissues during CR primordia development and to vascular bundles of mature crown and lateral roots. Notable changes in OsGER4 expression patterns caused by the polar auxin transport inhibitor NPA support its connection to auxin signaling. Phenotyping experiments with OsGER4 knockout mutants confirmed that this gene is required for CR development under exogenous JA treatment. Overall, our results provide important insights into JA-mediated regulation of CR development in rice.

Investigation of microplastic contamination in blood cockles and green mussels from selected aquaculture farms and markets in Thailand.

Recent studies have indicated that bivalves are bioindicators for microplastic pollution since they are filter feeders and accumulate microplastics (MPs) during their feeding process. This study focused on the investigation of MPs in blood cockles (Tegillarca granosa) and green mussels (Perna viridis) from selected aquaculture farms and markets in Thailand. The abundance of MPs was identified by fluorescence microscopy with Nile Red tagging and the polymer detection by micro-Fourier Transform Infrared Spectroscopy (micro-FTIR). The number of MPs in blood cockle samples from the Khlong Dan market and the BangBo aquaculture farm was 11 ± 5 and 6 ± 1 particles/individual, respectively. For green mussel samples, the number of MPs from the Talaad Thai market and the Sriracha fisheries research station was 96 ± 19 and 11 ± 7 particles/individual, respectively. The results of the study indicate that the number of MPs in bivalve samples from the markets is much higher than in the aquaculture farms. This probably is due to the contamination of MPs in bivalves during the packaging and transportation processes. However, further studies are needed to confirm this. The predominant MPs were fragments and fibres with a size range of 0.05-0.3 mm. Most polymers were polypropylene, polyethylene, copolymer, polyester, and nylon. In brief, this study showed the contamination of MPs in bivalves cultivated for human consumption. The accumulation of MPs in these marine bivalves can lead to the biomagnification of MPs along the food chain. This can impact food safety and human health.

Uptake of HIV testing among aging adults in Agincourt, South Africa: perception of community, social network, and individual characteristics.

This cross-sectional study examined the impact of perception of community, social network and individual variables on the likelihood of voluntary HIV testing of people 40 years and older living in Agincourt, South Africa. The data came from Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in SA (HAALSI) Cohort from Agincourt. We applied three logistic regression models. Results showed that voluntary uptake of HIV testing was significantly associated with two network factors, namely friendships within the network and frequency of fighting in the network. At the community level, attachment to place was significantly associated with voluntary testing, while at the individual level, education, sexual behaviour, employment and age were significantly associated with the voluntary uptake of HIV testing. The implications of these findings are that age-appropriate interventions must be devised to sensitise older people in Agincourt about HIV risks. Also, leadership at the community level and in social networks must encourage members to consider voluntary testing for their own and community interests.

Pediatric Acute Myocarditis With Short-Term Outcomes and Factors for Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Cohort Study in Vietnam.

Objective: Data on the management and outcomes of acute myocarditis treated with extracorporeal membrane oxygenation (ECMO) among low- and middle-income countries are limited. This study aimed to determine the short-term outcomes and also identify factors associated with ECMO use among children with acute myocarditis at a tertiary children's hospital in Vietnam. Methods: A single-center, retrospective observational study was conducted between January 2016 and February 2021. Pediatric patients with acute myocarditis, aged 1 month to 16 years, were included. Results: In total, 54 patients (male, 46%; median age, 7 years) with acute myocarditis were included; 37 of them received ECMO support. Thirty percent (16/54) of the patients died, and 12 of them received ECMO. Laboratory variables that differed between survivors and non-survivors included median left ventricular ejection fraction (LVEF) at 48 h (42 vs. 25%; p = 0.001), platelet count (304 g/L [interquartile range (IQR): 243-271] vs. 219 g/L [IQR: 167-297]; p = 0.014), and protein (60 g/dl [IQR: 54-69] vs. 55 [IQR: 50-58]; p = 0.025). Among patients who received ECMO, compared with the survivors, non-survivors had a low LVEF at 48 h (odds ratio (OR), 0.8; 95% confidence interval (CI): 0.6-0.9; p = 0.006) and high vasoactive-inotropic score (OR, 1.0; 95% CI: 1.0-1.0; p = 0.038) and lactate (OR, 2.8; 95% CI, 1.2-6.1; p = 0.013) at 24 h post-ECMO. Conclusions: The case fatality rate among children with acute myocarditis was 30 and 32% among patients requiring ECMO support. Arrhythmia was an indicator for ECMO in patients with cardiogenic shock.

Severe recurrent pneumonia in children: Underlying causes and clinical profile in Vietnam.

BACKGROUND: There is still limited data on severe recurrent pneumonia in children, especially in developing countries as Vietnam. This study was conducted to identify the underlying causes and clinical profile of children with severe recurrent pneumonia admitted to the Pediatric Intensive Care Unit (PICU), National Children's Hospital. METHODS: This was a prospective and descriptive study on 110 children with severe pneumonia admitted to the PICU from November 2019 to August 2020. Data were collected to investigate the clinical profile and underlying diseases. RESULTS: Severe recurrent pneumonia accounted for 29.4%. Underlying causes were diagnosed in 91.8% of sRP children, in which the most common causes were abnormalities in respiratory, cardiovascular system and immune disorders. 74.5% of sRP children admitted to ICU had been previously intubated or ventilated, 34.5% had shock, 7.3% had multiple organ failure. Recurrent lesions on chest x-ray in the same lobe accounted for 18.2%. CONCLUSIONS: The majority of patients with severe recurrent pneumonia had an underlying disease. Comprehensive management is necessary for severe recurrent pneumonia.

Hypocoagulable Tendency on Thromboelastometry Associated With Severity and Anticoagulation Timing in Pediatric Septic Shock: A Prospective Observational Study.

Objective: To identify whether coagulation profiles using thromboelastometry are associated with outcomes in pediatric septic shock. The primary outcomes were the development of disseminated intravascular coagulation (DIC) and the severity of the pediatric intensive care unit (PICU) existing scoring systems, while the secondary outcome was hospital mortality. This study aimed to contribute to current findings of the limitations of conventional tests in determining the optimal timing of anticoagulation in sepsis. Design: A prospective, observational study conducted between August 2019 and August 2020. Setting: PICU at a pediatric tertiary hospital in Hanoi, Vietnam. Patients: Fifty-five pediatric patients who met the septic shock criteria were enrolled. Measurements and Main Results: Fifty-five patients with septic shock were recruited. At the time of diagnosis, thromboelastometry revealed normocoagulability, hypercoagulability, and hypocoagulability in 29, 29, and 42% of the patients, respectively (p > 0.05); however, most patients in the overt DIC and non-survival groups progressed to hypocoagulability (82 and 64%, respectively). The overt DIC, PELOD-2 > 8, PRISM-III > 11, and non-survival group had a significant hypocoagulable tendency according to thromboelastometry parameters [prolonged clotting time (CT) and clot formation time (CFT); and reduced α-angle (α), maximum clot firmness (MCF), thrombodynamic potential index (TPI)] compared to the non-overt DIC, PELOD-2 ≤ 8, PRISM-III score ≤ 11 and survival group (p < 0.05). Conventional parameters between the normocoagulable and hypercoagulable groups were not different (p > 0.05). Hypocoagulability was characterized by lower platelet count and fibrinogen level, higher prolonged prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (APTT), and higher D-dimer level than in hypercoagulability (p < 0.05). Hypocoagulable tendency on thromboelastometry had a higher hazard at a PT > 16.1 s [area under the curve (AUC) = 0.747, odds ratio (OR) = 10.5, p = 0.002], INR > 1.4 (AUC = 0.754, OR = 6.9, p = 0.001), fibrinogen <3.3 g/L (AUC = 0.728, OR = 9.9, p = 0.004), and D-dimer > 3,863 ng/mL (AUC = 0.728, OR = 6.7, p = 0.004). Conclusions: Hypocoagulable tendency using thromboelastometry is associated with the severity of septic shock. Conventional coagulation tests may fail to detect hypercoagulability, which is crucial in determining anticoagulation timing.

Fibrinolytic Impairment and Mortality in Pediatric Septic Shock: A Single-Center Prospective Observational Study.

OBJECTIVES: Fibrinolytic shutdown is associated with poor prognosis in adult sepsis, but data in the pediatric population are sparse. This study aimed to identify the association between impaired fibrinolysis and mortality in pediatric septic shock. DESIGN: A prospective, observational study conducted between August 2019 and August 2020. SETTING: PICU at a pediatric tertiary hospital in Hanoi, Vietnam. PATIENTS: Fifty-six pediatric patients who met septic shock criteria were enrolled. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Conventional coagulation tests and rotational thromboelastometry were performed at diagnosis. The fibrinolytic activity on extrinsic pathway thromboelastometry was negatively correlated with the Vasoactive-Inotropic Score at 24 hours post-PICU admission, peak lactate level during the first 24 hours, Pediatric Logistic Organ Dysfunction-2 score, and Pediatric Risk of Mortality-III score (all p < 0.05). Compared with patients with nonovert disseminated intravascular coagulation, dysfunction of less than two organs, and who survived, patients with overt disseminated intravascular coagulation, dysfunction of greater than two organs, and who died showed significantly lower fibrinolytic activity, represented by significantly higher lysis indexes (%) and lower maximum lysis (%) (all p < 0.05). The threshold values for prediction of mortality were lysis index 60 minutes greater than 97.5 (area under the curve = 0.86; sensitivity = 73%; specificity = 90%), maximum lysis less than 6.5 (area under the curve = 0.83; sensitivity = 73%; specificity = 87%), and lysis index 45 minutes greater than 99.5 (area under the curve = 0.83; sensitivity = 73%; specificity = 85%). Hypofibrinolysis was associated with prolonged PICU length of stay in survivors and with early mortality in nonsurvivors. CONCLUSIONS: Fibrinolytic shutdown in pediatric septic shock is associated with an increase in disease severity and mortality. This highlights the need for further investigations regarding whether fibrinolytic therapy improved the outcome of pediatric septic shock.

Pertussis Infants Needing Mechanical Ventilation and Extracorporeal Membrane Oxygenation: Single-Center Retrospective Series in Vietnam.

OBJECTIVES: Pertussis is an infectious disease that causes epidemics and outbreaks and is associated with a high mortality rate, especially in infants, in both developed and developing countries. We aimed to characterize infants with pertussis with respiratory failure and shock and investigated the factors related to mortality. DESIGN: A retrospective, observational study conducted between January 2015 and October 2020. SETTING: This study was conducted at the Vietnam National Children's Hospital, which is a government hospital that serves as a tertiary care center in Hanoi, Vietnam. PATIENTS: Children who fulfilled the following inclusion criteria were included: 1) admitted to the PICU, 2) less than 16 years old, 3) pertussis confirmed by real-time polymerase chain reaction, and 4) treated with mechanical ventilation due to respiratory failure and shock. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Seventy-three mechanically ventilated children (40 boys; median age, 56 d), whereas 19 patients received extracorporeal membrane oxygenation support. Twenty-six patients (36%) died including 12 who received extracorporeal membrane oxygenation. Those who received extracorporeal membrane oxygenation support had higher leukocyte counts upon admission and were more frequently diagnosed with pulmonary hypertension and stage 3 acute kidney injury. Compared with survivors, nonsurvivors showed increased heart rates, leukocyte and neutrophil counts, and lower systolic and diastolic blood pressure at admission. Increased Vasoactive-Inotropic Score, stage 3 acute kidney injury, fluid overload, the use of renal replacement therapy, and extracorporeal membrane oxygenation use were prevalent among nonsurvivors. CONCLUSIONS: In this study, around one third of mechanically ventilated patients with pertussis died. Those who received extracorporeal membrane oxygenation had higher leukocyte counts, a higher prevalence of pulmonary hypertension, and advanced stages of acute kidney injury. Higher Vasoactive-Inotropic Score and advanced stages of acute kidney injury were associated with a greater risk of mortality.

Microplastics pollution with heavy metals in the aquaculture zone of the Chao Phraya River Estuary, Thailand.

Microplastics have received special attention due to their potential risks to environments. However, data on microplastics in estuaries of the Southeast Asian region is still insufficient. This study investigated the abundance and characteristics of microplastics in the sediment and surface water of the Chao Phraya River Estuary, Thailand. Concentrations of heavy metals extracted from microplastics were also reported. The abundance of microplastics in surface water and sediment was 48 ± 8 items/m3 and 39 ± 14 items/kg, respectively. Microplastics with small sizes of 0.05-0.3 mm were predominant in all collected samples. Polypropylene and polyethylene particles were the most abundant in the surface water and sediment, respectively. Toxic metals (Cr, Cu, Ni, Pb, Cd, and Zn) were found in microplastics from surface water samples. Since Chao Phraya River Estuary is an important aquaculture zone in Thailand, the presence of microplastics in this area may severely impact on aquaculture and human health.

Efficacy, metabolism and pharmacokinetics of Ro 15-5458, a forgotten schistosomicidal 9-acridanone hydrazone.

BACKGROUND: Treatment of schistosomiasis, a neglected disease, relies on just one partially effective drug, praziquantel. We revisited the 9-acridanone hydrazone, Ro 15-5458, a largely forgotten antischistosomal lead compound. METHODS: Ro 15-5458 was evaluated in juvenile and adult Schistosoma mansoni-infected mice. We studied dose-response, hepatic shift and stage specificity. The metabolic stability of Ro 15-5458 was measured in the presence of human and mouse liver microsomes, and human hepatocytes; the latter also served to identify metabolites. Pharmacokinetic parameters were measured in naive mice. The efficacy of Ro 15-5458 was also assessed in S. haematobium-infected hamsters and S. japonicum-infected mice. RESULTS: Ro 15-5458 had single-dose ED50 values of 15 and 5.3 mg/kg in mice harbouring juvenile and adult S. mansoni infections, respectively. An ED50 value of 17 mg/kg was measured in S. haematobium-infected hamsters; however, the compound was inactive at up to 100 mg/kg in S. japonicum-infected mice. The drug-induced hepatic shift occurred between 48 and 66 h post treatment. A single oral dose of 50 mg/kg of Ro 15-5458 had high activity against all tested S. mansoni stages (1-, 7-, 14-, 21- and 49-day-old). In vitro, human hepatocytes produced N-desethyl and glucuronide metabolites; otherwise Ro 15-5458 was metabolically stable in the presence of microsomes or whole hepatocytes. The maximum plasma concentration was approximately 8.13 µg/mL 3 h after a 50 mg/kg oral dose and the half-life was approximately 4.9 h. CONCLUSIONS: Ro 15-5458 has high activity against S. mansoni and S. haematobium, yet lacks activity against S. japonicum, which is striking. This will require further investigation, as a broad-spectrum antischistosomal drug is desirable.