Metabolic, renal, and hematological changes in chronic hepatitis C patients achieving rapid virologic response after 12 weeks of direct-acting antiviral treatment: A prospective cohort study.

The impact of direct-acting antivirals (DAA) therapy on lipid and glucose metabolism and kidney function in patients with hepatitis C virus (HCV) infection, along with its side effects on blood cells, remains controversial. Therefore, we conducted a study that enrolled 280 patients with HCV infection who achieved sustained virologic response after treatment with DAA therapy without ribavirin to evaluate the metabolic changes, renal function, and anemia risk based on real-world data. This study was an observational prospective study with a follow-up period of 12 weeks after the initiation of DAA therapy. Data on biochemical tests, renal function, blood counts, viral load, and host genomics were recorded before treatment and after 12 weeks of treatment with DAAs. DAA therapy reduced fibrosis-4 scores and improved liver function, with significant reductions in aspartate transaminase, alanine aminotransferase, and total bilirubin levels. However, DAA therapy slightly increased uric acid, cholesterol, and low-density lipoprotein cholesterol levels. It significantly reduced fasting blood glucose levels and hemoglobin A1C index (HbA1C) in the study group, while hemoglobin (Hb) and hematocrit (HCT) concentrations decreased significantly (4.78 ± 21.79 g/L and 0.09% ± 0.11%, respectively). The estimated glomerular filtration rate (eGFR) decreased by 12.89 ± 39.04 mL/min/1.73m2. Most variations were not related to the genotype, except for Hb, HCT, and HbA1C. Anemia incidence increased from 23.58% before treatment to 30.72% after treatment. Patients with HCV-1 genotype had a higher rate of anemia than did patients with genotype 6 (36.23% vs. 24.62%). Multivariate analysis showed that the risk of anemia was related to female sex, cirrhosis status, fibrosis-4 score, pretreatment eGFR, and pretreatment Hb level. The results of our study can provide helpful information to clinicians for the prognosis and treatment of HCV infection.

Risk factors associated with Salmonella spp. prevalence along smallholder pig value chains in Vietnam.

The objective of this study was to investigate the prevalence of, and risk factors for, Salmonella contamination along the smallholder pig value chain in northern Vietnam. Repeat cross-sectional (for farm and pork shops) and longitudinal (for slaughterhouses) studies were carried out in Hung Yen and Nghe An provinces in four sampling periods over a year (April 2014 to February 2015). In total, 72 pig farms and 217 pork shops were visited during the period, and 13 slaughterhouses were visited four times. Information on management and hygiene practices was collected using checklists and questionnaires, and risk factor analyses at the farm, slaughterhouse, and pork shop levels were performed using generalized mixed-effects models with the significant levels 10%. Salmonella prevalence was 36.1%, 38.9%, and 44.7% on pig pen floors, pig carcasses in slaughterhouses, and cut pork in pork shops, respectively. The risk factor for Salmonella prevalence on pig pen floors were having a pig pen next to a household (p = 0.06) and free access to the farm by visitors (p = 0.06). Our slaughterhouse model found a single risk factor for carcass contamination: slaughter area close to lairage without hygienic measures (p = 0.03). For pork shops, presence of flies or insects on pork at shop (p = 0.02) and use of a cloth at pork shop (p = 0.02) were risk factors. The Salmonella prevalence on pig carcass and cut pork was significantly lower in winter compared to that in other seasons. Our study results highlighted the need of improving farm hygiene at farm level, and pork hygiene practices to avoid cross-contamination at the slaughterhouse and market levels, to reduce the risk of salmonellosis through pork consumption in northern Vietnam.

Turning poop into profit: Cost-effectiveness and soil transmitted helminth infection risk associated with human excreta reuse in Vietnam.

Human excreta is a low cost source of nutrients vital to plant growth, but also a source of pathogens transmissible to people and animals. We investigated the cost-savings and infection risk of soil transmitted helminths (STHs) in four scenarios where farmers used either inorganic fertilizer or fresh/composted human excreta supplemented by inorganic fertilizer to meet the nutrient requirements of rice paddies in the Red River Delta, Vietnam. Our study included two main components: 1) a risk estimate of STH infection for farmers who handle fresh excreta, determined by systematic review and meta-analysis; and 2) a cost estimate of fertilizing rice paddies, determined by nutrient assessment of excreta, a retailer survey of inorganic fertilizer costs, and a literature review to identify region-specific inputs. Our findings suggest that farmers who reuse fresh excreta are 1.24 (95% CI: 1.13-1.37, p-value<0.001) times more likely to be infected with any STH than those who do not handle excreta or who compost appropriately, and that risk varies by STH type (Ascaris lumbricoides RR = 1.17, 95% CI = 0.87-1.58, p-value = 0.29; Hookworm RR = 1.02, 95% CI = 0.50-2.06, p-value = 0.96; Trichuris trichiura RR = 1.38, 95% CI = 0.79-2.42, p-value = 0.26). Average cost-savings were highest for farmers using fresh excreta (847,000 VND) followed by those who composted for 6 months as recommended by the WHO (312,000 VND) and those who composted for a shorter time (5 months) with lime supplementation (37,000 VND/yr); however, this study did not assess healthcare costs of treating acute or chronic STH infections in the target group. Our study provides evidence that farmers in the Red River Delta are able to use a renewable and locally available resource to their economic advantage, while minimizing the risk of STH infection.

Quantitative risk assessment of human salmonellosis in the smallholder pig value chains in urban of Vietnam.

OBJECTIVES: To quantify salmonellosis risk in humans through consumption of boiled pork in urban Hung Yen Province, Vietnam, using a quantitative microbial risk assessment. METHODS: We collected 302 samples along the pork value chain in Hung Yen between April 2014 and February 2015. We developed a model in @Risk, based on microbiological, market, and household surveys on cooking, cross-contamination and consumption, and conducted sensitivity analysis. RESULTS: Salmonella prevalence of pen floor swabs, slaughterhouse carcasses and cut pork were 33.3, 41.7 and 44.4%, respectively. The annual incidence rate of salmonellosis in humans was estimated to be 17.7% (90% CI 0.89-45.96). Parameters with the greatest influence risk were household pork handling practice followed by prevalence in pork sold in the central market. Wide confidence interval in the incidence estimate was mainly due to the variability in the degree of reduction in bacteria concentration by cooking, and pork consumption pattern. CONCLUSIONS: The risk of salmonellosis in humans due to boiled pork consumption appears to be high. Control measures may include improving the safety of retailed pork and improving household hygiene.