Risk factors for poor treatment outcomes of 2266 multidrug-resistant tuberculosis cases in Ho Chi Minh City: a retrospective study.

BACKGROUND: Multidrug resistant tuberculosis (MDR-TB) remains a serious public health problem with poor treatment outcomes. Predictors of poor outcomes vary in different regions. Vietnam is among the top 30 high burden of MDR-TB countries. We describe demographic characteristics and identify risk factors for poor outcome among patients with MDR-TB in Ho Chi Minh City (HCMC), the most populous city in Vietnam. METHODS: This retrospective study included 2266 patients who initiated MDR-TB treatment between 2011 and 2015 in HCMC. Treatment outcomes were available for 2240 patients. Data was collected from standardized paper-based treatment cards and electronic records. A Kruskal Wallis test was used to assess changes in median age and body mass index (BMI) over time, and a Wilcoxon test was used to compare the median BMI of patients with and without diabetes mellitus. Chi squared test was used to compare categorical variables. Multivariate logistic regression with multiple imputation for missing data was used to identify risk factors for poor outcomes. Statistical analysis was performed using R program. RESULTS: Among 2266 eligible cases, 60.2% had failed on a category I or II treatment regimen, 57.7% were underweight, 30.2% had diabetes mellitus and 9.6% were HIV positive. The notification rate increased 24.7% from 2011 to 2015. The treatment success rate was 73.3%. Risk factors for poor treatment outcome included HIV co-infection (adjusted odds ratio (aOR): 2.94), advanced age (aOR: 1.45 for every increase of 5 years for patients 60 years or older), having history of MDR-TB treatment (aOR: 5.53), sputum smear grade scanty or 1+ (aOR: 1.47), smear grade 2+ or 3+ (aOR: 2.06), low BMI (aOR: 0.83 for every increase of 1 kg/m2 of BMI for patients with BMI < 21). CONCLUSION: The number of patients diagnosed with MDR-TB in HCMC increased by almost a quarter between 2011 and 2015. Patients with HIV, high smear grade, malnutrition or a history of previous MDR-TB treatment are at greatest risk of poor treatment outcome.

Metals geochemistry and ecological risk assessment in a tropical mangrove (Can Gio, Vietnam).

Mangrove sediments act as natural biogeochemical reactors, modifying metals partitioning after their deposition. The objectives of the present study were: to determine distribution and partitioning of metals (Fe, Mn, Ni, Cr, Cu, Co and As) in sediments and pore-waters of Can Gio Mangrove; and to assess their ecological risks based on Risk Assessment Code. Three cores were collected within a mudflat, beneath Avicennia alba and Rhizophora apiculata stands. We suggest that most metals had a natural origin, being deposited in the mangrove mainly as oxyhydroxides derived from the upstream lateritic soils. This hypothesis could be supported by the high proportion of metals in the residual fraction (mean values (%): 71.9, 30.7, 80.7, 80.9, 67.9, 53.4 and 66.5 for Fe, Mn, Ni, Cr, Cu, Co, and As respectively, in the mudflat). The enrichment of mangrove-derived organic matter from the mudflat to the Rhizophora stand (i.e. up to 4.6% of TOC) played a key role in controlling metals partitioning. We suggest that dissolution of Fe and Mn oxyhydroxides in reducing condition during decomposition of organic matter may be a major source of dissolved metals in pore-waters. Only Mn exhibited a potential high risk to the ecosystem. Most metals stocks in the sediments were higher in the Avicennia stand than the Rhizophora stand, possibly because of enhanced dissolution of metal bearing phases beneath later one. In a context of enhanced mangrove forests destruction, this study provides insights on the effects of perturbation and oxidation of sediments on metal release to the environment.

Variability of CO2 emissions during the rearing cycle of a semi-intensive shrimp farm in a mangrove coastal zone (New Caledonia).

In New Caledonia, shrimp ponds are built not on cleared mangroves but on salt flats behind the mangroves. The objectives of this study were to determine the variability of CO2 fluxes from a semi-intensive shrimp pond during active and non-active periods of the farm and to determine the carbon dynamics from the upstream tidal creek to the downstream creek, which receives the farm's effluents. CO2 emissions from the active pond were estimated at 11.1 ±â€¯5.26 mmol CO2 m-2 d-1. By modifying the hydrodynamics of the creeks, farm practices also influenced CO2 emissions from both the upstream and downstream creeks. After tillage, all the organic carbon deposited at the pond bottom during the active period was mineralized, resulting in CO2 emissions to the atmosphere estimated at 7.9 TCO2 ha-1. Therefore, shrimp farming is an anthropogenic source of CO2 to the atmosphere, but suitable and optimized rearing practices limit these emissions.