Predictive Factors of Mortality in Patients with Severe COVID-19 Treated in the Intensive Care Unit: A Single-Center Study in Vietnam.

INTRODUCTION: The fourth outbreak of COVID-19 with the delta variant in Vietnam was very fierce due to the limited availability of vaccines and the lack of healthcare resources. During that period, the high mortality of patients with severe and critical COVID-19 caused many concerns for the health system, especially the intensive care units. This study aimed to analyze the predictive factors of death and survival in patients with severe and critical COVID-19. METHODS: We conducted a cross-sectional and descriptive study on 151 patients with severe and critical COVID-19 hospitalized in the Intensive Care Unit of Binh Duong General Hospital. RESULTS: Common clinical symptoms of severe and critical COVID-19 included shortness of breath (97.4%), fatigue (89.4%), cough (76.8%), chest pain (47.7%), loss of smell (48.3%), loss of taste (39.1%), and headache (21.2%). The abnormal biochemical features were leukopenia (2.1%), anemia, thrombocytopenia (18%), hypoxia with low PaO2 (34.6%), hypocapnia with reduced PaCO2 (29.6%), and blood acidosis (18.4%). Common complications during hospitalization were septic shock (15.2%), cardiogenic shock (5.3%), and embolism (2.6%). The predictive factors of death were being female, age > 65 years, cardiovascular comorbidity, thrombocytopenia (< 137.109/l), and hypoxia at inclusion or after the first week or blood acidosis (pH < 7.28). The use of a high dose of corticosteroids reduced the mortality during the first 3 weeks of hospitalization but significantly increased risk of death after 3 and 4 weeks. CONCLUSIONS: Common clinical symptoms, laboratory features, and death-related complications of critical and severe COVID-19 patients were found in Vietnamese patients during the fourth wave of the COVID-19 pandemic. The results of this study provide new insight into the predictive factors of mortality for patients with severe and critical COVID-19.

The beneficial role of FeNO in association with GINA guidelines for titration of inhaled corticosteroids in adult asthma: A randomized study.

PURPOSE: This study aimed to demonstrate the role of fractional concentration of exhaled nitric oxide (FeNO) in association with Global Initiative for Asthma (GINA) guidelines for treatment of adult patients with asthma. METHODS: It was a prospective and randomized study. The symptomatic asthmatic patients were randomly divided into two groups: GINA group (followed GINA guidelines; N = 86) or GINA + FeNO group (followed GINA guidelines + FeNO for titration of inhaled corticosteroids - ICS; N = 90). They were followed-up for 9 months. RESULTS: In GINA group, 37.2% patients had no treatment and 62.8% patients discontinued treatment vs. 40.0% and 60.0% in GINA + FeNO, respectively. After 3, 6 and 9 months of treatment, the percentage of mild, moderate and severe asthma showed no significant difference between the two groups. At 9th month, Δ moderate asthma (reduction) in GINA + FeNO group was significantly higher than in the GINA group (-22.0% vs. -11.6%; P = 0.018). The improvement of asthma control test (ACT) score was not different between the groups at 9th month (12 ± 6 vs. 10 ± 5; P > 0.05); the level of FeNO reduction in GINA + FeNO group was significantly higher than that in GINA group (-42 ± 11 vs. -35 ± 9; P = 0.022). The daily dose of ICS in GINA + FeNO group was significantly lower than that in GINA group (397 ± 171 vs. 482 ± 240 mcg and 375 ± 203 vs. 424 ± 221 mcg; respectively) at the end of 6 and 9 months. CONCLUSION: The use of FeNO in association with GINA guidelines has a beneficial role for accurate daily dose of ICS in adult patients with asthma.

Investigation into equity in utilization of curative care by using method of household survey

The study was conducted in 28 rural communes at 7 geographical regions, with the sample size 5579 households and population of 25243 involved. The time-serial sampling household survey was carried out with 8 cross-sectional studies during a two year period (2000-2001). The findings showed that: Self-medication was the most popular choice for sick persons, there was a progressive tendency that the more poor likely to use it than the rich (39.7% & 35.6%). The next choices were private clinics and commune health stations (CHS). Utilization of hospital care was quite low (5.2% - 11.3% for out-patients and 5.4% - 6.5% for in-patients). Inequity in health care utilization was seen in out-patients services at the hospital level, whereas it was not happened in in-patient care and at the CHS. The poor even those having health insurance used hospital care as 1/2 of the richest

Study on the changes in approaching and using health care services in Ninh Binh province in 1999 and 2004

Two cross-sectional studies were conducted in Ninh Binh province during 1999-2003 year period, concerning with the health care services. Results showed that: improvements were reported in terms of the accessibility to health service, especially to the health service at communal level, but the richest group trended to get more to health insurance, while the poorest group trend to increase the use of commune health station. Buying the medicaments from drug store for self treatment still was the common choice.

Study on the health needs and utilization of curative care in Hanoi metropolitan

The household sampling survey was conducted on 2099 household in 3 urban district of Hanoi, using a questionaire. Results showed that: the frequency per person was 1.05 episode per year; there are differences between age groups, for children above 5 year old age group, the frequency was the highest (2-3 times higher than other age group). The most choice for health care was self medication (36.5%), outpatients care (27.6%), using commune health station (21%) and private clinic (11.3%). Only 2.6% using state hospital as inpatients