Diagnostic value of cerebral vasospasm by transcranial doppler ultrasound in Vietnamese patients with subarachnoid hemorrhage.

OBJECTIVE: Although the application of transcranial Doppler (TCD) ultrasonography in clinical diagnosis of cerebral vasospasm is popular in clinical practice in Vietnam, available evidence of the predictive value of vasospasm on TCD in the literature was mostly reported from large institutions in developed countries. Hence, this study was conducted to evaluate the value of TCD ultrasonography in the diagnosis of vasospasm in patients with subarachnoid hemorrhage (SAH) in Vietnam. PATIENTS AND METHODS: This is a prospective observational study of all aneurysmal SAH patients consecutively admitted to a single center between 2008 and December 2011. TCD and 64-slice computed tomographic angiography (CTA) were used to cerebral vasospasm in SAH patients. RESULTS: 316 patients were analyzed (mean age = 52.97±12.27 years, 52.2% males). There were statistically significant difference rates of the cerebral vasospasm by Hunt and Hess Classification and Fisher classification (p <0.01). The proportion of the patients with cerebral vasospasm who were diagnosed exactly by TCD was 95.2%, while the proportion of the patients without cerebral vasospasm diagnosed exactly was 91.5%. TCD predictive diagnostic value was the highest, with the sensitivity of 0.95 (95% CI: 0.91-0.98), specificity of 0.91 (95% CI: 0.85-0.96), positive predictive value of 0.94 (5% CI: 0.90-0.97) and negative predictive value of 0.93 (95 CI: 0.87-0.97). Hemiplegia was the clinical symptom with the highest diagnostic value with the sensitivity of 0.34 (95% CI: 0.27-0.41), specificity of 0.92 (95% CI: 0.86-0.96), positive predictive value of 0.86 (95% CI: 0.76-0.93) and negative predictive value of 0.49 (95% CI: 0.41-0.54). CONCLUSIONS: Evidence of vasospasm diagnosis on TCD ultrasonography was found with high accuracy. Current study enables to suggest the wide application of TCD in Vietnam health facilities from central to grassroots levels instead of the CTA use.

Physical activity during pregnancy is associated with a lower prevalence of gestational diabetes mellitus in Vietnam.

AIMS: To assess the association between physical activity (PA) during pregnancy and the prevalence of gestational diabetes mellitus (GDM) accounting for sitting time. METHODS: The study used data from a cohort study of 2030 pregnant women in Vietnam. Women were recruited from six hospitals in Ha Noi, Hai Phong, and Ho Chi Minh City. Baseline measurements including PA and GDM were taken at 24-28 weeks of gestation. PA was assessed during the past 3 months before the interview using the interviewer-administered Pregnancy Physical Activity Questionnaire. GDM was diagnosed at 24-28 weeks of gestation using the 2013 World Health Organization criteria. RESULTS: 1987 out of 2030 pregnant women were included in the final analysis, of which 432 had GDM (21.7%). Women undertaking the highest level (upper tertile) of PA during pregnancy appeared to have a lower risk of GDM [odds ratio (OR) 0.70, 95% confidence interval (CI) 0.53-0.94, Ptrend 0.017] when compared to those at the lowest tertile of PA. Similarly, women with increased levels of moderate-intensive activity and household/caregiving activity during pregnancy were associated with reduced risks of GDM (OR 0.66, 95% CI 0.50-0.86, Ptrend 0.002 and OR 0.72, 95% CI 0.55-0.95, Ptrend 0.020, respectively). These apparent inverse associations were not attenuated by their sitting time. There were no significant associations between sitting time, light-intensity activity, vigorous-intensity activity, occupation, sports/exercise, commuting, or meeting exercise guidelines and GDM risk. CONCLUSIONS: High levels of PA, particularly moderate-intensity and household/caregiving activities during pregnancy were associated with a lower prevalence of GDM independent of sitting time.

Evaluation of the integrated clinic model for HIV/AIDS services in Ho Chi Minh City, Viet Nam, 2013-2014.

Setting: Ho Chi Minh City (HCMC), Viet Nam. Objective: To evaluate a new integrated service model for human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) care. Design: In HCMC, co-located services, including voluntary HIV counseling and testing (VCT), HIV treatment at out-patient clinics (OPC), and methadone maintenance therapy (MMT) for persons who inject drugs, have operated under different administrative structures. In the context of decreasing international financial support, integration of these services into one administrative structure with reduced staff occurred in seven districts in HCMC between October 2013 and June 2014. We used a pre-post study design to compare service-related outcomes from routinely collected data at health facilities 6 months before and 6 months after integration. Results: The proportion of HIV-infected persons linked from VCT to OPCs was unchanged or increased following integration. A higher percentage of patients eligible for antiretroviral therapy (ART) were started on ART. The proportion of ART patients lost to follow-up remained unchanged. The proportions of MMT patients who tested positive for heroin or other substances decreased or were unchanged. Conclusions: VCT, OPC and MMT service delivery quality remained the same or improved during the 6 months following the integration. Expansion of the integrated model should be considered for HIV-related services.

Contexte : Ho Chi Minh City (HCMC), Viet Nam.Objective : Evaluer un nouveau modèle intégré de services pour la prise en charge du virus de l'immunodéficience humaine (VIH) et syndrome de l'immunodéficience acquise (SIDA).Schéma : A HCMC, des services installés au même endroit, incluant le test et conseil volontaire du VIH (VCT), le traitement du VIH en consultation externe (OPC) et le traitement de substitution par méthadone (MMT) pour les utilisateurs de drogues injectables, ont fonctionné sous différentes structures administratives. Dans le cadre de la réduction du soutien financier international, l'intégration de ces services dans une seule structure administrative avec un personnel réduit a eu lieu dans sept districts de HCMC entre octobre 2013 et juin 2014. Nous avons utilisé un schéma d'étude avant-après afin de comparer les résultats liés à ces services à partir de données recueillies en routine dans des structures de santé 6 mois avant et 6 mois après l'intégration.Résultats : La proportion de patients VIH positifs envoyés du VCT vers les OPC n'a pas été modifiée ou a augmenté après l'intégration. Un pourcentage plus élevé de patients éligibles à les traitements antirétroviraux ont mis en route ce traitement. La proportion de patients sous ART perdus de vue est restée sans changement. Les proportions de patients MMT, chez qui la recherche d'héroïne ou d'autres substances a été positive, ont diminué ou sont restées inchangées.Conclusions: La qualité des services de VCT, OPC et MMT est restée la même ou s'est améliorée pendant les 6 mois suivant l'intégration. L'expansion du modèle intégré devrait être envisagée pour les services relatifs au VIH.

Marco de referencia: La Ciudad de Ho Chi Min.Objetivo: Evaluar un nuevo modelo de servicios integrados de atención de la infección por el virus de la inmunodeficiencia humana (VIH) y síndrome de inmunodeficiencia adquirida (SIDA).Método: En la Ciudad de Ho Chi Min, los servicios simultáneos de pruebas voluntarias y orientación sobre el VIH (VCT), de tratamiento en consulta externa de la infección por el VIH (OPC) y de tratamiento de mantenimiento con metadona a los consumidores de drogas inyectables (MMT) han funcionado en estructuras administrativas diferentes. En el contexto de una disminución del apoyo económico internacional, de octubre del 2013 a junio del 2014, se integraron estos servicios en una estructura administrativa única en siete distritos de la ciudad. En un estudio con análisis anterior y posterior a la intervención se compararon los resultados de estos servicios, a partir de los datos corrientes recogidos en los establecimientos de salud 6 meses antes de la integración y 6 meses después de la misma.Resultados: Después de la integración, la proporción de personas infectadas por el VIH vinculadas por los centros de VCT a los OPC permaneció invariable o aumentó; un porcentaje más alto de pacientes aptos para recibir el tratamiento antirretrovírico (TAR) lo iniciaron; la proporción de los pacientes en TAR que se perdieron durante el seguimiento permaneció estable; y las proporciones de los pacientes que recibían MMT que obtuvieron un resultado positivo para la heroína u otras sustancias disminuyeron o no se modificaron.Conclusión: Seis meses después de su integración, la calidad de la prestación de servicios de VCT, OPC y MMT permaneció estable o se mejoró. Se recomienda considerar la posibilidad de ampliar la escala de aplicación del modelo integrado de servicios relacionados con el VIH.

Naturally-acquired dengue virus infections do not reduce short-term survival of infected Aedes aegypti from Ho Chi Minh City, Vietnam.

Transmission of dengue virus (DENV) from mosquito to human is dependent upon the survival of the mosquito beyond the virus extrinsic incubation period. Previous studies report conflicting results of the effects of DENV on Aedes aegypti survival. Here, we describe the effect of DENV on the short-term survival (up to 12 d) of 4,321 Ae. aegypti mosquitoes blood-fed on 150 NS1-positive dengue patients hospitalized in the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. Mosquito survival was not different between cohorts that fed upon blood from which 0% of mosquitoes became DENV infected (N = 88 feeds), or 100% became infected (N = 116 feeds). Subgroup analysis also did not reveal serotype-dependent differences in survival, nor a relationship between survival and human plasma viremia levels. These results suggest that DENV infection adds minimal cost to Ae. aegypti, an important finding when parameterizing the vector competence of this mosquito.

Urinary bladder control during the first 3 years of life in healthy children in Vietnam--a comparison study with Swedish children.

OBJECTIVES: To study outcomes of early potty training in a population of healthy children with a tradition of early potty training and to compare these findings with a group of children to whom potty training was applied later. SUBJECTS AND METHODS: Mothers and their 47 healthy children in Vietnam participated in this longitudinal study. The voiding pattern and emptying ability were followed by the 4-h voiding observation method from 3 months to 3 years of age. A comparison is made with a group of 57 Swedish children investigated in a similar manner. RESULTS: In the group of Vietnamese children, 89% were on daily potty training at the age of 6 months. At the age of 24 months, potty training was complete for 98%. In the Swedish group, just a few (5%) had started daily potty training by the age of 24 months (p < 0.001). The Vietnamese group had fewer voidings and lower voided volumes than the Swedish group. In the Vietnamese children, bladder emptying could be regarded as having been completed, with no residual urine at 9 months, compared with the Swedish group, which first showed complete emptying at the age of 36 months. CONCLUSION: Potty training performed daily affects the emptying ability positively. In the Vietnamese group, no residual urine was found at the age of 9 months. These results differ significantly from those of the group of Swedish children.

[Two atypical courses of bronchial foreign body in children]. / Deux évolutions atypiques de corps étrangers bronchiques chez l'enfant.

The long-term course of bronchial foreign body retention is unknown. This article reports 2 cases with late diagnosis and their progression. In the first case, a transcutaneous eviction of the foreign body occurred. Migration through the lung and the muscular wall might have been facilitated by cough and the elongated shape of the foreign body. In the second case, retention of the foreign body produced bronchiectasis. Given the impossibility of extraction and the localized, symptomatic, and invalidating lung complications, lobectomy was performed. Surgical indications after foreign body inhalation remain exceptional and are not frequently reported in the literature.

[Antiparasitic treatments in pregnant women and in children in 2003]. / Traitements antiparasitaires chez la femme enceinte et chez l'enfant en 2003.

Like antibacterial agents, antiparasite drugs for pregnant women and children must be chosen in function of the stage of pregnancy, age of the child, and expected benefit-risk ratio. While no agent is totally safe, there are few absolute contraindications. Most zones of serious endemic parasite disease are located in developing countries where parasite, bacterial, or viral conditions combined with poor nutrition treatment make it necessary to treat disease in a complex pathogenic environment that weakens pregnant women and children with multiple parasite infections. In both temperate and tropical zones, there have been few real therapeutic advances involving release of new products on the market or development of new indications for existing products. Constant appearance and extension of hematozoa resistance to conventional and even more recent antimalarial agents have prompted research to find new active drugs and long-lasting treatment combinations. Real therapeutic breakthroughs have resulted from the need to develop safe drugs without substantial side-effects for single-dose use in control programs against endemic parasite diseases in mass populations including pregnant women and young children in tropical zones. There are several notable examples in the field of major verminous diseases. Ivermectin is a versatile drug that can be used against filariasis as well as for management of intestinal worms or ectoparasitosis in temperate and tropical countries. Praziquantel is an important advance in platyhelminthiasis, especially bilharziais. Triclabendazole, the latest addition to the benzimidazole family, has shown promise as a substitute for bithionol, that is difficult to procure and not recommended in pregnant women, for treatment distomiasis occurring in pregnant women and children. Other examples include albendazole against giardiasis, nitazoxamide against cryptosporidiosis, artemisinine against bilharziasis, and paramomycine, not recommended in pregnant women, against leishmaniasis.

A comparison of urinary incontinence among African American, Asian, Hispanic, and white women.

OBJECTIVE: This study was undertaken to compare urodynamic findings and the rate of incontinence diagnoses among various ethnic groups. STUDY DESIGN: Data were collected for all new patients referred to the urogynecology clinic during a 10-year period. One hundred ninety-five Hispanic, 95 white, 66 Asian, and 59 African American women had urodynamic testing and were included in the study. All women had a complete history, physical examination, and multichannel urodynamic studies. Demographic data, urodynamic data, and final diagnoses differences were analyzed. RESULTS: African American women had higher maximum urethral closure pressures than Hispanic, white, or Asian women (58 cm H2O vs 47, 47, and 48 cm H2O; P =.001, P =.005, and P =.02). African American women were less likely to be diagnosed with genuine stress incontinence than were Hispanic or white women (42% vs 67% and 59%; P <.001 and P =.046). Detrusor instability was diagnosed more often in African American women than in Hispanic, white, or Asian women (29% vs 8%, 15%, and 14%; P <.001, P =.04, and P =.04). CONCLUSIONS: African American women with urinary incontinence have different urodynamic diagnoses than Hispanic, white, or Asian women. Hispanic, white, and Asian women have similar rates of genuine stress incontinence. Although African American women have lower rates of genuine stress incontinence than Hispanic and white women, they have higher rates of detrusor instability than all 3 groups.

The role of DNA-protein salt bridges in molecular recognition: a model study.

A theoretical study is presented of the influence of salt bridges between cationic side chains and DNA phosphates on DNA conformation and flexibility. The DNA sequence studied is that of the catabolite activator protein binding oligomer from the crystallized complex. The effect of salt bridges is modeled by neutralization of net phosphate charges for the groups involved in such interactions in the crystallized complex. Energy-optimized conformations are obtained by molecular mechanics using the JUMNA program. Base sequence dependence is studied by moving the phosphate neutralization pattern along the sequence and also by point mutations. Normal mode analysis is used to evaluate DNA flexibility. The results obtained show that the free oligomer is already precurved in the direction favored by the protein, and the effect of phosphate neutralization is principally to increase this curvature. This effect is, however, strongly sequence dependent. In addition, it is shown that oligomer flexibility cannot be explained by a simple superposition of the properties of successive dinucleotide steps, strong long-range coupling effects are observed. In all the cases examined, phosphate neutralization, however, leads to a reduction in oligomer flexibility.

Sequence specificity of bacteriophage 434 repressor-operator complexation.

The binding affinity of the bacteriophage 434 repressor for its DNA operator depends strongly on the nature of two central base-pairs that are not in contact with the dimeric protein. In order to investigate the origin of this sequence specificity, we carried out molecular modelling of five model operators with central TA, AT, CG, GC and IC sequences. The five oligomers were studied both before and after complexation with the N-terminal binding domain of the 434 repressor. The relative importance of nucleic acid flexibility on operator-repressor binding was studied via a low frequency normal mode analysis using an internal coordinate method that we developed recently. The results suggest a higher twisting flexibility for TA and AT central steps than for CG, GC or IC steps, but the differences appear to be too small to account for the strength of repressor binding. An energetic analysis of the model operator-repressor complexes reveals rather that the preference for A.T and T.A base-pairs is electrostatic in origin and is linked to the presence of cationic Arg43 side-chains of repressor. This conclusion is supported by comparison with an R43A mutant and correlates with the sequence dependence of the electrostatic potential in the central minor groove of the operators.

Short- and long-term action of multiple doses of ivermectin on loiasis microfilaremia.

One hundred nine Gabonese patients infected with Loa loa microfilariae were treated with ivermectin (200 microg/kg of body weight) at the Parasitology, Mycology and Tropical Medicine Department (Faculte de Medecine et des Sciences de la Sante, Libreville, Gabon). Each was given one dose per month for six consecutive months. The peripheral blood microfilaria (mf) count before and after each dose showed an average decrease in the microfilaremia of 87.3% (short-term-single dose). An annual single-dose mass treatment with 200 microg/kg of ivermectin was sufficient to control the parasite in populations with low (< 400/ml) L. loa mf counts. One month after the sixth dose (short-term-multiple doses), the average microfilaremia rate had decreased by 99.2% compared with the initial infection (35 patients). Samples were taken from 28 patients one month after the first dose and one month after the sixth dose. The average mf count decreased by 96.4% after the first dose and by 99.6% after the sixth dose (average residual mf counts = 13.7 and 1.5 mf/ml, respectively). The mf count after the sixth dose was only 11.2% of the count after the first dose. The low mf count persisted for more than six months after the sixth treatment (long-term-multiple doses). Thus, mass treatment with multiple doses is more appropriate for areas where the blood mf count is very high. These results show that the number of the annual treatments used in mass chemotherapy with ivermectin can be adapted to each population to provide efficient protection.

[Aspects of malaria in the hospitalized child in Gabon]. / Aspects du paludisme de l'enfant en milieu hospitalier gabonais.

To gain insight into the impact of malaria on children in terms of frequency and severity, a study was carried out in a department of the Owendo Children's Hospital in Libreville, Gabon, a fully endemic area. Diagnosis of Plasmodium falciparum malaria was confirmed by blood smears in 295 of the 1592 children admitted in 1992, i.e. 18.5% of admissions. Malaria was therefore the primary cause of hospitalization. Of 122 deaths observed during the study period 9 were due to malaria-associated complications for an overall mortality rate of 7.4% and malaria-related mortality rate of 3.1%. These rates are low in comparison with those reported by other departments in Central Africa. Convulsions were observed in 30.5% of children in the department and malaria was the underlying cause of convulsions in 62.9% of these cases. Severe anemia (< 5 g/dl) was noted in 23.7% of children overall and was associated with malaria in 54.7%. Severe malaria as defined by the criteria of the World Health Organization was observed in 33.2% of children. These findings illustrate the extent of the impact of endemic malaria on children in Gabon and emphasize the need to promote malaria control programs and improve treatment.

Reduced Loa loa microfilaria count ten to twelve months after a single dose of ivermectin.

The action of a single dose of ivermectin (200 micrograms/kg) on 71 Gabonese patients with Loa loa microfilariae in the peripheral blood, and living in areas highly endemic for loiasis, has been evaluated. Ten to 12 months after treatment, 43 patients (63%) had no circulating microfilaria and the geometric mean peripheral blood microfilaria count had decreased by 88.6% (P < 0.02). Thus, a single annual dose of ivermectin can markedly reduce loiasis transmission.

Light microscopic changes in Plasmodium falciparum from Gabonese children treated with artemether.

The changes in Plasmodium falciparum in four Gabonese children suffering from severe malaria and treated with pure artemether were observed in thin blood smears fixed and stained with Giemsa and examined by light microscopy. Peripheral blood samples were taken every 8 hr up to 72 hr from three children and every 3 hr up to 9 hr from the other child. The morphologic changes involved all development stages (trophozoites, schizonts, and gametocytes); they were first seen 3 hr after the start of treatment and all parasites were abnormal after 24 hr. After two days of treatment, all infected erythrocytes disappeared except for a few with necrotic trophozoites. The morphologic changes were similar to the ultrastructural changes previously described in vivo and in vitro in experimental models. They confirm the rapid effect of artemisinin derivatives on parasite clearance and clinical recovery, particularly in cases of cerebral malaria.

[Cryopreservation of isolates of Toxoplasma gondii in cell culture]. / Cryopréservation d'isolats de Toxoplasma gondii en culture cellulaire.

For a better preservation and identification of Toxoplasma gondii isolates, we propose a new method of freezing of toxoplasma growth in THP-1 cell culture. A cystogenic strain isolated from foetal blood has been grown in these cells and frozen in liquid nitrogen. After thawing, toxoplasma recover the same growth rate and morphology in vitro and the same capacity to form brain cysts into mice compared to the initial strains. The freezing of the cell suspension provides a simple and appropriate method for preservation of Toxoplasma gondii within "bank" isolates.