Unmet Need for Emergency Medical Services in Hanoi, Vietnam.

Low- and middle-income countries urgently need to improve emergency medical services (EMSs) as a component of their healthcare systems. Here, we detailed EMS resources and their provision in Hanoi, Vietnam, and discussed necessary policies to upgrade EMSs. Between 2013 and 2018, EMS resources, measured as provider-to-population and ambulance-to-population ratios, decreased, whereas service provision, measured as the number of patients transported by ambulance per population, increased. EMS resources and their provision in Hanoi are far below the standards of high-income countries or figures in neighboring Asian countries. Therefore, it is imperative to upgrade health policies for the appropriate allocation of healthcare resources to EMSs and hospital services.

Outcomes for out-of-hospital cardiac arrest transported to emergency departments in Hanoi, Vietnam: A multi-centre observational study.

OBJECTIVE: To describe the outcomes of patients with out-of-hospital cardiac arrest (OHCA) transported to hospital in Hanoi, Vietnam. METHODS: This was a multi-centre observational study of patients presenting with OHCA to one of five tertiary care hospital EDs in Hanoi from 2017 to 2019. RESULTS: We analysed data from 239 OHCA cases of which 70.7% were witnessed, and 8.4% received bystander cardiopulmonary resuscitation (CPR). The emergency medical services (EMS) transported 20.5% of cases to hospital with the remaining being transported by private vehicle. No patients received external defibrillation before arriving to hospital. Return of spontaneous circulation in hospital was 33.1%, with 3.8% of patients survived to hospital discharge and only one patient (0.4%) discharged from hospital with a favourable neurological outcome. CONCLUSIONS: In cases of OHCA in Hanoi, both the proportion of cases receiving bystander CPR and EMS transportation were small. Urgent investments in pre-hospital capacity, training and capabilities are required to improve outcomes for OHCA in Hanoi.

Acemannan induces rapid early osseous defect healing after apical surgery: A 12-month follow-up of a randomized controlled trial.

BACKGROUND/PURPOSE: Acemannan is an osteoinductive material. This study's objective was to compare the outcomes of bone defect healing using 3-dimensional images after apical surgery with or without adding acemannan sponges. MATERIALS AND METHODS: Twenty-two anterior teeth from 9 males and 13 females requiring apical surgery were included in this randomized controlled trial. Post-surgery, the bone defects were randomly divided into three groups: blood clot control, 5-, or 10-mg acemannan sponge groups. CBCT scans were taken immediately (baseline), 3-, 6-, and 12-month post-surgery. Sagittal serial sections (1 mm thick slices parallel to the long axis of the tooth) of the defect image were created. The defect boundary was located and the total bone defect volume (BDV) was calculated from the sum of the volume of the serial defect sections. The bone healing was assessed by the percentage of total bone defect volume reduction (%ΔBDV). The paired t-test and one-way ANOVA were used to analyze the differences within each group and between groups, respectively. RESULTS: The baseline mean BDV of the control, 5-, and 10-mg acemannan groups were not significantly different (p > 0.05). After treatment, the mean BDV for each group was reduced in a time-dependent manner. Compared with the control group, the 5- and 10-mg acemannan groups had a significantly greater %ΔBDV (approximately 2- and 1.89-fold) at 3-months post-surgery, respectively (p < 0.05). However, at the 6- and 12- month follow-up, the %ΔBDV was not significantly different between the groups. CONCLUSION: These data suggest acemannan enhanced early bone healing after apical surgery.

Correlations between coronary plaque tissue composition assessed by virtual histology and blood levels of biomarkers for coronary artery disease.

PURPOSE: We investigated correlations of coronary plaque composition determined by virtual histology (VH) intravascular ultrasound (IVUS) and blood levels of biomarkers that represent the vulnerability of coronary plaques. MATERIALS AND METHODS: Pre- and postprocedural blood levels of high sensitivity C-reactive protein, soluble CD40 ligand (sCD40L), matrix metalloproteinase-9, and neopterin were measured in 70 patients with stable angina (SA) or unstable angina (UA) who were undergoing percutaneous coronary intervention (PCI) for single lesions. We evaluated the data for correlations between these biomarkers and necrotic core contents in PCI target lesions analyzed by VH. RESULTS: Clinical characteristics, IVUS, VH, and biomarker blood levels were not different between the SA and the UA group except for more frequent previous statin use (52.3% vs. 23.1%, p=0.017) and lower remodeling index in the SA group (0.98±0.09 vs. 1.10±0.070, p<0.001). Among the biomarkers evaluated, only pre-PCI neopterin level showed a weakly significant correlation with the absolute volume of the necrotic core (r=0.320, p=0.008). Pre- and post-PCI blood levels of sCD40L (r=0.220, p=0.072; r=0.231, p=0.062) and post-PCI blood level of neopterin (r=0.238, p=0.051) showed trends toward weakly positive correlations with the absolute volume of necrotic core. CONCLUSION: We found a weakly positive correlation between the pre-PCI neopterin level and necrotic core volume in the PCI-target lesion. The clinical implications of our findings need to be investigated in further studies.