Prevalence, risk factors and genotyping of chlamydia trachomatis from endocervical specimens of infertile women at a tertiary care hospital, Vietnam

BACKGROUND

To our knowledge, the prevalence, risk factors and distribution of C. trachomatis genotypes are rarely mentioned in Vietnam. This study aimed to find the prevalence, risk factors and distribution of C. trachomatis genotypes in infertile Vietnamese women.

METHODS

Endocervical swabs were collected from infertile women at the National Hospital of Obstetrics and Gynecology, Vietnam, between January 2020 and December 2021. All samples were analyzed for C. trachomatis presence by Cobas 4800 CT/NG Test. Sequencing methods of ompA gene were used to determine the C. trachomatis genotypes. An approximately 1200 bp ompA fragment was aligned with reference sequences from GenBank to identify the corresponding genotype.

RESULTS

The prevalence of endocervical C. trachomatis infection was 15.6% of 761 participants. Factors independently associated with CT infection among infertile women, obtained by multivariate analysis, included abnormal vaginal discharge, cervicitis, lower abdominal pain, a history of ectopic pregnancy, having more than one sex partner, and age at first intercourse. Among the samples, genotype E (25.93%) was most frequently found, followed by genotypes D/Da (22.23%), F (13.58%), G/Ga (12.35%), J (12.35%), H (6.17%), K (3.70%), B/Ba (2.47%), and I/Ia (1.23%), respectively. Genotype F was related to types of infertility, and genotype H was associated with a history of miscarriage.

CONCLUSIONS

The present study indicated a high prevalence of C. trachomatis in infertile Vietnamese women. The most common genotypes found in this population were E, D, and F. Our findings suggest that routine screening is necessary for early detection and performance of infection control methods.

HIV- and AIDS-related knowledge and attitude of residents in border regions of Vietnam

BACKGROUND

Residents in border areas are vulnerable to HIV/AIDS due to high rates of risk behaviors such as unprotected sexual practices or illicit drug use. Improving knowledge and attitude toward HIV/AIDS prevention and treatment are vital to diminish the burden of the HIV epidemic in this setting. However, evidence about this issue in Vietnam has been limited. This study aims to explore the knowledge and attitude toward HIV/AIDS among people in Vietnam border zones.

METHODS

We conducted a cross-sectional study in three border communes in Thanh Hoa province with 600 HIV(-) residents. Data about socio-demographic characteristics, general HIV knowledge, knowledge about prevention of mother-to-child transmission, treatment and care, HIV testing services, and attitude toward HIV/AIDS were collected. Multivariate Tobit regression was used to determine related factors with the knowledge and attitude.

RESULTS

The highest percentage of people having correct statements was for "HIV could be transmitted from mother to child" (98.2%), while the lowest percentage was for item "Know health facilities where HIV-positive people could register for care and check-up" (28.2%). People had the highest score in "Knowledge about HIV transmission routes" and the lowest score in "Knowledge about HIV/AIDS prevention measures". Most of the people were not afraid of being exposed to HIV-positive individuals (66.0%), willing to buy goods from HIV-positive sellers (78.9%), and willing to take care of people living with HIV in their family (90.1%). Education, ethnic, marital status, occupations, and HIV/AIDS information sources were found to be associated with knowledge and attitude toward HIV/AIDS.

CONCLUSIONS

The general knowledge and attitude on HIV/AIDS of residents were relatively good. Educational campaigns to improve knowledge and attitude toward PLWH, involving peer educators and local associations, are potential strategies for sustaining HIV intervention in this remote setting.

Concurrent drug use among methadone maintenance patients in mountainous areas in northern Vietnam

OBJECTIVES

With the rise in methadone maintenance therapy (MMT) for drug users in Vietnam, there has been growing interest in understanding if and how often MMT patients engage in concurrent illicit drug use while on methadone therapy in various settings. This study examined factors associated with concurrent opioid use among patients on MMT in a mountainous area in Vietnam.

SETTING

One urban and one rural MMT clinics in Tuyen Quang province.

PARTICIPANTS

Survey participants consisted of patients who were taking MMT at the selected study sites. A convenience sampling approach was used to recruit the participants.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants were asked a series of questions about their socioeconomic status, current alcohol and tobacco use, health problems (measured by the EuroQol-Five Dimension-Five Level instrument), psychological distress (measured by Kessler score), and factors associated with current and/or previous drug use. Regression models were used to determine factors associated with concurrent drug use among MMT patients.

RESULTS

Among the 241 male MMT patients included in the study, 13.4% reported concurrent opioid use. On average, the longer patients had been enrolled in MMT, the less likely they were to concurrently use drugs. Conversely, patients with higher levels of psychological distress were more likely to engage in concurrent drug use while on MMT.

CONCLUSION

Longer duration of MMT was significantly correlated with reduced illicit drug use among participants. Higher levels of psychological distress were associated with increased use of illicit drugs among MMT patients. Regardless of distance, long-term MMT is still effective and should be expanded in mountainous areas.

Sexual behaviors among methadone maintenance patients in a mountainous area in northern Vietnam

Background

Methadone maintenance treatment (MMT) improves patients’ ability to access HIV-related services and reduces needle sharing and other risky HIV-related behaviors. However, patients may continue to engage in risky sexual practices. In this study, we evaluate sexual behaviors of MMT patients in a mountainous province in Northern Vietnam.

Methods

We explored the health status, MMT and substance use history, and sexual practices of 241 male MMT patients in Tuyen Quang province. Health status was investigated using the EuroQOL-5 Dimensions-5 Levels (EQ-5D-5 L). Multivariate logistic regression was employed to assess associated factors.

Results

Most patients (66.4%) reported having at least one sexual partner within the previous twelve months. Most of these partners were spouses or primary partners (72.6%). About 8.3% of patients had casual partners, and 5.8% had visited sex workers; of those who engaged in casual sexual relationships, 90.9% reported using condoms. Current drug use and living in a remote area were associated with an increased odd of having two or more sexual partners, while anxiety or depression was associated with lower odds.

Conclusion

This study highlights a low proportion of having sexual risk behaviors among MMT patients in Vietnamese mountainous settings. Integrating education about safe sexual practices into MMT services, along with providing medical care and ensuring methadone treatment adherence, is an important component in HIV risk reduction for these patients who were at risk of unsafe sexual practices.

Ability to join the workforce and work productivity among drug users under methadone maintenance treatment in a mountainous area of Northern Vietnam: a cross-sectional study

OBJECTIVES

A major measure of treatment success for drug users undergoing rehabilitation is the ability to enter the workforce and generate income. This study examines the absenteeism and productivity among people who inject drugs (PWID) enrolled in methadone maintenance treatment (MMT) in Northern Vietnam.

SETTING

We conducted a cross-sectional study in two clinics in Tuyen Quang province.

PARTICIPANTS

A total of 241 patients enrolled in MMT.

PRIMARY AND SECONDARY OUTCOME MEASURES

Patients' work productivity was measured using the WPAI-GH instrument (Work Productivity and Activity Impairment Questionnaire: General Health V2.0). We also collected additional characteristics about participants' employment history, such as proficient jobs, whether they actively found a new job and be accepted by employers.

RESULTS

Most of the participants (>90%) were employed at the time of the study. Rates of absenteeism (missed work), presenteeism (impairment while working) and overall loss of productivity were 15.8%, 5.6% and 11.2%, respectively, as measured by the WPAI-GH questionnaire. The most proficient job was 'freelancer' (17.5%), followed by 'blue-collar worker' (10.6%) and 'farmer' (10.2%). Only 26.8% of patients reported that they actively sought jobs in the past. About half of them had been refused by employers because of their drug use history and/or HIV status. We found no statistically significant difference between patients enrolled in MMT for <1 year and those who had been enrolled >1 year. Factors associated with higher work productivity included not endorsing problems in mobility, self-care or pain; being HIV-negative and having greater MMT treatment adherence.

CONCLUSION

Our study highlights the high employment rate and work productivity among PWID in MMT programmes in remote areas of Northern Vietnam. The results can help to improve the quality and structure of MMT programmes across Vietnam and in other countries.

Stigmatization among methadone maintenance treatment patients in mountainous areas in northern Vietnam

Background

Stigma and discrimination may adversely affect the benefits of methadone maintenance treatment (MMT) for drug users, especially in disadvantaged settings. This study assessed stigma and discrimination against MMT patients in the mountainous and rural areas in Vietnam and explored their associated factors to inform implementation strategies.

Methods

We interviewed 241 MMT patients in two clinics: one in Tuyen Quang Province’s inner city and the other in Son Duong District, to assess stigma and discrimination that patients perceived and experienced. Socioeconomic status, health behaviors, health status, and history of drug abuse were examined. Multivariate linear and logistic regression models were used to explore factors associated with stigma and discrimination.

Results

The majority of respondents reported experiencing stigma and discrimination including blame/judgment (95.1%), shame (95.1%), disclosure (71.4%), and the fear of human immunodeficiency virus (HIV) transmission by others (74.1%). Unemployed patients were more likely to experience discrimination (Coef = −1.18, 95% CI = −1.87; −0.89). Those who were taking an antiretroviral were more likely to disclose their health status (Coef = 2.27, 95% CI = 0.6; 3.94). In addition, a higher likelihood of being blamed/judged and shamed was associated with those who suffered from anxiety/depression (Coef = 1.59, 95% CI = 0.24; 2.93 and Coef = 1.07, 95% CI = 0.36; 1.79, respectively).

Conclusions

MMT patients in these mountainous areas perceived high levels of stigma and discrimination which were associated with mental health disorders, unemployment, and HIV infection. These findings highlighted the importance of reducing drug use and HIV-related stigma against high-risk populations. Besides, psychosocial and familial supports, as well as job referrals, also play crucial roles in terms of promoting quality of life among MMT patients.

Situs inversus totalis: giant hiatal hernia repair by laparoscopic Collis gastroplasty and Nissen fundoplication

We report the repair of a giant hiatal hernia by laparoscopic Collis gastroplasty and Nissen fundoplication in a patient with situs inversus totalis, highlighting the unique anatomic challenges in this case. The 52-year old female patient had Kartageners syndrome, a giant hiatal hernia, and a history of chronic severe gastroesophageal reflux disease with uncontrolled regurgitation. The laparoscopic procedure was accomplished with five ports placed in a mirror-image configuration, reversed from our standard positions. After visual confirmation of the complete reversal of the intraabdominal anatomy, we performed a modified Collis gastroplasty and Nissen fundoplication. Significant technical challenges were encountered intraoperatively. To the best of our knowledge, this report is the first of its kind in the literature. The use of advanced laparoscopic techniques is highly adaptable to unusual anatomy. Laparoscopic hiatal hernia surgery is feasible in patients with situs inversus.

Reports of pain by children undergoing rapid palatal expansion

PURPOSE

This study described and quantified the prevalence, timing, and intensity of pain during the expansion phase of rapid palatal expansion (RPE) in children and investigated whether pain was related to age, sex, or rate of expansion.

METHODS

Ninety-seven children, 38 males and 59 females, between the ages of 5 to 13 years (median 7.7 years) undergoing RPE procedures with the Hyrax, Dentaurum, Newtown, PA, appliance were surveyed. The appliance was expanded with either one or two turns (1/4 mm/turn) per day based on the provider's preference. The child's pain response was measured no more than 5 minutes after each turn for the entire period of expansion using both the Facial Pain Scale and the Color Analog Scale.

RESULTS

Ninety-eight percent of the children reported at least some pain during RPE. The highest levels of pain were reported during the first 10 turns with the greatest intensity during the first 6 turns and a steadily decreasing amount of pain thereafter. Pain medication was taken after 7% of the expansion turns in the study with the majority of children taking the medication during the first 6 turns. Forty-eight percent of the children took pain medication at least once during the expansion phase of RPE. There was no difference in either reported pain or use of pain medication based on age, sex, or stage of dentition. During the first 10 turns, children whose rate of expansion was two turns/day were more likely to report pain and take pain medication than children whose rate of expansion was one turn/day, thereafter there were no differences.

CONCLUSIONS

The vast majority of children undergoing the active phase of rapid palatal expansion with a Hyrax appliance report pain. The pain generally occurs during the initial phase of expansion and diminishes thereafter, with two turns/day resulting in reports of pain greater than those expanding only once/day.

Post-infarction left ventricular remodeling induces changes in creatine kinase mRNA and protein subunit levels in porcine myocardium

Energy metabolism is altered in post-infarction remodeled pig myocardium. To understand the basis of this abnormality, we examined the pattern of creatine kinase (CK) gene expression and the relative content of CK protein subunits in pig hearts with proximal left circumflex coronary artery ligation. At 2 months after infarct, both Northern and Western blot analyses were performed on left ventricular myocardium remote from the infarct zone in ligation animals (n = 8). Results were compared with data from the left ventricular myocardium from similar sized normal (control) pigs (n = 7). Steady-state levels of mitochondrial CK mRNA decreased 46% in left ventricular remodeled (LVR) heart samples (93.40 +/- 18.60 arbitrary units) compared with controls (172.85 +/- 37.20 arbitrary units), whereas CK-M subunit mRNA levels remained unchanged between the control and LVR groups (319.50 +/- 35.25 and 352.50 +/- 62.18 arbitrary units, respectively). The mean control group CK-M protein subunits (2.04 +/- 0.31 arbitrary units) decreased 53% (P < 0.05) compared with the LVR group (0.95 +/- 0.25 arbitrary units). Similarly, the mean control group (n = 4) mitochondrial CK protein subunits (1.12 +/- 0.04 arbitrary units) decreased 30% (P < 0.05) compared with the LVR group (n = 4; 0.79 +/- 0.06 arbitrary units). Mean CK-B protein subunits in LVR pig hearts (0.84 +/- 0.23 arbitrary units) increased 77% compared with control (0.48 +/- 0.05 arbitrary units). The total CK activity did not change significantly between control hearts at 164 +/- 11 IU/mg and LVR at 212 +/- 32 IU/mg. We suggest that these alterations of the CK system represent the bioenergetic phenotype of LVR myocardium at the molecular level. The CK system response may ultimately prove inadequate in meeting the abnormal energy requirements of remodeled heart and, therefore, may contribute to the transition toward failure.