Lung abnormalities on computed tomography of Vietnamese patients with COVID-19 and the association with medical variables

Objectives

Patients with COVID-19 may experience a lung injury without presenting clinical symptoms. Early detection of lung injury in patients with COVID-19 is required to enhance prediction and prevent severe progression.

Methods

Lung lesions in patients with COVID-19 were defined using the Fleischner Society terminology. Chest computed tomography lesions and their correlation with demographic characteristics and medical variables were identified.

Results

Patients with mild and moderate COVID-19 had up to 45% lung injuries, whereas critical patients had 55%. However, patients with mild and moderate COVID-19 typically had low-level lung injuries. Ground-glass (68.1%), consolidation (48.8%), opacity (36.3%), and nodular (6.9%) lung lesions were the most prevalent in patients with COVID-19. Patients with COVID-19 infected with the Delta variant had worse lung injury than those infected with the Alpha and Omicron. People vaccinated with ≥2 doses showed a lower risk of lung injury than those vaccinated with <1 dose. Patients <18 years old were less likely to have a lung injury than patients >18 years old. The treatment outcomes were unaffected by the severity of the lung injury.

Conclusion

Patients with mild COVID-19 had a similar risk of lung injury as patients with severe COVID-19. Thus, using chest computed tomography to detect lung injury can enhance the treatment outcomes and reduce the patient's risk of pulmonary complications.

Implementing living-donor pediatric liver transplantation in Southern Vietnam: 15-year results and perspectives

BACKGROUND

ND2 in Ho Chi Minh City is currently the only public center that performs PLT in Southern Vietnam. In 2005, the first PLT was successfully performed, with support from Belgian experts. This study reviews the implementation of PLT at our center and evaluates the results and challenges.

METHODS

Implementation of PLT at ND2 required medico-surgical team building and extensive improvement of hospital facilities. Records of 13 transplant recipients from 2005 to 2020 were studied retrospectively. Short- and long-term complications, as well as the survival rates, were reported.

RESULTS

The mean follow-up time was 8.3 ± 5.7 years. Surgical complications included one case of hepatic artery thrombosis that was successfully repaired, one case of colon perforation resulting in death from sepsis, and two cases of bile leak that were drained surgically. PTLD was observed in five patients, of whom three died. There were no cases of retransplantation. The 1-year, 5-year, and 10-year patient survival rates were 84.6%, 69.2%, and 69.2%, respectively. There were no cases of complication or death among the donors.

CONCLUSION

Living-donor PLT was developed at ND2 for providing a life-saving treatment to children with end-stage liver disease. Early surgical complication rate was low, and the patient survival rate was satisfactory at 1 year. Long-term survival decreased considerably due to PTLD. Future challenges include surgical autonomy and improvement of long-term medical follow-up with a particular emphasis on prevention and management of Epstein-Barr virus-related disease.

Implementation of point-of-care testing of C-reactive protein concentrations to improve antibiotic targeting in respiratory illness in Vietnamese primary care: a pragmatic cluster-randomised controlled trial

BACKGROUND

In previous trials, point-of-care testing of C-reactive protein (CRP) concentrations safely reduced antibiotic use in non-severe acute respiratory infections in primary care. However, these trials were done in a research-oriented context with close support from research staff, which could have influenced prescribing practices. To better inform the potential for scaling up point-of-care testing of CRP in respiratory infections, we aimed to do a pragmatic trial of the intervention in a routine care setting.

METHODS

We did a pragmatic, cluster-randomised controlled trial at 48 commune health centres in Viet Nam between June 1, 2020, and May 12, 2021. Eligible centres served populations of more than 3000 people, handled 10-40 respiratory infections per week, had licensed prescribers on site, and maintained electronic patient databases. Centres were randomly allocated (1:1) to provide point-of-care CRP testing plus routine care or routine care only. Randomisation was stratified by district and by baseline prescription level (ie, the proportion of patients with suspected acute respiratory infections to whom antibiotics were prescribed in 2019). Eligible patients were aged 1-65 years and visiting the commune health centre for a suspected acute respiratory infection with at least one focal sign or symptom and symptoms lasting less than 7 days. The primary endpoint was the proportion of patients prescribed an antibiotic at first attendance in the intention-to-treat population. The per-protocol analysis included only people who underwent CRP testing. Secondary safety outcomes included time to resolution of symptoms and frequency of hospitalisation. This trial is registered with ClinicalTrials.gov, NCT03855215.

FINDINGS

48 commune health centres were enrolled and randomly assigned, 24 to the intervention group (n=18 621 patients) and 24 to the control group (n=21 235). 17 345 (93·1%) patients in the intervention group were prescribed antibiotics, compared with 20 860 (98·2%) in the control group (adjusted relative risk 0·83 [95% CI 0·66-0·93]). Only 2606 (14%) of 18 621 patients in the intervention group underwent CRP testing and were included in the per-protocol analysis. When analyses were restricted to this population, larger reductions in prescribing were noted in the intervention group compared with the control group (adjusted relative risk 0·64 [95% CI 0·60-0·70]). Time to resolution of symptoms (hazard ratio 0·70 [95% CI 0·39-1·27]) and frequency of hospitalisation (nine in the intervention group vs 17 in the control group; adjusted relative risk 0·52 [95% CI 0·23-1·17]) did not differ between groups.

INTERPRETATION

Use of point-of-care CRP testing efficaciously reduced prescription of antibiotics in patients with non-severe acute respiratory infections in primary health care in Viet Nam without compromising patient recovery. The low uptake of CRP testing suggests that barriers to implementation and compliance need to be addressed before scale-up of the intervention.

FUNDING

Australian Government, UK Government, and the Foundation for Innovative New Diagnostics.

A comparative study on essential oils from the leaves and stems of Vietnamese Mikania micrantha Kunth

Mikania micrantha Kunth is widely known as potential herbal medicine, although it is an invasive alien species in Southeast Asia. In this study, the essential oils from leaves and stems of M. micrantha were extracted by hydrodistillation method, and the chemical profiles of essential oils were then analysed by gas chromatography (GC) and gas chromatography coupled with mass spectrometry (GC/MS). It was found that there were similarities and differences in chemical compositions and their percentage between the essential oils obtained from these two parts. The dominant components of leaves essential oil are β-Cubebene, Germacrene D, and α-Zingiberene, accounting for 11.34%, 10.96%, and 10.76%, respectively. Additionally, the major components of stems essential oils are D-Limonene (16.99%), β-Pinene (7.91%), and α-Zingiberene (7.26%). The research sheds fresh light on the chemical makeup of M. micrantha essential oils, emphasising their potential for the future.

ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance

Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest.

Small chromium-doped silicon clusters CrSin: structures, IR spectra, charge effect, magnetism and chirality

A series of small chromium-doped silicon clusters CrSi_n with n = 3-10 in the cationic, neutral and anionic charge states were investigated using quantum chemical methods. The CrSi_n⁺ cations with n = 6-10 were produced in the gas phase and characterized by far-IR multiple photon dissociation (IR-MPD) spectroscopy. Good agreement between experimental spectra in the 200-600 cm^-1 frequency range and those determined for the lowest-energy isomers by density functional theory calculations (B3P86/6-311+G(d)) provide a strong support for the geometrical assignments. An extensive structural comparison for the three different charge states shows that the structural growth mechanism inherently depends on the charge. While the structures of the cationic clusters are preferentially formed by addition of the Cr dopant to the corresponding pure silicon cluster, it favors substitution in both the neutral and anionic counterparts. The Si-Cr bonds of the studied CrSi_n^+/0/- clusters are polar covalent. Apart from a basket-like Cr@Si₉^- and an endohedral Cr@Si₁₀^- cage, the Cr dopant takes an exohedral position and bears a large positive charge in the clusters. The exohedrally doped clusters also have a high spin density on Cr, manifesting the fact that the intrinsic magnetic moment of the transition metal dopant is well conserved. Three CrSi_n clusters have a pair of enantiomeric isomers in their ground state, namely the cationic n = 9 and the neutral and anionic n = 7. Those can be distinguished from each other by their electronic circular dichroism spectra, calculated using time-dependent density functional theory. Those enantiomers, being intrinsically chiral inorganic compounds, might be used as building blocks of optical-magnetic nanomaterials because of their high magnetic moments and ability to rotate the plane of polarization.

Detection and genetic characterization of canine distemper virus isolated in civets in Vietnam

Canine distemper (CD), caused by the canine distemper virus (CDV), is a lethal systemic disease to a wide range of wild and domestic carnivorous hosts, including civets. In this study, a possible CD outbreak in a backyard farm with 32 diseased civets (Viverricula indica) in Hanoi, Vietnam, was investigated. The sick civets showed CD-like clinical signs such as anorexia, sedentary behavior, diarrhea, dermatitis, nasal, and footpad hyperkeratosis. Various tissue samples collected from the dead civets were utilized for molecular screening of CDV and histopathological examination. The genetic detection and characterization confirmed that samples collected from dead civets tested positive for CDV. The phylogenetic analysis based on the full-length H gene sequences indicated that all CDV strains isolated from civets belonged to the Asia-1 lineage and were closely related to the CDV strains previously reported from dogs in Thailand, China, and Vietnam. Histopathological examination showed severe interstitial pneumonia, hemorrhagic alveolar septa, necrotic alveolar epithelial cells, necrotic, degenerated, or lost Purkinje cells, eosinophilic intracytoplasmic inclusion bodies, edema, and perivascular cuff. This study confirmed the detection of CDV in civets for the first time in Vietnam.

A Clinically Oriented antimicrobial Resistance surveillance Network (ACORN): pilot implementation in three countries in Southeast Asia, 2019-2020

Background: Case-based surveillance of antimicrobial resistance (AMR) provides more actionable data than isolate- or sample-based surveillance. We developed A Clinically Oriented antimicrobial Resistance surveillance Network (ACORN) as a lightweight but comprehensive platform, in which we combine clinical data collection with diagnostic stewardship, microbiological data collection and visualisation of the linked clinical-microbiology dataset. Data are compatible with WHO GLASS surveillance and can be stratified by syndrome and other metadata. Summary metrics can be visualised and fed back directly for clinical decision-making and to inform local treatment guidelines and national policy. Methods: An ACORN pilot was implemented in three hospitals in Southeast Asia (1 paediatric, 2 general) to collect clinical and microbiological data from patients with community- or hospital-acquired pneumonia, sepsis, or meningitis. The implementation package included tools to capture site and laboratory capacity information, guidelines on diagnostic stewardship, and a web-based data visualisation and analysis platform. Results: Between December 2019 and October 2020, 2294 patients were enrolled with 2464 discrete infection episodes (1786 community-acquired, 518 healthcare-associated and 160 hospital-acquired). Overall, 28-day mortality was 8.7%. Third generation cephalosporin resistance was identified in 54.2% (39/72) of E. coli and 38.7% (12/31) of K. pneumoniae isolates . Almost a quarter of S. aureus isolates were methicillin resistant (23.0%, 14/61). 290/2464 episodes could be linked to a pathogen, highlighting the level of enrolment required to achieve an acceptable volume of isolate data. However, the combination with clinical metadata allowed for more nuanced interpretation and immediate feedback of results. Conclusions: ACORN was technically feasible to implement and acceptable at site level. With minor changes from lessons learned during the pilot ACORN is now being scaled up and implemented in 15 hospitals in 9 low- and middle-income countries to generate sufficient case-based data to determine incidence, outcomes, and susceptibility of target pathogens among patients with infectious syndromes.

Molecular and histopathological characterization of lumpy skin disease in cattle in northern Vietnam during the 2020-2021 outbreaks

Lumpy skin disease (LSD) is a serious emerging infectious disease in cattle caused by a virus of the family Poxviridae. According to the Department of Animal Health, LSD first occurred in Vietnam at the end of October 2020 in Cao Bang and Lang Son provinces. So far, the disease has infected over 63,000 animals, resulting in 9170 deaths occurring in 32 different provinces in northern and central Vietnam. In this study, skin samples from lumpy skin disease virus (LSDV)-infected cattle from the northern provinces of Vietnam displaying clinical symptoms including fever (> 40 °C), runny nose, drooling, and skin lesions were used for genetic characterization and histopathology. Genetic analysis of the partial P32 (LSDV074), partial F (LSDV117), complete RPO30 (LSDV035), and complete G-protein-coupled-chemokine-like receptor (GPCR) (LSDV011) genes showed that all Vietnamese LSDV strains belonged to the genus Capripoxvirus and were closely related to LSDV strains isolated in China. Microscopic examination of the skin lesions showed thickening of the epidermal layer of the skin and hair follicles, hyperplasia of sebaceous glands, intracytoplasmic inclusion bodies, and hemorrhages in the mesoderm.

Antimicrobial susceptibility testing results from 13 hospitals in Viet Nam: VINARES 2016-2017

OBJECTIVE

To analyse data from 2016-17 from a hospital-based antimicrobial resistance surveillance with national coverage in a network of hospitals Viet Nam.

METHODS

We analysed data from 13 hospitals, 3 less than the dataset from the 2012-13 period. Identification and antimicrobial susceptibility testing data from the clinical microbiology laboratories from samples sent in for routine diagnostics were used. Clinical and Laboratory Standards Institute 2018 guidelines were used for antimicrobial susceptibility testing interpretation. WHONET was used for data entry, management and analysis.

RESULTS

42,553 deduplicated isolates were included in this analysis; including 30,222 (71%) Gram-negative and 12,331 (29%) Gram-positive bacteria. 8,793 (21%) were from ICUs and 7,439 (18%) isolates were from invasive infections. Escherichia coli and Staphylococcus aureus were the most frequently detected species with 9,092 (21%) and 4,833 isolates (11%), respectively; followed by Klebsiella pneumoniae (3,858 isolates - 9.1%) and Acinetobacter baumannii (3,870 isolates - 9%). Bacteria were mainly isolated from sputum (8,798 isolates - 21%), blood (7,118 isolates - 17%) and urine (5,202 isolates - 12%). Among Gram-positives 3,302/4,515 isolates (73%) of S. aureus were MRSA; 99/290 (34%) of Enterococcus faecium were resistant to vancomycin; and 58% (663/1,136) of Streptococcus pneumoniae proportion were reduced susceptible to penicillin. Among Gram-negatives 59% (4,085/6,953) and 40% (1,186/2,958) of E. coli and K. pneumoniae produced ESBL and 29% (376/1,298) and 11% (961/8,830) were resistant to carbapenems, respectively. 79% (2855/3622) and 45% (1,514/3,376) of Acinetobacter spp. and Pseudomonas aeruginosa were carbapenem resistant, respectively. 88% (804/911) of Haemophilus influenzae were ampicillin resistant and 18/253 (7%) of Salmonella spp. and 7/46 (15%) of Shigella spp. were resistant to fluoroquinolones. The number of isolates from which data were submitted in the 2016-2017 period was twice as high as in 2012-2013. AMR proportions were higher in 2016-2017 for most pathogen-antimicrobial combinations of interest including imipenem-resistant A. baumannii, P. aeruginosa and Enterobacterales.

CONCLUSIONS

The data show alarmingly high and increasing resistant proportions among important organisms in Viet Nam. AMR proportions varied across hospital types and should be interpreted with caution because existing sampling bias and missing information on whether isolates were community or hospital acquired. Affordable and scalable ways to adopt a sample- or case-based approach across the network should be explored and clinical data should be integrated to help provide more accurate inferences of the surveillance data.

A novel strain of porcine deltacoronavirus in Vietnam

Two porcine deltacoronavirus (PDCoV) strains (Binh21 and HaNoi6) were isolated from two pig farms in North Vietnam. Phylogenetic analysis of the complete genomes and the Spike and Membrane genes revealed that the two Vietnam PDCoVs belong to the same lineage as PDCoVs from Thailand and Laos; however, the N genes belonged to the same lineage as PDCoVs from the USA, Korea, China, and Hong Kong. The recombination detection program subsequently identified the major parent (S5011 strain) and minor parent (HKU15-44 strain) of the two Vietnam PDCoV strains (p < 0.01).

Detection of Novel Reassortant Influenza A (H3N2) and H1N1 2009 Pandemic Viruses in Swine in Hanoi, Vietnam

From May to September 2013, monthly samples were collected from swine in a Vietnamese slaughterhouse for influenza virus isolation and serological testing. A(H1N1)pdm09 viruses and a novel H3N2 originating from reassortment between A(H1N1)pdm09 and novel viruses of the North American triple reassortant lineage were isolated. Serological results showed low seroprevalence for the novel H3N2 virus and higher seroprevalence for A(H1N1)pdm09 viruses. In addition, serology suggested that other swine influenza viruses are also circulating in Vietnamese swine.

Application of the quartz crystal microbalance to the evaporation of colloidal suspension droplets

An investigation into the evaporation of sessile droplets of latex and clay particle suspensions is presented in this work. The quartz crystal microbalance (QCM) has been used to study the interfacial phenomena during the drying process of these droplets. Characteristic changes of the crystal oscillating frequency and crystal resistance (damping of the oscillating energy) have been observed and related to the different stages of the evaporation process. Measurements have been made for latex particle sizes from 1.9 to 10 microm and for rough and polished crystals using drops from 0.3 to 1.5 microL. The behavior of the QCM is shown to depend strongly on the size of particles present and on the morphology of the crystal surface. One of the most striking features is a drastic damping of the oscillation energy and corresponding rise in frequency observed during the final stages of evaporation, particularly for the clay suspensions.

Effects of ultrasound on the electrochemical cementation of cadmium by zinc powder

This work is devoted to a kinetics study of cadmium electrochemical cementation on zinc powder under ultrasonic low-frequency field (20 kHz). Compared to mechanical stirring with a Rushton turbine and for the same suspension quality, ultrasound lead to a lower kinetics during the major part of the reaction but to final conversion rate near 100%. Pointing out a thermal modification in the deposit morphology due to acoustic cavitation, gives explanation to these processes changes. Besides several acting parameter effects, such as temperature, metallic ion concentrations or ultrasonic power have been observed and analysed.

Protective role of nitric oxide in ocular toxoplasmosis

AIMS

To evaluate the role of nitric oxide (NO) in ocular involvement during systemic toxoplasmosis.

METHODS

C57B1/6 mice were infected with Toxoplasma gondii strain ME49. The synthesis of NO was inhibited by an intraperitoneal injection of aminoguanidine every 8 hours, starting on the day of infection. Control infected mice received phosphate buffered saline vehicle alone. After 14 days, the ocular lesions were evaluated by histopathological examination. The expression of NO synthase induced in the spleen by toxoplasma infection was evaluated by immunostaining. The production of NO by the spleen cells of infected mice was measured by the colorimetric assay of Griess in the supernatant of cultures stimulated with toxoplasma antigen or concanavalin A.

RESULTS

The inhibition of NO production in T gondii infected mice resulted in a marked increase in the symptoms of ocular inflammation. We observed a strong induction of NO synthase expression in the spleen of infected animals. In culture, the spleen cells from these mice produced high levels of NO in response to T gondii antigens. This elevation of NO synthesis was suppressed in the presence of aminoguanidine.

CONCLUSION

This study indicates that NO plays a crucial role in the protection against T gondii infection as reflected by the severity of the ocular involvement.

Differential effects of interleukin-1 alpha, tumor necrosis factor alpha, and transforming growth factor beta 1 on cell proliferation and collagen formation by cultured fat-storing cells

Fat-storing cells (FSCs), perisinusoidal cells which normally participate in metabolism of vitamin A, have been suggested to participate in collagen synthesis in fibrotic liver. However, key mediators which regulate collagen metabolism in FSCs are yet to be elucidated. In fibroblasts, Interleukin-1 (IL-1), Tumor Necrosis Factor alpha (TNF alpha), and Transforming Growth Factor beta (TGF beta) have been shown to induce diverse modulations of collagen metabolism and cell proliferation. In the present study, these cytokines were tested for their abilities to regulate collagen formation and proliferation by cultured rat FSCs. FSCs primary culture was established and incubated in the absence or presence of various concentrations of IL-1 alpha, TNF alpha, and TGF beta 1. Tritiated proline and thymidine were used to examine collagen formation and cell proliferation. IL-1 alpha (2.5-10 U/ml) had a concentration-dependent stimulatory effect on FSC proliferation with a maximal response of 160% compared to that of untreated FSCs. This mitogenic effect resulted in slight but significant increases (15-20%) in the net collagen formation. However, when this parameter was standardized relative to DNA content, significant inhibition of both collagen and noncollagen protein formation by IL-1 alpha was demonstrated. TNF alpha also exhibited a similar mitogenic effect but induced a more selective inhibition of collagen formation. In contrast, TGF beta 1 (0.01-1 ng/ml) specifically enhanced collagen formation by 60-80%, as also evidenced by significant increases in the ratio of [3H]hydroxyproline to [3H]proline incorporated in newly formed proteins.(ABSTRACT TRUNCATED AT 250 WORDS)