Background: According to the World Health Organization’s 2021 statistics, cardiovascular diseases (CVDs), particularly coronary artery disease (CAD), remain among the leading causes of global morbidity and mortality, affecting both high-income and low-income countries like Vietnam. Objective: Acute myocardial infarction (AMI) remains a major cause of mortality and cardiovascular complications, with a poor prognosis in patients with left ventricular systolic dysfunction (LVSD). High-sensitivity cardiac troponin I (hs-cTnI) is a specific biomarker of myocardial injury linked to infarct size and LVSD. However, its role in predicting left ventricular ejection fraction (LVEF) in non-ST-elevation myocardial infarction (NSTEMI) is underexplored. This study investigates the correlation between hs-cTnI and LVSD in NSTEMI patients. Methods: A descriptive, cross-sectional study was conducted on 117 patients with first-time NSTEMI treated at Cho Ray Hospital from February 2024 to April 2024. Admission hs-cTnI levels were measured and correlated with LVEF, assessed via echocardiography. The predictive value and optimal cut-off points of hs-cTnI for LVSD (LVEF < 50% and ≤ 40%) were determined using receiver operating characteristic (ROC) curve analysis. Results: Hs-cTnI levels showed a significant inverse correlation with LVEF (r = - 0.569, p < 0.001). Patients with moderate-to-severe LVSD (LVEF ≤ 40%) had the highest median hs-cTnI levels (25,000 pg/mL, p < 0.001). The area under the ROC curve (AUC) for predicting LVEF < 50% was 0.78, with a cut-off of 12,344 pg/mL (sensitivity 68.5%, specificity 82.5%). For LVEF ≤ 40%, the AUC was 0.82, with a cut-off of 20,979 pg/mL (sensitivity 73.3%, specificity 88.5%, accuracy 84.6%). These findings underscore hs-cTnI’s utility in identifying LVSD. Conclusion: Hs-cTnI is inversely correlated with LVEF and serves as a reliable biomarker for predicting LVSD in NSTEMI patients, facilitating risk stratification and early management decisions.

Background:Posterior pericardiotomy has been proposed to prevent postoperative pericardial effusion and tamponade in coronary artery bypass grafting, but its effect on pleural fluid accumulation during off-pump CABG (OPCAB) is not well defined.Objective:To compare intraoperative metrics and early postoperative outcomes—particularly rates of pleural and pericardial effusions—between OPCAB with and without posterior pericardiotomy.Methods:In this retrospective cohort, 68 patients underwent OPCAB from January to March 2025 and were stratified into pericardiotomy (n = 38) and control (n = 30) groups. Baseline demographics, comorbidities, left ventricular ejection fraction, operative time, and graft count were recorded. Postoperative outcomes included incidence of pericardial and pleural effusions (confirmed by echocardiography or chest radiography), new-onset atrial fibrillation (within seven days), chest-tube drainage volume, and in-hospital mortality.Results:Groups were similar in age (mean 66.5 ± 7.1 years), sex, and major comorbidities, though peripheral artery disease and multi-vessel coronary disease were more prevalent in the pericardiotomy group (p = 0.002 and p = 0.017). Operative time and ICU stay did not differ significantly. Mediastinal drainage was higher after pericardiotomy (861 ± 551 vs. 764 ± 347 mL; p = 0.03). Pericardial effusion rates were low and comparable (10.5% vs. 13.3%; p = 0.72), and no tamponade occurred. Pleural effusions were significantly more frequent with pericardiotomy (42.1% vs. 6.6%; p = 0.001). Atrial fibrillation incidence and in-hospital mortality were similar between groups.Conclusions:Posterior pericardiotomy in OPCAB effectively prevents clinically significant pericardial effusion and tamponade, though it redirects fluid into the pleural space, increasing pleural effusion rates. These effusions are manageable with routine drainage and do not prolong recovery. Prospective studies should further define patient selection and long-term implications.

Background: Vascular endothelial growth factor (VEGF) plays a crucial role in bladder cancer progression. Brolucizumab, an anti-VEGF agent, has been studied in various diseases; however, its potential in bladder cancer remains largely unexplored. Objective: This study aimed to analyze the molecular docking and dynamic stability of Brolucizumab as a VEGF inhibitor in bladder cancer. Methods: Target protein and ligand data mining were conducted. Proteins were prepared by removing water molecules using Discovery Studio 2019. Ligand energy minimization was performed using Pyrx v.0.9.8. Protein-ligand docking was conducted, and protein-protein docking was performed using the HADDOCK server. The interactions between compounds and proteins were visualized with BioVia Discovery Studio 2019. Molecular dynamics simulations were carried out using the YASARA Dynamic program. Results: Brolucizumab binding induced smaller conformational changes compared to VEGFR2 binding. When VEGFR2 interacted with the VEGFA-Brolucizumab complex, significant conformational changes occurred, suggesting an inhibitory and blocking effect of Brolucizumab. Bond relaxation was observed when Brolucizumab bound to VEGFA and VEGFR, initiating conformational changes as part of its inhibitory activity. Brolucizumab demonstrated strong and competitive binding to VEGFA, with greater affinity than VEGFR2. Conclusion: Brolucizumab exhibits inhibitory and blocking activity against VEGFR2, suggesting its potential as a therapeutic agent in bladder cancer.

Background:Anti-N-Out-of-hospital cardiac arrest (OHCA) remains a condition with high morbidity and mortality despite advancements in resuscitation strategies. Identifying prognostic factors in OHCA patients who achieve a return of spontaneous circulation (ROSC) is critical for optimizing post-resuscitation care and improving survival outcomes.Objective:This study evaluates clinical outcomes and predictors of in-hospital mortality in OHCA patients admitted to a tertiary referral center in Southern Vietnam.Methods:A retrospective cohort study was conducted on OHCA patients with ROSC admitted to Cho Ray Hospital, Ho Chi Minh City, Vietnam, from January 1, 2019, to June 15, 2024. Demographic characteristics, clinical variables, and survival outcomes were analyzed. Predictors of in-hospital mortality were identified through multivariate logistic regression.Results:Among 482 OHCA cases, 86 patients met the inclusion criteria. The mean age was 49.1 ± 17.2 years, with a male predominance (79.1%, male-to-female ratio: 3.8:1). Most cardiac arrests were witnessed (84.9%), and 32.5% presented with an initial shockable rhythm. Cardiac etiology was the predominant cause (67.4%). The overall in-hospital survival rate was 44.2%, with 25.6% achieving good neurological outcomes (Cerebral Performance Category [CPC] 1–2). Multivariate analysis identified lower Glasgow Coma Scale (GCS) scores (OR 1.42, 95% CI 1.01–2.00, p = 0.045), decreased estimated glomerular filtration rate (eGFR) (OR 1.03, 95% CI 1.00–1.06, p = 0.042), and higher cumulative epinephrine dose (OR 1.10, 95% CI 1.01–1.19, p < 0.05) as independent predictors of mortality. A predictive model incorporating these variables demonstrated strong discriminatory performance (AUC = 0.91). An epinephrine threshold of 7 mg was identified as a predictor of in-hospital mortality, with a sensitivity of 0.68 and specificity of 0.91.Conclusion:In OHCA patients with ROSC, the in-hospital survival rate was 44.2%, with 25.6% achieving good neurological outcomes (CPC 1-2). Lower GCS scores, reduced eGFR, and higher total epinephrine doses were independently associated with increased mortality. These findings underscore the need for early risk stratification and individualized post-resuscitation management to improve patient outcomes.

Background:Emergency medicine conferences play a pivotal role in advancing clinical knowledge, fostering professional networks, and improving patient outcomes. However, traditional large-scale formats face challenges in ensuring diversity, inclusivity, and participant engagement. This study investigates the effect of different medical conference experiences - traditional versus interactive - on the overall experience ratings of 143 healthcare professionals. The research also examines how professional role, experience level, and primary motivation for attendance influence these ratings.Objective:This study aims to assess the impact of alternative conference formats on engagement, inclusivity, and knowledge dissemination, with the goal of informing strategies to design more equitable and impactful emergency medicine conferences.Methods:Data were analyzed using a two-way mixed-design analysis of variance (ANOVA) and a paired-samples t-test. The findings indicate a statistically significant preference for interactive sessions over traditional ones across the entire sample (M=4.06 vs. M=3.75, p<.001). This preference was particularly strong among participants motivated by networking.Results:However, the study also revealed a nuanced relationship between professional experience and satisfaction, with late-career professionals (20+ years) rating their overall experience significantly lower than their less-experienced counterparts. The consistently high ratings for hands-on workshops across all groups highlight their universal value. These results suggest that tailoring conference content to meet the diverse needs of attendees, especially by incorporating more interactive and applied learning opportunities, can significantly enhance engagement and satisfaction.Conclusion:The results revealed generational differences in satisfaction between “Millennials” and “ Generation X” suggesting that future conferences should be tailored to diverse audience needs. Ultimately, the findings provide strong evidence that prioritizing interactive, applied learning can significantly boost engagement and knowledge retention.

Background: Subtotal cholecystectomy (SC) is considered a safe option for a bailout in the presence of a difficult laparoscopic cholecystectomy with a low incidence of complications. Objective: This report aims to describe the challenges in diagnosing and managing remnant gallbladder. Case presentation: Case 1 is a 31-year-old male who presented with right upper quadrant abdominal pain ten years following SC. Abdominal ultrasound (US) and computed tomography (CT) scan confirmed a ruminant gallbladder. He underwent successful completion of laparoscopic cholecystectomy. Case 2 is a 40-year-old male who was admitted as a case of ascending cholangitis. He had a history of subtotal cholecystectomy one year prior to his presentation. CT scan, Magnetic resonance cholangiography (MRCP), and US all confirmed the presence of a remnant gallbladder. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP), followed by the completion of laparoscopic cholecystectomy. Conclusion: Recurring symptoms due to the remnant gallbladder are often challenging to diagnose and treat. Herein, we highlight the importance of adequate preoperative investigations and surgical planning prior to intervention.

Background:Cancer pain is common and often undertreated. Although opioids are effective when prescribed appropriately, clinical practice remains cautious and variable.Objective:The aim of this study was to assess physicians’ knowledge and identify barriers to opioid prescribing for cancer pain in a tertiary hospital in Saudi Arabia’s Eastern Province.Methods:A cross-sectional survey was conducted during March–April 2025 among physicians managing cancer pain. An anonymous REDCap questionnaire, adapted from Ayoub et al. (2022), collected data on demographics, practice patterns, guideline use, access to the national monitoring system (Raqeeb), opioid-prescribing knowledge, and perceived barriers at staff, system, and patient levels. Descriptive statistics summarized the data.Results:Of 132 respondents (median age 38 years; 5 years’ experience), 47.0% always and 31.1% often managed cancer pain, yet only 31.1% routinely initiated opioids. Morphine (86.4%) and tramadol (74.2%) were most used. Awareness of the local guideline was 23.5%, and 62.9% had Raqeeb access. Only 32.5% received training within five years. Foundational knowledge was adequate (opioids for moderate–severe pain 95.7%; co-prescribing laxatives 81.0%), while advanced topics were limited (no ceiling dose for morphine 25.9%; titration 45.7%; rotation 46.6%). Major barriers included limited protocol familiarity (57.6%), insufficient training (56.1%), e-prescribing workload (40.2%), perceived over-regulation (39.4%), and patient fears of addiction (51.5%) or side effects (44.7%).Conclusion:Physicians frequently encounter cancer pain but demonstrate gaps in guideline awareness, training, and system access. Unified guidelines, structured training, and improved Raqeeb functionality are priorities for safer opioid use.

Background:Aortic stenosis is a prevalent disease affecting approximately 10% of the population by the eighth decade, it is a fatal disease without treatment, with an annual mortality rate reaching 25%. Valve replacement, either through surgical or transcatheter approach, is the only therapeutic option. Over the last 15 years, the indications for transcatheter aortic valve replacement (TAVR) have spread to include young and low surgical risk patients.Objective:Our study aims to address this gap in the literature by comparing the adverse outcome after TAVR through axillary versus femoral access in heart failure reduce ejection fraction (HFrEF) patients who underwent TAVR within 30 days of the procedure.Methods:We used data from TriNetX US collaborative network database, including HFrEF patients who had TAVR through axillary or femoral access between 2015 and 2025. Propensity score matching was done to minimize the difference in baseline characteristics between the two cohorts. Outcomes were observed within the first 30 days of TAVR.Results:A total of 206 patients in each cohort (axillary vs. femoral) were studied after propensity score matching. The incidence of permanent pacemaker (PPM) insertion was comparable between groups (5.0% vs. 5.1%; OR: 0.984, 95% CI: 0.400–2.419; HR: 0.365, 95% CI: 0.097–1.376; p = 0.157). Secondary outcomes showed no significant differences between the axillary and femoral approaches, including major vascular complications (OR: 0.542, 95% CI: 0.238–1.231; HR: 0.448, 95% CI: 0.192–1.046), acute kidney injury (OR: 0.922, 95% CI: 0.430–1.976; HR: 0.940, 95% CI: 0.459–1.922), all-cause mortality (OR: 1.010, 95% CI: 0.411–2.482; HR: 1.040, 95% CI: 0.433–2.498), cerebrovascular accident (OR: 0.980, 95% CI: 0.390–2.460; HR: 1.142, 95% CI: 0.384–3.399), and acute coronary syndrome (OR: 0.885, 95% CI: 0.355–2.208; HR: 1.211, 95% CI: 0.271–5.412).Conclusion:Our study finding showed no difference in the permanent pacemaker insertion or secondary outcomes (Major vascular complications, Acute Kidney Injury, Cerebrovascular accident, Acute coronary syndrome, and All-cause mortality) within the first 30 days of TAVR in patients with HFrEF, whether the access axillary or femoral.

Background: Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer with main option for therapeutic is chemotherapy. Natural compounds, such as durian (Durio zibethinus) and sapodilla (Manilkara zapota) extracts, have demonstrated anticancer properties, including apoptosis induction and the potential to overcome chemotherapy resistance. Objective: This systematic review evaluates the effects of these extracts on TNBC cells, focusing on their ability to enhance chemotherapy sensitivity with induced apoptosis and decreased chemotherapy resistance. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Literature searches in PubMed, Scopus, Web of Science, and Google Scholar identified studies investigating the effects of durian and sapodilla extracts on breast cancer. Data extraction focused on study design, cell lines, preparation and concentrations of extracts, and outcomes such as apoptosis, chemotherapy sensitivity, and molecular marker expression. Results: Included studies demonstrated that durian and sapodilla extracts significantly enhanced the efficacy of chemotherapy agents such as paclitaxel and doxorubicin. Both extracts contained bioactive that reduced Fas, Caspase-3, Caspase-9, and XIAP expression. The combination treatments were shown to synergistically enhance chemotherapy-induced cytotoxicity while reducing resistance mechanisms. Conclusion: Bioactive compounds in durian and sapodilla extracts target multiple pathways involved in TNBC apoptosis, progression and chemotherapy resistance. These findings suggest their potential as natural adjuvants to enhance chemotherapy efficacy. Further studies are needed to validate these results in vivo and explore their clinical applicability.

Background: Uncontrolled hypertension (UHT) is associated with an increased risk of target organ damage (TOD). Matrix metalloproteinase-2 (MMP-2) plays a role in vascular remodeling, and the rs243866 (-1575G/A) polymorphism has been implicated in cardiovascular diseases. Objective: This study aimed to evaluate the association between rs243866 and TOD in UHT patients. Methods: A cross-sectional study was conducted on 134 UHT patients at two hospitals in Vietnam. Genotyping of rs243866 was performed using PCR, and TOD was assessed via echocardiography (left ventricular hypertrophy - LVH), renal function tests (eGFR, albuminuria), and carotid ultrasound (carotid atherosclerosis). Results: The genotypic distribution was GG (79.9%), GA (18.6%), and AA (1.5%), with allele frequencies of 89.2% (G) and 10.8% (A). The A allele was associated with higher risks of LVH (OR=2.553, 95% CI: 1.052-6.196, p=0.035), CKD (OR=2.639, 95% CI: 0.986-7.066, p=0.048), and carotid atherosclerosis (OR=6.806, 95% CI: 2.203-21.024, p&lt;0.001). These associations remained significant after adjusting for confounders. Conclusion: The rs243866 polymorphism of MMP-2 is independently associated with TOD in UHT, particularly LVH, CKD, and carotid atherosclerosis. Genetic screening for rs243866 may provide insights into risk stratification and personalized hypertension management.