Cho Ray Hospital Research Articles

Clinical Characteristics and Factors Associated with 30-Day Mortality in Patients with Methicillin-resistant Staphylococcal Pneumonia

Objective: We aimed to identify the risk factors associated with 30-day mortality in patients with methicillin-resistant Staphylococcus spp. (MRS) pneumonia.Material and Methods: From March 2021 to March 2023, we conducted a prospective, observational study at Cho Ray Hospital, Viet Nam, in hospitalized patients aged ≥18 years with pneumonia due to MRS. To assess the risk factors for 30-day mortality, we performed univariable and multivariable logistic regression analyses.Results: The 30-day mortality was 39.1% (36 out of 92 patients with MRS pneumonia). The risk factors for death within 30 days in cases with MRS pneumonia were severe pneumonia, being overweight, respiratory failure, shock, or having a medical device (a tracheostomy or endotracheal tube, a central venous catheter, a urinary catheter, or a nasogastric tube). The 30-day mortality increased proportionally with the number of risk factors.Conclusion: Pre-existing factors were associated with the 30-day mortality risk of MRS pneumonia. Therefore, comprehensive therapy, including initial anti-MRS treatment, might be important for improving outcomes in patients with the studied risk factors.

Minimally Invasive Enucleation of Esophageal Leiomyoma: Experience From a Single Institution.

Esophageal leiomyoma is a rare disease, most of which are benign, and endoscopic tumor removal surgery is a widely accepted treatment method. The two surgical approaches, laparoscopic andthoracoscopic,must be selectedand applied according to the tumor size and location. The study aimed to evaluate the results, feasibility, and appropriate approach of minimally invasive surgery to treat esophageal leiomyoma. Subjects and research methods: A retrospective study of 27 cases of patients who underwent endoscopic tumor removal surgery to treat esophageal leiomyoma at Cho Ray Hospital was conducted from January 2015 to April 2020. Demographic characteristics, clinical symptoms, surgical characteristics, and postoperative complications were recorded. A total of16 men and 11 women were included in the study, with an average age of 47.2 years (25-76 years). In total, 92.6% of patients had symptoms, the most common beingdysphagia (n = 19); however, 7.4% of patients still had no symptoms. Tumor removal through right thoracoscopic surgery was performed in 18 patients; the remaining nine patients were approached through laparoscopic intra-abdominal surgery. The median tumor size in all patients is 3.0 cm (2.0-5.0 cm), with the smallest tumor being 1.2 cm and the largest tumor being 8 cm.Postoperative histopathology shows esophageal leiomyoma in 100% of cases. Three cases (11.1%) of esophageal mucosal perforation and one case (3.7%) of tracheal perforation occurred during surgery. There was no case of death or suture leak after surgery. There was one case of postoperative gastroesophageal reflux that was treated successfully with medical treatment for two weeks. The average follow-up period was 21.4 months, with no deaths or recurrences during follow-up. Endoscopic surgery is a safe, minimally invasive method for esophageal leiomyoma removal, with laparoscopy used for tumors near the gastroesophageal junction and right thoracoscopic surgery for remaining tumors, ensuring quick patient recovery.

Predictive value of neutrophil-to-lymphocyte ratio for adverse outcomes in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease: A retrospective study.

Chronic obstructive pulmonary disease (COPD) stands as one of the leading causes of mortality worldwide. Acute exacerbations of COPD (AECOPD) lead to rapid respiratory function decline and worsened disease status. Despite recent studies, the ability of the neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in patients with COPD remains controversial. We investigated the predictive value of NLR for adverse outcomes in hospitalized patients with AECOPD. A retrospective study was conducted at the Department of Pulmonary Medicine, Cho Ray Hospital (Vietnam) from November 2019 to November 2021. The study extracted data from patients diagnosed with AECOPD at discharge and met the inclusion criteria. NLR is calculated by dividing the number of neutrophils by the number of lymphocytes in the peripheral blood test. Adverse outcomes are defined as invasive mechanical ventilation, admission to intensive care unit, or in-hospital mortality. Multivariable regression analysis was conducted to identify variables predicting adverse outcomes. The cutoff, sensitivity, specificity, area under the curve, and receiver operating characteristic of NLR were determined for predicting adverse outcomes. Two hundred eighty-seven patients with AECOPD were included in the final analysis, with a mean age of 70.9, and males comprising 92.7%. The rate of adverse outcomes was 15.7%. Multivariable logistic regression identified reduced consciousness at admission (adjusted odds ratio = 0.08, 95% confidence interval [CI]: 0.02-0.38, P = .001) and high NLR (adjusted odds ratio = 1.17, 95% CI: 1.10-1.24, P < .001) as predictors of adverse outcomes. The receiver operating characteristic of NLR's predictive value yielded an area under the curve of 0.877 (95% CI: 0.83-0.93). An NLR cutoff of 11.0 predicted adverse outcomes with a sensitivity of 80.0%, specificity of 77.7%, and an odds ratio of 13.9 (95% CI: 6.3-30.7), P < .001. NLR is a simple, routine, and cost-effective tool for predicting adverse outcomes in hospitalized patients with AECOPD. Future studies should evaluate the kinetics of NLR in predicting treatment response in patients with AECOPD.

Evaluating the prognostic performance of the novel ERAP score in Vietnamese acute pancreatitis patients.

Early recognition of severe acute pancreatitis (AP) is crucial for timely intervention. This study aims to evaluate the prognostic accuracy of the Emergency Room Assessment of AP (ERAP) score and compare it with the Bedside Index for Severity in AP (BISAP) score in predicting severe AP, mortality, and persistent multiple organ failure (MOF) in Vietnamese patients. This prospective cohort study included AP patients admitted to Cho Ray Hospital between August 2021 and May 2022. Patient data, including demographics, clinical presentations, and laboratory results, were collected upon admission. The ERAP and BISAP scores were calculated from these admission data. The prognostic accuracy for severe AP, mortality, and persistent MOF was assessed via the area under the receiver-operating characteristic curve (AUC). Among 167 AP patients (mean age 41.5 ± 12.0 years), hypertriglyceridemia (34.7%) and alcohol (22.2%) were the most prevalent etiologies. Severe AP accounted for 33.5% of the patients. Mortality rates were higher in persistent MOF patients (42.9%) than in persistent single-organ failure patients (3.6%), with a P value <.001. The ERAP score had AUCs for predicting severe AP, mortality, and persistent MOF of 0.899, 0.817, and 0.867, respectively, with an optimal cutoff of ≥2. The ERAP score had a better prognostic value than the BISAP score in predicting severe AP (AUC: 0.899 vs 0.820; P = .0072) and persistent MOF (AUC: 0.867 vs 0.785; P = .0193) but had a similar prognostic value for mortality (AUC: 0.817 vs 0.728; P = .0628). The ERAP score has strong predictive value for severe AP and persistent MOF, surpassing the BISAP score in these categories while maintaining similar accuracy for mortality prediction in the Vietnamese population. The ERAP score can be a valuable tool for the early identification of high-risk AP patients, enabling timely and appropriate clinical interventions.

The results of thoracic endovascular aortic repair for high-risk type B aortic dissection

Overview: Evaluating the efficacy of endovascular intervention in treatment of high-risk type B aortic dissection Methods: Review a series case of high-risk type B aortic dissection cases treated with endovascular intervention at Cho Ray Hospital from January 2020 to December 2022. Results: The study included a total of 30 patients with high-risk type B aortic dissection who underwent endovascular intervention meeting all sampling criteria. The average age was 53 years (26-73 years), with males accounting for 86.7%. The most common risk factor was hypertension (86.7%). Pain was the primary reason for hospital admission, with chest pain being the most frequent (80%). The most prevalent high-risk factors were false lumen diameter &gt; 22mm (66.7%), followed by aortic diameter &gt; 40mm (36.7%), and entry tear diameter &gt; 10mm (33.3%). Regarding intervention characteristics, the average stent graft length was 207.3mm, with proximal landing zones predominantly in zone 1 (23.3%), zone 2 (40%), and zone 3 (36.7%). Twenty-nine patients were continuously monitored for an average of 4.3 months, with a complication rate of 10% including endoleak type Ia (6.9%) and retrograde dissection (3.4%). Aortic remodeling was evidenced by a significant reduction in false lumen size (p&lt;0.001) Conclusion: Follow-up results show a low rate of complications and a high rate of aortic reconstruction post-intervention.

Early outcomes of total arch replacement in the treatment of aortic dissection

Abstract: Overview: Aortic dissection are severe pathologies with high mortality and complication rates post-surgery despite significant advancements in both diagnosis and surgical treatment. Aortic arch replacement surgery is a classic and highly effective treatment method at Cho Ray Hospital. Objectives: Describe clinical, paraclinical characteristics, postoperative results, general complications and early hospital mortality. Methods: Descriptive cross sectional study. Results: 102 patients underwent aortic arch replacement surgery due to aortic dissection. Males predominated at 72.5%. The male:female ratio was 2.5:1. The average age was 56.45 ± 11.79 years. A history of hypertension was present in 81.4% of cases. Most patients with aortic dissection were admitted in an acute condition, accounting for 95%. Patients with type A aortic dissection accounted for 87.3%, with the entry tear in the ascending aorta at 27.5%. Isolated aortic arch replacement was performed in 46.1% of patients, while 53.9% underwent aortic arch replacement with frozen elephant trunk technique. 7 patients required aortic root replacement, 7 needed aortic valve surgery, and 10 required CABG. Most patients were cooled to 25 degrees C with cerebral perfusion to three branches. Ascending aorta cannulation was established in 45.2% of cases. The average cardiopulmonary bypass time was 257.7 minutes, with selective cerebral perfusion time at 115.9 minutes and lower body circulatory arrest time averaging 57.2 minutes. Postoperative neurological complications occurred in 10.8%, and the rate of renal failure requiring dialysis was 17.8%. The mortality rate was 9.6%. Longer cardiopulmonary bypass times and body temperatures above 25 degrees significantly increased the rate of postoperative renal failure requiring dialysis. Patients with postoperative renal failure requiring dialysis had a statistically significant increase in postoperative mortality rates. Aortic root intervention surgery combined with arch replacement did not affect the rate of postoperative complications. Aortic arch replacement with frozen elephant trunk technique did not affect cardiopulmonary bypass time, clamping time, or the rate of postoperative complications. Conclusions: Total arch replacement at Cho Ray Hospital initially showed a safe and effective with acceptable mortality rate.

Outcomes of endovascular intervention for infrarenal abdominal aortic aneurysm with hostile necks

Overview: Currently, endovascular intervention of the abdominal aortic aneurysm is considered the standard treatment method. Aneurysm neck’s morphology can affect 60% of the success or failure of endovascular intervention. Many advanced techniques to treat hostile necks have gradually become popular. However, endovascular intervention of the abdominal aortic aneurysms with hostile aneurysm necks are still considered a challenge. Objectives: Describe the characteristics of patients with infrarenal abdominal aortic aneurysms with hostile necks. Evaluate the perioperative and mid-term outcomes of endovascular intervention to treat infrarenal abdominal aortic aneurysms with hostile necks. Methods: The patients were diagnosed with infrarenal abdominal aortic aneurysms at the Vascular Surgery Department of Cho Ray Hospital, and were treated by endovascular intervention, from January 2020 to August 2023, and met the including criteria. Results: The technical success rate was 95.12%. The early death rate was 2.44%. There were no aneurysm-related deaths. Early endoleak rate was low at 4.88%. Late type I endoleak was 7.5%. The mid-term mortality rate was 9.76%. The mid-term mortality rate recorded in the aneurysm necks length ≤ 15mm group was significantly higher than the other group. Late type I endoleak had no significant difference, when comparing the short neck groups and the angulated neck groups. Conclusion: Endovascular intervention to treat infrarenal abdominal aortic aneurysms with hostile necks is a safe and effective method.

Rhinoplasty Exclusively Utilizing Autologous Costal Cartilage for Patients with Prior Unilateral Cleft Lip Repair.

Rhinoplasty in patients with previous unilateral cleft lip repair is a surgical challenge due to complex nasal deformities, including a horizontally positioned nasal wing, wide cleft side nostrils, nasal base defects, and a short and deviated nasal columella. To comprehensively address these complexities, we exclusively utilized autologous costal cartilage in rhinoplasty procedures, using various surgical techniques. This study presents a comprehensive case series of 39 patients who had previously undergone unilateral cleft lip surgery but still had nasal deformities. Rhinoplasty using autologous costal cartilage was performed at Cho Ray Hospital, Vietnam. Costal cartilage was partially crushed and then finely cut to shape the dorsal area and raise the nasal base on the cleft side. Partially crushed cartilage was also used to shape shield grafts, cap grafts, and alar batten grafts, whereas sliced cartilage was utilized for septal extension grafts. Evaluation was based on improvements in anthropometric indicators, patient satisfaction using Rhinoplasty Outcome Evaluation (ROE) scale and FACE-Q scores. The average age of patients was 25.13 years. All postoperative anthropometric indicators showed significant improvements. Postsurgery, the total ROE score was three times higher than before surgery (P < 0.001), and the total FACE-Q score was 2.26 times higher (P < 0.001). No significant intraoperative or postoperative complications were observed. This procedure effectively addresses complex nasal deformities in patients with prior unilateral cleft lip repair, emphasizing the value of autologous costal cartilage in rhinoplasty for such individuals.

Stress, Depression, Anxiety and Willingness to Seek Help of Healthcare Workers in the COVID-19 Pandemic

Background and objective: Although the serious stage of the COVID-19 pandemic has passed, the consequences are not only socio-economic but also affect the mental health of many people, in which healthcare workers tolerate the fiercest and longest-lasting consequences compared to other social groups in the community. This study aims to explore the status of healthcare workers' mental health and evaluate their capacity to effectively manage mental health issues in the context of the COVID-19 pandemic. Particularly, it explores the relationship between depression, anxiety, and stress (DASS) scale and seeking help from healthcare workers.Methods: The study was conducted from April 2022 to August 2022, using an online survey of 638 healthcare workers working at two frontline hospitals in Ho Chi Minh City, Vietnam. It was undertaken at two hospitals in Ho Chi Minh City (i.e., Cho Ray Hospital and the COVID-19 Resuscitation Hospital), facilitated through the social work departments of these hospitals.Results: The result shows that the majority of medical staff faces various mental health problems from mild to severe, with different degrees of severity, depending on the individual's psychological characteristics, gender, education level, and work position. The study also revealed a correlation between help-seeking attitudes and symptoms of depression, anxiety, and stress. It shows that only a minority of healthcare workers have the attitude demonstrated a willingness to seek help and request assistance from psychologists when experiencing mental health issues.Conclusion: Policymakers should prioritize regular awareness campaigns during the initial phases of a pandemic to enhance motivation, knowledge, and preventative measures among healthcare workers. This approach can help identify mental health issues early and reduce the stigma of seeking support. Encouraging group psychotherapy and addressing cultural barriers in the medical field can increase trust in therapists and psychiatrists, improving overall mental well-being.

ASSESSMENT OF NT-PROBNP LEVELS IN PATIENTS WITH CARDIAC ARRHYTHMIAS

Background: NT-proBNP is a valuable biomarker for the diagnosis and treatment of cardiovascular diseases, including arrhythmias. Objective: To evaluate NT-proBNP levels in patients with arrhythmias and analyze the correlation between NT-proBNP levels and several variables. Subjects and Methods: A cross-sectional descriptive study was conducted on 158 patients with arrhythmias from December 2023 to March 2024 at the Arrhythmias Treatment Department of Cho Ray Hospital. Clinical and paraclinical characteristics were analyzed; NT-proBNP levels were compared between patients with arrhythmias with and without heart failure (HF); and the correlation between NT-proBNP levels and several factors was analyzed using R software version 4.3.1. Statistical significance was considered at P &lt; 0.05. Results: The NT-proBNP level (Median [IQR]) in patients with arrhythmias (n = 158) was 367 (61.9-1297) pg/ml. NT-proBNP levels were higher in patients with arrhythmias with HF (n = 41) than in those without HF (n = 117), at 1273 (498-4173) vs. 210 (51-875) pg/ml (P &lt; 0.001). Univariate analysis showed that age, weight, HGB, EF, creatinine, and eGFR were statistically significantly correlated with NT-proBNP. Conclusions: The NT-proBNP level in patients with arrhythmias was 367.3 (61.9-1297) pg/ml; it was higher in patients with arrhythmias with HF than in those without HF. NT-proBNP level was statistically significantly correlated with age, weight, HGB, EF, creatinine, and eGFR.

PREVALENCE OF INSULIN RESISTANCE IN PREDIABETIC PATIENTS WITH HYPERTENSION

stage between normal people and patients with type 2 diabetes mellitus. The pathogenesis is mainly related to insulin resistance (IR). The relationship between IR and hypertension is a complex and multifactorial phenomenon. We examined the prevalence of IR in prediabetic patients with hypertension. Objectives: The present study aimed to determine the incidence of IR according to the HOMA2 model in the group of prediabetes with hypertension, compared with the group of prediabetes without hypertension. Subjects and Methods: The cross-sectional study described and collected data from 191 people with prediabetes from February 2023 to September 2023 at the Examination Department of Cho Ray Hospital. IR was determined by the HOMA2 calculator, using a threshold of 1.29 for IR. Prediabetes and hypertension were diagnosed according to ADA 2022 and ISH 2020 criteria, respectively. Results: The number of subjects selected to analyze the data was 179 patients, including 89 prediabetes patients without hypertension and 90 prediabetes patients with hypertension. The prevalence of IR in the overall prediabetes group was 56.9%. The prevalence of IR in the hypertensive group was 66.7%, higher than the non-hypertensive group at 47.2%, which was statistically significantly different. The values of the index in HOMA2 did not differ statistically significantly between non-hypertensive and hypertensive populations. Conclusions: The prevalence of IR in prediabetes patients with hypertension was 66.7%, greater than the prediabetes patients without hypertension of 47.2%, P = 0.013. Attention should be paid to good control of blood pressure in patients with prediabetes.

Computerized tomography on the 5th postoperative day helps distinguish grade C from grade B pancreatic fistula after pancreaticoduodenectomy for periampullary cancer

ABSTRACT Background Grade C pancreatic fistula (PF) is the most dangerous complication after pancreaticoduodenectomy (PD) and had not been identified on the early post-operative day yet. In this study, we aimed to introduce a new approach to distinguish grade C from grade B PF by using features on the 5th post-operative day’s computerized tomography (CT). Materials and Methods A bi-centric prospective cohort study was conducted from August 2021 to October 2023 at the University Medical Center (UMC) and Cho Ray Hospital, Viet Nam. Patients who diagnosed pancreatic fistula, underwent a CT scan on the 5th postoperative day were followed - up within 90 days after PD. The characteristics of CT scan images were analyzed to differentiate both grades of PF. Results During 26 months, 77 patients with periampullary cancer underwent PD and met the criteria of the study (46 males, mean age: 57.1 ± 13.7). Of these, 52 patients had biochemical PF and 25 had CRPF (18 grade B PF and 7 grade C PF). Specifications on the 5th postoperative day’s CT scan that can discriminate grade C from grade B included: fluid diffusing throughout abdomen, retroperitoneal abscess, hematoma beneath the liver, size of the fluid collection next to the pancreas (p = 0.031) and size of pancreatojejunostomy anastomosis dehiscence (p = 0.045). Conclusions Features on CT scan could be used to identify grade C from the 5th postoperative day. This result can help surgeons to make a plan for carefully follow-up those patients and indicate re-operation at an early stage.

Risk factors and nomogram of clinically relevant pancreatic fistula after pancreaticoduodenectomy for periampullary cancer: A prospective multicenter cohort study

Abstract Background Clinically relevant postoperative pancreatic fistula (CRPF) is considered the most dangerous morbidity associated with pancreaticoduodenectomy (PD). The purpose of this study is to evaluate the risk factors and to construct a predicted model for CRPF after PD. Material and Methods Consecutive patients who underwent pancreaticoduodenectomy between August 2021 and October 2023 at Cho Ray Hospital and University Medical Center were included in a multicenter cohort research. Multivariate logistic regression analyses was used to identify the risk factors of CRPF, and a nomogram was built based on these factors. The value of the nomogram in predicting CRPF was evaluated using the area under the receiver operating characteristic (ROC) curve. Results There were 183 eligible patients in this study (mean age: 57.5 ± 12.6 years; 101 males), and the prevalence of CRPF was 13,7% overall. Multivariate analyses showed that, four risk factors related to CRPF, including preoperative serum albumin &lt;3.5 g/dl, body mass index (BMI) ≥ 25 kg/m2, soft texture of the pancreas and estimated blood loss ≥400 ml were prognostic factors for CRPF (p &lt; 0.05). We built a nomogram based on four variables to predict CRPF, and the area under the ROC curve for this nomogram was 0.855 (95% CI: 0,768 – 0,933). Conclusions Nomogram developed from four risk factors shows good performance to predict CRPF after PD. The clinical findings of this study will help surgeons identify perioperative risk factors for high-risk patients with pancreatic fistula who should be managed differently from other patients. Clinical Trial Registry number: ClinicalTrials.gov NCT05017207. Statement of Significance We successfully developed a nomogram to predict the risk of pancreatic fistula using four perioperative factors. By incorporating these risk factors into clinical practice, surgeons can develop appropriate treatment plans and interventions for high-risk patient populations, potentially reducing the morbidity associated with CRPF.

Evaluating the correlation between WIFI score and outcome of intervention in infrainguinal artery in chronic limb threatening ischemia

Overview: The WIfI score was first introduced as an initial assessment, helping to predict the risk of limb amputation, the feasibility, and the benefit of revascularization in patients with chronic limb-threatening ischemia. Objectives: Determining the correlation between WIfI score and the outcome of endovascular intervention in the lower limb in chronic ischemia threatening limb stage. Methods: A retrospective study was conducted to identify the cases with chronic limb threatening ischemia of the infrainguinal artery occlusion, treated by endovascular intervention at the Department of Vascular Surgery, Cho Ray Hospital from August 2020 to May 2021. Results: There were 80 patients with 80 limbs that were treated, with mean age of 71.5, male gender accounted for 67.5%. Patients were admitted to the hospital with Rutherford stages 4,5,6 respectively 42.5%, 42.5% and 15%. WIfI stages 1,2,3,4 respectively 6.3%, 46.3%, 23.8%, 23.8%. The technical success rate was 96.3%, the wound healing rate was 79.1%, the primary patency rate was 64.9%, the limb salvage rate was 89.7%, the survival rate was 97.5%. The higher WIfI stage before intervention was associated with lower primary patency and limb salvage rates, statistically significant with p&lt;0.05. There was no correlation between WIfI stage and mortality rate. Conclusions: The WIfI classification system is very important in chronic limb-threatening ischemia, as it helps to estimate the limb salvage rate, predict the need for revascularization and wound healing.

Outcomes of balloon angioplasty and stent placement for iliac artery lesions classified as TASC II A, B: a single-center study.

Iliac artery stenosis or occlusion is a critical condition that can severely impact a patient's quality of life. The effectiveness of balloon angioplasty and intraluminal stenting for the treatment of iliac artery lesions classified as TASC II A and B was evaluated in this single-center prospective study. Conducted between October 2016 and September 2020 at Cho Ray Hospital's Vascular Surgery Department, this prospective study involved PAD patients categorized by TASC II A and B classifications who underwent endovascular intervention. Intervention outcomes were assessed peri-procedure and during short-term and mid-term follow-ups. Of the total of 133 patients, 34.6% underwent balloon angioplasty, while 65.4% received stenting. The immediate technical success rate was 97.7%, while the clinical success rate was 62.4%. Complications were minimal, with major limb amputation reported in 1.5% of the cases. There was a significant improvement in Rutherford classification and ABI at short-term follow-up, with a patency rate of 90.2%. The mid-term post-intervention follow-up yielded similar results with an 86.1% patency rate. The mortality rates associated with arterial occlusion were 2.3% during short-term follow-up and 1.7% during mid-term follow-up. Balloon angioplasty and stent placement are effective and safe interventions for TASC II A and B iliac artery occlusions with favorable short and mid-term outcomes. Further, multi-center studies with larger sample sizes are recommended for more comprehensive conclusions, including long-term follow-up assessment.

A Web-Based Dynamic Nomogram to Predict the Risk of Methicillin-Resistant Staphylococcal Infection in Patients with Pneumonia.

The aim of this study was to create a dynamic web-based tool to predict the risks of methicillin-resistant Staphylococcus spp. (MRS) infection in patients with pneumonia. We conducted an observational study of patients with pneumonia at Cho Ray Hospital from March 2021 to March 2023. The Bayesian model averaging method and stepwise selection were applied to identify different sets of independent predictors. The final model was internally validated using the bootstrap method. We used receiver operator characteristic (ROC) curve, calibration, and decision curve analyses to assess the nomogram model's predictive performance. Based on the American Thoracic Society, British Thoracic Society recommendations, and our data, we developed a model with significant risk factors, including tracheostomies or endotracheal tubes, skin infections, pleural effusions, and pneumatoceles, and used 0.3 as the optimal cut-off point. ROC curve analysis indicated an area under the curve of 0.7 (0.63-0.77) in the dataset and 0.71 (0.64-0.78) in 1000 bootstrap samples, with sensitivities of 92.39% and 91.11%, respectively. Calibration analysis demonstrated good agreement between the observed and predicted probability curves. When the threshold is above 0.3, we recommend empiric antibiotic therapy for MRS. The web-based dynamic interface also makes our model easier to use.

Short-Term Outcomes of Umbilical Hernia Repair with Cirrhosis and Ascites

Background: Umbilical hernia is a popular disease, especially in patients with cirrhosis and ascites. The high and prolonged intra-abdominal fluid leads to increased intra-abdominal pressure, which causes the hernia to grow rapidly and cause complications. The clinical manifestations are mainly two: signs of hernia and symptoms of cirrhosis and ascites. The diagnosis of this condition is relatively simple, based mainly on clinical findings, and sometimes supported by imaging techniques. Umbilical hernia management in patients with cirrhosis and ascites has shifted towards early surgical repair to avoid complications. Two techniques of hernia reconstruction are available: simple suture and mesh implantation. Mesh-based methods are regarded as superior, but surgery in this population has many potential hazards and is still a surgical dilemma. This study examines the short-term outcomes of umbilical hernia reconstruction in patients with cirrhosis and ascites. Subjects – Methods: We conducted a retrospective study on 43 patients with cirrhosis and ascites who had umbilical hernia repair surgery at Cho Ray Hospital from January 2018 to December 2022. The surgery was either elective or emergency. We recorded the patient characteristics, surgical approaches, morbidity, and mortality. We followed up the patients for 30 days after the surgery. Results: The male: female ratio was 4:1. The average of age was 56.8 ± 10.7 years old (range: 27 – 79 years old). BMI was categorized into four groups: underweight in 9/43 cases (9.3%), normal in 22/43 cases (51.2%), overweight in 8/43 cases (18.6%), and obese in 9/43 cases (20.9%). All patients had a protrusion in the umbilicus when they were admitted to the hospital. Hernia pain and tenderness were present in 51.2% and 55.8% of the cases, respectively. 8/43 cases (18.6%) had complications of hernia rupture. The mean size of the hernia was 6.4 ± 5.1 cm (range: 2 – 30 cm). The patients underwent emergency surgery in 37/43 cases (86%). All surgeries were open, and the methods of hernia repair were simple suture in 35/43 cases (81.4%), onlay mesh placement in 4/43 cases (9.3%), sublay mesh placement in 1/43 case (2.3%), and preperitoneal mesh placement in 3/43 cases (7%). The mean operative time was 93 ± 37.2 minutes (range: 50-200 minutes). The mean hospital stay was 7 ± 3.2 days (range: 2 – 17 days). There were 13 cases with postoperative complications, accounting for 30%. 2 deaths occurred due to intra-abdominal bleeding and severe peritonitis. Conclusion: Umbilical hernia is a frequent complication in patients with ascites and cirrhosis. The diagnosis is mainly based on clinical signs, and imaging techniques are used in complicated cases that require further evaluation of the content and condition of the hernia sac. The patients have a high rate of complications and mortality after surgery, which are related to late surgery, degree of cirrhosis, and MELD score ≥ 20. Therefore, the patients need early diagnosis and surgery to avoid complications that affect their survival.

Effect of AGTR1 A1166C genetic polymorphism on coronary artery lesions and mortality in patients with acute myocardial infarction.

The pathogenesis and prognosis of patients with acute myocardial infarction (AMI) may be influenced by both genetic and environmental factors. Findings on the relationship of polymorphisms in various genes encoding the renin-angiotensin-aldosterone system with coronary artery lesions and mortality in AMI patients are inconsistent. The aim of this study was to determine whether the AGTR1 A1166C genetic polymorphism affects coronary artery lesions and 1-year mortality in post-AMI patients. Patients with their first AMI admitted to Cho Ray Hospital, Vietnam, from January 2020 to August 2021 were enrolled in this prospective clinical study. All participants underwent invasive coronary angiography and were identified as having the genotypes of AGTR1 A1166C by way of a polymerase chain reaction method. All patients were followed up for all-cause mortality 12 months after AMI. The association of the AGTR1 A1166C polymorphism with coronary artery lesions and 1-year mortality was evaluated using logistic regression and Cox regression analysis, respectively. Five hundred and thirty-one AMI patients were recruited. The mean age was 63.9 ± 11.6 years, and 71.6% of the patients were male. There were no significant differences in the location and number of diseased coronary artery branches between the AA and AC+CC genotypes. The AC and CC genotypes were independently associated with ≥ 90% diameter stenosis of the left anterior descending (LAD) artery (odds ratio = 1.940; 95% confidence interval (CI): 1.059-3.552, p = 0.032). The 1-year all-cause mortality rate difference between patients with the AC and CC genotypes versus those with the AA genotype was not statistically significant (hazard ratio = 1.000, 95% CI: 0.429-2.328, p = 1.000). The AGTR1 A1166C genetic polymorphism is associated with very severe luminal stenosis of the LAD but not with mortality in AMI patients.

Prognostic value of NT-proBNP in the new era of heart failure treatment.

Heart failure is one of the leading causes of mortality and hospitalization in cardiovascular patients. Guideline-directed medical treatment (GDMT) in the current era includes novel medications such as ARNI and SGLT2 inhibitors, as well as an approach to treatment based on clinical phenotypes. To assess prognostic factors for mortality and hospital readmissions plays a crucial role in patient care. This study aimed to determine the rate of 90-day post-discharge events in patients having heart failure with reduced ejection fraction (HFrEF) and investigate the associated clinical factors. A prospective study was conducted on 110 HFrEF patients at the cardiology department of Cho Ray Hospital. The 90-day events included all-cause mortality and rehospitalization due to heart failure. The rate of 90-day events was 45.6%. After multivariable Cox regression analysis, NT-proBNP level ≥ 1858 pg/mL was identified as an independent factor associated with the 90-day events. NT-proBNP cut-off ≥ 1858 pg/mL can be used for the prognosis of 90-day events in HFrEF.

CORRELATION BETWEEN 1,5-ANHYDROGLUCITOL LEVELS AND GLYCEMIC VARIABILITY IN TYPE 2 DIABETIC PATIENTS USING CONTINUOUS GLUCOSE MONITORING

CORRELATION BETWEEN 1,5-ANHYDROGLUCITOL LEVELS AND GLYCEMIC VARIABILITY IN TYPE 2 DIABETIC PATIENTS USING CONTINUOUS GLUCOSE MONITORING