Cho Ray Hospital Research Articles

Association between Lipoprotein(a) Concentration and Adverse Cardiovascular Events in Vietnamese Patients with Acute Myocardial Infarction: An observational cohort study

Background: This study aimed to evaluate serum lipoprotein(a) concentrations in Vietnamese patients with acute myocardial infarction and to investigate the relationship between high serum concentrations of lipoprotein(a) and major adverse cardiovascular events after acute myocardial infarction. Methods: We conducted a prospective cohort study that included data from 199 patients with acute myocardial infarction admitted to the Cardiology Department, Cho Ray Hospital, Viet Nam. Data on demographics, and hematologic, and biochemical blood test results, including serum lipoprotein(a) concentrations and coronary angiography results, were collected. All major cardiovascular adverse events (MACE) were defined as cardiovascular mortality, non-fatal myocardial infarction, and non-fatal ischemic stroke in hospital 30 days after discharge. Results: In patients with acute myocardial infarction, serum concentrations of lipoprotein(a) were not normally distributed, and skewed to the right, with a median of 17.8 mg/dL, interquartile range (IQR) 7.6-34.5 mg/dL. Overall, 29.1%, 17.1%, 12.6%, and 6.5% of patients had a serum lipoprotein(a) concentration of ≥ 30, ≥ 50, ≥ 70, and ≥ 90 mg/dL, respectively. Patients with a serum lipoprotein(a) concentration of ≥ 50 mg/dL had a higher BMI (p = 0.04), a higher rate of non-ST-elevation myocardial infarction (NSTEMI) (p = 0.035), a lower GRACE score (p = 0.038), higher levels of total cholesterol, high-density lipoprotein cholesterol (HDL-C) and unadjusted low-density lipoprotein cholesterol (LDL-C) concentrations (p = 0.002, 0.015, < 0.001, respectively), and a higher rate of three-vessel disease (p = 0.023) compared to patients with a serum lipoprotein(a) concentration < 50 mg/dL. The relative risk between lipoprotein(a) ≥ 50 mg/dL and MACE was 2.37. Conclusions: Patients with acute myocardial infarction and serum lipoprotein(a) ≥ 50 mg/dL were more likely to have NSTEMI and a lower GRACE score. Lipoprotein(a) ≥ 50 mg/dL at the time of acute myocardial infarction was not associated with in-hospital MACE, 30-days-after-discharge MACE, nor with all-cause mortality within 6 months of study follow-up.

Early results of ultrasound-guided, vacuum-assisted breast biopsy for mammographic microcalcifications: combination with wire localization

Purpose: This study examined the usefulness of ultrasound-guided vacuum-assisted breast biopsy for mammographic microcalcification.Methods: case series from June- 2019 to June-2020 at Breast department Cho Ray hospital. The patients with BI-RADS Category 4 Mammographic microcalcification were included. Most microcalcifications were not observed on ultrasound. Sono-guided J-wire localization was first performed for the suspicious microcalcification area, and the location of the J-wire and calcification was determined with mammography in most cases. Sono-guided VABB was performed after removing the J-wire without a stereotactic device. On the other hand, Sono-guided VABB was performed directly without J-wire localization when microcalcification lesions were identified by mass on ultrasonography. In all cases, calcification was confirmed by specimen mammography and the pathology was performed. A follow-up examination was performed to confirm the presence of complications.Results: A total of 20 lesions of 18 patients with BI-RADS Category 4 Mammographic microcalcification were included. Mean age: 49,44 ± 9,49 (35-66). Mean size of lesions 10,83 ± 3,60 mm, (4-15mm). In 20 lesions, 6 lesions (30%) were diagnosed as a malignancy (2 cases of ductal carcinoma in situ, 3 cases of ductal carcinoma invasive, 1 case of atypical ductal hyperplasia). The remaining 14 lesions (70%) were diagnosed as benign (fibroadenoma: 4; fibrocystic exchange 7, fibrocystic desease: 1, typical hyperplasia : 2). There were no significant complications during follow up after VABB.Conclusion: Sono-guided VABB can be used effectively if combined with wire localization for microcalcification lesions.

THE FREQUENCY OF HYPOTHERMIA IN LAPAROSCOPIC PARTIAL GASTRECTOMY AT CHO RAY HOSPITAL, YEAR 2021

Introduction: Currently, the hypothermia in laparoscopic gastrectomy has not been given due attention, leading to a high rate of postoperative hypothermia. Therefore, the care, monitoring and intervention to reduce the rate of hypothermia during and after surgery is one of the issues that need attention.
 Objectives: The study was carried out with 2 objectives: (1) Determining the rate of hypothermia in patients during laparoscopic partial gastrectomy at Cho Ray Hospital; (2) Understanding risk factors for hypothermia in laparoscopic partial gastrectomy patients.
 Methods: Descriptive cross-sectional study on 65 laparoscopic partial gastrectomy patients under general endotracheal anesthesia, from February 2021 to July 2021. The temperature was continuously measured and noted every 30 minutes from induction to the end of surgery by esophageal probe.
 Results: In the study, all patients were under endotracheal anesthesia, The proportion of the age group 70 years and older is 35.38%, the rate of male 76.92%. The average anesthetic time was 166,77±44,05 minutes, the mean surgery time was 145,0±42,70 minutes. The average temperature of the operating room is 23,79°C. The rate of 87,69% of patients was warmed with just a sheet. Research results show that the rate of hypothermia in patients after surgery is 72,31%. Factors related to the rate of hypothermia include age group over 70, smoking, method of warming, BMI, operating room temperature.
 Conclusion: Need to monitor the body-temperature and use continously critacal warming methods the prevent the hypothermia during and after gastrectomy surgery patients.

RECONSTRUCTION OF LARGE ANTERIOR SKULL BASE DEFECTS AFTER RESECTION OF SINONASAL TUMORS WITH INTRACRANIAL EXTENSION BY USING PEDICLED DOUBLE FLAP TECHNIQUES

Background: Surgical resection of a large anterior skull base (ASB) tumor and sinonasal maglinancies with intracranial extension will result a large skull base defect. Reconstruction of large ASB defects by using traditional techniques may result in high risk of postoperative CSF leakage, meningitis and increase mortality rate. The use of pedicled double flap technique to reconstruct the anterior skull base defect may decrease the complications. In this study, we examine the clinical outcomes of patients who underwent this double flap reconstruction technique after the resection of sinonasal malignancies with significant intracranial extension at Cho Ray hospital, Vietnam. Methods: Case series study was conducted at Cho Ray hospital from 09/2010 to 09/2020. All patients with large sinonasal malignancies with intracranial invasion underwent combined transbasal - EEA approach. Reconstruction of large skull base defect ( > 2 cm ) was followed by using the pedicled double flap technique. Results: There were 75 patients who underwent the modified multi-layer with double flap reconstruction technique after the resection of ASB tumor from 09/2010 to 09/2020. The skull base defects were commonly seen at the horizontal plate of the ethmoid and the roof of the ethmoid ( 98.6%). The large skull base defects ( > 2cm) accounted for 81.3%. The risk of postoperative CSF leakage after double flap repair was very low. In this study, we had 1 patient with postoperative CSF leakage and 1 patient had postoperative meningitis. Conclusion: The use of two vascularize pedicled flap may decrease the incidence of postoperative cerebral spinal fluid (CSF) leakage and meningitis. This technique is an effective method for the reconstruction of the ASB with large defect.

Combined Nasal Endoscopic and Subfrontal Craniotomy for Resection Tumors of Anterior Skull Base.

Sinonasal tumors invading anterior skull base is difficult to treat in Otorhinolaryngology and Neurosurgery. Treatment requires the collaboration of ear, nose and throat (ENT) and neurosurgeon to remove the tumor completely. This study was to evaluate the outcome of combined technique nasal endoscopic and subfrontal approach in case of sinonasal tumors involving anterior skull base. Retrospective cross-sectional study. The study was a cross-sectional study that had taken place at Otorhinolaryngology and Neurosurgery Department of Cho Ray Hospital, Vietnam. All 45 patients were enrolled and underwent the surgery. 71.1% of these cases were malignant tumors. The ratio of sinonasal malignant tumor is squamous cell carcinoma and esthesioneuroblastoma were 24.4% and 11.1%, respectively. All the cases were diagnosed as sinonasal tumor invading anterior skull base and successfully removed by combining nasal endoscopic approach with subfrontal craniotomy. The combined nasal endoscopic with subfrontal craniotomy for resection nasoethmoid tumor invading the brain show a good result. This technique is an important adjunct that contribute to the treatment of anterior skull base tumor involving the brain.

Healthcare associated pneumonia: An old concept at a hospital with high prevalence of antimicrobial resistance

One of several reasons that the concept of healthcare-associated pneumonia (HCAP) was dismissed was the same presence of multidrug resistant organism (MDRO) between community-acquired pneumonia and HCAP at countries with the low prevalence of antimicrobial resistance (AMR). However, this finding could be unsuitable for countries with the high rates of AMR. A prospective observational study was conducted at the respiratory department of Cho Ray hospital from September 2015 to April 2016. All adult patients suitable for community acquired pneumonia (CAP) with risk factor for healthcare-associated infection were included. We found out 130 subjects. The median age was 71 years (interquartile range 57-81). The male/female ratio was 1.55:1. Prior hospitalization was the most common risk factor for healthcare-associated infection. There were 35 cases (26.9%) with culture-positive (sputum and/or bronchial lavage). Isolated bacteria included Pseudomonas aeruginosa (9 cases), Klebsiella pneumoniae (9 cases), Escherichia coli (4 cases), Acinetobacter baumannii (6 cases), and Staphylococcus aureus (7 cases) with the characteristic of AMR similar to the bacterial spectrum associated with hospital-acquired pneumonia. MDROs were detected frequently in CAP patients with risk factor for healthcare-associated infection at the hospital with the high prevalence of AMR. This requires the urgent need to evaluate risk factors for MDRO infection in community-onset pneumonia when the concept of HCAP is no longer used.

STUDY ON THE EFFECTIVENESS OF PLASMA EXCHANGE THERAPY IN PATIENTS WITH HYPERTRIGLYCERIDEMIA-INDUCED SEVERE ACUTE PANCREATITIS AT CHO RAY HOSPITAL

Objective: Data about effectiveness and safety of plasma exchange therapy for patients of hypertriglyceridemia-induced severe acute pancreatitis in Vietnam is still limited. This study is aimed at assessing the effectiveness of plasma exchange therapy in patients with hypertriglyceridemia-induced severe acute pancreatitis. Methods: A descriptive prospective study of 49 hypertriglyceridemia-induced severe acute pancreatitis patients, who were received plasma exchange therapy at ICU of Cho Ray Hospital from 02/2019 to 07/2020. Results: After one plasma exchange therapy session: The TG level decreased by (72.5%), mean arterial pressure increased significantly (80.71 ± 23.42/90.61 ± 13.68) with (p<0.05); pulse (134.02 ± 23.59/110.61± 20.59), SOFA score (6.20 ± 3.16/3.69 ± 2.90) and Intra-abdominal hypertension (18.43 ± 5.55/16.40 ± 4.86 mmHg) decreased significantly (p<0.01). There were improvement of creatinine (1.75 ± 1.81/1.16 ± 1.02 mg/dL), HCO3- (15.68 ± 5.19/21.13 ± 5.60 mmol/L), and pH (7.31 ± 0.09/7.40 ± 0.07). The most common complication was mild hypokalemia (9 patients, 18.3%), allergic reactions with plasma (5 patients, 10.2%). Mortality rate was 12.2%. Conclusions: Plasma exchange therapy appeared effectively and safely in hypertriglyceridemia - induced severe acute pancreatitis patients.

Factors associated with the severity of hypertriglyceridemia induced acute pancreatitis.

Hypertriglyceridemia induced acute pancreatitis (HTGP) was associated with increased risk of local complications, recurrent acute pancreatitis (AP), the frequency of other complications, and its high mortality as compared to other causes. Determining the factors associated with the severity of HTGP was necessary and important in the management of patients with AP.This study aims to examine the clinical and biochemical characteristics of HTGP patients, and to determine the factors associated with the severity of HTGP according to the revised Atlanta classification.This retrospective and prospective study enrolled 157 HTGP patients from January 2016 to May 2019 at Cho Ray Hospital who had serum TG levels measured within the first 48 hours of admittance with a TG concentration ≥ 1000 mg/dL and excluded other causes. The clinical features and outcomes of patients with HTGP were determined in terms of demographics, clinical symptoms, laboratory data, system complications, local complications, disease severity, and length of hospital stay. The primary outcome was the severity of HTGP as based according to the revised Atlanta classification. We evaluated the relationship between general information, clinical factors and laboratory data in the study population.There were 157 HTGP patients participated in this study. Patients with HTGP had evidence of obese or overweight range (61.2%), history of diabetes mellitus (32.5%) or undiagnosed diabetes (28.0%), history of AP (35.7%), alcohol use (23.6%), hypertension (15.9%), dyslipidemia (13.4%). The patients had typical symptoms of AP, including pancreatic abdominal pain (upper abdominal pain) (93%), nausea/vomiting (80.9%), fever (59.2%), distension abdomen (84.7%), and resistance of abdominal wall (24.8%). The severity of HTGP was significantly associated with fever, altered mental status, rapid pulse, and hypotension (P < .05). Patients with severe HTGP had significantly more pancreatic necrosis, higher values of Blood urea nitrogen and creatinine, longer prothrombin time and activated partial thromboplastin time on admission and higher CRP48 than not severe HTGP (P < .05).The severity of HTGP was significantly related to clinical factors including fever, altered mental status, rapid pulse, hypotension, and pancreatic necrosis. The value of Blood urea nitrogen, creatinine, prothrombin time, and activated partial thromboplastin time at admission is higher and longer in the severe AP group with P < .05.

Predicting atrial fibrillation after cardiac surgery using a simplified risk index

BackgroundPostoperative atrial fibrillation (POAF) is a common complication after cardiac surgery and can lead to increased risk of postoperative adverse events. However, atrial fibrillation and postoperative adverse events are preventable. In this study, a risk index was developed to predict atrial fibrillation after cardiac surgery. MethodsA prospective cohort study of 405 patients who had undergone adult cardiac surgery from 2015 September to 2016 August at Heart Institute of HCMC and Cho Ray Hospital were obtained. In order to predict POAF, a logistic regression model was developed, and a risk score was derived and validated by bootstrap. ResultsIn our study, 98 patients developed POAF (24.2%). The risk score included three significant risk factors (age ≥ 60, left atrial diameter > 41 mm, Coronary Artery Bypass Graft with concomitant mitral valve replacement or repair) that were consistent with other reports. Each of these risk factors was assigned one point. The total risk score ranges from 0 to 3 (AUC = 0.69, 95% CI: 0.63–0.75) with the best cutoff point at 1. According to this scoring system, the incidences of POAF in patients associated with each score of 0, 1, 2, and 3 were 8.6%, 30.1%, 40.8%, and 58.3% respectively. Bootstrapping with 5000 samples confirmed the final model provided was consistent with predictions. ConclusionsWe developed and validated a simple risk score based on clinical variables that can be obtained before surgery in order to accurately predict the risk of POAF in patients undergoing cardiac surgery.

Survey Anatomical Features and Related Factors of the Sphenopalatine Foramen on Computed Tomography.

The aim of the research is to define anatomical features of the sphenopalatine foramen (SPF) and be related to the SPF on computed tomography (CT) such as shape, location, size of the SPF, the appearance of the ethmoidal crest, and the distance from SPF to some landmarks in the nasal cavity. As a result, surgeons could quickly determine the SPF location in transnasal endoscopic sphenopalatine artery ligation (TESPAL). A cross-sectional study was conducted. This study was carried out at Cho Ray hospital from August 2019 to June 2020. Image data from 55 patients who had been indicated sinuses CT. Results show that the SPF had a wide range of shapes: oval (20.9%), triangle (19.1%), circle (18.2%), racket shape (7.3%), hourglass shape (6.4%), and other shapes. In the anteroposterior dimension, the mean SPF was 5.72 ± 1.22mm. In the craniocaudal dimension, the mean SPF measured 5.62 ± 1.99mm. The SPF was mainly located in the superior meatus and in the transition between the middle and superior meatus. The most reliable anatomical landmark to find the SPF was the ethmoidal crest with an appearance rate of about 95.5%. The mean distances from SPF to anterior nasal spine, nasal floor, nasal septum, maxillary line, anterior head of the middle turbinate, choanal arch, and base lamella were 57.04 ± 3.11, 24.71 ± 2.90, 11.26 ± 2.09, 34.93 ± 2.07, 32.69 ± 3.30, 8.82 ± 1.65, and 8.07 ± 1.28mm, respectively. CT scan images in this study can provide information about anatomical features of the SPF, which contribute to the quick and efficient identification of the SPF before and during TESPAL.

Serum fructosamine targeting the treatment of gestational diabetes mellitus

Background: Currently,the blood glucose control in women with gestational diabetes (GDM) in Vietnam has been still based on the criteria applied for non-pregnant diabetic patients, while these GDM patients require more specific criteria in order to get a better care of the women and the good delivery outcome. Objective: To determine serum fructosamine target as a supporting test for the treatment and follow-up of GDM. Methodology: A prospective study was done in 451women with GDM at Cho Ray Hospital from August 2016 to March 2019.At least 2 of 3 tests (Go, G2 and HbA1c) and serum fructosamine were determined every 2-3 week-up until delivery. Result: The target fructosamine reference value at Cho Ray Hospital was 188.5±42.3µmol/L. Conclusion: The specific target of serum fructosamine in GDM treatment at Cho Ray hospital should be £188.5 ± 42.3mmol/L.

Evaluating the effectiveness of standard tube feeding product on neurology surgery patients at Choray hospital

Rationale: Tube feeding in critically ill patients, especially after brain injury, is essential in critical care. However, the intolerance, complications related to tube feeding and high cost of imported products in Vietnam have been reported. Therefore, a clinical trial in the neurological patients of the Department of Neurology was implemented in Cho Ray Hospital.

KẾT QUẢ DÀI HẠN PHẪU THUẬT CẦU NỐI ĐỘNG MẠCH CHỦ NGỰC - ĐỘNG MẠCH CẢNH - DƯỚI ĐÒN

Objectives: The complex stenosis of the branches of the aortic arch is rare, it was the challenge for vascular surgeon to manage. The purpose of thisstudy was review our experience with diagnosis and surgical treatment for complex stenosis of the branches of the aortic arch .Methods: Prospective. Eveluate the clinical characteristics of complex stenosis of the branches of the aortic arches. Diagnosis was based on Dupplex scanning, MSCT and angiography. Intrathoracic bypass was indicated for all cases. Results: From 10/1999 to 10/2011, twelve patients with complex stenosis of the branches of the aortic arch were treated in Choray hospital and Thong nhat hospital. 4 cases stenosis of the carotid and the subclavian artery; 4 cases have stenosis the branchiocephalic artery; and 4had stenosis all of the branches of the aortic arch. 10 cases admission because of chronic upper extremity ischemia. 12 cases had TIA. Takayashu’s disease affected in 6 cases, atherosclerosis was the cause of 6 patients. All patients were diagnosed by Duplex scan, MSCT and arteriography. 2 cases with 99 percent stenosis, the others were completely occluded.Upper partial sternotomy were performed in all cases.; Aorto carotido-subclavian bypass in 7 cases; Aorto bi-carotid bi-subclavian bypass were performed in 4 cases; Branchiocephalo carotid and subclavian bypass in 1 case, PTFE prothesis graft was used in 2 cases. Dacron prothesis was used in the rest .No procedure-related mortality was observed. No stroke. There are 1 wound infection, No restenosis after 12 years follow up.Conclusions: Upper partial sternotomy is a very good approach for ascending aorto carotidosubclavian bypass operation. Ascending aorto carotido subclavian bypass should be done for stenosis of multi-branches.

Prevalence and Clinical Profile of Undiagnosed Diabetes Mellitus: Data from a Tertiary Hospital

The prevalence of diabetes mellitus in Vietnam is relatively low compared to other Asian countries, but it is accelerating with the economic and cultural transition. This study aimed to estimate the current prevalence and clinical profile of undiagnosed diabetes mellitus in a tertiary hospital in the south of Vietnam. A cross-sectional investigation was conducted to recruit 1, 250 participants, who were at least 18 year-old and randomly sampled from Cho Ray Hospital, Ho Chi Minh City, Vietnam. Fasting plasma glucose concentration and HbA1c were measured for each individual. The American Diabetes Association criteria were used to diagnose diabetes. Demographic data and other clinical characteristics of diabetes were also documented, including age, sex, residence, educational status, weight, height, waist and hip circumferences, blood pressure, familial history of diabetes, and lipid profile. The prevalence of undiagnosed diabetes mellitus was 7.5% in the population studied. Age, waist circumference, waist-hip ratio, body mass index, and hypertension, as well as dyslipidaemia were well-correlated with the diabetes rate. The prevalence of undiagnosed diabetes mellitus is increasing far more than expected. Newly diagnosed diabetic patients usually presented with multiple comorbidities, including overweight/ obesity, hypertension, and dyslipidaemia.

The initial study of EBNA-2 polymorphisms in nasopharyngeal carcinoma in Vietnam

Epstein-Barr virus (EBV) infection is the main cause of Nasopharyngeal Carcinoma (NPC). EBNA-2, one of the most important genes participating in the formation of NPC, also helps EBV evade an attack on the immune&#x0D; system. EBNA-2 has 4 variants including E2-A, E2-B, E2-C and E-2D, of which E2-A and E2-C are the characterized variants for NPC. This study aimed to evaluate the variations of EBNA-2 in NPC biopsy samples of Vietnamese patients. This initial study used 10 biopsy samples, which were positively confirmed to NPC, collected from Cho Ray Hospital. Nested PCR – nucleotide sequencing was applied to analyze the variants of EBNA-2. The results showed that 8 out of 10 samples, accounting for 80%, were positive to EBNA-2. Additionally, only two variants, E-2A and E-2C were detected in our study, in which, E2-A subtype was identified as the predominant subtype. These findings would provide initial data about potential contribution of EBNA-2 polymorphisms to etiology of NPC in Vietnamese population.

PRECIPITATING FACTORS AND EFFICACY OF COMBINING LACTULOSE PLUS RIFAXIMIN IN THE TREATMENT OF HEPATIC ENCEPHALOPATHY DUE TO CIRRHOSIS AT CHO RAY HOSPITAL

Background: Hepatic encephalopathy is an important evidence that confirms impairment of liver function, may occur in about 40% of cirrhotics. Data about efficacy of rifaximin plus lactulose in the treatment of Vietnamese patients was still limited. This study aimed to determine the precipitating factors and to access the efficacy of lactulose plus rifaximin in overt hepatic encephalopathy. Patients and Methods: The prospective single-blind randomized controlled trial, 43 cirrhotics with overt hepatic encephalopathy without portal systemic shunting addmitted to gastroenterology department of Cho Ray Hospital from March 2019 to August 2019, were randomized into two groups (group A lactulose plus rifaximin 1.100 mg/day, n = 21; and group B only lactulose; n = 22). All patients were recorded for onset factors, clinical characteristics and assessing the recovery of hepatic encephalopathy. Results: The mean age of patients in this study was 54.8 ± 12.1 years (the ratio of male to female patients is 4.38 : 1). The leading cause of cirrhosis was alcohol (39.5%). The most common clinical symptoms were jaundice (83.7%), spider naevi (41.9%) and ascites (37.2%). The most common triggers were infection (51.2%), gastrointestinal bleeding (37.2%) and constipation (25.6%). The percentage of patients with complete improvement after treatment with lactulose plus rifaximin was 81% compared to 63.6% in the lactulose-treated patients only (95% CI: 0.539 - 1.147, p value = 0.206). Conclusion: Our data revealed that common triggers of hepatic encephalopathy were infections, gastrointestinal bleeding and constipation. The combination of lactulose plus rifaximin was more effective than rifaximin alone in the treatment of overt hepatic encephalopathy. Key words: hepatic encephalopathy, precipitating factor, lactulose, rifaximin

Carbapenem Resistant Gene of Pseudomonas Aeruginosa

Truong Thien Phu01*, Le Phuong Mai2, Ngo Minh Quan2, Nguyen Van Thanh2, Ta Tuan Khanh2, Truong Ngoc Huong3 and Pham Thi Ngoc Thao4 Author Affiliations 1Department of Microbiology, Cho Ray Hospital, Vietnam 2Department of Microbiology, Cho Ray Hospital, Vietnam 3Department, of Medical Equipment Cho Ray Hospital, Vietnam 4Deputy Director of Cho Ray Hospital, Vietnam Received: July 06, 2020 | Published: July 17, 2020 Corresponding author: Truong Thien Phu, Head of Microbiology Department, Cho Ray Hospital, Vietnam DOI: 10.26717/BJSTR.2020.29.004730

COMPARISON THE PNED SCORE WITH THE GB, AIMS65 SCORES FOR RISK STRATIFICATION IN PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING

Back ground: Upper gastrointestinal bleeding (UGIB) is a common cause of internal medical or surgical emergencies and often make the life-threatening risks to patients. The stratification of risk in triage the patients with UGIB is very critical for clinicians. PNED score is still a fairly new scale in Vietnam and currently no research that evaluated and compared it with the GB and AIMS65 scores in risk stratification of UGIB patients has been found. This study were aimed to (i) evaluate the accuracy, predictive value of the GB, AIMS65 and PNED scores and (ii) to compare the PNED score with the GB and AIMS65 scores in risk stratification of patients with upper gastrointestinal bleeding on admission to the Department of Gastroenterology at Cho Ray Hospital. Subjects and Research Methods: A prospective cohort study investigating all patients presenting with UGIB on admission and treatment at the Department of Gastroenterology in Cho Ray Hospital from March 15th, 2019 to August 30th, 2019. We calculated PNED, GB, AIM65 scores and compared the area under the ROC curve (AUC) to determine the predicted value of the scores. Results: One hundred and seventy-five patients were included. Median age of 59.51 ± 14.36, male/female ratio of 2.07/1, proportion of patients requiring blood transfusion intervention: 45.1%, hemostatic endoscopy: 30.3%, surgery: 0.57%, re-bleeding during hospitalization: 9.7%, overall mortality: 5.1%. About predicting required blood transfusion intervention of GB score was highest then PNED score and finally AIMS65 score with AUC respectively 67.1%; 63.1%; 56.4% (p&lt;0.001). About predicting endoscopic intervention of PNED score was highest then GB score and finally AIMS65 score with AUC respectively 62.2%; 55.1%; 52.7%. About predicting required medical intervention of PNED score was highest then GB score and finally AIMS65 score with AUC respectively 69.7%; 66.2%; 56.3%. About predicting required re-bleeding of PNED score was highest then GB score score with AUC respectively 80.8%; 62.1%. AUC of AIMS65 score of 48.5% has no value in predicting re-bleeding. About predicting the risk of mortality of AIMS65 score was highest then GB score score and finally PNED score with AUC respectively 77.3%; 73.5%; 61.3%. The PNED score with a cut-off ≥ 6, has a positive predictive value is high for the overall medical intervention (76.81%) compared with GB score (68.33%) has cut-off ≥ 9 and AIMS65 score (61.33%) has cut-off ≥ 2. Conclusion: The PNED score is superior to the GB and AIMS65 scores in predicting hemostatic interventions, general medical interventions and re-bleeding. Key words: Upper gastrointestinal bleeding, PNED score, GB score, AIM65 score

PDG11 COST MINIMIZATION ANALYSIS OF TRASTUZUMAB SUBCUTANEOUS VERSUS INTRAVENOUS IN TREATMENT OF HER2-POSITIVE EARLY OR METASTATIC BREAST CANCER IN VIETNAM

The advent of trastuzumab biological medicine has opened up new strides in treatment of HER2-positive (HER2+) breast cancer. With the same efficacy and safety, trastuzumab subcutaneous (T-SC) is considered more advantagous than intravenous (T-IV) in terms of usability. With higher price of T-SC than T-IV, it is necessary to assess the economic efficiency of T-SC versus T-IV to consider the feasibility of using new therapies in clinical practice with tight medical budgets. Cost minimization analysis was used with cost components including drug cost, labor cost, other costs related to route of use, non-medical direct and indirect costs. The necessary information in the study was collected based on patient interviews and expert opinions at K hospital, Cho Ray hospital, Ho Chi Minh city Oncology hospital, Ha Noi Oncology hospital, Da Nang Oncology hospital and Bach Mai hospital. With an average weight of 54.78 ± 0.49 kg, T-SC is more economical than T-IV for each cycle from 2.51 to 3.65 million VND when not counting waste; from 3.55 to 4.59 million VND when calculating 10% of T-IV wastes and from 12.90 to 13.09 million VND when calculating 100% of T-IV wastes. For the entire course of treatment, T-SC economises from 45.11 to 232.16 million VND in early stage and from 25.52 to 91.65 million VND in metastasis stage depending on the percentage of wastage. In the minimized cost components, drug cost accounts for the highest proportion, fluctuating from 70.52% to 94.27% based on stage and portion of wastage. Other cost components are insignificant and do not change the value in all cases. T-SC is more economical than T-IV in treatment of HER2+ breast cancer in both cases of early and metastasis stage. In particular, drug cost is the most economical.

The validity of reticulocyte hemoglobin content and percentage of hypochromic red blood cells for screening iron-deficiency anemia among patients with end-stage renal disease: a retrospective analysis

BackgroundEarly detection of iron-deficiency anemia (IDA) can enhance the efficiency and effectiveness of clinical treatment and quality of life for end-stage renal disease (ESRD) patients. This study aimed to evaluate the validity of CHr and %Hypo in screening IDA among ESRD patients and compare their performance with screening IDA among non-ESRD patients.MethodA retrospective analysis of 312 participants was conducted at Cho Ray Hospital, Vietnam, including healthy control participants and ESRD patients. Receiver operator characteristics curves and the area under the curve (AUC) of models were used to evaluate the performance of CHr, %Hypo. Optimal cut-off values were determined using Youden’s index.ResultsDetecting IDA in ESRD patients is more complicated, as the screening performance of CHr and %Hypo in predicting IDA among ESRD patients were lower than non ESRD group, but still reasonable with AUC = 0.748 (95% CI: 0.656–0.840, power = 0.997) and 0.740 (95% CI: 0.647–0.833, power = 0.996), respectively. Cut-off values of CHr < 31.5 pg and %Hypo> 10.0 pg are recommended to obtain optimal screening ability for Vietnamese ESRD patients.ConclusionCHr and %Hypo appears to be useful tools for screening IDA among both non ESRD and ESRD patients. The low cost and accessible of the two markers encourage their utility as effective screening tools in clinical practice.