MedPharmRes

Quantitative vaginal fluid creatinine in prelabor rupture of membranes (PROM): factors associated with diagnostic power

2024-03-07T03:29:22+07:00

Introduction:

Prelabor rupture of membranes (PROM) remains a challenge in obstetrics with serious complications. Quantitative vaginal fluid creatinine concentration is a promising test for diagnosing PROM in resource-limiting settings. However, uncovered factors may affect the diagnostic power of this potential test. We aimed to investigate how clinical factors may affect this diagnostic power.

Methods:

We conducted a case-control diagnostic test study at Hung Vuong Maternity Hospital, Vietnam. Pregnant women between 24–42 weeks were enrolled into case and control groups, with a ratio of 1:2. Sterile speculum examination for fluid leak from cervix, nitrazine test and ferning test were used to determine membranes’ status. Quantitative creatinine from vaginal fluid was measured using the Jaffe method. We calculated sensitivity and specificity to describe the test’s diagnostic power. The receiver operating characteristic (ROC) curve and Youden’s J statistic were used to identify the optimal cut-off value of the test. Logistics regression models were used to detect factors that may affect the diagnostic power of the test. Ethics approval was obtained from the local ethics committee and all participants gave written informed consent.

Results:

We recruited a total of 693 pregnant women into the study – 231 participants in the study group and 462 participnts in the control group. There were two clinical factors affecting diagnostic power of quantitative vaginal fluid creatinine concentration: dilated cervix [OR=6.08(4.26–8.68); p<0.001) and urinary incontinence [OR=0.52(0.29–0.92); p=0.03). The optimal cut-off value for creatinine concentration is 0.29 mg/dL in the general group, in the closed cervix group and in the group with no urinary incontinence during pregnancy. The dilated cervix group provided a lower cut-off value (0.26 mg/dL) while the urinary incontinence group had a higher cut-off value (0.31 mg/dL). They both had lower diagnostic powers compared to the general group. However, the test accuracy, sensitivity and specificity remain above 90% in all subgroups.

Conclusions:

Quantitative creatinine in vaginal fluid is a potential diagnostic test for PROM in resource-limiting settings. Doctors should remain vigilant about its limitation in clinical applications.

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Outcomes of complex mitral valve repair through right mini-thoracotomy using artificial chordae

2024-03-07T03:29:24+07:00

Introduction:

Mitral regurgitation (MR) affects 2%–3% of the global population. The rising incidence of degenerative causes in developing countries leads to an increase in the number of surgeries for degenerative MR. In this study, we aimed to evaluate the safety, feasibility, and effectiveness of minimally invasive mitral repair (MIMR) using artificial chordae in complex cases of mitral valve regurgitation.

Methods:

This is a retrospective analysis of MIMR through right mini-thoracotomy approach with intermediate-to-complex level of repair difficulty. We analyzed the demographic information, echocardiography results, surgical details, and mid-term survival outcomes.

Results:

49 patients underwent surgery with a mean age of 49.1±13.3 years. 34 patients (69.39%) were classified as having intermediate level of MR complexity, four patients (8.2%) had a complex mitral valve score, and 11 patients (22.4%) were diagnosed with Barlow’s disease. We performed a ring annuloplasty in all patients, with additional repair techniques including edge-to-edge (10.2%), commisuroplasty (26.5%), and interscallop indentation closure (22.5%). There were no in-hospital deaths. We recorded three cases with minor complications: one case of pleural effusion, one case of low cardiac output syndrome, and one case of acute lower limb compartment syndrome. Cumulative recurrent MR rates measured at 12-mon, 24-mon and 36-mon are 92%, 88%, and 84%, respectively.

Conclusions:

MIMR of complex mitral valves using artificial chordae was effective, with low complication and recurrent rates. Optimal results can be achieved through proper lesion evaluation and choosing the appropriate repair strategies using artificial chordae combining with edge-to-edge, commisuroplasty or indentation closure techniques.

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Using team-based learning for post-graduate training: challenges and solutions

2024-03-07T03:29:25+07:00

Introduction:

Available evidence demonstrates that team-based learning (TBL) enhances teacher-learner interactions, solves cognitive gaps, connects concepts, and builds critical thinking. Nowadays, TBL has become a popular approach in undergraduate training (UGT). Surprisingly, only a few institutions implemented TBL into their post-graduate training (PGT) programs. UGT and PGT differ in their educational ecosystem, learning goals, and learner characteristics. Attempting to use TBL in PGT (TBL-PGT) requires adaptations to these differences. There are few conducted studies on TBL-PGT. Most discuss the possibility of using TBL in specific courses and do not discuss technical issues. We also experience challenges during our experiential TBL-PGT course. This paper aims to clarify TBL-PGT characteristics, identify potential challenges and discuss suitable solutions.

Methods:

We search papers on TBL-PGT, identify technical issues and discuss potential solutions.

Results:

To date, no systematic use of TBL in any post-graduate programs. All TBL-PGT attempts were experiential. The authors agreed that TBL could be part of the PGT program and that implementing TBL-PGT requires suitable adaptations. Experiences from experiential TBL-PGT affirm the crucial role of adapting course design to the particular PGT educational ecosystem, the complexity of knowledge, and the ability to link new concepts to real-life activities.We identify factors that might influence the TBL-PGT program outcomes, which include involving experts, enhancing learner accountability, building teams, determining educational goals, configuring assessments, preparing learning material, formulating authentic applications, training facilitators, and organizing in-class activities.

Conclusions:

TBL is suitable for PGT. It promotes certain advantages. However, curriculum developers should consider adaptations while implementing TBL-PGT.

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A retrospective study of hematological and biochemical parameters in coronavirus disease 2019 (COVID-19) patients in Vietnam

2024-03-07T03:29:26+07:00

Introduction:

The coronavirus disease 2019 (COVID-19) pandemic caused by the SARS-CoV-2 virus has had a serious impact on global public health. Currently, there are not many studies evaluating the impact of COVID-19 on changes in biochemical and hematological parameters of COVID-19 patients in Vietnam. This study aimed to investigate clinical characteris tics and changes in hematological and biochemical parameters in COVID-19 patients.

Methods:

This retrospective and cross-sectional study collected the medical records of 654 COVID-19 patients treated at Dong Nai General Hospital from August to December 2021. Medical information from COVID-19 patients was collected through handwritten medical records and HIS-FP software.

Results:

The age of the study population was 56.69±15.97. Diabetes was the most common comorbidity and had a significant relationship with COVID-19 severity and mortality. For hematological tests, total white blood cell (WBC) and Percentage of neutrophils (%NEU) in non-survivors (12.87±6.45) signifi- cantly increased compared with survivors (9.08±4.48) (p<0.001). Neutrophils (NEU), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) increased in both non-survivors and survivors; lymphocytes (LYM) and percentage of lymphocyte (%LYM) decreased in both groups. For biological parameters, aspartate transaminase (AST) in non-survivors [55.9 (38.5–89.1)] significantly increased compared with survivors [36.55 (23.02–67.12)] (p<0.001). Lactate dehy drogenase (LDH) activity, C-reactive protein (CRP), and D-dimer levels increased in both non-survivors and survivors.

Conclusions:

NEU, LYM, NLR, PLR, LDH, CRP, and D-dimer were related to the severity of COVID-19 disease.

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Survey of the characteristics of numbness in ischemic stroke patients: a cross-sectional study in the early rehabilitation phase

2024-03-07T03:29:26+07:00

Introduction:

Sensory disturbance is a common symptom of post-stroke. In traditional Chinese medicine (TCM), this symptom is classified as numbness (Ma Mu). While there have been many studies on the therapeutic effect of numbness in TCM, little research has been conducted on the characteristics of numbness. This study aimed to investigate the characteristics of numbness in patients with ischemic stroke in the early rehabilitation phase.

Methods:

This study consisted of two phases. Phase 1 investigated the characteristics of numbness based on medical literature; Phase 2 investigated the characteristics of numbness in patients with ischemic stroke in the early rehabilitation phase based on the cross-sectional study.

Results:

Phase 1 identified 9 characteristics of numbness based on 11 medical /literature, including: S1 (feeling of heaviness in the affected area), S2 (feeling of tension in the affected area), S3 (sensation of crawling insects), S4 (numbness in a fixed position), S5 (increased numbness with movement), S6 (increased numbness when exposed to cold), S7 (increased numbness when exposed to moisture), S8 (decreased with warm compresses), S9 (decreased when pressed). Phase 2, a clinical survey of 67 patients, recorded 9 characteristics (S1 to S9). We found that there is a relationship between the degree of sensory disturbance according to Fugl-Meyer Assessment with S2 and S6, and obesity with S5.

Conclusions:

The study examined the characteristics of numbness in ischemic stroke patients in the early rehabilitation phase from the perspective of TCM. This study provided a basis for individualized diagnosis and treatment combining traditional and modern medicine.

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Investigating the effect of processing conditions on the content of glycyrrhizic acid in licorice (Radix et Rhizoma Glycyrrhizae)

2024-04-25T10:15:11+07:00

Introduction:

Licorice is the root of Glycyrrhiza uralensis Fisch or Glycyrrhizae inflata L. or Glycyrrhiziae glabra L. It was a familiar medicinal herb in traditional medicine, which was commonly used in two different forms raw licorice (Sinh Cam thao) and honey-fried licorice (Chich Cam thao), with completely different effects. The processing enhanced the impact on the Spleen and Stomach organs and tonified Qi but reduced the bioactivities of clearing heat, antitussive, and detoxifying. The purpose of this study was to propose a processing method that minimizes the degradation of the main bioactive compound, glycyrrhizic acid in licorice.

Methods:

Honey-fired licorice was processed according to the guidance of Circular 30/2017/TT-BYT of the Vietnamese Ministry of Health. The frying conditions such as frying temperature, honey soaking time, the ratio of honey to licorice, and the ratio of water to honey were investigated in order. The content of glycyrrhizic acid was determined according to the process of Vietnamese Pharmacopoeia V.

Results:

Glycyrrhizic acid was least decomposed when processing honey-fired licorice under the following conditions: the frying temperature of 260°C, the honey soaking time of 1 hour, the ratio of honey to licorice was 1:10, and the ratio of water to honey was 1:1.

Conclusions:

The content of glycyrrhizic acid in licorice was influenced by the frying process, in which temperature was the most significant factor. Honey was an ingredient that altered the effects of licorice in traditional medicine, however, the presence of honey also contributed to the degradation of glycyrrhizic acid in this medicinal herb.

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Clinical characteristics and risk factors of in-hospital mortality in patients with Takotsubo syndrome

2024-04-25T10:20:46+07:00

Introduction:

Takotsubo cardiomyopathy is a condition of transient systolic dysfunction triggered by emotional or physical stress. Nowadays, Takotsubo cardiomyopathy is gaining attention and has been detected more frequently. However, there is no collected data on Vietnamese subjects. This study aims to describe the clinical characteristics of patients diagnosed with Takotsubo cardiomyopathy and determine of rates and independent risk factors for in-hospital mortality.

Methods:

A retrospective andobservational study was conducted at the University Medical Center Ho Chi Minh City, involved 103 patients diagnosed with Takotsubo cardiomyopathy between January 2015 and June 2022. The diagnosis was made based on the revised Mayo Clinic diagnostic criteria.

Results:

The average age of the study population was 71.2±15.3 years, with females accounting for 64.1% of the patients. The most common comorbidities among the patients were hypertension (57.3%), diabetes mellitus (30.1%), ischemic heart disease (15.5%), and chronic obstructive pulmonary disease (15.5%). Acute heart failure was observed in 30.1% of the patients, while ventricular arrhythmias were present in 17.6% of cases. The majority of triggers were attributed to physical factors, including infection (37.9%), respiratory failure (18.4%), postoperative status (3.9%), and acute neurological disease (2.9%). The in-hospital mortality rate was 17.5%, and the independent risk factors were identified as acute heart failure (OR=20.657, 95%CI 2.306–185.008, p=0.007) and respiratory failure (OR=10.397, 95% CI 1.117–96.795, p=0.040).

Conclusions:

Takotsubo cardiomyopathy patients have many comorbidities and are often triggered by physical factors. The in-hospital mortality rate is significant, with acute heart failure and respiratory failure identified as independent risk factors.

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The analgesic and disability improvement effects of trigger points electroacupuncture on chronic low back pain patients: an uncontrolled before-and-after study

2024-04-25T10:25:05+07:00

Introduction:

Low back pain (LBP) is the most common cause of disability in patients aged 45 to 65. Traditional medicine plays an important role in the treatment of this disease. Especially, electroacupuncture at 100 Hz is effective in the improvement of pain and symptoms. In addition, clinical and research evidence shows that trigger points acupuncture is effective in LBP treatment. However, these studies have small sample sizes, so their reliability is not high. Thus, our study aims to evaluate the effect of trigger points electroacupuncture (TrP-EA) at 100 Hz on chronic LBP patients with larger sample sizes.

Methods:

37 patients diagnosed with chronic LBP received TrP-EA at 100 Hz for 4 weeks. Outcome measures were the visual analogue scale (VAS), roland morris questionnaire (RMQ), and Oswestry low back pain disability index (ODI).

Results:

Compared with the pre-treatment baseline, VAS, RMQ, and ODI improved dramatically after 1 week of treatment (p<0.01), 2 weeks of treatment (p<0.01), 3 weeks of treatment (p<0.01) and 4 weeks of treatment (p<0.01).

Conclusions:

The results suggest that TrP-EA at 100 Hz had analgesic efficacy and may have the potential to improve disability in patients with chronic LBP.

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