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McBride A, Duyen HTL, Vuong NL, Tho PV, Tai LTH, Phong NT, Ngoc NT, Yen LM, Nhat PTH, Vi TT, Llewelyn MJ, Thwaites L, Hao NV, Yacoub S. Endothelial and inflammatory pathophysiology in dengue shock: New insights from a prospective cohort study in Vietnam. PLoS Negl Trop Dis 2024; 18:e0012071. [PMID: 38536887 PMCID: PMC11020502 DOI: 10.1371/journal.pntd.0012071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/16/2024] [Accepted: 03/14/2024] [Indexed: 04/18/2024] Open
Abstract
Dengue shock (DS) is the most severe complication of dengue infection; endothelial hyperpermeability leads to profound plasma leakage, hypovolaemia and extravascular fluid accumulation. At present, the only treatment is supportive with intravenous fluid, but targeted endothelial stabilising therapies and host immune modulators are needed. With the aim of prioritising potential therapeutics, we conducted a prospective observational study of adults (≥16 years) with DS in Vietnam from 2019-2022, comparing the pathophysiology underlying circulatory failure with patients with septic shock (SS), and investigating the association of biomarkers with clinical severity (SOFA score, ICU admission, mortality) and pulmonary vascular leak (daily lung ultrasound for interstitial and pleural fluid). Plasma was collected at enrolment, 48 hours later and hospital discharge. We measured biomarkers of inflammation (IL-6, ferritin), endothelial activation (Ang-1, Ang-2, sTie-2, VCAM-1) and endothelial glycocalyx breakdown (hyaluronan, heparan sulfate, endocan, syndecan-1). We enrolled 135 patients with DS (median age 26, median SOFA score 7, 34 required ICU admission, 5 deaths), together with 37 patients with SS and 25 healthy controls. Within the DS group, IL-6 and ferritin were associated with admission SOFA score (IL-6: βeta0.70, p<0.001 & ferritin: βeta0.45, p<0.001), ICU admission (IL-6: OR 2.6, p<0.001 & ferritin: OR 1.55, p<0.001) and mortality (IL-6: OR 4.49, p = 0.005 & ferritin: OR 13.8, p = 0.02); both biomarkers discriminated survivors and non-survivors at 48 hours and all patients who died from DS had pre-mortem ferritin ≥100,000ng/ml. IL-6 most strongly correlated with severity of pulmonary vascular leakage (R = 0.41, p<0.001). Ang-2 correlated with pulmonary vascular leak (R = 0.33, p<0.001) and associated with SOFA score (β 0.81, p<0.001) and mortality (OR 8.06, p = 0.002). Ang-1 was associated with ICU admission (OR 1.6, p = 0.005) and mortality (OR 3.62, p = 0.006). All 4 glycocalyx biomarkers were positively associated with SOFA score, but only syndecan-1 was associated with ICU admission (OR 2.02, p<0.001) and mortality (OR 6.51, p<0.001). This study highlights the central role of hyperinflammation in determining outcomes from DS; the data suggest that anti-IL-1 and anti-IL-6 immune modulators and Tie2 agonists may be considered as candidates for therapeutic trials in severe dengue.
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Affiliation(s)
- Angela McBride
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Brighton and Sussex Medical School, Brighton, United Kingdom
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Nguyen Lam Vuong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Phan Vinh Tho
- Hospital for Tropical Disease, Ho Chi Minh City, Vietnam
| | | | | | | | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Tran Thuy Vi
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nguyen Van Hao
- Hospital for Tropical Disease, Ho Chi Minh City, Vietnam
| | - Sophie Yacoub
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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2
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Hai HB, Cattrall JWS, Hao NV, Van HMT, Thuy DB, Nhat PTH, Khanh PNQ, Duong HTH, Duong TD, Lu P, Phuong LT, Greeff H, Zhu T, Yen LM, Clifton D, Thwaites CL. Heart Rate Variability Measured from Wearable Devices as a Marker of Disease Severity in Tetanus. Am J Trop Med Hyg 2024; 110:165-169. [PMID: 37983924 DOI: 10.4269/ajtmh.23-0531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/17/2023] [Indexed: 11/22/2023] Open
Abstract
Tetanus is a disease associated with significant morbidity and mortality. Heart rate variability (HRV) is an objective clinical marker with potential value in tetanus. This study aimed to investigate the use of wearable devices to collect HRV data and the relationship between HRV and tetanus severity. Data were collected from 110 patients admitted to the intensive care unit in a tertiary hospital in Vietnam. HRV indices were calculated from 5-minute segments of 24-hour electrocardiogram recordings collected using wearable devices. HRV was found to be inversely related to disease severity. The standard deviation of NN intervals and interquartile range of RR intervals (IRRR) were significantly associated with the presence of muscle spasms; low frequency (LF) and high frequency (HF) indices were significantly associated with severe respiratory compromise; and the standard deviation of differences between adjacent NN intervals, root mean square of successive differences between normal heartbeats, LF to HF ratio, total frequency power, and IRRR, were significantly associated with autonomic nervous system dysfunction. The findings support the potential value of HRV as a marker for tetanus severity, identifying specific indices associated with clinical severity thresholds. Data were recorded using wearable devices, demonstrating this approach in resource-limited settings where most tetanus occurs.
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Affiliation(s)
- Ho Bich Hai
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Jonathan W S Cattrall
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Department of Psychiatry, University of Oxford, United Kingdom
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- University Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Ha Thi Hai Duong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
| | - Tran Duc Duong
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Ping Lu
- Institute of Biomedical Engineering, University of Oxford, United Kingdom
| | - Le Thanh Phuong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Heloise Greeff
- Institute of Biomedical Engineering, University of Oxford, United Kingdom
| | - Tingting Zhu
- Institute of Biomedical Engineering, University of Oxford, United Kingdom
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - David Clifton
- Institute of Biomedical Engineering, University of Oxford, United Kingdom
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
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3
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Van Hao N, Tung DH, Hung NP, Hoa VX, Ha NT, Khanh Van NT, Tan PT, Van Trinh P. Green, facile and fast synthesis of silver nanoparticles by using solution plasma techniques and their antibacterial and anticancer activities. RSC Adv 2023; 13:21838-21849. [PMID: 37475759 PMCID: PMC10354697 DOI: 10.1039/d3ra03454b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023] Open
Abstract
We herein present a simple, fast, efficient and environmentally friendly method for preparing silver nanoparticles (AgNPs) using the solution plasma method in the presence of extracts from Paramignya trimera (P. trimera). The effects of P. trimera extract concentrations and the applied voltage on the formation of AgNPs were investigated. Surface plasmon resonance spectra show a strong peak at 413 nm for the prepared samples. The Fourier-transform infrared spectroscopy measurement results indicated the presence of possible functional groups in the prepared AgNPs. Morphological analysis revealed that the AgNPs were spherical with an average size of 8 nm. The prepared AgNPs exhibited good stability in solution compared to that of AgNPs prepared by the solution plasma technique without P. trimera extract. The formation mechanism of AgNPs is also proposed. The prepared AgNPs exhibited high antibacterial ability against Gram (+) Staphylococcus aureus, Gram (-) Pseudomonas aeruginosa bacteria and strong anticancer activity for the AGS gastric cancer cell line. The obtained results demonstrated that this is a simple, rapid, environmentally friendly method for preparing AgNPs instead of conventional methods using chemical reducing agents for potential applications.
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Affiliation(s)
- Nguyen Van Hao
- Institute of Sciences and Technology, TNU - University of Sciences Tan Thinh Ward Thai Nguyen City Vietnam
| | - Do Hoang Tung
- Institute of Physics, Vietnam Academy of Science and Technology 18 Hoang Quoc Viet Str., Cau Giay Distr. Hanoi Vietnam
| | - Nguyen Phu Hung
- Faculty of Biotechnology, TNU - University of Sciences Tan Thinh Ward Thai Nguyen City Vietnam
| | - Vu Xuan Hoa
- Institute of Sciences and Technology, TNU - University of Sciences Tan Thinh Ward Thai Nguyen City Vietnam
| | - Ngo Thu Ha
- Faculty of Biotechnology, TNU - University of Sciences Tan Thinh Ward Thai Nguyen City Vietnam
| | - Nguyen Thi Khanh Van
- Institute of Sciences and Technology, TNU - University of Sciences Tan Thinh Ward Thai Nguyen City Vietnam
| | - Pham The Tan
- Hung Yen University of Technology and Education Khoai Chau Distr. Hung Yen Province Vietnam
| | - Pham Van Trinh
- Institute of Materials Science, Vietnam Academy of Science and Technology 18 Hoang Quoc Viet Str., Cau Giay Distr. Hanoi Vietnam +84 94 319 0301
- Graduated University of Science and Technology, Vietnam Academy of Science and Technology 18 Hoang Quoc Viet Str., Cau Giay Distr. Hanoi Vietnam
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4
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Nhat PTH, Van Hao N, Tho PV, Kerdegari H, Pisani L, Thu LNM, Phuong LT, Duong HTH, Thuy DB, McBride A, Xochicale M, Schultz MJ, Razavi R, King AP, Thwaites L, Van Vinh Chau N, Yacoub S, Gomez A. Clinical benefit of AI-assisted lung ultrasound in a resource-limited intensive care unit. Crit Care 2023; 27:257. [PMID: 37393330 PMCID: PMC10314555 DOI: 10.1186/s13054-023-04548-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/24/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Interpreting point-of-care lung ultrasound (LUS) images from intensive care unit (ICU) patients can be challenging, especially in low- and middle- income countries (LMICs) where there is limited training available. Despite recent advances in the use of Artificial Intelligence (AI) to automate many ultrasound imaging analysis tasks, no AI-enabled LUS solutions have been proven to be clinically useful in ICUs, and specifically in LMICs. Therefore, we developed an AI solution that assists LUS practitioners and assessed its usefulness in a low resource ICU. METHODS This was a three-phase prospective study. In the first phase, the performance of four different clinical user groups in interpreting LUS clips was assessed. In the second phase, the performance of 57 non-expert clinicians with and without the aid of a bespoke AI tool for LUS interpretation was assessed in retrospective offline clips. In the third phase, we conducted a prospective study in the ICU where 14 clinicians were asked to carry out LUS examinations in 7 patients with and without our AI tool and we interviewed the clinicians regarding the usability of the AI tool. RESULTS The average accuracy of beginners' LUS interpretation was 68.7% [95% CI 66.8-70.7%] compared to 72.2% [95% CI 70.0-75.6%] in intermediate, and 73.4% [95% CI 62.2-87.8%] in advanced users. Experts had an average accuracy of 95.0% [95% CI 88.2-100.0%], which was significantly better than beginners, intermediate and advanced users (p < 0.001). When supported by our AI tool for interpreting retrospectively acquired clips, the non-expert clinicians improved their performance from an average of 68.9% [95% CI 65.6-73.9%] to 82.9% [95% CI 79.1-86.7%], (p < 0.001). In prospective real-time testing, non-expert clinicians improved their baseline performance from 68.1% [95% CI 57.9-78.2%] to 93.4% [95% CI 89.0-97.8%], (p < 0.001) when using our AI tool. The time-to-interpret clips improved from a median of 12.1 s (IQR 8.5-20.6) to 5.0 s (IQR 3.5-8.8), (p < 0.001) and clinicians' median confidence level improved from 3 out of 4 to 4 out of 4 when using our AI tool. CONCLUSIONS AI-assisted LUS can help non-expert clinicians in an LMIC ICU improve their performance in interpreting LUS features more accurately, more quickly and more confidently.
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Affiliation(s)
- Phung Tran Huy Nhat
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
- School of Biomedical Engineering Imaging Sciences, King's College London, London, UK.
| | - Nguyen Van Hao
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Hospital of Tropical Diseases, Ho Chi Minh City, Vietnam
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Phan Vinh Tho
- Hospital of Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Hamideh Kerdegari
- School of Biomedical Engineering Imaging Sciences, King's College London, London, UK
| | - Luigi Pisani
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | | | - Le Thanh Phuong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Angela McBride
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Miguel Xochicale
- School of Biomedical Engineering Imaging Sciences, King's College London, London, UK
| | - Marcus J Schultz
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Reza Razavi
- School of Biomedical Engineering Imaging Sciences, King's College London, London, UK
| | - Andrew P King
- School of Biomedical Engineering Imaging Sciences, King's College London, London, UK
| | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | - Sophie Yacoub
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Alberto Gomez
- School of Biomedical Engineering Imaging Sciences, King's College London, London, UK
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5
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Chau NVV, Trung TN, Khanh PNQK, Nhat PTH, Van HMT, Hai HB, Thuy DB, Tung NLN, Khoa DB, Vien TTD, Hao NV, Oanh PKN, Khoa TD, Phong NT, Nguyen NT, Huynh J, Walker TM, Van Nuil J, An LP, McKnight J, Toan LM, Tan LV, Dung NT, Truong NT, Thwaites CL. Wearable devices for remote monitoring of hospitalized patients with COVID-19 in Vietnam. Wellcome Open Res 2023; 7:257. [PMID: 38601327 PMCID: PMC11004598 DOI: 10.12688/wellcomeopenres.18026.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 04/12/2024] Open
Abstract
Patients with severe COVID-19 disease require monitoring with pulse oximetry as a minimal requirement. In many low- and middle- income countries, this has been challenging due to lack of staff and equipment. Wearable pulse oximeters potentially offer an attractive means to address this need, due to their low cost, battery operability and capacity for remote monitoring. Between July and October 2021, Ho Chi Minh City experienced its first major wave of SARS-CoV-2 infection, leading to an unprecedented demand for monitoring in hospitalized patients. We assess the feasibility of a continuous remote monitoring system for patients with COVID-19 under these circumstances as we implemented 2 different systems using wearable pulse oximeter devices in a stepwise manner across 4 departments.
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Affiliation(s)
| | | | | | - Phung Tran Huy Nhat
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Kings College, London, UK
| | | | - Ho Bich Hai
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Dao Bach Khoa
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | - Tran Dang Khoa
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | | | - Julie Huynh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Timothy M Walker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Jennifer Van Nuil
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Luu Phuoc An
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Jacob McKnight
- Health Systems Collaborative, University of Oxford, Oxford, UK
| | - Le Mau Toan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - C Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - OUCRU COVID Research Group
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Kings College, London, UK
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Health Systems Collaborative, University of Oxford, Oxford, UK
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6
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Pham TTH, Vu XH, Dien ND, Trang TT, Van Hao N, Toan ND, Thi Ha Lien N, Tien TS, Chi TTK, Hien NT, Tan PM, Linh DT. Synthesis of cuprous oxide/silver (Cu 2O/Ag) hybrid as surface-enhanced Raman scattering probe for trace determination of methyl orange. R Soc Open Sci 2023; 10:221623. [PMID: 37234497 PMCID: PMC10206471 DOI: 10.1098/rsos.221623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/17/2023] [Indexed: 05/28/2023]
Abstract
Recently, there have been publications on preparing hybrid materials between noble metal and semiconductor for applications in surface-enhanced Raman scattering (SERS) substrates to detect some toxic organic dyes. However, the use of cuprous oxide/silver (Cu2O/Ag) to measure the trace amounts of methyl orange (MO) has not been reported. Therefore, in this study, the trace level of MO in water solvent was determined using a SERS substrate based on Cu2O microcubes combined with silver nanoparticles (Ag NPs). Herein, a series of Cu2O/Agx (x= 1-5) hybrids with various Ag amounts was synthesized via a solvothermal method followed by a reduction process, and their SERS performance was studied in detail. X-ray diffraction (XRD) and scanning electron microscopy results confirmed that 10 nm Ag NPs were well dispersed on 200-500 nm Cu2O microcubes to form Cu2O/Ag heterojunctions. Using the as-prepared Cu2O and Cu2O/Agx as MO probe, the Cu2O/Ag5 nanocomposite showed the highest SERS activity of all samples with the limit of detection as low to 1 nM and the enhancement factor as high as 4 × 108. The logarithm of the SERS peak intensity at 1389 cm-1 increased linearly with the logarithm of the concentration of MO in the range from 1 nM to 0.1 mM.
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Affiliation(s)
- Thi Thu Ha Pham
- Faculty of Chemistry, TNU-University of Sciences, Tan Thinh ward, Thai Nguyen city 24000, Vietnam
| | - Xuan Hoa Vu
- Institute of Science and Technology, TNU-University of Sciences, Tan Thinh ward, Thai Nguyen city 24000, Vietnam
| | - Nguyen Dac Dien
- Faculty of Occupational Safety and Health, Vietnam Trade Union University, 169 Tay Son street, Dong Da district, Ha Noi city 100000, Vietnam
| | - Tran Thu Trang
- Institute of Science and Technology, TNU-University of Sciences, Tan Thinh ward, Thai Nguyen city 24000, Vietnam
| | - Nguyen Van Hao
- Institute of Science and Technology, TNU-University of Sciences, Tan Thinh ward, Thai Nguyen city 24000, Vietnam
| | - Nguyen Duc Toan
- Centre for Quantum Electronics, Institute of Physics, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet road, Cau Giay district, Ha Noi city 100000, Vietnam
| | - Nghiem Thi Ha Lien
- Centre for Quantum Electronics, Institute of Physics, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet road, Cau Giay district, Ha Noi city 100000, Vietnam
| | - Tong Sy Tien
- University of Fire Prevention and Fighting, 243 Khuat Duy Tien road, Thanh Xuan district, Ha Noi city 100000, Vietnam
| | - Tran Thi Kim Chi
- Institute of Materials Science, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet road, Cau Giay district, Ha Noi city 100000, Vietnam
| | - Nguyen Thi Hien
- Institute of Materials Science, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet road, Cau Giay district, Ha Noi city 100000, Vietnam
| | - Pham Minh Tan
- Faculty of Fundamental Sciences, Thai Nguyen University of Technology, 666 3/2 road, Thai Nguyen city 24000, Vietnam
| | - Dong Thi Linh
- Faculty of Fundamental Sciences, Thai Nguyen University of Technology, 666 3/2 road, Thai Nguyen city 24000, Vietnam
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7
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Du DH, Hao NQN, Van Hao N, Thanh TT, Loan HT, Yen LM, Thuy TTD, Thuy DB, Nguyen NT, Dung NTP, Kestelyn E, Duong HTH, Phong NT, Tuyen PT, Phu NH, Nghia HDT, Hanh BTB, Oanh PKN, Tho PV, Nhat PTH, Khanh PNQ, Wyncoll D, Day NPJ, Van Vinh Chau N, van Doorn HR, Van Tan L, Geskus RB, Thwaites CL. Urinary catecholamine excretion, cardiovascular variability, and outcomes in tetanus. Trop Med Health 2023; 51:20. [PMID: 36998027 PMCID: PMC10061701 DOI: 10.1186/s41182-023-00512-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/17/2023] [Indexed: 04/01/2023] Open
Abstract
Severe tetanus is characterized by muscle spasm and cardiovascular system disturbance. The pathophysiology of muscle spasm is relatively well understood and involves inhibition of central inhibitory synapses by tetanus toxin. That of cardiovascular disturbance is less clear, but is believed to relate to disinhibition of the autonomic nervous system. The clinical syndrome of autonomic nervous system dysfunction (ANSD) seen in severe tetanus is characterized principally by changes in heart rate and blood pressure which have been linked to increased circulating catecholamines. Previous studies have described varying relationships between catecholamines and signs of ANSD in tetanus, but are limited by confounders and assays used. In this study, we aimed to perform detailed characterization of the relationship between catecholamines (adrenaline and noradrenaline), cardiovascular parameters (heart rate and blood pressure) and clinical outcomes (ANSD, mechanical ventilation required, and length of intensive care unit stay) in adults with tetanus, as well as examine whether intrathecal antitoxin administration affected subsequent catecholamine excretion. Noradrenaline and adrenaline were measured by ELISA from 24-h urine collections taken on day 5 of hospitalization in 272 patients enrolled in a 2 × 2 factorial-blinded randomized controlled trial in a Vietnamese hospital. Catecholamine results measured from 263 patients were available for analysis. After adjustment for potential confounders (i.e., age, sex, intervention treatment, and medications), there were indications of non-linear relationships between urinary catecholamines and heart rate. Adrenaline and noradrenaline were associated with subsequent development of ANSD, and length of ICU stay.
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Affiliation(s)
- Duc Hong Du
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
| | - Nguyen Quan Nhu Hao
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- University Medical Center, Ho Chi Minh City, Vietnam
| | - Nguyen Van Hao
- University Medical Center, Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Huynh Thi Loan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Evelyne Kestelyn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | | | - Pham Thi Tuyen
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Ho Dang Trung Nghia
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Pham Ngoc, Thach Medicine University, Ho Chi Minh City, Vietnam
| | - Bui Thi Bich Hanh
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Pham Ngoc, Thach Medicine University, Ho Chi Minh City, Vietnam
| | | | - Phan Vinh Tho
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | | | | | - Nicholas P J Day
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol Oxford Research Unit, Bangkok, Thailand
| | | | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ronald B Geskus
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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8
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Chau NVV, Trung TN, Khanh PNQK, Nhat PTH, Van HMT, Hai HB, Thuy DB, Tung NLN, Khoa DB, Vien TTD, Hao NV, Oanh PKN, Khoa TD, Phong NT, Nguyen NT, Huynh J, Walker TM, Van Nuil J, An LP, McKnight J, Toan LM, Tan LV, Dung NT, Truong NT, Thwaites CL. Wearable devices for remote monitoring of hospitalized patients with COVID-19 in Vietnam. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18026.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Patients with severe COVID-19 disease require monitoring with pulse oximetry as a minimal requirement. In many low- and middle- income countries, this has been challenging due to lack of staff and equipment. Wearable pulse oximeters potentially offer an attractive means to address this need, due to their low cost, battery operability and capacity for remote monitoring. Between July and October 2021, Ho Chi Minh City experienced its first major wave of SARS-CoV-2 infection, leading to an unprecedented demand for monitoring in hospitalized patients. We assess the feasibility of a continuous remote monitoring system for patients with COVID-19 under these circumstances as we implemented 2 different systems using wearable pulse oximeter devices in a stepwise manner across 4 departments.
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9
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McBride A, Vuong NL, Van Hao N, Huy NQ, Chanh HQ, Chau NTX, Nguyet NM, Ming DK, Ngoc NT, Nhat PTH, Phong NT, Tai LTH, Tho PV, Trung DT, Tam DTH, Trieu HT, Geskus RB, Llewelyn MJ, Thwaites CL, Yacoub S. A modified Sequential Organ Failure Assessment score for dengue: development, evaluation and proposal for use in clinical trials. BMC Infect Dis 2022; 22:722. [PMID: 36057771 PMCID: PMC9441074 DOI: 10.1186/s12879-022-07705-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background Dengue is a neglected tropical disease, for which no therapeutic agents have shown clinical efficacy to date. Clinical trials have used strikingly variable clinical endpoints, which hampers reproducibility and comparability of findings. We investigated a delta modified Sequential Organ Failure Assessment (delta mSOFA) score as a uniform composite clinical endpoint for use in clinical trials investigating therapeutics for moderate and severe dengue. Methods We developed a modified SOFA score for dengue, measured and evaluated its performance at baseline and 48 h after enrolment in a prospective observational cohort of 124 adults admitted to a tertiary referral hospital in Vietnam with dengue shock. The modified SOFA score included pulse pressure in the cardiovascular component. Binary logistic regression, cox proportional hazard and linear regression models were used to estimate association between mSOFA, delta mSOFA and clinical outcomes. Results The analysis included 124 adults with dengue shock. 29 (23.4%) patients required ICU admission for organ support or due to persistent haemodynamic instability: 9/124 (7.3%) required mechanical ventilation, 8/124 (6.5%) required vasopressors, 6/124 (4.8%) required haemofiltration and 5/124 (4.0%) patients died. In univariate analyses, higher baseline and delta (48 h) mSOFA score for dengue were associated with admission to ICU, requirement for organ support and mortality, duration of ICU and hospital admission and IV fluid use. Conclusions The baseline and delta mSOFA scores for dengue performed well to discriminate patients with dengue shock by clinical outcomes, including duration of ICU and hospital admission, requirement for organ support and death. We plan to use delta mSOFA as the primary endpoint in an upcoming host-directed therapeutic trial and investigate the performance of this score in other phenotypes of severe dengue in adults and children. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07705-8.
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Affiliation(s)
- Angela McBride
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Nguyen Lam Vuong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Van Hao
- Hospital for Tropical Disease, Ho Chi Minh City, Vietnam
| | - Nguyen Quang Huy
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ho Quang Chanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Damien K Ming
- Department of Infectious Disease, Imperial College London, London, UK
| | | | | | | | | | - Phan Vinh Tho
- Hospital for Tropical Disease, Ho Chi Minh City, Vietnam
| | - Dinh The Trung
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Ronald Bertus Geskus
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Martin J Llewelyn
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Sophie Yacoub
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam. .,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
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10
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Lu P, Ghiasi S, Hagenah J, Hai HB, Hao NV, Khanh PNQ, Khoa LDV, Thwaites L, Clifton DA, Zhu T. Classification of Tetanus Severity in Intensive-Care Settings for Low-Income Countries Using Wearable Sensing. Sensors (Basel) 2022; 22:6554. [PMID: 36081013 PMCID: PMC9460354 DOI: 10.3390/s22176554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
Infectious diseases remain a common problem in low- and middle-income countries, including in Vietnam. Tetanus is a severe infectious disease characterized by muscle spasms and complicated by autonomic nervous system dysfunction in severe cases. Patients require careful monitoring using electrocardiograms (ECGs) to detect deterioration and the onset of autonomic nervous system dysfunction as early as possible. Machine learning analysis of ECG has been shown of extra value in predicting tetanus severity, however any additional ECG signal analysis places a high demand on time-limited hospital staff and requires specialist equipment. Therefore, we present a novel approach to tetanus monitoring from low-cost wearable sensors combined with a deep-learning-based automatic severity detection. This approach can automatically triage tetanus patients and reduce the burden on hospital staff. In this study, we propose a two-dimensional (2D) convolutional neural network with a channel-wise attention mechanism for the binary classification of ECG signals. According to the Ablett classification of tetanus severity, we define grades 1 and 2 as mild tetanus and grades 3 and 4 as severe tetanus. The one-dimensional ECG time series signals are transformed into 2D spectrograms. The 2D attention-based network is designed to extract the features from the input spectrograms. Experiments demonstrate a promising performance for the proposed method in tetanus classification with an F1 score of 0.79 ± 0.03, precision of 0.78 ± 0.08, recall of 0.82 ± 0.05, specificity of 0.85 ± 0.08, accuracy of 0.84 ± 0.04 and AUC of 0.84 ± 0.03.
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Affiliation(s)
- Ping Lu
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
| | - Shadi Ghiasi
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
| | - Jannis Hagenah
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
| | - Ho Bich Hai
- Oxford University Clinical Research Unit, Ho Chi Minh City 700000, Vietnam
| | - Nguyen Van Hao
- Hospital of Tropical Diseases, Ho Chi Minh City 700000, Vietnam
| | | | - Le Dinh Van Khoa
- Oxford University Clinical Research Unit, Ho Chi Minh City 700000, Vietnam
| | | | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City 700000, Vietnam
| | - David A. Clifton
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
- Hthe Oxford Suzhou Centre for Advanced Research, University of Oxford, Suzhou Dushu Lake Science and Education Innovation District, Suzhou 215123, China
| | - Tingting Zhu
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
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11
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Van Hao N, Loan HT, Yen LM, Kestelyn E, Hong DD, Thuy DB, Nguyen NT, Duong HTH, Thuy TTD, Nhat PTH, Khanh PNQ, Dung NTP, Phu NH, Phong NT, Lieu PT, Tuyen PT, Hanh BTB, Nghia HDT, Oanh PKN, Tho PV, Tan Thanh T, Turner HC, van Doorn HR, Van Tan L, Wyncoll D, Day NP, Geskus RB, Thwaites GE, Van Vinh Chau N, Thwaites CL. Human versus equine intramuscular antitoxin, with or without human intrathecal antitoxin, for the treatment of adults with tetanus: a 2 × 2 factorial randomised controlled trial. The Lancet Global Health 2022; 10:e862-e872. [PMID: 35561721 PMCID: PMC9115864 DOI: 10.1016/s2214-109x(22)00117-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/11/2022] [Accepted: 03/07/2022] [Indexed: 12/14/2022] Open
Abstract
Background Intramuscular antitoxin is recommended in tetanus treatment, but there are few data comparing human and equine preparations. Tetanus toxin acts within the CNS, where there is limited penetration of peripherally administered antitoxin; thus, intrathecal antitoxin administration might improve clinical outcomes compared with intramuscular injection. Methods In a 2 × 2 factorial trial, all patients aged 16 years or older with a clinical diagnosis of generalised tetanus admitted to the intensive care unit of the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, were eligible for study entry. Participants were randomly assigned first to 3000 IU human or 21 000 U equine intramuscular antitoxin, then to either 500 IU intrathecal human antitoxin or sham procedure. Interventions were delivered by independent clinicians, with attending clinicians and study staff masked to treatment allocations. The primary outcome was requirement for mechanical ventilation. The analysis was done in the intention-to-treat population. The study is registered at ClinicalTrials.gov, NCT02999815; recruitment is completed. Findings 272 adults were randomly assigned to interventions between Jan 8, 2017, and Sept 29, 2019, and followed up until May, 2020. In the intrathecal allocation, 136 individuals were randomly assigned to sham procedure and 136 to antitoxin; in the intramuscular allocation, 109 individuals were randomly assigned to equine antitoxin and 109 to human antitoxin. 54 patients received antitoxin at a previous hospital, excluding them from the intramuscular antitoxin groups. Mechanical ventilation was given to 56 (43%) of 130 patients allocated to intrathecal antitoxin and 65 (50%) of 131 allocated to sham procedure (relative risk [RR] 0·87, 95% CI 0·66–1·13; p=0·29). For the intramuscular allocation, 48 (45%) of 107 patients allocated to human antitoxin received mechanical ventilation compared with 48 (44%) of 108 patients allocated to equine antitoxin (RR 1·01, 95% CI 0·75–1·36, p=0·95). No clinically relevant difference in adverse events was reported. 22 (16%) of 136 individuals allocated to the intrathecal group and 22 (11%) of 136 allocated to the sham procedure experienced adverse events related or possibly related to the intervention. 16 (15%) of 108 individuals allocated to equine intramuscular antitoxin and 17 (16%) of 109 allocated to human antitoxin experienced adverse events related or possibly related to the intervention. There were no intervention-related deaths. Interpretation We found no advantage of intramuscular human antitoxin over intramuscular equine antitoxin in tetanus treatment. Intrathecal antitoxin administration was safe, but did not provide overall benefit in addition to intramuscular antitoxin administration. Funding The Wellcome Trust.
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Affiliation(s)
- Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Huynh Thi Loan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Evelyne Kestelyn
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Duc Du Hong
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Phung Tran Huy Nhat
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Phan Nguyen Quoc Khanh
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Thi Phuong Dung
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Hoan Phu
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Pham Thi Lieu
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Pham Thi Tuyen
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Bui Thi Bich Hanh
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Ho Dang Trung Nghia
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | | | - Phan Vinh Tho
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Hugo C Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
| | - Le Van Tan
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Nicholas Pj Day
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK; Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ronald B Geskus
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
| | - Guy E Thwaites
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
| | | | - C Louise Thwaites
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK.
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12
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Ghiasi S, Zhu T, Lu P, Hagenah J, Khanh PNQ, Hao NV, Thwaites L, Clifton DA. Sepsis Mortality Prediction Using Wearable Monitoring in Low-Middle Income Countries. Sensors (Basel) 2022; 22:s22103866. [PMID: 35632275 PMCID: PMC9145695 DOI: 10.3390/s22103866] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 02/05/2023]
Abstract
Sepsis is associated with high mortality—particularly in low–middle income countries (LMICs). Critical care management of sepsis is challenging in LMICs due to the lack of care providers and the high cost of bedside monitors. Recent advances in wearable sensor technology and machine learning (ML) models in healthcare promise to deliver new ways of digital monitoring integrated with automated decision systems to reduce the mortality risk in sepsis. In this study, firstly, we aim to assess the feasibility of using wearable sensors instead of traditional bedside monitors in the sepsis care management of hospital admitted patients, and secondly, to introduce automated prediction models for the mortality prediction of sepsis patients. To this end, we continuously monitored 50 sepsis patients for nearly 24 h after their admission to the Hospital for Tropical Diseases in Vietnam. We then compared the performance and interpretability of state-of-the-art ML models for the task of mortality prediction of sepsis using the heart rate variability (HRV) signal from wearable sensors and vital signs from bedside monitors. Our results show that all ML models trained on wearable data outperformed ML models trained on data gathered from the bedside monitors for the task of mortality prediction with the highest performance (area under the precision recall curve = 0.83) achieved using time-varying features of HRV and recurrent neural networks. Our results demonstrate that the integration of automated ML prediction models with wearable technology is well suited for helping clinicians who manage sepsis patients in LMICs to reduce the mortality risk of sepsis.
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Affiliation(s)
- Shadi Ghiasi
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
- Correspondence:
| | - Tingting Zhu
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
| | - Ping Lu
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
| | - Jannis Hagenah
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
| | - Phan Nguyen Quoc Khanh
- Oxford University Clinical Research Unit, Ho Chi Minh City 710400, Vietnam; (P.N.Q.K.); (L.T.)
| | - Nguyen Van Hao
- Hospital of Tropical Diseases, Ho Chi Minh City 700000, Vietnam;
| | | | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City 710400, Vietnam; (P.N.Q.K.); (L.T.)
| | - David A. Clifton
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
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13
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Van Trinh P, Anh NN, Cham NT, Tu LT, Van Hao N, Thang BH, Van Chuc N, Thanh CT, Minh PN, Fukata N. Enhanced power conversion efficiency of an n-Si/PEDOT:PSS hybrid solar cell using nanostructured silicon and gold nanoparticles. RSC Adv 2022; 12:10514-10521. [PMID: 35424997 PMCID: PMC8981491 DOI: 10.1039/d2ra01246d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/23/2022] [Indexed: 01/30/2023] Open
Abstract
Herein, the effect of nanostructured silicon and gold nanoparticles (AuNPs) on the power conversion efficiency (PCE) of an n-type silicon/poly(3,4-ethylene dioxythiophene):poly(styrene sulfonate) (n-Si/PEDOT:PSS) hybrid solar cell was investigated. The Si surface modified with different nanostructures including Si nanopyramids (SiNPs), Si nanoholes (SiNHs) and Si nanowires (SiNWs) was utilized to improve light trapping and photo-carrier collection. The highest power conversion efficiency (PCE) of 8.15% was obtained with the hybrid solar cell employing SiNWs, which is about 8%, 20% and 40% higher compared to the devices using SiNHs, SiNPs and planar Si, respectively. The enhancement is attributed to the low reflectance of the SiNW structures and large PEDOT:PSS/Si interfacial area. In addition, the influence of AuNPs on the hybrid solar cell's performance was examined. The PCE of the SiNW/PEDOT:PSS hybrid solar cell with 0.5 wt% AuNP is 8.89%, which is ca. 9% higher than that of the device without AuNPs (8.15%). This is attributed to the increase in the electrical conductivity and localized surface plasmon resonance of the AuNP-incorporated PEDOT:PSS coating layer.
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Affiliation(s)
- Pham Van Trinh
- Institute of Materials Science, Vietnam Academy of Science and Technology 18 Hoang Quoc Viet Str., Cau Giay Distr. Hanoi Vietnam +84 943190301.,Graduate University of Science and Technology, Vietnam Academy of Science and Technology 18 Hoang Quoc Viet Str., Cau Giay Distr. Hanoi Vietnam
| | - Nguyen Ngoc Anh
- Institute of Materials Science, Vietnam Academy of Science and Technology 18 Hoang Quoc Viet Str., Cau Giay Distr. Hanoi Vietnam +84 943190301
| | - Nguyen Thi Cham
- VNU University of Science, Vietnam National University 334 Nguyen Trai Str., Thanh Xuan Distr. Hanoi Vietnam
| | - Le Tuan Tu
- VNU University of Science, Vietnam National University 334 Nguyen Trai Str., Thanh Xuan Distr. Hanoi Vietnam
| | - Nguyen Van Hao
- Faculty of Physics and Technology, TNU-University of Sciences Tan Thinh Ward Thai Nguyen City Vietnam
| | - Bui Hung Thang
- Institute of Materials Science, Vietnam Academy of Science and Technology 18 Hoang Quoc Viet Str., Cau Giay Distr. Hanoi Vietnam +84 943190301
| | - Nguyen Van Chuc
- Institute of Materials Science, Vietnam Academy of Science and Technology 18 Hoang Quoc Viet Str., Cau Giay Distr. Hanoi Vietnam +84 943190301
| | - Cao Thi Thanh
- Institute of Materials Science, Vietnam Academy of Science and Technology 18 Hoang Quoc Viet Str., Cau Giay Distr. Hanoi Vietnam +84 943190301
| | - Phan Ngoc Minh
- Institute of Materials Science, Vietnam Academy of Science and Technology 18 Hoang Quoc Viet Str., Cau Giay Distr. Hanoi Vietnam +84 943190301.,Graduate University of Science and Technology, Vietnam Academy of Science and Technology 18 Hoang Quoc Viet Str., Cau Giay Distr. Hanoi Vietnam
| | - Naoki Fukata
- International Center for Materials Nanoarchitectonics, National Institute for Materials Science 1-1 Namiki, Tsukuba Ibaraki 305-0044 Japan
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14
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Van Tu N, Anh NN, Van Hau T, Van Hao N, Huyen NT, Thang BH, Minh PN, Van Chuc N, Fukata N, Van Trinh P. Improving the efficiency of n-Si/PEDOT:PSS hybrid solar cells by incorporating AuNP-decorated graphene oxide as a nanoadditive for conductive polymers. RSC Adv 2022; 12:27625-27632. [PMID: 36276048 PMCID: PMC9516359 DOI: 10.1039/d2ra05184b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/22/2022] [Indexed: 11/21/2022] Open
Abstract
A gold nanoparticle-decorated graphene oxide (GO-AuNP) hybrid material was prepared by using the chemical reduction method. The obtained results showed that the AuNPs of about of 15 nm are well bound on the surface of GO. The GO-AuNP hybrid material was used for transparent conductive film (TCF) and organic/inorganic hybrid solar cells. The TCF based on poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate) (PEDOT:PSS) containing GO-AuNPs was fabricated at room temperature. The obtained results show that the TCF containing 0.5 wt% GO-AuNPs has a high transmittance of 69.7% at 550 nm, a low sheet resistance of 50.5 Ω □−1 and a conductivity that increased to 3960 S cm−1, which is three times higher than those of the PEDOT:PSS and PEDOT:PSS/GO film. The power conversion efficiency (PCE) of the n-Si/PEDOT:PSS hybrid solar cell containing GO-AuNPs was 8.39% and is higher than pristine PEDOT:PSS (5.81%) and PEDOT:PSS/GO (7.58%). This is a result of the increased electrical conductivity and localized surface plasmon resonance of the PEDOT:PSS coating layer containing the GO-AuNP hybrid material. A GO-AuNP hybrid material was successfully prepared and used for improving the performance of the optoelectronics devices.![]()
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Affiliation(s)
- Nguyen Van Tu
- Institute of Materials Science, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet Str., Cau Giay Distr., Hanoi, Vietnam
| | - Nguyen Ngoc Anh
- Institute of Materials Science, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet Str., Cau Giay Distr., Hanoi, Vietnam
| | - Tran Van Hau
- Institute of Materials Science, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet Str., Cau Giay Distr., Hanoi, Vietnam
| | - Nguyen Van Hao
- Institute of Science and Technology, TNU-University of Science, Tan Thinh Ward, Thai Nguyen City, Vietnam
| | - Nguyen Thi Huyen
- Institute of Materials Science, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet Str., Cau Giay Distr., Hanoi, Vietnam
| | - Bui Hung Thang
- Institute of Materials Science, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet Str., Cau Giay Distr., Hanoi, Vietnam
| | - Phan Ngoc Minh
- Institute of Materials Science, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet Str., Cau Giay Distr., Hanoi, Vietnam
- Graduate University of Science and Technology, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet, Hanoi, Vietnam
| | - Nguyen Van Chuc
- Institute of Materials Science, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet Str., Cau Giay Distr., Hanoi, Vietnam
| | - Naoki Fukata
- International Center for Materials Nanoarchitectonics, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
| | - Pham Van Trinh
- Institute of Materials Science, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet Str., Cau Giay Distr., Hanoi, Vietnam
- Graduate University of Science and Technology, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet, Hanoi, Vietnam
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15
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Hung TM, Van Hao N, Yen LM, McBride A, Dat VQ, van Doorn HR, Loan HT, Phong NT, Llewelyn MJ, Nadjm B, Yacoub S, Thwaites CL, Ahmed S, Van Vinh Chau N, Turner HC. Direct Medical Costs of Tetanus, Dengue, and Sepsis Patients in an Intensive Care Unit in Vietnam. Front Public Health 2022; 10:893200. [PMID: 35812512 PMCID: PMC9263973 DOI: 10.3389/fpubh.2022.893200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background Critically ill patients often require complex clinical care by highly trained staff within a specialized intensive care unit (ICU) with advanced equipment. There are currently limited data on the costs of critical care in low-and middle-income countries (LMICs). This study aims to investigate the direct-medical costs of key infectious disease (tetanus, sepsis, and dengue) patients admitted to ICU in a hospital in Ho Chi Minh City (HCMC), Vietnam, and explores how the costs and cost drivers can vary between the different diseases. Methods We calculated the direct medical costs for patients requiring critical care for tetanus, dengue and sepsis. Costing data (stratified into different cost categories) were extracted from the bills of patients hospitalized to the adult ICU with a dengue, sepsis and tetanus diagnosis that were enrolled in three studies conducted at the Hospital for Tropical Diseases in HCMC from January 2017 to December 2019. The costs were considered from the health sector perspective. The total sample size in this study was 342 patients. Results ICU care was associated with significant direct medical costs. For patients that did not require mechanical ventilation, the median total ICU cost per patient varied between US$64.40 and US$675 for the different diseases. The costs were higher for patients that required mechanical ventilation, with the median total ICU cost per patient for the different diseases varying between US$2,590 and US$4,250. The main cost drivers varied according to disease and associated severity. Conclusion This study demonstrates the notable cost of ICU care in Vietnam and in similar LMIC settings. Future studies are needed to further evaluate the costs and economic burden incurred by ICU patients. The data also highlight the importance of evaluating novel critical care interventions that could reduce the costs of ICU care.
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Affiliation(s)
- Trinh Manh Hung
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Department of Infectious Diseases, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Angela McBride
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Hanoi, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Huynh Thi Loan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Martin J Llewelyn
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Behzad Nadjm
- Medical Research Council (MRC) Unit the Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Sophie Yacoub
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sayem Ahmed
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Hugo C Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, Norfolk Place, London, United Kingdom
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16
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Hao NV, Yen LM, Davies-Foote R, Trung TN, Duoc NVT, Trang VTN, Nhat PTH, Duc DH, Anh NTK, Lieu PT, Thuy TTD, Thuy DB, Phong NT, Truong NT, Thanh PB, Tam DTH, Puthucheary Z, Thwaites CL. The management of tetanus in adults in an intensive care unit in Southern Vietnam. Wellcome Open Res 2021; 6:107. [PMID: 34136651 PMCID: PMC8185581 DOI: 10.12688/wellcomeopenres.16731.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 01/18/2023] Open
Abstract
Background: Tetanus remains common in many low- and middle-income countries (LMICs) yet the evidence base guiding management of this disease is extremely limited, particularly with respect to contemporary management options. Sharing knowledge about practice may facilitate improvement in outcomes elsewhere. Methods: We describe clinical interventions and outcomes of 180 adult patients ≥16 years-old with tetanus enrolled in prospective observational studies at a specialist infectious diseases hospital in Southern Vietnam. Patients were treated according to a holistic management protocol encompassing wound-care, antitoxin, antibiotics, symptom control, airway management, nutrition and de-escalation criteria. Results: Mortality rate in our cohort was 2.8%, with 90 (50%) patients requiring mechanical ventilation for a median 16 [IQR 12-24] days. Median [IQR] duration of ICU stay was 15 [8-23] days. Autonomic nervous system dysfunction occurred in 45 (25%) patients. Hospital acquired infections occurred in 77 (43%) of patients. Conclusion: We report favourable outcomes for patients with tetanus in a single centre LMIC ICU, treated according to a holistic protocol. Nevertheless, many patients required prolonged intensive care support and hospital acquired infections were common.
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Affiliation(s)
- Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | | | - Du Hong Duc
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Pham Thi Lieu
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Pham Ba Thanh
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Dong Thi Hoai Tam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Zudin Puthucheary
- William Harvey Research Institute, Queen Mary, University of London, London, UK.,Royal London Hospital, London, UK
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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17
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Dat VQ, Yen LM, Loan HT, Phu VD, Binh NT, Geskus RB, Trinh DHK, Mai NTH, Phu NH, Phu Huong Lan N, Thuy TP, Trung NV, Trung Cap N, Trinh DT, Hoa NT, Van NTT, Luan VTT, Nhu TTQ, Long HB, Ha NTT, Van NTT, Campbell J, Ahmadnia E, Kestelyn E, Wyncoll D, Thwaites GE, Van Hao N, Chien LT, Van Kinh N, Van Vinh Chau N, van Doorn HR, Thwaites CL, Nadjm B. Effectiveness of continuous endotracheal cuff pressure control for the prevention of ventilator associated respiratory infections: an open-label randomised, controlled trial. Clin Infect Dis 2021; 74:1795-1803. [PMID: 34420048 PMCID: PMC9155610 DOI: 10.1093/cid/ciab724] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Indexed: 12/30/2022] Open
Abstract
Background An endotracheal tube cuff pressure between 20 and 30 cmH2O is recommended to prevent ventilator-associated respiratory infection (VARI). We aimed to evaluate whether continuous cuff pressure control (CPC) was associated with reduced VARI incidence compared with intermittent CPC. Methods We conducted a multicenter open-label randomized controlled trial in intensive care unit (ICU) patients within 24 hours of intubation in Vietnam. Patients were randomly assigned 1:1 to receive either continuous CPC using an automated electronic device or intermittent CPC using a manually hand-held manometer. The primary endpoint was the occurrence of VARI, evaluated by an independent reviewer blinded to the CPC allocation. Results We randomized 600 patients; 597 received the intervention or control and were included in the intention to treat analysis. Compared with intermittent CPC, continuous CPC did not reduce the proportion of patients with at least one episode of VARI (74/296 [25%] vs 69/301 [23%]; odds ratio [OR] 1.13; 95% confidence interval [CI] .77–1.67]. There were no significant differences between continuous and intermittent CPC concerning the proportion of microbiologically confirmed VARI (OR 1.40; 95% CI .94–2.10), the proportion of intubated days without antimicrobials (relative proportion [RP] 0.99; 95% CI .87–1.12), rate of ICU discharge (cause-specific hazard ratio [HR] 0.95; 95% CI .78–1.16), cost of ICU stay (difference in transformed mean [DTM] 0.02; 95% CI −.05 to .08], cost of ICU antimicrobials (DTM 0.02; 95% CI −.25 to .28), cost of hospital stay (DTM 0.02; 95% CI −.04 to .08), and ICU mortality risk (OR 0.96; 95% CI .67–1.38). Conclusions Maintaining CPC through an automated electronic device did not reduce VARI incidence. Clinical Trial Registration NCT02966392.
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Affiliation(s)
- Vu Quoc Dat
- Oxford University Clinical Research Unit, Wellcome Trust Africa Asia Programme, Vietnam.,Department of Infectious Diseases, Hanoi Medical University, Ha Noi, Vietnam
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Wellcome Trust Africa Asia Programme, Vietnam
| | - Huynh Thi Loan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Vu Dinh Phu
- National Hospital of Tropical Diseases, Hanoi, Vietnam
| | | | - Ronald B Geskus
- Oxford University Clinical Research Unit, Wellcome Trust Africa Asia Programme, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Dong Huu Khanh Trinh
- Oxford University Clinical Research Unit, Wellcome Trust Africa Asia Programme, Vietnam
| | - Nguyen Thi Hoang Mai
- Oxford University Clinical Research Unit, Wellcome Trust Africa Asia Programme, Vietnam
| | | | | | | | - Nguyen Vu Trung
- National Hospital of Tropical Diseases, Hanoi, Vietnam.,Trung Vuong Hospital, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Vy Thi Thu Luan
- Department of Microbiology, Hanoi Medical University, Ha Noi, Vietnam
| | | | - Hoang Bao Long
- Oxford University Clinical Research Unit, Wellcome Trust Africa Asia Programme, Vietnam
| | - Nguyen Thi Thanh Ha
- Oxford University Clinical Research Unit, Wellcome Trust Africa Asia Programme, Vietnam
| | - Ninh Thi Thanh Van
- Oxford University Clinical Research Unit, Wellcome Trust Africa Asia Programme, Vietnam
| | - James Campbell
- Oxford University Clinical Research Unit, Wellcome Trust Africa Asia Programme, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Ehsan Ahmadnia
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom
| | - Evelyne Kestelyn
- Oxford University Clinical Research Unit, Wellcome Trust Africa Asia Programme, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Duncan Wyncoll
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom
| | - Guy E Thwaites
- Oxford University Clinical Research Unit, Wellcome Trust Africa Asia Programme, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Le Thanh Chien
- Department of Microbiology, Hanoi Medical University, Ha Noi, Vietnam
| | | | | | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Wellcome Trust Africa Asia Programme, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Wellcome Trust Africa Asia Programme, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Behzad Nadjm
- Oxford University Clinical Research Unit, Wellcome Trust Africa Asia Programme, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.,Medical Research Council The Gambia at The London School of Hygiene & Tropical Medicine, The Gambia
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18
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Van Hao N, Huyen NNM, Ny NTH, Trang VTN, Hoang NVM, Thuy DB, Nguyen NT, Lieu PT, Duong HTH, Thuy TTD, Nhat PTH, Tam DTH, Boni MF, Yen LM, Van Tan L, Thanh TT, Campbell J, Thwaites CL. The Role of the Gastrointestinal Tract in Toxigenic Clostridium tetani Infection: A Case-Control Study. Am J Trop Med Hyg 2021; 105:494-497. [PMID: 34181568 PMCID: PMC8437200 DOI: 10.4269/ajtmh.21-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/29/2021] [Indexed: 11/07/2022] Open
Abstract
Tetanus arises from wound contamination with Clostridium tetani, but approximately one fifth of patients have no discernable entry wound. Clostridium tetani is culturable from animal feces, suggesting the gastrointestinal tract could be an endogenous reservoir or direct-entry portal, but human data are lacking. In this study of 101 Vietnamese adults with tetanus and 29 hospitalized control subjects, admission stool samples were cultured for C. tetani. Anti-tetanus toxin antibodies were measured by ELISA. Clostridium tetani toxigenicity was evaluated using polymerase chain reaction and sequencing. Toxigenic C. tetani was cultured from stool samples in 50 of 100 (50%) tetanus cases and 12 of 28 (42.9%) control subjects (P = 0.50), and stool samples of 44 of 85 (52.4%) tetanus cases with clinically identified wounds compared with 6 of 15 (47.6%) patients without clinically identified wounds (P = 0.28). Nine of 12 (75%) control subjects with toxigenic C. tetani in their stool samples lacked protective antibody concentrations. These findings fail to show evidence of an association between gastrointestinal C. tetani and tetanus infection, but emphasize the importance of increasing vaccination coverage.
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Affiliation(s)
- Nguyen Van Hao
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.,Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Ngoc My Huyen
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Thi Han Ny
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Nguyen Van Minh Hoang
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | | | - Pham Thi Lieu
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | | | - Phung Tran Huy Nhat
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Dong Thi Hoai Tam
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Maciej F Boni
- Center for Infectious Disease Dynamics, Department of Biology, Pennsylvania State University, University Park, Pennsylvania
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Le Van Tan
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - James Campbell
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Nuffield Department of Medicine Research Building, University of Oxford, Headington, Oxford, United Kingdom
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Nuffield Department of Medicine Research Building, University of Oxford, Headington, Oxford, United Kingdom
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19
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Davies-Foote R, Trung TN, Duoc NVT, Duc DH, Nhat PTH, Trang VTN, Anh NTK, Lieu PT, Thuy DB, Phong NT, Truong NT, Thanh PB, Tam DTH, Thuy TTD, Tuyen PT, Tan TT, Campbell J, Le Van Tan, Puthucheary Z, Yen LM, Van Hao N, Thwaites CL. Risk factors associated with mechanical ventilation, autonomic nervous dysfunction and physical outcome in Vietnamese adults with tetanus. Trop Med Health 2021; 49:50. [PMID: 34154672 PMCID: PMC8215632 DOI: 10.1186/s41182-021-00336-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tetanus remains common in many low- and middle-income countries, but as critical care services improve, mortality from tetanus is improving. Nevertheless, patients develop severe syndromes associated with autonomic nervous system disturbance (ANSD) and the requirement for mechanical ventilation (MV). Understanding factors associated with worse outcome in such settings is important to direct interventions. In this study, we investigate risk factors for disease severity and long-term physical outcome in adults with tetanus admitted to a Vietnamese intensive care unit. METHODS Clinical and demographic variables were collected prospectively from 180 adults with tetanus. Physical function component scores (PCS), calculated from Short Form Health Survey (SF-36), were assessed in 79 patients at hospital discharge, 3 and 6 months post discharge. RESULTS Age, temperature, heart rate, lower peripheral oxygen saturation (SpO2) and shorter time from first symptom to admission were associated with MV (OR 1.03 [ 95% confidence interval (CI) 1.00, 1.05], p = 0.04; OR 2.10 [95% CI 1.03, 4.60], p = 0.04; OR 1.04 [ 95% CI 1.01, 1.07], p = 0.02); OR 0.80 [95% CI 0.66, 0.94], p = 0.02 and OR 0.65 [95% CI 0.52, 0.79, p < 0.001, respectively). Heart rate, SpO2 and time from first symptom to admission were associated with ANSD (OR 1.03 [95% CI 1.01, 1.06], p < 0.01; OR 0.95 [95% CI 0.9, 1.00], p = 0.04 and OR 0.64 [95% CI 0.48, 0.80], p < 0.01, respectively). Median [interquartile range] PCS at hospital discharge, 3 and 6 months were 32.37 [24.95-41.57, 53.0 [41.6-56.3] and 54.8 [51.6-57.3], respectively. Age, female sex, admission systolic blood pressure, admission SpO2, MV, ANSD, midazolam requirement, hospital-acquired infection, pressure ulcer and duration of ICU and hospital stay were associated with reduced 0.25 quantile PCS at 6 months after hospital discharge. CONCLUSIONS MV and ANSD may be suitable endpoints for future research. Risk factors for reduced physical function at 3 months and 6 months post discharge suggest that modifiable features during hospital management are important determinants of long-term outcome.
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Affiliation(s)
| | | | | | - Du Hong Duc
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Phung Tran Huy Nhat
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Kings College, London, UK
| | | | | | - Pham Thi Lieu
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | - Pham Ba Thanh
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Dong Thi Hoai Tam
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | - Pham Thi Tuyen
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Thanh Tran Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - James Campbell
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Zudin Puthucheary
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Royal London Hospital, London, UK
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
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20
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Hao NV, Yen LM, Davies-Foote R, Trung TN, Duoc NVT, Trang VTN, Nhat PTH, Duc DH, Anh NTK, Lieu PT, Thuy TTD, Thuy DB, Phong NT, Truong NT, Thanh PB, Tam DTH, Puthucheary Z, Thwaites CL. The management of tetanus in adults in an intensive care unit in Southern Vietnam. Wellcome Open Res 2021; 6:107. [PMID: 34136651 DOI: 10.12688/wellcomeopenres.16731.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 01/18/2023] Open
Abstract
Background: Tetanus remains common in many low- and middle-income countries (LMICs) yet the evidence base guiding management of this disease is extremely limited, particularly with respect to contemporary management options. Sharing knowledge about practice may facilitate improvement in outcomes elsewhere. Methods: We describe clinical interventions and outcomes of 180 adult patients ≥16 years-old with tetanus enrolled in prospective observational studies at a specialist infectious diseases hospital in Southern Vietnam. Patients were treated according to a holistic management protocol encompassing wound-care, antitoxin, antibiotics, symptom control, airway management, nutrition and de-escalation criteria. Results: Mortality rate in our cohort was 2.8%, with 90 (50%) patients requiring mechanical ventilation for a median 16 [IQR 12-24] days. Median [IQR] duration of ICU stay was 15 [8-23] days. Autonomic nervous system dysfunction occurred in 45 (25%) patients. Hospital acquired infections occurred in 77 (43%) of patients. Conclusion: We report favourable outcomes for patients with tetanus in a single centre LMIC ICU, treated according to a holistic protocol. Nevertheless, many patients required prolonged intensive care support and hospital acquired infections were common.
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Affiliation(s)
- Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | | | - Du Hong Duc
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Pham Thi Lieu
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Pham Ba Thanh
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Dong Thi Hoai Tam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Zudin Puthucheary
- William Harvey Research Institute, Queen Mary, University of London, London, UK.,Royal London Hospital, London, UK
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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21
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Anh NTK, Yen LM, Nguyen NT, Nhat PTH, Thuy TTD, Phong NT, Tuyen PT, Yen NH, Chambers M, Hao NV, Rollinson T, Denehy L, Thwaites CL. Feasibility of establishing a rehabilitation programme in a Vietnamese intensive care unit. PLoS One 2021; 16:e0247406. [PMID: 33657158 PMCID: PMC7928504 DOI: 10.1371/journal.pone.0247406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/08/2021] [Indexed: 11/18/2022] Open
Abstract
Increasing numbers of people are surviving critical illness throughout the world, but survivorship is associated with long-term disability. In high-income settings physical rehabilitation is commonly employed to counter this and improve outcomes. These utilize highly-trained multidisciplinary teams and are unavailable and unaffordable in most low and middle income countries (LMICs). We aimed to design a sustainable intensive care unit (ICU) rehabilitation program and to evaluate its feasibility in a LMIC setting. In this project patients, care-givers and experts co-designed an innovative rehabilitation programme that can be delivered by non-expert ICU staff and family care-givers in a LMIC. We implemented this programme in adult patient with patients with tetanus at the Hospital for Tropical Diseases, Ho Chi Minh City over a 5-month period, evaluating the programme's acceptability, enablers and barriers. A 6-phase programme was designed, supported by written and video material. The programme was piloted in total of 30 patients. Rehabilitation was commenced a median 14 (inter quartile range (IQR) 10-18) days after admission. Each patient received a median of 25.5 (IQR 22.8-34.8) rehabilitation sessions out of a median 27 (22.8-35) intended (prescribed) sessions. There were no associated adverse events. Patients and staff found rehabilitation to be beneficial, enhanced relationships between carers, patients and staff and was deemed to be a positive step towards recovery and return to work. The main barrier was staff time. The programme was feasible for patients with tetanus and viewed positively by staff and participants. Staff time was identified as the major barrier to ongoing implementation.
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Affiliation(s)
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Pham Thi Tuyen
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Mary Chambers
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | | | - C. Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
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22
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Thuy DB, Campbell J, Thuy CT, Hoang NVM, Voong Vinh P, Nguyen TNT, Nguyen Ngoc Minh C, Pham DT, Rabaa MA, Lan NPH, Hao NV, Thwaites GE, Thwaites CL, Baker S, Chau NVV, Chung The H. Colonization with Staphylococcus aureus and Klebsiella pneumoniae causes infections in a Vietnamese intensive care unit. Microb Genom 2021; 7:000514. [PMID: 33502303 PMCID: PMC8208697 DOI: 10.1099/mgen.0.000514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/21/2020] [Indexed: 12/26/2022] Open
Abstract
Pre-existing colonization with Staphylococcus aureus or Klebsiella pneumoniae has been found to increase the risk of infection in intensive care patients. We previously conducted a longitudinal study to characterize colonization of these two organisms in patients admitted to intensive care in a hospital in southern Vietnam. Here, using genomic and phylogenetic analyses, we aimed to assess the contribution these colonizing organisms made to infections. We found that in the majority of patients infected with S. aureus or K. pneumoniae, the sequence type of the disease-causing (infecting) isolate was identical to that of corresponding colonizing organisms in the respective patient. Further in-depth analysis revealed that in patients infected by S. aureus ST188 and by K. pneumoniae ST17, ST23, ST25 and ST86, the infecting isolate was closely related to and exhibited limited genetic variation relative to pre-infection colonizing isolates. Multidrug-resistant S. aureus ST188 was identified as the predominant agent of colonization and infection. Colonization and infection by K. pneumoniae were characterized by organisms with limited antimicrobial resistance profiles but extensive repertoires of virulence genes. Our findings augment the understanding of the link between bacterial colonization and infection in a low-resource setting, and could facilitate the development of novel evidence-based approaches to prevent and treat infections in high-risk patients in intensive care.
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Affiliation(s)
- Duong Bich Thuy
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - James Campbell
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Cao Thu Thuy
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Phat Voong Vinh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Duy Thanh Pham
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Maia A. Rabaa
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | | | - Nguyen Van Hao
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Guy E. Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - C. Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Stephen Baker
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), University of Cambridge, Cambridge, UK
| | | | - Hao Chung The
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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23
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Van Hao N, Van Dang N, Tung DH, Tan PT, Van Tu N, Van Trinh P. Facile synthesis of graphene oxide from graphite rods of recycled batteries by solution plasma exfoliation for removing Pb from water. RSC Adv 2020; 10:41237-41247. [PMID: 35519195 PMCID: PMC9057798 DOI: 10.1039/d0ra07723b] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/05/2020] [Indexed: 12/07/2022] Open
Abstract
We herein present a simple, fast, efficient and environmentally friendly technique to prepare graphene oxide (GO) from graphite rods of recycled batteries by using solution plasma exfoliated techniques at atmospheric pressure. The prepared GO with an average 3 nm-thickness and 1.5 μm-length, having large surface area and high porosity, has been used to remove Pb(ii) ions from the water. The obtained results indicated that the adsorption of Pb(ii) onto GO depends on pH, contact time, temperature and initial concentration of Pb(ii). The maximum adsorption capacity of Pb(ii) onto GO determined from the Langmuir model (with a high R2 value of 0.9913) was 180.1 mg g−1 at room temperature. A removal efficiency of ∼96.6% was obtained after 40 min. Calculations of thermodynamic parameters (ΔG°, ΔH° và ΔS°) show the adsorption of Pb(ii) ions on the GO surface is spontaneous and intrinsically heat-absorbing. The potential mechanism can be suggested here to be the interaction of the π–π* bonding electrons and Pb(ii) as well as the electrostatic attraction between Pb(ii) and the oxygen-containing functional groups on GO. Facile synthesis of graphene oxide from graphite rods of recycled batteries by solution plasma exfoliation for removing Pb from water.![]()
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Affiliation(s)
- Nguyen Van Hao
- Faculty of Physics and Technology, TNU - Thai Nguyen University of Science Thai Nguyen City Vietnam
| | - Nguyen Van Dang
- Faculty of Physics and Technology, TNU - Thai Nguyen University of Science Thai Nguyen City Vietnam
| | - Do Hoang Tung
- Institute of Physics, Vietnam Academy of Science and Technology 18 Hoang Quoc Viet Hanoi Vietnam
| | - Pham The Tan
- Hung Yen University of Technical Education Khoai Chau Hung Yen Province Vietnam
| | - Nguyen Van Tu
- Institute of Materials Science, Vietnam Academy of Science and Technology 18 Hoang Quoc Viet Hanoi Vietnam
| | - Pham Van Trinh
- Institute of Materials Science, Vietnam Academy of Science and Technology 18 Hoang Quoc Viet Hanoi Vietnam .,Graduate University of Science and Technology, Vietnam Academy of Science and Technology 18 Hoang Quoc Viet Hanoi Vietnam
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24
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Duong HTH, Tadesse GA, Nhat PTH, Hao NV, Prince J, Duong TD, Kien TT, Nhat LTH, Tan LV, Pugh C, Loan HT, Chau NVV, Minh Yen L, Zhu T, Clifton D, Thwaites L. Heart Rate Variability as an Indicator of Autonomic Nervous System Disturbance in Tetanus. Am J Trop Med Hyg 2020; 102:403-407. [PMID: 31833471 PMCID: PMC7008337 DOI: 10.4269/ajtmh.19-0720] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Autonomic nervous system dysfunction (ANSD) is a significant cause of mortality in tetanus. Currently, diagnosis relies on nonspecific clinical signs. Heart rate variability (HRV) may indicate underlying autonomic nervous system activity and represents a potentially valuable noninvasive tool for ANSD diagnosis in tetanus. HRV was measured from three 5-minute electrocardiogram recordings during a 24-hour period in a cohort of patients with severe tetanus, all receiving mechanical ventilation. HRV measurements from all subjects—five with ANSD (Ablett Grade 4) and four patients without ANSD (Ablett Grade 3)—showed HRV was lower than reported ranges for healthy individuals. Comparing different severities of tetanus, raw data for both time and frequency measurements of HRV were reduced in those with ANSD compared with those without. Differences were statistically significant in all except root mean square SD, indicating HRV may be a valuable tool in ANSD diagnosis.
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Affiliation(s)
| | - Girmaw Abebe Tadesse
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | | | - Nguyen Van Hao
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.,Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - John Prince
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Tran Duc Duong
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Trịnh Trung Kien
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Chris Pugh
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Huynh Thi Loan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tingting Zhu
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - David Clifton
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Louise Thwaites
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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25
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Tadesse GA, Zhu T, Le Nguyen Thanh N, Hung NT, Duong HTH, Khanh TH, Quang PV, Tran DD, Yen LM, Doorn RV, Hao NV, Prince J, Javed H, Kiyasseh D, Tan LV, Thwaites L, Clifton DA. Severity detection tool for patients with infectious disease. Healthc Technol Lett 2020; 7:45-50. [PMID: 32431851 PMCID: PMC7199289 DOI: 10.1049/htl.2019.0030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/12/2019] [Accepted: 01/16/2020] [Indexed: 01/22/2023] Open
Abstract
Hand foot and mouth disease (HFMD) and tetanus are serious infectious diseases in low- and middle-income countries. Tetanus, in particular, has a high mortality rate and its treatment is resource-demanding. Furthermore, HFMD often affects a large number of infants and young children. As a result, its treatment consumes enormous healthcare resources, especially when outbreaks occur. Autonomic nervous system dysfunction (ANSD) is the main cause of death for both HFMD and tetanus patients. However, early detection of ANSD is a difficult and challenging problem. The authors aim to provide a proof-of-principle to detect the ANSD level automatically by applying machine learning techniques to physiological patient data, such as electrocardiogram waveforms, which can be collected using low-cost wearable sensors. Efficient features are extracted that encode variations in the waveforms in the time and frequency domains. The proposed approach is validated on multiple datasets of HFMD and tetanus patients in Vietnam. Results show that encouraging performance is achieved. Moreover, the proposed features are simple, more generalisable and outperformed the standard heart rate variability analysis. The proposed approach would facilitate both the diagnosis and treatment of infectious diseases in low- and middle-income countries, and thereby improve patient care.
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Affiliation(s)
- Girmaw Abebe Tadesse
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK.,IBM Research
- Africa, Nairobi, Kenya
| | - Tingting Zhu
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | | | | | | | | | | | - Duc Duong Tran
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Oxford Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Rogier Van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Centre for Tropical Medicine and Global Health, Oxford University, UK
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - John Prince
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Hamza Javed
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Dani Kiyasseh
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Le Van Tan
- Oxford Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Louise Thwaites
- Oxford Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Oxford University, UK
| | - David A Clifton
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
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26
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Turner HC, Hao NV, Yacoub S, Hoang VMT, Clifton DA, Thwaites GE, Dondorp AM, Thwaites CL, Chau NVV. Achieving affordable critical care in low-income and middle-income countries. BMJ Glob Health 2019; 4:e001675. [PMID: 31297248 PMCID: PMC6590958 DOI: 10.1136/bmjgh-2019-001675] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/18/2019] [Accepted: 05/25/2019] [Indexed: 01/09/2023] Open
Affiliation(s)
- Hugo C Turner
- Oxford University Clinical Research Unit, Wellcome Africa Asia Programme, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Sophie Yacoub
- Oxford University Clinical Research Unit, Wellcome Africa Asia Programme, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Van Minh Tu Hoang
- Oxford University Clinical Research Unit, Wellcome Africa Asia Programme, Ho Chi Minh City, Vietnam
| | - David A Clifton
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Guy E Thwaites
- Oxford University Clinical Research Unit, Wellcome Africa Asia Programme, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Arjen M Dondorp
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Wellcome Africa Asia Programme, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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27
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Loan HT, Yen LM, Kestelyn: E, Hao NV, Thanh TT, Dung NTP, Turner HC, Geskus RB, Wolbers M, Tan LV, Van Doorn HR, Day NP, Wyncoll D, Hien TT, Thwaites GE, Vinh Chau NV, Thwaites CL. Intrathecal Immunoglobulin for treatment of adult patients with tetanus: A randomized controlled 2x2 factorial trial. Wellcome Open Res 2018; 3:58. [PMID: 30809591 PMCID: PMC6372971 DOI: 10.12688/wellcomeopenres.14587.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 11/20/2022] Open
Abstract
Despite long-standing availability of an effective vaccine, tetanus remains a significant problem in many countries. Outcome depends on access to mechanical ventilation and intensive care facilities and in settings where these are limited, mortality remains high. Administration of tetanus antitoxin by the intramuscular route is recommended treatment for tetanus, but as the tetanus toxin acts within the central nervous system, it has been suggested that intrathecal administration of antitoxin may be beneficial. Previous studies have indicated benefit, but with the exception of one small trial no blinded studies have been performed. The objective of this study is to establish whether the addition of intrathecal tetanus antitoxin reduces the need for mechanical ventilation in patients with tetanus. Secondary objectives: to determine whether the addition of intrathecal tetanus antitoxin reduces autonomic nervous system dysfunction and length of hospital/ intensive care unit stay; whether the addition of intrathecal tetanus antitoxin in the treatment of tetanus is safe and cost-effective; to provide data to inform recommendation of human rather than equine antitoxin. This study will enroll adult patients (≥16 years old) with tetanus admitted to the Hospital for Tropical Diseases, Ho Chi Minh City. The study is a 2x2 factorial blinded randomized controlled trial. Eligible patients will be randomized in a 1:1:1:1 manner to the four treatment arms (intrathecal treatment and human intramuscular treatment, intrathecal treatment and equine intramuscular treatment, sham procedure and human intramuscular treatment, sham procedure and equine intramuscular treatment). Primary outcome measure will be requirement for mechanical ventilation. Secondary outcome measures: duration of hospital/ intensive care unit stay, duration of mechanical ventilation, in-hospital and 240-day mortality and disability, new antibiotic prescription, incidence of ventilator associated pneumonia and autonomic nervous system dysfunction, total dose of benzodiazepines and pipecuronium, and incidence of adverse events. Trial registration: ClinicalTrials.gov NCT02999815 Registration date: 21 December 2016.
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Affiliation(s)
- Huỳnh Thị Loan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Evelyne Kestelyn:
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Medicine and Pharmacy, Hong Bang International University, Ho Chi Minh City, Vietnam
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Thi Phuong Dung
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Hugo C. Turner
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
| | - Ronald B. Geskus
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
| | - Marcel Wolbers
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Le Van Tan
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - H. Rogier Van Doorn
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
| | - Nicholas P. Day
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
- Mahidol Oxford Research Unit, Bangkok, 10400, Thailand
| | - Duncan Wyncoll
- Guys and St Thomas’ Hospitals NHS Foundation Trust, London, SE1 7EH, UK
| | - Tran Tinh Hien
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
| | - Guy E. Thwaites
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
| | | | - C. Louise Thwaites
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
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28
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Thuy DB, Campbell J, Nhat LTH, Hoang NVM, Hao NV, Baker S, Geskus RB, Thwaites GE, Chau NVV, Thwaites CL. Hospital-acquired colonization and infections in a Vietnamese intensive care unit. PLoS One 2018; 13:e0203600. [PMID: 30192894 PMCID: PMC6128614 DOI: 10.1371/journal.pone.0203600] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/23/2018] [Indexed: 12/16/2022] Open
Abstract
Data concerning intensive care unit (ICU)-acquired bacterial colonization and infections are scarce from low and middle-income countries (LMICs). ICU patients in these settings are at high risk of becoming colonized and infected with antimicrobial-resistant organisms (AROs). We conducted a prospective observational study at the Ho Chi Minh City Hospital for Tropical Diseases, Vietnam from November 2014 to January 2016 to assess the ICU-acquired colonization and infections, focusing on the five major pathogens in our setting: Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), Klebsiella spp., Pseudomonas spp. and Acinetobacter spp., among adult patients with more than 48 hours of ICU stay. We found that 61.3% (223/364) of ICU patients became colonized with AROs: 44.2% (161/364) with rectal ESBL-producing E. coli and Klebsiella spp.; 30.8% (40/130) with endotracheal carbapenemase-producing Acinetobacter spp.; and 14.3% (52/364) with nasal methicillin-resistant S. aureus. The incidence rate of ICU patients becoming colonized with AROs was 9.8 (223/2,276) per 100 patient days. Significant risk factor for AROs colonization was the Charlson Comorbidity Index score. The proportion of ICU patients with HAIs was 23.4% (85/364), and the incidence rate of ICU patients contracting HAIs was 2.3 (85/3,701) per 100 patient days. The vascular catheterization (central venous, arterial and hemofiltration catheter) was significantly associated with hospital-acquired bloodstream infection. Of the 77 patients who developed ICU-acquired infections with one of the five specified bacteria, 44 (57.1%) had prior colonization with the same organism. Vietnamese ICU patients have a high colonization rate with AROs and a high risk of subsequent infections. Future research should focus on monitoring colonization and the development of preventive measures that may halt spread of AROs in ICU settings.
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Affiliation(s)
- Duong Bich Thuy
- Hospital for Tropical Diseases, Wellcome Trust Asia Programme, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Adult Intensive Care Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - James Campbell
- Hospital for Tropical Diseases, Wellcome Trust Asia Programme, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, United Kingdom
| | - Le Thanh Hoang Nhat
- Hospital for Tropical Diseases, Wellcome Trust Asia Programme, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Nguyen Van Minh Hoang
- Hospital for Tropical Diseases, Wellcome Trust Asia Programme, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Nguyen Van Hao
- Adult Intensive Care Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Department of Infectious Diseases, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Stephen Baker
- Hospital for Tropical Diseases, Wellcome Trust Asia Programme, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, United Kingdom
- Department of Medicine, Cambridge University, Cambridge, United Kingdom
| | - Ronald B. Geskus
- Hospital for Tropical Diseases, Wellcome Trust Asia Programme, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, United Kingdom
| | - Guy E. Thwaites
- Hospital for Tropical Diseases, Wellcome Trust Asia Programme, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, United Kingdom
| | - Nguyen Van Vinh Chau
- Department of Infectious Diseases, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
- Board of Directors, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - C. Louise Thwaites
- Hospital for Tropical Diseases, Wellcome Trust Asia Programme, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, United Kingdom
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29
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Loan HT, Yen LM, Kestelyn E, Hao NV, Mai NTH, Thuy DB, Duong HTH, Dung NTP, Phu NH, Lieu PT, Thanh TT, Geskus R, van Doorn HR, Tan LV, Wyncoll D, Day NPJ, Hien TT, Thwaites GE, Chau NVV, Thwaites CL. A Pilot Study to Assess Safety and Feasibility of Intrathecal Immunoglobulin for the Treatment of Adults with Tetanus. Am J Trop Med Hyg 2018; 99:323-326. [PMID: 29916342 PMCID: PMC6090350 DOI: 10.4269/ajtmh.18-0153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Tetanus remains a significant burden in many low- and middle-income countries. The tetanus toxin acts within the central nervous system and intrathecal antitoxin administration may be beneficial, but there are safety concerns, especially in resource-limited settings. We performed a pilot study to assess the safety and feasibility of intrathecal human tetanus immunoglobulin in five adults with tetanus before the conduct of a large randomized controlled trial. Intrathecal injection via lumbar puncture was given to all patients within a median 140 (range 100–165) minutes of intensive care unit (ICU) admission. There were no serious adverse effects associated with the procedure although three patients had probably related minor adverse events which resolved spontaneously. Median ICU length of stay was 14 (range 5–17) days. Two patients required mechanical ventilation and one developed a deep vein thrombosis. Within 240 days of hospital discharge, no patients died and all patients returned to work.
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Affiliation(s)
- Huynh Thi Loan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Evelyne Kestelyn
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Van Hao
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.,Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Thi Hoang Mai
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Duong Bich Thuy
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Nguyen Thi Phuong Dung
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Hoan Phu
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Pham Thi Lieu
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Ronald Geskus
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - H Rogier van Doorn
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Le Van Tan
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Duncan Wyncoll
- Guy's and St. Thomas' Hospitals NHS Trust, London, United Kingdom
| | - Nicholas P J Day
- Mahidol Oxford Research Unit, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Tran Tinh Hien
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Guy E Thwaites
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - C Louise Thwaites
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
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30
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Rudd KE, Seymour CW, Aluisio AR, Augustin ME, Bagenda DS, Beane A, Byiringiro JC, Chang CCH, Colas LN, Day NPJ, De Silva AP, Dondorp AM, Dünser MW, Faiz MA, Grant DS, Haniffa R, Van Hao N, Kennedy JN, Levine AC, Limmathurotsakul D, Mohanty S, Nosten F, Papali A, Patterson AJ, Schieffelin JS, Shaffer JG, Thuy DB, Thwaites CL, Urayeneza O, White NJ, West TE, Angus DC. Association of the Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) Score With Excess Hospital Mortality in Adults With Suspected Infection in Low- and Middle-Income Countries. JAMA 2018; 319:2202-2211. [PMID: 29800114 PMCID: PMC6134436 DOI: 10.1001/jama.2018.6229] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/23/2018] [Indexed: 12/29/2022]
Abstract
Importance The quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score has not been well-evaluated in low- and middle-income countries (LMICs). Objective To assess the association of qSOFA with excess hospital death among patients with suspected infection in LMICs and to compare qSOFA with the systemic inflammatory response syndrome (SIRS) criteria. Design, Settings, and Participants Retrospective secondary analysis of 8 cohort studies and 1 randomized clinical trial from 2003 to 2017. This study included 6569 hospitalized adults with suspected infection in emergency departments, inpatient wards, and intensive care units of 17 hospitals in 10 LMICs across sub-Saharan Africa, Asia, and the Americas. Exposures Low (0), moderate (1), or high (≥2) qSOFA score (range, 0 [best] to 3 [worst]) or SIRS criteria (range, 0 [best] to 4 [worst]) within 24 hours of presentation to study hospital. Main Outcomes and Measures Predictive validity (measured as incremental hospital mortality beyond that predicted by baseline risk factors, as a marker of sepsis or analogous severe infectious course) of the qSOFA score (primary) and SIRS criteria (secondary). Results The cohorts were diverse in enrollment criteria, demographics (median ages, 29-54 years; males range, 36%-76%), HIV prevalence (range, 2%-43%), cause of infection, and hospital mortality (range, 1%-39%). Among 6218 patients with nonmissing outcome status in the combined cohort, 643 (10%) died. Compared with a low or moderate score, a high qSOFA score was associated with increased risk of death overall (19% vs 6%; difference, 13% [95% CI, 11%-14%]; odds ratio, 3.6 [95% CI, 3.0-4.2]) and across cohorts (P < .05 for 8 of 9 cohorts). Compared with a low qSOFA score, a moderate qSOFA score was also associated with increased risk of death overall (8% vs 3%; difference, 5% [95% CI, 4%-6%]; odds ratio, 2.8 [95% CI, 2.0-3.9]), but not in every cohort (P < .05 in 2 of 7 cohorts). High, vs low or moderate, SIRS criteria were associated with a smaller increase in risk of death overall (13% vs 8%; difference, 5% [95% CI, 3%-6%]; odds ratio, 1.7 [95% CI, 1.4-2.0]) and across cohorts (P < .05 for 4 of 9 cohorts). qSOFA discrimination (area under the receiver operating characteristic curve [AUROC], 0.70 [95% CI, 0.68-0.72]) was superior to that of both the baseline model (AUROC, 0.56 [95% CI, 0.53-0.58; P < .001) and SIRS (AUROC, 0.59 [95% CI, 0.57-0.62]; P < .001). Conclusions and Relevance When assessed among hospitalized adults with suspected infection in 9 LMIC cohorts, the qSOFA score identified infected patients at risk of death beyond that explained by baseline factors. However, the predictive validity varied among cohorts and settings, and further research is needed to better understand potential generalizability.
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Affiliation(s)
- Kristina E. Rudd
- Department of Medicine and the International Respiratory and Severe Illness Center (INTERSECT), University of Washington, Seattle
| | - Christopher W. Seymour
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Adam R. Aluisio
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Danstan S. Bagenda
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha
| | - Abi Beane
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Jean Claude Byiringiro
- Division of Clinical Education and Research, University Teaching Hospital of Kigali, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Chung-Chou H. Chang
- Departments of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Nicholas P. J. Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Oxford Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford, United Kingdom
| | - A. Pubudu De Silva
- National Intensive Care Surveillance, Colombo, Sri Lanka
- Intensive Care National Audit & Research Centre, London, United Kingdom
| | - Arjen M. Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Oxford Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford, United Kingdom
| | - Martin W. Dünser
- Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - M. Abul Faiz
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Dev Care Foundation, Dhaka, Bangladesh
| | - Donald S. Grant
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Rashan Haniffa
- National Intensive Care Surveillance, Colombo, Sri Lanka
| | - Nguyen Van Hao
- Adult Intensive Care Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Department of Infectious Diseases, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Jason N. Kennedy
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Adam C. Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Direk Limmathurotsakul
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Oxford Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford, United Kingdom
| | - Sanjib Mohanty
- Ispat General Hospital, Rourkela, Odisha, India
- Center for Emerging Infectious Diseases, Asian Institute of Public Health, Bhubaneswar, Odisha, India
| | - François Nosten
- Oxford Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford, United Kingdom
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Alfred Papali
- Division of Pulmonary & Critical Care Medicine and Institute for Global Health, University of Maryland School of Medicine, Baltimore
- Division of Pulmonary & Critical Care Medicine, Atrium Health, Charlotte, North Carolina
| | | | - John S. Schieffelin
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana
| | - Jeffrey G. Shaffer
- Department of Global Biostatistics and Data Science, Tulane University, New Orleans, Louisiana
| | - Duong Bich Thuy
- Adult Intensive Care Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - C. Louise Thwaites
- Oxford Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford, United Kingdom
- Oxford University Clinical Research Unit (OUCRU), Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Nicholas J. White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Oxford Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford, United Kingdom
| | - T. Eoin West
- Department of Medicine and the International Respiratory and Severe Illness Center (INTERSECT), University of Washington, Seattle
| | - Derek C. Angus
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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31
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Loan HT, Yen LM, Kestelyn: E, Hao NV, Thanh TT, Dung NTP, Turner HC, Geskus RB, Wolbers M, Tan LV, Van Doorn HR, Day NP, Wyncoll D, Hien TT, Thwaites GE, Vinh Chau NV, Thwaites CL. Intrathecal Immunoglobulin for treatment of adult patients with tetanus: A randomized controlled 2x2 factorial trial. Wellcome Open Res 2018; 3:58. [PMID: 30809591 PMCID: PMC6372971 DOI: 10.12688/wellcomeopenres.14587.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2018] [Indexed: 10/06/2023] Open
Abstract
Despite long-standing availability of an effective vaccine, tetanus remains a significant problem in many countries. Outcome depends on access to mechanical ventilation and intensive care facilities and in settings where these are limited, mortality remains high. Administration of tetanus antitoxin by the intramuscular route is recommended treatment for tetanus, but as the tetanus toxin acts within the central nervous system, it has been suggested that intrathecal administration of antitoxin may be beneficial. Previous studies have indicated benefit, but with the exception of one small trial no blinded studies have been performed. The objective of this study is to establish whether the addition of intrathecal tetanus antitoxin reduces the need for mechanical ventilation in patients with tetanus. Secondary objectives: to determine whether the addition of intrathecal tetanus antitoxin reduces autonomic nervous system dysfunction and length of hospital/ intensive care unit stay; whether the addition of intrathecal tetanus antitoxin in the treatment of tetanus is safe and cost-effective; to provide data to inform recommendation of human rather than equine antitoxin. This study will enroll adult patients (≥16 years old) with tetanus admitted to the Hospital for Tropical Diseases, Ho Chi Minh City. The study is a 2x2 factorial blinded randomized controlled trial. Eligible patients will be randomized in a 1:1:1:1 manner to the four treatment arms (intrathecal treatment and human intramuscular treatment, intrathecal treatment and equine intramuscular treatment, sham procedure and human intramuscular treatment, sham procedure and equine intramuscular treatment). Primary outcome measure will be requirement for mechanical ventilation. Secondary outcome measures: duration of hospital/ intensive care unit stay, duration of mechanical ventilation, in-hospital and 240-day mortality and disability, new antibiotic prescription, incidence of ventilator associated pneumonia and autonomic nervous system dysfunction, total dose of benzodiazepines and pipecuronium, and incidence of adverse events. Trial registration: ClinicalTrials.gov NCT02999815 Registration date: 21 December 2016.
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Affiliation(s)
- Huỳnh Thị Loan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Evelyne Kestelyn:
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Medicine and Pharmacy, Hong Bang International University, Ho Chi Minh City, Vietnam
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Thi Phuong Dung
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Hugo C. Turner
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
| | - Ronald B. Geskus
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
| | - Marcel Wolbers
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Le Van Tan
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - H. Rogier Van Doorn
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
| | - Nicholas P. Day
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
- Mahidol Oxford Research Unit, Bangkok, 10400, Thailand
| | - Duncan Wyncoll
- Guys and St Thomas’ Hospitals NHS Foundation Trust, London, SE1 7EH, UK
| | - Tran Tinh Hien
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
| | - Guy E. Thwaites
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
| | | | - C. Louise Thwaites
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, OX3 7FZ, UK
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32
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Dat VQ, Geskus RB, Wolbers M, Loan HT, Yen LM, Binh NT, Chien LT, Mai NTH, Phu NH, Lan NPH, Hao NV, Long HB, Thuy TP, Kinh NV, Trung NV, Phu VD, Cap NT, Trinh DT, Campbell J, Kestelyn E, Wertheim HFL, Wyncoll D, Thwaites GE, van Doorn HR, Thwaites CL, Nadjm B. Continuous versus intermittent endotracheal cuff pressure control for the prevention of ventilator-associated respiratory infections in Vietnam: study protocol for a randomised controlled trial. Trials 2018; 19:217. [PMID: 29615093 PMCID: PMC5883270 DOI: 10.1186/s13063-018-2587-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 03/12/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Ventilator-associated respiratory infection (VARI) comprises ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT). Although their diagnostic criteria vary, together these are the most common hospital-acquired infections in intensive care units (ICUs) worldwide, responsible for a large proportion of antibiotic use within ICUs. Evidence-based strategies for the prevention of VARI in resource-limited settings are lacking. Preventing the leakage of oropharyngeal secretions into the lung using continuous endotracheal cuff pressure control is a promising strategy. The aim of this study is to investigate the efficacy of automated, continuous endotracheal cuff pressure control in preventing the development of VARI and reducing antibiotic use in ICUs in Vietnam. METHODS/DESIGN This is an open-label randomised controlled multicentre trial. We will enrol 600 adult patients intubated for ≤ 24 h at the time of enrolment. Eligible patients will be stratified according to admission diagnosis (180 tetanus, 420 non-tetanus) and site and will be randomised in a 1:1 ratio to receive either (1) automated, continuous control of endotracheal cuff pressure or (2) intermittent measurement and control of endotracheal cuff pressure using a manual cuff pressure meter. The primary outcome is the occurrence of VARI, defined as either VAP or VAT during the ICU admission up to a maximum of 90 days after randomisation. Patients in both groups who are at risk for VARI will receive a standardised battery of investigations if their treating physician feels a new infection has occurred, the results of which will be used by an endpoint review committee, blinded to the allocated arm and independent of patient care, to determine the primary outcome. All enrolled patients will be followed for mortality and endotracheal tube cuff-related complications at 28 days and 90 days after randomisation. Other secondary outcomes include antibiotic use; days ventilated, in ICU and in hospital; inpatient mortality; costs of antibiotics in ICU; duration of ICU stay; and duration of hospital stay. DISCUSSION This study will provide high-quality evidence concerning the use of continuous endotracheal cuff pressure control as a method to reduce VARI, antibiotic use and hospitalisation costs and to shorten stay. TRIAL REGISTRATION ClinicalTrials.gov, NCT02966392 . Registered on November 9, 2016. Protocol version: 2.0; issue date March 3, 2017.
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Affiliation(s)
- Vu Quoc Dat
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam.,Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam
| | - Ronald B Geskus
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Wellcome Asia Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Marcel Wolbers
- Wellcome Asia Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Huynh Thi Loan
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Wellcome Asia Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Nguyen Thi Hoang Mai
- Wellcome Asia Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nguyen Hoan Phu
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Nguyen Van Hao
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Hoang Bao Long
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Tran Phuong Thuy
- Wellcome Asia Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Vu Dinh Phu
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | | | | | - James Campbell
- Wellcome Asia Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Evelyne Kestelyn
- Wellcome Asia Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Heiman F L Wertheim
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Duncan Wyncoll
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - Guy Edward Thwaites
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Wellcome Asia Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - H Rogier van Doorn
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam.,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - C Louise Thwaites
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Wellcome Asia Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Behzad Nadjm
- Wellcome Trust Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam. .,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
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33
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Phu VD, Nadjm B, Duy NHA, Co DX, Mai NTH, Trinh DT, Campbell J, Khiem DP, Quang TN, Loan HT, Binh HS, Dinh QD, Thuy DB, Lan HNP, Ha NH, Bonell A, Larsson M, Hoan HM, Tuan ĐQ, Hanberger H, Minh HNV, Yen LM, Van Hao N, Binh NG, Chau NVV, Van Kinh N, Thwaites GE, Wertheim HF, van Doorn HR, Thwaites CL. Ventilator-associated respiratory infection in a resource-restricted setting: impact and etiology. J Intensive Care 2017; 5:69. [PMID: 29276607 PMCID: PMC5738227 DOI: 10.1186/s40560-017-0266-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/27/2017] [Indexed: 01/16/2023] Open
Abstract
Background Ventilator-associated respiratory infection (VARI) is a significant problem in resource-restricted intensive care units (ICUs), but differences in casemix and etiology means VARI in resource-restricted ICUs may be different from that found in resource-rich units. Data from these settings are vital to plan preventative interventions and assess their cost-effectiveness, but few are available. Methods We conducted a prospective observational study in four Vietnamese ICUs to assess the incidence and impact of VARI. Patients ≥ 16 years old and expected to be mechanically ventilated > 48 h were enrolled in the study and followed daily for 28 days following ICU admission. Results Four hundred fifty eligible patients were enrolled over 24 months, and after exclusions, 374 patients’ data were analyzed. A total of 92/374 cases of VARI (21.7/1000 ventilator days) were diagnosed; 37 (9.9%) of these met ventilator-associated pneumonia (VAP) criteria (8.7/1000 ventilator days). Patients with any VARI, VAP, or VARI without VAP experienced increased hospital and ICU stay, ICU cost, and antibiotic use (p < 0.01 for all). This was also true for all VARI (p < 0.01 for all) with/without tetanus. There was no increased risk of in-hospital death in patients with VARI compared to those without (VAP HR 1.58, 95% CI 0.75–3.33, p = 0.23; VARI without VAP HR 0.40, 95% CI 0.14–1.17, p = 0.09). In patients with positive endotracheal aspirate cultures, most VARI was caused by Gram-negative organisms; the most frequent were Acinetobacter baumannii (32/73, 43.8%) Klebsiella pneumoniae (26/73, 35.6%), and Pseudomonas aeruginosa (24/73, 32.9%). 40/68 (58.8%) patients with positive cultures for these had carbapenem-resistant isolates. Patients with carbapenem-resistant VARI had significantly greater ICU costs than patients with carbapenem-susceptible isolates (6053 USD (IQR 3806–7824) vs 3131 USD (IQR 2108–7551), p = 0.04) and after correction for adequacy of initial antibiotics and APACHE II score, showed a trend towards increased risk of in-hospital death (HR 2.82, 95% CI 0.75–6.75, p = 0.15). Conclusions VARI in a resource-restricted setting has limited impact on mortality, but shows significant association with increased patient costs, length of stay, and antibiotic use, particularly when caused by carbapenem-resistant bacteria. Evidence-based interventions to reduce VARI in these settings are urgently needed. Electronic supplementary material The online version of this article (10.1186/s40560-017-0266-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vu Dinh Phu
- National Hospital for Tropical Diseases, Hanoi, Vietnam.,Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Behzad Nadjm
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | | | - Nguyen Thi Hoang Mai
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - James Campbell
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Huynh Thi Loan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Quynh-Dao Dinh
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Duong Bich Thuy
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Huong Nguyen Phu Lan
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Ana Bonell
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | | | | | | | | | | | - Lam Minh Yen
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | | | | | - Guy E Thwaites
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Heiman F Wertheim
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, Netherlands
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - C Louise Thwaites
- Oxford University Clinical Research Unit, Hanoi, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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34
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Duyen HTL, Cerny D, Trung DT, Pang J, Velumani S, Toh YX, Qui PT, Hao NV, Simmons C, Haniffa M, Wills B, Fink K. Skin dendritic cell and T cell activation associated with dengue shock syndrome. Sci Rep 2017; 7:14224. [PMID: 29079750 PMCID: PMC5660158 DOI: 10.1038/s41598-017-14640-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/12/2017] [Indexed: 11/17/2022] Open
Abstract
The pathogenesis of severe dengue remains unclear, particularly the mechanisms underlying the plasma leakage that results in hypovolaemic shock in a small proportion of individuals. Maximal leakage occurs several days after peak viraemia implicating immunological pathways. Skin is a highly vascular organ and also an important site of immune reactions with a high density of dendritic cells (DCs), macrophages and T cells. We obtained skin biopsies and contemporaneous blood samples from patients within 24 hours of onset of dengue shock syndrome (DSS), and from healthy controls. We analyzed cell subsets by flow cytometry, and soluble mediators and antibodies by ELISA; the percentage of migratory CD1a+ dermal DCs was significantly decreased in the DSS patients, and skin CD8+ T cells were activated, but there was no accumulation of dengue-specific antibodies. Inflammatory monocytic cells were not observed infiltrating the skin of DSS cases on whole-mount histology, although CD14dim cells disappeared from blood.
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Affiliation(s)
- Huynh Thi Le Duyen
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Daniela Cerny
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore.,School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Dinh The Trung
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Jassia Pang
- Biological Resource Centre (BRC), Singapore, Singapore
| | - Sumathy Velumani
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore
| | - Ying Xiu Toh
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore
| | - Phan Tu Qui
- Hospital for Tropical Diseases, 764 Vo Van Kiet, Ho Chi Minh City, Vietnam
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, 764 Vo Van Kiet, Ho Chi Minh City, Vietnam.,University of Medicine and Pharmacy of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Cameron Simmons
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Department of Microbiology and Immunology, Peter Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Muzlifah Haniffa
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Bridget Wills
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.
| | - Katja Fink
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore. .,School of Biological Sciences, Nanyang Technological University, Singapore, Singapore.
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35
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Thuy DB, Campbell JI, Thanh TT, Thuy CT, Loan HT, Hao NV, Minh YL, Tan LV, Boni MF, Thwaites CL. Tetanus in Southern Vietnam: Current Situation. Am J Trop Med Hyg 2016; 96:93-96. [PMID: 27821690 PMCID: PMC5239717 DOI: 10.4269/ajtmh.16-0470] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/09/2016] [Indexed: 11/12/2022] Open
Abstract
In Vietnam, there are no accurate data on tetanus incidence to allow assessment of disease burden or vaccination program efficacy. We analyzed age structure of 786 tetanus cases admitted to a tertiary referral center in Vietnam for three separate years during an 18-year period to examine the impact of tetanus prevention programs, namely the Expanded Program on Immunization (EPI) and the Maternal and Neonatal Tetanus (MNT) initiative. Most cases were born before the initiation of EPI. Median age increased from 33 (interquartile range: 20–52) in 1994, to 46 (32–63) in 2012 (P < 0.001). Birth-year distribution was unchanged, indicating the same birth cohorts presented with tetanus in 1994, 2003, and 2012. Enzyme-linked immunosorbent assay measurements in 90 men and 90 women covered by MNT but not EPI showed 73.3% (95% confidence interval [CI]: 62.9–82.1%) of women had anti-tetanus antibody compared with 24.4% (95% CI: 15.9–34.7%) of men, indicating continued tetanus vulnerability in older men in Vietnam.
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Affiliation(s)
- Duong Bich Thuy
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - James I Campbell
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Cao Thu Thuy
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Huynh Thi Loan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Yen Lam Minh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Le Van Tan
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Maciej F Boni
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - C Louise Thwaites
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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36
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Le Minh V, Thi Khanh Nhu N, Vinh Phat V, Thompson C, Huong Lan NP, Thieu Nga TV, Thanh Tam PT, Tuyen HT, Hoang Nhu TD, Van Hao N, Thi Loan H, Minh Yen L, Parry CM, Trung Nghia HD, Campbell JI, Hien TT, Thwaites L, Thwaites G, Van Vinh Chau N, Baker S. In vitro activity of colistin in antimicrobial combination against carbapenem-resistant Acinetobacter baumannii isolated from patients with ventilator-associated pneumonia in Vietnam. J Med Microbiol 2015; 64:1162-1169. [PMID: 26297024 PMCID: PMC4755130 DOI: 10.1099/jmm.0.000137] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Acinetobacter baumannii has become one of the major infection threats in intensive care units (ICUs) globally. Since 2008, A. baumannii has been the leading cause of ventilator-associated pneumonia (VAP) in our ICU at an infectious disease hospital in southern Vietnam. The emergence of this pathogen in our setting is consistent with the persistence of a specific clone exhibiting resistance to carbapenems. Antimicrobial combinations may be a strategy to treat infections caused by these carbapenem-resistant A. baumannii. Therefore, we assessed potential antimicrobial combinations against local carbapenem-resistant A. baumannii by measuring in vitro interactions of colistin with four antimicrobials that are locally certified for treating VAP. We first performed antimicrobial susceptibility testing and multilocus variable number tandem repeat analysis (MLVA) genotyping on 74 A. baumannii isolated from quantitative tracheal aspirates from patients with VAP over an 18-month period. These 74 isolates could be subdivided into 21 main clusters by MLVA and >80 % were resistant to carbapenems. We selected 56 representative isolates for in vitro combination synergy testing. Synergy was observed in four (7 %), seven (13 %), 20 (36 %) and 38 (68 %) isolates with combinations of colistin with ceftazidime, ceftriaxone, imipenem and meropenem, respectively. Notably, more carbapenem-resistant A. baumannii isolates (36/43; 84 %) exhibited synergistic activity with a combination of colistin and meropenem than carbapenem-susceptible A. baumannii isolates (2/13; 15 %) (P = 0.023; Fisher's exact test). Our findings suggest that combinations of colistin and meropenem should be considered when treating carbapenem-resistant A. baumannii infections in Vietnam, and we advocate clinical trials investigating combination therapy for VAP.
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Affiliation(s)
- Vien Le Minh
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Division of Infectious Diseases, Department of Medicine, University of California San Francisco, CA, USA
| | - Nguyen Thi Khanh Nhu
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Queensland, Australia
| | - Voong Vinh Phat
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Corinne Thompson
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK
| | - Nguyen Phu Huong Lan
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Tran Vu Thieu Nga
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Pham Thi Thanh Tam
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ha Thanh Tuyen
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Do Hoang Nhu
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Huynh Thi Loan
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Christopher M Parry
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ho Dang Trung Nghia
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - James I Campbell
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK
| | - Tran Tinh Hien
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK
| | - Louise Thwaites
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK
| | - Guy Thwaites
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK
| | | | - Stephen Baker
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,London School of Hygiene and Tropical Medicine, London, UK.,Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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37
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Nhu NTK, Lan NPH, Campbell JI, Parry CM, Thompson C, Tuyen HT, Hoang NVM, Tam PTT, Le VM, Nga TVT, Nhu TDH, Van Minh P, Nga NTT, Thuy CT, Dung LT, Yen NTT, Van Hao N, Loan HT, Yen LM, Nghia HDT, Hien TT, Thwaites L, Thwaites G, Chau NVV, Baker S. Emergence of carbapenem-resistant Acinetobacter baumannii as the major cause of ventilator-associated pneumonia in intensive care unit patients at an infectious disease hospital in southern Vietnam. J Med Microbiol 2014; 63:1386-1394. [PMID: 25038137 PMCID: PMC4170484 DOI: 10.1099/jmm.0.076646-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Ventilator-associated pneumonia (VAP) is a serious healthcare-associated infection that affects up to 30 % of intubated and mechanically ventilated patients in intensive care units (ICUs) worldwide. The bacterial aetiology and corresponding antimicrobial susceptibility of VAP is highly variable, and can differ between countries, national provinces and even between different wards in the same hospital. We aimed to understand and document changes in the causative agents of VAP and their antimicrobial susceptibility profiles retrospectively over an 11 year period in a major infectious disease hospital in southern Vietnam. Our analysis outlined a significant shift from Pseudomonas aeruginosa to Acinetobacter spp. as the most prevalent bacteria isolated from quantitative tracheal aspirates in patients with VAP in this setting. Antimicrobial resistance was common across all bacterial species and we found a marked proportional annual increase in carbapenem-resistant Acinetobacter spp. over a 3 year period from 2008 (annual trend; odds ratio 1.656, P = 0.010). We further investigated the possible emergence of a carbapenem-resistant Acinetobacter baumannii clone by multiple-locus variable number tandem repeat analysis, finding a blaOXA-23-positive strain that was associated with an upsurge in the isolation of this pathogen. We additionally identified a single blaNDM-1-positive A. baumannii isolate. This work highlights the emergence of a carbapenem-resistant clone of A. baumannii and a worrying trend of antimicrobial resistance in the ICU of the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam.
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Affiliation(s)
- Nguyen Thi Khanh Nhu
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nguyen Phu Huong Lan
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - James I Campbell
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Christopher M Parry
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Corinne Thompson
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ha Thanh Tuyen
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nguyen Van Minh Hoang
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Pham Thi Thanh Tam
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Vien Minh Le
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, CA, USA.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Vu Thieu Nga
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Do Hoang Nhu
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Pham Van Minh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nguyen Thi Thu Nga
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Cao Thu Thuy
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Le Thi Dung
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Nguyen Van Hao
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Huynh Thi Loan
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Lam Minh Yen
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Ho Dang Trung Nghia
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Tinh Hien
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Louise Thwaites
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Guy Thwaites
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nguyen Van Vinh Chau
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Stephen Baker
- The London School of Hygiene and Tropical Medicine, London, UK.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, UK.,The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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38
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Whitehorn J, Van Vinh Chau N, Truong NT, Tai LTH, Van Hao N, Hien TT, Wolbers M, Merson L, Dung NTP, Peeling R, Simmons C, Wills B, Farrar J. Lovastatin for adult patients with dengue: protocol for a randomised controlled trial. Trials 2012; 13:203. [PMID: 23114081 PMCID: PMC3495012 DOI: 10.1186/1745-6215-13-203] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 10/24/2012] [Indexed: 01/02/2023] Open
Abstract
Background Dengue is the most important vector-borne viral infection of man, with approximately 2 billion people living in areas at risk. Infection results in a range of manifestations from asymptomatic infection through to life-threatening shock and haemorrhage. One of the hallmarks of severe dengue is vascular endothelial disruption. There is currently no specific therapy and clinical management is limited to supportive care. Statins are a class of drug initially developed for lipid lowering. There has been considerable recent interest in their effects beyond lipid lowering. These include anti-inflammatory effects at the endothelium. In addition, it is possible that lovastatin may have an anti-viral effect against dengue. Observational data suggest that the use of statins may improve outcomes for such conditions as sepsis and pneumonia. This paper describes the protocol for a randomised controlled trial investigating a short course of lovastatin therapy in adult patients with dengue. Methods/design A randomised, double-blind, placebo-controlled trial will investigate the effects of lovastatin therapy in the treatment of dengue. The trial will be conducted in two phases with an escalation of dose between phases if an interim safety review is satisfactory. This is an exploratory study focusing on safety and there are no data on which to base a sample size calculation. A target sample size of 300 patients in the second phase, enrolled over two dengue seasons, was chosen based on clinical judgement and feasibility considerations. In a previous randomised trial in dengue, about 10% and 30% of patients experienced at least one serious adverse event or adverse event, respectively. With 300 patients, we will have 80% power to detect an increase of 12% (from 10% to 22%) or 16% (from 30% to 46%) in the frequency of adverse events. Furthermore, this sample size ensures some power to explore the efficacy of statins. Discussion The development of a dengue therapeutic that can attenuate disease would be an enormous advance in global health. The favourable effects of statins on the endothelium, their good safety profile and their low cost make lovastatin an attractive therapeutic candidate. Trial registration International Standard Randomised Controlled Trial Number ISRCTN03147572
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Affiliation(s)
- James Whitehorn
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
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39
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Sahoo AK, Mohan CV, Shankar KM, Corsin F, Turnbull JF, Thakur PC, Hao NV, Morgan KL, Padiyar AP. Clinical white spot disease status in Penaeus monodon during the middle of the culture period - its epidemiological significance. J Fish Dis 2010; 33:609-615. [PMID: 20298451 DOI: 10.1111/j.1365-2761.2010.01144.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- A K Sahoo
- Fish Pathology and Biotechnology Laboratory, Department of Aquaculture, College of Fisheries, Mangalore, Karnataka, India.
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40
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Corsin F, Thakur PC, Padiyar PA, Madhusudhan M, Turnbull JF, Mohan CV, Hao NV, Morgan KL. Relationship between white spot syndrome virus and indicators of quality in Penaeus monodon postlarvae in Karnataka, India. Dis Aquat Organ 2003; 54:97-104. [PMID: 12747635 DOI: 10.3354/dao054097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
White spot disease (WSD) is a viral disease of shrimp caused by white spot syndrome virus (WSSV). Stocking WSSV-infected seed has been implicated as a major risk factor for outbreaks of WSD. In addition, the quality of postlarvae batches has been proposed as a predictor for good crops. This paper describes the relationship between indicators of quality and WSSV in postlarvae (PL) of Penaeus monodon from Karnataka, India, over the period September 1999 to January 2000. Three outcome variables were considered: the WSSV status of the PL, as determined by PCR, and 2 subjective assessments of PL quality, namely the activity of the PL and the quality of the PL as determined by research assistants and farmers, respectively. Of the 73 batches of PL, 49.3% from a random sample of farms tested positive for WSSV. After adjusting for confounding, stocking earlier in the growing season and duration of transportation were the main risk factors for the presence of WSSV. The quality assessed by farmers and the PL activity assessed by research assistants showed only fair agreement (kappa 0.252) reaffirming the subjective nature of such techniques. The only variables consistently associated with either assessment of quality in univariate analysis were PL length, number per bag and salinity of the water in the delivery bags. After adjusting for confounding, no single variable was consistently associated with PL quality and activity. The research assistants' assessment of PL activity was also associated with the hatchery and a brown-orange hepatopancreas in univariate analysis. After adjusting for confounding, a brown-orange hepatopancreas was still significant and fitted into the model together with the salinity of the water in the PL bags. The farmers' assessment of quality was associated with PL length, date of stocking and duration of transportation in both univariate and multivariable analyses. There was no relationship between quality assessment and WSSV in PCR-positive PL.
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Affiliation(s)
- F Corsin
- Institute of Aquaculture, University of Stirling, Stirling FK9 4LA, Scotland, United Kingdom
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41
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Mohan CV, Corsin F, Thakur PC, Padiyar PA, Madhusudan M, Turnbull JF, Hao NV, Morgan KL. Usefulness of dead shrimp specimens in studying the epidemiology of white spot syndrome virus (WSSV) and chronic bacterial infection. Dis Aquat Organ 2002; 50:1-8. [PMID: 12152899 DOI: 10.3354/dao050001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This paper describes the utility of dead shrimp samples in epidemiological investigations of the white spot syndrome virus (WSSV) and chronic bacterial infections. A longitudinal observational study was undertaken in shrimp farms in Kundapur, Karnataka, India, from September 1999 to April 2000 to identify risk factors associated with outbreaks of white spot disease (WSD) in cultured Penaeus monodon. As a part of the larger study, farmers were trained to collect and preserve dead and moribund shrimp (when observed) during the production cycle. At the end of the production cycle, 73 samples from 50 ponds had been collected for histopathology and 55 samples from 44 ponds for PCR. Intranuclear viral inclusion bodies diagnostic of WSSV infection were detected in dead samples from 32 ponds (64 %). Samples of dead shrimp from 18 ponds (36%) showed no histopathological evidence of WSSV infection. However, of these, samples from 13 ponds (26%) showed clear evidence of shell, oral, enteric and systemic chronic inflammatory lesions (CIL) in the form of haemocytic nodules, typical of bacterial infection. Samples from 5 ponds (10%) were negative for both WSSV and CIL. Samples from 8 ponds had dual WSSV and CIL, although both WSSV and CIL were only observed in the same shrimp from 1 pond. Useful information was obtained from these shrimp despite the presence of post-mortem changes. Samples from 19 ponds (43%) tested positive for WSSV by 1-step PCR and samples from an additional 10 ponds (22.7%) were positive by 2-step nested PCR. Samples from 15 ponds (34.1%) were negative for WSSV by 2-step nested PCR. There was moderate to substantial agreement between PCR and histopathology in the diagnosis of WSSV infection in dead shrimp. WSSV infection in dead shrimp was significantly associated with crop failures as defined by a shorter length of the production cycle (<90 d) and lower average weight at harvest (<22 g). WSSV infection was also associated with lower survival (<50%), but this was not significant. Ponds with CIL did not experience any crop failures, and the presence of CIL was significantly associated with successful crops. The study demonstrates that samples of dead shrimp can provide useful information for disease surveillance and epidemiological investigations of WSSV and chronic bacterial infections.
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Affiliation(s)
- C V Mohan
- Department of Aquaculture, College of Fisheries, University of Agricultural Sciences, Mangalore, India.
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42
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Thakur PC, Corsin F, Turnbull JF, Shankar KM, Hao NV, Padiyar PA, Madhusudhan M, Morgan KL, Mohan CV. Estimation of prevalence of white spot syndrome virus (WSSV) by polymerase chain reaction in Penaeus monodon postlarvae at time of stocking in shrimp farms of Karnataka, India: a population-based study. Dis Aquat Organ 2002; 49:235-243. [PMID: 12113310 DOI: 10.3354/dao049235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
White spot disease (WSD) is at present the most serious viral disease affecting cultivated shrimp species globally. The causative agent, white spot syndrome virus (WSSV), is extremely virulent, has a wide host range and can also be transmitted from broodstock to their offspring. The shrimp postlarvae (PL) act as asymptomatic, latent carriers of the virus, and stocking of WSSV-infected PL has been reported as a risk factor for WSD outbreaks in culture ponds. However, there is no population-based study on WSSV prevalence in PL of shrimp. The present manuscript documents the approaches and the results in the estimation of prevalence of WSSV in PL populations of Penaeus monodon at the time of stocking. A maximum of 300 PL from each of the 73 batches of PL stocked at various farms in the west coast of India during September 1999 to January 2000 were tested for the presence of WSSV by 2-step nested PCR. Thirty-six (49%) of the 73 batches tested positive for WSSV either by 1-step alone (3 batches) or after 2-step nested PCR (33 batches). Sub-samples of 5 PL each or 1 PL each tested to quantify the proportion of infected PL within batches showed that WSSV prevalence was very high in 1-step PCR-positive batches and low in 2-step PCR-positive batches. The study also showed that appropriate sampling and sample size were major factors in determining the prevalence of WSSV in PL populations, underlining the need for testing large samples of PL to reduce errors from falsely negative results.
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Affiliation(s)
- P C Thakur
- Department of Aquaculture, University of Agricultural Sciences, College of Fisheries, Mangalore, India
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43
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Corsin F, Phi TT, Phuoc LH, Tinh NTN, Hao NV, Mohan CV, Turnbull JF, Morgan KL. Problems and solutions with the design and execution of an epidemiological study of white spot disease in black tiger shrimp (Penaeus monodon) in Vietnam. Prev Vet Med 2002; 53:117-32. [PMID: 11821141 DOI: 10.1016/s0167-5877(01)00265-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
White spot disease (WSD) is caused by white spot syndrome virus (WSSV) and is an acutely fatal pandemic disease of crustaceans. It has resulted in massive losses to the shrimp-farming industry in Asia and has now spread to the Americas. This paper reports the problems and solutions associated with the design and execution of a longitudinal epidemiological study of shrimp (Penaeus monodon) health on farms practising a crop rotation of rice and shrimp in the Mekong Delta of Vietnam. The pre-sampling phase of the project involved selecting an appropriate site and sampling variables, obtaining permission and establishing the necessary laboratory and logistic facilities. At the start of the sampling phase, 40 farmers were selected and 32 of these were visited and interviewed. This resulted in the enrolment of only 17 farmers. A further seven had to be enrolled to obtain the maximum number of farmers that could be sampled by the study team. Compliance was enhanced through meetings, regular visits by senior members of the project team and ensuring that visits were punctual and that all information was treated confidentially. The production cycle began in January 1998 and lasted for approximately 5 months. An attempt was made to collect 500 post larvae (PL) before each pond was stocked to assess the health of the batch and to test for the presence of WSSV by one-step PCR. After stocking, the wild crustaceans also were sampled from the pond for PCR analyses. Information was collected on the management practices and samples of water, pond bottom, feed and shrimp collected throughout the production cycle. Water quality variables with predictable diurnal variation were sampled in the morning and afternoon, twice a week. Two months after stocking, the first outbreak of WSD occurred; subsequently, 18 farms conducted a complete emergency harvest due to the actual or perceived presence of a WSD outbreak. Detectable mortalities were reported from 19 farms, and moribund shrimps were collected from four of these for PCR and histological analyses.
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Affiliation(s)
- F Corsin
- Department of Veterinary Clinical Science and Animal Husbandry, The University of Liverpool, Chester High Road, Leahurst, Neston, UK
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44
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Corsin F, Turnbull JF, Hao NV, Mohan CV, Phi TT, Phuoc LH, Tinh NT, Morgan KL. Risk factors associated with white spot syndrome virus infection in a Vietnamese rice-shrimp farming system. Dis Aquat Organ 2001; 47:1-12. [PMID: 11797910 DOI: 10.3354/dao047001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
White spot disease (WSD) is a pandemic disease caused by a virus commonly known as white spot syndrome virus (WSSV). Several risk factors for WSD outbreaks have been suggested. However, there have been very few studies to identify risk factors for WSD outbreaks in culture systems. This paper presents and discusses the risk factors for WSSV infection identified during a longitudinal observational study conducted in a Vietnamese rice-shrimp farming system. A total of 158 variables were measured comprising location, features of the pond, management practices, pond bottom quality, shrimp health and other animals in the pond. At the end of the study period WSSV was detected in 15 of the 24 ponds followed through the production cycle (62.5%). One hundred and thirty-nine variables were used in univariate analyses. All the variables with a p-value < or = 0.10 were used in unconditional logistic regression in a forward stepwise model. An effect of location was identified in both univariate and multivariate analyses showing that ponds located in the eastern portion of the study site, closer to the sea, were more likely to test positive for WSSV by 1-step PCR at harvest. Ponds with shrimp of a smaller average size 1 mo after stocking tended to be positive for WSSV at the end of the production cycle. Average weight at 1 mo was also highlighted in multivariate analyses when considered as either a risk factor or an outcome. Other risk factors identified in univariate analyses were earlier date of stocking and use of commercial feed. A number of variables also appeared to be associated with a reduced risk of WSSV at harvest including the presence of dead post larvae in the batch sampled at stocking, presence of Hemigrapsus spp. crabs during the first month of production, feeding vitamin premix or legumes, presence of high numbers of shrimp with bacterial infection and the presence of larger mud crabs or gobies at harvest. No associations were detected with WSSV at harvest and stocking density, presence, or number or weight of wild shrimp in the pond. The multivariate model to identify outcomes associated with WSSV infection highlighted the presence of high mortality as the main variable explaining the data. The results obtained from this study are discussed in the context of WSD control and areas requiring further investigation are suggested.
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Affiliation(s)
- F Corsin
- Department of Veterinary Clinical Science and Animal Husbandry, The University of Liverpool, Neston, United Kingdom
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