Oral actinomycosis in Crohn’s disease patient: a case report

Case Study

Abstract

Patients with Crohn’s disease may present with lesions in their oral cavity. Oral lesions may be associated with the disease itself representing an extraintestinal manifestation, with nutritional deficiencies or with complications from therapy including infections. Actinomycosis is a slowly progressive bacterial infection caused by Actinomyces spp., anaerobic Gram-positive bacteria. These organisms are normal inhabitants of mucous membranes, especially of the oropharynx, and cause opportunistic infections. We report a case of a 30-year-old male with Crohn’s disease presenting with painful oral aphthous ulcers and swelling of the upper lip. A diagnosis of oral actinomycosis was confirmed by histopathological examination. The patient was treated with infliximab and a regimen of amoxicillin 1 g three times a day. He had a marked response to the treatment after 2 weeks. The plan was to continue amoxicillin for at least 6 months with regular follow-up. Physicians should be aware that actinomycosis may be a cause of oral lesions in Crohn’s disease patient, particularly in immunosuppressed patient. Bacterial cultures and pathology are the cornerstones of diagnosis and should be performed in suspected cases to prevent misdiagnosis.

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Development of the optimal procedure for increasing HbA1c concentration in control materials for external quality assessment

Original Research

Abstract

Background: The research aimed to increase certain HbA1c concentrations at medical decision levels for external quality control samples from healthy donor blood.

Methods: The in vitro study was performed from October 2019 to January 2021 at Quality Control Center for Medical Laboratory at University of Medicine and Pharmacy at Ho Chi Minh City. The study observed on the conditions including the optimal buffer solutions (BAGPM, BPS, Ringer, Saline), temperature (2ºC - 8ºC, 22ºC - 24ºC, 37ºC), and glucose concentration (100 mM, 305 mM, 500 mM) affecting the HbA1c concentration in vitro to make the external quality control samples fell in normal, prediabetes, and diabetes range. At every condition, the HbA1c concentration was measured by Tina Quant method to look for the optimal procedure to increase HbA1c concentration required of the external quality control protocol.

Results: The highest HbA1c concentration (11.57±0.2%) was found in BAGPM solution with 100 mM glucose after 15 days with the baseline HbA1c 5.43±0.13%; the HbA1c level increase dramatically at 37ºC in BAGPM 500 mM glucose solution in fifteen days (40.03±1.05%).

Conclusions: The appropriate conditions were identified to prepare HbA1c standards for prediabetic and diabetic levels. The standards for HbA1c concentrations were recommended to prepare by incubating RBCs from non-diabetic donor blood in BAGPM solution containing glucose at 37ºC for 24 hours. Glucose concentrations should be 100 mM and 500 mM, respectively, for prediabetic level (HbA1c ~ 6.0 ± 0.12%) and diabetic level (HbA1c ~ 9.6 ± 0.17%).

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Phytochemical compounds of Morus alba as anti-aging agent towards in silico binding to matrix metalloproteinase proteins

Original Research

Abstract

Skin aging is a natural phenomenon which is related to progressive loss of skin structural integrity and physiological function and affects aesthetics which has been of highly interest. Inhibition of matrix metalloproteinases (MMPs) such as MMP-1, MMP-3, MMP-9 is one of the potential approaches for anti-aging treatment as these targets are involved in molecular pathology to skin aging process from sunlight. The aim of the study was to investigate the binding affinity of 9 phytochemical compounds extracted from Morus alba Moraceae into the MMP enzymes leading to potential anti-aging activity by using in silico approaches including molecular docking and molecular dynamics simulations. All the compounds showed binding abilities into the targets. In particular, mulberrofuran H obtained the best docking results on the three MMPs. Molecular dynamics simulations of the complex of  mulberrofuran H and MMP-9 showed that this complex was stable. Combination of molecular docking and molecular dynamics simulations results, there was an important hydrophobic interaction between mulberrofuran H and His401 at the active site of the MMP-9, which determined the MMP-9 inhibitory potential of mulberrofuran H. The ligand mulberrofuran H was also stabilized into the MMP-9 protein by hydrogen bonds with Pro421 with the high occupancy of 77.67%. These results demonstrated the good binding of mulberrofuran H on the protein MMP-9 which highlighted its anti-aging potency.

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Production and application of lyophilized urine samples used in microbiology external quality assessment programme in Vietnam

Original Research

Abstract

Introduction: The external quality assessment (EQA) for microbiological laboratories is one of the most commonly used services for quality assurance. In Vietnam, the majority of EQA samples are imported from foreign markets, involving high costs, complicated procedures and further making it difficult to ensure quality in terms of transport and management. The objective of this study was to develop a process for producing lyophilized urine samples containing pathogens (Escherichia coli and Enterococcus faecalis), evaluating the homogeneity and stability of the produced samples and the subsequent application of these samples in the launching trial program of the clinical microbiology program.

Methods: The production process of was established according to ISO Guide 34:2009. The homogeneity and stability of production samples were evaluated according to the guidance of ISO 13528:2015. Produced samples were preserved at 2-8°C and assessed for stability after 2, 4, 6, 8, 10, and 12 weeks. Samples were subsequently utilized in the clinical microbiology EQA program, wherein they were sent to 26 laboratories located in several different regions across Vietnam.

Results: The production process thus conceived comprised eight steps that ensured the homogeneity of the samples produced. Two sets of quality samples were produced and stability within12 weeks. Approximately 92% of the laboratories met the set target.

Conclusions: The eight-step process to produce presumptive lyophilized urine samples has successfully developed. The produced samples reach the criteria for EQA samples and suitable to apply on clinical microbiology EQA scheme at national scale.

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Lactic acidosis had developed in diabetic patients receiving herbal therapy

Original Research

Abstract

Introduction: Herbal antidiabetic products are popular in Vietnam. Many cases have presented to hospitals with severe lactic acidosis, shock and were ultimately fatal. We reviewed the clinical findings of these patients for factors that contributed to their illness and death, and analyzed the ingredients contained in these herbal products sold for diabetic treatment.

Method: This was a single-center, retrospective, observational case series. Data were collected on all cases who presented with severe lactic acidosis after use of traditional herbal anti-diabetic pills, over the two-year time period 2018 – 2019. Past medical histories and clinical findings were reviewed. Samples of the herbal anti-diabetic products, and patient blood and urine were analyzed.

Results: A total of 18 cases of severe lactic acidosis associated with use of herbal anti-diabetic pills were reviewed. These patients had a diagnosis of diabetes for an average of 9 years (9.4 ± 4.6 years). The use of these herbals for blood glucose control ranged from one month to 8 years; approximately 50% of these patients consumed these products over a year’s time. Only two cases had combined herbal products and metformin 500 mg. A total mean of herbal pills consumed was 9 (SD ± 8); patients commonly took combinations of 2 different colored tablets. Major manifestations included gastrointestinal disorders, severe metabolic acidosis (pH = 6.85 ± 0.22, HCO3- = 4.4 ± 2.6), with multi-organ failure and shock on admission. Hyperlactatemia was present in all cases (195 ± 74 mg/dL). For lactate removal and acidosis correction, intermittent hemodialysis or continuous renal replacement therapy was performed, ranging from 2 hours to 72 hours depending on the severity of lactic acidosis and patient need. The mortality rate was 33.3% and all these patients became hypoglycemic, either at initial presentation or during treatment. 22 samples of herbal pills were available for testing that contained the biguanides metformin and phenformin, with a higher concentration of phenformin than metformin if both were present, Phenformin was presented in all samples. Arsenic was found in two samples.

Conclusion: Biguanides are an effective treatment for diabetes and were added to traditional herbal pills sold and used for blood glucose control. Many users of these products are doing so because of the cost and perception of the safety of natural remedies. Biguanide poisoning may still occur even in patients without renal impairment.

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

Original Research

Abstract

Background: One of several reasons that the concept of healthcare-associated pneumonia (HCAP) was dismissed was the same presence of multidrug resistant organism (MDRO) between community-acquired pneumonia and HCAP at countries with the low prevalence of antimicrobial resistance (AMR). However, this finding could be unsuitable for countries with the high rates of AMR.

Methods: A prospective observational study was conducted at the respiratory department of Cho Ray hospital from September 2015 to April 2016. All adult patients suitable for community acquired pneumonia (CAP) with risk factor for healthcare-associated infection were included.

Results: We found out 130 subjects. The median age was 71 years (interquartile range 57-81). The male/female ratio was 1.55:1. Prior hospitalization was the most common risk factor for healthcare-associated infection. There were 35 cases (26.9%) with culture-positive (sputum and/or bronchial lavage). Isolated bacteria included Pseudomonas aeruginosa (9 cases), Klebsiella pneumoniae (9 cases), Escherichia coli (4 cases), Acinetobacter baumannii (6 cases), and Staphylococcus aureus (7 cases) with the characteristic of AMR similar to the bacterial spectrum associated with hospital-acquired pneumonia.

Conclusion: MDROs were detected frequently in CAP patients with risk factor for healthcare-associated infection at the hospital with the high prevalence of AMR. This requires the urgent need to evaluate risk factors for MDRO infection in community-onset pneumonia when the concept of HCAP is no longer used.

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Pheochromocytoma: Impact of genetic testing on clinical practice in Vietnam

Original Research

Abstract

Introduction: Germline mutations in predisposing genes have been found in 30-40% of pheochromocytoma/paraganglioma patients. Screening for inherited genetic mutations provide clinicians with mutation-positive patient management strategies in addition to identifying family members at risk of disease. However, genetic testing for pheochromocytoma has not been performed widely in Vietnam.

Methods: Seven patients diagnosed with pheochromocytoma in Vietnam underwent germline genetic testing in known pheochromocytoma-associated genes by direct sequencing. When a germline mutation was identified the first-degree relatives were counseled and offered genetic testing for the inherited mutation.

Results: Mutations were found in five of seven cases and all mutations were in RET proto-oncogene codon 634 indicating a high risk of developing aggressive medullary thyroid cancer and in some cases leading to prophylactic thyroidectomy as recommended.

Conclusions: Genetic testing plays an essential role in the clinical management of pheochromocytoma patients. Genetic results have significantly changed the clinical approach in these patients and identified ‘at risk’ family members.

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Validation of a simple HPLC method to quantify mycophenolic acid concentrations in human plasma

Original Research

Abstract

Introduction: Mycophenolic acid (MPA) is an active metabolite of mycophenolate mofetil and mycophenolate sodium which are widely prescribed to prevent organ rejection after solid organ transplantations. However, MPA induced many side effects on gastrointestinal tract and haematological system.

Objectives: The purpose of this study is to establish a high-performance liquid chromatography (HPLC) method to determine the MPA concentration in plasma in order to optimize the treatment efficacy of MPA or apply to bioequivalence studies. MPA and visnadine (as an internal standard) were extracted from plasma samples with methanol by solid phase extraction using Osis HLB 1cc cartridge. 10 µL of sample extract was injected onto LiChroCART®125-4 (C18 reversed-phase column) at 43 °C on a Waters 2695 XE system. The signals were detected by PDA detector (photodiodes array) at 254 nm. The mobile phase was a mixture of acetonitrile and phosphate buffer (pH 3) with a flow rate of 1 mL/min. The validation criteria included: selectivity, linearity, accuracy, precision, recovery, lower limit of quantification.

Results: Total chromatographic runtime was 15 min. MPA and visnadine were found at 6.45 and 10.79 min, respectively. MPA concentrations were in the linear range from 0.25 to 50 µg/mL. The coefficient of variation (CV) of mean intra-day and inter-day precision levels for MPA was less than 7.5%. The lower limit of quantification was 0.25 µg/mL. No interference was found in the assay.

Conclusion: A simple and reliable HPLC method was developed to quantify the MPA concentration in plasma.

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Actinomycosis of bilateral psoas muscle: a case report

Case Study

Abstract

Actinomycosis is an underreported chronic invasive disease caused by Actinomyces spp. In that group of diseases, pelvic actinomycosis is very rare and most of the cases reported in the literature have shown unilateral psoas muscle involvement. We report a 35-year-old woman with a retroperitoneal mass located in the left psoas muscle that makes abdominal tenderness and difficulty in walking. She had a 7-year history of intrauterine device which had been removed one month just before this event. After undergoing two laparotomies to perform a biopsy with undetermined results, she developed a new mass in the right psoas muscle which was similar to the left one. On the third attempt, the histopathology revealed yellow sulfur granules of Actinomyces which reacted positively with periodic acid Schiff and Grocott’s dye. After three months of treatment with Amoxicillin plus Clavulanic acid, her abscesses were completely resolved. Actinomycosis should always be included in the diagnostic list in patients with a pelvic mass and a history of intrauterine device.

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A scoring scheme prediction model for dengue outbreaks using weather factors in Ho Chi Minh city, Vietnam

Original Research

Abstract

Background: The dengue infection cases are increasing in Ho Chi Minh city (HCMC), Vietnam. Previous studies have demonstrated the correlation between dengue cases and weather factors, which then are used to built prediction models for dengue outbreaks. However, the association between dengue and weather varies greatly between regions and locations. In HCMC, a tropical climate city in Vietnam, there is no such a weather-based prediction model for dengue outbreaks.

Objectives: This study aims to determine the correlation between weather factors and a weekly number of dengue cases and to develop a scoring scheme prediction model for dengue outbreaks using weather factors in HCMC, Vietnam. 

Methods: An ecological study was conducted on the evaluation of weekly time-series data from 1999 to 2017. A Poisson regression model coupled with Distributed Lag Non-Linear Model (DLNM) was constructed to evaluate the effects of weather factors (i.e., temperature, relative humidity, cumulative rainfall, wind speed) and the weekly dengue cases in HCMC with lag 1-12 weeks.

Results: The predictive model was based on the following weather factors: wind speed at lag 5-8 and 9-12 weeks; temperature amplitude and humidity at lag 5-8 weeks; rainfall at lag 1-4, 5-8, and 9-12 weeks. The predictive model using climate predictors explained about 80% of the variance in dengue cases with a small value of the mean absolute percentage error (MAPE= 0.17). The scoring scheme was then developed from the predictive model; it had a good prediction power – with the accuracy rate = 81%, sensitivity = 1, and specificity = 0.80. In summary, our study indicated that weather factors significantly influence and are predictors for the variation of dengue cases in Ho Chi Minh city, Vietnam. We recommend applying this model to improve the prevention of dengue outbreak.

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Inhibitory effect of medicinal plants on in vitro human peripheral blood mononuclear cell proliferation, interleukin-2 secretion and antioxidant activity

Original Research

Abstract

Many plant parts have been widely used in the treatment of immune diseases in Vietnam, yet just few of them are known about their mechanism of action. The goal of this study was to investigate the in vitro inhibitory effects of in vitro inhibitory effect of crude ethanol extracts and fractions of thirteen medicinal plants on proliferation of human peripheral blood mononuclear cells (PBMCs), interleukin-2 secretion and antioxidant activity. PBMCs were extracted from the whole blood of healthy volunteers. The effects of thirteen crude extracts in ethanol and twenty four fractionated extracts in chloroform, ethyl acetate and water on in vitro proliferation of PBMCs were evaluated using MTT test. Interleukin - 2 (IL - 2) concentrations secreted by PBMC were determined by ELISA method. The antioxidant capacity of ethanol extracts and fractionated extracts were assessed using the DPPH method. The results showed that out of thirteen crude ethanol extracts, six extracts inhibited PBMC proliferation and two extracts stimulated PBMC proliferation and five extracts had no effect on PBMC proliferation. The inhibitory extracts reduced the amount of IL-2, while the stimulant extracts while the stimulant extracts had no effect on IL-2 secretion compared to the control. The chloroform extract of Wedelia chinesis showed the strongest inhibitory activity with an IC50 concentration 16.1 µg/ml. The chloroform extract of Piper betle showed the strongest DPPH capture capacity with DPPH50 1.94 µg/ml and 2.1 times stronger than vitamin C. In conclusion, the chloroform extract of Wedelia chinensis may be considered for the treatment of autoimmune diseases.

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Phenotypic prevalence of resistance to carbapenems, colistin and genes encoding carbapenemase in Pseudomonas aeruginosa

Original Research

Abstract

Introduction: The production of carbapenem enzyme is one of the most frequent mechanisms reported in cabapenem resistant Pseudomonas aeruginosa. Besides, a growing number of mobile colistin resistance (MCR) genes are threatening the renewed interest of colistin as a "last-resort" against carbapenem-resistant pathogens. Therefore, the detection of carbapenem-resistant and colistin-resistant phenotypes as well as preventing transmission of multi-resistant P. aeruginosa strains with genes coding for carbapenemase is extremely necessary.

Material and methods: Among 159 P. aeruginosa strains were collected 46 isolates, which is resistant or intermediated to meropenem. Modified carbapenem inactivation (mCIM) and colistin broth disk elution (CBDE) methods were used to identify carbapenemase-producing strains and colistin resistance. In addition, a multiplex real-time PCR technique was applied to investigate the frequency of emergence of carbapenem resistance genes.

Results: The results revealed that 25 strains (54.3%) were positive with mCIM test and none of them resistant to colistin by CBDE method. Number of strains carrying a gene blaIMP: 4 strains (16%), blaNDM: 2 strains (8%). Strains are carrying two genes: blaIMP + blaNDM: 10 strains (40%), blaVIM + blaNDM: 1 strain (4%), blaNDM + blaOXA-48: 1 strain (4%) and are carrying three genes blaIMP + blaNDM + blaOXA-48: 6 strains (24%), blaKPC + blaIMP + blaNDM: 1 strain (4%).

Conclusions: All mCIM positive P. aeruginosa were contained carbapenemase genes. Colistin still reserved a good effect to combine with other antibiotics in multi-resistant treatment. Hence, the classification of genes can help clinicians selected appropriate antibiotics so that more effective treatment for patients.

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Rasmussen Encephalitis: A Rare Neurological Disorder

Case Study

Abstract

A case of Rasmussen encephalitis in a 8 year old child is reported here who presented with recurrent focal seizures and progressive weakness of left half of body. EEG showed electrical features of epilepsy. MRI brain showed cortical atrophy of one brain hemisphere. On the basis of clinical and radiological evidence, diagnosis of Rasmussen encephalitis was made which is a rare neurological disorder of childhood.

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Budget impact analysis of the HIV/AIDS treatment on a national scale: a study from the Vietnam Social Security perspective

Original Research

Abstract

Objectives: To analyze the budget impact of the HIV/AIDS treatment on a national scale, from the Vietnam Social Security (VSS) perspective.

Methods: A model with a 5-year time horizon was developed. The total first year direct medical cost (DMC) and its cost components were estimated for HIV-infected populations each year. Budget impact was described through the proportion of the DMC over the social health insurance (SHI) budget. A scenario analysis was conducted with four settings of different proportions of members and coverage levels of the SHI. All costs were converted to 2020 US dollars. 1-way sensitivity analyses were conducted with variations of mean values in a range of ±25%.

Results: The total DMC was estimated at $1.8M (10,000 cases) to treat all new infections and $27.7M (150,000 cases) to reach the treatment goal of the Ministry of Health (MOH) in 2020. The total DMC accounted for 0.6% of the SHI budget for the year 2020 to meet the treatment goal. The costs of CD4-count test and fully suppressive regimen containing Tenofovir Disoproxil Fumarate (TDF) were identified as key cost drivers. The proportion of the total DMC over the SHI budget among different scenarios did not vary significantly.

Conclusion: This is the first-ever study analyzing the budget impact of the HIV/AIDS treatment on a national scale, from the VSS perspective. The results showed that the cost of HIV/AIDS care was economical and the impact on the SHI budget was reasonable. Findings could be used to notify the MOH to allocate domestic resources and to optimize the current programs.

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Sex-selective abortion in Vietnam during 1999-2009: the first quantitative study at national level

Original Research

Abstract

Introduction: The sex ratio at birth has dramatically increased since 1999 in Vietnam and stood at 112.7 boys per 100 girls in 2017. This figure alarms many female fetuses are aborted for sex-selection but the numerical evidence is unknown. To depict an accurate picture about the sex-selective abortion, we conducted a study to analyze the national data for sex-abortion in Vietnam.

Methods: To estimate the number of sex-selective abortions between 1999 and 2009, the 2009 Census and 1999 Life table of Vietnam were adopted. We calculated the actual number of female and male births for ten years using the reverse survival method. Then the number of sex-selective abortions was the gap between the expected and actual numbers of female births.

Results: There was 217,902 sex-selective abortions, which accounted for 11.8% of all causes of abortion in Vietnam from 1999 to 2009. The number of sex-selective abortions was nearly double from 74,179 in 1999-2004 to 143,723 in 2005-2009, even the national punishments on sex-selective abortion were launched since 2003.

Conclusions: Female fetuses are more likely aborted before birth for sex-selection in Vietnam because of the son preference. In the situation of Vietnam, changing the social norm regarding female values and roles in both family and society is the key solution to end this problem.

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