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Thromboembolic stroke from the left atrial appendage (LAA) is the most feared complication in patients with atrial fibrillation (AF). The cornerstone for the management of chronic non-valvular AF is stroke reduction with oral anticoagulation (OAC). However, poor compliance, maintaining a narrow therapeutic window, and major side effects such as bleeding have severely limited their use, which creates a therapeutic dilemma. As much as 20% of AF patients are not receiving OAC due to contraindications and less than half of AF patients are not on OAC due to reluctance of the prescribing physician and/or patient non-compliance. Fortunately, over the past decade, there have been great interests in providing an alternative strategy unbeknownst to the practicing internist. The introduction of percutaneous approaches for LAA occlusion has added a different dimension to the management of chronic AF in patients with OAC intolerance. Occlusion devices such as the Amplatzer Cardiac Plug and WATCHMAN device are currently being investigated for stroke prophylaxis. More recently, the LARIAT device may provide an alternative means for potential stroke prophylaxis without the need for short-term post-procedural OAC. We aim to review the current literature and bring attention to an alternative strategy for high-risk AF patients intolerant to OAC.

AbstractThis study explores the factors that influence Vietnamese mobile banking users’ word-of-mouth behavior and sheds light on the impact of customer satisfaction, system quality, and individual performance. The data collected from 297 customers was analyzed through Smart PLS 4.0 utilization. The study findings reveal the direct and significant effect of customer satisfaction on word-of-mouth behavior. In addition, individual performance and mobile banking system quality have been found to be positive factors influencing customer satisfaction. The study also highlights the mediating role of customer satisfaction in the relationship between system quality, individual performance and word-of-mouth, which has not been explored in the prior studies. These results make substantial contributions to the existing literature on signaling theory in business management and hold important policy implications for Vietnamese commercial banks.

Abstract A previously healthy woman, 5 weeks pregnant, was admitted to the intensive care unit in critical condition for septic shock and acute respiratory distress syndrome due to methicillin‐resistant Staphylococcus aureus (MRSA) after being infected with Influenza for 3 days. The patient in this case suffered from severe sequelae due to necrotizing pneumonia and later died on the 20th day after admission. We would like to remind clinicians to be aware of this rare but serious diagnosis. The key is to begin appropriate treatment immediately because MRSA necrotizing pneumonia is mediated by toxins and once the toxins are released they cannot be limited by antibiotic treatments. Necrotizing pneumonia related to MRSA should be considered in young patients with pneumonia, sepsis, and neutropenia following seasonal influenza infection with rapidly progressive symptoms.

PURPOSEWe aimed to assess knowledge, attitudes, and perceived barriers among health care professionals (HCPs), policymakers, and regulators in Vietnam related to opioid therapy for cancer pain.METHODSWe conducted a cross-sectional study in Vietnam from June to August 2022. Participants completed a questionnaire on their demographic characteristics, knowledge and attitudes toward opioid therapy, and barriers to accessing opioids for cancer pain.RESULTSTwo hundred seven HCPs and 15 policymakers/regulators completed the questionnaire. Poor knowledge about opioids in cancer pain was found in 63.3% of HCPs and 80.0% of policymakers/regulators. Poor knowledge was associated with a lack of training in cancer pain management or palliative care (PC; prevalence ratio [PR], 1.14 [95% CI, 1.04 to 1.24]). Negative attitudes toward opioid therapy in cancer pain were held by 64.7% of HCPs and 80.0% of policymakers/regulators. Negative attitudes were associated with the unavailability of oral morphine in the workplace (PR, 1.10 [95% CI, 1.01 to 1.20]). The most common major barriers reported were the absence of national policy on pain management and PC (34.7%), inadequate training in opioid use for cancer pain (33.8%), lockdown of health facilities during the COVID-19 pandemic (32.4%), limited opioid availability in local health facilities (32.4%), and excessively restrictive regulation of opioid dispensing in pharmacies (32.4%).CONCLUSIONThis study found a knowledge deficit and negative attitudes toward opioid therapy for cancer pain among HCPs and policymakers/regulators. Improving education and training in opioid therapy is essential. Recognizing major barriers can guide strategies to enhance safe opioid accessibility for cancer pain management in Vietnam.

Aeromonas hydrophila has been identified as a causative agent of necrotizing fasciitis and myonecrosis, with most reported cases having a connection to aquatic-related trauma. Cases without such trauma history are rare in existing literature. Here, we present the case of a 56-year-old cirrhotic patient who lacked any prior aquatic-related trauma and arrived at the emergency department in a state of septic shock. The suspected route of entry was through necrotizing fasciitis and myonecrosis in his left forearm. Unfortunately, the patient succumbed to multi-organ failure and passed away within 12 hours of admission to the emergency department.

Abstract Background This study investigates the processes regarding changing malaria treatment policies in Vietnam. Moreover, it explores the feasibility of introducing triple artemisinin-based combination therapy (TACT) in Vietnam to support the national malaria control and elimination plan. Methods Data were collected via 12 in-depth interviews with key stakeholders, combined with a review of policy documents. Results TACT is considered as a useful backup strategy in case future treatment failures with current artemisinin-based combination therapy (ACT) would occur. Moreover, TACT is also considered as a promising strategy to prevent the re-establishment of malaria. However, regulatory procedures and implementation timelines for TACT were expected to be lengthy. Therefore, strategies to engage national decision-makers, regulators, and suppliers should be initiated soon, stipulating the benefits of TACT deployment. In Vietnam, a procedure to apply for an import permit without registration that has previously been applied to the introduction of artesunate-pyronaridine was proposed to accelerate the introduction of TACT. Global-level support through the World Health Organization recommendations and prequalification were considered critical for supporting the introduction of TACT in Vietnam. Conclusions Appropriate approach strategies and early stakeholder engagement will be needed to accelerate the introduction of TACT in Vietnam.

Piezoelectric biomaterials can generate piezoelectrical charges in response to mechanical activation. These generated charges can directly stimulate bone regeneration by triggering signaling pathway that is important for regulating osteogenesis of cells seeded on the materials. On the other hand, mechanical forces applied to the biomaterials play an important role in bone regeneration through the process called mechanotransduction. While mechanical force and electrical charges are both important contributing factors to bone tissue regeneration, they operate through different underlying mechanisms. The utilizations of piezoelectric biomaterials have been explored to serve as self-charged scaffolds which can promote stem cell differentiation and the formation of functional bone tissues. However, it is still not clear how mechanical activation and electrical charge act together on such a scaffold and which factors play more important role in the piezoelectric stimulation to induce osteogenesis. In our study, we found Poly(l-lactic acid) (PLLA)-based piezoelectric scaffolds with higher piezoelectric charges had a more pronounced osteoinductive effect than those with lower charges. This provided a new mechanistic insight that the observed osteoinductive effect of the piezoelectric PLLA scaffolds is likely due to the piezoelectric stimulation they provide, rather than mechanical stimulation alone. Our findings provide a crucial guide for the optimization of piezoelectric material design and usage.

Sepsis is a severe, life-threatening illness caused when the immune system responds inappropriately to infections, causing organ deterioration and negatively affecting the systems inside the body, one of which is the coagulation system. Most hematologic changes in red blood cells (RBCs) are non-antibody-mediated hemolytic anemia (NAHA). Autoimmune hemolytic anemia (AIHA) is a rare condition, challenging in diagnosis, requiring prompt recognition and management. Warm hemolytic anemia has recently been reported in patients with septic shock. This report presents a sepsis-induced autoimmune hemolytic anemia case. A 44-year-old Vietnamese female with no chronic disease came to the emergency department because of sudden periumbilical colicky pain after consuming a fresh garden salad. The abdominal pain appeared nine hours after the meal, following vomiting. Twelve hours later, she developed diarrhea, subsequently a fever, and chills. She was admitted to the emergency department in the fifteenth hour of the first symptom. Septic shock, multiple organ failure, and warm autoimmune hemolysis were all present in the patient. Hemolytic anemia and multiorgan failure made the situation worse, leading to death. Autoimmunity hemolytic anemia in sepsis or septic shock is rare, but treating both emergency hemolytic anemia and potential infectious etiology is crucial in acute situations.

Providing palliative care service involves ensuring adequate pain control, which may necessitate the use of opioids. Vietnam has a long history of limited availability of opioids, resulting in healthcare providers’ inexperience and discomfort with prescribing them. This leads to unnecessary patients suffering due to undertreatment of pain. This cross-sectional study examined the impact of the first pharmacist-led online education program in a university hospital in Vietnam on learners’ knowledge and perceived confidence in managing opioids for analgesia in the palliative care setting. Participants filled out a voluntary survey utilizing a five-point Likert scale, within one week of completing the program. We used descriptive statistics and multiple linear regression models to analyze the data. Of the 480 participants enrolled, 28.3% completed the post-course survey. On a scale of 1 to 5, participants reported positive scores in all endpoints, with a mean score ranging from 3.57±0.99 to 3.96±0.83. Significant improvement was seen in confidence with using opioids after the course (p

IntroductionDengue is a major public health challenge and a growing problem due to climate change. The release of Aedes aegypti mosquitoes infected with the intracellular bacterium Wolbachia is a novel form of vector control against dengue. However, there remains a need to evaluate the benefits of such an intervention at a large scale. In this paper, we evaluate the potential economic impact and cost-effectiveness of scaled Wolbachia deployments as a form of dengue control in Vietnam-targeted at the highest burden urban areas.MethodsTen settings within Vietnam were identified as priority locations for potential future Wolbachia deployments (using a population replacement strategy). The effectiveness of Wolbachia deployments in reducing the incidence of symptomatic dengue cases was assumed to be 75%. We assumed that the intervention would maintain this effectiveness for at least 20 years (but tested this assumption in the sensitivity analysis). A cost-utility analysis and cost-benefit analysis were conducted.ResultsFrom the health sector perspective, the Wolbachia intervention was projected to cost US$420 per disability-adjusted life year (DALY) averted. From the societal perspective, the overall cost-effectiveness ratio was negative, i.e. the economic benefits outweighed the costs. These results are contingent on the long-term effectiveness of Wolbachia releases being sustained for 20 years. However, the intervention was still classed as cost-effective across the majority of the settings when assuming only 10 years of benefits.ConclusionOverall, we found that targeting high burden cities with Wolbachia deployments would be a cost-effective intervention in Vietnam and generate notable broader benefits besides health gains.

To better understand the origin and evolution of the Milky Way bulge, we have conducted a survey of bulge red giant branch and clump stars using the High Efficiency and Resolution Multi-Element Spectrograph on the Anglo–Australian Telescope. We targeted ARGOS survey stars with predetermined bulge memberships, covering the full metallicity distribution function. The spectra have signal-to-noise ratios comparable to, and were analysed using the same methods as the GALAH survey. In this work, we present the survey design, stellar parameters, distribution of metallicity, and alpha-element abundances along the minor bulge axis at latitudes b  = −10°, − 7.5°, and −5°. Our analysis of ARGOS stars indicates that the centroids of ARGOS metallicity components should be located ≈0.09 dex closer together. The vertical distribution of α-element abundances is consistent with the varying contributions of the different metallicity components. Closer to the plane, alpha abundance ratios are lower as the metal-rich population dominates. At higher latitudes, the alpha abundance ratios increase as the number of metal-poor stars increases. However, we find that the trend of alpha-enrichment with respect to metallicity is independent of latitude. Comparison of our results with those of GALAH DR2 revealed that for [Fe/H] ≈ −0.8, the bulge shares the same abundance trend as the high-α disc population. However, the metal-poor bulge population ([Fe/H] ≲ −0.8) show enhanced alpha abundance ratios compared to the disc/halo. These observations point to fairly rapid chemical evolution in the bulge, and that the metal-poor bulge population does not share the same similarity with the disc as the more metal-rich populations. [ABSTRACT FROM AUTHOR]

The overlap between the spectroscopic Galactic Archaeology with HERMES (GALAH) survey and Gaia provides a high-dimensional chemodynamical space of unprecedented size. We present a first analysis of a subset of this overlap, of 7066 dwarf, turn-off, and sub-giant stars. These stars have spectra from the GALAH survey and high parallax precision from the Gaia DR1 Tycho-Gaia Astrometric Solution. We investigate correlations between chemical compositions, ages, and kinematics for this sample. Stellar parameters and elemental abundances are derived from the GALAH spectra with the spectral synthesis code SPECTROSCOPY MADE EASY. We determine kinematics and dynamics, including action angles, from the Gaia astrometry and GALAH radial velocities. Stellar masses and ages are determined with Bayesian isochrone matching, using our derived stellar parameters and absolute magnitudes. We report measurements of Li, C, O, Na, Mg, Al, Si, K, Ca, Sc, Ti, V, Cr, Mn, Co, Ni, Cu, Zn, Y, as well as Ba and we note that we have employed non-LTE calculations for Li, O, Al, and Fe. We show that the use of astrometric and photometric data improves the accuracy of the derived spectroscopic parameters, especially log g. Focusing our investigation on the correlations between stellar age, iron abundance [Fe/H], and mean alpha-enhancement [α/Fe] of the magnitude-selected sample, we recover the result that stars of the high-α sequence are typically older than stars in the low-α sequence, the latter spanning iron abundances of −0.7 <  [Fe/H] <  +0.5. While these two sequences become indistinguishable in [α/Fe] vs. [Fe/H] at the metal-rich regime, we find that age can be used to separate stars from the extended high-α and the low-α sequence even in this regime. When dissecting the sample by stellar age, we find that the old stars (>8 Gyr) have lower angular momenta Lz than the Sun, which implies that they are on eccentric orbits and originate from the inner disc. Contrary to some previous smaller scale studies we find a continuous evolution in the high-α-sequence up to super-solar [Fe/H] rather than a gap, which has been interpreted as a separate "high-α metal-rich" population. Stars in our sample that are younger than 10 Gyr, are mainly found on the low α-sequence and show a gradient in Lz from low [Fe/H] (Lz >  Lz, ⊙) towards higher [Fe/H] (Lz <  Lz, ⊙), which implies that the stars at the ends of this sequence are likely not originating from the close solar vicinity. [ABSTRACT FROM AUTHOR]