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Background: Plasmid mediated antimicrobial resistance in the Enterobacteriaceae is a global problem. The rise of CTX-M class extended spectrum beta lactamases (ESBLs) has been well documented in industrialized countries. Vietnam is representative of a typical transitional middle income country where the spectrum of infectious diseases combined with the spread of drug resistance is shifting and bringing new healthcare challenges. Methodology: We collected hospital admission data from the pediatric population attending the hospital for tropical diseases in Ho Chi Minh City with Shigella infections. Organisms were cultured from all enrolled patients and subjected to antimicrobial susceptibility testing. Those that were ESBL positive were subjected to further investigation. These investigations included PCR amplification for common ESBL genes, plasmid investigation, conjugation, microarray hybridization and DNA sequencing of a blaCTX–M encoding plasmid. Principal Findings: We show that two different blaCTX-M genes are circulating in this bacterial population in this location. Sequence of one of the ESBL plasmids shows that rather than the gene being integrated into a preexisting MDR plasmid, the blaCTX-M gene is located on relatively simple conjugative plasmid. The sequenced plasmid (pEG356) carried the blaCTX-M-24 gene on an ISEcp1 element and demonstrated considerable sequence homology with other IncFI plasmids. Significance: The rapid dissemination, spread of antimicrobial resistance and changing population of Shigella spp. concurrent with economic growth are pertinent to many other countries undergoing similar development. Third generation cephalosporins are commonly used empiric antibiotics in Ho Chi Minh City. We recommend that these agents should not be considered for therapy of dysentery in this setting. Author Summary: Shigellosis is a disease caused by bacteria belonging to Shigella spp. and is a leading cause of bacterial gastrointestinal infections in infants in unindustrialized countries. The Shigellae are dynamic and capable of rapid change when placed under selective pressure in a human population. Extended spectrum beta lactamases (ESBLs) are enzymes capable of degrading cephalosporins (a group of antimicrobial agents) and the genes that encode them are common in pathogenic E. coli and other related organisms in industrialized countries. In southern Vietnam, we have isolated multiple cephalosporin-resistant Shigella that express ESBLs. Furthermore, over two years these strains have replaced strains isolated from patients with shigellosis that cannot express ESBLs. Our work describes the genes responsible for this characteristic and we investigate one of the elements carrying one of these genes. These finding have implications for treatment of shigellosis and support the growing necessity for vaccine development. Our findings also may be pertinent for other countries undergoing a similar economic transition to Vietnam's and the corresponding effect on bacterial populations. [ABSTRACT FROM AUTHOR]

Summary: Objective: The purpose of this study was to estimate the prevalence of metabolic syndrome among Vietnamese diabetic patients and to investigate their characteristics. Methods: This cross-sectional study was conducted among 652 outpatients who were recruited from one public general hospital (People Hospital 115) and one private clinic (Medic Center) in Ho Chi Minh City, Vietnam. We obtained informed consent from participants, collected clinical information from medical files, and conducted patient interviews. We evaluated the collected information descriptively and diagnosed metabolic syndrome according to the International Diabetes Federation (IDF) Worldwide Definition of the Metabolic Syndrome. Results: A total of 517 eligible patients (175 men and 342 women) were analyzed. Mean age was 54.6 years for men and 60.7 years for women. Metabolic syndrome was observed in 39.4% of men and 70.5% of women. Central obesity was more prevalent among women (72.5%) compared to men (39.4%). Participants with metabolic syndrome were less likely to endorse a sense of general well-being, and women with metabolic syndrome were likely to have less diabetes-related distress. Conclusions: this study revealed a high prevalence of metabolic syndrome in diabetic Vietnamese patients, especially among women, and revealed central obesity as a key feature. A prospective study should be conducted in this population in order to assess impacts of metabolic syndrome on disease outcome. [ABSTRACT FROM AUTHOR]