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Hung Manh Pham,1,2 Anh Phuong Nguyen,1,2 Huong Thi Thu Nguyen,3,4 Tam Ngoc Nguyen,3,4 Thanh Xuan Nguyen,3,4 Thu Thi Hoai Nguyen,3,4 Huong Thi Thanh Nguyen,5,6 Anh Trung Nguyen,3,4 Quang Ngoc Nguyen,1,2 Giang Song Tran,1 Huyen Thi Thanh Vu3,4 1Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam; 2Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam; 3Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam; 4Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam; 5Physiology Department, Hanoi Medical University, Hanoi, 100000, Vietnam; 6Dinh Tien Hoang Institute of Medicine, Hanoi, 100000, VietnamCorrespondence: Anh Phuong Nguyen, Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam, Tel +84 989314464, Email npa6@bachmai.edu.vnPurpose: The aim of this study was to explore the impact of frailty on in-hospital adverse outcomes and net adverse clinical events (NACE) in older patients with acute coronary syndrome.Patients and Methods: This observational study included elderly patients (≥ 60 years old), diagnosed with acute coronary syndrome (ACS) at admission from February 2021 to August 2021. The primary outcome was net adverse clinical events (NACE) defined as a composite of all-cause mortality, stroke, and major bleeding. Secondary outcome was in-hospital adverse outcomes including arrhythmia, acquired pneumonia, stroke, major bleeding, and all-cause mortality. Frailty was assessed using the Frail scale (FS). Data about socio-demographics, comorbidities, body mass index, ACS type, coronary angiography, left ventricular ejection fraction, and length of hospital stay were also collected. Univariate and multivariate logistic regressions were employed to identify the potential association between frailty and outcomes.Results: Of the 116 ACS patients, 38 patients were frail (32.76%). Frail subjects were more often female (50%) and older (p < 0.01) and had higher rates of in-hospital adverse outcomes (OR = 2.37, p = 0.05) and NACE (OR = 7.12; p < 0.01). In univariate analysis, the increased frail score was significantly associated with increased odds of NACE (unadjusted OR = 1.98, 95% CI 1.17– 3.35 for each score increase in Frail Score). In multivariable logistic regression, models controlling for age, gender, PCI, LVEF, and coronary angiography (adjusted OR 2.19, 95% CI 1.12– 4.29 for each score increase in Frail Score).Conclusion: This study revealed the reference data of frailty assessment in older patients with ACS in Vietnam. Our result indicated that over 30% of ACS older patients presented with frailty which was associated with an increased risk of in-hospital adverse outcomes and NACE. This study also provided promising information about the simple FRAIL scale’s potential role in the risk stratification of older patients with ACS.Keywords: Frail scale, elderly, acute coronary syndrome

Yimin Chen,1 Thanh N Nguyen,2 James E Siegler,3 Mohammad Mofatteh,4 Jack Wellington,5 Rongshen Yang,6,7 Lihong Zeng,1 Jiale Wu,6,7 Xi Sun,6,7 Daiyu Liang,6,7 Qiubi Tang,8 Sijie Chen,6,7 Xisheng Huang,6,7 Shuiquan Yang,1 Xuxing Liao9,10 1Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People’s Hospital, Foshan, People’s Republic of China; 2Department of Neurology, Radiology, Boston University School of Medicine, Boston, MA, USA; 3Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA; 4School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK; 5School of Medicine, Cardiff University, Cardiff, UK; 6Medical Intern of Neurology Department, Foshan Sanshui District People’s Hospital, Foshan, People’s Republic of China; 7School of Medicine, Shaoguan University, Shaoguan, People’s Republic of China; 8Chronic Disease Department, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 9Dean Office and Advanced National Stroke Center, Foshan Sanshui District People’s Hospital, Foshan, People’s Republic of China; 10Department of Neurosurgery, First People’s Hospital of Foshan, Foshan, People’s Republic of ChinaCorrespondence: Shuiquan Yang, Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People’s Hospital, No. 16, Guanghaidadaoxi, Sanshui District, Foshan, People’s Republic of China, Email yangshuiquan1969@126.com Xuxing Liao, Dean Office and Advanced National Stroke Center, Foshan Sanshui District People’s Hospital, Foshan, People’s Republic of China, Email drliao210409@163.comPurpose: This study aimed to investigate the impact of characteristic ischemic stroke and outcomes during the first COVID-19 pandemic lockdown.Patients and Methods: A retrospective, observational cohort study of a comprehensive tertiary stroke center was conducted. Patients with ischemic stroke were divided into pre-COVID-19 lockdown (11/1/2019 to 1/30/2020) and COVID-19 lockdown (1/31/2020 to 4/30/2020) period groups. Patient data on stroke admission, thrombolysis, endovascular treatment, and 3-month routine follow-up were recorded. Data analysis was performed using SPSS according to values following a Gaussian distribution.Results: The pre-COVID-19 lockdown period group comprised 230 patients compared to 215 patients in the COVID-19 lockdown period group. Atrial fibrillation was more predominant in the COVID-19 lockdown period group (11.68% vs 5.65%, p=0.02) alongside patients who were currently smoking (38.8% vs 28.7%, p=0.02) and drinking alcohol (30.37% vs 20.00%, p=0.012) compared with that of the pre-COVID-19 lockdown period group. For patients receiving thrombolysis, the median door-to-CT time was longer in the COVID-19 lockdown period group (17.0 min (13.0, 24.0) vs 12.0 min (8.0, 17.3), p=0.012), median door to needle time was 48.0 minutes (35.5, 73.0) vs 43.5 minutes (38.0, 53.3), p=0.50, compared with that of the pre-COVID-19 lockdown period group. There were no differences for patients receiving mechanical thrombectomy. The median length of hospitalization (IQR) was no different. Discharge mRS scores (IQR) were higher in the COVID-19 lockdown period group (1.0 (1.0, 3.0) vs 1.0 (1.0, 2.0), p=0.022). Compared with the pre-COVID-19 lockdown period, hospitalization cost (Chinese Yuan) in the COVID-19 period group was higher (13,445.7 (11,009.7, 20,030.5) vs 10,799.2 (8692.4, 16,381.7), p=0.000). There was no difference observed in 3-month mRS scores.Conclusion: Patients presenting with ischemic stroke during the COVID-19 pandemic lockdown period had longer median door-to-CT time and higher hospitalization costs. There were no significant differences in 3-month outcomes. Multidisciplinary collaboration and continuous workflow optimization may maintain stroke care during the COVID-19 pandemic lockdown.Keywords: ischemic stroke, COVID-19 pandemic, thrombolysis, thrombectomy, hospitalization cost

Hung Manh Pham,1,2 Anh Phuong Nguyen,1,2 Huong Thi Thu Nguyen,3,4 Tam Ngoc Nguyen,3,4 Thanh Xuan Nguyen,3,4 Thu Thi Hoai Nguyen,3,4 Huong Thi Thanh Nguyen,5,6 Anh Trung Nguyen,3,4 Quang Ngoc Nguyen,1,2 Giang Song Tran,1 Huyen Thi Thanh Vu3,4 1Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam; 2Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam; 3Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam; 4Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam; 5Physiology Department, Hanoi Medical University, Hanoi, 100000, Vietnam; 6Dinh Tien Hoang Institute of Medicine, Hanoi, 100000, VietnamCorrespondence: Anh Phuong Nguyen, Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam, Tel +84 989314464, Email npa6@bachmai.edu.vn

Hanh Vu,1 Masahiro Hayashi,2,3 Thang Nam Nguyen,4 Diep Thi Khong,4 Hoa Thi Tran,4 Yoshimasa Yamamoto,1 Kaori Tanaka1– 3 1United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, Gifu City, Gifu, Japan; 2Life Science Research Center, Gifu University, Gifu City, Gifu, Japan; 3Institute for Glyco-core Research (iGCORE), Gifu University, Gifu City, Gifu, Japan; 4Center for Medical and Pharmaceutical Research and Service, Thai Binh University of Medicine and Pharmacy, Thai Binh City, Thai Binh, VietnamCorrespondence: Kaori TanakaUnited Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, 1-1 Yanagido, Gifu City, Gifu, 501-1194, JapanTel +81-58-230-6554Fax +81-58-230-6551Email kktb@gifu-u.ac.jpPurpose: Normal non-pathogenic flora can harm the host by acting as a reservoir of resistance determinants that are potentially transferable to human pathogens. This study aimed to assess the phenotypic and genotypic antimicrobial susceptibility patterns of the Bacteroides fragilis group (BFG) isolated from healthy individuals in Vietnam and Japan in order to elucidate the prevalence of antimicrobial resistance in human flora in the two economically and geographically different countries.Materials and Methods: BFG was isolated from fecal samples of 80 healthy individuals in Vietnam (n=51) and Japan (n=29). Isolated strains were identified using MALDI-TOF MS, and the minimum inhibitory concentration (MIC) of 18 antibiotics was determined using the agar dilution method. Additionally, 20 antimicrobial resistance genes were detected using standard PCR.Results: A total of 139 BFG strains belonging to 11 BFG species were isolated from the two countries, with diversity in the prevalence of each species. B. fragilis was not the predominant species. Isolations from Vietnam and Japan showed some similarities in terms of MIC50 values, MIC90 values, and the percentage of resistant strains. However, isolations from Vietnam showed significantly higher resistance to piperacillin, cefmetazole, clindamycin, tetracycline, and minocycline. ErmB, tet 36, tetM, nim, catA, and qnrA were not found in either country. CepA was more common in B. fragilis than in non-fragilis Bacteroides. In contrast, cfiA, ermG, mefA, msrSA, tetX, tetX1, bexA, qnrB, and qnrS were found only in non-fragilis Bacteroides. There were differences in the prevalence of ermG, linA, mefA, msrSA, and qnrS between isolates from Vietnam and Japan.Conclusion: This study is the first report on the antimicrobial susceptibility patterns in the BFG isolated from healthy individuals in Vietnam and Japan. Compared to isolations from Japan, isolations from Vietnam showed significantly higher resistance to antimicrobial agents. The distribution of various antibiotic resistance genes also differed between the two countries.Keywords: antimicrobial resistance patterns, resistance genes, human flora

Anh Trung Nguyen,1,2 Anh Kim Dang,3 Huong Thi Thu Nguyen,1,2,4 Thanh Xuan Nguyen,1,2 Tam Ngoc Nguyen,1,2 Thu Thi Hoai Nguyen,1,2 Thang Pham,1,2 Anh Lan Nguyen,1,2 Thuy Thi Ngoc Nguyen,1 Hien Nguyen Thi,5,6 Trang Ha Nguyen,5,6 Son Hoang Nguyen,7 Bach Xuan Tran,3,8 Carl Latkin,8 Roger CM Ho,9,10 Cyrus SH Ho,11 Huyen Thi Thanh Vu1,2 1Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam; 2Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam; 3Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam; 4Dinh Tien Hoang Institute of Medicine, Hanoi, 100000, Vietnam; 5Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam; 6Faculty of Nursing, Duy Tan University, Da Nang, 550000, Vietnam; 7Center of Excellence in Health Services and System Research, Nguyen Tat Thanh University, Ho Chi Minh, 700000, Vietnam; 8Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA; 9Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore; 10Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 119228, Singapore; 11Department of Psychological Medicine, National University Hospital, Singapore, 119228, SingaporeCorrespondence: Anh Trung NguyenGeriatrics Department, Hanoi Medical University, No 1 Ton That Tung, Dong Da, Hanoi, 100000, VietnamTel +84 903480774Email trunganhvlk@gmail.comBackground: Nurses play a pivotal role in pain management. Knowing more about nurses’ knowledge and attitudes regarding pain is important as we develop multidisciplinary pain services. Therefore, this study aimed to assess knowledge and attitudes regarding pain management among nurses in a geriatric hospital and its associated factors.Subjects and Methods: A survey was conducted of nurses worked at the National Geriatric Hospital over a 3-month period. The Knowledge and Attitudes Survey Regarding Pain (KASRP) was utilized to assess nurses’ knowledge and attitudes toward pain management. Four domains were defined based on KASRP, included cancer-related pain, pain assessment, pharmacology and substance abuse and physical dependence. Knowledge and attitudes regarding pain were classified as poor, fair, or good (≤ 50%, 50% - 75%, or ≥ 75% of the KASRP score). Multivariate Tobit regression models were applied to identify factors associated with the knowledge and attitudes regarding pain management.Results: Of 154 participants completed the survey, 72.2% (111 participants) had poor knowledge and attitudes regarding pain management. The participants had a correct mean score of 45.2% (SD = 2.2). Nurses’ knowledge of pain assessment was poor, with the proportion of correct answers to nine questions ranging from 2.6% to 50%. 44.8% of nurses reported never or rarely using pain assessment tools. Nurses who had previous training regarding pain at medical universities had significantly higher scores of knowledge and attitudes compared to those without training. Nurses who often use pain assessment tools had a significantly higher level of knowledge and attitudes than those who never or rarely use them.Conclusion: This study highlights significant deficits of knowledge and negative attitudes regarding pain management among nurses. The subject of pain management should be applied and enhanced in the nursing undergraduate curriculum. Nurses’ active participation in pain management should be encouraged by healthcare providers for older patients.Keywords: knowledge, attitude, nurse, pain management, older people

Huyen Thi Thanh Vu,1,2 Hue Thi Mai,3 Huong Thi Thu Nguyen,1,2 Thu Thi Hoai Nguyen,1,2 Thanh Xuan Nguyen,1,2,4 Tam Ngoc Nguyen,1,2 Thang Pham,1,2 Lan Thi Mai Nguyen,1 Giang Thu Vu,5 Hai Quang Pham,6,7 Hai Thanh Phan,6,7 Bach Xuan Tran,3,8 Carl A Latkin,8 Cyrus SH Ho,9 Roger CM Ho,6,10,11 Anh Trung Nguyen1,2 1Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam; 2Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam; 3Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; 4Dinh Tien Hoang Institute of Medicine, Hanoi, Vietnam; 5Center of Excellence in Evidence-Based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam; 6Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam; 7Faculty of Medicine, Duy Tan University, Da Nang, Vietnam; 8Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 9Department of Psychological Medicine, National University Hospital, Singapore, Singapore; 10Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; 11Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, SingaporeCorrespondence: Huong Thi Thu NguyenScientific Research Department, National Geriatric Hospital, 1A Phuong Mai - Dong Da, Hanoi 100000, VietnamTel +84 973056334Email thuhuonglk@hmu.edu.vnPurpose: The high prevalence of chronic pain and difficulties in pain management in older people are challenging for healthcare providers globally. Patient satisfaction regarding pain management is one of the measures to assess efficacy of pain control as well as healthcare services. Thus, our study aimed to evaluate the older patients’ satisfaction with pain management and its associated factors in Vietnam.Patients and Methods: A cross-sectional study was conducted at National Geriatric Hospital, Hanoi, Vietnam from May to October 2018. Face-to-face interviews were conducted on 495 older patients with chronic pain by using a structured questionnaire. The Pain Treatment Satisfaction Scale (PTSS) was used to assess the level of satisfaction with pain management. A Tobit regression model was used to estimate factors associated with satisfaction toward pain management.Results: The mean total satisfaction score was 1.77 (SD= 0.22). Older patients were most satisfied with the aspect of side effects of pain relief medication (mean=0.66, SD=0.56). On the contrary, they were most dissatisfied with information provided about pain and its treatment and efficacy of pain relief medication. Outpatients were less satisfied with information provided, the impact of current medication and pain management in general compared to inpatients. The regression model showed that patients with severe pain tended to be more dissatisfied with pain management than those with no pain.Conclusion: This study indicated that the general satisfaction with chronic pain management in older patients was quite good especially in the aspect of pain medication’s side effects. However, dissatisfactory factors remained, including information provided about pain and efficacy of current pain medication. Intensive training regarding pain in geriatric care, health education communication for older people, and improved quality of medical services should be performed to ensure the quality of pain management, especially in the older population.Keywords: chronic pain, elderly, pain management, satisfaction, Vietnam

Anh Trung Nguyen,1,2 Hai Quang Pham,3,4 Thanh Xuan Nguyen,1,2,5 Thu Thi Hoai Nguyen,1,2 Huong Thi Thu Nguyen,1,2 Tam Ngoc Nguyen,1,2 Dung Thi Kim Dinh,1 Hai Thanh Phan,3,4 Son Hoang Nguyen,6 Bach Xuan Tran,7,8 Carl A Latkin,8 Roger CM Ho,9,10 Cyrus SH Ho,9 Thang Pham,1,2 Huyen Thi Thanh Vu1,2 1Hanoi Medical University, Hanoi, Vietnam; 2National Geriatric Hospital, Hanoi, Vietnam; 3Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam; 4Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam; 5Dinh Tien Hoang Institute of Medicine, Hanoi, Vietnam; 6Center of Excellence in Health Services and System Research, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam; 7Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; 8Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 9Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; 10Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, SingaporeCorrespondence: Huyen Thi Thanh VuDepartment of Geriatrics, Hanoi Medical University, 01 Ton That Tung, Hanoi, VietnamTel +84 913531579Email vuthanhhuyen11@hmu.edu.vnBackground: Diabetes-related complications have become increasingly prevalent and complicated to manage, especially among frail older adults with co-morbidities, poor physical function, and impaired cognition. Thus, knowledge, attitude, and practice (KAP) of elderly diabetic patients play an essential role in controlling the disease and its complications.Patients and Methods: A cross-sectional study was conducted on 176 diabetic patients at the outpatient clinics, National Geriatric Hospital, Hanoi, Vietnam from August to November 2015. Patients’ knowledge, attitude, and practice regarding diabetes mellitus were assessed using a structured questionnaire. Exploratory factor analysis and multivariate Tobit regression model were used to identify factors associated with knowledge, attitude, practice about diabetes mellitus.Results: Of 176 diabetic patients, patients’ knowledge was divided into two main groups: “Diabetes definition and management” (mean score = 57.7 ± 25.6) and “Targets for diabetic control” (mean score = 66.1 ± 30.4). Patients scored high points of attitudes toward diabetes severity and its complications (mean score = 95.8 ± 13.0); however, knowledge and practice scores were only moderate (mean score = 68.1 ± 16.8). There were only 8.5% of people having daily self-blood glucose monitoring. Advanced age, low educational level, rural area, and duration of diabetes less than 5 years were negative associated with knowledge, attitude, and practice regarding diabetes mellitus. This study also shows that frailty and co-morbidities/diabetic complications could impair patients’ knowledge.Conclusion: Older patients with diabetes had high levels of perceived severity attitudes on diabetes mellitus. However, the knowledge and practice levels were still inadequate. Pragmatic diabetic health literacy, counseling and education programs, as well as home-based treatments are viable options to improve health outcomes.Keywords: attitude, diabetes, elderly, knowledge, practice

Tam Ngoc Nguyen,1,2 Anh Trung Nguyen,1,2 Long Quynh Khuong,3 Thanh Xuan Nguyen,1,2 Huong Thi Thu Nguyen,1,2 Thu Thi Hoai Nguyen,1,2,4 Minh Van Hoang,3 Thang Pham,1,2 Tu Ngoc Nguyen,5 Huyen Thi Thanh Vu1,6 1Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam; 2Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam; 3Hanoi University of Public Health, Hanoi, Vietnam; 4Dinh Tien Hoang Institute of Medicine, Hanoi, Vietnam; 5Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; 6Hanoi Medical University Hospital, Hanoi, VietnamCorrespondence: Huyen Thi Thanh VuDepartment of Geriatrics, Hanoi Medical University, 01 Ton That Tung, Dong Da, Hanoi, VietnamTel +84913531579Email vuthanhhuyen11@hmu.edu.vnBackground: The SARC-F questionnaire has been developed as a rapid diagnostic test that can be used to screen for sarcopenia.Aim: To investigate the reliability and validity of the Vietnamese version of SARC-F as a screening tool for sarcopenia in older patients in Vietnam.Methods: A cross-sectional study was conducted in older people attending the outpatient clinics of the National Geriatric Hospital in Vietnam. Muscle mass (using dual-energy X-ray absorptiometry), handgrip strength and gait speed were assessed. SARC-F was validated against the three standard criteria for sarcopenia: the Foundation for the National Institutes of Health (FNIH), Asia Working Group for Sarcopenia (AWGS 2019) and European Working Group on Sarcopenia in Older People (EWGSOP2).Results: There were 764 participants (mean age 71.5 ± 8.9 years). The Vietnamese SARC-F questionnaire had a good internal consistency (Cronbach’s alpha 0.85). The prevalence of sarcopenia was 49.2% according to SARC-F and 48.3%, 61.1% and 52.6% according to FNIH, AWGS 2019 and EWGSOP2, respectively. The sensitivity and specificity of SARC-F in identifying sarcopenia were 67.1% and 66.7% (for FINH), 66.7% and 67.1% (for AWGS 2019), and 64.9% and 68.2% (for EWGSOP2). The AUCs of SARC-F were 0.71– 0.72 against the three sarcopenia criteria.Conclusion: The Vietnamese version of SARC-F questionnaire has acceptable diagnostic value for sarcopenia. SARC-F could be used as an initial screening for sarcopenia in hospital clinics.Keywords: older patients, sarcopenia, SARC-F, Vietnam

Tan Van Nguyen,1,2 Duong Le,1,2 Khuong Dang Tran,1 Khai Xuan Bui,1 Tu Ngoc Nguyen3 1Department of Geriatrics & Gerontology, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam; 2Department of Interventional Cardiology, Thong Nhat Hospital, Ho Chi Minh City, Vietnam; 3Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, AustraliaCorrespondence: Tan Van NguyenDepartment of Geriatrics & Gerontology, University of Medicine and Pharmacy, Ho Chi Minh City, VietnamTel +84 903 739 273Email nguyenvtan10@ump.edu.vnBackground: There has been limited evidence about frailty in older patients with acute coronary syndrome (ACS) in Vietnam.Aim: (1) To investigate the prevalence of frailty in older patients hospitalised with ACS and its associated factors; (2) To investigate the impact of frailty on percutaneous coronary intervention (PCI) and adverse outcomes in this population.Methods: Patients aged ≥60 with ACS admitted to two teaching hospitals in Vietnam were recruited from 9/2017 to 4/2018. Frailty was defined by the Reported Edmonton Frail Scale. Multivariate logistic regression was applied to investigate the associated factors of frailty and the impact of frailty on PCI and adverse outcomes.Results: There were 324 participants, mean age 73.5±8.3, 39.2% female. The prevalence of frailty was 48.1%. Advanced age, female gender, history of hypertension, heart failure, stroke and chronic kidney disease were significantly associated with a frailty status. Overall, 50.3% of the participants received PCI (58.3% in the non-frail vs 41.7% in the frail, p=0.003). However, frailty did not have an independent impact on PCI (adjusted OR 0.66, 95% CI 0.41–1.08). Frailty was significantly associated with increased risk of having arrhythmia during hospitalisation (adjusted OR 2.24, 95% CI 1.32–3.80), hospital-acquired pneumonia (adjusted OR 2.27, 95% CI 1.24–4.17), in-hospital mortality (adjusted OR 3.02, 95% CI 1.35–6.75), 30-day mortality (adjusted OR 3.28, 95% CI 1.59–6.76), and 30-day readmission (adjusted OR 2.53, 95% CI 1.38–4.63).Conclusion: In this study, frailty was present in nearly half of older patients with ACS and was associated with increased adverse outcomes. These findings suggest that frailty screening should be performed in older patients with ACS in Vietnam.Keywords: frailty, acute coronary syndrome, elderly, older patients, adverse outcomes, Vietnam

Ryuji Kawahara,1,* Diep Thi Khong,2,* Ha Viet Le,2 Quang Ngoc Phan,2 Thang Nam Nguyen,2 Takahiro Yamaguchi,1 Yuko Kumeda,3 Yoshimasa Yamamoto4,5 1Department of Microbiology, Osaka Institute of Public Health, Osaka, Japan; 2Center of Medical, Pharmaceutical Science and Technology Services, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam; 3Research Center for the 21st Century, Osaka Prefecture University, Osaka, Japan; 4Life Science Research Center, Gifu University, Gifu, Japan; 5Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan*These authors contributed equally to this workCorrespondence: Yoshimasa YamamotoLife Science Research Center, Gifu University, 1-1 Yanagido, Gifu 501-1194, JapanTel/fax +81 58 230 6239Email yyamamot@sahs.med.osaka-u.ac.jpPurpose: The dissemination of colistin-resistant bacteria harboring the colistin-resistance gene mcr-1 in developing countries has recently entered the spotlight as an emerging public health threat, which is attributed to the abuse of colistin use in these countries. However, the prevalence of these bacteria in developing countries has not been extensively investigated. Therefore, in the present study, we examined the prevalence of cefotaxime-resistant commensal Escherichia coli harboring mcr-1 among residents of a representative Vietnamese village and assessed the characteristics of these isolates.Materials and methods: The stool samples, one stool sample per resident, of 612 residents were cultured on MacConkey agar with cefotaxime. Resulting E. coli-like colonies were isolated and examined further for the presence of colistin-resistant extended-spectrum β-lactamase (ESBL)-producing E. coli with mcr-1. Antibiotic susceptibility tests were performed, and clonal relationship among colistin-resistant isolates was assessed.Results: Thirty-one of the 451 cefotaxime-resistant E. coli isolates were resistant to colistin and the majority possessed mcr-1, blaCTX-M, and/or blaTEM, except for two isolates that produced the AmpC β-lactamase. All mcr-1 ESBL-producing E. coli isolates were multidrug-resistant (5–11 antibiotics). The isolates contained various plasmid replicon types, including the most prevalent types IncHI2 (54.8%), IncFIB (48.4%), and IncN (41.9%). In addition, 83.9% of the mcr-1 ESBL-E. coli isolates possessed a transposon ISApl1-mcr-1 segment. Furthermore, 77.4% of the mcr-1 ESBL-E. coli isolates belonged to phylogenetic group A. Pulsed-field gel electrophoresis analysis indicated limited clonal expansion of a specific strain.Conclusion: These results demonstrate the wide dissemination of colistin-resistant ESBL-E. coli harboring mcr-1 among commensal bacteria of rural residents in Vietnam, suggesting possible mobilization of the mcr-1 gene among ESBL-producing microbiota, which is a great public health concern.Keywords: mcr-1, residents, stool specimens, commensal bacteria, Vietnam

Thu Thi Hoai Nguyen,1–3 Huyen Thi Thanh Vu,1,3 Tam Ngoc Nguyen,1,3 Huyen Thi Dao,3 Thanh Xuan Nguyen,1,3 Huong Thu Thi Nguyen,1,3 Anh Kim Dang,4 Anh Trung Nguyen,1,3 Thang Pham,1,3 Giang Thu Vu,5 Bach Xuan Tran,6,7 Carl A Latkin,7 Cyrus SH Ho,8 Roger C Ho9,101National Geriatric Hospital, Hanoi, Vietnam; 2Dinh Tien Hoang Institute of Medicine, Hanoi, Vietnam; 3Hanoi Medical University, Hanoi, Vietnam; 4Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam; 5Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh city, Vietnam; 6Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; 7Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 8Department of Psychological Medicine, National University Hospital, Singapore, Singapore; 9Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam; 10Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporePurpose: Nutritional status is an important element for the wellness among older diabetic outpatients. This study aimed to assess the nutritional status of the older diabetic outpatient by using the Mini-Nutrition Assessment Short Form (MNA-SF) tool, and describe the relationship among related factors in older diabetic outpatients in the National Geriatric Hospital, Hanoi, Vietnam.Patients and methods: A cross-sectional study was conducted from June to September 2015 in the National Geriatric Hospital. A total of 158 diabetic patients aged ≥60 years at the Outpatient Department were included in this study. Patients were interviewed face-to-face to evaluate their nutritional status by using the MNA-SF. Socio-demographic, diabetic treatment information, frailty, exhaustion, cognitive function, hand grip strength and 4 m walk test were collected. Multivariate regression was used to determine factors associated with nutritional status.Results: The mean age was 69.52 (SD=6.758) with 31% patients malnourished and at risk of malnutrition. A significant association was found between the nutritional status and exhaustion, cognitive impairment, and frailty. In multiple logistic regression, the study found that risk of malnutrition was associated with frailty (OR=8.45; 95%CI=1.91–37.39) and cognitive impairment (OR=2.21; 95%CI=1.01–4.84).Conclusion: The results suggest that frailty was significantly associated with risk of malnutrition in older diabetic outpatients. Thus, early screening by nutritional assessment, and other interventions might improve the nutritional status of older outpatients with diabetes to prevent this complication and its effects.Keywords: elderly, nutritional status, outpatients, Vietnam

Anh Trung Nguyen,1,2 Thanh Xuan Nguyen,1,2 Tu N Nguyen,1,3 Thu Hoai Thi Nguyen,1,2,4 Thang Pham,1,2 Robert Cumming,5 Sarah N Hilmer,6 Huyen Thi Thanh Vu1,2 1The National Geriatric Hospital, Hanoi, Vietnam; 2Department of Geriatrics and Gerontology, Hanoi Medical University, Hanoi, Vietnam; 3Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; 4Dinh Tien Hoang Institute of Medicine, Hanoi, Vietnam; 5Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; 6Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital and Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia Aims: To investigate the impact of frailty on outcomes in older hospitalized patients, including prolonged length of stay and all-cause mortality 6 months after admission, using both the frailty phenotype and the Reported Edmonton Frail Scale (REFS).Patients and methods: This study is the follow-up phase of a study designed to investigate the prevalence of frailty and its impact on adverse outcomes in older hospitalized patients at the National Geriatric Hospital in Hanoi, Vietnam.Results: A total of 461 participants were included, with a mean age 76.2±8.9 years, and 56.8% were female. The prevalence of frailty was 31.9% according to the REFS and 35.4% according to Fried’s criteria. The kappa coefficient was 0.57 (95% CI =0.49–0.66) between the two frailty criteria in identifying frail and non-frail participants. There was a trend toward increasing the likelihood of prolonged hospitalization in participants with frailty defined by Fried’s criteria (adjusted OR =1.49, 95% CI =0.94–2.35) or by REFS (adjusted OR =1.43, 95% CI =0.89–2.29). During 6 months of follow-up, 210 were lost and 18/251 (7.2%) participants died. Mortality was higher in those with frailty defined by either Fried’s criteria or REFS. On multivariable survival analysis, adjusted HRs for mortality were 2.65 (95% CI =1.02–6.89) for Fried’s criteria and 4.19 (95% CI =1.59–10.99) for REFS.Conclusion: Fried’s frailty phenotype or REFS can be used as a screening tool to detect frailty in older inpatients in Vietnam and predict mortality. Frailty screening can help prioritize targeted frailty-tailored treatments, such as nutrition, early mobility and medication review, for these vulnerable patients to improve clinical outcomes. Keywords: frailty, elderly, inpatients, Vietnam

Huyen Thi Thanh Vu,1,2 Thanh Xuan Nguyen,2,3 Huong Thi Thu Nguyen,1,2 Tu Anh Le,4 Tam Ngoc Nguyen,1,2 Anh Trung Nguyen,2 Thu Thi Hoai Nguyen,1,2 Hoang Long Nguyen,5 Cuong Tat Nguyen,6 Bach Xuan Tran,7,8 Carl A Latkin,8 Thang Pham,2 Melvyn WB Zhang,9 Roger CM Ho10 1Department of Gerontology, Hanoi Medical University, Hanoi, Vietnam; 2National Geriatric Hospital, Hanoi, Vietnam; 3Dinh Tien Hoang Institute of Medicine, Hanoi, Vietnam; 4Department of Endocrinology, Nghe An Endocrinology Hospital, Nghe An, Vietnam; 5Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam; 6Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam; 7Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; 8Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 9Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore, Singapore; 10Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Background and aims: Depression and diabetes are becoming increasingly prevalent within the Vietnamese elderly population. However, the linkage between these health conditions in the Vietnamese elderly has not yet been fully investigated. This study aimed to assess the level of depressive symptoms and associated factors among elderly diabetic patients.Methods: A cross-sectional study was conducted at National Geriatric Hospital in the elder patients aged ≥60 years with type 2 diabetes mellitus (T2DM). Depressive symptoms were assessed using the Geriatric Depression Scale, with three categories: normal (0–4 points), mild (5–9 points), and moderate/severe depressive symptoms (≥10 points). We obtained information on the patient’s sociodemographic, medical history, glycemic control (fasting plasma glucose and HbA1c), daily activities (activities of daily living [ADLs] and instruments activities of daily living [IADLs] scale), and fall risks (Time Up and Go test). Logistic regression was used to analyze the factors associated with the presence of depressive symptoms.Results: Among 412 patients, 236 (57.3%) had HbA1c level at 7.0% or higher. There were 327 (79.4%) patients having depressive symptoms. The level of HbA1c was significantly different between the depressive symptom group and the non-depressive symptom group (7.74% and 6.61%, P

Huong Thi Thu Nguyen,1,2 Mackenzie PI Moir,3 Thanh Xuan Nguyen,2,4 Anh Phuong Vu,5 Long Hoang Luong,2,4 Tam Ngoc Nguyen,1,2 Long Hoang Nguyen,6 Bach Xuan Tran,7,8 Tung Thanh Tran,9 Carl A Latkin,8 Melvyn WB Zhang,10 Roger CM Ho,11 Huyen Thanh Thi Vu1,2 1Department of Gerontology, Hanoi Medical University, Hanoi, Vietnam; 2National Geriatric Hospital, Hanoi, Vietnam; 3School of Public Health, University of Alberta, Edmonton, AB, Canada; 4Dinh Tien Hoang Institute of Medicine, Hanoi, Vietnam; 5Hanoi Medical University, Hanoi, Vietnam; 6School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam; 7Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; 8Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 9Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam; 10Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore, Singapore; 11Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Background: Health-related quality of life (HRQoL) is an important indicator for designing care and treatment services for patients with diabetes. This is especially true given its rapid increase among the elderly population in Vietnam. HRQoL data in elderly diabetic Vietnamese are currently limited. This study aimed to 1) measure the HRQoL of elderly patients with type 2 diabetes (T2DM) in Vietnam and 2) identify related factors and their relationship with HRQoL. Patients and methods: A cross-sectional study was conducted. We recruited 171 patients aged ≥60 years with T2DM at the Outpatient Department, National Geriatric Hospital from June to November 2015. Patients were asked to evaluate their health status using the EuroQol Five Dimensions Three Levels (EQ-5D-3L) and the Visual Analog Scale (VAS). Sociodemographic, diabetic treatment, and management characteristics were collected. Multivariate Tobit regression was used to determine which factors were associated with HRQoL, and the strength of this relationship. Results: Patients reported some problems in all areas of the EQ-5D: pain/discomfort (50.9%), mobility (33.3%), anxiety/depression (24.0%), usual activities (21.1%), and self-care (10.5%). The mean EQ-5D index score was 0.80 (SD=0.20), and the mean EQ-VAS was 57.5 (SD=14.4). Patients who were male, lived in an urban area, could afford treatment, were taking fewer medications, and monitored blood pressure often (1–4 times a week) had a higher EQ-5D index when compared to other groups. Meanwhile, a longer duration of diabetes and older age were negatively associated with the EQ-5D index. Patients with any comorbidity had lower VAS scores than their counterparts. Conclusion: The presence of diabetes and comorbidity were responsible for a significant decrease in HRQoL. Screening and identifying health problems, providing prompt treatment, and facilitating self-management among patients have the potential to increase diabetic patients’ HRQoL. Keywords: elder, quality of life, diabetes, Vietnam

This study was performed to assess the effects of sulfuric acid inhalation, and partly to examine the potential suitability of the laboratory ferret as a respiratory tract clearance model. Separate groups of ferrets were first exposed nose-only to purified air, 0.5 mg/m3 ofsulfuric acid aerosol, and 1.0 mg/m3 ofsulfuric acid aerosol for 4 h. Following the deposition of radiolabeled tracer microspheres, the clearance rates from the head and chest regions were monitored using collimated radiation detection equipment. The results indicate that (1) neither of the acid atmospheres produced a statistically significant effect on the clearance rate of the head region; (2) the high-acid atmosphere produced a significant acceleration in the clearance rate of the lung region; and (3) the long-term lung clearance rate of the purified air-exposed ferrets was very close to that observed with humans. Also, the ferrets were docile and easy to handle, and seemed to be well suited to this type of study. © 1991 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.