Study on 22 nonketonic hyperosmolar coma patients (13 males and 9 females) at the B¹ch Mai hospital during the period from 6/98 to 5/99. Patients were followed a volume replacement protocol using a normal saline during 3 first hours and a half - strength saline solution after that until the plasma osmolatty restores a preset value ((320 mOsmol/kg). Results shown that 17 patients (77%) were treated successfully and discharged. 5 deaths (23%) were seen in study: 1 patient died within the first 12 hours, when he had been presenting an uncontrolled hyperosmolar condition; 4 others died from different causes (such as septic shock, cerebral infarction...). Conclusion: fluid challenge with normal saline and half - strength saline solutions in our study shown a high efficiency in management of nonketotic hyperosmolar coma of NIDDM and did not evoke any serious complications
Coma ; therapeutics

Purpose of this study was to measure the serum insulin level in 23 newly diagnosed type II diabetics during acute stress. Diagnosis of diabetes was based on the criteria recommended by WHO in 1986 and the serum fructosamine level more than 290 mol/L. Method: Patients were measured the insulin level on venous blood samples by ELISA method with Roche’s reagent and ES-33 apparatus. Turner’s equation was applied to evaluate the relationship between serum insulin and glucose level and to assess the insulin resistance (reference range is 0-30 and a value >50 was considered the insulin resistance). Result: The mean serum insulin level of the studied patients was 35.55.5 U/mL, with the values ranged from 5.97 to 131.34 U/mL. Out of 23 patients, only 3 (13%) had serum insulin levels in a normal range (i.e. in a reference interval of 3.68-7.67U/mL). 20 patients (83%) had higher insulin levels than reference. Assessing the insulin resistance by Turner’s equation showed that only 2 of 23 patients (8.6%) had a normal ratio (i.e. less than 50), almost patients in this study (21/23; 91.4%) were more than 50 in ratio, suggested an evident insulin resistance. Especially, 10/23 patients (43.8%) reached a value of more than 100, indicated the severe hyperinsulinemia. Conclusion: 83% of our patients with newly diagnosed type II diabetes showed the hyperinsulinemia during acute stress. Almost these patients (more than 90%) presented the strong evidence of insulin resistance.
Insulin ; Diabetes Mellitus, Type 2 ; Serum ; Emergency Medical Services

Sliding scale insulin was often applied for emergency patients. However there is no study on this therapy in Viet Nam. We used this therapy for 51 new onset hyperglycemic patients (glycemia > 200 mg/dl ) from 6/1998 to 2/2003. Regular insulin was injected when blood glucose>200 mg/dl, then blood glucose level was monitored by finger stick sugar Q4h. If glucose 200-300mg/dl, given 5IU of insulin, glucose>300 mg/dl, given 10 U.The goal blood glucose < 200mg/dl. Results: The average time to lower the blood glucose level to the target level was about 46h. The result after 7 days showed that glycemia was controlled < 200mg/dl and <150 mg/dl in 92% and 62% patientss, respectively.There was no severe hypoglycemia documented during the study.
Insulin ; Therapeutics ; Hyperglycemia ; Stress

99 patients aged 15 – 87 years old were hospitalized at Bach Mai Hospital from June 1998 to Feb.2003, among them 51 cases were diagnosed as sufferring from diabetes and in 48 other, diabetes were still not diagnosed. At admission, average blood level of glucose 18,97+/_8,1 mmol. In 35-50% of studied cases, plasma osmolarity >300 mOsmol/kg H2O during monitored time. There was no statistically significant difference between various groups in the variation of glucose plasma level .In 10-20% of cases, there was an increase of 145 mmol/l of natrium in plasma
Hyperglycemia ; Osmolar Concentration ; Plasma ; Electrolytes ; Emergencies

Insuline therapy was used on 99 over-15 years old patients of newly diagnosed diabetes first in internal emergency Department at Bach Mai Hospital from June1998 to Feb.2003 Subjects were divided into 2 groups: Group 1 included persons of the signs of high blood glucose level without diabetes; group 2 included patients sufferred from diabetes without confirmed diagnosis. In >92% of cases of group 1 and 74% of group 2, insuline therapy had effectiveness to control blood glucose level <11mmol from the 7th day of treatment and after the 7th day in >62% of group 1 and <36% of group 2. There was no complication of hypoglycemia
Insulin ; Therapeutics ; Hyperglycemia

Background: Hyperglycemia is commonly seen in cerebral vascular accidents in general and in acute phase in particular. It is difficult for doctors to treat. Objectives: To evaluate the effect of stress hyperglycemia on mortality risk and disability risk in patient with acute ischemic stroke. Subjects and method: 105 patients with acute ischemic stroke with admission blood glucose level >/= 8.0mmol/l without history of diabetes mellitus from 2004 to 2007. These patients were divided into two groups: group 1 with admission blood glucose level of 8.0-11.0mmol/l; group 2 with that level of >l1.0mmol/l. Results: There was a significant reverse correlation between blood glucose level and the Glasgow score scale on admission and after 24 hours. The mortality risk in hospital of group 2 was higher than that of group 1 and the disability level of group 2 was more severe than that of group 1. Conclusion: Stress hyperglycemia increased the risk of in-hospital mortality in acute ischemic stroke patients and risk of severe disability after leaving hospital. \r\n', u'\r\n', u'
Stress hyperglycemia ; acute ischemic stroke

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal neoplasms of the gastrointestinal tract. Management of GIST patients is currently based on clinicopathological features and associated genetic changes. However, the detailed characteristics and molecular genetic features of GISTs have not yet been described in the Vietnamese population.METHODS: We first identified 155 patients with primary GIST who underwent surgery with primary curative intent between 2011 and 2014 at University Medical Center at Ho Chi Minh City, Vietnam. We evaluated the clinicopathological features and immunohistochemical reactivity to p53 and Ki-67 in these patients. Additionally, KIT genotyping was performed in 100 cases.RESULTS: The largest proportion of GISTs was classified as high-risk (43.2%). Of the 155 GISTs, 52 (33.5%) were positive for Ki-67, and 58 (37.4%) were positive for p53. The expression of Ki-67 and p53 were correlated with mitotic rate, tumor size, risk assessment, and tumor stage. Out of 100 GIST cases, KIT mutation was found in 68%, of which 62 (91.2%) were found in exon 11, two (2.9%) in exon 9, and four (5.8%) in exon 17. No mutation in exon 13 was identified. Additionally, KIT mutations did not correlate with any clinicopathological features.CONCLUSIONS: The expression of Ki-67 and p53 were associated with high-risk tumors. Mutations in exon 11 were the most commonly found, followed by exon 17 and exon 9. Additionally, KIT mutation status was not correlated with any recognized clinicopathological features.
Academic Medical Centers ; Asian Continental Ancestry Group ; Exons ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Molecular Biology ; Risk Assessment ; Vietnam

Background: Langerhans cell histiocytosis (LCH) is more common in children than adults and involves many organs. In children, the BRAF V600E mutation is associated with recurrent and high-risk LCH. Methods: We collected paraffin blocks of 94 pediatric LCH patients to detect BRAF V600E mutation by sequencing. The relationship between BRAF V600E status and clinicopathological parameters were also critically analyzed. Results: BRAF V600E mutation exon 15 was detected in 45 cases (47.9%). Multiple systems LCH showed a significantly higher BRAF V600E mutation rate than a single system (p=.001). No statistical significance was evident for other clinical characteristics such as age, sex, location, risk organs involvement, and CD1a expression. Conclusions In Vietnamese LCH children, the proportion of BRAF V600E mutational status was relatively high and related to multiple systems.

BACKGROUND: Human epidermal growth factor receptor 2 (HER2) is related to the pathogenesis and poor outcome of numerous types of carcinomas, including gastric carcinoma. Gastric cancer patients with HER2 positivity have become potential candidates for targeted therapy with trastuzumab. METHODS: We investigated 208 gastric cancer specimens using immunohistochemistry (IHC), fluorescence in situ hybridization and dual in situ hybridization (ISH). We also investigated the concordance between IHC and ISH. The correlation between HER2 status and various clinicopathological findings was also investigated. RESULTS: In total, 15.9% (33/208) and 24.5% (51/208) of gastric cancers showed HER2 gene amplification and protein overexpression, respectively. A high level of concordance between ISH and IHC analyses (91.3%, κ = 0.76) was found. A significant correlation between HER2 status and intestinal-type (p < .05) and differentiated carcinomas (p < .05) was also noted. The HER2 heterogeneity was high in gastric cancers; we found 68.8% phenotypic heterogeneity and 57.6% genotypic heterogeneity. Heterogeneity in HER2 protein expression and gene amplification showed a close association with diffuse histologic type and IHC 2+. CONCLUSIONS: HER2 protein overexpression and gene amplification were detected in 24.5% and 15.9% of gastric cancer specimens, respectively. Intestinal-type showed a higher level of HER2 protein overexpression and gene amplification than diffuse type. HER2 status also showed a significant relationship with well- and moderately-differentiated carcinomas. The ratio of phenotypic and genotypic heterogeneity of HER2 was high in gastric carcinomas and was associated with HER2 IHC 2+ and diffuse histologic type.
Asian Continental Ancestry Group* ; Fluorescence ; Gene Amplification ; Genes, erbB-2 ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Population Characteristics* ; Receptor, Epidermal Growth Factor ; Stomach Neoplasms ; Trastuzumab

Objective: The purpose of this survey was to estimate the prevalence of viral load (VL) suppression and emergence of HIV drug resistance (HIVDR) among individuals receiving antiretroviral therapy (ART) for 36 months or longer in Viet Nam using a nationally representative sampling method. Methods: The survey was conducted between May and August 2014 using a two-stage cluster design. Sixteen ART clinics were selected using probability proportional to proxy size sampling, and patients receiving ART for at least 36 months were consecutively enrolled. Epidemiological information and blood specimens were collected for HIV-1 VL and HIVDR testing; HIVDR was defined by the Stanford University HIVDR algorithm. Results: Overall, 365 eligible individuals were recruited with a mean age of 38.2 years; 68.4% were men. The mean time on ART was 75.5 months (95% confidence interval [CI]: 69.0–81.9 months), and 93.7% of the patients were receiving non-nucleoside reverse transcriptase inhibitor-based regimens. Of the 365 individuals, 345 (94.7%, 95% CI: 64.1–99.4%) had VL below 1000 copies/mL and 19 (4.6%, 95% CI: 2.8-–7.5) had HIVDR mutations. Discussion Our nationally representative survey found a high level of VL suppression and a low prevalence of HIVDR among individuals who received ART for at least 36 months in Viet Nam. Continued surveillance for HIVDR is important for evaluating and improving HIV programs.