Bạch Mai Hospital

The efficacy and safety of endovascular treatment (EVT) for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO) in the posterior circulation remain controversial. This study aimed to provide further evidence on the safety and effectiveness of EVT through a prospective comparative cohort design. This prospective, descriptive study included 131 patients with AIS due to vertebrobasilar LVO admitted within 24 hours of symptom onset, from December 2023 to November 2024. Patients were allocated to either the EVT group (n = 70) or the best medical treatment group (n = 61). Functional outcome at 90 days was assessed using the modified Rankin Scale (mRS), along with mortality and rates of symptomatic hemorrhagic transformation. Favorable outcomes (mRS 0-3 at 90 days) were significantly more frequent in the EVT group compared to the non-EVT group (25.8% vs. 9.9%, p = 0.019). The 90-day mortality rate was significantly lower in the EVT group (22.8% vs. 66.8%, p = 0.001). However, the rate of symptomatic intracranial hemorrhage was higher in the EVT group (p = 0.001). The absence of hypertension and a time from admission to femoral artery puncture of ≤120 minutes were identified as independent predictors of favorable functional outcome at 90 days after the intervention. Endovascular treatment in AIS due to vertebrobasilar LVO is associated with better functional outcomes and lower mortality but carries an increased risk of hemorrhagic complications. These findings support the potential benefit of EVT in posterior circulation strokes, warranting further validation in larger studies.

Mục tiêu: Mô tả đặc điểm rối loạn giấc ngủ ở người bệnh rối loạn lo âu lan tỏa điều trị nội trú tại Viện Sức khỏe Tâm thần, Bệnh viện Bạch Mai. Đối tượng và phương pháp: Nghiên cứu mô tả cắt ngang trên 105 bệnh nhân điều trị nội trú tại Viện Sức khỏe Tâm thần, Bệnh viện Bạch Mai, được chẩn đoán xác định rối loạn lo âu lan tỏa theo ICD-10 nhằm mô tả đặc điểm lâm sàng rối loạn giấc ngủ ở đối tượng bệnh nhân này. Kết quả: 85,7% đối tượng nghiên cứu có rối loạn giấc ngủ. Đa số rối loạn giấc ngủ xuất hiện trước khi triệu chứng lo âu rõ rệt (67,8%). Thời gian rối loạn giấc ngủ trước vào viện trên 3 tháng là 52,2%. Về số đêm rối loạn giấc ngủ trong tuần, hầu hết đối tượng nghiên cứu có từ 5 đêm/tuần trở lên chiếm tỷ lệ 44,4%. Trong các loại mất ngủ, mất ngủ đầu giấc chiếm tỷ lệ cao nhất với 93,3%, tiếp đó là khó duy trì giấc ngủ chiếm 74,4%. Một người bệnh có thể có 1, 2 hoặc 3 loại mất ngủ, trong đó tỷ lệ có 3 loại mất ngủ chiếm tỷ lệ cao nhất với 42,2%. Theo đánh giá trên thang điểm ISI, mức độ mất ngủ vừa chiếm tỷ lệ cao nhất với 52,2%, tiếp đó là mức độ nhẹ với 27,8%. Mất ngủ đa phần ảnh hưởng đến chất lượng công việc trong ngày với mức vừa chiếm đa số 56,7%, có tới 31,1% mức độ nặng dẫn đến không làm được công việc. Kết luận: Rối loạn giấc ngủ thường gặp ở người bệnh rối loạn lo âu lan tỏa. Người bệnh rối loạn lo âu lan tỏa có thể có 1, 2 hoặc cả 3 loại mất ngủ, trong đó mất ngủ đầu giấc là loại mất ngủ hay gặp nhất. Mất ngủ gây ảnh hưởng nhiều đến công việc, trong nghiên cứu mức độ ảnh hưởng đến chất lượng công việc hàng ngày với mức độ ít, vừa và mức độ nặng dẫn đến không làm được công việc

Obstructive sleep apnea (OSA) is increasingly recognized as a major comorbidity in chronic respiratory diseases, particularly asthma and chronic obstructive pulmonary disease (COPD). The coexistence of OSA with asthma or COPD significantly complicates the clinical course, leading to poorer disease control, more frequent exacerbations, reduced lung function, impaired sleep quality, and increased cardiovascular and overall mortality. In asthma, OSA exacerbates airway inflammation, enhances bronchial hyperresponsiveness, and decreases responsiveness to standard therapies. In COPD, the “overlap syndrome” is associated with profound nocturnal hypoxemia, chronic hypercapnia, pulmonary hypertension, and a markedly elevated risk of hospitalization and death. Underlying mechanisms include chronic airway inflammation, oxidative stress induced by intermittent hypoxia, instability of ventilatory control (high loop gain), structural upper-airway alterations, and the burden of obesity and metabolic dysfunction. These interactions highlight the urgent need for integrated and proactive management strategies. Thus, we propose an Asthma–COPD–OSA Outpatient Unit (ACOSOU)—a care-delivery model, not a disease entity—designed to integrate systematic screening, diagnosis, treatment initiation, and long-term follow-up of OSA in patients with asthma and COPD. Optimal care requires systematic screening in respiratory outpatient settings, appropriate diagnostic pathways using polysomnography or home sleep apnea testing, and individualized treatment approaches. Continuous positive airway pressure (CPAP) remains the cornerstone therapy for OSA–asthma and OSA–COPD overlap, improving gas exchange, reducing exacerbations, and enhancing disease control. Comprehensive management also includes optimization of inhaled therapies, pulmonary rehabilitation, weight reduction, sleep hygiene, and multidisciplinary collaboration. This review proposes an integrated ACOSOU model to streamline screening, diagnosis, CPAP titration, and long-term follow-up. However, implementation in low- and middle-income countries faces challenges including limited trained sleep-medicine personnel, unequal access to diagnostic tools, and high CPAP costs without insurance coverage. Strengthening infrastructure, training, and policy support will be essential to improve outcomes for patients with chronic respiratory diseases and OSA comorbidity.

BACKGROUNDAcute kidney injury (AKI) is a severe complication of acute pancreatitis (AP) associated with increased morbidity and mortality. Early prediction of AKI remains a clinical challenge owing to the limitations of traditional biomarkers, such as serum creatinine.AIMTo evaluate the concentration and predictive value of plasma neutrophil gelatinase-associated lipocalin (NGAL) in patients with AP and AKI.METHODSThis cross-sectional descriptive study was conducted from October 2021 to June 2023 at Bach Mai Hospital. In total, 219 patients were enrolled, including 51 patients with AP and AKI, 168 patients with AP but without AKI, and 35 healthy controls. Plasma NGAL levels were measured and compared between groups. Receiver operating characteristic curve analysis was performed to determine the predictive value of NGAL levels for the severity of AKI and AP.RESULTSAmong AP and AKI cases, 47.1% were classified as Kidney Disease: Improving Global Outcomes stage 1, 33.3% as stage 2, and 19.6% as stage 3. The AP with AKI group (570.9 ng/mL) had significantly higher median plasma NGAL concentrations than the AP without AKI group (400.6 ng/mL) and the healthy control group (234.3 ng/mL) (P < 0.01). The NGAL levels increased proportionally with AKI severity. A plasma NGAL cutoff value of 504.29 ng/mL predicted AKI with 60.8% sensitivity and 68.4% specificity (area under the curve = 0.684; P < 0.001). A cutoff of 486.03 ng/mL predicted AP severity with 66.1% sensitivity and 66.4% specificity (area under the curve = 0.651; P < 0.005). NGAL positively correlated with international normalized ratio, urea, creatinine, lactate dehydrogenase, and lactate levels.CONCLUSIONPlasma NGAL levels predicted both AKI development and disease severity. Therefore, NGAL should be considered a useful biomarker for the early evaluation of patients with AP.

Lung cancer remains a significant medical problem in Asia, and improved treatments are needed for patients diagnosed with non-small cell lung cancer (NSCLC), who are frail with poor performance status or substantial comorbidities. This study aimed to investigate the efficacy and safety of first-line atezolizumab vs. single-agent chemotherapy in the Asian subpopulation in IPSOS trail. This exploratory analysis of the Asian subpopulation from the phase 3, global, open-label, randomized controlled IPSOS trial evaluated the efficacy and safety of atezolizumab (1200 mg intravenously every 3weeks) vs. single-agent chemotherapy (investigator's choice of vinorelbine or gemcitabine) as first-line treatment in patients with locally advanced or metastatic NSCLC, who were ineligible for platinum-based chemotherapy. The primary outcome was overall survival (OS); other outcomes were progression-free survival (PFS), objective response rate (ORR), duration of response (DOR), and safety. Seventy patients from China and Vietnam were included. Median OS was 15.8 months in the atezolizumab group vs. 12.5 months in the chemotherapy group; unstratified hazard ratio, 0.74 (95% confidence interval 0.41, 1.35). Median PFS was 8.1 months vs. 5.4 months, ORR was 27.9% vs. 7.4%, and median DOR was 18.7 months vs. 9.3 months, in the atezolizumab group vs. in the chemotherapy group, respectively. All-grade and grade 3-4 treatment-related adverse events (AEs) were less frequent with atezolizumab compared with chemotherapy. Two patients in the atezolizumab group had grade 5 AEs, namely pneumonia and acute left ventricular failure, with the latter considered treatment-related. Atezolizumab showed encouraging efficacy results and was well tolerated in an Asian subpopulation of patients with NSCLC who were deemed ineligible for standard platinum-based chemotherapy. The findings of this exploratory subpopulation analysis were consistent with those for the global IPSOS population. ClinicalTrials.gov, NCT03191786.

ObjectivesTo evaluate the accuracy of the arterial oxygen partial pressure/inspired oxygen fraction (PaO2/FiO2) ratio in predicting mortality among acute respiratory distress syndrome (ARDS) patients in Vietnam.DesignA retrospective observational study.SettingA central hospital in Vietnam.ParticipantsAdult patients diagnosed with ARDS based on the Berlin definition and admitted to Bach Mai Hospital between August 2015 and August 2023. ARDS severity was converted from descriptive categories to the Berlin score, ranging from 1 (PaO2/FiO2>300 mm Hg) to 4 (PaO2/FiO2≤100 mm Hg).Primary outcomeAll-cause hospital mortality.ResultsOf 345 patients, 67.5% were male, and the median age was 55.0 years (IQR: 39.0–66.0). Hospital mortality was 61.2% (211/345). On the first day of admission, the PaO2/FiO2 ratio (areas under the receiver operating characteristic curves (AUROC): 0.585 (95% CI 0.522 to 0.649)) showed limited predictive ability for hospital mortality. Incorporating the PaO2/FiO2 ratio into the Berlin score did not substantially improve accuracy (AUROC: 0.578 (95% CI 0.516 to 0.641)). Both measures were less accurate than Sequential Organ Failure Assessment (SOFA) (AUROC: 0.650 (95% CI 0.590 to 0.711)), Acute Physiology and Chronic Health Evaluation II (APACHE II) (AUROC: 0.685 (95% CI 0.628 to 0.742)) and Confusion, Urea >7 mmol/L (20 mg/dL), Respiratory rate ≥30 breaths/min, Blood pressure (systolic <90 mm Hg or diastolic ≤60 mm Hg) and Age ≥65 years (CURB-65) (AUROC: 0.689 (95% CI 0.617 to 0.762)). Higher PaO2/FiO2 values (adjusted OR, AOR: 0.988 (95% CI 0.979 to 0.996)) were independently associated with lower mortality risk, while higher Berlin (AOR: 2.477 (95% CI 1.190 to 5.156)), SOFA (AOR: 1.278 (95% CI 1.102 to 1.482)), APACHE II (AOR: 1.236 (95% CI 1.108 to 1.379)) and CURB-65 (AOR: 7.142 (95% CI 2.581 to 19.763)) scores were associated with increased mortality risk.ConclusionsIn this study of ARDS patients in Vietnam, the PaO2/FiO2 ratio demonstrated limited discriminatory ability for hospital mortality, and incorporating it into the Berlin score did not meaningfully improve performance. While less accurate than SOFA, APACHE II and CURB-65 scores, the PaO2/FiO2 ratio and Berlin score remained independently associated with mortality risk. These findings should be interpreted cautiously, given the retrospective design, single-centre setting and potential selection bias; further validation in larger, multicentre studies is warranted.

Electrical impedance tomography (EIT)–guided positive end-expiratory pressure (PEEP) titration may optimize ventilation and reduce ventilator-induced lung injury in acute respiratory distress syndrome (ARDS). We compared EIT-guided PEEP with low PEEP/FiO₂ strategy in patients with moderate-to-severe ARDS. In this randomized controlled trial, 108 patients with PaO₂/FiO₂ below 200 mmHg were allocated to EIT-guided PEEP after a recruitment maneuver (n = 56) or low PEEP/FiO₂ strategy (n = 52). Patients in the EIT group underwent PEEP titration guided by the intersection point between alveolar overdistension and collapse during a decremental PEEP trial. Primary outcomes were oxygenation (PaO₂/FiO₂) and static compliance. Secondary outcomes included mortality, ventilator-free days, ICU stay, barotrauma, rescue therapies, and sequential organ failure assessment (SOFA) score changes. On day 1, oxygenation was higher with EIT (mean PaO₂/FiO₂ 180 vs. 159 mmHg; p = 0.036). Static compliance was greater at both day 1 (26 vs. 23 mL/cmH₂O; p = 0.016) and day 2 (27 vs. 24 mL/cmH₂O; p = 0.029). Driving pressure was lower with EIT at day 1 (16 vs. 17 cmH₂O; p < 0.001) and day 2 (15 vs. 17 cmH₂O; p = 0.005). SOFA scores improved more in the EIT group (day 1: − 1 vs. 0, p = 0.013; day 2: − 1 vs. − 0.5, p = 0.015). Twenty-eight–day mortality was lower with EIT (29 vs. 44%), although not statistically significant (p = 0.090). ICU stay, ventilation duration, barotrauma, ECMO use, and rescue therapies were similar. Benefits were most pronounced in patients with severe ARDS. EIT-guided PEEP improved oxygenation, lung mechanics, and reduced organ dysfunction in moderate-to-severe ARDS, particularly in severe cases. It showed a trend toward reduced mortality and may serve as a practical bedside tool for lung-protective ventilation. Larger multicenter trials are needed to confirm its clinical benefits.Trial registration: ClinicalTrials, NCT06733168. Registered on 13/12/2024, https://clinicaltrials.gov/study/NCT06733168.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-29787-5.

The World Health Organization Bacterial Pathogen Priority List 2024 highlights carbapenem-resistant Gram-negative bacteria (CRGNB), including Enterobacterales (CRE), Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPA), as top priorities due to their virulence, resistance, transmission and limited treatment options. This national hospital survey aimed to assess the burden of CRGNB infections and evaluate microbiological laboratory capacity across Vietnam. An online survey was distributed to central hospitals and provincial departments of health in the 63 provinces of Vietnam, which then forwarded it to district and private hospitals. In total, 324 hospitals participated in this study: 20 central hospitals, 190 provincial hospitals, 106 district hospitals and eight private hospitals. Half reported microbiological capacity for bacterial culture and susceptibility testing. Among 57,667 reported Gram-negative isolates, 17,417 (30.2%) were CRGNB, including Klebsiella pneumoniae (CRE 37%), Escherichia coli (CRE 11%), A. baumannii (CRAB 64%) and P. aeruginosa (CRPA 39%). CRE sepsis treatment included cephalosporins, aminoglycosides, carbapenems, fluoroquinolones and colistin. CRE infections were associated with higher crude mortality rates (31.7% vs 20.2%; P<0.001), longer hospital stays (10.4 vs 8.9 days; P<0.001), and higher costs (1025 vs 773; P<0.001) compared with carbapenem-susceptible Enterobacterales. Reported infection prevention and control (IPC) interventions included CRE surveillance (41%), isolation (36%), point prevalence surveys (15%), and cohort care (7%). IPC funding sources included general health insurance (40%) and hospital funds (32%). CRGNB pose a significant burden in terms of morbidity, mortality and financial impact. There is an urgent need to strengthen the microbiological infrastructure, improve CRGNB screening, and enhance IPC measures.

ABSTRACTBackground and AimsLipoprotein(a) (Lp[a]) is an independent cardiovascular risk factor. Although current guidelines recommend Lp(a) testing, physicians are seldom screened, even though they remain at risk and often overlook their own health. In Vietnam, data on Lp(a) remain unclear. To address this, the Vietnam Atherosclerosis Society launched a pilot study to assess elevated Lp(a) among Vietnamese cardiologists, aiming to generate initial data, encourage physician screening, and raise medical and public awareness.MethodsA cross‐sectional study was conducted at the 2024 Vietnam Atherosclerosis Society Congress, inviting 800 cardiologists. After exclusions, 165 without cardiovascular disease were analyzed. Demographic, biochemical, and lipid profiles were collected, and Lp(a) was measured using the Tina‐quant Lp(a) Gen 2 assay.ResultsElevated Lp(a) levels (≥ 125 nmol/L) were observed in 12.12% of the participants. There were no significant differences in median age (p = 0.488) or sex distribution (p = 0.328) between participants with and without elevated Lp(a). Lp(a) levels were not correlated with other lipid parameters, body mass index, or age. No significant difference in Lp(a) levels was observed between statin users and nonstatin users. Among participants who achieved LDL‐C and non‐HDL‐C treatment targets, 8% still presented elevated Lp(a) levels.ConclusionAt the Vietnam Atherosclerosis Society Congress, elevated Lp(a) levels were detected in several cardiologists without prior cardiovascular disease, including those with well‐controlled lipid profiles according to current guideline targets.