Comparing Pediatric Index of Mortality 3, Pediatric Logistic Organ Dysfunction 2 (PELOD-2), and Modified PELOD-2 scores for Mortality Prognosis in Vietnamese Children with Multiple Organ Dysfunction Syndrome

Background: Multiple Organ Dysfunction Syndrome (MODS) is a complex medical condition characterised by dysfunction across multiple organs. With limited information available on mortality prediction in the paediatric population, particularly in low-middle income countries, this study evaluates the mortality predicting capabilities of lactate, D-dimer, and their combination. Methods: This prospective study involved paediatric patients admitted to the paediatric intensive care unit (PICU) of the largest central children’s hospital in the Mekong Delta region, Vietnam, from 2019 to 2021. The discriminative ability and calibration of both individual and combined tests were assessed using the receiver operating characteristic (ROC) curves and the Hosmer-Lemeshow goodness-of-fit test. Results: Among the patients studied, 63.1% did not survive. Lactate and D-dimer concentrations were significantly higher in the non-survivor group (P < 0.001). The area under the curve (AUC) values for lactate, D-dimer and the combined lactate-D-dimer test were 0.742, 0.775 and 0.804, respectively, with the combination showing the highest AUC value, though without statistical significance. Specific thresholds for lactate, D-dimer and the combination yielded sensitivities of 75.5%, 71.7%, and 66.0%, respectively. All three tests showed no statistically significant differences between observed and predicted mortality in the Hosmer-Lemeshow test (all P-values > 0.05). Conclusion: Lactate and D-dimer levels showed a significant association with mortality, along with good discrimination and calibration abilities. These results highlight the utility of lactate and D-dimer as effective predictors in paediatric MODS, particularly in resource-limited settings, and their role in improving patient outcomes.

Background: Improper inhaler technique negatively impacts asthma control, yet data on this issue in Vietnam remain limited. This study assessed the prevalence and impact of improper inhaler technique on pediatric asthma control and examined the role of caregivers in this context. Methods: An analytical cross-sectional study was conducted among children with asthma and their caregivers. Logistic regression analyzed associations between improper inhaler technique, uncontrolled asthma, and caregivers’ attitudes and practices in asthma management. Results: Among 186 children, 45.2% had improper inhaler technique, which was independently associated with uncontrolled asthma (AOR = 2.33, 95% CI: 1.27-4.3, P = .006). Regarding caregivers, failure to ensure adherence to prescribed controller medications and inadequate monitoring of remaining MDI medication were significantly associated with improper technique ( P < .05). Conclusion: Improper inhaler technique is common and associated with poor asthma control. Caregivers’ involvement in medication adherence and monitoring plays a crucial role in addressing this issue.

University students, particularly in their first year of medical training, face psychological and academic challenges that may impair well-being, hinder pe

Pediatric anemia remains a significant public health challenge in Northeast Thailand, where hemoglobinopathies and nutritional deficiencies coexist. Early identification of children at risk of anemia is crucial to prevent developmental and health consequences. This study assessed the prevalence of children under five being at risk of anemia using Masimo Rad-67® with Rainbow DCI-mini Sensor, while evaluating the association between caregivers’ knowledge, attitudes, and practices on complementary feeding and childhood anemia. A clustered randomized cross-sectional study was conducted involving 2,000 child-caregiver pairs (aged 6 months to 5 years) in Northeast Thailand from September 2022 to March 2023. Non-invasive hemoglobin measurement was used, with anemia risk defined as spectrophotometry hemoglobin (SpHb) < 13.0 g/dL. Data collection included demographic characteristics, natal history, and feeding practices. Additionally, a survey was conducted to assess associated factors of anemia and caregivers’ attitudes, knowledge, and practices regarding complementary feeding. The study found a 36.9% prevalence of at-risk anemia. Key predictors included age under 24 months (adjusted OR 2.1, 95%CI 1.7–2.6), maternal thalassemia trait (adjusted OR 1.8, 95%CI 1.4–2.3), and wasting (adjusted OR 1.6, 95%CI 1.2–2.1). Iron supplementation was a protective factor. Despite 48.2% of children receiving iron supplementation per government policy, only 24.6% met the daily iron intake according to the Thai dietary reference intake. Gap in caregiver knowledge persisted, with 68.1% of caregivers having received education on iron deficiency anemia, and only 32% able to name iron-rich foods. Public health strategies should combine nutritional education targeting iron-rich complementary feeding, implementation of a thalassemia-integrated screening protocol, and proactive community surveillance programs to improve iron intake. Thai clinical trial registration: TCTR20221024002.

Poorly controlled pediatric asthma increases morbidity, reduces quality of life, and raises healthcare use. Caregiver education on asthma and medication use is essential for control. In Vietnam, pediatric asthma services are centralized at tertiary centers, limiting access for many families. Telemedicine may help bridge these gaps. To evaluate the effectiveness of telemedicine education on asthma control in children with uncontrolled asthma and its impact on caregiver knowledge, attitudes, and children's MDI technique. We conducted a pragmatic randomized clinical trial among children aged 4-16 years with uncontrolled asthma. Participants were randomized 1:1, stratified by age and sex, to receive either a structured educational video call or a brief scheduling call. Changes in C-ACT/ACT scores, caregiver knowledge, caregiver attitudes, and children's MDI technique were compared between groups. A multivariable generalized linear model was used to identify factors associated with improvement in asthma control. Baseline characteristics were comparable between groups. At a median follow-up of 5 weeks (IQR 4-8), C-ACT scores were higher in the intervention than control group (median 25.0 vs 19.5, P < 0.001), with mean change exceeding the minimal clinically important difference. Caregiver knowledge and attitudes and children's MDI technique also improved more in the intervention group (P < 0.001 for all). In multivariable models, telemedicine education was independently associated with greater improvement in asthma control (β = 4.24, 95% CI: 2.64-5.85, P < 0.001). Telemedicine-based education improved asthma control and caregiver-related outcomes and may serve as an effective supportive strategy where access to pediatric asthma services is limited.