Background: The etiology of ischemic stroke is multifactorial. Several gene mutations have been identified as leading causes of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a hereditary disease that causes stroke and other neurological symptoms. Objective: We aimed to identify the variants of NOTCH3 and thrombophilia genes, and their complex interactions with other factors. Methods: We conducted a hierarchical cluster analysis (HCA) on the data of 100 patients diagnosed with ischemic stroke. The variants of NOTCH3 and thrombophilia genes were identified by polymerase chain reaction with confronting 2-pair primers and real-time polymerase chain reaction. The overall preclinical characteristics, cumulative cutpoint values, and factors associated with these somatic mutations were analyzed in unidimensional and multidimensional scaling models. Results: We identified the following optimal cutpoints: creatinine, 83.67 (SD 9.19) µmol/L; age, 54 (SD 5) years; prothrombin (PT) time, 13.25 (SD 0.17) seconds; and international normalized ratio (INR), 1.02 (SD 0.03). Using the Nagelkerke method, cutpoint 50% values of the Glasgow Coma Scale score; modified Rankin scale score; and National Institutes of Health Stroke Scale scores at admission, after 24 hours, and at discharge were 12.77, 2.86 (SD 1.21), 9.83 (SD 2.85), 7.29 (SD 2.04), and 6.85 (SD 2.90), respectively. Conclusions: The variants of MTHFR (C677T and A1298C) and NOTCH3 p.R544C may influence the stroke severity under specific conditions of PT, creatinine, INR, and BMI, with risk ratios of 4.8 (95% CI 1.53-15.04) and 3.13 (95% CI 1.60-6.11), respectively (Pfisher<.05). It is interesting that although there are many genes linked to increased atrial fibrillation risk, not all of them are associated with ischemic stroke risk. With the detection of stroke risk loci, more information can be gained on their impacts and interconnections, especially in young patients.

This study aimed to examine caregivers’ perceptions, practices, and challenges regarding rehabilitation services for people with disabilities, with a focus on identifying factors influencing their decisions to bring care recipients for formal rehabilitation. A cross-sectional study was conducted in rural Thai Nguyen Province, Vietnam. Data were collected from 214 primary caregivers using a structured questionnaire covering demographics, caregiving roles, and rehabilitation-related perceptions. A pilot study was conducted to refine the tool, and data were collected via face-to-face interviews by a trained team. Statistical analyses included descriptive statistics, chi-square tests, and stepwise logistic regression to identify key predictors of care-seeking behaviors. Results showed that 92% of caregivers perceived rehabilitation as necessary or very necessary. Female caregivers were more likely to provide care at home (95.3%), while male caregivers were more likely to utilize hospital-based services (73.5%) and to bring care recipients for rehabilitation overall (79.4% vs. 67.1%). Logistic regression revealed that female caregivers were significantly less likely than males to bring people with disabilities in for care (OR = 0.34, p = 0.02). Longer caregiving duration was associated with a reduced likelihood of seeking care (OR = 0.96 per year, p < 0.001), whereas caregivers of individuals with mobility needs (OR = 3.15, p < 0.001) and social integration needs (OR = 2.12, p = 0.05) were significantly more likely to seek care. These findings highlight gender-based differences and caregiving dynamics that influence access to rehabilitation. To enhance rehabilitation outcomes and support caregiver engagement, targeted policies are needed to address gender roles, caregiving fatigue, and the specific needs of care recipients.

BACKGROUND The etiology of ischemic stroke is multifactorial. Several gene mutations have been identified as leading causes of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a hereditary disease that causes stroke and other neurological symptoms. OBJECTIVE We aimed to identify the variants of NOTCH3 and thrombophilia genes, and their complex interactions with other factors. METHODS We conducted a hierarchical cluster analysis (HCA) on the data of 100 patients diagnosed with ischemic stroke. The variants of NOTCH3 and thrombophilia genes were identified by polymerase chain reaction with confronting 2-pair primers and real-time polymerase chain reaction. The overall preclinical characteristics, cumulative cutpoint values, and factors associated with these somatic mutations were analyzed in unidimensional and multidimensional scaling models. RESULTS We identified the following optimal cutpoints: creatinine, 83.67 (SD 9.19) µmol/L; age, 54 (SD 5) years; prothrombin (PT) time, 13.25 (SD 0.17) seconds; and international normalized ratio (INR), 1.02 (SD 0.03). Using the Nagelkerke method, cutpoint 50% values of the Glasgow Coma Scale score; modified Rankin scale score; and National Institutes of Health Stroke Scale scores at admission, after 24 hours, and at discharge were 12.77, 2.86 (SD 1.21), 9.83 (SD 2.85), 7.29 (SD 2.04), and 6.85 (SD 2.90), respectively. CONCLUSIONS The variants of MTHFR (C677T and A1298C) and NOTCH3 p.R544C may influence the stroke severity under specific conditions of PT, creatinine, INR, and BMI, with risk ratios of 4.8 (95% CI 1.53-15.04) and 3.13 (95% CI 1.60-6.11), respectively (Pfisher<.05). It is interesting that although there are many genes linked to increased atrial fibrillation risk, not all of them are associated with ischemic stroke risk. With the detection of stroke risk loci, more information can be gained on their impacts and interconnections, especially in young patients.

Cyanide poisoning is one of the most dangerous poisonings, it can be absorbed into the body through the mouth, inhalation and through the skin. A 32-year-old female patient was admitted to our poison control center because of high fever, severe vomiting, and seizures. Physical examination found that the patient was drowsy, had a high fever of 40 degrees Celsius, pulse of 140 beats/minute, and increased tendon and bone reflexes. Exploiting the patient's information, it was discovered that the patient bought Cyanide to drink with the intention of committing suicide. The patient was quickly treated with gastric lavage and activated charcoal. Echocardiography recorded EF: 35%, reduced movement of the entire myocardium. CK blood test: 4562 U/L. The patient's condition rapidly deteriorated and the patient was made ECMO, IHD and CVVHDF. After 3 days of treatment, the patient's condition did not improve, so the family asked for the patient to go home. This article aims to describe the rapidly progressing and severe damage to the heart and muscles of patients with cyanide poisoning.

Mục tiêu: Đánh giá hiệu quả của liệu pháp siêu âm xung trong điều trị viêm cân gan bàn chân mạn tính. Phương pháp nghiên cứu: Nghiên cứu can thiệp lâm sàng ngẫu nhiên có đối chứng, mù đôi được thực hiện trên 59 bệnh nhân (BN) được chẩn đoán viêm cân gan bàn chân mạn tính 1 bên. BN được chia thành 2 nhóm: Nhóm can thiệp với 30 BN được điều trị bằng siêu âm xung liều cao kết hợp với kéo giãn trong 4 tuần; nhóm chứng với 29 BN được điều trị bằng phương pháp kéo giãn trong 4 tuần. Điểm đau VAS (visual analog scale), độ dày cân gan bàn chân trên siêu âm và chỉ số chức năng bàn chân FFI (foot function index) được đánh giá lúc nhập viện và sau điều trị 4 tuần. Số liệu được phân tích và xử lý bằng các thuật toán thống kê và mức ý nghĩa thống kê đề xuất là 5%. Kết quả: Sau 4 tuần điều trị điểm đau VAS, độ dày cân gan bàn chân và FFI bên bệnh đều giảm đáng kể ở nhóm can thiệp so với nhóm chứng, có ý nghĩa thống kê với cùng giá trị p = 0,001. Kết luận: Liệu pháp siêu âm xung liều cao tiến hành trước khi thực hiện kéo giãn có tác dụng giảm đau nhanh và cải thiện chức năng bàn chân trong điều trị viêm cân gan bàn chân mạn tính.

Wounds caused by human bites have a high infection rate. A 59-year-old male patient came to our poison control center because of soft tissue injuries in the left arm and left hand, pain, swelling, and necrosis. Before entering the hospital, he had a high fever. Physical examination found that the patient’s lips were dry, his tongue was dirty, his skin and mucous membranes were less pink, his pulse was 80 beats/min, and his temperature was 36.5°C. Information on May 9, 2024, the patient was bitten on the left arm by a child. The patient had a negative blood culture, a negative burn fluid culture, high-sensitivity C-reactive protein of blood chemistry is 458.1 mg/L, total blood cell analysis with white blood cell is 19.9 G/L, percent of neutrophil is 92.4, soft magnetic resonance imaging of the arm and hand areas with images is cellulitis under the skin of the left arm.The patient was injected with antitetanus toxin serum, antibiotics (Dalacin C, Linezonide, meropenem), and was infused paracetamol. After 1 day of treatment, the patient’s condition did not improve and worsened, so the patient was transferred to the National Burn Hospital for further treatment. This article aims to talk about soft tissue injuries due to soft tissue inflammation or necrosis that can occur in patients who are bitten by human. This is the first patient with soft tissue damage with cellulitis under the skin of the left arm known at our poison center.