Publications
86 results found
Pham QT, Rabaa MA, Duong HL, et al., 2021, The First 100 Days of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Control in Vietnam, CLINICAL INFECTIOUS DISEASES, Vol: 72, Pages: E334-E342, ISSN: 1058-4838
Haymet AB, Bartnikowski N, Wood ES, et al., 2021, Studying the Endothelial Glycocalyx <i>in vitro</i>: What Is Missing?, FRONTIERS IN CARDIOVASCULAR MEDICINE, Vol: 8, ISSN: 2297-055X
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- Citations: 16
Vuong NL, Lam PK, Ming DKY, et al., 2021, Combination of inflammatory and vascular markers in the febrile phase of dengue is associated with more severe outcomes
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Early identification of severe dengue patients is important regarding patient management and resource allocation. We investigated the association of ten biomarkers (VCAM-1, SDC-1, Ang-2, IL-8, IP-10, IL-1RA, sCD163, sTREM-1, ferritin, CRP) with the development of severe/moderate dengue (S/MD).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We performed a nested case-control study from a multi-country study. A total of 281 S/MD and 556 uncomplicated dengue cases were included.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>On days 1-3 from symptom onset, higher levels of any biomarker increased the risk of developing S/MD. When assessing together, SDC-1 and IL-1RA were stable, while IP-10 changed the association from positive to negative; others showed weaker associations. The best combinations associated with S/MD comprised IL-1RA, Ang-2, IL-8, ferritin, IP-10, and SDC-1 for children, and SDC-1, IL-8, ferritin, sTREM-1, IL-1RA, IP-10, and sCD163 for adults.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our findings assist the development of biomarker panels for clinical use and could improve triage and risk prediction in dengue patients.</jats:p></jats:sec><jats:sec><jats:title>Summary of the main point</jats:title><jats:p>Higher levels of any of VCAM-1, SDC-1, Ang-2, IL-8, IP-10, IL-1RA, sCD163, sTREM-1, ferritin, and CRP on illness days 1-3 increased the risk of developing severe/moderate dengue. The relationships differed between children and adults and some changed when assessed together.</jats:p></jats:sec>
Nguyen VVC, Ho BH, Greeff H, et al., 2021, Wearable remote monitoring for patients with COVID-19 in low-resource settings: case study, BMJ INNOVATIONS, Vol: 7, ISSN: 2055-8074
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- Citations: 3
Choisy M, McBride A, Chambers M, et al., 2021, Climate change and health in Southeast Asia - defining research priorities and the role of the Wellcome Trust Africa Asia Programmes., Wellcome Open Res, Vol: 6, ISSN: 2398-502X
This article summarises a recent virtual meeting organised by the Oxford University Clinical Research Unit in Vietnam on the topic of climate change and health, bringing local partners, faculty and external collaborators together from across the Wellcome and Oxford networks. Attendees included invited local and global climate scientists, clinicians, modelers, epidemiologists and community engagement practitioners, with a view to setting priorities, identifying synergies and fostering collaborations to help define the regional climate and health research agenda. In this summary paper, we outline the major themes and topics that were identified and what will be needed to take forward this research for the next decade. We aim to take a broad, collaborative approach to including climate science in our current portfolio where it touches on infectious diseases now, and more broadly in our future research directions. We will focus on strengthening our research portfolio on climate-sensitive diseases, and supplement this with high quality data obtained from internal studies and external collaborations, obtained by multiple methods, ranging from traditional epidemiology to innovative technology and artificial intelligence and community-led research. Through timely agenda setting and involvement of local stakeholders, we aim to help support and shape research into global heating and health in the region.
McBride A, Chanh HQ, Fraser JF, et al., 2020, Microvascular dysfunction in septic and dengue shock: Pathophysiology and implications for clinical management., Glob Cardiol Sci Pract, Vol: 2020, ISSN: 2305-7823
The microcirculation comprising of arterioles, capillaries and post-capillary venules is the terminal vascular network of the systemic circulation. Microvascular homeostasis, comprising of a balance between vasoconstriction, vasodilation and endothelial permeability in healthy states, regulates tissue perfusion. In severe infections, systemic inflammation occurs irrespective of the infecting microorganism(s), resulting in microcirculatory dysregulation and dysfunction, which impairs tissue perfusion and often precedes end-organ failure. The common hallmarks of microvascular dysfunction in both septic shock and dengue shock, are endothelial cell activation, glycocalyx degradation and plasma leak through a disrupted endothelial barrier. Microvascular tone is also impaired by a reduced bioavailability of nitric oxide. In vitro and in vivo studies have however demonstrated that the nature and extent of microvascular dysfunction as well as responses to volume expansion resuscitation differ in these two clinical syndromes. This review compares and contrasts the pathophysiology of microcirculatory dysfunction in septic versus dengue shock and the attendant effects of fluid administration during resuscitation.
Nguyen VVC, Vo TL, Nguyen TD, et al., 2020, The Natural History and Transmission Potential of Asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infection, CLINICAL INFECTIOUS DISEASES, Vol: 71, Pages: 2679-2687, ISSN: 1058-4838
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- Citations: 106
Zellweger RM, Yacoub S, Chan YFZ, et al., 2020, Disentangling etiologies of CNS infections in Singapore using multiple correspondence analysis and random forest, SCIENTIFIC REPORTS, Vol: 10, ISSN: 2045-2322
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- Citations: 5
Phung KL, McBride A, Duyen HTL, et al., 2020, Visual and Biochemical Evidence of Glycocalyx Disruption in Human Dengue Infection, and Association With Plasma Leakage Severity, FRONTIERS IN MEDICINE, Vol: 7
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- Citations: 11
, 2020, Establishing a critical care network in Asia to improve care for critically ill patients in low- and middle-income countries, CRITICAL CARE, Vol: 24, ISSN: 1364-8535
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- Citations: 11
Gan ES, Tan HC, Duyen HTL, et al., 2020, Dengue virus induces PCSK9 expression to alter antiviral responses and disease outcomes, JOURNAL OF CLINICAL INVESTIGATION, Vol: 130, Pages: 5223-5234, ISSN: 0021-9738
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- Citations: 36
Ming DK, Sorawat S, Chanh HQ, et al., 2020, Continuous physiological monitoring using wearable technology to inform individual management of infectious diseases, public health and outbreak responses, International Journal of Infectious Diseases, Vol: 96, Pages: 648-654, ISSN: 1201-9712
Optimal management of infectious diseases is guided by up-to-date information at the individual and public health level. For infections of global importance including emerging pandemics such as COVID-19 or prevalent endemic diseases such like dengue, identifying patients at risk of severe disease and clinical deterioration can be challenging given the majority present with a mild illness. In our article, we describe the use of wearable technology for continuous physiological monitoring in healthcare. Deployment of wearables in hospital settings for the management of infectious diseases, or in the community to support syndromic surveillance during outbreaks could provide significant, cost effective advantages and improve healthcare delivery. We highlight a range of promising technologies employed by wearable devices and discuss the technical and ethical issues relating to implementation in the clinic, with specific focus on low- and middle- income countries. Finally, we propose a set of essential criteria for the roll-out of wearable technology for clinical use.
Gallagher P, Chan KR, Rivino L, et al., 2020, The association of obesity and severe dengue: possible pathophysiological mechanisms, JOURNAL OF INFECTION, Vol: 81, Pages: 10-16, ISSN: 0163-4453
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- Citations: 7
Redoni M, Yacoub S, Rivino L, et al., 2020, Dengue: Status of current and under-development vaccines, REVIEWS IN MEDICAL VIROLOGY, Vol: 30, ISSN: 1052-9276
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- Citations: 34
Sanz MG, De Sario V, Garcia-Mingo A, et al., 2020, Chagas disease in the United Kingdom: A review of cases at the Hospital for Tropical Diseases London 1995-2018. The current state of detection of Chagas disease in the UK, TRAVEL MEDICINE AND INFECTIOUS DISEASE, Vol: 36, ISSN: 1477-8939
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- Citations: 7
Nguyen LV, Huynh TLD, Phung KL, et al., 2020, C-reactive protein as a potential biomarker for disease progression in dengue: a multi-country observational study, BMC MEDICINE, Vol: 18, ISSN: 1741-7015
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- Citations: 26
Yacoub S, Nguyen NM, Chanh HQ, et al., 2020, Metformin as adjunctive therapy for dengue in overweight and obese patients: A protocol for an open-label clinical trial (MeDO), Wellcome Open Research, Vol: 5
Background: Dengue is a disease of major global importance. While most symptomatic infections are mild, a small proportion of patients progress to severe disease with risk of hypovolaemic shock, organ dysfunction and death. In the absence of effective antiviral or disease modifying drugs, clinical management is solely reliant on supportive measures. Obesity is a growing problem among young people in Vietnam and is increasingly recognised as an important risk factor for severe dengue, likely due to alterations in host immune and inflammatory pathways. Metformin, a widely used anti-hyperglycaemic agent with excellent safety profile, has demonstrated potential as a dengue therapeutic in vitro and in a retrospective observational study of adult dengue patients with type 2 diabetes. This study aims to assess the safety and tolerability of metformin treatment in overweight and obese dengue patients, and investigate its effects on several clinical, immunological and virological markers of disease severity. Methods: This open label trial of 120 obese/overweight dengue patients will be performed in two phases, with a metformin dose escalation if no safety concerns arise in phase one. The primary endpoint is identification of clinical and laboratory adverse events. Sixty overweight and obese dengue patients aged 10-30 years will be enrolled at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam. Participants will complete a 5-day course of metformin therapy and be compared to a non-treated group of 60 age-matched overweight and obese dengue patients. Discussion: Previously observed antiviral and immunomodulatory effects of metformin make it a promising dengue therapeutic candidate in appropriately selected patients. This study will assess the safety and tolerability of adjunctive metformin in the management of overweight and obese young dengue patients, as well as its effects on markers of viral replication, endothelial dysfunction and host immune responses. Trial
Nguyen NM, Chanh HQ, Tam DTH, et al., 2020, Metformin as adjunctive therapy for dengue in overweight and obese patients: a protocol for an open-label clinical trial (MeDO)., Wellcome Open Res, Vol: 5, ISSN: 2398-502X
Background: Dengue is a disease of major global importance. While most symptomatic infections are mild, a small proportion of patients progress to severe disease with risk of hypovolaemic shock, organ dysfunction and death. In the absence of effective antiviral or disease modifying drugs, clinical management is solely reliant on supportive measures. Obesity is a growing problem among young people in Vietnam and is increasingly recognised as an important risk factor for severe dengue, likely due to alterations in host immune and inflammatory pathways. Metformin, a widely used anti-hyperglycaemic agent with excellent safety profile, has demonstrated potential as a dengue therapeutic in vitro and in a retrospective observational study of adult dengue patients with type 2 diabetes. This study aims to assess the safety and tolerability of metformin treatment in overweight and obese dengue patients, and investigate its effects on several clinical, immunological and virological markers of disease severity. Methods: This open label trial of 120 obese/overweight dengue patients will be performed in two phases, with a metformin dose escalation if no safety concerns arise in phase one. The primary endpoint is identification of clinical and laboratory adverse events. Sixty overweight and obese dengue patients aged 10-30 years will be enrolled at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam. Participants will complete a 5-day course of metformin therapy and be compared to a non-treated group of 60 age-matched overweight and obese dengue patients. Discussion: Previously observed antiviral and immunomodulatory effects of metformin make it a promising dengue therapeutic candidate in appropriately selected patients. This study will assess the safety and tolerability of adjunctive metformin in the management of overweight and obese young dengue patients, as well as its effects on markers of viral replication, endothelial dysfunction an
Gan P, Yacoub S, 2019, Picturing health: dengue in Vietnam, LANCET, Vol: 394, Pages: 2059-2066, ISSN: 0140-6736
Hung TM, Wills B, Clapham HE, et al., 2019, The uncertainty surrounding the burden of post-acute consequences of dengue infection, Trends in Parasitology, Vol: 35, Pages: 673-676, ISSN: 0169-4758
Post-acute consequences currently form a significant component of the dengue disability-adjusted life year (DALY) burden estimates. However, there is considerable uncertainty regarding the incidence, duration, and severity of these symptoms. Further research is needed to more accurately estimate the health and economic burden of these dengue manifestations.
Turner HC, Nguyen VH, Yacoub S, et al., 2019, Achieving affordable critical care in low-income and middle-income countries, BMJ Global Health, Vol: 4, Pages: 1-4, ISSN: 2059-7908
Whitehorn J, Yacoub S, 2019, Global warming and arboviral infections, CLINICAL MEDICINE, Vol: 19, Pages: 149-152, ISSN: 1470-2118
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- Citations: 31
Rodriguez-Manzano J, Ying Chia P, Wen Yeo T, et al., 2018, Improving Dengue diagnostics and management through innovative technology, Current Infectious Disease Reports, Vol: 20, ISSN: 1534-3146
Purpose of Review:Dengue continues to be a major global public health threat. Symptomatic infections can cause a spectrum of disease ranging from a mild febrile illness to severe and potentially life-threatening manifestations. Management relies on supportive treatment with careful fluid replacement. The purpose of this review is to define the unmet needs and challenges in current dengue diagnostics and patient monitoring and outline potential novel technologies to address these needs.Recent Findings:There have been recent advances in molecular and point-of-care (POC) diagnostics as well as technologies including wireless communication, low-power microelectronics, and wearable sensors that have opened up new possibilities for management, clinical monitoring, and real-time surveillance of dengue.Summary:Novel platforms utilizing innovative technologies for POC dengue diagnostics and wearable patient monitors have the potential to revolutionize dengue surveillance, outbreak response, and management at population and individual levels. Validation studies of these technologies are urgently required in dengue-endemic areas.
Rodriguez-Manzano J, Chia PY, Yeo TW, et al., 2018, Improving Dengue Diagnostics and Management Through Innovative Technology (vol 20, 25, 2018), CURRENT INFECTIOUS DISEASE REPORTS, Vol: 20, ISSN: 1523-3847
Morra ME, Altibi AMA, Iqtadar S, et al., 2018, Definitions for warning signs and signs of severe dengue according to the WHO 2009 classification: Systematic review of literature, REVIEWS IN MEDICAL VIROLOGY, Vol: 28, ISSN: 1052-9276
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- Citations: 28
Nguyen THM, Nguyen HP, Ho DTN, et al., 2018, Dengue-Associated Posterior Reversible Encephalopathy Syndrome, Vietnam, EMERGING INFECTIOUS DISEASES, Vol: 24, Pages: 402-404, ISSN: 1080-6040
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- Citations: 12
Yacoub S, Trieu HT, Phung KL, et al., 2017, Cardio-haemodynamic assessment and venous lactate in severe dengue: Relationship with recurrent shock and respiratory distress, PLOS NEGLECTED TROPICAL DISEASES, Vol: 11, ISSN: 1935-2735
BackgroundDengue can cause plasma leakage that may lead to dengue shock syndrome (DSS). In approximately 30% of DSS cases, recurrent episodes of shock occur. These patients have a higher risk of fluid overload, respiratory distress and poor outcomes. We investigated the association of echocardiographically-derived cardiac function and intravascular volume parameters plus lactate levels, with the outcomes of recurrent shock and respiratory distress in severe dengue.Methods/Principle findingsWe performed a prospective observational study in Paediatric and adult ICU, at the Hospital for Tropical Diseases (HTD), Ho Chi Minh City, Vietnam. Patients with dengue were enrolled within 12 hours of admission to paediatric or adult ICU. A haemodynamic assessment and portable echocardiograms were carried out daily for 5 days from enrolment and all interventions recorded.102 patients were enrolled; 22 patients did not develop DSS, 48 had a single episode of shock and 32 had recurrent shock. Patients with recurrent shock had a higher enrolment pulse than those with 1 episode or no shock (median: 114 vs. 100 vs. 100 b/min, P = 0.002), significantly lower Stroke Volume Index (SVI), (median: 21.6 vs. 22.8 vs. 26.8mls/m2, P<0.001) and higher lactate levels (4.2 vs. 2.9 vs. 2.2 mmol/l, P = 0.001). Higher SVI and worse left ventricular function (higher Left Myocardial Performance Index) on study days 3–5 was associated with the secondary endpoint of respiratory distress. There was an association between the total IV fluid administered during the ICU admission and respiratory distress (OR: 1.03, 95% CI 1.01–1.06, P = 0.001). Admission lactate levels predicted patients who subsequently developed recurrent shock (P = 0.004), and correlated positively with the total IV fluid volume received (rho: 0.323, P = 0.001) and also with admission ALT (rho: 0.764, P<0.001) and AST (rho: 0.773, P<0.001).Conclusions/SignificanceEcho-derived intravascular volume assessment and venou
Yacoub S, Lam PK, Huynh TT, et al., 2017, Endothelial nitric oxide pathways in the pathophysiology of dengue: a prospective observational study., Clinical Infectious Diseases, Vol: 65, Pages: 1453-1461, ISSN: 1058-4838
Background: Dengue can cause increased vascular permeability that may lead to hypovolemic shock. Endothelial dysfunction may underlie this; however the association of endothelial nitric oxide pathways with disease severity is unknown. Methods: We performed a prospective observational study in two Vietnamese hospitals, assessing patients presenting early (<72 hours fever) and patients hospitalized with warning signs or severe dengue. The reactive hyperaemic index (RHI), which measures endothelium-dependent vasodilation and is a surrogate marker of endothelial function and NO bioavailability was evaluated using peripheral artery tonometry (EndoPAT) and plasma levels of L-arginine, Arginase-1 and ADMA were measured at serial time-points. The main outcome of interest was plasma leakage severity. Results: 314 patients were enrolled, median age of the participants was 21 (IQR 13-30) years. No difference was found in the endothelial parameters between dengue and other febrile illness (OFI). Considering dengue patients, the RHI was significantly lower for patients with severe plasma leakage compared to those with no leakage (1.46 vs. 2.00, P<0.001), over acute time-points, apparent already in the early febrile phase (1.29 vs. 1.75, P=0.012). RHI correlated negatively with arginase-1, and positively with L-arginine (P=0.001). Endothelial dysfunction/NO bioavailability is associated with worse plasma leakage, occurs early in dengue illness and correlates with hypoargininaemia and high arginase-1 levels.
Yacoub S, Lam PK, Vu LH, et al., 2016, Association of microvascular function and endothelial biomarkers with clinical outcome in dengue: an observational study, Journal of Infectious Diseases, Vol: 214, Pages: 697-706, ISSN: 1537-6613
Background. The hallmark of severe dengue is increased microvascular permeability however alterations in the microcirculation and their evolution over the course of dengue are unknown.Methods. We conducted a prospective observational study to evaluate the sublingual microcirculation using sidestream dark field imaging in patients presenting early (<72 hours fever) and patients hospitalized with warning signs or severe dengue in Vietnam. Clinical, microvascular function, global haemodynamics assessed by echocardiograms and serological markers of endothelial activation were performed at 4 time points.Results. 165 patients were enrolled. No difference was found between the microcirculatory parameters comparing dengue with other febrile illnesses. Proportion of perfused vessels (PPV) and Mean Flow Index (MFI) were lower in dengue patients with plasma leakage (PPV: 88.1% vs. 90.6%, P=0.010 and MFI: 2.1 vs. 2.4, P=0.007) most marked during the critical phase. PPV and MFI correlated with the endothelial activation markers, VCAM-1 (P<0.001 for both) and Angiopoietin-2 (P<0.001 and P=0.001 respectively) with a negative association.Conclusion. Modest microcirculatory alterations occur in dengue, are associated with plasma leakage and correlate with molecules of endothelial activation, Angiopoietin-2 and VCAM-1.
Jaenisch T, Dong THT, Nguyen TTK, et al., 2016, Clinical evaluation of dengue and identification of risk factors for severe disease: protocol for a multicentre study in 8 countries, BMC Infectious Diseases, Vol: 16, ISSN: 1471-2334
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