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<span class="text_page_counter">Trang 1</span><div class="page_container" data-page="1">
<b><small>Thầy thuốc tận tâm</small></b>
</div><span class="text_page_counter">Trang 2</span><div class="page_container" data-page="2"><b><small>Thầy thuốc tận tâmChăm mầm đất nước</small></b>
<i><b><small>(MOH, 2016)</small></b></i>
</div><span class="text_page_counter">Trang 5</span><div class="page_container" data-page="5"><b><small>Thầy thuốc tận tâmChăm mầm đất nước</small></b>
</div><span class="text_page_counter">Trang 6</span><div class="page_container" data-page="6"><b><small>Thầy thuốc tận tâmChăm mầm đất nước</small></b>
<b>Immunopathogenesis of Dengue </b><i><b><small>(Simmons CP et al.(2012). N Engl J </small></b></i>
<i><b><small>Med 366;15, 1423-1432)</small></b></i>
</div><span class="text_page_counter">Trang 7</span><div class="page_container" data-page="7"><b><small>Thầy thuốc tận tâm</small></b>
<b>Dengue virus infection</b>
<i><b>(Hung and Thanh, 2002) </b></i>
</div><span class="text_page_counter">Trang 8</span><div class="page_container" data-page="8"><b><small>Thầy thuốc tận tâmChăm mầm đất nước</small></b>
<i><b>(PAHO, Dengue- Guidelines for patient care in the Region of the Americas, 2016)</b></i>
</div><span class="text_page_counter">Trang 9</span><div class="page_container" data-page="9"><b><small>Thầy thuốc tận tâm</small></b>
<b><small>Chăm mầm đất nước</small></b>
<b><small>Thầy thuốc tận tâmChăm mầm đất nước</small></b>
<b>(CT SXHQG, 2017)</b>
<small>10</small>
</div><span class="text_page_counter">Trang 11</span><div class="page_container" data-page="11"><b><small>Thầy thuốc tận tâm</small></b>
</div><span class="text_page_counter">Trang 16</span><div class="page_container" data-page="16"><b>* Some studies on infants</b>
<b>* Most cases -Secondary infections</b>
<b>* Many studies on the clinical, epidemiological, and immunological aspects.</b>
<i><b>(*WHO, Handbook for clinical management of Dengue, 2012; **PAHO, Dengue- Guidelines for patient care in the Region of the Americas, 2016)</b></i>
</div><span class="text_page_counter">Trang 18</span><div class="page_container" data-page="18"><b><small>Thầy thuốc tận tâm</small></b>
<b><small>Chăm mầm đất nước</small></b>
<i><b><small>(WHO, 2012; PAHO, 2016)</small></b></i>
<b><small>Thầy thuốc tận tâm</small></b>
</div><span class="text_page_counter">Trang 20</span><div class="page_container" data-page="20"><b><small>Thầy thuốc tận tâmChăm mầm đất nước</small></b>
<b>TDMP / SXH IV, trẻ 11 tháng.</b>
<i><b><small>(Hung et al., 2004)</small></b></i>
</div><span class="text_page_counter">Trang 22</span><div class="page_container" data-page="22"><b>Tất cả BN SXH không sốc Sốc SXH</b>
</div><span class="text_page_counter">Trang 26</span><div class="page_container" data-page="26"><b>Capture IgM và IgG ELISA</b>
<b><small>Đáp ứng MD Tất cả BNSXH không sốc Sốc SXH P</small></b>
</div><span class="text_page_counter">Trang 27</span><div class="page_container" data-page="27"><b>Ngày bệnh N3 N4 N5 N6 N7 N8 Tcộng</b>
<b>Sốc ca, 6 45 92 71 30 1 245 </b>
<b><small>% (2,4) (18,3) (37,5) (28,9) (12,2) (0,4) (100)</small></b>
<b>79,3% trẻ NN có KT IgM (+) từ ngày thứ 5 trở đi và đáp ứng chéo rất ít với vi rút VN Nhật Bản --> Thử </b>
<b>IgM ELISA từ N5 trở đi giúp + các trường hợp SXHNN.</b>
</div><span class="text_page_counter">Trang 28</span><div class="page_container" data-page="28"><i><b>(Chau et al. PLoS Negl Trop Dis. 2010 Apr 13;4(4):e657)</b></i>
</div><span class="text_page_counter">Trang 30</span><div class="page_container" data-page="30"><b><small>Using BD Human Th1/Th2 </small></b>
<b><small>Cytokine Cytometric BeadArray Kit-II & Flow Cytometry</small></b>
<b><small>to determine the plasma levels of </small></b>
</div><span class="text_page_counter">Trang 31</span><div class="page_container" data-page="31"><i><b><small>[Hung et al. (2004). J of Infectious Diseases, 189:221-232]</small></b></i>
</div><span class="text_page_counter">Trang 32</span><div class="page_container" data-page="32"><b><small>Mối liên hệ giữa phân phối tuổi trẻ nhũ nhi bị SXH/ SốcSXH và hiệu quả bảo vệ và thúc đẩy nhiễm trùng của</small></b>
<i><b><small>kháng thể từ mẹ (Halstead, Lan et al. Emerging Inf. Dis,</small></b></i>
<i><b><small>Dec,2002, 1474-1479) ).</small></b></i>
</div><span class="text_page_counter">Trang 33</span><div class="page_container" data-page="33"><b><small>(n=208)(n=145) (n=63) Lượng dịch TTM110,4 33,6102,1 28,4</small></b> <i><b><small>P<0,001</small></b></i> <b><small>129,8 36,9</small></b>
<b><small>Tỉ lệ dùng CPT48 (23%) 13 (8,9%) </small></b><i><b><small>P<0,001</small></b></i> <b><small>35 (55,5%)</small></b>
<b><small>Lượng CPT55,1 25,939,4 16,2</small></b> <i><b><small>P=0,01</small></b></i> <b><small>60,9 26,5</small></b>
<b><small>Tỉ lệ truyền máu28 (13,4%) 11 (7,5%) </small></b><i><b><small>P<0,001</small></b></i> <b><small>17 (26,9%)Lượng máu tươi38,7 32,5</small></b> <i><b><small>27,3 18,2 P=0,1</small></b></i> <b><small>44,7 38,1Thời gian TTM(giờ) 25,8 8,825,9 8,1</small></b> <i><b><small>P=0,5</small></b></i> <b><small>25,7 10,2</small></b>
<i><b><small>[Hung et al. 2006, Am J Trop Med Hyg 72: 370- 374]</small></b></i>
</div><span class="text_page_counter">Trang 38</span><div class="page_container" data-page="38"><i><b>(WHO-SEARO, Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever. 2011)</b></i>
</div><span class="text_page_counter">Trang 40</span><div class="page_container" data-page="40"><i><small>*[Hung et al. (2006). Am. J. Trop. Med. Hyg.,74(4):684-691]</small></i>
<small>42</small>
</div><span class="text_page_counter">Trang 43</span><div class="page_container" data-page="43"><b><small>Rev Cubana Med Trop.1993;45(2):97-101.[Dengue fever and hemorrhagic dengue in </small></b>
<b><small>infants with a primary infection]. </small></b>
</div><span class="text_page_counter">Trang 44</span><div class="page_container" data-page="44"><b>Am. J. Trop. Med. Hyg. 74(4), 2006, pp. 684-691 </b>
<b><small>Simmons CP, Chau TN, Thuy TT, Tuan NM, Hoang DM, Thien NT, Lien le B, Quy NT, Hieu NT, Hien TT, McElnea C, Young P, Whitehead S, Hung NT, Farrar J.</small></b>
<b><small>J Infect Dis. 2007 Aug 1;196(3):416-24. Epub 2007 Jun 19.</small></b>
<b><small>birth cohort study of Vietnamese infants.</small></b>
<b><small>Chau TN, Hieu NT, Anders KL, Wolbers M, Lien le B, Hieu LT, Hien TT, Hung NT, Farrar J, Whitehead S, Simmons CP.</small></b>
<b><small>J Infect Dis. 2009 Dec 15;200(12):1893-900. </small></b>
<b><small>correlate with age-related disease epidemiology, and cellular immune responses correlate with disease severity.</small></b>
<b><small>Chau TN, Quyen NT, Thuy TT, Tuan NM, Hoang DM, Dung NT, Lien le B, Quy NT, Hieu NT, Hieu LT, Hien TT, Hung NT, Farrar J, Simmons CP.</small></b>
<b><small>J Infect Dis. 2008 Aug 15;198(4):516-24.</small></b>
<b><small>Chau TN, Anders KL, Lien le B, Hung NT, Hieu LT, Tuan NM, Thuy TT, Phuong le T, Tham NT, Lanh MN, Farrar JJ, Whitehead SS, Simmons CP.PLoS Negl Trop Dis. 2010 Apr 13;4(4):e657. </small></b>
</div><span class="text_page_counter">Trang 48</span><div class="page_container" data-page="48"><b>Dengue & Pregnancy?</b>
</div><span class="text_page_counter">Trang 49</span><div class="page_container" data-page="49"><b>- Maternal death from Dengue is infrequently.</b>
<b>- Pregnant women may miscarryor be at risk of miscarriage or prematureduring or up to one month following Dengue infection.</b>
<b>-Fetal growth retardation occurs in a variable proportion of Dengue cases (4-17%) in pregnant women.</b>
<small>49</small>
</div><span class="text_page_counter">Trang 50</span><div class="page_container" data-page="50"><i><b><small>(Tan P et al. Obstetrical & Gynecological Survey, 2008, 111:1111–1117.)</small></b></i>
<b>Compare events and pregnancy outcomes between two paired groups of pregnant women: women having presented with </b>
<b>symptomatic dengue during pregnancy (n = 73) and women having had neither fever nor dengue during pregnancy (n = 219). 27% of the women with symptomatic dengue had at least one clinical or biological warning sign. These </b>
<b>complications occurred after the 28th week of gestation in 55% of cases. </b>
<b><small>(Basurko C, Everhard S, Matheus S, Restrepo M, HildeÂral H, Lambert V, et al. (2018) Aprospective matched study on symptomatic</small></b>
<b><small>dengue in pregnancy. PLoS ONE 13(10): e0202005).</small></b>
<small>51</small>
</div><span class="text_page_counter">Trang 52</span><div class="page_container" data-page="52"><b><small>(Basurko C, Everhard S, Matheus S, Restrepo M, HildeÂral H, </small></b>
<b><small>Lambert V, et al. (2018) Aprospective matched study on symptomaticdengue in pregnancy. PLoS ONE 13(10): e0202005).</small></b>
<small>52</small>
</div><span class="text_page_counter">Trang 53</span><div class="page_container" data-page="53"><b>• Asymptomatic,</b>
<b>hepatomegaly, </b>
<b>bleeding, circulatory failure, massive intracerebralhemorrhage and death. </b>
<small>54</small>
</div><span class="text_page_counter">Trang 55</span><div class="page_container" data-page="55"><b>onset of fever and that of their neonates, were 5–13 days (median, 7 days)</b>
<b>• Fever in neonates occurred at 1–11 days of life(median, 4 days)</b>
<b>• The duration of fever in neonates was 1–5 days(median, 3 days)</b>
<i><b><small>(Sirinavin S et al. Pediatric Infectious Disease Journal,2004, 23:1042–1047.)</small></b></i>
<small>55</small>
</div><span class="text_page_counter">Trang 56</span><div class="page_container" data-page="56"><small>56</small>
</div><span class="text_page_counter">Trang 57</span><div class="page_container" data-page="57"><small>57</small>
</div><span class="text_page_counter">Trang 58</span><div class="page_container" data-page="58"><b>* The diagnosis of neonatal dengue could eventually be suspected on clinical grounds and then confirmed in the laboratory, but initial presentation may be confused with bacterial sepsis, birth trauma and other causes of neonatal illness.</b>
<b>* Symptomatic and supportive treatment under close observation is the mainstay of treatment.</b>
<small>58</small>
</div><span class="text_page_counter">Trang 59</span><div class="page_container" data-page="59"><b>Results: 23 patients were reported</b>
<b>≤ 7 days of life: 18 cases> 7 days of life: 5 cases </b>
<b>• There were 16 mothers have fever, and among them, 10 mothers were diagnosed DHFat or near time of </b>
<b>A Study of Neonatal Dengue at Children’s Hospital 2-Ho Chi Minh City, March 2008- June, 2012</b>
<b><small>(Nguyen Thi Kim Anh, Tran Thi Hoa Phuong, 2016)</small></b>
</div><span class="text_page_counter">Trang 60</span><div class="page_container" data-page="60"><b>The clinical symptoms: </b>
<b>• Others: Jaundice (8 newborns); Poor feeding (5); </b>
<b>Vomiting (4); wheezing (2), cough (10), diarrhea (1). </b>
<small>60</small>
</div><span class="text_page_counter">Trang 61</span><div class="page_container" data-page="61"><b>• WBC count < 5,000/mm<small>3 </small>: 3 newborns</b>
<b>• Coagulation abnormalities: 5 newborns</b>
<b>• X-ray (n=17): 6 newborns having mild pleural effusion.• Abdominal ultrasound exam (n=17): 6 newborns having </b>
<b>signs of gallbladder wall thickening and intraperitonealfree fluid. </b>
<small>61</small>
</div><span class="text_page_counter">Trang 62</span><div class="page_container" data-page="62"><small>62</small>
</div><span class="text_page_counter">Trang 63</span><div class="page_container" data-page="63"><small>63</small>
</div><span class="text_page_counter">Trang 64</span><div class="page_container" data-page="64"><b>• Chẩn đốn ban đầu: NTH SS. </b>
<b>• SXH-D: 18,8%, SXH-D cảnh báo: 81,2%. </b>
<b>• Chỉ có 6,3% trường hợp được truyền dịch nhằm mục </b>
<b>đích duy trì nhu cầu cơ bản và ngưng truyền trước 24 giờ. Chỉ có 1 trường hợp được chỉ định truyền TC vì TC giảm nặng <10000/mm<small>3</small>. </b>
<small>66</small>
</div><span class="text_page_counter">Trang 67</span><div class="page_container" data-page="67"><b>Conclusions </b>
<b>It is difficult to diagnose neonatal DHF early and </b>
<b>differentiate with neonatal sepsis. We should suspect of neonatal DHF if the neonate has fever lasting for 3-4 days, thrombocytopenia and good general condition, meanwhile, other investigations for bacterial infections being normal, and maternal history with having DHF at or near time of delivery <small>(Nguyen Thi Kim Anh, Tran Thi Hoa Phuong, 2016; Tuan et al., 2017).</small></b>
<small>67</small>
</div><span class="text_page_counter">Trang 68</span><div class="page_container" data-page="68"><b>• Prof. Nguyen Trong Lan; Dr. Bach Van Cam (Vietnam)• Prof. Scott Halstead; Prof. Duane J. Gubler (USA)</b>
<b>• Prof. Suchitra Nimmanitya; Dr Siripen</b>
<b>Kalayanarooj (Thailand) </b>
<b>• Prof. Huan-Yao Lei; Prof. Ching-Chuan Liu; Dr. JH </b>
<b>Huang (Taiwan)</b>
<b>• Colleagues at Children’s Hospital 1 &2; Hospital for </b>
<b>Tropical Diseases; Oxford University Clinical Research Unit (OCRU); Pasteur Institutes- Ho Chi Minh City. </b>
</div><span class="text_page_counter">Trang 69</span><div class="page_container" data-page="69"><b><small>Am. J. Trop. Med. Hyg., 00(0), 2018, p. 1</small></b>
<b><small>doi:10.4269/ajtmh.18-0695Copyright © 2018 by The American Society of Tropical Medicine and Hygiene</small></b>
</div><span class="text_page_counter">Trang 70</span><div class="page_container" data-page="70"><b><small>Thầy thuốc tận tâmKhối 3: khối điều trị</small></b>
<b><small>nội trú theo yêu cầu</small></b>
</div><span class="text_page_counter">Trang 71</span><div class="page_container" data-page="71"><b><small>Thầy thuốc tận tâmChăm mầm đất nước</small></b>
</div>