School of Tropical Medicine and Global Health,

Nagasaki University, Nagasaki 852-8523, Japan.


Nguyen Tien Huy, M.D., Ph.D

Associate Professor

Founder of Online Research Club, Head of Lab.

School of Tropical Medicine and Global Health, Nagasaki University,

1-12-4 Sakamoto, Nagasaki, 852-8523, Japan


Tel: +81-95-819-7558

Fax: +81-95-819-7846


A reminder to keep an eye on older people during heatwaves
Published on
The Lancet Healthy Longevity

Authors: Marcel Alied, Nguyen Tien Huy


Burden and mortality of sepsis and septic shock at a high-volume, single-center in Vietnam: a retrospective study
Published on
Hospital Practice

Authors: Truong Hong Hieu, Pham Thi Ngoc Thao, Federica Cuce, Nguyen Hai Nam, Abdullah Reda, Osman Gamal Hassan, Le Thanh Hung, Dinh Thi Kim Nguyen, Jeza M Abdul Aziz, Loc Le Quang, Alison Marie Carameros, Nguyen Tien Huy




Sepsis and septic shock have high mortality rates and often require a prolonged hospital stay. Patient outcomes may vary according to multiple factors. We aim to determine the prevalence of antimicrobial resistance and factors associated with mortality and hospital stay.


Clinical and microbiological data of patients with sepsis or septic shock were retrospectively collected for 15 months. Patients with negative blood cultures and patients that did not meet the SEPSIS 3 criteria were excluded.


We included 48 septic shock and 28 septic patients (mean APACHE II 20.32 ± 5.61 and mean SOFA 9.41 ± 3.17), with a mean age of 60.5 ± 16.8 years and 56.6% males. WBCs, neutrophils, INR, and fibrinogen levels were significantly associated with mortality. 59.5% of the cultured bacteria were gram-negative (most common E. coli) and 27.8% were gram-positive (most common S. aureus), while 7.6% were other types of bacteria and 5.1% were fungi. Resistance patterns to gram-negative were varying, and resistance to piperacillin/tazobactam, carbapenems, and aminoglycosides were from 60% to 100% (A. baumanii), while they were highly sensitive to Colistin. E. coli was also resistant to ceftriaxone (77.8%) and sulbactam/cefoperazone (44.4%). Resistance rates for Gram-positives were high, from 86% to 100% for oxacillin, while for vancomycin, teicoplanin, and linezolid, they were often low but arrived up to 42.8%. According to our logistic regression analysis, patients over 65 year-old and those who received corticosteroids had a significantly increased risk of in-hospital mortality (OR: 4.0; OR: 4.8).


Sepsis still poses a significant threat to patients’ health, even when positive blood culture results allow the administration of specific antibiotic treatment.

SARS-CoV-2 Omicron and its current known unknowns: A narrative review
Published on
Reviews in Medical Virology

Authors: Trang Thi Bich Le, Tamilarasy Vasanthakumaran, Hau Nguyen Thi Hien, I-Chun Hung , Mai Ngoc Luu, Zeeshan Ali Khan, Nguyen Thanh An, Van Phu Tran, Wei Jun Lee, Jeza Muhamad Abdul Aziz, Tasnim Ali, Shyam Prakash Dumre, Nguyen Tien Huy

DOI: 10.1002/rmv.2398


The emergence of the SARS-CoV-2 Omicron variant (B.1.1.529) has created great global distress. This variant of concern shows multiple sublineages, importantly B.1.1.529.1 (BA.1), BA.1 + R346K (BA.1.1), and B.1.1.529.2 (BA.2), each with unique properties. However, little is known about this new variant, specifically its sub-variants. A narrative review was conducted to summarise the latest findings on transmissibility, clinical manifestations, diagnosis, and efficacy of current vaccines and treatments. Omicron has shown two times higher transmission rates than Delta and above ten times more infectious than other variants over a similar period. With more than 30 mutations in the spike protein's receptor-binding domain, there is reduced detection by conventional RT-PCR and rapid antigen tests. Moreover, the two-dose vaccine effectiveness against Delta and Omicron variants was found to be approximately 21%, suggesting an urgent need for a booster dose to prevent the possibility of breakthrough infections. However, the current vaccines remain highly efficacious against severe disease, hospitalisation, and mortality. Japanese preliminary lab data elucidated that the Omicron sublineage BA.2 shows a higher illness severity than BA.1. To date, the clinical management of Omicron remains unchanged, except for monoclonal antibodies. Thus far, only Bebtelovimab could sufficiently treat all three sub-variants of Omicron. Further studies are warranted to understand the complexity of Omicron and its sub-variants. Such research is necessary to improve the management and prevention of Omicron infection.

Keywords: B.1.1.529; BA.1; BA.2; Omicron; SARS-CoV-2; subvarian

Assessment of physical activity and its facilitators and barriers among Syrian refugees living in Amman City, Jordan: a cross-sectional study
Published on
BMC Public Health

Authors: Yasue Yoshino, Miho Sato, Ibraheem Abu-Siam, Nadine Khost, Sumihisa Honda, Ahmad T Qarawi, Osama Gamal Hassan, Nguyen Tien Huy, Yasuhiko Kamiya

DOI: 10.1186/s12889-022-14064-1


Background: Physical inactivity is one of the major risk factors for non-communicable diseases. Few studies about physical activity have been conducted among refugees from neighbouring countries. Given changes in the situation of Syrians, assessment of physical activity among Syrian refugees is required to understand their situation. This study aimed to evaluate the degree of self-reported physical activity and to identify perceived facilitators of and barriers to physical activity among Syrian refugees living in Amman, Jordan, in 2017.

Methods: This community-based cross-sectional study was conducted using a structured questionnaire and the short form of the International Physical Activity Questionnaire. Participants were eligible for the study if they were Syrian refugees aged 18-64 years, living in Amman city, and were either registered with the United Nations High Commissioner for Refugees, waiting for their registration, or had a service card issued by the Jordanian Ministry of Interior. The relationship between physical activity level and sex was assessed using the chi-square test and Cochran-Armitage tests. The Mann-Whitney U test was performed to assess the relationship between the median metabolic equivalent scores of physical activity and gender. Backward stepwise logistic regression analysis was used to analyse the association between predictors of physical inactivity and physical activity level.

Results: Among the 173 participants, the majority (91.9%) reported moderate to a high level of physical activity, and 8.1% were physically inactive. The metabolic equivalent scores for the walking activity of males (median: 1039.5, IQR: 0, 2772) was significantly higher than that of females (median: 396, IQR: 0, 1188) (p < 0.01). "Perceived change in the amount of physical activity" was a significant predictor of physical inactivity (adjusted OR = 3.00; 95%CI: 1.27-7.26). Common facilitators of physical activity were "psychological wellbeing"(49.7%) and "prevent diseases"(46.8%). The greatest barriers to physical activity were "time limitation"(43.4%) and "high cost"(57.8%).

Conclusion: This study revealed the physical activity level among Syrian refugees in Amman. The perceived facilitators and barriers to physical activity identified among Syrian refugees were similar to those in previous studies conducted among non-refugees. These results provide a valuable baseline for future examinations of physical activity level and to verify its possible facilitators and barriers.

Keywords: Barriers; Facilitators; Health; IPAQ; Jordan; Non-communicable diseases; Physical activity; Physical inactivity; Syrian Refugees; Urban refugees.

Evaluation of risk factors associated with SARS-CoV-2 transmission
Published on
Current medical research and opinion

Authors: Mai Ngoc Luu 1, Shamael Thabit Mohammed Alhady 2, Minh Duc Nguyen Tran 3, Le Van Truong 4, Ahmad Qarawi 5, U Venkatesh 6, Ranjit Tiwari 7, Ian Christopher Naungayan Rocha 8, Le Huu Nhat Minh 9, Rohanti Ravikulan 10, Shyam Prakash Dumre 11, Hoang Thi Nam Giang 12, Dmytro Pavlenko 13, Fatmaelzahraa Yasser Ali 14, Bao-Tran Do Le 15, Sedighe Karimzadeh 16, Parshal Bhandari 17, Jaffer Shah 18, Jeza Muhamad Abdul Aziz 19 20, Nguyen Tien Huy 21, and the TMGH COVID-19 Collaborators

DOI: 10.1080/03007995.2022.2125258


Objective: Coronavirus disease 2019 (COVID-19) has caused high morbidity and mortality worldwide. Since there is not enough evidence of risk factors of SARS-CoV-2 transmission, this study aimed to evaluate them.

Methods: This survey-based study was conducted across 66 countries from May to November 2020 among suspected and confirmed individuals with COVID-19. The stepwise AIC method was utilized to determine the optimal multivariable logistic regression to explore predictive factors of SARS-CoV-2 transmission.

Results: Among 2372 respondents who participated in the study, there were 1172 valid responses. The profession of non-healthcare-worker (OR: 1.77, 95%CI: 1.04 - 3.00, p = 0.032), history of SARS-CoV or MERS-CoV infection (OR: 4.78, 95%CI: 2.34 - 9.63, p < 0.001), higher frequency of contact with colleagues (OR: 1.17, 95%CI: 1.01 - 1.37, p = 0.041), and habit of hugging when greeting (OR: 1.25, 95%CI: 1.00 - 1.56, p = 0.049) were associated with an increased risk of contracting COVID-19. Current smokers had a lower likelihood of having COVID-19 compared to former smokers (OR: 5.41, 95%CI: 1.93-17.49, p = 0.002) or non-smokers (OR: 3.69, 95%CI: 1.48-11.11, p = 0.01).

Conclusions: Our study suggests several risk factors for SARS-CoV-2 transmission including the profession of non-healthcare workers, history of other coronavirus infections, frequent close contact with colleagues, the habit of hugging when greeting, and smoking status.

Keywords: COVID-19; Global Survey; Health Surveys; Risk Factors; Transmission

Association of self-reported allergic rhinitis with dengue severity: a case-control study
Published on
Acta Tropica

Authors: Nguyen Thi Cam Huong, Nguyen Thi Ngan, Abdullah Reda, Vinh Dong, Dong Thi Hoai Tam, Van The Trung, Dao Huy Manh, Nguyen Hoang Quan, Abdelrahman M Markam, Shyam Prakash Dumre, Kenji Hirayama, Nguyen Tien Huy




The severity of dengue infection has been reportedly associated with patients’ allergic reactions. To further elucidate the role of allergy in dengue severity, we conducted a matched case-control study to assess the association between allergic background and dengue shock syndrome.


This is a matched case-control study that was carried out in the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam from January to December 2017. Dengue infection was determined by non-structure protein 1 (NS1) diagnostic quick test or anti-dengue antibodies (IgM). The total and dengue-specific IgE levels were measured using ELISA. Patients’ demographics, clinical, and allergic profiles were collected using a structured questionnaire.


A total of 572 dengue patients with positive NS1 (92.7%) or IgM antibodies (7.3%) results were included in this study. Of these patients, 143 patients developed dengue shock syndrome (case group) while the other 429 patients did not (control group). None of the baseline characteristics including age, sex, or being overweight was significantly different between the two groups (p>0.05). In multivariable analysis, having a history of dengue infection (OR=3.35, 95% CI: 1.8-6.17, p<0.001) and allergic rhinitis (OR=1.95, 95% CI: 1.11-3.4, p=0.019) were found to be associated with dengue shock syndrome. Higher levels of dengue-specific IgE were not associated with worse outcomes in patients with allergies (p=0.204) or allergic rhinitis (p=0.284).


Dengue patients presenting with a history of a previous dengue infection or allergic rhinitis should be considered high-risk patients for the development of dengue shock syndrome.

Factors associated with the very high caesarean section rate in urban areas of Viet Nam
Published on

Authors: Hoang Thi Nam Giang, Do Thi Thuy Duy, Le Tho Minh Hieu, Nguyen Lam Vuong, Nguyen Thi Tu Ngoc, Mai Thi Phuong, Nguyen Tien Huy




Caesarean section and associated factors require detailed investigation globally. This study aims to determine the rate and associated factors of caesarean deliveries in urban areas of Vietnam.


A cross-sectional study using questionnaire answered by women who had infants aged under 30 months was conducted from March to May 2021. Data were collected in 18 commune health centres in two cities during the day of routine immunization. Multivariable logistic regression was performed to assess factors associated with caesarean section.


The overall caesarean section rate was 49.6%. The caesarean section rate in private hospitals (57.8%) were significantly higher than in public hospitals (49.1%). Caesarean section rate in first-time mothers (47.1%) were as high as this rate among mothers who had given birth before (50.6%). Factors associated with higher rate of caesarean section include increasing in women’s age, pre-pregnancy body mass index, gestational weight gain, and infant’s birth weight; first-time mothers; mothers living in urban areas; and mothers giving birth in private hospitals.


This study revealed a high rate of caesarean deliveries in urban areas of Vietnam. Comprehensive investigations of both medical and non-medical reasons for caesarean deliveries in Vietnam are urgent needs to shape the prioritized interventions.

Dengue fever on the rise in Southeast Asia
Published on
BMC Pediatrics

Authors: Marcel Alied, Dang Nguyen, Jeza Muhamad Abdul Aziz, Dang Phuc Vinh, Nguyen Tien Huy


The timing setting in kinetic dengue studies: A systematic review
Published on
Acta Tropica

Linh Tran , Nguyen Minh Tuan , Dao Ngoc Hien Tam , Abdulmueti Alshareef , Essam Emad , Ahmed Mohamed Khalifa , Truong Hong Hieu , Zeeshan Ali Khan , Lee Wei Jun , Kenji Hirayama , Nguyen Tien Huy



Dengue is classified as an endemic infectious disease, which is transmitted by Aedes mosquitos. Kinetic studies, which monitor the viral load of the disease, have been the mainstay for several decades in humanity's quest to control this disease. Our study aims to systematically evaluate the usage of different timing systems in dengue kinetic studies. A search in nine electronic databases and manual search of reference and citation lists were conducted to find relevant studies. A quality assessment using the National Institute of Health tools for observational cohort and cross-sectional studies was performed. The protocol was registered in PROSPERO with number CRD42018086435. As results, among included 87 studies, 71 studies (81.6%) use a timing system which is based on the day of illness onset, of which, 11 studies designate the day of illness onset as “day 0″ (type 1A) while 60 studies designate it as “day 1″ (type 1B). Only ten articles (11.5%) designate the day of defervescence as “day 0″, the day before and after defervescence as “day -1″ and “day +1″, respectively. Four articles (4.6%) use a timing system based on the day of hospital admission. Lastly, two studies (2.3%) designate the day of hemorrhagic manifestation as “day 0″ and two studies (2.3%) designate the day of pharmacological treatment as “day 1″. Therefore, the timing system which designates the day of illness onset as “day 1″ (type 1B) was most commonly used. Inconsistent definitions of "day 0″ and “day 1″ may lead to disparities in results across the studies and may have a negative impact on treatment guidelines implementation.

Prevalence of early skin-to-skin contact and its impact on exclusive breastfeeding during the maternity hospitalization
Published on
BMC Pediatrics

Authors: Hoang Thi Nam Giang , Do Thi Thuy Duy, Nguyen Lam Vuong, Nguyen Thi Tu Ngoc, Thu Thi Pham, Le Quang Tuan, Le Oai, Pham Do Thuc Anh, Ton That Khanh, Nguyen Thi Anh Thi, Mai Ngoc Luu, Tran Thi Tuyet Nga, Le Tho Minh Hieu, Nguyen Tien Huy

DOI: 10.1186/s12887-022-03455-3


Background: Early essential newborn care has been implemented in countries regardless high or low neonatal mortality. This study aims to investigate the current practice of skin-to-skin contact (SSC) and its effect on exclusive breastfeeding during the hospital stay.

Methods: This is a cross-sectional study of 1812 Vietnamese mothers in multicenter. A questionnaire answered by the mothers was used to assess the duration of both SSC and breastfeeding practices. Multivariable logistic regression was used to identify a dose-response relationship between early SSC and prevalence of exclusive breastfeeding in hospital.

Results: There were 88.7% of mothers experiencing SSC with their infants right after birth and the highest prevalence of SSC was found in district hospitals. Among those experiencing SSC, 18.8% of the infants received more than 90 min of SSC and completed the first breastfeeding during SSC time. Prevalence of exclusive breastfeeding during maternity hospital stay was 46.7%. We found a significant dose-response relation between the duration of SSC and exclusive breastfeeding in hospital. Compared with infants without SSC, the prevalence of exclusive breastfeeding was higher in infants who experienced SSC for 15-90 min (adjusted odds ratio [aOR], 95% confidence interval [95%-CI]: 2.62 [1.61-4.27]) and more than 90 min (aOR [95%-CI]: 5.98 [3.48-10.28]). Completed first breastfeeding during SSC time (aOR [95%-CI]: 4.24 [3.28-5.47]) and being born in district hospitals (aOR [95%-CI]: 2.35 [1.79-3.09]) were associated with increased prevalence of exclusive breastfeeding during hospital stay. On the other hand, mother education level as high school/intermediate (aOR [95%-CI]: 0.58 [0.42-0.82]) and place of residence classified as rural decreased odds of exclusive breastfeeding in hospital (aOR [95%-CI]: 0.78 [0.61-0.99]).

Conclusion: Our results demonstrate a strong dose-response relationship between duration of SSC and exclusive breastfeeding in hospital. Interventions that support exclusive breastfeeding during hospital stay, especially achieving prolonged uninterrupted SSC, could improve the duration of breastfeeding.

Trends in Primary Gallbladder Cancer Incidence and Incidence-based Mortality in the United States, 1973 to 2015
Published on
American Journal of Clinical Oncology

Soon Khai Low , Dimitrios Giannis , Nguyen D Thuong , Nguyen Hai Nam , Abdulmueti Alshareef , Ioannis Koulas , Georgios Geropoulos , Dimitrios Moris , Ernesto P Molmenti , Nguyen Tien Huy

DOI: 10.1097/COC.0000000000000918


Objectives: Primary gallbladder cancer (GBC) is the most common biliary tract cancer with poor survival despite aggressive treatment. This study aimed to investigate the trends of GBC incidence and incidence-based mortality (IBM) over the last 4 decades.

Materials and methods: GBC cases diagnosed between 1973 and 2015 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Incidence rates, IBM rates, and annual percent changes (APCs) were calculated and stratified according to population and tumor characteristics.

Results: The cohort consisted of 10,792 predominantly white (81%) and female (71%) GBC patients. The overall GBC incidence decreased by 1.65% (95% confidence interval [CI]: 1.45% to 1.84%) per year since 1973, but has plateaued since 2002. IBM decreased by 1.69% (95% CI: 1.22% to 2.16%) per year from 1980 to 2015; the rate of decrease in IBM rates was lower during 1997 to 2015 (APC: -1.19%, 95% CI: -1.68% to -0.71%) compared with 1980 to 1997 (APC: -3.13%, 95% CI: -3.68% to -2.58%).

Conclusions: The incidence and IBM rates of GBC have been decreasing over the last 40 years, but the decrease plateaued over the last 2 decades. The effects of treatment modalities, including laparoscopic cholecystectomy, adjuvant chemotherapy, and radiation on the incidence and IBM of GBC need to be further investigated.

Negative impact from school closures on children and parents in Vietnam during COVID-19
Published on The Lancet Respiratory Medicine

Authors: Ngoc Phuong Hong Tao; Abdelrahman M Makram; Phan Nguyen Quoc Khanh; Nguyen Thanh An; Adnan Safi; Nguyen Tien Huy


The Global Response: How Cities and Provinces Around the Globe Tackled Covid-19 Outbreaks in 2021
Published on The Lancet Regional Health Southeast Asia

Authors: Nityanand Jain, I-Chun Hung, Hitomi Kimura, Goh Yi Lin, William Jau, Khoa Le Anh Huynh, Deepkanwar Singh Panag, Ranjit Tiwari, Sakshi Prasad, Emery Manirambona, Tamilarasy Vasanthakumaran, Tan Weiling Amanda, Ho-Wei Lin, Nikhil Vig, An Nguyen Thanh, Emmanuel Uwiringiyimana, Darya Popkova, Ting-Han Lin, Minh Anh Nguyen, Shivani Jain, Tungki Pratama Umar, Mohamed Hoosen Suleman, Elnur Efendi, Chuan-Ying Kuo, Sikander Pal Singh Bansal, Hui-Hui Peng, Mohit Bains, Marija Rozevska, Thang Huu Tran, Meng-Shan Tsai, Pahulpreet, Suvinai Jiraboonsri, Ruo-Zhu Tai, Zeeshan Ali Khan, Dang Thanh Huy, Supitsara Kositbovornchai, Ching-Wen Chiu, Thi Hien Hau Nguyen, Hsueh-Yen ChenThanawat Khongyot, Kai-Yang Chen, Dinh Thi Kim Quyen, Jennifer Lam, Kadek Agus Surya Dila, Thanh Ngan Cu, Tam Huynh Thi My, Le Anh Dung, Kim Oanh Nguyen Thi, Hoai An Nguyen Thi, My Trieu Duc Thao, Yen Cao Thi, Thien Trang Pham, Koya Ariyoshi, Chris Smith, Nguyen Tien Huy



Tackling the spread of COVID-19 remains a crucial part of ending the pandemic. Its highly contagious nature and constant evolution coupled with a relative lack of immunity make the virus difficult to control. For this, various strategies have been proposed and adopted including limiting contact, social isolation, vaccination, contact tracing, etc. However, given the heterogeneity in the enforcement of these strategies and constant fluctuations in the strictness levels of these strategies, it becomes challenging to assess the true impact of these strategies in controlling the spread of COVID-19.


In the present study, we evaluated various transmission control measures that were imposed in 10 global urban cities and provinces in 2021– Bangkok, Gauteng, Ho Chi Minh City, Jakarta, London, Manila City, New Delhi, New York City, Singapore, and Tokyo.


Based on our analysis, we herein propose the population-level Swiss cheese model for the failures and pitfalls in various strategies that each of these cities and provinces had. Furthermore, whilst all the evaluated cities and provinces took a different personalized approach to managing the pandemic, what remained common was dynamic enforcement and monitoring of breaches of each barrier of protection. The measures taken to reinforce the barriers were adjusted continuously based on the evolving epidemiological situation.

Impediments to child education, health and development during the COVID-19 pandemic in India
Published on The Lancet Regional Health Southeast Asia
Authors: Akshay Raut; Nguyen Tien Huy

Chest imaging features of Coronavirus disease 2019 pneumonia: a systematic review and meta-analysis
Link: DOI: 10.23736/S2784-8477.21.01937-4
Edizione Minerva Medica
Soon K. LOW, Mai N. LUU, Le H. MINH, Abdelaziz ABDELAAL, Sze JIA NG, Abdelrahman G. GAD, Le H. NHI, Tran N. LE, Nguyen T. HUY
INTRODUCTION: This study aimed to systematically review the evidence reporting the key imaging findings in confirmed COVID-19 pneumonia.
EVIDENCE ACQUISITION: A systematic search for articles reporting the prevalence of imaging findings in patients with COVID-19 pneumonia was conducted in seven databases up to April 10, 2020. The study protocol was registered in PROSPERO (CRD42020172528).
EVIDENCE SYNTHESIS: A total of 25 imaging features were identified in 29 studies. The most characteristic radiographic features of COVID-19 pneumonia include peripheral distribution (92.4%, 95% CI: 86.8-95.8), bilateral involvement (82.8%, 95% CI: 76.0-87.9), and ground-glass opacities (GGO) (76.0%, 95% CI: 59.5-87.3). Right lower lobe (RLL) was the most frequently involved lobe (89.0%, 95% CI: 79.6-94.4), followed by left lower lobe (LLL) in 86.5% (95% CI: 74.8-93.2) of patients. The atypical imaging features included bronchial wall thickening, lymphadenopathy, and pleural effusion, which were observed more commonly in severe and critical COVID-19 pneumonia compared to mild and moderate condition.
CONCLUSIONS: Chest imaging can help to diagnose COVID-19 pneumonia, especially in regions where the availability of RT-PCR testing kits is limited. Recognition of key radiographic features of COVID-19 pneumonia is essential to identify patients at early stages, monitor disease progression, and optimize their management plan.

The efficacy and adverse effects of favipiravir on COVID-19 patients: a systematic review and meta-analysis of published clinical trials and observational studies

AUTHORS: Dang The Hung; Suhaib Ghula; Jeza Muhamad Abdul Aziz; Abdelrahman M.Makram; Gehad Mohamed Tawfik; Ali Ahmed-Fouad Abozaid; Rohan Andrew Pancharatnam; Amr Mohamed Ibrahim; Muhammad Besher Shabouk; Morgan Turnage; Saloni Nakhare; Zahra Karmally; Basel Kouz; Tran Nhat Le; Suleiman Alhijazeen; Nguyen Quoc Phuong; Alaa Mohamed Ads; Ali Hussein Abdelaal; Nguyen Hai Nam; Tatsuo Iiyama; Kyoshi Kita; Kenji Hirayama; Nguyen Tien Huy.


Objectives: This study aimed to evaluate the efficacy and adverse events of favipiravir in COVID-19 patients.

Methods: Our protocol was registered on PROSPERO (CRD42020206305). Fourteen databases were searched until February 8th, 2021. An update search for new RCTs was done on March 2nd, 2022. Meta-analysis was done for randomized controlled trials (RCTs) and non-RCTs.

Results: Overall, 157 studies (24 RCTs, one non-RCT, 21 observational studies, two case series, and 106 case reports) were included. On hospitalized patients, in comparison to standard of care, favipiravir showed a higher rate of viral clearance at day 5 (RR=1.60, p=0.02), defervescence at day 3-4 (RR=1.99, p<0.01), chest radiological improvement (RR=1.33, p<0.01), hospital discharge at day 10-11 (RR=1.19, p<0.01), and shorter clinical improvement time (MD=-1.18, p=0.05). Regarding adverse events, favipiravir groups had higher rates of hyperuricemia (RR=9.42, p<0.01), increased alanine aminotransferase (RR=1.35, p<0.01), but lower rates of nausea (RR=0.42, p<0.01) and vomiting (RR=0.19, p=0.02). There were no differences regarding mortality (RR=1.19, p=0.32), and increased aspartate aminotransferase (RR=1•11, p=0•25). On non-hospitalized patients, no significant differences were reported.
Conclusion: Adding favipiravir to the standard of care provides better outcomes for hospitalized COVID-19 patients. Pregnant, lactating women, and patients with a history of hyperuricemia should avoid using favipiravir.

Keywords: Favipiravir; COVID-19; SARS-CoV-2; efficacy; side effects

Parasites Protect from Severe COVID-19. Myth or Reality?

March 2022 | International Journal of Infectious Diseases

AUTHORS: Abdelrahman M.Makram, Marcel Alied, Zeeshan Ali Khan, Nguyen Tien Huy

Keywords: COVID-19; Parasitic coinfection; Severity; Mortality; Morbidity

Clinical and laboratory factors associated with coronavirus disease 2019 (Covid-19): a systematic review and meta-analysis

Summary: Covid-19 is one of the most widespread viruses globally during the 21st century, whose severity and ability to cause severe pneumonia and death vary.

We performed a comprehensive systematic review of all studies that met our standardized criteria and then extracted data on the age, symptoms, and different treatments of Covid-19 patients and the prognosis of this disease during follow-up. Cases in this study were divided according to severity and death status and meta-analyzed separately using raw mean and single proportion methods.

We included 171 complete studies including 62,909 confirmed cases of Covid-19, of which 148 studies were meta-analyzed. Symptoms clearly emerged in an escalating manner from mild-moderate symptoms, pneumonia, severe-critical to the group of non-survivors. Hypertension (Pooled proportion (PP): 0.48 [95% Confident interval (CI): 0.35-0.61]), diabetes (PP: 0.23 [95% CI: 0.16-0.33]) and smoking (PP: 0.12 [95%CI: 0.03-0.38]) were highest regarding pre-infection comorbidities in the non-survivor group. While acute respiratory distress syndrome (PP: 0.49 [95% CI: 0.29-0.78]), (PP: 0.63 [95%CI: 0.34-0.97]) remained one of the most common complications in the severe and death group respectively. Bilateral ground-glass opacification (PP: 0.68 [95% CI: 0.59-0.75]) was the most visible radiological image. The mortality rates estimated (PP: 0.11 [95% CI: 0.06-0.19]), (PP: 0.03 [95% CI: 0.01-0.05]), and (PP: 0.01 [95% CI: 0-0.3]) in severe-critical, pneumonia and mild-moderate groups respectively.

This study can serve as a high evidence guideline for different clinical presentations of Covid-19, graded from mild to severe, and for special forms like pneumonia and death groups.

Keywords: Covid-19, SARS-CoV-2, ARDS, symptomatology, pneumonia, death, critical, mild, radiology, laboratory

Download full-text & supplement materials here, Original article here

How to cite: Minh LHN, Abozaid AAA, Ha NX, Le LQ, Gadmil A, Tiwari R, Le TN, Dinh QK, AL-Manaseer B, Kien ND, Vuong NL, Zayan AH, Nhi LHH, Dila KAS, Varney J, Huy NT. Clinical aspect of novel Coronavirus (2019-nCoV): a systematic review and meta-analysis. Rev Med Virol. 2021;e2288. doi:10.1002/rmv.2288.

Reviews in Medical Virology (RMV); Short Title: Rev Med Virol; DOI: 10.1002/(ISSN)1099-1654; Electronic ISSN: 1099-1654; Print ISSN: 1052-9276; Article ID: RMV2288; Article type: review article; Article DOI: 10.1002/rmv.2288; Copyright: © 2021 John Wiley & Sons Ltd.

Lessons Learned from the Reemergent Coronavirus Disease 2019 (COVID-19) Cases in Areas of Long-reported No Community Transmission

Sep 2020 | Clinical Infectious Diseases

AUTHORS: Ibrahim Y, Raut A, Varney J, Sidhu A, Dong V, Huy NT

Keywords: COVID-19, outbreak, community transmission, containment measures, solutions

COVID-19: the current situation in Afghanistan

Jun 2020 | Lancet Glob Health

AUTHORS: Shah J, Karimzadeh S, Al-Ahdal TMA, Mousavi SH, Zahid SU, Huy NT.

No abstract available.

Frequent inappropriate use of unweighted summary statistics in systematic reviews of pathogen genotypes or genogroups

Mar 2020 | J Clin Epidemiol

AUTHOR: Tran L, Y MN, Thai Le Ba Nghia TLB, Hendam A, Vuong NL, Alzalal E, Ahmed M. Sayed AM, Hussain MM, Akash Sharma A, Tieu T, Peterson Gitonga Mathenge PG, Hirayama K, Alexander N, Huy NT.


Objectives: Our study aimed to systematically assess and report the methodological quality used in epidemiological systematic reviews (SRs) and meta-analysis (MA) of pathogen genotypes/genogroups.

Study design and setting: Nine electronic databases and manual search of reference lists were used to identify relevant studies. The method types were divided into three groups: 1) with weighted pooling analysis (which we call MA), (2) unweighted analysis of the study-level measures (which we call summary statistics), and (3) without any data pooling (which we call SR only). Characteristics were evaluated using Assessment of Multiple Systematic Reviews (AMSTAR), Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), and Risk Of Bias In Systematic reviews (ROBIS) tools. The protocol was registered in PROSPERO with CRD42017078146.

Results: Among 36 included articles, 5 (14%) studies conducted SR only, 16 (44%) performed MA, and 15 (42%) used summary statistics. The univariable and multivariable linear regression of AMSTAR and PRISMA scores showed that MA had higher quality compared with those with summary statistics. The SR only and summary statistics groups had approximately equal scores among three scales of AMSTAR, PRISMA, and ROBIS. The methodological quality of epidemiological studies has improved from 1999 to 2017.

Conclusion: Despite the frequent use of unweighted summary statistics, MA remains the most suitable method for reaching rational conclusions in epidemiological studies of pathogen genotypes/genogroups.

Keywords: Genogroups; Genotypes; Meta-analysis; Methodological quality; Summary statistics; Systematic review.

Introduction of Novel Surgical Techniques: A Survey on Knowledge, Attitude, and Practice of Surgeons

Oct 2019 | Surg Innov

AUTHORS: Ahmed AM, Giang HTN, Sherief G, Hosni S, Altibi AM, Huynh S, Tang NA, Cuong T, Tuan LQA, Vuong NL, Mohamed A, Ghorab, Muhammad, Ngan T, Sameh E, Elmaraezy A, Minh LHN, Hirayama K, Huy NT.


Purpose: To investigate the knowledge, attitude, and practice of surgeons toward introducing novel surgical techniques in Egypt, Palestine, and Vietnam.

Summary Background Data: Despite the recent advances in modern surgical care and its role in advancing the quality and the length of lives, surgery in the developing world has stagnated or even regressed.

Methods: A survey was undertaken among the surgeons in 9 hospitals belonging to the 3 countries. Questions were categorized into knowledge, attitude, and practice questions. Meta-analyses were performed to estimate the event rate and compare between knowledge and practice, senior and junior surgeons.

Results: A total of 244 responses, with a response rate of 79.7%, were included in the analysis. Regarding knowledge and attitude, the results were satisfactory except that only 55.8% of surgeons appraised their level of education and 43.3% wanted to earn money from the novel procedure. There was a significant difference between knowledge and practice regarding getting informed consent from the patients (P = .024), discussing the novelty of the procedure (P < .001), discussing the alternative procedures (P < .001), discussing the surgeons' experience and level of skills (P < .001), discussing the risk of the new procedure (P < .001), and monitoring the outcomes after the new procedure (P < .001).

Conclusions: Most surgeons have sufficient knowledge and are motivated regarding adopting novel surgical techniques in order to provide the best care for the patients. However, there was a gap between knowledge and practice. Training programs and evidence-based guidelines regarding the introduction of novel surgical techniques are needed to overcome these challenges.

Keywords: business of surgery; evidence-based medicine; evidence-based surgery; surgical education.

Participants' understanding of informed consent in clinical trials over three decades: systematic review and meta-analysis

Mar 2015 | Bull World Health Organ.

AUTHORS: Tam NT, Huy NT (CA) Thoa LTB, Long NP, Trang NTH, Hirayama K, Karbwang J.


Objective: To estimate the proportion of participants in clinical trials who understand different components of informed consent.

Methods: Relevant studies were identified by a systematic review of PubMed, Scopus and Google Scholar and by manually reviewing reference lists for publications up to October 2013. A meta-analysis of study results was performed using a random-effects model to take account of heterogeneity.

Findings: The analysis included 103 studies evaluating 135 cohorts of participants. The pooled proportion of participants who understood components of informed consent was 75.8% for freedom to withdraw at any time, 74.7% for the nature of study, 74.7% for the voluntary nature of participation, 74.0% for potential benefits, 69.6% for the study's purpose, 67.0% for potential risks and side-effects, 66.2% for confidentiality, 64.1% for the availability of alternative treatment if withdrawn, 62.9% for knowing that treatments were being compared, 53.3% for placebo and 52.1% for randomization. Most participants, 62.4%, had no therapeutic misconceptions and 54.9% could name at least one risk. Subgroup and meta-regression analyses identified covariates, such as age, educational level, critical illness, the study phase and location, that significantly affected understanding and indicated that the proportion of participants who understood informed consent had not increased over 30 years.

Conclusion: The proportion of participants in clinical trials who understood different components of informed consent varied from 52.1% to 75.8%. Investigators could do more to help participants achieve a complete understanding.