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


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.