Y HOC VIET NAM THANG - SO 2/2014 mg/ngay. Tan suat sff dyng heroin hang eua benh nhan giam di rd ret: tru'dc dieu tri 1,24 lan/ngay; giai doan dd lieu 1,07 lan/ngay sau ngay, 0,33 lan/ngay sau 30 va sau thang dieu tri la 0,08 lan/ngay. Ty te benh nhan dffdc chuyen girl den cac dich vu y te khac nhff: Dieu trj ARV la 44,5%, dieu tn nhiem triing cd hdi 30,8%, cung cap BKT sach 21,3%, tff van xet nghiem HIV ty nguyen 8,3%, Oa sd benh nhan dang dffdc dieu trj tai cac cd sd deu cho biet hp rat hai Idng, hai Idng vdi cac djch vy ddn tiep benh nhan, thai dp bac sy lam viec, thai dp nhan vien tff van cung nhff hai Idng vdi thai dp eiia cae nhan vien cdng tac tai cd sd dieu trj Methadone. T A I L l g U T H A M KHAO 1. B$ Y te (2013), Bao cao ket qua hoat ddng phong chdng HIV/AIDS thang dau va phUOng hffdng nhiem vu thang cudi nam 2013. Bo Y te (2009), Bao cao ket qua trien khai thi diem dieu tri nghien cac chat dang thuoc phien bang thuoc Methadone tai TP. Hai Phong va TP, Ho Chi Minh nam 2008, tr, 1- 9, Bp Y te (2005), "Cac cong trinh nghien CLAJ khoa hoc ve HIV/AIDS giai doan 2000-2005", Tap chi Y hoc thifc hanh nam 2006. Bp Y te (2007), Hu'dng dan xay di/ng khung cac can thiep dPa tren hoat dong cua cac cd sd dieu tri Methadone ,yi5 Noi, tr, 5- 24. Bp Y te (2010), Hudng dan dieu tri thay the nghien cac chit dang thudc phien bang thuoc methadone, Ha Noi, tr, 3- 25. Trung tam phong chong HIV/AIDS Ha Npi (2013), Bao cao ket qua hoat dong phong chong HIV/AIDS thang dau va phUOng hUdng nhiem vu thang cuoi nam 2013, Thu tu'dng Chinh phu (2012), Chien \Mc qudc gia phong chdng HIV/AIDS d Viet Nam den nam 2020 va tam nhin 2030, NGHIEN Ciru BIEN DOI SO LU'O'NG VA HINH THAI MAU TIEU CAU 6" BENH NHAN GIAM TIEU CAU JVlAU NGOAI VI Nguyen Thj Minh Phuong* T M TAT Giam tieu cau thu'dng gap cac benh ly huyet hpc cung nhU khong huyet hpc. Xet nghiem tiiy ddng mpt vai trd quan trong chan doan, Muc tidu: Tim hieu sif bien ddi sd lUdng va hinh thai mau tieu rau d benh nhan giam tieu cau mau ngoai vi. Doi tffdng va phu'dng phSp nghien cffu: hoi cffu ket hijp tien ciru, mo ta, cat ngang dUdc thyc hien d BVrWQD 108 ty 2008-2013, Ket qua: 400 trUdng hpp giam tieu a u mau ngoai vi ddn thuan hoac kem giam HC Tuoi trung binh la 53,2 tuoi {14-94 tudi), Oa so cic BN nhom tuoi >45 tud'i, Xuat huyet giam tieu cau vo c3n (ITP) la nguyen nhan bien nhat tiep theoja glim sin tiiy, bach cau cap, 57,25% BN so lu'dng mau tieu c3u tiiy binh thu'dng hoac giam nhffng hinh thai vln binh thu'dng. Trong 97/400 BN tang so lUdng m§u ti^u d u vdi hinh thai dang non thi hau het la ITP KSt lu^n: Tiiy la xet nghiem quan de chan do^n xac djnh nguyen nhan giam tieu cau. Titldida: Giam teu cau, Chpc hiit bjy xUOng (tiiy do) • Khoa huyet hpc lam sang Benh vi$n TWQD108 PhAn bl$n khoa hgc: PGS.TS Nguyen Lieu SUMMARY STUDY OF CHANGES I N NUMBER AND MORPHOLOGY OF THE MEGAKARYOCYTES I N PATIENT W I T H THROMBOCYTOPENIA Thrombocytopenia i5 commonly encountered in haematological and non-haematological disorders. Bone marrow aspiration plays a major role in diagnosis. Objective: to analyse the changes in number and morphology of the megakaryocytes in patient with Thrombocytopenia, Patients and methods: This restrospective and prospective crosssectional study was carried out at 108 military central hospital. Results: 400 cases with thrombocytopenia. Mean age of patients was 53,2 years. Maximum number of cases was seen in age group of above 45 years. Idiopathic thrombocytopenic purpura (ITP) was the commonest cause followed by hypoplastic marrow, acute leukaemia respectively. Most patients increased number of megacaryocyte with immature form is ITP. Conclusion: bone marrow aspiration is an important diagnostic modality to determine the aetiology of thrombocytopenia. Keywords: aspiration Thrombocytopenia, bone marrow YHOC VIET NAM THANG - SO 2/2014 I. BAT VAN DE Tieu cau (TC) ddng mpt vai trd quan trpng ddng mau va cam mau maeh bi ton thffdng. Giam so iffdng tieu cau (thrombocytopenia) se tang nguy ed ehay mau. Giam TC thffdng gap thyc hanh lam sang. Mae dii ed rat nhieu nguyen nhan gay giam tieu cau nhffng cd the chia lam nhdm chinh: Suy giam kha nang sinh tieu cau, tang hiiy TC hoac tieu thu TC, giam TC phan bd va mat mau Idn (Levine, 2003) [4], Cac chf djnh tiiy thffdng dffdc dffa giam tieu cau khdng giai thfch dydc hoac cd giam ddng ngoai mau vl. Bleu hien lam sang thffdng gap d eac benh ly gay giam TC la xanh xao, met mdi, laeh to, hach to, sot, ehay mau, giam can, va gan to (Tariq et al,, 2010).Tham kham lam sang ky cang va xet nghiem mau ngoai vi cd the giiip djnh hffdng chan doan. Tuy nhien xet nghiem la rat can thiet gdp phan quan trpng khang djnh chan doan. Chpc hut tiiy xydng de lam tiiy dd la thii thuat xam lan nhffng an toan dffdc thffc hien thffdng quy eae benh vien de tim cac nguyen nhan gay giam tieu eau (Egesie et al., 2009) ca trffdng hdp cd giam tieu cau nang (Kibria et al., 2010) [2]. Mue tieu eiia nghien cffu la danh gia vai trd cua tiiy xffdng cac trffdng hdp giam tieu cau. II. OOI TU'ONG VA PHt/CTNG PHAP NGHIEN OJM 2.1. Doi tu'dng nghien cu'u: 400BN giam tieu cau mau ngoai vi dieu trj tai Benh vienTWQO 108. Loai trff cac trffdng hdp Iffdng dich hut tiiy xffdng khdng dii de dpc xet nghiem hoac tiiy kho khd hilt djch, benh nhan dang sff dung cae thuoc cd kha nang gay giam tieu cau, BN ung thff dieu trj hda ehat hoac xa trj. 2.2. Pliffdng pliap nghien cu'u: Hoi ciitj ket hdp tien cffu, md ta cat ngang Chi tieu nghien cffu: Cac trieu chffng lam sang, xet nghiem mau ngoai vi va dypc phan ti'ch chi tiet. Tieu cau dffdc coi la giam sd Iffdng dffdi 150 G/L. Cdng thffc mau dffdc dem bang may tff dpng. So Iffdng mau tieu can binh thffdng (mdt mau tieu cau / den vi trffdng), tang (hdn hai mau tieu cau / vi trffdng), giam (mpt mau tieu cau / den 10 vi trffdng), Thay doi hinh thai ciia mau tieu cau la cac bien ddi dang non, loan san va nhan trd. Sd lieu nghien cffu dffdc xff ly bang phan mem SPSS 18.0 . KET QUA Bang 1: Dac diem chung cua cac BN nghien cffu So lu'dng BN Ty le % 60 137 34,25 Nam 251 62.8 Gidi NO149 37.3 Sot 134 33,5 Xuat huyet 235 58,75 Da xanii, niem mac ntidt 290 72,5 Gan to 92 23 Lach to 106 26,5 Hach to 65 16,25 Dau xu'dng 47 11,8 Cac trieu chCrnq khac 82 20,5 400 BN giam tliu cau du tliu chuan d&dc chpn vao nghien c&V. Tudi trung btnh ia 53,2 tuoi (14 tudi). Nhdm tudi th&dng gap nhit la >45 tudi (69,25%, sd 400 binh nhan). 62,8% la nam g'i& 37,3% la n&gidi vdi ty li nam:n&la 1,6:1. Trieu ch&ng lam sang th&dng gap nhit la da xanh, h^ mac nhdt (72.5%) sau den xuit huyet da, niim mac hoac phu tang (58,75.0%), sdt (33,5%) w gan lach to lan l&dt la 23, % va 26,5%. y HOC VIET NAM THANG • SO 2/2014 Bang 2: Xet nqhiem mau nqoai vi cua cac BN nqhien cu'u Cac chi so mau ngoai vi Gia tri trunq binh (Mean ± SD) Hb rq/il 106,46 ±27,16 Tonq so iu'dnq bach cau (G/L) 19,45±41,77 7,78 ± 24,9 So iydnq tuyet doi BC hat (G/L) So iu'Onq tieu cau (G/i) 63,62±33,39 Hinh thai te bao So lu'dng BN (n= 400), ty le («/o) Hinh thai hong HC Binh thu'dng dang sac 326 81,5%) HC Nho, nhu'dc sac cau 39 (9,75%) HCto 35 (8,75%) Te bao bat thu'dng mau ngoai vi 93 23.25%) Kit qua cong th&c mau cua 100 BN giam TC thay so luang TC trung binh la 63,62±33,39 G/L, so luang BC trung binh 19,45±41,77 G/L va hong cau binh thu'dng, dang sac chiem 81.5%. Bang 3: Mat te bao xi/dnq d cac BN nqhien ciru Sd tlTdng te bao (G/L) Sd lu'dng BN Ty le (%) So iu'dng binh thu'dng (30-100 G/L) 194 48,5% Tuy tang so luang te bao (>100 G/L) 97 24,25% Tuy qiam so lu'dnq te bao (45 tudi (59,25%, sd 400 BN). Trong mdt nghien cffu ciia Muhury va es (2009), da sd eae BN dffdi 10 tudi [6]. Tudi trung binh nghien cffu ciia chiing tdi la 53,25 tudi . (62,8%) la nam gidi (37,3%) la nff gidi vdi ty le nammff la 1,6:1. Trong nghien cffu eiia Muhury va es giam TC thffdng gap d nam hdn la nff d dp tuoi 10 nam dau tien [6]. Trong nghien cffu ciia chung tdi 400 BN giam tieu eau 8.6 % giam ddng. Nghien cffu ciia Jha etal. (2008) [l],Bashawri va cs. (2002), va Pudasaini va cs. (2002) [7] ty le xet nghiem tiiy de danh gia giam ddng lan Iffdt la 17.34%, 11.9% and 50%. ITP la phd bi§n nhat thay d 89 BN (22,25%). Cac nghien effu khae eae ty le lan Iffdt la 6.21%, 14.5%, 6,8% va 5% kibria va es 2010 [2]; Ahmad va cs 2011; Pudasaini va cs 2002;Knodke va es 2001) [3], [7]. Nguyen nhan phd' bien thff gay giam tieu eau la giam san tiiy (85/400 BN chiem 21,75%) sau dd la bach eau tiiy cap (53 BN, 13,25%). Trong 53 trffdng hdp AML, the phd bien la AML-M2 (22 BN), sau la AML-Ml (8 BN) va AML-M4 (7 BN). Tffdng tff nhff nghien cffu cua chiing tdi thi bach cau cap cung la nguyen nhan phd bien thff gay giam tieu cau nghien cffu ciia Savage va cs (1999) va tffdng tff nhff nghien cffu ciia Varma va Dash (1992). Cac nghien cffu khac (Egesie va cs 2009; Gayathri va cs 2011; Jha va cs 2008; Kibria va cs 2010) eung thay baeh cau cap la benh mau ac tinh phd bien nhat va bach cau cap ddng bien hdn ddng lympho. Thieu mau hong cau khdng Id thay d 37 trffdng hdp (9,25%). Nghien cffu ciia chung toi thay bach cau cap la nguyen nhan thff 3. Niazi va cs (2004),Jha va cs (2008) Gayathri va cs (2011) thay thieu mau hong cau khdng Id la nguyen nhan phd bien thff cdn d nghien cffu ciia ehung tdi la giam san tuy. So sanh vdi nghien cffu eiia ehiing tdi thi thieu mau giam san tiiy gap lan Iffdt d 19%, 29% and 14% cac nghien cffu (Gayathri va cs 2011;Knodke va es 2001; Niazi va cs 2004). Chiing tdi cung gap tang sinh ac tinh piasmocyte nhffng vdi ty le thap (3,25 %) va rdi loan sinh tiiy (4,75%). Cac nghien effu khac nhff cua Kibria va cs 2010; Laishram va cs 2008) thay t/ Ie da u tiiy xffdng tff 0.94% tdi 4.1% va rdi loan sinh tiiy tff 2% to 7.9%. Ve so Iffdng va hinh thai mau tieu cau thi tang sd Iffdng va dang non dffdc thay hau het cae trffdng hdp FTP. George va cs (1994) va Levine va es (1999) cung cho ket qua tffdng tff. V. KET LUAN Ciing vdi cac trieu chiffig lam sang thi xet nghiem tiiy la mdt bffdc quan trpng de chan doan xac djnh cac benh ly huyet hpc cd giam tieu cau. Xuat huyet giam tieu cau vd can la nguyen nhan bien nhat gay giam tieu cau nghien cffu ciia chung tdi. 57,25% BN sd Iffdng mau tieu cau tiiy binh thffdng ho3c giam nhffng hinh thai van binh thffdng. Trong sd 97 BN tang sd Iffdng mau tieu cau vdi hinh thai dang non thi hau het la cac trffdng hdp ITP. Hinh thai rdi loan dffde thay tat ea cac trffdng hdp roi loan sinh tiiy. Y HOC VlfT NAM THANG - SO 2/2014 TAI LIfU T H A M KHAO 1. Jha, A., Sayami, G., Adhikari, R. C , Panta, D., Jha, R. (2008). Bone marrow examination in cases of pancytopenia. Nepal Med Assoc, 47, 12-17. 2. Kibria, S. G., Islam, M. D. U. (2010). Prevalence of Hematological Disorder: A Bone MantJW Study of 177 Cases In a Private Hospital at Fandpur. Farldpur Med. Coll J, S, 11-13. 3. Knodke, K., Marwah, S (2001). Bone marrow examination in cases of pancytopenia. J Academy QinMed,!, 55-59. 4. Levine, F. C. (1999). "Idiopathic" thrombocytopenia. Arch Intern Med, 88, 701-728. I 13. Levine, S. P. (2003). Thrombocytopenia: pathophysiology and classification. In Greer 3P, Foerster J, Lukens JN, et al. (Eds.), Wintrobe's clinical hematology 11th ed. (vol. 2, pp. 15301532). Philadelphia: Lippincott Williams & Wilkins. MeKenzie S. B. (Ed.), (1996). Textbook of hematology, 2nd ed. Painsylvania: Willaims& Wilkins. Muhury, M., Mathai, A. M (2009). Megakaryocytic alterations in thrombocytopenia: A bone marrow aspirabon study. Indian J PatholMlcrobioi, 52, 490^94. Pudasaini, S., Prasad, K. B. R (2002). Interpretation of bone marrow aspirabon in hematological disorder. Journal of Pathology of Nepal, 2, 309-312. THirC TRANG AN TOAN VE SINH THITC PHAM TAI BEP AN TAP THE COA M O T "SO DOANH N G H I E P - T H A N H PHO HAI DiraNG NAM Dinh Huy Hung*, Vu Due Long** TbM TAT Nghien ciiff thUe trang An toan ve sinh thiTc pham t?i cic bep 3n tap the (BATT) ciia doanh nghiep tren dja ban phd Hai DUdng , ket qua cho thay : Dien tich phong che bien < lOOm^ chiem ty le nhieu nhat (50%); di?n ti'ch phong an 200-500m^ chiem t/ le nhiSu nhat (45%); Cdn ed 44% BATT chUa dat yeu cau ve thii tuc hanh chinh; 17,5% khdng dat yeu cau ve CO sd tang; 20% BATT ngudi phuc vu (NPV) khdng mang day dii bao hp lao dpng lam viec; 20% NPV khong sff dung dung cy sach che bien; Tren cac mau xet nghiem deu thay co ty le nhiem vi sinh vat (VSV): tren thi/c pham chin, dung cu chira (Jyhp thu'c pham chin, ban tay NPV, Trong ty le nhiem VSV tren ban tay NPV la cao nhat: Coliform (72,5%); E.coli (25,0%); S.aureus(32,0%). SUMMARY SAFETY S I T U A H O N I N FOOD HYGIENE AT CANTEENS OF SEVERAL BUSINESSES H A I DUONG CITY I N Research the current status of food safety and hygiene in the canteens of businesses in Hai Duong city, the results show that processing room area < lOOm^ acmunting for largest proportion (50%), dining room area of 200 - 500 m^ accounting for the largest preiportion (45%); there are 44% of the canteens is ' SdYte tinh Hal DuVng " TnAlmg Cao dSng Y teHai Phdng Phin b/^n khoa hgc: GS.TSKH Nguyen VSn Hien unsatisfactorily on administrative procedures; 17.5% is unsatisfactorily on infrastructure, 20% waiters not carry adequate labor protection at work; 20% waiters not use clean utensils when processing; In the specimens founded microorganism ratio on cooked food, containers of cooked food , hands of waiters. In which the infection rates on the waiters' hands is the highest; Coliform (72.5%), E, coli (25,0%), S, aureus (32,0%), I. OAT VAN OE An toan ve sinh thffc pham(ATVSTP) hien dang la mdi quan tam Idn ciia nhieu Qudc gia tren the gidi, Tren the gidi ffdc tfnh, hang nam cd khoang - ty ngu'di bj tieu ehay, ed 3-5 trieu ngLfdi tff vong, khoang 1.400 trieu Iffpt tre em/nam bi mac benh tieu chay ,trong sd dd 70 % nguyen nhan an, udng thi/e pham bj d nhiem [5],[6]. Tai Viet Nam, sd trffdng hdp ngd ddc thffc pham cd xu hffdng cang gia t a n g [ l ] , Theo thdng ke chffa day du ciia cue ATVSTP cac nam 2007-2011, toan qudc da ghi nhan 927 vu NOTP vdi 30.733 ngu'di mac va 299 ngffdi chet. Trung binh cd 185 vu/nam, dd sd vu ngd ddc tai bep an tap the chiem tff 12,7 den 20,6% tong sd vu moi nam, Tuy nhien day chi la sd iieu thdng ke chu'a day du ,thffc te sd ngd dpc thffe pham hang nam cdn eao hdn rat nhieu[2]. Theo ffdc tinh eiia WHO, d Viet Nam sd ngd dpc thffe pham hang nam khoang tren trieu ngffdi [5]. Hai Dffdng la mdt . vdi cac djch vy ddn tiep benh nhan, thai dp bac sy lam viec, thai dp nhan vien tff van cung nhff hai Idng vdi thai dp eiia cae nhan vien cdng tac tai cd sd dieu trj Methadone. TAILlgUTHAM . tieu can binh thffdng (mdt mau tieu cau / 1 den 3 vi trffdng), tang (hdn hai mau tieu cau / 1 vi trffdng), giam (mpt mau tieu cau / 5 den 10 vi trffdng), Thay doi hinh thai ciia mau tieu. l&dt la 23, % va 26,5%. y HOC VIET NAM THANG 2 • SO 2/2014 Bang 2: Xet nqhiem mau nqoai vi cua cac BN nqhien cu'u Cac chi so mau ngoai vi Hb rq/il Tonq so iu'dnq