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Y HOC VIET NAM THANG • SO 2/2014 - Da xac dinh dac tfnh sinh hoc, ddc hpc ciia npc eac loai ran dpc thffdng xuyen gay nan cho ngffdi tai Viet Nam, Lao va Campuchia, vdi lieu chet {LD50 yg/g/TM/)/ chudt ciia npc ran ho dat (0,4), npc ho chiia (1,2), npc cap nong (1,4), npc cap nia Nam (0,1), npc luc xanh mdi trang (0,5) va npc Choam quap (6,1). Day la cd sd khoa hpc can ban gdp phan giai quyet van de y khoa tdn tai, dong thdi md chi/dng trinh ve nghien cffu che tao thudc mdi t y npc ran Viet Nam. TAI LIEU T H A M KHAO 1. Tr^an Kien, Nguyin Quoc Th^ng., 1995. Cac loai ran doc Viet Nam. Nha xuat ban KHKT,7-198. 2. Au.L.C, Huang, Y.B., Huang, T.F., 1991. A common precursor for a putative hemorrhagic protein and rhodostomin, a platelet aggregation inhibitor of the venom of Calloselasma rhodostoma: Molecular cloning and sequence analysis. Biochem. Biophys. Researdi Communications, 181-585. John Coborn., 1991. The Atlas of snakes of the World. Distributed in the United States by T.F.H. Publications, Inc. 1-590. Smith Sonian; A field guide to the snakes of south Vietnam, United States National Museum City of Washington, 1970. Tan, N.H and Fung, SY., 2002. A hemorrhagic toxin from the venom of Tn'meresunis purpureomaculatus snake. European Journal of Biochemistry 269, 99. Warrell, D.A., Looareesuwan, S., Theakston, R.D.G.,1983. Severe neurotoxic envenoming by the Malayan krait Bungarus candidus. response to antivenom and anticholinesterase. British Medical Journal 286:678-680. WHO Guidelines for the production, control, and regulation of antivenom immunoglobulins. 2008, 30-210. NGHIEN CU'U KET QUA TUY DO Of CAC BENH NHAN THIEU MAU Nguyen Thi Minh Phuo'ng*, Tru-ong Thi Thao Hien* TOM TAT Thieu mau la roi loan huyet hpc gap kha thffdng xuyen d tat ca mgi Iffa liuoi. Tuy dong mot vai tro quan trpng chan doan cac nguyen nhan thieu mau. Muc tieu nghien cu'u: danh gia mffc do, phan loai thieu mau va cac roi loan huyet hpc gay thieu mau qua xet nghiem mau ngoai vi va tiiy do. Doi tffdng va phu'dng phap nghien cu'u: nghien cffu hoi cffu ket hdp tien ciTu tren 506 benh nhan (BN) thieu mau dieu tn tai Benh vien TL/QD 108 tff 1/2008 den 12/2013. Kham lam sang va dUOc lam cho tat ca cac BN. Ket qua: thieu mau mffc nhe 42,1%, trung binh 45,6% va n§ng 11,3%. Thieu mau dang sac hong cau (HC) binh thu'dng chiem 59,3%; nhi/pc sac HC nho 34,6% va Uu sac HC to 6,1%. Trong 506 BN thieu mau dUcfc lam tiiy tang smh dong piasmocyte chtem 16,6%. tang smh dong HC chiem 15,2%; giam san dong HC 13,1%. Bach cau cap gap d 16 BN (3,1%) 11 BN bach cau cap va BN bach cau lympho cap. 43,3% thieu mau nhUng tiiy hoan toan binh thi/dng. Ket luan: Tiiy dd la bUdc quan trpng de chan doan nhieu rdi loan huyet hgc gay thieu mau. Tu'khda:Tt\\^u mau, dd SUMMARY STUDY ON BONE MARROW ASPIRATION I N A N E M I C PATIENTS Anemia is hematological disorders that are quite frequent in all age group. Bone Marrow Aspiration plays a major role in the diagnosis of its underlying cause. Objective: To evaluate the grade, classification and the causes of anemia through interpret the blood counts and bone marrow aspiration findings. Materials and Methods: This was a retrospective and prospective study carried out at 108 military central hospital from 1/2008 to 12/2013 on 506 anemic patent, Bone marrow aspiration of all patients was carried out. Results: mild anemia 42,1%, moderate anemia 46,6% and severe anemia 11,3%. Normochromic normocytic anemia 59,3%, microcytc hypochromic 34,6% and Macrocytic hyperchromic 6,1%. Out of 506 anemic patients was performed bone marrow aspiration, plasmocytic hyperplasia was sew m 16,6%, erythroid hyperplasia was seen in 15,2%). erythroid hypoplasia was seen in 13,1%. Acute * Khoa Huyet hoc lam sang Benh vien TWQD 108 Phan bien khoa hgc: PGS.TS VQ Van KhiSn Y HQC VlgT NAM THANG - SO 2/2014 leukemia was diagnosed in 16 patients (3,1%) 11 cases acute myeloid and acute lymphoid leukemia. 43,3% anemic patients with nornial bone marrow aspiration. Conclusion: Bone marrow aspiration is an important step to arnve at the confirmatory diagnosis of many hematological disorders causing anemia. Keywords: Anemia;Bone marrow aspiration \. DAT V A N OE Thieu mau la hien tffdng giam so Iffdng hong a u , hoac nong dp huyet sac to mau ngoai vi. Day la mpt rdi loan huyet hpc bien cd the gcip d mpi Iffa tudi va d mpi qudc gia tren toan the gidi, dac biet d cac nffdc dang phat trien nhff Vi?t Nam. Tuy nhien cd sff khac biet ddi chiit ve nguyen nhan gay thieu mau giffa cac nffdc dang phat trien va phat trien [3].De chan doan nguyen nhan thieu mau trffdc tien can kham lam sang va lam cac xet can thiet. Tuy nhien hau het cac trffdng hdp chi cd xet nghiem xffdng mdi khSng djnh 6\Jdc chan doan. Dac biet trffdng hdp thieu mau kem theo giam cac ddng te bao mau va benh bach cau cap thi cd vai trd khang dinh chan doan [3]. Tiiy cho biet rd hdn phan ffng ve sff sinh san hong cau ciia cd quan tao mau tinh trang thieu mau ma xet nghiem mau ngoai vi ddn thuan khdng the biet dffdc ddng thdi cung phat hien dffdc cac te bao la [3]. Tuy dffpc lam thffdng quy bpnh vien de chan doan va theo ddi dieu trj cac roi loan huyet hpc [ ] , [ ] . Day la xet nghiem xam lan nhffng kha an toan, rat ft hoac khdng cd nguy cd chay mau tham chf ca trffdng hdp cd giam tieu cSu nang [ ] . Nghien cffu dffdc thffc hien vdi muc dfch danh gia mffc dp thieu mau, phan loai thieu mau va dm nguyen nhan ciia cac rdi loan huyet hpc gay thieu mau d 506 BN qua xet nghiem mau ngoai vi va tiiy dd. II. DOI Tif ONG VA PHU'ONG PHAP NGHIEN CLTU . . Ooi tu'dng n g h i e n c f f u ; 506 BN thieu mau chu'a rd nguyen nhan qua kham lam sang va xet nghiem mau ngoai vi sau da loai trff nguyen nhan xuat huyet cac phii tang dieu trj tai Benh vien TL/QO 108 tff 1/2008 den 12/2013 cd chi dinh lam do. Tuy lam tai khoa Hda nghiem Benh vien TIjQO 108. - Tieu chuan chan doan thieu mau; HC dffdi 3,8 T/l; HST d nam < 130g/l; d nff < 120g/l; - Mffc dp thieu mau: Nhe: 90 g/l < HST< binh thffdng; trung binh: 70 60 tudi. Trong dd nghien cyu ciia Pudasaini tren 57 BN thieu mau d Nepal thay hau het t y 31-45 tudi.Ty le nam; nff 1,2: ciia Pudasaini nam; nff 1; 1,1. Oa sd BN thieu mau mffc dp nhe (42,1%) va trung binh (46,6%). Chi 11,3% cd thieu mau mffc dp nang. Loai thieu mau dang sac hdng cau binh thffdng chiem hdn mdt nffa so BN (59,3%) va thieu mau ffu sac HC to , % . Ty le thap hdn nghien cffu ciia Pudasaini lan Iffdt la 80,7% va 12,3%. Tffdng tff nhff nghien cffu ciia Pudasaini, Jha va cs ddi vdi cac BN cd thieu mau ffu she hong cau to chimg tdi khdng dinh Iffdng dffdc axit folic va vitamin B12 [ ] . Ty le thieu mau ffu sac HC to ciia Pudasaini cao hdn kha nSng ty le thieu hut dinh dffSng cao hdn cac doi tffdng nghien cffu. Ty le thieu mau nhffdc sSc HC nhd 34,6% cao hdn cua Pudasaini ia 7% va tffdng t y nhff cua Ahmad va cs 23.8% da sd liin quan tdi thieu mau thieu sat [1]. Chi djnh chpc tiiy dd phd bien nhat nghien culi la thieu mau nhieu benh canh khac 202/506 BN chiem 48 % sau 6a loai ffff nguyen nhan mat mau xuat huyet cac phii tang thieu mau chffa ro nguyen nhan chiem hdn mdt r\ifa, AsimMomani va cs d Jordan nghien cffu tren 200 BN thieu mau thay chi djnh bien lam tiiy la thieu mau chu^ rd nguyen nhan chiem tdi % [2]. Benh mau ac tfnh la chf dinh phd bien thff hai chiem 26.5% dd nghi ngd benh da u tiiy xffdng 14,8%. Nghien cifu ciia AsimMomani benh mau ac tinh cung la chi djnh phd bien thff vdi t^ le gan % [2]. Cac ket qua tiiy chii yeu ciia nghien cffu: thieu mau khdng phai benh mau vdi tiiy hoan toan binh thffdng chiem tdi 43,3% va tang sinh lanh tinh ddng HC dap ffng vdi thieu mau ngo^l vi chiem 15,2%. Tang sinh ddng piasmocyte benh canh da u xffdng chigm 16,6% vdi ty le piasmocyte chiem tff 16% den 77% so Iffdng te bao cd nhan tiiy kem bien doi hinh thai. Cac nghien ciili khac thay ty le tang piasmocyte benh canh da u xffdng dao dpng tff 9,04% (Jha va cs den 20,5% (Laishram va cs) [ ] , [ ] . AsimMomani va cs bao cao ty le binh thu'dng d cac BN cd thieu mau cac benh ly man tfnh thap hdn nghien cffu ciia chung tdi (18%) [2]. Tang sinh ddng HC dap ffng vdi thieu mau ngoai vi chiem 15,2%. Trong nhffng trffdng hdp tiiy dd chi tang sinh ddng HC ngoai khdng thay cac bat thu'dng nao khac. Ty le nghien ciru tu'dng t y nhu' ciia Khodke va cs la 14% [5] va thap hdn ciia Pudasaini va Jha lan Iffdt la % va 19,6% [4], Bach cau cap gap d 16 BN (3,1%) thap hdn nghien cffu cua Pudasaini la 12,3%. sd dd 11 BN bach cau tiiy cap va BN bach cau lympho cap. Trong 11 BN bach cau tiiy cap cd BN AML-M2; BN AML-Ml; BN AMLM4 , AML-M3; AML-M5 va ML-M6. Tat ca BN bach cau lympho cap deu la ALL-L2. Cac nghien cyu khac cung thay benh bach cau cap thi bach cau tiiy cap chiem ty le cao hdn bach cau lympho cap [3], [4]. Trong tat ca 66 BN (13,1%) thieu mau tiiy giam san ddng HC thi sd Iffdng te bao deu giam va hau het cd ffc che ddng. Ket qua tffdng t y nhff cac nghien cffu khac la 19%, 29%, 14% [4], [5]. Pudasaini va cs phat hien thieu mau giam san ddng HC chi d 5,3%. Ca nghien cffu ciia chiing tdi va cua Pudasaini chan doan giam san chii yeu dya tren tiiy ma chffa cd dieu kien lam dffdc smh thiet tuy. Cac khuyen cao ciia cac Hdi Huyet hpc truyen mau Hoa ky va chau au thi trffdng hdp nghi ngd thieu mau giam san tiiy hoac suy tiiy can phai lam ddng thdi ca tiiy dd va sinh thiet tiiy vi tiiy dd chi cho thdng tin ve hinh thai te bao cdn sinh thiet tiiy cdn cho biet chi tiet hdn ve mat dp te bao tiiy xffdng va cac bat thffdng khac nhff tham nhiem tiiy xffdng, xd tiiy , ma tiiy khdng the phat hien dffdc [4]. Thieu mau benh canh sdt keo dai d 12 BN (2,4%) vdi tang smh ddng BC hat va sd Iffdng te bao tiiy binh thffdng hoac tang nhe thap hdn ciia Pudasaini (12,3%). Trong nghien ciru tac gia cdn phat hien 12,3% cd 1,8% benh Leishmaniasis. V. KET LUAN Qua nghien cffu tren 506 BN thieu mau tai Benh vien TTjQD 108 chung tdi riit mpt sd ket luan sau: thieu mau myc dd nhe (42,1%) va Y HOC VIET NAM THANG - SO 2/2014 trung binh (46,6%). Loai thieu mau dang sac hong cau binh thffdng chiem 59,3%. 62.5% thieu mau khdng cac benh ly tiiy xffdng vdi tiiy dd binh thffdng hoac tang sinh lanh tfnh dong HC. Benh mau ac tinh la nguyen nhan gay thieu mau chiem , % . Tiiy dd la bffdc quan de chan doan nhieu rdi loan huyet hoc gay thieu mau. TAI UEU T H A M KHAO 1. Ahmad SQ, Khan OU, Zafar N. Utility of Bone Marrow Examination in a Secondary Care Hospital JRMC 2011;15:40-1. 2. AsimMomani, RameKhasawneh (2012). Spectrum of Bone Man-ow aspirabon test resultsat Prince Rashid Hospital/Jordan. A Year Experienceint J Biol Med Res. 2012; 3(2): 1648-1650 Egesie OJ, Joseph DE, Egesie UG, Ewuga 03. Epidemiology of anemia necessitating bone marrow aspiration cytology in Jos. Niger Med J. 2009;50:61-1. Jha A, Sayami G, Adhikari RC, Panta D, Jha R. Bone marrow examination In cases of pancytopenia, J Nepal Med Assoc 2008;47:12-7. Khodke K, Marwah S, Buxi G, Yadav RB, Chaturvedi NK. Bone Marrow Examination in Cases of Pancytopenia. JIACM 2001;2;55-9. Laishram S, Shimray R, Sharma AB, Pukhrambam G, Singh AM, Sharma LDC Neoplastic lesions in the bone marrow: a 10 year study in a teaching hospital. JIACM 2008;9;175-8. Pudasaini, Prasad KBR (2012). Interpretation of bone marrow aspiration in hematological disorder Journal of Pathology of Nepal (2012) Vol. 2, 309 -312 MO TA HANH VI NGUY C a NHIEM HIV VA XAC DINH TY LE NHIEM HIV C O A N H O M NGHIEN CHICH MA TUY THAM GIA CHU'ffNG TRINH DUNG THUOC THAY THE METHADONE TAI T H A N H PHO HA NOI Bui Thi Nga*, Nguyen Anh Quang*, Nguyen Thanh Long** T6M TAT Nghien ciTu mo ta cat ngang dffpc thffc hien tren 400 ngi/di nghien chfch ma tai 02 co sd dieu trj Methadone tai phd Ha Npi. Ket qua nghien cyu cho thay: Ngffdi nghien chfch ma dang doi mat vdi cac hanh vi nguy cd lay nhiem HIV nhi/ tud'i bat d'au tiem chich ma tuy, sff dung chung bdm kim tiem hem chfch ma va khdng sy dyng bao cao su cho tat ca cac lan quan he tinh dye. Day chfnh la cac hanh vi nguy cd can dupe can thiep nhSm lam giam ty le lay nhiem HIV nhdm ngffdi nghien chich ma tuy. SUMMARY EVALUTION ON I N J E C H O N DRUGS USERS ( I D U S ) I N TWO METHADONE TREATMENT CENTERS I N H A N O I CITY The cross - sectional descnptive study was done on 400 injecction drug users in 02 methadone treatment centers in Hanoi city. The study results showed that; injection drug users who are facing risks behavior for HIV injection such as mibabon of injection daig use, sharing needles used to inject drugs and not using condoms for all sex times. This is the risk behavior interventions should be aimed at reducing the prevalence of HIV infection among drug injectors. Tit khoa: HIV/AIDS, Nghien chich ma tuy, Hanli VI nguy cd. Ha Npi I. O J ^ T V A N D E Theo bao cao cua Bp Y te tinh den 30/6/2013 so cac trffdng hdp nhiem HIV sdng la 213.413 ngffdi, cd 63.373 ngufli bi AIDS va 65.133 ngffdi tff vong AIDS [1). Cac dffdng lay truyen HIV chii yeu d Vi|t Nam la diing chung bdm kim tiem (BKT) tiem chich ma (TCMT) va hanh vi hoat dpng tinh due khdng an toan. Khdng chi co hanh vi tiem chich va tinh due khdng an toan la cd nguy lay nhiem HIV ma tinh trang nguy cd cua ban tinh hoac ban chich cung cd vai trd dff bao nguy aJ * Trung tam phdng chdng HIV/AIDS Ha Ngi **BdYti Phan bign khoa hgc:lS. Nguyen Quoc Trffdng