Đặc điểm lâm sàng, cận lâm sàng và các yếu tố liên quan với chảy máu tiêu hóa ở bệnh nhi sốt xuất huyết dengue tt tiếng anh

MINISTRY OF EDUCATION AND TRAINING MINISTRY OF DEFENSE VIETNAM MILITARY MEDICAL UNIVERSITY LE MINH DUNG CLINICAL, SUBCLINICAL CHARACTERISTICS AND FACTORS ASSOCIATED WITH GASTROINTESTINAL BLEEDING IN DENGUE PEDIATRIC PATIENTS Major: No: Internal medicine 72 01 07 SUMMARY OF DOCTORAL DISSERTATION HA NOI-2020 THE RESEARCH WAS COMPLETED AT MILITARY MEDICAL UNIVERSITY Instructor: Nguyen Duy Thang, Ph.D., Associate Professor Nguyen Quang Duat, Ph.D., Associate Professor Reviewer 1: Dao Van Long, Ph.D., Professor Reviewer 2: Nguyen Van Kinh, Ph.D., Professor Reviewer 3: Vu Van Khien, Ph.D., Associate Professor The dissertation was protected at the school-level council At …… , ……… 2020 The dissertation can be found in: 3 Vietnam National Library Military Medical University Library INTRODUCTION Dengue hemorrhagic fever is a tropical infectious disease that often leads to a pandemic due to the absence of vaccines and unable to control the transmission vectors According to the World Health Organization (WHO), about 2.5 billion people are at risk of dengue virus infection worldwide Among that, approximately 390 million cases of dengue infection per year It is estimated that the majority of the subjects (about 95%) are children under 15 years old In particular, in Vietnam, Dengue hemorrhagic fever is the main cause of death among the most common infectious diseases The clinical and subclinical characteristics of Dengue hemorrhagic fever in children are diverse causing difficulties in diagnosing Bleeding in general and gastrointestinal bleeding, in particular, are common symptoms in Dengue patients who have warning signs and shock Children with severe or prolonged shock usually have severe bleeding To improve the effectiveness of early detection, giving prognosis and intervention for Dengue-infectied pediatric patients, we conducted the study with the following aims: To assess clinical and subclinical characteristics of Dengue pediatric patients with gastrointestinal bleeding in Nhi Dong Hospital from 12/2014 to 12/2015 To evaluate the relationship between gastrointestinal bleeding and clinical, subclinical characteristics and virus type of Dengue pediatric patients at Nhi Dong Hospital from 12/2014 to 12/2015 New contributions to the dissertation: This is the first study in Vietnam to conduct with complete, systematic, detailed information about gastrointestinal (GI) bleeding in Dengue pediatric patients The study has shown some clinical, subclinical characteristics of gastrointestinal bleeding in Dengue pediatric patients In which the main symptoms are abdominal pain (78%) and fatigue (74.6%) In addition, the most common symptoms are vomiting blood (hematemesis) (93.2%) and blood in the stomach sonde (86.4%) and abdominal pain (78%) The common subclinical symptoms are PT rate < 60% ( 81.3%) and APTT time > 60 seconds (81.4%) The study identified some factors associated with GI bleeding in Dengue pediatric patients There are related symptoms: abdominal pain, lethargy, fatigue In addition, physical symptoms that were related to GI bleeding on univariate analysis are vomiting, bloating, neurological disorders, edema, and nasal bleeding There were subclinical symptoms: PT rate < 60% and APTT time > 60 seconds, more common and statistically significant differences between GI bleeding and GI nonbleeding group (p 60 seconds 48 81,4 Table 3.9 shows: 72.8% of children with GI bleeding have increased erythrocyte upon admission In the group of pediatric patients with bleeding GI bleeding 65.5%, the number of white blood cells decreased 91.5% of subjects had GI bleeding with thrombocytopenia At the time of the lowest platelet count, 100% of the patients in the GI bleeding group had values lower than normal 32.2% of pediatric patients with hematocrit bleeding decreased 81.3% of pediatric patients with GI bleeding had a PT rate < 60% 81.4% of pediatric patients with GI bleeding had APTT > 60 seconds 3.2 Relationship between gastrointestinal bleeding with clinical, subclinical and viral symptoms in Dengue dengue patients 3.2.1 Clinical, subclinical characteristics and virus identification results of research subjects Table 3.22 Distribution of dengue virus type due to gastrointestinal bleeding GI non- GI bleeding Total (n=59) (n=119) n (%) n (%) n (%) Type 40 (66,7%) 13 (22,0%) Type (15,0%) 39 (66,1%) Type (1,7%) (3,4%) Assay 18 bleeding (n=60) p 53 < (44,5%) 0,01 48 (40,4%) (2,5%) 19 Type 10 (16,7%) 15 (8,5%) (12,6%) Table 3.22 shows that: in the group of children with GI bleeding, the highest is type 2, accounting for 66.1%; while in the group without major GI bleeding, type account for 66.7% The difference is significant with p