THE NECESSITY OF EVALUATING THE EFFICIENCY OF HEALTH SUPPLEMENTS
Evaluating the efficacy and safety of health supplements (including dietary supplements, health-protecting foods, supplementary for subjects with special nutritional regimens, etc.) in Vietnam currently becomes more necessary, especially in the period when there are many health supplements with announced uses that are amplified and exceed their real effects, which can mislead users and cause disrepute for the company. An existing problem is that the majority of dietary supplements lack evidence, and research results demonstrating efficacy and clinical benefit. The announcement of the use of dietary supplements today is almost exclusively based on the announced uses of the ingredients in the product, but there is no research to evaluate specific efficacy. That is the weakness of Vietnam’s health supplements industry when competing with other countries in the world, especially developed countries, which have had many experiences in research, production, and use of health supplements such as the USA and Japan… In the context of socio-economic development, people’s knowledge, as well as the demand for health care, are increasing. Before deciding to buy and use health supplements, consumers will ask many questions. The most important is “how effective is the product, is there any research confirming its benefit?”. Therefore, setting up clinical trials for health supplements is essential. Currently, Vietnam is in the stage of building and establishing a network of clinical trials of pharmaceuticals and health supplements, creating a legal corridor for people to have access to new effective, and safe products. In Article 4, Circular 43/2014/TT-BYT Guiding the Management of Functional Foods, the Ministry of Health (MOH) emphasized testing the effectiveness of functional foods for human health: “Products that must be tested for their effects on human health include: a) Products that are announced to have the effect of supporting the treatment of diseases; b) Products that are announced to have new indications which have not been recognized in other countries in the world; c) Products containing new active ingredients that have not yet been approved for use; d) Health protection products with formulas different from those already proven by scientific evidence, which is put on the market for the first time; e) Products originated herbal or animal that is put on the market for the first time and have different compositions from those of the published traditional medicine products in scientific journals; f) Medical nutrition food and food for special dietary, which have not been approved by the competent authority or by the law of the country of origin, certified by the exporting country, the indication and dosing & uses are allowed to be stated on the goods label.” The clinical trials will provide accurate scientific evidence, ensuring the legal element so that a health supplement product can maximize its effects on human health in preventing recurrence/relapse, development of non-infective chronic diseases, and effectively supporting disease treatment, recovery, and health promotion.
25% of Vietnamese adults have high blood pressure
25% of Vietnamese adults have high blood pressure, which is one in four adults, but few people measure it regularly, according to statistics from the National Heart Institute (NHI). “Patients who need to go to the ICU due to cardiovascular disease confess that they have never measured their blood pressure,” Professor Nguyen Lan Viet, Vice President of the Vietnam Heart Association said at the press conference on the 18th Congress of Cardiology on October 5th. He said high blood pressure quadrupled the risk of dying from stroke and tripled the risk of dying from cardiovascular disease, compared with people without the disease. Mr. Viet recommends that to diagnose the disease, the simplest way is to measure blood pressure regularly and actively to control it. At the same time, people should examine their health every 6 months to detect body abnormalities early and promptly treat them. Vietnam’s disease pattern has changed a lot. Non-communicable diseases tend to increase, while infectious diseases decrease. Which, 4 main diseases are increasing and leading causes of death including cardiovascular disease, diabetes, cancer, and mental disorders. In Vietnam, in 1970 about 2% of adults had hypertension. To date, epidemiological research by the NHI shows that 25% of adults have hypertension, in some places this rate is up to 40%. High blood pressure is very common, but many people are apathetic, subjective, uninterested, uncontrolled, and treated unfollowing doctors’ guidance. Meanwhile, this is a silent disease with many potential complications, especially cardiovascular disease, according to doctors. Associate Professor Nguyen Manh Hung, Director of the Vietnam Heart Institute, said that people do not really care about their blood pressure, especially do not have the habit of periodic health checks. Of those with high blood pressure, half don’t know they have this disease. Once the disease is diagnosed, one-third of them do not receive treatment. “Among those treated, 64% did not achieve the targeted blood pressure of less than 140/90 mmHg,” said Mr. Hung, adding that hypertension leads to serious complications such as stroke, heart failure, vision impairment, blindness, kidney failure… The causes of high blood pressure are closely related to nutrition diet and lifestyle. People eat more comfortably, and obesity rates increase. Smoking, tobacco, drinking alcohol… are the causes leading to high blood pressure, dyslipidemia, diabetes, and atherosclerosis. Besides, the pressure of modern lifestyles makes people stressed and cause diseases. Experts estimate that the number of people diagnosed with high blood pressure is still lower than reality, the number of people receiving treatment is quite low, and the number of patients receiving proper treatment is not much. The burden of morbidity and mortality due to hypertension has become an urgent problem today, requiring early diagnosis and timely, adequate treatment. The principles of hypertension treatment are lifestyle adjustments such as reducing obesity, reducing salt, limiting foods high in cholesterol, saturated fatty acids, reducing alcohol, and quitting smoking. Increase physical activity at an appropriate level, and avoid nervous tension. In addition, the patient needs to choose the right antihypertensive drug, prescribed by the doctor; blood pressure should be lowered slowly, avoiding decreasing too quickly; treatment should be continuous and long-term.
Urgent dispatch of the Vietnam Ministry of Health about strengthening the prevention of monkeypox disease
On October 3rd, 2022, the Ministry of Health (MOH) sent an urgent official dispatch No. 5470/BYT-DP to the Committee of provinces and cities on strengthening the prevention of monkeypox disease. Accordingly, the MOH considered that since May 2022, the monkeypox epidemic has increased continuously in both the number of cases and the number of countries/territories recording cases. On July 23, 2022, the World Health Organization (WHO) declared this disease an international public health emergency. By September 26, 2022, there were 64,561 cases of monkeypox in 105 countries around the world. In particular, the Western Pacific has several countries recording cases, including: Australia (132), Singapore (19), China (5), New Zealand (5), Japan (4), Philippines (4). ), Korea (2), Guam (1), New Caledonia (1). Before the complication of the monkeypox epidemic in the world and in some Southeast Asian countries, including Vietnam; in order to proactively monitor, detect disease cases early, and control the epidemic in time to prevent an outbreak of monkeypox disease, and minimize the number of cases and deaths, the MOH proposed to the Committee of provinces and cities in directing the immediate implementation of the following activities: Directing departments, agencies, organizations and units within the area to strictly implement the direction of the Government and the Official Dispatch No. 680/CD-TTg dated August 1, 2022 of the Prime Minister on strengthening the prevention of monkeypox and the guidelines of the MOH: monitoring, diagnosis, treatment and prevention of monkeypox in humans; prevention of monkeypox infection in monkeypox medical examination and treatment establishments. Getting ready for local epidemic prevention and control: – To step up the strict implementation of disease surveillance at border gates, supervision at medical treatment facilities and event-based surveillance in the community for early detection and timely prevention of epidemics. – Organize training for health staff at all levels; – Ensure the collection, classification, and treatment of patients at medical examination and treatment facilities and infection prevention at testing and medical facilities; – Review and update response plans, scenarios, and drills according to specific situations to be ready to respond in the event of an epidemic; – Be available with drugs, equipment, human resource, and funds. When a case is recorded: – Urgently carry out a thorough investigation of all exposures to the case of Monkey Smallpox to identify the source of infection; timely manage and handle the outbreak to prevent the epidemic from spreading to the community. – Organize quarantine, treatment of positive cases, avoid death, pay attention to cross-infection for medical staff during care and treatment process. Promote communication in various methods to the communities about disease prevention measures at border gates and about monkeypox epidemic as recommended by the MOH. Strictly implement informing and reporting work follow regulations. Source: Vietnam Ministry of Health
Monkeypox
Overview Monkeypox virus is an orthopoxvirus that causes a disease with symptoms similar, but less severe, to smallpox. While smallpox was eradicated in 1980, monkeypox continues to occur in countries of central and west Africa. Two distinct clade are identified: the west African clade and the Congo Basin clade, also known as the central African clade. Monkeypox is a zoonosis: a disease that is transmitted from animals to humans. Cases are often found close to tropical rainforests where there are animals that carry the virus. Evidence of monkeypox virus infection has been found in animals including squirrels, Gambian pouched rats, dormice, different species of monkeys and others. Human-to-human transmission is limited, with the longest documented chain of transmission being 6 generations, meaning that the last person to be infected in this chain was 6 links away from the original sick person. It can be transmitted through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets and contaminated objects. Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for monkeypox. The best diagnostic specimens are directly from the rash – skin, fluid or crusts, or biopsy where feasible. Antigen and antibody detection methods may not be useful as they do not distinguish between orthopoxviruses. Symptoms Monkeypox presents with fever, an extensive characteristic rash and usually swollen lymph nodes. It is important to distinguish monkeypox from other illnesses such as chickenpox, measles, bacterial skin infections, scabies, syphilis and medication-associated allergies. The incubation period of monkeypox can range from 5 to 21 days. The febrile stage of illness usually lasts 1 to 3 days with symptoms including fever, intense headache, lymphadenopathy (swelling of the lymph nodes), back pain, myalgia (muscle ache), and an intense asthenia (lack of energy). The febrile stage is followed by the skin eruption stage, lasting for 2 to 4 weeks. Lesions evolve from macules (lesions with a flat base) to papules (raised firm painful lesions) to vesicles (filled with clear fluid) to pustules (filled with pus), followed by scabs or crusts. The proportion of patients who die has varied between 0 and 11% in documented cases and has been higher among young children. Treatment Treatment of monkeypox patients is supportive dependent on the symptoms. Various compounds that may be effective against monkeypox virus infection are being developed and tested. Prevention and control of human monkeypox rely on raising awareness in communities and educating health workers to prevent infection and stop transmission. Most human monkeypox infections result from a primary animal-to-human transmission. Contact with sick or dead animals should be avoided, and all foods containing animal meat or parts need to be properly cooked before eating. Close contact with infected people or contaminated materials should be avoided. Gloves and other personal protective clothing and equipment should be worn while taking care of the sick, whether in a health facility or in the home. Vaccination against smallpox with first generation vaccinia virus-based smallpox vaccine was shown to be 85% effective in preventing monkeypox in the past. Family and community members, health workers and laboratory personnel who were vaccinated against smallpox in childhood may have some remaining protection against monkeypox.
Clinical trials access in low- and middle-income countries (LMICs)
The global burden of cancer is estimated with more than 20 million cases by 2030, most of them occur in low- and middle-income countries (LMICs). LMICs account for 64% of global cancer deaths and 80% of life-years lost because of disability. In spite of this, only 5% of the global cancer resources are spent in LMICs causing a high mortality-to-income ratio. Despite the burgeoning number of clinical trials in the HICs, there are several reasons to conduct clinical trials in LMICs. Strengths Large sample of patients with diverse genetic pool Trained manpower Large market share for the pharmaceutical industry Increase in insurance coverage in both public and privates sectors FDA approved WHO GMP facilities Information technology support Engagement of DCGI/SEC/CDSCO with stakeholders Weaknesses Lack of more centers of excellence Lack of transparency Lack of accountability Opportunities Strengthen current academic institutions and empower academic researches Establish a central body like NIHR in UK for oversea of trial approval and research funding From central ethics committee to provide oversight Healthy Public-Private partnership Threats Lack of funding Cultural view on clinical trials Overzealous media Delayed approvals Cumbersome paperwork To ensure true progress in clinical trial landscape in the LMICs, regionally sensitive policy making is a necessity. Efficiency in government, academia, and pharmaceutical industry; with improved funding opportunities and incentives for healthcare providers will play a pivotal role in development. Scientific education for the lay public and media, while simultaneously bolstering the research training among LMICs can prove beneficial in long term. Lastly, increased partnership not only among experts but with patients-empowering them as vital stakeholders will be essential for progress in LMICs. Sources: Aakash Desai, Bhawna Sirohi & Aju Mathew (2021) Clinical Trial Access in Low- and Middle-Income Countries: A Case Study on India, Cancer Investigation, 39:9, 685-689
HEALTH: PREVENTION IS BETTER THAN TREATMENT
The concept of health According to the World Health Organization (WHO), “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Totally physical comfort is all of the life activities including physical activity, shape, eating, sleeping, sexual activity, etc. are in the best state and suitable for each age. Mental comfort is peace of mind, knowing how to cope with and overcome life’s stresses. Totally social comfort is occupation with a sufficient living income and guaranteed social security. No disease or disability is not having physical illness, mental illness, and socially related illness. The WHO has decided to take April 7, since 1950, as “World Health Day” with the wish that people care about their own health and that of the community. It can be said that health is a highly profitable investment and the greatest responsibility of each person. We often talk better than act, therefore we have to bear the disease for the rest of our lives. Why do we regret our efforts and money to prevent illness, only to later regret spending a lot of money hoping to cure the disease? Thus, the golden key of health care is to be proactive: Prevention is better than cure. The WHO has divided health into 3 levels: (1) Healthy; (2) Average – Weak and (3) Sick. Of which, only 5% people are really healthy, 80% are average – weak, and the rest are sick. The 80% average – weak is always close to risks of germs of diseases, and epidemics, especially modern epidemics such as: SARS 2003, H1N1 2009, MERS 2012 and SARS – CoV2 2019-2021… Article 10 of the 14 articles of commandments of the Buddha also empharizes: “The greatest asset in human life is health and wisdom”. A healthy body without illness is the dream of many people. Good health and a healthy mind are conditions for us to fulfill our dreams, ambitions, and meaningful things in our life. But when a person is sick, he only dreams of having good health like normal people. Factors affecting health Health is affected by the combined effects of natural factors (physical, chemical …), biological and economic, and social factors. The change in the ecological environment, especially the social environment, causes negative effects on human psychology and emotions and is the reason for pathology. Factors that are critical to human health include: – Genetic factors: Biological factors that determine the structure and function of the body. Abnormal changes in the structure of genes can cause corresponding diseases. Currently, gene mapping has been used as a diagnostic tool for a number of diseases such as sickle cell anemia, pancreatic cystic fibrosis, and diabetes (diseases that can have bad consequences for the next generation)… Most genetic factors cannot be changed and so far, medicine can only limitedly intervene. – Environmental factors: Environmental factors have played a very important role in determining the health status of any community. Environment factors includes: social environment (such as social organization, resources), natural environment, (such as temperature, sunlight, air, soil, water, natural disasters, degraded roads, floods, hurricanes, earthquakes, and other natural disasters that can cause death or injury to people), living and working environment (such as the difficulty in housing, working, family and community easily lead to mental health problems). – Health care system: Quality of treatment and care; people’s accessibility to health services (costs, waiting time…); whether the attitude and professional qualifications of the medical staff meet the requirements; the nature of the health care system (specialized health care, public or private health care). The state of individual and community health is highly dependent on the status of the above factors belonging to the health care system. – Nutritional factors and human lifestyle: good nutrition is the best foundation for health, stature, and intelligence. A nutritious and scientific diet is to eat enough and suitable for an individual’s nutritional needs. Human lifestyle is related to the creation, protection, care and promotion of health, or to a certain health problem, such as: exercise and sanitation. Personal health behavior is the center of health education and research. Unhealthy behaviors and lifestyles are a cause of illness, death, and other health problems… Prevention Prevention is always the root of health. The human body can protect its own health and compensate up to 31%, so the body is the perfect “doctor” of healing. Compensatory capacity is highest at about 35-40-year-olds and decreases over time. However, a body that is supplied too “poorly” in terms of nutrients, vitamins, and minerals, will not have enough resistance againsting disease. To prevent the disease proactively, you need to take actions as follows: – Equip knowledge: It is necessary to equip yourself with basic knowledge about medical and health. This gives you important insights into taking care of and improving the health of yourself and your family. – Periodic health examination: According to scientific statistics, 40% of cancers can be prevented, 30% can prolong quality of life and 30% can be cured if detected and treated early. Therefore, perform periodic health examinations to detect, monitor, and prevent harmful complications for health. – Doing exercise regularly: Each person should spend at least 30 minutes/day to exercise appropriately to achieve the best result in enhancing and protecting health. – Eating a balanced diet: The daily diet should be reasonable and scientific based on each age and health status. Pay attention to food hygiene and safety, not eating too much salt, eating green vegetables and fruits, supplements vitamins, and minerals through genuine functional foods. – Drink enough water to help boost metabolism and detox. The amount of water that is enough for the body is 400ml/10 kg of body weight in 24 hours. Disease treatment Naturally, when being sick, no one can take the disease for you. Whatever is lost can be regained, there is only one thing that cannot be regained, which is life. In fact, many Vietnamese people only care about their health
Chemotherapy and Targeted therapy for Acute myeloid leukemia (AML)
AML is a fast-growing cancer of myeloid progenitor cells. As a results, there is a buildup of blasts in the marrow and blood. In turn, there are not enough red blood cells, platelets, and mature granulocytes. This cause serious health problems. If left untreated, AML is fatal. Figure 1. The process of hematopoietic stem cells differentiate into mature cells. In AML, the process of differentiation and proliferation of myeloblasts into leukocytes is disrupted. (Source: Terese Winslow U.S. Govt). Chemotherapy Chemotherapy kills fast-growing cells throughout the body, including cancer cells and normal cells. Chemotherapy drugs used for the treatment of AML affect the instructions (genes) that tell cancer cells how and when to grow and divide. This disrupts the life cycle of cancer cells. There are some types of chemotherapy used to treat AML: Anthracyclines: damage and disrupt the making of DNA causing cell death of both cancercous and non-cancerous cells. Some of the anthracyclines used to treat AML include daunorubicin, idarubicin, and mitoxantrone. These drugs can cause heart problems. Anti-metabolites: prevent the “building blocks” of DNA from being used. Some of the anti-metabolites used to treat AML include cladribine, clofarabine, cyratabine, fludarabine, methotrexate. Hypomethylating agents (HMAs): block methyl groups from binding to DNA. Some of the HMAs used to treat AML include decitabine, azacitidine. HMAs may be a good option for older patients or patients having serious health issues. There are dosage forms that combine drugs belonging to the above drug groups. For instant, dual-drug liposome of cytarabine and daunorubicin (VyxeosTM, CPX-351) includes an anti-metabolite and an anthracycline. Targeted therapy Targeted therapy works throughout the body. It is drug therapy that focuses on specific or unique features of cancer cells. Targeted therapy seeks out how cancer cells grow, divide, and move in the body. These drugs stop the action of molecules that help cancer cells grow and/or survive. Targeted therapy might be used alone or in combination with chemotherapy. Here is a list of some targeted therapies used in treating AML, classified by their targets: CD33 surface protein: Gemtuzumab ozogamicin (GO) is a type of targeted therapy that is linked to a chemotherapy drug. Gemtuzumab attaches to CD33 in, then GO enters the cells. Once inside, ozogamicin is released and kills cancer cells. Many leukemic blasts have CD33 proteins. Mature blood cells do not have CD33 and are not affected. GO may cause liver issues. FLT3: Gilteritinib or midostaurin is used to treat AML with FLT3-ITD and FLT3-TKD gene mutations. Sorafenid with azacitidine or decitabine may be used to treat AML with FLT3-ITD mutation. IDH1 and IDH2: Ivosidenib is used to treat AML with IDH1 mutation. Enasidenib is used to treat AML with IDH2 mutation. Source: National Comprehensive Cancer Network (NCCN) guideline for patient, AML, 2022.