Allopurinol (ALP) is commonly used as a drug for gout treatment. However, ALP is known to cause cutaneous adverse reactions (CARs) in patients. The HLA-B*58:01 allele is considered a biomarker of severe CAR (SCAR) in patients with gout, with symptoms of Stevens Johnson syndrome, and with toxic epidermal necrolysis. However, in patients with gout and mild cutaneous adverse drug reactions (MCARs), the role of HLA-allele polymorphisms has not been thoroughly investigated. In this study, 50 samples from ALP-tolerant patients and ALP-induced MCARs patients were genotyped in order to examine the polymorphisms of their HLA-A and HLA-B alleles. Our results showed that the frequencies of HLA-A*02:01/HLA-A*24:02 and HLA-A*02:01/HLA-A*29:01, the dual haplotypes in HLA-A, in patients with ALP-induced MCARs were relatively high, at 33.3% (7/21), which was HLA-B*58:01-independent, while the frequency of these dual haplotypes in the HLA-A locus in ALP-tolerant patients was only 3.45% (1/29). The HLA-B*58:01 allele was detected in 38% (8/21) of patients with ALP-induced MCARs, and in 3.45% (1/29) of ALP-tolerant patients. Notably, although HLA-B*58:01 may be a cause for the occurrence of MCARs in patients with gout, this correlation was not as strong as that previously reported in patients with SCAR. In conclusion, in addition to the HLA-B*58:01 allele, the presence of the dual haplotypes of HLA-A*02:01/HLA-A*24:02 and/or HLA-A*02:01/HLA-A*29:01 in the HLA-A locus may also play an important role in the appearance of ALP-induced MCARs in the Vietnamese population. The obtained primary data may contribute to the development of suitable treatments for patients with gout not only in Vietnam but also in other Asian countries.
Allopurinol is now the first-line treatment for managing gout and its increasing usage has brought more gout patients at risk of developing allopurinol-induced hypersensitive reactions. Up to now, our attempts to identify the biomarkers for hypersensitivity to allopurinol are still finite. Besides, the association between drug-induced hypersensitive reactions and some mitochondrial DNA (mtDNA) alterations has been proved but remains unclear in gout patients. In this study, 41 blood samples of gout patients prescribed with allopurinol including 22 hypersensitive and 29 tolerant ones were used to analyze their mtDNA large-scale deletions through PCR and determine the mtDNA deletion level and the copy number by quantitative PCR. The results indicated that the mtDNA large-scale deletions and mtDNA copy number of the hypersensitive group were lower than that of the tolerant one (p < 0.05). However, no association was found between the mtDNA deletion level and the appearance of hypersensitive reactions in gout patients. In addition, the study showed that the mtDNA deletion level and copy number were negatively correlated with the copy numbers of mitochondrial DNA in gout patients (R = -0.3495; p = 0.0119) and allopurinol hypersensitive group (R = -0.6744; p = 0.0005). Thus, a decrease in mtDNA copy number might serve as a potential biomarker for further investigation to assess the risk of hypersensitive reactions to allopurinol in gout patients.
COVID-19 caused significant mortality worldwide, including in Vietnam. This study aimed to evaluate the effectiveness of Extracorporeal membrane oxygenation (ECMO) in the treatment of COVID-19 patients with acute respiratory distress syndrome (ARDS). From January 1, 2022 to March 31, 2022, the COVID-19 hospital admitted 395 critical patients, including 10 patients required veno-venous Extracorporeal membrane oxygenation (VV-ECMO). This descriptive study revealed relatively high survival rate of 60% (6/10 patients) with the median duration of ECMO was 11.5 days. The study group's SOFA and RESP scores were 6 and 4, respectively. Time from symptom onset to mechanical ventilation, duration of NIV and/or HFNC before mechanical ventilation, time from symptom onset to ECMO of the study patients were 9.5, 0 and 11.5 days, respectively. The most common complication in ECMO patients was nosocomial infection (70%), in addition to bleeding, embolism, or both at the same time. This preliminary research showed that ECMO was effective in the management of acute respiratory distress syndrome in patients with COVID-19.
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