Heme degradation plays a pivotal role in the availability of the essential nutrient, iron, in pathogenic bacteria. A previously unannotated protein from Mycobacterium tuberculosis, Rv3592, which shares homology to heme-degrading enzymes, has been identified. Biochemical analyses confirm that Rv3592, which we have termed MhuD (mycobacterial heme utilization, degrader), is able to bind and degrade heme. Interestingly, contrary to previously reported stoichiometry for the Staphylococcus aureus heme degraders, IsdG and IsdI, MhuD has the ability to bind heme in a 1:2 protein to heme ratio, although the MhuD-diheme complex is inactive. Furthermore, the 1.75 Å crystal structure of the MhuD-diheme complex reveals two stacked hemes forming extensive contacts with residues in the active site. In particular, the solvent-exposed heme is axially liganded by His75 and is stacked planar upon the solvent-protected heme. The solvent-protected heme is coordinated by a chloride ion which is, in turn, stabilized by Asn7. Structural comparison between MhuD-diheme and inactive IsdG and IsdI bound to only one highly distorted metalloporphyrin ring reveal that several residues located in α-helix 2 and the subsequent loop appear to be responsible for heme stoichiometric differences and suggest open and closed conformations for substrate entry and product exit.

Background. Patients with type 2 diabetes mellitus (T2DM) who have limited knowledge about hypoglycemia and insulin pen use are likely to have hypoglycemia and other complications. Objective. This study aimed to evaluate the effectiveness of health education on knowledge about hypoglycemia and insulin pen use among outpatients with T2DM at a primary care hospital in Vietnam. Methods. A pretest–posttest study was conducted among 80 patients with T2DM at District 11 Hospital in Ho Chi Minh City, Vietnam. At baseline, patients were interviewed through a predefined, structural questionnaire to assess their knowledge about hypoglycemia and insulin pen use. After that, patients underwent an individual health education session about hypoglycemia and insulin pen. One month and two months after this intervention, knowledge about hypoglycemia and insulin pen use were recorded again. Results. The majority were males (65.0%) and the mean age was 59.6 (standard deviation 8.1, range 35-75) years. Very few patients had good knowledge and proper insulin pen use, with percentages ranging from 13.8% to 60%. There was a significant improvement of knowledge and practice after the intervention. Such improvement remained high one month and two months after the intervention. Conclusions. The health education intervention is effective in improving knowledge and practice in this population. There is a pressing need for such intervention at primary care hospitals to optimize treatment for patients with T2DM, possibly focusing on those who had characteristics to have the best effectiveness found in this study.

Purpose Immunization is the most cost-effective health strategy, contributing significantly to public health interventions for all ages, particularly for children. However, caregivers’ satisfaction with immunization systems affects their decisions on immunization for their children. This study evaluated the levels of clients’ satisfaction toward child immunization and to identify its associated factors. Methods A cross-sectional study was conducted at 40 commune health centers (CHCs) in 24 districts in Ho Chi Minh City, Vietnam among 1200 caregivers of children aged under 5 years. Clients who took their children to CHCs for immunization were recruited based on convenience sampling technique and were asked to complete a self-report questionnaire. Satisfaction was measured using the Satisfaction with Immunization Service Questionnaire (SWISQ). Ordinal logistic regression models were fitted to identify factors associated with satisfaction levels. Results The majority of participants were female (85.5%) with a mean age of 33.3 (standard deviation = 9.0). Approximately 60% of participants reported a moderate (40.2%) or high (17.1%) level of satisfaction. Participants with older children and those who waited for a longer duration had a lower satisfaction level. In contrast, high satisfaction level was found to be positive associated with being reminded by healthcare workers and the condition of follow-up areas, vaccine storage and the immunization process met participant’s need. Conclusion The level of clients’ satisfaction toward child immunization at grassroot healthcare centers in Ho Chi Minh City is relatively low, with 40.2% having moderate satisfaction and 17.1% having high satisfaction. Strategies to improve vaccination programs at CHCs are needed, focusing on clients’ experiences at CHCs during vaccination sessions. Further studies are also needed to have an in-depth understanding of more factors affecting satisfaction in this population.

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