Recurrent syncope with seizure-like stiffening may mimic epilepsy or neurological disorders, and when routine tests are repeatedly normal, intermittent arrhythmia can be easily overlooked. We report a case of a 65-year-old man with hypertension, hyperuricaemia, dyslipidaemia, and asthma who experienced recurrent syncopal episodes over one month. He presented several times to emergency departments and tertiary hospitals. Neurological and cardiovascular investigations—including brain MRI, echocardiography, coronary angiography, laboratory tests, and a previous Holter ECG—were consistently unremarkable. The initial diagnosis was hypertensive crisis based on marked post-event blood pressure surges, which was later recognized as a secondary phenomena rather than the primary cause of syncope. On the index admission, continuous emergency monitoring captured a sinus arrest of 17 s with absent arterial pulse waveform, followed by bradyarrhythmia. Post-event blood pressure spiked to 220/110 mmHg. A repeat Holter ECG confirmed intermittent Mobitz II and complete AV block with asystole up to 18.6 s. EEG, performed during this admission to exclude epilepsy, was normal. A dual-chamber permanent pacemaker was implanted with complete resolution of symptoms (Shen et al, Circulation 136(5):e60-e122, 2017; Kusumoto et al, Circulation 140(8): e382-e482, 2019; Brignole et al, Eur Heart J 39(21):1883-1948, 2018). This case demonstrates how intermittent AV block may masquerade as seizure or hypertensive crisis, underlining the critical role of emergency department monitoring and prolonged ECG recording in recurrent unexplained syncope.
Objective: Language delay (LD) is a common developmental condition in which children fail to achieve age-appropriate language milestones, affecting communication, cognition, and social integration. It affects approximately 1 in 14 preschool children and may have long-term consequences into adulthood. The period from 12 to 36 months is a critical window for language development, during which children begin to comprehend and produce their first words. Early identification of risk factors during this stage is essential for timely intervention. However, in Vietnam, data on factors associated with language delay in this age group remain limited. Therefore, this study aimed to identify factors associated with language delay in children aged 12–36 months. Methods: A case–control study was conducted, including 55 children with language delay and 55 typically developing children aged 12–36 months. Personal, familial, medical, and environmental data were collected using structured questionnaires. Univariate and multivariable logistic regression analyses were performed to identify factors associated with language delay. Results: A total of 110 children (43 boys and 67 girls) were included. The strongest risk factor was the use of screens to calm or occupy children (OR = 36.6; p < 0.001). Early bilingual exposure was a significant protective factor (OR = 0.12; p = 0.014), while shared reading or picture viewing showed a strong but borderline protective effect (OR = 0.23; p = 0.051). Conclusions: The use of screens to calm or occupy children was the main risk factor for language delay, whereas early bilingual exposure and shared reading or picture viewing were protective factors. These findings highlight the importance of limiting non-interactive screen use and promoting interactive language activities to support early language development.
Abstract Background Inadequate spectacle correction limits the benefit of school vision screening, yet most evidence addresses only whether a child owns glasses rather than whether those glasses work. This study examined the prevalence, predictors, and persistence of inadequate spectacle correction among schoolchildren in three Vietnamese cities. Methods We analyzed annual vision screening records of students from a private school network in Ha Noi, Ho Chi Minh City, and Hai Phong, 2021 to 2024. Inadequate correction was defined as visual acuity below the age-appropriate threshold despite current glasses. A population-averaged modified-Poisson regression with robust standard errors, clustered by child, estimated adjusted prevalence ratios (aPR) for city, age, sex, and calendar year. Children linked across consecutive years allowed persistence analysis. Results Among 39,697 spectacle-wearing examinations, 30,936 (77.9%) were inadequately corrected, ranging from 64.8% (95%CI= 63.9, 65.8) in Ho Chi Minh City to 96.7% (96.0, 97.3) in Hai Phong. After adjustment, prevalence was lower in Ho Chi Minh City (aPR= 0.76; 95%CI= 0.75, 0.78; p<0.001) and higher in Hai Phong (aPR= 1.25; 95%CI= 1.23, 1.26; p<0.001) relative to Hanoi, and fell with age (aPR= 0.97 per year; 95%CI= 0.96, 0.97; p<0.001). Among 9,285 linked year pairs from 8,341 children, 85.3% (84.4, 86.1) of initially inadequately corrected children remained so the following year. Conclusions Most spectacle-wearing children in this Vietnamese cohort were inadequately corrected, with wide geographic variation and high persistence. School vision programs need mechanisms to verify correction adequacy after glasses are dispensed, not only to detect refractive error.
Background Multimorbidity in children remains poorly characterized in low- and middle-income countries (LMICs), with no prior large-scale network-analytic study in Vietnam. We aimed to describe the prevalence, structure, and demographic determinants of pediatric multimorbidity using a population-level school health database. Methods We analyzed 283,926 annual school health visits from 72,909 children aged 1 to 18 years attending a private school system in Vietnam (2020 to 2025). Multimorbidity was defined as ≥ 2 ICD-10 diagnoses per child. A six-layer multiplex network was constructed to identify disease hubs via betweenness centrality. Temporal trajectories were assessed with directed binomial tests, and multivariable logistic regression estimated adjusted odds ratios for comorbidity pairs. Association rules were extracted via Apriori and phenotype clusters were derived using Uniform Manifold Approximation and Projection (UMAP) followed by Leiden community detection. Results Multimorbidity was present in 53.7% of children, with higher burden in males (55.7% vs. 51.5%) and the 6 to 11-year age group (65.7%). The strongest co-occurrences involved blindness/low vision with protein-energy malnutrition (OR 6.71) and hyperalimentation (OR 8.73), constituting a visual-nutritional double burden. Hypertrophy of tonsils and dental caries emerged as universal disease hubs. Hyperalimentation preceding obesity was the highest-risk temporal sequence (RR 2.45). Seven phenotype clusters were identified (multimorbidity prevalence 39.3% to 69.5%), with disorders of refraction and dental caries present across all groups. Conclusion Multimorbidity is highly prevalent in this urban Vietnamese pediatric population. A nutritional-ophthalmological cluster and an upper airway-oral health cluster support integrated school-based screening and interventions in Vietnam and comparable LMICs.
Spinal cord injury (SCI) causes devastating and permanent neurological disability, with no restorative treatments currently available. Cell-based therapies have long been regarded as the most promising regenerative strategy, demonstrating robust functional improvement in preclinical models. However, clinical outcomes have been inconsistent, exposing a persistent translational gap. This review critically appraises leading cell therapy platforms, ranging from mesenchymal and neural stem cells to next-generation engineered tissues. We dissect the molecular mechanisms underlying therapeutic efficacy and analyze key translational barriers, including GMP manufacturing, potency assay development, and clinical trial design. Integrating lessons from past failures with emerging advances in imaging biomarkers and immune-microenvironment modulation, we propose a strategic roadmap framed by a “renovate-and-rebuild” paradigm. We identify timing-by-mechanism mismatches and inadequate scar remodeling as central drivers of variable efficacy, and introduce a biomarker-gated indication algorithm to align therapies with lesion biology. Collectively, these insights argue for reframing SCI repair as a staged, biology-matched process rather than a single-shot intervention.
