Help fight childhood cancer

Motionless, painful with bone cancer

On the afternoon of February 22, doctors at the Centre for Joint Surgery and Sports Medicine, under the Hanoi-based Tam Anh General Hospital successfully performed the surgery to replace the entire thighbone for the child patient to treat her bone cancer.

Q.A, 11, from Ho Chi Minh City, had suffered a dull pain in right thigh which increased over the past year. Her family sent her to the HCMC Children’s Hospital where she was diagnosed with femoral cancer and transferred to HCMC Cancer Hospital for continued treatment.

However, after three chemotherapy sessions, she did not get better, while there were signs that the tumour continued to grow, leading to an invasion, breaking the thighbone and causing the child to have the entire right leg cast. At the same time, she still had to endure motionlessness and nagging pain, while continuing to receive further treatment to prepare for next surgeries to remove the tumour.

Her family tried their best to take Q.A to Hanoi for further treatment in the hope of keeping her right leg. At the Centre for Joint Surgery and Sports Medicine, Professor, Dr. Tran Trung Dung, in charge of the centre’s expertise, said that bone cancer in children is a dangerous disease with very high malignancy properties, which not only puts patients at risk of disability but even risks their lives.

In the case of Q.A, the tumour had overgrown along the femoral body, leading to fracture. Therefore, the only solution is to remove the entire thigh bone with the tumour. But if there is no alternative to the defective position of the bone, the risk of having to amputate her leg to save her life is very high. As the child is still too young and the family yearns to put a lot of faith in the preservation of her legs, doctors at the centre have found the most suitable solution for her.

The giant tumour that destroyed almost the entire right thighbone of the patient.

Daring decision to replace artificial bone for the young patient

With their experience of having successfully replaced artificial bones for a number of cases in Vietnam, specialists gathered to seek solutions in this case. Finally, the decision was made to remove the entire cancerous femur and then replace this removed bone with an artificial thighbone made of titanium alloy material. However, this is the youngest child patient in Vietnam to this case, so doctors must consider many factors.

Experts have to carefully measure and calculate how they can replace the artificial bone that is almost identical to the child’s bone to help Q.A be able to recover and walk normally as before. Just a small mistake in the design and the child may experience complications such as dislocation or stiffness right after the surgery.

To solve the remaining difficult part of this problem, Professor, Dr. Tran Trung Dung said: “We have to scan a 3D model of the entire two legs of Q.A before the surgery to simulate the parameters of the femoral bone that needs to be replaced. At the same time, we also calculate whether the muscle tendon around the remaining bone is enough to ensure the child’s leg works or not. We planned to use positioning robots throughout the operation to ensure the surgical steps are of the highest accuracy.”

Undergoing a pre-operative chemical treatment and a major surgery that lasted nearly three hours, doctors finally removed the damaged thigh bone and the giant tumour measuring 28x10cm, weighing nearly three kilograms, while successfully replacing artificial femur with artificial hip and knee joints.

Dr. Dung said this artificial thigh bone is designed for 3D printing with super durable, light titanium alloy ordered in accordance with the anatomical design parameters provided by surgeons. This artificial femur is designed in the form of a removable module, so when the child grows up, the doctor can lengthen the surgical leg to match the healthy leg.

The 3D printed titanium alloy artificial thighbone made in line with the anatomical parameters of the patient.

In addition, thanks to the positioning support of the Artis Pheno robot and surgeons’ expertise, the function, length and shape of the two legs of the patient after surgery are similar.

“If the postoperative progress is favourable, after only two days, the patient will be able to sit up and practice walking with support equipment,” Dr. Dung informed.

The surgery at Tam Anh General Hospital is the 3rd complete replacement of the thighbone in Vietnam and the 2nd case of replacing the entire thighbone due to cancer. More specifically, in research in the world medicine documents, this is a femoral replacement surgery for the youngest patient in Vietnam and the 2nd youngest in the world, after a similar surgery on a ten-year-old patient in in Egypt in 2010.

Over the past year, Professor, Dr. Tran Trung Dung and experts at his centre have been very successful in many complicated surgeries, such as replacing one side artificial pelvis, replacing eight finger joints at the same time and replacing complicated shoulder, elbow, hip, and knee joints.

This team is also the same as the first two artificial thigh replacement surgeries in Vietnam. Fortunately, the first thigh bone replacement due to cancer on a 25-year-old girl was a success, and now after nearly two years since the surgery, she is still healthy and is currently working as a medical secretary for the surgical team that saved her leg at Tam Anh Hospital.

Bus catches fire.

By Chi Thach – Translated by Kim Khanh

The HCMC Department of Transport shared that the city aims at possessing a multi-means public transport system, including 8 metro lines, 3 tram lines, 6 bus rapid transit lines (BRT), and 200 regular bus lines, in order to meet the traveling demands of the community.

Due to the dense population in HCMC, leading to the large number of private vehicles, urban traffic at the moment has to shoulder a heavy burden, and the average velocity of vehicles in the downtown is just 20-25km per hour.

To tackle this problem, the municipal authorities have adjusted the planning of the urban transport system to implement the Transit Oriented Development (TOD) model. This model maximizes the link between residential, business, manufacturing areas and the existing public transport system.

HCMC is going to apply this model along Metro Line No.1 (from Ben Thanh in the downtown to Suoi Tien in Thu Duc City), Metro Line No.2 (the first phase: Ben Thanh – Tham Luong in District 12; the second phase: Tham Luong – Cu Chi District) and Metro Line No.5 (the first phase Bay Hien Intersection in Tan Binh District – Sai Gon Bridge; the second phase: Can Giuoc Coach Station in Long An Province – Bay Hien Intersection).

The HCMC Management Center of Public Transport (MCPT) is going to introduce 21 high-quality bus lines. This is expected to rebuild the community’s trust towards buses, and thus increasing their bus use.

In order to fulfill the goal, these buses must maintain their route schedule and are not allowed to skip bus-stops or passengers under any circumstances. They have free Wi-Fi, a route monitoring device, a sound system automatically connected to MCPT to announce destinations, free newspapers to serve passengers.

Bus attendants must have good manner, especially towards the senior, the disabled, the ill, and the invalids. Bus drivers must ensure safety by strictly obeying traffic laws and minimizing disorder inside the bus.

The new 21 lines must have sufficient infrastructure, including bus stops, stopping space, regularly updated information boards about current routes and schedules. These facilities must be clean and not illegally occupied by peddlers.

As suggested by Associate Prof. Dr. Pham Xuan Mai from HCMC University of Technology (Vietnam National University – HCMC), it is critical that bus route schedules be maintained so that customer confidence is regained, and people come back to this common public transport.

Prof. Dr. Nguyen Thi Canh from the University of Economics and Law (Vietnam National University – HCMC) said that the formerly piloting scheme of bus priority lane on Tran Hung Dao Street encountered certain objection from the community. However, it is this practice, along with careful planning, that is implemented widely in developed countries to help buses be more welcomed by the public.

Experts in the field suggested that HCMC should launch the piloting scheme for bus priority lane on some major streets like Dien Bien Phu (from Ly Thai To Roundabout – Sai Gon Bridge) or Vo Thi Sau (from Dan Chu Roundabout – Dinh Tien Hoang Street), which has many bus lines.

Simultaneously, better private vehicle restriction rules should be introduced on these two streets to make the scheme more effective.

Accepted the recommendation, MCPT is going to pilot bus priority lanes on the mentioned streets at morning and afternoon peak hours on weekdays. Each lane is supposed to be 3.25m wide, separated with other lanes by road fence. These lanes are for buses, ambulances, firetrucks, mini buses, and passenger vehicles 12-seat+.

Lately, HCMC has built several new streets; yet the proportion of traffic space in the urban land use is a tiny minority of 10 percent, which is not even 1/2 of the standard. Adding to the problem is the ever-increasing number of private vehicles, reaching 9 million at present (including 7.2 million scooters).

With such a high traffic density, with a priority lane, it is truly challenging for buses to maintain their schedules. Some bus companies reported that 80 percent of their buses cannot fulfill this goal. Some are even 1 hour late.

Just 3 years ago, buses were the most favorite choice of students coming to Thu Duc University Village, and there was a bus running each 10 minutes. Sadly, over 1/2 of those lines are canceled now since they cannot ensure the precise arrival time.

Obviously, the development of public transportation must go along with a more logical control of private vehicle growth.

By Quoc Hung – Translated by Vien Hong

The groups include health professionals, the pandemic prevention and fight task force (members of steering committees, people working in quarantining areas, reporters and others), diplomats, and customs and immigration staffs, military personnel, police force, teachers, and the elderly aged over 65.

Others include those working to maintain the supply of essential services such as aviation, transportation, tourism, electricity and water supply, as well as people with chronic diseases,people going abroad on a mission, to work, or study, and those in pandemic-hit areas.

The Ministry of Health (MoH) has announced the plan on the reception, preservation, distribution, and use of COVID-19 vaccines during 2021-2022 with the support of the COVAX Facility – the global procurement mechanism of COVAX.

Vietnam aims to have 80 per cent of its population get vaccinated against COVID-19. However, due to the limited supply, the rate can hit 20 per cent in 2021-2022.

COVAX is co-led by the Coalition for Epidemic Preparedness Innovations (CEPI), GAVI – the Vaccine Alliance, and the World Health Organization (WHO), alongside key delivery partner UNICEF. Its aim is to accelerate the development and manufacturing of COVID-19 vaccines and to guarantee fair and equitable access for every country in the world.

The COVAX Facility aims to supply COVID-19 vaccines to 190 countries worldwide. On December 10, 2020, GAVI named Vietnam as a member nation. GAVI and COVAX Facility expect to provide COVID-19 vaccines for 20 per cent of the population of member nations.

In spite of this, it is currently estimated that the COVAX Facility will provide the vaccine and materials for vaccination free of charge for 15-16 per cent of the population of 92 countries, including Vietnam. On January 29, the COVAX Facility said that more than 4.8 million doses of COVID-19 vaccine produced by AstraZenecca will be delivered to Vietnam in the first half of this year, while the next delivery will be announced later.

As planned, around 600,000 Vietnamese people, comprising healthcare and COVID-19 combat workers, will be given shots in the first quarter. Meanwhile, 1.8 million customs officers, diplomats, army and police personnel, and teachers will be injected in the second quarter. During the second half, over 16 million teachers and people above 65 will access 33 million doses of vaccines to be provided by the COVAX Facility later.

At a recent online meeting with cities and provinces, Health Minister Nguyen Thanh Long said that in 2021 Vietnam will 150 million doses of the vaccine to ensure sufficient supply. The COVAX Facility has committed to supply 30 million doses for Vietnam this year, mainly used for the remaining six months of the year. AstraZeneca also committed to supply the same doses.

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By Bich Thuy