BASIC INVESTIGATING THE HEALTH SITUATION OF VICTIMS OF AGENT ORANGE IN SOME PROVINCE SOUTH VIETNAM

1. INTRODUCTION

From 1961 to 1971, the US military sprayed about 80 million liters of herbicides over South Vietnam through an operation called \"Operation Ranch Hand\". leaves” are pink substances, green substances, white substances, purple substances, and most of them orange substances.

Agent Orange, a 50:50 mixture of 2,4-D and 2,4,5-T, was the most commonly used herbicide.

While synthesizing 2,4,5-T at high temperature and pressure, chemical companies have known the presence of dioxin which is the most toxic chemical to all species, including, and most is human.

DIOXIN substance, chemical formula is 2,3,7,8 tetra-chloro-dibenzo-para-dioxin – referred to as 2,3,7,8 TCDD. for short

Agent Orange/dioxin increases the number and percentage of children with birth defects in Vietnam and a number of other health conditions in both exposed adults and children such as cancer, heart disease. cardiovascular disease, diabetes... for Vietnamese people, as well as for US soldiers and soldiers from other countries that sent people to fight in Vietnam during the war.

Until now, it is well known, dioxin is the most toxic substance for the human body, created by man himself! In 1996, the International Agency for Research on Cancer (IARC) confirmed that dioxin is a carcinogen.

In addition to the 17 diseases that the US government has recognized as caused by dioxins, some recent European studies have been reported at the 2018 American Rheumatology and French Rheumatology Annual Meetings. also showed that gout can be derived from dioxin exposure.

Gut is one of the most common form of inflammatory joint disease, reduces the quality of life is very serious because lead to symptoms of chronic pain [ heumatology/cream150.\">1 - heumatology/kep047.\">3 ].

The overall prevalence of gout around the world is 1 – 10% and there is considerable variation from country to country. Taiwan has the highest rate, 9.5% male and 2.8% female. South Korea has a very low rate of disease, less than 1%. Currently, Vietnam has not published the overall prevalence of the disease and only a few small studies have estimated the number and proportion of gout patients in the population. According to the 2000 statistics of Trung Liet ward - Hanoi and Tan Truong district - Hai Duong, the rate of gout accounted for 0.14% of the population.

According to Professor Thomas Bardin, Head of the Department of Musculoskeletal, Musculoskeletal and Joints, Lariboisière Hospital - Paris VII, France, gout is a dangerous disease because long-term complications are heart failure, chronic kidney failure, or complications of type diabetes. 2 is difficult to treat, even deadlocked. In a study of his cooperation with the Institute of Gout in Ho Chi Minh City and the Faculty of Medicine, University of Medicine and Pharmacy in Ho Chi Minh City, the average age of patients was 47 years old.

Before gout, patients often had high uric acid in the blood.

Among people with high uric acid in the blood, up to 40-50% will develop gout. The time from hyperuricemia to the first gout attack can take 20 to 30 years, and about 10 to 40% of them may have renal colic, even before arthritis.

Gout mainly occurs in men, the current male/female ratio is 3 – 4/1.

To understand as well as try to support the treatment of diseases and physical pain that seriously reduce the quality of life of victims of Agent Orange/dioxin in localities after 60 years of direct or indirect exposure. In contact with Agent Orange/dioxin, the Association of Victims of Agent Orange/dioxin in Vietnam, in collaboration with member associations, provincial associations, district associations, and local hospitals, began to carry out a cross-sectional study. Equalize the health status of Agent Orange/dioxin victims with the most necessary tests on general condition, pathology, organ function - especially liver and kidney, uric acid, finding out the risks cause the disease to be treated sooner and more effectively.

Research successful agency

Research lead agency: Scientific Committee of Vietnam Association of Victims of Agent Orange/dioxin.

Coordinating agency: Provincial and district general hospitals are capable of examining and doing ultrasound and testing with the consent of the Department of Health.

Person assigned to be responsible for writing outline and conducting research: Doctor Nguyen Thi Ngoc Phuong with the cooperation and support of the scientific research team of My Duc hospital, Ho Chi Minh City.

2. RESEARCH SUBJECTS AND METHODS

2.1. Research subjects

The main research objective: the general health status of victims of DC/Dioxin 60 years after the distribution of chemical compounds in Vietnam, stratified by age group, distinguishing victims of direct or indirect exposure. continuously during the war and after the war (in or near dioxin-remaining airfields), in each locality to study and pool all local victims, with a major focus on the incidence of diseases:

- Cardiovascular: high blood pressure, coronary heart disease, heart failure

- Respiratory organs: lungs and upper respiratory tract

- Liver: liver function, types of tumors and liver cancer

- Kidney: kidney function and other damage

- Diabetes

- Gout and gout-related defects, uric acid levels in each locality,

- Mean serum uric acid concentration in each location and age

- Which age group has high uric acid levels? Among those with high uric acid, how many have gout?

Sub-goals: If the victim has gout, test, diagnose and treat the victim early.

2.2. Research methods

This is a cross-sectional descriptive study in July 2020 (Dong Nai); In October and November 2020 in other localities, special attention should be paid to screening for serum uric acid levels and gout for treatment in order to improve the quality of life for victims of AC/Dioxin.

The data will be analyzed using R software.

3. RESEARCH RESULTS AND DISCUSSION

- All victims of 3 districts of Ho Chi Minh City were selected at random by lottery: District 2 (inner city - 118 victims), Hoc Mon district (periphery - 120 victims) and Cu Chi district (outer suburbs) – 345 victims).

- 2 provinces in the Mekong Delta, randomly selected: Ben Tre and Bac Lieu

- 3 provinces in the Southeast, randomly selected: Dong Nai, Tay Ninh.

- Each province selected 300 victims.

The total number of victims who agreed to participate in the study was 2079, with the following characteristics:

Due to the Covid-19 situation, the time for basic investigation and medical examination has been delayed until March 2021.

- The number of people who went to the doctor was less than expected because they were dead or seriously, unable to walk; due to moving to another place.

- We analyze separately the group of victims over the age of 50 because they were born during or shortly after exposure to toxic chemicals, including Agent Orange and dioxin.

- The study also analyzed and compared gout in men and women

- Most of the victims of ACD/Dioxin are old, so they suffer from many diseases, both of the elderly and also caused by AC/Dioxin:

+ High blood pressure: 48.2 – 82.3%

+ Diabetes: 28.3 (Central Highlands) – 71.0 (Bien Hoa)

+ Cardiovascular disease: 37.4 – 59.3 (Bien Hoa)

+ Types of cancer: the total rate of 3 types of cancer of liver, lung, prostate is 67.1%.

+ Gout in both male and female groups is 402/2079 = 19.3%, higher than other countries (the rate in the world is 1 - 10%)

Figure 1. Prevalence of gout.

Table 1. Prevalence of disease and abnormal laboratory indicators of 2 groups of patients aged 50 years and under and over 50 years old

Symptom	≤50 years old (n = 320) (%)	50 years old (n= 1.732) (%)
Joint pain	138 (43.1%)	1.447 (83.5%)
Deformation of limbs	93 (29.1%)	279 (16.1%); Bien Hoa 26 (8.8%)
Gout	18 (5.6%)	380 (21.9%); Bien Hoa 67 (22.6%)
Is there a treatment for gout?	22 (6.9%)	354 (20.4%)
High blood pressure	32 (10.0%)	1.309 (75.6%)
Diabetes	15 (4.7%)	936 (54.0%)
Heart-related diseaes	49 (15.3%)	942 (54.4%)
Cancer	22	228 (80.3%)
High blood sugar	28 (9.2%)	661 (40.1%)
High Creatinine	7 (2.3%)	291 (17.0%)
High SGOT	88 (28.9%)	290 (17.0%); Bien Hoa 29 (10.0%)
High SGPT	64 (20.9%)	261 (15.3%); Bien Hoa 33 (11.2%)
Uric acid >7 mg/dL	55 (17.9%)	460 (26.8%)

Victims over 50 years of age, infected with AC/dioxin during the time they are still spreading ASF seem to have a higher rate of disease than children, infected indirectly through breast milk or through the environment. It may also be due to the age factor.

4. CONCLUDE

- The Vietnam Association of Victims of Agent Orange/dioxin needs more research to delve into more effective care and treatment for victims.

- In the immediate future, we will analyze the study in more detail.