B\u1ec7nh nh\u00e2n n\u1eef 31 tu\u1ed5i, PARA 1001, ti\u1ec1n s\u1eed m\u1eafc h\u1ed9i ch\u1ee9ng Wolff-Parkinson-White, m\u1edbi \u0111\u00e2y \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n u lympho Hodgkin giai \u0111o\u1ea1n II, \u0111\u1ee3t n\u00e0y xu\u1ea5t hi\u1ec7n ban ng\u1ee9a. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n u lympho Hodgkin khi mang thai 35 tu\u1ea7n, v\u00e0 \u0111\u01b0\u1ee3c m\u1ed5 l\u1ea5y thai sau \u0111\u00f3 1 tu\u1ea7n. 3 tu\u1ea7n sau khi sinh, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u0111i\u1ec1u tr\u1ecb ho\u00e1 ch\u1ea5t (\u0111\u1ee3t 1, ng\u00e0y 1) b\u1eb1ng adriamycin, bleomycin, vinblastine v\u00e0 dacarbazine (ABVD). V\u00e0o ng\u00e0y 15 c\u1ee7a \u0111\u1ee3t 1, b\u1ec7nh nh\u00e2n xu\u1ea5t hi\u1ec7n c\u00e1c ban d\u1ea1ng v\u1ec7t, d\u1ea3i th\u1eb3ng, t\u0103ng s\u1eafc t\u1ed1 tr\u00ean c\u00e1nh tay, l\u01b0ng v\u00e0 ch\u00e2n. Ng\u1ee9a nhi\u1ec1u, lan to\u1ea3 xu\u1ea5t hi\u1ec7n trong v\u00f2ng 24h sau ng\u00e0y \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb, c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y \u0111\u00e1p \u1ee9ng k\u00e9m v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1ng histamine v\u00e0 steroid b\u00f4i da. Sau ng\u1ee9a l\u00e0 c\u00e1c v\u1ebft g\u00e3i s\u1eabm m\u00e0u nh\u01b0 trong H\u00ecnh. C\u00e1c x\u00e9t nghi\u1ec7m c\u1eadn l\u00e2m s\u00e0ng c\u00f3 k\u1ebft qu\u1ea3 nh\u01b0 sau : b\u1ea1ch c\u1ea7u 1,6 G\/L, s\u1ed1 l\u01b0\u1ee3ng b\u1ea1ch c\u1ea7u trung t\u00ednh l\u00e0 0,5 G\/L, bilirubine to\u00e0n ph\u1ea7n l\u00e0 0.3 mg\/dL, kh\u00f4ng thay \u0111\u1ed5i so v\u1edbi n\u1ed3ng \u0111\u1ed9 bilirubin to\u00e0n ph\u1ea7n c\u01a1 s\u1edf.<\/p>\n
Tr\u01b0\u1edbc khi c\u00f3 ch\u1ea9n \u0111o\u00e1n u lympho Hodgkin, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u0103m s\u00f3c tr\u01b0\u1edbc sinh th\u01b0\u1eddng qui, ch\u1ec9 b\u1ecb ng\u1ee9a (nh\u01b0ng kh\u00f4ng xu\u1ea5t hi\u1ec7n ban) trong su\u1ed1t qu\u00ed 1 thai k\u00ec. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c th\u0103m kh\u00e1m khi xu\u1ea5t hi\u1ec7n s\u01b0ng h\u1ea1ch th\u01b0\u1ee3ng \u0111\u00f2n, kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh trong qu\u00ed 3 thai k\u00ec. C\u00e1c k\u1ebft qu\u1ea3 sinh thi\u1ebft h\u1ea1ch ph\u00f9 h\u1ee3p v\u1edbi u lympho th\u1ec3 x\u01a1 n\u1ed1t \u0111i\u1ec3n h\u00ecnh. X\u00e9t nghi\u1ec7m h\u00ecnh \u1ea3nh cho th\u1ea5y h\u1ea1ch to v\u00f9ng c\u1ea3nh th\u01b0\u1ee3ng \u0111\u00f2n, c\u1ea1nh kh\u00ed qu\u1ea3n v\u00e0 trung th\u1ea5t; t\u1ed1c \u0111\u1ed9 l\u1eafng h\u1ed3ng c\u1ea7u l\u00e0 67 mm\/h. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n u lympho Hodgkin giai \u0111o\u1ea1n II, nguy c\u01a1 kh\u00f4ng thu\u1eadn l\u1ee3i.<\/p>\n
A. \u0110\u1ed9c t\u00ednh c\u1ee7a bleomycin
\nB. B\u1ec7nh l\u00ed da c\u1eadn ung th\u01b0
\nC. Ban \u0111a h\u00ecnh do thai ngh\u00e9n
\nD. \u0110\u1ed9c t\u00ednh c\u1ee7a vinblastine<\/p>\n
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B\u1ec7nh nh\u00e2n \u0111\u00e3 xu\u1ea5t hi\u1ec7n vi\u00eam da h\u00ecnh roi do bleomycin, v\u1edbi bi\u1ec3u hi\u1ec7n \u0111\u1eb7c tr\u01b0ng l\u00e0 c\u00e1c v\u1ec7t t\u0103ng s\u1eafc t\u1ed1 g\u00e2y ng\u1ee9a nh\u01b0 b\u1ecb roi \u0111\u00e1nh, xu\u1ea5t hi\u1ec7n ch\u1ee7 y\u1ebfu \u1edf v\u00f9ng th\u00e2n m\u00ecnh v\u00e0 c\u00e1c chi. Bleomycin l\u00e0 thu\u1ed1c ch\u1ed1ng ung th\u01b0 ch\u1ee9a l\u01b0u hu\u1ef3nh, \u1ee9c ch\u1ebf giai \u0111o\u1ea1n G2 c\u1ee7a chu k\u00ec t\u1ebf b\u00e0o th\u00f4ng qua \u1ee9c ch\u1ebf t\u00edch h\u1ee3p thymidine v\u00e0o DNA \u0111ang t\u00e1i b\u1ea3n gi\u00e1ng ho\u00e1 c\u00e1c chu\u1ed7i DNA \u0111\u01a1n v\u00e0 k\u00e9p, v\u00e0 ph\u00e2n c\u1eaft RNA t\u1ebf b\u00e0o [1]. Bleomycin ph\u00e2n ph\u1ed1i r\u1ed9ng kh\u1eafp trong c\u01a1 th\u1ec3 v\u00e0 b\u1ecb b\u1ea5t ho\u1ea1t \u1edf t\u1ea5t c\u1ea3 c\u00e1c c\u01a1 quan tr\u1eeb da v\u00e0 ph\u1ed5i do \u1edf \u0111\u00e2y kh\u00f4ng c\u00f3 c\u00e1c enzyme hydrolase c\u00f3 vai tr\u00f2 chuy\u1ec3n ho\u00e1 thu\u1ed1c [2]. Kh\u00f4ng c\u00f3 enzyme n\u00ean thu\u1ed1c b\u1ecb t\u00edch lu\u1ef9, t\u1eeb \u0111\u00f3 c\u00f3 th\u1ec3 d\u1eabn t\u1edbi x\u01a1 ph\u1ed5i v\u00e0 c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n kh\u00e1c nhau tr\u00ean da li\u00ean quan \u0111\u1ebfn bleomycin [1].<\/p>\n
Vi\u00eam da h\u00ecnh roi l\u00e0 ch\u1ea9n \u0111o\u00e1n ch\u1ee7 y\u1ebfu d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng v\u00ec kh\u00f4ng c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m m\u00f4 h\u1ecdc \u0111\u1eb7c hi\u1ec7u cho b\u1ec7nh. C\u00e1c tri\u1ec7u ch\u1ee9ng m\u00f4 h\u1ecdc s\u1edbm ph\u00f9 h\u1ee3p v\u1edbi ph\u1ea3n \u1ee9ng do thu\u1ed1c, v\u00e0 \u1edf c\u00e1c giai \u0111o\u1ea1n mu\u1ed9n h\u01a1n ph\u1ea3n \u00e1nh t\u00ecnh tr\u1ea1ng ph\u1ea3n \u1ee9ng h\u1eadu vi\u00eam [3]. Th\u1eddi \u0111i\u1ec3m kh\u1edfi ph\u00e1t r\u1ea5t thay \u0111\u1ed5i, di\u1ec5n ra trong v\u00f2ng t\u1eeb v\u00e0i gi\u1edd \u0111\u1ebfn 9 tu\u1ea7n sau d\u00f9ng thu\u1ed1c, t\u1ea7n su\u1ea5t m\u1eafc m\u1edbi vi\u00eam da h\u00ecnh roi do bleomycin \u0111\u01b0\u1ee3c ghi nh\u1eadn trong kho\u1ea3ng 8 \u0111\u1ebfn 22% [4]. C\u00e1c tri\u1ec7u ch\u1ee9ng n\u00f3i chung c\u00f3 th\u1ec3 ki\u1ec3m so\u00e1t t\u1ed1t b\u1eb1ng c\u00e1c thu\u1ed1c kh\u00e1ng histamine, corticosteroid v\u00e0 ng\u1eebng bleomycin. C\u00e1c m\u00f4 t\u1ea3 ban \u0111\u1ea7u v\u1ec1 vi\u00eam da h\u00ecnh roi do bleomycin ghi nh\u1eadn \u1edf 8 \u0111\u1ebfn 66% b\u1ec7nh nh\u00e2n c\u00f3 t\u1ec9 l\u1ec7 m\u1eafc d\u01b0\u1eddng nh\u01b0 ph\u1ee5 thu\u1ed9c li\u1ec1u; tuy nhi\u00ean khi \u0111\u00f3 c\u0169ng ghi nh\u1eadn r\u1eb1ng v\u1edbi bleomycin li\u1ec1u th\u1ea5p kho\u1ea3ng 5 mg \u0111\u00e3 xu\u1ea5t hi\u1ec7n ban d\u1ea1ng roi m\u00e0 kh\u00f4ng c\u00f3 \u0111\u1eb7c \u0111i\u1ec3m d\u1ef1 b\u00e1o n\u00e0o [2-4]. Ng\u01b0\u1ee3c l\u1ea1i, khi ph\u00e2n t\u00edch g\u1ed9p Ziemer v\u00e0 c\u1ed9ng s\u1ef1 [4] \u0111\u00e3 quan s\u00e1t th\u1ea5y c\u00e1c b\u1ec7nh nh\u00e2n n\u1eef d\u00f9ng bleomycin \u0111\u1eb7c hi\u1ec7u trong tr\u01b0\u1eddng h\u1ee3p r\u1ed1i lo\u1ea1n sinh lympho b\u00e0o r\u1ea5t c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng nh\u1ea5t xu\u1ea5t hi\u1ec7n vi\u00eam da h\u00ecnh roi kh\u1edfi ph\u00e1t c\u1ea5p t\u00ednh \u1edf li\u1ec1u th\u1ea5p.<\/p>\n
B\u1ec7nh nh\u00e2n n\u00e0y ban \u0111\u1ea7u ng\u1eebng 1 \u0111\u1ee3t bleomycin, nh\u01b0ng khi d\u00f9ng l\u1ea1i bleomycin k\u00e8m theo steroid b\u1ed5 tr\u1ee3 l\u1ea1i dung n\u1ea1p t\u1ed1t. B\u1ec7nh nh\u00e2n \u0111\u1ea1t lui b\u1ec7nh sau h\u01a1n 2 n\u0103m k\u1ebft th\u00fac ho\u00e1 tr\u1ecb v\u00e0 kh\u00f4ng c\u00f3 bi\u1ec3u hi\u1ec7n t\u00e1c d\u1ee5ng \u0111\u1ed9c t\u00ednh c\u1ee7a bleomycin \u1edf ph\u1ed5i. Cho t\u1edbi nay v\u1eabn ch\u01b0a c\u00f3 h\u01b0\u1edbng d\u1eabn ch\u1eafc ch\u1eafn n\u00e0o v\u1ec1 vi\u1ec7c li\u1ec7u ng\u1eebng h\u1eb3n hay d\u00f9ng l\u1ea1i bleomycin sau ph\u00e1t ban vi\u00eam da h\u00ecnh roi. Th\u1eed nghi\u1ec7m RATHL (\u0110i\u1ec1u tr\u1ecb u lympho Hodgkin ti\u1ebfn tri\u1ec3n c\u00f3 hi\u1ec7u ch\u1ec9nh theo \u0111\u00e1p \u1ee9ng b\u1ec7nh nh\u00e2n) ph\u00e2n ng\u1eabu nhi\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng \u00e2m t\u00ednh khi ch\u1ee5p PET sau 2 \u0111\u1ee3t ABVD v\u00e0o nh\u00f3m ho\u1eb7c d\u00f9ng ti\u1ebfp ABVD ho\u1eb7c xu\u1ed1ng thang th\u00e0nh AVD (adriamycin, vinblastine, and dacarbazine) [5]. \u0110\u1ed9 ch\u00eanh l\u1ec7ch tuy\u1ec7t \u0111\u1ed1i v\u1ec1 t\u1ec9 l\u1ec7 s\u1ed1ng s\u00f3t kh\u00f4ng t\u00e1i ph\u00e1t sau 3 n\u0103m gi\u1eefa 2 nh\u00f3m l\u00e0 1,6% (kho\u1ea3ng tin c\u1eady 95% l\u00e0 \u22123.2% \u0111\u1ebfn 5.3%) v\u00e0 t\u1ea7n su\u1ea5t m\u1eafc m\u1edbi v\u1ec1 \u0111\u1ed9c t\u00ednh ph\u1ed5i th\u1ea5p h\u01a1n h\u1eb3n khi kh\u00f4ng d\u00f9ng bleomycin [5]. M\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng l\u1edbn pha 3 kh\u00e1c (ECHELON-1) [6] so s\u00e1nh gi\u1eefa 2 nh\u00f3m brentuximab vedotin ph\u1ed1i h\u1ee3p AVD (A+AVD) v\u1edbi ph\u00e1c \u0111\u1ed3 ABVD chu\u1ea9n \u1edf qu\u1ea7n th\u1ec3 b\u1ec7nh nh\u00e2n u lympho Hodgkin giai \u0111o\u1ea1n III ho\u1eb7c IV ch\u01b0a \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3. Brentuximab vedotin ph\u1ed1i h\u1ee3p AVD th\u1ec3 hi\u1ec7n s\u1ef1 v\u01b0\u1ee3t tr\u1ed9i, v\u1edbi t\u1ec9 l\u1ec7 nguy c\u01a1 ung th\u01b0 ti\u1ebfn tri\u1ec3n, g\u00e2y t\u1eed vong ho\u1eb7c \u0111\u00e1p \u1ee9ng kh\u00f4ng ho\u00e0n to\u00e0n sau 2 n\u0103m gi\u1ea3m 4,9%, trong khi \u0111\u1ed9c t\u00ednh tr\u00ean ph\u1ed5i l\u00e0 d\u01b0\u1edbi 1% so v\u1edbi t\u1ec9 l\u1ec7 3% \u1edf nh\u00f3m ABVD [6]. M\u1eb7c d\u00f9 c\u00e1c nghi\u00ean c\u1ee9u n\u00e0y kh\u00f4ng h\u01b0\u1edbng \u0111\u1ebfn \u0111\u00edch x\u00e1c vi\u00eam da h\u00ecnh roi, c\u00e1c d\u1eef li\u1ec7u n\u00e0y g\u1ee3i \u00fd r\u1eb1ng c\u00f3 th\u1ec3 c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb chu\u1ea9n theo h\u01b0\u1edbng r\u00fat d\u1ea7n bleomycin \u1edf b\u1ec7nh nh\u00e2n b\u1ecb bi\u1ebfn ch\u1ee9ng do \u0111\u1ed9c t\u00ednh c\u1ee7a thu\u1ed1c, nh\u1ea5t l\u00e0 khi ban \u0111\u1ea7u h\u1ecd bi\u1ec3u hi\u1ec7n c\u00f3 \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng thu\u1eadn l\u1ee3i v\u1edbi thu\u1ed1c.<\/p>\n
C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 tr\u00ean da n\u00f3i chung l\u00e0 ph\u1ea3n \u1ee9ng hay g\u1eb7p trong \u0111i\u1ec1u tr\u1ecb ho\u00e1 ch\u1ea5t, v\u00e0 bleomycin th\u00ec li\u00ean quan \u0111\u1ebfn r\u1ea5t nhi\u1ec1u bi\u1ec3u hi\u1ec7n ph\u1ea3n \u1ee9ng tr\u00ean da, bao g\u1ed3m n\u1ed1t d\u1ea1ng vi\u00eam, m\u1ea3ng, b\u1ecdng n\u01b0\u1edbc, thay \u0111\u1ed5i v\u1ec1 m\u00f3ng v\u00e0 r\u1ee5ng t\u00f3c [3]. Tuy nhi\u00ean, vi\u00eam da h\u00ecnh roi \u0111\u01b0\u1ee3c xem l\u00e0 bi\u1ec3u hi\u1ec7n kinh \u0111i\u1ec3n c\u1ee7a \u0111\u1ed9c t\u00ednh do bleomycin [4]. B\u1ec7nh da c\u1eadn ung th\u01b0 do u lympho Hodgkin c\u0169ng \u0111\u01b0\u1ee3c ghi l\u1ea1i trong y v\u0103n nh\u01b0ng \u0111i\u1ec3n h\u00ecnh c\u00f3 xu\u1ea5t hi\u1ec7n ng\u1ee9a nhi\u1ec1u c\u00f3 ho\u1eb7c kh\u00f4ng k\u00e8m theo n\u1ed1t ng\u1ee9a, kh\u00f4 da \u0111\u00f3ng v\u1ea3y m\u1eafc ph\u1ea3i, r\u1ee5ng t\u00f3c ho\u1eb7c c\u00e1c lo\u1ea1i ban kh\u00e1c kh\u00f4ng ph\u1ea3n \u00e1nh t\u00ecnh tr\u1ea1ng ung th\u01b0 x\u00e2m l\u1ea5n. Hi\u1ebfm g\u1eb7p h\u01a1n l\u00e0 s\u1ef1 lan tr\u00e0n c\u00e1c t\u1ebf b\u00e0o \u00e1c t\u00ednh c\u00f3 th\u1ec3 g\u00e2y ra nhi\u1ec1u thay \u0111\u1ed5i da h\u01a1n, \u0111i\u1ec3n h\u00ecnh l\u00e0 c\u00e1c ch\u1ea5m kh\u00f4ng \u0111au, n\u1ed1t, m\u1ea3ng v\u00e0 lo\u00e9t, c\u00e1c thay \u0111\u1ed5i n\u00e0y v\u1ec1 m\u00f4 b\u1ec7nh h\u1ecdc t\u01b0\u01a1ng t\u1ef1 nh\u01b0 \u1edf c\u00e1c h\u1ea1ch b\u1ecb di c\u0103n v\u00e0 n\u00f3i chung ti\u00ean l\u01b0\u1ee3ng x\u1ea5u [7,8]. Ban \u0111a h\u00ecnh do thai k\u00ec c\u0169ng c\u00f3 th\u1ec3 l\u00e0 ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t cho tr\u01b0\u1eddng h\u1ee3p n\u00e0y v\u00ec xu\u1ea5t hi\u1ec7n ngay sau khi mang thai; tuy nhi\u00ean \u0111\u1eb7c \u0111i\u1ec3m \u0111\u1eb7c tr\u01b0ng l\u00e0 c\u00e1c ch\u1ea5m v\u00e0 m\u1ea3ng ng\u1ee9a r\u1ea5t kh\u00e1c nhau [9].<\/p>\n
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1. Yamamoto T. Bleomycin and the skin. Br J Dermatol. 2006;155(5):869-875. doi:10.1111\/j.1365-2133.2006.07474.x<\/p>\n
2. Mowad CM, Nguyen TV, Elenitsas R, Leyden JJ. Bleomycin-induced flagellate dermatitis: a clinical and histopathological review. Br J Dermatol. 1994;131(5):700-702. doi:10.1111\/j.1365-2133.1994.tb04986.x<\/p>\n
3. Vuerstaek JD, Frank J, Poblete-Guti\u00e9rrez P. Bleomycin-induced flagellate dermatitis. Int J Dermatol. 2007;46(suppl 3):3-5. doi:10.1111\/j.1365-4632.2007.03499.x<\/p>\n
4. Ziemer M, Goetze S, Juhasz K, Elsner P. Flagellate dermatitis as a bleomycin-specific adverse effect of cytostatic therapy: a clinical-histopathologic correlation. Am J Clin Dermatol. 2011;12(1):68-76. doi:10.2165\/11537080-000000000-00000<\/p>\n
5. Johnson P, Federico M, Kirkwood A, et al. Adapted treatment guided by interim PET-CT scan in advanced Hodgkin\u2019s lymphoma. N Engl J Med. 2016;374(25):2419-2429. doi:10.1056\/NEJMoa1510093<\/p>\n
6. Connors JM, Jurczak W, Straus DJ, et al; ECHELON-1 Study Group. Brentuximab vedotin with chemotherapy for stage III or IV Hodgkin\u2019s lymphoma. N Engl J Med. 2018;378(4):331-344. doi:10.1056\/NEJMoa1708984<\/p>\n
7. Introcaso CE, Kantor J, Porter DL, Junkins-Hopkins JM. Cutaneous Hodgkin\u2019s disease. J Am Acad Dermatol. 2008;58(2):295-298. doi:10.1016\/j.jaad.2005.11.1055<\/p>\n
8. Silverman CL, Strayer DS, Wasserman TH. Cutaneous Hodgkin\u2019s disease. Arch Dermatol. 1982;118(11):918-921. doi:10.1001\/archderm.1982.01650230046026<\/p>\n
9. Taylor D, Pappo E, Aronson IK. Polymorphic eruption of pregnancy. Clin Dermatol. 2016;34(3):383-391. doi:10.1016\/j.clindermatol.2016.02.011<\/p>\n
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Clayton Jackson; Lindsey Strowd; Zanetta Lamar \u0110\u0103ng tr\u00ean JAMA ng\u00e0y 7\/2\/2019. B\u1ec7nh nh\u00e2n n\u1eef 31 tu\u1ed5i, PARA 1001, ti\u1ec1n s\u1eed m\u1eafc h\u1ed9i ch\u1ee9ng Wolff-Parkinson-White, m\u1edbi \u0111\u00e2y \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n u lympho Hodgkin giai \u0111o\u1ea1n II, \u0111\u1ee3t n\u00e0y xu\u1ea5t hi\u1ec7n ban ng\u1ee9a. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n u lympho Hodgkin khi mang thai 35 tu\u1ea7n, v\u00e0 […]\n","protected":false},"author":1,"featured_media":4099,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-4098","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/4098","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=4098"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/4098\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/4099"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=4098"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=4098"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=4098"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}