Mpox was diagnosed in 2 women returning to Vietnam from the United Arab Emirates. The monkeypox viruses belonged to an emerging sublineage, A.2.1, distinct from B.1, which is responsible for the ...ongoing multicountry outbreak. Women could contribute to mpox transmission, and enhanced genomic surveillance is needed to clarify pathogen evolution.
Background. The optimal time to initiate antiretroviral therapy (ART) in human immunodeficiency virus (HIV)—associated tuberculous meningitis is unknown. Methods. We conducted a randomized, ...double-blind, placebo-controlled trial of immediate versus deferred ART in patients with HIV-associated tuberculous meningitis to determine whether immediate ART reduced the risk of death. Antiretroviral drugs (zidovudine, lamivudine, and efavirenz) were started either at study entry or 2 months after randomization. All patients were treated with standard antituberculosis treatment, adjunctive dexamethasone, and prophylactic co-trimoxazole and were followed up for 12 months. We conducted intention-to-treat, perprotocol, and prespecified subgroup analyses. Results. A total of 253 patients were randomized, 127 in the immediate ART group and 126 in the deferred ART group; 76 and 70 patients died within 9 months in the immediate and deferred ART groups, respectively. Immediate ART was not significantly associated with 9-month mortality (hazard ratio HR, 1.12; 95% confidence interval CI,.81-1.55; P = .50) or the time to new AIDS events or death (HR, 1.16; 95% CI,.87-1.55; P = .31). The percentage of patients with severe (grade 3 or 4) adverse events was high in both arms (90% in the immediate ART group and 89% in the deferred ART group; P = .84), but there were significantly more grade 4 adverse events in the immediate ART arm (102 in the immediate ART group vs 87 in the deferred ART group; P = .04). Conclusions. Immediate ART initiation does not improve outcome in patients presenting with HIV-associated tuberculous meningitis. There were significantly more grade 4 adverse events in the immediate ART arm, supporting delayed initiation of ART in HIV-associated tuberculous meningitis.
Even with antituberculosis therapy, tuberculous meningitis causes death or severe disability in more than half of affected adults. In this double-blind, placebo-controlled trial, conducted in ...Vietnam, dexamethasone treatment was associated with a reduced risk of death as compared with placebo (31.8 percent vs. 41.3 percent).
Dexamethasone treatment was associated with a reduced risk of death but the proportion of survivors with severe disability is not reduced.
Tuberculous meningitis is the severest form of infection with
Mycobacterium tuberculosis,
causing death or severe neurologic deficits in more than half of those affected in spite of antituberculosis chemotherapy.
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Attenuation of the inflammatory response in bacterial and mycobacterial meningitis may improve outcome by reducing the likelihood or severity of neurologic complications. Early studies suggested that corticosteroids reduced cerebrospinal fluid inflammation and time to recovery in patients with tuberculous meningitis, but the studies were too small to confirm any effect on survival.
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7
Concern remained that corticosteroids might reduce the case fatality rate but increase the number of disabled patients. . . .
Background.Tuberculous meningitis occurs more commonly in human immunodeficiency virus (HIV)–infected individuals than in HIV-uninfected individuals, but whether HIV infection alters the presentation ...and outcome of tuberculous meningitis is unknown MethodsWe performed a prospective comparison of the presenting clinical features and response to treatment in 528 adults treated consecutively for tuberculous meningitis (96 were infected with HIV and 432 were uninfected with HIV) in 2 tertiary-care referral hospitals in Ho Chi Minh City, Vietnam. Logistic regression was used to model variables associated independently with HIV infection, 9-month survival, and the likelihood of having a relapse or an adverse drug event. Kaplan-Meier estimates were used to compare survival rates and times to fever clearance, coma clearance, relapse, and adverse events ResultsHIV infection did not alter the neurological presentation of tuberculous meningitis, although additional extrapulmonary tuberculosis was more likely to occur in HIV-infected patients. The 9-month survival rate was significantly decreased in HIV-infected patients (relative risk of death from any cause, 2.91 95% confidence interval, 2.14–3.96; P<.001), although the times to fever clearance and coma clearance and the number or timing of relapses or adverse drug events were not significantly different between the groups ConclusionsHIV infection does not alter the neurological features of tuberculous meningitis but significantly reduces the survival rate
BackgroundTuberculous meningitis (TBM) caused by Mycobacterium tuberculosis resistant to 1 or more antituberculosis drugs is an increasingly common clinical problem, although the impact on outcome is ...uncertain MethodsWe performed a prospective study of 180 Vietnamese adults admitted consecutively for TBM. M. tuberculosis was cultured from the cerebrospinal fluid (CSF) of all patients and was tested for susceptibility to first-line antituberculosis drugs. Presenting clinical features, time to CSF bacterial clearance, clinical response to treatment, and 9-month morbidity and mortality were compared between adults infected with susceptible and those infected with drug-resistant organisms ResultsOf 180 isolates, 72 (40.0%) were resistant to at least 1 antituberculosis drug, and 10 (5.6%) were resistant to at least isoniazid and rifampicin. Isoniazid and/or streptomycin resistance was associated with slower CSF bacterial clearance but not with any differences in clinical response or outcome. Combined isoniazid and rifampicin resistance was strongly predictive of death (relative risk of death, 11.63 95% confidence interval, 5.21–26.32) and was independently associated with human immunodeficiency virus infection ConclusionsIsoniazid and/or streptomycin resistance probably has no detrimental effect on the outcome of TBM when patients are treated with first-line antituberculosis drugs, but combined isoniazid and rifampicin resistance is strongly predictive of death
Purpose
Recognition that not every climate adaptation policy is a good one has shifted attention to new tools and methods to measure the adequacy and effectiveness of adaptation policies. This study ...aims to propose and apply and applies an innovative adaptation policy assessment framework to identify the extent to which climate adaptation policies in Vietnam exhibit conditions that are likely to ensure a sufficient, credible and effective adaptation.
Design/methodology/approach
In total, 21 conditions, categorized under five normative principles and covering critical issue areas in adaptation domain, form the climate adaptation policy assessment framework. The principles were double-checked and tested in case studies through observations and analyses of policy documents to ensure that each condition should be distinct and not overlapping across principles. To see if the principles and attendant conditions were able to capture all relevant aspects of adaptation, the authors used structured expert judgment. In total, 39 policy documents pertaining to climate change adaptation were selected for qualitative document analysis. In-depth interviews with local officials and experts were conducted to address data gaps.
Findings
The study reveals major weaknesses constituting a reasonably worrisome picture of the adaptation policies in Vietnam since several critical conditions were underrepresented. These results shed new light on why some adaptation policies falter or are posing adverse impacts. The findings suggest that a sound policy assessment framework can provide evidence on what effective adaptation policy looks like and how it can be enabled. The framework for climate adaptation policy assessment in this study can be easily adjusted and used for different socio-environmental contexts in which new conditions for policy assessment might emerge.
Social implications
The findings show underlying weaknesses constituting a reasonably worrisome picture of the adaptation regime in Vietnam. In the absence of mechanisms and measures for accountability and transparency in policy processes, adaptation in Vietnam appears more likely to be prone to maladaptation and corruption. While solving these problems will not be easy for Vietnam, the government needs to evaluate whether the short-term gains in sustaining the existing adaptation policies really make progress and serve its long-term climate-adaptive development goals.
Originality/value
Although interpretations of adaptation effectiveness may be very divergent in different normative views on adaptation outcomes, the authors argue that a common, agreed-upon effectiveness can be reached if it is clearly defined and measurable in adaptation policies. Thus, the climate adaptation policy assessment framework proposed in this study is critical for policymakers, practitioners, donors and stakeholders dealing with adaptation to better understand the weaknesses in policymaking processes, pinpoint priority areas of action and timely prevent or prepare for possible adverse impacts of policies.
Globally, agriculture is both a victim and contributor to anthropogenic global warming. While farmers' climate change perception generally increases, a low-carbon agricultural transition is not ...always an easy choice. There are numerous studies looking at the constraints hampering farmers' adoption of adaptation strategies in climate-prone areas worldwide. The extent to which their assertion applies to farmers in carbon-intensive agricultural areas with less experience of climate change effects, however, is not clear and cannot be assumed given the shared social and cultural specificities of the farming population. This paper seeks to address this gap by scrutinizing critical determinants of farmers' adaptation action in agriculturally rich An Giang province, where climate change impacts are generally less evident. Intense crop cultivation in the province involves the liberal use of fertilizers, crop-residue burning, frequent tilling, and other harmful farming practices that release carbon. Primary data were collected through household surveys (n = 133), field observation, and in-depth interviews (n = 24). A chi-square (χ2) test and a binary logistic regression model was used to analyze the factors influencing farmers' adaptation decisions. The results indicated that farmers' adaptation intent and decisions in the research area were significantly determined by market accessibility, uncertainty/instability of existing crops, and extreme weather conditions. These findings shed new light on approaches that are likely to motivate or hamper farmers' climate-friendly transition in carbon-intensive agricultural hubs. We suggest that adaptive farming initiatives that have the potential to improve marketability and sustainability should be a starting point for mobilizing farmers for a low-carbon farming transition.
The coronavirus disease 2019 (COVID-19) pandemic has caused a lot of ethical controversy in the equal provision of healthcare, including vaccination. Therefore, our study was designed to assess the ...impact of Ho Chi Minh City's policy to hold the second dose of the COVID-19 vaccine. Using a cross-sectional study design to assess low saturation of peripheral oxygen (SPO2) risk based on vaccination status, we included patients who were confirmed to have SARS-CoV-2 and were treated at home. The stepwise method was used to determine participants' low SPO2 risk-related factors. The average age of the 2836 respondents was 46.43 ± 17.33 (years). Research results have shown that seven factors are related to the low SPO2 status of participants, including age, sneezing, shortness of breath, coughing, and fainting as COVID-19 symptoms, the number of people living with COVID-19, and a history of lung disease. A statistically significant (
= 0.032) finding in this study was that fully vaccinated patients had a 6% lower risk of low SPO2 compared to the first dose less than 21 days group. This result was similar in the vaccine holder group (
< 0.001). Holding the second dose of the COVID-19 vaccine is associated with a lower SPO2 risk than that of fully vaccinated patients. Therefore, this approach should be considered by governments as it could bring a greater benefit to the community.
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