A Cross-Sectional Survey of Fixed-Dose Combination Antihypertensive Medicine Prescribing in Twenty-Four Countries, Including Qualitative Insights.

Background: Treatment inertia, non-adherence and non-persistence to medical treatment contribute to poor blood pressure (BP) control worldwide. Fixed dose combination (FDC) antihypertensive medicines simplify prescribing patterns and improve adherence. The aim of this study was to identify factors associated with prescribing FDC antihypertensive medicines and to understand if these factors differ among doctors worldwide. Methods: A cross-sectional survey was conducted online from June 2023 to January 2024 to recruit doctors. We collaborated with an international network of researchers and clinicians identified through institutional connections. A passive snowballing recruitment strategy was employed, where network members forwarded the survey link to their clinical colleagues. The survey instrument, developed through a literature review, interviews with academic and clinical researchers, and pilot testing, assessed participants perspectives on prescribing FDC antihypertensive medicines for hypertension. Participants rated their level of agreement (5-point Likert scale) with statements representing six barriers and four facilitators to FDC use. Findings: Data from 191 surveys were available for analysis. 25% (n = 47) of participants worked in high-income countries, 38% (n = 73) in upper-middle income, 25% (n = 48) in lower-middle income, 6% (n = 10) in low-income countries. Forty percent (n = 70) of participants were between 36-45 years of age; two thirds were male. Cost was reported as a barrier to prescribing FDC antihypertensive medicines [51% (n = 87) agreeing or strongly agreeing], followed by doctors' confidence in BP measured in clinic [40%, (n = 70)], access [37%, (n = 67)], appointment duration [35%, (n = 61)], concerns about side-effects [(21%, n = 37)], and non-adherence [12%, (n = 21)]. Facilitators to FDC antihypertensive polypills prescribing were clinician facing, such as access to educational supports [79%, (n = 143)], more BP measurement data [67%, (n = 120)], a clinical nudge in health records [61%, (n = 109)] and patient-facing including improved patient health literacy [49%, (n = 88)]. The levels of agreement and strong agreement across all barriers and facilitators were similar for participants working in higher or lower income countries. Across all countries, participants rated FDC antihypertensive medications highly valuable for managing patients with non-adherence, (82% reported high or very high value), for patients with high pill burden (80%). Interpretation: Cost and access were the most common barriers to prescribing FDCs across high- and low-income countries. While greater educational support for clinicians was perceived as the leading potential facilitator of FDC use, this seems unlikely to be effective without addressing access.

The prescription of beta-blockers in older patients with heart failure with reduced ejection fraction: an observational study in Vietnam.

This study in older hospitalized patients with heart failure with reduced ejection fraction (HFrEF) aimed to examine the prevalence of beta-blocker prescription and its associated factors. A total of 190 participants were recruited from July 2019 to July 2020. The inclusion criteria included: (1) aged ≥ 60 years, (2) having a diagnosis of chronic HFrEF in the medical records, (3) hospitalized for at least 48 h. The participants had a mean age of 75.5 ± 9.1, and 46.8% were female. Of these, 55.3% were prescribed beta-blockers during admission. To explore the factors associated with beta-blocker prescription, multivariable logistic regression analysis was applied and the results were presented as odds ratios (OR) and 95% confidence intervals (CI). On multivariate logistic regression models, higher NYHA classes (OR 0.49, 95%CI 0.26-0.94), chronic obstructive pulmonary disease (OR 0.17, 95% CI 0.04-0.85), chronic kidney disease (OR 0.40, 95% CI 0.19-0.83), and heart rate under 65 (OR 0.34, 95% CI 0.12-0.98) were associated with a reduced likelihood of prescription. In this study, we found a low rate of beta-blocker prescriptions, with only around half of the participants being prescribed beta-blockers. Further studies are needed to examine the reasons for the under-prescription of beta-blockers, and to evaluate the long-term benefits of beta-blockers in elderly patients with HFrEF in this population.

On the taxonomic status of three enigmatic Indochinese frog species (Amphibia: Anura) described by L. G. Andersson.

In the first half of the 20th century, four Swedish expeditions to Indochina contributed significantly to the knowledge on the herpetofauna of mainland Southeast Asia. The collected material was examined by L. G. Andersson in Stockholm, resulting in the description of seven new species and forms of amphibians and reptiles from Vietnam and Thailand. However, the taxonomic status of three enigmatic frog species described by Andersson, namely Rana scutigera, Oxyglossus laevis var. vittata, and Microhyla fusca, remained doubtful. All three taxa are only known from their type specimens and their short original descriptions. Though subsequent studies have doubted their validity or systematic assignment, they have been treated as valid species until today. We have examined the external morphology and coloration of the type specimens, what led to a taxonomic reallocation of these three species. We demonstrate that Rana scutigera Andersson, 1916 is a junior synonym of Polypedates megacephalus Hallowell, 1861, Oxyglossus laevis var. vittata Andersson, 1942 is synonymized with Occidozyga martensii (Peters, 1967), and Microhyla fusca Andersson, 1942 represents a junior synonym of Microhyla butleri Boulenger, 1900.

A preliminary study to identify the likely risk for sarcopenia in older hospitalised patients with cardiovascular disease in Vietnam.

OBJECTIVE: To investigate the prevalence of sarcopenia, its associated factors and its impact on readmission in older hospitalised patients with cardiovascular diseases (CVD) in Vietnam. METHODS: Patients aged ≥60 with CVD were recruited from 12/2018 to 6/2019 at a tertiary hospital in Vietnam. Sarcopenia was defined by the criteria proposed by the Asian Working Group for Sarcopenia (AWGS). RESULTS: There were 251 participants, with a mean age of 73.7 ± 8.8, 39.4% were female, and 34.3% had sarcopenia. On multivariable logistic regression, heart failure, chronic kidney disease and being currently unmarried were significantly associated with sarcopenia. The incidence of 5-month readmission was 35.7% (50.0% in sarcopenic participants and 27.9% in non-sarcopenic participants, P = .001). Sarcopenia independently increased the risk of readmission (adjusted OR 2.19, 95% CI 1.08-4.42). CONCLUSION: Sarcopenia was present in one-third of older hospitalised patients with CVD and increased their risk of readmission. This finding suggests the need to raise awareness of sarcopenia among clinicians and older patients in Vietnam.

A new species of Opisthotropis from northern Vietnam previously misidentified as the Yellow-spotted Mountain Stream Keelback O. maculosa Stuart amp; Chuaynkern, 2007 (Squamata: Natricidae).

The Yellow-spotted Mountain Stream Keelback Opisthotropis maculosa was originally described based on a single male specimen from northeastern Thailand. Recently, based on morphological data, new records of this species were published initially from southern China and subsequently from northern Vietnam. In this study, we provide the first molecular comparisons between the holotype and other populations in China and Vietnam using the mitochondrial cytochrome b gene and use an integrative taxonomic approach to show that the population from Vietnam represents a distinct taxon. Opisthotropis haihaensis sp. nov. is characterized by a combination of the following characters: internasal not in contact with loreal; prefrontal not touching supraocular; frontal touching preocular; one preocular; one postocular; one anterior temporal; one posterior temporal; eight supralabials, fourth and fifth in contact with eye; 24 maxillary teeth; anterior pair of chin shields longer than posterior pair; 169 ventrals + 2 preventrals); 79 subcaudals, paired; 15 dorsal scale rows at neck, at midbody and before vent; body and tail scales smooth; chin shields yellow with brownish black mottling; body and tail dorsum dark with each a light spot per scale. Phylogenetically, the new species is supported as the sister taxon to "O. maculosa" from China (but separated by approximately 10% uncorrected pairwise sequence divergence) and is distantly related to O. maculosa sensu stricto from Thailand, warranting a taxonomic revision of the maculosa-like species. According to our results, O. maculosa should be delisted from the herpetofauna of Vietnam, which currently consists of nine Opisthotropis species. Five species, O. cucae, O. daovantieni, O. haihaensis, O. tamdaoensis, and O. voquyi, are endemic to the country.

Neurosurgical Oncology in Vietnam.

BACKGROUND: In conjunction with Vietnam's unparalleled economic growth over the past 20 years, our scope of neurosurgical interventions has considerably diversified throughout this time period. METHODS: Although still appreciably limited, healthcare resources and infrastructure have expanded and shifted the focus within neurosurgery at Ho Chi Minh City's Cho Ray Hospital from head trauma (which remains highly prevalent) to an equal proportion of elective cases for vascular lesions, tumors, and degenerative spine disease. Arguably the most significant progress throughout the new millennium has been achieved in the realm of neurosurgical oncology. RESULTS: About 1000 craniotomies are performed annually for brain tumors at our institution, most of which are for lower-grade lesions that result in excellent surgical outcomes. We continue to strive to improve the standard of care for patients with malignant brain tumors, as the first multidisciplinary neuro-oncology care team was founded recently in 2016. CONCLUSIONS: This article is the first in the English neurosurgical literature to report on the current state and outcomes of neuro-oncology in Vietnam, as we highlight our experiences in caring for patients with brain tumors at Cho Ray Hospital.