Acute kidney injury (AKI) is associated with significant short-term morbidity and mortality. However, its long-term outcomes, particularly in resource-limited settings, remain poorly understood. This study aimed to evaluate 2-year major adverse kidney events (MAKE) in patients with severe AKI. We analyzed data from the India and Southeast Asia Renal Replacement Therapy (InSEA-RRT) registry, a multicenter cohort study conducted between April 2019 and December 2023 across 24 hospitals in Southeast Asia and India. Critically ill patients with AKI stage 3, as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria, were enrolled. The primary outcome was 2-year MAKE, defined as a composite of persistent kidney dysfunction, long-term dialysis, and all-cause mortality at 2 years post-enrollment. A total of 2,315 patients were enrolled, of whom 1,033 (47
Background Vascular pythiosis, caused by Pythium insidiosum, is a life-threatening disease with high mortality rate in patients with residual disease post-surgery. This study evaluated the effectiveness of a combination therapy of surgery, azithromycin, doxycycline, and itraconazole. Methods In this open-label, Phase II multicenter trial, 51 patients were enrolled. Patients were categorized based on residual disease post-surgery (unresectable lesions, incomplete resection, or persistent symptoms). Patients with residual disease received azithromycin (500 mg daily), doxycycline (100 mg twice daily), and itraconazole (200 mg thrice daily) until beta-d-glucan (BDG) levels were negative (< 80 pg/ml) for three months. Those without residual disease received the same regimen for six months. Outcomes included all-cause mortality at six months, adverse events, changes in BDG levels over time, and factors associated with residual disease and mortality. Results At six months, the all-cause mortality rate was 15.7%. Mortality in patients with residual disease was 31.5% compared to 6.25% for those without (p=0.04). Lesions above the popliteal artery were a significant predictor of residual disease (incidence rate ratio [IRR] 3.20, 95% confidence interval [CI] 1.08-11.70). BDG levels decreased over time (odds ratio [OR] 0.82, 95%CI 0.77-0.88 per week, p<0.001), but remained higher in the residual disease group (OR 4.29, 95% CI 1.55-11.92) Conclusions The combination therapy of surgery, azithromycin, doxycycline, and itraconazole improves survival in patients with vascular pythiosis, including those with residual disease. This regimen is well-tolerated and should be considered a standard of care, with further research needed for long-term outcomes.
Objectives: We investigated the effect modification of health literacy (HL) in ameliorating the negative impact of underlying health conditions (UHC) on long COVID among non-hospitalized and hospitalized survivors. Study design: An online cross-sectional study was conducted in Vietnam from December 2021 to October 2022. Methods: A sample of 4507 participants recruited from 18 hospitals and health centers were those aged 18 or older, had contracted COVID-19 for at least 28 days, and were not in the acute phase of reinfection. Participants reported their long COVID symptoms, UHC, health literacy, socio-demographics, clinical parameters, the COVID19 impact battery disability scale, and health-related behaviors. The logistic regression models were used to examine the associations and interactions. Results: Underlying health conditions were associated with a higher likelihood of long COVID in non-hospitalized participants (adjusted odds ratio, aOR = 2.10 [1.61, 2.61]; p < 0.001), and hospitalized ones (aOR = 2.26 [1.87, 2.73]; p < 0.001). In non-hospitalized participants, higher HL scores were significantly linked to a reduced likelihood of experiencing long COVID (aOR = 0.96 [0.95, 0.97]; p < 0.001). Furthermore, HL moderated the adverse effect of underlying health conditions (UHC) on long COVID in this group (aOR = 0.97 [0.94-0.99]; p = 0.042). In hospitalized participants, although higher HL scores were also associated with a lower risk of long COVID (aOR = 0.99 [0.98-0.99]; p = 0.036), HL did not significantly mitigate the negative impact of UHC on long COVID (aOR = 1.01 [0.99-1.03]; p = 0.332). Conclusions: In non-hospitalized individuals, high health literacy ameliorated the negative impact of UHC on long COVID. Such effects of health literacy were not observed in hospitalized COVID-19 survivors.
BackgroundThe COVID-19 pandemic has underscored the significance of adopting healthy lifestyles to mitigate the risk of severe outcomes and long-term consequences. ObjectiveThis study focuses on assessing the prevalence and clustering of 5 unhealthy lifestyle behaviors among Vietnamese adults after recovering from COVID-19, with a specific emphasis on sex differences. MethodsThe cross-sectional data of 5890 survivors of COVID-19 in Vietnam were analyzed from December 2021 to October 2022. To examine the sex differences in 5 unhealthy lifestyle behaviors (smoking, drinking, unhealthy diet, physical inactivity, and sedentary behavior), the percentages were plotted along with their corresponding 95% CI for each behavior. Latent class analysis was used to identify 2 distinct classes of individuals based on the clustering of these behaviors: the “less unhealthy” group and the “more unhealthy” group. We examined the sociodemographic characteristics associated with each identified class and used logistic regression to investigate the factors related to the “more unhealthy” group. ResultsThe majority of individuals (male participants: 2432/2447, 99.4% and female participants: 3411/3443, 99.1%) exhibited at least 1 unhealthy behavior, with male participants being more susceptible to multiple unhealthy behaviors. The male-to-female ratio for having a single behavior was 1.003, but it escalated to 25 for individuals displaying all 5 behaviors. Male participants demonstrated a higher prevalence of combining alcohol intake with sedentary behavior (949/2447, 38.8%) or an unhealthy diet (861/2447, 35.2%), whereas female participants tended to exhibit physical inactivity combined with sedentary behavior (1305/3443, 37.9%) or an unhealthy diet (1260/3443, 36.6%). Married male participants had increased odds of falling into the “more unhealthy” group compared to their single counterparts (odds ratio [OR] 1.45, 95% CI 1.14-1.85), while female participants exhibited lower odds (OR 0.65, 95% CI 0.51-0.83). Female participants who are underweight showed a higher likelihood of belonging to the “more unhealthy” group (OR 1.11, 95% CI 0.89-1.39), but this was not observed among male participants (OR 0.6, 95% CI 0.41-0.89). In both sexes, older age, dependent employment, high education, and obesity were associated with higher odds of being in the “more unhealthy” group. ConclusionsThe study identified notable sex differences in unhealthy lifestyle behaviors among survivors of COVID-19. Male survivors are more likely to engage in unhealthy behaviors compared to female survivors. These findings emphasize the importance of tailored public health interventions targeting sex-specific unhealthy behaviors. Specifically, addressing unhealthy habits is crucial for promoting post–COVID-19 health and well-being.
