Existing Treatment Guidelines Research Articles

Narrative review and call to action on reporting and representation in orthobiologics research for knee osteoarthritis.

Osteoarthritis affects a significant portion of U.S. adults, and knee osteoarthritis contributes to 80% of disease burden. Previous data have shown that non-White patient populations often report worse symptoms and less favorable outcomes following arthroplasty, a definitive treatment for knee osteoarthritis. There is a lack of demographics data on race/ethnicity, as well as socioeconomic status (SES) and social determinants of health (SDOH), in knee osteoarthritis treatment guidelines and knee arthroplasty research. In addition, there is underrepresentation of non-White patient populations in the existing treatment guidelines for knee osteoarthritis. Over the past decade, orthobiologics have emerged as an alternative to surgical intervention. Our hypothesis is that there would be a similar lack of reporting of demographics data and underrepresentation of non-White populations in studies pertaining to orthobiologics, including evaluating differences in outcomes. This study reviewed U.S.-based research in orthobiologics as a treatment option for knee osteoarthritis. We identified a lack of demographics reporting in terms of race/ethnicity, and none of the studies reported SES or SDOH. Non-White populations were underrepresented; White patients contributed to 80% or more of all study populations that reported race/ethnicity. None studied the correlation between symptoms and outcome measures, and the race/ethnicity, SES, and SDOH of the patients. Based on a review of existing literature, we strongly advocate for ongoing research encompassing patients of all races/ethnicities, SES, and SDOH, and an exploration into potential variations in symptoms and outcomes among distinct population subgroups. Furthermore, SES barriers may influence health care delivery on orthobiologics for disadvantaged populations.

Biologics in Focus: A Comprehensive Review of the Current Biological Therapies for Ulcerative Colitis in the United Arab Emirates (UAE)

Background: Ulcerative colitis (UC) is a relapsing–remitting inflammatory condition that has an increasing incidence across the world, including in the Middle East. Biological monoclonal antibody drugs (biologics) have been shown to be advantageous in treating UC. We undertook a review of the currently available biological and small-molecule therapies, with a particular emphasis on those currently licensed in the United Arab Emirates (UAE). Methods: We conducted a literature search for studies on biological therapies using the PubMed, MEDLINE, and Embase databases using a list of keywords that were generated following referral to existing treatment guidelines for UC. Papers looking at biological and small-molecule treatments for UC in adult populations were included. Pediatric, pregnancy, and cost-effectiveness studies were excluded. Results and Discussion: There are currently three classes of biologics (anti-tumor necrosis factors (anti-TNFs), anti-integrins, and anti-interleukins) and one class of small-molecule therapy (Janus kinase (JAK) inhibitor) licensed for UC treatment in the UAE. Within the anti-TNF class, three medications have been approved: infliximab, adalimumab, and golimumab. For JAK inhibitors, there are two: tofacitinib and upadacitinib. There is only one licensed medication in the remaining classes: vedolizumab (anti-integrin) and ustekinumab (anti-interleukin). The length of studies varied from 6–8 weeks for induction studies and 52 weeks for maintenance studies. The studies demonstrated increased efficacy in these medications compared to placebos when clinical response, clinical remission, and other secondary measures such as mucosal healing were assessed following the induction and maintenance phases. Biosimilars of infliximab and adalimumab are also available for treating UC, and their safety and efficacy were compared to their biologic originators. Conclusions: The introduction of biologics has been proven to be beneficial for the treatment of UC. This review summarizes the efficacy and safety of each biological class in the treatment of the disease; however, biological drug registries and further studies are required to offer more insight into the comparative efficacy and safety of these agents.

Integrated treatment for comorbid eating disorders and substance use disorders: a scoping review protocol.

This review will identify and summarize the literature on the integrated treatment of comorbid eating disorders and substance use disorders, focusing on clinical practice guidelines and treatment studies. Eating disorders and substance use disorders are the deadliest psychiatric conditions, frequently co-occur, and are linked to greater symptom severity and poorer treatment outcomes. Despite repeated calls for their integrated treatment, such an approach has rarely been empirically evaluated. To advance the development of integrated treatments for comorbid eating disorders and substance use disorders, a critical first step is to describe existing treatment guidelines and summarize research evidence for this approach. This review will consider all peer-reviewed and gray literature describing the integrated treatment of comorbid eating disorders and substance use disorders, focusing on i) clinical practice guidelines; and ii) treatment studies. We will not place limitations on populations, types of eating disorders, types of substance use disorders, or other contextual factors. Databases to be searched will include MEDLINE (Ovid), Embase, CINAHL (EBSCOhost), PsycINFO (EBSCOhost), Scopus, and clinical practice guidelines databases identified by CADTH Grey Matters. No date or language limits will be applied to the search. At the screening stage, we will only consider literature in English or French. Two independent reviewers will screen studies at the title/abstract and full-text levels, and extract relevant studies. Disagreements will be resolved through discussion. Findings will be presented in tabular format and a narrative summary. Open Science Framework https://osf.io/za35j/.

A case of exogenous lipoid pneumonia: Diesel aspiration pneumonitis

Exogenous lipoid pneumonia including diesel aspiration pneumonia is a challenging scenario for the physician view varied clinical presentation and no existing treatment guidelines. Clinico-radiological profiling remains the key toward early diagnosis of the condition. We present a case of a 32-year-old car mechanic presenting post accidental aspiration of diesel vehicle while siphoning air from the fuel pipe, a common practice in Indian subcontinent; highlighting the clinical and radiological presentation and therapeutic outcomes of corticosteroids in this case. The case reemphasizes the role of good clinical history, efficient physical examination, early management, and specific radiological evaluation toward management of this entity.

Hipertensión arterial en la enfermedad renal crónica

Chronic kidney disease (CKD) is increasingly prevalent worldwide, and it is associated with cardiovascular disease (CVD). Hypertension (HT) is therefore a cause as well as a consequence of CKD, and it affects the great majority of patients with CKD. It is highly important to control HT in individuals with CKD, as this slows down the progression of the disease and also reduces the risk of CVD. Existing treatment guidelines do not agree on the optimum target figures for blood pressure (BP) in this population. It is therefore crucially important to understand the mechanisms which contribute to the appearance of this pathology, to indicate the most suitable treatment to control it appropriately. Although non-pharmaceutical interventions are useful for reducing BP in CKD, they are rarely enough to achieve sufficient control of BP. Patients with CKD and HT often require a combination of antihypertensive drugs to achieve their target BP. Some pharmacological therapies have an action which protects the kidneys and/or the heart independently of their effect on BP, and this should be taken into account when prescribing a therapy. It is important to underline that a personalized and evidence-based management plan is still the key to achieve BP targets, reducing the risk of CVD and slowing down the progress of CKD.

Substance use severity as a predictor for receiving medication for opioid use disorder among adolescents: An analysis of the 2019 TEDS

BackgroundMedication for opioid use disorder (MOUD) is vastly underutilized in adolescents. Existing treatment guidelines for OUD largely focus on adults, providing limited guidance for pediatric populations. Limited information is known about use of MOUD in adolescents based on substance use severity. MethodsThis secondary data analysis examined how patient-level variables influenced the receipt of MOUD in adolescents aged 12–17 (n = 1866) using the Treatment Episode Data Set (TEDS) 2019 Discharge data set. A crosstabulation and chi-square statistic evaluated the relationship between a proxy for clinical need based on high-risk opioid use (either reporting daily opioid use within the past 30 days and/or history of injection opioid use) for MOUD in states with and without adolescents receiving MOUD (n = 1071). A two-step logistic regression analysis in states with any adolescents receiving MOUD examined the explanatory power of demographic, treatment intake, and substance use characteristics. ResultsCompletion of 12th grade, a GED, or beyond, decreased the likelihood of receiving MOUD (odds ratio [OR]= 0.38, p = 0.017), as did being female (OR = 0.47, p = .006). None of the remaining clinical criteria were significantly associated with MOUD, although a history of one or more arrests increased the likelihood of MOUD (OR = 6.98, p = 0.06). Only 13% of individuals who met criteria for clinical need received MOUD. ConclusionsLower education could serve as a proxy for substance use severity. Guidelines and best practices are needed to ensure the proper distribution of MOUD to adolescents based on clinical need.

Modified prolonged exposure therapy as Early Intervention after Rape (The EIR-study): study protocol for a multicenter randomized add-on superiority trial

BackgroundSexual assault and rape are the traumatic life events with the highest probability for posttraumatic stress disorder (PTSD), which can have devastating consequences for those afflicted by the condition. Studies indicate that modified prolonged exposure (mPE) therapy may be effective in preventing the development of PTSD in recently traumatized individuals, and especially for people who have experienced sexual assault. If a brief, manualized early intervention can prevent or reduce post-traumatic symptoms in women who have recently experienced rape, healthcare services targeted for these populations (i.e., sexual assault centers, SACs) should consider implementing such interventions as part of routine care.Methods/designThis is a multicenter randomized controlled add-on superiority trial that enrolls patients attending sexual assault centers within 72 h after rape or attempted rape. The objective is to assess whether mPE shortly after rape can prevent the development of post-traumatic stress symptoms. Patients will be randomized to either mPE plus treatment as usual (TAU) or TAU alone. The primary outcome is the development of post-traumatic stress symptoms 3 months after trauma. Secondary outcomes will be symptoms of depression, sleep difficulties, pelvic floor hyperactivity, and sexual dysfunction. The first 22 subjects will constitute an internal pilot trial to test acceptance of the intervention and feasibility of the assessment battery.DiscussionThis study will guide further research and clinical initiatives for implementing strategies for preventing post-traumatic stress symptoms after rape and provide new knowledge about which women may benefit the most from such initiatives and for revising existing treatment guidelines within this area.Trial registrationClinicalTrials.gov NCT05489133. Registered on 3 August 2022

Current Limitations and Recent Advances in the Management of Asthma

BackgroundAsthma is a significant worldwide health issue affecting kids and adults. Asthma management is mainly straightforward, but considering the associated co-morbidities, it is essential to diagnose the disease accurately. Steroid resistance and dependence, along with inhaler abuse, are the other challenges in clinical practice. Despite being treated with the recommended guidelines, a good portion of the population has persistent symptoms. Emerging biological treatments can alter the global landscape of managing severe asthma. With these new therapeutic possibilities, phenotype- and endotype-specific therapies can be used to individualize treatment plans. MethodologyWe searched Medline, Embase, Google Scholar, and PubMed until March 2022 for all types of literature. Medical Subject Heading (MeSH) terms such as “asthma,” “pathogenesis,” “diagnosis and classification,” “comorbidities,” “treatments,” “inhaler abuse & corticosteroid resistance,” and “biologics” were used in the searches. To better understand the disease, we analyzed the literature on asthma regarding pathophysiology, diagnostic criteria, endotypic and phenotypic classification, comorbidities, existing treatment guidelines, management challenges, and potential for biologics in uncontrolled cases. ResultsAfter exploring the data, our review article aims to highlight current limitations in the clinical management of asthma and the advances in treating asthma. ConclusionClinical practice should consider an integrative approach to the care and prevention of asthma. We advocate for a large-scale cohort of observation studies and RCTs that further look into the underlying immunological mechanisms, the function of hereditary and environmental variables, and the novel molecular targets of asthma in light of the rising incidence and prevalence of the disease. Even with rising steroid resistance and dependence, the standard therapy will be the mainstream of asthma management. Biologics have promiscuous results and the potential for changing the treatment of uncontrolled asthma. Optimizing the standard therapy with biologics is needed to decrease asthma-related morbidity.

The effect of active visual art therapy on health outcomes: protocol of a systematic review of randomised controlled trials

BackgroundArt therapy is a form of complementary therapy to treat a wide variety of health problems. Existing studies examining the effects of art therapy differ substantially regarding content and setting of the intervention, as well as their included populations, outcomes, and methodology. The aim of this review is to evaluate the overall effectiveness of active visual art therapy, used across different treatment indications and settings, on various patient outcomes.MethodsWe will include randomised controlled studies with an active art therapy intervention, defined as any form of creative expression involving a medium (such as paint etc.) to be actively applied or shaped by the patient in an artistic or expressive form, compared to any type of control. Any treatment indication and patient group will be included. A systematic literature search of the Cochrane Library, EMBASE (via Ovid), MEDLINE (via Ovid), CINAHL, ERIC, APA PsycArticles, APA PsycInfo, and PSYNDEX (all via EBSCOHost), ClinicalTrials.gov and the WHO’s International Clinical Trials Registry Platform (ICTRP) will be conducted. Psychological, cognitive, somatic and economic outcomes will be used. Based on the number, quality and outcome heterogeneity of the selected studies, a meta-analysis might be conducted, or the data synthesis will be performed narratively only. Heterogeneity will be assessed by calculating the p-value for the chi2 test and the I2 statistic. Subgroup analyses and meta-regressions are planned.DiscussionThis systematic review will provide a concise overview of current knowledge of the effectiveness of art therapy. Results have the potential to (1) inform existing treatment guidelines and clinical practice decisions, (2) provide insights to the therapy’s mechanism of change, and (3) generate hypothesis that can serve as a starting point for future randomised controlled studies.Systematic review registrationPROSPERO ID CRD42021233272

Advanced calibration of mortality prediction on cardiovascular disease using feature-based artificial neural network

Cardiovascular (CVD) is the leading cause of death worldwide and a significant public health concern. Therefore, its mortality prediction is crucial to many existing treatment guidelines. Medical claims data can be used to accurately foresee the health outcomes of patients contracting to a variety of diseases. Many machine learning algorithms, especially deep learning artificial neural networks, can predict mortality rate among patients with CVD using clinical data. Calibration of probabilistic prediction is essential for precise medical interventions as it indicates how well a model’s output matches the probability of the event. However, deep learning neural networks are poorly calibrated. Through experiments, we observe that feature representation is an important factor influencing calibration. This paper proposes a novel feature-based deep learning neural network framework to predict the mortality rate among patients with CVD. Our focus is to present a comprehensive study to achieve advanced performance calibration of mortality prediction on CVD in leveraging deep learning architecture and feature representations. Our study demonstrates that the proposed feature-based neural network framework integrated with Principal Component Analysis or Autoencoders significantly reduces training time and boosts calibration, making model updates in clinical context more flexible and decision-making in medical prevention more reliable.

Antifungal therapy for chronic pulmonary aspergillosis

Chronic pulmonary aspergillosis is a progressive disease caused by Aspergillus spp in patients with underlying chronic lung disease and affects more than 3 million people worldwide.1 Diagnosis is on the basis of consensus criteria, and existing treatment guidelines are mainly based on cohort studies.2 Correct diagnosis is a huge challenge in countries with a high burden of pulmonary tuberculosis, as the clinical presentations are similar; in addition, chronic pulmonary aspergillosis is a well recognised complication of pulmonary tuberculosis.

Comparison of national antimicrobial treatment guidelines, African Union.

ObjectiveTo identify and compare antimicrobial treatment guidelines from African Union (AU) Member States.MethodsWe reviewed national government agency and public health institutes’ websites and communicated with country or regional focal points to identify existing treatment guidelines from AU Member States. We included guidelines if they contained disease-, syndrome- or pathogen-specific treatment recommendations and if those recommendations included antimicrobial name or class, dosage and therapy duration. The scope of the review was limited to infections and clinical syndromes that often have a bacterial cause. We assessed treatment guidelines for alignment with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We compared treatment recommendations for various common bacterial infections or clinical syndromes described across national guidelines and those described in three World Health Organization guidelines.FindingsWe identified 31 treatment guidelines from 20 of the 55 (36%) AU Member States; several countries had more than one treatment guideline that met our inclusion criteria. Fifteen (48%) guidelines from 10 countries have been published or updated since 2015. Methods used to develop the guidelines were not well described. No guidelines were developed according to the GRADE approach. Antimicrobial selection, dosage and duration of recommended therapies varied widely across guidelines for all infections and syndromes.ConclusionAU Member States lack antimicrobial treatment guidelines that meet internationally accepted methods and that draw from local evidence about disease burden and antimicrobial susceptibility.

Use of drugs to treat symptoms and acute conditions during pregnancy in outpatient care in Switzerland between 2014 and 2018: analysis of Swiss healthcare claims data.

Evidence on the use of drugs during pregnancy in Switzerland is lacking. To evaluate utilisation of prescribed drugs during pregnancy in outpatient care in Switzerland, focusing on treatments for pain, infections, gastro-oesophageal reflux, nausea/vomiting, and constipation. We conducted a descriptive study using the Swiss Helsana claims database (2014–2018). We established a cohort of pregnancies by identifying deliveries and estimating the date of the last menstrual period. We identified claims for the following drugs during pregnancy; analgesics (opioids, paracetamol, and nonsteroidal anti-inflammatory drugs [NSAIDs]), oral antibiotics, antacids, proton pump inhibitors (PPIs), anti-nausea drugs (propulsives and 5HT3-antagonists), and laxatives. Within these drug groups we quantified exposure prevalence to the most prescribed drugs (to >1% of pregnancies) during pregnancy as well as to specific potentially teratogenic or fetotoxic drugs during specific risk periods. Results were extrapolated relative to the demographic distribution of the Swiss population. We identified an extrapolated population of 369,371 pregnancies, with a weighted mean maternal age of 32.0 years (weighted standard deviation 5.1). Analgesics were claimed in 34.5% (95% confidence interval [CI] 33.9–35.0%) of pregnancies, most frequently paracetamol (30.3%, 29.8–30.8%), followed by NSAIDs (8.6%, 8.3–8.8%), and opioids (2.6%, 2.4–2.8%). NSAIDs were claimed in 1.3% (1.2–1.4%) of pregnancies after week 24, and opioids were claimed in 1.3% (1.2–1.4%) in trimester 3. Antibiotics were dispensed in 26.3% (25.8–26.8%) of pregnancies, most frequently amoxicillin (14.6%, 95% CI 14.2–14.9%). Claims for potentially teratogenic or fetotoxic antibiotics during risk periods were each recorded in <0.6% of pregnancies. PPIs were claimed in 16.0% (15.6–16.3%) and antacids in 10.6% (10.3–11.0%) of pregnancies, but several antacid products are not reimbursed and thus not present in insurance claims. Anti-nausea drugs were claimed in 16.4% (16.0–16.7%) of pregnancies, most frequently metoclopramide in 14.4% (14.0–14.7%). Ondansetron was mainly dispensed in trimester 1, 1.0% (0.9–1.1%). In total, 6.4% (6.2–6.7%) of pregnancies had a claim for laxatives, most frequently for macrogol (2.4%, 95% CI 2.2–2.5%). The observed pattern of claimed drugs during pregnancy is in line with existing treatment guidelines. Exposure to potentially teratogenic and fetotoxic drugs was small, but given the lack of recorded diagnosis, we cannot determine if their use was clinically indicated.

MRI-guided minimally invasive treatment of prostate cancer

Multiparametric magnetic resonance imaging (mpMRI) of the prostate plays acrucial role in the diagnosis and local staging of primary prostate cancer. Image-guided biopsy techniques such as MRI-ultrasound fusion not only allow guidance for targeted tissue sampling of index lesions for diagnostic confirmation, but also improve the detection of clinically significant prostate cancer. Minimally invasive, focal therapies of localized prostate cancer complement the treatment spectrum, especially for low- and intermediate-risk patients. In patients of low and intermediate risk, MR-guided, minimally invasive therapies could enable local tumor control, improved functional outcomes and possible subsequent therapy escalation. Further study results related to multimodal approaches and the application of artificial intelligence (AI) by machine and deep learning algorithms will help to leverage the full potential of focal therapies for prostate cancer in the upcoming era of precision medicine. Completion of ongoing randomized trials comparing each minimally invasive therapy approach with established whole-gland procedures is needed before minimally invasive therapies can be implemented into existing treatment guidelines. This review article highlights minimally invasive therapies of prostate cancer and the key role of mpMRI for planning and conducting these therapies.

Nonfactor Therapies: New Approaches to Prophylactic Treatment of Haemophilia.

For several decades, the treatment of haemophilia has relied on factor replacement therapy, which restores haemostasis by replacing the missing coagulation factor. In recent years, novel alternative therapies for the treatment of haemophilia in patients with and without inhibitors have been developed. These emergent therapies promote haemostasis by mimicking coagulation factors or inhibiting natural anticoagulants. They provide a less invasive route of administration (i.e. subcutaneous) and some offer reduced frequency of dosing (i.e. every 2 weeks, monthly) compared with the majority of factor replacement therapies, and thus have the potential to simplify treatment, increase adherence and subsequently improve outcomes for patients. Their introduction has transformed the care of haemophilia patients with inhibitors to factor VIII, with similar expectation for haemophilia B patients with inhibitors. However, these therapies also come with several new challenges including their limitation to prophylactic treatment, the observed increased incidence of thrombosis, or their impact on the natural history of the disease and potential disruption of existing treatment guidelines like the use of immune tolerance induction. Moreover, questions remain regarding the long-term impact of non-replacement therapies on joint health as well as the optimal strategy to manage breakthrough bleeds in patients with inhibitors.

Revamping Pediatric Dental Practice: The Covid-19 Influence

The massive outbreak of the coronavirus disease (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a pandemic situation, posing a serious challenge to the healthcare professionals across the globe, including the oral healthcare personnel. With the transmission of the disease occurring mainly via droplet spread and contact routes, the dental procedures performed, carry a high potential to trigger a cross infection as they operate in and around the oral cavity of the patient. The children seeking dental care, further aggravate the situation as they present with minimal symptoms of COVID-19 and may go unnoticed. All of this has forced the dental personnel around the globe to call for a change in the treatment approach, by modifying the existing treatment guidelines and protocols, to reduce the risk of transmission and help fight the pandemic. This review article tries to shed light on the COVID-19 disease, the clinical characteristics of the disease in children, its modes of transmission and proposes a modified approach to pediatric dental practice in the post pandemic time, that would provide optimal treatment care, abiding by the revised infection control norms and guidelines.

Diagnosis and treatment of pancreatic duct disruption or disconnection: an international expert survey and case vignette study

BackgroundPancreatic duct disruption or disconnection is a potentially severe complication of necrotizing pancreatitis. With no existing treatment guidelines, it is unclear whether there is any consensus among experts in clinical practice. We evaluated current expert opinion regarding the diagnosis and treatment of pancreatic duct disruption and disconnection in an international case vignette study. MethodsAn online case vignette survey was sent to 110 international expert pancreatologists. Expert selection was based on publications in the last 5 years and/or participation in development of IAP/APA and ESGE guidelines on acute pancreatitis. Consensus was defined as agreement by at least 75% of the experts. ResultsThe response rate was 51% (n = 56). Forty-four experts (79%) obtained a MRI/MRCP and 52 experts (93%) measured amylase levels in percutaneous drain fluid to evaluate pancreatic duct integrity. The majority of experts favored endoscopic transluminal drainage for infected (peri)pancreatic necrosis and pancreatic duct disruption (84%, n = 45) or disconnection (88%, n = 43). Consensus was lacking regarding the treatment of patients with persistent percutaneous drain production, and with persistent sterile necrosis. ConclusionThis international survey of experts demonstrates that there are many areas for which no consensus existed, providing clear focus for future investigation.

Commentary: Potential transmissibility of SARS-CoV-2 infection via donor corneal tissue.

Commentary: Potential transmissibility of SARS-CoV-2 infection via donor corneal tissue.

Health Coaching as an Intervention for Picky Eaters.

Although childhood "picky eating" or "fussy eating" or "food neophobia" is well established as a subject of research, commentary, and treatment guidelines, there is very little published research exploring the origins and basis of adult food neophobia, much less its treatment. Existing treatment guidelines for picky eating tend to focus on cognitive behavioral interventions. The consequences of picky eating, although not extensively researched, include inadequate nutrition and weight management difficulties-both significant contributors to the worldwide disease burden. Health coaching has a focus on personal choice, reflection on previous successes and current strengths, as well as identification of a personal health vision and achievable goals. As such, it may play a useful role in supporting behavioral change in adult picky eaters. A structured intervention, rooted in health coaching skills and culinary medicine aimed at supporting such change, is proposed.

Unprecedented Prevalence of Azole-Resistant &lt;i&gt;Aspergillus fumigatus&lt;/i&gt; Identified in the Environment of Vietnam, with Marked Variability by Land Use Type

Background: Azole-resistant Aspergillus fumigatus (ARAF) presents a threat to global public health, particularly where prior tuberculosis or underlying lung disease is prevalent. Southeast Asia is estimated to have a large burden of Aspergillus disease yet mycology diagnostic laboratory capacity is limited and systematic surveillance for drug resistance is absent. ARAF’s threat is thus poorly understood in this populous region. Methods: We conducted environmental surveillance in southern Vietnam, collecting air and ground samples across land-use types including cultivated land, urban residential land, and national park. We determined susceptibilities of A. fumigatus and non-fumigatus Aspergillus section Fumigati (ASF) isolates using EUCAST methodology, and measured residual agricultural azole concentrations in soil using liquid chromatography / tandem mass spectrometry. Findings: 95·2% of A. fumigatus isolates (59/62) were azole-resistant (31·6% for non- fumigatus ASF isolates (18/57)). Of all 119 ASF isolates, 55% were resistant or non-wild type to itraconazole, 65% to posaconazole and 50% to voriconazole. Both resistant isolates and agricultural azole residues were over-represented in cultivated land. The odds ratio for azole-resistance being detected, compared to national park sites, was ranged from 3·15-7·16 in cultivated lands types, and was highest in urban residential sites (9·31, p=0.0002). cyp51A gene sequence analysis showed 38/56 resistant A. fumigatus isolates carried known resistance mutations, with TR34/L98H most frequent (34/38). Interpretation: Our data demonstrate alarmingly high levels of azole-resistant A. fumigatus in this region, which challenge the reliance of existing treatment guidelines on empiric azole therapy. Funding Statement: This project received internal funding from the University of Sydney. Declaration of Interests: None of the authors have any financial and personal potential conflicts of interest. Ethics Approval Statement: National Lung Hospital, Hanoi, Vietnam provided ethical approval for the study.