Holmes Regional Medical Center

Background This study aimed to gain a comprehensive understanding of oral COVID-19 antiviral prescribing in Australian general practice. Methods The study was a retrospective observational cohort study. Routinely collected, de-identified, Australian general practice consultation and prescription data was used with permission from participating primary health networks, from 938 general practices between March 2022 and September 2023. Study cohorts were patients aged ≥15 encompassing (i) an 'antiviral cohort' comprising patient records with ≥1 oral COVID-19 antiviral prescription/s and (ii) a 'comparison cohort' of remaining records. Primary outcome measures were the frequency and type of oral COVID-19 antivirals prescribed, and sociodemographic and health characteristics of patients prescribed antivirals. Secondary measures were the frequency of antiviral repeat prescribing and consultation modality. Results Within the study population of 3,813,051 patients, oral COVID-19 antivirals were prescribed to 3.39% (129,267) of patients including 14.79% (82,215/555,757) of patients aged ≥70years. Molnupiravir prescribing exceeded nirmatrelvir-ritonavir across all study months. Proportionally, antiviral prescribing was higher in the female population (74,709/2,059,676: 3.63%), Victoria (81,184/2,222,837: 3.65%), residing in high socioeconomic advantage areas (87,530/2,224,501: 3.93%), and ages 80-84 years (16,419/100,911: 16.27%). Of patients prescribed COVID-19 antivirals, 7.27% (9402/129,267) had repeat prescribing. Cardiovascular and musculoskeletal conditions were the most prevalent chronic diagnoses, and telehealth (58,660/107,727: 54.45%) exceeded face-to-face consultations. Conclusions Oral COVID-19 antiviral prescribing volumes in general practice may serve as an indicator of periods of increased transmission of COVID-19, through increases in prescribing activity. Telehealth exceeding face-to-face for oral COVID-19 antiviral prescribing supports continued access to telehealth to reduce exposure to COVID-19 and provide time-critical access to treatment.

BackgroundHarvesting bone graft (BG) from the intramedullary canal to treat bone defects is largely conducted using the Reamer–Irrigator–Aspirator (RIA) system. The RIA system uses irrigation fluid during harvesting, which may result in washout of osteoinductive factors. Here, we propose a new harvesting technology dedicated to improving BG collection without the potential washout effect of osteoinductive factors associated with irrigation fluid. This novel technology involves the conceptual approach of first aspirating the bone marrow (BM) with a novel aspirator prototype, followed by reaming with standard reamers and collecting the bone chips with the aspirator (reaming–aspiration method, R–A method). The aim of this study was to assess the harvesting efficacy and osteoinductive profile of the BG harvested with RIA 2 system (RIA 2 group) compared to the novel harvesting concept (aspirator + R–A method, ARA group).MethodsPre-planning computed tomography (CT) imaging was conducted on 16 sheep to determine the femoral isthmus canal diameter. In this non-recovery study, sheep were divided into two groups: RIA 2 group (n = 8) and ARA group (n = 8). We measured BG weight collected from left femur and determined femoral cortical bone volume reduction in postoperative CT imaging. Growth factor and inflammatory cytokine amounts of the BGs were quantified using enzyme-linked immunosorbent assay (ELISA) methods.ResultsThe use of the stand-alone novel aspirator in BM collection, and in harvesting BG when the aspirator is used in conjunction with sequential reaming (R–A method) was proven feasible. ELISA results showed that the collected BG contained relevant amounts of growth factors and inflammatory cytokines in both the RIA 2 and the ARA group.ConclusionsHere, we present the first results of an innovative concept for harvesting intramedullary BG. It is a prototype of a novel aspirator technology that enables the stepwise harvesting of first BM and subsequent bone chips from the intramedullary canal of long bones. Both the BG collected with the RIA 2 system and the aspirator prototype had the capacity to preserve the BG’s osteoinductive microenvironment. Future in vivo studies are required to confirm the bone regenerative capacity of BG harvested with the innovative harvesting technology.

Journal Article Exploring the 3D Resolution of Parallax Phase Reconstruction from 4D STEM: A Dopant Depth Case Study Get access EWC Terzoudis-Lumsden, EWC Terzoudis-Lumsden School of Physics and Astronomy, Monash University, Melbourne, VIC, Australia Corresponding author: Emmanuel.Terzoudis-Lumsden1@monash.edu Search for other works by this author on: Oxford Academic Google Scholar TC Petersen, TC Petersen Monash Centre for Electron Microscopy, Monash University, Melbourne, VIC, Australia Search for other works by this author on: Oxford Academic Google Scholar HG Brown, HG Brown Ian Holmes Imaging Center, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, VIC, Australia Search for other works by this author on: Oxford Academic Google Scholar PM Pelz, PM Pelz National Center for Electron Microscopy, Molecular Foundry, Lawrence Berkeley National Laboratory, Berkeley, CA, USADepartment of Materials Science and Engineering, University of California, Berkeley, CA, USA Search for other works by this author on: Oxford Academic Google Scholar C Ophus, C Ophus National Center for Electron Microscopy, Molecular Foundry, Lawrence Berkeley National Laboratory, Berkeley, CA, USA Search for other works by this author on: Oxford Academic Google Scholar SD Findlay SD Findlay School of Physics and Astronomy, Monash University, Melbourne, VIC, Australia Search for other works by this author on: Oxford Academic Google Scholar Microscopy and Microanalysis, Volume 28, Issue S1, 1 August 2022, Pages 404–405, https://doi.org/10.1017/S1431927622002331 Published: 01 August 2022

McBride, Joshua1; Hanify, Jennifer2; Breslin, James3; Larizadeh, Kristina4; Gilbert, Stephen5; Sanchez, Michael4 Author Information

Topic: Empress Eugénie (1826-1920), the widow of Emperor Napoléon III of France, developed mature cataracts late in life. In 1920, at age 94, she underwent surgery to one eye by Ignacio Barraquer (1884-1965), a member of the famous dynasty of ophthalmologists originally from Barcelona, Spain. Clinical relevance: Barraquer used his new instrument which employed a vacuum cup to hold the lens for intracapsular extraction. Methods: Research of historical documents. Results: The surgery was a success; the Empress was pleased that she could read again although she did not have long to live. She was his first famous cataract patient and his fame spread internationally. Barraquer spoke at the International Congress of Ophthalmology held in Washington, DC, in 1922 and demonstrated his technique on patients in Washington, DC, New York, Boston, Philadelphia and Richmond, VA. Conclusion: Barraquer's surgery on Éugenie, who was the most powerful woman in Europe during her husband's reign, influenced the course of development of cataract surgical technique.

The management of penetrating colon injuries in civilians has evolved over the last four decades. The objectives of this meta-analysis are to evaluate the current treatment regimens available for penetrating colon injuries and assess the role of anastomosis in damage control surgery to develop a practice management guideline for surgeons. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, a subcommittee of the Practice Management Guidelines section of EAST conducted a systematic review using MEDLINE and EMBASE articles from 1980 through 2017. We developed three relevant problem, intervention, comparison, and outcome (PICO) questions regarding penetrating colon injuries. Outcomes of interest included mortality and infectious abdominal complications. Thirty-seven studies were identified for analysis, of which 16 met criteria for quantitative meta-analysis and included 705 patients considered low-risk in six prospective randomized studies. Seven hundred thirty-eight patients in 10 studies undergoing damage control laparotomy and repair or resection and anastomosis (R&A) were included in a separate meta-analysis. Meta-analysis of high-risk patients undergoing repair or R&A was not feasible due to inadequate data. In adult civilian patients sustaining penetrating colon injury without signs of shock, significant hemorrhage, severe contamination, or delay to surgical intervention we recommend that colon repair or R&A be performed rather than routine colostomy. In adult high-risk civilian trauma patients sustaining penetrating colon injury, we conditionally recommend that colon repair or R&A be performed rather than routine colostomy. In adult civilian trauma patients sustaining penetrating colon injury who had damage control laparotomy, we conditionally recommend that routine colostomy not be performed; instead, definitive repair or delayed R&A or anastomosis at initial operation should be performed rather than routine colostomy. Systematic review/meta-analysis, level III.

Liver abscess is a rare complication seen in Crohn's disease (CD) and has been rarely reported. Our aim is to illustrate a case of liver abscess in a patient with CD and the importance of a complete history and physical examination in identifying the potential cause of a hepatic abscess in an immune competent individual in who the diagnosis of CD was apparently ignored for two years before she presented to us. Although the manifestation of a hepatic abscess without any perianal abscess or fistula in CD is extremely rare, recognition of this would facilitate the diagnosis and appropriate management of abscess and CD.

Background: Although carcinosarcoma of the fallopian tube is a rare entity, evidence suggests that the fallopian tube is the origin of a number of advanced high-grade serous carcinomas categorized under the umbrella of ovarian, fallopian-tube, and primary peritoneal carcinoma. An identifier of the fallopian tube as the site of origin is the presence of serous tubal intraepithelial carcinoma. A case with this rare entity showing the presence of serous tubal intraepithelial carcinoma (STIC) is presented here. Case: An 84-year-old female patient presented with serosanguinous vaginal drainage. Results: Ultrasonography identified a pelvic mass, which was subsequently shown to be a tumor in association with STIC. Conclusions: This case is consistent with and supports the recent evidence for the fallopian tube as the primary site for advanced high-grade serous carcinoma of the ovary. Furthermore, the case identifies carcinosarcoma arising from STIC as likely to be a histologic variation of the same process. (J GYNECOL SURG 33:205)

Sir: We read with interest Roy et al’s1 case report of a patient with pseudoangiomatous stromal hyperplasia (PASH) causing gigantomastia. We report a similar case in a 29-year-old woman with rapidly progressing macromastia (Fig. 1), who also complained of cyclical breast swelling and multiple palpable breast masses, with biopsy proven PASH.Fig. 1: Preoperative appearance of bilateral macromastia caused by PASH and phyllodes tumor of the right breast.Although we commend the aesthetic result achieved by Roy et al1, we differ in our algorithm. Because of the propensity for PASH to recur and owing to its inherently diffuse involvement within the breast tissues, we opted for a more aggressive approach: bilateral Wise-pattern mastectomy with immediate tissue expander reconstruction. At the time of the mastectomy, several large (5–7 cm) discrete breast masses were identified, one of which was histopathologically consistent with a benign phyllodes tumor (a fibroepithelial stromal tumor with malignant potential).2 Reconstruction proceeded using the Wise pattern: the lower pole of the breast was deepithelialized and used as soft-tissue reinforcement, reapproximating the dermal edge against the cut edge of the pectoralis major muscle, in place of an alloplastic dermal tissue matrix.3 The patient’s expansion proceeded uneventfully, and no chemoradiation was recommended by the institutional tumor board. She underwent expander–implant exchange using 425-cc Sientra (Santa Barbara, Calif.) textured round base anatomic devices bilaterally and is without complications now 3 months postoperatively (Fig. 2).Fig. 2: Postoperative appearance 3 months after second-stage reconstruction using Sientra round base 425-cc anatomic cohesive silicone gel breast implants. Wise-pattern mastectomy scar patterns can be visualized.Although PASH is rare, and most commonly a benign clinical entity, there have been reports of malignancy arising within PASH.4 Indeed, in our patient, a phyllodes tumor was found as a synchronous mass. Although benign, this lesion does harbor malignant potential. Furthermore, recurrence rates up to 22% have been reported in the literature for PASH.5 Therefore, we feel that a more aggressive treatment plan is indicated when PASH is identified. Given the abundance of breast skin in these patients, a Wise-pattern mastectomy with expander–implant based reconstruction is a viable and aesthetically pleasing option, which also obviates the burdensome need for ongoing oncological surveillance in these patients. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.