Melbourne Clinic

To compare the anatomical and functional outcomes of internal limiting membrane (ILM) flap and conventional ILM peeling in idiopathic full-thickness macular holes (FTMHs). Retrospective cohort study of all eyes treated with vitrectomy and ILM peeling (ILM-P) with or without ILM flap (ILM-F) for primary idiopathic FTMH repair in the Australian and New Zealand Society of Retinal Specialists (ANZSRS) Registry between 2006 and 2023. Propensity score weighting and multivariable regression analysis adjusted for baseline characteristics and covariates, including surgeon grade, lens status, and follow-up duration, were used to evaluate hole closure rate and best corrected visual acuity (BCVA) change at 3 months. Two thousand nine hundred ninety eyes of 2905 patients were included (mean age 69 ± 9 years). One Hundred Ninety-nine eyes underwent ILM-F and 2871 underwent ILM-P. On weighted multivariable regression analysis, ILM-F showed higher odds of hole closure compared to ILM-P (OR = 2.97, 95% CI: 1.08-8.20, p = 0.04). The adjusted closure rate was > 95% across all hole sizes in the ILM-F group, while only falling below 90% for X-large + holes (> 550 μm) in the ILM-P group. No significant difference in BCVA gain was observed between the two groups at 3 months (p = 0.08). The effects of ILM-F compared to ILM-P were consistent across all hole sizes. Although the ILM-F technique was more effective in idiopathic FTMH closure, visual acuity outcomes were comparable to conventional ILM peeling. These findings suggest that ILM-F is not required for the treatment of small and medium FTMHs.

Filler-induced vascular occlusion remains a rare but serious complication in aesthetic medicine, particularly in the lips, where collateral circulation is limited. Polynucleotide (DOT-PN) is a polynucleotide-based medical device primarily characterized by its hydration capacity and viscoelastic properties. When administered intradermally, PN provides structural support to the extracellular matrix (ECM) and contributes to the optimization of the local tissue microenvironment. Such ECM-level modulation may create conditions favorable for tissue stabilization and secondary vascular recovery following ischemic injury. We report a case involving a 41-year-old woman with upper lip necrosis following hyaluronic acid filler injection. Initial treatment with hyaluronidase partially alleviated ischemia but failed to prevent necrosis. Polynucleotide (DOT-PN; a polynucleotide-based medical device; PharmaResearch Co.,Ltd.; Seoul, Republic of Korea)) was administered intradermally in 4 sessions at 8-hour intervals (q8h×4), alongside conservative wound care. Clinical improvement was observed within 36 hours of the first PN injection. The lesion demonstrated progressive improvement in tissue color, epithelial continuity, and surface integrity over a 4-week period, with no scarring or adverse events. Patient-reported satisfaction was rated 9 out of 10, with minimal pain and no functional sequelae during follow-up. Further controlled studies are warranted to define optimal PN dosing intervals, timing of administration, and comparative effectiveness versus other adjunctive treatments for filler-induced ischemic complications.

BackgroundMobile stroke units (MSUs) accelerate prehospital acute stroke care and improve outcomes. Both onboard and telemedicine neurologist models of care are used but have not been directly compared.MethodsMSU-TELEMED was a randomized, open-label, blinded-endpoint trial comparing onboard neurologist care to a telemedicine care model for people presenting to an MSU with suspected stroke. MSU care was prospectively randomized by day to onboard versus telemedicine care. The primary outcome was a hierarchical composite outcome using a win-odds approach that prioritized: (1) safety, (2) scene-to-treatment-decision time, and (3) percentage of the total case time the neurologist spent in direct care (higher values denote better resource use). Every participant in each group was compared to those in the other, resulting in a “win/tie/loss” distribution for telemedicine compared to onboard.ResultsA total of 275 participants were assigned to telemedicine (n=135) or onboard (n=140) neurologist care groups. The primary outcome of win/tie/loss distribution favored the telemedicine model (76%/4%/20%) with an adjusted win odds of 3.5 (95% confidence interval [CI], 2.4–5.1). Safety events were similar (13% telemedicine vs. 12% onboard, risk ratio 0.9; 95% CI, 0.5–1.8). Median scene-to-treatment-decision time was 19 minutes in the telemedicine group and 13 minutes in the onboard group (adjusted difference in median time 4 minutes; 95% CI, 1.9–5.9). The median percentage of the neurologist’s time directly involved in patient care was 100% in the telemedicine group and 33% in the onboard group (adjusted difference in median percentage 63 percentage points; 95% CI, 53–74).ConclusionsCompared to an onboard model, an MSU telemedicine model of care was superior based on a composite hierarchical outcome of safety, scene-to-treatment-decision time, and percentage of the neurologist’s time spent in direct care. (Funded by the Sylvia and Charles Viertel Charitable Foundation and the Medical Research Future Fund “Golden Hour”; ClinicalTrials.gov number, NCT05991310.)

The prevalence of high blood pressure in children is increasing, with health consequences reaching into adulthood. Individual-level interventions may help address the burden of high blood pressure at a population level, but there is less evidence from pediatric settings. To assess the effectiveness of school- or community-based lifestyle interventions to reduce high blood pressure in children (aged 3-18 years) and identify components that support effectiveness. Ovid MEDLINE, Embase, and PubMed were searched for studies from June 2013 to March 2024. Randomized clinical trials and quasi-experimental studies were assessed using the following strict inclusion criteria: longer than 6-month intervention duration, participants aged 3 to 18 years, major aim to modify cardiometabolic risk, and measurement of blood pressure before and after the intervention. Interventions aimed at specific patient groups were excluded. Quality assessment was performed using the Joanna Briggs Institute critical appraisal tools. Blood pressure before and after the intervention was extracted, with the mean difference in blood pressure recorded. Data analysis was performed from June 2023 to July 2024. A total of 27 studies were included, of which 13 reported a beneficial effect on blood pressure; 24 studies targeted physical activity, 15 targeted nutrition, 16 targeted education, and 11 included family involvement. Of 14 multicomponent studies, 9 reported a beneficial effect on blood pressure. In this systematic review, results indicate that lifestyle interventions can have a beneficial effect on blood pressure in the pediatric population, with multicomponent designs targeting both physical activity and nutrition showing the most promise. Future research should aim to further clarify intervention design and physical activity dosage, feasibility, and scalability, along with the long-term success of interventions that promote healthy blood pressure in children.

This study represents the first investigation into the prevalence of pathogenic bacteria in isolated, free-ranging Eastern Grey Kangaroos (Macropus giganteus) inhabiting a human-shared environment. Samples were collected from the nasal and rectal passages of state-authorised culls of M. giganteus within a military training area, where recruits had reported recurrent cases of skin and soft tissue infections. The objective was to identify clinically relevant pathogenic microorganisms present in the nasal and rectal flora of these kangaroos. Analysis revealed carriage rates of 11% for methicillin-sensitive Staphylococcus aureus (MSSA) and 2% for methicillin-resistant S. aureus (MRSA). Other potentially pathogenic bacteria isolated included Pseudomonas spp., Streptococcus (Groups B and D), Acinetobacter spp., and multiple coagulase-negative Staphylococcus (CoNS) species. Notably, CoNS species were present in 17% of nasal isolates, with Mammaliicoccus sciuri (formerly Staphylococcus sciuri) detected in 41% of these isolates, suggesting a potential reservoir for antibiotic resistance genes and virulence factors. These findings support a One Health perspective, highlighting the interconnectedness of pathogenic bacteria, M. giganteus, humans, and their shared environment.

Endophthalmitis requiring multiple ocular tissue sampling for microbiological testing is uncommon and has not been previously studied. This study aims to analyse cases with at least two ocular tissue samplings and testing of different ocular samples against culture yields. A 27-year prospective observational study using data from the Victorian Endophthalmitis Registry, managed through the REDCap data platform. The study included 314 patients (317 eyes) who underwent at least two aqueous or vitreous specimen collections. The primary outcome measures included microbiological culture results from repeat and multiple intraocular samples and identification of isolated microorganisms. The overall initial culture positivity rate was 75.7%, while the culture positivity rate at the second intervention was 34.7%. First vitreous taps had the highest culture yield (72.6%) among different sample types. Notably, 19.5% of eyes with initial negative vitreous cultures had subsequent positive results. Further analysis showed that 24.4% of eyes with initial negative vitreous cultures had corresponding positive aqueous cultures. Additionally, 12.2% of eyes with negative initial vitreous taps yielded positive cultures from vitreous biopsies or washings from vitrectomy. Staphylococcus and Streptococcus species were the main pathogens isolated (40.4% and 31.3% of cases respectively). Our study demonstrated the trends and utility of repeated and different ocular tissue sampling in challenging endophthalmitis. Aqueous taps are most useful at the first biopsy, beyond which it has little diagnostic value. A second sampling can be valuable in patients who are initially culture-negative. Surgical specimens contribute meaningfully to the overall culture yield and enhance cumulative culture positivity.

ABSTRACTOver 5000 patients are newly diagnosed with Alopecia areata (AA) in Australia each year. AA severity varies from a single small patch to complete loss of scalp hair, body hair including eyelashes and eyebrows. Approximately 40% of affected individuals experience only a single patch and achieve spontaneous, complete and durable remission within 6 months (acute AA). A further 27% develop additional patches but still attain complete remission within 12 months (chronic AA). Chronic persistent AA (CPAA) is defined by an episode duration of > 12 months and occurs in approximately 33% of patients. Without systemic treatment, 55% of individuals with CPAA will have persistent multifocal relapsing and remitting disease, 30% will progress to alopecia totalis (AT) and 15% will ultimately develop alopecia universalis (AU). The physical disfigurement, unpredictable course, social isolation and rejection contribute to the psychological distress attributable to AA. A wide range of topical, intralesional and systemic agents used to treat AA were evaluated in the 2018 Australian expert consensus statement. In 2020, the international Alopecia Areata Consensus of Experts (ACE) publication stated that if reimbursed, Janus Kinase inhibitors (JAKi's) would be an ideal systemic treatment for adults with AA. TGA approval of baricitinib in 2023 and ritlecitinib in 2024 for severe AA is the first step on the pathway for these systemic medications to be reimbursed on the Australian Government Pharmaceutical Benefits Scheme (PBS). Reimbursement would significantly transform the Australian therapeutic landscape for AA. The purpose of this 2025 Update on the Australian Expert Consensus Statement on the treatment of chronic, moderate to severe AA is to augment the 2018 treatment algorithm to include these TGA‐approved medications and to address indications for initiation, continuation and dose titration of systemic JAKi treatment, appropriate choice of agent, satisfactory outcome measures and to provide guidance on when to discontinue successful or unsuccessful treatment.