Port Macquarie Base Hospital

A case of a 55 year old woman with recanalised umbilical vein thrombosis in a patient with gastritis who does not have liver cirrhosis or portal hypertension. This patient had presented with mild nausea and acute onset of epigastric pain. CT abdomen and pelvis had demonstrated this finding of a recanalised umbilical vein with thrombus formation, along with some thickening of the gastric antrum with mild surrounding fat stranding suggestive of gastritis. The patient underwent an inpatient gastroscopy to rule out malignancy in context of these findings, which only demonstrated some healed gastric ulcers. Histopathology report described chronic gastritis and intestinal metaplasia, no evidence of established malignancy. This is an unusual case that highlights that recanalisation of the umbilical vein could occur without portal hypertension. This may have been a spontaneous event or could have been caused by local inflammation such as gastritis.

Penile cancer is a rare malignancy, with an Australian incidence of 0.6 in 100 000 men, with a wide range of clinical presentations, from localised, curable tumours to aggressive forms with high morbidity and mortality. Epidemiological data and management guidelines for penile cancer in Australia are limited. The Australian Penile Cancer Clinical Registry (APCCR) aims to address this gap through a centralised database studying local risk factors, treatment effectiveness, and outcomes. The APCCR is a national, multicentre, prospective clinical quality registry. The primary objective is to map demographic and tumour characteristics, human papillomavirus infection rates, long-term surgical and non-surgical (radiotherapy and chemotherapy) interventions in penile cancer. Secondary objectives include elucidating disparities and interdisciplinary gaps in care and identifying areas for further studies. The registry aims to capture adult men with penile cancer in, utilising retrospective data collection and a prospective cohort design. Retrospective data are extracted from existing medical records, and prospective data are collected at enrolled sites. The registry is built in Research Electronic Data Capture (REDCap) and hosted on BioGrid Australia servers, enabling standardised data collection. Registration with the Australian Register of Clinical Registries is pending approval. The pilot phase of the APCCR is currently operational, with ongoing site recruitment. Five sites in Victoria and New South Wales are currently enrolled in the registry. The APCCR Steering Committee determined reporting and data protocols to ensure accurate data collection. The dataset was developed to comprise relevant clinical metrics on penile cancer diagnosis, disease, intervention, and surveillance. The APCCR is a robust platform for furthering the understanding of penile cancer diagnostic and treatment practices in Australia, aiming to further research and clinical practice changes. This will drive further collaboration and improvements in outcomes for Australian men affected by penile cancer, particularly with ongoing national expansion and improved longitudinal data.

To provide insights into the effectiveness and safety of faricimab for treatment-naïve eyes with neovascular age-related macular degeneration (nAMD). A retrospective cohort study using a prospectively-designed registry. Treatment-naïve eyes with nAMD in Australia starting treatment with faricimab between Jan 2023-Sep 2024 were included. Controls were treatment-naïve eyes starting with aflibercept 2 mg before 2022. Visual acuity (VA), macular neovascularisation activity, time to first inactivity, number of injections, injection intervals and number of visits at 12 months were investigated. Eyes treated with faricimab versus aflibercept 2 mg were compared using overlap weighting. The main outcome measure was the 12-month VA change. Twenty-three practitioners treated 160 eyes with a 4-letter gain in VA (mean, 61.5-65.5 letters) and 48% attaining a dosing interval of ≥ 12 weeks, although 22% were still treated at < 8 weekly intervals. The small proportion (6.9%) of eyes switching to another agent had improved vision but were mostly active when switching off faricimab. Eyes received 7.2 injections (mean) at 7.4 visits (mean), receiving treatment at 98% of visits indicating a strongly proactive treatment regimen. Most (71%) lesions became inactive by 12 months with a mean time to inactivation of 10.3 weeks. Eyes starting faricimab had a significantly higher inactivation rate with more eyes reaching the last injection interval of ≥ 12 weeks than those starting aflibercept 2 mg. These findings indicate that faricimab is safe and effective for treatment-naive eyes with nAMD. Faricimab had a stronger effect on nAMD lesion activity than aflibercept 2 mg.

Spontaneous bilateral ectopic pregnancy is extremely rare, with an estimated incidence of 1 in 200,000 spontaneous pregnancies. Diagnosis is challenging, particularly in rural and remote settings where clinicians may have limited experience with rare presentations and reduced access to advanced imaging and specialist support. This report presents the case of a 36-year-old woman (gravida4, para 3) who presented to a rural hospital with vaginal bleeding and pelvic pain at 4+5weeks of gestation. Serial quantitative beta-human chorionic gonadotropin levels increased from 962IU/L to 6545IU/L over 15days. Transvaginal ultrasound demonstrated no intrauterine pregnancy, a right adnexal mass, and bilateral haemorrhagic ovarian cysts. She was admitted with suspected right tubal ectopic pregnancy. After discussion regarding the ultrasound findings and management options, the patient was consented for a right salpingectomy. However, at laparoscopy, bilateral unruptured tubal ectopic pregnancies were identified. Following an intraoperative discussion with next of kin, a right salpingectomy and additional left salpingostomy were performed to preserve natural fertility. Her postoperative recovery was uncomplicated and she was discharged home with serial quantitative testing of beta-human chorionic gonadotropin levels until negative. Histopathology confirmed bilateral tubal ectopic pregnancies. Bilateral ectopic pregnancy is difficult to diagnose preoperatively. This case highlights the potential diagnostic significance of bilateral corpus lutea and the importance of maintaining a high index of suspicion. In rural settings, limited access to sonographic expertise and fertility services may complicate both diagnosis and management. Bilateral ectopic pregnancy should be considered in suspected ectopic pregnancies with bilateral adnexal findings. Careful imaging review and fertility-conscious surgical planning are essential, particularly in rural and remote healthcare settings.

ABSTRACTEffective conservation of threatened species relies on precise detection methods to inform conservation management strategies. Here, we developed a new environmental DNA (eDNA) assay to detect the endangered Booroolong frog (Litoria booroolongensis) in river water samples throughout their range in Australia. The suitability of the assay to detect Booroolong frog eDNA was first validated ex situ from a population of captive‐bred frogs at Taronga Zoo, New South Wales. We then established the detectability of Booroolong frog DNA from river water samples collected in situ. The new assay successfully detected Booroolong frog eDNA in water samples collected from the breeding enclosure, from water samples exposed to adult frogs and frog egg masses. Testing in the field confirmed the effectiveness of the assay at detecting Booroolong frog eDNA in environmental water samples collected in situ from sites with known presence of the species determined from prior nocturnal surveys. Our results demonstrate the efficacy of eDNA for detecting Booroolong frogs from river water samples across its geographic range. Ongoing monitoring utilizing eDNA has the potential to support conservation efforts by enabling more efficient and widespread surveys for this endangered species.

BACKGROUNDSessile serrated lesions (SSLs) are premalignant polyps implicated in up to 30% of colorectal cancers. Australia reports high SSL detection rates (SSL-DRs), yet with marked variability (3.1%-24%). This substantial variation raises concerns about missed lesions and post-colonoscopy colorectal cancer. This study investigates determinants associated with SSL-DR variation in regional Australia.AIMTo study how patient, clinical, and colonoscopy factors are associated with SSL detection in a regional Australian practice. We aimed to contribute high-detection data to the literature by analyzing the association of SSL detection with various determinants.METHODSThis retrospective, cross-sectional analysis examined 1450 colonoscopies performed at Port Macquarie Gastroenterology during 2023. Sigmoidoscopies and repeat procedures were excluded. Multivariate logistic regression analyzed associations between SSL detection and patient demographics, clinical indications, procedural factors, and comorbidities.RESULTSThe overall SSL-DR was 30.7%. Multivariate analysis identified several independent predictors: Clinical indication, bowel preparation quality, inflammatory bowel disease status, and serrated polyposis syndrome. The faecal occult blood test positive (FOBT) (+) cohort showed the highest predicted SSL detection probability (39.8%), while clinical symptoms showed the lowest (22.3%). After adjustment, SSL detection odds were 2.3 times greater among FOBT (+) patients than those with clinical symptoms (adjusted odds ratio = 2.30, 95% confidence interval: 1.20-4.40, P = 0.004).CONCLUSIONSSL-DR as a quality indicator requires contextualization regarding clinical indications, bowel preparation quality, and comorbidities. There was a significantly higher prevalence of SSLs in FOBT (+) patients. Despite comprehensive adjustment, this study cannot fully explain the wide SSL-DR variation in Australia, highlighting the need for standardized detection protocols and further research to ensure optimal cancer prevention outcomes.

ABSTRACTProcesses of koala recovery will require reintroductions into parts of the species' former range and/or supplementation of other populations to assist their longer term viability. In this study, six wild‐caught and three rehabilitated koalas were translocated into a new habitat area. The area into which the translocated koalas were introduced was not the subject of significant habitat use by other koalas at the time of their introduction, and a soft‐release protocol that temporarily confined translocated individuals to a tree species known to be preferred for feeding purposes was also employed. Based on the results of a short‐term radio‐tracking programme, the translocation was deemed successful given no mortalities (including the survival of pouch young known to be present at initial capture), minimal movements away from the release site and rapid commencement of home‐ranging behaviours. Male koalas ranged greater distances from their respective release sites than did female koalas. One subadult male koala moved approximately 1.6 km from the release site over a period of 5–6 weeks following release but subsequently returned. Koala activity across the area known to be utilised by the translocated koalas at the time of collar removal was monitored benignly using Spot Assessment Technique sampling at 250 m intervals for the ensuing 3 years, during which time koala activity remained dynamic but statistically constant, implying longer term survival and maintenance of site fidelity by the translocated koalas. The protocols utilised for this translocation are likely to provide a useful tool for future small‐scale koala translocation programmes where reintroductions or population supplementation is required.

This report details a face-to-face educational event hosted by the Urgo Foundation, which brought clinicians together to learn from wound care experts in addressing the challenges faced when discussing, recommending, and applying therapeutic graduated compression. Education and networking opportunities sought to increase both confidence and capability.

Purpose of ReviewRural communities experience higher rates of adverse health outcomes compared to their urban counterparts, and involving community members in intervention design and implementation is increasingly recognized as a pivotal factor in fostering successful intervention outcomes. This review aims to synthesize the evidence on rural food environment modifications globally, and to understand the role and involvement of community members in these interventions. Eligible records were dated between 1st January 2011 and 6th September 2024. Two independent reviewers conducted screening, quality assessment, and data extraction. Studies were included if they addressed a food environment, described food environment modifications, indicated community involvement, were based in regional or rural areas and published in English. The Mixed Methods Appraisal Tool was used to assess the risk of bias. Results were reported as a narrative synthesis.Recent FindingsThirty-three studies were eligible for inclusion following appraisal of full texts, comprised of 46 reports. Of these, 12 studies (16 reports) focused on First Nations populations and will be reported separately, due to the complex and sensitive nature of engaging with these communities. Therefore, 21 studies (30 reports) were included in this review. Study designs were heterogenous. Restaurants, supermarkets and schools were a common focus for modifications, while some programs simultaneously targeted several food environments. However, community involvement was inconsistently reported across studies, making conclusions about involvement difficult.SummaryStandardized reporting of the involvement of community members is needed to ensure systematic and authentic approaches to community involvement are integrated into rural public health interventions and research to enhance success.RegistrationProspero; CRD42023400455.