Royal Perth Hospital

Abstract The May Measurement Month (MMM) campaign was conducted in Australia in 2023 to raise awareness of raised blood pressure (BP). This article reports the results of the campaign. Adults aged ≥18 years were recruited through convenience sampling in metropolitan and regional Australia including hospitals, universities, pharmacies, libraries, and community centres. Three seated BP readings were taken on each participant, and a questionnaire collected information on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or being on BP-lowering medication. Controlled BP was defined as being on BP-lowering medication with a BP <140/90 mmHg. Multiple imputation was used to estimate missing BP readings. In total, 2284 were screened, with a mean age of 39.5 years and 52.1% of whom were female. Of all participants, 679 (29.7%) had hypertension, of whom 356 (52.4%) were aware, and 315 (46.4%) were on antihypertensive medication. Of those on antihypertensive medication, 156 (49.5%) had controlled BP, and of all participants with hypertension, 23.0% had controlled BP. The MMM campaign in Australia identified a substantial number of participants with untreated or inadequately treated hypertension. The MMM campaign continues to be a cost-effective strategy in Australia to screen participants for hypertension, assess BP control and refer participants to primary care physicians where appropriate. Further efforts from all stakeholders are essential to further improve the reach of the MMM campaign in Australia, to increase awareness and improve BP control in line with the National Hypertension Taskforce of Australia Roadmap.

Little is known about the palliative care needs of people living with a mental illness and a life-limiting illness. To gain an understanding of palliative care need and service utilization in adult inpatients with mental health issues across a metropolitan area health service in Perth, Western Australia. Data were collected at four sites from patient medical records. Adult patients who were admitted at study sites' mental health units were eligible for inclusion. In total, 192 patient records were reviewed. Almost one-third of patients (32%, n = 61) had at least one condition listed in the Gold Standards Framework, and 30% (n = 18) of these could have potentially benefited from palliative care. There was evidence of one patient receiving some form of palliative care. In this cohort, there was unmet need for palliative care, especially among older adults. The majority of patients with potential palliative care needs were admitted to older adult mental health wards. There are missed opportunities to provide holistic care to adult inpatients with mental health issues experiencing life-limiting conditions, likely to result in poorer symptom control and reduced quality of life. Approaches to identify and respond to palliative care needs in mental health settings need to be adopted.

Biologic and small-molecule therapies are increasingly used in dermatology for conditions such as psoriasis and atopic dermatitis. Live and live-attenuated vaccines are traditionally avoided in patients receiving these agents due to concerns regarding vaccine-strain infection. We conducted a systematic review to evaluate the safety of live and live-attenuated vaccines in patients receiving biologic or small-molecule therapies used in dermatologic practice. PubMed, Embase (Ovid) and the Cochrane Library were searched from January 2010 to February 2025 for human studies reporting safety or immunogenicity outcomes following live vaccine administration in patients receiving relevant therapies. Of 1104 records identified, nine studies met inclusion criteria, comprising one randomised controlled trial, three cohort studies, three retrospective case series, one cross-sectional observational study and one case report. Vaccines evaluated included measles-mumps-rubella, measles-mumps-rubella-varicella, varicella, live zoster and yellow fever vaccines. Across studies, no cases of vaccine-strain infection or disseminated vaccine-related disease were reported. Mild and self-limiting post-vaccination reactions were described in several cohorts. Where assessed, immunogenicity responses were generally preserved, although data were limited and inconsistently reported. Most included studies involved patients receiving biologic or small-molecule monotherapy, though some cohorts permitted background conventional immunomodulatory therapy. The available evidence, although limited and predominantly observational, suggests that selected live and live-attenuated vaccines may be administered without serious adverse outcomes in carefully chosen patients receiving biologic or small-molecule therapies. Larger prospective studies are needed to better define safety and immunogenicity across newer targeted agents.

Renal nerves are critical modulators of kidney function and blood pressure (BP) control. Their influence on sodium and fluid retention, renin release and vasoconstriction rendered them a therapeutic target more than a century ago when surgical splanchnicectomy emerged as one of the first effective antihypertensive therapies. Revisiting the concept using catheter-based approaches to ablate renal afferent and efferent nerves more selectively with various energy sources demonstrated the efficacy of renal denervation in reducing sympathetic nerve activity. A series of sham-controlled randomised clinical trials in patients with uncontrolled or resistant hypertension either on or off concomitant antihypertensive drugs demonstrated procedural safety and clinically meaningful BP reduction. Durability of the BP lowering efficacy has been demonstrated out to 10 years in observational studies. Major international guidelines now recommend renal denervation as an adjunct therapy in patients with uncontrolled or resistant hypertension where other means have failed or resulted in insufficient BP control. Patient selection and patient preference are relevant aspects to be considered in a shared decision-making process leading up to the denervation procedure, which should be performed in experienced centres. While approved in the USA, most countries in Europe, Asia-Pacific and many other regions lack adequate reimbursement currently, which remains a barrier for more widespread implementation into clinical practice despite favourable cost-effectiveness analyses. While now established in the context of hypertension management, ongoing research explores its potential utility in other conditions characterised by increased sympathetic drive, with most promising results in patients with chronic kidney disease, atrial fibrillation, heart failure and others. Further refinement of procedural aspects may reduce procedure time and augment the BP lowering efficacy. Clinicians should embrace the additional options that device-based therapies offer to improve BP management, mostly in combination with pharmacologic therapies. After all, it is just another means of bringing the pressure down.

Reverse shoulder arthroplasty (RSA) has evolved from a reliable solution for cuff-deficient shoulders into a broadly utilized reconstructive replacement procedure [...].

Immune checkpoint inhibitor immunotherapy enhances T cell activity against cancer cells but often leads to the immune system targeting healthy cells, causing 'immune-related adverse events' (irAEs). We report the case of a man in his 70s with metastatic melanoma being treated with ipilimumab and nivolumab. He presented with febrile neutropenia after lacerating a thumb on his compost bin. The neutrophil count only recovered once oral prednisolone was commenced, indicating a haematological irAE. A restaging Positron Emission Tomography scan revealed intramuscular ring-enhancing collections throughout his body, one of which was aspirated and cultured the fungus Lomentospora prolificans He was treated with voriconazole plus terbinafine, both of which were later substituted with olorofim due to a voriconazole-induced rash. After 4 months, the collections had resolved on repeat imaging, and olorofim was ceased due to transaminitis. This case highlights neutropenia as a lesser-known adverse effect of immunotherapy and raises awareness about L. prolificans infection.

Editor's Note.-RadioGraphics Update articles supplement or update information found in full-length articles previously published in RadioGraphics. These updates, written by at least one author of the previous article, provide a brief synopsis that emphasizes important new information such as technological advances, revised imaging protocols, new clinical guidelines involving imaging, or updated classification schemes.

Ultra-low-field (ULF) point-of-care (PoC) Magnetic Resonance Imaging (MRI) offers a promising pathway to improve accessibility in medical imaging due to its portability and lower cost. However, the diagnostic utility of ULF MRI is currently limited by lower image quality, particularly in signal-to-noise ratio, resolution, and contrast. To address this, we introduce SynPoC, a generative diffusion model designed to enhance ULF MRI by synthesizing high-field MRI-like images. SynPoC employs a conditional adversarial diffusion framework that leverages both noise and contrast-specific features to model inter-field representations. We evaluated SynPoC across a multi-site dataset of 180 participants, including both healthy individuals and patients with a variety of brain conditions. The enhanced images exhibited improved anatomical clarity and structural alignment with corresponding high-field MRI, as supported by quantitative and volumetric analyses. Our model demonstrates promise for image quality enhancement and research applications; however, as with other generative approaches, there is a non-zero risk of hallucinated or misleading features, particularly near low-SNR boundaries and fine structures. We therefore provide synchronized slice-by-slice comparison videos (3T, PoC, SynPoC) to aid reader inspection and emphasize that SynPoC is not intended for diagnostic decision-making without additional safeguards and validation. Further validation is warranted before diagnostic use.