Waikato Hospital

Sarcoidosis is a multi-system inflammatory disease characterised by granulomas, primarily affecting the respiratory system, but it has extra-thoracic involvement. Sarcoidosis may have different presentations and disease courses based on ethnicity; however, limited data exist on its differences in Māori and New Zealand (NZ) Europeans. To investigate the clinical characteristics, treatment and disease progression of sarcoidosis in Waikato District Health Board (DHB) patients, and compare these in Māori and NZ European ethnic groups. A retrospective cohort analysis was conducted using Waikato DHB electronic records (2019-2021) for 158 patients with confirmed sarcoidosis. Baseline demographics, radiologic grading, lung function and treatments were collected and analysed. Differences between Māori and NZ European patients were assessed using χ2, analysis of variance and Mann-Whitney tests, with P < 0.05 considered statistically significant. The cohort (mean age: 56 years; 17% Māori, 70% NZ European) exhibited high rates of co-morbidities, notably obesity (46%). There was extra-thoracic involvement in 39% of patients, which was commonly ocular and cutaneous. Diagnosis relied on radiological methods solely or endobronchial ultrasound transbronchial needle aspiration in most cases. Māori patients displayed significantly higher extra-thoracic sarcoidosis involvement (P = 0.045) and lower rates of lung fibrosis. No significant differences were found in lung function decline, respiratory-related hospitalisations or mortality between groups. Our cohort demonstrates heterogeneous staging and prevalent extra-thoracic manifestations. Māori patients have greater extra-thoracic involvement and lower lung fibrosis than European patients without significant differences in treatment or disease course but with significant metabolic comorbidities. Systemic steroids are well tolerated, but steroid-sparing agent use is limited.

Management of acute cholecystitis (AC) in high-risk surgical candidates is challenging. Drainage via percutaneous transhepatic gallbladder drainage (PT-GBD) has been standard of care, with high complication and re-intervention rates. Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) is proposed as an alternative. This study evaluates the efficacy and safety of LAMS in EUS-GBD for non-surgical candidates presenting with AC. An institution-based prospective database has tracked all patients who undergo EUS-GBD using LAMS for AC. Within this database, we analysed outcomes of technical and clinical success rates, reintervention rates, adverse events, and mortality. Thirty seven patients (20 females, 17 males; mean age 74.9 years) underwent EUS-GBD between July 2024 and December 2025. Patients were comorbid (mean Charlson Comorbidity Index 5.7), frail (mean Clinical Frailty Scale 4.2), and had high peri-operative risk (mean ASA score 3). EUS-GBD was technically and clinically successful in 100% and 94.6% of cases, respectively. Two patients (5.4%) required reintervention for LAMS occlusion with recurrent AC, and one patient was re-admitted with conservatively managed recurrence. Three patients died during follow up: two (5.4%) of sepsis despite intervention and one unrelated death 23 days post-procedure. There were no other adverse events after median follow up of 366 days. EUS-GBD with LAMS is effective and safe for non-surgical candidates with AC. High success rates, coupled with low mortality and adverse events, support its role as the preferred option for drainage in non-surgical candidates. Larger prospective studies are warranted to confirm these findings.

The Diversity and Equity Committee (DEC) of the Asian Pacific Society of Nephrology (APSN) conducted a regional review to characterise disparities in kidney disease burden, healthcare access and nephrology service delivery across the Asia-Pacific (AP) region. A descriptive summary was compiled using national reports, registries, and expert inputs from DEC representatives. Data included kidney disease prevalence, dialysis and transplant modalities, healthcare system characteristics and disparity-related indicators. Comparative insights were drawn across countries using structured tables and narrative synthesis. The AP region exhibits a disproportionate burden of chronic kidney disease (CKD) and kidney failure with marked heterogeneity in disease aetiology, healthcare financing, and infrastructure. High-income countries such as Japan, Korea, Taiwan and Australia demonstrate mature universal insurance systems, comprehensive dialysis networks and national CKD prevention programs. Middle- and lower-income countries-including Indonesia, Myanmar, Mongolia and parts of South and Southeast Asia-face critical challenges such as workforce shortages, limited dialysis and transplant capacity and geographic inequities. Despite these challenges, several countries have introduced exemplary models to enhance equity and sustainability in kidney care: PD-first policies (Hong Kong, Thailand), pay-for-performance CKD programs (Taiwan), Kidney Health Plan 2033 (Korea), HALT-CKD (Singapore), and ACT-KID (Malaysia), indigenous kidney health efforts in Australia and the inclusion of additional insurance points for patient education in Japan. Persistent gaps remain in early detection, transplantation access, rural care and minority equity. Kidney disease care in the Asia-Pacific region reflects both diversity and disparity. Although universal health coverage and national kidney health initiatives have improved access in many countries, substantial inequities persist across geography, income and cultural groups. The collective experiences highlight both common challenges and innovative solutions. Strengthening regional collaboration, policy-driven efforts and sustainable workforce development are essential to achieving equitable kidney health for all.

Eczema is a chronic skin condition, characterised by inflammation, erythema, and pruritus. Usage of topical therapies containing botanical extracts is common, however evidence of efficacy is often lacking. This trial investigated the safety and efficacy of a mānuka-oil based cream, 2% ECMT-154, versus vehicle control (VC) for the topical treatment of eczema. This single-blind, parallel group randomised controlled trial was undertaken in 11 community pharmacies across New Zealand. Adults with moderate-to-severe eczema (Patient Oriented Eczema Measure [POEM] ≥ 8 to ≤ 24) were randomised 1:1 to topical 2% ECMT-154 or VC cream, applied twice daily for six weeks. The primary outcome was POEM at week six. 118 participants were recruited between 20th January 2022 and 22nd May 2023. Between baseline and week six mean POEM score (standard deviation) improved from 16.3 (4.2) to 8.8 (5.7) in the ECMT-154 group, and from 16.9 (3.8) to 8.8 (5.7) in the VC group, a between group difference of -0.38 (95% CI: -2.58 to 1.82, p = 0.74). No statistically significant differences were observed across all secondary outcome measures, and no serious adverse events were reported. Whilst symptoms of eczema improved in both treatment groups, there was no evidence of a difference in efficacy between ECMT-154 and VC cream in the treatment of eczema. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001096842, the study was registered on 18th of August 2021.

BackgroundThe Global Initiative for Asthma recommends as-needed combination inhaled corticosteroid-formoterol reliever for mild asthma. Its cost-effectiveness is uncertain outside double-blind regulatory trials. The study objectives were to assess the cost-effectiveness of as-needed budesonide-formoterol versus maintenance budesonide plus as-needed salbutamol, and versus as-needed salbutamol, in averting exacerbations in adults with mild asthma during 12-month follow-up of the New Zealand participants (n=551) of the open-label Novel START multicountry clinical trial.MethodsNew Zealand health-system and societal perspectives were adopted using 2025 resource costs. Healthcare utilisation comprised electronically monitored inhaler use (with multiple imputation for missing data), asthma-related pharmaceuticals, primary-care visits, emergency-department visits and hospitalisations. Regression methods were used for cost-effectiveness analysis. Scenarios included generic substitution and prescription-charge exemption.ResultsAs-needed budesonide-formoterol, compared with maintenance budesonide plus as-needed salbutamol, is more effective at reducing severe exacerbations and provides an annual health-system cost saving of NZD 12 (95% CI 0–28) per patient, increasing to NZD 22 (95% CI −15–58) if a societal perspective is adopted. Compared with as-needed salbutamol alone, as-needed budesonide-formoterol costs the health system NZD 38 and NZD 111, respectively, to prevent an exacerbation and a severe exacerbation. From a societal perspective it is cost-saving NZD 70 (95% CI 2–134). Findings were robust to scenario analyses.ConclusionFor patients with mild asthma, as-needed budesonide-formoterol 200/6 μg is cost-saving from health-system, patient and societal perspectives, while improving outcomes, dominating maintenance budesonide plus as-needed salbutamol. Compared with as-needed salbutamol, as-needed budesonide-formoterol is cost-effective from a health-system perspective and dominates from a societal perspective.

Introduction: There have been several prognostic tools proposed for determining spinal epidural abscess patient outcomes. One such method is the "mortality in spinal infection" scoring system. In this study, we aim to externally validate this score within the New Zealand population.

To quantify the current state of the cardiology specialist workforce in Health New Zealand - Te Whatu Ora. The Cardiac Society of Australia and New Zealand sent a survey to all Health New Zealand - Te Whatu Ora cardiology departments in 2024, requesting information on specialist cardiac staff. Population information was obtained from Health New Zealand - Te Whatu Ora. International comparisons were obtained by website search. Of 154 Health New Zealand - Te Whatu Ora-employed cardiologists, 119 (77%) were male, and 113 (73%) received cardiology training in New Zealand. Over half were aged >50, 35% >55, including 18% >60 years. Time in current position was 12±9 years and the vacancy rate was 14%. The current ratio of persons per cardiologist is 35,000. In the five districts with the highest proportion of Māori and Pacific peoples, this ratio exceeds the national average: Tairāwhiti 54,000; Counties Manukau 38,000; Lakes 61,000; Northland 52,000; Hawke's Bay 47,000. For cities with cardiac surgery the ratio is 32,000 and without is 46,000. International ratios include: United States of America (USA) 15,000; Canada 25,000; United Kingdom (UK) 40,000 and Australia 25,000 persons per cardiologist. Health New Zealand - Te Whatu Ora has an experienced but ageing cardiologist workforce, with many vacancies. Districts with higher Māori/Pacific populations have fewer cardiologists per capita than the national average of 1:35,000, which is similar to the UK, but less than the USA, Australia and Canada.

Disclosure: A. Niyagama: None. M. Elston: None. V. Boyle: None. B. Corley: None. E. Walsh: None. J. Yeoh: None. J. Tamatea: None. S.G. Soule: None. K. Yong: None. W. Park: None. R.W. Carroll: None.BackgroundMultiple endocrine neoplasia type 1 (MEN1) is a rare inherited condition resulting from pathogenic mutations of the MEN1 gene, resulting in neoplasia of endocrine and neuroendocrine tissues.The presentation of MEN1 is diverse, even within a family without a clear genotype-phenotype correlation. Most MEN1-related tumors are indolent but aggressive cancers can occur. The wide range of presentation raises surveillance and management challenges. Globally, the prevalence of MEN1 is approximately 2 per 100,000. New Zealand (NZ) has just over 5 million people with most healthcare provided through a national public healthcare system, but this is divided by region. No data is available on MEN1 prevalence in NZ, surveillance practices or management of MEN1-related neoplasia. The Familial Endocrine Disorders Registry NZ (FERNZ) was established with the aim to provide national data on patients with conditions such as MEN1.AimsTo assess the prevalence of MEN1 in NZ and to collect information on presentation, surveillance, and management of MEN1-related conditions. Methods Potential participants were identified by their primary endocrinologist and invited to participate. Data collected included basic demographics and MEN1-related conditions.ResultsFifty patients were identified from 8 different regions of NZ. 42 patients, from 13 kindreds consented to be included in the registry. Genetic analysis in 31 patients identified 13 different gene variants. A total of 22 females, 19 males, and 1 nonbinary were included with a median age of 46 (age range 12-89 years). Māori comprised 26% of the cohort compared to 17% of the population. Hyperparathyroidism was diagnosed in 38, with parathyroidectomy in 24, 50% requiring more than 1 operation. Nearly half of those patients experienced nephrolithiasis. Pituitary adenomas were present in 11 patients, of which 9 were prolactinomas. Pancreatic neuroendocrine tumors (PNETs) were present in 23 patients: 14 with non-functioning PNETs, 8 with gastrinomas and one, an insulinoma. Additional MEN 1-related lesions included adrenocortical carcinoma and lung carcinoid tumors. All most all patients (>95%) had regular specialist surveillance, follow-up schedules and imaging varied based on individual presentations.ConclusionsThe number of FERNZ participants with MEN 1 aligns with international estimates, but further efforts are needed to improve recruitment to the registry. A comprehensive registry will ensure more robust data, enabling a deeper understanding of the disease's clinical variability across different regions and ethnicities, to facilitate equitable, high-quality management for MEN 1 patients in NZ, supporting both clinical care and future research initiatives into genetic factors and disease outcomes.Presentation: Saturday, July 12, 2025