International Network of Antibiotic Allergy Nations (iNAAN): Protocol for a type 2 hybrid effectiveness-implementation multicentre prospective cohort and target trial emulation study evaluating penicillin allergy delabeling via direct oral challenge.

Background: Penicillin allergies are reported in 1 in 10 hospitalised patients globally and are associated with inferior patient and health service outcomes. However, more than 95% of low-risk penicillin allergies can be removed by direct oral challenge (DOC).

Objective: The International Network of Antibiotic Allergy Nations (iNAAN) aims to evaluate the utility of an audit and feedback (A&F) and education implementation strategy to increase the adoption of penicillin DOC in patients with a low-risk penicillin allergy, while concurrently assessing the impact of penicillin DOC on antibiotic prescribing and health service outcomes.

Long-Term Follow-Up of Patients in a Prospective Study of NA Discontinuation Identifies Different Patterns of HBsAg Loss.

Background And Aims: Discontinuing nucleos(t)ide analogues (NAs) may lead to functional cure (HBsAg loss) in selected patients with chronic hepatitis B (CHB). We evaluated the rates and predictors of HBsAg loss during long-term follow-up in a prospective cohort.

Methods: This real-world extension study followed participants from a prospective trial of NA discontinuation.

A Pilot Study Evaluating Meal Timing, Macronutrient Composition, and Faster-Acting Insulin Aspart Versus Insulin Aspart on Postprandial Glycemia with the Medtronic Advanced Hybrid Closed-Loop System.

This study compared postprandial glycemia with faster-acting insulin aspart (FiAsp) versus insulin aspart delivered by advanced hybrid closed loop (AHCL) according to varying meal composition, time of day, and premeal bolus dose estimation in adults with type 1 diabetes. Participants received 11 weeks of insulin aspart and FiAsp in sequence, delivered by the MiniMed™ 780G AHCL algorithm, and within each period ingested 12 standardized meals. Test meals, containing 60 g of carbohydrate but varying by fat and protein content (high fat low protein [HFLP], high fat high protein [HFHP], and low fat low protein [LFLP]), were each eaten in the morning and evening and with a full bolus or 50% reduction.

Neutral and constitutional coronal alignment yield similar outcomes in total knee arthroplasty at mid-term follow-up using the coronal plane alignment of the knee classification.

Purpose: Achieving neutral coronal mechanical alignment in knee arthroplasty is traditionally considered crucial for implant longevity and function. However, recent studies suggest alternative alignment strategies. This study examines the correlation between preoperative and postoperative coronal alignment and patient-reported outcome measures (PROMs) at midterm follow-up.

Glycaemic impact of the pre-exercise timing of an elevated glucose target implemented using an automated insulin delivery system in adults with type 1 diabetes.

Aim: To determine the impact of a temporary elevated glucose target (TT) on hypoglycaemia and glycaemic outcomes with exercise in adults with type 1 diabetes using an automated insulin delivery (AID) system.

Materials And Methods: Twenty-six participants using the Medtronic MiniMed™ 780G system performed 16 exercise bouts: 12 afternoon bouts (four 40 min and four 90 min moderate-intensity exercise [MIE] and four 40 min high-intensity interval exercise [HIE]) and four morning bouts of 40 min MIE, with a TT set 60 min (TT60), 20 min (TT20), 0 min (TT0) or no TT (TTnil) pre-exercise. Oral carbohydrate was consumed pre-exercise for glucose <100 mg/dL and during exercise for sensor glucose <70 mg/dL or symptomatic hypoglycaemia confirmed by fingerprick blood glucose.

Optimising the detection of Trichophyton indotineae and its prevalence in a large Australian laboratory.

The aim of this study was to estimate the prevalence of Trichophyton indotineae, an emerging drug-resistant fungus, in specimens submitted for dermatophyte examination at a large laboratory in Melbourne, Australia, from January to June 2024, and to examine approaches for best laboratory practice for detection of this species. T. indotineae has not been previously isolated at our laboratory.

The role of penicillin major and minor determinants in skin testing for suspected penicillin hypersensitivity.

Background: In the evaluation of patient-reported penicillin allergy labels (PALs), the utility of skin testing to the penicillin major determinant, known as penicilloyl polylysine (PPL), and to the minor determinant mixture (MDM), has been questioned.

Methods: A review of a clinical antibiotic allergy database from April 2015 to December 2023 at Austin Health (Melbourne, Australia) was performed. Patients with PALs who underwent skin prick testing (SPT) and intradermal testing (IDT) to a previously-published standardised beta-lactam panel were selected.

β-Cell Function Derived From Routine Clinical Measures Reports and Predicts Treatment Response to Immunotherapy in Recent-Onset Type 1 Diabetes.

Objective: Baricitinib preserves β-cell function in people with recently diagnosed type 1 diabetes. We aimed to determine whether simple routine clinical measures could be used to assess β-cell preservation and predict treatment response.

Research Designs And Method: Measures of β-cell function derived from clinical and biochemical measures were calculated using data from the BAricitinib in Newly DIagnosed Type 1 diabetes (BANDIT) randomized trial of baricitinib in recent-onset type 1 diabetes.

Osteosarcopenia and frailty risk in community-dwelling older adults: A follow-up of the I-Lan Longitudinal Aging Study.

Background: Osteosarcopenia is suggested to be on the causal pathway to frailty; however, data on this topic is scarce, and it is unclear if osteosarcopenia is associated with frailty risk.

Objectives: To investigate if osteosarcopenia is associated with frailty risk in community-dwelling older adults.

Design: Retrospective analysis of a prospective cohort study.

Outcomes of Invasive Aspergillosis in Liver Transplant Recipients From an Institution Using Targeted Antifungal Prophylaxis and an Antifungal Stewardship Program.

Background: Recent evidence suggests liver transplant recipients (LiTRs) with invasive aspergillosis (IA) have lower rates of dissemination and mortality compared to historical data. However, contemporary data from other centers remain scarce. We aimed to evaluate modern IA outcomes at our institution, where targeted perioperative echinocandin prophylaxis and an active antifungal stewardship program (AFSP) have been implemented.

Rationale and design of a randomised phase II multicentre crossover trial investigating a sodium-glucose co-transporter 2 inhibitor, dapagliflozin, combined with a novel continuous ketone monitor in adults with type 1 diabetes to reduce the risk of diabetic ketoacidosis: the PARTNER study.

Introduction: Sodium-glucose co-transporter inhibitors have potential glycaemic and non-glycaemic benefits in people with type 1 diabetes (T1D). However, the increased risk of diabetic ketoacidosis (DKA) limits their widespread use. We hypothesise that dapagliflozin 10 mg daily, combined with the use of continuous ketone monitoring (CKM) and education strategies to mitigate progression to DKA, will demonstrate improved glycaemic control without increasing DKA events.

Development of an Acute Coronary Syndrome-Cardiogenic Shock Risk Score for 30-day Mortality From the Victorian Cardiac Outcomes Registry (VCOR ACS-CS Risk Score).

Introduction: Acute coronary syndrome-cardiogenic shock (ACS-CS) confers a 30-day mortality rate of ~50%. A simple bed-side risk score for 30-day all-cause mortality may aid in rapid prognostication in these high-risk patients.

Methods: We analyzed data from consecutive patients with ACS-CS enrolled in the Victorian Cardiac Outcomes Registry (VCOR), a state-wide procedure-based clinical quality registry, between 2013 and 2021.

Antibiotic Exposure and Risk of Allograft Rejection and Survival After Liver Transplant: An Observational Cohort Study From a Tertiary Referral Centre.

Introduction: Our goal is to understand whether there is an association between Abx exposure-and the inferred downstream damage to the intestinal microbiome-and the key patient outcomes of overall survival and rejection following liver transplant.

Methods: We conducted a retrospective cohort study of 462 liver transplant recipients treated at a multistate liver transplant (LTx) service during a 7-year period. The association between antibiotic exposure and outcome was tested across models that addressed antibiotic spectrum, duration, and timing relative to transplant.

Perioperative Penicillin and Cephalosporin Antibiotic Allergy Assessment and Testing: The PREPARE Pilot Randomized Clinical Trial.

Importance: Antibiotic allergy labels (AALs) impact patient health and perioperative outcomes. Antibiotic allergy delabeling could improve antibiotic prescribing and infection-related outcomes perioperatively.

Objective: To assess the feasibility and safety of antibiotic allergy assessment and delabeling in anesthesiologist-led preoperative assessment clinics and expand delabeling efforts outside of specialist allergy clinics.

Using Deep Learning to Perform Automatic Quantitative Measurement of Masseter and Tongue Muscles in Persons With Dementia: Cross-Sectional Study.

Background: Sarcopenia (loss of muscle mass and strength) increases adverse outcomes risk and contributes to cognitive decline in older adults. Accurate methods to quantify muscle mass and predict adverse outcomes, particularly in older persons with dementia, are still lacking.

Objective: This study's main objective was to assess the feasibility of using deep learning techniques for segmentation and quantification of musculoskeletal tissues in magnetic resonance imaging (MRI) scans of the head in patients with neurocognitive disorders.

Drug Survival of Biological Therapies in Smokers and Non-Smokers With Psoriasis: A Retrospective Cohort Study Using Data From the Australasian Psoriasis Registry.

Background: Smoking is a modifiable risk factor that increases the likelihood of developing psoriasis and the severity of the disease. In recent years, biological therapies have transformed the management of psoriasis. There is conflicting evidence about whether smoking affects the efficacy of biologics.

Decreased endogenous nitric oxide production in acute decompensated heart failure with a reduced ejection fraction.

Aims: Heart failure represents a substantial burden to both patients and healthcare systems worldwide. Nitric oxide (NO) dysregulation may play a key role in patients transitioning from chronic to acute heart failure with a reduced ejection fraction (HFrEF). Plasma nitrite (NO ) is highly reflective of local nitric oxide production and has not been studied in acute HFrEF.

Deep Learning Technique for Automatic Segmentation of Proximal Hip Musculoskeletal Tissues From CT Scan Images: A MrOS Study.

Background: Age-related conditions, such as osteoporosis and sarcopenia, alongside chronic diseases, can result in significant musculoskeletal tissue loss. This impacts individuals' quality of life and increases risk of falls and fractures. Computed tomography (CT) has been widely used for assessing musculoskeletal tissues.

Prolonged versus single dose in penicillin oral challenge testing: protocols for a pilot and definitive randomised controlled trial (PROSPECTOR studies).

Introduction: Penicillin allergy labels (PALs) are reported in 1 in 10 hospitalised patients globally and associated with inferior patient, hospital and microbiological outcomes; however, the majority are incorrect and should be removed. Direct oral penicillin challenge has been demonstrated to be a safe and effective method for the removal of PALs. However, the question of whether a single dose is sufficient to ascertain true allergy status remains unanswered, with some studies suggesting that extended challenges of 3 or more days are superior for the exclusion of delayed immune reactions.

Circulating lipocalin-2 across the adult lifespan.

Lipocalin-2 (LCN2), a hormone produced by adipocytes, osteoblasts, and renal tubular cells, is implicated in age-related diseases, including cardio-metabolic disease. To understand the role LCN2 may play in pathological states, we first need to elucidate the relationship between circulating LCN2 with indices of cardio-metabolic health during "normal" aging. This study examined the relationship between serum levels of LCN2, age, and cardio-metabolic measures across the adult lifespan in males and females.

A Comparison of Glucose and Additional Signals for Three Different Exercise Types in Adolescents with Type 1 Diabetes Using a Hybrid Closed-Loop System.

To compare glycemic outcomes during and following moderate-intensity exercise (MIE), high-intensity interval exercise (HIE), and resistance exercise (RE) in adolescents with type 1 diabetes (T1D) using a hybrid closed-loop (HCL) insulin pump while measuring additional physiological signals associated with activity. Twenty-eight adolescents (average age 16.3 ± 2.

Latent Tuberculosis Infection Amongst Allogeneic Hematopoietic Stem Cell Transplant Recipients: The Impact of Routine Pretransplant Review by a Transplant Infectious Diseases Physician.

Background: Identifying patients with latent tuberculosis infection (LTBI) is challenging. This is particularly true amongst immunocompromised hosts, in whom the diagnostic accuracy of available tests is limited. The authors evaluated the impact of routine pretransplant review by a transplant infectious diseases (TID) physician on LTBI screening in allogeneic hematopoietic stem cell transplant (alloHSCT) recipients.

Do CYP2D6 genotypes affect oxycodone dose, pharmacokinetics, pain, and adverse effects in cancer?

Aims: To examine the associations between and polymorphisms, plasma oxycodone and metabolite concentrations, and oxycodone response (dose, pain scores, and adverse effects) in people with pain from advanced cancer.

Patients & Methods: This multi-center prospective cohort study included clinical data, questionnaires (pain and adverse effects), and blood (pharmacokinetics, DNA). Negative binomial regression and logistic regression were used.