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BACKGROUND: The efficacy of simvastatin in critically ill patients with coronavirus disease 2019 (Covid-19) is unclear. METHODS: In an ongoing international, multifactorial, adaptive platform, randomized, controlled trial, we evaluated simvastatin (80 mg daily) as compared with no statin (control) in critically ill patients with Covid-19 who were not receiving statins at baseline. The primary outcome was respiratory and cardiovascular organ support-free days, assessed on an ordinal scale combining in-hospital death (assigned a value of -1) and days free of organ support through day 21 in survivors; the analyis used a Bayesian hierarchical ordinal model. The adaptive design included prespecified statistical stopping criteria for superiority (>99% posterior probability that the odds ratio was >1) and futility (>95% posterior probability that the odds ratio was

Objective: To review the contemporary bladder trauma epidemiology, diagnosis and management over a 12-year period at a level 1 trauma centre in Australia. Patients and Methods: From July 2001 through June 2013, 97 multi-trauma patients at a level 1 trauma centre in Australia were identified to have sustained bladder rupture. Data on demographics, clinical presentation, diagnosis, management and complications were extracted from the TraumaNET database, medical records and health-coding database. Results: Of the 97 patients, 98% of bladder ruptures resulted from blunt trauma mostly from road accidents. There was a male preponderance of 64%. Intra-peritoneal bladder rupture (51%) was the most common type of injury followed by extra-peritoneal bladder ruptures (42%) and combined intra- and extra-peritoneal bladder ruptures (7%). Concomitant pelvic fractures occurred in 78% of patients and concurrent intra-abdominal injuries in 68%. Initial imaging missed 28% of bladder ruptures, with computed tomography with intravenous contrast missing 65% of bladder ruptures. The majority of intra-peritoneal bladder ruptures and 56% of extra-peritoneal bladder ruptures were repaired surgically, with 83% of repairs performed in conjunction with another surgical procedure. The in-hospital mortality rate was 9%, and all deaths were due to concomitant injuries. Conclusion: Traumatic bladder rupture is associated with a 9% mortality rate due to the frequently associated significant concurrent injuries. Computed tomography cystogram or plain cystogram is the imaging modality of choice in diagnosing bladder rupture. Intra-peritoneal bladder ruptures should be repaired surgically, while extra-peritoneal bladder ruptures can be treated conservatively in selected patients. The timing of surgical repair should be coordinated with other specialties. Level of evidence: 4 [ABSTRACT FROM AUTHOR]

Objective: To describe the frequency of hospitalisation and in‐hospital death following moderate to severe traumatic brain injury (TBI) in Australia, both overall and by patient demographic characteristics and the nature and severity of the injury. Design, setting: Cross‐sectional study; analysis of Australia New Zealand Trauma Registry data. Participants: People with moderate to severe TBI (Abbreviated Injury Score [head] greater than 2) who were admitted to or died in one of the twenty‐three major Australian trauma services that contributed data to the ATR throughout the study period, 1 July 2015 – 30 June 2020. Major outcome measures: Primary outcome: number of hospitalisations with moderate to severe TBI; secondary outcome: number of deaths in hospital following moderate to severe TBI. Results: During 2015–20, 16 350 people were hospitalised with moderate to severe TBI (mean, 3270 per year), of whom 2437 died in hospital (14.9%; mean, 487 per year). The mean age at admission was 50.5 years (standard deviation [SD], 26.1 years), and 11 644 patients were male (71.2%); the mean age of people who died in hospital was 60.4 years (SD, 25.2 years), and 1686 deaths were of male patients (69.2%). The overall number of hospitalisations did not change during 2015–20 (per year: incidence rate ratio [IRR], 1.00; 95% confidence interval [CI], 0.99–1.02) and death (IRR, 1.00; 95% CI, 0.97–1.03). Conclusion: Injury prevention and trauma care interventions for people with moderate to severe TBI in Australia reduced neither the incidence of the condition nor the associated in‐hospital mortality during 2015–20. More effective care strategies are required to reduce the burden of TBI, particularly among younger men. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: Studies have shown a significant relationship between low oral health literacy (OHL) and poor oral health outcomes. National calls for action include better training of dental providers to meet the needs of the low OHL public. The purpose of this research was to determine the extent OHL education is being included in US dental hygiene (DH) education programs. Methods: In fall of 2020, a 23-itemdigital survey was sent to 321 Commission on Dental Accreditation-accredited DH schools in the US. Results: Survey generated 90 eligible responses (28%). Respondents reported that OHL education is being included in DH curricula to some degree. Communication strategies (82.4%) were the most likely OHL concept to be taught. Subject areas included community health (89%), cultural competency (78%), and special populations (78%). Respondents ranked lack of assessment instruments, lack of concrete activities, lack of clear understanding of OHL, and difficulty in implementing OHL concepts as the top barriers to incorporating OHL education in the DH curriculum. Conclusion(s): OHL is an established determinant of oral health. As prevention and patient education experts, dental hygienists play an important role in improving patient OHL. More fully integrating OHL into DH curricula would provide future DHs with the training needed to improve oral health outcomes and would better align DH education programs with national OHL initiatives. [ABSTRACT FROM AUTHOR]

Aim: To determine the long‐term impact of telemedicine in child neurology care during the COVID‐19 pandemic and with the reopening of outpatient clinics. Method: We performed an observational cohort study of 34 837 in‐person visits and 14 820 telemedicine outpatient visits across 26 399 individuals. We assessed differences in care across visit types, time‐period observed, time between follow‐ups, patient portal activation rates, and demographic factors. Results: We observed a higher proportion of telemedicine for epilepsy (International Classification of Diseases, 10th Revision G40: odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3–1.5) and a lower proportion for movement disorders (G25: OR 0.7, 95% CI 0.6–0.8; R25: OR 0.7, 95% CI 0.6–0.9) relative to in‐person visits. Infants were more likely to be seen in‐person after reopening clinics than by telemedicine (OR 1.6, 95% CI 1.5–1.8) as were individuals with neuromuscular disorders (OR 1.6, 95% CI 1.5–1.7). Self‐reported racial and ethnic minority populations and those with highest social vulnerability had lower telemedicine participation rates (OR 0.8, 95% CI 0.8–0.8; OR 0.7, 95% CI 0.7–0.8). Interpretation: Telemedicine continued to be utilized even once in‐person clinics were available. Pediatric epilepsy care can often be performed using telemedicine while young patients with neuromuscular disorders often require in‐person assessment. Prominent barriers for socially vulnerable families and racial and ethnic minorities persist. [ABSTRACT FROM AUTHOR]

Testicular tumours can present outside the testis in about 5 % of cases, including as a primary lesion within the retroperitoneal space. These arise insidiously and can be hard to detect. Salmonella is an uncommon cause of abscess formation and the subtype of bovismorbificans, arising from geckos, only scarcely reported to cause an abscess. We describe a case in line with SCARE Criteria where a retroperitoneal non-seminomatous germ cell tumour presented with a salmonella bovismorbificans abscess and subsequent bacteraemia. A 37 year old male presented unwell with fevers and right flank pain suggestive of pyelonephritis. He had a salmonella bacteraemia on initial blood cultures, subsequently isolated to be salmonella bovismorbificans, and a CT scan demonstrate a large 7.7 cm retroperitoneal mass with surrounding lymphadenopathy. An initial attempt at tissue sampling failed as the lesion was filled with purulent material requiring a pig tail drain to remain in place. He progressed slowly with resolution of fevers and bacteraemia however the lesion did not reduce in size despite adequate antibiotic treatment for two weeks. A repeat core biopsy and aspiration after 19 days revealed ongoing salmonella infection with a yolk sac tumour and seminoma. His AFP markers at this time were elevated at 3330kIU/L. A underlying malignancy should be consider when a retroperitoneal abscess fails to resolve with adequate treatment especially when a organism unknown to cause abscess is isolated. • Testicular tumour presenting primarily as an abscess outside of the testis is rare. • Commonly found within North Australian geckos, Salmonella Bovismorbificans can cause abscesses. • A retroperitoneal testicular cancer complicated by a salmonella Bovismorbificans abscess. [ABSTRACT FROM AUTHOR]

Background: Traumatic brain injury (TBI) is the largest contributor to death and disability in people who have experienced physical trauma. There are no national data on outcomes for people with moderate to severe TBI in Australia.Objectives: To determine the incidence and key determinants of outcomes for patients with moderate to severe TBI, both for Australia and for selected population subgroups, including Aboriginal and Torres Strait Islander Australians.Methods and Analysis: The Australian Traumatic Brain Injury National Data (ATBIND) project will analyse Australia New Zealand Trauma Registry (ATR) data and National Coronial Information Service (NCIS) deaths data. The ATR documents the demographic characteristics, injury event description and severity, processes of care, and outcomes for people with major injury, including TBI, assessed and managed at the 27 major trauma services in Australia. We will include data for people with moderate to severe TBI (Abbreviated Injury Scale [AIS] (head) score higher than 2) who had Injury Severity Scores [ISS] higher than 12 or who died in hospital. People will also be included if they died before reaching a major trauma service and the coronial report details were consistent with moderate to severe TBI. The primary research outcome will be survival to discharge. Secondary outcomes will be hospital discharge destination, hospital length of stay, ventilator-free days, and health service cost.Ethics Approval: The Alfred Ethics Committee approved ATR data extraction (project reference number 670/21). Further ethics approval has been sought from the NCIS and multiple Aboriginal health research ethics committees. The ATBIND project will conform with Indigenous data sovereignty principles.Dissemination Of Results: Our findings will be disseminated by project partners with the aim of informing improvements in equitable system-level care for all people in Australia with moderate to severe TBI.Study Registration: Not applicable. [ABSTRACT FROM AUTHOR]

Evidence for the effect of favipiravir treatment of acute COVID-19 on recovery, hospital admissions and longer-term outcomes in community settings is limited. In this multicentre. open-label, multi-arm, adaptive platform randomised controlled trial participants aged ≥18 years in the community with a positive test for SARS-CoV-2 and symptoms lasting ≤14 days were randomised to: usual care; usual care plus favipiravir tablets (loading dose of 3600 mg in divided doses on day one, then 800 mg twice a day for four days); or, usual care plus other interventions. Co-primary endpoints were time to first self-reported recovery and hospitalisation/death related to COVID-19, within 28 days, analysed using Bayesian models. Recovery at six months was the primary longer-term outcome. Trial registration: ISRCTN86534580. The primary analysis model included 8811 SARS-CoV-2 positive mostly COVID vaccinated participants, randomised to favipiravir (n = 1829), usual care (n = 3256), and other treatments (n = 3726). Time to self-reported recovery was shorter in the favipiravir group than usual care (estimated hazard ratio 1·23 [95% credible interval 1·14 to 1·33]), a reduction of 2·98 days [1·99 to 3·94] from 16 days in median time to self-reported recovery for favipiravir versus usual care alone. COVID-19 related hospitalisations/deaths were similar (estimated odds ratio 0·99 [0·61 to 1·61]; estimated difference 0% [−0·9% to 0·6%]). 14 serious adverse events occurred in the favipiravir group and 4 in usual care. By six months, the proportion feeling fully recovered was 74·9% for favipiravir versus 71·3% for usual care (RR = 1·05, [1·02 to 1·08]). In this open-label trial in a largely vaccinated population with COVID-19 in the community, favipiravir did not reduce hospital admissions, but shortened time to recovery and had a marginal positive impact on long term outcomes. [ABSTRACT FROM AUTHOR]

Objective Methods Results Interpretation Monoallelic variants in the transient receptor potential melastatin‐related type 3 gene (TRPM3) have been associated with neurodevelopmental manifestations, but knowledge on the clinical manifestations and treatment options is limited. We characterized the clinical spectrum, highlighting particularly the epilepsy phenotype, and the effect of treatments.We analyzed retrospectively the phenotypes and genotypes of 43 individuals with TRPM3 variants, acquired from GeneMatcher and collaborations (n = 21), and through a systematic literature search (n = 22). We included all patients with a pathogenic TRPM3 variant.The median age at the time of the study was 10 years, with a preponderance of girls (60%) versus boys (40%). Frequent findings were developmental delay and/or intellectual disability (93%), global or axial hypotonia (77%), ocular involvement (70%), musculoskeletal anomalies (65%), and dysmorphic features (58%). Epilepsy was diagnosed in 31 patients (72%), classified in all as developmental and epileptic encephalopathy with or without spike wave activation in sleep (DEE/DEE‐SWAS). Patients with the variant p.Val1002Met (n = 24) significantly more often had developmental delay and epilepsy. The most effective anti‐seizure medication was primidone. All treated patients showed an improvement in seizure frequency, motor and speech development, and/or learning capability with this drug.Developmental delay/intellectual disability and epilepsy are dominant phenotypic features in patients with TRPM3 variants. Given that epilepsy can negatively impact development, screening for awake and sleep electroencephalogram abnormalities and other manifestations are essential to offer early intervention. The TRPM3 channel blocker primidone has shown promising effects and should be considered in every child with a TRPM3 gain‐of‐function variant. ANN NEUROL 2025 [ABSTRACT FROM AUTHOR]

Objective Methods Results Significance Electroencephalographic seizures (ES) are common in neonates with hypoxic–ischemic encephalopathy (HIE), but identification with continuous electroencephalographic (EEG) monitoring (CEEG) is resource‐intensive. We aimed to develop an ES prediction model.Using a prospective observational study of 260 neonates with HIE undergoing CEEG, we identified clinical and EEG risk factors for ES, evaluated model performance with area under the receiver operating characteristic curve (AUROC), and calculated test characteristics emphasizing high sensitivity. We assessed ES incidence and timing in neonates subdivided by ES risk group (low, moderate, high) as determined by EEG risk factors.ES occurred in 32% (83/260) of neonates. Performing CEEG for only 24 h would fail to identify the 7% (17/260) of neonates with later onset ES (20% of all neonates experiencing ES). Identifying 90% or 95% of neonates with ES would require CEEG for 63 or 74 h, respectively. The optimal model included continuity and epileptiform discharges, both assessed in the initial 1 h of CEEG. It yielded an AUROC of .80, and at a cutoff that emphasized sensitivity, had sensitivity of 94%, specificity of 45%, positive predictive value of 44%, and negative predictive value of 95%. The model would avoid CEEG beyond 1 h in 32% (84/260) of neonates, but 6% (5/83) of neonates with ES would not have ES identified. ES incidence was significantly different (p < .01) across ES risk groups (6% low, 40% moderate, and 83% high). Only ~6 h of CEEG would identify all neonates with ES in the low‐risk group, whereas 75 and 63 h of CEEG would be required to identify 95% of neonates with ES in the moderate‐risk and high‐risk groups, respectively.Among neonates with HIE, a model employing two EEG variables from a 1‐h screening EEG and stratifying neonates into low‐, moderate‐, and high‐risk groups could enable evidence‐based strategies for targeted CEEG use. [ABSTRACT FROM AUTHOR]