Royal Darwin Hospital (RDH) is a 360-bed Australian teaching hospital located in Tiwi, Northern Territory, a northern suburb of the Territory capital Darwin. It is part of the Top End Health Service, which covers an area of 475,338 km2 (183,529 sq mi). RDH is the only tertiary referral hospital in the Northern Territory, also providing complex, high-level clinical services for patients in parts of Western Australia and Southeast Asia. Following the 2002 Bali bombings, the National Critical Care and Trauma Response Centre was established by the Australian Government, bolstering Royal Darwin Hospital's capacity to respond to trauma and support deployed medical assistance teams during crises and medical emergencies in the Asia-Pacific.It is the main teaching hospital for Charles Darwin University's School of Medicine and is also home to a campus of Flinders University. The Menzies School of Health Research, established in partnership with the University of Sydney, is headquartered at the hospital. This school maintains research facilities and provides opportunities for post-graduate studies specialising in Aboriginal health and tropical medicine at Royal Darwin Hospital. The Palmerston Regional Hospital operates as a campus of RDH for treatment of sub-acute conditions and rehabilitation, with staff shared between the two hospitals..
Background: Otoacariasis, the infestation of the external auditory canal (EAC) by ticks, is a common presentation in endemic regions and an emerging clinical consideration in Australia. Conventional agents, including local anaesthetics and oils, often fail to rapidly inactivate hard ticks, potentially prolonging patient discomfort and increasing the risk of infectious complications. Dimethicone, a low-toxicity, low-viscosity organosilicon compound, has demonstrated efficacy against arthropods but has not been formally evaluated for hard tick otoacariasis. This study aims to investigate whether dimethicone outperforms conventional agents in inactivating hard ticks. Methods: In a laboratory-based experiment, 48 Rhipicephalus haemaphysaloides ticks were randomly allocated into four treatment groups (n=12 per group): dimethicone, olive oil, coconut oil, and 2% xylocaine. Ticks were submerged in the test agent and observed under magnification, with time to complete inactivity recorded. Inactivity was defined as cessation of all leg movement despite stimulation. Data were analysed using Statistical Package for Social Sciences (SPSS), with between-group comparisons performed to assess differences in time to inactivity. Results: Time to inactivity was significantly shorter in the dimethicone group (75.0 +/- 10.4 s) compared with olive oil (753.3 +/- 78.3 s), coconut oil (1,056.6 +/- 122.8 s), and 2% xylocaine, in which no inactivity was observed within the 1,800-second observation period (all comparisons P<0.001). Conclusions: Dimethicone rapidly and reliably inactivated hard ticks in vitro, outperforming commonly used agents. This effect is likely mediated by its ability to penetrate the tick spiracular system and impair respiration. Given its favourable safety profile and rapid action, dimethicone may represent a practical option for managing otoacariasis in outpatient and emergency settings. Further in vivo studies are warranted to confirm clinical applicability in the Australian context.
BACKGROUND:MRI is recommended for men with clinical suspicion of significant prostate cancer. Those with high clinical risk but non-suspicious or equivocal MRI often undergo prostate biopsy, but have a low likelihood of clinically significant prostate cancer, and a high incidence of clinically insignificant prostate cancer. We aimed to investigate whether gallium-68 ([68Ga]Ga)-prostate-specific membrane antigen (PSMA)-11 PET-CT could reduce the number of people requiring prostate biopsy and limit biopsy to targeted cores, without compromising clinically significant prostate cancer diagnosis. METHODS:In this multicentre, non-inferiority, phase 3, randomised controlled trial, done at at seven Australian hospitals, we recruited biopsy-naive participants with clinical suspicion of significant prostate cancer, equivocal (Prostate Imaging-Reporting and Data System [PI-RADS] 3) or non-suspicious (PI-RADS 2) MRI but high clinical risk (eg, prostate-specific antigen [PSA] density of >0·1 ng/mL/mL, strong family history of prostate cancer, abnormal digital rectal examination, BRCA mutation, PSA >10 ng/mL, PSA doubling time <36 months, or PSA velocity >0·75 ng/mL per year), PSA of 20 ng/mL or less, and clinical T2 disease or less. Participants were randomly assigned (1:1) using a centralised web-based system to undergo [68Ga]Ga-PSMA-11 PET-CT (experimental group) or systematic transperineal prostate biopsy (control group), using block sizes of two or four and stratification by study site. There was no masking for participants or investigators. Participants with positive [68Ga]Ga-PSMA-11 PET-CT (PRIMARY score 3-5) underwent PSMA-PET-targeted transperineal prostate biopsies, whereas those with a negative result (PRIMARY score 1-2) avoided biopsy. The co-primary outcomes were the proportion of participants with clinically significant prostate cancer, defined as a Gleason score of 3 + 4 (≥10% pattern 4) or higher, and the proportion of participants in the [68Ga]Ga-PSMA-11 PET-CT group who avoided biopsy within 6 months of random assignment. A two-sided 95% Wald CI based on a binomial model was used to estimate the risk difference in the proportion of participants with clinically significant prostate cancer (non-inferiority margin 10%) and to estimate the proportion of participants in the experimental group who had avoided biopsy 6 months after random assignment (20% threshold), analysed based on intention to treat. This trial is registered with ClinicalTrials.gov, NCT05154162, and participant follow-up is ongoing. FINDINGS:Between March 2, 2022, and Aug 24, 2025, 660 eligible male participants were enrolled and had a median age of 61 years (IQR 56-66), a median PSA of 5·2 ng/mL (4·0-7·0), and a median PSA density of 0·13 ng/mL/mL (0·09-0·17). There were PI-RADS 2 in 335 (51%) participants and PI-RADS 3 in 325 (49%) participants. Ethnicity data were not collected. 329 (50%) were assigned to the control group with systematic transperineal prostate biopsy, and 331 (50%) were assigned to the experimental group with [68Ga]Ga-PSMA-11 PET-CT. The proportion of participants with clinically significant prostate cancer in the experimental group (39 [12%] of 331) was non-inferior to the control (51 [16%] of 329; difference -3·7% [95% CI -8·9 to 1·5%]; p=0·0093). Use of [68Ga]Ga-PSMA-11 PET-CT avoided biopsy in 163 (49%) of 331 participants (95% CI 44 to 55%; p <0·0001). After prostate biopsy, participants reported similar proportions of pain (33 [21%] in the experimental group vs 62 [21%] in the control group), haematuria (60 [38%] vs 126 [43%]), and haematospermia (77 [48%] vs 133 [45%]). INTERPRETATION:[68Ga]Ga-PSMA-11 PET-CT could have the potential to improve the diagnostic pathway of patients with a high clinical risk but non-suspicious or equivocal prostate MRI. Further research, including health-economic analyses and validation with other PSMA radiopharmaceuticals, are needed to confirm the clinical implementation and generalisability of this approach. FUNDING:Prostate Cancer Foundation, National Health and Medical Research Council, St Vincent's Curran Foundation, and Peter MacCallum Cancer Foundation.
Optimal dosing of vancomycin in critically ill patients receiving renal replacement therapy (RRT) is uncertain due to high pharmacokinetic variability. We aimed to develop individualised vancomycin dosing recommendations that optimise efficacy while minimising toxicity. Prospective, international, pharmacokinetic study enrolling critically ill patients treated with vancomycin and various RRT modalities. A population pharmacokinetic model was developed, externally validated and applied to perform Monte Carlo dosing simulations. We calculated the probability of each dosing regimen to achieve the efficacy target against methicillin-resistant Staphylococcus aureus (ratio of the area under the concentration–time curve to the minimum inhibitory concentration (AUC0-24 h/MIC) ≥ 400) without exceeding the toxicity threshold (AUC0-24 h ≥ 700 mg.h/L). We enrolled 65 critically ill patients from 6 countries receiving continuous RRT (50.8
Background:Emerging evidence suggests the 4CMenB vaccine provides moderate protection against gonorrhea, likely due to the close genetic relationship between Neisseria gonorrhoeae and Neisseria meningitidis. 4CMenB has an impact on unencapsulated meningococcal oropharyngeal carriage, where outer membrane proteins are exposed, potentially exerting selective pressure on these strains. We assessed the impact of 4CMenB immunization on gonorrhea disease and oropharyngeal meningococcal carriage among adolescents in the Northern Territory (NT), Australia. Methods:All adolescents aged 14-19 years in the NT were eligible to receive two doses of 4CMenB between 2021 and 2023. Participants had oropharyngeal swabs collected at baseline and 12 months. Vaccine effectiveness (VE) against gonorrhea was assessed using linked notification and immunization data. A Cox proportional hazards model stratified by sex, age, and geography estimated VE. Mixed-effects logistic regression estimated postvaccination odds of meningococcal carriage. Results:A total of 30 650 adolescents were included in the VE analysis, with 9.6% receiving 2 doses of 4CMenB, and 42.4% of the population identifying as Aboriginal or Torres Strait Islanders. Gonococcal notifications were reduced in vaccinated adolescents (VE 38.4%, 95% CI: 18.6-53.4). Overall, meningococcal carriage increased from 4.0% to 6.2% (OR 1.68, 95% CI: 1.14-2.48), driven by genogroup B and nongroupable strains. Carriage of disease-associated meningococci remained stable. Conclusions:4CMenB confers modest protection against gonorrhea in a real-world setting with higher adolescent disease prevalence. These findings are important for women, considering infections are often asymptomatic and have the potential for serious complications. The NT has now introduced a 4CMenB infant and adolescent program.
Household overcrowding is a major driver of acute rheumatic fever and rheumatic heart disease, along with other adverse social, cultural and health outcomes in remote Aboriginal communities. Overcrowding is compounded by poor thermal performance of current housing, energy insecurity and climate change. Despite strong evidence of the causes of rheumatic heart disease, upstream prevention through housing design remains underexplored. Wilya Janta, an Aboriginal-led organisation in Tennant Creek, has developed the Explain Home design: a culturally responsive, climate-adapted prototype designed to reduce overcrowding-related harms. With an unprecedented $4 billion investment in remote housing, health professionals have a critical role in advocating for evidence-informed, culturally safe housing as a form of preventive health intervention to improve equity and outcomes.
