Westmead Hospital is a major tertiary hospital in Sydney, Australia. Opened on 10 November 1978, the 975-bed hospital forms part of the Western Sydney Local Health District, and is a teaching hospital of Sydney Medical School at the University of Sydney.The hospital serves a population of 1.85m people and is located on one of the largest health and hospital campuses in Australia. In 2016/17, Westmead Hospital provided more than 1.5m occasions of care to outpatients, in addition to approximately 107,000 inpatients. Annually, there are over 21,000 medical operations, almost 5,800 births, and more than 75,000 presentations to emergency department.Westmead Hospital is located on the junction of Darcy and Hawkesbury Roads in Westmead and provides a full range of tertiary medical and dental services except for paediatrics which is serviced by the adjacent Children's Hospital at Westmead, relocated from Camperdown to Westmead in 1995. The Hospital includes a large Dental Clinical School and extensive clinical pathology and medical research facilities. From 1995 to 2017 the statewide NETS (NSW), the Newborn and paediatric Emergency Transport Service was hosted at Westmead Hospital, prior to moving to make way for a new acute services block for the hospital.Located nearby are the Cumberland Hospital (providing outpatient and inpatient psychiatric care) and Westmead Private Hospital, a division of Ramsay Health Care.
Background: Modified radical mastoidectomy (MRM) is a mainstay treatment for cholesteatoma but is associated with long-term morbidity, especially in tropical climates where water exposure, microbial colonisation, and limited access to care amplify complications. Obliteration techniques may mitigate these effects, but outcomes in tropical populations remain underreported. This study aims to evaluate clinical, audiological, and quality of life outcomes following MRM obliteration in a North Queensland (NQ) cohort. Methods: A retrospective, multi-centre cohort study was conducted at two surgical centres between 2014 and 2021. Patients undergoing MRM obliteration for post-cholesteatoma complications were included. Primary outcomes were audiometric air conduction thresholds and post-operative ear discharge. Secondary outcomes included swimming ability, caloric effects, re-presentation rates, and patient-reported quality of life using the Glasgow Benefit Inventory (GBI). Results: Twenty-nine patients (32 procedures) were included. Of 23 procedures with full audiometry, mean air conduction improved by similar to 10 dB across frequencies. Ear discharge occurred only in 7/27 patients (26%); 9/26 patients (35%) required ongoing ear care at final follow-up. 3 patients were unable to swim; no patients reported caloric effects. GBI results (n=17) showed that 11 scored >= 50, indicating moderate-to-strong improvement in quality of life. No cholesteatoma recurrences were observed. Conclusions: MRM obliteration in tropical NQ is associated with improved hearing, reduced discharge, and enhanced quality of life. It offers a viable solution for mastoid cavity complications in tropical and remote populations.
Accurate size estimation of large (≥ 20 mm) colorectal laterally spreading tumors (LSTs) is essential for procedural planning, risk stratification, and predicting technical difficulty. Yet, the reliability of visual LST size assessment among endoscopists has not been systematically evaluated. 46 LSTs were recorded during colonoscopy. Twenty-four international expert endoscopists independently reviewed de-identified videos and provided visual estimates for (1) maximal diameter, (2) oral–anal axis, (3) left–right axis, and (4) percentage of colonic circumference involved. Each lesion was assessed twice in randomized order. Fleiss’s kappa, Krippendorff’s alpha, and intraclass correlation coefficients (ICC) were used to evaluate inter- and intra-rater agreement. A total of 1104 measurements were collected. Inter-endoscopist kappa agreement for maximal diameter was poor (κ = 0.16), with similarly poor agreement for the oral–anal (κ = 0.15) and left–right axes (κ = 0.14). The percentage of circumferential involvement demonstrated moderate reproducibility (ICC 0.74 and 0.70 across rounds). Subgroup analyses showed consistently poor agreement for larger lesions for diameter-based methods, whereas circumferential percentage estimation ranged from poor to good depending on LST size and morphology. Intra-endoscopist agreement for diameter- and axis-based approaches showed wide variability (κ range 0.01–0.67), while circumferential estimates achieved good to excellent agreement for most endoscopists. Visual estimation of large colorectal LST size is highly variable among expert endoscopists. Maximal diameter and axial lengths demonstrate poor inter- and intra-observer reliability. Circumferential extent is the most reproducible descriptor and may be the preferred approach for reporting LST size in clinical practice and research.
Differences in immunity in males and females throughout the life span manifest as differences in susceptibility to chronic diseases, infections, cancer, and responses to therapeutic interventions such as immunomodulatory drugs and vaccines. Sex steroids and sex chromosome-linked immune response genes have major roles in driving these differences, but the cells and signaling pathways governing these are disease-specific and often not known. Such knowledge is required to better understand sex differences in disease incidence and clinical course, and to provide treatments tailored to sex-divergent pathways underlying specific diseases. This Essay explores the major areas where further research is required to determine sex-differential mechanisms.
Cardiometabolic disease has become the dominant noncommunicable health challenge of the 21st century, with its burden increasingly centered in Asia. Rising obesity, type 2 diabetes mellitus, hypertension, and dyslipidemia now account for more than one-third of cardiovascular mortality. This escalation reflects the interaction of biological susceptibility with rapid urbanization, digitalized food environments, physical inactivity, and persistent tobacco exposure. Health-system limitations, including low diagnosis rates, poor risk-factor control, and uneven access to essential therapies, further amplify vulnerability across South, East, and Southeast Asia. Environmental pressures such as air pollution and extreme heat compound these risks, while migrant data illustrate how biological predisposition is magnified in obesogenic settings. This review synthesizes evolving epidemiology, biological diversity, behavioral and environmental drivers, and health-system gaps shaping cardiometabolic risk across Asia. It also outlines policy and therapeutic strategies, including strengthened primary care, prevention-focused interventions, and emerging therapeutics needed to reduce cardiometabolic disease in the region.
OBJECTIVES:To develop OMERACT core domain sets for chronic and recurrent calcium pyrophosphate deposition (CPPD) disease and acute calcium pyrophosphate (CPP) crystal arthritis. METHODS:Following OMERACT methodology, the CPPD Working Group (comprising of patient research partners, fellows, clinicians, and methodologists) defined the core domain sets. The development of the core sets occurred through a scoping review, qualitative study, Delphi surveys, and ranking exercises to identify the most relevant domains. A virtual e-module was developed to enable members of the OMERACT community to discuss and vote for endorsement of the OMERACT CPPD core domain sets. RESULTS:The core domains for chronic and recurrent CPPD are pain intensity, joint tenderness, joint swelling, acute CPP crystal arthritis flares, overall function, patient global assessment of disease activity, physician global assessment of disease activity, and adverse events including death. In voting, this core domain set was endorsed by 14/14 (100%) patient research partners and 85/87 (98%) other participants. The core domains for acute CPP crystal arthritis are pain intensity, joint tenderness, joint swelling, duration of acute CPP crystal arthritis flare, overall function, patient global assessment of disease activity, and adverse events including death. In voting, this core domain set was endorsed by 14/14 (100%) patient research partners and 83/86 (97%) other participants. Definitions for all core domains have been developed. CONCLUSION:These core domains provide a foundation for future clinical trials and longitudinal studies in CPPD by defining the minimum outcomes that should be assessed and reported to ensure relevance and comparability across studies.
