Objectives: COVID-19 severity prediction scores need further validation due to evolving COVID-19 illness. We evaluated existing COVID-19 risk prediction scores in Aotearoa New Zealand, including for M & amacr;ori and Pacific peoples who have been inequitably affected by COVID-19. Methods: We conducted a multicenter retrospective cohort study in adults hospitalized with COVID-19 from January to May 2022, including all M & amacr;ori and Pacific patients, and every second non-M & amacr;ori, non-Pacific (NMNP) patient to achieve equal analytic power by ethnic grouping. We assessed the accuracy of existing severity scores (4C Mortality, CURB-65, PRIEST, and VACO) to predict death in the hospital or within 28 days. Results: Of 2319 patients, 582 (25.1%) identified as M & amacr;ori, 914 (39.4%) as Pacific, and 862 (37.2%) as NMNP. There were 146 (6.3%, 95% confidence interval 5.4-7.4%) deaths, with a predicted probability of death higher than observed mortality for VACO (10.4%), modified PRIEST (15.1%) and 4C mortality (15.5%) scores, but lower for CURB-65 (4.5%). C-statistics (95% CI) of severity scores were: 4C mortality: M & amacr;ori 0.82 (0.75, 0.88), Pacific 0.87 (0.83, 0.90), NMNP 0.90 (0.86, 0.93); CURB-65: M & amacr;ori 0.83 (0.69, 0.92), Pacific 0.87 (0.82, 0.91), NMNP 0.86 (0.80, 0.91); modified PRIEST: M & amacr;ori 0.85 (0.79, 0.90), Pacific 0.81 (0.76, 0.86), NMNP 0.83 (0.78, 0.87); and VACO: M & amacr;ori 0.79 (0.75, 0.83), Pacific 0.71 (0.58, 0.82), NMNP 0.78 (0.73, 0.83). Conclusions: Following re-calibration, existing risk prediction scores accurately predicted mortality.

Objectives: This multicenter cohort study describes Aotearoa New Zealand children hospitalized during the country's first wave of sustained SARS-CoV-2 transmission, Omicron variant. Methods: Children younger than 16 years, hospitalized for > 6 hours with COVID-19 across New Zealand from January to May 2022 were included. Admissions for all M & amacr;ori and Pacific and every second non-Maori non-Pacific children were selected to support equal explanatory power for ethnic grouping. Attribution of hospital admission, demography, clinical presentation, comorbidity, treatment, and outcome data were collected. Results: Of 444 hospitalizations of children positive for COVID-19, 292 (65.5%) from 290 children were considered admissions attributable to COVID-19. Of these admissions, 126 (43.4%) were aged under 1; 118 (40.7%), 99 (34.1%), and 87 (30.0%) were children of M & amacr;ori, Pacific, and non-Maori non-Pacific ethnicity, respectively. Underlying respiratory disease was the most common comorbidity, present in 22 children (7.6%); 16 children (5.5%) were immunosuppressed. Median length of stay was 1 day (interquartile range 0.0-2.0). Four children received antiviral, 69 (24%) antibacterial, and 24 (8%) supplemental oxygen. Although eight children required intensive care, there were no deaths. Conclusions: Children hospitalized during the first significant wave of SARS-CoV-2 infection in New Zealand presented with a multi-system viral illness and rarely with severe disease.

Pulmonary mucormycosis (PM) is a rare but rapidly progressive fungal infection associated with high mortality. A review of the literature suggests that pleural effusions and pneumothoraces are uncommon manifestations associated with distant dissemination. Combined surgical interventions and prolonged antifungal therapy constitute the standard first-line management, with significantly poorer outcomes seen in patients managed with medical therapy alone. Here, we report an unusual case of PM complicated by hydropneumothorax in an immunocompromised patient, in whom comorbidities and disease burden precluded surgical debridement. His disease was ultimately treated with intravenous amphotericin B and maintenance posaconazole after adjunctive drainage. This clinical experience highlights the efficacy of antifungal therapy alone in the treatment of potentially fatal cases of PM unsuitable for surgery.

High-flow nasal therapy significantly reduces exacerbation rates and improves quality of life in patients with stable bronchiectasis. High-flow nasal therapy is therefore a potential treatment option for patients with bronchiectasis.https://bit.ly/2JFXuQc

Hypertrophic pulmonary osteoarthropathy (HPOA) is a well-documented complication of pulmonary malignancy and cystic fibrosis (CF). However, HPOA associated with exacerbations of non-CF bronchiectasis has only been reported once previously in an adolescent. We describe a case of an adult patient with bronchiectasis and HPOA, whose joint symptoms flared during pulmonary exacerbations and improved with treatment of each exacerbation.

used as an intravesical immunotherapy to treat superficial bladder cancer. Complications after intravesical BCG therapy are mostly local reactions, more recently systemic side effects were reported. Case: A 69-year-old male patient was operated for bladder cancer and weekly intravesical BCG applications were started. Fever, weakness and shortness of breath were observed after the 6th treatment. Liver enzymes were found to be high, thoracic tomography showed widespread consolidation areas. With the diagnoses of pneumonia and toxic hepatitis, Meropenem 3x1 g i.v. + Moxifloxacin 1x400 mg + Oseltamivir phosphate 2x75 mg po treatment was started. During follow-up respiratory distress developed and Methylprednisolone 2x80 mg IV was added. Oxygen saturation was found to be 67% and by 8 lt/minute oxygen support it was 90%. He was transferred to the Intensive Care Unit on the 3rd day of the treatment. Urine, sputum and blood culture samples were taken. Noninvasive mechanical ventilation (NIMV) support was initiated. In the sputum ARB, in the blood the Quantiferon test was negative. The need for NIMV support decreased, the infiltrates on chest X-ray were regressed and biochemical analysis showed a decrease in liver function tests. Reducing the corticosteroid dose, on the 8th day from intensive care unit and on the 15th day, he was discharged from the hospital. Thoracic CT revealed near-complete regression, liver function tests normalized and mycobacterium culture was still negative. Discussion: Complications of BCG therapy may result from hypersensitivity with diffuse granulomatous reaction without isolation of M. bovis, or may represent an infectious disease related to the dissemination of M. bovis, isolated from the involved sites. They may harbour different clinical aspects and have various degrees of severity, sometimes leading to death. Mechanisms remain poorly understood and highly controversial. AO1566

Introduction The prevalence of bronchiectasis in New Zealand (NZ) is higher than comparable countries (180/100,000 population)1; the burden and severity of disease are incompletely understood. Bronchiectasis registries such as EMBARC (>14,000 participants) and the Australian Bronchiectasis Registry (ABR, 1360 participants) have improved understanding of bronchiectasis and identified future research priorities. The aim of the NZ Bronchiectasis Registry (NZBR) is to contribute to the understanding of bronchiectasis aetiology and management, both in NZ and internationally. It is closely aligned with ABR and supported by Lung Foundation Australia. Methods NZBR shares data fields with ABR and EMBARC, with additional fields to reflect unique socio-demographic characteristics of NZ participants. NZBR is a multi-centre, prospective, observational study enrolling consecutive patients in NZ. Participants are identified from existing clinical and research databases, and from inpatient and outpatient encounters. Eligible adult participants have a clinical diagnosis of bronchiectasis, excluding cystic fibrosis, confirmed on CT thorax. All participants are seen face-to-face and provide written consent. Demographics, clinical information, exacerbation history (including antibiotic prescription data) and health-related quality of life assessment are collected at enrolment and annual review. Data is entered into a secure online platform, which sits alongside ABR in REDCap. Results National ethical approval is in place. Enrolment began at the primary site in June 2018, shortly followed by a second site. Two additional sites have local research governance approval. To date, 117 participants have been enrolled across 2 sites: 63/117 females (53.8%); mean age 62.4 (±15.6) years. 45/117 (38.4%) of participants are of M&x0101;ori or Pacific Island origin; 41/117 (35.0%) participants live in the most deprived socioeconomic quintile. Conclusion These early steps have paved the way for a national bronchiectasis registry and are an early indicator of health inequalities for bronchiectasis in NZ. NZBR will contribute to a regional Australasian Bronchiectasis Registry to create a comprehensive longitudinal dataset across Australia and NZ, to help establish the burden of disease, promote changes in clinical practice and improve clinical outcomes. Future plans include addition of paediatric sites and increased collaboration with international registries. Reference Telfar Barnard L, Zhang J. Asthmaand Respiratory Foundation New Zealand; 2017.

Clinical end-points are a crucial part of any clinical trial. In bronchiectasis, debate has arisen over the optimal end-points to use because of variable results from recent intervention trials. We discuss the challenges faced in choosing end-points and review the end-points that have been used in bronchiectasis clinical trials to date. These clinical end-points and potential biomarkers include exacerbations, health-related quality of life and symptom-burden assessment, exercise capacity and lung function, radiological changes, sputum and systemic inflammatory markers, and microbiological assessment (including microbiome analysis). Limited evidence is available about when an end-point is preferable, and each end-point provides a unique insight into bronchiectasis morbidity. It is hoped that as we begin to understand bronchiectasis in greater detail, these clinical end-points can be tailored to specific groups and interventions in order to provide meaningful outcomes for patients, and ultimately more evidence-based treatment options.

BACKGROUND:Radial-probe endobronchial ultrasound (radial-EBUS) is becoming an important investigation for peripheral pulmonary lesions (PPL). A key advantage of radial-EBUS is the favourable risk profile compared with current gold-standard computerised tomography-guided biopsy.AIM:To investigate the diagnostic yield, predictors of positive yield and radial-EBUS safety in a New Zealand institution. We also determined whether molecular analysis was possible on the same tissue samples.METHODS:We performed a retrospective analysis of all patients (n = 68) from Middlemore Hospital, Auckland, undergoing radial-EBUS with guide-sheath for PPL from March 2015 to August 2016. Clinical, radiological and procedural data were collected. Radial-EBUS diagnostic yield was determined for malignant and benign diagnoses, and molecular analysis yield was determined on appropriate malignant samples. Logistic regression was used to determine factors predicting successful radial-EBUS.RESULTS:Overall diagnostic yield of radial-EBUS was 55.9% (95% confidence interval (CI): 44.3-67.9). Malignant diagnostic sensitivity was 60.8% (95% CI: 46.1-74.2) and benign diagnostic sensitivity was 50% (95% CI: 23-77). Lesions close to the hilum (P = 0.039), concentric radial-probe positioning (P = 0.008) and the use of forceps as first instrument (P = 0.0049) significantly predicted successful diagnostic yield. Of the malignant cases 81.0% (95% CI: 58.1-94.6) were sufficient for molecular analysis. Pneumothorax occurred in 4.4% (95% CI: 0.9-12.4), none required chest drain intervention. There were no cases of significant pulmonary haemorrhage.CONCLUSION:Radial-EBUS was shown to be safe with diagnostic yield similar to international reports. Important predictors of success include distance from hilum, probe position and forceps as first instrument. We also demonstrated that molecular analysis is possible in radial-EBUS obtained samples.

BACKGROUND:The aim was to identify potential factors associated with acute corneal hydrops in a New Zealand population with keratoconus referred to a hospital eye service.METHODS:In a single hospital centre, in a retrospective review, demographic and clinical features of subjects with keratoconus and corneal hydrops over a 17-year period were compared with an age- and gender-matched control group of subjects with keratoconus but no history of corneal hydrops.RESULTS:One hundred and one eyes of 101 subjects (mean age 24.6 ± 8.4 years) were identified with keratoconus-related corneal hydrops. Subjects were more likely to be of Pacific but less likely to be of New Zealand European ethnicity than control subjects (n = 101). In comparison, Maori ethnicity was not found to have a significantly positive or negative association with hydrops. The pre-hydrops visual acuity (VA) of affected eyes was poorer than that of controls (p < 0.001) at first presentation to our tertiary referral corneal and contact lens service. Hydrops typically developed approximately four years after diagnosis of keratoconus. Subjects with hydrops were more likely to have a history of eye-rubbing (p = 0.011) but less likely to have a family history of keratoconus (p = 0.05). In 31 cases, the acute hydrops event was their first optometric/ophthalmologic contact. There were no statistically significant differences in the prevalence of atopic disease, contact lens wear or overall corneal transplantation rate between the two groups.CONCLUSIONS:Pacific ethnicity, history of eye-rubbing, poor VA at first hospital presentation and lack of family history were statistically associated with developing acute corneal hydrops in keratoconus in a New Zealand population. Greater understanding of such predisposing risk factors may help develop early management strategies to delay or prevent progression of this disease.

PURPOSE:Gap junctions are intercellular channels that have been implicated in the pathogenesis of neuronal death after central nervous system injury. This study determines the expression pattern of gap junction protein connexin43 in the human retina and optic nerve.METHODS:An affinity-isolated polyclonal antibody to the C-terminal segment of the cytoplasmic domain of human connexin43 was used to determine connexin43 localization. Postmortem human eyes were examined by immunohistochemical staining of frozen sections using antibodies to connexin43. Antibody binding was detected using confocal microscopy and fluorochrome-conjugated secondary antibodies. Double-label immunohistochemistry identified the cell types expressing connexin43.RESULTS:Connexin43 immunoreactivity was detected in the human retina on glial fibrillary acidic protein (GFAP)-positive astrocytes in the retinal ganglion cell layer and, to a lesser extent, on the processes of glutamine synthetase-labeled Müller cells. The retinal and choroidal circulations showed strong connexin43 immunolabeling. Dense connexin43 immunoreactivity was present between adjacent cells of the retinal pigment epithelium, and there was diffuse connexin43 immunoreactivity on GFAP-positive astrocytes in the optic nerve.CONCLUSIONS:In the human retina and optic nerve, connexin43 is present on glia, blood vessels, and epithelial cells. An understanding of the distribution of connexin43 in the normal retina and optic nerve may be used to evaluate changes associated with retinal and optic nerve disease.