👤 Catherine Sciascia

Increased lipoprotein(a) (Lp[a]) is a genetically determined causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Historically, Lp(a) testing has been uncommon in Australia. This study aims to assess the prevalence and trends in Lp(a) testing in Australia, and the associated patient characteristics. This retrospective cross-sectional study examined over 1.1 million de-identified electronic medical records from patients seen in the Advara HeartCare network from 2011 to 2022. Adult patients from 2011 to 2021 comprised the historical group, while those from 2022 formed the baseline group. A natural language processing algorithm identified patients with ASCVD and Lp(a) testing, and extracted demographics, characteristics, and cardiovascular comorbidities from clinical letters. Patients with ASCVD in the baseline group were followed up for 18 months to assess trends in Lp(a) testing. Testing Lp(a) was infrequent among patients with ASCVD but increased gradually over time. In the historical cohort, of 164,121 patients identified with ASCVD, 1,501 (0.9%) underwent Lp(a) testing. Of these, 44.8% had Lp(a) levels <30 mg/dL, and 25.0% >90 mg/dL. In the baseline cohort, 1,460 (2.6%) of 55,427 patients with ASCVD underwent Lp(a) testing. Of 730 with recorded Lp(a) values, 30.2% had Lp(a) levels ≥70 mg/dL, and 86.8% were on lipid-lowering therapy. Dyslipidaemia was the most common comorbidity (72.8%), followed by Stage 1 or 2 chronic kidney disease (40.1%). During 18-month follow-up from the baseline period, 329 additional patients underwent Lp(a) testing in 2023. The study revealed that Lp(a) testing is underutilised among patients with ASCVD in Australia despite recent guidelines recommending it. This emphasises the need to expand Lp(a) testing to improve health outcomes for high-risk patients. Show less

This study aims to investigate the current evidence regarding long-term outcomes using laparoscopic peritoneal lavage (LPL) versus primary bowel resection (PR) in Hinchey III diverticulitis. A systematic review was undertaken based upon articles published between January 1, 2000, and March 1, 2024. Databases Pubmed, Scopus, and Embase were used employing the key search terms "Diverticulitis" and "Peritoneal Lavage." Articles were selected according to the PRISMA guidelines and statistical analysis was undertaken. Cumulative analysis of diverticulitis recurrence and secondary outcomes of disease-related mortality, serious adverse events, stoma incidence, reoperation, and readmission rates were performed. An initial search identified 506 articles for review. A total of 294 patients were included for final analysis from 3 prospective randomized controlled trials. There was no significant difference in disease-related mortality or serious adverse events between LPL and PR. There was significantly decreased likelihood of having a stoma in the LPL group; however, there was also a significantly increased likelihood of having recurrent diverticulitis. There was heterogenicity across all trials. There is a paucity of level 1 evidence available regarding the long-term outcomes of Hinchey III diverticulitis managed with LPL. At 3-year follow-up, there is a significantly decreased likelihood of having a stoma, tempered by the fact that there is a significantly increased likelihood of having recurrent diverticulitis. Further homogenous high-quality randomized studies are required to clarify whether LPL shows long-term benefit over PR. Show less

As in many autoimmune diseases, the pathogenesis of the antiphospholipid syndrome (APS) is the result of a complex interplay between predisposing genes and triggering environmental factors, leading to a loss of self-tolerance and immune-mediated tissue damage. While the first genetic studies in APS focused primarily on the Show less