The Australasian Registry for Severe Cutaneous Adverse Reactions (AUS-SCAR) - Providing a roadmap for closing the diagnostic, patient, and healthcare gaps for a group of rare drug eruptions.

Background: Severe cutaneous adverse reactions (SCAR) are a group of delayed presumed T-cell mediated hypersensitivities associated with significant morbidity and mortality. Despite their shared global healthcare burden and impact, the clinical phenotypes, genomic predisposition, drug causality, and treatment outcomes may vary. We describe the establishment and results from the first Australasian registry for SCAR (AUS-SCAR), that via a collaborative network advances strategies for the prevention, diagnosis and treatment of SCAR. Methods: Prospective multi-center registry of SCAR in Australian adult and adolescents, with planned regional expansion. The registry collects externally verified phenotypic data drug causality, therapeutics and long-term patient outcomes. In addition, biorepository specimens and DNA are collected at participating sites. Results: we report on the first 100 patients enrolled in the AUS-SCAR database. DRESS (50%) is the most predominant phenotype followed by SJS/TEN (39%) and AGEP (10%), with median age of 52 years old (IQR 37.5, 66) with 1:1 male-to-female ratio. The median latency for all implicated drugs is highly variable but similar for DRESS (median 15 days IQR 5,25) and SJS/TEN (median 21 days, IQR 7,27), while lowest for AGEP (median 2.5 days, IQR 1,8). Antibiotics (54.5%) are more commonly listed as primary implicated drug compare with non-antibiotics agent (45.5%). Mortality rate at 90 days was highest in SJS/TEN at 23.1%, followed by DRESS (4%) and AGEP (0%). Conclusion: In the first prospective national phenotypic and biorepository of SCAR in the southern hemisphere we demonstrate notable differences to other reported registries; including DRESS-predominant phenotype, varied antibiotic causality and low overall mortality rate. This study also highlights the lack of standardised preventative pharmacogenomic measures and in vitro/in vivo diagnostic strategies to ascertain drug causality. Trial registration: ANZCTR ACTRN12619000241134. Registered 19 February 2019.

Clinical and dermoscopic features of nail unit melanoma in an Australian nail clinic cohort.

Nail unit melanoma carries diagnostic challenges conferring with its poor prognosis. This audit aims to characterise both clinical and dermoscopic features of nail unit malignant lesions and compare them with biopsied benign lesions. It focuses on informing future practice by aiding in the stratification and recognition of malignant diagnostic patterns in the Australian context.

Carotid artery stenosis: An approach to its diagnosis and management.

BACKGROUND: Carotid artery stenosis (CAS) is one of the major causes of acute ischaemic stroke, accounting for approximately 20% of cases. It is not always symptomatic; however, when it is, the neurological vascular territory it commonly affects is the anterior circulation of the brain, causing symptoms such as hemiplegia, dysphasia or vision loss. OBJECTIVE: The aim of this article is to review the current literature on CAS, summarise the main updates and evidence base for surgical management, and discuss when vascular surgical input may be beneficial. DISCUSSION: CAS can be classified as symptomatic or asymptomatic disease. Carotid endarterectomy remains important in the treatment of symptomatic disease because of a strong evidence base for its benefit in the overall reduction of recurrent stroke risk. The benefit of surgery is less clear for asymptomatic disease. Commencement of best medical therapy as well as cardiovascular risk factor modification is a mainstay of treatment for both groups of patients.

Skin checks in primary care.

BACKGROUND: The incidence of skin cancers in Australia continues to rise. Early detection and timely management are required. OBJECTIVE: This article presents a framework for skin examinations in primary care and outlines the various measures available to facilitate early skin cancer detection. Common characteristics of malignant cancers are also discussed. DISCUSSION: Skin cancer awareness campaigns encourage patients to see their general practitioners (GPs) for complete skin examination. GPs are expected to correctly identify benign and malignant skin lesions and understand their high risk patients. A systematic approach to the skin examination combined with knowledge and awareness of diagnostic tools can aid in the early detection of skin malignancies, and prompt escalation as necessary.

Barriers and Facilitators to Weight and Lifestyle Management in Women with Polycystic Ovary Syndrome: General Practitioners' Perspectives.

BACKGROUND: Weight and lifestyle management is advocated as the first-line treatment for polycystic ovary syndrome (PCOS) by evidence-based guidelines. Current literature describes both systems- and individual-related challenges that general practitioners (GPs) face when attempting to implement guideline recommendations for lifestyle management into clinical practice for the general population. The GPs' perspective in relation to weight and lifestyle advice for PCOS has not been captured. METHODS: Fifteen GPs were recruited to take part in semi-structured interviews. NVIVO software was used for qualitative analysis. RESULTS: We report that GPs unanimously acknowledge the importance of weight and lifestyle management in PCOS. Practice was influenced by both systems-related and individual-related facilitators and barriers. Individual-related barriers include perceived lack of patient motivation for weight loss, time pressures, lack of financial reimbursement, and weight management being professionally unrewarding. System-related barriers include costs of accessing allied health professionals and unavailability of allied health professionals in certain locations. Individual-related facilitators include motivated patient subgroups such as those trying to get pregnant and specific communication techniques such as motivational interviewing. System-related facilitators include the GP's role in chronic disease management. CONCLUSIONS: This study contributes to the understanding of barriers and facilitators that could be addressed to optimize weight and lifestyle management in women with PCOS in primary care.