PULMONOLOGY

Vocal cord dysfunction/inducible laryngeal obstruction (VCD/ILO) is a common condition characterized by breathlessness due to laryngeal narrowing. An international Roundtable conference was held in Melbourne to address key questions and improve collaboration in the field. The discussions focused on diagnosing VCD/ILO, understanding its pathogenesis, current management approaches, and identifying research gaps. Diagnosis conventionally involves laryngoscopy, but computed tomography shows promise for faster diagnosis. The condition's complex pathogenesis and interactions with other conditions make it challenging to pinpoint a single disease mechanism. Currently, there is no evidence-based standard of care due to the lack of randomized trials. Multidisciplinary models of care need further investigation, along with studying patient perspectives and healthcare utilization. The Roundtable provided valuable insights and set priorities for future research in this impactful condition.

Vocal Cord Dysfunction (VCD) and Inducible Laryngeal Obstruction (ILO): Insights from International Roundtable Conference on Diagnosis, Pathogenesis, and Management Strategies

Reduced temporalis muscle thickness was associated with greater disability and higher mortality risk in oral cancer patients.

Temporalis Muscle Thickness Linked to Oral Cancer Outcomes

A retrospective study of 527 patients with oral cancer found that reduced temporalis muscle thickness (TMT) on MRI was associated with greater disability and higher all-cause mortality. After adjustment, patients with higher TMT had significantly lower odds of severe disability and lower mortality risk, suggesting TMT may serve as an imaging-derived marker of muscle status and prognosis.

CRITICAL CARE

A systematic review examines ICU-acquired weakness prevalence, risk factors, and outcomes in critically ill children.

ICU-Acquired Weakness in Children: Prevalence, Risk Factors and Outcomes

A systematic review of 14 studies found a pooled prevalence of 52% for ICU-acquired weakness (ICUAW) among critically ill children, with substantial heterogeneity between studies. Researchers identified 34 personal, disease, and treatment-related factors and 11 associated biomarkers. The findings emphasize early detection, prevention, and standardized diagnostic criteria in pediatric intensive care.

NEUROLOGY

Long sleep duration was associated with increased all-cause mortality risk, potentially mediated partly by systolic blood pressure.

Long Sleep Duration and All-Cause Mortality Risk: Taiwanese Cohort Study

A prospective Taiwanese cohort study of 3,305 participants followed for a median of 30.8 years found that sleeping ≥9 hours was associated with a 17% higher risk of all-cause mortality (adjusted HR 1.17; 95% CI 1.01–1.35). No significant association was observed with cardiovascular mortality. Systolic blood pressure may partially mediate this relationship.

PSYCHIATRY

Experts recommend screening and monitoring for eating disorders before prescribing GLP-1 receptor agonists.

GLP-1RA Use and Eating Disorder Safety: Expert Consensus

A three-round Delphi consensus involving 45 experts and individuals with lived experience achieved 91.7% average agreement on GLP-1RA safety recommendations. Guidance supports eating disorder screening, risk-based monitoring, patient education, and concurrent psychotherapy, while generally advising against use in active anorexia nervosa and bulimia nervosa with significant dietary restraint.

ONCOLOGY

Reduced temporalis muscle thickness was associated with increased disability and mortality in patients with oral cancer.

Temporalis Muscle Thickness Predicts Disability and Mortality in Oral Cancer

A retrospective study of 527 patients with oral cancer found that reduced temporalis muscle thickness (TMT) on MRI was associated with greater disability and higher all-cause mortality. Patients in the highest TMT quartile had a lower risk of severe disability (adjusted OR 0.38) and reduced mortality risk (adjusted HR 0.44–0.54). Prospective validation is needed.

A systematic review identifies ICUAW prevalence, risk factors, and outcomes in critically ill children, highlighting early detection.

ICU-Acquired Weakness in Critically Ill Children: Prevalence and Risk Factors

A systematic review of 14 studies found that ICU-acquired weakness (ICUAW) among critically ill children had a pooled incidence of 2% and prevalence of 52%, with substantial study heterogeneity. Researchers identified 34 personal, disease, and treatment-related factors and 11 associated biomarkers. The findings emphasize standardized diagnosis, early detection, and preventive strategies in pediatric intensive care.

A prospective Taiwanese cohort study of 3,305 adults followed for a median of 30.8 years found that sleeping ≥9 hours was associated with a 17% higher risk of all-cause mortality (adjusted HR 1.17; 95% CI 1.01–1.35). No significant association was observed between long sleep and cardiovascular mortality. Systolic blood pressure may partially mediate this association.

Experts recommend eating disorder screening and monitoring before prescribing GLP-1 receptor agonists.

Expert Consensus on GLP-1 Receptor Agonists and Eating Disorder Safety

A three-round Delphi consensus involving 45 experts and individuals with lived experience achieved 91.7% average agreement on recommendations for GLP-1 receptor agonist use in people with eating disorders. Guidance emphasizes pre-treatment screening, risk-based monitoring, patient education, and concurrent psychotherapy. GLP-1RAs should generally be avoided in individuals with active anorexia nervosa or bulimia nervosa with significant dietary restriction.

A large Swedish genetic study identifies interconnected clusters and shared genetic risks across psychiatric and substance use disorders.

Genetic Risk Network Maps Links Across Psychiatric and Substance Use Disorders

A Swedish population-based genetic study using data from 1,510,974 individuals identified five interconnected clusters of psychiatric and substance use disorders: internalizing, externalizing, neurodevelopmental, eating, and psychotic disorders. Genetic risks for major depression and drug use disorder were central, while ADHD, bipolar disorder, OCD, and autism spectrum disorder bridged different clusters.

RHEUMATOLOGY

Study finds substantial variation in D2T-RA classification and proposes a two-year framework for early and late disease.

Difficult-to-Treat Rheumatoid Arthritis Criteria Vary Across Clinical Applications

A real-world study of 1,121 patients with rheumatoid arthritis found that published applications of EULAR difficult-to-treat RA criteria identified different patient groups, with prevalence ranging from 5.5% to 11.7%. A two-year threshold from first advanced therapy initiation classified approximately 40% as early and 60% as late D2T-RA, supporting improved temporal stratification.

An umbrella review identifies updated risk factors and potential prevention targets for psychotic disorders.

Updated Risk and Protective Factors for Psychotic Disorders

An umbrella review of 69 systematic reviews covering 970 studies and 221 factors identified six factors with convincing evidence of association with psychotic disorders. High population attributable fractions were observed for childhood adversities (40.69%), Toxoplasma gondii IgG positivity (20.47%), frequent cannabis use (12.75%), and clinical high risk for psychosis (12.68%).

PEDIATRICS

Norwegian TOPSE and Teen TOPSE questionnaires demonstrate strong reliability for assessing parenting self-efficacy after pediatric brain injury.

Norwegian TOPSE Questionnaires Validated After Pediatric Brain Injury

A validation study found that Norwegian versions of the TOPSE and Teen TOPSE questionnaires demonstrated good-to-excellent psychometric properties in parents of children with pediatric acquired brain injury. Internal consistency was excellent (Cronbach’s α=0.94 and 0.96), while test–retest reliability was strong (ICC=0.90 and 0.89).

GASTROENTEROLOGY

T-TAS showed reproducible assessment of thrombus formation in cirrhosis with thrombocytopenia, warranting prospective validation.

T-TAS Assesses Primary Haemostasis in Thrombocytopenic Cirrhosis

The CirTAS study involving 81 patients with cirrhosis and thrombocytopenia found that the Total Thrombus Analysis System (T-TAS) demonstrated high reproducibility, including at platelet counts below 50 × 10⁹/L. Thrombus formation decreased with worsening disease severity and bacterial infection, supporting further validation of T-TAS for assessing bleeding-related risks.

Moral injury and PTSD commonly co-occurred among Dutch veterans and were associated with psychopathology and poorer family functioning.

Moral Injury and PTSD Profiles Among Dutch Treatment-Seeking Veterans

A study of 455 treatment-seeking Dutch veterans found three distinct profiles of moral injury and PTSD: subclinical (20.9%), moderate (47.9%) and high (31.2%). Greater symptom severity was associated with increased comorbid psychopathology and poorer family functioning, highlighting the importance of assessing moral injury in veteran mental healthcare.

GYNAECOLOGY - IVF

Pre-delivery PTSD was associated with modestly higher risks of cesarean delivery, low birth weight, and preterm birth.

PTSD Before Delivery Linked to Adverse Pregnancy Outcomes

A nationwide Taiwanese matched cohort study of 8,706 women found that PTSD diagnosed within 1 year before delivery was associated with increased risks of cesarean delivery (aOR 1.18), low birth weight (aOR 1.19), and preterm birth (aOR 1.21). No significant associations were observed with stillbirth, congenital anomalies, or abnormal Apgar scores.

Vocal cord dysfunction/in...

Vocal cord dysfunction/inducible laryngeal obstruction—2022 Melbourne Roundtable Report