119 research outputs found

    Two decades of action on nutrition for the Maltese population

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    Malta, like many other countries, has experienced significant challenges in nutrition over the past 20 years. Given the increasing prevalence of diet-related diseases and overweight and obesity across all ages, nutrition has been high on the Ministry for Health agenda over the past 15 years. Public Health practitioners in Malta have been drivers of public health nutrition reform throughout this period. The Health Promotion and Disease Prevention Directorate was set up to mainly focus on health promotion and non-communicable diseases including healthy nutrition in 2007. Over the years a number of strategies have been outlined targeting nutrition for the Maltese population including the Non Communicable Disease Strategy, the National Cancer Plan, the National Healthy Weight for Life Strategy, the Food and Nutrition Policy and Action Plan for Malta, Diabetes: A National Public Health Priority – A National Strategy for Diabetes 2016-2020, Whole of School Approach to Healthy Lifestyle: Healthy Eating and Physical Activity Policy and Strategy and the National Breastfeeding Policy and Action Plan 2015 – 2020. With input from WHO and the EU, Malta has participated in many surveys allowing for continuous monitoring and evaluation. In 2015, Malta embarked on a first National Food Consumption Survey, results of which will provide a baseline on eating habits to target priority areas for action, inform policy and monitor trends.peer-reviewe

    Giant gastric folds in a patient with hypoalbuminaemia

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    A 70-year-old man presented with a 3-month history of persistent epigastric pain, 8 kg weight loss and lower limb swelling. Examination revealed a normal abdomen and bilateral lower limb oedema. Blood results were unremarkable except for hypoalbuminaemia (23 g/l) and peripheral eosinophilia (1.06×109/l). Urinalysis and CT of the abdomen were negative. An oesophagogastroduodenoscopy (OGD) revealed large gastric folds involving the fundus and the body of the stomach (figure 1), and a small antral polyp. Histology showed marked reactive mucosal changes, pronounced foveolar hyperplasia and cystic dilatation (figure 2), compatible with a diagnosis of Ménétrier’s disease. Helicobacter pylori was absent and the antral polyp was adenomatous. He was given omeprazole and prednisolone (20 mg daily), which was tailed down after 2 months. Subsequently, his symptoms improved significantly. He regained 10 kg in weight and his albumin levels normalised. OGD done post therapy and 1 year later still showed prominent, but less pronounced, gastric folds, and histological evidence of hyperplastic gastropathy.peer-reviewe

    Maternal preconception intake of folic acid in Malta

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    Background: Neural tube defects (NTDs) are serious birth defects arising from abnormalities in neural tube development during early embryogenesis. Research shows that taking folic acid (FA) prior to and throughout the first 12 weeks of pregnancy will significantly decrease the occurrence of NTDs. The prevalence of NTDs in Malta is 10.0/10,000 births, yet this rate can be brought down to 5.0-6.0/10,000 births with preconception FA. This study aims to investigate the maternal intake of preconception FA in Malta. Methods: The National Obstetric Information System (NOIS) collects detailed demographic, pregnancy, delivery and infant outcome data on all births in Malta. One of the variables recorded at the first antenatal visit is whether the mother took FA prior to pregnancy. NOIS data for 2015 was obtained, Excel and SPSS were used for analysis. Results: 4385 women delivered a baby in 2015, of these 1125 (25.7%) reported taking FA before pregnancy. Both univariate and multivariate logistic regression showed that maternal age, parity, education, nationality, locality of residence, marital status, planned pregnancy and use of artificial reproductive technology were all significantly associated with taking preconception FA (p<0.001). Conclusion: Although preconception folic acid supplementation has been advised since the early 1990s, in Malta only a quarter of mothers are taking this before pregnancy. This low compliance is also documented in other countries. Several maternal factors have been found to be associated with better intake of preconception FA. Effective methods of increasing maternal preconception intake of FA are necessary to decrease the rate of NTDs in Malta.peer-reviewe

    Tenofovir as rescue therapy following clinical failure to lamivudine in severe acute hepatitis B

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    Acute hepatitis B (AHB) is a self-limiting condition in more than 95% of cases. Treatment is however recommended in patients with severe AHB (<1% of cases), aiming to prevent liver failure and death. Various nucleos(t)ide analogues (NA) have been found to be effective in severe AHB, although NA-resistant strains causing AHB have been also recently reported. The use of tenofovir in severe AHB has only been described in 3 cases (1 adult and 1 infant with HBV mono-infection, 1 adult with HBV/HIV co-infection). We hereby report a 47-year-old treatment-naïve male, who developed severe AHB and was initially treated with lamivudine (LMV). Initial rapid biochemical response was followed by biochemical breakthrough after 9 days, suggesting LMV resistance. Rescue therapy with ‘add-on’ tenofovir brought about a sustained improvement in biochemical, serological and virological markers until HBsAg was lost after 4 months. Thus, this is the second adult HBV mono-infected patient, who responded successfully to tenofovir in severe AHB.peer-reviewe

    The Potential Malignancy of a Solitary Fibrous Tumour of the Lung

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    Solitary fibrous tumours (SFTs) are rare neoplasms that in the majority of cases are benign. We present the case of a 52-year-old male, with a 23-year history of a slow growing pleural mass, presenting to our department with worsening dyspnoea and localised chest discomfort. The purpose of this case report is to highlight the potential malignancy of a solitary fibrous tumour of the lung along with the key features in diagnosis and management

    Identification of antibiotic resistance patterns in Helicobacter pylori strains isolated from gastric biopsies using real-time PCR and genotypic analysis

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    Background Helicobacter pylori (H. pylori) is associated with dyspepsia, mucus-associated lymphoid tissue lymphoma, gastritis, and peptic ulcer disease. Treatment in Malta consists of triple therapy, which consists of a proton pump inhibitor and 2 of the antibiotics amoxicillin, clarithromycin, metronidazole and fluoroquinolones. We aimed to determine the resistance rates for clarithromycin and fluoroquinolones in patients with H. pylori, and its incidence, in patients undergoing an esophagogastroduodenoscopy (EGD) using real-time polymerase chain reaction (RT-PCR). Methods Patients undergoing an EGD were recruited. A rapid urease test (RUT) was performed, and 4 gastric biopsies were also taken (2 from antrum, 2 from corpus) and analyzed using RT-PCR. Positive samples were tested for antibiotic resistance using amplification and reverse hybridization techniques. Results Two hundred patients (mean age 53.6 [range 20-92] years; 53.1% female) were recruited; the majority were (78%) non-smokers. H. pylori was identified in 21.0% of the patients. Fluoroquinolone resistance was detected in 21.4% of the patients. Clarithromycin resistance was observed in 26.2%, with dual resistance identified in 4.8% of the patients. A high concordance was present with patients testing negative for H. pylori with both RUT and RT-PCR (94.3%). Only 57.6% of patients tested positive with both tests. However, 92.9% of RT-PCR positive patients had a positive genotype HelicoDR test. Conclusions This data demonstrates a high rate of H. pylori resistance to both clarithromycin and fluoroquinolones. These should be avoided when treating H. pylori by utilizing different treatment regimes. Furthermore, we derived important data on the role of RT-PCR, which may be implemented in routine clinical practice.peer-reviewe

    Late-Stage Metastatic Melanoma Emerges through a Diversity of Evolutionary Pathways

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    UNLABELLED: Understanding the evolutionary pathways to metastasis and resistance to immune-checkpoint inhibitors (ICI) in melanoma is critical for improving outcomes. Here, we present the most comprehensive intrapatient metastatic melanoma dataset assembled to date as part of the Posthumous Evaluation of Advanced Cancer Environment (PEACE) research autopsy program, including 222 exome sequencing, 493 panel-sequenced, 161 RNA sequencing, and 22 single-cell whole-genome sequencing samples from 14 ICI-treated patients. We observed frequent whole-genome doubling and widespread loss of heterozygosity, often involving antigen-presentation machinery. We found KIT extrachromosomal DNA may have contributed to the lack of response to KIT inhibitors of a KIT-driven melanoma. At the lesion-level, MYC amplifications were enriched in ICI nonresponders. Single-cell sequencing revealed polyclonal seeding of metastases originating from clones with different ploidy in one patient. Finally, we observed that brain metastases that diverged early in molecular evolution emerge late in disease. Overall, our study illustrates the diverse evolutionary landscape of advanced melanoma. SIGNIFICANCE: Despite treatment advances, melanoma remains a deadly disease at stage IV. Through research autopsy and dense sampling of metastases combined with extensive multiomic profiling, our study elucidates the many mechanisms that melanomas use to evade treatment and the immune system, whether through mutations, widespread copy-number alterations, or extrachromosomal DNA. See related commentary by Shain, p. 1294. This article is highlighted in the In This Issue feature, p. 1275
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