36 research outputs found

    Subarachnoid Haemorrhage in Malta : Are outcomes adversely affected due to lack of a local neurovascular service?

    Get PDF
    Objective: This study was performed to assess the incidence, treatment and outcome of non-traumatic Subarachnoid Haemorrhage (SAH) in an island which does not offer a neurovascular service and to determine whether such limitation is associated with a poor outcome. Method: Data of adult patients with a diagnosis of non-traumatic SAH was analysed retrospectively over a two-year period from January 01, 2009 to December 31, 2010. Results: The incidence of SAH in Malta is 3.16 cases per 100 000 population per year. An underlying aneurysm was found in 50% of all cases investigated with angiography. These patients were transported to the United Kingdom for definitve management and the outcome of all these patients at 6 months was excellent. (modified Rankin Scale of 0 or 1). Conclusions: With the incidence of non-traumatic SAH being in the low range, setting up an interventional neuroradiology service in our country to treat aneurysmal SAH would not have the required numbers to maintain expertise and would probably translate into worse clinical outcomes. Despite having geographical and logistic limitations, our standards of care and survival rates are not below those of other international centres. Outcomes for patients with low initial Hunt and Hess scores have not been adversely.peer-reviewe

    Bilateral ptosis with complete ophthalmoplegia

    Get PDF
    An 89-year-old woman was referred to the accident and emergency department with droopy eyelids. The onset of symptoms coincided with the initiation of clarithromycin prescribed for a respiratory tract infection. She was also reported to have a change in the quality of her voice and was choking on fluids.peer-reviewe

    An Adult Case of Acute EBV Cerebellitis

    Get PDF
    Acute neurological manifestations of infectious mononucleosis are uncommon and have been predominantly reported in the paediatric population. We report a case of acute Epstein-Barr virus cerebellitis in an adult in whom spontaneous resolution of symptoms and signs occurred after 2 weeks of supportive treatment. An infective cause for an acute cerebellar syndrome in an adult must always be considered in the differential diagnosis when appropriate

    Brain symmetry index in healthy and stroke patients for assessment and prognosis

    Get PDF
    Quantitative neurophysiological signal parameters are of value in predicting motor recovery after stroke.Thenovel role of EEG-derived brain symmetry index formotor function prognostication in the subacute phase after stroke is explored. Ten male stroke patients and ten matched healthy controls were recruited. Motor function was first assessed clinically using the MRC score, its derivativeMotricity Index, and the Fugl–Meyer assessment score. EEG was subsequently recorded firstwith subjects at rest and then during hand graspingmotions, triggered by visual cues. Brain symmetry index (BSI) was used to identify the differences in EEG-quantified interhemispheric cortical power asymmetry observable in healthy versus cortical and subcortical stroke patients. Subsequently, any correlation between BSI and motor function was explored. BSI was found to be significantly higher in stroke subjects compared to healthy controls ( = 0.023). The difference in BSI was more pronounced in the cortical stroke subgroup ( = 0.016). BSI showed only a mild general decrease on repeated monthly recording. Notably, a statistically significant correlation was observed between early BSI and Fugl–Meyer score later in recovery ( < 0.050). Brain symmetry index is increased in the subacute poststroke phase and correlates with motor function 1-2 months after stroke.peer-reviewe

    The effect of alloying elements on the properties of pressed and non-pressed biodegradable Fe–Mn–Ag powder metallurgy alloys

    Get PDF
    Current trends in the biodegradable scaffold industry call for powder metallurgy methods in which compression cannot be applied due to the nature of the scaffold template itself and the need to retain the shape of an underlying template throughout the fabrication process. Iron alloys have been shown to be good candidates for biomedical applications where load support is required. Fe–Mn alloys were researched extensively for this purpose. Current research shows that all metallurgical characterisation and corrosion test on Fe–Mn and Fe–Mn–Ag non pre-alloyed powder alloys are performed on alloys which are initially pressed into greens and subsequently sintered. In order to combine the cutting-edge field of biodegradable metallic alloys with scaffold production, metallurgical characterisation of pressed and non-pressed Fe, Fe–Mn and Fe–Mn–Ag sintered elemental powder compacts was carried out in this study. This was performed along with determination of the corrosion rate of the same alloys in in vitro mimicking solutions. These solutions were synthesised to mimic the osteo environment in which the final scaffolds are to be used. Both pressed and non-pressed alloys formed an austenite phase under the right sintering conditions. The corrosion rate of the non-pressed alloy was greater than that of its pressed counterpart. In a potentiodynamic testing scenario, addition of silver to the alloy formed a separate silver phase which galvanically increased the corrosion rate of the pressed alloy. This result wasn't replicated in the non-pressed alloys in which the corrosion rate was seen to remain similar to the non-silver-bearing alloy counterparts.peer-reviewe

    Influence of cold rolling on in vitro cytotoxicity and electrochemical behaviour of an Fe-Mn-C biodegradable alloy in physiological solutions

    Get PDF
    The properties of cold-worked Fe-13Mn-1.2C steel, as candidate material for scaffolding and stenting applications, have been investigated. The study of the electrochemical corrosion susceptibility of Fe-13Mn-1.2C alloy in protein bearing and non-protein bearing physiological solutions, revealed that there were no differences between the as-received, 10% and 20% cold worked Fe-13Mn-1.2C samples. Although protein addition reduces the overall corrosion rate in static immersion degradation tests for both the cold worked and non-cold worked alloys, there were no discernible differences in the corrosion rates of samples with different percentages of cold work deformations. Similarly, potentiodynamic testing showed no differences between the corrosion rates in solutions with and without protein addition. Atomic absorption spectroscopy (AAS) results—post static immersion—showed similar values of Fe and Mn concentrations in the electrolyte for all the investigated conditions. Cold working was found to increase Grain Average Misorientation (GAM) and deformation twins within the steel, and, consequently, this led to an increase in the elastic modulus. Hence, cold-rolling may be used to achieve smaller sections (volumes) in order to support the equivalent load of the non-cold worked counterpart, giving a larger surface area to the volume ratio, thereby increasing the corrosion rate, and, in turn, rendering the degradation process shorter. When considering cytocompatibility in vitro, the collected supernatant particulate free Fe-13Mn-1.2C steel electrolytes were seen to be equally cytocompatible with no differences being observed between the different percentage cold work conditions. The presence of solid 80 μm size particles in the seeded elutions were seen to change the results and render the Fe-13Mn-1.2C steel non-cytocompatible.peer-reviewe

    Brain Symmetry Index in Healthy and Stroke Patients for Assessment and Prognosis

    Get PDF
    Objective. Quantitative neurophysiological signal parameters are of value in predicting motor recovery after stroke. The novel role of EEG-derived brain symmetry index for motor function prognostication in the subacute phase after stroke is explored. Methods. Ten male stroke patients and ten matched healthy controls were recruited. Motor function was first assessed clinically using the MRC score, its derivative Motricity Index, and the Fugl-Meyer assessment score. EEG was subsequently recorded first with subjects at rest and then during hand grasping motions, triggered by visual cues. Brain symmetry index (BSI) was used to identify the differences in EEG-quantified interhemispheric cortical power asymmetry observable in healthy versus cortical and subcortical stroke patients. Subsequently, any correlation between BSI and motor function was explored. Results. BSI was found to be significantly higher in stroke subjects compared to healthy controls ( = 0.023). The difference in BSI was more pronounced in the cortical stroke subgroup ( = 0.016). BSI showed only a mild general decrease on repeated monthly recording. Notably, a statistically significant correlation was observed between early BSI and Fugl-Meyer score later in recovery ( &lt; 0.050). Conclusions. Brain symmetry index is increased in the subacute poststroke phase and correlates with motor function 1-2 months after stroke

    Occupation and amyotrophic lateral sclerosis risk : a case-control study in the isolated island population of Malta

    Get PDF
    Objective: Amyotrophic lateral sclerosis (ALS) is a mostly sporadic neurodegenerative disease. The role of environmental factors has been extensively investigated but associations remain controversial. Considering that a substantial proportion of adult life is spent at work, identifying occupations and work-related exposures is considered an effective way to detect factors that increase ALS risk. This process may be further facilitated in population isolates due to environmental and genetic homogeneity. Our study investigated occupations and occupational exposures potentially associated with ALS risk in the isolated island population of Malta, using a case-control study design. Methods: Patients with ALS and randomly identified matched controls (1:1) were recruited throughout a four-year window, from 2017 through 2020. Data on educational level, residence, main occupation, smoking, and alcohol history were collected. Results: We found that compared to controls (44.4%), a higher percentage (73.7%) of ALS patients reported a blue-collar job as their main occupation (OR 2.04, 95% CI 1.2-3.72; p = 0.0072). Through regression analysis, craft and related trades occupations such as carpentry and construction (ISCO-08 major group 7), were found to be positively associated with ALS, with patients in this occupational category found to be more prone to develop bulbar-onset ALS (p = 0.0297). Overall, patients with ALS reported a significantly higher exposure to work-related strenuous physical activity (OR 2.35, 95% CI 1.53-3.59; p = 0.0002). Conclusion: Our findings suggest that manual workers particularly those working in the carpentry and construction industries have an increased ALS risk, possibly due to a history of intense or sustained physical activity.peer-reviewe

    Genetic landscape of ALS in Malta based on a quinquennial analysis

    Get PDF
    Genetic risk for amyotrophic lateral sclerosis (ALS) is highly elevated in genetic isolates, like the island population of Malta in the south of Europe, providing a unique opportunity to investigate the genetics of this disease. Here we characterize the clinical phenotype and genetic profile of the largest series of Maltese ALS patients to date identified throughout a 5-year window. Cases and controls underwent neuromuscular assessment and analysis of rare variants in ALS causative or risk genes following whole genome sequencing. Potentially damaging variants or repeat expansions were identified in more than 45% of all patients. The most commonly affected genes were ALS2, DAO, SETX and SPG11, an infrequent cause of ALS in Europeans. We also confirmed a significant association between ATXN1 intermediate repeats and increased disease risk. Damaging variants in major ALS genes C9orf72, SOD1, TARDBP and FUS were however either absent or rare in Maltese ALS patients. Overall, our study underscores a population that is an outlier within Europe and one that represents a high percentage of genetically explained cases.peer-reviewe

    Global monitoring of antimicrobial resistance based on metagenomics analyses of urban sewage

    Get PDF
    Antimicrobial resistance (AMR) is a serious threat to global public health, but obtaining representative data on AMR for healthy human populations is difficult. Here, we use meta-genomic analysis of untreated sewage to characterize the bacterial resistome from 79 sites in 60 countries. We find systematic differences in abundance and diversity of AMR genes between Europe/North-America/Oceania and Africa/Asia/South-America. Antimicrobial use data and bacterial taxonomy only explains a minor part of the AMR variation that we observe. We find no evidence for cross-selection between antimicrobial classes, or for effect of air travel between sites. However, AMR gene abundance strongly correlates with socio-economic, health and environmental factors, which we use to predict AMR gene abundances in all countries in the world. Our findings suggest that global AMR gene diversity and abundance vary by region, and that improving sanitation and health could potentially limit the global burden of AMR. We propose metagenomic analysis of sewage as an ethically acceptable and economically feasible approach for continuous global surveillance and prediction of AMR.Peer reviewe
    corecore