Preliminary notes on the early stages of Isturgia pulinda (Walker, 1860) (Lepidoptera: Geometridae)

The early stages, larval hostplant and voltism of Isturgia pulinda in the Maltese Islands are documentedpeer-reviewe

Local attitudes in the treatment of low prognosis head and neck squamous cell carcinoma

The incidence of head and neck carcinoma in Malta is 2.44 per 100,000 population, with 5-year survival rate of 20%. International studies have however shown that head and neck squamous cell carcinoma (HNSCC) carries an average 30% survival rate. The cost of treatment of low prognosis HNSCC patients in Malta is roughly €62,500 per year per person and considering that 7 patients out of those diagnosed are treated curatively annually, the total cost would increase to nearly half a million Euros per annum. In view of this, one is bound to ask the question whether not treating patients with a 30% survival rate is justifiable, especially in view that surgical and oncologic treatment can result in severe disfigurement and poses great physical and psychological stress on patients. No studies about local decision-making with respect to HNSCC have been published. This study set out to explore this issue from the ethical point of view, taking into account a number of variables with respect to treatment and the patient factors. A pre-determined set of questions was formulated and these questions were tackled by ten medical professionals, nine of which had direct contact with HNSCC patients. Issues such as informed consent, old age, quality of life, social variables, autonomy, healthcare rationing, medico-legal problems and past experiences with patients have been identified and discussed with reference to the local situation. It was noted that the majority of interviewed professionals (70%), still emphasised the need to provide full treatment for low prognosis HNSCC.peer-reviewe

Role of Posidonia oceanica bed structure in determining the diversity of associated macroinvertebrate assemblages

Merged with duplicate record 10026.1/2481 on 06.20.2017 by CS (TIS)Seagrass beds are highly productive shallow-water marine ecosystems and serve as a habitat for numerous invertebratesa nd fishes, some of which constitute important fisheries species.S eagrassb eds play an important role in physical coastal dynamics, since they stabilise soft bottoms, while their leaf canopy attenuates strong wave action and currents, thereby, reducing coastal erosion. However, seagrass habitats are undergoing a decline worldwide, hence, there is an urgent need for data on the influence of bed fragmentation and changes in plant architecture on the diversity of associated biota. In the Mediterranean Sea, the endemic seagrass Posidonia oceanica forms extensive beds that have a high structural complexity and support a high biodiversity, making them one of the most important marine habitat types in the region. The present study investigated the influence of P. oceanica bed structure (seagrassb ed morphology and within-bed architecture) on the diversity of associatedm acrofauna.P ilot surveys were made to map the occurrence and spatial distribution of different types of P. oceanica beds present off the northeastern coast of the Maltese Islands, to enable selection of four appropriate study locations. A quantitative sampler, which samples the total macroinvertebrate assemblages of P. oceanica beds, was designed and tested to determine the appropriate area and number of sampling units required to achieve given levels of accuracy and precision. Using data gathered from the pilot survey, studies were made to examine for differences in P. oceanica plant architecture, and in the species richness and abundance of motile macroinvertebrates between continuous (non-fragmented) and reticulate (fragmented)b eds of the seagrassa, crosst hree different spatial levels: (a) large (severalk m), (b) medium (circa 100 in) and small (tens of metres). A separate study examined differences in the species richness and abundance of associated motile macro invertebrates between living matte (bearing living shoots) and dead matte (without living shoots) of P. oceanica. Results of univariate and multivariate analyses indicated that there was no consistent pattern of significant differences in plant architecture,a nd in the speciesr ichnessa nd abundanceo f associatedm otile macroinvertebratesb etween the two P. oceanica bed types. Significant differences in macroinvertebrate species richness and abundance were detected between P. oceanica beds at the large spatial level that were significantly related to seagrasse piphytesa nd mean sedimentg rain size. Significant differences in macroinvertebrate species richness and abundance were detected between P. oceanica beds at the medium spatial level that were significantly related to shoot biomass. Significant differences in the assemblage composition of macroinvertebrates associated with P. oceanica beds were detected by multivariate analysis at the large and small spatial levels, with the best explanation for the multivariate assemblage structure being a combination of environmental variables that included epiphytes and sediment grain size. The results of the study comparing the motile macroinvertebrates of living and dead matte showed that dead matte supported significantly higher species richness and abundance of associated motile macro invertebrates, and had a significantly different macroinvertebrate assemblage structure, compared to living matte. Furthermore, a greater number of species occurred exclusively in dead matte than in living matte. It was concluded that natural fragmentation of continuous to reticulate P. oceanica beds does not lead to changes in plant architectural differences, or to a reduction in diversity of associated macroinvertebrates, nor does complete loss of the foliar canopy necessarily lead to a reduced diversity of macrofauna. Local factors, including nutrient levels in the water colunm (which enhanced epiphytic growth on the seagrass), sediment grain size and the hydrodynamic regime, were more important in influencing the diversity of macrofauna associated with P. oceanica beds, than bed type, leading to significant spatial variation in the associatedm acroi nvertebrate assemblagesT. he study concluded that the relative importance of different factors in influencing the diversity of macro invertebrates associated with P. oceanica beds varied, depending on scale. The results are discussed in the light of the available published data on fragmentation of seagrass habitat and on current Euro-Mediterranean proposals for the conservation of different bed types of P. oceanica. Attempts to classify different bed types of P. oceanica in categories according to value should be based on adequate ecological data. Different bed types of P. oceanica all form part of a dynamic heterogeneousla ndscapew here transformation from one bed type to another may occur, but which does not necessarily lead to loss of biodiversity. Hence, equal effort should be directed at conserving and managing different bed types of P. oceanica

Conference scene : Golden Helix Pharmacogenomics Days : educational activities on pharmacogenomics and personalized medicine

The Golden Helix Pharmacogenomics Days are high-profile international educational scientific meetings discussing pharmacogenomics and personalized medicine. Here, we provide an overview of the scientific lectures and the topics discussed during the 4th Golden Helix Pharmacogenomics Day, held in Cagliari, Italy, on 7 October 2011, and the 5th Golden Helix Pharmacogenomics Day, that was held in Msida, Malta, on 3 December 2011. The scientific programs of both events included scientific and company lectures on pharmacogenomics, bioinformatics and personalized medicine by local and international speakers from Europe and the USA.peer-reviewe

Relevance of pharmacogenomics for developing countries in Europe : implementation in the Maltese population

Pharmacogenomics is a promising new discipline that can realize personalized treatment for patients suffering from many common diseases, particularly those with multiple treatment modalities. Recent advances in the deciphering of the human genome sequence and high throughput genotyping technology have led to the reduction of the overall genotyping costs and enabled the inclusion of genotype-related dosing recommendations into drug package inserts, hence allowing the integration of pharmacogenomics into clinical practice. Although, pharmacogenomics gradually assumes an integral part in mainstream medical practice in developed countries, many countries, particularly from the developing world, still do not have access either to the knowledge or the resources to individualize drug treatment. The PharmacoGenetics for Every Nation Initiative (PGENI) aims to fill in this gap, by making pharmacogenomics globally applicable, not only by defining population-specific pharmacogenomic marker frequency profiles and formulating country-specific recommendations for drug efficacy and safety but also by increasing general public and healthcare professionals’ awareness over pharmacogenomics and genomic medicine. This article highlights the PGENI activities in Europe and its implementation in the Maltese population, in an effort to make pharmacogenomics readily applicable in European healthcare systems.peer-reviewe

The impact of heat on occupational injuries, illnesses and associated economic costs in Australia

Introduction: High temperatures have been associated with increased morbidity and impaired labor productivity in workers. Despite extensive relevant literature, there is limited understanding of the associated economic impact. This PhD aimed to analyse economic burden secondary to occupational heat stress and create an Australian national cost profile of heat-attributable occupational injuries and illnesses (OIIs) within Australia. Literature review: Estimated retrospective and future heat-attributable occupational economic burdens are substantial. Predicted global costs from lost worktime were US$607 billion annually from 2001-2020. This was projected to US$1,069, US$1,626, and$3,286 billion worldwide following a 1, 2, and 4!C increase in global average temperature. In Australia from 2013-2014, annual costs of US$6.2 (95$1 million in Spain and Guangzhou, China and US$250,000 in Adelaide, Australia. Low- and middle-income countries and countries with warmer climates had greater losses as a proportion of GDP. Methodology: Climate and workers’ compensation claims data were extracted representing OIIs from July 2005 to June 2018 in seven Australian capital cities: Adelaide, Brisbane, Darwin, Hobart, Melbourne, Perth, and Sydney. Daily maximum wet bulb globe temperature was used to measure the impact of temperatures above and below the mean. The Excess Heat Factor was used to define the presence, intensity, and duration of heatwaves. OIIs and associated costs were estimated separately per city with time series, distributed lag non-linear models and modelled using (quasi-)Poisson and Tweedie distributions, respectively. City-level estimates were pooled together with multivariate meta-analysis. Heatwave-attributable risks were projected to the 2030s and 2050s under RCP4.5 and RCP8.5. Temperature-attributable OIIs: Heat-attributable and cold-preventable fractions of OIIs were 1.66$651 and AU$574 million, representing AU$94 million annually and AU$88.1 and AU$76.3 per worker, respectively. Heatwave-attributable OIIs: 0.13% of OIIs (95%eCI: 0.11-0.16%) were heatwaveattributable, equivalent to 120 OIIs annually. These were associated with 0.25% of heatwave-attributable costs (95%eCI: 0.18-0.34%), equal to AU$4.3 million annually. By 2050, 0.17% (95%eCI: 0.10-0.27%) and 0.23% (95%eCI: 0.13-0.37%) of OIIs were heatwave-attributable under RCP4.5 and RCP8.5, respectively. Projected costs estimates under RCP4.5 and RCP8.5 were 0.13% (95%eCI: -0.27-0.46%) and 0.04% (95%eCI: -0.66-0.60), with significant associations observed with extreme heatwaves in 2030 (0.04%, 95%eCI: 0.02-0.06%) and 0.04% (95%eCI: 0.01-0.07), respectively. Attributable fractions were similar to baseline when assuming theoretical 100% climate adaptation. Implications: OIIs and associated costs increase with both moderate and extreme heat. This morbidity and financial burden is substantial. Expenses are likely to be less than the costs secondary to labor productivity loss not associated with OIIs. Collectively, however, they portray a more detailed estimate of the economic impact secondary to heat in the workplace. Climate adaptation and mitigation are imperative to minimize future morbidity and costs.Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 202

A review of the national adverse drug reaction (ADR) & medication errors reporting system of Malta

The overall objectives of Pharmacovigilance include early identification of potential safety hazards, evaluation, monitoring and where appropriate, implementation of regulatory action to maximise benefits and minimise risks associated with medicinal products. Reporting of an ADR associated with use of a medicinal product as well as medication errors is an essential source of necessary information that is required to achieve these objectives. Safety concerns that arise from spontaneous reporting contribute to assessment of the risk benefit balance and hence lead to a regulatory action which could be suspension or revocation of marketing authorization of the product or change in the product information. Furthermore these safety concerns can be communicated to healthcare professionals through Direct Healthcare Professional Communications (DHPCs) and safety circulars and they form the basis of designing Risk Minimisation Measures (RMMs). The establishment of a functional ADR reporting system by law since 2004, not only facilitates participation in the national and EU regulatory process, but also enables Malta to participate in the WHO Programme for International Drug Monitoring, both by contributing to and obtaining data from this extensive information resource.peer-reviewe

Local experience of transcutaneous bilirubinometry : an accurate alternative to serum sampling?

Background: Babies are frequently referred to the Paediatric Emergency Department from the Breastfeeding Clinic and Community Discharge Liaison service with jaundice as indicated by high transcutaneous bilirubin (TCB) readings measured using transcutaneous bilirubinometry. Serum bilirubin (SEB) testing is then performed in the Emergency Department and the need for admission for phototherapy decided based upon on SEB. If there is strict correlation between these modes of bilirubin measurement, there would be no need to verify TCB with SEB levels in cases where bilirubin is clearly above cut – off, thus reducing hospital waiting time, costs and time to starting treatment. --- Objectives: To establish whether TCB is a reliable screening test for neonatal jaundice necessitating phototherapy based on the relationship between TCB and SEB in patients in Malta. --- Method: Neonates referred from the Breastfeeding Clinic to the Paediatric Emergency Department with raised TCB over five months (June-October 2017) were included. Data was obtained from the Breastfeeding Clinic, local delivery suite and iSOFT Clinical Database, and interpreted using in-built data analysis tools and custom-made data analysis spreadsheets on Microsoft Excel®. --- Results: There was a significant difference between the two groups, mean TCB being significantly greater than SEB (t=2.32, p=0.04). However, TCB occasionally also under-read bilirubin levels. --- Conclusions: These findings differ from results of similar studies conducted in other centres. Given the significant difference between TCB and SEB, it is recommended that, locally, baseline SEB levels continue to be repeated in the Emergency Department prior to establishing the need for phototherapy in neonatal jaundice.peer-reviewe

Treatment of Leber’s hereditary optic neuropathy : an overview of recent developments

Leber’s hereditary optic neuropathy (LHON) is a rare, maternally-inherited optic neuropathy caused by mitochondrial DNA point mutations and which can cause blindness. Currently, Raxone (idebenone) is the only available medicinal product authorised to treat LHON within the European Union and LHON remains an unmet medical need. The aim of this article was to summarise interventional clinical trials published over the past 5 years (between 2014 and 2019) with the primary purpose of treating LHON. Therapeutic approaches discussed include modulating agents of the mitochondrial electron transport chain such as Raxone, cysteamine bitartrate and KH176, inhibitors of apoptosis such as elamipretide, gene therapy medicinal products such as GS010 and scAAV2P1ND4 and retinal tissue regeneration medicinal products such as bone marrow-derived stem cells.peer-reviewe

Evaluation of the impact of a pharmaceutical care service offered to rheumatoid arthritis patients within an ambulatory setting

The objectives of the study were to evaluate the impact of a newly developed pharmaceutical care services directed to rheumatoid arthritis patients attending an out-patient setting. A total of 88 patients participated in the study and were randomly divided into two equal groups, Group A and Group B. The study was carried out over three phases. In phase 1 (time 0), Group A patients were assessed and offered a pharmaceutical care session. Group B patients were assessed but no pharmaceutical care session was delivered. At phase 2 (4-6 months), group A patients were re-assessed (first assessment post pharmaceutical care plan). Group B patients were re-assessed a second time (second baseline assessment) and a pharmaceutical care session was offered to Group B patients. At phase 3 (time 10-11 months) both groups were re-assessed a third time. The Health Assessment Questionnaire and the Short Form-36 were used as outcome measures during each assessment. There were statistically significant differences (p<0.05) in all the 8 domains of the SF-36 between Phase 1 and 3 for both groups. For the Health Assessment Questionnaire, a statistical improvement in the daily activities was identified after the pharmaceutical care intervention for both groups (Phase 2 for Group A and phase 3 for Group B). The newly developed individualised pharmaceutical care service provided by the pharmacist led to an improved quality of life as measured by the health related quality of life questionnaires.peer-reviewe