Bilateral microform cleft lip

Microform cleft lip (MCL), also called congenital healed cleft lip or cleft lip "frustré", is a rare congenital anomaly. MCL has been described as having the characteristic appearance of a typical cleft lip which has been corrected in utero. We present a girl with bilateral microform cleft lip associated with a preauricular sinus and bilateral camptodactyly.peer-reviewe

Hepatitis B prevalence in two Maltese sub-populations

Hepatitis B surface antigen was measured by enzyme immunoassay in a random sample of 1258 healthy pregnant women attending the ante-natal clinics of St. Luke’s Hospital, Malta and Gozo General Hospital, Gozo, and 364 intravenous drug users attending the detoxification centre, SLH. Eight of the pregnant women and ten of the drug addicts were positive for the surface antigen, accounting for a prevalence of 6/1000 and 30/1000 for each cohort, respectively. This would be consistent with low/intermediate prevalence rate in accordance with WHO criteria.peer-reviewe

Declining mortality from congenital heart disease in Malta

Congenital heart disease (CHD) is the most common congenital anomaly occurring in approximately 10/1000 live births. Analysis of official Maltese Health Division statistics listing CHD as the primary cause of death on death•certificates has shown a significant fall in mortality from CHD in Malta from 1952 to 1993 (r = -0.84, p<0.0001). This decline has persisted despite the steady incidence of CHD and has not yet plateaued. The decreasing mortality from CHD may be attributed to advances in paediatric cardiology and paediatric cardiac surgery over the past four decades.peer-reviewe

The impact of COVID-19 on the Malta Medical School

The novel coronavirus COVID-19 is currently pandemic and Malta has carried out numerous measures in a stepwise fashion to enforce a soft-lockdown, and from which it is slowly emerging. This paper outlines the history of Malta’s Medical School, culminating in a state-of-the-art facility, and document the School’s (and Malta University’s) adjustments in the wake of COVID-19. Changes span physical alterations carried at very short notice, drastic changes in teaching practices to comply with social distancing measures, transition to online learning and migration to on-line, hands-off and patient-free examinations.peer-reviewe

Cows fed hydroponic fodder and conventional diet: effects on milk quality

The technology of green fodder production is especially important in arid and semiarid regions. Hydroponics improves on average the amount of crops in the same space, as traditional soil-based farming and can reduce water consumption compared to traditional farming methods. Limited research has been carried out on the use of hydroponic fodder and milk quality. A comparative study of traditional (Malta farm) and hydroponic fodder (Gozo farm) was conducted in Malta with 20 cows of the Holstein\u2013Friesian breed from two farms. Individual and bulk-tank milk samples were collected once a week for a period of 1 month in order to evaluate physical (pH, conductivity, density, freezing point) and chemical (fat, protein, ash, lactose, solid nonfat) parameters as well as mineral (Zn, Cu, Pb, Ba) content. Milk proximate and physical data were processed by analysis of variance (ANOVA) for repeated measures and an ANOVA procedure with farm and time as effects for minerals. The results indicated differences in fat content and pH, showing higher values (P &lt; 0.05) in milk samples of cows fed with the hydroponic rather than the traditional fodder; a significant time effect (P &lt; 0.001) was found in all qualitative analyses except for lactose and salts. Minerals were in the range as reported elsewhere; Cu and Pb content was significantly higher (P &lt; 0.001) in the Gozo farm than the one in Malta, whereas Zn content showed higher values in Malta (P &lt; 0.001) than Gozo. Although the proximate results were similar for both farms, except for the higher fat content for the Gozo farm, principal component analysis (PCA) revealed that milk quality for the Gozo farm was superior to that of the Malta farm. However, further studies are needed to determine the effects of different hydroponic fodder using a large herd size

Mitral valve infective endocarditis following device occlusion of a coronary artery fistula

A three year old girl, with a right coronary artery fistula and signs of a hyperdynamic circulation, underwent uncomplicated closure of the fistula using an occluding device introduced via the femoral arterial route and covered with appropriate antibiotics. Two months later she presented with a persistent fever, signs of infective endocarditis (IE) and embolic phenomena in the left lower limb. Mitral valve endocarditis was confirmed immediately and treated effectively. However, initial ultrasound and doppler did not show the femoral artery thrombo-occlusion that was only confirmed on magnetic resonance angiography (MRA) one month later. This case highlights the usefulness of MRA in diagnosing suspected vessel occlusion in young children, and is in keeping with the latest NICE guidelines that suggest that prophylactic antibiotics do not always prevent IE. Parent and patient education on ‘what to look out for’, combined with careful clinical vigilance is paramount in the early detection of IE with a consequent reduction in morbidity and mortality.peer-reviewe

LargeScale Precursors to Major Lake Effect Snowstorms Lee of Lake Erie

Lake‐effect snowstorms are primarily a mesoscale feature; however, major lakeeffect snowstorms are linked closely to their synoptic environment. Thus, a lakeeffect system which lasts for more than 24 h cannot only be explained by the boundary layer; it is also associated with the upper tropospheric flow. This research will address whether major lake‐effect snow events off of Lake Erie can also be associated with large‐scale planetary features several days prior to event onset. The goal is to aid in the forecast process by increasing the accuracy and leadtime of lake‐effect snow forecasts. This study includes 31 cases recorded from the National Weather Service at Buffalo’s lake effect database. These 31 cases were then stratified into categories depending on its: length, the time of year, and the type of event. This categorization allowed for comparison of the state of the atmosphere in the days prior to different types of events. In order to assess the large‐scale pattern, teleconnections were used as a proxy for the state of the atmosphere. For cases that lasted for greater than 42 hours, there was a correlation to the phase Madden Julian oscillation eight days prior to onset. The cases that occurred during the positive and negative states of the Arctic Oscillation had two different upper level trough patterns, the former originating in Southern Canada and the latter over the Southwestern United States

The Removal of Artificially Generated Polarization in SHARP Maps

We characterize the problem of artificial polarization for the Submillimeter High Angular Resolution Polarimeter (SHARP) through the use of simulated data and observations made at the Caltech Submillimeter Observatory (CSO). These erroneous, artificial polarization signals are introduced into the data through misalignments in the bolometer sub-arrays plus pointing drifts present during the data-taking procedure. An algorithm is outlined here to address this problem and correct for it, provided that one can measure the degree of the sub-array misalignments and telescope pointing drifts. Tests involving simulated sources of Gaussian intensity profile indicate that the level of introduced artificial polarization is highly dependent upon the angular size of the source. Despite this, the correction algorithm is effective at removing up to 60% of the artificial polarization during these tests. The analysis of Jupiter data taken in January 2006 and February 2007 indicates a mean polarization of 1.44%+/-0.04% and 0.95%+/-0.09%, respectively. The application of the correction algorithm yields mean reductions in the polarization of approximately 0.15% and 0.03% for the 2006 and 2007 data sets, respectively.Comment: 19 pages, 7 figure

Can registration procedures of pharmaceuticals inadvertently contribute to off-label prescribing in children?

Background: In Malta, off-label prescribing of medicines in children stands at 45%, mainly because of failure by prescribers to follow the dosing recommendations in the product literature. In addition, registration procedures of pharmaceuticals may inadvertently contribute to this high incidence of off-label prescribing. Methods: A literature review was conducted to identify regulatory provisions relating to the registration of medicines in Malta that could give rise to off-label use. Furthermore, the product literature of the 2 classes of medicines most commonly prescribed in children, antibiotics and respiratory medicines, were reviewed. This was done in order to gauge whether the different registration routes implemented in Malta to market these medicines could give rise to off-label use. Results: The national registration procedure relating to Article 126a of Directive 2001/83/EC and, to a lesser extent, line extensions, parallel importation, and the provision detailed in Article 11 of Directive 2001/83/EC were found to lead to discrepancies and potentially misleading inclusions in the product literature. These, in turn, may well contribute to off-label use of medicines in children. Conclusions: Off-label prescribing does not necessarily mean that efficacy and safety data are unavailable. Variances in the product literature of medicines having the same active ingredients but imported from different countries may cause divergent prescribing practices, leading to inadvertent off-label use. The various stakeholders, including member states such as Malta, should devise strategies to harmonize the most recent labeling information in order to support the safe and effective use of pediatric medicines, thereby decreasing off-label usepeer-reviewe

The value of multiple 2D ultrasound scanning views in the detection of Congenital Heart Disease in the second trimester (18 to 24 weeks)

Antenatal detection for Congenital Heart Disease (CHD) is poor, but may be improved by adding views to routine ultrasound scanning. From June 2014-July 2015, 600 randomly selected women between 18 to 24 weeks of pregnancy, had a routine 4-chamber ultrasound scan at Mater Dei Hospital view (Basic 4CV). In addition, they completed an Extended Cardiac Ultrasound Examination (ExCUSE) including the left outflow tract, right outflow tract, 5-chamber view and 3-vessel view. All views were timed. The results obtained from the 600 women who received Basic and the ExCUSE scanning were followed-up clinically after delivery of the infants. Validity testing of both 4CV and ExCUSE views was carried out, and the detection rate of CHD compared. During the 12-month period, 61 cases from a total of 4,200 children up to 1 year of age were diagnosed with CHD by Paediatric Echocardiography. 19 were included in the 600-study cohort, of which 12 were detected antenatally, 1 via the 4CV alone, 4 by both the 4CV plus at least 1 of the ExCUSE views and 7 by 1 or more of the ExCUSE views alone. On average, ExCUSE views took approximately 6 minutes longer, yet there was a significant difference between the detection rate of CHD by the 4CV compared with the ExCUSE views (χ2 = 0.031, p=0.05). Sensitivity and specificity of the 4CV were 31.6% and 100%, respectively, and 63.1% and 100%, respectively for ExCUSE views. Antenatal diagnosis of CHD is improved with additional ultrasound views, but this will necessitate staff training and adjustments in clinic schedules to accommodate increased scan time.peer-reviewe