Biologic treatments in rheumatoid arthritis and juvenile idiopathic arthritis

A number of biological approaches to the management of inflammtory arthropathies have been explored. These include the development of IL-1 receptor antagonists and TNF antagonists. Four biological agents are currently marketed in Europe. Most studies have revolved around Rheumatoid Arthritis, but an increasing number of studies are now completed or ongoing in the other inflammatory joint diseases. These studies are reviewed in this article with a view to guiding practice and usage in the Maltese Islands.peer-reviewe

Calcium, vitamin D and bone

Calcium, protein and vitamin D are the main nutrients relevant to bone health. This short article discusses the importance of vitamin D and its relation to calcium homeostasis. The various causes, clinical manifestations and treatment are outlined.peer-reviewe

A CIAR study in a male dominated ICT Company in Malta which looks at work-life issues through the masculine lens: a case of: if it ain’t broke, don’t fix it?

The focus of this action research study is the analysis of invisible assumptions that sustain gendered work processes based on the ideal worker values. The case study, which is set within a Maltese ICT company, also explores the potential for action research (CIAR) to challenge the gendered processes in ways that enable better work-life integration through the Dual Agenda logic. Data for this research, which adopts a constructionist and interpretivist approach, were obtained through various cycles of qualitative interviews and focus group meetings with participants, the majority of whom were males. These were analysed through NVivo on the principles of Thematic Analysis. This research showed how the hegemonic masculine values of the leaders which led to the conceptualisation of the ideal worker, allowed them the opportunity to perform their masculinity in a culturally approved manner, and because this brought them power and benefits, such values prevailed. It also confirmed that the default expectations by which ideal worker values were measured, stemmed from culturally normative behaviour typically linked to unencumbered men. This rendered anomalous, suspicious and undesirable attempts to integrate work and life for family-related reasons. This happened in an organisational context where the means to assess productivity were low, where organisational learning was weak, and within a national context where the work-life challenge is typically linked to mothers. This illustrates how interlinking factors within the multi-layers of context underpin the current notions of ideal worker thus rendering CIAR insufficient to tackle the multi-forces at play which perpetuate the Single Agenda logic. This research highlights the importance of studying situated hegemonic masculinity in the micro context of organisations without neglecting the interlinking factors at play within the broader context that sustain it. This multi-dimensional approach is useful in allowing a better understanding of the complexities surrounding the concept of gendered organisations within a dominant hegemonic masculine culture. Overall, this research strives to make a contribution to the debate about gendered organisations and work-life issues through a better understanding of hegemonic masculinity. Furthermore, it adds knowledge about the potential and barriers to Dual Agenda change through the use of the CIAR approach

Translation and validation of the Fatigue Severity Scale, Pittsburgh Sleep Quality Index and Modified Health Assessment Questionnaire into the Maltese language, in a cohort of Maltese Systemic Lupus Erythematosus patients

PURPOSE: The assessment of fatigue, sleep quality and functional disability requires the use of validated instruments such as the Fatigue Severity Scale (FSS), the Pittsburgh Sleep Quality Index (PSQI) and the Modified Health Assessment Questionnaire (mHAQ) respectively. The aim of this study was to translate and validate these instruments into the Maltese Language. METHOD: Forward translation from the original English version into Maltese was carried out by two translators. The two versions were compiled to produce a preliminary initial Maltese translation. This was translated back into English by two other translators. This led to the development of the pre-final version of the Maltese translation, which was pilot-tested in 20 bilingual patients with systemic lupus erythematosus. RESULTS: Psychometric testing revealed good reliability of the Maltese translation of the three questionnaires. Cronbach’s alpha of the Maltese versions of the FSS, PSQI and mHAQ were 0.877, 0.859 and 0.897 respectively, showing good internal consistency. Validity of the Maltese version of the FSS was shown, since it had a significant positive correlation with visual analogue scale for fatigue (r=0.809, p<0.001). CONCLUSION: The Maltese translations were thus finalised, and could be used for clinical assessment or research purposes.peer-reviewe

Spatio-temporal variation in the structure of a deep water Posidonia oceanica meadow assessed using non-destructive techniques

The Malta-Comino Channel (Maltese islands, central Mediterranean), supports extensive meadows of the seagrass Posidonia oceanica that in some places extend to a depth of around 43 m, which is rare for this seagrass. To assess spatial and temporal variation in the state of the deeper parts of the P. oceanica meadow with time, data on the structural characteristics of the seagrass meadow at its lower bathymetric limit were collected during the summers of 2001, 2003 and 2004 from four stations (two stations within each of two sites) located at a similar depth, over a spatial extent of 500 m. Shoot density was estimated in situ, while data on plant architecture (number of leaves, mean leaf length, and epiphyte load) were successfully obtained using an underwater photographic technique that was specifically designed to avoid destructive sampling of the seagrass. Results indicated that P. oceanica shoot density was lower than that recorded from the same meadow during a study undertaken in 1995; the observed decrease was attributed to the activities of an offshore aquaculture farm that operated during the period 1995–2000 in the vicinity of the meadow. ANOVA indicated significant spatial and temporal variations in meadow structural attributes at both sites during the 3-year study; for example, shoot density values increased overall with time at site A; a indication of potential recovery of the meadow following cessation of the aquaculture operations. Lower shoot density values recorded from site B (compared with site A) were attributed to higher epiphyte loads on the seagrass, relative to those at site A. The findings, which include new data on the structural characteristics of P. oceanica occurring at depths >40 m, are discussed with reference to the use of the nondestructive photographic technique to monitor the state of health of deep water seagrass meadows.peer-reviewe

Seronegative spondyloarthropathies : a review : part I: classification and differential diagnosis

The seronegative spondyloarthropathies comprise a group of non-rheumatoid disorders with similar clinical, laboratory and genetic features. Recognition of new clinical features has supported the notion that they all form part of a clinical spectrum. These features and the classification of the seronegative spondyloarthropathies are discussed in the review.peer-reviewe

Coupled continuum hydrodynamics and molecular dynamics method for multiscale simulation

We present a new hybrid methodology for carrying out multiscale simulations of flow problems lying between continuum hydrodynamics and molecular dynamics, where macro/micro lengthscale separation exists only in one direction. Our multiscale method consists of an iterative technique that couples mass and momentum flux between macro and micro domains, and is tested on a converging/diverging nanochannel case containing flow of a simple Lennard-Jones liquid. Comparisons agree well with a full MD simulation of the same test case

Seronegative spondyloarthropathies : a review : part II: genetics and pathogenesis

In none of the spondyloarthropathies is the pathogenesis well understood. Much of the investigation into the aetio-pathogenesis of these diseases has focused on the association with HLA-B27 and the known triggering potential of certain infectious agents. In this article the author describes that the HLA linked genes which is subdivided into three groups, class I, class II and class III, which are structurally and functionally distinct from each other.peer-reviewe

Structural changes in a Posidonia oceanica meadow exposed to a pollution gradient from a marine fish-farm in Malta (Central Mediterranean)

Posidonia oceanica morphological parameters where measured at increasing distance from a marine fish-farm that has been operational for 7 years. Most parameters changed significantly with increasing distance from the cages, the greatest change occurring in the first 50 m.peer-reviewe

The effects of a marine fish-farm on the species richness and abundance of molluscs, decapods and echinoderms associated with a "Posidonia oceanica" meadow in Malta (Central Mediterranean)

The composition of the echinoderm, mollusc and decapod assemblages associated with a Posidonia oceanica meadow located close to a fish-farm varied with distance from the cages Three ecological zones were identified. The intermediate zone II (40-160m from the cages) had a higher species richness and abundance than either zones I (nearest the cages) and III (320m from the cages), probably due to the higher production resulting from a moderate level of nutrient enrichment at intermediate distances from the source of pollution.peer-reviewe