The freshwater crab Potamoll fluviatile lanfrancoi: a newly discovered locality at II-Wied ta' Gordajna and a clarification of records from l-lmtahleb

The freshwater crab Potamon fluviatile lanfrancoi is recorded froIll a new locality in Malta : II-Wied ta' Gordajna. IndividuaJ crabs. cXlIvire. snail shell fragments. excavated mud piles and burrows were discovered at various points, indicating the prcsence of a sizeable population. Records from the nearby area of L-lmtallleb arc also clarified. ~lU S adding a furt her new record from \Vied Markozz. The occurrence of P. jluvialile at II-Wied ta' Gordajna is particularly interesting due 10 its location roughly midway between other known stations for this species at L-Imlahlcb and Wied il-Bahrija.peer-reviewe

Presentation and management of diabetic ketoacidosis in adults in Malta

Aim: The aim of this audit was to assess adherence to local guideline in the management of Diabetic Ketoacidosis (DKA). Method: Patients admitted with DKA between April 2013 and March 2015 were identified and data was retrospectively collected from patients’ confidential files and Isoft®. Data collected included initial parameters recorded and biochemical investigations taken (initial and subsequent assessment of pH, HCO3-, blood glucose, potassium levels and urinary ketones), insulin regime started and intravenous fluid administered. Results: During the established time period 40 cases of DKA were identified in 18 patients. Median age was 33 years with a female preponderance of 60%. Six patients had newly diagnosed diabetes mellitus while 8 patients had more than one admission of DKA. All cases had capillary blood glucose monitoring (BGM) and/or venous random blood (plasma) glucose (RBG) checked and pH and HCO3- recorded on admission. 0.9% sodium chloride was the intravenous fluid started in all cases (as recommended by the guideline) and a median of 6.75L was prescribed during the first 24 hours. The median time spent on intravenous insulin infusion was 42.7 hours while the median time to pH >7.30, HCO3- >15mmol/L and negligible urinary ketones were 6.88, 12.83 and 34.5 hours respectively. Subcutaneous insulin was started at a median time of 48.21 hours from initiation of DKA protocol. Conclusion: This audit showed good adherence to local guideline. The great discrepancy between the time to pH >7.3 and the time to negligible urinary ketones highlights the need to introduce tools to measure systemic ketone production in the management of DKA with an update in the current local clinical practice guideline.peer-reviewe

The first documented case of neurotoxicity in two patients following octopus flesh ingestion in the Mediterranean : a case study from the Maltese Islands (central Mediterranean)

Tetrodotoxin is a naturally occurring potent neurotoxin, widely distributed in marine animals, including a number of members of the Tetraodontidae fish family (e.g. Lagocephalus sceleratus, the silver-cheeked toadfish), a marine invasive species native of the Indo-Pacific region which is increasingly being reported from the Mediterranean. Various human fatalities have been documented globally as a result of intoxication through tetrodotoxin, but these have rarely been associated with the ingestion of octopus flesh. We hereby report the case of two patients from the Maltese Islands (central Mediterranean) who presented symptoms consistent with neurotoxicity, following the consumption of the well-cooked flesh of the common octopus. Both patients required supportive care, until complete recovery within a few days, with one of whom requiring intensive care. The reported cases of neuromuscular disturbances following the consumption of octopus flesh is highly suggestive of neurotoxicity due to tetrodotoxin poisoning, the first such cases documented for the Mediterranean waters, although alternative scenarios are also postulated in this study due to the lack of definite evidence for the TTX poisoning, including the release of histamine by psychrotrophic bacteria or the accumulation of HAB-related toxins. The postulated TTX intoxication mechanism involves predation by Octopus vulgaris, the common octopus or ‘scuttle’, on a toxic marine species harbouring tetrodotoxin.peer-reviewe

THE FRESHWATER CRAB POTAMON FLUV1ATILE LANFRANC01: A NEWLY DISCOVERED LOCALITY AT IL-WIED TA' GORDAJNA, AND A CLA RJFICATlON OF RECORDS FROM L-IMTAHLEB

ABSTRACT The freshwater c rab Po/amoll jluviatile lanfrancoi is recorded froIll a new locality in Malta : II-Wied ta' Gordajna. IndividuaJ crabs. cX lIvire. snail shell fragments. excavated mud piles and burrows were discovered at various points, indi cat ing the prcsence of a sizea ble population . Records from the nearby area of L-lmtallleb arc also clarified. ~lUS adding a furt her new record from \Vied Markozz. The occ urrence of P. jluvialile at II-Wied ta' Gordajna is particularly interesting du e 10 it s location roughly ll1id\\'a~' between other known stations for thi s species at L-Imlahlcb and Wied il-Bahrija

Thyroid nodules, FNA cytology and thyroid cancer in Malta

INTRODUCTION: Thyroid nodules are very common and elucidating the nature of these thyroid nodules is an important task.METHODOLOGY: Patients who had an ultrasound guided fine needle aspiration (FNA) of a thyroid nodule between January 2008 and June 2012 were retrospectively audited and their ultrasonographic and biochemical characteristics where analysed. For those patients who were operated nodule characteristics were correlated with thyroid histology.RESULTS: 397 thyroid aspirates were identified. Using The Betsheda System for Reporting Thyroid Cytopathology (TBSRTC) 59.5% were classified as category II (benign), 15.4% category IV (follicular) 4.8% category V (suspicious for malignancy) and 8.4% category VI (malignant). Statistical analysis of operated patients (n=97) yielded a positive predictive value for malignancy (for those who were classified according to TBSRTC categories V and VI) of 89.5%, a negative predictive value of 86.4%, sensitivity of 81.0% and specificity of 92.7%. 42 patients who were operated had thyroid malignancy, of whom 41 had a papillary carcinoma and 1 patient had a medullary thyroid carcinoma. The mean age at presentation was 48.0 years (S.D.±12.6 years), the mean largest diameter of the papillary carcinomas was 13.8 mm (S.D.±8.6 mm) and 48.8% had lymph node involvement. 58.5% of patients with malignant histology had more than 1 focus of malignancy in the thyroid. The mean size of thyroid nodule on ultrasound of these patients was 17.5 mm (S.D.±9.4 mm), 53.7% had a hypoechoic nodule and 48.8% had microcalcifications. These findings differed from those who had a follicular adenoma on histology, where 13.0% had a hypoechoic nodule on ultrasound and 16.1% had microcalcifications.CONCLUSIONS: These findings further establish that FNA of thyroid nodules is a very important and helpful tool in the management of thyroid nodules. Important characteristics of thyroid cancer are shown including the high rate of multifocality seen in our patient cohort.peer-reviewe

Cardiovascular risk factors in Maltese patients with newly diagnosed Type 2 Diabetes presenting to the Diabetes clinic at St Luke’s Hospital in 2003, Malta

Methods: A representative sample of newly diagnosed Type 2 diabetes was studied retrospectively. All patients in the above category (N:110) attending the diabetes clinic on three specific days of the week were studied. Glycaemic status, blood lipid levels, blood pressure, creatinine levels and smoking status were assessed. Results: During the study period, 93.6% of patients had their blood pressure measured, with 39% and 58.2% of the patients having a level of more than the recommended targets of 140 systolic and 85 diastolic blood pressures, respectively. 62.7% of the study population were tested for HbA1c values with the mean HbA1c value for the entire study population being 7.69%. 66.4% of the study population were tested for lipid values. Overall, 54% had total cholesterol levels of 4.8 mmol/l or more, 52.7% had LDL cholesterol levels of 3 mmol/L or more and 37.2% had triglyderide levels of 3mmol/l or more; these were classified as at increased risk of cardiovascular disease. 19.1% of patients were smokers. Conclution: This study showed that the number of patients tested for HbA1C and lipid values needs to be increased and that a high proportion of patients with newly diagnosed Type 2 diabetes have risk factors for diabetes-related complications. Good disease management of diabetes requires attention to a multiplicity of factors if guideline targets are to be met and long term complications avoided.peer-reviewe

Towards a quality education for all

This document summarises the recommendations being proposed in the NCF and examines the implications of such recommendations. There can only be a meaningful strategy for the implementation of the NCF once the recommendations are debated and the full impact of their implications understood. This process of consultation needs to include all stakeholders in a professionally engaging manner. Moreover, the consultation and implementation strategies need to be based on the full understanding of a change management process. This document will therefore map out the way forward by presenting: • a summary of the recommendations being proposed by the NCF; • implications of these recommendations for implementation; • ideas about the management of change which underpin the consultation and implementation strategies the NCF would like to promote; • a strategy for the consultation process following the publication of the draft NCF; and • a proposed timeline for the implementation process of the NCF, following consultation and agreement with the wider educational community about the way forward.peer-reviewe

Cortical Gyrification and Sulcal Spans in Early Stage Alzheimer's Disease

Alzheimer's disease (AD) is characterized by an insidious onset of progressive cerebral atrophy and cognitive decline. Previous research suggests that cortical folding and sulcal width are associated with cognitive function in elderly individuals, and the aim of the present study was to investigate these morphological measures in patients with AD. The sample contained 161 participants, comprising 80 normal controls, 57 patients with very mild AD, and 24 patients with mild AD. From 3D T1-weighted brain scans, automated methods were used to calculate an index of global cortex gyrification and the width of five individual sulci: superior frontal, intra-parietal, superior temporal, central, and Sylvian fissure. We found that global cortex gyrification decreased with increasing severity of AD, and that the width of all individual sulci investigated other than the intra-parietal sulcus was greater in patients with mild AD than in controls. We also found that cognitive functioning, as assessed by Mini-Mental State Examination (MMSE) scores, decreased as global cortex gyrification decreased. MMSE scores also decreased in association with a widening of all individual sulci investigated other than the intra-parietal sulcus. The results suggest that abnormalities of global cortex gyrification and regional sulcal span are characteristic of patients with even very mild AD, and could thus facilitate the early diagnosis of this condition