The Maltese version of the DN4 questionnaire : initial validation to assess neuropathic pain in patients with chronic spinal or spinal-radicular pain

Background: Neuropathic pain is frequently encountered in patients with spinal and spinal-related pain which needs specific treatment. Therefore, the objective of this study was to do an initial linguistic translation and validation of the Maltese DN4 questionnaire to diagnose neuropathic pain in this population. Methods: The study was designed as a single-blinded, observational, prospective collected data and retrospective analysis. The English and French DN4 questionnaires underwent forward and backward translation, literal assessment and adaptation of the semantic equivalence into the Maltese language, followed by assessment of the Maltese DN4 during the initial patient assessment in patients who met the inclusion criteria. Results: The total Maltese DN4 score obtained a Cronbach’s alpha of 0.735 therefore having satisfactory internal consistency. Test-retest using the Intraclass Correlation Coefficient (95% CI) ranged from 0.975 to 0.991 (p=0.000), while inter-rater agreement using Intraclass Correlation Coefficient (95% CI) ranged from 0.986 to 0.995 (p=0.000). Test-retest reliability yielded an intraclass correlation coefficient (95% CI) ranging from 0.975 to 0.991 (p < 0.001), while inter-rater reliability yielded an intraclass correlation coefficient (95% CI) ranging from 0.986 to 0.995 (p < 0.001). Both the English and the Maltese DN4 questionnaires obtained the same sensitivity and specificity values of 0.422 and 0.941 respectively, and a positive likehood ratio of 7.153 and a negative likehood ratio of 0.614, at a cutoff score of 4. Conclusion: The results of this study support the transcultural internal consistency, inter-rater, test-retest reliability, validity of the Maltese DN4 questionnaire to differentiate between neuropathic and nociceptive pain in patients with chronic spinal and spinal-radicular pain. Therefore, this simple tool can be used both in daily clinical practice but also in the clinical research setting to quickly screen for neuropathic pain.peer-reviewe

Nicotine dependence and the International Association for the Study of Pain neuropathic pain grade in patients with chronic low back pain and radicular pain : is there an association?

Background: This study investigated whether current smoking and a higher nicotine dependency were associated with chronic low back pain (LBP), lumbar related leg pain (sciatica) and/or radicular neuropathic pain.Methods: A cross-sectional study was conducted on 150 patients (mean age, 60.1 ± 13.1 yr). Demographic data, the International Association for the Study of Pain (IASP) neuropathic pain grade, STarT Back tool, and the Fagerström test were com- pleted. A control group (n = 50) was recruited.Results: There was a significant difference between current smokers and non- smokers in the chronic LBP group in the mean pain score (P = 0.025), total STarT Back score (P = 0.015), worst pain location (P = 0.020), most distal pain radiation (P = 0.042), and in the IASP neuropathic pain grade (P = 0.026). There was a significant difference in the mean Fagerström score between the four IASP neuropathic pain grades (P = 0.005). Current smoking yielded an odds ratio (OR) of 3.071 (P = 0.011) for developing chronic LBP and sciatica, and an OR of 4.028 (P = 0.002) for obtaining an IASP “definite/probable” neuropathic pain grade, for both cohorts. The likelihood for chronic LBP and sciatica increased by 40.9% (P = 0.007), while the likelihood for an IASP neuropathic grade of “definite/probable” increased by 50.8% (P = 0.002), for both cohorts, for every one unit increase in the Fagerström score.Conclusions: A current smoking status and higher nicotine dependence increase the odds for chronic LBP, sciatica and radicular neuropathic pain.peer-reviewe

Is chronic low back pain and radicular neuropathic pain associated with smoking and a higher nicotine dependence? A cross-sectional study using the DN4 and the Fagerström test for nicotine dependence

Objectives: To evaluate, if a current smoking status and a higher nicotine dependence were associated with chronic low back pain (LBP) and/or radicular neuropathic leg pain. Methods: The study was designed as a cross-sectional study on the first eligible consecutive 120 patients. Demographic data, pain intensity, worst pain location, most distal pain radiation, the DN4 questionnaire, STarT back tool, and the Fagerström test were collected during the initial examination. An age- and gender-matched control group (n=50), free from chronic LBP was recruited. Results: In the chronic pain group, there was a significant difference between smokers and lifetime non-smokers in the average pain intensity score (p=0.037), total DN4 score (p=0.002), STarT Back tool (p=0.006), worst pain location (p=0.023), and the most distal pain radiation (p=0.049). The mean total DN4 score increased with a corresponding increase in the number of cigarettes smoked daily (p=0.002). Current smokers had an OR of 3.071 (p=0.013) (95% CI 1.268–7.438) for developing chronic LBP and lumbar related leg pain and an OR of 6.484 (p<0.001) (95% CI 2.323–18.099) for developing chronic radicular neuropathic leg pain. For every one-unit increase in the Fagerström test score, the likelihood for chronic LBP and lumbar related leg pain increased by 40.71% (p=0.008) (95% CI 1.095–1.809) and for chronic radicular neuropathic leg pain increased by 71.3% (p<0.001) (95% CI 1.292–2.272). Conclusion: A current smoking status and a nicotine dependence were both independently associated with an increased risk for chronic LBP and/or chronic radicular neuropathic leg pain.peer-reviewe

National analyses on survival in Maltese adult patients on renal replacement therapy started during 2009–2012

Chronic kidney disease patients on maintenance dialysis (CKD 5D) experience major morbidity and mortality. No data on survival in Maltese dialysis patients exist; therefore, the aim of this study was to rigorously examine survival statistics in a complete cohort of Maltese CKD 5D patients. The study population was comprised of all incident chronic patients (N=328) starting dialysis at the renal unit, Mater Dei hospital, Msida, Malta, for 4 consecutive years (2009–2012). Each yearly cohort was analysed in detail up to 31st December 2017, providing up to 8 years follow-up. Demographics (male 65%; female 35%), aetiology of renal failure (diabetic kidney disease: n=191; 58.2%), comorbidities, transplant status, and death were documented. Data collection and follow up were completed and statistical analysis was performed on the aggregated cohorts with SPSS version 23 with censoring up to 31st December 2017. The cumulative adjusted 5-year overall survival in Maltese CKD 5D patients was 0.36 and 0.25 at 8 years. No statistical difference was observed according to the year of starting dialysis. Cox regression analysis showed that age and transplant status influenced survival. The unadjusted hazard of death increased by 3% for every 1-year increase in age and was increased by 7% if the patient did not receive a transplant, and overall 22% (n=72) of the entire cohort eventually received transplants. This study reports an approximate 65% mortality at 5 years in Maltese haemodialysis patients, a poor prognosis that, despite optimal medical management, is consistent with worldwide reports.peer-reviewe

Illness perceptions predict mortality in patients with predialysis chronic kidney disease : a prospective observational study

Background: Illness perceptions have been shown to predict a range of psychosocial and clinical outcomes in kidney disease; including quality of life, distress, treatment adherence and even survival in end-stage renal disease patients on dialysis. The aim of this study was to evaluate whether illness perceptions impact mortality in incident predialysis Chronic Kidney Disease (CKD) patients.Methods: Over the study period between September 2015 and June 2019, a total of 200 participants with predialysis CKD were recruited from the Nephrology Outpatient’s clinics at Mater Dei Hospital, Malta. The participants were followed up until June 2019, and the mortality information was collected. Cox proportional hazards models were used to examine the association between illness perceptions, and mortality risk, after adjustment for covariates including distress, kidney function, co-morbidity and psychological distress.Results: Of the 200 cases available for analysis, there were 43 deaths. The mean survival time was 718.55 days (min. 3 days, max. 1297 days). The cumulative survival 1-year post the assessment of the Revised Illness Perceptions Questionnaire (IPQ–R) was 93%. Stronger identity beliefs (HR = 1.199, 95% CI: 1.060–1.357, p = 0.004), perceptions of a chronic timeline (HR = 1.065, 95% CI: 1.003–1.132, p = 0.041), personal control beliefs (HR = 0.845, 95% CI: 0.748– 0.955, p = 0.007) and perceptions of control over the treatment (HR = 0.812, 95% CI: 0.725–0.909, p = 0.000) demonstrated a significant association with mortality after controlling covariates. In a subsequent saturated model, perceived identity, chronic timeline and treatment control perceptions remained significant predictors of mortality, together with serum albumin, comorbidities and urea.Conclusions: CKD patients’ perceptions of treatment control, perceptions of a chronic timeline and perceived illness identity predict survival independently of clinical prognostic factors, including kidney function and co- morbidity. Illness perceptions are important and potentially modifiable risk factors in CKD. Further studies are required to test whether the assessment and the implementation of psychological interventions aimed to modify maladaptive illness perceptions influence clinical outcomes in CKD.peer-reviewe

Design considerations for therapeutic devices - an investigation of pre-schoolers preferences for an artefact's basic characteristics

Toys are children's first consumer products and while playing they acquire numerous skills, learn about their environment and socialise with other children and adults. Toys are adapted and used by clinicians as therapeutic devices because they allow them to create bonds and communicate with children. Aesthetical aspects should be considered early in the design process, especially since pre-schoolers’ views are still dominated by the appearance of artefacts, also known as, the perceptual salient characteristics. The study of emotions mediates the understanding of the relationships between a product, user and the process with which consumers set up preferences over products. Decisions taken in each design stage will influence whether therapeutic devices will be enjoyed by children. An experiment was carried out to test out pre-schoolers’ preferences on individual attributes: form, dimension, material (hardness and weight) and surface (appearance and texture). This study exposed dominant characteristic preferences and the fact that some are influenced by gender and age. Employing these findings in therapeutic devices will enable clinicians to better engage the children during therapy

Afrika

Ġabra ta’ poeżiji u proża li tinkludi: Kavallier ta’ Sergio Grech – Tiġrib ta’ Toni Aquilina – Kappella pprofanata ta’ Ġorġ Borg – Leħħiet ta’ Pawlu Aquilina – Fir-raqda ħadra ta’ Carmel Calleja – Epigrammi: X’dinja din! ta’ J. J. Camilleri – Karnival 1999 (Għawdex) ta’ Joe M. Attard – Ħarsti lejn l-art ta’ Ġorġ Zammit – Lill-mewt ta’ J. Zammit Tabona – Tifkira ta’ Lillian Sciberras – Lill-pitirross ta’ K. Vella Haber – Lill-irġiel miżżewġa ta’ Ġanni A. Cilia – Meta Hamlet u l-fjuri eterni jiltaqgħu ta’ Doreen Micallef – It-tren iżomm il-ħin ta’ Pawlu Aquilina – Kemm tiswa tarbija? ta’ Ġorġ Mallia – Jien naf ta’ J. J. Cremona – Odessa ta’ Charles Coleiro – L-isptar ta’ Charles Coleiro – Agunija ta’ Charles Coleiro – Milied XXI ta’ Charles Coleiro – Entużjażmu ta’ Charles Briffa – Londra ta’ Charles Briffa – Dal-ġebel kbir ta’ Emanuel Attard – Lit-Teatru Rjal ta’ Maurice Mifsud Bonnici – Fl-Ewropa magħquda ta’ Doreen Micallef – Fil-mewt ta’ Ġorġ Pisani ta’ Carm Cachia – Lejl id-19 ta’ Diċembru ta’ Charles B. Spiteri – Kont waħdi ta’ Suzanne Gatt – Imħabbti ta’ Nathalie Micallef – Xi ġralek, Ma? ta’ Oliver Friggieri – Anki t-tislima ta’ Oliver Friggieri – Fuq xifer nimxu ta’ Oliver Friggieri – Afrika ta’ Oliver Friggieri.peer-reviewe

A History of Drug Discovery for Treatment of Nausea and Vomiting and the Implications for Future Research.

The origins of the major classes of current anti-emetics are examined. Serendipity is a recurrent theme in discovery of their anti-emetic properties and repurposing from one indication to another is a continuing trend. Notably, the discoveries have occurred against a background of company mergers and changing anti-emetic requirements. Major drug classes include: (i) Muscarinic receptor antagonists-originated from historical accounts of plant extracts containing atropine and hyoscine with development stimulated by the need to prevent sea-sickness among soldiers during beach landings; (ii) Histamine receptor antagonists-searching for replacements for the anti-malaria drug quinine, in short supply because of wartime shipping blockade, facilitated the discovery of histamine (H1) antagonists (e.g., dimenhydrinate), followed by serendipitous discovery of anti-emetic activity against motion sickness in a patient undergoing treatment for urticaria; (iii) Phenothiazines and dopamine receptor antagonists-investigations of their pharmacology as "sedatives" (e.g., chlorpromazine) implicated dopamine receptors in emesis, leading to development of selective dopamine (D2) receptor antagonists (e.g., domperidone with poor ability to penetrate the blood-brain barrier) as anti-emetics in chemotherapy and surgery; (iv) Metoclopramide and selective 5-hydroxytryptamine3(5-HT3) receptor antagonists-metoclopramide was initially assumed to act only via D2 receptor antagonism but subsequently its gastric motility stimulant effect (proposed to contribute to the anti-emetic action) was shown to be due to 5-hydroxytryptamine4 receptor agonism. Pre-clinical studies showed that anti-emetic efficacy against the newly-introduced, highly emetic, chemotherapeutic agent cisplatin was due to antagonism at 5-HT3 receptors. The latter led to identification of selective 5-HT3 receptor antagonists (e.g., granisetron), a major breakthrough in treatment of chemotherapy-induced emesis; (v) Neurokinin1receptor antagonists-antagonists of the actions of substance P were developed as analgesics but pre-clinical studies identified broad-spectrum anti-emetic effects; clinical studies showed particular efficacy in the delayed phase of chemotherapy-induced emesis. Finally, the repurposing of different drugs for treatment of nausea and vomiting is examined, particularly during palliative care, and also the challenges in identifying novel anti-emetic drugs, particularly for treatment of nausea as compared to vomiting. We consider the lessons from the past for the future and ask why there has not been a major breakthrough in the last 20 years

Comparing public service motivation within various Europe countries: do institutional environments make a difference?

status: publishe