High order multiple births in the Maltese population

Triplets are a relatively rare occurrence being encountered in the Maltese Islands with an overall incidence of about 0.1 per 1000 maternities. The incidence appears to be on the increase over the last twenty years rising from the 0.08 per 1000 maternities in the decade 1960-69 to 0.11 per 1000 maternities in the following two decades. This increase has been correlated with the increasing use of ovulation induction agents, as has the occurrence of two quadruplets and one octuplet pregnancies in 1988-90. Triplets are shown to occur more frequently in elderly mothers, but no relationship to parity could be identified. Higher order births are shown to have a high incidence of antenatal and intrapartum problems, and are associated with a higher fetal loss than singleton pregnancies.peer-reviewe

Maltese national birth weight for gestational age centile values

The relevance of using literature derived birth weight for gestational age centile charts for the Maltese population is debatable. The study set out to develop national weight for gestational age centile charts and compare these to other populations. Method: Anonymised birth weight for gestational age data with relevant maternal and neonatal observations over the period 1995-2009 were obtained from national statistics. The formats were standardised and imported into an SQL database that enabled filtration for single live births and grouping by sex. The data was scrutinized manually for obvious keying errors. The best estimate of gestational age from the last menstrual period (LMP) and expected date of delivery (EDD) was selected using established guidelines. A Box-Cox gamma transform was used to fit the model and generate separate centile charts. The data was compared to previous birth weight data reported in Maltese newborns in previous decades and to data from other countries. Results: A total of 58,899 neonates were included in the study and birth weight for gestational age centile charts were generated between 23 and 42 weeks of gestation using Revolution R with VGAM. There has been a statistically significant gradual fall in mean birth weight in Maltese newborns over the last four decades. There are also statistically significant differences between the Maltese data and those from other countries. Conclusion: The observed differences make the use of national birth weight for gestational age centile charts desirable both for routine clinical assessment and epidemiological studies.peer-reviewe

Surgical case report of uterine leiomyosarcoma metastasising to the pancreas resected by enucleation

A 64-year old lady presented with worsening abdominal pain, vomiting and constipation. She had diffuse abdominal tenderness with peritonism, requiring an emergency laparotomy as a result of a perforated sigmoid tumour. An incidental hard lump was identified on the anterior surface of the pancreas and was removed by enucleation. It was later diagnosed as metastatic leiomyosarcoma based on histology and from her history of uterine malignancy. No recurrence is reported up to this day. Uterine leiomyosarcomas are aggressive malignant tumours with a high predisposition to metastasis, commonly to the lungs, liver, brain and bone. Metastasis to the pancreas is a rare occurrence and considered highly unusual, which can typically present with non-specific symptoms and signs. Imaging can pick up a pancreatic lesion and a radiologically-guided FNA as a pre-operative attempt is acceptable in order to differentiate the lesion before undertaking any major surgery. However, in view of only a few case reports found in the literature, surgical management of pancreatic metastases is not clearly defined with a questionable long-term prognosis. Most cases are managed by elective radical excision with good result. Review of the literature shows other more radical surgical approaches were used. This is the first report of metastatic uterine leiomyosarcoma to the pancreas being managed by enucleation, with a successful follow-up and no recurrence.peer-reviewe

Soil Erosion Risk Analysis of a Small Watershed

Malta is being rapidly exposed to developmental activities occurring inland and along its coastline, which in turn triggers erosion and flooding in the event of high-intensity rainfall. Most of the rainwater-containing several contaminants from urban and agricultural areas are lost as runoff into the coastal waters, which in turn have adverse environmental and socioeconomic impacts. The extent of soil erosion and runoff can be investigated starting from the watershed basin downhill till coastal waters. This study links the runoff of soil along an ecologically sensitive watershed in Malta with the use of multidisciplinary techniques. These included the estimation of soil erosivity coupled with satellite remote sensing chlorophyll-a (CHLA) and total suspended matter (TSM) in coastal waters adjacent to the mouth of the valley. This represents a novel study for the Maltese islands because it provides a precise map of soil erosion hotspots in the Ramla watershed as high as 30 ton ha−1 yr−1. Using three case studies of past torrential rain episodes, the sedimentation process resulted in a 120% and 133% increase in CHLA and TSM levels, respectively, against background levels. This information is vital for proper risk management of ecologically sensitive watershed basins

A Novel and Cost-Effective Monitoring Approach for Outcomes in an Australian Biodiversity Conservation Incentive Program

We report on the design and implementation of ecological monitoring for an Australian biodiversity conservation incentive scheme - the Environmental Stewardship Program. The Program uses competitive auctions to contract individual land managers for up to 15 years to conserve matters of National Environmental Significance (with an initial priority on nationally threatened ecological communities). The ecological monitoring was explicitly aligned with the Program's policy objective and desired outcomes and was applied to the Program's initial Project which targeted the critically endangered White Box-Yellow Box-Blakely's Red Gum Grassy Woodland and Derived Native Grassland ecological community in south eastern Australia. These woodlands have been reduced to <3% of their original extent and persist mostly as small remnants of variable condition on private farmland. We established monitoring sites on 153 farms located over 172,232 sq km. On each farm we established a monitoring site within the woodland patch funded for management and, wherever possible, a matched control site. The monitoring has entailed gathering data on vegetation condition, reptiles and birds. We also gathered data on the costs of experimental design, site establishment, field survey, and data analysis. The costs of monitoring are approximately 8.5% of the Program's investment in the first four years and hence are in broad accord with the general rule of thumb that 5-10% of a program's funding should be invested in monitoring. Once initial monitoring and site benchmarking are completed we propose to implement a novel rotating sampling approach that will maintain scientific integrity while achieving an annual cost-efficiency of up to 23%. We discuss useful lessons relevant to other monitoring programs where there is a need to provide managers with reliable early evidence of program effectiveness and to demonstrate opportunities for cost-efficiencies.Specialist staff within SEWPaC assisted in the design of the monitoring program to ensure its policy relevance. The funders contributed to development of the monitoring program but this did not prejudice the content of the paper in any way. The funders had no role in data collection, analysis and interpretation of results. The funders read and suggested improvements to the manuscript and agreed to publication

AN ACT to further amend the Criminal Code, Cap. 9. Bill No. 28A : position paper

This position paper is prepared by a group of experts in various fields. We are gravely concerned about the new Bill that government wants to introduce and thus we strongly urge the wording of the proposed Bill to be changed to: No crime is committed under article 241(2) or article 243 when the death or bodily harm of an unborn child results from a medical intervention conducted with the aim of saving the life of the mother where there is a real and substantial risk of loss of the mother's life from a physical illness. Moreover, we raise the following serious concerns and propose several recommendations aimed at improving the drafting of the Bill in order to contribute to a healthy discussion on this Bill. 1.The Bill is too telegraphic and bereft of detail. Bearing in mind that the Bill touches upon nothing less than the most fundamental of all human rights – the right to life -we propose that it would be better to include more details as to how the provision ought to operate in practice. 2.Key terminology is not defined and might be misconstrued. The term “health” can sometimes be used to describe non-life-threatening situations. This might place obstetricians in a position where they are unable to carry out their duty of care to patients without risking criminal prosecution or disciplinary proceedings because of lack of clarity in the language used. 3.There is inconsistency in the terms used between this Bill and other relevant articles in the Criminal Code, contributing to further lack of clarity and leading one to understand that there is a difference between these same concepts where there ought to be none. 4.There is no mention in government’s Bill to the effect that where medically possible a viable foetus should be allowed to be born prematurely rather than resorting to a termination of life in utero. In addition, we recommend, inter alia, that: 1.More legal certainty be employed in the drafting of the Bill, which would benefit the medical professional undertaking the medical procedure, the pregnant woman and the unborn child, be it at the foetal or embryonic stage, and the judiciary who might eventually be called upon to interpret the provision of the Criminal Code. 2.A new article be added to the Criminal Code, which is to apply only in those cases of a pregnant woman whose life is in manifest danger of death or where a real risk to her life exists from a physical illness. 3.Doubt is to be avoided and legal clarity ensured by stating that cases where a pregnant woman’s life is in danger does not include non-life-threatening cases (e.g.anxiety, emotional distress, organic mental disorder, rape, foetal abnormality etc.).non peer-reviewe

White matter microstructure associations with episodic memory in adults with Down syndrome: a tract-based spatial statistics study.

BACKGROUND: Nearly all persons with Down syndrome will show pathology of Alzheimer's disease in their 40s. There is a critical need for studies to identify early biomarkers of these various pathological changes of Alzheimer's disease in the Down syndrome population and understand the relationship of these biomarkers to cognitive symptoms in order to inform clinical trials. Although Alzheimer's disease is often considered a disease of gray matter, white matter degeneration has been documented during the preclinical stage of Alzheimer's disease. The current study examined the association between diffusion tensor imaging (DTI) measures of white matter microstructure and episodic memory performance in 52 adults with Down syndrome. METHODS: Seventy (N = 70) participants (M = 40.13, SD = 7.77 years) received baseline scans as part of the Neurodegeneration in Aging Down Syndrome (NiAD) study at two imaging facilities (36 at the University of Wisconsin-Madison [UW-Madison] and 34 at the University of Pittsburgh Medical Center [UPMC]). All participants had genetically confirmed trisomy 21. Fifty-two (N = 52) participants remained after QC. The DTI measures, fractional anisotropy (FA) and mean diffusivity (MD), were calculated for each participant. A combined measure of episodic memory was generated by summing the z-scores of (1) Free and Cued Recall test and (2) Rivermead Behavioural Memory Test for Children Picture Recognition. The DTI data were projected onto a population-derived FA skeleton and tract-based spatial statistics analysis was conducted using the FSL tool PALM to calculate Pearson's r values between FA and MD with episodic memory. RESULTS: A positive correlation of episodic memory with FA and a negative correlation of episodic memory and MD in the major association white matter tracts were observed. Results were significant (p < 0.05) after correction for chronological age, imaging site, and premorbid cognitive ability. CONCLUSION: These findings suggest that white matter degeneration may be implicated in early episodic memory declines prior to the onset of dementia in adults with Down syndrome. Further, our findings suggest a coupling of episodic memory and white matter microstructure independent of chronological age

Regional Cerebral Oximetry as an Indicator of Acute Brain Injury in Adults Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation–A Prospective Pilot Study

Background: Regional cerebral oxygen saturation (rScO2) measured by near-infrared spectroscopy (NIRS) can be used to monitor brain oxygenation in extracorporeal membrane oxygenation (ECMO). ECMO patients that develop acute brain injuries (ABIs) are observed to have worse outcomes. We evaluated the association between rScO2 and ABI in venoarterial (VA) ECMO patients.Methods: We retrospectively reviewed prospectively-collected NIRS data from patients undergoing VA ECMO from April 2016 to October 2016. Baseline demographics, ECMO and clinical characteristics, cerebral oximetry data, neuroradiographic images, and functional outcomes were reviewed for each patient. rScO2 desaturations were defined as a &gt;25% decline from baseline or an absolute value &lt; 40% and quantified by frequency, duration, and area under the curve per hour of NIRS monitoring (AUC rate, rScO2*min/h). The primary outcome was ABI, defined as abnormalities noted on brain computerized tomography (CT) or magnetic resonance imaging (MRI) obtained during or after ECMO therapy.Results: Eighteen of Twenty patients who underwent NIRS monitoring while on VA ECMO were included in analysis. Eleven patients (61%) experienced rScO2 desaturations. Patients with desaturations were more frequently female (73 vs. 14%, p = 0.05), had acute liver dysfunction (64 vs. 14%, p = 0.05), and higher peak total bilirubin (5.2 mg/dL vs. 1.4 mg/dL, p = 0.02). Six (33%) patients exhibited ABI, and had lower pre-ECMO Glasgow Coma Scale (GCS) scores (5 vs. 10, p = 0.03) and higher peak total bilirubin levels (7.3 vs. 1.4, p = 0.009). All ABI patients experienced rScO2 desaturation while 42% of patients without ABI experienced desaturation (p = 0.04). ABI patients had higher AUC rates than non-ABI patients (right hemisphere: 5.7 vs. 0, p = 0.01, left hemisphere: 119 vs. 0, p = 0.06), more desaturation events (13 vs. 0, p = 0.05), longer desaturation duration (2:33 vs. 0, p = 0.002), and more severe desaturation events with rScO2 &lt; 40 (9 vs. 0, p = 0.05). Patients with ABI had lower GCS scores (post-ECMO initiation) before care withdrawal or discharge than those without ABI (10 vs. 15, p = 0.02).Conclusions: The presence and burden of cerebral desaturations noted on NIRS cerebral oximetry are associated with secondary neurologic injury in adults undergoing VA ECMO

Total serum IgE and specific IgE levels in 10-15 year old children with respiratory symptoms and healthy controls in Sicily and Malta

Introduction: The RESPIRA study (EU Funded-Italia-Malta) was performed in the district of Gela (Southern Sicily) and Malta in 2012/3 in 10-15 years old schoolchildren (n=2,047) by means of standard respiratory questionnaires (ISAAC),and clinical exam of case and control subjects. Aims and Objectives: To measure total serum IgE levels in cases (n=127, males=45) and controls (n=142, Males=64), specific IgEs in cases (n=90, Males=53), and controls (n=82, Males=38). Materials and Methods: Cases reported wheeze and/or use of asthma medications in the last 12 months, while controls answered negatively to both and rhinitis. Results: Total Serum IgE (n=269) was raised (>144 IU/l) in 70/127 cases vs 25/142 controls (p=.0001). In males 30/76 of cases vs 11/64 controls (p=.005), while in females cases 15/51 vs 14/78, (p=.14). Positive specific IgE (>0.34 U/ml) was noted for at least one allergen in 54/90 cases vs 30/82 controls (p=.002). House dust mite (HDM) was positive in 27/90 cases vs 12/82 controls (p=.0001), Parietaria positive 12/90 cases vs 2/82 controls (p=.011), cat 22/90 vs 13/82 controls (p=.19), while in male subgroup 14/53 of cases were positive vs 4/38 controls (p=.06). Dog 9/90 cases vs 8/82 controls (NS). Olive positive in 13/90 cases vs 8/82 controls (NS). Alternaria positive in 6/90 cases vs 2/82 controls (NS). Goldenrod Solidago Virgaurea positive in 2/90 cases vs 1/82 controls, and Cladosporium 0/90 cases, 1/82 controls. Conclusion: Positive Total serum IgE and specific IgE to HDM and Parietaria in all patients and cat in males only were higher in cases than in controls.peer-reviewe

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