The outcome of the follow-up of consolidations on chest radiographs in a Maltese population, presenting from the community, aged 50 or over : a retrospective study

Background: The British Thoracic Society (BTS) guidelines for community-acquired pneumonia (CAP) suggest a repeat chest radiograph 6 weeks after treatment for patients over the age of 50 to screen for lung malignancy. The benefit of this practice is not well determined. Method: We conducted a retrospective study involving patients from the community over 50 years old with consolidations on chest radiography. These patients presented in Mater Dei Hospital, Gozo General Hospital and Maltese Health Centres during the months of January 2013-2017 and August 2013-2016. The occurrence of follow-up imaging and subsequent diagnosis of lung malignancy was documented. All chest radiographs were reviewed by a radiologist. Results: 402 patients met our inclusion criteria. Follow-up imaging was done in 214 patients (53.2%) within 12 weeks. There was no statistical significance in the follow-up rates when matched for the presenting month, whether radiologists recommended repeat imaging, whether patients were admitted to hospital, and for the patients’ age and gender. The diagnostic yield of lung malignancy was 1.74% (7 patients) within 12 weeks with all malignancies being at an advanced stage at diagnosis (lowest stage being IIIA) when detected. All seven patients had a smoking history. Conclusion: 53.2% of community-acquired pneumonia patients over the age of 50 had follow-up imaging within 12 weeks. No clinical variables explaining this low rate could be identified. This practice results in a low diagnostic yield. Moreover, the diagnosis of lung malignancy is achieved at an advanced stage, making it a poor screening tool.peer-reviewe

A study to assess the utilization of the influenza vaccine amongst doctors and nurses in the medical wards at Mater Dei Hospital

Introduction: Seasonal influenza may be associated with a high morbidity and mortality rate. Efforts at promoting effective influenza vaccination in the general population and amongst health-care workers have been of increasing importance over recent years. Aim: To assess use of influenza vaccine amongst doctors and nurses working in the medical wards at Mater Dei Hospital. Method: Data was collected using questionnaires supplied to nurses on the wards and posted online to doctors. Results: A total of 130 questionnaires were completed. Results showed underutilization of the vaccine, with only 34% of respondents taking the vaccine in 2015. 43% of doctors (n=76) and 20% of nurses (n=54) confirmed taking the vaccine. 44% of senior doctors (HST level and above; n=27), were compliant with the vaccination; 43% of the junior doctors (n=49) took the vaccine, of which foundation-year doctors formed the larger portion (FY 55%; BST 19%). In the case of nurses, 25% of the 8 senior nurses took the vaccine, and 19% of the 46 staff nurses were compliant. The commonest reasons for non-compliance to vaccination included doubt about its beneficial effects and fear of side effects. The most effective method for promoting the influenza vaccine included nurses handing out the vaccine on site Conclusion: The influenza vaccination coverage-rate in Malta amongst health-care workers during the 2015-2016 season was estimated to be 33.8%. The audit was limited by its small sample size and selection bias. Improved education about the beneficial effects of the vaccine is recommended in order to improve outcomes.peer-reviewe

Geochemistry of the soll facies of the Lower Globigerina Limestone formation, Malta

Rock from the "soll" seams of the Lower Globigerina Limestone Formation is distinguishable from 'franka" because of its characteristic honeycomb weathering. However, when freshly quarried, "soll" limestone, aninferior building material, is not so readily recognizable. This study was aimed at characterizing "soll" on the basis of its inorganic geochemistry. It is shown that "soll" has a significantly higher silicon content than normal "franka". The silica content of "soll', which is a measure of its clay content, is typically less than 5%. Therefore, the traditional belief that "soll" is a limestone which is rich in clay is untenable. The silicon content may be useful in differentiating "soll" limestone from 'franka ". Besides that in silicon, other elemental anomalies are found associated with the "soll" facies of the Lower Globigerina and also with "soll ahdar ", a stratigraphically related grey-green variety.peer-reviewe

Obesity and respiratory diseases

The obesity epidemic is a global problem, which is set to increase over time. However, the effects of obesity on the respiratory system are often underappreciated. In this review, we will discuss the mechanical effects of obesity on lung physiology and the function of adipose tissue as an endocrine organ producing systemic inflammation and effecting central respiratory control. Obesity plays a key role in the development of obstructive sleep apnea and obesity hypoventilation syndrome. Asthma is more common and often harder to treat in the obese population, and in this study, we review the effects of obesity on airway inflammation and respiratory mechanics. We also discuss the compounding effects of obesity on chronic obstructive pulmonary disease (COPD) and the paradoxical interaction of body mass index and COPD severity. Many practical challenges exist in caring for obese patients, and we highlight the complications faced by patients undergoing surgical procedures, especially given the increased use of bariatric surgery. Ultimately, a greater understanding of the effects of obesity on the respiratory disease and the provision of adequate health care resources is vital in order to care for this increasingly important patient population

Effects of diabetes family history and exercise training on the expression of adiponectin and leptin and their receptors

The daughters of patients with diabetes have reduced insulin sensitivity index (ISI) scores compared with women with no family history of diabetes, but their ISI increase more in response to exercise training(1). The present study aimed to determine whether differences between these groups in exercise-induced changes in circulating adiponectin and leptin concentrations and expression of their genes and receptors in subcutaneous adipose tissue (SAT), could explain differences in the exercise-induced changes in ISI between women with and without a family history of diabetes

Examining the contribution of smoking and HPV towards the etiology of oral cavity squamous cell carcinoma using high-throughput sequencing: A prospective observational study.

Oral cavity Squamous Cell Carcinoma (OCSCC) is a common form of head and neck cancer throughout the developed and developing world. However, the etiology of OCSCC is still unclear. Here, we explored the extent to which tobacco use, Human Papillomavirus (HPV) infection and genetic and transcriptomic changes contributed to the oncogenesis of OCSCC. In a prospective observational study, we analysed fresh tissue biopsies from 45 OCSCC collected from 51 subjects presenting with OCSCC to the Brisbane Head and Neck Clinics between 2013 and 2015. Exploration of the genetic and transcriptomic landscape of the biopsies were performed using RNA sequencing (RNA-seq) and whole exome sequencing. HPV associated tumours were determined using p16 staining of histological sections and RNA sequencing. Patient demographics including tumor location within the oral cavity, and history of tobacco and alcohol use were correlated with genomic and transcriptomics analyses. About 4.5% of OCSCC were HPV associated. The most frequent mutations in the OCSCC samples were in the TP53 and CDKN2A genes, but no association of specific mutations with HPV or tobacco use was observed. Using weighted gene co-expression network analysis to explore the RNA-seq data, tumors from participants with a history of tobacco use showed a significant trend towards increased mammalian target of Rapamycin (mTOR) signaling and decreased mitochondrial respiration. In conclusion, HPV was shown to be an uncommon association with OCSCC and changes in TP53 transcriptional regulation, mTOR signaling and mitochondrial function were associated with a history of tobacco use. Larger data sets will be required to enable detection of differences which may help with development of personalized therapeutics in the future

The Extended Treatment Window’s Impact on Emergency Systems of Care for Acute Stroke

The window for acute ischemic stroke treatment was previously limited to 4.5 hours for intravenous tissue plasminogen activator and to 6 hours for thrombectomy. Recent studies using advanced imaging selection expand this window for select patients up to 24 hours from last known well. These studies directly affect emergency stroke management, including prehospital triage and emergency department (ED) management of suspected stroke patients. This narrative review summarizes the data expanding the treatment window for ischemic stroke to 24 hours and discusses these implications on stroke systems of care. It analyzes the implications on prehospital protocols to identify and transfer large‐vessel occlusion stroke patients, on issues of distributive justice, and on ED management to provide advanced imaging and access to thrombectomy centers. The creation of high‐performing systems of care to manage acute ischemic stroke patients requires academic emergency physician leadership attentive to the rapidly changing science of stroke care.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150496/1/acem13698.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150496/2/acem13698_am.pd

Tonic-Clonic Activity at Subarachnoid Hemorrhage Onset: Impact on Complications and Outcome

Objective: Tonic-clonic activity (TCA) at onset complicates 3% to 21% of cases of subarachnoid hemorrhage (SAH). The impact of onset TCA on in-hospital complications, including seizures, remains unclear. One study associated onset TCA with poor clinical outcome at 6 weeks after SAH, but to our knowledge no other studies have confirmed this relationship. This study aims to assess the impact of onset TCA on in-hospital complications, poor functional outcome, mortality, and epilepsy at 3 months. Methods: Analysis of a prospective study cohort of 1479 SAH patients admitted to Columbia University Medical Center between 1996 and 2012. TCA within 6 hours of hemorrhage onset was identified based on accounts of emergency care providers or family witnesses. Results: TCA at onset was described in 170 patients (11%). Patients with onset TCA were younger (P = 0.002), presented more often with poor clinical grade (55% vs. 26%, P<0.001) and had larger amounts of cisternal, intraventricular, and intracerebral blood than those without onset TCA (all, P<0.001). After adjusting for known confounders, onset TCA was significantly associated with in-hospital seizures (OR 3.80, 95%-CI: 2.43–5.96, P<0.001), in-hospital pneumonia (OR 1.56, 95%-CI: 1.06–2.31, p = 0.02), and delayed cerebral ischemia (OR 1.77, 95%-CI: 1.21–2.58, P = 0.003). At 3 months, however, onset TCA was not associated with poor functional outcome, mortality, and epilepsy after adjusting for age, admission clinical grade, and cisternal blood volume. Conclusions: Onset TCA is not a rare event as it complicates 11% of cases of SAH. New and clinically relevant findings are the association of onset TCA with in-hospital seizures, pneumonia and delayed cerebral ischemia. Despite the increased risk of in-hospital complications, onset TCA is not associated with disability, mortality, and epilepsy at 3 months