Escherichia coli O157:H7 in Malta

E coli O157:H7 infection causes a wide spectrum of disease ranging from asymptomatic carriage to severe disease leading to death. Typical disease includes a non-bloody diarrhoea, haemorrhagic colitis, HUS and thrombotic thrombocytopaenic purpura. While the incubation period is commonly 3-4 days, it can range from one to eight days. In this article the author describes the epidemiology, the clinical features and the microbiology of the infection, whilst giving a short view of the local situation.peer-reviewe

Drug Resistant Streptococcus pneumoniae (DRSP) in the Maltese Islands

The DRSP prevalence rate for the Maltese Islands was investigated. Consecutive samples were obtained, both from adults and children, from September 2000 through April 2002. Penicillin-intermediately-resistant isolates amounted to 27%, erythromycin-resistant isolates 31%, and clindamycin-resistant isolates 19%. The oxacillin disk was found to be an effective screening method for the detection of penicillin resistance. An association was found in patients who had DRSP, as well as diabetes and/ or cardiovascular disease. Finally, an investigation of the local antibiotic consumptions over the period 1997-2000, for the National Health Service was conducted. The highest consumption rates were obtained with co-amoxiclav, amoxicillin, erythromycin, cephalexin and ciprofloxacin. The results obtained here call for more judicious use of antibiotics. In addition, the setting up of a local DRSP surveillance unit is mandatory. Moreover, the use of molecular techniques to investigate specific genes, such as ermAM and mefE associated with macrolide-resistance, should be introduced as part of investigational laboratory work.peer-reviewe

A focus on the newer antibiotics targeting Gram-positive bacteria

The incidence of antimicrobial resistance has continued to rise with a threat to return to the “pre-antibiotic” era. This has included a sharp increase in multi-drug resistant organisms, which may cause life-threatening infections. Efforts have been made to develop new antibiotics with novel modes of action, aimed at acting against these multi-drug resistant strains. This review aims to focus on newly available and investigational antibiotics targeting Grampositive organisms. It is likely that these antibiotics will be used mainly in a secondary care setting; however primary care health care professionals also need to have an understanding of these antibiotics, since patients may be discharged home on them.peer-reviewe

Periodic shock-emission from acoustically driven cavitation clouds:a source of the subharmonic signal

Single clouds of cavitation bubbles, driven by 254 kHz focused ultrasound at pressure amplitudes in the range of 0.48–1.22 MPa, have been observed via high-speed shadowgraphic imaging at 1 × 10⁶ frames per second. Clouds underwent repetitive growth, oscillation and collapse (GOC) cycles, with shock-waves emitted periodically at the instant of collapse during each cycle. The frequency of cloud collapse, and coincident shock-emission, was primarily dependent on the intensity of the focused ultrasound driving the activity. The lowest peak-to-peak pressure amplitude of 0.48 MPa generated shock-waves with an average period of 7.9 ± 0.5 μs, corresponding to a frequency of f₀/2, half-harmonic to the fundamental driving. Increasing the intensity gave rise to GOC cycles and shock-emission periods of 11.8 ± 0.3, 15.8 ± 0.3, 19.8 ± 0.2 μs, at pressure amplitudes of 0.64, 0.92 and 1.22 MPa, corresponding to the higher-order subharmonics of f₀/3, f₀/4 and f₀/5, respectively. Parallel passive acoustic detection, filtered for the fundamental driving, revealed features that correlated temporally to the shock-emissions observed via high-speed imaging, p(two-tailed) 200 μm diameter, at maximum inflation), that developed under insonations of peak-to-peak pressure amplitudes >1.0 MPa, emitted shock-waves with two or more fronts suggesting non-uniform collapse of the cloud. The observations indicate that periodic shock-emissions from acoustically driven cavitation clouds provide a source for the cavitation subharmonic signal, and that shock structure may be used to study intra-cloud dynamics at sub-microsecond timescales

The effects of socioeconomic determinants on hypertension in a cardiometabolic at-risk European country

Background. A relationship has been established between socioeconomic status and hypertension. The aim of this study was to determine the prevalence of hypertension and to explore the links between hypertension and socioeconomic factors in the adult population of Malta. Methods. A national representative cross-sectional health examination study was performed between 2014 and 2016. Sociodemographic and medical history data was gathered by validated questionnaires while blood pressure was measured. Prevalence rates of known hypertension, newly hypertension, and global hypertension were calculated. Associations between sociodemographic characteristics and hypertension were identified through logistic regression models. Results. Hypertension contributed to 30.12% (CI 95%: 28.71–31.57) of the study population, with a male preponderance. The majority was known hypertensive (73.59% CI 95%: 71.01–76.02), with only three-quarters on medication. Multivariant analyses showed that increasing age and body mass index, male gender, and living in Gozo, Western district, and Northern Harbour district were associated with having hypertension. Conclusion. Hypertension is a problem in Malta especially in the male population and with increasing age and body mass index. Education did not exhibit any associated risk for having hypertension, which is inconsistent with the literature, while habitat localities played a role in hypertension development.peer-reviewe

Diabetes, pre-diabetes and their risk factors in Malta : a study profile of national cross-sectional prevalence study

Type 2 diabetes mellitus constitutes a global epidemic and a major burden on health care systems across the world. Prevention of this disease is essential, and the development of effective prevention strategies requires validated information on the disease burden and the risk factors. Embarking on a nationally representative cross-sectional study is challenging and costly. Few countries undertake this process regularly, if at all. This paper sets out the evidence-based protocol of a recent cross-sectional study that was conducted in Malta. Data collection took place from November 2014 to January 2016. This study presents up-to-date national data on diabetes and its risk factors (such as obesity, smoking, physical activity and alcohol intake) that will soon be publicly available. This protocol was compiled so that the study can be replicated in other countries. The protocol contains step-by-step descriptions of the study design, including details on the population sampling, the permissions required and the validated measurement tools used.peer-reviewe

Methicillin resistant S. Aureus in autopsy cases

Objective: To determine whether hospital stay predisposes to nasal colonisation with Staphylococcus aureus and Methicillin Resistant S. aureus (MRSA). Method: Nasal swabs were taken from cadavers undergoing post-mortem examinations at the mortuary of St. Luke’s Hospital. The swabs were taken to the Bacteriology Laboratory where attempts were made to culture S. aureus. Vitek® Gram Positive Susceptibility Cards were used for antibiotic susceptibility. MRSA positive organisms were tested using Penicillin Binding Protein Latex Agglutination. Key Findings: Ninety-three swabs were taken. The proportion of S. aureus nasal carriage was similar in both hospitalised and non-hospitalised groups. However, 8 out of 15 (53%) S. aureus carriers in the hospitalised group were MRSA positive, compared to 4 out of 19 (21%) S. aureus carriers in the non-hospitalised group. Conclusion: Hospitalisation increases the incidence of MRSA carriage compared to the non-hospitalised population.peer-reviewe

Prevalence of obesity in Malta

Background: Obesity is a global epidemic with the Mediterranean island of Malta being no exception. The World Health Organization (WHO) has identified Malta as one of the European countries with the highest obesity prevalence. Method: A cross-sectional study was conducted (2014–2016) under the auspices of the University of Malta. The prevalence of overweight-obesity in Malta was calculated and then age stratified for comparisons with previous studies. Results: The study identified 69.75% (95% CI: 68.32–71.18) of the Maltese population to be either overweight or obese. The men overweight/obese prevalence (76.28% 95% CI: 74.41–78.14) was statistically higher than that for women (63.06% 95% CI: 60.92–65.20) (p = 0.0001). Age stratification revealed that both genders had the highest overweight prevalence rates between 55 and 64 years (Men = 23.25% 95% CI: 20.43–26.33; Women = 24.68% 95% CI: 21.44–28.22). Men obesity prevalence rates were highest in the 35 to 44 years group (22.52% 95% CI: 19.65–25.68) while for women it was highest in the 55 to 64 years group (28.90%, 95% CI: 25.44–30.63). Conclusion: Over a 35-year period, an overall decrease in the normal and overweight BMI categories occurred with an increase in the prevalence of obesity. An exception was observed in the women, where the prevalence of normal BMI increased over this time period. Also, it appears that while the total population obesity prevalence increased (for 2016), a percentage of the women have shifted from an obese to an overweight status.peer-reviewe

The diabesity health economic crisis - the size of the crisis in a European island state following a cross-sectional study

Background: Diabetes type 2 and obesity are well-established global epidemics and contributors to clinical, social and economic health burdens. The prevalence rates of these diseases are still on the rise among countries resulting in a corresponding public health burden. The Mediterranean island of Malta, known for it’s high diabetes and obesity rates, provides a good fundamental basis to portray the economical health burden of these diseases. Method: A recent randomised stratified representative cross-sectional survey conducted in Malta tackling diabetes, obesity and other determinants, was used to work out the population prevalence of these diseases. The cost burden of diabetes and obesity, based on published data, was incorporated to the established population prevalence rates, in order to estimate the Maltese economical burden. Projections to the year 2050 by a bottom-up prevalence based design were performed. Results: One eight of the Maltese adults (25 to 64 years) suffered from diabetes out of which approximately 10,000 adults were unaware of the disease. Alarmingly, more than a third of the Maltese population suffer from obesity. The approximate health care costs (direct and indirect) for the diabetic adult population was of €29,159,217 (€21,994,676 - €38,919,121) annually, amounting to 3.64% (2.75–4.875%) of the total health expenditure in Malta. The obesity cost burden was of €23,732,781 (€21,514,972-€26,049,204) annually contributing for 2.97% (2.69–3.26%) of the total health expenditure. The projected prevalence and costs for 2050 exhibited an estimated cost burden increase of €33,751,487 (€25,458,606–€45,048,473) for the diabetes mellitus population and €46,532,294 (€42,183,889–€51,074,049) for the obese population. These projected cost burdens are expected to increase exponentially the total health care expenditure in Malta by 2050. Conclusion: Having an understanding of the prevalence and the economic cost burden of diabetes and obesity within a country, along with projections of the expected burden will enable policy and public health officials to clearly visualize this growing problem. It also helps in establishing effective preventive strategies and screening programs targeting these epidemics.peer-reviewe