An overview of irrigation system performance on the island of Malta

The island of Malta has a typical Mediterranean climate with an annual precipitation of circa 500mm spreading over the October to March period. The semi arid environment has always provoked the indigenous population to develop and adopt techniques that would maximise water harvesting and distribution efficiency. Within the nine year span (1991-2000), the agricultural land in Malta decreased by an estimated 1,164 hectares, reaching a total land base of 10,738 hectares. Despite this loss, the National Statistics Office registered an increase of 420 hectares in irrigated land. This could be interpreted as 1) water availability has increased or 2) efficiency in water distribution has increased. Furthermore, protected cropping through the use of greenhouses and cloches equipped with drip irrigation systems are now increasing in use and popularity. The use of treated sewage water was a key factor in stimulating agricultural development in the south region. Irrigation efficiency may be measured using a variety of indicators, such as: area under irrigation, amount of produce marketed, volume of water storage, and deterioration of ground water resources. A review of irrigation under a Maltese context is presented.peer-reviewe

Pyogenic granuloma as a surrogate indicator of deep seated foreign bodies: a case report

Although pyogenic granulomas are often clinically associated with foreign bodies or recurrent traumatic injury, this association is not well documented. We report a case of a recurrent, intractable pyogenic granuloma due to a missed foreign body. An extensive search retrieved no previous literature reporting this association. This lack of evidence bases may hinder the hand surgeon from extending the wound incision and thorough exploration. Recurrent pyogenic granulomas should lead the hand surgeon to entertain the possibility of a missed foreign body

Fluid resuscitation in adults with severe burns at risk of secondary abdominal compartment syndrome—An evidence based systematic review

Background: Secondary abdominal compartment syndrome (sACS) in adults with severe burns is commonly unsuspected, can be rapidly fatal and seriously compromises the reliability of urine output as an indicator of perfusion and resuscitation status. Current literature lacks an exhaustive, evidence-based review critically appraising all retrieved literature on which clinical decisions may be based. Methods: The evidence on three inter-related concepts was evaluated: fluid-volume management and its contribution to sACS; the role of urinary bladder pressure monitoring; and awareness of the burns community to sACS. Literature published over the last ten years across the major databases was retrieved, and the search strategy was fully reported to reduce the retrieval bias ubiquitous in previous literature. Each article was individually appraised and classified into a framework of evidence, enabling the formulation of specific, graded recommendations. Results: Current best evidence supports recommendations to reduce fluid-volume administered through use of colloids or hypertonic saline especially if the projected resuscitation volume surpasses a ‘volume ceiling’. Continuous intra-vesical monitoring is recommended: to guide fluid resuscitation for early diagnosis of sACS; and as a guide to reliability of urine output as indicator of organ perfusion. A priming volume of 75 cm3 or less is recommended. Conclusion: Fluid resuscitation volume is causative to sACS, especially once a predetermined maxima is reached. Continuous intra-vesical pressure monitoring is a cheap, reliable, userfriendly monitoringmethod recommended in high-risk patients. Poor awareness among the burns community requires urgent dissemination of evidence based information

Method of detecting bacterial infection in a biological sample

A method of indicating the presence of a bacterial infection in a biological sample is provided. The method detects a marker for infection by providing a device, the device including a biosensor, an interaction arising be tween the biosensor and the marker when the marker is present in the biological sample. Contacting at least a part of the biological sample with the biosensor of the device, therefore, provides analysis of the biological sample with respect to the marker by detecting for the interaction between the biosensor and the marker. A preferred marker is the enzyme amylase.peer-reviewe

Method of detecting bacterial infection in a biological sample

A method of indicating the presence of a bacterial infection in a biological sample is provided. The method detects a marker for infection by providing a device, the device including a biosensor, an interaction arising between the biosensor and the marker when the marker is present in the biological sample. Contacting at least a part of the biological sample with the biosensor of the device, therefore, provides analysis of the biological sample with respect to the marker by detecting for the interaction between the biosensor and the marker. A preferred marker is the enzyme amylase.peer-reviewe

Family education seminar for hypospadias surgery, a powerful preoperative tool -7yr outcomes

The effectiveness of educational pre-operative interventions is welldocumented. Parents of children with hypospadias have been shown to retain little of the information provided in the standard hospital outpatient setting.1 Pre-operative educational interventions have not been documented in hypospadias2 . We present experience of our multidisciplinary hypospadias family seminars over 7 years (20122018) in a regional centre. The contribution to parents satisfaction, of various domains demonstrated through formal quantitative-qualitative analysis.peer-reviewe

Method of detecting bacterial infection in a biological sample

A method of indicating the presence of a bacterial infection in a biological sample is provided. The method detects a marker for infection by providing a device, the device including a biosensor, an interaction arising between the biosensor and the marker when the marker is present in the biological sample. Contacting at least a part of the biological sample with the biosensor of the device, therefore, provides analysis of the biological sample with respect to the marker by detecting for the interaction between the biosensor and the marker. A preferred marker is the enzyme amylase.peer-reviewe

Value of clinical, ultrasonographic and MRI signs as diagnostic differentiators of non-benign lipomatous tumours

Suspicion of malignant change within a lipoma is a common and increasing workload within the UK Sarcoma multidisciplinary team (MDT) network, and a source of considerable patient anxiety. Currently, there is no lipoma-specific data, with regard to which clinical or radiographic features predict non-benign histology, or calculate an odds-ratio specific to a lipomatous lesion being non-benign. We performed a 9-year, double-blind, unmatched cohort study, comparing post-operative histology outcomes (benign versus non-benign) versus 15 signs across three domains: Clinical (size of tumour, depth, growth noticed by patient, previous lipoma, patient felt pain), Ultrasonographic (size, depth, vascularity, heterogenous features, septae) and MRI (size, depth, vascularity, heterogenous features, septae, complete fat signal suppression). Receiver operating characteristic (ROC) analysis, odds ratios and binary logistic regression analysis was performed double-blind. When each sign is considered independently, (ROC analysis, followed by binary logistic regression) only Ultrasound depth is a significant predictor (p = 0.044) of a histologically non-benign lipoma. Ultrasonographically determined vascularity and septation were not statistically significant predictors. None of the clinical signs were statistically significant (p > 0.05). Of the MRI signs none was statistically significant (p > 0.05). However, heterogeneous MRI features fared better than MRI depth. Ultrasound signs (Pseudo R-Square = 0.105) are more predictive of the post-operation histology outcome than Clinical signs (Pseudo R-Square = 0.082) or MRI tests (Pseudo R-Square = 0.052) Ultrasound and Clinical tests combined (Pseudo R-Square = 0.147) are more predictive of the post-operation histology outcome than MRI tests (Pseudo R-Square = 0.052). This work challenges the traditional perception of “red-flag” signs when applied to lipomatous tumours. We provide accurate data upon which an informed choice can be made, and provides a robust bases for expedited risk/benefit. The importance of an experienced and cohesive MDT network is emphasised.peer-reviewe

Pyogenic granuloma as a surrogate indicator of deep seated foreign bodies: A case report

Although pyogenic granulomas are often clinically associated with foreign bodies or recurrent traumatic injury, this association is not well documented. We report a case of a recurrent, intractable pyogenic granuloma due to a missed foreign body. An extensive search retrieved no previous literature reporting this association. This lack of evidence bases may hinder the hand surgeon from extending the wound incision and thorough exploration. Recurrent pyogenic granulomas should lead the hand surgeon to entertain the possibility of a missed foreign body

Rapidly expanding thenar eminence ganglion: A case report

Introduction This study documents the first reported case of a rapidly growing (volar) thenar eminence ganglion arising form the first carpometacarpal joint, masquerading as a sarcoma. The discussion informs the hand surgeon on the evidence regarding the unusual presenting features. Case presentation An 85 year old left hand dominant female presented with a six week history of rapidly growing lump on the thenar eminence. Clinical examination revealed a non-tender large lobulated mobile swelling measuring 5 × 4 cm and involving the whole thenar eminence. Conclusion Ganglia may present from the thenar eminence and are a source of diagnostic confusion