Malta : language, literacy and identity in a Mediterranean island society

Available documentation for the early modern period indicates that the Malta harbor towns achieved literacy earlier than the countryside. The Maltese townsmen lived on a trading route, and it was necessary for them to learn the lingua franca, as the language of trade in the Mediterranean. The educated elite were able to acquire fluent speaking knowledge, as well as the ability to write, Tuscan (a dialect then in the process of becoming standard Italian), while continuing to employ their local Maltese ‘dialect’ on numerous occasions. By and large, the erosion of the position of Maltese as the subordinate language was an inevitable by-product of this development. The Maltese language was able to attain the function of a literary language in the nineteenth century but it had no standard orthography until 1931 and was only adopted as Malta’s official language in 1964.peer-reviewe

[Linezolid therapy for the treatment of nocardial infection: report of a case and review of the literature]

Treatment of Nocardia infections continues to be difficult, especially for central nervous system infections or disseminated diseases and when sustained by highly drug-resistant species such as Nocardia farcinica. Linezolid, the first oxazolidinone approved for clinical use, shows an excellent in vitro activity against all species of Nocardia, and achieves good central nervous system and lung concentrations. We describe the case of a patient with pulmonary nocardiosis and intolerance to trimethoprim/sulfamethoxazole successfully treated with linezolid, and review all the published cases of systemic nocardiosis treated with this agent. On the basis of the available evidence, linezolid appears an effective option for the treatment of nocardiosis

[Linezolid therapy for the treatment of nocardial infection: report of a case and review of the literature].

Treatment of Nocardia infections continues to be difficult, especially for central nervous system infections or disseminated diseases and when sustained by highly drug-resistant species such as Nocardia farcinica. Linezolid, the first oxazolidinone approved for clinical use, shows an excellent in vitro activity against all species of Nocardia, and achieves good central nervous system and lung concentrations. We describe the case of a patient with pulmonary nocardiosis and intolerance to trimethoprim/sulfamethoxazole successfully treated with linezolid, and review all the published cases of systemic nocardiosis treated with this agent. On the basis of the available evidence, linezolid appears an effective option for the treatment of nocardiosis

Successful conservative treatment of descending necrotizing mediastinitis with fistola formation in the hypopharinx

Descending necrotizing mediastinitis is a rare life- threatening complication of odontogenic or oropharyngeal infection spreading into the mediastinum through the cervical fasciae. Despite improvements in diagnostic imaging and treatment, its mortality rate remains relatively high. We describe a unique case of descending necrotizing mediastinitis leading to the formation of a fistula in the lateral wall of the hypopharynx. The fistula, providing spontaneous drainage of the purulent mediastinitis, contributed to the successful outcome of the patient requiring only transcervical surgical drainage

Successful conservative treatment of descending necrotizing mediastinitis with fistola formation in the hypopharinx.

Descending necrotizing mediastinitis is a rare life- threatening complication of odontogenic or oropharyngeal infection spreading into the mediastinum through the cervical fasciae. Despite improvements in diagnostic imaging and treatment, its mortality rate remains relatively high. We describe a unique case of descending necrotizing mediastinitis leading to the formation of a fistula in the lateral wall of the hypopharynx. The fistula, providing spontaneous drainage of the purulent mediastinitis, contributed to the successful outcome of the patient requiring only transcervical surgical drainage

In vitro activity of fosfomycin in combination with vancomycin or teicoplanin against Staphylococcus aureus isolated from device-associated infections unresponsive to glycopeptide therapy

Fosfomycin is a molecule that inhibits the early stage of peptidoglycan synthesis and shows a broad-spectrum bactericidal activity against Gram-positive and Gram-negative bacteria. Using the Killing-curve method, we tested the in vitro bactericidal activity of fosfomycin alone or in combination with vancomycin or teicoplanin at a concentration of 8 microg/mL, that is easily achievable in serum at standard dosing regimens, against seven methicillin-resistant Staphylococcus aureus strains, isolated from patients with well documented device-associated infections unresponsive to or relapsing after glycopeptide therapy. MICs of vancomycin ranged from 1 to 4 microg/mL, MICs of teicoplanin from 2 to 8 microg/mL; MICs of fosfomycin were 8 microg/mL for two strains and >128 microg/mL for the remaining strains. The seven strains proved tolerant when tested for vancomycin and teicoplanin used alone at 2x MIC concentration. Fosfomycin was bactericidal (reduction of 2 log of the inoculum) only against the two susceptible strains. In all cases both vancomycin and teicoplanin in combination with fosfomycin developed bactericidal synergism already at a concentration of 1x MIC. If these results are confirmed by in vivo experiments, the combination of fosfomycin with glycopeptides might be useful for treating device-associated infections, and in preventing the phenomenon of increasing MICs for glycopeptides

In vitro activity of fosfomycin in combination with vancomycin or teicoplanin against Staphylococcus aureus isolated from device-associated infections unresponsive to glycopeptide therapy

Fosfomycin is a molecule that inhibits the early stage of peptidoglycan synthesis and shows a broad-spectrum bactericidal activity against Gram-positive and Gram-negative bacteria. Using the Killing-curve method, we tested the in vitro bactericidal activity of fosfomycin alone or in combination with vancomycin or teicoplanin at a concentration of 8 microg/mL, that is easily achievable in serum at standard dosing regimens, against seven methicillin-resistant Staphylococcus aureus strains, isolated from patients with well documented device-associated infections unresponsive to or relapsing after glycopeptide therapy. MICs of vancomycin ranged from 1 to 4 microg/mL, MICs of teicoplanin from 2 to 8 microg/mL; MICs of fosfomycin were 8 microg/mL for two strains and >128 microg/mL for the remaining strains. The seven strains proved tolerant when tested for vancomycin and teicoplanin used alone at 2x MIC concentration. Fosfomycin was bactericidal (reduction of 2 log of the inoculum) only against the two susceptible strains. In all cases both vancomycin and teicoplanin in combination with fosfomycin developed bactericidal synergism already at a concentration of 1x MIC. If these results are confirmed by in vivo experiments, the combination of fosfomycin with glycopeptides might be useful for treating device-associated infections, and in preventing the phenomenon of increasing MICs for glycopeptides

Methicillin-resistant staphylococcal bacteremia in patients with hematologic malignancies: clinical and microbiological retrospective comparative analysis of S. haemolyticus, S. epidermidis and S. aureus

Although Staphylococcus haemolyticus (SH) represents an emerging etiology of methicillin-resistant (MR) coagulase-negative staphylococcal nosocomial bacteremia, little is known of clinical significance of this infection. Thus, we performed case-control retrospective comparative analysis of MRSH bacteremias (MRSHB), methicillin-resistant S. epidermidis bacteremias (MRSEB), and methicillin-resistant S. aureus bacteremias (MRSAB) in patients with hematologic malignancies. Most patients in the three groups were neutropenic and had a central venous catheter (CVC) in place at the onset of bacteremia. However, MRSHB patients had a CVC in place prior to bacteremia for a time significantly more prolonged than MRSEB and MRSAB ones (p<0.05). Severe sepsis or septic shock were more common in patients with MRSAB as compared with MRSHB (p=0.02). Nosocomial attributable mortality rate was very low in the 3 study groups (0 to 5.4%) and only two patients developed metastatic infections. Overall, reduced susceptibility to teicoplanin was observed in 19 (47.5%) MRSH and in 4 (10%) MRSE isolates. Resistance to teicoplanin was observed in 6 isolates, all MRSH. Reduced susceptibility or resistance to vancomycin was observed in 2 isolates, both MRSH. All MRSA isolates were susceptible to the glycopeptides. Comparison between cases of bacteremia in patients with MRSH isolates with reduced susceptibility to teicoplanin and those with susceptible MRSH did not reveal significant differences in the clinical-microbiological response to teicoplanin therapy and outcome. Our results seem to suggest that MRSHB in hematologic patients is associated with low morbidity and mortality rates. MRSH frequently shows a reduced susceptibility to teicoplanin; however these in vitro data do not seem associated with an unfavorable clinical response to teicoplanin therapy for MRSHB in patients with hematologic malignancies

Retrospective case-control analysis of patients with staphylococcal infections receiving daptomycin or glycopeptide therapy

Glycopeptides have been considered the antimicrobials of choice for serious meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-resistant coagulase-negative staphylococci (MR-CoNS) infections for several years. Daptomycin is a new option for the treatment of these infections, including those exhibiting reduced susceptibility to glycopeptides. The aim of this study was to compare glycopeptides and daptomycin for the treatment of infections caused by MRSA or MR-CoNS. Data for 106 patients with bloodstream infections (bacteraemia or infective endocarditis) or skin and soft-tissue infections (SSTIs) were retrospectively reviewed, of which 43 were treated with daptomycin (DAP group) and 63 were treated with vancomycin or teicoplanin (GLYCO group). Patients included in the two comparison groups were homogeneous in terms of age, risk factors and clinical severity. Aetiology was mainly represented by MRSA in both groups, followed by various species of MR-CoNS. Daptomycin was used more frequently in patients with central venous catheter-associated bacteraemia or pacemaker-associated infection. Patients with SSTIs included in the GLYCO group had a longer mean duration of antibiotic therapy (18.2 days vs. 14.6 days; P=0.009) and a longer mean length of hospital stay (28.2 days vs. 19.6 days; P=0.01) compared with those included in the DAP group. A longer mean duration of antibiotic therapy was also observed in patients with bloodstream infections receiving glycopeptide therapy (25.6 days vs. 18 days; P=0.004). In conclusion, the good clinical efficacy of daptomycin is associated with a more rapid resolution of the clinical syndrome and a reduced length of hospitalisation. This latter aspect may have important pharmacoeconomic implications, promoting the use of daptomycin in the clinical setting