Prosthetic joint infections

Objectives: To review the available literature on prosthetic joint infections and provide recommendations on management particularly the importance of identifying the causative organism and starting the most appropriate antimicrobial therapy. Methods: The medical literature was searched using PubMed, employing the key words prosthetic joint infections. There appears to be no UK consensus guidelines on the management of prosthetic joint infections or the use of prophylactic antibiotics to prevent them. There is however a number of key documents and trust policies which deal with the subject extensively. We also made use of ‘The Sanford Guide to Antimicrobial therapy 2012’ for the latest recommendations on the correct antimicrobial therapy. Conclusion: Although diagnosis is often difficult, there are a number of investigations which can help us identify the organism. We recommend that the local prevalence of such infections is studied together with identification of the commonest organisms. Work is already underway between the infectious disease team and orthopaedic surgeons to devise locally adapted protocols for the identification and management of such infections. They should work in close liaison to implement the correct treatment which often involves a combination of both surgical and antimicrobial therapy.peer-reviewe

The impact of microbiological pollutants on school indoor air quality

The submitted manuscript has not been previously published in any form and is not currently under consideration for publication elsewhere.Asthma is common in children with allergens and mould influencing the development of the disease. Since children spend most of their time outside their homes within the school environment, school indoor air quality can directly influence their respiratory health. This study aims to identify microbiological contaminants in Maltese schools. The association between contaminants, res-piratory health and school characteristics has been analysed. Five primary schools were selected with 9 to 11 years old students participating. Standardised health questionnaires, lung function tests, and school characterisation were performed. Dust samples were analysed for fungi, bacteria and allergens were performed. Penicillium/Aspergillus/Paecilomyces/Variotii (PenAsp) group had the highest median indoor concentration followed by Mycobacterial and Streptomyces species. There was a significant negative correlation between PenAsp and Mycobacterium spp levels in all the participating schools (r = −0.42; p = 0.03). Cat allergen in classroom dust correlated positively with the number of cat owners (r = 0.43; p = 0.041). High exposure to fungi, bacteria and allergens was significantly associated with upper and lower airway atopy. School/classroom characteristics and cleaning protocols were significantly as-sociated with exposure to these pollutants. In conclusion, fungi, bacteria, en-dotoxin, cat and dog allergens have been found to have a direct influence on school indoor air quality in the Maltese Islands. A significant association was observed between these contaminants and upper and lower airway atopy. Specific school, classroom, cleaning and maintenance characteristics have been identified as having a direct impact on indoor air quality.peer-reviewe

Food consumption and the risk of childhood allergy

Background: The prevalence of allergic conditions is increasing in most countries. One possible explanation may be childhood nutrition. Objective: The aim of the study was to investigate the relationship between consumption of pre-specified types of food in school-aged children and presence of respiratory and allergic symptoms. Methods: A total of 191 students aged 9–11 years were recruited from 5 schools to geographically cover all of Malta. Data was collected between October 2011 and February 2012. This was part of a bigger study which included clinical and environmental tests besides standardized health questionnaires. For the purposes of this part of the study only the health questionnaires were used. These standardized health questionnaires based on the International Study of Asthma and Allergies in Childhood (ISAAC) were used to identify the presence of respiratory and allergic symptoms and to identify the types of foods and the frequency of consumption of various types of foods. Results: We found that milk, meat, butter, olive oil, and yoghurt consumption had a negative association with allergic symptoms in children, whilst fish consumption had a detrimental effect. These relationships remained significant after correction for paternal level of education. Conclusion: The study highlights the fact that nutrition in early childhood may have a significant effect on the risk of allergic conditions. Our results, taken together with data in the literature, suggest that different types of fish might have had different effects. This is probably related to their different fatty acid constitution thus warranting further studies.peer-reviewe

Indoor climate and its impact on atopic conditions in Maltese school children

Several studies on the prevalence of allergic conditions have identified that allergic conditions are on the increase worldwide. The aim of this study was to study the effect of classroom humidity and temperature levels on schoolchildren in Malta. Our cohort included 191 children. Standardised ISAAC health questionnaires were answered by the children’s parents. Lung function tests, acoustic rhinometry, exhaled NO, exhaled CO and nasal lavage were performed on the participating children. School building characteristics were also studied. A significant association was noted between a high relative humidity exposure and nasal cross-sectional areas (p=0.003), and doctor diagnosed allergic rhinitis (p=0.002), indicating the presence of allergic rhinitis, as was increased indoor temperature (p=0.003). Increased indoor temperature was also associated with increased exhaled nitric oxide (FeNO) (p<0.001) indicating uncontrolled asthma. In conclusion, increased classroom temperatures and humidity, both linked to decreased classroom ventilation, were associated with increased incidence of allergic conditions in schoolchildren in Malta. These results emphasize the important need for the introduction of climate control and dehumidifying systems in our schools with the aim of decreasing the prevalence and severity of such conditions in this cohort of patients.peer-reviewe

The impact of school environment on children’s respiratory health

The study was done as part of the European Union SINPHONIE Study commissioned by DG SANCO. The authors received some funding from SINPHONIE (European Commission service contract of the DG Sanco).Abstract Background/Aims: School indoor air quality is important because children spend most of their time outside home within the school environment. This study aimed to investigate the school environment and its impact on the respiratory health of the children. Methods: A total of 191 pupils in the 9- to 11-year age group were selected from 5 primary state schools. Validated school and health questionnaires, spirometry, acoustic rhinometry, nasal lavage, urine for environmental tobacco smoke biomarkers and traffic counts were used. Results: Cumulative (32.98%) and current wheezing (17.8%) were in keeping with the International Study of Asthma and Allergies in Childhood Malta data. Southern schools had the highest prevalence of current wheezers (OR 3.77; p = 0.012), rhinoconjunctivitis (OR 3.59; p = 0.003) and nasal eosinophilic cationic protein levels (p < 0.001). Small openable window areas increased rhinitic symptoms (OR 3.14; p = 0.016). Classes facing roads had increased current wheezers (OR 2.27; p = 0.03) and exhaled carbon monoxide (eCO) levels (p < 0.001). Current wheezing was significantly associated with the number of light and heavy vehicles passing near the school (p < 0.001). The presence of smokers at home was significantly associated with urinary cotinine and 3HC (p < 0.001). Proximity to power plants increased the current wheezers (OR 5.89; p = 0.001) who had impaired spirometry (p = 0.003). Asthma symptoms (OR 5.25; p = 0.001) and elevated eCO levels (p < 0.001) were associated with fuel storage facilities near schools. The accumulation of dust on flat surfaces within classrooms was related to wheezing (OR 5.23; p = 0.001). Conclusions: The school environment had a direct impact on the respiratory health of children, with several factors having a direct impact on the children's health.peer-reviewe

Pulmonary rehabilitation in chronic obstructive pulmonary disease : outcomes in a 12 week programme

Objective. The optimal time-frame for pulmonary rehabilitation (PR) in patients diagnosed with chronic obstructive pulmonary disease (COPD) is still debated. A 12 week programme was designed looking at whether the benefits were reached at or before a 12 week period of PR for COPD patients. Method. Seventy-five patients (59 males, 16 females) aged 40 75 years were referred from the local general hospital in Malta. Baseline assessments were carried out on all patients 2 weeks before initiation of the programme. Sixty patients were eligible to start a twice-weekly, 12 week multidisciplinary programme delivered after the screening process. The Six-Minute Walk Test (6MWT), dyspnoea score using the Borg scale, spirometry testing, plethysmography, COPD Assessment Tool (CAT) score, St George's Respiratory Questionnaire (SGRQ) and Hospital and Anxiety scale score were monitored at 4 weekly intervals throughout the 12 weeks of PR for these COPD patients. Results. The 6MWT distance increased by a mean total of 132.45 m (p < 0.001) by 12 weeks, with the highest change recorded in the first 4 weeks for the milder COPD patients. Lung function test improvements were marginal. Borg scale readings at rest and following exertion decreased significantly from weeks 0 to 4 but remained fairly constant thereafter. The Body mass index, airway Obstruction, Dyspnoea, and Exercise capacity (BODE) index, SGRQ and CAT score values decreased significantly throughout the weeks irrespective of the initial Medical Research Council score. Anxiety scoring decreased significantly by 12 weeks, while the depression rating improved by 8 weeks. Conclusion. These findings show that 12 weeks of PR in this cohort of COPD patients resulted in clinically significant changes in functional outcome measures which are supported by statistically significant changes in health-related quality of life measures. In milder COPD cases, by 4 weeks of PR gains in exercise tolerance had already resulted. The more severe group required more time to obtain improvements. Therefore, hospitals could organize shorter PR programmes for larger numbers of patients with milder COPD.peer-reviewe

Training in infectious diseases across Europe in 2021 - a survey on training delivery, content and assessment

Objectives: To define the status of infectious diseases (ID) as an approved specialty in Europe; to enumerate the number of specialists (in general and in relation to the overall population) and specialist trainees and describe the content, delivery and evaluation of postgraduate training in ID in different countries.Methods: Structured web-based questionnaire surveys in March 2021 of responsible national authorities, specialist societies and individual country representatives to the Section of Infectious Diseases of the European Union for Medical Specialties. Descriptive analysis of quantitative and qualitative responses.Results: In responses received from 33/35 (94.3%) countries, ID is recognized as a specialty in 24 and as a subspecialty of general internal medicine (GIM) in eight, but it is not recognized in Spain. The number of ID specialists per country varies from <5 per million inhabitants to 78 per million inhabitants. Median length of training is 5 years (interquartile range 4.0–6.0 years) with variable amounts of preceding and/or concurrent GIM. Only 21.2% of countries (7/33) provide the minimum recommended training of 6 months in microbiology and 30% cover competencies such as palliative care, team working and leadership, audit, and quality control. Training is monitored by personal logbook or e-portfolio in 75.8% (25/33) and assessed by final examinations in 69.7% (23/33) of countries, but yearly reviews with trainees only occur in 54.5% (18/33) of countries.Conclusions: There are substantial gaps in modernization of ID training in many countries to match current European training requirements. Joint training with clinical microbiology (CM) and in multidisciplinary team working should be extended. Training/monitoring trainers should find greater focus, together with regular feedback to trainees within many national training programmes.peer-reviewe

Malaria vaccine–is it still required? Are vaccine alternatives enough to achieve malaria control?

Despite ongoing continuous research towards developing a malaria vaccine, we have still not achieved this target and the malaria parasite continues to kill thousands, especially children in developing countries. However, current control methods have had good results in some countries. Can these control methods be enough or should people still keep hoping for a vaccine? Would eradication of malaria be a possibility if no vaccine remains available

Impact of school air quality on children's respiratory health

Background: Asthma is common in children with indoor pollutants influencing the development of the disease. Since children spend most of their time outside their homes within the school environment, school indoor air quality can directly influence their respiratory health. Aims: This study aims to analyze the indoor and outdoor air quality of Maltese schools and if an association exists between indoor pollutants and respiratory health in children. Settings and Design: Five primary schools were selected with 9- to 11-year-old students participating. Materials and Methods: Standardized health questionnaires and lung function tests were utilized. Indoor and outdoor air sampling together with traffic counts were carried out. Statistical Analysis Used: SPSS version 21 was used and the Chi-squared, logistic regression, and Pearson's correlation were used. Results: The mean indoor PM 2.5 level of 17.78 μg/m3 and CO (9.11 ppm) exceeded World Health Organization thresholds. Indoor ozone levels exceeded the mean European school's indoor ozone concentration of 8 μg/m3. High exposure to formaldehyde, NO2, and ozone was associated with atopy in children. Heavy vehicles passing near the schools were associated with current wheezing (P < 0.001) but not nocturnal cough (P = 0.34). Conclusions: School indoor and outdoor environment has a direct impact on children's respiratory health. This study has identified significant associations between high exposures to indoor air pollutants, school characteristics, and upper and lower airway inflammation.peer-reviewe

The first wave of COVID-19 in Malta; a national cross-sectional study

INTRODUCTION: The COVID-19 pandemic has posed major challenges to all aspects of healthcare. Malta’s population density, large proportion of elderly and high prevalence of diabetes and obesity put the country at risk of uncontrolled viral transmission and high mortality. Despite this, Malta achieved low mortality rates compared to figures overseas. The aim of this paper is to identify key factors that contributed to these favorable outcomes. METHODS: This is a retrospective, observational, nationwide study which evaluates outcomes of patients during the first wave of the pandemic in Malta, from the 7th of March to the 24th of April 2020. Data was collected on demographics and mode of transmission. Hospitalization rates to Malta’s main general hospital, Mater Dei Hospital, length of in-hospital stay, intensive care unit admissions and 30-day mortality were also analyzed. RESULTS: There were 447 confirmed cases in total; 19.5% imported, 74.2% related to community transmission and 6.3% nosocomially transmitted. Ninety-three patients (20.8%) were hospitalized, of which 4 were children. Patients with moderate-severe disease received hydroxychloroquine and azithromycin, in line with evidence available at the time. A total of 4 deaths were recorded, resulting in an all-cause mortality of 0.89%. Importantly, all admitted patients with moderate-severe disease survived to 30-day follow up. CONCLUSION: Effective public health interventions, widespread testing, remote surveillance of patients in the community and a low threshold for admission are likely to have contributed to these favorable outcomes. Hospital infection control measures were key in preventing significant nosocomial spread. These concepts can potentially be applied to stem future outbreaks of viral diseases. Patients with moderate-severe disease had excellent outcomes with no deaths reported at 30-day follow up