Mitral valve infective endocarditis following device occlusion of a coronary artery fistula

A three year old girl, with a right coronary artery fistula and signs of a hyperdynamic circulation, underwent uncomplicated closure of the fistula using an occluding device introduced via the femoral arterial route and covered with appropriate antibiotics. Two months later she presented with a persistent fever, signs of infective endocarditis (IE) and embolic phenomena in the left lower limb. Mitral valve endocarditis was confirmed immediately and treated effectively. However, initial ultrasound and doppler did not show the femoral artery thrombo-occlusion that was only confirmed on magnetic resonance angiography (MRA) one month later. This case highlights the usefulness of MRA in diagnosing suspected vessel occlusion in young children, and is in keeping with the latest NICE guidelines that suggest that prophylactic antibiotics do not always prevent IE. Parent and patient education on ‘what to look out for’, combined with careful clinical vigilance is paramount in the early detection of IE with a consequent reduction in morbidity and mortality.peer-reviewe

Myocardial extracellular volume quantification with computed tomography-current status and future outlook

Non-invasive quantification of the extracellular volume (ECV) is a method for the evaluation of focal and diffuse myocardial fibrosis, potentially obviating the need for invasive endomyocardial biopsy. While ECV quantification with cardiac magnetic resonance imaging (ECV$_{MRI}$) is already an established method, ECV quantification with CT (ECV$_{CT}$) is an attractive alternative to ECV$_{MRI}$, similarly using the properties of extracellular contrast media for ECV calculation. In contrast to ECV$_{MRI}$, ECV$_{CT}$ provides a more widely available, cheaper and faster tool for ECV quantification and allows for ECV calculation also in patients with contraindications for MRI. Many studies have already shown a high correlation between ECV$_{CT}$ and ECV$_{MRI}$ and accumulating evidence suggests a prognostic value of ECV$_{CT}$ quantification in various cardiovascular diseases. Adding a late enhancement scan (for dual energy acquisitions) or a non-enhanced and late enhancement scan (for single-energy acquisitions) to a conventional coronary CT angiography scan improves risk stratification, requiring only minor adaptations of the contrast media and data acquisition protocols and adding only little radiation dose to the entire scan. Critical relevance statement: This article summarizes the technical principles of myocardial extracellular volume (ECV) quantification with CT, reviews the literature comparing ECV$_{CT}$ with ECV$_{MRI}$ and histopathology, and reviews the prognostic value of myocardial ECV quantification for various cardiovascular disease. Key points: • Non-invasive quantification of myocardial fibrosis can be performed with CT. • Myocardial ECV quantification with CT is an alternative in patients non-eligible for MRI. • Myocardial ECV quantification with CT strongly correlates with ECV quantification using MRI. • Myocardial ECV quantification provides incremental prognostic information for various pathologies affecting the heart (e.g., cardiac amyloidosis)

Organotin pollution in Malta coastal zone

The speciation of organotins in seawater, surface microlayer and sediments in the marine environment of Malta is described. Concentrations of tributyltin (TBT) in bulk seawater inside the harbours were as high as 0.3 μg Sn L‐1 but were below detection limits (5 ng Sn L‐1) in open sea, 1.6 km offshore. In sediments, TBT levels were highest for the yacht marinas and ranged between 0.03 and 1.5 ug Sn g‐1. Dibutyltin is more common in the surface microlayer than TBT. Diphenyl and monophenyltin were found infrequently in bulk seawater and in sediments. Tetrasubstituted organotins, namely, MenBu(4_n)Sn, where n = 1, 2, and 3, were found frequently in TBT‐contaminated sediments (0.1–9μg Sng‐1), in seawater and in the microlayer where concentrations as high as 140 μg Sn L‐1 (Me3BuSn) were measured. Direct environmental methylation of TBT and that of its debutylated analogues may play a significant role in the geochemical cycling of tin under certain environmental conditions.peer-reviewe

A comparison of Colletotrichum species associated with berry diseases of Coffea arabica L.

Forty isolates of Colletotrichum species associated with coffee berry anthracnose in Papua New Guinea were characterised and identified on the basis of cultural, morphological and molecular characteristics. Of these, 29 isolates were identified as C. gloeosporioides, while the 11 remaining were identified as C. acutatum. None of the isolates had characteristics common to C. kahawae

Transcatheter device closure of atrial septal defect and patent foramen ovale in Malta

Significant atrial septal defects (ASD) are closed, surgically or through a transcatheter device, in order to avoid pulmonary hypertension in late life. A patent foramen ovale (PFO) may need to be closed because of transient shunt reversal resulting in transient ischaemic events or stroke. We report the Maltese experience to date in transcatheter closure of these defects. A total of 46 ASDs and 51 PFOs have been successfully closed at our unit (total 97), with very low complication rates, rates that compare very favourably with results from larger international centres.peer-reviewe

Jellyfish blooms in the Mediterranean

The temporal and spatial distributions of coastal aggregations of the scyphomedusa Pelagia noctiluca around the Maltese Islands during the period 1980 to 1986 were investigated by means of sighting reports from volunteers as well as by periodic monitoring at fixed stations both offshore and onshore. The available data indicate that the outbreaks of coastal aggregations of this species started in 1980 and reached maximum densities during 1981-1983. During the period 1984 to 1985, these occurrences decreased both in duration and population density, with coastal aggregations being more frequent during March and April. Such aggregates were characterized by large numbers of small medusae, probably of recent spawning. Sexually mature medusae as well as ephyrae were however present in coastal waters almost throughout the year for the period 1981-1982. The geographic distribution of such aggregates of jellyfish in the coastal areas indicate that they are passive accumulations, the pattern of which is largely determined by the prevalent wind direction.peer-reviewe

Educating the next generation of bioscientists: the challenge for higher education in Australia

Traditional science boundaries continue to be challenged, thereby creating broader employment opportunities for appropriately skilled graduates. However, many factors including limited time and resources, diverse student cohorts and large student numbers, may limit good practice when it comes to developing highly skilled bioscientists. Within this context, it is timely to examine the role of undergraduate teaching in educating the next generation of bioscientists. This paper describes preliminary findings from a project supported by the Australian Learning and Teaching Council, which is examining current teaching practice in bioscience disciplines. The project is using a qualitative research framework to identify innovative approaches used by educators to enhance the scientific inquiry capabilities of their students. Twenty cases have been studied where the priority to teach scientific inquiry skills has influenced the design of the teaching approach. Cases have been identified from nine universities across five states. In general, the approaches are variations of inquiry or problem-based learning, and have been delivered through online environments, laboratory classes and lectures. Skills that educators aim to develop include: formulation of research questions and hypotheses; experimental design; critical appraisal of literature and ideas; collaboration; communication of arguments and findings. Educational technology has been used to provide solutions for distance and asynchronous communication, collaboration, incorporation of immediate learner feedback, and has been used in numerous ways to enhance the learning experience. While the extent of implementation was diverse, there were some interesting overlaps in strategies