Incidence of acoustic neuroma in Malta

Objective: Establishing the incidence of acoustic neuroma in Malta over the last 17 years. Methods: A retrospective study whereby records of patients referred for treatment abroad were reviewed along with the Magnetic Resosnance Images of the Internal Auditory Meatus (MRIAMs) performed from 2009 until 2016. All new cases of acoustic neuroma were included in the study. Results: 76 new cases of acoustic neuroma were discovered over the 17 years, resulting in an incidence of 1.1 per 100000. Conclusion: This is the first study trying to establish the incidence and epidemiology of acoustic neuroma in Malta.peer-reviewe

University food environment, an example of health inequality?

Background: Universities provide an influential life structure for students during their transition into adulthood through tuition as well as through the ground’s environment. Ensuring a healthy and safe university environment forms the basis of health equity within such institutions. The objective was to evaluate the food environment through vending machines situated across the grounds of the only state university in Malta, whilst acquiring students’ perspective on these facilities. Method: An audit was conducted on the food and beverage items available within vending machines across university grounds. This was reevaluated a year later. Students’ perceptions and use of such facilities were gathered through electronic-distributed questionnaires. Results: All machines were stocked with identical sugary items. 71.03% of responders purchased from machines due to their easy accessibility, while 61% considered items as “too unhealthy”, with 74.60% showing enthusiasm for healthier choices. 60% reported a willingness to pay more in exchange for healthier options. Conclusion: Limited consumable options leave students without healthier options on campus. Provision of a healthier food environment is a prerequisite in addressing health inequalities. Action is required to tackle this situation urgently especially due to the growing obesity epidemic.peer-reviewe

Trans-oral resection of Nasopharyngeal Pleomorphic Adenoma : a case report

Introduction: Around 80% of all salivary gland tumours are pleomorphic adenomas, most commonly found in the parotid gland. This case report regards the rare finding of a pleomorphic adenoma in the nasopharynx. Case Presentation: a 29 year old lady presented to the ENT department with a 4 month history of worsesning and non-resolving nasal obstruction, change in voice, snoring and right aural congestion. A smooth mass pushing the uvula forward was seen on oral examination, and flexible nasoendoscopy revealed an exophytic mass from the right nasopharynx. CT and MRI showed a non-erosive mass in the right nasopharynx. Incisional biopsy was carried out which showed features of pleomorphic adenoma. Lesion was excised using transoral technique to remove the tumour with an intact capsule. Literature Review and Discussion: A PubMed search found only 12 previously reported cases of pleomorphic adenoma from 1970 to 2015. The treatment of choice was surgical in all cases, one case reports the use of radiotherapy, without affect. The trans-oral technique used in this case ensured that the tumour was removed with the surrounding capsule intact, thus reducing risk of recurrence. Conclusion: This is the first reported case of nasopharyngeal pleomorphic adenoma from Malta. Diagnosis was made by the triple assessment – examination, radiology and histology. The tumour was excised completely and the plan is for the patient to have regular follow up.peer-reviewe

Determining the role of novel metabolic pathways in driving intracranial pressure reduction after weight loss

Idiopathic intracranial hypertension, a disease classically occurring in women with obesity, is characterised by raised intracranial pressure. Weight loss leads to reduction in intracranial pressure. Additionally, pharmacological glucagon-like peptide-1 agonism reduces cerebrospinal fluid secretion and intracranial pressure. The potential mechanisms by which weight loss reduces intracranial pressure are unknown and was the focus for this study.Meal stimulation tests (fasted plasma sample, then samples at 15, 30, 60, 90 and 120 minutes following a standardised meal) were conducted pre- and post-bariatric surgery (early (2 weeks) and late (12 months)) in patients with active idiopathic intracranial hypertension. Dynamic changes in gut neuropeptides (glucagon-like peptide-1, gastric inhibitory polypeptide, and ghrelin) and metabolites (untargeted ultra-high performance liquid chromatography-mass spectrometry) were evaluated. We determined the relationship between gut neuropeptides, metabolites, and intracranial pressure.18 idiopathic intracranial hypertension patients were included (Roux-En-Y gastric bypass n=7, gastric banding n=6, or sleeve gastrectomy n=5). At 2 weeks post-bariatric surgery, despite similar weight loss, Roux-En-Y gastric bypass had a two-fold (50%) greater reduction in intracranial pressure compared to sleeve. Increased meal stimulated glucagon-like peptide-1 secretion was observed after Roux-En-Y gastric bypass (+600 %) compared to sleeve (+319 %). There was no change in gastric inhibitory polypeptide and ghrelin. Dynamic changes in meal stimulated metabolites after bariatric surgery consistently identified changes in lipid metabolites, predominantly ceramides, glycerophospholipids and lysoglycerophospholipids, which correlated with intracranial pressure. A greater number of differential lipid metabolites were observed in the Roux-En-Y gastric bypass cohort at 2 weeks, and these also correlated with intracranial pressure.In idiopathic intracranial hypertension, we identified novel changes in lipid metabolites and meal stimulated glucagon-like peptide-1 levels following bariatric surgery which were associated with changes in intracranial pressure. Roux-En-Y gastric bypass was most effective at reducing intracranial pressure despite analogous weight loss to gastric sleeve at 2 weeks post-surgery and was associated with more pronounced changes in these metabolite pathways. We suggest that these novel perturbations in lipid metabolism and glucagon-like peptide-1 secretion are mechanistically important in driving reduction in intracranial pressure following weight loss in patients with idiopathic intracranial hypertension. Therapeutic targeting of these pathways, for example with glucagon-like peptide-1 agonist infusion, could represent a therapeutic strategy

Photocatalytic activity of titanium dioxide nanotubes following long-term aging

Anodic titanium dioxide (TiO2) nanotubes were found to be active photocatalysts. These photocatalysts possess a high surface area, even when supported, rendering them potential candidates for water treatment. In this work, photocatalytic surfaces were produced by anodizing commercially pure Ti plates using two different electrolyte compositions and correspondingly diverse process parameters. Changes in the physical and chemical stability as well as photocatalytic activity were studied over a fifty-two-week aging process. During this period, the nanotubular surfaces were exposed to flowing synthetic greywater, solar irradiation, and the natural environment. The physical and phase stability of the materials anodized using the organic electrolyte were found to be outstanding and no degradation or change in crystalline structure was observed. On the other hand, materials anodized in the aqueous electrolyte proved to suffer from light-induced phase transition from anatase to rutile. Surfaces synthesized in the organic electrolyte were more resistant to fouling and showed a better tendency to recover photocatalytic activity upon cleaning. In conclusion, the nanotubes produced in the organic electrolyte proved to be stable, rendering them potentially suitable for real-life applications.peer-reviewe

An artificial neural network for nasogastric tube position decision support

Purpose: To develop and validate a deep learning model for detection of nasogastric tube (NGT) malposition on chest radiographs and assess model impact as a clinical decision support tool for junior physicians to help determine whether feeding can be safely performed in patients (feed/do not feed). Materials and Methods: A neural network ensemble was pretrained on 1 132 142 retrospectively collected (June 2007–August 2019) frontal chest radiographs and further fine-tuned on 7081 chest radiographs labeled by three radiologists. Clinical relevance was assessed on an independent set of 335 images. Five junior emergency medicine physicians assessed chest radiographs and made feed/do not feed decisions without and with artificial intelligence (AI)-generated NGT malposition probabilities placed above chest radiographs. Decisions from the radiologists served as ground truths. Model performance was evaluated using receiver operating characteristic analysis. Agreement between junior physician and radiologist decision was determined using the Cohen κ coefficient. Results: In the testing set, the ensemble achieved area under the receiver operating characteristic curve values of 0.82 (95% CI: 0.78, 0.86), 0.77 (95% CI: 0.71, 0.83), and 0.98 (95% CI: 0.96, 1.00) for satisfactory, malpositioned, and bronchial positions, respectively. In the clinical evaluation set, mean interreader agreement for feed/do not feed decisions among junior physicians was 0.65 ± 0.03 (SD) and 0.77 ± 0.13 without and with AI support, respectively. Mean agreement between junior physicians and radiologists was 0.53 ± 0.05 (unaided) and 0.65 ± 0.09 (AI-aided). Conclusion: A simple classifier for NGT malposition may help junior physicians determine the safety of feeding in patients with NGTs

Research priorities for the sustainability of coral-rich western Pacific seascapes

Nearly a billion people depend on tropical seascapes. The need to ensure sustainable use of these vital areas is recognised, as one of 17 policy commitments made by world leaders, in Sustainable Development Goal (SDG) 14 (‘Life below Water’) of the United Nations. SDG 14 seeks to secure marine sustainability by 2030. In a time of increasing social-ecological unpredictability and risk, scientists and policymakers working towards SDG 14 in the Asia–Pacific region need to know: (1) How are seascapes changing? (2) What can global society do about these changes? and (3) How can science and society together achieve sustainable seascape futures? Through a horizon scan, we identified nine emerging research priorities that clarify potential research contributions to marine sustainability in locations with high coral reef abundance. They include research on seascape geological and biological evolution and adaptation; elucidating drivers and mechanisms of change; understanding how seascape functions and services are produced, and how people depend on them; costs, benefits, and trade-offs to people in changing seascapes; improving seascape technologies and practices; learning to govern and manage seascapes for all; sustainable use, justice, and human well-being; bridging communities and epistemologies for innovative, equitable, and scale-crossing solutions; and informing resilient seascape futures through modelling and synthesis. Researchers can contribute to the sustainability of tropical seascapes by co-developing transdisciplinary understandings of people and ecosystems, emphasising the importance of equity and justice, and improving knowledge of key cross-scale and cross-level processes, feedbacks, and thresholds

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

A Comparative Evaluation of Voxel-based Spatial Mapping in Diffusion Tensor Imaging

This paper presents a comparative evaluation of methods for automated voxel-based spatial mapping in diffusion tensor imaging studies. Such methods are an essential step in computational pipelines and provide anatomically comparable measurements across a population in atlas-based studies. To better understand their strengths and weaknesses, we tested a total of eight methods for voxel-based spatial mapping in two types of diffusion tensor templates. The methods were evaluated with respect to scan-rescan reliability and an application to normal aging. The methods included voxel-based analysis with and without smoothing, two types of region-based analysis, and combinations thereof with skeletonization. The templates included a study-specific template created with DTI-TK and the IIT template serving as a standard template. To control for other factors in the pipeline, the experiments used a common dataset, acquired at 1.5T with a single shell high angular resolution diffusion MR imaging protocol, and tensor-based spatial normalization with DTI-TK. Scan-rescan reliability was assessed using the coefficient of variation (CV) and intraclass correlation (ICC) in eight subjects with three scans each. Sensitivity to normal aging was assessed in a population of 80 subjects aged 25 to 65 years old, and methods were compared with respect to the anatomical agreement of significant findings and the R(2) of the associated models of fractional anisotropy. The results show that reliability depended greatly on the method used for spatial mapping. The largest differences in reliability were found when adding smoothing and comparing voxel-based and region-based analyses. Skeletonization and template type were found to have either a small or negligible effect on reliability. The aging results showed agreement among the methods in nine brain areas, with some methods showing more sensitivity than others. Skeletonization and smoothing were not major factors affecting sensitivity to aging, but the standard template showed higher R(2) in several conditions. A structural comparison of the templates showed that large deformations between them may be related to observed differences in patterns of significant voxels. Most areas showed significantly higher R(2) with voxel-based analysis, particularly when clusters were smaller than the available regions-of-interest. Looking forward, these results can potentially help to interpret results from existing white matter imaging studies, as well as provide a resource to help in planning future studies to maximize reliability and sensitivity with regard to the scientific goals at hand