Ileostomy Adenocarcinoma : a case report

Proctocolectomy is the standard treatment for patients suffering from ulcerative colitis which is long-standing, refractory to pharmacotherapy or otherwise associated with complications. An ileal pouch with pouch-anal anastomosis is fashioned in the majority of cases; however, in some instances terminal ileostomy is preferable. Ileostomy cancer is rare but a number of cases have been reported over the past twenty years suggesting a rising incidence. We report a case that developed thirty years post-operatively.peer-reviewe

Financial reporting in Maltese voluntary organisations

In this paper we analyse the adequacy and effectiveness of the legal aspects of the current Maltese voluntary organisations’ (VOs) regulatory framework, the guidelines and best practices being adopted by Maltese charities in compiling their financial reports. In doing this we also look at the key operational internal control and other challenges being faced by such VOs in complying with the existing regulatory framework. Data is also gathered through the responses of an online questionnaire, which we distributed to enrolled VOs and through responses of semi-structured interviews carried out with the financial administrators of eleven large charities. Findings reveal that while the existing VO regulatory framework was a considerable improvement, changes are still necessary since gaps still remain and need to be resolved. This study contributes to the enhancement of the Maltese VO regulation by identifying and highlighting these gaps and providing recommendations to mitigate and resolve them.peer-reviewe

Glycosylated haemoglobin (HbA1c) and cortisol levels on admission to intensive care as predictors of outcome

Objective: To evaluate the predictive value of glycosylated haemoglobin and cortisol on admission, in critical care patients. Design: Prospective, observational, single centre study. Setting: 14 bedded Intensive care unit of a tertiary-level university hospital. Patients: 124 consecutive emergency medical and surgical patients. Methods: Data collected on admission included patient demographics, medical history, medication, diagnosis, type of nutrition, TISS28 score, serum blood glucose, Glycosylated haemoglobin (HbA1c), cortisol, mean arterial blood pressure, and the use of inotropes in the first 24hrs. Daily baseline tests included complete blood count, urea and electrolytes, creatinine, twice weekly liver function tests. The primary outcome measure was intensive care unit mortality. Secondary outcome measures were ITU stay, days of ventilation, peak urea, peak creatinine, lowest platelet count, peak bilirubin, lowest Pa/FiO2, and the number of transfusions. Measurements and results: 124 patients (mean age 56.2 years SD 23.2) were included. Regression analysis was used to identify any potential predictors of outcome: HbA1c levels on admission were not found to be significantly associated with mortality (p=0.51), or any other secondary endpoints listed above. However, subgroup analysis revealed a predictive role of HbA1c with regards to length of ITU stay (p= 0.01) and number of days of ventilation (p=0.007) in those patients with a history of diabetes. Glucose level on admission emerged as an independent marker of mortality (p=0.009). Conclusions: This study suggests that HbA1c may not be a predictor of outcome in the general ITU population but may be of predictive value in diabetic ITU patients. On the other hand, blood glucose levels on admission emerged as a predictor of mortality, whilst no association was found between HbA1c and cortisol levels on admission.peer-reviewe

Additional observations on the nesting behavior of \u3ci\u3eMiscophus (Nitelopterus) californicus\u3c/i\u3e (Ashmead) (Hymenoptera: Crabronidae)

Close-up photographs of nest entry, nest closure and prey transport taken on sandy coastal back dunes in Santa Barbara County, CA by Alice J. Abela substantiate and enhance written descriptions of these nesting be­havior components in Miscophus californicus (Ashmead) [=M. laticeps (Ashmead)] (Hymenoptera: Crabronidae). Dictynidae (Dictyna Sundevall or Emblyna Chamberlin) is introduced as a new host family and host spider leg amputation is revealed for the first time for this small miscophine wasp. Miscophus (Nitelopterus) californicus (Ashmead) (Hymenoptera: Crabronidae) is a small (4.5–7.0 mm) Nearctic miscophine wasp that ranges from California and Arizona north to southern Alberta and Saskatchewan (M. Buck, Royal Alberta Museum, Edmonton, AB, 2020 pers. comm.). This species is extremely common in California with larger black individuals inhabiting relict sand dunes along the Pacific Coast (Wasbauer 1978). The females excavate short shallow burrows in friable soil and hunt various tiny spiders which they immobilize with a sting in the cephalothorax. They transport the prey forward in flight or on the ground, depending on its relative size and weight, and return periodically to an open or closed nest entrance holding the spider face forward and venter to venter. They release the prey on the ground in that position, enter the burrow, pull the spider inside, and, after several spiders are deposited within and oviposition on a single prey occurs, close the burrow and entrance with loose soil. The nesting behavior of Miscophus californicus [as M. laticeps (Ashmead)] was studied in 2010, 2011 and 2012 at Montaña de Oro State Park, San Luis Obispo County, CA by Kurczewski et al. (2012) to clarify variation in previous reports on this species. Voucher specimens from this study were collected from coastal sand dunes in San Luis Obispo and Santa Barbara counties, CA, deposited in the University of California–Davis R.M. Bohart Insect Museum, and identified as M. laticeps by L.S. Kimsey, University of California–Davis. This study was basically in agreement with that on M. californicus by Powell (1967) and in disagreement with the study of M. laticeps by Cazier and Mortenson (1965). Miscophus laticeps is a heretofore previously unpublished synonym of M. californicus in Joanne Slansky Wasbauer’s (1978) Ph. D. Thesis from the University of California–Davis (L.S. Kimsey, University of California–Davis, Davis, CA, 2020 pers. comm.)

Presentation and management of diabetic ketoacidosis in adults in Malta

Aim: The aim of this audit was to assess adherence to local guideline in the management of Diabetic Ketoacidosis (DKA). Method: Patients admitted with DKA between April 2013 and March 2015 were identified and data was retrospectively collected from patients’ confidential files and Isoft®. Data collected included initial parameters recorded and biochemical investigations taken (initial and subsequent assessment of pH, HCO3-, blood glucose, potassium levels and urinary ketones), insulin regime started and intravenous fluid administered. Results: During the established time period 40 cases of DKA were identified in 18 patients. Median age was 33 years with a female preponderance of 60%. Six patients had newly diagnosed diabetes mellitus while 8 patients had more than one admission of DKA. All cases had capillary blood glucose monitoring (BGM) and/or venous random blood (plasma) glucose (RBG) checked and pH and HCO3- recorded on admission. 0.9% sodium chloride was the intravenous fluid started in all cases (as recommended by the guideline) and a median of 6.75L was prescribed during the first 24 hours. The median time spent on intravenous insulin infusion was 42.7 hours while the median time to pH >7.30, HCO3- >15mmol/L and negligible urinary ketones were 6.88, 12.83 and 34.5 hours respectively. Subcutaneous insulin was started at a median time of 48.21 hours from initiation of DKA protocol. Conclusion: This audit showed good adherence to local guideline. The great discrepancy between the time to pH >7.3 and the time to negligible urinary ketones highlights the need to introduce tools to measure systemic ketone production in the management of DKA with an update in the current local clinical practice guideline.peer-reviewe

Nesting behavior, ecology, and functional morphology of the trapdoor spider-hunting spider wasp \u3ci\u3eAporus (Plectraporus) hirsutus\u3c/i\u3e (Banks) (Hymenoptera: Pompilidae)

Macrophotographs in series taken by Alice Abela on sandy coastal dunes in Santa Barbara and San Luis Obispo Counties, CA in 2010–2021 supplement and enhance F. X. Williams (1928) study of the ecol­ogy and nesting behavior of the trapdoor spider-hunting spider wasp Aporus (Plectraporus) hirsutus (Banks) (Hymenoptera: Pompilidae: Aporini). Abela’s macrophotographs and observations provide new details of adult wasp feeding, functional morphology, hunting, digging and prey transport, and host spider trapdoor, entrance, burrow structure, host capture and escape activity. Newly reported host records from this study and online photographs expand A. hirsutus host selection in the large wafer-lid trapdoor spider genus Aptostichus Simon (Araneae: Mygalomorphae: Euctenizidae). The A. hirsutus California geographic distribution map by Wasbauer and Kimsey (1985) is updated, thereby providing a broader definition of intraspecific variation in this species. Aporus (Plectraporus) hirsutus (Banks) (Hymenoptera: Pompilidae: Aporini) is black, its body, antennae, legs and forewings rendered brilliant bluish, greenish or violaceous by its pubescence (Evans 1966; Wasbauer and Kimsey 1985) (Fig. 1). Females of A. hirsutus are 6.5–13.0 mm in body length, their size depending on the size of the host spider on which they fed as a larva (Evans 1966; F. E. Kurczewski pers. obs.). Females have the appropriate structural characteristics for preying on the wafer-lid trapdoor spider genus Aptostichus Simon (Araneae: Myga­lomorphae: Euctenizidae) in loose sand of active and relict coastal sand dunes and deserts in the western U. S. (Williams 1928; Wasbauer and Kimsey 1985). Aporus hirsutus ranges from Oregon and California eastward to Idaho, Nevada and western Arizona, and southward into Sonora and Baja California, Mexico (Evans 1966; Was­bauer and Kimsey 1985) (Fig. 9; Table 1)

‘I am worthless and kind’: the specificity of positive and negative self-evaluation in adolescent depression

Objectives: Adolescence represents a critical phase when the concept of self is developed and consolidated. Depressed adolescents globally endorse more negative and fewer positive self-descriptive words compared with non-depressed adolescents. Yet the methods used have not allowed for more detailed exploration of the specific content of these self-endorsements. Methods: Adolescents, aged 12-18 years, were recruited from the community (n = 204) and from a child and adolescent mental health service in the UK (n = 87). Participants completed measures of depression and a self-description questionnaire which included 12 positive and 12 negative self-descriptive adjectives. Results: As expected, we replicated previous findings that depressive symptoms are associated with global positive and negative self-endorsements. The difference between mean scores was examined for each adjective. Depressed adolescents endorsed all negative adjectives more highly relative to community adolescents; ratings of ‘worthless’ and ‘useless’ had the biggest difference between community and depressed adolescents. Surprisingly, a group of positive prosocial self-descriptors were endorsed equally by depressed and community adolescents and were not associated with severity of depressive symptoms. Conclusions: Although depressed adolescents endorsed more negative descriptions of themselves than community adolescents, positive self-endorsements related to their relationships with other people were not impaired

Neural networks engaged in tactile object manipulation: patterns of expression among healthy individuals

<p>Abstract</p> <p>Background</p> <p>Somatosensory object discrimination has been shown to involve widespread cortical and subcortical structures in both cerebral hemispheres. In this study we aimed to identify the networks involved in tactile object manipulation by principal component analysis (PCA) of individual subjects. We expected to find more than one network.</p> <p>Methods</p> <p>Seven healthy right-handed male volunteers (aged 22 to 44 yrs) manipulated with their right hand aluminium spheres during 5 s with a repetition frequency of 0.5-0.7 Hz. The correlation coefficients between the principal component temporal expression coefficients and the hemodynamic response modelled by SPM (ecc) determined the task-related components. To establish reproducibility within subjects and similarity of functional connectivity patterns among subjects, regional correlation coefficients (rcc) were computed between task-related component image volumes. By hierarchically categorizing, selecting and averaging the task-related component image volumes across subjects according to the rccs, mean component images (MCIs) were derived describing neural networks associated with tactile object manipulation.</p> <p>Results</p> <p>Two independent mean component images emerged. Each included the primary sensorimotor cortex contralateral to the manipulating hand. The region extended to the premotor cortex in MCI 1, whereas it was restricted to the hand area of the primary sensorimotor cortex in MCI 2. MCI 1 showed bilateral involvement of the paralimbic anterior cingulate cortex (ACC), whereas MCI 2 implicated the midline thalamic nuclei and two areas of the rostral dorsal pons.</p> <p>Conclusions</p> <p>Two distinct networks participate in tactile object manipulation as revealed by the intra- and interindividual comparison of individual scans. Both were employed by most subjects, suggesting that both are involved in normal somatosensory object discrimination.</p

Estimation of brain network ictogenicity predicts outcome from epilepsy surgery

Surgery is a valuable option for pharmacologically intractable epilepsy. However, significant post-operative improvements are not always attained. This is due in part to our incomplete understanding of the seizure generating (ictogenic) capabilities of brain networks. Here we introduce an in silico, model-based framework to study the effects of surgery within ictogenic brain networks. We find that factors conventionally determining the region of tissue to resect, such as the location of focal brain lesions or the presence of epileptiform rhythms, do not necessarily predict the best resection strategy. We validate our framework by analysing electrocorticogram (ECoG) recordings from patients who have undergone epilepsy surgery. We find that when post-operative outcome is good, model predictions for optimal strategies align better with the actual surgery undertaken than when post-operative outcome is poor. Crucially, this allows the prediction of optimal surgical strategies and the provision of quantitative prognoses for patients undergoing epilepsy surgery.MG, MPR and JRT gratefully acknowledge the financial support of the EPSRC via grant EP/N014391/1. They further acknowledge funding from Epilepsy Research UK via grant number A1007 and the Medical Research Council via grant MR/K013998/1. The contribution of MG and JRT was generously supported by a Wellcome Trust Institutional Strategic Support Award (WT105618MA). MPR is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust. CR and AE were supported by the Swiss National Science Foundation (grant SPUM 140332). KS is grateful for support from the Swiss National Science Foundation (grants 122010 and 155950)

Primary care in Malta : the patients’s expectations in 2009

Given the strong literature base to support the positioning of Primary Care at the core of a sustainable National Health Service, this study examines what the Maltese general public prefer, and expect, from their family doctor, and explores their preferred systems of care changes.peer-reviewe