Genetic confirmation of the first Mediterranean record of Holacanthus africanus Cadenat, 1951

The first Mediterranean record of the pomacanthid Holacanthus africanus, caught within the Maltese waters, was assigned based on morphological and meristic characters. However, molecular and genetic analyses are required to confirm the taxonomic determination and avoid misidentification given the abundance of closely-related Pomacanthidae species and the biogeographic significance of this record for the Mediterranean. At the species level, the analyzed specimens gave a 99.7% identity match with H. africanus. This study represents yet another example of molecular analyses supplementing the conclusions of conventional morphological identification exercises.peer-reviewe

The management of neuropathic ulcers of the foot in diabetes by shock wave therapy

<p>Abstract</p> <p>Background</p> <p>Diabetes is becoming one of the most common chronic diseases, and ulcers are its most serious complication. Beginning with neuropathy, the subsequent foot wounds frequently lead to lower extremity amputation, even in the absence of critical limb ischemia. In recent years, some researchers have studied external shock wave therapy (ESWT) as a new approach to soft tissue wound healing. The rationale of this study was to evaluate if ESWT is effective in the management of neuropathic diabetic foot ulcers.</p> <p>Methods</p> <p>We designed a randomized, prospective, controlled study in which we recruited 30 patients affected by neuropathic diabetic foot ulcers and then divided them into two groups based on different management strategies. One group was treated with standard care and shock wave therapy. The other group was treated with only standard care. The healing of the ulcers was evaluated over 20 weeks by the rate of re-epithelization.</p> <p>Results</p> <p>After 20 weeks of treatment, 53.33% of the ESWT-treated patients had complete wound closure compared with 33.33% of the control patients, and the healing times were 60.8 and 82.2 days, respectively (p < 0.001). Significant differences in the index of the re-epithelization were observed between the two groups, with values of 2.97 mm²/die in the ESWT-group and 1.30 mm²/die in the control group (p < 0.001).</p> <p>Conclusion</p> <p>Therefore, ESWT may be a useful adjunct in the management of diabetic foot ulceration.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN21800909</p

Unifocality as Prognostic Factor for Unilateral Retinoblastoma: Preliminary Results of 32 Eyes Treated with Intra-Arterial Chemotherapy Alone

Purpose: To evaluate the role of intra-arterial chemotherapy (IAC) in the management of unilateral, unifocal retinoblastoma (RB) as a single therapy, associated to neither focal nor systemic adjunctive therapies. Methods: Prospective, single center, interventional case series of 32 consecutive eyes diagnosed with unilateral unifocal RB and treated exclusively with selective ophthalmic intra-arterial chemotherapy, with no adjunctive systemic or focal treatments. Results: Full regression of the lesion was observed in 30 eyes (93.75%). 2 eyes were enucleated. Ophthalmoscopic remissions type I and III with higher calcific component were achieved. Additionally, neither recurrences nor new tumors appeared during the patient follow-up, which ranged from 10 months to 13 years. Conclusion: Selective intra-arterial chemotherapy has demonstrated to be highly effective in terms of disease control and anatomical preservation in case of unilateral unifocal disease, without requiring any additional systemic and/or focal therapy

The accuracy of burn depth diagnosis: Clinical assessment before and after enzymatic debridement

Abstract Introduction The most common technique used to determine burn depth is clinical assessment by experienced burn surgeons, although this has been shown to be reliable in only 60–75% of the cases. Overestimation of burn depth may result in needles surgery, while burn depth underestimation can led to an increased length of stay in the hospital, risk of contracture and hypertrophic scar formation. The aim of this study was to assess the clinical evaluation of burn depth before and after enzymatic debridement with Nexobrid®. Methods The study model was retrospective. 69 patient records were collected at our burn units, from Jan 2018 to Jan 2019. Each target wound was directly assessed by a single expert physician before and after enzymatic debridement. It was investigated whether the expert, by single wound, would have indicated the need for skin grafts before treatment with Nexobrid® and after treatment. Results Prior to treatment with Nexobrid®, the expert physician assessed that a graft was necessary for 47/69 patients (68.1%). Following debridement, the same expert deemed that the patients needing a graft were 19/69 (27.5%); analysing K-agreement, a 40.6% discrepancy between the pre and post-treatment opinion with Nexobrid® was observed. Discussion The use of Nexobrid® enzymatic debridement can positively affect burn depth clinical assessment, increasing its specificity and sensitivity, without any need for delay. This can lead to a significant change in clinical practice, minimizing the use of surgery, therefore increasing quality and precision of the reconstructive phase

Using local ecological knowledge to search for non-native species in Natura 2000 sites in the central Mediterranean sea : an approach to identify new arrivals and hotspot areas

The management of biological invasions is among the most urgent of global challenges and requires a significant monitoring effort to obtain the information needed to take the appropriate decisions. To complement standard monitoring, citizen science is increasingly being used. Within citizen science, the approach of collecting and investigating Local Ecological Knowledge (LEK) proved to be useful in the monitoring of non-native species. A LEK survey was carried out in 10 Sicilian and Maltese Natura 2000 sites in order to help in the early detection of non-native species. The survey was addressed to local fishers and SCUBA divers in order to investigate the occurrence of 24 selected marine non-native species and to identify potential hotspot areas of invasion through the use of six indicators: the occurrence of newly introduced nonindigenous species, the cumulative impacts of invasive alien species (CIMPAL) and the relative importance of species on the cumulative impacts (D1, D2, D3, and D4). The respondents confirmed the presence of 22 species since the year 2000 and reported 10 new ones registered in the investigated areas. The highest CIMPAL value was observed in two Sicilian Natura 2000 sites (ITA090028 and ITA040014) and the lowest on the western coast of Malta (MT0000101, MT0000102, MT0000103, and MT0000104) The four top-priority species according to indicators D1–D4 were Caulerpa cylindracea, C. taxifolia, Siganus luridus and S. rivulatus. The study produced a valid and useful scientific output to suggest and address management strategies to monitor the establishment of the non-native species.peer-reviewe

Italian recommendations on enzymatic debridement in burn surgery.

Abstract Introduction Nexobrid®, a bromelain-based type of enzymatic debridement, has become more prevalent in recent years. We present the recommendations on enzymatic debridement (Nexobrid®)'s role based on the practice knowledge of expert Italian users. Methods The Italian recommendations, endorsed by SIUST (Italian Society of Burn Surgery), on using enzymatic debridement to remove eschars for burn treatment were defined. The definition followed a process to evaluate the level of agreement (a measure of consensus) among selected experts, representing Italian burn centers, concerning defined clinical aspects of enzymatic debridement. The consensus involved a multi-phase process based on the Delphi method. Results The consensus panel included experts from Italy with a combined experience of 1068 burn patients treated with enzymatic debridement. At the end of round 3 of the Delphi method, the panel reached 100% consensus on 26 out of 27 statements. The panel achieved full, strong consensus (all respondents strongly agreed on the statement) on 24 out of 27 statements. Discussion The statements provided by the Italian consensus panel represent a "ready to use" set of recommendations for enzymatic debridement in burn surgery that both draw from and complete the existing scientific literature on the topic. These recommendations are specific to the Italian experience and are neither static nor definitive. As such, they will be updated periodically as further quality evidence becomes available

Paediatric recurrent pericarditis: Appropriateness of the standard of care and response to IL1-blockade

Objective: To analyse, in a cohort of paediatric patients with recurrent pericarditis (RP) undergoing anti-IL-1 treatment: the agent and dosing used as first line treatment, the long-term efficacy of IL1-blockers, the percentage of patients achieving a drug-free remission, the presence of variables associated with drug-free remission. Study design: Data were collected from patients' charts. Annualized relapse rate (ARR) was used for evaluation of treatment efficacy, bivariate logistic regression analysis for variables associated with drug-free remisison. Results: 58 patients, treated between 2008 and 2018, were included in the study (mean follow-up 2.6 years). 14/56 patients non-responsive to first line drugs were under-dosed. 57 patients were treated with anakinra: the ARR before and during daily treatment was 3.05 and 0.28, respectively (p<0.0001); an increase to 0.83 was observed after the reduction/withdrawal of treatment (p<.0001). The switch from anakinra to canakinumab (5 patients) was associated to an increase of the ARR (0.49 vs 1.46), but without statistical significance (p=0.215). At last follow-up only 9/58 patients had withdrawn all treatments. With the limits of a retrospective study and the heterogeneity between the patients enrolled in the study, a shorter duration of treatment with anakinra was the only variable associated with drug-free remission. Conclusion: This study shows that most of the pediatric patients with RP needing IL-1 blockade received an inadequate treatment with first line agents. The effectiveness of anakinra is supported by this study, but few patients achieved drug free-remission. The different rate of response to anakinra and canakinumab may suggest a possible role of IL1α in the pathogenesis of RP