The Maltese version of the DN4 questionnaire : initial validation to assess neuropathic pain in patients with chronic spinal or spinal-radicular pain

Background: Neuropathic pain is frequently encountered in patients with spinal and spinal-related pain which needs specific treatment. Therefore, the objective of this study was to do an initial linguistic translation and validation of the Maltese DN4 questionnaire to diagnose neuropathic pain in this population. Methods: The study was designed as a single-blinded, observational, prospective collected data and retrospective analysis. The English and French DN4 questionnaires underwent forward and backward translation, literal assessment and adaptation of the semantic equivalence into the Maltese language, followed by assessment of the Maltese DN4 during the initial patient assessment in patients who met the inclusion criteria. Results: The total Maltese DN4 score obtained a Cronbach’s alpha of 0.735 therefore having satisfactory internal consistency. Test-retest using the Intraclass Correlation Coefficient (95% CI) ranged from 0.975 to 0.991 (p=0.000), while inter-rater agreement using Intraclass Correlation Coefficient (95% CI) ranged from 0.986 to 0.995 (p=0.000). Test-retest reliability yielded an intraclass correlation coefficient (95% CI) ranging from 0.975 to 0.991 (p < 0.001), while inter-rater reliability yielded an intraclass correlation coefficient (95% CI) ranging from 0.986 to 0.995 (p < 0.001). Both the English and the Maltese DN4 questionnaires obtained the same sensitivity and specificity values of 0.422 and 0.941 respectively, and a positive likehood ratio of 7.153 and a negative likehood ratio of 0.614, at a cutoff score of 4. Conclusion: The results of this study support the transcultural internal consistency, inter-rater, test-retest reliability, validity of the Maltese DN4 questionnaire to differentiate between neuropathic and nociceptive pain in patients with chronic spinal and spinal-radicular pain. Therefore, this simple tool can be used both in daily clinical practice but also in the clinical research setting to quickly screen for neuropathic pain.peer-reviewe

Difficulties in the Definition of Matter States

A matter in liquid state is known to attain the shape of the vessel which holds it ndash water is a glass will assume the shape of the glass. Solids, however, will retain their own shape wherever they are contained. What do these statements rely on and are they always valid

‘Your daily reality is rubbish’: Waste as a means of urban exclusion in the suspended spaces of East Jerusalem

Drawing on ethnographic and visual research, this article examines the role of waste in two areas of occupied East Jerusalem cut off from the city by the Separation Wall and military checkpoints, Kufr Aqab and Shuafat Refugee Camp as well as their immediate surroundings. In asking how urban exclusion operates on the margins of the city, we argue that rubbish can disclose broader socio-spatial relations at work in Jerusalem from the ground up. We find that waste serves to reduce the ambiguity at work in these interstitial zones by furthering exclusion – it operates through the urban everyday where the legal and political situations are in suspension. Conceptually, we contribute to the discussion on spatial stigma associated with infrastructural violence by arguing for a multi-layered understanding of the way waste ‘works’ in urban exclusion. Three registers mutually constitute each other in this process: the materiality of waste with its embodied and affective interactions, the symbolic and discursive violence associated with waste, as well as spatialised stigma and bordering processes

Beyond equality, women require extra care in cardiovascular imaging

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In suspension: the denial of the rights of the city for Palestinians in Israel and its effects on their socio-economic, cultural and political formation: the case of Umm Al-Fahem

This thesis is concerned with the absence of substantive, functioning Palestinian cities, and of Palestinian urbanisation and urbanism in Israel. Framed and guided by conceptions of the city and public space, their potentialities, the possibilities they allow, and the challenges they pose to the state, the thesis using Umm al-Fahem as a case study seeks to investigate the Palestinian city in Israel, its materiality, the semiotics of its public space and socio-spatiality, and to deconstruct the historical, structural, political and social forces that shape its (un)making. Employing mixed qualitative methods of ethnography, photography, archival research, historical, sociological and discourse analysis, the thesis questions and deconstructs the nominal status of the city of Umm al-Fahem, the first Palestinian village to earn the official status of a city in Israel. It considers how to conceptualise Palestinian cities inside Israel and aims to give answers to questions such as: what can be made of Palestinian cities inside Israel? What kind of spatial configurations and arrangements are being formed and why? What kind of socio-political and cultural order is being formed and why? How does the city respond under (post)colonial conditions? Can there be a functioning Palestinian city and a fulfilment of the right to the city under (post)colonial conditions? Umm al-Fahem, the subject and object of research, suggests that the process unfolding is one of absenting the Palestinian city, depriving Palestinian citizens of the right to the city, and producing domesticated, suspended, fragmented city and citizens. The production and mastery of space is used as a technology of control to achieve this, and forms part of a governmentality project whose underlying objective is the management of Palestinians

Is having a sweetheart enough to survive?

Almost three decades after the description of improved left ventricular function caused by chronic impaired coronary perfusion, and the rise of the term “Hibernation,” finding that hibernating myocardium is still a challenge for cardiologists

Nicotine dependence and the International Association for the Study of Pain neuropathic pain grade in patients with chronic low back pain and radicular pain : is there an association?

Background: This study investigated whether current smoking and a higher nicotine dependency were associated with chronic low back pain (LBP), lumbar related leg pain (sciatica) and/or radicular neuropathic pain.Methods: A cross-sectional study was conducted on 150 patients (mean age, 60.1 ± 13.1 yr). Demographic data, the International Association for the Study of Pain (IASP) neuropathic pain grade, STarT Back tool, and the Fagerström test were com- pleted. A control group (n = 50) was recruited.Results: There was a significant difference between current smokers and non- smokers in the chronic LBP group in the mean pain score (P = 0.025), total STarT Back score (P = 0.015), worst pain location (P = 0.020), most distal pain radiation (P = 0.042), and in the IASP neuropathic pain grade (P = 0.026). There was a significant difference in the mean Fagerström score between the four IASP neuropathic pain grades (P = 0.005). Current smoking yielded an odds ratio (OR) of 3.071 (P = 0.011) for developing chronic LBP and sciatica, and an OR of 4.028 (P = 0.002) for obtaining an IASP “definite/probable” neuropathic pain grade, for both cohorts. The likelihood for chronic LBP and sciatica increased by 40.9% (P = 0.007), while the likelihood for an IASP neuropathic grade of “definite/probable” increased by 50.8% (P = 0.002), for both cohorts, for every one unit increase in the Fagerström score.Conclusions: A current smoking status and higher nicotine dependence increase the odds for chronic LBP, sciatica and radicular neuropathic pain.peer-reviewe

Megakaryocyte Diversity in Ontogeny, Functions and Cell-Cell Interactions

Hematopoietic stem cells (HSCs) rely on local interactions in the bone marrow (BM) microenvironment with stromal cells and other hematopoietic cells that facilitate their survival and proliferation, and also regulate their functions. HSCs and multipotent progenitor cells differentiate into lineage-specific progenitors that generate all blood and immune cells. Megakaryocytes (Mks) are hematopoietic cells responsible for producing blood platelets, which are essential for normal hemostasis and blood coagulation. Although the most prominent function of Mks is platelet production (thrombopoiesis), other increasingly recognized functions include HSC maintenance and host immune response. However, whether and how these diverse programs are executed by different Mk subpopulations remains poorly understood. This Perspective summarizes our current understanding of diversity in ontogeny, functions and cell-cell interactions. Cumulative evidence suggests that BM microenvironment dysfunction, partly caused by mutated Mks, can induce or alter the progression of a variety of hematologic malignancies, including myeloproliferative neoplasms (MPNs) and other disorders associated with tissue scarring (fibrosis). Therefore, as an example of the heterogeneous functions of Mks in malignant hematopoiesis, we will discuss the role of Mks in the onset and progression of BM fibrosis. In this regard, abnormal interactions between of Mks and other immune cells might directly contribute to fibrotic diseases. Overall, further understanding of megakaryopoiesis and how Mks interact with HSCs and immune cells has potential clinical implications for stem cell transplantation and other therapies for hematologic malignancies, as well as for treatments to stimulate platelet production and prevent thrombocytopenia