Primary CNS lymphoma with intravitreal metastasis : using vitreous cavity samples to monitor response to therapy

A fifty-eight year old male patient presented to the ophthalmic department with a 3 day history of reduced visual acuity, blurred vision and floaters, associated with recent lethargy, headaches and behavioural changes. Fundal examination revealed a bilateral vitritis. Steroid therapy was started. MRI of the brain revealed multiple hypodense and hyperdense lesions. Vitrectomy was performed in view of the poor response to steroids. A biopsy showed non-hodgkin B-Cell lymphoma. The patient was started on intravenous Methotrexate and Cytarabine. Repeat vitreous cavity biopsies were performed in order to assess response to therapy. All biopsies to date have revealed evidence of on-going lymphoma.peer-reviewe

Bilateral breast reduction surgery at Mater Dei Hospital : analysis of physical and psychological symptoms using the BREAST-Q

Introduction: The literature describes the high patient satisfaction rate after breast reduction. In this retrospective study, we use the BREAST-Q to analyse satisfaction with breast appearance and physical, psychosocial and sexual well-being of patients who underwent bilateral breast reduction (BBR) at Mater Dei Hospital (MDH). We also looked into whether age, co-morbidities and weight of breast tissue removed makes a difference to the overall satisfaction rate. Method: Permission to use the BREAST-Q questionnaire and translate it into Maltese was obtained from Mapi Reasearch Trust. The questionnaire was offered either in Maltese or in English, after an official translation was produced following a linguistic validation process. All patients who underwent BBR at MDH under the care of both consultant Plastic Surgeons were invited to complete the BREAST-Q questionnaire via a telephone call and asked to come to MDH to fill it in. Other patient specific information was obtained from their hospital notes. Results: We hope to demonstrate a better quality of life following surgery and aim to compare the results of this study to others carried out worldwide. In this way we can better understand the local situation and see where there is the room for improvement. Conclusion: In this world of evidence-based medicine, the BREAST-Q is ideal for a holistic approach in analysing patient satisfaction after BBR. Having local data at hand makes it easier for patients who are interested in undergoing the surgery to associate themselves with other local individuals.peer-reviewe

A retrospective study on the radiographic evaluation of the tibial component alignment in total knee arthroplasty and its postoperative significance

BACKGROUND: The goal of tibial component positioning in total knee arthroplasty is to achieve neutral tibial alignment. Malalignment of the tibial component alters the distribution of tibial loading, resulting in increased wear. The purpose of this study was to correlate two radiological parameters (mechanical and anatomical axis) of the tibial component in total knee arthroplasty with patient related outcome measures at 5 years.METHOD: 91 primary total knee arthroplasties were considered in this study. Tibial component alignment was assessed using post op radiographs. All x-rays were taken immediately post operatively. The Oxford Knee Score was used to quantify the patient’s pain and function following the total knee arthroplasty. Patient follow up at Orthopaedic outpatients and date of discharge were also considered. The radiographic outcome was then correlated with the patient reported outcome over 5 years. Correlation was measured using either the parametric Pearson correlation coefficient (testing for a linear correlation) and its non-parametric counterpart; the Spearman’s rank correlation coefficient.RESULTS: There is a very weak correlation between the Oxford Knee Score and the varus angle of deviation. The correlation is stronger in the valgus position, but still not statistically significant. There is also a weak negative correlation between the angle of deviation and the number of follow ups at Orthopaedic outpatients.CONCLUSION: From our study, we can conclude that an angle of deviation of £ 6o in both varus and valgus did not have a negative prognostic effect on patient outcome.peer-reviewe

Follow-up of the re-evaluation of polyglycerol esters of fatty acids (E 475) as a food additive

Polyglycerol esters of fatty acids (PEFA, E 475) was re-evaluated in 2017 by the former EFSA Panel on Food Additives and Nutrient sources added to Food (ANS). As a follow-up to this assessment, in this opinion, the Panel on Food Additives and Flavouring (FAF) addresses the data gaps identified to support an amendment of the EU specifications for E 475. The Panel performed a risk assessment of undesirable impurities and constituents potentially present in E 475. The Panel concluded that the maximum limits in the EU specifications for the 4 toxic elements (arsenic, lead, mercury and cadmium) should be lowered based on actual levels in the commercial food additive E 475. The Panel also concluded that maximum limits for erucic acid, 3-monochloropropanediol and glycidyl esters should be included in the EU specifications for E 475. Alternatively, the Panel recommends an amendment of the definition of E 475 to include a requirement that the fats and oils used in the manufacturing of E 475 comply with the respective EU legislation regarding suitability for human consumption. Further, the Panel concluded that there is no need for setting a specification limit for the content of trans-fatty acids in E 475 as a limit is established in the Regulation (EU) No 2019/649, i.e. 2 g of trans-fat per 100 g fat in food for the final consumer. Finally, the Panel recommends a modification of the definition of E 475 indicating that polyglycerol used for the manufacturing of E 475 should be produced from glycerol meeting the specifications for E 422 (Commission Regulation (EU) No 231/2012). In this case, respective specification limits for epichlorohydrin, acrolein and butanetriol would not be needed for E 475

Follow-up of the re-evaluation of glycerol (E 422) as a food additive

Glycerol (E 422) was re-evaluated in 2017 by the former EFSA Panel on Food Additives and Nutrient sources added to Food (ANS). As a follow-up to that assessment, in this opinion, the Panel on Food Additives and Flavourings (FAF) addresses the data gaps identified to support an amendment of the EU specifications for E 422 in Commission Regulation (EU) No 231/2012. The Panel performed a risk assessment of undesirable impurities present in E 422. The Panel concluded that the maximum limits in the EU specifications for the four toxic elements (arsenic, lead, mercury and cadmium) should be lowered based on actual levels in the commercial food additive E 422. The Panel recommended setting a numerical limit value for acrolein in the specifications for E 422. The potential exposure to free 3-monochloropropanediol at the maximum limit of 0.1 mg/kg, as laid out in the specifications for E 422, does not give rise to a health concern. The Panel recommended to consider modifying the definition of E 422 in Commission Regulation (EU) No 231/2012 indicating that E 422 is obtained only from vegetable oils and fats and undergoes purification processes that involve distillation, and other clean up steps to obtain refined glycerol. Overall, the Panel concluded that the technical data provided support an amendment of the specifications for glycerol (E 422)

Follow-up of the re-evaluation of polyglycerol polyricinoleate (E 476) as a food additive

Polyglycerol polyricinoleate (PGPR, E 476) was re-evaluated in 2017 by the former EFSA Panel on Food Additives and Nutrient sources added to Food (ANS). As a follow-up to this assessment, in this opinion, the Panel on Food Additives and Flavouring (FAF) addresses the data gaps identified to support an amendment of the EU specifications for E 476. Additionally, this opinion deals with the assessment of the proposed extension of use for E 476 in edible ices and a revision of the maximum permitted level in emulsified sauces. The Panel concluded that the proposed extension of use, if authorised, would not give rise to a safety concern. Additionally, the Panel performed a risk assessment of undesirable impurities potentially present in E 476. The Panel concluded that the maximum limits in the EU specifications for the four toxic elements (arsenic, lead, mercury, cadmium) should be lowered based on actual levels in the commercial food additive E 476. The Panel also concluded that maximum limits for glycidyl esters and 3-monochloropropanediol should be included in the EU specifications for E 476. Alternatively, the Panel recommends an amendment of the definition of E 476 to include a requirement that the fats and oils used in the manufacturing of E 476 comply with the respective EU legislation regarding suitability for human consumption. Further, the Panel recommends a modification of the definition of E 476 indicating that polyglycerol used for the manufacturing of E 476 should be produced from glycerol meeting the specifications for E 422 (Commission Regulation (EU) No 231/2012). In this case, respective specification limits for epichlorohydrin, acrolein and butanetriol would not be needed for E 476. Finally, the Panel concluded that the proposed method based on the determination of ricinoleic acid is suitable for the determination of E 476 content in food

Re-evaluation of metatartaric acid (E 353) as a food additive

Acknowledgements: The FAF Panel wishes to thank Claude Lambre and Esraa Elewa for the support provided to this scientific output. The FAF Panel wishes to acknowledge all European competent institutions, Member State bodies and other organisations that provided data for this scientific output.Publisher PD

Re-evaluation of acetic acid, lactic acid, citric acid, tartaric acid, mono- and diacetyltartaric acid, mixed acetic and tartaric acid esters of mono- and diglycerides of fatty acids (E 472a-f) as food additives

Publisher PD