Piles and more... dealing with incompetent veins

The day that man took his first steps on his two hind legs is considered a milestone in the evolutionary dominance of mankind. Yet this feat has borne with it one huge burden – the human being is just about the only species to suffer from varicose veins and haemorrhoids, the visible effects of venous insufficiency. Chronic venous disease (CVD) has been described as ‘an abnormally functioning venous system caused by venous valvular incompetence with or without associated venous outflow obstruction, which may affect the superficial venous system, the deep venous system, or both’.1 With the minor inclusion of postthrombotic syndrome, the majority of CVD can be attributed to chronic venous insufficiency (CVI) which is the pathophysiological mechanism for both abnormal leg veins and haemorrhoids.peer-reviewe

Automatically generating runtime monitors from tests

A large portion of the software development industry relies on testing as the main technique for quality assurance while other techniques which can provide extra guarantees are largely ignored. A case in point is runtime verification which provides assurance that a system’s behaviour is correct at runtime. Compared to testing, this technique has the advantage of checking the actual runs of a system rather than a number of representative testcases.peer-reviewe

Using gherkin to extract tests and monitors for safer medical device interaction design

Number entry systems on medical devices are safety critical and it is important to get them right. Interaction design teams can be multidisciplinary, and in this work we present a process where the requirements of the system are drawn up using a Controlled Natural Language (CNL) that is understandable by non-technical experts or clients. These CNL requirements can also be directly used by the Quality Assurance (QA) team to test the system and monitor whether or not the system runs as it should once deployed. Since commonly, systems are too complex to test all possible execution paths before deployment, monitoring the system at runtime is useful in order to check that the system is running correctly. If at runtime, it is discovered that an anomaly is detected, the relevant personnel is notified through a report in natural language.peer-reviewe

A retrospective longitudinal analysis of mental health admissions : measuring the fallout of the pandemic

Background: In this research article, we review the infrequently considered long-term impact of the pandemic on inpatient mental health, by reviewing the clinical parameters of all psychiatric admissions to Mount Carmel Hospital, our region’s main psychiatric healthcare facility, from 2019–2021. Methods: 4292 patients were admitted during the research period of this retrospective longitudinal analysis. Taking 2019 as the pre-COVID reference year, we compared mean monthly admissions from 2020 and 2021, looking at patient demographics, status under the Mental Health Act, diagnosis, and self-injurious behaviour. Results: While the pandemic was reflected in a moderate increase in mean monthly presentations with suicidal ideation and suicidal self-injury, presentations in 2020 otherwise remained largely stable. This contrasted with a surge in presentations in 2021 with mood disorders, schizophrenia, anxiety, personality disorders, and autism spectrum disorders. Furthermore, presentations involving self-injurious behaviour continued to grow. Involuntary admissions also increased significantly in 2021. Conclusions: This paper highlights the pernicious long-term impact of the pandemic on mental health presentations, demonstrated by an increase in hospital admissions and more serious presentations. These findings should be considered in the guidance for responses to any future pandemic, giving attention to the evidence of the impact of restrictive measures on mental health.peer-reviewe

Sunetti ta’ William Shakespeare

Ġabra ta’ poeżiji u proża li tinkludi: Grand Prix ta’ Carmel Azzopardi – Pizza marinara ta’ Carmel Azzopardi – Ħajku ta’ Kit Azzopardi – Ix-xemgħa qiegħda ta’ Charles Bezzina – U taħti ramel, ramel ta’ Charles Bezzina – Vażett ta’ Ġorġ Borg – Bniedem li mhux ta’ Ġorġ Borg – Il-ħajbu ta’ Antoine Cassar – Il-mistoħbija ta’ Manwel Cassar – Għasel ta’ Carmel G. Cauchi – Dgħajsa ta’ Carmel G. Cauchi – Ħitan ta’ Alfred Degabriele – Skeletru silwett...f’realtà moħbija ta’ Stefano Farrugia – Minjatura tal-enimmi ta’ Stefano Farrugia – Mnejn jgħaddi Kristu ta’ Joe Friggieri – Rebbiegħa ta’ Reno Fenech – Blogger ta’ Charles Flores – Veġeterjana ta’ Charles Flores – Mejju ta’ Joe P. Galea – Kien hemm lejla u tmien nisa ta’ Claudia Gauci – Ħobbni ta’ Sergio Grech – Mitlufin ta’ Maria Grech Ganado – Moħħi ta’ Maria Grech Ganado – Viżjoni ta’ Maria Grech Ganado – Inkontinenza ta’ Adrian Grima – Andrew jħebb in-nar ta’ Adrian Grima – It-Tlieta, 20 ta’ Lulju 2004 ta’ Alfred Massa – Fuq l-għolja tal- Verdala ta’ Jane Micallef – Imm’issa ta’ Jane Micallef – Baby blues ta’ Immanuel Mifsud – Ġo dar sawra ta’ Immanuel Mifsud – Lil Dun Karm ta’ Maurice Mifsud Bonnici – Il-fuklar ta’ Achille Mizzi – Ut videam ta’ Achille Mizzi – Karnival solitarju ta’ Patrick Sammut – Mill-baħħ etern ta’ Joe Zammit Tabona – ...fil-ħmieġ ta’ ftit blatiet... ta’ Paul P. Borg – Bħall-qasab ta’ Steve Borg – L-aħħar żjara ta’ Victor Fenech – Ħelwa.morra 18 ta’ Ann Marie Schembri – Jack & Jill ta’ Trevor Żahra – Għadbilura ta’ Russell Davis, traduzzjoni ta’ Toni Aquilina – Sunetti ta’ William Shakespeare, traduzzjoni ta’ Oliver Friggieri.peer-reviewe

Hybrid cosmic ray measurements using the IceAct telescopes in coincidence with the IceCube and IceTop detectors

IceAct is a proposed surface array of compact (50 cm diameter) and cost-effective Imaging Air Cherenkov Telescopes installed at the site of the IceCube Neutrino Observatory at the geographic South Pole. Since January 2019, two IceAct telescope demonstrators, featuring 61 silicon photomultiplier (SiPM) pixels have been taking data in the center of the IceTop surface array during the austral winter. We present the first analysis of hybrid cosmic ray events detected by the IceAct imaging air-Cherenkov telescopes in coincidence with the IceCube Neutrino Observatory, including the IceTop surface array and the IceCube in-ice array. By featuring an energy threshold of about 10 TeV and a wide field-of-view, the IceAct telescopes show promising capabilities of improving current cosmic ray composition studies: measuring the Cherenkov light emissions in the atmosphere adds new information about the shower development not accessible with the current detectors, enabling significantly better primary particle type discrimination on a statistical basis. The hybrid measurement also allows for detailed feasibility studies of detector cross-calibration and of cosmic ray veto capabilities for neutrino analyses. We present the performance of the telescopes, the results from the analysis of two years of data, and an outlook of a hybrid simulation for a future telescope array

Three-year performance of the IceAct telescopes at the IceCube Neutrino Observatory

IceAct is an array of compact Imaging Air Cherenkov Telescopes at the ice surface as part of the IceCube Neutrino Observatory. The telescopes, featuring a camera of 61 silicon photomultipliers and fresnel-lens-based optics, are optimized to be operated in harsh environmental conditions, such as at the South Pole. Since 2019, the first two telescopes have been operating in a stereoscopic configuration in the center of IceCube\u27s surface detector IceTop. With an energy threshold of about 10 TeV and a wide field-of-view, the IceAct telescopes show promising capabilities of improving current cosmic-ray composition studies: measuring the Cherenkov light emissions in the atmosphere adds new information about the shower development not accessible with the current detectors. First simulations indicate that the added information of a single telescope leads, e.g., to an improved discrimination between flux contributions from different primary particle species in the sensitive energy range. We review the performance and detector operations of the telescopes during the past 3 years (2020-2022) and give an outlook on the future of IceAct

Fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin with gemtuzumab ozogamicin improves event-free survival in younger patients with newly diagnosed aml and overall survival in patients with npm1 and flt3 mutations

Purpose To determine the optimal induction chemotherapy regimen for younger adults with newly diagnosed AML without known adverse risk cytogenetics. Patients and Methods One thousand thirty-three patients were randomly assigned to intensified (fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin [FLAG-Ida]) or standard (daunorubicin and Ara-C [DA]) induction chemotherapy, with one or two doses of gemtuzumab ozogamicin (GO). The primary end point was overall survival (OS). Results There was no difference in remission rate after two courses between FLAG-Ida + GO and DA + GO (complete remission [CR] + CR with incomplete hematologic recovery 93% v 91%) or in day 60 mortality (4.3% v 4.6%). There was no difference in OS (66% v 63%; P = .41); however, the risk of relapse was lower with FLAG-Ida + GO (24% v 41%; P < .001) and 3-year event-free survival was higher (57% v 45%; P < .001). In patients with an NPM1 mutation (30%), 3-year OS was significantly higher with FLAG-Ida + GO (82% v 64%; P = .005). NPM1 measurable residual disease (MRD) clearance was also greater, with 88% versus 77% becoming MRD-negative in peripheral blood after cycle 2 (P = .02). Three-year OS was also higher in patients with a FLT3 mutation (64% v 54%; P = .047). Fewer transplants were performed in patients receiving FLAG-Ida + GO (238 v 278; P = .02). There was no difference in outcome according to the number of GO doses, although NPM1 MRD clearance was higher with two doses in the DA arm. Patients with core binding factor AML treated with DA and one dose of GO had a 3-year OS of 96% with no survival benefit from FLAG-Ida + GO. Conclusion Overall, FLAG-Ida + GO significantly reduced relapse without improving OS. However, exploratory analyses show that patients with NPM1 and FLT3 mutations had substantial improvements in OS. By contrast, in patients with core binding factor AML, outcomes were excellent with DA + GO with no FLAG-Ida benefit

Cosmetic dermatology : a medical intervention or an aesthetic procedure?

Disfigurement of face and body through disease or trauma has inspired the development of various ingenious surgical and non-invasive techniques which, aided by advances in research and technology, have evolved into the speciality of plastic and reconstructive surgery. In tandem with these developments, society has imposed an increasing desire to retain and enhance aesthetic features, so it is not surprising that the application of these techniques would eventually evolve into the fascinating art and science of aesthetic dermatology. The boundary between correcting and enhancing desirable features or changing unflattering ones has thus been blurred, and in the following article, we shall be reviewing some examples of these applications.peer-reviewe

The follow-up of solitary pulmonary nodules at Mater Dei Hospital

Background: Solitary pulmonary nodules (SPNs) are a common incidental radiological finding, occurring in 28% of smokers, 20% of ex-smokers and 36% of non-smokers. These nodules represent a diagnostic challenge. Under-evaluation may delay the diagnosis of early lung cancer whilst over-evaluation may increase expenditure, radiation and also patient concern. The aim of this audit was to evaluate whether the Fleischner Society Guidelines are adhered to in the follow-up of SPNs locally. Methodology: This retrospective study includes all SPNs diagnosed incidentally on Computed Tomography (CT) between January 2013 and December 2014, excluding patients with a history of malignancy. The follow-up of the nodules was compared with Fleischner Society Recommendations (FSR) as the gold standard. Standard Use: FSR 2005, which stratify nodules based on size and smoking history. Results: From a cohort of 100 patients, guideline-concordant care was found in 29%. SPNs were under-evaluated in 36% of cases, while over-evaluation occurred in 12%. Twenty-two SPNs had insufficient description for further evaluation. From the total cohort, lung malignancy was diagnosed in 47% and the risk of malignancy increased with increasing nodule size (10.6% in ≤4mm, 19% in 5-8mm, and 61.7% in >8mm). Key Messages and Recommendations: It is the responsibility of the ordering physician to give appropriate smoking history information on request. The reporting radiologist should then be clearly documenting the size and nodule characteristics, followed by timely follow-up according to FSR criteria. Appropriate specific booking request information and standardised medical imaging reporting systems should be implemented to ensure adequate follow-up of SPNs according to international recommendations.peer-reviewe