Endocardial fibroelastosis

This is an article delivered at a meeting of the British Medical Association (Malta Branch) on the 7th March 1967. During the eleven-year period 1955-66 eight cases of endocardial fibroelastosis were diagnosed or confirmed at autopsy. This represents an incidence of 1.9% in the 424 necropsies carried out on children less than two years of age. The frequency of congenital heart diseases was found in the same series to be 13.4%. In almost 1.2% of the cases endocardial fibroelastosis was associated with cardiac anomalies. The literature on the subject is reviewed, and the findings of the present study are compared with those of previous reports.peer-reviewe

Bilateral microform cleft lip

Microform cleft lip (MCL), also called congenital healed cleft lip or cleft lip "frustré", is a rare congenital anomaly. MCL has been described as having the characteristic appearance of a typical cleft lip which has been corrected in utero. We present a girl with bilateral microform cleft lip associated with a preauricular sinus and bilateral camptodactyly.peer-reviewe

Mitral valve infective endocarditis following device occlusion of a coronary artery fistula

A three year old girl, with a right coronary artery fistula and signs of a hyperdynamic circulation, underwent uncomplicated closure of the fistula using an occluding device introduced via the femoral arterial route and covered with appropriate antibiotics. Two months later she presented with a persistent fever, signs of infective endocarditis (IE) and embolic phenomena in the left lower limb. Mitral valve endocarditis was confirmed immediately and treated effectively. However, initial ultrasound and doppler did not show the femoral artery thrombo-occlusion that was only confirmed on magnetic resonance angiography (MRA) one month later. This case highlights the usefulness of MRA in diagnosing suspected vessel occlusion in young children, and is in keeping with the latest NICE guidelines that suggest that prophylactic antibiotics do not always prevent IE. Parent and patient education on ‘what to look out for’, combined with careful clinical vigilance is paramount in the early detection of IE with a consequent reduction in morbidity and mortality.peer-reviewe

Clinicopathological conference

In October 1969, professor V.G. Griffiths inaugurated monthly clinicopathological conferences at St. Luke's Hospital Malta. Two of the case studies presented at the April 1970 meeting are hereby published. A guest participant was professor Linell, of the University Institute for Pathology, associated with the Almanna Sjukhuset of Malmo, Sweden, who was then visiting the medical school. The main focus of the subject of the conference is on tumours of the kidneys and ureters, whereby an interesting discussion about the cases in question is presented, outlining the respective detailed medical examinations and evaluations processes.peer-reviewe

Preliminary Structural Interpretation of a Seismic Profile across the Frontal Sector of the Eastern Achara-Trialeti Fold-and-Thrust Belt

This paper presents a new structural model for the frontal part of the eastern Achara-Trialeti fold- and-thrust belt based on the interpretation of a seismic reflection profile across the retro-wedge of the Lesser Caucasus orogen. The structural details from the interpreted seismic reflection profile provide new data on the deep structure of the frontal part of the eastern Achara-Trialeti fold-and- thrust belt. The seismic reflection profile crosses, from south to north, the Varketili anticline, the Ormoiani syncline, and a south-directed imbricate thrust system. Seismic interpretation is constrained by surface geology, exploration wells, and application of theoretical models on fault- related folding. Seismic reflection data interpretation reveals the interaction between south- and north-vergent fold-thrust structures and north-vergent duplexes at depth. The duplexes are well imaged on the seismic profile and constituted by a lower and an upper duplex system. The lower duplex involves the Cretaceous-Middle Eocene sequence, whereas the upper duplex affects the Upper Eocene strata

Subpathotypes of Avian Pathogenic Escherichia coli (APEC) Exist as Defined by their Syndromes and Virulence Traits

Avian pathogenic Escherichia coli (APEC) strains cause different types of systemic extraintestinal infections in poultry, collectively termed colibacillosis, which can cause significant economic losses in the poultry industry. To date, there have been no descriptions of genes or characteristics that allow for the classification of avian strains pathotypes responsible for causing specific diseases in their hosts. In this study we aimed to characterize avian E. coli strains representing 4 groups, including one of commensal strains (AFEC – Avian Fecal Escherichia coli) and 3 groups of APEC strains, where each group is responsible for causing a different disease syndrome in their respective hosts (septicemia, omphalitis and swollen head syndrome). We chose to examine several biological characteristics of these strains including: adhesion to eukaryotic cells, pathogenicity levels according to the lethal dose (50%) assay, phylogenetic group and virulence gene profiles. The comparison of strains based on these genotypic and phenotypic traits, using multivariate statisticals tools and complex networks, allowed us to infer information about the population structure of the studied groups. Our results indicate that APEC strains do not constitute a unique homogeneous group, but rather a structured set of subgroups, where each one is associated with a specific infectious syndrome which can possibly be used to define pathotypes or subpathotypes within APEC strains. These results offer new possibilities with which to study the genes responsible for various pathogenetic processes within APEC strains, and for vaccine development. It may be important to consider these subgroups when developing a vaccine in an effort for obtain cross protection, which has not yet been successfully accomplished when working with APEC strains

Ceratite aguda por herpes zoster: um relato de caso/ Acute zoster keratitis: a case report

Introdução: O vi?rus varicela-zo?ster (VZV), ou herpesvi?rus tipo 3, causa duas síndromes virais distintas: varicela (catapora) e herpes-zo?ster. O principal fator desencadeante do herpes zo?ster e? a idade avançada, seguida por imunossupressão, trauma e irradiac?a?o. O herpes-zo?ster ofta?lmico (HZO) se inicia com o pro?dromo de febre, cefaleia e fadiga, e, posteriormente, evolui com manifestações cutâneas localizadas no derma?tomo inervado pelo ramo acometido. O exantema inicia-se como erupc?a?o maculopapular, evoluindo para vesículas de conteúdo claro que tornam-se pu?stulas flavas e, posteriormente, crostas. Alguns sinais são característicos do acometimento do ramo trigêmio, como o sinal de Hutchinson (vesi?culas e pústulas na ponta do nariz). O tratamento da fase aguda do HZO e? sistêmico, com o uso de antivirais orais no paciente imunocompetente e tópicos quando há ceratite. Relato de caso: Paciente de 82 anos, proveniente de Onça de Pitangui, MG. Apresentou-se em abril/2018 à UBS queixando-se de hiperemia, dor conjuntival e secreção ocular flava, além de lesão pruriginosa em região frontal. É firmado o diagnóstico de conjuntivite bacteriana e iniciado tratamento com Cilodex®. Após 3 dias, paciente evolui com aparecimento de pústulas em região frontal e dorso nasal. Encaminhado ao hospital em Belo Horizonte, foi efetuado diagnóstico de ceratite herpética por VZV. Discussão: O paciente avaliado apresenta fatores desencadeantes, como exposição solar e idade que corroboram com o desenvolvimento de HZO. Sintomas prodrômicos não foram encontrados no caso, apesar de serem frequentes nessa patologia. O sinal de Hutchinson, indicativo de acometimento do ramo nasociliar do nervo oftálmico, foi o direcionador para a possibilidade diagnostica de HZO e para posterior investigação especifica de ceratite herpética. O tratamento deve ser introduzido precocemente para evitar complicações e sequelas.  Conclusão: A ceratite herpética por VZV é, portanto, um quadro desafiador no aspecto de identificação e tratamento. Faz-se assim importante o relato do caso, para que possa-se ter maior conhecimento sobre a lesão e menos complicações, como danos oculares irreversíveis. O tratamento é simples e, quando adequado, evita perda visual permanente

Changing in the post-surgery infective complications following the shortening of the antibiotic prophylaxis in the patients undergoing skin dermal substitutes reconstruction

Background: Bioengineered skin dermal substitutes (SDS) represent a novel therapeutic opportunity for restoring damaged tissue, both in massive deep burns, extensive full-thickness wounds, and reconstruction after cancer resection. Antimicrobial prophylaxis duration in such procedures has not been well established yet. The aim of the study was to evaluate the changing of infective complications following shortening of perioperative prophylaxis in patients undergoing surgical reconstruction with SDS. Material & Methods: Infective complications at the site of SDS were compared in two groups of patients: subjects undergoing surgical reconstruction between September 2014 and January 2016 (PERIOD A) who received a >24h-antibiotic prophylaxis, and subjects undergoing surgical reconstruction between May 2016 and June 2017 (PERIOD B) who received a ≤24h-antibiotic prophylaxis. Differences in the incidence of infection and pathogen prevalence were explored. Univariate linear regression analysis was performed to evaluate the risk factors for infection (sex, age, ASA code, perioperative antibiotic prophylaxis, site of SDS intervention, type of SDS, dimensions of surgical area, chronic renal impairment, and diabetes mellitus). Results: Between September 2014 and June 2017, 116 patients underwent a surgical reconstruction with a SDS. The 66.4% (n=77) of the study population was male, and the mean age was 73 years (22-92 years). Seventy-eight patients (67.2%) were positive for hypertension, 20 (17.2%) for diabetes mellitus, 16 (13.8%) for chronic renal impairment, 22 (19%) were former or current smokers, and 45 (38.8%) had an ASA code ≥3. In the 94.8% of the patients (n=110) the reason of surgical intervention was a skin cancer. Surgical SDS reconstruction involved the scalp in 44 cases (37.9%), the face in 28 (24.1%), the chest in 11 (9.5%), the arm or the hand in 9 (7.8%), the leg in 12 (10.3%) and the foot in 12 (10.3%). Among 116 patients undergoing SDS surgical reconstruction, 62 (53.4%) received a >24h-prophylaxis and 54 (46.6%) received a ≤24h-prophylaxis. The average duration of prophylaxis in the 2 groups of patients was 6.6 days and 0.5 day, respectively. Overall incidence rate of infection was 20.7% (24/116). The most frequently isolated pathogen was S. aureus (41.6%), followed by P. aeruginosa (29.1%), P. mirabilis (8.3%), and E. faecalis (4.1%). Patients undergoing SDS reconstruction in limb/foot had higher infection rate in comparison with those undergoing SDS reconstruction in chest/head (33.3% and 15.6%, respectively; p=0.034). No differences in the infection rate were observed between the patients who received >24h or ≤24h-antibiotic prophylaxis (22.5% and 18.5%, respectively; p=0.590). The two groups resulted similar for gender, age, comorbidities, ASA score, and type of skin cancer. No significant differences in pathogen prevalence were found (p=0.692). Conclusion: Antibiotic prophylaxis reduction to 24 hours or less demonstrated to be beneficial to patients undergoing surgical reconstruction with SDS. Shortening of antibiotic prophylaxis did not increase infection rate, and it allowed to reduce of 6 days-per-patient the antibiotic exposure

Genomic heterogeneity and efficacy of PI3K pathway inhibitors in patients with gynaecological cancer

Malignitats ginecològiques; Fracció al·lel mutant; PI3KNeoplasias ginecológicas; Fracción alélica mutante; PI3KGynecologic malignancies; Mutant allele fraction; PI3KObjectives Aberrant PI3K/AKT/mTOR activation is common in gynaecological malignancies. However, predictive biomarkers of response to PI3K pathway inhibitors (PAMi) have yet to be identified. Methods We analysed the outcomes of patients with advanced gynaecological cancer with available genomic data, treated with PAMi as single agents or in combination in phase I clinical trials. Clinical relevance of the PIK3CA mutant allele fraction (MAF) was investigated. MAF of each variant was normalised for tumour purity in the sample (adjMAFs) to infer clonality of PIK3CA mutations, defined as clonal (≥0.4) or subclonal (<0.4). Results A total of 50 patients with gynaecological cancer (24 ovarian; 15 endometrial; 11 cervical) with available targeted mutation profiling were selected. PAMi therapy was matched to PIK3CA/PTEN mutation in 30 patients (60%). The overall response rate, median time to progression (mTTP) and clinical benefit rate (CBR) of the entire population were 10% (N=5), 3.57 months (2.57–4.4) and 40% (N=18), respectively. Genotype-matched therapy did not lead to a favourable CBR (OR 0.91, p=1 (0.2–3.7)) or mTTP (3.57 months (2.6–4.4) vs 3.73 months (1.9–13.2); HR 1.41; p=0.29). We did not detect differences in mTTP according to therapy or PIK3CA codon mutation (HR 1.71, p=0.24). Overall, 41% of patients had a TTP ratio (TTP PAMi/TTP on immediately prior or subsequent palliative chemotherapy) ≥1.3, without statistically significant differences according to tumour type (p=0.39), molecular alteration status (p=0.13) or therapy (p=0.54). In univariate analysis, genotype-matched therapy in patients with PIK3CA clonal events was associated with improved mTTP (HR 3.6; p=0.03). Conclusions Our study demonstrates that patients with advanced gynaecological cancer, refractory to standard therapies, achieved meaningful clinical benefit from PAMi. The impact of PI3KCA clonality on response to selected PAMi in patients with gynaecological cancer deserves further investigation

The Phytochemical Constitution of Maltese Medicinal Plants – Propagation, Isolation and Pharmacological Testing

Fourteen Maltese medicinal plants, that were significantly used in tradition, were studied for their phytochemical constitution and pharmacological activities. These include Drimia maritima (L.) Stearn, Ecballium elaterium (L.) A.Rich., Mentha pulegium L., Salvia officinalis L., Verbena officinalis L., Hedera helix L., Crataegus monogyna Jacq., Calendula officinalis L., Melissa officinalis L., Olea europea L., Urtica dubia Forsk., Capparis spinosa L., Ephedra fragilis Desf. and Nicotiana glauca RC Graham. Cultivation and micropropagation practices, in relation to secondary metabolite production, were also considered for some these plants. This article highlights the main findings for these plants.peer-reviewe