Scanning medical images for screen presentation

The purpose of this article is to remove the myths and black art surrounding electronic imaging and prove beyond doubt that any mind competent in the workings of the human body is capable of producing good on-screen images from adequate equipment. Note that in this day and age of SI units imaging still uses inches to describe diagonal screen size and pixels per inch to describe resolution.peer-reviewe

Maltese national birth weight for gestational age centile values

The relevance of using literature derived birth weight for gestational age centile charts for the Maltese population is debatable. The study set out to develop national weight for gestational age centile charts and compare these to other populations. Method: Anonymised birth weight for gestational age data with relevant maternal and neonatal observations over the period 1995-2009 were obtained from national statistics. The formats were standardised and imported into an SQL database that enabled filtration for single live births and grouping by sex. The data was scrutinized manually for obvious keying errors. The best estimate of gestational age from the last menstrual period (LMP) and expected date of delivery (EDD) was selected using established guidelines. A Box-Cox gamma transform was used to fit the model and generate separate centile charts. The data was compared to previous birth weight data reported in Maltese newborns in previous decades and to data from other countries. Results: A total of 58,899 neonates were included in the study and birth weight for gestational age centile charts were generated between 23 and 42 weeks of gestation using Revolution R with VGAM. There has been a statistically significant gradual fall in mean birth weight in Maltese newborns over the last four decades. There are also statistically significant differences between the Maltese data and those from other countries. Conclusion: The observed differences make the use of national birth weight for gestational age centile charts desirable both for routine clinical assessment and epidemiological studies.peer-reviewe

Surgical excision of renal cell carcinoma with caval and intra-atrial tumour thrombus extension using deep hypothermic circulatory arrest

Surgery for tumour thrombus extension in Renal Cell Carcinoma may be associated with a good prognosis if no distant metastases are identified and if the thrombus can be completely excised. The surgical approach chosen will depend on the level of tumour thrombus extension. We present a case of Renal Cell Carcinoma in the right kidney with tumour thrombus extension into the right atrium. This was successfully removed by right radical nephrectomy and excision of the atrial thrombus using cardio-pulmonary bypass and deep hypothermic circulatory arrest. This is the first procedure of its kind to be undertaken in Malta.peer-reviewe

Outcome of Nephrectomies in Malta since 2000

Aim: To audit the oncological results and perioperative surgical outcome of nephrectomies performed in Malta since year 2000. Method: A retrospective index case list of all nephrectomies carried out by three urological surgeons at St Luke’s and Mater Dei Hospitals from 1st September 2000 to 31st March 2012 was compiled from departmental data. Clinical, radiological and histological data were compiled from the case notes and hospital intranet computerised investigation results. Clinical staging of all patients was revised using the Union Internationale Contre le Cancer TNM staging 2009. All the patients who underwent nephrectomy for clear cell renal cell carcinoma were stratified according to individual predicted prognosis based on the SSIGN score developed by the Mayo clinic. Results: Between September 2000 and March 2012, 319 nephrectomies were carried out at the Urology Unit, of these 288 were carried out for malignancy, 218 of which were clear cell renal cell carcinoma (RCC). 112 complications were recorded for the whole cohort; two patients died from perioperative complications. 80 patients passed away, 51 of these as a direct consequence of their renal cell cancer. Median duration of follow up was 42.7 months. A Cox model reveals that a SSIGN score greater than 6 significantly worsens survival rate for RCC (p<<0.001). Conclusion: Morbidity following surgery, mortality rates, and oncological results in our single centre study are acceptable when compared to larger series.peer-reviewe

An overlooked and unexpected introduction? Occurrence of the spotted scat Scatophagus argus (Linnaeus, 1766) (Osteichthyes : Scatophagidae) in the Maltese Islands

The spotted scat Scatophagus argus (Linnaeus, 1766) is recorded for the first time from Malta and the Mediterranean from fish offered for sale at a Maltese fish market. Interviews with fish sellers and fishermen showed that this fish is caught occasionally in small numbers in trammel nets from shallows on seagrass meadows in the southeast of Malta and that it has been present since at least 2007. The native range of the species is the Indian Ocean and the tropical to warm temperate Pacific but the species is commercially available as a brackish water aquarium fish. Given that this species has also been regularly imported into Malta by the aquarium trade since at least 1986, an escape or deliberate release by an aquarist seem to be the most probably mode of introduction. It is surprising that this euryhaline species which requires brackish water to complete its life cycle should have become established in Malta where there is a dearth of such habitats.peer-reviewe

Occurrence of Paraleucilla magna Klautau et al., 2004 (porifera : Calcarea) in Malta

The calcareous sponge Paraleucilla magna, first recorded from the Mediterranean in 2001 (southern Tyrrhenian, southern Adriatic and northwest Ionian coasts of Italy), is recorded from Malta (Central Mediterranean) where it was found forming part of the fouling community on small, surface marker-buoys around a fish-farm in Marsaxlokk Bay.peer-reviewe

Local survival outcomes in metastatic renal cell carcinoma

A quarter of patients who develop renal cell carcinoma will have metastatic disease at presentation. The role of cytoreductive surgery in these patients is a topic of debate. The aim of this study was to analyse survival outcomes of patients treated in Malta who did and did not receive a nephrectomy. Data was gathered retrospectively from the Malta Cancer Registry and Mortality Data at the Department of Health Information, records of multidisciplinary team meetings held within the urology department at Mater Dei Hospital, hospital imaging and patient records. Data gathered included: patient demographics, date of diagnosis, TNM staging, tumour histology, Fuhrman grade, time to treatment and modality of treatment. Exclusions included: • Localized disease relapsing after surgery • Non-renal cell histological subtypes • Presence of metastasis at diagnosis not certain • Concomitant primary tumours 77 patients diagnosed over 5 years between 04.03.2005 and 13.2.2009 were included. The age at presentation ranged from 30 to 88 years, with a median age of 67 years. 11 were incidental findings and 47 were symptomatic. The most prevalent symptoms were abdominal pain and gross haematuria. Five-year cancer specific survival in patients who received a nephrectomy was significantly better at 65%, compared to patients who did not undergo surgery (32%) P value <0.05, CI 95%. These results where compared favourably with SEER data outcomespeer-reviewe

Blood-Based Protein Changes in Childhood Are Associated With increased risk for later psychotic disorder: evidence from a nested case–control study of the ALSPAC Longitudinal Birth Cohort

The identification of early biological changes associated with the psychotic disorder (PD) is important as it may provide clues to the underlying pathophysiological mechanisms. We undertook the first proteomic profiling of blood plasma samples of children who later develop a PD. Participants were recruited from the UK Avon Longitudinal Study of Parents and Children (ALSPAC) cohort who also participated in psychiatric assessment interviews at age 18. Protein expression levels at age 11 were compared between individuals who developed PD at age 18 (n = 37) with population-based age-matched controls (n = 38). Sixty out of 181 plasma proteins profiled were found to be differentially expressed (P < .05) in children with an outcome of the PD. Thirty-four of these proteins were found to be differentially expressed following correction for multiple comparisons. Pathway analysis implicated the complement and coagulation cascade. A second, targeted proteomic approach was used to verify these findings in age 11 plasma from subjects who reported psychotic experiences at age 18 (n = 40) in comparison to age-matched controls (n = 66). Our findings indicate that the complement and coagulation system is dysregulated in the blood during childhood before the development of the PD

Empirically driven transdiagnostic stages in the development of mood, anxiety and psychotic symptoms in a cohort of youth followed from birth

Staging models with transdiagnostic validity across mood, psychotic, and anxiety disorders could advance early intervention efforts as well as our understanding of the common underpinnings of such psychopathology. However, there are few well-supported operationalisations for such transdiagnostic models, particularly in community-based samples. We aimed to explore the inter-relationships among mood, psychotic, and anxiety symptom stages, and their common risk factors to develop data-informed transdiagnostic stages. We included participants from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective ongoing birth cohort study. We developed operational thresholds for stages of depressive, hypomanic, anxiety, and psychotic symptoms based on the existing literature, refined further by expert consensus. We selected 1b level as the primary stage or outcome of interest. This represents moderate symptoms that are likely to be associated with the onset of the need for clinical mental health care. We used questionnaire and clinic data completed by young people ages 18 and 21 years. We used descriptive methods and network analyses to examine the overlap among Stage 1b psychopathology. We then examined the patterns of relationships between several risk factors and 1b stages using logistic regressions. Among 3269 young people with data available to determine all symptom stages, 64.3% were female and 96% Caucasian. Descriptive and network analyses indicated that 1b level depressive, anxiety, and psychotic symptom stages were inter-related while hypomania was not. Similarly, anxiety, depressive, and psychotic 1b stages were associated with the female sex, more emotional and behavioral difficulties in early adolescence, and life events in late adolescence. Hypomania was not related to any of these risk factors. Given their inter-relationships and similar risk factors, anxiety, psychotic and depressive, symptoms could be combined to form a transdiagnostic stage in this cohort. Such empirical transdiagnostic stages could help with prognostication and indicated prevention in youth mental health