Organ donation in Malta : what’s new?

Malta transposed Directive 2010/45/EU of the European Parliament and of the Council of 7 July 2010 on standards of quality and safety of human organs intended for transplantation (European Parliament and Council, 2010) on 12th October 2012 through Legal Notice 345 of 2012, entitled Organ Transplants (Quality and Safety) Regulations, 2012, Subsidiary Legislation to the Human Blood and Transplants Act (Cap483), enacted in 2006. This long awaited legislation provides a firm legal backing for transplantation services that are structured such as to ensure health and safety to both donor and recipient. The regulations apply to practices and procedures along the entire pathway from donation to transplantation of solid organs, and even beyond, to the collection of post transplant medical data. Malta has a good track record of safe working practices in transplant services. These have been offered since the early 1980’s, initially limited to corneal transplants, but soon followed by the first kidney transplant in 1983. Heart transplants are performed once a year, with the first being in 1996. (Transplant Support Group, Malta, 2013) Patients requiring liver transplants are referred to the UK while recently, in 2011, an agreement was reached with Palermo, Sicily for a lung transplant service. (ACCORD, 2012)peer-reviewe

Attitudes of family doctors, attached to the Department of Family Medicine, towards consulting and treating young people

Background: There is a perceived concern that there is no law which governs the right of young people (YP), defined as ages 15-18, to be treated by doctors and to have their privacy protected from their parents or legal guardians. On the other hand doctors seem not to be covered by a specific law which allows them to see and treat this age group, although the Medical Council has expressed itself once in this regard. Method: This study aimed to assess the perception of doctors to seeing young adults alone since they are considered vulnerable because of their age and may not express concerns and practices if in front of parents or guardians. In this regard a questionnaire was delivered to family doctors attached with the department of family medicine at the University of Malta. Results: the response rate was 72.5%. Most respondents were males. Most (89.6%) agreed that YP have a right toe speak to the family doctor alone. Doctors are happy to discuss various topics with YP alone, but in certain issues, find difficulty in providing treatment to YP alone. There seems to be a significant difference in attitude towards the sex of the doctor with respect to the sex of the patient. Conclusion: The study was meant to be a pilot study including those doctors attached to the Department of Family Medicine at the Medical School, with a future study planned on a larger number. The significance and importance of the results however merited previous publication of this study as a sentinel. Doctors are largely concerned about the law and are sometimes reluctant to see young adults alone even if they feel that they should be able to do so. The importance of having a clarification of the law by an amendment is discussed.peer-reviewe

Dwarna : a blockchain solution for dynamic consent in biobanking

Dynamic consent aims to empower research partners and facilitate active participation in the research process. Used within the context of biobanking, it gives individuals access to information and control to determine how and where their biospecimens and data should be used. We present Dwarna—a web portal for ‘dynamic consent’ that acts as a hub connecting the different stakeholders of the Malta Biobank: biobank managers, researchers, research partners, and the general public. The portal stores research partners’ consent in a blockchain to create an immutable audit trail of research partners’ consent changes. Dwarna’s structure also presents a solution to the European Union’s General Data Protection Regulation’s right to erasure—a right that is seemingly incompatible with the blockchain model. Dwarna’s transparent structure increases trustworthiness in the biobanking process by giving research partners more control over which research studies they participate in, by facilitating the withdrawal of consent and by making it possible to request that the biospecimen and associated data are destroyed.peer-reviewe

Primary study of the non-marine epilithic diatom communities of Malta and Gozo

Non-marine epilithic diatom communities of two major Maltese islands, Malta & Gozo, were investigated for the first time. Fourty four samples were collected from eleven stations, which represented different springs and spring-fed streams distributed over the two islands. Extraction of diatoms and preparation of clean slides for microscipic investigation was carried out. A total number of 51 taxa belonging to 23 genera were identified. The most represented genera were Nitzschia, Amphora, Surirella, Luticola & Navicula. The most represented species were Gomphonema parvulum, Hanztschia amphysioxy, Nitzschia palea & Amphora ovalis. Most of the identified taxa show moderate to strong association with pollution, and show potential as indicators for forensic science and environmental assessment.peer-reviewe

Health, bioethics and the law

This book sets out the provisions of Maltese Law dealing with health, bioethics and the law in an organised and user-friendly manner. It also discusses the various international and regional contributions which have been made in this delicate field by way of, inter alia, international and regional conventions, declarations, recommendations and plans of action which are undoubtedly pertinent to a study of this nature. This publication demonstrates how complex the law is in this field of human knowledge. It can be seen also that over the last few years there has been an entire overhaul of Maltese law concerning health and the health sector but, this notwithstanding, there are certain areas where Malta is still lagging behind. These aspects need undoubtedly further deep thought with a view to regulation, for as things stand today, in certain cases much is left to the discretion of the medical practitioner, with no local guidelines provided to act as eye openers for the profession, as to how it should conduct itself in such instances. Yet, where there are lacunae in the law, the authors have directed the reader to foreign sources which may possibly be of assistance to the local authorities in adopting similar codes of practice or guidelines. Health, Bioethics and the Law is a compendium of legislation - both primary and secondary- on the subject under review. It serves as a ready reckoner for those members of the medical profession who do not have the time to stay researching where to find the pertinent provisions of the law dealing with health issues and, to this extent, it makes life easier for one and all. This vademecum is also of interest to the law practitioner, to medical and law students and, generally, to the various professions referred to in this publication itself who have a role to play within the health sector.peer-reviewe

Serum amyloid A in airway cells

Introduction: Acute-phase serum amyloid A (A-SAA) molecules, encoded for by SAA1 and SAA2 genes, are cytokine-inducible acute phase proteins. Increased A-SAA is implicated in various chronic inflammatory diseases including rheumatoid arthritis, asthma and COPD. Besides its major hepatic secretory source, extrahepatic A-SAA has been identified in bronchoalveolar lavage fluid, and has been claimed to be a potentially useful biomarker for airway inflammation. The cellular origin of airway-released A-SAA, however remains unknown.peer-reviewe

Systemic inflammation in COPD is not influenced by pulmonary rehabilitation

Purpose: Pulmonary rehabilitation is known to lead to improvements in exercise tolerance, health-related quality of life and help reduce symptoms. Exercise, one of the largest components of such an intervention, although of great benefit, can increase the inflammatory response related to chronic obstructive pulmonary disease, depending on intensity and duration. Through this study, the effects of a 12week, high-intensity PR programme on COPD inflammatory-related markers were investigated. Materials and methods: This study is a longitudinal, observational type of study. Sixty COPD patients were enrolled, 49 of which completed the programme. A 2-h high-intensity PR programme was delivered, twice weekly for 12 weeks. The following markers were assessed at baseline, 4, 8 and 12 weeks through rehabilitation – C-reactive protein, erythrocyte sedimentation rate, neutrophil, eosinophil counts, complete blood count, six-minute walk test and St. George’s Respiratory Questionnaire. Serum amyloid A levels were assessed at baseline, week 8 and 12 and exhaled NO at baseline and upon completion of the programme. Results: This 12-week PR programme resulted in no changes in the inflammatory markers but resulted in significant improvements in both the 6MW distance and health quality of life. Conclusions: Beneficial effects on functional and HRQoL measures resulted, which, however, appear unrelated to changes in the systemic inflammatory markers.peer-reviewe

P-Akt as a biomarker of a subset of triple negative breast cancer patients potentially sensitive to the pp2a activator, FTY720

Introduction: The most commonly used biomarkers to predict the response of breast cancer patients to therapy are oestrogen receptor (ER), progesterone receptor (PgR), and HER2. Patients positive for these biomarkers are eligible for specific therapies including anti-oestrogen therapy for ER and PgR positive patients, and trastuzumab, a monoclonal antibody, in the case of HER2 positive patients. Patients who are negative for all three biomarkers, the so-called triple negatives, however, derive little benefit from such therapies and are associated with a worse prognosis. The PI3K/Akt pathway has been found to be activated in triple negative breast cancer cases, providing a possible target for therapy. Patients having an elevated activation of the PI3K/Akt pathway could benefit from therapies targeting this pathway. Possibilities include using inhibitors of the PI3K/Akt pathway, or drugs which activate phosphatases involved in the pathway such as FTY720 which activates the phosphatase PP2A. Aim: The purpose of this study was to investigate the incidence of increased Akt activation in triple negative breast cancers in Malta by immunohistochemical staining, and the effect of FTY720 on the activation of Akt in two human breast cancer cell lines. Methodology: A serine-473 Akt1 antibody (p-Akt (S473)) was used to investigate the activation of Akt in triple negative breast cancer cases in the Maltese population. Scoring of stained sections was performed on the basis of intensity. Furthermore, the effect of FTY720, a pharmacological activator of the phosphatase PP2A which negatively regulates Akt activity, on the activity of Akt in two human breast cancer cell lines: MCF-7 and HCC1937, was investigated. This was tested under conditions of starvation, and also Akt stimulation by IGF-1 using In-Cell Western blotting. HCC1937 was of particular interest since it is also negative for ER, PgR, and HER2, and is known to have enhanced Akt activity. Results: 27% of triple negative breast cancer patients had an elevated level of p-Akt (S473). FTY720 at a concentration of 1μM, which did not affect cell viability, was shown to suppress Akt activation in MCF-7 and HCC1937 cells subjected to IGF- 1, an activator of Akt. Conclusion: The subset of triple negative having elevated Akt activation (27%) would be eligible for treatment using therapies which target the PI3K/Akt pathway, such as kinase inhibitors or phosphatase activators. The in vitro experiment using FTY720 suggests that it is a potential drug for use in adjuvant therapy in breast cancer cases having a high p-Akt (S473).peer-reviewe

Serum amyloid A in chronic obstructive pulmonary disease

Introduction: Serum Amyloid A types 1 and 2 (SAA1, SAA2) are acute phase proteins elevated in inflammatory conditions. They are biomarkers of disease activity and participants in pathogenesis. Production is primarily hepatic, while pulmonary expression has also been reported in COPD. This project aimed to (i) study the cytokine-induced SAA transcriptional regulation in human airway related cells (ii) investigate temporal changes in serum SAA levels in stable COPD patients undergoing a 12-week pulmonary rehabilitation (PR) programme.peer-reviewe