Delayed discharges and unplanned admissions from the Day Care Unit at Mater Dei Hospital, Malta

Day care units are playing an increasingly important role in healthcare provision, however they require the development of specialised resources to fulfil their role. The rate of unplanned admissions following day-case procedures is considered as one of several indicators of the quality of day-case services available.1 The aim of this study is to identify how often there are delayed discharged or unplanned admissions following day-cases at the Day Care Unit at Mater Dei Hospital (MDH), Malta. A list of patients whose discharge did not go as planned was forwarded daily to the authors by the Bed Management Unit at MDH. The medical files of these patients were then reviewed and data collected. This included demographics, type of procedure carried out and reasons for delayed discharge or unplanned admission. The study was carried out over 45 days.peer-reviewe

Acute liver impairment in a young, healthy athlete : hypoxic hepatitis and rhabdomyolysis following heat stroke

Any process that substantially diminishes arterial blood flow or arterial oxygen content to the liver can result in hypoxic (ischaemic) hepatitis. 90% of hypoxic hepatitis occurs in unstable patients in intensive care units with haemodynamic failure secondary to heart failure, respiratory failure and toxic shock. The rate of in-hospital mortality in hypoxic hepatitis is very high with studies recording mortalities of 61.5%. It tends to be very uncommon in healthy, young patients with no underlying medical problems. We report here the case of a young healthy athlete who developed heat stroke associated with rhabdomyolysis and hypoxic hepatitis while he was running the final stages of a marathon. The patient required intensive care admission and inotropic support for a few hours after he was admitted with heat stroke. He underwent a rapid recovery after he was resuscitated with fluids. N-acetyl cysteine was also given during the acute stage of the hepatitis. This case highlights an uncommon case of hypoxic hepatitis in a young, healthy patient secondary to hypotension and heat stroke. Inotropic support might have precipitated the hypoxic hepatitis in this young patient.peer-reviewe

Perfil do usuário e riscos pelo uso indiscriminado de termogênicos: Revisão de literatura

There has long been an abusive increase in the consumption of nutritional supplements and drugs, which induce greater thermogenic action. The indiscriminate use of these products, without knowledge of their effects and their action, can compromise the quality of life of the individual, which can cause harm to health. The objective of the study was to verify through the literature the profile of the user who makes indiscriminate use of thermogenic, report the risks associated with this practice, describe the socioeconomic profile of users, and identify the side effects of these individuals. This is a systematic review study. The search for evidence was carried out in national and international databases: Scielo, PubMed and Google Scholar. If chosen, for select, only field research articles, carried out in human beings, which indicated the socioeconomic profile, the reason for use of supplements and indication of the same and review articles in the period from 2010 to 2020. 18 articles were used, in which a high demand from users of these products was observed, in 9 studies it was reported that the highest percentage of indication was by unprepared people and, in only one study, was related to the higher rate of consumption of these supplements by indication of qualified professionals. Thus, it was possible to conclude in the research contained in this review, that there was a high prevalence of individuals using indiscriminately thermogenic, in addition to their association with various side effects such as insomnia, aggressiveness, headache and, among them, cardiovascular diseases.Há tempos observa-se o aumento abusivo no consumo de suplementos nutricionais e fármacos, que induzem maior ação termogênica. O uso indiscriminado desses produtos, sem conhecimento de seus efeitos e sua ação, pode comprometer a qualidade de vida do indivíduo, podendo causar malefício à saúde. O objetivo do estudo foi verificar através da literatura o perfil do usuário que faz uso indiscriminado de termogênicos, relatar riscos associados com esta prática, descrever o perfil socioeconômico dos usuários e identificar os efeitos colaterais desses indivíduos. Tratou-se de um estudo de revisão de literatura. A busca por evidências foi realizada em bases de dados nacionais e internacionais: Scielo, PubMed e Google Scholar. Optaram-se, por selecionar, apenas artigos de pesquisa de campo, realizados em seres humanos, que indicasse o perfil socioeconômico, o motivo pelo uso de suplementos e indicação do mesmo e artigos de revisão no período de 2010 a 2020. Foram utilizados 18 artigos, no qual foi observado uma grande demanda de usuários desses produtos, em 9 estudos foi relatado uma maior porcentagem de indicação por pessoas despreparadas e, em apenas um estudo, foi relatado maior índice de consumo desses suplementos por indicação de profissionais habilitados. Desta maneira, foi possível concluir nas pesquisas contidas nesta revisão, que houve uma alta prevalência de indivíduos que utilizam indiscriminadamente termogênicos, além da associação deles com diversos efeitos colaterais como insônia, agressividade, dor de cabeça e, entre eles, doenças cardiovasculares

Household energy consumption and solar PV energy generation : a case study in Malta

The household energy consumption is an essential parameter to design renewable energy generation systems, to carry out demand response studies and to optimize the operation of energy management systems. Nevertheless, only few studies in literature analyze the user’s electrical consumption profile in detail. Hourly data are often used and the electrical loads are typically assumed to operate at their rated power. This paper presents a detailed analysis of the electrical consumption profile of a dwelling located in Malta. The electrical demand was monitored for over one year at a resolution of 30 seconds. Measurements of the electricity generated by a photovoltaic system installed on the roof-top of the dwelling, have also been performed and a parametric analysis has been carried out to evaluate the effect of different solar PV system sizes. Moreover, different strategies to increase the self-consumed electricity and reduce the excess electricity injected into the grid are described.peer-reviewe

Inherent Interfacial Mechanical Gradients in 3D Hydrogels Influence Tumor Cell Behaviors

Cells sense and respond to the rigidity of their microenvironment by altering their morphology and migration behavior. To examine this response, hydrogels with a range of moduli or mechanical gradients have been developed. Here, we show that edge effects inherent in hydrogels supported on rigid substrates also influence cell behavior. A Matrigel hydrogel was supported on a rigid glass substrate, an interface which computational techniques revealed to yield relative stiffening close to the rigid substrate support. To explore the influence of these gradients in 3D, hydrogels of varying Matrigel content were synthesized and the morphology, spreading, actin organization, and migration of glioblastoma multiforme (GBM) tumor cells were examined at the lowest (<50 µm) and highest (>500 µm) gel positions. GBMs adopted bipolar morphologies, displayed actin stress fiber formation, and evidenced fast, mesenchymal migration close to the substrate, whereas away from the interface, they adopted more rounded or ellipsoid morphologies, displayed poor actin architecture, and evidenced slow migration with some amoeboid characteristics. Mechanical gradients produced via edge effects could be observed with other hydrogels and substrates and permit observation of responses to multiple mechanical environments in a single hydrogel. Thus, hydrogel-support edge effects could be used to explore mechanosensitivity in a single 3D hydrogel system and should be considered in 3D hydrogel cell culture systems

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

In vitro and in vivo evaluation of cerium oxide nanoparticles in respiratory syncytial virus infection

Respiratory syncytial virus (RSV) is the most common cause of viral bronchiolitis among children worldwide, yet there is no vaccine for RSV disease. This study investigates the potential of cube and sphere-shaped cerium oxide nanoparticles (CNP) to modulate reactive oxygen (ROS) and nitrogen (RNS) species and immune cell phenotypes in the presence of RSV infection in vitro and in vivo. Cube and sphere-shaped CNP were synthesized by hydrothermal and ultrasonication methods, respectively. Physico-chemical characterization confirmed the shape of sphere and cube CNP and effect of various parameters on their particle size distribution and zeta potential. In vitro results revealed that sphere and cube CNP differentially modulated ROS and RNS levels in J774 macrophages. Specifically, cube CNP significantly reduced RSV-induced ROS levels without affecting RNS levels while sphere CNP increased RSV-induced RNS levels with minimal effect on ROS levels. Cube CNP drove an M1 phenotype in RSV-infected macrophages in vitro by increasing macrophage surface expression of CD80 and CD86 with a concomitant increase in TNFα and IL-12p70, while simultaneously decreasing M2 CD206 expression. Intranasal administration of sphere and cube-CNP were well-tolerated with no observed toxicity in BALB/c mice. Notably, cube CNP preferentially accumulated in murine alveolar macrophages and induced their activation, avoiding enhanced uptake and activation of other inflammatory cells such as neutrophils, which are associated with RSV-mediated inflammation. In conclusion, we report that sphere and cube CNP modulate macrophage polarization and innate cellular responses during RSV infection

Application of Elastomeric Polymers for Bladder Regeneration

The urinary bladder is one of the few organs that has been successfully engineered and implanted in humans for a long-term clinical trial .However; scaffolds such as PGA-collagen used in the previous studies possess inadequate mechanical properties for organs that exhibit large deformation. The present study explored the use of biodegradable elastomers, poly-glycerol sebacate-polycaprolactone (PGS-PCl), poly (ether-urethane) urea (PEUU), and poly (carbonate-urethane) urea (PCUU) for urinary bladder tissue engineering since these materials have previously been shown to exhibit high extensibility and cytocompatibility. The present study compared mechanical properties of PGS-PCL, PEUU& PCUU elastomers. PGS-PCL, PEUU and wet PCUU specimens were subjected to uni-axial tensile loads under hydrated conditions (PBS at 37ºC) at a rate of 18mm/min until rupture using MTS synergie 100. The mechanical behaviors of these materials were analyzed by comparing the maximum tensions and stretch ratios at failure. The Mechanical characterization indicated that the PCUU may be more suitable for the bladder tissue engineering application than PEUU and PGS-PCL. Further studies, characterizing the stiffness of PCUU sutured rat bladders are currently underway using a custom-made in-vitro pressure-volume device

An unusual artery causing an unusual stroke.

Bilateral thalamic infarctions are uncommon and often lead to more severe and long-lasting symptoms than unilateral thalamic infarctions. This article describes a patient with bilateral thalamic infarction caused by occlusion in the artery of Percheron, an anatomic variant thought to be present in 4% to 12% of the population