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San Pawl il-Baħar, Malta

Pace D.,Paediatric Infectious Diseases Clinic | Williams T.N.,Oxford and KEMRI Wellcome Trust Unit | Grochowska A.,Materials Dei Hospital | Betts A.,Materials Dei Hospital | And 3 more authors.
Travel Medicine and Infectious Disease

Leishmania infantum is endemic in the Maltese archipelago, a group of islands in the Mediterranean which are visited frequently by tourists from Northern European countries. The burden of leishmaniasis is highest in children who may present with cutaneous or visceral manifestations. We describe systematically the manifestations, diagnosis and management of leishmaniasis in children <14 years of age, who had a histopathological diagnosis of leishmaniasis in Malta, from 2004 to 2008. Eleven children were diagnosed with leishmaniasis; 8 children (15-44 months of age) had visceral disease and three (aged 9-13 years) suffered cutaneous infections. Prolonged high grade fever, pallor, hepatosplenomegaly, and pancytopenia were common presenting features of visceralisation. Diagnosis was based on the visualisation of amastigotes from bone marrow aspirates. Pentavalent antimonials were associated with treatment failure in two children, whilst liposomal amphotericin B was curative in all. Children with cutaneous leishmaniasis had dry crusted ulcero-nodular lesions on exposed areas which responded to intra-lesional instillation of sodium stibogluconate or to cryotherapy. Leishmaniasis should be included in the differential diagnosis of fever and hepatosplenomegaly or chronic cutaneous lesions in children who travel to Malta. © 2010 Elsevier Ltd. All rights reserved. Source

Objectives: To compare the diagnostic information in detection and assessment of knee pathology from knee radiographs using either the PA standing with partial flexion projection or AP fully extended standing projection. Method: A set of 32 knee radiographs was retrospectively compiled from 16 adult patients imaged using both projections over a 2-year period (PA: n = 16 and AP: n = 16). Repeat radiographs (n = 6) were added to the image set facilitating inter and intra observer reliability. Image evaluation was performed by 5 orthopaedic surgeons performing Absolute Visual Grading Analysis assessing image quality based on 6 anatomical image quality criteria specifically developed to evaluate and compare the two projections. The resulting image quality scores were analysed using Visual Grading Characteristics. Results: Image quality scores were higher for the PA projection but variation between the two projections was not significant (p > 0.05). The PA projection was significantly (p < 0.05) better in the visualization of 2 anatomical image quality criteria involving the joint space width and tibial spines. Conclusion: Both projections can be used for general evaluation of the knee joint, however the PA partial flexion projection is preferred for the investigation of specific knee pathology. Recommendations for minimizing variations in radiographic positioning technique are also highlighted. © 2015 The College of Radiographers. Source

Campone M.,Center Rene Gauducheau | Campone M.,French Institute of Health and Medical Research | Bondarenko I.,Dnepropetrovsk State Medical Academy | Brincat S.,Sir Paul Boffa Hospital | And 10 more authors.
Annals of Oncology

Background: This phase II study evaluated single-agent bosutinib in pretreated patients with locally advanced or metastatic breast cancer. Patients and methods: Patients received oral bosutinib 400 mg/day. The primary end point was the progression-free survival (PFS) rate at 16 weeks. Secondary end points included objective response rate, clinical benefit rate, 2-year overall survival rate, safety, and changes in levels of bone resorption/formation biomarkers. Results: Seventy-three patients were enrolled and treated. Median time from diagnosis of metastatic disease to initiation of bosutinib treatment was 24.5 months. For the intent-to-treat population, the PFS rate at 16 weeks was 39.6%. Unexpectedly, all responding patients (n = 4) were hormone receptor positive. The clinical benefit rate was 27.4%. The 2-year overall survival rate was 26.4%. The main toxic effects were diarrhea (66%), nausea (55%), and vomiting (47%). Grade 3-4 laboratory aminotransferase elevations occurred in 14 (19%) patients. Myelosuppression was minimal. No consistent changes in the levels of bone resorption/formation biomarkers were seen. Conclusions: Bosutinib showed promising efficacy in prolonging time to progression in chemotherapy-pretreated patients with locally advanced or metastatic breast cancer. Bosutinib was generally well tolerated, with a safety profile different from that of the Src/Abl tyrosine kinase inhibitor dasatinib in a similar patient population. © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. Source

Gouder C.,Materials Dei Hospital | West L.M.,Sir Paul Boffa Hospital | Montefort S.,University of Malta
International Journal of Clinical Pharmacy

Background Omalizumab was introduced in Malta in 2011. To date, no local data have been published. Objective To obtain baseline characteristics of our local cohort, determine effectiveness of omalizumab at 52 weeks, compare clinical outcomes 52 weeks pre- and postomalizumab therapy and to assess its safety and tolerability. Setting The Mater Dei Hospital in Malta. Method All consented adult patients who were eligible to start treatment with omalizumab for asthma were enrolled in this open, prospective observational real-life study. A questionnaire was completed and an Asthma Control Test and spirometry performed. Patients were reviewed on a regular basis. Any undesirable symptoms were recorded. Treatment effectiveness was evaluated at 16 and 52 weeks, during which a decision was taken whether patients were responders. Outcomes were compared 52 weeks pre- and post- treatment initiation. Main outcome measure To determine effectiveness of treatment following 1 year of omalizumab by assessing its impact on the rate of asthma-related exacerbations and health care utilization including hospitalizations. Results Our cohort included 22 patients, all non-smokers (mean age 52.7 ± 11, 64 % males). The mean baseline IgE level was 448.6 ± 444 IU/ml. At week 12, treatment was stopped in one patient due to arthralgias. The drug was stopped in two patients at week 16 due to treatment ineffectiveness. At week 20, treatment was stopped in another patient in view of arthralgias. A significant reduction in the number of asthma exacerbations (p = .03) and number of systemic steroid courses required (p = .03) was identified at 52 weeks. There was a significant improvement in the ACT score (p < .001) after 52 weeks but no significant improvement in FEV1. There was a non-significant decline in the number of hospitalizations (p = .6), asthma-related healthcare visits (p = .2) and days off work (p = .09). Adverse events occurred in 10 % of patients. Costs related to asthma hospital-stay and medicines administered during hospitalisations were decreased by half following 1 year on omalizumab. Conclusion Omalizumab treatment resulted in an improved asthma control, with a significant reduction in asthma exacerbations and systemic steroid courses required and improvement on ACT score. Adverse events were infrequent and the drug was well tolerated. © 2014, Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie. Source

Sciberras C.,Materials Dei Hospital | Boffa M.J.,Sir Paul Boffa Hospital
Malta Medical Journal

A review of a Paediatric Dermatology clinic set up in 2009 at the Department of Dermatology and Venereology, Sir Paul Boffa Hospital, was carried out in 2011. The aim of the exercise was to identify the main conditions being seen in this clinic and to analyse management and referral patterns. Data was collected on a total of 130 patients (80 new and 50 follow-up). Of the patients attending, 86 (66%) were males and 44 (34%) were females. Overall, the commonest conditions seen were acne, eczema, naevi, fungal infections and psoriasis. General practitioners accounted for 69% of referrals whereas paediatricians and other specialists accounted for the other 31%. Of the 80 new patients seen, 55% were given a follow-up appointment in the Paediatric Dermatology clinic, 30% were discharged and 15% were given an appointment for further therapy e.g. skin surgery, laser treatment or cryotherapy. Parents/carers accompanying children to the clinic all stated that Saturday was the best day of the week for them to attend. Source

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