An observational study of the Covid-19 situation following the first pan-European mass sports event.

BACKGROUND: All events in Europe, including EURO2020 football championship, were postponed due to Covid-19 in 2020. Instead, Euro2020 took place in 2021, as mitigation measures were relaxed, cross-country mobility increased and the Delta variant was spreading across Europe. This study explored the possibility of an increased Covid-19 spread across Europe following EURO2020 matches. METHODS: Covid-19 data on cases, vaccination and delta variant for participating countries, host cities/regions and neighbouring countries, for May till July 2021, were obtained from European Centre for Disease Prevention and Control, Our World in Data, Johns Hopkins COVID-19 Dashboard and the UK Government website. EURO2020 data were obtained from the Union of European Football Associations official website. RESULTS: A general increase in Covid-19 positivity trend in Europe was observed following a week of EURO2020 matches across most countries and host cities. A similar trend was observed for the Delta variant sample positivity rate. The increased incidence was mostly among the young generation (<49 years). A decline in positive cases was observed on a national level for most countries following the Finals match. CONCLUSION: The EURO2020 was an anticipated mass sports event, and it was the first-time spectators were allowed to enter stadiums in Europe. Stadiums instituted several mitigations to safeguard the spectators although reports of transmission were still present. The major challenges were the gatherings outside the stadiums that might have contributed to these observations. Targeted restrictions might be required during mass sport events especially in the presence of highly transmissible variant(s) and low vaccination rates among the young generation.

Sella turcica bridging: a systematic review.

PURPOSE: Sella turcica bridging (STB) has significant implications during neurosurgery, since it alters regional anatomy; however, no studies have investigated the global prevalence of STB. Our systematic review aimed to establish the global prevalence of STB, in specimens/individuals with and without comorbidities, in males and females, and of partial, complete, unilateral, and bilateral bridging. METHODS: A literature search was conducted in MEDLINE/PubMed, ScienceDirect, and Google Scholar with various key words relating to Sella turcica bridging. Quantitative data were extracted and statistically analysed. RESULTS: Eighty-two studies satisfied our inclusion criteria. The mean prevalence of STB was 26.54%, and most prevalent in Europe. STB was detected more frequently using radiological investigations. STB was less prevalent in healthy individuals (21.12%) when compared to individuals with comorbidities (33.31%). Partial STB was found to be the more prevalent in both individuals with (41.06%) and without (21.55%) comorbidities. The prevalence of unilateral and bilateral STB was only studied in healthy individuals, with unilateral bridging being the more prevalent (6.26% vs 3.84%). CONCLUSION: The global overall prevalence of Sella turcica bridging in the general population was found to be higher than previously thought. Anatomical and embryological textbooks should consider including information on STB in their texts, due to its considerable prevalence and effects to the regional anatomy.

Wnt/PCP signalling cascade disruption by JNK inhibition as a potential mechanism underlying the teratogenic effects of potato glycoalkaloids.

It is hypothesised that the inhibition of the non-canonical Wnt/PCP intracellular signalling cascade by potato glycoalkaloids, [Formula: see text]-solanine and [Formula: see text]-chaconine, results in an increased risk of neural tube defects (NTDs). One very prominent intracellular signalling pathway with substantial implications in the development and closure of the neural tube is the Wnt/PCP pathway. Experimental inhibition of this results in NTDs. A vital element of this signalling cascade is JNK, which controls the transcription of DNA, which controls cell polarity and directional cell migration. JNK inhibition also results in NTDs experimentally. Through their use in cancer research, [Formula: see text]-solanine and [Formula: see text]-chaconine were found to inhibit metastasis by inhibiting JNK, among other intracellular signalling molecules. Thus, this shows that potato glycoalkaloids increase the likelihood of causing NTDs by inhibiting the proper functioning of JNK in the Wnt/PCP pathway, resulting in defective neural tube closure.

From Trauma to Tumor: Exploring Post-Traumatic Brain Injury Glioblastoma Patient Characteristics.

OBJECTIVE: Glioblastoma multiforme (GBM) following traumatic brain injury (TBI) is very rare and has not been comprehensively characterized by current literature. This systematic review aimed to characterize demographics of patients with post-TBI GBM. METHODS: A systematic review of case studies and case series was conducted for reports published up to April 2023. All case reports that satisfied the criteria for diagnosing post-TBI GBM were included. The JBI case report appraisal was used to assess the quality of reporting of included articles. RESULTS: Our review comprised 13 studies including 16 patients, most of whom were male (81%). Contusive TBI was the most frequent initial insult observed, with most patients requiring surgical intervention to manage TBI. The median latency between TBI and GBM diagnosis was 9.5 years with a negative correlation observed against patient age at TBI occurrence, but a positive correlation was noted for patients with IDH-wildtype GBM. Median age at GBM diagnosis was 56 years. CONCLUSIONS: This systematic review highlights a possible link to GBM development at the previous TBI site. Updated criteria for identifying post-TBI brain tumors are proposed to keep abreast with the latest advances in classifying central nervous system tumors. To establish a definitive link, a large-scale international multicenter study investigating the occurrence of World Health Organization grade IV IDH-wildtype de novo GBM after TBI is crucial. Regular monitoring, especially in middle-aged and older patients with TBI, is advisable.

Analysing the Impact of an Elective Research Experience on Medical Students' Research Perceptions.

Introduction: Physicians are at the centre of bench-to-bedside research, yet the number of physicians engaging in research is declining. One solution to overcome this alarming trend is exposing medical students to research. This study aims to assess the impact of engaging medical students in research, and the feasibility of conducting research solely using online communication. Methods: A pilot elective research opportunity was offered to medical students enrolled to the University of Malta Doctor of Medicine and Surgery course by a resident academic (summer 2021) of the same institute to assess the epidemiology of COVID-19 in Europe. An anonymous survey was distributed to seventy medical students recruited to participate in this elective research project. The data collected was analysed and interpreted. Results: A response rate of 88.73% was achieved. "Career progression" and "lack of time" were the most reported motivating and hindering factors towards conducting research, respectively, before engaging in a research experience. Research experience helped overcome reported barriers (p < 0.01), while also challenging students' perceptions towards research. An increase in positive perceptions towards research was observed after conducting research. An overwhelming majority (90.47%) of participants reported that mentorship played an influential role in their overall experience, and 95.24% commented that they would like research opportunities to be made available by their faculty. Discussion and Conclusion: Giving students the opportunity to conduct research demonstrated how research experience improves students' soft skills and the understanding of research. This study also portrayed how remote research opportunities are effective in engaging students and increased the number of students who would consider a career in research. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01727-w.

LITT for biopsy proven radiation necrosis: A qualitative systematic review.

INTRODUCTION: With the widespread use of stereotactic radiosurgery (SRS), post-radiation treatment effects (PTREs) are increasing in prevalence. Radiation necrosis (RN) is a serious PTRE which carries a poor prognosis. Since 2012, laser interstitial thermal therapy (LITT) has been used to treat RN. However, reviews have attempting to generalise the efficacy of LITT against biopsy-proven RN are limited. In this systematic review, patient demographic characteristics and post-LITT clinical outcomes are characterised. METHODS: A systematic literature search was conducted in four major databases for cohort studies and case reports published between 2012 and 2022, following the PRISMA 2020 checklist. Data was extracted and descriptively analysed. Quality of reporting was assessed using the PROCESS criteria and reporting bias was evaluated using the ROBINS-I scoring system. RESULTS: Eleven studies met our inclusion criteria, with an overall moderate risk of reporting bias being observed. Mean pre-LITT target lesion volume was 6.75 cm3, and was independent of gender, time since SRS, age and number of interventions prior to LITT. DISCUSSION AND CONCLUSION: LITT is a versatile treatment option which may be used to treat a vast range of patients with refractory biopsy-proven RN. However, neurosurgeons should exercise caution when selecting patients for LITT due to insufficient data on the treatment's efficacy against biopsy-proven RN. This warrants further studies to unequivocally determine the safety and clinical outcomes.

Allied Health Professional Students' Perceptions on Research: A Multi-disciplinary Mixed-Methods Study.

Introduction: Modern medicine necessitates evidence-based interdisciplinary patient care. Research is at the centre of fostering an evidence-based mindset in healthcare teams. Studies have demonstrated that exposing students to research translates into better patient care. Studies investing the perceptions of students towards research have focused on the views of medical students, leaving the perceptions of allied health professional (AHP) students unaccounted for. Methods: A mixed-methods, anonymous online questionnaire was distributed to 837 AHP students studying at the University of Malta, across five different courses. The collected data was then statistically analysed through descriptive statistics and chi-square testing. Qualitative results were coded, triangulated and subsequently analysed. Results: An overall response rate of 28.43% was achieved. Only 2.49% of respondents managed to publish research, despite many participants stating that research is important for their future careers. Career progression and lack of opportunity were identified as the major motivating and stumbling factors, respectively. Students pursuing research-focused degrees considered their curriculum to sufficiently equip them with research skills, compared to students studying clinically oriented degrees (p < 0.01). Conclusion: The results obtained from this study indicate that the perceptions of AHP students towards research are on par with the already established medical students. AHP students face the same stumbling blocks, are driven by the same motivating factors and experience a similar disparity between interest in research and research being produced, as medical students. Thus, a joint effort, between stakeholders in medical and AHP students' education, should be taken to address the factors limiting undergraduate students from conducting research. This will enable the implementation of an evidence-based mindset in the clinic, ultimately resulting in better patient care. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01715-6.

Closed loop deep brain stimulation: A systematic scoping review.

BACKGROUND: At the turn of the 21st century, closed-loop deep brain stimulation (CL-DBS) systems have emerged as promising neuromodulatory treatment strategies, that integrate real-time feedback based on the brain's condition to fine-tune the stimulation being applied. CL-DBS promises numerous advantages over open-loop deep brain stimulation (OL-DBS) systems. However, no up-to-date review articles are available which characterise the clinical outcomes of CL-DBS therapy. METHODS: A systematic literature search was conducted in seven major databases with various keywords relating to CL-DBS, for non-randomised cohort studies, finalised clinical trials, case reports, and nonrandomised control trials published between 2011 and 2021. RESULTS: Seven studies satisfied our inclusion criteria. Six investigated the use of CL-DBS therapy for neurological disorders, while one investigated its use for psychiatric disorders. The average patient age was 61 years (range: 27 - 78), and the mean disease duration before CL-DBS therapy was 15 years (range: 4 - 47). Patients included with essential tremor (ET) (n = 11) were older than patients with freezing of gait (FoG) in Parkinson's disease (PD) (n = 6) (p = 0.009), albeit insignificantly longer disease duration (p = 0.199). Following CL-DBS intervention, patients with ET (n = 11), major depressive disorder (n = 1) and Tourette syndrome (n = 1) had improvements in clinical outcomes, while PD patients had heterogeneous outcomes (n = 7). CL-DBS systems utilised by the included studies demonstrated a mean of 51.94 % (range: 36.62 - 68) energy-saving capacity over OL-DBS systems. CONCLUSIONS: To date, there is insufficient evidence that CL-DBS offers significant superior clinical outcomes over OL-DBS. Our scoping review suggests that CL-DBS can improve symptoms of specific neurological and psychiatric disorders, whilst demonstrating improved energy-saving capacity which has the potential to decrease battery replacement surgeries. Real-time adjustment of patients' symptoms using CL-DBS may improve patients' overall quality of life. Further studies are required to validate our observations.

The impact of the COVID-19 pandemic on the Mediterranean region over 18 months: bridging the health outcomes and sustainable development goals.

Background: The COVID-19 pandemic spread across the globe, including across the Mediterranean basin. This region presents diversity in economy, culture, and societal affairs. We attempted to evaluate the impact of COVID-19 on the population and on the Sustainable Development Goals (SDGs), our aim being to aid in the development of COVID-19 national plans. Methods: Epidemiological data was obtained from 'Our World in Data' databases (January 2020 - July 2021). Case, mortality, and vaccination incidence comparisons were made across neighbouring countries. The SDG index, universal health coverage (UHC) and health workforce targets were collected for each country. Correlations between SDG targets and COVID-19 outcomes were analysed. Results: Similarities in morbidity and mortality outcomes were present across neighbouring countries, with a bidirectional relationship between cumulative fully vaccinated population and infectivity fatality rates. Positive relationships were present between SDG indexes, UHC and health workforces and COVID-19 cases, deaths, and vaccinations. Conclusion: At prima face, high-income countries seem to have sustained worse morbidity and mortality outcomes, despite having had better UHC and a greater health workforce in the pre-COVID-19 era however, one must also consider that factors such as health-seeking behaviour and underdiagnosis may have influenced this. Cross-border infectivity was, however, evident. Pan-Mediterranean action must therefore be taken to ensure COVID-19 transmissibility and mortality are reduced across borders, while ensuring an equitable health outcome across populations.

A Case for Cross-Border Governance? A Comparative Trend Assessment of COVID-19 Transmission, Vaccination, and Outcomes Among 35 Nations in Europe Across 18 months.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) spread globally, including across Europe, resulting in different morbidity and mortality outcomes. The aim of this study was to explore the progression of the COVID-19 pandemic over 18 mo in relation to the effect of COVID-19 vaccination at a population level across 35 nations in Europe, while evaluating the data for cross-border epidemiological trends to identify any pertinent lessons that can be implemented in the future. METHODS: Epidemiological data were obtained from European Centre for Disease Prevention and Control and Our World in Data databases while Ministry of Health websites of each respective country and local newspapers were used for COVID-19-related vaccination strategies. Case, mortality, and vaccination incidence comparative analyses were made across neighboring countries. RESULTS: Similar morbidity and mortality outcomes were evident across neighboring countries over 18 mo, with a bidirectional relationship evident between cumulative fully vaccinated population and case fatality rates. CONCLUSION: Countries' COVID-19 outcome is related on national mitigative measures, vaccination rollouts, and neighboring countries' actions and COVID-19 situations. Mass population vaccination appeared to be effective in reducing COVID-19 case severity and mortality rates. Vaccination equity and pan-European commitment for cross-border governance appear to be the way forward to ensure populations' return to "normality."

Medical Students' Perceptions on Research: Results from a Small European Island State.

BACKGROUND: A crucial aspect of medical education is research training. Many studies have been conducted targeting the publishing rate among medical students, but information is lacking about the perceptions of medical students towards research, especially of students studying in small island states. This study aims to investigate students' perceptions towards research and increase the insight on what motivates and hinders medical students to conduct research. METHODS: An anonymous mixed-methods cross-sectional online questionnaire was distributed to five hundred and forty-nine medical students studying at the University of Malta. The data gathered was statistically analysed and consequently interpreted. RESULTS: A response rate of 25.05% was achieved, with 10.00% of students having already published their research. Despite 86.43% of students interested in conducting research, only 22.86% have pursued a research endeavour. The main reason for conducting research was 'out of students' own interest'. The main barrier hindering students from conducting research was perceived as the absence of research opportunities. DISCUSSION: Medical students have a positive attitude towards the conduction of research, to enhance their medical education. Hence, identification of potential barriers hindering medical students from conducting research should be sought out and hands-on research opportunities should be provided, on an elective basis, to pursue their research interest. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01426-4.