A population-based paediatric Covid-19 vaccination progress and outcomes: The Malta case.

Background: Covid-19 is still pandemic with population vaccination, including among children, remaining the mainstay for hastening the exit from the pandemic. The article provides an insight in Malta's national paediatric vaccination modus operandi, vaccination uptake, and epidemiological trends while exploring geographical social inequalities among the ≤ 15 years cohort up till end of August 2022. Methods: The Vaccination Coordination Unit in Malta's only regional hospital provided an account of the strategic roll-out along with anonymised cumulative vaccination doses by age band and district. Descriptive and multivariant logistic regression analyses were performed. Results: By mid-August 2022, 44.18% of the under 15's population had received at least 1 vaccine dose. A bi-directional relationship was observed between increased cumulative vaccination and reported Covid-19 cases until early 2022. Central vaccination hubs were set up with invitation letters and SMSs sent to parents. Children residing in the Southern Harbour district (OR: 0.42, P < 0.01) had the highest full vaccination uptake (46.66%) as opposed to the Gozo district (lowest at 27.23%; OR: 0.3, P = 0.01). Conclusion: Successful paediatric vaccination is not only dependent on easily accessible vaccination but also on vaccine effectiveness against variants, as well as population characteristics, with potential geographical social inequalities hindering uptake.

Universal admission screening: a potential game-changer in hospitals with high prevalence of MRSA.

INTRODUCTION: Despite the perception that meticillin-resistant Staphylococcus aureus (MRSA) is now under control in high-income countries, global prevalence remains high, even increasing in some regions. Universal admission screening and decolonization has been instituted in some hospitals to attempt control but the practice remains controversial. METHODS: In 2014, Mater Dei Hospital in Malta introduced a universal admission screening policy, utilizing a novel, centralized and customized approach to achieve high compliance and low cost. Admissions are screened nasally by designated staff using chromogenic media, irrespective of risk factors. Carriers are decolonized without concurrent isolation or contact precautions. In this study, longitudinal, quasi-experimental evaluation was undertaken using time series analysis to analyse the impact of the intervention on the proportion of MRSA among clinical S. aureus isolates (%MRSA) and incidence per 1000 bed-days. A cost-utility analysis was also attempted to identify approximate quality-adjusted life years (QALYs) gained. RESULTS: A transfer function model approach concluded that the intervention had a significant effect on both %MRSA and incidence. Six years following its introduction, the screening programme had led to an overall 43% long-term reduction in %MRSA from pre-screening levels [R2=0.687; Bayesian information criterion (BIC)=4.063], translating to a decrease in incidence of approximately 0.56 cases/1000 bed-days (R2=0.633, BIC=-3.063). No correlation was identified with consumption of antibiotics or alcohol hand rub. The annual cost-benefit of the programme was calculated at €1058 per QALY gain per year. CONCLUSION: The universal admission screening and decolonization intervention was successful and cost-effective in this high-endemicity setting. It facilitated improvement in the prevalence of MRSA, achieving reduction levels rarely reported by Mediterranean hospitals.

Primary extrasac orbital lymphoma presenting as nasolacrimal obstruction.

Primary orbital lymphoma is an unusual cause of epiphora in the elderly population. Lymphomas that give rise to nasolacrimal duct obstruction usually arise from within the lacrimal sac. Epiphora is a common presenting complaint that may be easily disregarded as a minor debilitating symptom. This case describes a 58-year-old Caucasian man presenting with epiphora due to primary extrasac orbital lymphoma, causing external mechanical compression on the nasolacrimal duct system. Although a rare presentation, it highlights the need for a thorough examination in patients presenting with epiphora. Nasolacrimal duct obstruction could well be the initial manifestation that leads to the diagnosis of a more serious underlying systemic disease, and lymphoma needs to be included in the differential diagnosis of secondary nasolacrimal duct obstruction.

Three different consecutive manifestations of morphoeic BCC in the same patient: presenting first as ectropion, then entropion, and finally medial canthal dystopia with epicanthus inversus.

Morpheaform basal cell carcinoma (BCC) can cause diagnostic difficulty due to an atypical clinical presentation. Successful treatment requires a high index of clinical suspicion together with an early confirmatory biopsy. We present the case of an 81-year-old lady with a delayed diagnosis of morphoeic BCC due to an unusual presentation of evolving lid malposition, and we highlight the limitations of a punch biopsy in diagnosing atypical lesions. An appropriate biopsy technique is vital, with consideration for repeat biopsies when necessary, especially if the clinical picture is changing over time.

Paediatric blepharoptosis: a 10-year review.

PURPOSE: To examine the characteristics of blepharoptosis and the success of surgical intervention in a large group of children presenting to a specialist at paediatric ophthalmology center. METHODS: Ten-year retrospective case notes review of patients presenting to the Birmingham Children's Hospital for blepharoptosis surgery. Resultant database was interrogated for aetiology of ptosis; severity; surgical correction; outcome; complications and need for reoperation. RESULTS: One hundred and fifty five children (186 eyes) underwent blepharoptosis surgery. Hundred and ten patients (71%) were treated with a levator resection procedure, 28 (18%) underwent a brow suspension using Mersilene mesh, 15 (10%) with Fasanella Servat procedure and 2 (1%) with La Mange procedure. The mean post-operative follow-up was 30.82 months with 84 children completing a minimum of 12 months follow-up. Overall, 70.97% lids were successfully corrected with a single operation. In 9.14% lids, the results were fair but no further surgery was carried out. Reoperation was required in 19.89% of lids with the mean time to second surgery being 32.69 months. Amblyopia was found in 26.45% (41 children); in 3 patients, their amblyopia became manifest after the ptosis surgery. A concomitant squint was present in 14.19%, and 18.70% had a significant refractive error requiring spectacles prescription, with anisometropia present in more than 72% of these patients. CONCLUSIONS: Early referral to an ophthalmologist is necessary even though surgical correction may be delayed. Children with congenital ptosis need to be monitored for amblyopia both pre- and post-operatively, as the incidence of strabismus and refractive errors is much higher than the general population and these may develop even after ptosis surgery.

A new grading system for assessing orbicularis muscle function.

PURPOSE: To establish an objective parameter (orbicularis function) to measure the efficacy of botulinum toxin treatment in weakening the orbicularis of blepharospasm and hemifacial spasm sufferers. METHODS: The following scale has been used by one of the authors (VTT) in his botulinum clinic for several years: Grade 0: Incomplete eyelid closure.Grade 1: Lids just closing, minimal resistance to overcome.Grade 2: Closing well, some resistance, easily overcome.Grade 3: Strong closure, can be overcome with difficulty.Grade 4: Very strong closure, cannot be overcome or overcome with extreme difficulty. In order to establish the interobserver agreement, one consultant ophthalmologist, three ophthalmologists in training, and one nurse practitioner evaluated the same 65 patients, undergoing treatment with botulinum toxin for essential blepharospasm and hemifacial spasm. Observers assessed orbicularis function by asking each patient to close both eyes forcefully, while the observer tried to open them manually. The measure of agreement across the observers was estimated by kappa statistics. RESULTS: Overall interobserver agreement (kappa=0.54) was satisfactory. We used Kruskal-Wallis nonparametric test to determine agreement between the observers. The P-values for both right and left eyes were well above 0.05, indicating good consistency between the observers when using this grading system. CONCLUSIONS: A simple, new, five-point, clinical grading system for orbicularis muscle function is presented. Medical staff with different levels of experience can use it reliably.