Sexually transmitted infections epidemiology and risk assessment at the main correctional facility in Malta (2017-2019).

BACKGROUND: Inmates suffer from mental and physical ailments combined with substance misuse and addiction which are often underreported or disregarded by sufferers, for fear of being stigmatized. This vulnerable group has complex medical and psychosocial needs and hence gathering data is essential for a holistic approach to care. OBJECTIVES: Understanding the interplay between sexually transmitted (STIs) and blood borne infections, substance misuse and mental health is essential to enable targeted interventions and outreach programmes. The aim was to analyse the occurrence of STIs, hepatitis and tuberculosis in inmates at the main custodial facility in Malta; to assess risk behaviours and vulnerabilities through an outreach programme; to offer treatment and referral and to develop recommendations for screening of prison inmates. METHODS: A mixed methodology study was used which involved analysis of health data pooled from the Genitourinary Clinic (GUC) and Corradino Correctional Facility (CCF) in Malta. RESULTS: In the study period, 206 inmates were tested for STIs, 67.9% males, aged between 14 and 72. Only 27% were not sexually active in the 6 months prior to testing. Among those sexually active, 31% had had sex with casual partners and 43% had never used condoms for sexual intercourse. Seventy-five percent admitted to drug use. The most common STI diagnosed was HPV (16.5%), followed by syphilis (5.8%). Genital dermatoses were also frequent (9.2%). The prevalence of Hepatitis C was high (24.5%), in relation to intravenous drug use. CONCLUSION: The authors advocate for more collaboration between sexual health clinics and prisons to address educational interventions and STIs' testing. Cultural and linguistic barriers should be considered when devising national health strategies and screening recommendations in custodial settings. Adequate follow-up should extend into the community setting once inmates leave the prison to ensure a continuum of care.

Mycobacterium chimaera infection following cardiac surgery in the United Kingdom: clinical features and outcome of the first 30 cases.

OBJECTIVES: Mycobacterium chimaera infection following cardiac surgery, due to contaminated cardiopulmonary bypass heater-cooler units, has been reported worldwide. However, the spectrum of clinical disease remains poorly understood. To address this, we report the clinical and laboratory features, treatment and outcome of the first 30 UK cases. METHODS: Case note review was performed for cases identified retrospectively through outbreak investigations and prospectively through ongoing surveillance. Case definition was Mycobacterium chimaera detected in any clinical specimen, history of cardiothoracic surgery with cardiopulmonary bypass, and compatible clinical presentation. RESULTS: Thirty patients were identified (28 with prosthetic material) exhibiting a spectrum of disease including prosthetic valve endocarditis (14/30), sternal wound infection (2/30), aortic graft infection (4/30) and disseminated (non-cardiac) disease (10/30). Patients presented a median of 14 months post surgery (maximum 5 years) most commonly complaining of fever and weight loss. Investigations frequently revealed lymphopenia, thrombocytopenia, liver cholestasis and non-necrotizing granulomatous inflammation. Diagnostic sensitivity for a single mycobacterial blood culture was 68% but increased if multiple samples were sent. In all, 27 patients started macrolide-based combination treatment and 14 had further surgery. To date, 18 patients have died (60%) a median of 30 months (interquartile range 20-39 months) after initial surgery. Survival analysis identified younger age, mitral valve surgery, mechanical valve replacement, higher serum sodium concentration and lower C-reactive protein as factors associated with better survival. CONCLUSIONS: Mycobacterium chimaera infection following cardiac surgery is associated with a wide spectrum of disease. The diagnosis should be considered in all patients who develop an unexplained illness following cardiac surgery.

Pooling European all-cause mortality: methodology and findings for the seasons 2008/2009 to 2010/2011.

Several European countries have timely all-cause mortality monitoring. However, small changes in mortality may not give rise to signals at the national level. Pooling data across countries may overcome this, particularly if changes in mortality occur simultaneously. Additionally, pooling may increase the power of monitoring populations with small numbers of expected deaths, e.g. younger age groups or fertile women. Finally, pooled analyses may reveal patterns of diseases across Europe. We describe a pooled analysis of all-cause mortality across 16 European countries. Two approaches were explored. In the 'summarized' approach, data across countries were summarized and analysed as one overall country. In the 'stratified' approach, heterogeneities between countries were taken into account. Pooling using the 'stratified' approach was the most appropriate as it reflects variations in mortality. Excess mortality was observed in all winter seasons albeit slightly higher in 2008/09 than 2009/10 and 2010/11. In the 2008/09 season, excess mortality was mainly in elderly adults. In 2009/10, when pandemic influenza A(H1N1) dominated, excess mortality was mainly in children. The 2010/11 season reflected a similar pattern, although increased mortality in children came later. These patterns were less clear in analyses based on data from individual countries. We have demonstrated that with stratified pooling we can combine local mortality monitoring systems and enhance monitoring of mortality across Europe.

Sentinel Surveillance: an option for surveillance of infectious intestinal disease.

Sentinel surveillance systems offer advantages over passive surveillance which is known to have limitations due to incomplete reporting. Sentinel surveillance gathering data from selected sources was piloted as an option for surveillance of infectious intestinal disease (IID) in Malta. Between October 2004 and May 2005, 22 general practitioners (GPs) voluntarily participated in the study and reported on the number of IID cases (by age and sex) and all primary care encounters in their practice. The GPs' reporting activity lasted for 35 weeks, covering a total of 55,425 primary care encounters, of which 1.95% concerned IID. For every case reported via the routine passive notification system, seven cases would be picked up by this enhanced sentinel surveillance.

Familial pseudoexfoliation in Gozo.

AIMS: To describe the occurrence of pseudoexfoliation in three Gozitan families. METHODS: Three families with a high incidence of pseudoexfoliation were identified. All members of the three families who agreed to participate were interviewed and underwent a full ophthalmologic examination. The pseudoexfoliation status was classified as present, absent, or unknown. RESULTS: A total of 55 individuals from three separate family probands and with a male : female sex ratio of 5 : 4 were examined. In all, 18 had definite evidence of pseudoexfoliation, 17 of them bilaterally and one showing only unilateral signs. Age was the main risk factor, with 18 out of the 20 individuals who were over the age of 60 years having pseudoexfoliation, while none of the 35 who were below the age of 60 years had pseudoexfoliation. The ophthalmological findings varied in different families. Family I had a high incidence of both cataract and glaucoma, family II had mainly glaucoma, while in family III all individuals had cataract but none had evidence of glaucoma. The first generation of these three families were deceased but their hospital and clinical records revealed that in all three families the father was affected and there was no evidence of maternal involvement. CONCLUSIONS: In all three families, pseudoexfoliation appeared to be genetically transmitted as a late onset autosomal dominant trait of variable expression. Maternal transmission could not be confirmed in these families.

Case Report. Keratomycosis due to Alternaria alternata in a diabetic patient.

A case of keratitis caused by Alternaria alternata in a diabetic male, after traumatic corneal injury with a sharp object, is described. The patient was treated with topical amphotericin B solution and a full uneventful recovery was achieved. This is the first reported case of fungal keratamycosis in Malta, which was substantiated with both positive direct microscopy and a positive culture of the fungus.

Experimental transplantation of human retinal pigment epithelial cells on collagen substrates.

We studied the use of human retinal pigment epithelial cells cultured on a collagen support as a potential transplantation therapy to replace diseased or damaged retinal pigment epithelium. Using a transvitreal approach, we transplanted human retinal pigment epithelial cells attached to either a sheet of noncross-linked or cross-linked type I collagen into the subretinal space of New Zealand white rabbits, whose eyes lack pigment. Animals were killed after six weeks, and the eyes were fixed for light microscopy. The results demonstrated that, in eyes receiving the noncross-linked collagen support, a layer of pigmented donor retinal pigment epithelium was visible within the subretinal space, with a normal-appearing retina and no evidence of proliferative vitreoretinopathy or graft rejection. We believe this method may be applicable to replace dysfunctional retinal pigment epithelial cells in humans.

Timing of removal of sutures in control of post-operative astigmatism.

A prospective, randomised study was carried out in 135 patients to determine whether the time of removal of continuous sutures in the relief of post-operative astigmatism had any effect on subsequent changes in cylinder power or axis. After uncomplicated extracapsular cataract extraction with a corneal section and continuous 10/0 nylon suture, patients with more than 3 dioptres of cylinder were allocated to have their suture removed at 6, 9 or 12 weeks post-operatively. Visual and optical outcome were assessed 1 week after suture removal and at 6 months. Although the time of removal did not affect the change in cylindrical power, the subsequent refraction was more stable when the suture was removed at 12 weeks. However, initial against-the-rule astigmatism did not significantly change after suture removal and resulted in an unsatisfactory final prescription. Suture removal should therefore be performed at 12 weeks, glasses should not be prescribed early, and a poor outcome may be anticipated in those initially against-the-rule.