A national snapshot of substance misuse among child and adolescent psychiatric inpatients in Malta

This paper reports on a patient record survey that was undertaken with the central aim of establishing reliable, baseline information to inform strategic planning and organisation of future CAMHS in Malta. The records of the total population of children and adolescents admitted into the psychiatric hospital over a five year period were surveyed. Results showed that the characteristics and circumstances of children and adolescents with mental disorder and comorbid substance misuse in Malta are similar to those described in international studies. The survey emphasized the pressing need for further research into this sub group and also highlighted gaps in reliable data systems locally.peer-reviewe

Risk factors for self-harm in children and adolescents admitted to a psychiatric hospital in Malta

The aim of this research was to identify risk factors for self-harm amongst the total population of children and adolescents admitted to an in-patient psychiatric hospital over a five-year period. A retrospective audit of patient records (N = 212) covering 2010 to 2014 (both years included) showed that approximately 38% of all children and adolescents who were in-patients at the psychiatric hospital during the study period harmed themselves prior to admission. Male gender was found to be associated with self-harm. Results also suggested that family factors, specifically living with a single parent, significantly added to the risk of self-harm amongst the study population. Although the findings revealed that being male and hailing from a single-parent family are significant risk factors for self-harm in Maltese children and adolescents, this study did not establish why this is the case, therefore suggesting the need for further research. A prospective, longitudinal design would assess predictors of self-harm more clearly. Furthermore, self-reports would increase accuracy and reduce third-party reporter bias, while permitting more indepth exploration of the risk factors involved in child and adolescent deliberate self-harm.peer-reviewe

The occurrence of coastal swarms of the Scyphomedusa, Pelagia Noctiluca (Forskiil) around the Maltese Islands

The author wishes to acknowledge the contribution of the Maritime Section of the Task Force, Malta in the collection of data.Data on the occurrence of coastal swarms by Pelagia noctiluca around the Maltese Islands for January, February and March 1984 is presented, together with details of the characteristics of such swarms and relevant environmental parameters. The small average size of the component individuals indicates that they are representatives of recent spawning. It is suggested that such swarms reached the islands from the NW sector.peer-reviewe

Pulse-Administered Toceranib Phosphate Plus Lomustine for Treatment of Unresectable Mast Cell Tumors in Dogs.

BackgroundNonresectable mast cell tumors (MCT) in dogs remain a therapeutic challenge, and investigation of novel combination therapies is warranted. Intermittent administration of tyrosine kinase inhibitors (TKI) combined with cytotoxic chemotherapy may effectively chemosensitize canine MCT while decreasing cost and adverse effects associated with either agent administered as monotherapy.Hypothesis/objectivesThe primary study objectives were to (1) identify the maximally tolerated dose (MTD), (2) determine the objective response rate (ORR) and (3) describe the adverse event profile of pulse-administered toceranib phosphate (TOC) combined with lomustine.AnimalsForty-seven client-owned dogs with measurable MCT.MethodsToceranib phosphate was given PO on days 1, 3 and 5 of a 21-day cycle at a target dosage of 2.75 mg/kg. Lomustine was given PO on day 3 of each cycle at a starting dosage of 50 mg/m(2) . All dogs were concurrently treated with diphenhydramine, omeprazole, and prednisone.ResultsThe MTD of lomustine was established at 50 mg/m(2) when combined with pulse-administered TOC; the dose-limiting toxicity was neutropenia. Forty-one dogs treated at the MTD were evaluable for outcome assessment. The ORR was 46% (4 complete response, 15 partial response) and the overall median progression-free survival (PFS) was 53 days (1 to >752 days). On multivariate analysis, variables significantly associated with improved PFS included response to treatment, absence of metastasis, and no previous chemotherapy.Conclusions and clinical importanceCombined treatment with pulse-administered TOC and lomustine generally is well tolerated and may be a reasonable treatment option for dogs with unresectable or metastatic MCT

Asymmetric speed modulation of a rotary blood pump affects ventricular unloading

OBJECTIVES Rotary blood pumps (RBPs) running at a constant speed are routinely used for the mechanical support of the heart in various clinical applications, from short-term use in heart-lung machines to long-term support of a failing heart. Their operating range is delineated by suction and regurgitation events, leaving limited control on the cardiac workload. This study investigates whether different ratios of systolic/diastolic support are advantageous over a constant-speed operation. METHODS In order to effectively control the load on the heart, this study aimed at developing a pulsatile control algorithm for rotary pumps to investigate the impact of pump speed modulation during systole and diastole on the left ventricle unloading. The CentriMagTM RBP with a modified controller was implanted in four sheep via a left thoracotomy and cannulated from the ventricular apex to the descending aorta. To modulate the pump speed synchronized with the heartbeat, custom-made real-time software detected the QRS complex of the electrocardiogram and controlled the pump speed during systole and diastole. Four different speed modulations with the same average speed but different systolic and diastolic speeds were compared with the baseline and the constant speed support. Left ventricular (LV) pressure and volume, coronary flow and pump flow were analysed to examine the influence of the pump speed modulation. RESULTS Pulsatile setting reduces the cardiac workload to 64% of the baseline and 72% of the constant speed value. Maximum unloading is obtained with the highest speed during diastole and high-pulse amplitude. End-diastolic volume in the pulsatile modes varied from 85 to 94% of the baseline and 96 to 107% of the constant speed value. Consequently, the mechanical load on the heart can be adjusted to provide assuagement, which may lead to myocardial recovery. The higher pump speed during systole results in an increase in the pulse pressure up to 140% compared with the constant speed. CONCLUSIONS The present study is an initial step to more accurate speed modulation of RBPs to optimize the cardiac load control. To develop future control algorithms, the concept of high speed during diastole having a maximal unloading effect on the LV and high speed during systole increasing the pulse pressure is worth considerin