Impacts of climate change on the public health of the Mediterranean Basin population - Current situation, projections, preparedness and adaptation.

The Mediterranean Basin is undergoing a warming trend with longer and warmer summers, an increase in the frequency and the severity of heat waves, changes in precipitation patterns and a reduction in rainfall amounts. In this unique populated region, which is characterized by significant gaps in the socio-economic levels particularly between the North (Europe) and South (Africa), parallel with population growth and migration, increased water demand and forest fires risk - the vulnerability of the Mediterranean population to human health risks increases significantly. Indeed, climatic changes impact the health of the Mediterranean population directly through extreme heat, drought or storms, or indirectly by changes in water availability, food provision and quality, air pollution and other stressors.

Prognostic indicators and generation of novel risk equations for estimation of 10-year and 20-year mortality following acute coronary syndrome.

Objectives: Although risk assessment is an integral part of management, there are currently no risk calculators of long-term mortality after acute coronary syndrome (ACS). The aim was to provide risk equations for 10-year and 20-year mortality following ACS.

Methods: Patients hospitalised with ACS from December 1990 to June 1994 were recruited and followed up through 31 December 2012.

Children discharged against medical advice.

Discharge against medical advice (DAMA) occurs when a patient leaves a clinical setting before the end of treatment and against medical recommendation. The most important aspects of DAMA are to ensure ongoing medical needs are met and that it is documented meticulously. This article describes a recent retrospective case note (audit) study of DAMA in paediatric patients attending a district general hospital, followed by a literature review.

Clinical update: recognising brain tumours early in children.

Brain tumour accounts for a quarter of all childhood cancers and is the leading cause of cancer related deaths in children. Initial symptoms can be misleading and is often misinterpreted as being caused by a less serious childhood illness. Available statistics show that it takes almost three times longer for the brain tumour in children to get diagnosed in the United Kingdom in comparison to other developed countries.

Analysis of the DISC1 translocation partner (11q14.3) in genetic risk of schizophrenia.

The Disrupted-in-Schizophrenia 1 (DISC1) locus on human chromosome 1 was identified as a consequence of its involvement in a balanced translocation (1;11)(q42.1;q14.3) segregating with major psychiatric disorders in a Scottish family.

Interfacing an ion mobility spectrometry based explosive trace detector to a triple quadrupole mass spectrometer.

Hardware from a commercial-off-the-shelf (COTS) ion mobility spectrometry (IMS) based explosive trace detector (ETD) has been interfaced to an AB/SCIEX API 2000 triple quadrupole mass spectrometer. To interface the COTS IMS based ETD to the API 2000, the faraday plate of the IMS instrument and the curtain plate of the mass spectrometer were removed from their respective systems and replaced by a custom faraday plate, which was fabricated with a hole for passing the ion beam to the mass spectrometer, and a custom interface flange, which was designed to attach the IMS instrument onto the mass spectrometer. Additionally, the mass spectrometer was modified to increase the electric field strength and decrease the pressure in the differentially pumped interface, causing a decrease in the effect of collisional focusing and permitting a mobility spectrum to be measured using the mass spectrometer.

Risk communication: climate change as a human-health threat, a survey of public perceptions in Malta.

Background: Scientific evidence shows that climate change is very likely the product of human behaviour and lifestyle. The effects of climate change on human health are diverse in nature and range from direct effects due to extreme weather events such as heat waves, floods and storms, to indirect effects such as those caused by water and food shortages.

Methods: A telephone survey was conducted between January and February 2009, on a stratified representative random sample of the Maltese population over the age of 18 years (N = 310,819).

Public perceptions of climate change as a human health risk: surveys of the United States, Canada and Malta.

We used data from nationally representative surveys conducted in the United States, Canada and Malta between 2008 and 2009 to answer three questions: Does the public believe that climate change poses human health risks, and if so, are they seen as current or future risks? Whose health does the public think will be harmed? In what specific ways does the public believe climate change will harm human health? When asked directly about the potential impacts of climate change on health and well-being, a majority of people in all three nations said that it poses significant risks; moreover, about one third of Americans, one half of Canadians, and two-thirds of Maltese said that people are already being harmed. About a third or more of people in the United States and Canada saw themselves (United States, 32%; Canada, 67%), their family (United States, 35%; Canada, 46%), and people in their community (United States, 39%; Canada, 76%) as being vulnerable to at least moderate harm from climate change. About one third of Maltese (31%) said they were most concerned about the risk to themselves and their families.

Immediate versus delayed free TRAM breast reconstruction: an analysis of perioperative factors and complications.

Immediate breast reconstruction provides superior psychological benefit to the patient compared with delayed reconstruction, and has a financial advantage. Smokers undergoing immediate free TRAM breast reconstruction have a higher incidence of flap necrosis than smokers undergoing delayed free TRAM reconstruction. Whereas the differences in psychological benefit, effects of smoking and cost are well addressed in the literature, the differences in morbidity between immediate and delayed free TRAM breast reconstruction are still unknown.

Merkel cell tumour with leiomyosarcomatous differentiation.

Aims: To report and confirm the identity of tumour cells showing leiomyosarcomatous differentiation in a regional lymph node containing metastatic Merkel cell tumour.

Methods And Results: A 79-year-old woman was found to have metastatic Merkel cell tumour within an axillary lymph node 4 months after excision of the primary tumour from the forearm. The lymph node was effaced by tumour identical to that of the primary tumour but there was an additional focus of loose spindle cells.

A histological analysis of a high voltage electric current injury to an upper limb.

The mechanisms and patterns of high voltage electric current injury to living tissues are not fully understood. Most available data is derived from animal experimentation using voltages that are considerably lower that those encountered by human victims during electrocution accidents. This work aims to contribute human tissue histological data by analyzing the pattern of tissue damage after a real life unfortunate high voltage electrocution accident.

The survival of human skin stored by refrigeration at 4 degrees C in McCoy's 5A medium: does oxygenation of the medium improve storage time?

To establish the viable storage time of human skin stored by refrigeration at 4 degrees C in McCoy's 5A medium and to establish whether oxygenating the medium improves the viable storage time, the following experiment was conducted. Eighty discs of human split-thickness skin graft, each 3 mm in diameter, were stored in 40 sterile sealable containers under four different conditions: in 0.9% saline, in McCoy's 5A medium, in oxygenated McCoy's 5A medium, and in carbon dioxide supplemented McCoy's 5A medium.

Our experience with the use of the dorsal ulnar artery flap in hand and wrist tissue cover.

We describe a series of six cases exploring the limits of reliability of the dorsal ulnar artery fasciocutaneous flap as described by Becker and Gilbert (1988a; b). Although the territory supplied by the dorsal ulnar artery is 10 cm to 20 cm long by 5 cm to 9 cm wide, Becker and Gilbert suggested that flaps should be confined to smaller dimensions. We have found that larger flaps (15 to 20 cm long and 5 to 8 cm wide) are feasible, extending the use of the flap to the radial side of the wrist and hand.

A simple, inexpensive method for precise application of cyanoacrylate tissue adhesive.

The use of cyanoacrylate tissue adhesives is well described in the literature for closure of skin wounds. The main problem with their application in my hands is that the glue tends to flow/run away from the point of application, making precise application difficult even when the supplied plastic tube is used. This problem is inherent to the low viscosity of the adhesive.

Vasoconstrictor infiltration in breast reduction surgery: is it harmful?

The efficacy of vasoconstrictor infiltration in reducing blood loss is well known. However, adrenaline infiltration is potentially harmful to tissues. The question of whether or not adrenaline infiltration is harmful in breast reduction surgery remains unanswered.

Towards a fluorescent chemoreceptive lipid membrane-based optode.

Lipid membranes have been deposited on the surface of glass slides and quartz fibres for the development of optical chemical sensors. The fluorescence properties of probes embedded within ordered lipid matrices were sensitive to physical and electrostatic environmental alterations of the membrane caused by various non-selective processes. This work reports criteria for surface deposition of monolayers of phosphatidylcholine-steroid mixtures and stearic acid by Langmuir-Blodgett techniques.