Claudia Fsadni - Academia.edu (original) (raw)

Papers by Claudia Fsadni

Objectives: To review the available literature on prosthetic joint infections and provide recomme... more Objectives: To review the available literature on prosthetic joint infections and provide recommendations on management particularly the importance of identifying the causative organism and starting the most appropriate antimicrobial therapy. Methods: The medical literature was searched using PubMed, employing the key words prosthetic joint infections. There appears to be no UK consensus guidelines on the management of prosthetic joint infections or the use of prophylactic antibiotics to prevent them. There is however a number of key documents and trust policies which deal with the subject extensively. We also made use of 'The Sanford Guide to Antimicrobial therapy 2012' for the latest recommendations on the correct antimicrobial therapy. Conclusion: Although diagnosis is often difficult, there are a number of investigations which can help us identify the organism. We recommend that the local prevalence of such infections is studied together with identification of the common...

PLoS ONE, 2021

[This corrects the article DOI: 10.1371/journal.pone.0239389.].

BMJ Case Reports, 2021

A 47-year-old man, positive for SARS-CoV-2, was diagnosed with acute coronary syndrome (ACS) comp... more A 47-year-old man, positive for SARS-CoV-2, was diagnosed with acute coronary syndrome (ACS) complicated by myocarditis on a background of COVID-19 pneumonia. He was medically treated for ACS; however, 3 days into his admission, the patient developed neurological complications confirmed on MRI of the brain. MRI showed established infarcts involving a large part of the left temporal lobe and right occipital lobe, with minor foci of micro-haemorrhagic transformation in the left temporal lobe. A left ventricular mural thrombus was then confirmed on echocardiogram, and this was attributed as the cause of his neurological infarct. Further infarctions in the kidneys and spleen, and thrombi in the superior mesenteric and left femoral artery were also identified on imaging of the abdomen. The left ventricular mural thrombus was removed surgically via a midline sternotomy incision under general anaesthesia. Surgery was successful and the patient was discharged to a rehabilitation centre.

Introduction: Pulmonary Rehabilitation (PR) is a recommended standard of care in Chronic Obstruct... more Introduction: Pulmonary Rehabilitation (PR) is a recommended standard of care in Chronic Obstructive Pulmonary Disease, but to date, there is no consensus of opinion regarding the optimal duration of the interventions. Method: 60 subjects suffering from COPD were recruited after being screened by medical doctors and physiotherapists. A multidisciplinary programme was delivered which consisted of two classes per week for 12weeks. All participants were reviewed again after 4, 8 and at the end of the 12weeks. Exercise capacity using the 6 Minute Walk test was measured and the oxygen saturation was measured before, during and after the test. Dyspnoea scores were taken using the Borg Category Ratio Scale. The St George’s respiratory questionnaire (SGRQ) and Hospital Anxiety and Depression scale (HAD) were administered to the participants. The subjects were then enrolled into a one hour of exercise training and was then followed up by one hour of educational talks. Results This study show...

Background: Asthma is common in children with indoor pollutants influencing the development of th... more Background: Asthma is common in children with indoor pollutants influencing the development of the disease. Since children spend most of their time outside their homes within the school environment, school indoor air quality can directly influence their respiratory health. Aims: This study aims to analyze the indoor and outdoor air quality of Maltese schools and if an association exists between indoor pollutants and respiratory health in children. Settings and Design: Five primary schools were selected with 9- to 11-year-old students participating. Materials and Methods: Standardized health questionnaires and lung function tests were utilized. Indoor and outdoor air sampling together with traffic counts were carried out. Statistical Analysis Used: SPSS version 21 was used and the Chi-squared, logistic regression, and Pearson's correlation were used. Results: The mean indoor PM 2.5 level of 17.78 μg/m3 and CO (9.11 ppm) exceeded World Health Organization thresholds. Indoor ozone ...

Several studies on the prevalence of allergic conditions have identified that allergic conditions... more Several studies on the prevalence of allergic conditions have identified that allergic conditions are on the increase worldwide. The aim of this study was to study the effect of classroom humidity and temperature levels on schoolchildren in Malta. Our cohort included 191 children. Standardised ISAAC health questionnaires were answered by the children’s parents. Lung function tests, acoustic rhinometry, exhaled NO, exhaled CO and nasal lavage were performed on the participating children. School building characteristics were also studied. A significant association was noted between a high relative humidity exposure and nasal cross-sectional areas (p=0.003), and doctor diagnosed allergic rhinitis (p=0.002), indicating the presence of allergic rhinitis, as was increased indoor temperature (p=0.003). Increased indoor temperature was also associated with increased exhaled nitric oxide (FeNO) (p<0.001) indicating uncontrolled asthma. In conclusion, increased classroom temperatures and...

BMJ Case Reports

We report a case of Mycobacterium avium complex immune reconstitution inflammatory syndrome (MAC-... more We report a case of Mycobacterium avium complex immune reconstitution inflammatory syndrome (MAC-IRIS) in a patient with HIV positive. Initial presentation was that of a purpuric purple macular rash in-keeping with Kaposi sarcoma as an AIDS defining illness. Three weeks following the initiation of antiretroviral treatment (ART) she developed chest pain, dry cough and fever. A diagnosis of MAC was made through imaging and sputum cultures and appropriate treatment was initiated. Despite adequate management with evidence of good immunological and virological response, the patient represented with persistent symptoms. Repeat CT of the chest confirmed worsening lymphadenopathy with necrosis. Given these findings, a diagnosis of MAC-IRIS was made with resolution of fever after corticosteroids were initiated. This case highlights the importance of considering MAC as a cause of IRIS in severely immunosuppressed patients with HIV.

PLOS ONE

Introduction The COVID-19 pandemic has posed major challenges to all aspects of healthcare. Malta... more Introduction The COVID-19 pandemic has posed major challenges to all aspects of healthcare. Malta's population density, large proportion of elderly and high prevalence of diabetes and obesity put the country at risk of uncontrolled viral transmission and high mortality. Despite this, Malta achieved low mortality rates compared to figures overseas. The aim of this paper is to identify key factors that contributed to these favorable outcomes. Methods This is a retrospective, observational, nationwide study which evaluates outcomes of patients during the first wave of the pandemic in Malta, from the 7 th of March to the 24 th of April 2020. Data was collected on demographics and mode of transmission. Hospitalization rates to Malta's main general hospital, Mater Dei Hospital, length of in-hospital stay, intensive care unit admissions and 30-day mortality were also analyzed. Results There were 447 confirmed cases in total; 19.5% imported, 74.2% related to community transmission and 6.3% nosocomially transmitted. Ninety-three patients (20.8%) were hospitalized, of which 4 were children. Patients with moderate-severe disease received hydroxychloroquine and azithromycin, in line with evidence available at the time. A total of 4 deaths were recorded, resulting in an all-cause mortality of 0.89%. Importantly, all admitted patients with moderate-severe disease survived to 30-day follow up. Conclusion Effective public health interventions, widespread testing, remote surveillance of patients in the community and a low threshold for admission are likely to have contributed to these favorable outcomes. Hospital infection control measures were key in preventing significant nosocomial spread. These concepts can potentially be applied to stem future outbreaks of

Clinical Microbiology and Infection

BMJ Case Reports

Measles, which was once thought to be a disappearing viral infection due to effective vaccination... more Measles, which was once thought to be a disappearing viral infection due to effective vaccination, has been re-emerging globally, with increasing cases in adolescents and adults. This has been attributed to anti-vaccination campaigning in the early 21st century, which has resulted in a drop in overall herd immunity. In this case series we report three patients with complications secondary to measles who presented to a hospital in Malta in 2019. Through this series, we discuss the range of possible complications caused by the measles virus, ranging from mild viraemic symptoms to multiorgan involvement which could possibly lead to high-dependency care and may even be fatal. We also highlight recent global statistics which reflect the exponential increase in the incidence of measles, with a special focus on Europe. It is emphasised that vaccine education and compliance with the two-dose measles vaccine should be implemented worldwide.

BMJ Case Reports

The syndrome of inappropriate antidiuretic hormone (SIADH) secretion is a frequent cause of hypon... more The syndrome of inappropriate antidiuretic hormone (SIADH) secretion is a frequent cause of hyponatraemia. It is a dilutional hyponatraemia secondary to impaired urinary dilution in the absence of renal disease or any identifiable non-osmotic stimulus known to induce antidiuretic hormone secretion. SIADH can arise secondary to various respiratory tract infections; however, the association between SIADH and influenza A infection is described in only a few cases in the literature. The authors present a case report of influenza A that may have caused a profound SIADH-related hyponatraemia.

Asia Pacific Allergy

Background: The prevalence of allergic conditions is increasing in most countries. One possible e... more Background: The prevalence of allergic conditions is increasing in most countries. One possible explanation may be childhood nutrition. Objective: The aim of the study was to investigate the relationship between consumption of pre-specified types of food in school-aged children and presence of respiratory and allergic symptoms. Methods: A total of 191 students aged 9-11 years were recruited from 5 schools to geographically cover all of Malta. Data was collected between October 2011 and February 2012. This was part of a bigger study which included clinical and environmental tests besides standardized health questionnaires. For the purposes of this part of the study only the health questionnaires were used. These standardized health questionnaires based on the International Study of Asthma and Allergies in Childhood (ISAAC) were used to identify the presence of respiratory and allergic symptoms and to identify the types of foods and the frequency of consumption of various types of foods. Results: We found that milk, meat, butter, olive oil, and yoghurt consumption had a negative association with allergic symptoms in children, whilst fish consumption had a detrimental effect. These relationships remained significant after correction for paternal level of education. Conclusion: The study highlights the fact that nutrition in early childhood may have a significant effect on the risk of allergic conditions. Our results, taken together with data in the literature, suggest that different types of fish might have had different effects. This is probably related to their different fatty acid constitution thus warranting further studies.

Journal of Geoscience and Environment Protection

Asthma is common in children with allergens and mould influencing the development of the disease.... more Asthma is common in children with allergens and mould influencing the development of the disease. Since children spend most of their time outside their homes within the school environment, school indoor air quality can directly influence their respiratory health. This study aims to identify microbiological contaminants in Maltese schools. The association between contaminants, respiratory health and school characteristics has been analysed. Five primary schools were selected with 9 to 11 years old students participating. Standardised health questionnaires, lung function tests, and school characterisation were performed. Dust samples were analysed for fungi, bacteria and allergens were performed. Penicillium/Aspergillus/Paecilomyces/Variotii (PenAsp) group had the highest median indoor concentration followed by Mycobacterial and Streptomyces species. There was a significant negative correlation between PenAsp and Mycobacterium spp levels in all the participating schools (r = −0.42; p = 0.03). Cat allergen in classroom dust correlated positively with the number of cat owners (r = 0.43; p = 0.041). High exposure to fungi, bacteria and allergens was significantly associated with upper and lower airway atopy. School/classroom characteristics and cleaning protocols were significantly associated with exposure to these pollutants. In conclusion, fungi, bacteria, endotoxin, cat and dog allergens have been found to have a direct influence on school indoor air quality in the Maltese Islands. A significant association was observed between these contaminants and upper and lower airway atopy. Specific school, classroom, cleaning and maintenance characteristics have been identified as having a direct impact on indoor air quality.

Annals of Allergy, Asthma & Immunology, 2016

Malta Medical Journal, 2013

Clinical Neuropharmacology, 2008

Integrative Medicine International, 2015

Background/Aims: School indoor air quality is important because children spend most of their time... more Background/Aims: School indoor air quality is important because children spend most of their time outside home within the school environment. This study aimed to investigate the school environment and its impact on the respiratory health of the children. Methods: A total of 191 pupils in the 9-to 11-year age group were selected from 5 primary state schools. Validated school and health questionnaires, spirometry, acoustic rhinometry, nasal lavage, urine for environmental tobacco smoke biomarkers and traffic counts were used. Results: Cumulative (32.98%) and current wheezing (17.8%) were in keeping with the International Study of Asthma and Allergies in Childhood Malta data. Southern schools had the highest prevalence of current wheezers (OR 3.77; p = 0.012), rhinoconjunctivitis (OR 3.59; p = 0.003) and nasal eosinophilic cationic protein levels (p < 0.001). Small openable window areas increased rhinitic symptoms (OR 3.14; p = 0.016). Classes facing roads had increased current wheezers (OR 2.27; p = 0.03) and exhaled carbon monoxide (eCO) levels (p < 0.001). Current wheezing was significantly associated with the number of light and heavy vehicles passing near the school (p < 0.001). The presence of smokers at home was significantly associated with urinary cotinine and 3HC (p < 0.001). Proximity to power plants increased the current wheezers (OR 5.89; p = 0.001) who had impaired spirometry (p = 0.003). Asthma symptoms (OR 5.25; p = 0.001) and elevated eCO levels (p < 0.001) were associated with fuel storage facilities near schools. The accumulation of dust on flat surfaces within classrooms was related to wheezing (OR 5.23; p = 0.001). Conclusions: The school environment had a direct impact on the respiratory health of children, with several factors having a direct impact on the children's health.

Asian Pacific Journal of Tropical Biomedicine, 2014

PLoS ONE, 2021

[This corrects the article DOI: 10.1371/journal.pone.0239389.].

BMJ Case Reports, 2021

BMJ Case Reports

PLOS ONE

Clinical Microbiology and Infection

BMJ Case Reports

Asia Pacific Allergy

Journal of Geoscience and Environment Protection

Annals of Allergy, Asthma & Immunology, 2016

Malta Medical Journal, 2013

Clinical Neuropharmacology, 2008

Integrative Medicine International, 2015

Asian Pacific Journal of Tropical Biomedicine, 2014