Publications by authors named "Claudia Fsadni"

10 Publications

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The first wave of COVID-19 in Malta; a national cross-sectional study.

PLoS One 2020 15;15(10):e0239389. Epub 2020 Oct 15.

Department of Infectious Diseases, Mater Dei Hospital, Msida, Malta.

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 7th of March to the 24th 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 viral diseases. Patients with moderate-severe disease had excellent outcomes with no deaths reported at 30-day follow up.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239389PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7561161PMC
October 2020

Complications of measles: a case series.

BMJ Case Rep 2020 Feb 17;13(2). Epub 2020 Feb 17.

Department of Infectious Disease, Mater Dei Hospital, Msida, Malta.

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.
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http://dx.doi.org/10.1136/bcr-2019-232408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206919PMC
February 2020

Impact of School Air Quality on Children's Respiratory Health.

Indian J Occup Environ Med 2018 Sep-Dec;22(3):156-162

Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.

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/m and CO (9.11 ppm) exceeded World Health Organization thresholds. Indoor ozone levels exceeded the mean European school's indoor ozone concentration of 8 μg/m. High exposure to formaldehyde, NO, and ozone was associated with atopy in children. Heavy vehicles passing near the schools were associated with current wheezing ( < 0.001) but not nocturnal cough ( = 0.34).

Conclusions: School indoor and outdoor environment has a direct impact on children's respiratory health. This study has identified significant associations between high exposures to indoor air pollutants, school characteristics, and upper and lower airway inflammation.
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http://dx.doi.org/10.4103/ijoem.IJOEM_95_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309359PMC
January 2019

Food consumption and the risk of childhood allergy.

Asia Pac Allergy 2018 Oct 16;8(4):e35. Epub 2018 Oct 16.

Department of Medicine, Mater Dei Hospital, Msida, Malta.

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.
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http://dx.doi.org/10.5415/apallergy.2018.8.e35DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209597PMC
October 2018

Influenza A: another cause of SIADH?

BMJ Case Rep 2018 Oct 17;2018. Epub 2018 Oct 17.

Department of Medicine, Infectious Diseases Division, Mater Dei Hospital, Msida, Malta.

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.
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http://dx.doi.org/10.1136/bcr-2018-226154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254460PMC
October 2018

Association between obstructive sleep apnea and atopy in adult Maltese patients.

Ann Allergy Asthma Immunol 2016 Oct 27;117(4):441-442. Epub 2016 Aug 27.

Department of Medicine, Mater Dei Hospital, Msida, Malta.

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http://dx.doi.org/10.1016/j.anai.2016.07.040DOI Listing
October 2016

Association of prevalence of rhinitis, atopic eczema, rhinoconjunctivitis and wheezing with mortality from infectious diseases and with antibiotic susceptibility at a country level.

Asia Pac Allergy 2015 Jul 29;5(3):145-55. Epub 2015 Jul 29.

Department of Medicine, Mater Dei Hospital, Msida, MSD 2090, Malta. ; Faculty of Medicine and Surgery, University of Malta, Msida, MSD 2090, Malta.

Background: It was previously reported that there is a positive correlation between incidence of type 1 diabetes and prevalence of asthma and atopic eczema. A negative correlation between the prevalence of type 1 diabetes and mortality from infectious diseases as well as a positive correlation with antibiotic susceptibility at a country level have also been reported.

Objective: The aim of this study was to investigate the association between country prevalence of rhinitis, atopic eczema, rhinoconjunctivitis, and wheezing with mortality from infectious diseases and also with antibiotic susceptibility at a country level.

Methods: Data for prevalence of rhinitis, eczema, rhinoconjunctivitis, and wheezing was obtained from the International Study of Asthma and Allergies in Childhood study (ISAAC). ISAAC Phase one was a multicentre multicountry cross sectional study involving over 700,000 children in 2 age groups of school children, 13-14 years old (adolescents) and 6-7 years old (children) in 156 centres from 56 countries. Mortality from infectious diseases was taken from World Health Organisation data. The Alexander project was used to identify antibiotic susceptibilities to common bacteria.

Results: There were significant positive correlations between atopic eczema and mortality from all infectious diseases studied, diarrhoeal illness, tropical infections, and childhood infections. A negative correlation exists between the prevalence of rhinitis and Streptococcus pneumoniae susceptibility to penicillin and to erythromycin, rhinitis and Haemophilus influenzae susceptibility to ampicillin and between rhinoconjunctivitis and H. influenzae susceptibility to ampicillin.

Conclusion: Th1/Th2 responses might influence the pathogenesis of infectious disease mortality, while antibiotic overprescription could explain the negative association between atopy and antibiotic susceptibility.
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http://dx.doi.org/10.5415/apallergy.2015.5.3.145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521163PMC
July 2015

Primary laryngeal tuberculosis: An unusual cause of hoarseness.

Ear Nose Throat J 2014 Oct-Nov;93(10-11):E15-7

Department of Medicine, Mater Dei Hospital, Msida MSD 2090, Malta.

Tuberculosis (TB) of the larynx is usually associated with concomitant pulmonary TB, but approximately 20% of cases represent primary disease. We report the case of an 85-year-old woman with asthma who presented with a 6-month history of persistent hoarseness. Bronchoscopy confirmed the presence of a lesion in the hemilarynx, and histology identified tuberculoid granulomas that were suggestive of TB. Treatment with a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol led to a complete resolution of symptoms. A high index of suspicion for laryngeal TB is required in patients who present with hoarseness.
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October 2015

Correlation of worldwide incidence of type 1 diabetes (DiaMond) with prevalence of asthma and atopic eczema (ISAAC).

Clin Respir J 2012 Jan 10;6(1):18-25. Epub 2011 May 10.

Department of Medicine, Mater Dei Hospital, Birkirkara, Malta.

Introduction: Environmental factors play a role in pathogenesis of both type 1 diabetes and atopic disease but they remain incompletely understood. T cell-mediated responses primarily of the T helper type 1 (Th1) are involved in type 1 diabetes while T helper type 2 (Th2) responses favour allergic disease. This TH 1/TH 2 paradigm is currently the source of much controversy in various studies.

Objective: The aim of the study was to compare the reported country incidence of type 1 diabetes with the prevalence of atopic disease.

Methods: The prevalence of wheeze, rhinitis, rhinoconjunctivitis and atopic eczema in the preceding 12 months in the 13- to 14-year-old age group was taken from The International Study of Asthma and Allergies in Childhood phase 1 study. These were compared to the age specific incidence of type 1 diabetes in children per 100 000 per year obtained from the Diabetes Mondiale Project Group study from those countries participating in both studies. Data collected from these 31 countries together with latitude was analysed using a Pearson correlation and significance analysis. A multiple regression analysis determined the confounding effect of latitude.

Results: The incidence of type 1 diabetes was found to have a positive correlation with both wheezing (P = 0.009) and atopic eczema (P < 0.01). There was a no correlation between the incidence of type 1 diabetes and the prevalance of rhinitis (r = 0.02, P = 0.88) or of rhinoconjunctivitis (r = 0.026, P = 0.88). Latitude correlated negatively with type 1 diabetes and positively with rhinitis and rhinoconjnctuvits; it was not significantly correlated with wheeze or eczema. Regression analysis showed that latitude is a significant confounding factor in the correlation of rhinitis (P value < 0.0008) and rhinoconjunctivitis (P value < 0.0003) with diabetes.

Conclusions: The study suggests that common environmental and/or genetic factors predispose to type 1 diabetes, wheezing and atopic eczema while factors predisposing to rhinitis and rhinoconjunctivitis appear to be distinct from those predisposing to type 1 diabetes.
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http://dx.doi.org/10.1111/j.1752-699X.2011.00239.xDOI Listing
January 2012

Carbamazepine-induced drug reaction with eosinophilia and systemic symptoms syndrome in a 35-year-old man with epilepsy.

Clin Neuropharmacol 2008 Sep-Oct;31(5):295-8

Infectious Diseases Unit, St Luke's Hospital, Gwardamangia, Malta.

The drug reaction with eosinophilia and systemic symptoms syndrome describes a hypersensitivity reaction to a number of drugs. It is characterized by a triad of fever, rash, and internal organ involvement. Carbamazepine is suspected to be the cause of the drug reaction with eosinophilia and systemic symptoms syndrome in this young man who presented with fulminant hepatitis and an exfoliating rash 8 weeks after starting carbamazepine. Symptoms gradually resolved after stopping carbamazepine and starting systemic steroids.Because we encountered only a few similar cases in the literature, we wish to highlight the importance of recognizing these symptoms as a syndrome that can be fatal, especially if not recognized early.
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http://dx.doi.org/10.1097/WNF.0b013e31815a3ed6DOI Listing
May 2009