Publications by authors named "Sarah Micallef"

8 Publications

  • Page 1 of 1

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

Acute hepatitis C infection with secondary liver injury successfully treated with sofosbuvir/velpatasvir combination.

Br J Hosp Med (Lond) 2020 Aug 21;81(8):1-3. Epub 2020 Aug 21.

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

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http://dx.doi.org/10.12968/hmed.2020.0047DOI Listing
August 2020

Hepatic Necrosis after Trans-Arterial Embolization of Metastatic Neuroendocrine Tumour.

Eur J Case Rep Intern Med 2020 19;7(5):001530. Epub 2020 Mar 19.

Department of Oncology, Sir Anthony Mamo Oncology Centre, Msida, Malta.

Liver metastases from neuroendocrine tumours (NETs) are usually seen on cross-sectional imaging at presentation. In such cases, curative surgical resection is usually not possible given that most patients have bilobar disease. Various locoregional approaches are now widely available that enable local control of disease and management of systemic symptoms. These include trans-arterial embolization (TAE), trans-arterial chemoembolization (TACE), selective internal radiotherapy and thermal ablation. We describe a rare case of hepatic necrosis after TAE in a 61-year-old woman with a metastatic NET. Cross-sectional imaging showed extensive necrosis affecting segments VII and VIII of the liver. This occurred secondary to thrombosis in the portal vein branches to these segments, confirmed on a Doppler ultrasound scan. The mechanism of portal vein thrombosis after TAE could be due to the presence of occult arterioportal anastomoses. These allow transit of the embolizing agents into the portal vein branches supplying the treated segments and subsequent thrombosis.

Learning Points: Hepatic necrosis is a very rare but significant complication of TAE. The incidence of this complication after TAE has not yet been reported.Hepatic necrosis may be mimicked by the more commonly encountered post-embolization syndrome (PES). Hepatic necrosis should be suspected when symptoms are prolonged, or if the patient exhibits any form of deterioration. Prompt cross-sectional imaging is crucial in establishing diagnosis.Thorough supportive management is key in the setting of liver injury or failure. Sepsis should be treated aggressively with regular blood cultures and specialist input should be sought for optimization of antibiotic regimes.
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http://dx.doi.org/10.12890/2020_001530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213831PMC
March 2020

Gastrointestinal lymphoma: an unusual presentation.

BMJ Case Rep 2019 May 10;12(5). Epub 2019 May 10.

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

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http://dx.doi.org/10.1136/bcr-2019-229322DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536263PMC
May 2019

Environmental Influences on Neuromorphology in the Non-Native Starling Sturnus vulgaris.

Brain Behav Evol 2018 13;92(1-2):63-70. Epub 2018 Sep 13.

Deakin University, Geelong, Victoria, Australia.

Cognitive traits are predicted to be under intense selection in animals moving into new environments and may determine the success, or otherwise, of dispersal and invasions. In particular, spatial information related to resource distribution is an important determinant of neural development. Spatial information is predicted to vary for invasive species encountering novel environments. However, few studies have tested how cognition or neural development varies intraspecifically within an invasive species. In Australia, the non-native common starling Sturnus vulgaris inhabits a range of habitats that vary in seasonal resource availability and distribution. We aimed to identify variations in the brain mass and hippocampus volume of starlings in Australia related to environmental variation across two substantially different habitat types. Specifically, we predicted variation in brain mass and hippocampal volume in relation to environmental conditions, latitude, and climatic variables. To test this, brain mass and volumes of the hippocampus and two control brain regions (telencephalon and tractus septomesencephalicus) were quantified from starling brains gathered from across the species' range in south eastern Australia. When comparing across an environmental gradient, there was a significant interaction between sex and environment for overall brain mass, with greater sexual dimorphism in brain mass in inland populations compared to those at the coast. There was no significant difference in hippocampal volume in relation to environmental measures (hippocampus volume, n = 17) for either sex. While these data provide no evidence for intraspecific environmental drivers for changes in hippocampus volume in European starlings in Australia, they do suggest that environmental factors contribute to sex differences in brain mass. This study identifies associations between the brain volume of a non-native species and the environment; further work in this area is required to elucidate the mechanisms driving this relationship.
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http://dx.doi.org/10.1159/000491672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390445PMC
July 2019

CMV encephalitis in an immune-competent patient.

BMJ Case Rep 2018 Jul 5;2018. Epub 2018 Jul 5.

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

After being admitted to hospital with atypical chest pain, a 61-year-old woman was noted to become lethargic and confused. She also developed global dysphasia. MRI was suggestive of encephalitis, and lumbar puncture was positive for cytomegalovirus (CMV) PCR. The patient was treated with intravenous ganciclovir and subsequent oral valganciclovir and she gradually made a reasonable recovery. While this infection is usually closely linked to immunosuppression, the patient was found to be HIV negative, and was not on any immunosuppressive therapy. Going through the patient's medical history revealed two possible risk factors which might have led to the development of CMV encephalitis: immunosuppression secondary to underlying poorly controlled diabetes mellitus; and previous admission to the intensive care unit which might have lead to CMV reactivation.
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http://dx.doi.org/10.1136/bcr-2018-224740DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040547PMC
July 2018

Antiphospholipid syndrome masquerading as a case of infective endocarditis.

BMJ Case Rep 2018 Jun 4;2018. Epub 2018 Jun 4.

Infectious Diseases, Mater Dei Hospital, Msida, Malta.

A 54-year-old Caucasian woman presented with an episode of loss of consciousness and dysphasia. MRI revealed a number of ischaemic foci indicating an embolic source. Echocardiography showed a mitral valve vegetation. After taking three sets of blood cultures, she was started on empirical treatment for infective endocarditis. The blood cultures remained negative and a presumed diagnosis of culture-negative endocarditis was entertained. However, despite the antibiotic therapy, the patient deteriorated further. Subsequently the patient was found to be positive for antiphospholipid antibodies. Eventually, after a convoluted hospital stay, a diagnosis of antiphospholipid syndrome complicated by Libman-Sacks endocarditis was reached. The patient was treated with steroids and anticoagulation with dramatic improvement.
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http://dx.doi.org/10.1136/bcr-2018-224404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990064PMC
June 2018

Novel applications of COX-2 inhibitors, metformin, and statins for the primary chemoprevention of breast cancer.

J Turk Ger Gynecol Assoc 2016 1;17(4):214-223. Epub 2016 Dec 1.

Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Tal-Qroqq, Msida, Malta.

Recent evidence shows that commonly prescribed drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs), metformin, and statins, may have beneficial roles in the primary chemoprevention of breast cancer. Therefore, these drugs could potentially be used in addition to the hormonal drugs currently used for this purpose (namely, selective estrogen receptor modulators and aromatase inhibitors) due to their alternative mechanisms of action.
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http://dx.doi.org/10.5152/jtgga.2016.15200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5147761PMC
December 2016