Neil Grech

Background and Objectives The incidence of glioblastoma multiforme (GBM) ranges from 0.59 to 5 per 100,000 persons, and it is on the rise in many countries. The reason for this rise is multifactorial, and possible contributing factors include an aging population, overdiagnosis, ionizing radiation, air pollution and others. The aim of this study is to conduct an epidemiological study of GBM in a well-defined population over a 10-year period and determine its significance, while comparing results with international standards. Materials and Methods All histological diagnoses of GBM in Malta from 2008 to 2017 were identified. Poisson regression was used to determine significance in incidence variation. Log-rank tests were used to compare the survival distributions of each variable. Cox regression for survival analysis with the Breslow method for ties was then performed to consider the overall model. Results A total of 100 patients (61 males; mean age 60.29±10.09 years) were diagnosed with GBM over the period 2008 to 2017. There was a significant increase in incidence from 0.73 to 4.49 per 100,000 over the 10-year period (p≤0.001). The most common presenting complaint was limb paresis (29%). Approximately 65% of patients were treated with maximum safe resection (MSR). Using Cox regression analysis, younger age at presentation and treatment with MSR significantly improved survival (p=0.026 and p≤0.001, respectively). The median survival was 10 months. Conclusions An increasing incidence of GBM is becoming evident, while the median survival remains low. This troubling trend emphasizes the importance of further research into GBM etiology and treatment.

Introduction and Aims. The first COVID-19 case in Malta was confirmed on the 7th of March 2020. This study is aimed at investigating a significant difference between the number of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) admissions and their inpatient outcome at Mater Dei Hospital during the COVID-19 pandemic when compared to the same period in 2019. Furthermore, we aim to determine predictors of mortality in AECOPD inpatients. Method. Data was collected retrospectively from electronic hospital records during the periods 1st March until 10th May in 2019 and 2020. Results. There was a marked decrease in AECOPD admissions in 2020, with a 54.2% drop in admissions ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>n</a:mi> <a:mo>=</a:mo> <a:mn>119</a:mn> </a:math> in 2020 vs. <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>n</c:mi> <c:mo>=</c:mo> <c:mn>259</c:mn> </c:math> in 2019). There was no significant difference in patient demographics or medical comorbidities. In 2020, there was a significantly lower number of patients with AECOPD who received nebulised medications during admission (60.4% in 2020 vs. 84.9% in 2019; <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>p</e:mi> <e:mo>≤</e:mo> <e:mn>0.001</e:mn> </e:math> ). There were also significantly lower numbers of AECOPD patients admitted in 2020 who received controlled oxygen via venturi masks (69.0% in 2020 vs. 84.5% in 2019; <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>p</g:mi> <g:mo>=</g:mo> <g:mn>0.006</g:mn> </g:math> ). There was a significant increase in inpatient mortality in 2020 (19.3% [ <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>n</i:mi> <i:mo>=</i:mo> <i:mn>23</i:mn> </i:math> ] and 8.4% [ <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>n</k:mi> <k:mo>=</k:mo> <k:mn>22</k:mn> </k:math> ] for 2020 and 2019, respectively, <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mi>p</m:mi> <m:mo>=</m:mo> <m:mn>0.003</m:mn> </m:math> ). Year was found to be the best predictor of mortality outcome ( <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"> <o:mi>p</o:mi> <o:mo>=</o:mo> <o:mn>0.001</o:mn> </o:math> ). The lack of use of SABA pre-admission treatment ( <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"> <q:mi>p</q:mi> <q:mo>=</q:mo> <q:mn>0.002</q:mn> </q:math> ), active malignancy ( <s:math xmlns:s="http://www.w3.org/1998/Math/MathML" id="M10"> <s:mi>p</s:mi> <s:mo>=</s:mo> <s:mn>0.003</s:mn> </s:math> ), and increased length of hospital stay ( <u:math xmlns:u="http://www.w3.org/1998/Math/MathML" id="M11"> <u:mi>p</u:mi> <u:mo>=</u:mo> <u:mn>0.046</u:mn> </u:math> ) were also found to be predictors of mortality for AECOPD patients; however, these parameters were unchanged between 2019 and 2020 and therefore could not account for the increase in mortality. Conclusions. There was a decrease in the number of admissions with AECOPD in 2020 during the COVID-19 pandemic, when compared to 2019. The year 2020 proved to be a significant predictor for inpatient mortality, with a significant increase in mortality in 2020. The decrease in nebuliser and controlled oxygen treatment noted in the study period did not prove to be a significant predictor of mortality when corrected for other variables. Therefore, the difference in mortality cannot be explained with certainty in this retrospective cohort study.

This study aimed to investigate the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on all types of acute cardiac admissions (ACAs) and cardiac mortality in Malta. Number, characteristics and delay to presentation of ACAs to our institution during the study period (28 February–30 April 2020) were compared with the corresponding 2019 period. Non-parametric correlation analyses between daily SARS-CoV-2 cases in Malta, Italy and the UK and daily ACAs were performed. Differences in cardiac death distribution (community vs. in-hospital) during the two periods were analysed. There was a significant decline in daily ACAs in 2020 (median 3 [IQR 3]) vs. 2019 (median 5 [IQR 4]), p < 0.001. Patient characteristics were comparable. Delay to presentation for 2020 ACAs was significantly higher across all categories (ST-elevation myocardial infarction [STEMI] median: 2019 [1 h, IQR 1] vs. 2020 [4 h, IQR 43.8], p = 0.009; non-ST-elevation-acute coronary syndrome [NSTE-ACS] median: 2019 [4 h, IQR 71] vs. 2020 [48 h, IQR 199], p = 0.001; non-ACS median: 2019 [24 h, IQR 95] vs. 2020 [84 h, IQR 499.8], p < 0.001). There was a significant negative correlation between ACAs and daily Malta SARS-CoV-2 infection cases (rs = −0.298, p = 0.018) but not with cases in Italy and the UK when controlling for Malta cases. Significantly more cardiac deaths occurred in the community in 2020 (107, 61.8%) compared to 2019 (87, 46.8%) (p = 0.004). Fear of SARS-CoV-2 infection led to a significant avoidance of acute cardiac care with an accompanying rise in community cardiac deaths, suggesting a need for better public education on recognising and addressing cardiovascular symptoms.