Tenecteplase is a thrombolytic protein drug used by paramedics, emergency responders, and critical care medical personnel for the prehospital treatment of blood clotting diseases. Minimizing the time between symptom onset and the initiation of thrombolytic treatment is important for reducing mortality and improving patient outcomes. However, the structure of protein drug molecules makes them susceptible to physical and chemical degradation that could potentially result in considerable adverse effects. In locations that experience extreme temperatures, lyophilized tenecteplase transported in emergency service vehicles (ESVs) may be subjected to conditions that exceed the manufacturer’s recommendations, particularly when access to the ambulance station is limited.

This study evaluated the impact of heat exposure (based on temperatures experienced in an emergency vehicle during summer in a regional Australian city) on the stability and efficacy of lyophilized tenecteplase.

Vials containing 50mg lyophilized tenecteplase were stored at 4.0°C (39.2°F), 35.5°C (95.9°F), or 44.9°C (112.8°F) for a continuous period of eight hours prior to reconstitution. Stability and efficacy were determined through assessment of: optical clarity and pH; analyte concentration using UV spectrometry; percent protein monomer and single chain protein using size-exclusion chromatography; and in vitro bioactivity using whole blood clot weight and fibrin degradation product (D-dimer) development.

Heat treatment, particularly at 44.9°C, was found to have the greatest impact on tenecteplase solubility; the amount of protein monomer and single chain protein lost (suggesting structural vulnerability); and the capacity for clot lysis in the form of decreased D-dimer production. Meanwhile, storage at 4.0°C preserved tenecteplase stability and in vitro bioactivity.

The findings indicate that, in its lyophilized form, even relatively short exposure to high temperature can negatively affect tenecteplase stability and pharmacological efficacy. It is therefore important that measures are implemented to ensure the storage temperature is kept below 30.0°C (86.0°F), as recommended by manufacturers, and that repeated refrigeration-heat cycling is avoided. This will ensure drug administration provides more replicable thrombolysis upon reaching critical care facilities.

The physical aspect of Maltese patients treated with antipsychotics

Patients with mental health problems are known to have more physical comorbidities resulting in reduced life expectancy when compared to the general population. The NICE guidelines (2014) has directed clinicians to monitor the physical health of patients with psychosis.

This study sets to determine whether management of physical health comorbidities of Maltese patients treated with antipsychotics is optimal.

The aim of this study is to screen for risk factors of poor physical health, features of the metabolic syndrome and other physical comorbidities amongst Maltese patients treated with antipsychotics.

Patients treated with antipsychotics were randomly enrolled in the study. Parameters measured included weight and waist circumference. Blood pressure and blood glucose monitoring was reviewed. Lipid profiles were checked for dyslipidaemia. Patients were questioned about physical comorbidities (particularly diabetes, cardiovascular diseases and respiratory problems), their smoking status, diet and level of physical activity.

Preliminary results indicate that the physical health of patients treated with antipsychotics in Malta is suboptimal and may be improved.

Patients treated with antipsychotics in Malta need better identification and management of their poor lifestyle choices and physical comorbidities. Simple interventions such as offering suitable advice, education and referring to appropriate specialists to treat identified physical problems may greatly improve patient's quality of life.

The intricate connection between the mind and the body is reflected in the complex relationship between mental and physical health. Previous studies have shown that there may be a link between obesity and poor mental health, with depression in particular. This is more of a concern in Malta since the mean population body mass index (BMI) lies on the upper end of the spectrum.

To examine the association between mental health and obesity in a sampled Maltese population.

To screen for mental health problems and determine the prevalence of somatoform, depression, anxiety, eating disorders and alcohol labuse in various categories of BMI.

A random sample of Maltese people were recruited from various settings including health centres and the general hospital. A questionnaire was carried out for participants who agreed to participate. Their BMI and several risk factors for physical comorbidities were recorded. The ‘PatientHealth Questionnaire’ was then used to screen for the mental health conditions listed in the aims section.

Preliminary results indicate that an increasing BMI is linked to a poorer mental health.

The association between poor mental health andobesity in the sampled Maltese population is of concern since Malta is one ofthe leading countries with the highest prevalence of obesity. Better mental health may be promoted by targeting to achieve a healthier BMI in the local population.

The development of treatment-resistant schizophrenia in a 16-year-old Maltese girl was analyzed in terms of its biopsychosocial model of disease.

To highlight the presentation of treatment-resistant schizophrenia.

To investigate the etiology of treatment-resistant schizophrenia.

To utilize the biopsychosocial model of disease in order to investigate the aetiology of treatment-resistant schizophrenia.

To highlight the treatment modalities utilized in this case of treatment-resistant schizophrenia.

Interviewing the patient.

Analyzing all investigations and documentation made during her admission in an acute psychiatric hospital.

Evaluating the response to various treatment modalities.

Carrying out literature reviews.

Image attached.

Although the aetiology of treatment-resistant schizophrenia remains somewhat unclear even after many years of study, the biopsychosocial model is nevertheless useful in understanding the development of this condition. The treatment modalities to which the patient was resistant were also identified.

Figure not available.

The authors have not supplied their declaration of competing interest.

Addiction refers to a pattern of:

– loss of control, as shown by unsuccessful efforts to stop the behaviour;

– continuation of the behaviour despite adverse consequences – such as marriage breakdown;

– an obsession with obtaining, using or recovering from the behaviour.

To date, DSM-5 does not recognize sex addiction as a disorder, however when problematic sexual behaviours fulfil these same three criteria, the process is considered to be an addiction.

This case report describes the development of problematic addictive sexual behaviour, possibly as a result of other psychiatric comorbidities including obsessive-compulsive disorder (OCD), alvinophilia, and obsessional fetishism. The presence of the Madonna-Puttana syndrome is also explored.

To use the biopsychosocial model to investigate the aetiology of addictive problematic sexual behaviour. To explore the role of psychiatric comorbidities in the expression of such behaviour. To examine the holistic impact of sexual addictions. To examine the treatment modalities of addictive problematic sexual behaviour.

A 25 year old happily-married nurse who confessed to serial extramarital affairs was interviewed. Underlying psychiatric comorbidities were identified. Family members were also interviewed for a collateral history. The above objectives were explored and the response to various treatment modalities were evaluated. Literature reviews were carried out.

This case illustrates a form of OCD which manifested as addictive problematic sexual behaviour. The message portrayed is that hope exists for such couples once various treatment modalities are put into action.

The authors have not supplied their declaration of competing interest.

To study potentially modifiable factors associated with the severity of agitation or aggression (A/A) symptoms among Alzheimer’s disease (AD) patients.

Data from the Impact of Cholinergic Treatment Use (ICTUS) study, European longitudinal prospective observational study.

Community dwelling outpatients included in 29 European memory clinics.

1375 participants with probable AD (Mini-Mental State Examination score of 10–26) with an informal caregiver.

At baseline and twice yearly over the two-year follow-up, patients underwent comprehensive clinical and neuropsychological assessments: sociodemographic data, cognitive status, functional impairment, and assessment of neuropsychiatric symptoms based on Neuro-Psychiatric Inventory (NPI). The ZARIT scale assessed the caregiver’s burden. The variable of interest was the severity of the item of A/A of the NPI. To study factors associated to the severity of A/A symptoms six months later, a multivariate mixed regression model was used.

Frequency of A/A symptom varied from 30% to 34% at each visit. Two factors were found to be independently associated with the severity of A/A: (1) the presence of affective disorder (anxiety, depression, and/or irritability) that increased the severity of the A/A by 0.89 point (coefficient:0.89; 95% Confidence Interval (CI) = [0.48,1.30], p < 0.001), and (2) a severe caregiver burden that increased the severity of the A/A by 1.08 point (coefficient:1.08; 95% CI = [0.69,1.47], p < 0.001).

Research should evaluate whether the identification and treatment of an affective disorder along with the evaluation and optimal management of the caregiver would have a positive impact on the course of A/A in mild to moderate AD patients.

To estimate the impact of comorbid diabetes on caregiver stress in Alzheimer's disease (AD) patients from the Impact of Cholinergic Treatment Use (ICTUS) study.

Using the Data from the ICTUS study, diabetes mellitus (DM) was recorded at baseline and caregiver burden was assessed twice per year using the Zarit Burden Interview (ZBI) scale. The three-factorial model of ZBI (the effect on the social and personal life of caregivers, the psychological burden and the feelings of guilt) was adopted. Linear mixed models were used to examine the relation between DM and the scores of ZBI.

The present analyses were conducted on 1,264 AD subjects. A total of 156 patients (12.3%) had DM with taking antidiabetic medication and/or self-report of a history. At baseline, the caregivers of patients with or without DM had similar ZBI global scores and similar scores of three different factors of ZBI. Unadjusted and adjusted models both indicated that ZBI global score increased over a 24-month follow-up without significant effect of DM. Similarly, unadjusted model showed that DM was not determining any significant difference in the score of any factor. However, adjusted model indicated that in diabetic patients, the scores of the social and personal life of caregivers and the psychological burden increased more slowly than those in non-diabetic patients (p = 0.04 and 0.01, respectively).

DM may affect the caregivers’ daily social and personal life and psychological burden in AD patients. It is necessary for further research.