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Rapporteur’s report
Full text linkAs rapporteur, it is my privilege to provide a summary of our key discussions and
outcomes over the past two days on the theme: “Upholding Good Governance
in Challenging Times – The Role of the Ombudsman.”
We have heard invaluable perspectives that, together, highlight the importance of
the Ombudsman. The Parliamentary Ombudsman of Malta reminded us of the heart of
the mission: protecting citizens in their everyday interactions with the state. While the
Office is no longer new, I quote “it does not have an expiry date,” it remains a dynamic
guardian of fairness, rights, and accountability. [excerpt]peer-reviewe
Use of Integra for thumb length conserving surgery for an acral melanoma in-situ
Full text linkBACKGROUND: Acral melanoma (AM) is an uncommon subtype of melanoma and has traditionally been managed with amputation of the affected digit, even in cases of in-situ disease. Such an approach may result in significant functional and psychological morbidity, particularly in elderly patients.METHODS: We report the case of an 80-year-old gentleman who presented with an AM in-situ affecting the left thumb, which had been present for over 20 years. Following refusal of amputation, a conservative surgical approach was undertaken. A degloving procedure was performed, and reconstruction was achieved using a dermal regeneration template (Integra®).RESULTS: Despite the technical and oncological limitations associated with conservative management, the patient achieved a functionally and aesthetically satisfactory outcome, with preservation of thumb length and function.CONCLUSION: Although amputation of the affected digit has historically been recommended for AM, this case highlights that, in carefully selected patients with in-situ disease, a more conservative surgical approach may be a viable alternative. Such an approach may allow adequate disease control while preserving function and improving quality of life.peer-reviewe
AI-driven and data-intensive auditing : enhancing sustainability and intelligent assurance
Full text linkThe integration of artificial intelligence (AI) and big data analytics has revolutionized audit practices, offering unprecedented advancements in efficiency, transparency, and sustainability. This study critically examines the role of AI-powered auditing in risk detection, anomaly identification, and the development of sustainable audit frameworks. Through an extensive literature review, the adoption of machine learning (ML), natural language processing (NLP), and continuous auditing methodologies is explored, highlighting their impact on audit quality and assurance. It is demonstrated that AI-driven auditing significantly enhances error detection and risk assessment while expediting audit procedures and improving overall accuracy. However, critical challenges remain, including data security risks, algorithmic opacity, and ethical concerns related to decision-making autonomy. Addressing these issues necessitates the establishment of robust governance mechanisms, increased algorithmic transparency, and the implementation of continuous professional training programs to ensure auditors' proficiency in AI-based systems. Furthermore, AI-driven automation enables real-time monitoring and predictive analytics, fostering a proactive approach to auditing that mitigates financial and operational risks. By leveraging AI and data-driven methodologies, audit frameworks can be rendered more adaptive, resilient, and aligned with the evolving digital economy. These findings underscore the necessity for organizations to integrate AI-driven auditing as a strategic imperative while ensuring regulatory compliance and ethical oversight.peer-reviewe
High grade endometrial stromal sarcoma tumor recurrence
Full text linkBACKGROUND: Endometrial stromal sarcomas (ESS) are very rare type of malignant uterine tumors, making up around 0.2-1% of all uterine neoplasms and less than 10% of uterine sarcomas.CLINICAL CASE: 59 year old lady, previously treated for grade III invasive ductal breast carcinoma with surgery, anthracycline chemotherapy and external beam radiotherapy to the pelvis to ablate the ovaries, presented with postmenopausal bleeding. A transvaginal ultrasound scan (TVUS) showed a 4.5cm by 5.1cm heterogeneous area in the endocavity, suspicious of haematometria. Hysteroscopy, dilation and curettage (D&C) noted multiple clots as well as a mass, suspicious of a fibroid or tumour arising from the endometrium. An MRI of the uterus reported a pedunculated intracavitary fibroid. A total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH + BSO) was performed in view of worsening symptoms. Histology reported high grade endometrial stromal sarcoma, limited to the uterus, measuring 75mm in greatest dimension, pT1b Nx (FIGO IB). Six months later the patient presented again with pv bleeding. Upon examination a polypoid exophytic mass was noted in the vaginal vault. A sample was taken and sent for histology, which reported features in keeping with recurrence of the previous endometrial stromal sarcoma. An MRI of the pelvis showed vaginal vault stump recurrence and a 1.7cm serosal nodule on the mid sigmoid colon. CT of the abdomen and pelvis showed no evidence of extra pelvic disease. Patient was scheduled for a resection of the upper vagina including the vault nodule and adjacent sigmoid colon. Histology of the resected specimens reported recurrence of the high grade uterine stromal sarcoma in the vaginal vault, which invaded the sigmoid colon.CONCLUSION: The mainstay treatment for ESS is a TAH + BSO. This case demonstrates that although complete remission can be obtained, recurrence can still happen. Clinicians should follow these patients closely, even when disease free. Early diagnosis and surgical removal of recurrence is of utmost importance to survival of these patients.peer-reviewe
Imagining, designing and teaching regenerative futures : art-science approaches and inspirations from around the world
Full text linkPermaculture can be considered synonymous with regeneration. In a world where
so much damage has been done to the ecosystem that conservation and preservation
are not enough, regeneration and restoration need to take the central stage.
Permaculture is a “set of principles that integrates land, resources, people, and
the environment through mutually beneficial synergies. It aims to imitate and recreate natural ecosystems through the use of closed-loop and no-waste techniques”
(PermaModule, n.d.). Unlike intensive agriculture, which often sacrifices biodiversity for high productivity, permaculture offers holistic alternatives rooted in ethics,
specifically earth care, people care, and fair shares.peer-reviewe
An empirical comparative analysis of the gold market dynamics of the Indian and U.S. commodity markets
Full text linkThis study examines the dynamic relationship between the gold markets of India and the United States from 2005 to 2025. Recognising gold’s role as a hedge and safe-haven during market uncertainty, we employ the Autoregressive Distributed Lag (ARDL) model to assess long-term co-integration and apply the Toda–Yamamoto causality test to evaluate directional influences. Additionally, the Generalised Autoregressive Conditional Heteroskedasticity (GARCH) (1, 1) model is applied to examine volatility spillovers. Results reveal no long-term co-integration between the two markets, suggesting they function independently over time. However, unidirectional causality is observed from the U.S. to the Indian gold market, and the GARCH model confirms bidirectional volatility transmission, indicating interconnected short-run dynamics. These findings imply that gold market shocks in one country may affect short-term pricing in the other, but not long-term trends. From a portfolio diversification and risk management perspective, investors may benefit from allocating assets across both markets. This study contributes a novel empirical framework by integrating ARDL, Toda–Yamamoto Granger causality, and GARCH(1, 1) models over a two-decade period (2005–2025), incorporating post-COVID market dynamics. The combination of these methods, applied to both an emerging (India) and developed (U.S.) economy, provides a comprehensive understanding of gold market interdependence. In doing this, the paper offers valuable insights into causality, volatility transmission, and diversification potential. The econometric rigour of the study is enhanced through residual diagnostic tests, including tests of normality, autocorrelation, and other heteroscedasticity tests, as well as VAR stability tests. These ensure strong inference and model validity; more specifically, they are pertinent to the analysis of financial time series.peer-reviewe
Serial ultrasound-guided Stellate ganglion block using bupivacaine, dexamethasone, and methylcobalamin to treat Complex Regional Pain Syndrome type II : a case report ad interim
No full textBACKGROUND: Stellate ganglion block (SGB) has been widely used as a therapeutic approach for refractory complex regional pain syndrome (CRPS), but clinical outcome varies, long-term pain-relieving effect is unknown, and most studies employed local anesthesia per se. We would like to address if the combination of bupivacaine (Bupi), dexamethasone (Dex), and methylcobalamin (MeCbl) can provide a clinically meaningful reduction of pain intensity and quality, as well as improving patient’s sleep and functional qualities in a sustainable fashion.CASE PRESENTATION: We performed a monthly serial SGB to a painful CRPS type II patient using Bupi and Dex in the first 2 months, then added MeCbl into the regimen until the fifth month onward. We measured weekly baseline pain intensity using baseline and evoked NRS, pain quality and affective using McGill Short-Form Questionnaire (SF-MPQ), sleep quality using Pittsburgh Sleep Quality Index (PSQI), and functional activities using Pain Disability Index (PDI) questionnaire during pre-procedure until the end of the fourth week post procedure. All spectra of pain assessments were also compared between pre- and post-addition of MeCbl and tested using independent t test analysis. Repeated SGBs were safely performed in the absence of significant adverse effects. A dramatic reduction of all spectra of pain measurements, comprising baseline (-62,5%), evoked (-60%) NRS, SF-MPQ (-39.4%), PSQI (-53.3%), and PDI (-56.9%) was observed immediately after procedure. The addition of MeCbl was able to further reduce the baseline (mean reduction 1.38 [-12.5%]; 95% CI 0.53 – 2.22; p=0.003), evoked (mean reduction 1.17 [-20%]; 95% CI -0.16 – 2.50; p=0.048) NRS, SF-MPQ (mean reduction 3.38 [-24.2%]; 95% CI 0.70 – 6.05; p=0.016), PSQI (mean reduction 1.29 [-13.4%]; 95% CI -0.22 – 2.8; 0.089), and PDI (mean reduction 9.75 [-26.2%]; 6.96 – 12.54; p<0.0001), compared to the first week of first injection. Clinical improvements were stable and sustainable until the end of observation period.CONCLUSIONS: Monthly serial US-guided SGB with Bupi, Dex, and MeCbl were proven to be safe, clinically effective, and sustainable to ameliorate baseline and evoked pain intensity and quality, as well as improving sleep quality and functional activities of a subject with CRPS type II.peer-reviewe
Translating words, transferring wisdom, traversing worlds
Full text linkThe paper discusses whether traditional translation theories can be applied to the translation of European Union (EU) law. It will start by explaining EU multilingualism. Then, from the law, the discussion moves to translation techniques and whether they can apply to EU law. Then, the role of the Court of Justice of the European Union is discussed within the context of harmonisation of European Union law. Will the theological approach carry the day, or will the literal approach be the norm? The paper concludes with a discussion on using a lingua franca as a working language and the effect of Euro-English.peer-reviewe
Challenges in accessing difficult-to-source medicines
Full text linkIntroduction: Shortages
of medicines are experienced worldwide, with
the cause being both supply and demand related. The
development of long term mitigation strategies contributes
to delivering patients their required medicines, both critical
medicines and others in a timely manner.Aim: To
conduct an evaluation of the situation in Malta regarding
medicines shortages through feedback from community
pharmacists, and to identify challenges in accessing difficult
to source medicines.peer-reviewe
Secretory carcinoma of parotid and diagnostic challenge of salivary gland malignancy
Full text linkSecretory carcinoma (SC) or also known as mammary analogue secretory carcinoma (MASC) is a new distinct entity of salivary gland carcinoma that histopathologically resemble secretory carcinoma of breast. It was first documented in salivary gland in 2010 and included in World Health Organization classification in 2017. Formerly it was misdiagnosed as acinic cell carcinoma or adenocarcinoma in majority of cases, but comparably it is more aggressive. Present of translocation mutation t (12;15) (p13; q25) with fusion of ETV6-NTRK3 genes is typical feature for SC that absent in other salivary gland neoplasm. Diagnostic challenges are always seen in salivary gland tumor due to the morphological diversity, rapid change in nomenclature, some subtypes are extremely rare and lack of specific laboratory test in some center. Surgery is the mainstay of treatment same as other salivary gland carcinoma but increasing evidence of alternative medical treatment with tropomyosin receptor kinase antagonist that make SC more special.peer-reviewe