https://www.um.edu.mt/library/oar/handle/123456789/40293 2026-04-26T10:05:42Z https://www.um.edu.mt/library/oar/handle/123456789/42768 Title: Determining the 'in vitro' effect of Padina pavonica on the oestrogen receptor and oestrogen responsive primary cell lines Abstract: Backgound: Padina pavonica appears to improve the bone mineral density at the lumbar spine and at the hip in post-menopausal women (1). The aims of this project are to compare it to other treatments available on the market, for the treatment of post-menopausal osteoporosis and to shed more light on the mechanism of action of Padina pavonica. Aims and Objectives: The aim of this research-based experiment is to compare the ability of osteoblasts treated with the extract of Padina pavonica (EPP) to differentiate and fix calcium, with osteoblasts treated with raloxifene and oestradiol. Raloxifene, a selective oestrogen receptor modulator (SERM) and oestradiol in the form of hormone replacement therapy (HRT) are drugs normally used in the management of post-menopausal osteoporosis. A secondary aim is to determine whether the extract exerts its action by modulating the oestrogen receptor. This would imply that the extract of Padina pavonica has a SERM-like activity and is thus potentially prone to the same adverse effects, as other members of this class. Methodology: This is a research-based experiment in which primary osteoblasts were isolated and cultured from human bone explants. Primary cells obtained using this method were used to objectively assess the extract's effect on the differentiation of progenitor bone cells to terminally mature osteoblasts. Results were compared to bone cells treated with raloxifene and oestradiol. Alkaline phosphatase activity was measured as an early marker of osteoblast differentiation using spectrophotometry. An MTT assay was employed as a measure and marker of cellular viability and proliferation. These tests were performed after seven days of incubation. The alkaline phosphatase: MTT ratio was calculated and used as another end point in order to reflect whether any increases in alkaline phosphatase were due to an increase in cell mass or whether this was due to the formation of more terminally differentiated osteoblasts. Cells were also incubated with the drugs for fifteen days. The Alizarin Red assay was then performed. The latter was employed as measure of calcium fixation and bone matrix mineralization. Oestrogen receptor mono clonal IgG antibodies were used in order to try and assess whether the drugs' activity was oestrogen receptor dependent or independent. The results was analysed usmg multiple-linear regression analysis and the Kruskall-Wallis non-parametric test. Results: Human primary osteoblasts cells can be easily grown in culture and used as a model for the testing of drugs with potential use in the management of postmenopausal osteoporosis. Cells treated with the extract of Padina pavonica expressed alkaline phosphatase activity. This was then found not to be statistically different from oestrogen or raloxifene (p-value: 0.501). A statistically significant difference between drugs was noted in the cell viability assay (MTT) (p-value: 0.002). The highest cell viability was noted in the cells treated with oestradiol. There was no statistically significant difference between cells treated with EPP and cells treated with raloxifene on the cell viability assay (p-value: 0.528). The latter was reflected in the alkaline phosphatase:MTT ratio of the differently treated cultures which revealed a statistically significant difference between groups (p-value 0.034). Cells treated with the extract of Padina pavonica were only slightly inferior to raloxifene in tenns of osteoblast differentiation as supported by the second highest average estimated marginal means of the alkaline phosphatase to MTT ratio. The different drugs did not show any statistically significant difference in the bone matrix mineralization assay (p-value: 0.548). The oestrogen receptor antibody tests did not reveal any statistically significant results, but suggest a SERM-like activity ofEPP. Conclusions: Our data supports previous studies, which show a potential role for the extract of Padina pavonica in the management of post-menopausal osteoporosis. The mechanism of action of this drug remains to be fully understood. This work indicates a possible direct or indirect modulation (by co-factors) of the oestrogen receptors by EPP and suggests a SERM-like activity of this product. Further Quantitative Polymerase Chain reaction (q-PCR) studies supported and confirmed by Western-blot protein analysis are key steps in understanding the impact of the extract of Padina pavonica on the protein component of bone matrix and to be able to relate differential gene expression signatures to established cell signaling in physiological and pathological pathways. Description: M.SC.REPRODUCTIVE HEALTH 2016-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/40356 Title: Diagnostic performance of CA125, ultrasound score and risk malignancy index in determining adnexal masses Abstract: Context: Pre-operative assessment of adnexal masses aids in appropriate referral and in planning the optimal surgery. CA 125, Ultrasound Score and Risk of Malignancy Index are methods that can be used to triage such masses. Objective: The aim of this study was to evaluate the ability to of CA125, Ultrasound Score and Risk Malignancy Index to differentiate a benign from a malignant pelvic mass. Study Design: This IS a retrospective study of 97 women admitted to the Department of Obstetrics and Gynaecology at Mater Dei Hospital, between September 2015 and February 2016 for surgical investigation of pelvic masses. To diagnose ovarian cancer, the sensitivity, specificity, and positive predictive value of serum CA125, ultrasound score and menopausal status were taken separately and combined into four risk malignancy indices, RMI 1 - 4. Results: This study confirms that, for the diagnosis of malignancy, all four malignancy risk indices were more accurate than menopausal status, serum CA 125 levels, and ultrasound findings separately. We found that there is no statistically significant difference in the performance of the four different RMIs in discriminating malignancy. Conclusion: We concluded that all of the four malignancy risk indices described can be utilised for selection of cases for optimal treatment. These methods are simple techniques that can be used even in less-specialized gynaecology clinics to facilitate the triaging of cases for referral to an oncology unit. Keywords: Adnexal mass, Ovarian cancer, Ultrasonography, CA125, Risk Malignancy Index Description: M.SC.REPRODUCTIVE HEALTH 2016-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/38175 Title: Optimal gestational age for delivery in uncomplicated dichorionic twin pregnancies: a population-based study Abstract: The Maltese islands have seen an increase in multiple pregnancy rate in the past century, from 1.04% in 1900-1969 to 1.4% as reported in the 2014 National Obstetric Information report. This increase has been an effect of social customs such as delayed childbearing and the ever-increasing use of assisted reproductive treatments. Twin neonates have been shown to have a higher risk of prematurity, low birth weight, respiratory morbidity and higher mortality rates when compared to their singleton counterparts. Appropriate timing for delivery of twin pregnancies is a matter of acknowledging the dynamic balance that exists between in-utero foetal stillbirth risk and ex-utero neonatal risk. Such a consideration should drive the empowerment of both obstetricians and parents towards more informed decision-making when balancing the risks and benefits of discretionary delivery. This study undertakes a retrospective analysis of gestational age-specific neonatal outcome in 254 uncomplicated dichorionic twin pregnancies. Our data suggests that in the absence of complications, dichorionic twin neonates continue to benefit from advancing gestation with no consequence on foetal or neonatal mortality. Elective delivery should be delayed up until at least 38 weeks (38+°-38+6) in uncomplicated dichorionic twin pregnancies as this is associated with a significant reduction in the proportion of infants with LBW, RDS, TTN, hypoglycaemia or requiring NPICU care. Keywords: Twin pregnancy. Delivery. Gestational age. Neonatal outcome. Description: M.SC.REPRODUCTIVE HEALTH 2016-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/34420 Title: Advanced maternal age and pregnancy outcome in Malta Abstract: Introduction: The trend towards delayed motherhood has accelerated in developed countries over the last few decades. Advanced maternal age (AMA) is defined as age 35 years and older at the estimated date of delivery. Aim: The aim of this study is to assess for the association between AMA and adverse pregnancy outcomes after adjustment for confounding factors. Method: Mothers of 20 years and older, who delivered singleton babies in Malta and Gozo between 1st January 2000 and 3rd December 2014 were studied. All data was derived from the National Obstetric Information System. Results: The study population included 55,943 singleton births. 12.2% (6,838) of mothers were between 35 - 39 years and 2.4% (1,325) were 40 years and older. Significant difference was found between maternal age and BMI (p < 0.0001), maternal smoking status (p < 0.0001), non-insulin dependent diabetes mellitus (p = 0.004), history of stillbirth (p < 0.0001), gestational diabetes (p < 0.0001), pregnancy - induced - hypertension (p = 0.008) and pre-eclampsia (p = 0.008). Significant difference was also found between maternal age and mode of delivery (p < 0.0001), preterm birth (p < 0.0001), infant birth weight (p <0.0001) and infant outcome (p < 0.0001). No significant difference was found between maternal age and Apgar scores at 1 minute (p = 0.28) and at 5 minutes (p = 0.099). Regression analysis revealed persistent significant differences between maternal age and different pregnancy outcomes. Conclusion: This study demonstrates that AMA in Malta significantly increases the risk for hypertension in pregnancy, gestational diabetes, caesarean delivery, preterm births, low birth weight, stillbirths and neonatal deaths. Care providers need to be aware of these increased risks and adjust their obstetric management according to the individual to ensure optimal maternal and perinatal outcomes. Description: M.SC.REPRODUCTIVE HEALTH 2016-01-01T00:00:00Z