566 research outputs found

    Management of epilepsy

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    Figures for the incidence of epilepsy in Malta are not available. The overall figure for epilepsy given by the Royal College of General Practitioners (Reid 1960) is 4.82 per 1,000 population. As there is no reason to expect and difference in the incidence in these Islands, one can expect that there are at least 1,500 epileptics in Malta. This would mean that all general practitioners would, at some time, come across a patient with epilepsy.peer-reviewe

    Carotid artery disease screening : assessment of criteria

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    The Department of Radiology at St. Luke’s Hospital has provided a screening service for stroke related disease since April 1991. This consisted of Duplex Ultrasound screening (DUS) for Extracranial Carotid Artery Disease (ECAD) followed by angiography or intra-arterial digital subtraction angiography (lADSA) or digital intravenous angiography (DIVA) if ultrasound screening was positive for significant disease. The aim of this study was to evaluate in the local context, the various criteria for assessment already established overseas and to devise the best combination of these criteria to improve the detection of disease, thus improving the quality of the•local screening service. 504 patients have been screened for stroke related disease. Twelve patients (6M : 6F) with significant disease, who were considered for surgery, were referred for angiography, IADSA or DIVA. Comparison of these two modalities, DUS and vascular study, were made on 22 sides for the Multicentre Criteria (MCC), the Modified Seattle Criteria (MSC) and the Modified Washington Criteria (MWC). The accuracy, sensitivity, specificity, positive predictive value and negative predictive value were calculated for the MCC, the MSC and the MWC for peak systolic velocity. For the MCC the end diastolic velocity, the systolic velocity ratio and the diastolic velocity ratio were also compiled. The highest precision for extra cranial carotid artery disease screening can be achieved by a combination of the MCC or MSC for peak systolic velocity and with the systolic velocity ratio for the MCC.peer-reviewe

    Torsade de Pointes : a diagnostic pitfall

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    Torsade de pointes is an unusual arrhythmia which is found in certain well defined clinical situations. The authors present two cases of Torsade de pointes which were admitted on two consecutive days, where the diagnosis was not immediately appreciated. It is important that one should become familiar with the E.C.G. appearance and be aware of the possible aetiology so that appropriate treatment can be initiated.peer-reviewe

    Domiciliary nasal respiratory support : first experiences in Malta

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    Nasal respiratory support is a non-invasive alternative to conventional assisted ventilation with endotracheal intubation, or the more cumbersome negative pressure ventilators. The two main types of this relatively new therapy are nasal intermittent positive pressure ventilation (NIPPV) and nasal continuous positive airway pressure (NCPAP) respiratory support, which are mostly used in chronic hypoventilatory states and obstructive sleep apnoea (OSA) respectively. We have introduced these two types of respiratory support to five patients suffering from neuromuscular disorders and twenty-four patients with OSA with marked improvement in the quality of life of all patients concerned. Our experiences with these patients should hopefully lead to further development in the diagnostic and therapeutic facilities in this field in Malta.peer-reviewe

    Automatic parametrisation of beached microplastics

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    Four sandy beaches on the island of Malta were regularly sampled for Large MicroPlastic (LMP) particles having a diameter between 1mm and 5mm, at stations located at the waterline, and 10m inshore. The extracted LMPs were characterised (dimensions, surface roughness, colour) by microscopic analyses, as well as by a developed algorithm. Two-thirds of the isolated particles were smooth and the majority of these belonged to the grey -white colour category suggesting that these were preproduction pellets. Roughly six times as many particles were recorded within the inshore sampling stations as the particles recorded at the waterline stations. The automated image processing algorithm performed well when the dimension and colour parameter values it delivered were compared with those obtained by microscopic analyses.peer-reviewe

    A spatial prioritisation exercise for marine spatial planning implementation within the North-East MPA of the Maltese Islands

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    The cumulative pressure/risk posed to both Posidonia oceanica seagrass meadows and maerl beds by ongoing maritime activities as well as the cumulative user-user conflict within the NE MPA were quantified and mapped to serve as a decision-support tool for MPA managers implementing MSP provisions in the area.peer-reviewe

    Subarachnoid Haemorrhage in Malta : Are outcomes adversely affected due to lack of a local neurovascular service?

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    Objective: This study was performed to assess the incidence, treatment and outcome of non-traumatic Subarachnoid Haemorrhage (SAH) in an island which does not offer a neurovascular service and to determine whether such limitation is associated with a poor outcome. Method: Data of adult patients with a diagnosis of non-traumatic SAH was analysed retrospectively over a two-year period from January 01, 2009 to December 31, 2010. Results: The incidence of SAH in Malta is 3.16 cases per 100 000 population per year. An underlying aneurysm was found in 50% of all cases investigated with angiography. These patients were transported to the United Kingdom for definitve management and the outcome of all these patients at 6 months was excellent. (modified Rankin Scale of 0 or 1). Conclusions: With the incidence of non-traumatic SAH being in the low range, setting up an interventional neuroradiology service in our country to treat aneurysmal SAH would not have the required numbers to maintain expertise and would probably translate into worse clinical outcomes. Despite having geographical and logistic limitations, our standards of care and survival rates are not below those of other international centres. Outcomes for patients with low initial Hunt and Hess scores have not been adversely.peer-reviewe

    Etiological and epidemiological factors in facial palsy

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    The present study is an analysis of 243 patients with facial palsy referred to St. Luke's Hospital Malta during the six year period extending from October 1965 to October 1971. The vast majority of the patients' records collected were from the Medical, Pediatric, Orthopedic, E.N.T. and Physiotherapy Departments. The records were analysed with special reference to: onset of symptoms, age, sex, side of palsy, date of referral to hospital, town of origin and referring doctor. A history of hypertension and diabetes mellitus, previous occurrences of facial palsy and any other relevant illness were also recorded. The sex distribution was also compared with that in other series because of the recent Egyptian reports of facial palsy developing more often in females. The age groups of the Maltese patients were also analysed and compared with those in some other studies. Following this study, it was concluded that probably there were no significant geographical variations. In the older age groups, however, atherosclerosis, diabetes and hypertension are postulated as aggravating factors. Underlying diabetes and hypertension should, therefore, be excluded in patients with Bell's Palsy, all the more so, because of the increased risks, if such patients are treated with steroids.peer-reviewe

    Extensive Pulmonary Embolism in late pregnancy associated with Anticardiolipin Antibodies

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    The leading cause of morbidity and mortality during pregnancy and the puerperium is venous thromboembolism. Though uncommon, the risk is five times higher in a pregnant woman than in a non-pregnant woman of similar age.1,2 In pregnancy, all three underlying factors for venous thrombosis are present: hypercoagulability, venous stasis and vascular damage (Virchow's triad). Of these, the most constant predisposing factor is increasing venous stasis due to the pressure of the gravid uterus on the pelvic vasculature. In addition the presence of a thrombophilia, (congenital or acquired) will increase this risk substantially. During pregnancy hypercoagulability is a physiological preparation for the haemostatic challenge of delivery. There are increases in procoagulant factors, such as von Willebrand factor, factor VIII, factor V, and fibrinogen together with an acquired resistance to activated protein C and a reduction in protein S. Increases in plasminogen activator inhibitors impair fibrinolysis. The third factor of this triad, vascular damage, is a possible complication of trophoblastic invasion of the uterine spiral arterioles or of delivery.peer-reviewe
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