Are local guidelines on investigations in children admitted with acute gastroenteritis being adhered to?

The aim of this article is to assess adherence to local guidelines on the investigation of children admitted with acute gastroenteritis. Children admitted to Mater Dei Hospital with a diagnosis of gastroenteritis between December 2012 and February 2013 were selected. Their investigations were retrospectively assessed in relation to the degree of dehydration and the type of management given. Hospital guidelines relating to investigations performed in children admitted with gastroenteritis were reviewed and compliance was assessed. A total of 411 investigations were carried out in 76 children with the most common investigations being serum electrolytes, urea and creatinine and random blood glucose. Guidelines were met in 4/76 (5.3%) of the study population. Serum electrolytes had the greatest impact on management. The conclusion is that the local guideline on gastroenteritis is not being adhered to in the vast majority of cases. There is an urgent need to raise awareness about the availability and utilisation of this guideline amongst doctors working in paediatrics.peer-reviewe

Pubblikazzjoni mhux maghrufa tal-Kanonku Fortunato Panzavecchia

This study sheds light on a recently discovered publication in Maltese and Italian by Canon Fortunato Panzavecchia (1797-1850). Even though the publication does not give the author's details, we are sure that it belongs to Panzavecchia. This publication is one of others which Panzavecchia published for Maltese children attending primary schools, and it gives information on Panzavecchia 's alphabet.peer-reviewe

COMBINING ANTIPSYCHOTICS; IS THIS STRATEGY USEFUL?

Antipsychotic drugs are commonly combined in psychiatric practice in an attempt to treat schizophrenia. Such practice is widespread, despite the lack of explicit endorsement by many of the main regulatory bodies. There are varying rationales behind combining these potent drugs-either to augment the effect of a drug whose action alone is inadequate for patients with treatment resistant schizophrenia (TRS), or to improve the side effects seen due to treatment. Augmentations are most frequently observed with clozapine, a drug reserved for use when other antipsychotic medications have failed. Several drugs have been chosen as adjuvants, including aripiprazole, sulpiride, amisulpiride and risperidone. A small number of RCTs (randomized controlled trials) have been performed but, despite this data and numerous case reports showing positive changes in symptomatology, Cochrane reviews of available studies have been unable to definitively confirm the efficacy of these combinations, frequently citing the need for larger, longer term, prospective studies.Evidence for benefits of combination therapy on side effects is also inadequate. Some RCTs and case series have shown they can positively alter side effects due to drugs such as clozapine, e.g. metabolic side effects. However, despite many of the combinations being relatively well tolerated, there is some evidence they can cause adverse effects of their own. More evidence is essential as, on the current data alone, it is not possible to make a firm recommendation on the efficacy and safety of antipsychotic combinations. In addition it is vital that the importance of a fair trial of monotherapy at adequate dosages is reinforced to clinicians, so that patients are not put onto these relatively unknown treatment strategies unnecessarily

BIPOLAR II DISORDER AND BORDERLINE PERSONALITY DISORDER - CO-MORBIDITY OR SPECTRUM?

We assess the number of patients who we have on the Database of a Community Mental Health Team in the UK who have Bipolar Disorder and Borderline Personality Disorder. We report how many of these have been seen as having both disorders. Hence we discuss the issue as to whether Borderline Personality disorder is to be placed within the bipolar spectrum. We note the difficulties regarding the use of phenomenology alone to decide this problem, and we note the similarities in genetics, neuroimaging observations and neurobiological mechanisms among the following conditions; Bipolar Disorder, Unipolar Depression, Post-traumatic Stress Disorder, and Borderline Personality Disorder. Ethiologies such as Trauma, Abuse, Childhood adversity and exposure to War appear to influence all these conditions via epigenetic mechanisms. Hence we argue that for a spectrum to be proposed, conditions in the spectrum need to be underpinned by similar or common Neuroimaging and neurobiological mechanisms.On this basis, it may be reasonable to include Borderline Personality Disorder within a broadly described bipolar spectrum. New details of the common Neurobiological mechanisms continue to emerge

CINEMATHERAPY AND FILM AS AN EDUCATIONAL TOOL IN UNDERGRADUATE PSYCHIATRY TEACHING: A CASE REPORT AND REVIEW OF THE LITERATURE

Film possesses an extraordinary power and offers an unrivalled medium for entertainment and escapism. There are many films that revolve around a mental illness theme and the medical specialty that most commonly features in motion picture is psychiatry. Over the last few decades films have become increasingly used as an educational tool in the teaching of psychiatry topics such as mental state examination to undergraduate students. Above and beyond its utility in pedagogy, film also has the power to heal and the term cinematherapy has been coined to reflect this. Indeed, there are case studies of people with first-hand experience of psychopathology who report that watching films with a mental illness theme has contributed to their recovery. We provide a first person narrative from an individual with schizophrenia in which he expounds on the concepts of cinematherpy and metaphorical imagery in films which theme on psychosis

Siltiet minn Stedina ta’ Vassalli fil-ġurnal Il-Kaulata Maltia (1839)

Fit-taqsima tar-Riċerka Storika nsibu x-xogħol ta’ David Agius Muscat li fih jeħodna lura fl-ewwel xhur ta’ meta Malta kisbet il-libertà tal-istampa. Waqt li kien qed jeżamina wieħed mill-ewwel ġurnali bil-Malti, Il Kaulata Maltia (1839), Agius Muscat sab li t-tielet u l-aħħar ħarġa li għandna f’idejna ta’ dan il-ġurnal fiha siltiet minn Stedina ta’ Mikiel Anton Vassalli. Fil-ħarġa m’hemmx l-isem tal-awtur. Sa qabel din is-sejba kien maħsub li Stedina kienet dehret l-ewwel darba fl-1841 f’pubblikazzjoni ta’ George Percy Badger. Fl-istess artiklu Agius Muscat jagħti tagħrif ġdid fuq Mikelanġ Camilleri, kittieb tas-seklu 19. Fih huwa attribwielu pubblikazzjonijiet li sal-lum jew konna nqisuhom anonimi, jew inkella konna nattribwuhom lil awturi oħrajn. Fl-artiklu Agius Muscat iġib ukoll ittra tal-1844 li tinsab fl-arkivju tal-Pontificio Collegio Irlandese, Ruma. F’din l-ittra jissemma kif il-Maltin ġabu ruħhom ma’ Camilleri meta minn qassis Kattoliku qaleb Protestant u żżewweġ.peer-reviewe

One-and-a-half syndrome : its presentation, causes and neuroanatomy

BACKGROUND: One-and-a-half syndrome involves a combination of an ipsilateral horizontal gaze palsy and an ipsilateral internuclear ophthalmoplegia. This condition is easily missed due to its presentation, but can be the first sign of serious disease. We aim to increase awareness of this syndrome’s presentation and give an insight into the intricate neuroanatomical connections that are affected in it.CASE PRESENTATION: We present a case of a 39-year-old previously healthy female who presented with a one-week history of diplopia and non-vertiginous dizziness. On examination, a left horizontal gaze palsy with deficits in left abduction and right adduction was noted, accompanied by left adduction weakness and right horizontal disconjugate jerk nystagmus in abduction. A diagnosis of OAHS was made, and she was admitted for further tests. An MRI of her brain revealed multiple hyperintensities throughout, along with an enhancing lesion in keeping with active disease. A diagnosis of Multiple Sclerosis was made and she was given a five-day course of methylprednisolone, with which her vision, and ultimately her gait, improved. She was discharged with outpatient follow-up, to further discuss treatment options for her new diagnosis.CONCLUSION: Diplopia and vertigo are symptoms that should prompt careful clinical examination with proper attention to ocular motility testing, and subsequent referral to neurology if required. Unnecessary delays in diagnosis and management could ultimately be detrimental to the patient, and being aware of uncommon presentations would go a long way in enhancing patient safety.peer-reviewe

A locally destructive, completely asymptomatic, C1-root schwannoma with base of skull invasion : a case report

Patients with C1 nerve root schwannomas usually present with signs relating to nerve root compression. However, asymptomatic presentations have never been reported. A healthy, 37-year-old female was referred in view of a slow-growing lump in the left posterosuperior aspect of the neck. The lump was asymptomatic and neurological examination was normal. Magnetic resonance imaging revealed a left C1 nerve root tumour, extending around the C1 vertebra and compressing the thecal sac. The tumour had invaded the basiocciput and was impinging on the left cerebellar hemispheric dura. Stereotactic biopsies of the lesion showed a spindle-cell tumour exhibiting an immunoprofile consistent with a schwannoma. The lesion was surgically excised by blunt dissection using a posterior midline approach. The case report adds to the diverse modes of presentation of C1 nerve root schwannomas, in that such lesions must be included in the differential diagnosis of asymptomatic posterior neck lumps.peer-reviewe

Audit on A-scan use prior to cataract surgery in Mater Dei Hospital

The A-scan is a method of measurement of the ocular axial length (L). It is coupled with corneal curvature keratometry (K) readings so that one can measure the required power (P) of an intraocular lens (IOL) used for cataract surgery. The Sanders, Retzlaff and Kraft (SRK) formula calculates the required P of the IOL as P = A − 2.5L − 0.9K where A is the specific IOL constant. The power of the lens determines the refraction of the image onto the retina and thus determines the visual acuity of the eye. The axial length of the eye is measured by the time a signal takes to be reflected back to the source, like ultrasound or light. Distance is calculated by the velocity formula, depending on the speed of the signal. In Mater Dei hospital, two methods are used to determine the axial length of the eye prior to cataract surgery, namely an ultrasound method and an optical method.peer-reviewe

A method to extract slip system dependent information for crystal plasticity models

A tool to implement a length scale dependency to classical crystal plasticity simulations is presented. Classical crystal plasticity models do not include a size effect; therefore, the size of the grain does not influence the simulated deformation. Classical crystal plasticity advancements have been through the inclusion of stress or strain gradient based constitutive models to improve the simulation of length scale dependent deformation. However, this tool presents an alternative to implementing a length scale, where the influence of slip pile-up in the form of dislocations at grain boundaries as a potential to explaining the Hall-Petch effect in materials. This is achieved by calculating the slip distance in adjacent grains for each slip system, by assuming the total slip length spans the grain in the slip direction. These calculations can occur in two ways. The first is the analysis occurs at the start of the simulation, therefore, only occurs once. If this approach is used, the computational cost of this tool is minute. However, if the simulations consider large deformations, during which it is expected that the grains are going to undergo large rotations, then it would be advantageous to the have the tool recalculate the information during the analysis. Consequently, the computational cost would depend on the resolution of the modelled geometry, the number of grains, and the number of slip systems. The tool also provides a capability to develop constitutive models based on complex grain boundary features which can be implemented in classical crystal plasticity models and gradient based crystal plasticity models. The described calculation process is implemented through a Fortran subroutine, which has been designed to be easily used in crystal plasticity simulations. The presented tool also includes Python code designed to link with microstructures built using DREAM.3D to extract the required input data to the Fortran subroutine. The proposed tool is not limited to classical crystal plasticity formulations, instead the data extracted and outputted from the Fortran subroutine can be used to serve alternative purposes in both stress and strain gradient crystal plasticity models. The proposed tool can be modified to extract additional data to that presented. The slip distance in the adjacent grain, the distance from the grain boundary of the current calculation point, and the interaction between slip systems between grains can be used in any crystal plasticity constitutive models