Hypopituitarism following traumatic brain injury

Traumatic brain injury (TBI) is a worldwide public health problem and an important cause of hypopituitarism. The incidence of hypopituitarism following moderate to severe TBI varies in different studies and may occur as multiple or isolated hormonal deficiencies, with gonadotrophin and growth hormone insufficiencies predominating, particularly in the acute setting. Adrenocorticotropic hormone deficiency is also common during the recovery phase. Pituitary function assessment in the acute phase post TBI is subject to multiple caveats and pitfalls due to hormonal alterations which occur as normal physiological responses to critical illness and the effects of drugs that are used in the intensive care unit. Nonetheless, assessment of the hypothalamo-pituitary-adrenal axis is of paramount importance during this period. Predictors of hypopituitarism during the acute phase of TBI remain unclear - further research is warranted.peer-reviewe

The role of kisspeptin signalling in the hypothalamic-pituitary-gonadal axis

Kisspeptin is a hypothalamic peptide hormone, which plays a crucial role in puberty and fertility control by stimulating the release of gonadotrophin-releasing hormone, which in turn stimulates the release of luteinizing hormone and follicle stimulating hormone. It also interacts with neuropeptides neurokinin B and dynorphin A, and is under negative and positive feedback influences relayed by gonadal sex steroids. Loss of kisspeptin signalling results in hypogonadotrophic hypogonadism and impaired puberty. Kisspeptin expression and secretion is also affected by metabolic status and stress. Several studies have indicated a potential role for kisspeptin in the treatment of disorders causing hypogonadotrophic hypogonadism. This review aims to summarize the importance of kisspeptin and its role in the hypothalamic- pituitary-gonadal axis.peer-reviewe

Aetiology of thyroid autoimmunity

Autoimmune thyroid disease (AITD) is characterised by the development of thyroid autoantibodies, mainly anti-thyroid peroxidase antibodies, anti-thyroglobulin antibodies (primarily involved in the development of Hashimoto’s thyroiditis [HT]) and thyroid stimulating hormone receptor antibodies (mostly involved in the development of Graves’ disease [GD]). While genetic factors provide 70 to 80% of the risk for the development of thyroid autoimmunity (TAI), environmental factors contribute about 20 to 30% to the immunopathogenesis of AITD. Such environmental factors include smoking (predisposes to GD but protects against HT), alcohol (moderate consumption protects against both HT and GD), stress (predisposes to GD) and iodine (possibly increases risk of AITD). Low selenium and vitamin D levels might increase the risk of TAI, although data remains indeterminate and selenium supplementation did not always improve TAI in clinical studies. Additionally, certain drugs, toxic chemicals, infections, birth in winter and autumn and radiation exposure have also been implicated in the development of TAI. Preventive interventions to decrease the risk of AITD are limited and not always feasible, though personal and public health interventions might help with smoking and iodine exposure.peer-reviewe

Audit on follow-up of patients with primary Osteoporosis

Aim: To document the frequency of Dual-energy X- ray absorptiometry (DEXA) scanning and Rheumatology clinic follow-up visits of patients with primary osteoporosis, and compare these with recommended guidelines. Method: Medical notes of all primary osteoporotic patients attending a hospital Rheumatology clinic were reviewed over a period of four months. Data was collected on age, gender, frequency of follow up visits, frequency of DEXA scanning, osteoporosis treatment, any changes in such treatment during the last visit, and comparison of the last two DEXA scan results. Frequency of follow up DEXA scans was compared to Group Health Osteoporosis Screening Diagnosis and Treatment guidelines.1 Results: Eighty-two patients were included, 6 males (7.3%) and 76 females (92.7%). The age range was 35-87 years (mean age was 68.6 years). In total, 42.7% of all the patients were on combined calcium and vitamin D, with added Bisphosphonates, Strontium ranelate, or Denosumab. During their last clinic visit, 61% showed improvement in T score since their previous result, and 64.6% of patients had no change in treatment. In this audit, 29.3% were being followed up on a 13 monthly basis, and 72% had annual bone mineral density scans or more frequently Conclusion: According to the guidelines, none of the patients included in this audit should have had a repeat DEXA scan within less than two years. Patients attending the clinic have too frequent DEXA scans and therefore, too frequent follow up appointments.peer-reviewe

A case of anorectal agenesis : postoperative complications

An analysis of the postoperative complications of a case of ano-rectal agenesis is here presented. The multiplicity of factors involved, with special emphasis on protein-calorie malnutrition, together with the importance of team-work in the management of this case, is emphasised. The postoperative care of a seriously ill child who has undergone major surgery and may be suffering from multiple complications, necessitates close liaison between the surgeon, the pediatrician and the laboratory and nursing staff. It is clear from the comments about this case that the utmost attention to detail is crucial in the management of such casespeer-reviewe

Insulin prescription and administration and blood glucose monitoring at Mater Dei Hospital

Background: Incorrect insulin prescription and administration has been associated with substantial medication-related patient harm and mortality. We aimed to assess whether blood glucose was being monitored according to our local hospital protocol and whether insulin was being prescribed accurately by doctors and administered safely by nurses. Moreover, we evaluated whether education to nurses and doctors resulted in less insulin prescription and administration errors. Methods: Inpatients on insulin in Mater Dei hospital’s medical wards were recruited. Data was collected from patients’ files on errors in insulin prescription and on the timing of blood glucose monitoring and insulin administration in relation to meals. The first audit was carried out in 2013. A re-audit was carried out in 2017 following education to doctors and nurses and a change in the treatment chart format. The z-test was used to compare the two audits. Results: On re-auditing, a significant improvement was noted in the timing of blood glucose monitoring and insulin administration in relation to meals, in the legibility of the insulin doses, ‘Units’ were more written in full and supplementary Actrapid® was more frequently prescribed where indicated. However, inappropriate omission of fixed insulin doses occurred more often, while written instructions by doctors on when to administer fixed insulin, including supplementary Actrapid®, were still lacking. Moreover, there was no improvement in adherence to the supplementary Actrapid® algorithm by nurses. Conclusion: Further education and an improved treatment chart including hypo- and hyperglycaemia trouble-shooting guidelines are required to further reduce insulin prescription and administration errors.peer-reviewe

Ultrasonographic features and management of thyroid nodules undergoing ultrasound-guided fine needle aspiration

INTRODUCTION: Thyroid nodules can be detected in 50 to 60% of healthy individuals, particularly in the elderly and females. An increase in differentiated thyroid cancer has been noted over the years, especially papillary thyroid cancer.OBJECTIVES: To assess different approaches to management and histological nature of thyroid nodules in Malta, as well as to evaluate the association of ultrasound characteristics with biochemical and histological features.METHODS: All thyroid nodules undergoing ultrasound-guided fine needle aspiration (FNA) between July 2013 and December 2017 were evaluated. Data was collected on ultrasonographic nodule characteristics, FNA histology (using Bethesda system), follow-up of these nodules with repeat ultrasound or FNA and histology report of those nodules undergoing surgery. Sensitivity and specificity of thyroid nodule FNA was calculated.RESULTS: A total of 1420 patients who had 1522 FNAs were identified. They had a mean age of 57.4 (+/− 15.3) years at the time of FNA and the majority (76.1%) were female. Most nodules were benign (69.3%), while only 1.9% and 4% were suspicious of malignancy or malignant respectively. Lobectomy or total thyroidectomy was undertaken in 21.5% of patients. Of those operated 19.6% had a follicular adenoma, 4.6% had a follicular carcinoma, 35.6% had papillary carcinoma, 1.3% medullary carcinoma, 0.3% anaplastic and 41.8% had benign nodules, with multinodular goitre predominating in 69.5% of benign cases. Where documented on ultrasound, most malignant nodules were at least 2 cm in size (37.2%), had chaotic intranodular vascularity (35.7%), were hypoechoic (62%), had irregular borders (22.6%) and microcalcifications (27.7%). The sensitivity and specificity of FNA cytology for malignancy (including both Bethesda categories 5 and 6) were 85.3% and 95.1% respectively.CONCLUSION: Our sensitivity and specificity results for FNA cytology compare well with ranges quoted by current guidelines. Papillary carcinoma was found to be the most prevalent thyroid malignancy in Malta.peer-reviewe

Innovative teachers from the perspective of teacher educators

No abstract available

Transformative professional development to develop and support innovative teachers

No abstract available

Project X experiences of multidisciplinary Arch/COFA/Eng teaching

The present paper describes two multidisciplinary design courses, named Project X and Project X2, that were available for the first time in 2007 to students from three design-based faculties at the University of New South Wales (UNSW): Faculty of the Built Environment (FBE), College of Fine Arts (COFA) and Faculty of Engineering (FE). During these courses the students designed, fabricated and constructed from cardboard and timber an enormous sculpture of a snake, nick-named Ed and consisting of five massive arches and a five meter tall head