Developing a theme in social studies : an alternative approach

The Council of Europe in its documents on the place of History in Secondary schools, states that 'the teacher who stands in front of the class with a chalk is almost soundly condemned as the teacher who uses the stick'. The statement, directed to teachers who still insist on boring their students by chalking and talking, leaves no room for interpretation. It is direct and clear, emphasizing that: beyond the world of soar throats and chalky air there is a wealth of resources that can inject interest and curiosity, make possible variation of teaching methods, provide stimuli for the fantasy world of students, acquaint students with research techniques, make it easier for students to pursue self-instruction, show the relation of previously isolated facts, relate abstract generalisations with realistic details and, above all, add clarity and precision to the way the lesson is presented.peer-reviewe

Multiple problems in siblings with Gardner’s syndrome

The problems encountered in the diagnosis of two siblings suffering from a high penetration variant of Gardner’s syndrome are presented. The importance of recognizing the extra colonic manifestations of the syndrome at an early stage and technical difficulties encountered during colonoscopy are noted. Operative procedures available to treat multiple colonic polyps in Gardner’s syndrome are discussed in relation to technical problems which may be encountered in the individual case. Hopefully this presentation will highlight the importance of the setting up of a Familial Polyposis Coli register in Malta in order to facilitate early diagnoses and treatment of the condition.peer-reviewe

Primary localised laryngeal amyloidosis : an atypical presentation

Primary localised laryngeal amyloidosis is a rare disease that classically presents with dysphonia. We present a case of a 38-year-old woman who presented with a history of early morning haemoptysis, progressively worsening hoarseness and intermittent dysphagia. A bulky left false vocal cord was seen on examination. A computed tomography scan of the neck and trunk revealed thickening of the left side of the larynx with associated asymmetry. Direct laryngoscopy showed a round, well-circumscribed lesion on the left false vocal cord and histological examination of the lesion confirmed the presence of amyloid. Systemic disease was ruled out and the patient was treated with endoscopic excision of the mass through carbon dioxide laser technology. The patient’s symptoms improved and the patient is being followed up yearly to exclude disease recurrence. The report highlights the presentation, diagnosis and appropriate management of localised laryngeal amyloidosis.peer-reviewe

Hepatitis B immunisation : a survey of surgeons and theatre nurses

Acute viral hepatitis remains a serious condition. Its long-term sequelae include cirrhosis and hepatocellular carcinoma. Health workers constitute a high-risk group for contracting hepatitis B. A group of clinicians associated with invasive procedures and nurses working in operating theatres were invited to answer a confidential questionnaire concerning hepatitis B immunisation and the use of protective measures. A self-administered confidential questionnaire was sent to 152 clinicians and 97 theatre nurses, of whom 82 and 74 respectively responded, giving an overall response rate of 63 %. Whilst 91% of respondents considered their speciality as being of high risk for hepatitis B only 63% of them were fully immunised and of these only 51% had had their immunity tested. Out of those who checked their antibody status 19% did so following a needle stick injury. 60% of our respondents had had a needle stick injury over the past year. Even so barrier precaution techniques were used infrequently with only 17% always or at least frequently using double gloving and 10% wearing a visor during operations. Some respondents also commented on the poor availability of resources such as impermeable gowns or blunt needles which are established precautions against contamination from hepatitis B.peer-reviewe

Scurvy in children with autistic spectrum disorder : not such a rarity

Scurvy is an uncommon nutritional deficiency that results from low serum levels of vitamin C (ascorbic acid). Part of human history since ancient times, its incidence rapidly decreased following the discovery by Sir James Lind that citrus fruits can prevent it. Despite this scurvy still exists today within certain predisposed groups. We report three cases of scurvy that presented within a short time frame to the Paediatric Department in Mater Dei Hospital (MDH), Malta. All three children were known to have autistic spectrum disorder (ASD) with restricted diets. A high index of suspicion together with appropriate history and examination can lead to timely diagnosis of this disease. In children deemed at-risk of developing scurvy we recommend routine screening for low serum levels of vitamin C.peer-reviewe

Trans-oral resection of Nasopharyngeal Pleomorphic Adenoma : a case report

Introduction: Around 80% of all salivary gland tumours are pleomorphic adenomas, most commonly found in the parotid gland. This case report regards the rare finding of a pleomorphic adenoma in the nasopharynx. Case Presentation: a 29 year old lady presented to the ENT department with a 4 month history of worsesning and non-resolving nasal obstruction, change in voice, snoring and right aural congestion. A smooth mass pushing the uvula forward was seen on oral examination, and flexible nasoendoscopy revealed an exophytic mass from the right nasopharynx. CT and MRI showed a non-erosive mass in the right nasopharynx. Incisional biopsy was carried out which showed features of pleomorphic adenoma. Lesion was excised using transoral technique to remove the tumour with an intact capsule. Literature Review and Discussion: A PubMed search found only 12 previously reported cases of pleomorphic adenoma from 1970 to 2015. The treatment of choice was surgical in all cases, one case reports the use of radiotherapy, without affect. The trans-oral technique used in this case ensured that the tumour was removed with the surrounding capsule intact, thus reducing risk of recurrence. Conclusion: This is the first reported case of nasopharyngeal pleomorphic adenoma from Malta. Diagnosis was made by the triple assessment – examination, radiology and histology. The tumour was excised completely and the plan is for the patient to have regular follow up.peer-reviewe

Ulcerated lesions as a risk factor for Henoch-Schonlein purpura nephritis

Objective: To determine the correlation between the severity of Henoch-Schonlein purpura skin manifestations and development of nephritis and to characterise the disease within the Maltese paediatric population. -- Design: A retrospective analysis of the 96 cases diagnosed with Henoch-Schonlein purpura at Mater Dei Hospital between January 2008 and January 2016. Clinical notes were reviewed and anonymised data regarding the presentation, progression and follow-up of these cases was entered into a database. -- Results: 96 cases met the inclusion criteria with a male to female ratio of 1.35:1 and with a mean age at presentation of 6.4 years (interquartile range 3.5 years). 99% had the typical rash at presentation with 75% having other associated clinical findings. Renal involvement was found in 36.5%: isolated proteinuria in 19.8%, isolated haematuria in 13.5%, haematuria, proteinuria and hypertension in 3.1% and nephrotic range proteinuria in 2% of cases. A severe rash at presentation was shown to be a prognostic indicator for renal involvement. -- Conclusion: Henoch-Schonlein purpura in the Maltese paediatric population is similar in incidence to that quoted in the literature. The majority of cases are uncomplicated and the outcome is frequently favourable. The presence of a severe rash at presentation significantly increases the risk of renal involvement and long term complications.peer-reviewe

Back trauma resulting in commotio cordis

Commotio cordis (Latin: "agitation of the heart") is a dysrhythmia provoked by praecordial trauma during the early part of cardiac repolarisation. Recorded rhythms include ventricular tachycardia/fibrillation, bradyarrhythmias, idioventricular rhythm, complete heart block and asystole. The quoted fatality rate is 65% even with prompt CPR and defibrillation, and exceeds 80% in the absence of such interventions. Above a certain threshold of trauma/impact, structural cardiac damage may also occur (contusio cordis).peer-reviewe

Aerial remote sensing and spatial analysis of marine benthic habitats in St George’s Bay (Malta)

This study was financed by the Malta Tourism Authority (MTA) through contract dated 14th April 2004 and tender MTA/104/2004 dated 26th November 2004, both awarded to Ecoserv.The spatial distribution of marine benthic assemblages and habitats present in St George’s Bay (St Julians, Malta) was mapped using aerial photography and GIS techniques as part of an environmental monitoring programme to assess the potential impacts of beach replenishment works carried out in the bay. Maps showing the distribution of benthic habitats in the study area were produced in May 2004 (prior to initiation of the beach replenishment works), and in April 2005 (one year following the beach replenishment works). On both occasions, data from the maps was ground-truthed by SCUBA divers, who also collected data on the occurrence of characteristic plant and animal species from each habitat type. The results from the remote techniques and diving surveys indicated the presence of four main benthic assemblage types in the study area: (i) an assemblage of bare sand; (ii) an assemblage of photophilic algae on hard substrata; (iii) Posidonia oceanica meadows; and (iii) Cymodocea nodosa meadows. Comparison of the map produced in 2004 (pre-replenishment) with the one produced in 2005 (post-replenishment) indicated that, following the beach replenishment works, the main changes in the distribution of benthic assemblages and habitats in the study area consisted of: (i) a decrease in coverage of assemblages of bare sand; and (ii) a corresponding increase in coverage of supralittoral sand habitat. Overall, the results from the first year of environmental monitoring showed that the beach replenishment works did not have any adverse impacts on the marine benthic assemblages and habitats of the area. The results are discussed in the light of use of aerial photography and GIS techniques for the first time locally to monitor potential adverse impacts from coastal development works on marine benthic habitats.peer-reviewe

Investigation of domestic solar water heating installations in Malta

Malta enjoys favourable weather conditions that encourage the use of solar water heating systems, but their market penetration has so far remained low. In an effort to identify the reasons behind this lack of impetus, the Institute for Energy Technology has devised a number of study programmes. This paper deals with one of those studies, namely the technical aspects of installed domestic solar heating systems. Results showed that there are a number of issues that are contributing towards lower solar water heating systems performance. Most of these shortcomings can be easily overcome, but it is clear that there is a need for proper training programmes for installers as well as better diffusion of information on the proper utilisation of this technology.peer-reviewe