Acyclovir induced nephropathy : a case report

Acyclovir is frequently used in the management of suspected or proven serious viral infections in children. Despite its good safety profile serious side effects are known to occur. We describe a case of suspected viral encephalitis treated with intravenous acyclovir and complicated by acute, reversible, renal failure. To our knowledge this is the first such report in a Maltese Paediatric patient.peer-reviewe

Current trends in the management of childhood gastroenteritis in the community

Infection of the gastrointestinal tract are still amongst the most common infections of childhood. Despite improvements in the standard of living over the last fifty years, gastroenteritis still constitutes a sizeable amount of general practitioner consultations and hospital admissions, Although most infections’ are mild and self-limiting with the minimum of active treatment, a small proportion require more aggressive management and hospital admission. With the advent of oral rehydration solutions the management of gastroenteritis has become simpler and the complication of hypernatraemic dehydration rare.peer-reviewe

The use of inhaled corticosteroids in wheezy pre-school age children : current practice and literature review

Preschool children and infants frequently suffer wheezy episodes, mostly associated with viral respiratory tract infections. There is no evidence to support the use of maintenance low dose inhaled corticosteroids to prevent or manage episodic mild wheeze caused by such viral infections. However, infants and young children with recurrent episodic wheeze and a positive asthma risk index (i.e. risk factors associated with a predisposition for the future development of asthma) should be considered for a short, three-month trial of an inhaled corticosteroid. Failure to respond to an inhaled corticosteroid should prompt its discontinuation and not an increase in the drug dose. Persistent wheezing should suggest a possibility of an alternate diagnosis and the child should be referred for further investigations. Some recurrently wheezy infants and children simply do not respond to inhaled corticosteroids and most symptoms remit spontaneously after the age of five years, especially among those who do not have an atopic predisposition. The use of large doses of inhaled corticosteroids in young children whose wheezing persists should be discouraged due to the significant risk of long-term effects.peer-reviewe

Declining Visceral Leishmaniasis in Malta

Aims: To study visceral leishmaniasis (VL) trends in Malta. Methods: Analysis of epidemiological and clinical trends, a veterinary questionnaire and questioning a canine laboratory testing facility. Results: A decline in VL in the past 25 years (1980-2005) was noted for both paediatric (p<0.001) and adult (p=0.002) populations. No seasonal variation in infection rates was found. Serological testing was reliable and a useful adjunct to bone marrow diagnosis. Treatment with sodium stibogluconate was highly effective and there were no permanent sequelae associated with disease or treatment. Vets are encountering less canine VL with no differences in localities Discussion: The decline in VL was paralleled by a decline in the stray canine reservoir population and by better management of canine infection in both sanctuaries and in domestic settings.peer-reviewe

Benign recurrent intrahepatic cholestasis : report of two local cases

Benign Recurrent Intrahepatic Cholestasis (BRIC) is a rare disorder characterized by recurrent episodes of cholestasis without permanent liver damage. Familial and sporadic cases have been reported and both autosomal recessive and autosomal dominant inheritance described. We report two children with BRIC without any previous family history.peer-reviewe

An audit of compliance of inhaled steroid medication in Maltese asthmatic children : a comparison between 2008 and 2014

In the treatment of bronchial asthma, inhaled therapy with bronchodilators and corticosteroids represents the basis for acute and long-term management. Drug therapy in asthma is predominantly by pressurized metered dose inhalers. The impact of treatment on the disease morbidity and mortality depends to a large extent on appropriate delivery of drugs to the lungs by means of a spacer device and on the continuity of treatment. Poor compliance with medication is a well known problem in conditions which require long-term treatment. This is especially so in asthma where initial improvement may be followed by longer remission and a tendency to stop treatment. Compliance is "the extent to which a person’s behaviour (in terms of taking medications, following diets, or executing lifestyle changes) coincides with medical or health advice." 1. Compliance with preventive therapy such as inhaled corticosteroids (ICS), the effects of which are seen over a period of weeks, may be less than compliance with drugs that relieve asthma symptoms more rapidly such as bronchodilators. To our knowledge there are no previous studies which have assessed the prevalence of non-compliance with inhaled corticosteroids in Maltese children.peer-reviewe

Prevalence of obesity in a paediatric outpatient clinic

This study assessed the rate of overweight and obese children at a general paediatric outpatient clinic, Mater Dei Hospital, Malta, in 2011. This was an observational, prospective study where 220 patients aged 2-14 years attending this clinic, with a preponderance of asthmatic children, had their height and weight measured and their BMI calculated. Overall, 40.5% of the children were either overweight (14.1%) or obese (26.4%). There were more obese boys (31.8%) than girls (18.2%) (p=0.025). Half of the asthmatic patients were overweight or obese (49.6%), compared to a quarter of the non-asthmatic patients (27.5%) (p=0.001). The high rate of obesity in this setting presents an opportunity and challenge for paediatricians to address the most important nutritional problem in children.peer-reviewe

A resistant case of Kawasaki Disease

Kawasaki disease (KD) is an acute febrile illness of childhood of unknown origin which may cause coronary arteritis and death. The Maltese incidence has been calculated at 3.2/100,000 population 4 years of age, similar to that reported in European communities and far lower than that reported in Asian countries. The use of steroids in this condition remains contentious. We report a resistant case of KD who required two doses of pulsed steroids in addition to standard treatment with aspirin and immunoglobulin.peer-reviewe

Panhypopituitarism : a rare cause of neonatal cholestatic jaundice

Although not uncommon, neonatal cholestatic jaundice is usually caused by congenital anatomical defects of the biliary tree or intrinsic liver pathology. We describe a case of persistent cholestatic jaundice in a six week old female infant caused by panhypopituitarism. To our knowledge this is the first report of hypopituitarism presenting with cholestatic jaundice in Malta. Prolonged obstructive jaundice in the neonatal period should be urgently investigated until a cause is found.peer-reviewe

Prevalence of Infantile Hypertrophic Pyloric Stenosis and relation to breast feeding trends in the Maltese Islands between 1995 and 2007

Introduction: Several studies have indicated that breastfeeding may protect against the development of infantile hypertrophic pyloric stenosis (IHPS). This study investigated trends in IHPS over the period 1995-2007 in Malta and analysed the relationship of IHPS and changes in infant feeding practices during the same time period. Methods: Patients with IHPS were identified from Hospital Activity Analysis reports. The case notes were obtained and the following data were collected: birth order of the patient, gender and type of feeding. Breast feeding information trends were obtained from published reports. Population data were obtained from publications of the National Statistics Office. Results: A total of 125 patients were operated for IHPS. Case records were available for 86. The incidence was 2.26 per 1000 live births. There was an expected preponderance of males with no mortality. Seventy one patients (82.5%) had been formula fed from day one, while ten patients were exclusively breast fed. Five patients were breast fed and supplemented with formula at presentation. Forty-six patients were first born infants. A nonsignificant downward trend was noted. IHPS was significantly less common in breast fed infants (χ2 72.4, p=<0.001). Conclusion: These findings further support the hypothesis that breast feeding protects against the development of IHPS.peer-reviewe