Recent advances in ophthalmology

These are exciting times for ophthalmology with developments in recent years taking place across a spectrum of eye diseases from the front to the back of the eye.peer-reviewe

Antimalarials and the eye

Following the first reports in 1954 of the beneficial effects of chloroquine in cases of lupus erythematosus, this drug and its numerous derivatives have been used extensively in the treatment of systemic and discoid lupus erythematosus and rheumatoid arthritis. The small dosage of chloroquine used in the prophylaxis of malaria is comparatively free from any serious side effects; higher dosage administered over a prolonged period of time for chronic connective tissue disorders gives rise to concern and requires careful monitoring.peer-reviewe

Herschel views on ultra-luminous X-ray sources

The nature of ultra-luminous X-ray sources (ULXs), which are off-nuclear extragalactic X-ray sources that exceed the Eddington luminosity for a stellar-mass black hole, is still largely unknown. They might be black hole X-ray binaries in a super-Eddington accretion state, possibly with significant beaming of their emission, or they might harbor a black hole of intermediate mass (10^2 to 10^5 solar masses). Due to the enormous amount of energy radiated, ULXs can have strong interactions with their environment, particularly if the emission is not beamed and if they host a massive black hole. We present early results of a project that uses archival Herschel infrared observations of galaxies hosting bright ULXs in order to constrain the nature of the environment surrounding the ULXs and possible interactions. We already observe a spatial correlation between ULXs and dense clouds of cold material, that will be quantified in subsequent work. Those observations will allow us to test the similarities with the environment of Galactic high mass X-ray binaries. This project will also shed light on the nature of the host galaxies, and the possible factors that could favor the presence of a ULX in a galaxy.Comment: Accepted for publication in Proceedings of Science (INTEGRAL 2012), Eds. A. Goldwurm, F. Lebrun and C. Winkler, based on a presentation at the 9th INTEGRAL Workshop, October 15-19, 2012, Paris, Franc

Storing medicines while reducing electricity consumption

Temperature storage requirements for medicinal products stored at room temperature were compiled. The rate of heat loss in a local pharmacy was investigated. Necessary measures required to achieve temperature controlled storage conditions in the most efficient manner were proposed. Energy efficiency together with carbon emission reductions were calculated.peer-reviewe

Some moral problems associated with human transplants

This paper is an abridged version of the St. Luke's Day lecture delivered to the Malta Branch of the British Medical Association on the 18th October 1972 at the Medical School of the University. When dealing with the moral aspects of transplants one has to think of a double operation, that by which the tissue or organ is taken from one person, and that by which it is grafted on to another: hence we should consider both the receiver and the donor. The crucial problem is how to be certain that the donor is dead, because if he is not, even though his state is hopeless and it is certain that he would die very soon, an excision made upon him which terminates his life is murder. The case of transplants from human beings who are still alive raises greater problems. If what is taken from the donor destroys or substantially impairs the biological functionality of the organism, provoking death, then or later, the excision is not morally allowed. Further views by theologians regarding excisions and mutilations are also outlined, delineating Papal statements and pronouncements.peer-reviewe

Ocular onchocerciasis

A case report of a patient who was admitted to the City Hospital, Edinburgh in September 1974 is described. The patient who while on vacation in Ibadan, Nigeria had been feeling generally unwell, and for several months had transient acute ocular symptoms such as photophobia and watering and itching of both eyes. The diagnosis indicated that the patient was suffering from ocular onchocerciasis, an anomaly caused by infection by the threadworm onchocerca volvulus. This is a parasitic worm that is found in two continents, in Central and West Africa, and in parts of Central America, Columbia, Ecuador, Peru and Guatemala. The clinical features and ocular findings of this case are studied and discussed.peer-reviewe

Concordance of gout management with European League against Rheumatism recommendations in hospital practice

Aim: To assess the concordance of gout management with the European League Against Rheumatism (EULAR) gout recommendations in hospital practice. Methods: This was a retrospective review of case notes of patients presenting to rheumatology outpatients between June and December 2009 under the care of 2 consultant rheumatologists. Data collected consisted of demographics, time lag to specialist referral, comorbidities, details about acute and recurrent attacks, lifestyle advice and use of urate lowering therapies. Documented management was assessed for concordance with the EULAR recommendations. Results: Thirty consecutive patients (27 males, 3 females) attending Rheumatology clinic at Mater Dei Hospital were recruited. Mean age at the time of survey was 59.4 ± 10.7 years, while mean age at diagnosis was 51.1 ± 14 years. Documentation of lifestyle advice was recorded for alcohol reduction (83%), weight loss (43%), diet (13%), and exercise (13%). Adequate control of comorbidities was attained in hyperlipidaemia (71%), diabetes mellitus (55%) and hypertension (30%). Advice about smoking cessation was given to 37%. Uric acid levels below target were achieved in 47%. The mean uric acid level at time of survey was 379 ± 146 μmol/l. This was significantly less than that at presentation (p=0.001). Conclusions: Current treatment of gout is poorly concordant with many of the EULAR recommendations. Documentation of lifestyle modifications advice is infrequent except for alcohol reduction. A significant number of patents on allopurinol still have hyperuricaemia implying that more aggressive management is required to improve standard of care. A proforma has been developed to make and help sustain the necessary improvements.peer-reviewe