The major changes in medical practice in the 20th century

One could truly say that there were more advances in medicine in the last 60 years than there had been in the previous 500 years. Indeed the medical breakthroughs of the last 50 years have probably saved more lives than those of any epoch since medicine began. In this article the author examine the major changes in medical practice in the 20th century.peer-reviewe

Medical education and the 21st century

Medical education at both the undergraduate and postgraduate levels has been undergoing continuous changes in the last 40 years. The author why future Maltese doctors should continue with their medical education and have the opportunity to specialize in their fields locally. The duty of the medical profession and the State is to ensure that such a programme is not only instituted but also supported and be actively monitored and audited.peer-reviewe

Community-Acquired Pneumonia : what is new in aetiology and treatment

Community-Acquired Pneumonia (CAP) remains a considerable problem in terms of morbidity, mortality and use of hospital resources despite the remarkable advances in antibiotic therapy. This study describes the changes in the pattern of pneumonias, as manifested by new diseases, new modes of transmission and new manifestations of old diseases.peer-reviewe

The great simulator

Cardiac myxoma often simulates multisystem disease and initially defies diagnosis. In this paper, we present three cases of cardiac myxoma in adults. Their clinical features and differential diagnosis will be reviewed, with special emphasis on their insidiousness and suspicion necessary for correct and prompt diagnosis. The role of echocardiography in diagnosis and treatment will be discussed, and finally, the surgical management and prognosis is briefly outlined.peer-reviewe

Bilateral simultaneous spontaneous pneumothorax

Bilateral simultaneous spontaneous pneumothorax, although rare, constitutes a grave emergency when it occurs. One of the strongest arguments in favour of prompt closed catheter drainage in the treatment of massive pneumothorax is the possibility that another pneumothorax may occur on the opposite side. The purpose of this paper is to report a case of simultaneous bilateral pneumothorax which presented as an acute medical emergency requiring immediate intervention. This is a condition which requires prompt treatment. Immediate needle decompression of one or both sides is a life-saving procedure. This has to be followed however by tube thoracotomies which have to be carried out bilaterally. It was felt that open thoracotomy or talc poudrage should not be undertaken in the present case as the reactive effusion produced by the intercostal tube was such that a chemical pleurodesis was likely. The lungs have remained completely expanded.peer-reviewe

Hospital mortality in myocardial infarction

The World Health Organisation (1969) reported that ischemic heart disease has reached enormous proportions, striking more and more at younger subjects. Acute myocardial infarction is an extremely common emergency in general hospitals with a high incidence of acute medical admissions. It is now generally agreed that the introduction of coronary care units, by providing facilities for early detection of arrhythmias and emergency resuscitation, has contributed substantially to lower the hospital mortality from myocardial infarction. The purpose of this paper is to review the cases of myocardial infarction admitted into a medical unit of St. Luke's Hospital Malta in the years 1968 and 1969 as well as to assess the factors affecting the hospital mortality in this group of patients. All studies on myocardial infarction have confirmed the fact that most of the hospital deaths occur in the first 48 hours. In the present series, 34.6% of all deaths occurred in the first 24 hours.peer-reviewe

A study of bronchial asthma in Malta

This paper was read at the 12th Annual Clinical Meeting of the British Medical Association in Malta. The incidence of bronchial asthma in Malta is not well documented. Nevertheless, the general impression among practicing physicians in Malta is that the incidence of asthma in these Islands is high. This paper is based on a study of a personal series of 419 patients treated for bronchial asthma between 1964 and 1968. There were 217 males and 202 females. The age of onset was worked out for all the cases. It is interesting to note that in females, the age of onset extended over a longer period of time. Nonetheless the age of onset of asthma in the Maltese patients studied follows more or less the same pattern as that reported by other workers. It was also noted that many patients, who had asthma in childhood outgrew their asthmatic tendency at the time of puberty and started to have asthmatic attacks again in adult life. Results of skin tests showed that house dust and pollens were by far the most important allergens. In essence, the study reviews the relative findings with particular comparisons to other studies carried out overseas, also leading to the conclusion that Malta is not the ideal environment for the asthmatic patient who plans to come to Malta with the intention of improving his condition.peer-reviewe

The intradermal Leishmanin test as an epidemiological tool

Malta had been an endemic area for Kala-azar long before Critien made the diagnosis of the first case of infantile leishmaniasis in 1911. There is no doubt that the dramatic drop in the incidence which has occurred since 1948 must be related to the general improvement in sanitation. The purpose of this preliminary study was to confirm the hypothesis that actual cases of Kala-azar are a microfocus of infection in the community as well as to assess the usefulness of this skin test in epidemiological work. It is likely that the leishmanin skin test can prove as useful in the study of the epidemiology of leishmaniases as the tuberculin test in tuberculosis.peer-reviewe

Nutriomes and nutrient arrays - the key to personalised nutrition for DNA damage prevention and cancer growth control

DNA damage at the base-sequence, epigenome and chromosome level is a fundamental cause of developmental and degenerative diseases. Multiple micronutrients and their interactions with the inherited and/or acquired genome determine DNA damage and genomic instability rates. The challenge is to identify for each individual the combination of micronutrients and their doses (i.e. the nutriome) that optimises genome stability and DNA repair. In this paper I describe and propose the use of high-throughput nutrient array systems with high content analysis diagnostics of DNA damage, cell death and cell growth for defining, on an individual basis, the optimal nutriome for DNA damage prevention and cancer growth control

Antibiotic prescribing on two medical wards at St Luke’s Hospital : what scope for improvement?

Antibiotics are frequently prescribed drugs and form a significant part of the hospital budget. The literature suggests that prescribing is not without problems and may need constant review. We have no data relating to our hospital. This study aims to explore some aspects of antibiotic use in our setting. Records of all patients prescribed antibiotics on two medical wards over a 4 month period were analysed for indication, choice of antibiotic, outcome and cost. There were 126 patients: 54% males; 75.4%, >60 years old; 62% were admitted because of infection. Of the whole group, 8.7% received antibiotics with no evidence of infection and no indication for prophylaxis. There were 118 infections, 64% respiratory, 13.5% urinary and the rest of miscellaneous sites; 14% of infections were nosocomial. Microbiological studies were available in only 29% of infections. For 6 patients, the antibiotics prescribed were relatively contraindicated because of impaired hepatic and renal function. There was one adverse drug reaction. The total drug cost was Lm2181.79; i.v. treatment accounted for 93% of this cost and ceftazidime for 60%. There is room for improvement in the selection of antibiotics and their route of administration. The hospital microbiologists and the Antibiotic Policy should be consulted more often. Laboratory diagnosis of infection and biochemical patient monitoring are inadequate. Restricting i.v. treatment could reduce cost very substantially.peer-reviewe