Case number 2 : infective endocarditis in a patient with tetralogy of fallot

Mr. FG is a 29-year-old man from Fgura. He is a known case of Tetralogy of Fallot and mitral valve replacement (double-disc prosthetic valve), and presented at Accident and Emergency with a headache and fever. Following history, examination and investigations it was found that the patient was suffering from Subacute Bacterial Endocarditis. He was given antibiotics to treat the infection and due to his high risk of recurrence he continued the antibiotics.peer-reviewe

Littoral cell angioma of the spleen : a case report

The patient is a 54 year old, presenting with a 4 month history of worsening lower back pain, radiating to both lower limbs. CT Thorax Abdomen and Pelvis was carried out which showed a 6.2cm dense fluid density lesion in the spleen. The case was discussed at the multidisciplinary team meeting and open splenectomy was carried out. Histological diagnosis was consistent with an infarcted littoral cell angioma.peer-reviewe

Return to work after hernia repair

Background: The development of mesh repairs and the introduction of laparoscopic techniques have decreased recurrence rates of hernia and made the return to usual activities faster. Provided the surgery is uncomplicated and the patient does not need to lift more than 10kg at work, it appears safe to encourage a return to work soon after surgery. Methods: The study involved obtaining data of patients that had open, primary unilateral elective hernia repair surgery from January to June 2015. These patients were operated by all the surgical firms working at Mater Dei Hospital and all were performed by experienced specialists. 100 patients were interviewed over the phone. Results: Age of patients ranged from 20 to 84 years with a median age of 65 years. The absolute majority of patients were males (90 %). 43% of patients were given information about return to work after hernia repair by a senior doctor where 51% advised to return to work 6 weeks after hernia repair. 69% of patients adhered to the advice that they were given. 39% of self-employed patient returned to work earlier than advised as opposed to 26.3% of employed who returned to work before advised.peer-reviewe

Psoriasis

Psoriasis is a chronic, persistent, life-long inflammatory disease. Psoriasis is an inflammatory disease presenting with red scales on the skin, most commonly at the elbows and knees. At the moment there is no complete cure for this disease but there are a wide range of therapies which can control it, and the patients can live a normal life. However this brings on the patients an economic burden, which increases in proportion with the severity of the diseasepeer-reviewe

Pre-operative fasting times in paediatric patients admitted to the orthopaedic department

Background: Recent research has shown that children are often fasted for unnecessarily long intervals and prolonged fasting could have detrimental metabolic and behavioural effects in small children. In 2011, the European Society of Anaesthesiology proposed the 6-4-2 regimen for pre-operative fasting in paediatric patients. Solids, including semi-solid food and milk-containing products should be avoided 6 hours, breast milk, 4 hours and clear fluids 2 hours before anaesthesia induction respectively.Methods: Patients aged 16 years and younger requiring emergency surgery within the Orthopaedics department were included in this audit over a three-month period. 49 patients were identified from the trauma lists issued daily by the Orthopoedics Department. Data was collected from patient's case notes.Results: Out of 41 patients, 22 patients (54%) were advised to remain starved from fluids and solids from 2 am in the morning. On the other hand, 37% of the patients (15 patients) were advised to remain starved from midnight.Conclusion: The majority of doctors that admit paediatric patients within the Orthopaedics Department seem to be unaware of the guidelines from the European Society of Anaesthesiology regarding pre-operative fasting times in children. As a result, these patients are fasted for unnecessarily long intervals leading to detrimental metabolic and behavioural effects.peer-reviewe

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

Novel leukocyte-depleted platelet-rich plasma-based skin equivalent as an in vitro model of chronic wounds : a preliminary study

Background: Chronic leg ulcerations are associated with Haemoglobin disorders, Type2 Diabetes Mellitus, and long-term venous insufficiency, where poor perfusion and altered metabolism develop into a chronic inflammation that impairs wound closure. Skin equivalent organotypic cultures can be engineered in vitro to study skin biology and wound closure by modelling the specific cellular components of the skin. This study aimed to develop a novel bioactive platelet-rich plasma (PRP) leukocyte depleted scaffold to facilitate the study of common clinical skin wounds in patients with poor chronic skin perfusion and low leukocyte infiltration. A scratch assay was performed on the skin model to mimic two skin wound conditions, an untreated condition and a condition treated with recombinant tumour necrotic factor (rTNF) to imitate the stimulation of an inflammatory state. Gene expression of IL8 and TGFA was analysed in both conditions. Statistical analysis was done through ANOVA and paired student t-test. P <0.05 was considered significant.Results: A skin model that consisted of a leukocyte-depleted, platelet-rich plasma scaffold was setup with embedded fibroblasts as dermal equivalents and seeded keratinocytes as multi-layered epidermis. Gene expression levels of IL8 and TGFA were significantly different between the control and scratched conditions (p <0.001andp <0.01 respectively), as well as between the control and treated conditions (p<0.01 and p <0.001 respectively). The scratch assay induced IL8 upregulation after 3h (p <0.05) which continued to increase up to day 1 (p <0.05). On the other hand, the administration of TNF led to the downregulation of IL8 (p <0.01), followed by an upregulation on day 2.IL8 gene expression decreased in the scratched condition after day 1 as the natural healing process took place and was lower than in the treated condition on day 8 (p <0.05). Both untreated and treated conditions showed a downregulation of TGFA 3h after scratch when compared with the control condition (p <0.01). Administration of rTNF showed significant downregulation of TGFA after 24h when compared with the control (p <0.01) and treated conditions (p <0.05).peer-reviewe

The impact and management SARS-CoV-2 in a psychiatric hospital setting

BACKGROUND: During the months of August and September 2020, an outbreak of SARS-CoV-2 took root in Mount Carmel Hospital and affected 29 elderly female chronic psychiatric inpatients, representing a significant clinical undertaking within the context of this low-resource healthcare setting.METHODS: An emergency isolation ward was set up to contend with the outbreak, while a medical response team comprised of two psychiatric doctors and five extended foundation trainees was established in order to care for this vulnerable patient cohort. Close liaison with the Infectious Diseases team at Mater Dei Hospital fostered an effective therapeutic setting within which these patients could be treated. This represented a unique approach in an environment where literature on SARS-CoV-2 is scarce - the psychiatric inpatient setting.RESULTS: All 29 of our patients recovered from SARS-CoV-2 during the course of this period as a result of close clinical observation, a system of twice-daily patient review, early identification of patient deterioration and effective cross-speciality communication.CONCLUSION: An outbreak of SARS-CoV-2 within the mental health inpatient setting represents a number of unique clinical, managerial and interpersonal challenges, though straightforward clinical measures and effective patient monitoring can greatly aid the response to viral outbreaks in low-resource healthcare settings.peer-reviewe