Hypothermia in the early neonatal period

Background: Hypothermia in neonates is a common problem and is associated with increased morbidity and mortality. Prevention of hypothermia is therefore an essential aspect of neonatal care especially in the immediate neonatal period. Aim: To evaluate the efficacy of thermal care of the neonate in the labour ward at St Luke's Hospital, Malta. Method: Retrospective study analysing the temperature on admission to the nursery from the labour ward. A consecutive sample of 754 neonates admitted during 2002 was studied. Results: The proportion of babies admitted with normal body temperature (36.5-37.5°C) was 25.5%. The rest were mildly (36.0-36.5°C) (42.2%) or moderately (<36.0°C) (32.2%) hypothermic. Significantly less normothermia was evident in winter births (19.6%) than in summer births (38.1%) (Chi squared=26.5, p<0.0001). Implications: The results indicate the need for an improvement in thermal support in the labour ward.peer-reviewe

Current weaning practices in a group of Maltese parents

Background: Certain weaning practices are known to increase the risk of problems such as allergies, fussy eaters and childhood obesity. Aim:To assess the variations in weaning practices, including the time of introduction of food and of lumpy/finger foods in a group of Maltese parents. Methods: Email questionnaire-based survey of the weaning practices of 300 parents. Results: There were 130 respondents. One-third of infants were exclusively breast fed. Two-thirds of parents started weaning between 4 and 6 months. Lumpy foods were introduced after eight months in 74% of cases. Conclusions Significant deviations from the recommended weaning advice were identified which potentially increases the risk of problems in these children.peer-reviewe

Hypothermia in the early neonatal period : follow-up study

Background: Thermal care is an essential aspect of the routine care of the newborn because hypothermia is an important and preventable contributor to morbidity. Aim: To evaluate whether the new practice of postponing bathing of the newborn at St Luke's Hospital has resulted in an improvement in neonatal thermal care. Methods: Analysis of the temperature on admission to the nursery from labour ward during 2005 of a consecutive sample of 877 infants, compared to the results obtained from a similar study in 2002. Results: The proportion of babies admitted with normal body temperature (36.5-37.5°C) was 43.4% in 2005, compared to 25.5% in 2002. The proportion of babies admitted with moderate hypothermia was reduced from 32.3% in 2002 to 14.4% in 2005. Implications: Delayed bathing has resulted in a significant improvement in thermal care of the newborn.peer-reviewe

Acute modified Blalock-Taussing shunt obstruction successfully treated with urokinase and heparin

Acute modified Blalock-Tuassig shunt obstruction due to thrombosis may be lifethreatening. We report non-invasive relief of shunt obstruction with thrombolysis and heparinisation, a potentially life-saving intervention that is applicable in all settings, including outside tertiary paediatric cardiology centres.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

SIDS and infant sleeping position : audit on the advisory campaign in Malta

Background: The baby’s sleeping position is the most important modifiable risk factor in Sudden Infant Death Syndrome (SIDS). The “back to sleep” position is safer than side or prone position. Objectives: To determine what advice midwives and nurses at St Luke’s Hospital give to new mothers about the baby’s sleeping position; and whether the practice has changed following a series of lectures on SIDS and a focused circular issued by the Department of Health in February 2007. Methods: A questionnaire-based, descriptive, and crosssectional before-after trial. Results: In 2007, 81% of midwives/nurses advised exclusive back sleeping position, compared to 38% in 2006 (p<0.0001). Conclusion: The audit demonstrates a notable increase in the number of midwives/nurses giving correct advice to the new mothers.peer-reviewe

The Libyan civil conflict : selected case series of orthopaedic trauma managed in Malta in 2014

Aim: The purpose of this series of cases was to analyse our management of orthopaedic trauma casualties in the Libyan civil war crisis in the European summer of 2014. We looked at both damage control orthopaedics and for case variety of war trauma at a civilian hospital. Due to our geographical proximity to Libya, Malta was the closest European tertiary referral centre. Having only one Level 1 trauma care hospital in our country, our Trauma and Orthopaedics department played a pivotal role in the management of Libyan battlefield injuries. Our aims were to assess acute outcomes and short term mortality of surgery within the perspective of a damage control orthopaedic strategy whereby aggressive wound management, early fixation using relative stability principles, antibiotic cover with adequate soft tissue cover are paramount. We also aim to describe the variety of war injuries we came across, with a goal for future improvement in regards to service providing.Methods: Prospective collection of six interesting cases with severe limb and spinal injuries sustained in Libya during the Libyan civil war between June and November 2014.Conclusions: We applied current trends in the treatment of war injuries, specifically in damage control orthopaedic strategy and converting to definitive treatment where permissible. The majority of our cases were classified as most severe (Type IIIB/C) according to the Gustilo-Anderson classification of open fractures. The injuries treated reflected the type of standard and improved weaponry available in modern warfare affecting both militants and civilians alike with increasing severity and extent of damage. Due to this fact, multidisciplinary team approach to patient centred care was utilised with an ultimate aim of swift recovery and early mobilisation. It also highlighted the difficulties and complex issues required on a hospital management level as a neighbouring country to war zone countries in transforming care of civil trauma to military trauma.peer-reviewe

Physicochemical characterization of Gozitan honey

Honey quality is clearly defined in the EU Directive 2001/110/EC, and by Codex Alimentarius (Codex Stan 12-1981) and the International Honey Commission (International Honey Commission, 2002). Our investigation aimed to characterize the physicochemical properties of honey produced on a small island, Gozo which is situated near Malta. Ten randomly collected honey samples were analysed for moisture content, pH, free acidity, water insoluble content, hydroxymethylfurfural (HMF) content and total phenolic compounds. Moisture content, pH, free acidity, water insoluble content, and HMF content were within the range specified in standards but the electrical conductivity was generally higher than 0.800 mS cm−1. This may be the result of the relatively high atmospheric and soil salinity on this small island. All the samples analysed were within the 40 mg kg−1 HMF limit, which is an indicator of honey quality. The total phenolic compounds, which represent some of the constituents derived from the nectar and pollen obtained during foraging, ranged between 236.555 and 294.209 GAE kg−1 honey. Principal Component Analysis showed the properties of polyfloral honey samples obtained from the southern part of the island to be different from those obtained from the northern part.peer-reviewe

Selection of Acetic Acid Bacterial Strains and Vinegar Production From Local Maltese Food Sources

This study investigates the isolation, identification, and fermentation performance of autochthonous acetic acid bacteria (AAB) from local niche habitats on the Island of Gozo (Malta) and their further use for vinegar production, employing local raw materials. The bacteria were isolated from grapevine berries and vinegar produced in the cottage industry. Following phenotype and genotype identification, the AAB were ascribed to the genera Acetobacter, Gluconobacter, and Komagataeibacter. A mixture of selected AAB was tested as an inoculum for vinegar production in bench fermenters, under different conditions and substrates, namely, grapes, honey, figs, onions, prickly pear, and tomatoes. The bench fermenters were operated under semi-continuous fermentation where working volumes were maintained by discharging and subsequent recharging accordingly to maintain the acidity in fermenters by adding 30-50 g/l of acetic acid for optimal Acetobacteraceae performance. Finally, the vinegar products obtained from the different substrates were evaluated for their quality, including organoleptic properties, which showed the superior quality of wood-treated vinegar samples with respect to neat vinegar samples

Validation of a competence profile for MR radiographers using a formal research process

Owing to the limited time for continuous professional development available and hence the impossibility of covering all the knowledge, skills and competences required for the full range of MR techniques available today, it’s important that competence profiles are context specific. This study sought to develop and validate a context specific competence profile for MR radiographers that would be necessary and sufficient to deliver the MR service portfolio and care pathway in Malta. The study forms part of a wider study on continuous professional development for MR radiographers in Malta.peer-reviewe