Reducing the expense of ear wax

Ear wax is one of the commonest presenting complaints both in Ear Nose and Throat surgery and in General Practice. The commonest treatment by far given for this condition is Arachis oil (Cerumol®). Results from various studies however show that this appears not to be the most effective treatment and that cheaper options exist which may drastically reduce the costs incurred by the Health Department in this respect. We hereby outline the advantages of the use of 0.9% saline drops in the treatment of ear wax.peer-reviewe

Review of the financial and medicolegal implications of nasal fractures seen at St Luke’s Hospital

Simple nasal bone fractures are the third most common type of all fractures leading to numerous patient visits at the Accident & Emergency department. Nasal fractures are commonly over-investigated in St Luke’s hospital leading to a substantial financial burden on our health system. In this article we review the frequency of simple nasal fractures as well as the necessity or otherwise of nasal x-ray imaging in addition to the financial and health consequences that result from nasal x-ray imaging. These issues are also discussed from a legal perspective.peer-reviewe

Audit on the use of radiological investigations in the management of rhinosinusitis

Objectives: The aim of this audit is to establish the cost to the Maltese health system from the use of radiological imaging in managing rhinosinusitis and to identify areas in which these costs can be minimised by following guidelines on the management of rhinosinusitis. Methods: All plain radiographs and computed tomography scans (CT) of the paranasal sinuses requested in the Mater Dei Hospital over a one year period were analysed. Data was collected regarding: the quantity of investigations ordered, age of the patients, cost and requesting department. Results: Over one year: 205 CT scans and 113 sets of plain radiographs of the paranasal sinuses were requested, costing a total of euro103,440. The majority (73%) were elective requests made by ENT consultants. Five percent of CT scans were requested for patients less than 10 years of age. Conclusion: Rhinosinusitis is diagnosed clinically, only requiring radiological investigation in more complex cases best managed by specialists in ENT. Plain radiographs have limited use in the management of rhinosinusitis. Judicious use of imaging requests whilst following clinical guidelines is required to save money and minimise patient exposure to ionising radiation.peer-reviewe

A single trapped atom in front of an oscillating mirror

We investigate the Wigner-Weisskopf decay of a two level atom in front of an oscillating mirror. This work builds on and extends previous theoretical and experimental studies of the effects of a static mirror on spontaneous decay and resonance fluorescence. The spontaneously emitted field is inherently non-stationary due to the time-dependent boundary conditions and in order to study its spectral distribution we employ the operational definition of the spectrum of non-stationary light due to the seminal work by Eberly and Wodkiewicz. We find a rich dependence of this spectrum as well as of the effective decay rates and level shifts on the mirror-atom distance and on the amplitude and frequency of oscillations of the mirror. The results presented here provide the basis for future studies of more complex setups, where the motion of the atom and/or the mirror are included as quantum degrees of freedom.Comment: 10 pages, 12 figures, contribution to the special issue in Optics Communications devoted to Krzysztof Wodkiewicz's memor

A unique case of esophageal perforation caused by prickly pears

This is a report of a previously healthy 20-year-old male presenting with the sensation of a foreign object being stuck in the throat and difficulty speaking after the ingestion of 2 prickly pears. Tests were performed, confirming an esophageal perforation which was managed medically. The patient was discharged after 7 days in hospital with no complications.peer-reviewe

Post-tonsillectomy bleeding in Malta

Patients presenting with post-tonsillectomy haemorrhage are frequently readmitted to hospital, usually for observation, but surgical intervention may sometimes be necessary. A 10 year retrospective analysis of 3553 patients who underwent tonsillectomy with or without adenoidectomy at the Mater Dei hospital was carried out. Clinical notes were used to determine the post-tonsillectomy haemorrhage rate and its relationship to the use of antibiotics.peer-reviewe

Tnehid ta’ ltim

Ġabra ta’ poeżiji u proża li tinkludi: Minn fuq il-Barrakka ta’ K. Xuereb – Triqat Mitlufa ta’ Ġorġ Pisani – Għall-mewt ta’ G. K. Chesterton ta’ Karmenu Vassallo – Imħabba u mibegħda ta’ Ġużè Chetcuti – Mill-mewt għall-ħajja! ta’ R. M. B. – Tnehid ta’ ltim ta’ Mario Agius.N/

Sisyphus Cooling of Electrically Trapped Polyatomic Molecules

The rich internal structure and long-range dipole-dipole interactions establish polar molecules as unique instruments for quantum-controlled applications and fundamental investigations. Their potential fully unfolds at ultracold temperatures, where a plethora of effects is predicted in many-body physics, quantum information science, ultracold chemistry, and physics beyond the standard model. These objectives have inspired the development of a wide range of methods to produce cold molecular ensembles. However, cooling polyatomic molecules to ultracold temperatures has until now seemed intractable. Here we report on the experimental realization of opto-electrical cooling, a paradigm-changing cooling and accumulation method for polar molecules. Its key attribute is the removal of a large fraction of a molecule's kinetic energy in each step of the cooling cycle via a Sisyphus effect, allowing cooling with only few dissipative decay processes. We demonstrate its potential by reducing the temperature of about 10^6 trapped CH_3F molecules by a factor of 13.5, with the phase-space density increased by a factor of 29 or a factor of 70 discounting trap losses. In contrast to other cooling mechanisms, our scheme proceeds in a trap, cools in all three dimensions, and works for a large variety of polar molecules. With no fundamental temperature limit anticipated down to the photon-recoil temperature in the nanokelvin range, our method eliminates the primary hurdle in producing ultracold polyatomic molecules. The low temperatures, large molecule numbers and long trapping times up to 27 s will allow an interaction-dominated regime to be attained, enabling collision studies and investigation of evaporative cooling toward a BEC of polyatomic molecules

Validation of the new consensus criteria for the diagnosis of corticobasal degeneration

BACKGROUND: Corticobasal degeneration (CBD) is a complex neurodegenerative disorder. Accurate diagnosis is increasingly important, with the advent of clinical trials of drugs aimed at modifying the underlying tau pathology. CBD often presents with a ‘corticobasal syndrome’ including impairments of movement and cognition. However, patients with similar corticobasal syndromes can have neurodegenerative pathologies that are not CBD. In addition, patients with CBD may present with aphasia or behavioural change. The clinical diversity of CBD and mimicry by non-CBD pathologies hinders accurate diagnosis. METHODS: We applied the new consensus criteria of Armstrong and colleagues et al 1 to a cohort of patients with detailed longitudinal clinical evaluation and neuropathology. RESULTS: In patients with pathologically confirmed CBD, accuracy of diagnosis was similar under the new and previous criteria: 9/19 (47%) met criteria for probable CBD at presentation, 13/19 (68%) at last clinical assessment. Patients with a corticobasal syndrome but without CBD pathology all (14/14) met the new diagnostic criteria of probable or possible CBD, demonstrating that the new criteria lacks the necessary specificity for an accurate ante mortem clinical diagnosis of CBD. None of the clinical features used in the new criteria were more common in the patients with CBD pathology (n=19) than without (n=14). CONCLUSIONS: The Armstrong criteria usefully broadens the recognised clinical phenotype of CBD but does not sufficiently improve the specificity of diagnosis to increase the power of clinical trials or targeted applications of tau-based disease-modifying therapies. Further work is required to show whether biomarkers could be more effective than clinical signs in the diagnosis of CBD