Prescribing humour in healthcare : part 2

Title on article is Prescribing humour in healthcare - part IPart 1 of this article can be found in this link : https://www.um.edu.mt/library/oar//handle/123456789/12758Part 2 of the article. With regards to the effects of humour and laughter on immunity, research is not so conclusive. while some studies have reported that IgA, T-cells and Natural Killer Cells increase with laughter, methodical problems question these conclusionpeer-reviewe

An evaluation of the bariatric surgical patient

Obesity continues to be one of the most common prevalent chronic diseases worldwide with recent data stating that it has now reached global pandemic proportions making it a major public health problem. In 2008 the World Health Organisation (WHO) stated that worldwide around 1.4 billion adults were overweight (body mass index [BMI] 25.0-29.9 kg/m2) and a further 500 million were obese (BMI ?30 kg/m2). Of note, the prevalence of obesity has tripled in Europe over the last 30 years with around 50% of the population in the majority of European countries being overweight or obese.1-4 Locally, the situation is also alarming with data from the European Health Interview Survey (EHIS) in 2011 stating that Malta had the highest rate of obese males in Europe (24.7%) and when it comes to females, Maltese women were the second most obese after British women (21.1% and 23.9% respectively).5 Even more worrisome is the fact that Malta also tops the charts for the highest prevalence of overweight and obesity in school-aged children thus accentuating the fact that urgent action needs to be taken in order to tackle effectively this world-wide epidemic.6 Unfortunately obesity is strongly linked to several co-morbid conditions such as type 2 diabetes, hypertension, cardiovascular disease, dyslipidaemia, obstructive sleep apnoea, non-alcoholic steatohepatitis, osteoarthrosis, as well as some cancers (including breast, ovary, prostate, endometrium and colon) and psychiatric illnesses and thus it stands to reason that an increase in prevalence of obesity has also led to an increase in prevalence of these co-morbidities resulting in an impaired overall quality of life and decreased life expectancy in these subjects.peer-reviewe

An essay on some aspects of medicine in Malta between 1934 - 1990

It has been wisely said that experience is not what happens to you but what you do with what happens to you. Especially the young tend to sneer at one who is always ready to justify whatever he says or does by saying that is what experience has taught him. This is hardly fair since he who quotes his experience is really only offering to present his listener with what he has acquired by his own exertions. In this essay I will in many ways offer to the reader what experience has taught me for which gratitude should be a fit reward. It is clear that what the "Medical Association of Malta" requires is an essay, qualifying this only by saying that "authors may choose any subject" as long as it has a medical variant, which is rather broad as a term of reference. It seems to me this could suggest the description of some clinical condition or procedure, of some technique or some special therapeutic measure. It could also mean presuming the eassayist is a medical man that the writer would be describing in biographic terms some part of his life which he had assumed to be of medical interest. Since I am one of the oldest doctors living in Malta and since I have had a varied life it is along these lines that this essay will be cast.peer-reviewe

Review of the risks and/or benefits of thyroxine treatment in ‘mild’ subclinical hypothyroidism

Subclinical hypothyroidism (SCH) is a form of mild thyroid failure and is a commonly encountered condition in clinical practice. It denotes the presence of a raised serum thyroid stimulating hormone (TSH) and normal serum free thyroid hormone concentrations (tri-iodothyronine [T3] and thyroxine [T4]). ‘Mild’ subclinical hypothyroidism is associated with a TSH level between 4.5-9mIU/L (0.4-4.2) whereas patients with a serum TSH level ?10mIU/L are classified as having the ‘severe’ form. The clinical significance of this condition has aroused a lot of interest over the last decade, especially its effects on various health outcomes (namely cardiovascular disease, lipid metabolism, fertility, pregnancy outcomes and fetal neurocognitive function). Unfortunately the unavailability of adequately powered, double-blind randomised controlled studies precludes the availability of clear cut guidelines as to how one should treat subclinical hypothyroidism. This review looks at the available evidence for and against treatment of SCH with levothyroixine. Most authors agree on the use of clinical judgement as well as individualising management based on the underlying unique patient characteristics when it comes to formulating a management plan for this condition.peer-reviewe

An update on pharmacotherapy for type 2 diabetes

Glucose lowering drugs have been available for clinical use for over the past 60 years or so with the last 2 decades seeing a significant number of new agents being developed making treatment increasingly complex and also somewhat controversial. This stems from the fact that while it is now known that patients with diabetes have an increased risk for cardiovascular disease and mortality there are mounting concerns with regards to the cardiovascular effects of certain antihyperglycemic agents leading to uncertainties when it comes to drug prescription. This has left many clinicians perplexed with respect to optimal strategies for management for management of such patients leading to many regulatory bodies to issue recommendations for antihyperglycimic therapy in adults with type 2 diabetes. These all uniformly advocate an individualised approach, keeping in mind each patients’ unique health profile (such as age and weight) and their cardiovascular risk factors vis-a-vie the specific attributes, side effects and adverse effects of each antihyperglycemic agent. This article will focus on the ten major categories of diabetic therapies looking specifically at their mode of action, safety profile as well as key trial data and where possible the long-term outcome studies for each class.peer-reviewe

Becoming a young doctor : meeting Sophie Butler and Clare Holt

Becoming a doctor is a major life changing event for any medical student. Students grow into their new role over the first ‘foundation’ years. Here, a year after their graduation, a senior doctor talks with two junior doctors, who are his friends and colleagues, about their experiences over the first year of their career. The author Dr Mark Agius, a Psychiatrist in Bedford and Cambridge, England is working with a couple of FY2 Doctors, or rather, they have just become FY2 Doctors, a year ago they were still medical students. Their names are Sophie Butler and Clare Holt. He talks to them about what it felt like to stop being medical students and become Doctors and how it has felt over this last year.peer-reviewe

How effective is our feedback? : feeding forward and self-regulation

Giving and receiving feedback is based on a number of stages, procedures, and factors that could determine whether the feedback is effective or not. The key stakeholders of feedback are the tutor and the student, who could work together towards building bridges, such as holding dialogues, giving and receiving constructive criticism. Ideally, feedback is not a one-way, top-down approach, where the tutor ‘commands’ the discourse, whilst the student is merely a passive recipient. In whatever form it is delivered, the feedback that is passed on to the student should be more than ‘correcting’ the work; it could involve a communicative approach whereby the tutor passes on salient information that the student may utilise to sharpen his or her work. Hence, the possession of feedback is not solely relegated to the tutor. Instead, there is a transference where the student claims ownership of the feedback, and thus becomes responsible for its implementation. The responsibility to do so should not be perceived by the student as though he or she were doing a favour to their tutor, but an action which is undertaken for their own personal benefit and gain. Rather than feeding ‘back’, it is transformed to feeding ‘forward’, as the tutor provides suggestions that help shape future writing or assigned work. This paper, which is the result of a doctoral study conducted by the author, aims to present some benefits and challenges of feedback. Whilst exploring various areas of feedback, it suggests that, by revisiting practices, perceptions, and conceptualisations, there can be a shift towards feed forward and eventually offer the possibility of harnessing students’ autonomy and self-regulation.peer-reviewe

Tumor angiogenic switch determines sustained proliferative malignant transformation in tumorigenesis and overlaps with para-inflammatory phenomena

Contextual BCR-ABL tyrosine kinase over-activity determines in formulated fashion the emergence of proliferation and anti-apoptosis that arise largely as derived phenomena of otherwise homeostatic mechanisms of the c-ABL gene within hematopoietic stem cells and hemangioblasts in the bone marrow. The ability to suppress almost completely, both in terms of phenotype and cytogenetically, the myeloid cell line expansion by imatinib mesylate is indicative of a phenomenon that depends strictly on the transformed status of the cell of origin in the chronic myeloid leukemia process. It is with relevance to complex participation of the dynamics of the fused BCR- ABL protein product that contextual conditioning of the cells of origin of the gene translocation further motivates the dimensional expansion of the transformed myeloid cell clones to increasing proliferative rates, thus leading to blast crisis as eventual loss of differentiating potential.peer-reviewe

A dual origin for Bcr-Abl gene translocation/fusion as dynamics of synergism of the hematopoietic stem cell and hemangioblast in chronic myeloid leukemia

Contextual BCR-ABL tyrosine kinase over-activity determines in formulated fashion the emergence of proliferation and anti-apoptosis that arise largely as derived phenomena of otherwise homeostatic mechanisms of the c-ABL gene within hematopoietic stem cells and hemangioblasts in the bone marrow. The ability to suppress almost completely, both in terms of phenotype and cytogenetically, the myeloid cell line expansion by imatinib mesylate is indicative of a phenomenon that depends strictly on the transformed status of the cell of origin in the chronic myeloid leukemia process. It is with relevance to complex participation of the dynamics of the fused BCR- ABL protein product that contextual conditioning of the cells of origin of the gene translocation further motivates the dimensional expansion of the transformed myeloid cell clones to increasing proliferative rates, thus leading to blast crisis as eventual loss of differentiating potential.peer-reviewe

A case of intraplacental twin transfusion

There have been several reports of polycythaemia in one of uniovular twins with anaemia in the other twin. This syndrome has been recently fully recorded and reviewed by Corney and Aherne (1965). We describe here a severe example of this condition, with jaundice in the polycythaemic twin necessitating exchange transfusion. The severe anaemia in the other twin caused death in utero, and the birth of a macerated foetus. The twins showing intraplacental transfusion are described. Successful treatment of the polycythaemia and hyperbilirubinaemia is described. Bilirubin estimation should be performed routinely in such cases because polycythaemia may mask severe jaundice. Furthermore, previous reports of the condition and its management are briefly discussed.peer-reviewe