Santu Wistin fil-ħsieb u l-qalb ta' Dun Karm

L-awtur janalizza l-kitba ta’ Dun Karm li fiha hemm imsemmi Santu Wistin.N/

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

Anxiety and the management of asthma in an adult outpatient population

Review of the literature suggests that anxiety is more common among patients with asthma than among the general population, yet it does not appear to be given the attention it deserves as part of the overall management of asthma. The aim of this study was to investigate the relationship between anxiety and asthma management, in terms of Global Initiative for Asthma steps, lung function and medication. Methods: A total of 201 consecutive patients with respiratory physician-diagnosed asthma were recruited from an adult outpatient asthma clinic. Participants underwent a sociodemographic review, and a medical interview which included a detailed drug history. Forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF) values were recorded using a Micro Medical portable spirometer. The level of anxiety was assessed using the Beck Anxiety Inventory (BAI). Results: A total of 51.5% of participants registered clinically significant levels of anxiety. Of these only 21% had already been diagnosed and were receiving treatment. Females reported significantly higher BAI scores than males (p<0.01). More females (66.3%) registered clinically significant levels of anxiety as compared with males (33.7%) (p<0.05). There was a positive correlation between the BAI score and the prescribed dose of inhaled glucocorticoids (rs¼0.150, p<0.05) and between anxiety and GINA treatment step (rs¼0.139, p<0.05). There was also a positive correlation between anxiety and the number of medicines taken by patients (rs¼0.259, p<0.001). Conclusions: Physicians treating patients with asthma should be sensitised to the association between asthma and anxiety, and should also consider assessing patients for the possibility of anxiety disorders as part of asthma management plans.peer-reviewe

Pharmacy of Your Choice scheme and management of hypertension

Objective: The aim of this project was to assess pharmacist intervention in patients suffering from hypertension to improve management of their condition by identifying risk factors, evaluating side-effects, monitoring, assessing drug-drug interactions and providing advice to help control blood pressure. Method: Two questionnaires were used in the study; the first questionnaire intended to identify drug-related problems and risk factors and a second questionnaire was developed as a shorter version of the first questionnaire. The questionnaires were used on 3 occasions when the patients came to collect their Pharmacy of Your Choice (POYC) medications from a local community pharmacy. The first questionnaire was used at time=0 (visit 1) and the second questionnaire was used twice, at t=2 months (visit 2) and t=4 months (visit 3). Blood pressure and pulse readings were recorded each time and patients were referred in cases of abnormal readings and in cases of interactions or side-effects. Advice was given to the patients on all the 3 occasions and any care issues were addressed. Key findings: Out of the 35 patients who participated, initially 22 patients were hypertensive. This number decreased to 20 patients at t=2 months and 16 patients at t=4 months. Abnormal pulse readings were initially found in 7 patients that in the subsequent visits decreased to 4 patients with 2 patients being investigated. The need for patient referral decreased from 24 patients at t= 0, to 21 patients at t= 2 months and 17 at t= 4 months. Conclusion: Pharmacist intervention in patient monitoring of chronic conditions supported patients in managing their blood pressure. Several comorbidities and mortalities can be reduced when the patient is regularly monitored by a pharmacist and any drug-related problems identified, addressed and patient is referred as necessary.peer-reviewe

Sudden bilateral loss of vision in a 19-year-old man

Introduction: Posterior Reversible Leukoencephalopathy Syndrome (PRES) is caused by ischaemia commonly affecting the posterior cerebral vasculature. It presents with sudden decreased vision, headaches, nausea, vomiting, seizures, and altered mental status. Case presentation: A 19-year-old male presented to the ophthalmic emergency complaining of sudden bilateral loss of vision, which was down to light perception He reported headaches, nausea, and drowsiness since the previous day. He was a known case of hypertension secondary to IgA nephropathy. Magnetic resonance imaging (MRI) with STIR and FLAIR sequences showed foci of hyperintensity within the occipital lobes bilaterally. This confirmed the suspected diagnosis of PRES. Discussion: Aetiological factors of PRES include sudden increase in blood pressure, eclampsia, porphyria, renal disease, and Cushing syndrome. These lead to blood-brain barrier injury either by hyper- or hypoperfusion, endothelial dysfunction, changes in blood vessel morphology, hypocapnea, or immune system activation. Histopathological changes in PRES include activated astrocytes, scattered macrophages and lymphocytes, often in the absence of inflammation or neuronal damage. Conclusion: PRES is usually a reversible neuroophthalmological condition, however prompt recognition and appropriate management is important to prevent permanent brain injury or even death.peer-reviewe

Pharmacy of Your Choice scheme and management of hypertension

Objective: The aim of this project was to assess pharmacist intervention in patients suffering from hypertension to improve management of their condition by identifying risk factors, evaluating side-effects, monitoring, assessing drug-drug interactions and providing advice to help control blood pressure. Method: Two questionnaires were used in the study; the first questionnaire intended to identify drug-related problems and risk factors and a second questionnaire was developed as a shorter version of the first questionnaire. The questionnaires were used on 3 occasions when the patients came to collect their Pharmacy of Your Choice (POYC) medications from a local community pharmacy. The first questionnaire was used at time=0 (visit 1) and the second questionnaire was used twice, at t=2 months (visit 2) and t=4 months (visit 3). Blood pressure and pulse readings were recorded each time and patients were referred in cases of abnormal readings and in cases of interactions or side-effects. Advice was given to the patients on all the 3 occasions and any care issues were addressed. Key findings: Out of the 35 patients who participated, initially 22 patients were hypertensive. This number decreased to 20 patients at t=2 months and 16 patients at t=4 months. Abnormal pulse readings were initially found in 7 patients that in the subsequent visits decreased to 4 patients with 2 patients being investigated. The need for patient referral decreased from 24 patients at t= 0, to 21 patients at t= 2 months and 17 at t= 4 months. Conclusion: Pharmacist intervention in patient monitoring of chronic conditions supported patients in managing their blood pressure. Several comorbidities and mortalities can be reduced when the patient is regularly monitored by a pharmacist and any drug-related problems identified, addressed and patient is referred as necessary.peer-reviewe

Deep MERLIN 5GHz Radio Imaging of Supernova Remnants in the M82 Starburst

The results of an extremely deep, 8-day long observation of the central kpc of the nearby starburst galaxy M82 using MERLIN (Multi-Element Radio Linked Interferometer Network) at 5 GHz are presented. The 17E-06 Jy/beam, rms noise level in the naturally weighted image make it the most sensitive high resolution radio image of M82 made to date. Over 50 discrete sources are detected, the majority of which are supernova remnants, but with 13 identified as HII regions. Sizes, flux densities and radio brightnesses are given for all of the detected sources, which are all well resolved with a majority showing shell or partial shell structures. Those sources within the sample which are supernova remnants have diameters ranging from 0.3 to 6.7 pc, with a mean size of 2.9 pc. From a comparison with previous MERLIN 5 GHz observations made in July 1992, which gives a 9.75 year timeline, it has been possible to measure the expansion velocities of ten of the more compact sources, eight of which have not been measured before. These derived expansion velocities range between 2200 and 10500 km/s.Comment: 34 pages, 10 figures. Accepted by MNRA

Health and the Economy : a statement of concern

The relationship between health and the economy is an intimate and complex one. The economy of health and the apportioning of funds to different medical services and health care programs are issues that depend on the health profile of a given community as well as the expectations of its members. Decisions ultimately depend on available resources and political priorities. Health and the economy cannot be isolated and contrasted, as the integrity of a given economic system clearly depends on the state of health of the community both at an individual level as well as at a population level.peer-reviewe