Tetanus : forgiven, not forgotten

Tetanus is an illness that is still prevalent although the incidence has markedly decreased largely due to immunisation programmes. The latest four cases managed at St. Luke's hospital over 2001-2002 are presented. All of these patients survived. We give an overview of the illness and discuss the cases and management. The potential benefit of using dual antibiotic therapy is questioned.peer-reviewe

Hepatitis C : an emerging concern

Hepatitis C has surfaced worldwide as a formidable concern to public health. Recent developments have sharpened methods of serological detectability, epidemiological study and patient treatment. In the light of the global situation, this article briefly presents known local epidemiology about hepatitis C derived from routine data and personal communication from some key workers. The occurrence of a serious, potentially progressive, transmissible condition in a young population will incur high-costs to patients, contacts and care services. The article concludes by highlighting the areas offering greatest scope to check this condition through prevention and patient management.peer-reviewe

Aspiration of a speaking valve

Foreign body aspiration (FBA) is a relatively common and serious condition that can result in a spectrum of presentations ranging from incidental to acutely life-threatening. Described here is a case of aspiration of a tracheo-oesophageal speaking valve through a permanent tracheostomy that went unnoticed for a number of years, and an overview of the technique used for its removal. A 70-year-old ex-heavy smoker with a permanent tracheo-oesophageal fistula presented with a relatively recent history of increasing shortness of breath, sputum purulence and haemoptysis. Further investigation with a CT scan and bronchoscopy revealed the presence of a foreign body within his right lower lobe bronchus which was later removed by advancing a flexible bronchoscope over a rigid one.peer-reviewe

Two cases of aspiration of calcium tablets

Two clinical cases of aspiration are reported in elderly ladies with differing presentations following inhalation of the same brand of calcium tablet. One of the patients distinctly recalled the choking episode, whereas the other failed to do so making the diagnosis of aspiration difficult. One of the aspirated tablets was successfully retrieved during rigid bronchoscopy after the patient reported several months of cough requiring multiple courses of antibiotics. The other aspirated tablet was coughed up by the patient after the successful treatment of a pneumonia complicated by a parapneumonic effusion.peer-reviewe

Lymphadenopathy after Initiating HAART in an HIV-positive Patient with Kaposi's Sarcoma: a Case of Multicentric Castleman's Disease

We present the case of a 33-year-old lady who was diagnosed with disseminated Kaposi’s sarcoma and HIV infection. The patient improved on highly active antiretroviral therapy (HAART), however, nine days into treatment, she became febrile and dyspnoeic and developed tender cervical and axillary lymphadenopathy. Despite treatment for suspected sepsis and immune reconstitution, she died in intensive care. Lymph node biopsies revealed coexistent Castleman’s disease and Kaposi’s sarcoma. Initiation of HAART can be rarely associated with unmasking and rapid progression of Castleman’s disease, a phenomenon called immune reconstitution. Urgent investigation and treatment with agents such as steroids and cytotoxic drugs can be life-saving

Leprosy in Malta : not to be forgotten

Leprosy is a granulomatous infection that was once endemic on the Maltese Islands. Locally this disease was eradicated thanks to the Leprosy Eradication Programme which was concluded in 1999 and utilized a multidrug therapy regime. However, in view of the influx of migrant populations over the years we are starting to encounter leprosy in nationals of countries where the disease is still endemic. We report a case of a Philippino man presenting with nodular lesions over the face, trunk and limbs and a hypoaesthetic patch over the arm. A skin biopsy supported the clinical suspicion of midline borderline/borderline lepromatous leprosy and triple therapy with clofazimine, dapsone and rifampicin was initiated. Despite having a wide clinical differential diagnosis, leprosy must always be kept in mind by clinicians, especially when treating nationals from endemic areas.peer-reviewe

A time and motion study of patients presenting at the accident and emergency department at Mater Dei Hospital

<p>Abstract</p> <p>Background</p> <p>To carry out a time and motion study of patients presenting at the Emergency Department (ED) by measuring waiting times at the ED dept throughout the day. The objectives were:</p> <p indent="1">• to determine whether waiting times are prolonged, and</p> <p indent="1">• if prolonged, at which station(s) bottlenecks occur most often in terms of duration and frequency.</p> <p>Results will be compared to the United Kingdom guidelines of stay at the emergency department.</p> <p>Methods</p> <p>A group of 11 medical students monitored all patients who attended ED between 0600 hours on the 25^thAugust and 0600 hours on the 1st September 2008. For each 24 hour period, students were assigned to the triage room and the 3 priority areas where they monitored all patient-related activity, movement and waiting times so that length of stay (LOS) could be recorded. The key data recorded included patient characteristics, waiting times at various ED process stages, tests performed, specialist consultations and follow up until admitted, discharged, or referred to another hospital area. Average waiting times were calculated for each priority area. Bottle-necks and major limiting factors were identified. Results were compared against the United Kingdom benchmarks - i.e. 1 hour until first assessment, and 4 hours before admitting/discharge.</p> <p>Results</p> <p>1779 patients presented to the ED in the week monitored. As expected, patients in the lesser priority areas (i.e. 2 & 3) waited longer before being assessed by staff. Patients requiring laboratory and imaging investigations had a prolonged length of stay, which varied depending on specific tests ordered. Specialty consultation was associated with longer waiting times. A major bottleneck identified was waiting times for inpatient admission.</p> <p>Conclusions</p> <p>In conclusion, it was found that 30.3% of priority 1 patients, 86.3% of priority 2 patients and 76.8% of priority 3 patients waited more than 1 hour for first assessment. We conclude by proposing several changes that may expedite throughput.</p

Servitude et grandeur militaires

Ġabra ta’ poeżiji u proża li tinkludi: Notturn op. 9 nru 2 ta’ Beverly Agius – Naf ta’ Carmel Azzopardi – Ħsejjes ħajja ta’ Clifton Azzopardi – Il-ġrajja t’għasfur stramb ta’ Mario Azzopardi – Tektik...u għana ta’ Rena Balzan – Kun af li f’qiegħ għajnejk ta’ Charles Bezzina – Il-qalb imwebbsa ta’ Ġorġ Borg – Bħal ħuta mġewħa ta’ Louis Briffa – Taħt il-Mezquita, Cordòba ta’ Norbert Bugeja – Il-maskarat ta’ Alfred Degabriele – Trid mara ta’ Leanne Ellul – Id-dgħajsa ta’ Victor Fenech – Ilħna ta’ Joe Friggieri – Roulette ta’ Joe Friggieri – Għera ta’ Joe P. Galea – Ħġieġa ta’ Maria Grech Ganado – Ġenna qatt mirbuħa ta’ Karmenu Mallia – Il-fantażma tal-mara mqarba ta’ Albert Marshall – Daħlet Qorrot ta’ Daniel Massa – Granada, parque central ta’ Immanuel Mifsud – Waħda mara ta’ Immanuel Mifsud – Mors ta’ Therese Pace – Għada ta’ Alfred Palma – Emmint xejn ma jintemm ta’ Ġorġ Peresso – Tuffieħa bl-imsiemer tal-qronfol ta’ John Peter Portelli – Lil Karmenu Vassallo ta’ Andrew Sciberras – Irrid il-qamar jiddi ta’ Carmel Scicluna – Din il-biċċa ħuta ta’ Steve Borg – Karta li taret mar-riħ ta’ Lina Brockdorff – Nixtieq, u kemm nixtieq! ta’ J. J. Camilleri – Caterina ta’ Sandro Mangion – L-għajta tal-pappagall ta’ Pierre J. Mejlak – Id-destin ta’ Laurence Mizzi – L-arloġġ tal-bozza ta’ Rita Saliba – Kurżità ta’ Alfred Sant – Il-ġeneral ta’ Vincent Vella – Mirja ta’ Trevor Żahra – L-adulteri ta’ Golan Haji, traduzzjoni ta’ Clare Azzopardi u Albert Gatt – L-istennija ta’ Berislav Blagojević, traduzzjoni ta’ Kit Azzopardi – Il-qattus ta’ Ghassan Kanafani, traduzzjoni ta’ Walid Nabhan – L-iben addottat ta’ Guy de Maupassant, traduzzjoni ta’ Josette Attard – Sunett nru. 18 ta’ William Shakespeare, traduzzjoni ta’ Alfred Palma – Llanto por Ignacio Sánchez Mejías ta’ Federico Garcia Lorca, traduzzjoni ta’ Therese Pace – Servitude et grandeur militaires ta’ Alfred de Vigny, traduzzjoni ta’ Paul Zahra.peer-reviewe

Variegate Porphyria Triggered by Acute Hepatitis A Infection

Background: Variegate porphyria (VP) is a rare disorder of haem biosynthesis. We report a novel association with hepatitis A infection.Patient and methods: A 31-year-old man was diagnosed with acute hepatitis A infection. During recovery, he presented with abdominal pain and a photoaggravated blistering skin eruption.Results: Urine porphyrin precursors were markedly raised with high coproporphyrin III isomer levels. Faecal protoporphyrin levels were markedly increased and a maximum plasma fluorescence emission at 629 nm was noted. Discussion: Acute hepatitis A infection, and the associated metabolic stress exerted on the haem biosynthetic pathway, induced overt presentation of latent VP