A review of acute bacterial meningitis in childhood

This paper reviews the epidemiology, pathogenesis and management of acute bacterial meningitis in childhood. The epidemiology of this infection has undergone significant changes with the implementation of effective immunisation, antibiotic therapy and chemoprophylaxis. The reported incidence of bacterial meningitis in children in the Maltese Islands is low compared to other countries. A high index of suspicion is required to diagnose the onset of bacterial meningitis especially in infants. Third-generation cephalosporins are currently the antibiotics of choice for the acute disease. The timely administration of penicillin may be life saving in cases of meningococcal septicaemia. Adjuvant therapy such as dexamethasone may reduce the occurrence and the severity of sequelae, in particular sensorineural hearing loss. Chemoprophylaxis with rifampicin has played an important role in curtailing epidemics of meningococcal disease. The Haemophilus influenzae type b (Hib) vaccine has made a significant impact on the incidence of H. influenzae meningitis in children. Effective vaccines against pneumococci and meningococci (type b) do not yet exist, however ongoing research seeks to produce these vaccines in an effort to emulate the successful outcome attained by the Hib vaccine.peer-reviewe

Traditional boats of Malta

Around the shores of the Maltese Islands, one can see various small, working boats which developed over a period of hundreds of years. When we refer to the traditional boats of Malta we refer to the five that have survived and which show the same constructional characteristics. It is interesting to note that one may come across certain local boats which originated after 1800 with the introduction of British rule in Malta but which do not comply with the traditional characteristics .peer-reviewe

The Breast Care Support Group

The Breast Care Support Group (BCSG) is a voluntary organisation, set up in the late eighties by a small group of women who had been through the trauma of having breast cancer, and felt that there was not enough support or advice available for women like themselves. Originally the word mastectomy was incorporated into the group title, but as surgery for breast cancer changed, so did the name of the group.peer-reviewe

Use of Propolis chemical and Asian tiger mosquito bites : case report and review

Propolis is a substance of variable composition which incorporates resins derived from plants and beeswax. It varies depending on the geographic location and local flora such as plant and bee species. Propolis possesses several attributes such as immune enhancement, antimicrobial, antioxidant, analgesic as well as reported anti-tumour effects.1,2 Several research efforts have focused on studying the chemical composition of propolis.3-7 The diverse biological activity probably relates in part to the significant changes in extract constituents. Propolis has been popularized in the past as a natural remedy but significant possible pharmaceutical use is envisaged. This brief review details a case of how multiple annoying localized allergic skin reactions secondary to Asian tiger mosquito bites were soothed and resolved very rapidly with the application of Propolis.peer-reviewe

Amyand’s hernia : a case report

The presence of vermiform appendix, whether normal or inflamed in the inguinal hernia, is referred to as Amyand’s hernia. This is rare occurring in about 1% of inguinal hernias in adults. This is a report of Amyand’s hernia, which presented as a component along with partially necrotic omentum with metastasis in a 75 year old male patient. Appendicectomy followed by hernia repair using synthetic mesh was performed with an uneventful recovery.peer-reviewe

Portraiture : finding the valid fragment

The paper deals with the concepts of fragmentation and reconstruction in the field of portraiture. Taking a portrait as a large fragment of information, we look into ways in which it can be optimised and reduced such that it remains valid but becomes more efficient. The paper commences by exploring the concept of the fragment from various facets, including historically, especially from the modernist point of view, and goes forth to investigate various techniques from practices both adjunct and outside of the field of art in order to inform the portraiture process itself on how information can be collected, optimised and presented to the viewer.peer-reviewe

Syndrome X

JS, a 34-year-old contractor, presented with a two day history of a sore throat. He was noted to have become increasingly centrally obese since his last visit – which he blamed on having gotten married in the interim – and was known to be a smoker. JS’ sore throat was his priority. However, a family history of diabetes mellitus and his history of ‘borderline’ hypertension were of more concern to his doctor. Is this the metabolic syndrome? How should this patient be managed? With a name as elusive as Syndrome X, it is all too easy to dismiss the topic as a rather exotic phenomenon for the internists and researchers to deal with. Nevertheless, what was described as Syndrome X in 1988 by Gerald Reaven and is now referred to as metabolic syndrome, appears to be one of the commonest conditions encountered in general practice. The metabolic syndrome, being a syndrome should innately be a collection of signs and symptoms of a pathological process together constituting a picture of a particular clinical condition warranting particular management. The gist of it all can be seen to lie in different perspectives; the metabolic syndrome can be seen as: • ‘simply’ a clustering of cardiovascular risk factors – possibly preventable and treatable or, • a multiplex of metabolic risk conditions namely atherogenic dyslipidaemia, hypertension, glucose intolerance, a proinflammatory and a prothrombotic state. This offers, perhaps, a more pathophysiological description of the condition. When it comes to the young gentleman described above, dismissing his possible collection of risk factors or failing to give them their due importance can result in the loss of a precious opportunity at preventive care which is definitely neither exotic nor beyond the scope of the primary care physician.peer-reviewe

The Hospice Movement

The Hospice Movement had its beginning in the U.K. some three decades ago and has now spread to over 70 countries throughout the world. It is rooted in the Christian ethos of profound respect of the human person and of human life threatened by inexorable and progressive disease. It has given rise to the new medical specialty of Palliative Medicine which embraces the most recent advances in scientific medicine and psycho-social science in its daily practice of succour and relief of the suffering of patients and their families. The Hospice idea came to Malta ten years ago. It is now well established as a voluntary organisation providing services to sufferers from advanced cancer and motor neurone disease.peer-reviewe

The future of public health practice in Europe

The European Public Health Association (EUPHA) identifies research, training, policy and practice as the four pillars for all its work. At a conference organised by the Association of School of Public Health in the European Region (ASPHER) in May 2016, an interesting session setting out a vision for these four areas for the coming years was organised. Josep Figueras and John Middelton outlined the challenges facing training and policy respectively in this session. They invited us to think outside the box and in a sense to reinvent public health in the 21st century. In this contribution, I focus on public health practice. Public health practitioners, who constitute an important part of EUPHA’s membership, are persons who typically work at the front line to translate research and policy into meaningful initiatives at local level.peer-reviewe

Windmills and the production of gunpowder in Malta

Each and every discussion revolving around the history of windmills in Malta has always and, wrongly so, focused on their exclusive use for grinding wheat and barley, without taking into consideration that some of these windmills, in particular those situated behind the fortified walls (but not only), could have had a dual function; that of being powder mills and machines for the grinding of corn. Old maps of the Grand Harbour have clearly documented the use of windmills in Malta forthe exclusive production of gunpowder at the turn of the seventeenth century. For security reasons, gunpowder mills were mostly situated within the city walls. However, in the absence of historical records, the major difficulties are: which of these windmills were used for milling grain? Which had a dual function? Which were used exclusively for producing gun powder? This paper seeks to answer these questions.peer-reviewe