/library/oar/handle/123456789/33418 2025-11-15T14:02:10Z 2025-11-15T14:02:10Z Fenech, Manuel /library/oar/handle/123456789/19873 2017-06-15T01:36:59Z 2017-01-01T00:00:00Z

Title: Sepsis : where are we up to? Authors: Fenech, Manuel Abstract: It is quite common that we read about novel infections. We are all aware about the mortality secondary to ST elevation Myocardial Infarction which stands at around 8%. Meanwhile, sepsis is an old enemy that still kills many of our patients across the board. Mortality has remained high despite advances in pathobiology due to its complexity and heterogeneity with up to 10% for sepsis going up to 40% for septic shock. Considerable changes in the 2001 definitions of Sepsis were published in the third international consensus definitions for sepsis and septic shock (Sepsis-3). The old definitions including SIRS (Systemic inflammatory response syndrome), Severe Sepsis and Septic Shock were found to be lacking in sensitivity and specificity while being too lax to allow consistency in gathering data. By using electronic health record data from patients admitted with infection it was possible to retrospectively evaluate the best tools to screen for sepsis in patients with suspected infection while aiming for simplicity.

2017-01-01T00:00:00Z Attard Biancardi, Mark Anthony Spiteri, Peter Pace, Maria Pia /library/oar/handle/123456789/19872 2017-07-21T08:06:36Z 2017-01-01T00:00:00Z

Title: Cardiac arrest recognition and telephone CPR by emergency medical dispatchers Authors: Attard Biancardi, Mark Anthony; Spiteri, Peter; Pace, Maria Pia Abstract: Emergency Medical Service (EMS) systems annually encounters about 275 000 out-of-hospital cardiac arrest (OHCA) patients in Europe and approximately 420,000 cases in the United States.1 Survival rates have been reported to be poor with approximately 10% survival to hospital discharge.2 The chance of surviving from an OHCA is highly associated with Emergency Medical Dispatchers’ (EMD) recognition of cardiac arrest, early bystander cardiopulmonary resuscitation (CPR), and early defibrillation.3-6 This study was a simulation based study. All emergency nurses who were eligible by training to answer 112 calls and activate the EMS were included in this study. The simulations were run by two experienced ED nurses who followed predefined scripts. The two key questions that the authors were after included ascertaining patient responsiveness and breathing status. EMDs who offered telephone assisted CPR (tCPR) were noted and observed. The mean percentage recognition of out of hospital cardiac arrest by the Maltese EMDs was 67%. 28% of EMDs who recognized cardiac arrest asked both questions regarding patient’s responsiveness and breathing whilst only 8% of EMDs who did not recognize cardiac arrest asked both questions. The mean percentage of telephone assisted CPR was 58%. Conclusion: When compared to other European countries, OHCA recognition by Maltese EMDs needs to improve. However, given that the local EMDs have no formal guidelines or algorithms for their use during 112 calls, results are encouraging to say the least especially in telephone assisted CPR. With educatio

2017-01-01T00:00:00Z Cini, Erica /library/oar/handle/123456789/19871 2018-03-09T13:08:04Z 2017-01-01T00:00:00Z

Title: Medical or surgical approaches to obesity treatment, or both? Authors: Cini, Erica Abstract: Obesity is a growing concern in the medical profession, particularly due to the co-morbidities that are related to obesity. Various methods have been trialled to manage obesity with varying effects, but can we ever say that one which is better than the other? This article looks at various lifestyle, pharmacological and surgical aspects of the management of obesity and discusses the diverse theories as to why the maintenance of weight loss can be difficult.

2017-01-01T00:00:00Z Zammit, Daniela Cini, Charles Cutajar, Jonathan /library/oar/handle/123456789/19870 2018-04-02T08:41:49Z 2017-01-01T00:00:00Z

Title: Surgical case report of uterine leiomyosarcoma metastasising to the pancreas resected by enucleation Authors: Zammit, Daniela; Cini, Charles; Cutajar, Jonathan Abstract: A 64-year old lady presented with worsening abdominal pain, vomiting and constipation. She had diffuse abdominal tenderness with peritonism, requiring an emergency laparotomy as a result of a perforated sigmoid tumour. An incidental hard lump was identified on the anterior surface of the pancreas and was removed by enucleation. It was later diagnosed as metastatic leiomyosarcoma based on histology and from her history of uterine malignancy. No recurrence is reported up to this day. Uterine leiomyosarcomas are aggressive malignant tumours with a high predisposition to metastasis, commonly to the lungs, liver, brain and bone. Metastasis to the pancreas is a rare occurrence and considered highly unusual, which can typically present with non-specific symptoms and signs. Imaging can pick up a pancreatic lesion and a radiologically-guided FNA as a pre-operative attempt is acceptable in order to differentiate the lesion before undertaking any major surgery. However, in view of only a few case reports found in the literature, surgical management of pancreatic metastases is not clearly defined with a questionable long-term prognosis. Most cases are managed by elective radical excision with good result. Review of the literature shows other more radical surgical approaches were used. This is the first report of metastatic uterine leiomyosarcoma to the pancreas being managed by enucleation, with a successful follow-up and no recurrence.

2017-01-01T00:00:00Z