/library/oar/handle/123456789/37093 2025-12-22T12:03:52Z /library/oar/handle/123456789/21493 Title: Leadership with a small 'l' Abstract: Towards the end of summer our membership was called to select a group of doctors who are to lead the college through new and tough, yet exciting challenges that lay ahead. Looking back at the past six years I served as college secretary I wonder what went well and what could have been done better. One thing that I feel we should have, are doctors with a sense of leadership, even if they would be leaders without grand visions, or leaders who are intrinsically introverts without fabulous oratory skills. 2009-12-01T00:00:00Z /library/oar/handle/123456789/21492 Title: Diabetic dyslipidaemia in Gozo Authors: Gatt, Bryen; Brown, Scott Abstract: Purpose: To determine the frequency with which Type Il Diabetes Mellitus (T2DM) patients managed in a primary care setting in the Gozitan community achieved American Diabetes Association (ADA) treatment goals for lipids and whether this was affected by the degree of glycaemic control. Methods: A cross-sectional study of 215 randomly selected nDM patients treated on a primary care level was conducted. Fasting venous blood samples were collected from all patients and analysed for HbAlc, FBG, TChol, HDL and LDL (Friedewald equation). Patients were subdivided into three groups according to glyceamic control: {HbAlc < 7% (Good); 7-8% (Satisfactory); >8% (Poor)}. Amongst the three glycaemic control groups, differences in mean lipid levels were evaluated by one-way analysis of variance (ANOVA), and differences in ADA lipid target achievement by Chi squared testing. Results: Amongst the three glycaemic control groups, there were Significant differences: in all the mean lipid levels (TChol, p<0.004; Tri, p<O.OOI; HDL, p<0.04; LDL, p<0.004 ) and lipid target achievement for Tchol (p<0.03); Tri (p<O.OOl); HDL (p<0.05). Frequency of ADA target achievements were: HbAlc (33.9%), TChol (58.6%), ill (67.9%), HDL(66%), LDL (40%). Frequency of targets at goal: (none = 9.3%; 1 = 16.7%; 2 = 29.3%; 3 = 21.4%; all 4 = 23.3%). Key Words Type 2 Diabetes Mellitus; Glycaemic control; Diabetic Dyslipidaemia, American Diabetes Association, Primary Care. 24 VOLUME 18 ISSUE 01 DECEMBER 2009 Conclusion: Better glycaemic control is associated with a significantly better lipid profile for each of the lipid components. The magnitude of this association was sufficient to influence achievement of all individual ADA lipid goals except that for LDL. 2009-12-01T00:00:00Z /library/oar/handle/123456789/21490 Title: Caring for the diabetic foot in primary care Authors: Bugeja, Anton Abstract: Non-insulin dependent diabetes mellitus (NlDDM) is a common condition affecting 10% of the world population, a further 1 0-lS% of adults aged over 40 years having pre-diabetes and thus carrying an increased high risk of progression to the condition2 Major complications in NlDDM are mainly of vascular nature, the renal, ophthalmic, and nervous (peripheral and autonomic) complications ariSing mainly secondary to microvascular complications while macrovascular pathology being responsible to cerebrovascular, peripheral vascular and coronary heart pathology. Foot ulcers in diabetics are common and seriousl , and likely to increase in the coming years with increasing incidence of diabetes in the community4. As the diabetic foot syndrome leads to amputations, disability and reduced quality of life5, lower extremity complications in persons with diabetes have become an increasingly Significant public health concern in both the developed and developing world6 Indeed the prevalence of the diabetic foot varies between 9% to lS% according to the population studied,7,8 with an estimated annual incidence lying between 1-4% and a lifetime risk of lS%9,10 Viewed differently the risk oflower limb amputation in a diabetic is SO-lOO times that of the general populationll claiming about SO% of non- traumatic, lower extremity amputations. 12 The Public Health impact of these numbers is significant. While in the U.K. this is estimated to cost the NHS around £12.9 million per annum, 1l in the United States an estimated 4% of patients diagnosed with diabetes account for 46% of annual hospitalisations for foot ulcers.14 Equally of concern is the high mortality of patients with diabetic foot ulcers. Five-year mortality rates in these patients have been reported between 43% and SS%, spiralling up to 74% in patients with lower-extremity amputation. These rates are higher than those for several types of cancer including prostate, breast, colon, and Hodgkin's disease. 15 In patients previously hospitalized with a diabetic foot, mortality is often related to cardiovascular disease. In one study the cause of death was mainly due to acute myocardial ischaemia (24.2%), infection (21.2%) and cerebrovascular accident 00.6%), the prevalence of cardiovascular disease calculated at 70.1 %16 Thus new-onset diabetic foot ulcers should be considered as a marker for significantly increased mortality and should be aggressively managed locally, systemically, and psychologically. 17 Maltese Family Doctor l[-Tabib tal-Familja A number of factors are involved in the development and maintenance of a diabetic foot ulcer. These include polyneuropathy, mechanical overload, peripheral arterial disease and infection. 18 In up to 8S% foot ulcers precede amputations in diabetic patients. 19 Since evolution of the disease is slow, it is possible to implement prevention and control measures,20 but as patient outcomes (such as amputation and death) occur erratically, widespread adoption of auditing this aspect of diabetic care emerges as crucial. Indeed, examination of the feet in a diabetes clinic setting is notoriously known to leave much to be desired but good results may be attained if appropriate measures are taken. Despite treatment up to 15% of ulcers fail to heal within 6 months in established specialised ulcer clinics, hence the importance of prevention. 2009-12-01T00:00:00Z /library/oar/handle/123456789/21489 Title: The pageant of life and other facets Authors: Boffa, Charles J. Abstract: The story of human life dates back from written history through oral tradition to the records of geological, palaeontological and archaeological discoveries. About 22 thousand years ago or earlier, Europe was held in thrall by probing masses of thick ice from the North of Europe to cover most of Great Britain, Northern Germany, Poland, Scandinavia, Switzerland and Russia, etc. Smaller ice-caps crept southwards covering Austria, Northern France and Northern Italy. Stone Age hunters struggled to survive hunting herds of reindeer, mammoth and other animals. Great floods are mentioned in the Bible. Perhaps about 15,000 years ago, or so, the ice sheets began to retreat. Within about 10,000 years ago or so, these had withdrawn roughly from most of Europe. I think that the less vigorous climate could have attracted a lot of migration south to the Mediterranean. I believe that the Mediterranean region owed its flowering and civilization, at least partially to its mild sunny climate. Various valleys in Malta and Gozo, such as Wied iz-Zurrieq, Wied Babu, Wied Incita, Wied il-Kbir, Xlendi etc. are suggestive of large volumes of water passing through for long periods in ancient times. 2009-12-01T00:00:00Z