/library/oar/handle/123456789/458 2025-11-14T08:16:45Z /library/oar/handle/123456789/508 Title: The persona and deaths of Six 16th century Grand Masters of the Order of St. John Authors: Bonello, Giovanni Abstract: In a previous issue of this Journal, I focused on the personal and psychological traits of four sixteenth century Grand Masters of Malta, perhaps the most popular, or, anyway, the better known. I believe it would be equally rewarding to investigate the physical and mental set-up and health of the other six, who may have left a more indistinct impact on the course of Maltese history, but are nonetheless net contributors to the formation of our nationhood. 2004-01-01T00:00:00Z /library/oar/handle/123456789/507 Title: A smile a day keeps the lawyers away! : the importance of effective communication in preventing litigation Authors: Hegan, Timothy J. Abstract: Effective communication is the cornerstone of the doctor/patient relationship. The British Medical Association, in its discussion paper on communication skills education for doctors , highlighted four key benefits of effective communication: • improve the doctor-patient relationship by helping the doctor seek the relevant information and recognise the problems of the patient • help the patient to understand and comply with treatment instructions, thereby improving patient satisfaction • improve patient health - better communication and dialogue between doctor and patient has a beneficial effect in terms of promoting better emotional health, resolution of symptoms and pain control • improve the overall quality of care by ensuring that patients’ views and wishes are taken into account. However, in the blame and claim world in which we live it is also essential to help prevent litigation. 2004-01-01T00:00:00Z /library/oar/handle/123456789/506 Title: Remission during pregnancy of severe Chronic Hypertension due to 11-ß Hydroxylase Deficiency Authors: Attard, Gerhardt; Cachia, Mario J. Abstract: When hypertension is a result of an underlying identifiable abnormality, the latter's early discovery can lead to a timely cure of the hypertension and the prevention of its complications. We present a case of high blood pressure lowered by pregnancy, suggestive of an endocrine cause. This was confirmed following a detailed history which revealed severe hypertension intractable to therapy, yet which remitted during pregnancy. A diagnosis of 11-beta hydroxylase deficiency was made consequent upon the finding of raised serum 11-desoxycorticosterone levels. The blood pressure was finally controlled with glucocorticoid replacement therapy and spironolactone. 2004-01-01T00:00:00Z /library/oar/handle/123456789/505 Title: Extensive Pulmonary Embolism in late pregnancy associated with Anticardiolipin Antibodies Authors: Galea, David P.; Formosa, Mark; Brincat, Mark P.; Buhagiar, Louis; Samuel, Anthony; Kunovski, Goce Abstract: The leading cause of morbidity and mortality during pregnancy and the puerperium is venous thromboembolism. Though uncommon, the risk is five times higher in a pregnant woman than in a non-pregnant woman of similar age.1,2 In pregnancy, all three underlying factors for venous thrombosis are present: hypercoagulability, venous stasis and vascular damage (Virchow's triad). Of these, the most constant predisposing factor is increasing venous stasis due to the pressure of the gravid uterus on the pelvic vasculature. In addition the presence of a thrombophilia, (congenital or acquired) will increase this risk substantially. During pregnancy hypercoagulability is a physiological preparation for the haemostatic challenge of delivery. There are increases in procoagulant factors, such as von Willebrand factor, factor VIII, factor V, and fibrinogen together with an acquired resistance to activated protein C and a reduction in protein S. Increases in plasminogen activator inhibitors impair fibrinolysis. The third factor of this triad, vascular damage, is a possible complication of trophoblastic invasion of the uterine spiral arterioles or of delivery. 2004-01-01T00:00:00Z