/library/oar/handle/123456789/29041 Sat, 27 Dec 2025 15:48:58 GMT 2025-12-27T15:48:58Z /library/oar/handle/123456789/37521 Title: Gastroscopic pancreatic necrosectomy : reporting the first two cases performed at Mater Dei Hospital Abstract: Background: Severe acute pancreatitis is associated with significant pancreatic and peri-pancreatic necrosis. Infection of this necrotic tissue is associated with a mortality in the region of 30%. Infected pancreatic necrosis was conventionally treated with open surgical techniques, but this approach was associated with a very high morbidity and mortality. Over the past two decades minimally invasive techniques have proved to be both effective and safe. Methods: A 54-year-old male presented with biliary severe acute pancreatitis. He was admitted to the ITU on the second day post-admission where he required ventilatory support, dialysis and parenteral nutrition. Regular pancreatic CT’s showed evolving walled-off pancreatic necrosis. The patient’s septic markers indices deteriorated requiring intervention for infected necrosis. A cyst-gastrostomy was fashioned, which was then dilated with a CRE oesophageal balloon. The necrosis was then debrided, washed out, and three pig-tail stents left in-situ. During week 8, the patient required endoscopic retrograde cholangio-pancreatography and bile duct stenting as he developed jaundice and worsening septic markers. A final necrosectomy was performed during week 10. Following this, he was discharged home and an elective laparoscopic cholecystectomy was organised. Results: Aggressive ITU care was required to help this patient with severe acute pancreatitis to survive. Three sessions were required to achieve resolution after the walled-off pancreatic necrosis was judged mature. As opposed to percutaneous, laparoscopic or retroperitoneoscopic techniques, this approach obviates the development of pancreatic fistula and the need for cumbersome constant irrigation. Conclusion: Pancreatic necrosectomy can be performed safely and effectively with readily available ERCP and gastroscopic equipment, with the help of EUS localisation. This procedure should be considered as treatment of choice for patients developing walled-off pancreatic necrosis. Mon, 01 Oct 2018 00:00:00 GMT /library/oar/handle/123456789/37521 2018-10-01T00:00:00Z /library/oar/handle/123456789/37520 Title: Decisional impulsivity in obesity Authors: Falzon Aquilina, Francesca; Grech, Anton; Strelchuk, Daniela; Donamayor, Nuria; Agius, Mark; Voon, Valerie Abstract: Introduction: Elevations in impulsivity have been clearly shown in various psychiatric conditions, especially in those of addiction. Evidence does suggest some overlap between the pathological use of food and drugs but no clear evidence to date has been made available with regards to obesity. In this study we hypothesize that obese subjects would have relatively more impulsive profiles when compared to healthy volunteers. Method: Delayed discounting is also studied by means of the Monetary Choice Questionnaire, also hypothesizing impairments in this subtype of impulsivity. Results: Obese subjects sought less evidence prior to making a decision when compared to healthy controls. Greater delayed discounting was also evident in this cohort of subjects as compared to healthy ones. Premature responding was not shown to occur in the obese subjects. Conclusion: Obesity is therefore characterized by impaired reflection impulsivity and greater delayed discounting. Both suggest a deficit in deciding on the basis of future outcomes that are more difficult to represent. This evidence could suggest possible therapeutic domains which need targeted interventions on the aspects of decision making deficits. Mon, 01 Oct 2018 00:00:00 GMT /library/oar/handle/123456789/37520 2018-10-01T00:00:00Z /library/oar/handle/123456789/37450 Title: Insulin prescription and administration and blood glucose monitoring at Mater Dei Hospital Authors: Cardona Attard, Carol; Agius, Rachel; Psaila, Alison; Fava, Stephen Abstract: Background: Incorrect insulin prescription and administration has been associated with substantial medication-related patient harm and mortality. We aimed to assess whether blood glucose was being monitored according to our local hospital protocol and whether insulin was being prescribed accurately by doctors and administered safely by nurses. Moreover, we evaluated whether education to nurses and doctors resulted in less insulin prescription and administration errors. Methods: Inpatients on insulin in Mater Dei hospital’s medical wards were recruited. Data was collected from patients’ files on errors in insulin prescription and on the timing of blood glucose monitoring and insulin administration in relation to meals. The first audit was carried out in 2013. A re-audit was carried out in 2017 following education to doctors and nurses and a change in the treatment chart format. The z-test was used to compare the two audits. Results: On re-auditing, a significant improvement was noted in the timing of blood glucose monitoring and insulin administration in relation to meals, in the legibility of the insulin doses, ‘Units’ were more written in full and supplementary Actrapid® was more frequently prescribed where indicated. However, inappropriate omission of fixed insulin doses occurred more often, while written instructions by doctors on when to administer fixed insulin, including supplementary Actrapid®, were still lacking. Moreover, there was no improvement in adherence to the supplementary Actrapid® algorithm by nurses. Conclusion: Further education and an improved treatment chart including hypo- and hyperglycaemia trouble-shooting guidelines are required to further reduce insulin prescription and administration errors. Mon, 01 Oct 2018 00:00:00 GMT /library/oar/handle/123456789/37450 2018-10-01T00:00:00Z /library/oar/handle/123456789/37449 Title: Bilateral breast reduction surgery at Mater Dei Hospital : analysis of physical and psychological symptoms using the BREAST-Q Authors: Parnis, Juanita; Aquilina, Duncan; Borg, Matthew; Darmanin, Francis X.; Briffa, Joseph E. Abstract: Introduction: The literature describes the high patient satisfaction rate after breast reduction. In this retrospective study, we use the BREAST-Q to analyse satisfaction with breast appearance and physical, psychosocial and sexual well-being of patients who underwent bilateral breast reduction (BBR) at Mater Dei Hospital (MDH). We also looked into whether age, co-morbidities and weight of breast tissue removed makes a difference to the overall satisfaction rate. Method: Permission to use the BREAST-Q questionnaire and translate it into Maltese was obtained from Mapi Reasearch Trust. The questionnaire was offered either in Maltese or in English, after an official translation was produced following a linguistic validation process. All patients who underwent BBR at MDH under the care of both consultant Plastic Surgeons were invited to complete the BREAST-Q questionnaire via a telephone call and asked to come to MDH to fill it in. Other patient specific information was obtained from their hospital notes. Results: We hope to demonstrate a better quality of life following surgery and aim to compare the results of this study to others carried out worldwide. In this way we can better understand the local situation and see where there is the room for improvement. Conclusion: In this world of evidence-based medicine, the BREAST-Q is ideal for a holistic approach in analysing patient satisfaction after BBR. Having local data at hand makes it easier for patients who are interested in undergoing the surgery to associate themselves with other local individuals. Mon, 01 Oct 2018 00:00:00 GMT /library/oar/handle/123456789/37449 2018-10-01T00:00:00Z