A comparison between dual axis rotational coronary angiography and conventional coronary angiography.

Background: Coronary angiography remains the gold standard for the investigation of coronary artery disease, and is carried out in multiple, predefined stationary views, at different angulations around the patient, for both left and right coronary arteries. Dual axis rotational coronary angiography (DARA) is an alternative technique wherein the c-arm rotates around the patient in a preprogrammed single acquisition, exposing the entire coronary artery at different angulations. The DARA system has been recently installed in the Cardiac Catheterisation Suite at Mater Dei Hospital, Malta, where a monoplane and a biplane machine are available.

A time and motion study of patients presenting at the accident and emergency department at Mater Dei Hospital.

Background: To carry out a time and motion study of patients presenting at the Emergency Department (ED) by measuring waiting times at the ED dept throughout the day. The objectives were:• to determine whether waiting times are prolonged, and• if prolonged, at which station(s) bottlenecks occur most often in terms of duration and frequency.Results will be compared to the United Kingdom guidelines of stay at the emergency department.

Factors influencing the future of paediatric private practice in Malta.

In Malta, the health system is hybrid, with similarities to both UK system and the US system, where the National Health Service is supplemented by private practice. This is widely performed either as a primary job or as a supplement to a government salary. This article reviews unfavourable secular trends in Maltese fertility, births, marriages, separations, single parenthood and loans incurred after marriage, and relates them to (equally unfavourable in terms of private practice) escalating numbers of paediatricians working in private practice.

Propranolol, infantile haemangiomas, and serendipity: new use for an old drug.

Capillary haemangiomas are benign lesions that may occur anywhere on the skin, may grow rapidly in the first two years of life and may impair vital organs. Propranolol has been recently discovered to shrink these lesions effectively. We report the first such patient treated in Malta with this drug.

Interim prostacyclin therapy for an isolated disconnected pulmonary artery: a case report.

Introduction: Disconnected pulmonary arteries are unusual and may result in pulmonary hypertension with acute right heart failure.

Case Presentation: We report a case of a three-month-old Asian girl who presented with heart failure and severe pulmonary hypertension due to a disconnected right pulmonary artery. An epoprostenol (prostacyclin) infusion was instrumental in lowering pulmonary artery pressures and stabilizing the child prior to surgery.

Recurrent pneumonia and a normal heart: late complication after repair of hemianomalous pulmonary venous drainage-a cautionary tale.

Hemianomalous pulmonary venous drainage with intact atrial septum is a rare congenital anomaly and reports of its surgical repair and the long-term complications related to the correction are only infrequently encountered in the literature. We report the case of a patient with hemianomalous pulmonary venous drainage and intact atrial septum who underwent surgical repair using a pericardial baffle and creation of an "atrial septal defect" aged 15 years. Dyspnoea and recurrent chest infections started 7 months after surgery when he was seen by a respiratory physician without cardiac followup.

Email spam: a single user's perspective.

Email spam is a global nuisance and financial burden. This paper analyses the current breakdown of email in an active email account, subdividing spam by proportion and type.

Body mass index estimation in a school-entry aged cohort in Malta.

This study measured body mass index (BMI) in a national cohort of school-entry children in Malta (04/2007, n=3461). By International Obesity Task Force criteria, over a quarter are overweight/obese. CDC criteria classify one-third as overweight/obese.

Antenatal psychiatric morbidity in Maltese women.

Objective: There has been no empirical research on the occurrence of antenatal psychiatric morbidity in Maltese women. Epidemiological studies have shown that depressive episodes occur in 10-20% of pregnant women. Furthermore, studies have shown that antenatal psychiatric morbidity can adversely affect maternal and foetal well being.

Preseptostomy myocardial infarction in a patient with complex transposition of the great arteries.

In transposition of the great arteries, systemic venous return is preferentially routed to the aorta, and any spontaneous or iatrogenic emboli may therefore cause organ infarction. We present a patient with transposition of the great arteries who developed myocardial infarction prior to balloon septostomy and, also, was later documented to have sustained brain infarction despite adequate precautionary measures. Minimal handling of venous sites in these patients is crucial.

Stenosis of the upper body arteries in association with coarctation and interrupted aortic arch.

Coarctation of the aorta and interrupted aortic arch are not usually associated with stenosis of the innominate, common carotid, or subclavian arteries. We report two patients with stenoses of combinations of these arteries, one in association with coarctation (stented later in life) and the other in association with interrupted arch (arterial stenoses surgically repaired at the time of surgery for the arch proper). Both have done well.

Isolated obstruction of the right ventricular infundibulum in a patient with Williams' syndrome.

Williams' syndrome is a rare condition that is associated with severe cardiovascular manifestations. We report a patient with Williams' syndrome who also has isolated obstruction of the right ventricular infundibulum, an association that, to the best of our knowledge, has not been previously reported.

Risk factors for QRS prolongation after repaired tetralogy of Fallot.

Introduction: Repaired tetralogy of Fallot is usually conducive to a normal and unrestricted lifestyle. However, occasionally, late sudden death occurs due to ventricular tachycardia. This is thought to be due to a combination of factors, including both left and right ventricular dilation, which may be associated with valvular incompetence and residual right ventricular outflow tract obstruction.

Assessment of use of spacer devices for inhaled drug delivery to asthmatic children.

In the treatment of bronchial asthma, inhaled therapy with both bronchodilators and corticosteroids represents the basis for acute and long-term management. Drug therapy in asthma is predominantly by pressurized metered dose inhalers. The impact of treatment on the disease morbidity and mortality depends to a large extent on appropriate delivery of drug to the lungs by means of a spacer device.

Prevalence rates and psychosocial characteristics associated with depression in pregnancy and postpartum in Maltese women.

Background: Investigators have commented on the apparent high prevalence of psychiatric symptoms in pregnancy. In Malta there is lack of epidemiological data and therefore, the prevalence of depression during pregnancy and at 8 weeks postpartum among a community sample of Maltese women was carried out.

Method: A random sample of 239 pregnant women were interviewed at booking using a detailed sociodemographic history, the revised version of the clinical interview schedule (CIS-R) and Maltese translation of the Edinburgh postnatal depression scale (EPDS).

Increasing age at diagnosis of celiac disease in Malta.

Objective: Recent studies have shown that celiac disease is being diagnosed at a progressively later age. This paper analyses trends in age at diagnosis in a closed island population.

Methods: Patient case notes of all known patients with celiac disease were retrieved and demographic information, mode of presentation including symptomatology and diagnostic criteria were obtained.

Late concomitant repair of tetralogy of Fallot and aortic valve replacement following successful pregnancy.

The importance of patient follow-up after repair of tetralogy of Fallot, with special attention to the development of arrhythmias, has been widely studied. It is only recently that postoperative problems relating to the aortic root of these individuals have been looked into. The present case report refers to a patient with tetralogy of Fallot who underwent complete correction, together with aortic valve replacement at 33 years of age following a successful pregnancy.

The prevalence of coeliac disease in Down's syndrome in Malta.

The prevalence of coeliac disease is increased in individuals with Down's syndrome. The objective of this study was to assess the frequency of coeliac disease in Down's syndrome in Malta. One hundred children and adults with Down's were screened for coeliac disease.

Type 2 cryoglobulinemia treated with plasmapheresis associated with IgA nephropathy.

Cryoglobulinemia is caused by antibodies which precipitate in blood on exposure to cold, and redissolve on warming. The authors present a child with essential, Type 2 cryoglobulinaemia, successfully treated with plasmapheresis, who developed glomerulonephritis due to IgA nephropathy. Conservative treatment resulted in spontaneous improvement with no deterioration in renal function.

Complex congenital cardiac disease in a patient with partial trisomy for the long arms of chromosomes 11 and 22.

Abnormalities of chromosomes 11 and 22 are associated with congenital cardiac disease and/or various syndromes. We present a patient with partial trisomy for the long arms of chromosomes 11 and 22, the result of a maternal balanced reciprocal translocation between these two chromosomes. Our patient was dysmorphic and had coarctation of the aorta, an atrioventricular septal defect with common atrioventricular junction and exclusively atrial shunting, patency of the arterial duct, supracardiac totally anomalous pulmonary venous connection, a single kidney, and tracheobronchomalacia.

Country-wide availability of paediatric medical protocols via the local hospital intranet site.

In paediatrics, a wide variety of procedures and interventions (protocols) are standardized. The entire hard-copy collection of paediatric protocols used in Malta (47 to date) was put together as a website, and is hosted on the hospital intranet. Some protocols consist of Excel spreadsheets that are used for the calculation of fluids and drugs.