https://www.um.edu.mt/library/oar/handle/123456789/135751 2026-04-09T10:03:43Z 2026-04-09T10:03:43Z https://www.um.edu.mt/library/oar/handle/123456789/135961 2025-05-30T10:05:53Z 2025-01-01T00:00:00Z

Title: Against the dying of the light : medicine’s quiet resistance Abstract: The world groans under the weight of war. From the ruins of Gaza to the shelled hospitals of Ukraine, from the famine-stricken clinics of Yemen to the tense standoff over the South China Sea, the twenty-first century, far from fulfilling its promise of peace and progress, has revealed a darker truth. This is the century wherein precision-guided missiles fly faster than ambulances, where cities crumble while laboratories strive to build miracles of healing, and where the medical oath to preserve life is tested by the organised machinery of death. The juxtaposition is grotesque: as one hand reaches for the scalpel, the other reaches for the trigger. And in the middle of this violence we, the medical profession, must not take sides, but remain steadfast, and stubbornly humane.

2025-01-01T00:00:00Z Mizzi, Maria Mifsud, Simon https://www.um.edu.mt/library/oar/handle/123456789/135959 2025-05-30T09:48:13Z 2025-01-01T00:00:00Z

Title: Insulin : the modern era Authors: Mizzi, Maria; Mifsud, Simon Abstract: Insulin – a naturally occurring hormone produced by beta cells in the pancreas, has been successfully isolated and purified in the year 1921 by the scientists Banting and Best in Toronto. Since then, more than 100 years later, different formulations and delivery methods have been developed. Type 1 diabetes depends on insulin for survival and reduced morbidity. Therefore, it came naturally with time to research newer technologies that mimic as much as possible the job of the pancreatic beta cells to provide insulin. This led to the development of the first model of continuous subcutaneous insulin infusion in the 1970s. Several advantages have been linked to the insulin pump as opposed to multiple daily insulin injections. Literature mentions better glycaemic outcomes with increased time in range and reduced hypoglycaemic episodes with insulin pumps. Other benefits vary from practical and psychological benefits with regards to the changing mentality towards living with type 1 diabetes, to long-term benefits involving the reduction of micro- and macrovascular complications. Studies are still being conducted to determine whether type 2 diabetic patients could also benefit from such insulin pumps.

2025-01-01T00:00:00Z Suteja, Richard Christian Purnamasidhi, Cokorda Agung Wahyu Utama, I Made Susila Somia, I Ketut Agus Merati, Ketut Tuti Parwati https://www.um.edu.mt/library/oar/handle/123456789/135958 2025-05-30T09:43:33Z 2025-01-01T00:00:00Z

Title: Basic respiratory physiology in the use of ECMO in critically-ill COVID-19 patients Authors: Suteja, Richard Christian; Purnamasidhi, Cokorda Agung Wahyu; Utama, I Made Susila; Somia, I Ketut Agus; Merati, Ketut Tuti Parwati Abstract: The use of ECMO may help sustain extracorporeal life support in cases where regular less-invasive modalities failed to adequately assist the body in maintaining basic life mechanisms. The authors synthesized information from articles found in trusted search engines using predetermined keywords. Typically, VV-ECMO is used in life-threatening respiratory failure. However, experts must consider relative contraindications, answering the question: ‘Will the patient really benefit from this treatment, or will it only add emotional and economic burden, also exposing the patient to various risks of complications?’. The physiology of oxygenation within the lungs, tissues, and ECMO machine, is a modification of the basic principles of respiratory physiology. In typical VV-ECMO cannula insertion, drainage cannula is inserted via the right femoral vein percutaneously and is guided upwards through inferior vena cava with its tip 10 cm below cavoatrial junction while the reinjection cannula will be inserted through the intrajugular vein. This places the artificial lungs in series with the normal lungs rather than in a parallel form. The artificially-oxygenated blood was then returned and mixed with the native venous blood. It is important to measure maximum drainage flow to prevent shunting of the veins by setting the ECMO to the highest flow. Frequent complications during ECMO initiation due to critical COVID-19 manifestations include co-infection up to sepsis and coagulopathy up to complications following it. Therefore, it is always beneficial to acquire multidisciplinary judgement, particularly with hematologists, intensivists, and infectious disease specialists prior, during, and post-ECMO use.

2025-01-01T00:00:00Z Busuttil, Gerald Goh, Darren Dale, Rebecca Rajan, Prabhakar Briggs, Tum Nathan, Senthil Kelly, John Galbraith, Rex Shaw, Greg https://www.um.edu.mt/library/oar/handle/123456789/135957 2025-05-30T09:36:00Z 2025-01-01T00:00:00Z

Title: A systematic review of the effects of nerve sparing during radical prostatectomy Authors: Busuttil, Gerald; Goh, Darren; Dale, Rebecca; Rajan, Prabhakar; Briggs, Tum; Nathan, Senthil; Kelly, John; Galbraith, Rex; Shaw, Greg Abstract: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement (2009). MEDLINE, EMBASE, The Cochrane Library, Health Technology Assessment Database, and Web of Science were searched from 1966 to December 2015, yielding 60 records. RCTs and other controlled or comparative studies were eligible for inclusion. Studies reporting on at least one of the following outcomes, positive surgical margins, continence and potency with data available for nerve sparing and non-nerve sparing groups were included. 16 studies were available for final analysis and included 16269 participants. Primary outcomes analysed where positive surgical margins and functional outcomes (continence and potency). Comparing nerve sparing with non-nerve sparing prostatectomy, the proportion of cases resulting in incontinence is lower for nerve sparing prostatectomy. The proportions of cases resulting in impotence were 0.92 (Cl: 0.88 – 0.96) for non-nerve sparing operations, 0.43 (Cl: 0.40 – 0.46) for all nerve sparing operations, 0.59 (CI: 0.51 – 0.67) for unilateral and 0.39 (CI: 0.35 – 0.42) for bilateral nerve sparing. With regards to positive margin rates, these are higher for T3 cancers than for T2 cancers, both for operations that used nerve sparing and for those that did not. For T2 cancers there is little or no difference in the proportion of cases resulting in positive margins for operations with and without nerve sparing. For T3 cancers the proportions of cases with positive margins were practically the same for operations with and without nerve sparing .

2025-01-01T00:00:00Z