https://www.um.edu.mt/library/oar/handle/123456789/144521 2026-05-05T21:07:40Z https://www.um.edu.mt/library/oar/handle/123456789/146148 Title: Assessing adherence to pre-operative spirometry testing guidelines among medical doctors in Malta Authors: Bartolo, Kieran; Debono, Claudia; Gauci, Jonathan; Bartolo, Kyra; Micallef, Josef Abstract: BACKGROUND: Pulmonary complications arising from surgical procedures are frequently encountered in the clinical setting, resulting in high levels of patient morbidity and mortality. It is important to assess the risk of developing these complications during the pre-operative assessment. Spirometry is a simple and non-invasive means of evaluating pulmonary function, yet it should not be utilised unnecessarily.; AIMS: To assess whether pre-operative spirometry requests at Mater Dei Hospital, Malta are indicated.; METHODS: A retrospective analysis of all pre-operative spirometry requests and tests during September 2022 at the Pulmonary Function Lab at Mater Dei Hospital was performed. Patient characteristics were noted from the pre-operative assessment note. The local guideline entitled ‘pre-operative generic investigations for adult elective surgery’ was used as the gold standard to determine whether the spirometry request was indicated.; RESULTS: A total of 156 patients had pre-operative spirometry performed in September 2022. Pre-operative spirometry testing was not indicated in 63.5% (n= 99). Patients in whom spirometry was indicated, 54.3% (n=31) had an American Society of Anaesthesiologists (ASA) classification of 3 or above, 29.8% (n=17) were unable to climb two flights of stairs, and 15.8% (n=9) had both indications.; CONCLUSION: Routine ordering of spirometry is discouraged in the pre-operative period. Instead, pre-operative spirometry should be requested if the patient is classified as an ASA of 3 or above, or if they cannot manage to climb two flights of stairs. Taking a careful approach to choosing which patients undergo pre-operative spirometry could result in reduced costs and shorter waiting times. 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/146147 Title: Treating severe Ig-E mediated allergic adult asthmatics with Omalizumab outside the dosing table Authors: Ceci Bonello, Etienne; Gouder, Caroline Abstract: INTRODUCTION: According to the summary of product characteristics of omalizumab, patients whose weight and/or total IgE falls outside the dosing table are not eligible to receive omalizumab. In view of the absence of alternative biological agents for asthma in Malta at time of data collection, it was decided that such patients would receive the maximum recommended dose of 600mg every 2 weeks.; METHODS: The aim of this study was to assess the safety, efficacy and tolerability of adult patients receiving omalizumab for asthma who did not fall within the dosing table and compare these factors to patients within the dosing table. All adult patients receiving omalizumab for more than one year were recruited. Data collection included demographic data, baseline weight, IgE levels, side-effects reported, number of exacerbations, hospitalizations and corticosteroids needed.; RESULTS: Our cohort included 71 patients (mean age 48.8 ± 13.3, 45% males). When comparing patients who received omalizumab according to the recommended dosing chart (n=56) versus those who did not (n=15), there was no statistical significance for treatment discontinuation (p=0.79). Mean baseline IgE was higher in the outside of dosing category (p=0.001). Mean total number of exacerbations since treatment initiation was significantly less for the outside of dosing category (p=0.01) as was the mean total number of systemic corticosteroid courses (p=0.02). There was no statistical significance in hospitalization rate (p=0.09).; CONCLUSIONS: Our results reaffirm our decision to treat severe IgE-mediated asthmatic patients with an IgE level and/or weight outside the dosing chart with the maximum recommended dose with good clinical outcomes and good safety and tolerability profiles. 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/146146 Title: Recurrence rate and prognostic factors in laparoscopically resected colorectal malignancies Authors: Mohamed, Khairun Nisa’; Zahari, Zalina; Hashim, Mohd Nizam Md; Zain, Wan Zainira Wan; Abd. Aziz, Syed Hassan Syed; Zakaria, Zaidi; Wong, Michael Pak-Kai; Zakaria, Andee Dzulkarnaen Abstract: BACKGROUND: There are limited data on the 2-year recurrence rate and prognostic factors for recurrence in laparoscopically resected colorectal malignancies. The aim of this study was to determine the 2-year recurrence rate and prognostic factors for recurrence of colorectal carcinoma in patients who underwent elective laparoscopic colectomy.; METHODS: Data from patients with colorectal carcinoma who had undergone elective laparoscopic colectomy in HPUSM were retrospectively reviewed. All patients who had a follow-up of at least 24 months and traceable records were included in the study, whereas patients with concurrent pathologies were excluded. Patients' clinicopathologic data and follow-up data for 2 years after surgery were examined. Cox proportional hazard regression was used to determine the possible prognostic factors for colorectal cancer recurrence.; RESULTS: Of 40 patients, five patients had recurrence within 2 years after surgery, representing a recurrence rate of 12.5%. The average time to recurrence was 21.2 months, with the earliest recurrence occurring on the 15th day after surgery. Postoperative serum level of carcinoembryonic antigen (CEA) was the prognostic factor for colorectal cancer recurrence [hazard ratio (HR): 1.05, 95% CI: 1.00, 1.10, p = 0.04].; CONCLUSION: The results of our study showed that the 2-year recurrence rate in this study setting was 12.5%. The significant prognostic factor for recurrence of colorectal cancer in patients who underwent elective laparoscopic colectomy was postoperative CEA levels. 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/146141 Title: Identification of fetal intrauterine growth restriction in pregnancy-induced hypertension women in Saudi Arabia Authors: Salma, Umme; Sheikh, Sayed Ali; Elshamy, Reem maged Abstract: INTRODUCTION: There is evidence that intrauterine growth restriction (IUGR) has negative effects on pregnancy. Placental dysfunction, which limits fetal growth, is intimately related to pregnancy-induced hypertension. This study aims to identify the IUGR in women with pregnancy-induced hypertension.; METHODS: This cross-sectional study, which was done at the Obstetric Department of the Maternity and Children Hospital (MCH) Sakaka, Aljouf, Saudi Arabia, between January 2021 and January 2022, included 162 women with pregnancy-induced hypertension (PIH). Whether nulliparous or multiparous, all of the PIH women were between the ages of 16 and 45. We observed IUGR and outcomes in accordance with the criteria listed in the operational definition. Clinical examinations, patient data files, and ultrasound reports were used to collect the data.; RESULTS: Of these, 105 (64.8%) had fetal detected intrauterine growth restriction, which included low Apgar scores of 19.3%, abortions at 11.4%, low birth weights at 19.3%, preterm births at 20%, and stillbirths at 13.3%. According to our findings, the mean SD values for the population as a whole were 38.95±8.92, 33.73±6.92, 3.00±2.0, 4.91±1.52, 1811±3.32 and 4.21±1.21 for the maternal age, gestational age, duration of disease (weeks), baby weight (grams), and Apgar score, respectively. The relationship of stillbirth in PIH women to maternal age, gestational age, and parity is 89. %, 88.8%,86.6%,72.7% and84.2%,88% and87.6%,85% at considered (p = 0.00), (p = 0.05) and (p=0.00), respectively.; CONCLUSION: The frequency of intrauterine growth restriction (IUGR) in patients with PIH was found to be 64.8%. IUGR is frequently a complication of hypertensive disorders during pregnancy. 2026-01-01T00:00:00Z