https://www.um.edu.mt/library/oar/handle/123456789/8206 2026-04-11T14:23:36Z https://www.um.edu.mt/library/oar/handle/123456789/8231 Title: Primary CNS lymphoma with intravitreal metastasis : using vitreous cavity samples to monitor response to therapy Authors: Fenech, Matthew T.; Aquilina, Nicola; Grech Hardie, John; Pirotta, Suzanne T.; Fenech, Thomas; Debono, Patricia Abstract: A fifty-eight year old male patient presented to the ophthalmic department with a 3 day history of reduced visual acuity, blurred vision and floaters, associated with recent lethargy, headaches and behavioural changes. Fundal examination revealed a bilateral vitritis. Steroid therapy was started. MRI of the brain revealed multiple hypodense and hyperdense lesions. Vitrectomy was performed in view of the poor response to steroids. A biopsy showed non-hodgkin B-Cell lymphoma. The patient was started on intravenous Methotrexate and Cytarabine. Repeat vitreous cavity biopsies were performed in order to assess response to therapy. All biopsies to date have revealed evidence of on-going lymphoma. 2015-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/8230 Title: Sudden bilateral loss of vision in a 19-year-old man Authors: Pirotta, Suzanne T.; Sciriha, Gabriella M.; Cauchi, David; Vassallo, James; Fenech, Thomas Abstract: Introduction: Posterior Reversible Leukoencephalopathy Syndrome (PRES) is caused by ischaemia commonly affecting the posterior cerebral vasculature. It presents with sudden decreased vision, headaches, nausea, vomiting, seizures, and altered mental status. Case presentation: A 19-year-old male presented to the ophthalmic emergency complaining of sudden bilateral loss of vision, which was down to light perception He reported headaches, nausea, and drowsiness since the previous day. He was a known case of hypertension secondary to IgA nephropathy. Magnetic resonance imaging (MRI) with STIR and FLAIR sequences showed foci of hyperintensity within the occipital lobes bilaterally. This confirmed the suspected diagnosis of PRES. Discussion: Aetiological factors of PRES include sudden increase in blood pressure, eclampsia, porphyria, renal disease, and Cushing syndrome. These lead to blood-brain barrier injury either by hyper- or hypoperfusion, endothelial dysfunction, changes in blood vessel morphology, hypocapnea, or immune system activation. Histopathological changes in PRES include activated astrocytes, scattered macrophages and lymphocytes, often in the absence of inflammation or neuronal damage. Conclusion: PRES is usually a reversible neuroophthalmological condition, however prompt recognition and appropriate management is important to prevent permanent brain injury or even death. 2015-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/8229 Title: A review of the One Health concept : increasing awareness and collaboration between the Maltese medical and veterinary professionals Authors: Buttigieg, Mauro Abstract: The One World, One Health concept was initiated in 2004 by the Wildlife Conservation Society with the aim of establishing an interdisciplinary and crosssectoral approach to preventing epidemic or epizootic diseases and to maintain ecosystem integrity. This concept has gained importance nowadays due to the increase in emerging and re-emerging diseases most of which are zoonotic in nature. Collaboration between the Maltese medical and veterinary professions is necessary to diagnose and control these diseases. A number of points are made questioning the current state of collaboration between these professions, with the aim of increasing the trust and communication between the said professions thus ensuring the best possible defence against diseases which can be a threat to both the human and animal population on the Maltese islands 2015-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/8228 Title: Hypopituitarism following traumatic brain injury Authors: Attard, Carol; Vella, Sandro Abstract: Traumatic brain injury (TBI) is a worldwide public health problem and an important cause of hypopituitarism. The incidence of hypopituitarism following moderate to severe TBI varies in different studies and may occur as multiple or isolated hormonal deficiencies, with gonadotrophin and growth hormone insufficiencies predominating, particularly in the acute setting. Adrenocorticotropic hormone deficiency is also common during the recovery phase. Pituitary function assessment in the acute phase post TBI is subject to multiple caveats and pitfalls due to hormonal alterations which occur as normal physiological responses to critical illness and the effects of drugs that are used in the intensive care unit. Nonetheless, assessment of the hypothalamo-pituitary-adrenal axis is of paramount importance during this period. Predictors of hypopituitarism during the acute phase of TBI remain unclear - further research is warranted. 2015-01-01T00:00:00Z