https://www.um.edu.mt/library/oar/handle/123456789/942 2026-04-11T14:21:06Z https://www.um.edu.mt/library/oar/handle/123456789/1032 Title: Who invented vaccination? Authors: Jesty, Robert; Williams, Gareth Abstract: Edward Jenner, whose ‘Inquiry’ (1798)1 was the first published report of vaccination against smallpox, is widely seen as the inventor of vaccination. However, other individuals could lay claim to this title, notably his contemporaries, Benjamin Jesty and John Fewster. Jesty, a Dorset farmer, performed vaccinations in 1774, 22 years before Jenner’s first vaccination in 1796. Fewster, an apothecary-surgeon who knew Jenner personally, is also reported to have performed the procedure several years before Jenner. However, neither Jesty nor Fewster published or publicised their work and both were recognised retrospectively, notably by critics of Jenner. This article compares the contributions of these three putative ‘inventors’ of vaccination. 2011-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/1031 Title: Bisphosphonate-related bilateral atypical femoral fractures : be aware and beware Authors: Depasquale, Ruben; Matthews, Claire; Cassar-Pullicino, Victor N. Abstract: Although bisphosphonates have a well established therapeutic role in the prevention of osteoporosis-related fractures, several reports published over the past 5-6 years suggest a possible causative relationship between long-term use of bisphosphonates and development of ‘atypical’ subtrochanteric and femoral diaphyseal fractures. A high level of clinical suspicion and prompt imaging when these patients present with groin/thigh pain should lead to a timely diagnosis. Appropriate elective management to mitigate against the increased risks of these fractures becoming complete could then be instituted. We present a case of complete bilateral atypical subtrochanteric fractures in a patient on long-term bisphosphonates for osteoporosis. Our objective is to highlight the fracture risk of this patient population; present the current knowledge; and discuss the dilemmas in management of both femora. 2011-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/1030 Title: Oxygen prescription and administration at the Emergency Department and medical wards in Mater Dei Hospital Authors: Asciak, Rachelle; Fenech, Valerie Anne; Gatt, Jurgen; Montefort, Stephen Abstract: Aims: The aim of this study was to audit current practices on oxygen prescription in the Emergency Department (ED), and on accurate oxygen administration in the wards of Mater Dei Hospital. Method: Two hundred and forty eight adult patients attending the ED with diagnoses most likely to require oxygen therapy (mainly cardio-respiratory conditions) were randomly selected during 5 winter weeks. Data were collected on oxygen saturation, arterial blood gases, oxygen administration at the ED, oxygen prescription and its documentation, and oxygen administration in wards. The z-test was used to assess statistical significance of results and Fisher’s exact test was used to determine the effect of oxygen prescription documentation in treatment charts. Results: Oxygen treatment was indicated in 85 of the 248 patients. Of these, documented oxygen administration at the ED was only present in 23.5% (p<0.0001). Formal instructions on oxygen use were documented in 85.9% (p<0.0001), however in 51.8% of these there were incomplete details. Only 7.1% of patients in whom oxygen treatment was prescribed received oxygen therapy in the wards according to instructions (p<0.0001). It was also found that documenting oxygen prescription in treatment charts made no significant difference to the number of patients who actually received oxygen correctly in the ward. Conclusion: This study shows that there is need for better prescription, documentation and administration of oxygen in our hospital. Introduction of simple standardized oxygen charts may ensure that oxygen prescription and monitoring in the ED is carried out properly and that these instructions are then faithfully carried out in our wards. 2011-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/1029 Title: Consumption of antibiotics within ambulatory care in Malta Authors: Zarb, Peter; Borg, Michael Angelo Abstract: Background: Antibiotic use is recognised as the most important driver for the development of antimicrobial resistance in community pathogens. Surveillance is therefore critical for improvement programmes. Methods: Antimicrobial distribution data for the years 2007 to 2009 were collected retrospectively by the National Antibiotic Committee from all licensed wholesale distributors (WSL) in Malta and analysed according the World Health Organization Anatomical Therapeutic Chemical classification (ATC) level 4 criteria. Results: Overall consumption increased from 18.6 defined-daily-doses/1000-inhabitant-days (DID) in 2007 to 22.7 DID in 2008 and reached 24.4 DID in 2009 - an increase of more than 30% over the three years, Penicillins with beta-lactamase inhibitor increased in volume (7.1 to 8.8 DID) but decreased in proportion (38.4% to 36.0%) between 2007 and 2009. On the other hand, second generation cephalosporins increased in both volume and proportion (2.8 to 5.4 DID; 15.0% to 22.0%). The proportion for macrolides remained stable at approximately 16% but the volume of use again increased (2.9 DID to 3.9 DID). Fluoroquinolone proportion decreased from 9.1% to 6.8%, maintaining a stable volume of use in the region of 1.7 DID. Conclusions: Antibiotic consumption in Malta has shown a consistent increasing trend over the past three years, despite a reduction in over-the-counter acquisition. Furthermore, there is evidence of a strong, and possibly unjustified, prescription of wide spectrum antibacterials. This is potentially an important driver for documented resistance in Streptococcus pneumoniae and Escherichia coli and needs to be addressed at a national level. 2011-01-01T00:00:00Z