HealthFest is one of the Malta Medical Students Association’s (MMSA) biggest annual events. Its aim is to celebrate our health with the general public and promote and overall healthy lifestyle.
The theme of this year’s HealthFest is: „Health; Our Greatest Wealth“. This year’s event starts off on the 18th and 20th of March at the University of Malta, where students are encouraged to participate in interactive competitions involving physical activity, where they could have the chance to win great prizes. They may also take part in leisurely activities from which all proceeds will go to Puttinu Cares. Also, students can have their blood pressure, blood glucose and BMI measured, and also have the opportunity to become organ donors.
On the 19th of March, being a Public Holiday, a competition is going to be organized in the limits of Rabat, Dingli and Buskett, where students team up to take part in a walk in the Maltese countryside, with health-oriented challenges along the way. This serves as a fun way to spend a day off outdoors and empowering their knowledge about public health issues.
HealthFest reaches its peak on the final day, on Saturday the 21st of March, where the celebrations are moved to the De Valette Square in Valletta, to target the general public. Apart from our usual free blood glucose, blood pressure and BMI testing, the public also has the opportunity to get to know more about our various health campaigns, held all year round. OS4U, a supplier of healthy food products will also be present to promote their products to the public, especially targeted to those with specific food requirements. An interactive Taekwondo demonstration will also take place to promote the sport and encourage people to enrol and promote physical activity. A children’s area will also be present for children to learn more about their health.
Between the 16th and 21st of March, a „Healthy Lifestyles Conference is also taking place. The conference involves daily 2-hour sessions (excluding the 19th of March), where participants get to know more about different health issues, the governments‘ position on these issues and debate together what can be done regarding these issues. A policy paper will then be drafted from the outcome of these sessions, which will be presented on the final day of the conference.
The topics will be as follows:
16th March - Alcohol and Substance Abuse
17th March - Smoking ·
18th March - Youth Pregnancies ·
20th March - Mental Health and the Youth ·
21st March - Life is Worth Living – A Youth’s Perspective to a Healthy Life.
The sessions between the 16th and 20th of March will take place at the University of Malta Campus, while the last session will take place at the De Valette Square. Apart from presenting a policy paper, the MMSA is also presenting another project which has been initiated this term.
The Malta Medical Students' Association is closely observing developments in the discussion on the proposed changes in the legal age of consent for sexual activities in Malta.
As the leading body representing all the medical students studying in our island, the MMSA recognises the social changes which the Maltese community is going through. This recognition is further strengthened by our continuous contact with patients and with the medical profession.
MMSA External Meeting with Dr. Chris Fearne to voice medical students' concerns about the building of the Barts Medical School in Gozo – 19th November 2014Written by Super User
Gabriel J. Ellul
Epilepsy is a neurological condition characterized by a continuing predisposition to generate epileptic seizures; it may be diagnosed after at least two unprovoked seizures (not caused by a known medical condition such as very low blood sugar) occurring more than 24 hours apart or after one unprovoked seizure if a person has a condition that places him/her at risk of having further seizures.
By Amy Chircop,
Reviewer: Dr. Justine Farrugia Preca
First described by Sato et al. in 1990 in Japan, Takotsubo Cardiomyopathy (TCM) is a cardiac phenomenon where the patient presents with features of acute coronary syndrome in the absence of obstructive coronary artery disease1.
Although not frequently encountered, TCM may be responsible for up to1-2% of admission for acute coronary syndromes in industrialised countries2. Patients present mainly with abrupt onset of chest pain and dyspnoea, and are admitted to hospital where a workup for acute coronary syndrome is usually started. In the majority of patients with TCM, initial investigations point towards an ischemic event, with characteristic ECG changes such as ST segment elevation and T wave inversion, further supported with increased cardiac biomarkers: Troponin T and Troponin I3. However, on echocardiography, there is characteristic hypokinesia or akinesia of mid-segment and apex of the left ventricle extending beyond the distribution of any single coronary artery (See Fig 1). This is confirmed by a coronary angiography which shows intact coronary arteries and characteristic apical ballooning, and a left ventriculography which shows characteristic wall motion and reduced ejection fraction4. Guidelines have been developed by Kawai et al. which give 4 diagnostic criteria which the patient must meet in order to be diagnosed with TCM5. These include:
- Transient hypokinesia, dyskinesia, or akinesia of the left ventricular mid-segments, with or without apical involvement; the regional wall-motion abnormalities extend beyond a single epicardial vascular distribution, and a stressful trigger is often, but not always, present
- Absence of obstructive coronary disease or angiographic evidence of acute plaque rupture
- New electrocardiographic abnormalities (either ST-segment elevation and/or T-wave inversion) or modest elevation in cardiac troponin level
- Absence of pheochromocytoma or myocarditis
The aetiology of TCM has been linked to multivessel coronary artery spasm, impaired cardiac microvascular function, impaired myocardial fatty acid metabolism, acute coronary syndrome with reperfusion injury, and endogenous catecholamine-induced myocardial stunning and microinfarction6. The vast majority of cases have been reported to occur after a severely stressful or emotional event or else with other physical stressors such as trauma, surgery, severe hypoglycemia or asthma; events which result in a high surge of adrenaline release. In fact, studies have shown that patients diagnosed with TCM have a higher level of cathecholamines than patients with myocardial infarction7. The apex of the left ventricle has the highest portion of sympathetic innervation hence this might explain why this phenomenon predominantly affects this region of the heart8.
The greater number of patients diagnosed with TCM are post-menopausal women, and interestingly a study by Pilgrim et al. done in 2008 found that patients with TCM have a lower incidence of cardiac risk factors such as hypertension, hyperlipidemia and diabetes4. TCM is a transient condition and left ventricular function is regained within 7 to 37 days. Initial management should be that for acute coronary syndrome due to the identical presentation and due to the fact that initial investigations are unable to differentiate between the two9. If the patient is haemodynamically unstable, then intra-aortic balloon pump counterpulsation is recommended. There are no current randomized control trials about the chronic management of TCM, however treatment with beta-blockers appears beneficial by preventing excessive sympathetic activation10.
1. Satoh H, Tateishi H, Uchida T, Dote K, Ishihara M. Takotsubo-type cardiomyopathy due to multivessel spasm. Clinical Aspect of Myocardial Injury: From Ischemia to Heart Failure. Tokyo: Kagakuhyouronsya Co., 1990: 56-64.
2. Banning AP. Takotsubo Cardiomyopathy. BMJ 2010; 340:1272
3. Jain SKA, Larsen TR, Sougiyyeh A, David SW. Takotsubo cardiomyopathy: reversible stress-induced cardiac insult- a stress protective mechanism. Am J Cardiovasc Dis. 2013; 3(1):53-59.
4. Pilgrim TM, Wyss TR. Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review. Int J Cardiol. 2008; 124 (3):283-292.
5. Kawai S, Kitabatake A, Tomoike H. Guidelines for diagnosis of takotsubo (ampulla) cardiomyopathy. Circ J. 2007;71(6)990-992
6. Afonso L, Bachour K, Awad K, Sandidge G. Takotsubo Cardiomyopathy: pathogenic insights and myocardial perfusion kinetics using myocardial contrast echocardiography. Eur J Echocardiogr. 2008; 9(6):849-854.
7. Buchholz S, Rudan G. Tako-tsubo syndrome on the rise: a review of the current literature. Postgrad Med J. 2007;83(978):261-264.
8. Dorfman TA, Iskandrian AE. Takotsubo cardiomyopathy: State-of-the-art review. J Nucl Cardiol. 2009;16(1):122-134
9. Kolkebeck TE, Contant CL, Krasuski RA. Takotsubo cardiomyopathy: an unusual syndrome mimicking an ST- elevation myocardial infarction. Am J Emerg Med. 2007;25(1):92-95.
10. Palacek T, Kuchynka P, Linhart A. Treatment of Takotsubo cardiomyopathy. Current Pharm Des. 2010; 16(26):2905-2909.
The Malta Medical Students' Association (MMSA) wishes to express its concern for the news regarding the setting up of a new Barts medical school in Gozo.
The MMSA welcomes the fact that Barts Medical School is known for its excellence in the teaching of medicine and surgery and agrees that it would be an asset to the country's teaching resources.
Shafia Khanum, Dr Azra Pachenari (Middlesex University, London)
by Sarah Craus and reviewed by Dr. D. Sammut
It is a known fact that Malta is one of the countries where obesity is a major problem. With over 60% of its population either overweight or obese, Malta has one of the highest rates of obesity in the world and the problem is escalating. Being overweight and obese are epidemic problemsand worldwide, at all ages, particularly in Westernised societies. The direct, indirect and long term health risks for the individual and population as a whole are indisputable. Unless tackled, the current Maltese obesity trends will result in an astronomical increase in morbidity and mortality from ischaemic heart disease, stroke and cancers. Overweight and obesity account for about 80% of cases of type 2 diabetes, 35% of ischaemic heart disease and 55% of hypertensive disease in Europe. In addition, obesity increases the risk for various cancers (breast, ovaries, colon, prostate), gallstones, impaired fertility, asthma, cataracts and various musculoskeletal disorders. Social stigma is another consequence of obesity and the condition has been linked to bullying, anxiety and depression (Sammut et. al, 2012) Obesity imposes an economic burden on society through increased direct medical costs incurred to treat the diseases associated with it, and indirect costs due to lost productivity because of absenteeism from work and premature death (Grech et al. 2007)
Dr Sammut (a GP who recently carried out an audit about adult obesity) suggests that one can walk to work or park few minutes away from the place of work so that he or she would be exercising daily. Many people use their private cars to go to work or travel even for a short distance. Studies show that people are interested in traveling for short distances by bicycles but they are discouraged by the lack of bicycle lanes present in our roads and the reckless driving. They are also discouraged by the huge amount of traffic on our roads, hence making it unsafe to go by bicycle.
Sammut thinks that the government needs to start aiming slightly below people's bulging waistlines, by laying siege to their pockets. Fast food such as pizza or cheesecakes is cheaper than healthy food and more readily available. Most women are very busy with work and they spend a lot of time outside their homes. This means that they have less time available to buy fresh fruit and vegetables and to cook healthy meals. They also have less time to exercise. Physical education is not offered as a subject in all schools after students leave their secondary school. This further augments the problem of obesity. Advertising by food companies has probably led to the increased consumption of energy-dense foods and drinks. Some even argue that the government should increase the prices of unhealthy food in the same way as it does with tobacco as both smoking and unhealthy food are harmful.
The influence of the mother’s body weight prior to conception and during pregnancy has a key bearing on the weight of the neonate at birth and thereafter. The National Obstetrics Information System reports that between 2007 and 2009, 37% of mothers were obese in early pregnancy and 49% were overweight.
The Malta Food and Nutrition Policy is being revised to take account of the national epidemic of obesity and the current food consumption patterns. The new food and nutrition policy will concentrate on improving the availability, accessibility, and affordability of fruit and vegetables. Fruit and vegetables are being given for free each week to children at school in order to encourage healthy eating and minimize the problem of obesity (School Fruit and Vegetable Scheme).
According to a report by the EU and the World Health Organization, 29.5% of Maltese children aged 11-15 were either overweight or obese, far higher than the EU average. A sedentary lifestyle is one of the major causes of obesity in both adults and children (Graph 1). Most people tend to spend a lot of hours watching TV or on their computer instead of engaging in physical activity. Urbanization has led to a decrease in physical activity.
Graph 1 – Participation in physical activity
(A Healthy Weight for Life: A National Strategy for Malta 2012 – 2020)
In July 2013, the government launched an outreach team about anti-obesity. This team is found at various popular places such as in Valletta and leaflets are distributed in order to stress the importance of exercising, at least half an hour three times a week. This campaign also encourages people to eat a Mediterranean balanced diet based mainly on fruit and vegetables, grains, olive oil, beans, nuts and legumes. Poultry, eggs and meat should not be consumed daily.
There are many ways of tackling the growing problem of an overweight population and it is vital to recognise that any initiatives taken to address this issue are important investments in the future. By improving the lifestyles of children in Malta we are likewise improving the health of the adults that these children will one day grow into. An overall healthier population will alleviate much of the unnecessary burden on European healthcare systems. For this to be achieved, however, cooperation is needed – not only across member states, but also between policy-makers and citizens themselves (Casa, 2012)
‘Tax fast foods, says doctor about Malta’s obesity problem.’ (February 2013) Jacob Borg www.maltatoday.com
‘Childhood obesity: a critical Maltese health issue’ (2007), Journal of the Malta College of Pharmacy Practice, Issue 12. Victor Grech
‘Audit of the diagnosis and management of adult obesity in a Maltese general practice’, 2012
Daniel Sammut, David Sammut, Jason Bonnici. Malta Medical Journal Volume 24 Issue 01
‘Comparison of body mass index of a national cohort of Maltese children over a 3-year interval’ (2011). Victoria Farrugia Sant’Angelo, Victor Grech. Malta Medical Journal Volume 23 Issue 01
A Healthy Weight for Life: A National Strategy for Malta 2012 – 2020
Solving problems associated with rising obesity (2012), David Casa http://www.independent.com.mt/mobile/2012-12-01/opinions/solving-problems-associated-with-rising-obesity-462422022/
by Sarah Craus
APH complicates 3–5% of pregnancies. It is bleeding from or into the genital tract, occurring from 24+0 weeks of pregnancy and prior to the delivery of the baby. APH can lead to both fetal and maternal morbidity and mortality1 such as hypoxia, intrauterine growth retardation, infection, anaemia and post-partum haemorrhage1.
Causes of APH include placenta praevia and placental abruption (Figure 1a and b respectively2).
Risk factors include a previous pregnancy complicated by abruption or placenta praevia, multiparity, low BMI, advanced maternal age, pre-eclampsia, fetal malpresentation and smoking.
History and examination are vital when a woman presents with APH3. If there is a suspicion of placenta praevia, a vaginal examination should not be carried out as this leads to catastrophic bleeding. Ultrasound can be used to confirm the presence of a placenta praevia and then the mother should be kept in hospital until delivery, which is normally via caesarean section at 37 weeks.
If the mother is between 24+0 and 34 +6 weeks of gestation, dexamethasone should be given as the fetus’s lungs are not yet well developed. Tocolysis should not be used if the mother is hemodynamically unstable, has suffered major APH or there is evidence of fetal compromise4. The fetus should be monitored using a CTG to detect any signs of fetal distress.
In the acute setting, maternal blood should be taken for a complete blood count and coagulation screen, as well as to obtain a cross match. Oxygen should be given at 15L/minute via a mask with reservoir. Mother can be transfused with O negative blood if blood loss was significant (Figure 2).
Figure 2: Management of APH5
1. Calleja-Agius J, Custo R, Brincat MP, Calleja N. Placental abruption and placenta praevia. Eur Clin Obstet Gynaecol 2006; 2:121–7
2. Bleeding in Pregnancy/Placenta Previa/ Placental Abruption [http://www.stanfordchildrens.org/]
3. Royal College of Obstetricians and Gynaecologists. Placenta Praevia, Placenta Praevia Accreta and Vasa Praevia: Diagnosis and Management. Green-top Guideline No. 27. London: RCOG; 2011
4. Royal College of Obstetricians and Gynaecologists. Tocolytic Drugs for Women in Preterm Labour. Green-top Guideline No. 1b. London: RCOG; 2011
5. Late Pregnancy Bleeding ELLEN SAKORNBUT, M.D., Family Health Center of Waterloo, Waterloo, Iowa, LAWRENCE LEEMAN, M.D., M.P.H., University of New Mexico, Albuquerque, New Mexico PATRICIA FONTAINE, M.D., M.S., University of Minnesota, Minneapolis, Minnesota. Am Fam Physician. 2007 Apr 15;75 (8):1199-1206.
by Rebecca Stoner, on behalf of the Malta Medical Students' Association
The Malta Medical Students' Association (MMSA) welcomes the news that work is being done to increase the number of posts being offered in the Maltese Foundation Programme.