Mater Dei Hospital (MDH; Maltese: Sptar Mater Dei), also known simply as Mater Dei, is an acute general and teaching hospital in Msida, Malta. It is a public hospital affiliated to the University of Malta, offering hospital services and specialist services.
This update and revision of the international guideline for urticaria was developed in accordance with the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is an initiative of the Global Allergy and Asthma Excellence Network (GA(2)LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), with the participation of 210 delegates from 107 national and international societies, from 59 countries. The consensus conference was held on December 6th, 2024. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, defined by a rapid appearance of wheals, angioedema, or both. The lifetime prevalence of acute urticaria is estimated to be approximately 20%. Chronic urticaria, categorized as either chronic spontaneous urticaria or chronic inducible urticaria, is disabling, impairs quality of life, and affects performance at work and school, however, novel therapies are available. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
Optic neuritis is a rare immune-related adverse event of immune checkpoint inhibitor use and may result in poor visual outcomes. We describe an elderly woman with metastatic malignant melanoma treated with nivolumab, a programmed cell death protein 1 immune checkpoint inhibitor. After 2 months, she developed bilateral painless loss of vision due to optic neuritis. Although there is limited evidence, expert opinion favours early corticosteroid use and/or plasma exchange, as recommended for neuromyelitis optica spectrum disorders. Optic neuritis is increasingly recognised as an immune-related adverse event, likely to occur more frequently with greater use of immune checkpoint inhibitors. Its early recognition is important as prompt treatment can improve outcomes.
INTRODUCTION:Evidence suggests that existing pre-operative fasting guidelines are associated with prolonged fasting times. Prolonged fasting, particularly from clear liquids, has the potential to harm patients through reduced peri-operative wellbeing; impaired glucose metabolism and peri-operative inflammatory response; delayed return of bowel function; and reduced muscle strength. Liberalisation of fasting practices has, therefore, become increasingly common. Such a change in practice dictates the need for updated practice guidance. We aimed to develop recommendations on peri-operative fasting that reflect increasing global awareness of the adverse effects of prolonged fasting. METHODS:Following a systematic literature review, 13 draft recommendations related to peri-operative fasting were developed iteratively. These were modified during a three-round Delphi process by an international, multidisciplinary stakeholder panel, which included: patients; anaesthetists; surgeons; physicians; nurses; and members of relevant international organisations from five continents. RESULTS:Sixty-eight stakeholders participated in the Delphi consensus process. The panel subsequently agreed on eight recommendations. We recommend continuing current practices on pre-operative fasting for solid food and non-clear liquids. We recommend encouraging clear liquids until 2 h before the start of anaesthesia or sedation, unless institutional protocols allow for more liberal liquid intake. We further recommend implementation of institutional protocols that allow more liberal clear liquid intake < 2 h before the start of anaesthesia or sedation. Salivation stimulants can be used until transfer for the procedure. Oral intake should be resumed as soon as clinically feasible. Preprocedural gastric ultrasound performed by a trained provider may be used to guide clinical decisions when additional information is required. DISCUSSION:This international, multidisciplinary consensus statement aims to improve the quality of patient care by minimising periprocedural fasting times, within safe margins. To achieve this, liberalised pre-operative clear liquid intake regimens may be implemented with institutional protocols.
Paediatric athletes are not simply 'mini adults'. Most existing recommendations for cardiac screening in paediatric athletes are primarily based on evidence in adults and are designed for adult athletes. Paediatric-specific recommendations are needed due to the specifics of cardiac physiology, maturation and growth, age-related disease expression, modified diagnostic pathways, training adaptations, and to address relevant ethical considerations. This clinical consensus document from the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC) introduces specific advice for paediatric athletes for the first time, based on expert consensus, and where available, data from paediatric athlete populations. Members of the writing group voted anonymously on key advice statements, with ≥80% agreement required for consensus. All advice in this document applies to paediatric athletes aged <16 years, including those under 12 years of age. This document advises that cardiac screening of paediatric athletes with personal and family medical history, physical examination and 12-lead resting electrocardiogram (ECG) should be performed and should start no later than the age of 12 years. Implementing a screening programme requires ensuring the availability of necessary healthcare resources. One transthoracic echocardiogram may be appropriate to identify high-risk structural cardiac diseases not identifiable on ECG, provided appropriate infrastructure for baseline diagnostic assessments is in place. This document also includes suggested definitions of normal, borderline and abnormal ECG findings in paediatric athletes. Detailed advice is provided for further evaluation if suspicious findings are identified on initial tests. This document highlights that further research is required to optimise screening strategies, accurately assess and quantify the risk of sudden cardiac death and provide evidence-based eligibility recommendations for paediatric athletes with cardiac disease. It is also noted that increased opportunities for paediatric sports cardiology training are required to provide adequate medical care for the paediatric athlete population.
Pediatric cholecystitis and cholelithiasis management is heterogeneous. We surveyed European centers to map current practices, training exposure, and outcomes of pediatric biliary cholecystectomy. A 24-item cross-sectional international survey was developed by the European Union of Medical Specialists (UEMS) Section of Paediatric Surgery and distributed to centers in 31 UEMS member states. Items covered institutional resources, indications and timing, surgical approach and adjuncts (ERCP, ICG), training exposure, and center-level outcomes; results are reported as n (
