It is evident that there is a lack of awareness of the importance of pre-pregnancy planning to avoid pregnancy-related complications with diabetes. This emphasizes the need for more education and it is imperative for healthcare professionals to address these issues with adolescent female patients.

Background:Eosinophilic gastroenteropathy is an uncommon condition whose causes can be numerous and non-specific. The aim of the study was to characterize the presence of gastrointestinal disorders in the adult Maltese population and assess the degree of association with atopic diseases.Methods:Adult patients with gastrointestinal eosinophilia in the gastrointestinal tract on histology were identified and their clinical case notes were reviewed. Patients were interviewed and asked questions regarding asthma, allergic rhinitis, and eczema.Results:Sixty-six patients (39 female) were recruited. The most common clinical symptoms were diarrhea (42.4%) and abdominal pain (33.3%). The sites involved were stomach (10.6%), colon (56.1%), small bowel (10.6%), small bowel and colon (18.2%), esophagus (1.5%), and esophagus and colon (1.5%). Forty percent had persistent lower gastrointestinal symptoms and a repeat ileocolonoscopy was performed within 12 months. These patients were diagnosed with ulcerative colitis (n=10; 47.6%), Crohn’s disease (n=6; 28.6%), indeterminate colitis (n=1; 4.8%) or microscopic colitis (n=4; 19%). Allergic rhinitis was present in 39.4% of the study group, eczema in 26.1%, and asthma in 19.7%. These findings were compared with local data for atopic conditions and the study group was found to have a significantly higher prevalence of allergic rhinitis (P=0.002), but not of asthma (P=0.62) or eczema (P=0.19).Conclusions:A high proportion of patients with eosinophilic gastrointestinal infiltration were subsequently diagnosed with inflammatory bowel disease. Patients persistently symptomatic or who do not respond to treatment should be reassessed to exclude inflammatory bowel disease, given its high prevalence in this group of patients.

The birth of an individual with a blend of both male and female internal or external genitalia is known as an intersex condition. The incidence of genital anomalies is estimated to occur in 1 in 4,500 live births. Each intersex condition is determined by the external genital appearance, internal genital structures, and fertility potential. The main concept involved in the management of intersex is the establishment of an experienced multidisciplinary team. Management of intersex conditions is complex and involves a person's gender identity, gender role behavior, sexual orientation, sexual functioning, and psychological adjustment. This review will outline the management of intersex in the light of the latest research. We focus on diagnosis, surgical techniques, and the psychological aspects that are encountered in the management of intersex.

IntroductionEosinophilic gastroenteropathy (EG) is an uncommon condition. The causes for this can be numerous as well as non-specific. Inflammatory Bowel Disease (IBD) is one of the causes. It can also be a manifestation of atopy. The aims of our study were (1) to determine if patients who present with eosinophilia of the gut are eventually diagnosed with IBD and (2) to determine if patients with EG have a higher rate of atopic conditions namely, asthma, allergic rhinitis and eczema.MethodsAdult patients who had gastrointestinal eosinophilia were identified through the histopathology department and recruited. Their clinical case notes were reviewed. Patients were interviewed and asked questions regarding asthma, allergic rhinitis and eczema.Results66 patients (39 females; mean age 48.4 SD±18.5) were recruited. The mean eosinophilic count was 0.353 SD±1.08 (normal range 0.10–0.70 x 10 9/L).The commoner clinical presentations were diarrhoea (42.4%), abdominal pain (33.3%) and weight loss (8.2%). The parts of the gastrointestinal tract where eosinophilic infiltration was present were: stomach (6), colon (37), small bowel (SB) (7), SB and colon (12), oesophgeal (1), oesophageal and colon (2), stomach, SB and colon (1).25.8% of patients were later diagnosed with IBD (10 patients - ulcerative colitis, 6 patients – Crohn’s disease and 1 patient had indeterminate colitis). No other secondary causes for GE were present in the rest of the patients and their symptoms resolved without any medical intervention.The prevalence of allergic rhinitis (41.3%) (p < 0.002) and eczema (26.1%)(p < 0.001) with GE were higher than that of the general population. Although asthma (17.4%) was more frequently present in patients with GE than the population, this did not reach statistical significance (p < 0.62).ConclusionA high proportion of patients (25.8%) with GE was subsequently diagnosed with IBD. Asthma, eczema and allergic rhinitis in patients with underlying EG are higher than in the general population. Most of the patients had transient GI symptoms that later resolved. Thus, GE may represent an atopic condition of the gut or a response to a food allergen.Disclosure of InterestNone Declared

Background Cardiac CT and MRI are relatively new, non-invasive modalities of cardiac imaging, obtaining excellent image quality mainly pertaining to the heart. However, both these modalities also obtain diagnostic quality images of extracardiac structures. International studies quote varying rates of positive extracardiac findings (ECF) ranging from 20-30% in cardiac MRI and 30-40% in CT. Purpose To evaluate the prevalence of incidental ECF in cardiac imaging in the Maltese Islands and assess for any differences in prevalence between sexes and age groups. Methods All patients having performed cardiac CT and cardiac MRI scans performed in the year 2017 in the Maltese Islands (n = 733) were enrolled. Imaging reports of these scans were retrospectively reviewed, making a note of the patient’s age and sex and any positive ECF. ECF were then subdivided according to clinical significance and anatomical site. Results Positive ECF were present in 219 (29.9%), whilst 514 (70.1%) had no ECF of note. When subdivided, 14.6% of MRI and 35.0% of CT were positive for ECF, p &lt; 0.001. There was a propensity for older patients to have more positive findings, with these present in 11.9% of patients aged &lt;20, 8.1% of patients aged 20-29, 18.2% of patients aged 30-39, 21.9% of patients aged 40-49, 30.1% of patients aged 50-59 and 40.5% of patients aged ≥60, p= &lt;0.001. Females had a higher proportion of positive findings (38.1%) despite having less total scans (n = 312) when compared to men (23.8%, n = 421), p= &lt;0.001. Of the positive findings, 72.1% were newly discovered. These were classified according to clinical significance with 17.7% of these findings classified as definitely resulting in a change in management, 19.0% most likely resulting in a change in management, 46.8% possibly resulting in a change in management and 16.5% being normal variants or expected post-operative changes. Findings were most commonly lung pathologies (28.8%) followed by gastrointestinal pathologies (21.5%) and liver and gall bladder pathologies (14.6%). Conclusions ECF in cardiac imaging are common in the Maltese islands with around a third of all scans having a positive finding. CT was the imaging modality that was more likely to pick up ECF. ECF are increasingly frequent in older patients and also more likely to be found in females, despite less women having been scanned than males. Most findings were newly discovered with a large proportion being of clinical relevance.

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Background In the past, cardiac imaging modalities did not obtain much information about extracardiac structures. With the introduction of newer modalities such as CT and MRI, diagnostic quality images of structures surrounding the heart are now being obtained. This has led to the need for interpretation of images of extracardiac structures. Nowadays, this is being performed by cardiologists and radiologists; either separately or conjointly. Purpose To evaluate whether there is any difference in the rate of positive extracardiac findings (ECF) between radiologists and cardiologists and to assess whether these ECF are of any clinical importance. Methods All patients having had a cardiac MRI and cardiac CT performed in the year 2017 in a single centre were enrolled (n = 733). Reports of these images were reviewed retrospectively and information was obtained as regards to any differences in number of ECF picked up by cardiologists, radiologists or both working together. These ECF were then stratified according to their clinical importance and these subdivisions compared in the context of reporting physician. Results A total of 733 scans were reviewed, 219 (29.9%) of these had positive ECF whilst 514 (70.1%) had none. Of the total amount, 314 (42.8%) were reported by cardiologists, 318 (43.4%) by radiologists and 101 (13.8%) jointly by both a cardiologist and a radiologist. Cardiologists found positive ECF in 18.2% of scans reviewed, radiologists reported findings in 37.4% of scans and, of those reported jointly, 42.6% were positive, p= &lt;0.001. A pattern emerged where cardiologists found less clinically significant ECF with only 5.3% of findings classified as will definitely change management, in comparison to 19.3% by radiologists and 16.3% when reviewed jointly; and, only 15.8% of findings classified as will probably change management when compared to 23.5% by radiologists and 23.3% when reviewed jointly. However, it is important to note that this pattern was not statistically significant, p = 0.1432. Conclusions A strongly statistically significant difference in the reporting of extracardiac findings has been highlighted in this article with cardiologists picking up less than half of extracardiac findings reported by radiologists. There was a pattern of cardiologists recognising less clinically important extracardiac findings, however this was not found to be statistically significant. These results should be reviewed with caution, taking into consideration the limitations of results obtained from a single centre. However, should this pattern keep repeating itself, one might consider increasing cardiologist training in ECF or having cardiac imaging reported conjointly by a cardiologist and a radiologist. Further studies are also necessary to ascertain the clinical relevance of the difference in ECF between cardiologists, radiologists or both specialists working together.