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thesynapse.net Advances in Cardiovascular Imaging New Perspectives in Barrett’s Oesophagus Arthroscopic Shoulder Surgery theSyNAPSe Meeting Maria Angela Grima the M edical P rOfessionalS’ N etwOrk Volume 13 Issue 06 ISSN number 2313-8084 Seebri Breezhaler 44 micrograms inhalation powder, hard capsules WARNINGS/PRECAUTIONS: ♦ Seebri Breezhaler is not indicated for the initial ADVERSE REACTIONS: ♦ Common (≥1/100 to <1/10): Nasopharyngitis, treatment of acute episodes of bronchospasm. ♦ Paradoxical bronchospasm has insomnia, headache, dry mouth, gastroenteritis, urinary tract infection. ♦ been observed with other inhalation therapy and can be life threatening. If this Uncommon (≥1/1,000 to <1/100): Rhinitis, cystitis, hyperglycaemia, This medicinal product is subject to additional monitoring to allow quick occurs, Seebri Breezhaler should be discontinued immediately and alternative hypoaesthesia, atrial fibrillation, palpitations, sinus congestion, productive cough, identification of new safety information. Healthcare professionals are asked to report therapy instituted. ♦ Caution in patients with narrow angle glaucoma or urinary throat irritation, epistaxis, dyspepsia, dental caries, rash, pain in extremity, any suspected adverse reactions. Refer to section 4.8 of the SmPC for how to report retention. Patients should be informed about the signs and symptoms of acute musculoskeletal chest pain, dysuria, urinary retention, fatigue, asthenia, adverse reactions. narrow angle glaucoma and should be informed to stop using Seebri Breezhaler and hypersensitivity, angioedema to contact their doctor immediately should any of these signs or symptoms develop. PRESENTATION: ♦ In patients with severe renal impairment including those with end stage renal LEGAL CATEGORY: POM Each capsule contains 63 micrograms of glycopyrronium bromide equivalent to 50 disease requiring dialysis, Seebri Breezhaler should be used only if the expected micrograms of glycopyrronium. The delivered dose (the dose that leaves the benefit outweighs the potential risk. ♦ Seebri Breezhaler should be used with caution PACK SIZES: Single pack containing 30x1 hard capsules, together with one mouthpiece of the inhaler) is equivalent to 44 micrograms of glycopyrronium. in patients with a history of cardiovascular disease. ♦ Patients with rare hereditary inhaler. problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose INDICATIONS: Indicated as a maintenance bronchodilator treatment to relieve malabsorption should not take this medicine. ♦ There are no data from the use of MARKETING AUTHORISATION HOLDER: Novartis Europharm Limited, symptoms in adult patients with chronic obstructive pulmonary disease (COPD). Seebri Breezhaler in pregnant women. Glycopyrronium should only be used during Wimblehurst Road, Horsham, West Sussex, RH12 5AB, United Kingdom. pregnancy if the expected benefit to the patient justifies the potential risk to the DOSAGE: The recommended dose is the inhalation of the content of one capsule foetus. ♦ The use of glycopyrronium by breast feeding women should only be MARKETING AUHORISATION NUMBER: once daily. Seebri Breezhaler is recommended to be administered, at the same time considered if the expected benefit to the woman is greater than any possible risk to Seebri Breezhaler 44 micrograms inhalation powder, hard capsules - of the day each day. If a dose is missed, the next dose should be taken as soon as the infant. ♦ Glycopyrronium has no or negligible influence on the ability to drive and EU/1/12/788/001-006 possible. Patients should be instructed not to take more than one dose in a day. use machines. INTERACTIONS: ♦ The co-administration of Seebri Breezhaler with other Please refer to Summary of Product Characteristics (SmPC) before CONTRAINDICATIONS: ♦ Hypersensitivity to the active substance or to any of the anticholinergic containing medicinal products has not been studied and is therefore prescribing. Full prescribing information is available on request from Novartis excipients. not recommended. ♦ No clinically relevant drug interaction is expected when Pharma Services Inc., Representative Office Malta, P.O. Box 4, Marsa, MRS glycopyrronium is co-administered with cimetidine or other inhibitors of organic cation 1000, Malta. Tel: +356 21222872 2014-MT-SBR-1-JUL-2014 transport. SEE Ad1 12/14 MT edItOrIAl A tribute tO SteVeN SpielBerG o you remember the Minority Report? This science fiction later stages of metamorphosis. Thus the renewed tissue growth has been penned in 1956 by Philip Dick and adapted to around the MEMS will tend to heal and form a reliable and dthe silver screen in 2002 by Steven Spielberg. The main stable tissue-machine interface. actor was Tom Cruise. It tells the story of a future society where Skipping to the medical field, the FDA has recently given the murders are prevented through the efforts of three mutants green light to a piece of technology, which until a couple of years who can see the future. Closer to us, if you have seen G.I. Joe: ago, similarly to the above technologies, was expected to hail Retaliation (2013), starring Dwayne Johnson and Bruce Willis, from a Star Trek episode. FDA has approved the Proteus Digital do you remember the scenes which depict camera-carrying flies Health’s new chip-embedded capsules which can report back (which could also explode)? to a sensor and your smartphone when medications have been Notwithstanding the fact that most of us consider such film ingested. The tiny silicon-based chips are no larger than a grain excerpts as pure science fiction, the Department of Homeland of sand. When swallowed and exposed to digestive juices, those Security (US) has developed the Future Attribute Screening materials produce a slight voltage which can be detected by Technology (FAST) programme. Its primary aim is to detect a special skin patch and relayed to a smartphone. It not only crimes in sensitive areas, example, airports, by screening people serves as a fool-proof reminder as to if and when you’ve taken for “psychological and physiological indicators” including the medication, but it also allows healthcare providers to know heart rate, skin temperature, breathing, facial expression, body for sure if medication has been taken by a patient who has movement, pupil dilation, and other “psychophysiological/ trouble caring for themselves. Indeed, Proteus Digital Health has behavioral patterns” to stop “unknown terrorists”. partnered with NHS England and the UK Trade & Investment Indeed, security has made great advances. The development (UKTI) to investigate further whether its ingestible sensors - of Hybrid Insect Micro-Electro-Mechanical Systems (HI- taken with medications - monitor more effectively whether NHS MEMS) is a project of the US Department of Defense. The patients follow their medicines regime. primary goal is to developing machine-insect interfaces by Wishing you a peaceful Christmas & health and happiness placing micro-mechanical systems inside the insects during (and reason to appreciate both) in the forthcoming year. the early stages of metamorphosis in order to exert control over the insect’s locomotion. The reason why the electronic system is attached during the early stage of metamorphosis is that the majority of tissue development in insects occurs in the Editor-in-Chief: Wilfred Galea Annual subscription rates outside Malta: Six issues €90 or equivalent, worldwide Managing Editor: Ian C Ellul Production: Outlook Coop Sales & circulation Director: Carmen Cachia Printing: Europrint Ltd Email: [email protected] The magazine is distributed free of charge to all Maltese doctors, pharmacists Telephone: +356 21453973/4 & dentists, as well as students of the aforementioned professions, with a print run of 3500 copies. Publisher: Advertising policy: Advertisers are liable for contents of any of the advertisments. The advertisers shall indemnify and hold harmless Medical Portals Ltd against and from any and all claims, damages, liabilities, cost and expenses Medical Portals Ltd whatsoever, including counsel fees, arising from the content of any of their advertisments. Medical Portals Ltd The Professional Services Centre disclaims any responsability or liability for non-compliance of advertising artwork to regulatory units. The opinions expressed in this publication are those of the respective authors and do not necessarly reflect the opinions Cover: Valletta Balconies Guzi Cutajar Street, Dingli of the editors or the institutions with which the author is affiliated unless this is clearly specified. Dr Adrian Mizzi Malta, Europe our collaborators AuthOrS ISSue GuIde 06 ReCeNt AdvanceS IN CArdiovasculAr Mr John A Casaletto MD FRCS(Tr&Orth) is a consultant orthopaedic surgeon in the UK and visiting IMAGING – PArt I Upper Limb Surgeon at Mater Dei Hospital. He trained in Wrightington and Liverpool and has a special interest in arthroscopy of the shoulder and elbow and computer- assisted shoulder replacement. 08 New PerSPeCtIVeS IN BArrett’S OeSOPhAGuS Dr Alexander Borg MD (Malta) MD (Manchester) MRCP (London) qualified from the University of Malta in 1997, underwent cardiology training in Manchester, UK, and has been 10 ArthrOSCOPIC ShOulder SurGery – PArt II working as a consultant cardiologist since 2012. His subspeciality interest is cardiovascular imaging, valvular heart disease and myocardial deformation imaging, with practical skills in advanced echocardiography, cardiac 12 The SlIPPery SlOPe Of MOderN MedICAl magnetic resonance imaging and cardiac CT scanning.