Chronic kidney disease patients on maintenance dialysis (CKD 5D) experience major morbidity and mortality. No data on survival in Maltese dialysis patients exist; therefore, the aim of this study was to rigorously examine survival statistics in a complete cohort of Maltese CKD 5D patients. The study population was comprised of all incident chronic patients (N=328) starting dialysis at the renal unit, Mater Dei hospital, Msida, Malta, for 4 consecutive years (2009–2012). Each yearly cohort was analysed in detail up to 31st December 2017, providing up to 8 years follow-up. Demographics (male 65%; female 35%), aetiology of renal failure (diabetic kidney disease: n=191; 58.2%), comorbidities, transplant status, and death were documented. Data collection and follow up were completed and statistical analysis was performed on the aggregated cohorts with SPSS version 23 with censoring up to 31st December 2017. The cumulative adjusted 5-year overall survival in Maltese CKD 5D patients was 0.36 and 0.25 at 8 years. No statistical difference was observed according to the year of starting dialysis. Cox regression analysis showed that age and transplant status influenced survival. The unadjusted hazard of death increased by 3% for every 1-year increase in age and was increased by 7% if the patient did not receive a transplant, and overall 22% (n=72) of the entire cohort eventually received transplants. This study reports an approximate 65% mortality at 5 years in Maltese haemodialysis patients, a poor prognosis that, despite optimal medical management, is consistent with worldwide reports.

A 61-year-old gentleman who lives with his wife and 20-year-old son, presented to the polyclinic with a four week history of pruritus. On examination he was found to be jaundiced and his LFTs were high. Consequently he was referred to Mater Dei Hospital where, following ERCP and MRCP, he was found to have a tumour of the head of the pancreas, causing a stricture of the common bile duct, with consequent obstructive jaundice. The patient was planned for Whipple's operation (pancreatico-duodenectomy), which was extended to total pancreatectomy, splenectomy and cholecystectomy. The operation was successful and the patient is recovering.

Background:Inflammatory arthritis (IA) patients on immunosuppressant disease modifying drugs (DMARDs) are at an increased risk of infections. Influenza and pneumococcal vaccines are recommended as part of the BSR and EULAR guidelines for the clinical management of these patients. Prior to commencing DMARDS, the patients are reviewed by the nurse specialist, who discusses the benefits versus risks of DMARDS, necessary monitoring and recommends the pneumococcal and influenza vaccines.Objectives:The aim of this audit is to assess the uptake of the pneumococcal and the influenza vaccine in IA patients prior to starting biologic or synthetic DMARDs as advised by the nurse specialist during the education visit with the patient.Methods:The study sample included 139 patients with various types of IA, including rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, who attended the rheumatology nurse education sessions prior to starting DMARDs in a secondary care hospital in 2017. Verbal advice supported by a vaccination leaflet developed in 2016 was given by the rheumatology nurse. Data was compiled by means of a telephone questionnaire.Results:One hundred and twenty six (90.6%) participants recalled being given advice on vaccinations. Seventy eight (62%) of these patients received the influenza vaccine. The rest (28%) did not receive the vaccine for various reasons including fear of side effects, fear of developing a worse infection, belief of inefficacy and fear of injections.A significant improvement (p=0.0084) in the influenza vaccination rates was noted since a previous audit in 2016, where following verbal education by a rheumatologist, only 41.4% received the influenza vaccine.A significant improvement in uptake was also noted in the pneumococcal vaccination rates since only 17.2% of the patients received the pneumococcal vaccine in 2016 compared to 62.7% in 2017 (p<0.0001). Various reasons including fear of side effects, belief of inefficacy, fear of injections and financial implications were given by patients who did not receive the pneumococcal vaccine.Overall, 62% of the patients received both vaccines after education given by the rheumatology specialist nurse and receiving the vaccination leaflet.Conclusion:This audit showed a significant progress in the uptake of the influenza and pneumococcal vaccinations in patients with inflammatory arthritis following verbal advice by the specialist rheumatology nurse and the introduction of a vaccinations’ educational leaflet. Disclosure of Interests:None declared

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