Albanian Medical Journal

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Authors: Katarzyna Czabanowska, Kenneth A. Rethmeier

During the past twenty plus years, Albania like many Central and Eastern European countries has been undergoing significant evolutionary reforms to their healthcare system which resulted in meaningful improvements of the health status of its population including a significant increase in life expectancy in both sexes and a considerable decrease in infant mortality and maternal death rates.

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Authors: Wojciech Czabanowski

The article attempts to analyse the notion of healthcare in the information society in terms of communication theory and Marxism. Concentrating on the role of health care professionals, it shows in what way communication is crucial in developing health consciousness in modern societies. The argumentation leads to the notion of orthobiosis, which expresses the idea of a modern health-conscious democratic community. Keywords: health, information society, political consciousness.

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Authors: Marjeta Tanka, Erjona Abazaj, Nikollaq Leka, Sofika Qamirani, Gjergji Vreto

Aim: Ruptured abdominal aortic aneurysm remains a true surgical emergence, therefore appropriate diagnosis and prompt treatment is required. Computed tomography is the best rapid imaging modality in evaluation of the location of the aneurysm, its extent and complications. The purpose of this case report is to categorize the imaging findings and the role of computed tomography in evaluation of ruptured aortic aneurysm. Methods: In this case report, we describe a patient with severe back pain who was preliminarily considered to have a spinal pathology. We proceeded with CT imaging of the abdomen. Results: CT scan revealed a ruptured abdominal aortic aneurysm with anterior displacement of kidneys and retroperitoneal hematoma. Conclusions: CT is the first choice in a patient with a classical midline sharp, tearing abdominal pain that radiates to the back, and has a midline pulsatile mass upon examination.

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Authors: Zamira Shabani, Arben Hoxha, Fatmir Vadahi, Kujtim Pelinku, Rina Gera

Aim: Autism is a group of developmental brain disorders, collectively called autism spectrum disorder (ASD). The term “spectrum” refers to the wide range of symptoms, skills, and levels of impairment or disability which children with ASD display. We conducted a review of the autism cases in Shkodra city. We described the spread of this disease by gender, place of residence, age groups and the situation of education of these children in two institutions in Shkodra city. Methods: A survey point study was done among children in two institutions that provide services for all children with autism. The data collection took place in the following two institutions in Shkodra city: “Development Center of Children” and “Special School”. A descriptive method was used in the current review work. Results: Overall, there were 49 children diagnosed with autism who followed their studies in these two institutions (34 children attended the “Development Center of Children” and further 15 the “Special School”). This study has evidenced that males were more affected than females (79% males vs. 21% females). The vast majority of cases were from urban areas (86%). Conclusions: Our study provides evidence on the distribution of children with autism in Shkodra city, an under-researched topic in Albania which deserves robust investigation. The available evidence indicates that the problem of autism is not well-known in this region of Albania. The Albanian health system faces considerable challenges regarding the diagnostic and treatment capacities of this condition which also poses a serious burden to families of the affected children.

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Authors: Mariana Bukli, Enver Roshi

Aim: This paper analyses the associations between socio-economic determinants and anaemia among children 6-59 months of age in Albania, in order to improve the targeting of interventions for better health and nutrition outcomes for Albanian children. Methods: The analysis uses data from the Albanian Demographic and Health Survey 2008-2009 (ADHS). To assess the anaemia status of children and their mothers, ADHS measured blood haemoglobin levels using the portable HemoCue system. Measures were taken only for children six months of age or older. Data are analysed using descriptive statistics, chi-square test of independence (significance level set at both P≤0.05 and P≤0.01). Binary logistic regression was used to measure the odds ratios of all the confounding factors. All analyses were carried out using the SPSS statistical software. Results: Bivariate analysis showed that age of the child (P<0.001), age of the mother (P=0.054), educational level of the mother (P=0.005), household wealth index (P=0.013), region (P<0.001) and urban/rural residence (P<0.001) were significantly related to anaemia. In the multivariate analysis, the youngest group of children (6-23 months) were 3.5 times more likely to be anaemic (P<0.001); urban children aged 6-23 months were five times more likely to be anaemic (P<0.001); children living in mountainous areas were 1.6 times more likely to be anaemic (P<0.05); girls living in coastal areas were 1.6 times more likely to be anaemic (P>0.05), and; boys living in mountainous areas were 1.8 times more likely to be anaemic (P>0.05). Conclusions: Interventions to address anaemia as an important public health concern in Albania should use a combination of nutrition-specific and nutrition-sensitive approaches and should also take into consideration characteristics of the high-risk population subgroups.

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Authors: Kyriakos Martakis

Aims: Climate change, interacting with other environmental phenomena, affects human health. The impact of climate change worldwide and in Europe in 2050 is uncertain. Such uncertainty calls for the inclusion of a broad range of assumptions when studying the outcomes. This study presents a range of assumptions concerning the past and the ongoing influence of the European Commission on the health effects of global climate change in the year 2050. Methods: Scenario planning and the evaluation of the adaptation options are core public health activities, aiming at development of strategies that steer the future towards the most desirable setting. Results: Once the driving forces, key patterns and trends were identified, the assumptions were described extensively in the scenario plots. The studied dimensions include: temperature and UV-related illness and death, extreme weather-related and air-pollution-related health effects, water, food, vector and rodent-borne diseases, the effects of food and water shortages, infectious, mental, nutritional diseases, social and economic disruption and the role of politics and the society. Conclusions: A series of strategies for the European Commission to implement are recommended. These include effective health monitoring and quality assurance, addressing medical needs, water and food shortages and the vulnerability of the European population, prevention of the natural disasters related hazard, addressing directly the driving forces of the climate change and efficient involvement of the European Union in global health politics.

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Authors: Majlinda Zahaj, Aurela Saliaj, Sonila Nikaj, Vasilika Prifti

Aim: The main factors that lead to antibiotic resistance are overuse and misuse of the antibiotics. The patients themselves have a considerable role on this, either by medical staff influence or self-use of antibiotics. Hence, the population awareness regarding this issue is of primary importance. This study assessed the level and determinants of patients’ awareness in Vlora regional hospital, in South Albania, and the putative link with use of antibiotics and antibiotic resistance. Methods: In a sample of 488 patients hospitalized at Vlora regional hospital, we gathered information about their knowledge on the use of antibiotics. Subsequently, in most of these patients we collected bacterial cultures (throat and urine cultures). Results: Overall, 247 patients were antibiotic-resistant based on antibiograms’ testing. The level of knowledge for a proper use of antibiotics was quite low in this population sample of Southern Albanians. Compared with the low-educated patients, individuals with middle and high levels of awareness relied on official sources and the authorized personnel regarding antibiotic use. Furthermore, highly-educated participants tended to use less antibiotics than their low-educated counterparts. Conclusions: In our study, the low-educated patients had a higher probability to exhibit lower levels of awareness and this may lead to a higher level of antibiotic resistance. The information retrieved from non-authorized sources of information may explain the unsatisfactory levels of awareness among participants in our study.

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Authors: Arben Rroji, Eugen Enesi, Iva Rudi, Fjorda Tuka, Sonja Saraçi, Gjergji Vreto

Aim: Four-section CT angiography (MSCTA) accurately detects aneurysms at (or more) than 4 mm, but is less accurate for those less than 4 mm. Our purpose was to determine the accuracy of 6-section MSCTA (6MSCTA) in aneurysm detection vs. combined digital subtraction angiography (DSA) and 3D rotational angiography (3DRA). Methods: In a retrospective review of patients studied because of acute symptoms suspicious for arising from an intracranial aneurysm, 96 subjects were included who had undergone CT angiography (CTA). Of these, 40 patients underwent catheter DSA. The most common indication was subarachnoid hemorrhage (SAH; N=57). Two neuroradiologists independently viewed CTA, DSA and 3DRA. Results: A total of 36 aneurysms were found in 25 patients. Reliability was excellent (k=0.98) between the aneurysm size on 6MSCTA and DSA/3DRA. Ultimately, 36 aneurysms were detected by DSA/3DRA in 25 of the 40 patients who underwent conventional angiography. One 6MSCTA was false negative; one 1.5-mm aneurysm was missed by CTA. Also, in four patients, CTA detected only one aneurysm, but DSA/3DRA detected two aneurysms. The sensitivity of CTA for aneurysms less than 4 mm was 64%, whereas it was 100% for those 4-10 mm and more than 10 mm (overall: 84%). Conclusions: This study suggests that 6MSCTA is appropriate in detecting aneurysms less than 4-mm. However, the combination of DSA with 3DRA is currently the most sensitive technique to detect untreated aneurysms and should be considered in suspicious cases of SAH where the aneurysm is not depicted by 6MSCTA, because 6MSCTA may occasionally miss aneurysms less than 3-4 mm of size. A consequence of this conclusion is the protocol of aneurysmal SAH diagnosis.

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Authors: Mirko Zganjer, Anter Cizmic

Inflammatory myofibroblastic tumor (IMT) is a rare benign neoplasm, which mainly involves lungs of the children. Extra-pulmonary locations are manifested mostly in viscera, but localization in the spleen is extremely rare with only few case reports in literature. Although it is commonly seen in children, the numbers of childhood cases are limited. We described a case of IMT of the spleen in a 16-year-old boy who visited our hospital with worsening fatigue symptoms and mild upper abdominal discomfort. The abdominal ultrasound was performed indicating a low echoic mass located in the spleen and measuring 18x10x10 cm. An abdominal CT scan was performed and demonstrated a large low-density hypovascular mass. Splenectomy was indicated and performed. Intra-operative and postoperative courses were uneventful. Keywords: Children, Croatia, inflammatory myofibroblastic tumor, pediatrics, spleen.

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Authors: Krenar Malaj, Valentina Baka, Mimoza Bega, Majlinda Gjika

Aim: This study examined the levels of anemia, severity, and improvement of various blood parameters following treatment for Helicobacter pylori. Methods: The study involved 75 patients presented at the Gastrohepathology/Hematology Ward at the Regional Hospital in Vlora, examined at the laboratory of this hospital during the period January-December 2012. Results: Of the 75 patients examined, 76.9% (N=30) resulted positive for Helicobacter pylori, with 40% of the total (N=30) exhibiting symptoms of anemia. Conclusion: Helicobacter pylori is one of the many causes of anemia, but responds well to proper medical treatment, resulting in quick improvement of blood parameters. We recommend implementation of serologic and other analysis for Helicobacter pylori as a component of routine hospital services.

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Authors: Dorisa Meta, Alfred Priftanji

Baker’s asthma is an allergic occupational disease, caused most often from wheat flour inhalation. Herewith we present a case of new-onset work-related asthma in a 27-year-old patient who works in a pizzeria. The patient with nasal congestion, sneezing over and over, runny nose, dyspnea and wheezing, was recently followed up in our clinic. He reported a history of five years with these complains, or three years after he began to work in a pizzeria. These complaints were present especially in the morning, when he was working. He was free of symptoms when he is not working. Skin prick tests and specific IgE measurements for aeroallergens and trofoallergenes were positive for wheat and wheat flour. Spirometry showed a moderate airflow obstruction. He was diagnosed with baker’s asthma. The treatment with inhaled corticosteroids, intranasal corticosteroids and antihistamines was recommended.

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Authors: Izet Sadiku, Muharrem Bajrami, Arjan Harxhi, Albina Ponosheci, Ajete Aliu

Aim: First cases of tularemia in Kosovo were confirmed in 2000. During the 2000-2002 epidemic outbreak over 600 cases occurred whereas in 2010 over 320 tularemia cases were reported. Our aim was to present the epidemiological, clinical and diagnostic characteristics and treatment of patients with tularemia treated in the Clinic for Infectious Disease at University Clinical Center of Kosovo, during 2006-2011. Methods: A total of 100 patients were examined. Medical records data including anamnesis, clinical examinations, laboratory tests and treatment were analyzed. Results: Mean age of patients was 23.7 years. The average hospital stay was 15.7 days/patient. All patients were from rural areas and 66% of them had access only to well water. The predominant manifestation of the disease was the glandular form whereas 19% and 17% of cases presented pharyngeal and pulmonary forms too, respectively. High Erythrocyte Sedimentation rate was recorded in 95% of patients. 51% of cases had slight anemia and 47% had leukocytosis. Agglutination test in all cases was positive. The Polymerase Chain Reaction test was positive in all taken samples and Francisella tularensis subspecies holartica was isolated as putative agent. Besides Gentamycin (88%) and Streptomycin (12%), incision and drainage of lymph nodes as accessory therapy was applied in 51% of patients. Conclusion: Tularemia still represents a public health problem in Kosovo. The glandular form of the disease predominates. Incision and drainage of inflamed glands as accessory therapy has shown to be a good method of treatment for severe forms of disease in combination with antimicrobial therapy.

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Authors: Gazmend Bojaj, Katarzyna Czabanowska, Fitim Skeraj, Zejdush Tahiri, Genc Burazeri

Aim: The aim of this study was to assess the level of skills, abilities and competencies of family physicians from primary health care users’ perspective in Kosovo, a post-war country in the Western Balkans. Methods: In this article we report the preliminary results of a nationwide cross-sectional study, conducted in Kosovo in January-June 2013, including a representative sample of 601 primary health care users aged ≥18 years (301 males and 300 females; mean age: 49.1±17.7 years). All participants were asked to assess the level of abilities, skills and competencies of their respective family physicians regarding different domains of the quality of health care. Overall, the questionnaire included 37 items organized into six domains. Answers for each item of the tool ranged from 1 (“novice” physicians) to 5 (“expert” physicians). An overall summary score (including 37 items; range: 37-185) and a subscale summary score for each domain were calculated. Demographic and socioeconomic information was also collected. Cronbach’s alpha was used to assess the internal consistency of the instrument, whereas Mann-Whitney’s U-test was used to compare the mean scores for the overall scale and each subscale between males and females. Results: Overall, the internal consistency of the instrument (37 items) was Cronbach’s alpha=0.94; it was higher in males than in females (0.95 vs. 0.92, respectively). The overall summary score for the 37-item instrument was 123.7±19.1; it was similar in males and females (123.4±20.1 vs. 124.1±18.0, respectively, P=0.587). There was a weak inverse correlation of the overall summary score of the instrument with age of participants and the number of visits to the health center in the past year, but a mild positive correlation with educational attainment and income level. Conclusion: The preliminary findings from this nationwide survey provide useful information on the level of skills, abilities and competencies of family physicians from primary health care users’ standpoint in transitional Kosovo.

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Authors: Vili Slavchev Zahariev, Lidia Mladenova Georgieva, Nikolai Milenov Hristov

Aim: Optimization of medical care in cases of radiation terrorism or radiation accidents through study and analysis of the preparedness of general practitioners (GPs) in Sofia, Bulgaria, to participate in such activities in line with the recommendations of leading international organizations in the field of nuclear safety. Methods: We performed a single cross-sectional study in order to collect data and analyse the preparedness of general practitioners. The study was performed in September 2011. The relative share of the study group of 400 GPs was 45% (out of a total of 890) with a standard error of 2.5% and 95%CI=40.1%-49.9%. Results: Knowledge and skills of general practitioners are fragmented and superficial, where any practical experience in the medical care for victims is missing. The majority of participants in the study reported that they needed additional training in the medical management of victims of radiation terrorism or radiation accident (85.5%, 95%CI=81.66%-88.8%). Conclusions: Preparedness stands on a low level in Bulgaria. It is necessary to establish instructions and algorithms for action in the cases of radiological terrorism and injuries from ionising radiation to support physicians in providing medical care.

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Authors: Dorina Çanaku, Eduard Kakarriqi, Alba Merdani, Enver Rroshi

Aim: The aim of this study was to present an overview of the regional distribution of congenital malformation (CMs) in Albania in order to provide researchers and policymakers with scientific information for implementing appropriate CMs prevention policies and consider local health care implications. Methods: This is a cross-sectional study implemented on national level. The data available for this study were extracted from the CM surveillance system of the National Institute of Public Health, during 2011-2012. Absolute numbers and frequencies of CMs according to mothers’ and birth-related characteristics were reported. Chi square test was used to check for any statistically significant difference. Results: The total reported rate of CMs per 1000 live births was 15.2 in 2011 and 14.3 in 2012. In both years, the majority of CMs cases were males. The most frequent CM affected the cardiovascular system. There was a significant decline in the proportion of reported CMs of central nervous system and chromosomal defects between 2011 and 2012 (9.6% vs. 5.8%, P=0.026 and 10.6% vs. 6.6%, P=0.025, respectively). No significant associations were observed with mother and birth-related characteristics. A not straight-forward trend could be offered in regional level. Conclusions: The present survey offered for the first time a more detailed overview of CMs distribution in Albania. Despite the novelty of information, the issues related to under-reporting continue to be a considerable problem towards correct estimation of CMs rates, prevalence and risk factors.

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Authors: Theodhore H. Tulchinsky

Classical public health is a strong tradition which goes back several centuries with many governmental activities to ensure health protection of the population from many hazards causing premature deaths of uncounted millions in epidemics, food borne disease, poor maternal and child health and unsafe workplaces. Public health systems evolved in keeping with traditions of various societies. In western countries local governmental authorities were the primary agencies for public health including sanitation, food control, business licensing vital records and other facets of public health. State and national governments began to assist and develop services beyond the financial and professional capacities of local authorities. Gradually national governments became the overarching agency responsible to protect the health protection of the nation’s population.

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Authors: Albana Adhami, Llukan Rrumbullaku

Aim: Our aim was to describe the level of primary health care visits conducted by family physicians in Albania in the past decade. Methods: We reviewed the number of primary health care visits conducted in each of the 36 districts of Albania separately for urban areas and rural areas for the period 2005-2012. The information was collected from the files of the Institute of Health Insurance. Results: For both urban areas and rural areas, there was evidence of a significant increase in the number of the overall primary health care visits performed by family physicians in Albania. In urban areas of Albania, the overall number of primary health care visits increased from 2436314 in 2005 to 3767941 in 2012 (linear trend: P<0.01). Conversely, in rural areas of Albania, the overall number of primary health care visits increased from 1001990 in 2005 to 1863592 in 2012 (linear trend: P<0.01). Conclusion: There has been a considerable and consistent increase in the overall number of health visits conducted by general practitioners and family physicians in Albania over the past decade. Future studies should explore the putative link between the frequency of health visits and the quality of health care services provided by primary health care professionals in Albania.

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Authors: Teuta Bare, Nikita Manoku

Aim: Preterm birth still remains a major cause of perinatal morbidity and mortality and its rate has not declined over the last two decades despite the improvement in perinatal management. The aim of our study was to assess the use of fetal fibronectin (fFN) testing and cervical length (CL) measurement to predict preterm delivery. Methods: This was a prospective study including all patients admitted between November 2009 and June 2011 to the UniversityObstetric-Gynecologic Hospital “Mbretëresha Geraldinë” in Tirana, with the diagnosis of increased preterm uterine contractility and intact membranes between 22 and 34 weeks of gestation (N=254). Results: Among 245 women with complete data, the mean gestational age at recruitment was 29.4±2.5 weeks. Six women (9.6%) delivered within two weeks of assessment and 14 (22.5%) women delivered before 34 weeks. A positive fFN test resulted in a sensitivity of 83%, a specificity of 84%, a positive predictive value of 36%, and a negative predictive value of 98% for delivery within two weeks. For CL <25 mm, these figures were: 50%, 52%, 10%, and 91%, respectively. Conclusion: In our study conducted in the capital city of Albania, fFN screening provided the best predictive capacity for preterm delivery. Cervical ultrasound after fFN triage appears to be an acceptable option, depending on the resources available.

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Authors: Artur Zoto, Hasan Hafizi, Elizana Petrela, Teuta Backa, Renato Osmenaj, Zamira Ylli

Aim: The purpose of our study was the identification of pulmonary manifestations in patients with scleroderma, their assessment in relations to immunological alterations, their relations to gender, andtheassessment of the sensitivity in the examinations that are used to detect lung injuries. Methods: This is a cross-sectional study including 58 patients with scleroderma during January-September 2011. Patients’ history of disease was carefully extracted and recorded. Patients were underwent immunological tests such as anti-nuclear antibody test, anti-topoisomeraseand anti-centromere tests. Furthermore, chest X-ray, pulmonary high-resolution computed tomography, pulmonary function tests and echocardiography Doppler were also performed. Chi-square test was used to assess potentially statistically significant associations. Results: Mean age of the patients (86.2% females) was 49.38±8.92 years. Mean duration of the disease was 7.29±4.5 years. Pulmonary involvements were found in 42 (72%) patients. Interstitial lung diseases were found in 42 (72%) patients, pulmonary arterial hypertensions in 6 (10%) patients and restrictive ventilator insufficiency in 32 (55%) patients. The proportion of individuals with pulmonary injuries was significantly higher among patients with immunological alterations compared with patient without immunological alterations and among females (both P<0.001). Conclusions: In our study, pulmonary manifestations were common in patients with scleroderma. These injuries are anatomical and functional. Our findings confirm that immunological alterations are an important factor in pulmonary injuries. Sex was also associated with pulmonary injuries in this sample of Albanian patients. High-resolution computed tomography is the most sensitive examination for the detection of pulmonary injuries in scleroderma.

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Authors: Monika Cenameri

Aim: This research is an exploratory and descriptive study on the way the Internet use influences the child development. It has three objectives: i) to provide an overview about the spread of the Internet in Albania; ii) to indicate how adolescents’ online activities affect their well-being, and; iii) to suggest the efficient ways used by parents to assist children on the problems created by such addictive behaviors. Methods: The most recent studies of the intersection between technology and development as young people confront and deal with the challenges and issues that are present in their lives were reviewed. Results were presented based on the data from seven countries that are part of the World Internet Project (WIP; see at: www.worldinternetproject.net). The WIP is a global international survey on the impact of the Internet on individuals and societies, coordinated by the Center for the Digital Future at the USC Annenberg School for Communication. Results: Digital media, such as computers, the Internet, video games, and mobile phones, have come to occupy a central place in the lives of today’s youth. It is important to consider the implications of young people’s online living, especially for their development and well-being. The Internet is a fundamental tool and, therefore, the particular ways that teens employ the Internet will ultimately determine the effects on their well-being. Conclusion: Te current review of the literature supports the conclusion that Internet use during childhood is associated with both positive and negative developmental outcomes.

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Authors: Rudina Cakraj, Donika Prifti

Aim: The olive oil industry generates big amounts of by-products: pomace and waste water that may result in very negative environmental impacts if there are no accu­rate management strategies. The Cleaner Production (CP) is a continuous application of an inte­grated preventive environmental strategy applied to processes and prod­ucts to increase efficiency and reduce risks to humans and the envi­ronment. This study was carried out to demonstrate the application of Cleaner Production Technology in the olive oil industry. Methods: The CP demonstration was carried out during the period 2011-2012, in an olive oil mill. The methodology used for conducting on-site evaluation of the CP included: i) pre-assessment of the company (description of the company and the processes, input-output analysis through in­terviewing staff of the company); ii) material and energy flow analysis, with the aim to identify pollution sources and the related pollution causes; iii) option generation and feasibility study from technical, economic and environmental view, identification of feasible measures, and; iv) implementation of feasible measures by the company and monitoring of the achieved effects. Results: The identified CP measures included the following: development of the information system, monitoring and saving of water consumption, improvement of the quality of olives, process modification: installation of the sec­ond centrifuge in the oil cleaning process, processing the pomace to be used as fuel (drying and pressing of the pomace), treatment of waste waters before discharging into municipal sewage system (op­tional treatment system “reed bed system” or “constructed wet­land”). Conclusion: This study demonstrates how CP can be implemented successfully in the olive oil industry using efficiently the available resources.

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Authors: Elinda Gjata, Ervin Toçi

Aim: The aim of this study was to retrieve information regarding the results of in-vitro fertilization procedures (IVF) and factors associated with pregnancy and live birth after IVF procedures in order to shed light into this under-researched topic in Albania. Methods: We included 246 infertile couples who showed up at the “Iakentro” IVF clinic during 2006-2012. Estradiol level, endometrium thickness and the number of embryos transferred were measured in all cases. In addition, basic socio-demographic information was collected. Binary logistic regression was used to assess the association of socio-demographic and laboratory parameters with pregnancy and live birth after IVF. Results: The rate of pregnancy after IVF was 45%. Among these, 67.3% of pregnancies resulted in live births. In our total sample, the rate of live births was 30.3% whereas the abortion rate after IVF was 14.7%. Upon multivariable adjustment, the higher number of embryos transferred was significantly associated with higher odds of pregnancy and live birth after IVF. Conclusions: Our findings indicate that pregnancy and live birth rates after IVF in Albania are comparable to those in developed countries. In the future, information regarding IVF procedures and their results in Albania should be more complete and accurate in order to ensure the quality of IVF services and improve the regulation of this sector.

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Authors: Izet Masič, Enes Kujundič

The revolution in information-communication technologies has led to the appearance of a “real tide” of different types of information sources that are offered in digital form. These new resources, far more than it was the case with traditional sources (books - handwritten and printed, contributions in scientific periodicals, archives and museums’ holdings, etc.), placed members of the scientific and research community at a serious dilemma: “Which sources to choose, how to evaluate and use them in a useful manner in scientific research?” This paper discusses aspects of the influence of modern information technology in scientific research. It also provides a review of the most important products and sources of knowledge necessary for scientific research, issues of information preservation, digital libraries, e-books, and information resources in the digital environment, databases and the use of sources of scientific information. Finally, it discusses how to validate the results of professional scientific work through the procedures of statistical processing, analysis, interpretation, technical and linguistic preparation and review, evaluation and impact of the dissemination of knowledge in various scientific publications. Keywords: ICT, IMRAD, publications, quoting literature, review of the articles.

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Authors: Peter Schröder-Bäck, Helmut Brand

In Europe we have more than four dozen countries and many different health systems. To look across borders and to see how public health and health care is organized in our neighbour countries and what policies and interventions they employ can be a worthwhile exercise. Maybe our neighbours have already found a solution for a pressing health issue we still do not have any idea how to tackle.

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Authors: Jolanda Hyska, Entela Bushi, Enkeleda Kadiu, Iris Mone

Aim: Iodine deficiency disorders (IDDs’) currently constitute a major global public health problem. IDDs’ remain a public health concern in Albania too. We undertook this survey in Albania to determine median urinary iodine concentration in a sample of school children, and asses the level of iodine in salt samples at the household level. Methods: A nationwide cross-sectional study was conducted in Albania in 2012 including a representative sample of 1027 school children aged 6-13 years. Urine and salt samples were examined for iodine concentration. Results: The median urinary iodine concentration was 100.4 μg/l, indicating no iodine shortage. Conversely, 49.6%of the examined urine samples indicated iodine deficiency. Iodine content was found to be adequate in 62.1% of salt samples. The median iodine concentration of salt samples was 18.5 mg/kg. Conclusion: Our findings indicate that IDDs’ are still an important public health problem in Albania. These results point to the need for strengthening the national IDD Control Program in Albania, and the need to ban production, trading and use of the non-iodized salt.

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Authors: Xhevat Kurhasani, Hasan Hafizi

Aim: At a global level, there has been a significant progress towards reduction of tuberculosis morbidity and mortality in the past decades. Our objective was to describe the incidence and case notification rate of tuberculosis in Kosovo for the period 2000-2010. Methods: Data about all new cases of tuberculosis, incidence rate and case notification rate for the period 2000-2010 were obtained from the National Tuberculosis Control Program in Kosovo. Furthermore, selected indicators of tuberculosis in Kosovo were retrieved from the World Health Organization Global Tuberculosis Report 2012. Results: In the past decade, there has been a significant decrease in the incidence rate of tuberculosis in Kosovo. More specifically, the incidence of tuberculosis declined twice in the period 2000-2010: it was 89.9 per 100,000 population in 2000 vs. 43.7 per 100,000 population in 2010 (linear trend: P<0.01). Similarly, case notification rate declined from 78.2 per 100,000 population in 2001 to 43.7 per 100,000 population in 2010 (linear trend: P<0.01). Conclusion: Official statistics for Kosovo indicate a downward trend in tuberculosis incidence and case not ificat ion rate in the past decade. Nevertheless, the most significant decrease concerns the period from the year 2000 to the year 2003. Afterwards, there has been a fluctuation in the incidence rate and the case notification rate.

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Authors: Afrim Pirraçi, Arben Mitrushi, Drita Totozani

In surgical settings, it is very important to know and understand the anatomy and different types of variations of the gall bladder and the biliary tract, because these structures are in close connection with the adjoining organs and may show various anomalies and anatomic variations. There exist several variations of the normal gall bladder including duplicat ions (ectopic cysts), septate cholecyst , agenesis and hypognesis of the gall bladder, variations of the form of the gall bladder including “Phrygian cap”, Hartmann’s pocket, as well as other types of anatomic variations. In this short report, we highlight some of these anatomic variations of the gall bladder which are also examined and documented among hospitalized patients at the University Hospital Center “Mother Theresa” in Tirana and in a large and representative sample of primary health care users in Tirana municipality, the Albanian capital. Keywords: anatomic anomaly, anatomic variation, biliary tract, ectopic gallbladder, gall bladder, multiseptate gall bladder, Phrygian cap.

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Authors: Altina Xhaferi, Medien Xhaferi, Astrit Hoxhaj, Gentiana Qirjako

Introduction: Dissection of the carotid arteries can occur in the general population as a result of blunt trauma to the neck, such as a car accident or a fall, or from hyperextension of the neck in sportsor exercise. According to recent studies, the incidence of carotid artery dissection as a result of blunt injuries (mainly high-speed motor vehicle accidents) ranges from less than 1% to 3%. Methods: We present a case of dissection of the right common carotid artery in a 25 years old patient after blunt neck trauma at the workplace. Results: The patient complained of neck pain. The radiologic exam revealed a dissection of the right CCA associated with the stenosis of the lumen up to 75-78 %. The angiosurgeon of the case confirmed the radiologic diagnosis. Conclusion: During the traumas of the neck region, performing the right protocol of examinations will improve treatment and prognosis.

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Authors: Anri Troja, Orion Muçaj

Aims: Adverse effects associated with opioid use are numerous and can be treatment limiting, but a variety of management strategies and tactics exists. The aim of this study was to review opioid use adverse effects and their treatment options. Methods: We reviewed the recent literature and highlighted the most common adverse effects associated with opioid use and the suggested treatment options and tactics. Results: Adverse effects of opioids range from common ones (constipation, nausea) to the less common (hiccups, lower leg edema), from the relatively mild (dry skin, runny nose) to the severe (respiratory depression). The adverse effects of opioids may be classified into inhibitory and excitatory, although they somet imes occur simultaneously. Ultra-low doses of opioid antagonists can reduce excitatory effects which, in turn, can heighten the inhibitory response (and possibly potentiate analgesia). Conclusions: Patients on opioid therapy may benefit from a change in drugs (ideally to a non-opioid altogether, but possibly to a lower dose or different opioid) or combination therapy. Specific medications or therapies have been shown to be effective in managing some adverse effects of opioid therapy, but there is considerable intra-patient variability. Opioid therapy confers analgesic benefits to well-selected patients, but adverse effects of this therapy are common and may require physician management.

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Authors: Fitim Skeraj, Katarzyna Czabanowska, Gazmend Bojaj, Bajram Hysa, Elizana Petrela, Jolanda Hyska, Genc Burazeri

Aim: Our aim was to validate an international instrument measuring abilities, skills and competencies of family physicians from practitioners' and policymakers' perspective in Kosovo. Methods: A sample of 20 family physicians in primary health care services and 20 policymakers in the health sector was interviewed in December 2012 and subsequently re-interviewed in January 2013. A structured questionnaire, administered and subsequently re-administered after two weeks (test -retest) to all participants, assessed physicians level of abilities, skills and competencies regarding different domains of quality of health care. The questionnaire included 37 items grouped into 6 subscales/ omains. Answers for each item of the instrument ranged from one (novice physicians) to five (expert physicians). An overall summary score (range: 37-185) and a subscale score for each domain were calculated for the test and retest procedures. Cronbach’s alpha was employed to assess the reliability (internal consistency) for both the test and the retest procedures, whereas Spearman’s rho was used to assess the test-retest reliability (stability over time) of the tool. Results: Among policymakers, the instrument exhibited a higher internal consistency (Cronbach’s alpha was 0.97 for the test and 0.96 for the retest procedure) compared to family physicians (0.89 and 0.88, respectively). Subscale coefficients, however, were not very different in each group. In particular, the patient care and safety domain behaved similarly in both groups for the test and the retest procedure. Overall, stability over time of the instrument was slightly higher among policymakers (Spearman’s rho: 0.87, P<0.01) compared to practitioners (Spearman’s rho: 0.83, P<0.01). Except the continuing professional development domain, for all the other subscales, the test-retest reliability coefficients were higher among policymakers than practitioners. Conclusion: Our findings point to an adequate internal consistency (for both the test and retest procedures) and stability over time (test -retest reliability) in this sample of family physicians and policymakers in Kosovo. From this perspective, this validation study provides useful evidence on cross-cultural adaptation of an international instrument measuring the level of competencies of family physicians in Kosovo. Seemingly, the instrument indicates a good potential for wide scale application to policymakers and especially to nationally representative samples of family physicians in transitional Kosovo.

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Authors: Valbona Duraj, Argjent Tafaj, Teuta Backa

Rheumatoid arthritis is basically considered a clinical syndrome across several disease subsets characterized by systemic inflammation, persistent synovit is, and autoantibodies. Genetic factors account for 50%of the risk of developing rheumatoid arthritis. In population-based studies in developed countries, it has been reported that rheumatoid arthritis affects 0.5%-1.0% of adults. The condition is three times more frequent in women than men. In both sexes, the prevalence increases with age. The prevalence of rheumatoid arthritis has remarkable geographical variations. The disease is more prevalent in Northern Europe and North America compared with many parts of the developing world. Nonetheless, valid and reliable data about developing countries and/or transitional societies are scarce. The new classification criteria for rheumatoid arthritis, developed by the American College of Rheumatology and the European League Against Rheumatism, assess joint involvement, autoantibody status, and acute-phase response and symptom duration. Notwithstanding the unresolved difficulties and challenges related to management of rheumatoid arthritis, the ongoing introduction of ground-breaking treatments may turn out to be rather effective. In any case, it has been convincingly argued that the new direction of treatment and management of rheumatoid arthritis should be towards short intensive therapeutic courses that result in remission instead of the traditional approach that is long-term suppressive treatment strategies. Keywords: arthritis, rheumatoid arthritis, rheumatic conditions, rheumatology.

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Authors: Alketa Hoxha, Ermira Kola, Numila Kuneshka, Eduard Tushe

Aims: The aim of this study was to compare the efficacy and safety of oral versus intravenous ibuprofen for the pharmacological closure of patent ductus arteriosus (PDA) in low birth weight (LBW) preterm infants and assess the impact of perinatal infection to pharmacological closure of PDA in LBW preterm infants. Methods: A randomized, single-blinded, clinical trial included 68 premature infants with significant PDA confirmed through cardiac ultrasound at the Koço Gliozheni maternity hospital in Tirana, Albania, during January 2010-December 2012. Infants were randomly assigned to receive either intravenous (n=32) or oral ibuprofen (n=36) at an initial dose of 10 mg/kg, followed by 5 mg/kg after 24 hours and after 48 hours. The rate of ductal closure, reopening, the need for surgical ligation, and the patients’ clinical course were recorded. Results: After the first t reatment cycle, the PDA closed in 83.3% of the patients receiving oral vs. 71.8%of those receiving intravenous ibuprofen. 16.6%of the patients in the oral group required a second cycle of treatment, compared with 28.1%in the intravenous group; all these cases had clinical signs of infection and positive bloodculture. No reopening of the ductus after its closure was noticed. Furthermore, there were no patients with oliguria. Conclusions: Oral ibruprofen showed a similar rate of ductal closure and renal tolerance, but fewer adverse effects compared to intravenous ibuprofen. Association of PDA with perinatal infection has a negative impact in pharmacological closure of the ductus, increasing the need for a second treatment cycle and surgical ligation. Larger comparative studies are needed to replicate these findings.