Albanian Medical Journal

3

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.

4

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.

5

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.

6

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.

6

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.

7

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.

8

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.