Albanian Medical Journal

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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.