Albanian Medical Journal

2

Authors: Helmut Brand

What do we, here in Maastricht, know about the Balkans? What do we really know about this part in the centre of Europe? Do we understand what happened when former Yugoslavia broke up? Why could a war start in Europe again?

4

Authors: Manika Kreka, Eleni Nastas, Gentiana Qirjako, Bledi Kreka, Vjollca Hajro, Floreta Kurti, Anila Godo

Aim: Although the frequency of the painful sickle cell crisis, which is an important marker of sickle cell disease related complication, is considered a parameter of this disease’s severity, most patients do not frequently experience such crisis that can require always medical assistance. Methods: We studied 64 patients with sickle cell disease from December 2011 to December 2012 at the University Hospital Center, Tirana, Albania. About 63% of the patients were female. Pain rate was assessed by calculating the cumulative number of admissions for painful crisis (like articular, muscular, abdominal pain). The patients were categorized into three groups: 0, 1, or ≥1 crises per year. Painful crises that did not require medical assistance were excluded. Results: Sixteen patients did not have crisis, and 15 patients had more than one crisis per year. Avascular necrosis, acute chest syndrome, cholelithiasis and iron overload were significantly related to pain rate. Cholelithiasis was the prominent clinical manifestation amongst this group of patients. There was no significant change in laboratory findings. Pain was evaluated as an important marker and was present (one or more per year) in 15 patients with Sickle Cell Disease and Thalassaemia Sickle Cell Disease. Conclusion: The association between iron overload and the pain rate is probably the result of many blood transfusions used for treating painful crisis. Our data shows that several major diseases which are complications of sickle cell disease are not strictly related to pain rate and occur in a very significant number of patients that seem clinically well. Hence, we have to evaluate systematically these complications, even in patients which represent a mild-to-moderate clinical panorama of disease in order to prevent the severe complications.

5

Authors: Brunilda Hysaj (Vila), Lila Shundi, Mimoza Basho, Silva Bino, Eriona Abazaj, Tefta Rexha

Aim: To determine the prevalence and HCV genotype among high risk groups in Albania. Methods: In this study we analyzed 172 blood samples collected from various high risk groups for the presence and genotype of HCV virus with HCV-RNA (Cobas Amplicor HCV Test v2.0, Roche), HCV genotype (Line Probe Assay-LiPA, Bayer). The data analysis was done using SPSS, version 16.0. Results: A total of 172 blood samples were screened including thalasemic patients, dialysis patients, and injecting drug users (IDUs). Initial screening was done for anti-HCV using ELISA-test. Confirmation of active HCV infection was carried out with the help of Cobas Amplicor test V 2.0. Out of 172 samples, 121 (70.34%) were both HCV positive for anti-HCV and HCV RNA. Prevalence of active HCV-RNA infection in individual risk groups was: 20 (41.66%) for 48 thalasemics patients, 74 (88%) for 84 cases with dialysis and 27 (67.5%) for 40 cases in injection drug users, respectively. Four major genotypes (1, 2, 3, 4) and their subtypes (1a, 1b, 1a/b, 3a, 4a, 4e) were identified. The most frequent HCV genotypes were 1 and 3. There was no significant relationship between virus genotypes and sex, age and risk-group. Conclusions: The prevalence of HCV-RNA was higher in these population groups. Genotype 1, subtype 1b was the most prevalent in dialysis patients and genotype 3 was the most prevalent between the IDUs group, but more detailed studies with a larger number of patients are necessary to understand the HCV dynamics in this population subgroup of Albania.

6

Authors: Eralda Mariani, Polikron Pulluqi, Enver Roshi, Doriana Frashëri, Entela Buzali

Aim: Human brucellosis is a serious disease that can result in disabling complications. Brucellosis is still one of the most challenging issues of both health and economy. This study was designed to determine the epidemiological features of brucellosis in Korça prefecture, as this is one of the endemic areas in Albania. Methods: This is a retrospective descriptive study. Data on socioeconomic and occupational factors and history of exposure to animals and animal products over a 7-year period 2005–2012 were collected in Korça prefecture by using a structured questionnaire. Results: In total, 737 cases of brucellosis were reported. The incidence rate of brucellosis decreased from 95/100,000 in 2005 to 11/100,000 in 2012. The male-to-female ratio was 1.6 and the disease was most common in individuals aged 40-49 years. 62.8% of cases were from rural areas. Cases occurred throughout the year, with the highest incidence rate between May and August. Among the occupations identified, 37.3% were housewives, 22.6% farmers, 21.3% students, 6.1% shepherds and 12.7% of the patients had other occupations. Conclusions: Exposure and contact to home-owned animals and consumption of homemade milk and dairy products were identified as probable sources of human brucellosis infection in the districts included in this study conducted in Albania.

7

Authors: Nikolin Filipi, Kozeta Filipi, Blerim Saraçi

Aim: Cardiac surgery interventions can often be associated with complications. One of the most important of them is postoperative acute kidney injury (AKI) that can significantly contribute in a higher postoperative morbidity and mortality. The risk and prevention of acute kidney injury (AKI) following cardiac surgical interventions is less well understood and still remains a challenge. By conducting the study, we evaluated the factors that may predispose the appearance of AKI in terms of cardiac surgery. Methods: The study was based on the recorded clinical and demographic data of 72 adult patients (age ≥18 years) who underwent coronary artery bypass graft (CABG) surgery and valve surgery (with or without concomitant CABG) at the Hygeia Hospital Tirana, Albania, in cardiac surgery department during September 2011 – May 2012. According to RIFLE/AKIN classifications, risk factors such as patient’s condition, lowest mean arterial pressure during intervention, aortic clamp time, bypass time, intubation total time and hemorrhage and creatinine levels were studied during the first five postoperative days. Results: 72 patients were included in the study. Mean age was 61.3±9.7 years; 76.4% were men and 23.6% were women. About 78% were intervened of cardiopulmonary bypass, 11% underwent valvular replacement surgeries and 7% combined surgeries. Around 14% of patients developed signs of AKI within the fifth postoperative day. Pre, intra- and postoperative risk factors for acute renal failure were evaluated. By studying the variables’ correlation with AKI, we found a highly significant association (P<0.001) for values like total intubation time and ICU (intensive care unit) stay time as well as mean value of urea and creatinine within five days. A less significant association was found with lactate values taken 24 hours after cardiac interventions (P=0.05). Conclusion: In patients that undergo surgical procedures in cardiac surgery, the postoperative renal function tests, as well as intubated and ICU time, play a very important role in development of the postoperative AKI. Reducing these factors to their lowest limits, can directly help in minimizing the postoperative development of AKI and will surely reduce the treatment costs of the postoperative patient. Quality improvement strategies should be incorporated at all institutions in order to identify and track quality indicators relevant to the prevention of postoperative renal dysfunction during the index admission for cardiac surgery. Once identified, clinicians can implement preventative measures for high-risk patients.

8

Authors: Vjollca Shpata, Xhensila Prendushi, Alma Nurçe, Alketa Hoxha, Floreta Kurti, Ilir Ohri

Aim: Malnutrition is a frequent concomitant of surgical illness, especially in gastrointestinal surgery. The purpose of the studywas to evaluate the prevalence of malnutrition for intensive care unit (ICU) patients, who underwent gastrointestinal surgery and to determine the correlation with post-operative outcome. Methods: We prospectively studied 313 post-surgical patients 18 years that stayed 4 days at the Intensive Care Unit (ICU) of the UniversityHospital Center Mother Teresa in Tirana, Albania. Patients were divided into well-nourished (NRS 2002 <3) and malnourished groups (NRS 2002 3) according to their nutritional status. All patients were followed up clinically until discharge from ICU or death and their outcomes were recorded. Univariate and multivariate logistic regression analysis were used to identify the relationship between malnutrition and the clinical outcome. Results: The prevalence of pre-operative malnutrition was 61.7% and for gastrointestinal cancer patients it was 80.2%. Malnutrition, as analyzed by a multivariate logistic regression model, was an independent risk factor for higher complications, higher nosocomial infections, increased mortality, and longer stay in the ventilator and ICU. Conclusion: This study shows that malnutrition is a significant problem in surgical patients, especially in patients with gastrointestinal cancer, staying for more than four days in the intensive care unit. Malnutrition in gastro-intestinal surgery patients is an independent risk factor on increased post-operative morbidity and mortality.

8

Authors: Jeremy G. Guillory

Aim: The burden of disease among populations is not spread evenly across Europe. Some nations in Europe have the lowest disease burden in the world, while some lag far behind among industrialized nations. These differences make real-world impacts in the lives of the residents of Europe, and are thus important to investigate. The objective of this paper was, firstly, to examine the correlation between the geographic locations of nations in Europe and the amount of burden of disease accumulated by their populations. Looking further, to correlate the burden of disease with the amount spent on healthcare per capita in these nations. Finally, to investigate the question of how health system efficiency is affected by healthcare spending. Methods: Using data concerning burden of disease, healthcare spending and health system efficiency, correlations were made both visually and numerically in order to show the results. Results: There is a strong correlation between the high number of DALY’s accumulated by a population and living in Eastern Europe. This is related to low healthcare spending and lack of efficiency in the health systems of these nations. Conclusion: In order to reduce the burden of disease in Eastern Europe when compared to Western Europe, healthcare spending per capita must be increased to reach a minimum level where efficient practices can take place and DALY’s can be reduced.

9

Authors: Shpëtim Doksani, Anila Kristo, Sokol Myftiu, Fatime Elezi

Aim: There has been an increase in the levels of alcohol intake in Albania, particularly among men. In recent years, the use of pharmacotherapy together with psychosocial interventions has enhanced the percentage of success in maintaining alcoholic patients in remission. The aim of this study was to describe an alcohol treatment program in Albania, as well as to assess the response to psychotherapeutic and pharmacologic treatment of alcohol-addicted patients in Albania. Methods: This is a prospective study including 51 consecutive subjects admitted to the Clinic for the Treatment of Alcohol Addiction at the University Hospital Center “Mother Teresa” in Tirana, Albania, over the period September 2010 – September 2011. After the three week period of hospitalization all patients were followed up for one year after discharge. Results: Mean age of the patients was 47.3± 9.8 years (range 31-60 years). About 96% of the patients were males. The most frequent disorders among patients were psychiatric disorders in 41 (80%) patients, followed by internal disorders in 36 (70%) patients and neurological disorders in 15 (30%) patients. Patients with high dependence were 3.2 times more likely to manifest anxiety and general depressive disorders than patients with low dependence without a significant difference between them (OR= 3.2, 95%CI=0.6-19.28, P=0.1). About 45% of the patients achieved one year abstinence (95%CI=33.2-58.6). About 55% (95%CI=41.3-67.7) of the patients relapsed to alcohol use. Divorced patients were 8.7 times more likely to relapse compared to the married counterparts (OR=8.7, 95%CI=1.7-66.4). Around 67% of married patients who relapsed manifested family/spouse relationship difficulties (P<0.01). Conclusion: The high rates of associated psychiatric disorders in patients with alcohol-use disorders require that alcoholic patients undergo careful psychiatric evaluation. Similarly, the treatment of alcohol-dependent patients with comorbid disorders is complex. The pharmacotherapy should not be considered as the only form of treatment, but as an integrated part of a multimodal approach including psychological and social support.