Albanian Medical Journal

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Authors: Konstantinos H. Katsanos, Alexandros Skamnelos, Dimitrios Christodoulou, Epameinondas V. Tsianos

The term “diversion colitis” has been introduced to describe an unspecific inflammation occurring in a defunctionalized portion of bowel, following either loop ileostomy, colostomy, or Hartmann’s procedure for various reasons. Endoscopic findings are not specific and include friability, petechia, erythema, ulcers, exudate, and more rarely nodules or polyps. Biopsy is not specific and in severe cases parallels severe ulcerative colitis.We present herein a 32 year-old male with a loop colostomy due to a motorcycle accident who underwent endoscopy for designing ostomy closure. Diagnosis of diversion colitis should be differentiated from other diseases with similar clinical manifestations. Clinical history is very important in order to correctly focus on the differential diagnosis. Ischemic colitis is associated with cardiovascular disorders, diabetes, hematological diseases and a history of abdominal operation. Endoscopic appearance is similar to diversion colitis but in severe cases longitudinal ulcerations and strictures may be found. Keywords: bowel loop, diversion colitis, ischemic colitis, petechiae.

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Authors: Murat Berisha, Hysen Heta, Nexhmi Hyseni, Kastriot Haxhirexha

Aim:The University Clinical Center is the single hospital center in Kosovo for endoscopic treatment of vesicoureteral reflux in children. This modern treatment has started since 2009. The aim of this study was to show the results of endoscopic treatment of vesicoureteral reflux in Pediatric Surgery Clinic-Pristina, Kosovo. Methods: From March 2009 to December 2013, fifty-five children (78 ureters) with VUR were treated with subureteral injection of Deflux (dextranomer hyaluronic acid copolymer). Three months postoperatively, a voiding cystourethrogram was performed as a control treatment. Results: The study included 78 refluxing ureters of 55 patients (40 females and 15 males) with VUR. There were 22 children with refluxed ureters alltogether and 33 children had a unilateral reflux. The age of the patients ranged from six months to 12 years old. The mean age of the patients was 5.2 years. There were no complications, but with few recurrences of VUR. In six patients (16.6%), endoscopic treatment with Deflux was conducted twice, while in three patients (8.5%), the endoscopic treatment with deflux was performed three times, because of recurrence. Conclusion: We recommend the endoscopic Deflux injection as first line treatment for children with vesicoureteral reflux. Endoscopic treatment is a minimally invasive method for treatment of vesicoureteral reflux in pediatric patients and it is not associated with complications.

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Authors: Orjola Pampuri, Katarzyna Czabanowska, Bajram Hysa, Enver Roshi, Genc Burazeri

There is an urgent need to develop robust leadership skills among public health professionals. From this point of view, competencies in the area of public health leadership are an important dimension which should be fostered among public health professionals at all levels. To date, there have been developed several competency frameworks in the area of public health leadership as well as medical leadership, which bring together the main principles and concepts of leadership and have been also considered useful for planning professional training and continuous professional development. Notwithstanding the laudable amount of work for the development of leadership competencies in the public health and medical area, the existing frameworks are deemed quite generic and not specific enough to support and strengthen the educational curriculum and training models for public health professionals. From this point of view, recent attempts were made to develop a specific public health leadership competency framework which is meant to significantly strengthen and support the competency-based European public health leadership curriculum. This framework was designed in the context of the Leaders for European Public Health (LEPHIE) Erasmus Multilateral Curriculum Development Project, supported by the European Union Lifelong Learning Programme. This recently established framework will be adopted in the Albanian context. The adoption process will undergo several steps including the procedures of translation and back-translation of the instrument, as well as assessment of validity and reliability of the tool in a pre-test exercise involving a sample of public health professionals in Tirana. Keywords: adoption, competency, framework, leadership, public health.

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Authors: Driton Shabani, Adnan Bozalia, Petrit Bara, Klejda Hudhra, Ledian Malaj, Besnik Jucja

In the public health and medical field, but more specifically in the clinical settings, particular attention should be made in order to avoid adverse drug interactions and their potential toxic effects. In any case, regardless of the efforts to avoid drug interactions and their resulting toxic effects, for individuals taking at least two medications (drugs), the risk of a drug interaction has been estimated at 15%. On the other hand, for individuals taking at least five medications the risk of adverse drug interactions increases up to 40%. Finally, for individuals taking at least seven medications the risk amounts to a disturbing 80%. Hence, the risk of a toxic medication interaction is real considering that more than one half of non-institutionalized adults older than 65 years take five or more different medications, and 12% use ten or more medications.In the United States of America, among the hospitalized patients, adverse drug interactions are estimated to be as high as the fourth leading cause of death. Toxic drug interactions can occur when two or more medications compete in such a way that their pharmacologic interaction causes a detrimental physiologic response.Alternatively, toxic drug interaction can occur when a medication is prescribed in excessive amounts, or when one medication produces inconvenient consequences although it is prescribed according to established guidelines. It has been argued that this last effect is often the most difficult to predict because drug absorption and metabolism can vary with age, concomitant illness, gastric motility, pH of the gastrointestinal milieu, genetic variation, smoking, or some other obscure physiologic parameter. It has been demonstrated that the most dangerous drug combinations in the nursing home population involve warfarin interactions with non-steroidal anti-inflammatory drugs (NSAIDs), sulfonamides, macrolides, or quinolones; angiotensin-converting enzyme (ACE) inhibitor interactions with potassium supplements or spironolactone; digoxin interactions with amiodarone; and theophylline interactions with quinolones. However, the available information on drug interactions and their health effects is scarce for Kosovo including Gjilan region. In this framework, there is an obvious need to conduct population-based studies assessing the potential toxic effects of drug interactions in Kosovo, a post-war country in the Western Balkans. Keywords: drug interactions, Gjilan region, Kosovo, toxic effects.

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Authors: Lindita Ajazaj-Berisha, Salih Ahmeti, Dhimiter Kraja, Sadie Namani, Anita Shala, Emine Qehaja-Buçaj, Bahrie Halili

Aim: This study represents the epidemiological, clinical and laboratory characteristics of Crimean-Congo Hemorrhagic Fever (CCHF) infection in children. Methods: In this retrospective study, there were included 27 children infected with CCHF virus. They were treated in the Infectious Diseases Clinic at the University Clinical Center of Kosovo during the time period 2006-2011. Results: From the 27 children with CCHF, 21 were male (77.8%) and 6 were female (22.2%). Age varied from 16 months to 15 years. The dominating age group was 10-15 years, with a total of 19 cases (70.3%). The majority of children (77.8%) had a history of tick bite. Fever, muscle pain, joint pain, nausea, and vomiting dominated the clinical picture. Increased levels of CPK, LDH, leucopenia and thrombocytopenia were more pronounced in the age group of 10-15 years. CCHF infection was confirmed through ELISA and by real-time polymerase chain reaction (RT-PCR). Ribavirin was given to 51.8% of the cases. Only one case had a fatal outcome. The case fatality ratio was 3.7%. Conclusion: Crimean-Congo Hemorrhagic Fever is a potentially lethal disease. Milder forms of disease are noted in pediatric patients with CCHF. No significant differences in cytokine level are reported between pediatric patients and adults that could count for less severe forms of CCHF in children. Developing immune system of children may be partly responsible for the differences in the disease course of CCHF observed in this age group.

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Authors: Loreta Pojani, Luela Aranitasi, Ramazan Isufi

Aim: Comparison of socio-demographic and clinical data regarding odontogenic infections among hospitalized and ambulatory adults in Albania. Methods: The clinical and socio-demographic data of 159 patients treated in Maxillo-facial Surgery Service at University Hospital Center, Tirana, during the year 2011, were the basis of this retrospective study. Hospitalized and outpatients with odontogenic infections were included in this study. Results: No significant differences were found in age, gender, social status or education of the two groups of patients. A high percentage of hospitalized patients had trismus, edema of the floor of the mouth and decreased mobility of the tongue. The most frequent cause of odontogenic infections in these patients were the mandibular third molars followed by the mandibular first and second molars, whereas in outpatients this role belonged to mandibular first two molars. Conclusion: Important differences exist in the clinical features of odontogenic infections among patients with and without need for hospitalization. Some of these features can help identify potential cases that require hospitalization.

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Authors: Erjola Likaj-Bolleku, Gentian Caco, Nereida Spahia, Merita Rroji, Saimir Seferi, Myftar Barbullushi, Nestor Thereska

Aim: Vascular access has a major impact on morbidity, survival, quality of life and costs of treatment among dialysis patients. In Albania, vascular access problems have become increasingly prominent. In this context, our aim was to study the actual situation of vascular access and factors that contribute to fistula failure in Albania and compare our data with the European and US data and guidelines in order to achieve a better planning with a multidisciplinary team. Methods: In May 2013, we conducted a cross sectional study in six hemodialysis centers in Albania. Overall, 484 patients were enrolled (63% males and 37% females; age range: 19-78 years; mean age: 49.9 years). A thorough present and past history of vascular access was retrieved from all participants. Results: Diabetes was present in 13.8% of participants, whereas time in hemodialysis treatment ranged from 1 month to 22 years (mean value: 3.8 years). At the time of study, 83.5% of the patients had an arteriovenous (AV) native fistula, 2.25% an AV graft and 14.25% a catheter. Fistula failure was significantly more frequent among diabetics, older subjects, those whose fistula was made after initiation of hemodialysis, those with previous subclavian catheters, those who did not use antiaggregants, and in those who had frequently hypotension episodes during hemodialysis sessions. Conclusion: AV fistula is the predominant form of vascular access used for hemodialysis. Subclavian catheters, diabetic nephropathy, older age, non-use of anticoagulants and starting hemodialysis without a fistula were found to be related to fistula failure, implying considerable challenges for the multidisciplinary team.

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Authors: Irida Agolli-Nasufi, Marina Ndrio, Artur Rada

This article explores the phenomenon of stigma and discrimination and their impact among people living with HIV/AIDS (hereafter, PLWHA). Furthermore, this article describes the stigma and discrimination experiences in workplaces, family, community, healthcare environments and the impact of media. Secondary data analysis, semi-structured interviews and content analyses of individual/personal diaries of PLWHA are used as research methods to explore the research questions. Participants of the study (PLWHA and service providers) have been identified at the Ambulatory Care Center in Infectious Disease Service at University Hospital Center of Tirana (UHCT), Albania. Data analysis shows high levels of stigma experienced by PLWHA. Stigma related to HIV brings different obstacles and difficulties to PLWHA, which makes them giving up on services for PLHA. There were no cases reported on direct stigma in the workplace, but PLWHA are more than convinced that they would be stigmatised and discharged from their work, if people will come to know that they are infected. Stigma and discrimination expressed by healthcare personnel is more evident in healthcare centers of different cities of Albania where information about PLWHA is missing. Keywords: discrimination, HIV, AIDS, PLWHA, stigma.

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Authors: Wanda Van Hemelrijck, Peter Schröder-Back

The European White Paper “Together for Health” states that reducing health inequalities is an important goal for European health strategies. At first sight, all European countries have universal insurance coverage, implying that there is universal and equal access to health care services. Several studies have shown, however, that this is not the case. Also, although there has been some research on the subject, information on differential health care utilization is incomplete. By taking a look at Andersen’s conceptual framework on the access of health care services and literature on the subject, we composed a list of individual demographic and socioeconomic determinants of health care utilization that should be available in several databases if one’s aim is researching the subject. The aim of this paper is to evaluate whether European data sources make analyses on individual demographic and socioeconomic determinants of health care service utilization possible with the data that is provided. The Health for All Database does not seem to focus on utilization measures and the necessary demographic and socioeconomic indicators, making ecological correlational studies difficult. Eurostat provides more opportunities for this. The European Social Survey does allow some analysis on the subject. However, health care utilization measures are rather limited. The European Health Information Survey includes all of the necessary determinants, as well as measures of health care utilization. Comparability of data resulting from this survey might, however, be restricted. Keywords: demographic and socioeconomic determinants, health care utilization, health for all database.