Albanian Medical Journal

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Authors: Sadet Gjata, Elizana Petrela, Altin Gjata, Genc Burazeri

Aim: A national surveillance system on congenital malformations was established in Albania in 2009. The aim of this study was to portray the prevalence and types of congenital malformations in Elbasan prefecture during 2010-2013, following the introduction of the surveillance system also in this region of Albania. Methods: A cross-sectional study was conducted covering the whole prefecture of Elbasan over the period 2010-2013. Data on the number of congenital malformations in Elbasan region for the period under study were retrieved from the national surveillance system. Conversely, the information about live births and infant deaths was collected from the Albanian Ministry of Health. Results: Overall, during the period 2010-2013, there were 68 cases of congenital malformations in Elbasan region. The prevalence of the congenital malformations for the whole region of Elbasan for the overall period under study was 7.6 per 1000 live births (95%CI=5.9-9.6 per 1000 live births). Overall, there were 22 (32.4%) births defects affecting the cardiovascular system; 13 (19.1%) malformations of the musculoskeletal system; 11 (16.2%) chromosomal defects; 10 (14.7%) defects affecting the genital system; and 12 (17.6%) other types of congenital malformations. Conclusions: Health professionals and policymakers in Elbasan region should take into consideration the magnitude and health consequences of congenital malformations in order to control and prevent them at a population level.

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

Aim: Drug-drug interactions are increasingly acknowledged as an area of major concern in medical care due to their serious health consequences and clinical damage. Our aim was to assess the potential adverse outcomes of drug-drug interactions among hospitalized patients in Gjilan region, Kosovo. Methods: This was a cross-sectional study which included a representative sample of 1921 patients aged 18 years and over (50.3% women) from the regional hospital of Gjilan, Kosovo, during 2011-2013. Drug-drug-interactions were assessed employing the Drug Interactions Checker within www.drugs.com database. In addition, potential adverse outcomes of drug-drug interactions, other relevant clinical data, as well as demographic and socioeconomic information were collected. Results: Overall, 1192 (62%) of the patients experienced drug-drug interactions. Of these, 30% had major interactions, 37% moderate interactions, whereas 33% manifested minor interactions. Main adverse outcomes included liver damage, treatment failure, kidney damage, hemorrhage, anemia, nerve damage, or a decrease in treatment efficacy. Conclusions: Our study highlights the main adverse effects of drug-drug interactions among adult patients in a regional hospital of Kosovo. Health professionals in transitional Kosovo should be aware of the importance of a careful selection of drugs and a proper pharmaceutical care for their patients in order to avoid negative consequences of drug-drug interactions.

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Authors: Irena Seferi, Erind Cafi

Aim: Recently reported experiences suggest that early use of FFP together with RBC in 1:1 ratio in massive transfusion is associated with improved outcome. Our aim was to investigate the current situation of massive transfusion in our country. Methods: We analyzed retrospectively data from trauma patients hospitalized during January 2012-August 2013. We included in the study trauma patients that received more than 5 units of red cells in 4 hours, 23 in total. The transfusion therapy of these patients was evaluated by registering all the components transfused. The RBC:FFP ratio was calculated for each patient. According to the value of this ratio the patients were divided in three groups: patients with RBC:FFP ratio above 1.1, with RBC:FFP ratio 0.9-1.1, RBC:FFP ratio under 0.9. The mortality rate for each group was calculated and groups were compared with each other for transfusion therapy used, and mortality rate. Results: The overall mortality rate was 21.7%. The mortality rate was higher in the groups transfused either with higher or with lower RBC:FFP ratio, the difference between them was not statistically significant, p=0.536. No death was registered in the group transfused with RBC:FFP ratio of 0.9:1.1. The mortality rate was 25% in patients transfused with high RBC:FFP ratio and 40% in patients transfused with low RBC:FFP ratio. Conclusion: Literature data suggest for an early aggressive treatment of coagulopathy in trauma patients by keeping a RBC:FFP ratio of 1:1. We also observed better outcome for patients treated with 1:1 RBC:FFP ratio with no deaths registered. Well defined and updated protocols are needed for the correct treatment of trauma patients with blood components. These protocols should include most recent recommendations on ratios between blood components (RBC, FFP and PC) used in trauma patients, as well as the proper use of fibrinogen and tranexamic acid for better patient outcome.

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Authors: Suzana Kukulj, Marina Serdarević, Silvana Smojver-Ježek, Luka Brčić, Branka Čučević, Miroslav Samaržija, Kristina Galić

Ewing's sarcoma (ES) family of tumors (EFT) is a group of neoplastic diseases including ES, peripheral primitive neuroectodermal tumors, malignant small-cell tumor of the chest wall (Askins tumor) and atypical ES. Primitive neuroectodermal tumours and extraskeletal ES have a similar neural phenotype and can be considered as the same entity. EFT can develop in any bone or soft tissue, but primary appearance in the lung parenchyma is rare presentation. We report a case of young male with primary ES arising in the left lung. Patient referred with history of dry cough and hemoptysis. Computed tomography scan revealed a mass lesion of the left upper lobe and lingula, without verified distal metastasis. Repeated bronchoscopy failed to resolve diagnostic dilemma so minimal thoracotomy was performed. Cytologic diagnosis on the intraoperative samples was malignant neoplasm, possibly epithelial. Based on histology and immunohistochemistry final diagnosis was ES, which was further proved by RT-PCR analysis demonstrating EWS/ERG translocation. Due to difficulties in diagnosing and agressiveness of tumor itself the diagnosis was set at the time when tumor was inoperable with metastatic spread. Although primary Ewing's sarcoma of the lung parenchyma is an extremely rare condition, it should be considered as a part of differential diagnostic algorithm for lung masses. Keywords: Ewing, lung, neuroectodermal tumor, sarcoma.

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Authors: Klodiana Poshi, Geriolda Topi, Sofika Qamirani

Aim: The aim of this study was to evaluate the ponderal index (PI) and other anthropometric measures in newborn infants of women with gestational diabetes (GD) and pre-gestational diabetes (PGD). Methods: We conducted a cross-sectional study including 110 pregnant women (38 with diabetes mellitus and 72 with GD) and their newborn babies, during the period January 2010-February 2013. All the data for pregnant mothers were taken form medical records of University Hospital Obstetric and Gynecology "Koco Gliozheni" in Tirana. Anthropometric measures of infants were recorded within 24 hours after birth. All women included in the study were pregnant for the first time (primigravidae) and with singleton pregnancies. Results: There was no statistically significant difference of PI between infants born from pre-gestational diabetic mothers and mothers with GD. Infant's body mass index (BMI) of mothers with PGD was strongly and significantly correlated with infant's head perimeter (r=0.635, P<0.001), thorax perimeter (r=0.676, P<0.001) and abdominal perimeter (r=0.536, P=0.001). For infants of mothers with GD, no correlation was found between baby's BMI and head, thorax and abdominal perimeters. There was no correlation of infant's PI with pre-pregnancy and current maternal BMI, and this was consistent for both women with pre-gestational and gestational diabetes. Conclusion: No statistically significant changes were found regarding anthropometric values such as BMI, PI, head, thorax and abdomen perimeter in newborn infants of long-time diabetic mothers and mothers with gestational diabetes.

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Authors: Merita Alushani, Ermira Kasa, Ervin Toçi, Nikita Manoku

Aim: Molar pregnancy (MP), the most common form of gestational trophoblastic disease, is statistically associated with an increased risk of gestational choriocarcinoma. Routine use of ultrasound examination has dramatically changed the clinic of MP. In Albania there is scarce information about the effectiveness of ultrasound in early detection of MP. In this context, our aim was to assess the role of ultrasound examination in the diagnosis of MP in Albania. Methods: A cross-sectional survey was carried out in Tirana among 584 subjects who showed up in "Queen Geraldine" obstetric-gynecologic university hospital with signs and symptoms of missed abortion during 2010-2012. Ultrasound and biopsy examination was carried out and results were compared. Basic demographic information and full history of present and past pregnancies was also retrieved. Results: The overall prevalence of MP detected by ultrasound and biopsy was 17% and 50%, respectively. The sensitivity of ultrasound examination to detect MP was 31%. According to the type of MP (complete or partial MP), the sensitivity of ultrasound compared to biopsy was 92% and 29%, respectively. Results of ultrasound and biopsy were of moderate strength (Spearman's rho=0.382, P<0.001). Increased age of mother (>40 years) significantly increased the risk of detection of MP via ultrasound by more than five folds (OR=5.4, P=0.002). Conclusions: Ultrasound examination detects about one third of MPs in Albania. This figure is low compared to the European and world standards where about half of MPs are detected. It is necessary to strengthen diagnosing capacities of molar pregnancies in Albania.

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Authors: Patricia Brownell

In spite of a general consensus in the international research community that domestic violence is a public health matter and knowing rates of prevalence and incidence in the population is useful, there is notoriously little consensus on these rates for elder neglect, abuse and violence. A review of the prevalence literature on neglect, abuse and violence against older women using diverse research frames, categorized as social gerontology or active ageing, adult protection, and intimate partner violence (IPV), provides insight into reasons for this lack of consensus. This overview of the prevalence of neglect, abuse and violence against older women based on different and sometimes competing research frames demonstrates the difficulties in using these data to understand and promote older women's right to live lives of dignity, free of abuse. In order to address the current fragmentation in research on older women and neglect, abuse and violence, the international research community must come together to formulate guidelines that standardize measures, eliminate ageist views, and reflect a more holistic perspective on older women in society. Keywords: abuse, neglect, older women, violence.

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Authors: Iris Allajbeu

Aim: To evaluate the prevalence of coronary artery plaques (CAP) detected by CT angiography in a group of consecutive Albanian individuals with no history of coronary artery disease (CAD) or acute coronary syndrome and investigate the relation between the prevalence of CAP, traditional risk factors and Ca Score. Methods: This was a prospective study including 456 patients with no history of CAD who underwent CTAC at the American Hospital of Tirana from September 2009 to March 2013. CT scan was performed with a 64 detector CT, including Ca Score and angiography of coronaries with IV contrast. Results: The prevalence of CAP diagnosed by CTAC was calculated as 55.7%, overall. Significant correlation was found between all traditional risk factors and CAP, except for hyperlipidemia. Though the presence and severity of CAP increased significantly with the increase of Ca Score, 67% of patients of low risk group (Ca score 0-10) had CAP in CT angiography, from these 46.6% were stenotic lesions (>50%) and 5.4% with severe stenosis. Conclusion: Although a direct relation between the prevalence of CAP, risk factors and the amount of calcium in coronaries was present, a significant prevalence of CAP in low-risk group according to Ca score was found with a considerable presence of stenotic lesions. Although the calcium score does add prognostic value to standard risk factors and serum markers, imaging the vessel wall directly may be helpful to identify CAP and guide therapy.

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Authors: Arben Rroji, Eugen Enesi, Fatmir Bilaj, Edmond Celiku, Fjorda Tukaj, Besian Gega, Sonja Saraci (Butorac)

Malignant biliary obstruction may be due to a wide range of tumors, such as cholangiocarcinoma, gallbladder carcinoma, recurrent or advanced gastrointestinal and colorectal tumors, pancreatic adenocarcinoma and metastasis, causing malignant obstruction through invasion of either the distal, or the hilar or the intrahepatic bile ducts. At the time of diagnosis, the vast majority of such patients are not good candidates for surgical resection, but they may benefit from palliative treatments. Palliative treatment options include percutaneous and endoscopic intervention, chemotherapy and radiotherapy, or the multimodality approach, as a combination of such techniques and therapies. Percutaneous plastic stenting is the treatment of choice for biliary decompression in carefully selected patients with malignant biliary tract obstruction, with significant symptomatic relief, improvement in the quality of life and extension of the survival time. We report two cases of successful percutaneous biliary decompression with good outcomes in patients' survival time and quality of life in two patients with malignant obstructive jaundice as a result of advanced disease. Keywords: endoscopic intervention, malignant biliary obstruction, percutaneous biliary decompression.