Albanian Medical Journal

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Authors: Edlira Harizi (Shemsi), Arben Rroji, Sazan Gabrani

The circle of Willis constitutes a key collateral network for preserving a satisfactory cerebral perfusion. Therefore, changes in the normal morphology of the circle of Willis may lead to different types and degrees of cerebrovascular disorders including aneurysms, infarctions and other vascular abnormalities. This short report summarizes the main types of anatomical variations of the circle of Willis such as: (i) hypoplasia (affecting the posterior communicating artery; the circular part of the posterior cerebral artery; the circular part of the anterior cerebral artery; or the anterior communicating artery); (ii) accessory vessels (in the form of duplications/triplications of one of the components of the polygon); (iii) anomalous origin (consisting of the persistence of the embryonic derivation of the posterior cerebral artery from the internal carotid); (iv) absent vessels (of one or other posterior communicating arteries). Besides single anomalies, multiple abnormalities (consisting of different combinations of the variations mentioned above) of the circle of Willis are not rare. In addition to different vascular accidents, it is important to identify the status of the circle of Willis in order to determine the capability of the brain circulation in operations, especially for cerebral aneurysms. Similar to other countries in the world, it is important to assess the magnitude and different types of anatomical variations in adult human brains in the Albanian population. Keywords: aneurysms, cerebrovascular disorders, circle of Willis, hypoplasia.

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Authors: Brizida Refatllari, Loreta Kuneshka, Admir Nake, Vjollca Shpata, Ergeta Ktona, Ferdinand Canaj

Aim: The aim of this study was to assess the influence of disease characteristics (severity, localization, duration) on the level of depression symptoms in patients with acne vulgaris in Albania. Methods: In this cross-sectional study conducted in 2011-2012, participated 382 patients with acne vulgaris, of both sexes, aged 18-40 years, (mean age: 22.6±4.5 years). Acne was classified by severity of lesions into mild, moderate and severe grade; by localization of lesions: mostly in face, mostly in chest and back and on face, chest, back; by the duration of acne: less than 6 months, 6 months-1 year, 2-5 years, over 5 years. The DASS questionnaire was used to assess the symptoms of depression. Results: From 382 patients with acne vulgaris, 56.3% of them had a mild grade of acne, 31.4% of them had a moderate grade of acne and 12.3% had a severe grade of acne. About 56% of the patients had lesions mostly in face, 21% of them had lesions mostly in chest and back, and 20% of them in face, chest and back. About 27% of the patients referred a duration ≤1 year, 33% of them a duration 2-5 years and 39.3% of them a duration >5 years. The symptoms of depression were present among 27.5% of the patients. There was no correlation between severity, localization and duration of acne and severity of depression symptoms. Conclusions: The clinical features did not affect the level of depression symptoms in this study which included Albanian patients with acne vulgaris. Our finings need more robust investigation in future studies in Albania and other similar settings.

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Authors: Altin Gjata, Teuta Backa, Sadet Gjata

Aim: The purpose of this study was to assess the magnitude and distribution of rheumatoid arthritis in Elbasan district, which is part of one of the main regions in Central Albania. Methods: A cross-sectional study was conducted in Elbasan district including all cases with rheumatoid arthritis seeking care at primary health care services during the period January 2012 to December 2014 (219 cases: 81 men and 138 women). Diagnosis of rheumatoid arthritis was based on clinical signs and symptoms and laboratory examination. Fisher's exact test was used to compare sex-differences in the distribution of genetic factors and behavioral characteristics. Results: Overall, the prevalence of rheumatoid arthritis for the three-year study period was 78/100,000 population. Conversely, the mean annual incidence of rheumatoid arthritis in Elbasan district was 3.7/100,000 population. Genetic factors were more prevalent among female cases, whereas smoking, alcohol intake and excessive meat consumption were more prevalent in male cases. On the other hand, there were no sex-differences in the prevalence of chronic conditions including hypertension, heart diseases and diabetes. Conclusion: This study provides important evidence about the magnitude and distribution of rheumatoid arthritis in Elbasan district, which constitutes an under-researched area of transitional Albania. Health professionals and policymakers in Albania should be aware of the negative health impact of rheumatoid arthritis in the adult population.

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Authors: Edlira Beqiri, Amarold Balliu

Aim: To assess whether blockade of nociceptive input with bupivacaine during tonsillectomy can decrease post-operative pain. Methods: This study was carried out during 2009-2012 and included 347 Albanian children aged 2.5-16.0 years who received either pre-incisional peritonsillar infiltration with lidocaine 0.2% 4-5mg/kg+ epinephrine 0.001% (group I), or pre-incisional peritonsillar infiltration with bupivacaine 0.25% 1-2mg/kg+ epinephrine 0.001% (group II) as a method of relieving post-operative (tonsillectomy) pain. Post-operative pain was assessed using a four-point system. T-test and chi-square test were used to compare the results between the two study groups. Results: In this study, pre-incisional Bupivacaine infiltration into the tonsillar fossa resulted in better and longer pain free periods compared to lidocaine use of local anesthesia. Conclusions: Pre-incisional Bupivacaine infiltration into the tonsillar fossa could effectively reduce the post-operative pain in Albanian children following tonsillectomy.

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Authors: Floreta Kurti, Albana Duni, Ernst Plefka, Tatjana Çina

Aim: Inflammatory Bowel Syndrome (IBS) is characterised by recurrent abdominal pain, diarrhea, constipation or alternating constipation and diarrhea, as well as gassiness and meteorism. The aim of this multicentre study was to demonstrate the efficacy and tolerability of compounded charcoal tablets in a large number of patients with IBS treated over a period of 12 weeks. Methods: 802 patients from three countries (Hungary, Morocco and Albania) participated in this study [543 patients (68.2%) were female and 253 patients (31.8%) were male]. IBS was diagnosed at the beginning of the study in 756 (95.5%) of 792 patients, of whom 488 patients (59.9%) were with constipation. Diarrhea was diagnosed in 90 patients (12.0%) and in 148 patients (19.8%) alternating constipation and diarrhea. IBS in patients was evident since 36.8±50.2 months. Daily dosage of six pills per day was adapted within the 12-week therapy step-by-step. The dosage was documented at the start of the trial, at week six and at the end of the trial (at week twelve). Results: Evaluation of the efficacy by physicians and patients at the end of the study (week 12) shows a significant reduction of abdominal pain, significant improvement of symptoms, which are influencing also the quality of life, such as constipation, hard stool, modified bowel movement and abdominal press, abrupt impulse to defecate, sense of incomplete defecation, flatulencies, and abdominal distension. Conclusion: This multicentre study showed that this highly significant and clinically relevant reduction of abdominal pain, as well as the significant improvement of most of the other symptoms, has a clear impact on the improvement of the quality of life in patients with IBS. The side-effects were few and not relevant. The efficacy and tolerability of this natural compounded charcoal tablets, composed of solely natural ingredients can, therefore, be described as very satisfactory.

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Authors: Nevila Tabaku, Ilir Bibolli, Adriana Babameto

Aim: Hiatal hernia may cause reflux. The prevalence and size of hernias in patients with reflux including its subgroups (NERD, GERD, or Barrett's esophagus) was investigated in the current study conducted in Albania. Methods: Patients were recruited at Regional Hospital of Shkodra, northern Albania. A total of 255 patients (53% male; overall mean age: 51.90±9.65 years) were included in this study. Following an assessment of medical history, all patients underwent a digestive endoscopy. Results: There was a statistically significant difference between patients with esophagitis and Barret esophagus, and without esophagitis with regard to the presence and size of hiatal hernia (P<0.001). Hiatus hernia was found in 42% of the patients with GERD, in 66.7% of the patients with reflux esophagitis and in 69.2% of the patients with Barrett esophagus. Reflux esophagitis and Barrett esophagus were significantly related to hiatus hernia (P<0.001). The severity of esophagitis was significantly related to the presence and size of hernia (P<0.001). Conclusions: Hiatal hernia was associated with an increased risk of physical complications from gastroesophageal reflux. The knowledge of risk factors may help to distinguish patients with increased risk of endoscopic lesions of the esophagus and, as a result, a higher risk of developing physical complications from GERD. Also, hiatal hernia is likely to contribute to the development of Barrett's esophagus. This is of particular importance for the occurrence of Barrett's esophagus, as a risk factor of the esophageal adenocarcinoma.

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Authors: Prosper Adogu, Ifeoma Udigwe, Gerald Udigwe, Chika Onwasigwe

Aim: Adolescents constitute one-fifth of Nigerian population. Risky sexual behaviour is reported to be rampant amongst them and the females often bear the brunt of the consequence. A comparative analysis was made of the sexual and contraceptive practices of unmarried female students and non students, in Onitsha Anambra State, Nigeria. Methods: This was a cross-sectional comparative design in which 391 school girls were selected from 25 private and 17 public schools in the local government making use of multistage sampling method. Another 392 out-of school adolescent girls were selected from a major market in the same area using cluster sampling technique. Data on socio-demographic profile, sexual practices and contraceptive use were collected by means of pre-tested questionnaires. Results: A statistically significant proportion of the out-of-school girls 24.3% has had sex compared to the in-school girls 17.1% (P<0.05). The out-of-school girls also had statistically significantly lower mean age of sexual debut 14.7±2.7 compared to the in-school girls with a mean of 15.0±2.6. The main reasons for sexual initiation were pressure from partner and friends, transactional and non-consensual sex were also common among both groups. About half of the girls in both groups had multiple sexual partners but a larger proportion of the in-school respondents had sexual partners 5-10 years older than their age. There was no statistically significant difference in the proportion that used contraception at first or last sexual intercourse in both groups. Conclusion: Stakeholders in adolescent reproductive health should develop appropriate strategies such as sustainable peer education to improve the sexual health behaviour of the adolescents, especially the out-of-school girls who are evidently more vulnerable than their in-school counterparts. Community participation in health is also advocated for greater positive impact on the sexual practice and contraceptive use by the adolescents.

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Authors: Vladimir Khryshchanovich, Stanislau Tretyak, Youssef Ghoussein

Aim: To present the long-term allotransplant activity in seven patients who had undergone allotransplantation of macroencapsulated parathyroid cells for surgical hypoparathyroidism. Also, a modified technique to prepare parathyroid cellular allografts is described. Methods: From December 2010 to November 2011, seven patients with severe postsurgical hypoparathyroidism underwent seven allotransplantations of cultured macroencapsulated parathyroid cells. Mean recipient age was 52 years (range: 39-59 years). Donors were selected from patients undergoing parathyroidectomy for primary (adenoma) and secondary (due to chronic renal failure) hyperparathyroidism. Results: After cultivation and freezing, the parathyroid cells showed their high secretory activity of parathormone (2927.5 [1400.5-4847] pg/ml). The viability of cultured cells was 99%. For all patients, the median cellular allograft survival was three months (range: 1-9 months). In four patients (57.1%) the allografts retained their endocrine function for more than two months. None of the patients showed clinical symptoms of hyperparathyroidism in the post-transplantation follow-up period. Conclusion: The present study has shown that in some patients parathyroid cell allotransplantation may be considered a method of treatment for permanent hypoparathyroidism after thyroid surgery. Allografted human cultured parathyroid cells showed evident but transient hormonal activity. Graft function and/or survival did not depend on the donor age and recipient characteristics.