Albanian Medical Journal

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Authors: Mari Pollari

Most of the countries in the world have developed effective health services based on universal health coverage. Albania, a transitional country in the Western Balkans, should also embark in this difficult journey towards universal health coverage. While there is no doubt for the need of such integrated attempts, there is a significant amount of ill-health which can be prevented effectively by investing in health promotion and disease prevention.

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Authors: Mirlinda Likmeta, Artan Shkoza, Sokol Myftiu

Peg-interferon alpha is a molecule frequently used in the treatment of chronic hepatitis B, C, and D, with immunomodulatory and antiviral activity. It is also used in some cancer types. It has been widely claimed that interferon alpha triggers autoimmunity, with its broad adverse effect profile. Here we present the case of a 49-year-old male patient with chronic hepatitis B diagnosis, who developed type 1 diabetes mellitus and peripheral neuropathy during the treatment with peg-interferon alfa-2a. Within four months of initiation of treatment with peg-interferon alfa-2a, the patient presented to our clinic with tiredness, myalgia, arthralgia, and blood glucose level of 166 mg/dL. Four months later, on November 2013, his fasting blood glucose level was 287 mg/dL. The patient complained of thirst, decreased balance and gait changes; he was admitted to the gastro-hepatology clinic for a thorough evaluation. Endocrinology consultation was requested and the patient was diagnosed with type 1 diabetes mellitus. Insulin therapy and diabetic diet was started, and blood glucose and HbA1C levels were monitored regularly thereafter. The endocrinologist recommended the evaluation of nerve conduction. The results of this examination showed metabolically-induced axonal demyelinating sensitive neuropathy with subnormal evoked potential amplitude and conduction velocity of sural nerve. For patients who will receive treatment with interferon alpha, especially those individuals with chronic hepatitis, pancreatic autoantibodies should be checked; close monitoring of glucose levels, neurological signs and symptom, prior to and during the treatment, are also mandatory.

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Authors: Rubena Moisiu, Alketa Hoxha, Enkeleda Prifti, Ehadu Mersini, Jolanda Hyska, Eduard Tushe

Aim: Initiation of breastfeeding within the first hour can help prevent neonatal deaths caused by sepsis, pneumonia, and diarrhea and may also prevent hypothermia-related deaths, especially in preterm and low birth weight infants. The aim of this study was to assess the level of awareness and training of the maternity staff in Tirana, Albania, for performing, documenting and reporting indicators of breastfeeding within the first hour of life. Methods: This was a prospective study conducted at the Department of Obstetrics of the Maternity Koco Gliozheni in Tirana during the period July-October 2014. Overall, 80 infants were included in this study. Results: The average gestational ages was 39.4±0.9 weeks, whereas the average birth weight of the newborns was 3224±306 g. Evaluation based on physical development of infants was as follows: AGA: 59 (73%), LGA: 11 (13.7%), and SGA/IUGR: 10 (12.5%). Distribution by sex: 44 (55%) males and 36 (45%) females. Based on the parity, 21 (26.2%) were primiparous, 34 (42.5%) were secondiparous and 34 (42.5%) were tertiparous. About 49% of the babies were placed in the breast within the first hour of life. The medical charts, however, documented that 100% of infants were placed in the breast within the first hour of life. Conclusions: Nearly half of the babies were not put in the breast within the first hour of life in this study conducted in Tirana. Babies were put in the breast significantly more in the morning hours where the attention of the medical staff is usually much higher. Medical staff is aware of documenting breastfeeding within the first hour of life, but we noticed discrepancies between documentation and the exact time of initial breastfeeding of the newborns.

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Authors: Alma Barbullushi, Etleva Refatllari, Anyla Bulo, Anila Beqja, Jovan Basho

Aim: Anemia is one of the most important symptoms associated with several pathologies of the gastrointestinal tract. The aim of this study was to assess the level and types of anemia among patients with different diseases of the gastrointestinal system in Albania. Methods: This study included 100 patients with various pathologies of the gastrointestinal tract, who were admitted at the Gastroenterology and Hepatology Service of the University Hospital Center Mother Teresa in Tirana, Albania. All of the patients were examined and treated during the period February-June, 2012. Results: The infections/inflammation of the gastrointestinal tract accounted for 41% of the overall patients included in this study. In this group, 82% of the patients had erythropenia, 15% had normal values of erythrocytes and 3% had an increased number of erythrocytes. Based on hemoglobin levels, 60% of the patients had minor anemia, whereas moderate and severe anemia comprised 20% of cases each. Conclusion: In the Albanian context, we showed that the most common cause of chronic anemia consists of gastrointestinal diseases, and this fact explains why the majority of the patients with anemia are referred to gastroenterologists.

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Authors: Leonard Simoni, Ervina Shirka, Artan Goda

Aim: We sought to investigate the impact of body mass index (BMI) on morbidity and all-cause mortality in patients following first-time elective percutaneous coronary intervention (PCI). Methods: We included in this study 334 patients who underwent for the first-time elective PCI from September 2011 to October 2012 at the Department of Cardiology and were followed for a period of one year. The impact of BMI on prognosis was examined. We excluded patients who had previously undergone revascularization. Patients were categorized according to BMI groups: BMI=18.5-24.9 kg/m2 (normal group); BMI=25-29.9 kg/m2 (overweight group) and; BMI>30 kg/m2 (obese group). Results: During the follow-up period there was only one death in each group. Compared with normal weight individuals, those overweight had more high risk for coronary anatomy (either three vessel disease or left main stem stenosis) (13.6% vs 1.6%, P=0.0241), length of stents per person higher (29.89±14.75 vs 35.17±18.23, P=0.042) and were older (60.56±9.94 years vs 57.37±10.26 years, P=0.042). The mean diameter of stents per person used in obese individuals was significantly larger compared to normal weight individuals (3.15±0.35 vs 2.95±0.29, P<0.001). Compared to normal weight individuals, those overweight had a significantly reduced number of hospitalizations for CVD (7.9% vs 24.2%, P=0.0008) and all cause death or hospitalizations for CVD (8.5% vs 25%, P<0.001). Also, compared to normal weight, obese individuals had a reduced number of hospitalizations for CVD (11.3% vs. 24.2%, P=0.09). Conclusion: Patients with increased BMI undergoing percutaneous coronary intervention have a more favorable clinical performance.We suggest that the obesity paradox partially can be explained with the existence of a large coronary damage, which may contribute to more favorable outcomes and with the inverse association between diameters of vessels treated and clinical outcomes.

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Authors: Philip Astaire Hines

Quality-adjusted life years (QALYs) have received a growing amount of criticisms. This paper sought to evaluate the future of QALYs though establishing and assessing common critical themes. Electronic searches of PubMed and Web of Science were conducted. The resulting papers were screened for their common critical themes. A total of 19 relevant studies were found, with six common critical themes: direct and indirect assessments report different disease weightings; patients and the public report different disease weightings; underreporting and lack of standardisation in generation of disease weightings; ageism of QALYs and equity vs. efficiency. The critical themes identified call into questions QALY s validity and reliability. However, they do not completely nullify QALYs as a pragmatic tool for Health Technology Assessments and health economics more broadly. They also highlight areas where QALYs can be improved such as standardisation and incorporating social welfare functions into the QALY construct.

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Authors: Indrit Kellici, Bledar Kraja, Rozana Aleksi, Marsela Sina, Skerdi Prifti

Aim: To compare the prevalence and severity of gastroesophageal and extraesophageal symptoms in patients with gastroesophageal reflux disease (GERD) in Albania. Methods: In this descriptive study, we investigated 248 patients (mean age: 46.5±16.3 years)diagnosed with erosive esophagitis by upper endoscopy. We assessed the severity of esophagitis by Los Angeles (LA) classification and the gastroesophageal and extraesophageal symptoms by a standard questionnaire. The prevalence of symptoms between mild erosive esophagitis(LA grade A/B: 230 patients) and severe erosive esophagitis (LA grade C/D: 18 patients) were described and reported. Results: The prevalence of severe gastroesophageal symptoms (heartburn, acid regurgitation, and dysphagia) was higher in patients with severe erosive esophagitis than in those with mild erosive esophagitis. Patients with severe erosive esophagitis also had a higher prevalence of extraesophageal symptoms (cough and sore throat) than patients with mild erosive esophagitis (44% vs. 19% and 28% vs. 16%, respectively). Conclusions: The prevalence of gastroesophageal and extraesophageal symptoms were higher among patients with severe erosive esophagitis. In the future, prospective clinical studies in multiple medical centers are warranted to generalize our findings in the overall Albanian population.

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Authors: Robert Qirko, Elton Koroveshi, Bledar Benja, Alojva Xhelilaj, Verona Beka

Aim: The aim of this study was to assess the cerebro-placental ratio and its influence on postnatal outcomes in pregnancies complicated with preeclampsia in Albania. Evaluation of this ratio and its values were determined based on fetal outcomes. Methods: In this study there were involved 106 patients diagnosed with preeclampsia or gestational hypertension hospitalized in the Queen Geraldine University Hospital in Tirana during the time period 1 October 2010 31 July 2012. For each patient, a Doppler flow velocity was performed and the result of the last examination conducted before labor was taken into consideration. The cerebro-placental ratio (PI ACM/PI AU) was considered abnormal or inverted when its value was lower than one. The fetal wellbeing was assessed immediately after delivery and in the first days after birth. The corresponding values were determined. Results: Patients were evaluated based on their mothers age, prematurity, Apgar in the first and the fifth minute, method of delivery, corresponding IUGR, or fetal weight. Mortality and morbidity of newborns were evaluated based on their ratio of cerebro-placental blood flow in utero. The same evaluation including amniotic fluid was the basis of evaluation for IUGR, preeclampsia severity and fetal outcomes. Conclusions: Cerebro-placental blood flow velocity can be used to decide the time of delivery for preeclamptic women. Fetal outcome is often compromised in cases with inverted flow velocity. Abnormal cerebro-placental blood flow velocity results in a higher rate of Cesarean section delivery. Morbidity and mortality indicators may be improved if the cerebro-placental ratio is considered.