Albanian Medical Journal

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Authors: Amarildo Belshi, Gjergji Belba

Aim: Understanding of the epidemiology of palpebral tumors is of paramount importance for ophthalmologists and other health professionals, as well as decision-makers and policymakers involved with health care planning and policy formulation. The aim of this study was to describe the palpebral lesions with regard to their geographical and ethnic variations, as well as differences in the incidence rates in various countries of the world. Methods: Data about palpebral lesions for the current report were collected from the Ophthalmology Service of the University Hospital Center Mother Theresa in Tirana, in addition to a wide array of international scientific articles. In particular, the current report describes differences in the incidence rates and the geographical and ethnic variations of palpebral lesions in different parts of the world. Results: There are significant differences in the incidence rates of palpebral tumors between various countries in the world which are presumably related to variations in skin types, geographical latitudes, health behavior including sun exposure, disease awareness among the general population and the surveillance systems for these diseases. Regardless of the geographical variations, the incidence of malignant palpebral tumors is increasing in many countries of the world. Conclusion: Given the fact that palpebral lesions constitute an important share of the overall skin lesions, early diagnosis of these pathologies is of paramount importance. From this point of view, a prompt and accurate assessment of the clinical characteristics of palpebral lesions can inform early treatment which is a basic prerequisite for a favorable prognosis of these conditions.

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Authors: Armand Shehu, Migena Kika, Afërdita Tako, Sonila Tomorri, Robert Rado, Aida Bushati, Valentina Tashko

Aim: Epilepsy is quite common in autism spectrum disorders (ASD) and represents a challenge for its treatment. We aimed to assess the prevalence of epilepsy in children diagnosed with ASD in Tirana, the capital of Albania. Methods: This is a cross-sectional study including 128 children diagnosed with autism spectrum disorder showing up at the National Center of Child Welfare, Development and Rehabilitation in Tirana during the period 2012-2013. Electroencephalographic (EEG) recordings were obtained for all subjects. In addition, all children underwent a psychiatric examination. Two independent child neurologists examined ASD children and diagnosed and classified epilepsy according to agreed criteria. Results: The mean age of children was 4.2±1.6 years (range: 0-7 years). Prevalence of epilepsy among ASD children was 21.1% during the study period. According to age-group, seizures occurred in 15.6% of the children aged <3 years and 29.4% of those aged 4-7 years. Among epileptic ASD children, the most common type of epilepsy was the psychomotor epilepsy, present in 59% of cases, alone or combined with other types of epilepsy. Around 22% of epileptic ASD children had epilepsies that caused a great deal of complications in the child's daily life and that proved to be therapy resistant. Conclusion: Epilepsy in ASD children in Albania is quite common. Therefore, ASD children must be carefully examined in order to detect the existence of co-existing epilepsy and adapt the treatment to this scenario. Clearly, treating epilepsy and ASD poses considerable challenges to the individual, family and the health system in Albania.

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Authors: Tony Yonkov Vekov

This study analyzes the differential growth of the relative changes of the quantity of the medical products in the reimbursement list and the respective relative changes of public expenditure in Bulgaria for a decade of experience (2004-2013). For this purpose, we used the reimbursement lists for the respective years and the accounts on the cash execution of the budget of the National Health Insurance Fund in Bulgaria. After 2008, a double digit growth was registered in the number of reimbursed medicines annually, and the dynamics and the public expenditure for these medicines were similar. We propose additional conditions for including medical products in the positive and reimbursement lists, in order to optimize the control both of the public, as well as the personal expenses for the price of the medical therapies in Bulgaria.

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Authors: Rezart Ajazi, Orgeta Maci, Gazmend Bejtja

Aim: Gestational diabetes (GDM) and preeclampsia (PE) are associated with an increased risk of maternal and perinatal short-term and long-term complications. Despite the available evidence, there is no definitive information about the association of GDM and PE, particularly in developing countries. In this context, we aimed to determine whether GDM is associated with an increased risk for subsequent preeclampsia in transitional Albania. Methods: This was a retrospective cohort study including all pregnant women being hospitalized for different reasons in the two public tertiary obstetric-gynecologic university hospitals in Tirana, the capital of Albania, during 2005-2012. Diagnosis of GDM was based on a fasting plasma glucose level higher than 120 mg/dl, or postprandial glucose levels higher than 180 mg/dl (exposed group). The non-GDM control group comprised hospitalized pregnant women who did not develop GDM during the same time interval. Pregnant women with previously known diabetes, chronic hypertension, chronic renal disease and prior hepatic disease were excluded from both study groups. Incidence of PE was measured in both groups and results were compared. Results: GDM occurred in 89 (2.8%) patients among all pregnant women meeting study criteria (N=3218). The incidence of preeclampsia was significantly higher in the exposed group (GDM pregnant women) than in the non-exposed group (non-GDM pregnant women)(27% and 13.5%, respectively, P=0.039). GDM pregnant women were 2.37 times more likely to develop PE compared to non-GDM pregnant women. Conclusion: GDM is a significant risk factor for preeclampsia in pregnant women in Albania. Special attention should be paid to the association between GDM and PE in order to improve the treatment quality of these patients. Future studies are needed in order to support our findings.

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Authors: Rubena Moisiu, Enkeleda Prifti, Alketa Hoxha, Enver Roshi, Eriola Pupi

Aim: Our aim was to assess the role of gestational age and weight at delivery of intrauterine growth restricted (IUGR) preterm fetuses with placental dysfunction in order to help clinicians and parents for a better planning of the time of delivery. Methods: A prospective observational study was conducted during 2010-2014 at the University Hospital of Obstetrics-Gynecology Koço Gliozheni in Tirana including pregnant women with a unique fetus, between 26.0wGA-36.6wGA, with intact membranes, with a fetal weight lower than the tenth percentile, and with at least one abnormal Arterial Doppler up to three days before delivery. After delivery, we collected data about adverse perinatal outcome as a composite outcome of perinatal mortality and severe morbidity: HIV (intraventricular hemorrhage), LP(periventricular leucomalacia), EN (necrotizing enterocolitis), BD (bronchopulmonary dysplasia), and sepsis. Results: Our study included 91 cases. For all the subjects: Mean Gestational Age during diagnosis was 33±2.1wGA, Estimated Ultrasound Mean Fetal Weight was 1471±368g, Mean Gestational Age during delivery was 33.0±2.1wGA, and Mean Neonatal Weight was 1477±360g. Perinatal deaths were around 11%. Deaths and severe morbidity were significantly related to gestational age (LR: 1.18-2.82, P=0.001) and Fetal Weight (LR: 181-487, P=0.001). According to Kaplan-Meier analysis, for a gestational age below 31wGA, findings conferred a 31-fold increased risk of adverse perinatal outcome (HR=31.0, 95%CI=30.1-31.8, P<0.0001). Conclusion: Perinatal outcome in preterm IUGR fetuses was significantly related to gestational age and weight at delivery in this study conducted in Tirana, the capital city of Albania.

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Authors: Artur Kollcaku, Julia Kollcaku, Valbona Duraj, Teuta Backa, Argjend Tafaj

Aim: The purpose of this study was to determine selected socio-demographic and lifestyle/behavioral independent correlates of low bone mineral density among women in post-communist Albania. Methods: We carried out a cross-sectional study in Tirana city in 2010 involving a populationbased sample of 549 women >35 years (mean age: 55.6±9.1 years; response rate: 92%). Bone mineral density was assessed with a bone ultrasound device which is recommended for screening of bone mineral density in similar population-based studies. General linear model was used to calculate mean T-scores for bone mineral density between different socio-demographic and behavioral categories of women included in this study. Results: In multivariable-adjusted general linear models, mean value of the T-score was significantly lower among older women (P<0.001), those with a lower level of education (P<0.001), in smokers (P=0.001), women who reported a frequent consumption of coffee(P=0.019) and in normal weight women (P<0.001). Upon multivariable adjustment for the other covariates, the association with tea consumption was borderline statistically significant (P=0.092). Furthermore, in multivariable-adjusted models, there were no significant relationships with marital status, or employment status (P=0.108 and P=0.097, respectively). Conclusion: This study informs about selected independent factors associated with bone mineral density in adult women in the Albanian population. Our findings may help rheumatologists and other health professionals in Albania to identify the socio demographic and behavioral groups of women who are most at risk for development of low bone mineral density in this transitional society.

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Authors: Florian Dashi, Arsen Seferi1, Arben Rroji, Eugen Enesi, Suzana Gjeci, Fatime Elezi, Valbona Alikaj, Mentor Petrela

Epilepsy is a serious disease affecting people of all ages, races and socioeconomic backgrounds. It is the second most common cause of mental health disability. Despite treatment with antiepileptic drugs, 40% of the patients are resistant to treatment and suffer from chronic epilepsy, long term disability and premature death (SUDEP). The most common cause of these drug-resistant epilepsies is temporal lobe epilepsy related to mesial sclerosis. It has been demonstrated through randomized clinical trials that surgery may render a good proportion of these patients seizure-free. But, patients should undergo a non-invasive, yet specific, pre-surgical evaluation to achieve the best results from surgery. The aim of this article was to demonstrate the Albanian experience with four cases, inviting health care professionals to consider surgery as an option for their drug-resistant patients. Keywords: epilepsy, sclerosis, surgery.

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Authors: Kevin Rieger

Aim: The world has faced a major transition in causes of death from communicable to non-communicable diseases as well as lifestyle risk factors. However, quantifying these challenges for health policymakers is a difficult but necessary task in order to tackle specific health problems. Regional health profiles may facilitate the identification of certain patterns and enable policymakers and researchers to generate further hypotheses and pathways of investigation. The aim of this study was to develop a regional health profile of the Western Balkan countries using Disability-Adjusted Life Years (DALYs). Methods: DALYs provide a uniform tool to measure the health gaps of countries. DALYs quantify the number of years lost for each individual due to premature death and years lived with a health limiting condition. In this analysis, DALYs of seven indicators were used to assess the health of the Western Balkan countries and to identify regional patterns. Results: Only nutritional deficiencies show decreasing DALYs for the whole region. Ischemic heart diseases, high blood pressure and tobacco consumption are decreasing, but not for all countries equally. Years lost due to alcohol use is slightly increasing but constitutes a major challenge for Bosnia and Herzegovina, while diabetes and road injuries show diverse increasing and decreasing trends throughout the region. Conclusion: Applying DALYs to generate a quick health profile of the Western Balkan region has proved effective. Major similar trends have been identified, as was the case for nutritional deficiencies. Furthermore, this cross-country comparison may be used to generate additional research questions that might investigate the huge gap in DALYs attributed to alcohol in most of the Western Balkan countries.