Albanian Journal of Trauma and Emergency Surgery

11 -13

Authors: Edvin Selmani, Fatmir Brahimi, Leard Duraj

The concept of damage control surgery was first described for the purpose of treating medically unstable patients with abdominal trauma. The purpose of such surgery is rapid control of hemorrhage and contamination, not definitive repair of injuries. The goal is to improve survival of patients with the potentially lethal triad of hypothermia, acidosis and coagulopathy. Definitive repair of injuries and abdominal closure are not performed at the time of initial laparotomy. Rather, the abdominal wound is left open, a dressing is placed, and the patient is transported to the intensive care unit for continued resuscitation. This includes optimization of hemodynamic condition, respiratory support, warming, and correction of coagulopathy. Following successful resuscitation, when the patient is medically stable, a return to the operating room is scheduled for repair of injuries and abdominal closure.

21 - 26

Authors: Agron Dogjani, Engjellushe Jonuzi, Shkelzen Osmanaj, Fadil Gradica, Rustem Celami, Rifat Latifi

Background: In the last decade, the risk of terrorist attacks has increased largely almost worldwide. In this setting, disaster response personnel must understand the unique physiopathology of injuries associated with explosions and must be prepared to assess and treat the people injured in such tragedies. The ammunition explosion in Gërdec, Vora, just 13 miles from the capital of Albania, Tirana, confronted our country with a real human tragedy with severe casualties. The striking force of the two consecutive explosions resulted in two consecutive earthquakes with respectively an amplitude of 9.2 and 2.5 on the Richter scale. Objective: To explain the classification of explosives and in connection with it to identify the major types of explosive and blast injuries, and the management options in the cases of explosions and blast injuries. Material & Methods: Efforts to dismantle Albania’s stockpiles of obsolete munitions took a catastrophic turn on March 15th, when a series of explosions occurred as crews were clearing out a storage depot in Gërdec, on 15th of March 2008, at 12:15 AM hours. Gërdec is located 10 km northwest of the capital of Albania, Tirana; near the national highway Tirana-Durres and at a distance of 3-4 km in air line from National Airport. Data presented here were collected from the patients’ files in our Trauma UHC and from the official reports from the different governmental offices. Conclusion: The explosive and blast injuries now present a true modern epidemic disease that threaten the very survival of the free world. A thorough understanding of detonation and blast dynamics by the treating teams is required to better correlate the injury patterns presented. This is also critical for revision of current multiple casualty protocols. It is up to the medical establishment to prepare suitable protocols, coordinate manpower and secure medical resources to successfully handle such events.

31-35

Authors: Altin Habazaj, Holta Tafa, Donika Bardhi, Hasan Hafizi

Background: Physiological research on dyspnea has provided some information on how sex differences in lung and airway size can influence the experience of dyspnea during exercise; however, there is still a knowledge gap with regard to sex-related differences in other respiratory symptoms, including cough and sputum production. Objective: The objective of this analysis was to assess sex related differences in reported objective symptoms using data from the population-based Burden of Obstructive Lung Disease (BOLD) study in Albania. Method: Males and females with impaired lung function may experience the same symptoms but perceive and/or report them differently. In this analysis were included 997 responders who had completed the core questionnaire, which included data on respiratory symptoms using the following questions: “Do you usually cough when you don’t have a cold?” and “Do you usually bring up phlegm from your chest, or do you usually have phlegm in your chest that is difficult to bring up when you don’t have a cold. Chronic was defined as three months or more per year. Data used were drawn from the final report for Albania provided by BOLD team. Results: Overall, male gender was associated with increased odds for reported chronic cough at any group age [Total: 14.7 (2.3) vs. 6.6 (0.9)]. This difference is very much reduced in the group age 70+ years old [25.8 (8.2) vs. 21.3 (6.8)]. In the contrary when we used the estimated population prevalence of chronic cough by pack-years and gender, female gender was associated with increased odds for reported chronic cough especially in the 10+ pack-years groups [50.4 (11.0) vs. 12.2 (8.3) in 10-20 pack-years and 29.0 (5.5) vs. 26.0 (3.3) 20+ pack-years] indicating a increased smoking susceptibility of female gender. In contrast, female gender was associated with decreased odds for reported phlegm. Even for the same pack-years of smoking, female gender is associated with decreased odds for reported chronic phlegm [0 vs. 7.1 (8.6) in 10-20 pack-years group; 0 vs. 15.4 (3.0) in 20+ pack-years group]. Conclusions: Physicians need to recognize that although a female may not report chronic sputum or phlegm production and a male may not report chronic cough, a diagnosis of Chronic Obstructive Pulmonary Disease should still be considered as symptoms often are the first step to a diagnosis of underlying airway disease.

41-51

Authors: Lutfi Zylbeari, Sihana Ahmeti Lika, Nasir Behxheti, Mirlind Behxheti, Zamira Bexheti, Jetmire Jakupi- Alimani, Hanife Ahmeti, Ferizate Dika Haxhirexha, Ledia Kaci, Kastriot Haxhirexha

Background: Homocystinuria is a rare autosomal recessive disease complicated by early and aggressive occlusive arterial disease. This may be related to the grossly increased homocysteine concentrations seen in this disease. More recently, milder hyperhomocysteinemia has been proposed as an independent risk factor for coronary artery disease. Cardiovascular disease (CVD) is among the diseases with multiple contributing factors, hence making it difficult to pinpoint a particular factor alone. The main factor that is of relevance to this study is homocysteine. Coronary artery disease is the narrowing or blockage of the arteries and vessels that supply oxygen and nutrients to the heart (1, 2). CVD is the major cause of morbidity and mortality worldwide. Obesity, HTA, Diabetes mellitus, hypercholesterolemia, and smoking have been recognized as major risk factors for CVD. Aim: Aim of this paper is to examine concentrations of Hcyt and lipid profiles in patients with CVD and positive personal history for CVD, comparing them with the control group composed of healthy individuals. Our study aimed to verify the role of Homocysteine as a new independent risk factor on the onset of early atherosclerosis and atheromatous processes in coronary arteries in patients with CVD. Materials and methods: The results obtained represent the average value earned once every three months in the 3 year period. 5ccm serum with a few heparin spots was sent to the Clinical Laboratory of the University Clinic of Skopje. Results: The results obtained from patients with CVD and control groups are presented in the following text, where a statistically significant difference was observed for p <0.0001 between the parameters obtained by patients with CVD compared to the control group. Concentrations of homocysteine and lipids in patients with CVD compared to the control group showed statistically significant difference with p<0.0001, expected results, and verified in many other multicentric studies. These facts show that raised Hcyt has more impact on the onset of CVD. When Hcy levels are in the blood, the activity of the cystathionine-synthetase enzyme is raised. It is believed that this enzyme plays a vital role in the metabolism of Hcyt. In recent years a lot of studies have been made on the effect of hyperhomocysteinemia and its impact on the onset of coronary and all have verified that hyperhomocysteinemia is a significant parameter for the onset of early atherosclerosis of coronary and CVD(6,7,8). Conclusions: In the above-mentioned cases, it is recommended substitutive therapy with folic acid, pyridoxine, vitamin B12, vitamin E and other antioxidants which are found that have an effect on the prevention of premature atherosclerosis in patients with CVD and raised Hcyt: acute myocardial infarction, CARB, angina pectoris. PTCA, Stenting, and prevention of stroke.

57-60

Authors: Leon Kaza, Senad Halluni, Rustem Celami, Zef Delia

Cezarean Hysterectomy refers to emergency peripartum hysterectomy - EPH, which is performed as a life saving procedure in cases of continual obstetric hemorrhage secondary to uterine atony, uterine rupture, placental disorders, fibroids, and lacerations during cesarean section - CS or vaginal parturition. Emergency peripartum hysterectomy - EPH, although rare in modern obstetrics, remains a lifesaving procedure in cases of severe hemorrhage. In contemporary obstetrics, overall incidence of severe postpartum hemorrhage was reported to occur in 6.7/1,000 deliveries worldwide. It is one of the leading causes of maternal mortality and morbidity and represents the most challenging complication that an obstetrician will face. The incidence of peripartum hysterectomy in the literature is reported as 0.24, 0.77, 2.3, and 5.09 per 1,000 deliveries by many authors mentioning a few; Sakse et al., Whiteman et al., Bai et al., and Zeteroglu et al., respectively. Nevertheless, there is a lack of Albanian data on EPH. To our knowledge, there is no Portuguese information on postpartum hemorrhage and EPH, which does not mean that we do not have suc obstetrical complication and therefore such emergency intervention. This paper’s intention is to bring awareness of such catastrophic obstetrical complication especially in young primigavida and primipara women.