Background: Traumatic brain injury (TBI) is the leading cause of mortality and invalidity worldwide. Objective: To explore whether traumatic brain injury may be a risk factor for subsequent stroke and to evaluate the role of other risk factors correlated with TBI and stroke. Methods: We analysed 643 patients presented in the emergency department of Trauma UHC, from 1stof June 2011 - 1st of December 2011. We evaluated the following factors: age, gender, and severity of head trauma, type of head trauma, systemic hypertension, atrial fibrillation, and diabetes mellitus. Results: During 1-year of follow upperiod 32 (4.97%) strokes occurred in TBI patients. The evaluation was done in correlation with the other risk factors taken into account in the study. Conclusions: The role of TBI is underestimated in the evaluation of stroke. This study demonstrated that during the first year after TBI, 13.53 % of patients experienced stroke. After careful statistical correlations with the selected co-morbidities, we found that the diagnosis of stroke was strongly related with TBI.

Background: Bronchiectasis is usually caused by pulmonary infections and bronchial obstructions. It is still a serious problem in developing countries, as our country. We reviewed the morbidity and mortal-ity rates and outcomes of bronchiectasis surgical treatment. Patients and methods: Between years 2000 and 2016, one hundred and seven (107) patients, sixty nine (69) of whom female and thirty eight (38) male underwent pulmonary resection for bronchiecta-sis. The mean age was 35years (range, 13–66 years). Mean duration of symptoms was 12 years. Results: Symptoms were copious amount of purulent sputum in 84 patients, expectoration of foul-smelling sputum in 72, haemoptysis in 21 and cough in all patients. The indications for pulmonary resection were: medical therapy failure in eighty two (82) patients, massive haemoptysis in eighteen and lung abscess in seven (7) patients. The disease was bilateral in twenty seven (27) patients and mainly confined in the lower lobe. Eighty six (86) patients had a lobectomy, 7 had a segmentectomy, two patients right pneumonectomy. Operative morbidity was seen in 47 patients (43.9 %) and mor-tality in two (2) patients. Follow-up was complete in 97 patients with a mean of 5 years. Overall, 78 patients were asymptomatic after surgical treatment; symptoms were improved in 24, and unchanged or worse in 5. Conclusions: Surgical treatment of bronchiectasis is more effective in patient with localized disease. It is satisfactory with acceptable ratio of morbidity and mortality.

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.

Abstract Background: Bronchiectasis is usually caused by pulmonary infections and bronchial obstructions. It is still a serious problem in developing countries, as our country. We reviewed the morbidity and mortal-ity rates and outcomes of bronchiectasis surgical treatment.Patients and methods: Between years 2000 and 2016, one hundred and seven (107) patients, sixty nine (69) of whom female and thirty eight (38) male underwent pulmonary resection for bronchiecta-sis. The mean age was 35years (range, 13–66 years). Mean duration of symptoms was 12 years. Results: Symptoms were copious amount of purulent sputum in 84 patients, expectoration of foul-smelling sputum in 72, haemoptysis in 21 and cough in all patients. The indications for pulmonary resection were: medical therapy failure in eighty two (82) patients, massive haemoptysis in eighteen (18) and lung abscess in seven (7) patients. The disease was bilateral in twenty seven (27) patients and mainly confined in the lower lobe. Eighty six (86) patients had a lobectomy, 7 had a segmentectomy, two patients right pneumonectomy. Operative morbidity was seen in 47 patients (43.9 %) and mor-tality in two (2) patients. Follow-up was complete in 97 patients with a mean of 5 years. Overall, 78 patients were asymptomatic after surgical treatment; symptoms were improved in 24, and unchanged or worse in 5. conclusions: Surgical treatment of bronchiectasis is more effective in patient with localized disease. It is satisfactory with acceptable ratio of morbidity and mortality.

Introduction: Usually, cervical pedicle screw fixation has been considered too risky for neurovascular structures. The purpose of this case report is to present a young male patient who suffered a C4-C5 fracture after a motor vehicle accident treated with a 360°surgical approach without spinal instrumentation. Case report: A young male patient suffered a motor vehicle accident driving the vehicle without seat belt. Instantly after the accident he reports about severe neck pain, inability to move his left extremities, difficulty moving his right extremities, burning pain. All patients had various degrees of cord injury, and they were classified according to the American Spinal Cord Injury Association (ASIA) Impairment Scale and Denis classification. Results: We present this young patient, where the selected surgical approach without using spinal instrumentation resulted has favorable outcome. Conclusion: Surgical options regarding to cervical spine fractures include stabilization and decompression with and without spinal instrumentation. Carefully selected cases may be treated safely without instrumentation avoiding potential complications of spinal instrumentation such pseudoarthrosis, instrumentation failure, infection, etc.

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.

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.

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 are 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 profile in patients with CVD and positive personal history for CVD, comparing them with the control group composed from healthy individuals. Our study aimed to verify the role of Homocysteine as new indipendent risk factor on the onset of early atherosclerosis and atheromateous 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 group 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. In Concentrations of homocysteine and lipids in patietns with CVD compared to the control group showed satisticaly significant difference with p<0.0001, expected results and verified in many other multicentric studies. These facts show that raised Hcyt have more immpact on the onset of CVD .When Hcy levels are in blood, the activity of cystathionine-synthethasae enzyme is raised. It is believed that this enzyme plays vital role on the metabolism of Hcyt. 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 artherosclerosis of coronary and CVD(6,7,8). Conclusions: In above mentioned cases it is recom-mended substi-tuive therapy with folic acid, pyridoxine, vitamin B12, vitamin E and other antioxidants which is found that have effect on prevention of premature artherosclerosis in patients with CVD and raised Hcyt: acute myocardial infarction,CARB,angina pectoris. PTCA, Stenting and prevention of stroke.

Peritonitis (P) is the main complication and primary limiting factor in the extension of continuous ambulatory peritoneal dialysis(CAPD) in developing countries, because of exposure to potential external contamination, especially in people with unsatisfactory hygiene habits.We will present a case of peritonitis in 62 years old woman after the first three months of CAPD treatment. The peritoneal infection is confirmed by cloudy fluid with increased WBC in the dialysis solution (2300..1300..1100 cells/cmm; polymorphonuclears between 60% to 80%), augmented fluid protein content(cca.2.4 g/l), presence of microorganisms and symptoms of acute peritoneal infection(isolated Enterobacteria species, abdominal pain and diarrhoea). The peritonitis was treated following the Oreopoulos group’s recommendations1 and after a report of the sensitivity of the isolated Enterobacteria, with appropriate antibiotic (Amikacine) in recommended intraperitoneal dose. Three days after successful treatment of peritonitis, the definite deafness is developed.

Chronic respiratory diseases are associated with severe, not only pulmonary, but also systemic damage such as dysfunction of peripheral muscles, dysfunction of respiratory muscles, nutritional disorders, cardiac injuries, skeletal disorders, sensory debilities, and psychological dysfunction. Mechanisms of these injuries are many and different. Pulmonary recovery (PR) is an integral part of clinical therapy in patients with chronic respiratory disease who continue to be symptomatic or continue to have pulmonary function depression, regardless of standard medical treatment.

Postsurgical gastro-intestinal or intestinal-intestinal anastomotic leaks while not frequent, are the most feared complications for any anastomoses performed in the gastrointestinal tract (GIT) by general surgeons. This is particularly important in the upper GIT, such as gastro esophageal anastomosis, where leaks can lead to severe sepsis and septic shock, need for re-operation, or stent placement. For this short review we will address postoperative leaks following esophagectomy and sleeve gastrectomy as the most frequent bariatric procedure today. The factors and causes responsible for Upper Gastro-Intestinal Anastomosis, as they relate to patient, surgeon or technique will be reviewed. Moreover, the diagnosis and current management will be examined.

Background: The presence of foreign bodies in the digestive tract usually occurs in pediatric, adolescent and psychiatric patients. Current Protocols focus mainly on pediatricians and adults. We present some cases mainly of feminine age. Most swallowed foreign bodies will harmlessly pass through the GI tract, but some will lead to health problems if they become lodged (too big to pass, such as a spoon, or small objects like a pill that adheres to a moist surface); traumatize the mucosa (sharp or pointed object, like a razor blade or pin), or cause burn-like illness (biologically active, such as a button battery or a medication patch) may cause problems. which during X-Ray abdominal exfoliation show varying objects in the digestive tract at different levels. The following examinations highlighted the most accurate localization. Asymptomatic clinical data continued to deteriorate, despite imaging evidence. This article discusses the challenges involved in the management of foreign troops in the digestive tract and the re-evaluation of literature

Background: Radical surgical resection of lung cancer with or without adjuvant treatment is still a prerequisite for cure. Advances in operative and postoperative care led to a decline in complications and mortality rates during the last decades. In spite of different additional modes of treatment, survival is still poor. The aim of study: To examine the operative mortality and morbidity after lung cancer surgery and to identify factors associated with an adverse outcome. Material and methods: The study comprised 968 consecutive patients referred to University Hospital of Lung Disease, “Shefqet Ndroqi” Tirana, Albania, for lung carcinoma, during a 13-years period (January 2004-December 2017). All patients underwent routine laboratory examinations spirometry and preoperative CT- scan of the thorax and upper abdomen. PET-CT, EBUS–EUS, Mediastinotomy or Mediastinoscopy wasn’t performed as routine. Results: Of 968 patients, 690 (70.5%) were male and 278 (28.7%) female. Mean age 65.5±9.4 years (range 15 - 87 years). Lobectomy was the most used surgical modality in 566 (58.5%) patients, meanwhile pneumonectomy was performed in 112 (11.6%) of patients. Minor complications during surgery occurred in 45 (11.7%) of patients. Continuous air leakage was the most complication after surgery in 25.3%, followed by lung atelectasis in 21.3% and cardiovascular complications in 17%. Conclusion: our results show low mortality and morbidity after lung cancer surgery. However, patients with reduced lung capacity, older age and those undergoing pneumonectomy should be treated with great care.

Background:The presence of foreign bodies in the digestive tract usually occurs in pediatric, adolescent and psychiatric patients. Current Protocols focus mainly on pediatricians and adults.We present some cases mainly of feminine age. Most swallowed foreign bodies will harmlessly pass through the GI tract, but some will lead to health problems if they become lodged (too big to pass, such as a spoon, or small objects like a pill that adheres to a moist surface); traumatize the mucosa (sharp or pointed object, like a razor blade or pin), or cause burn-like illness (biologically active, such as a button battery or a medication patch) may cause problems.which during X-Ray abdominal exfoliation show varying objects in the digestive tract at different levels. The following examinations highlighted the most accurate localization.Asymptomatic clinical data continued to deteriorate, despite imaging evidence. This article discusses the challenges involved in the management of foreign troops in the digestive tract and the re-evaluation of literature.

Background: Laparoscopic or robotic assisted prostatectomy has become common world wide. However, to our knowledge, laparoscopic radical prostatectomy has not been reported in Albania. Objective: To analyze the early perioperative and oncologic results obtained with the extraperitoneal laparoscopic prostatectomy (ELRP). Patients and Method: A retrospective study of all the patients operated at Salus Hospital Tirana, Albania. All data were collected and evaluated retrospectively on the basis of thorough clinical and pathological examination. For data management and statistical analysis, all variables pre-, intra- and perioperative data were collected in a spreadsheet. Results: In the 4-year period ( outline the period), 25 patients underwent the ELRP procedure. The average age of patients was 65 year-old and the PSA of 17.5 ng/dl. The total surgery time was 168 minutes on average. Only one patient was transfused after surgery, and limfocele was present in 2 patients. No other complications occured. Pathological examination revealed pT2 and pT3 cancers in 72% (18/25) and 25% (6/25) of patients, respectively. One patient had regional lymph nodes infiltration. The incidence of positive surgical margins and biochemical relapse rate was 16 % (4/25) and 32 % (8/25), respectively. Conclusion: The ELRP technique is safe and effective procedure in the treatment of prostate cancer, with low morbidity.

Background; This systematic review aims to illustrate the published results of “minimally invasive” procedures for correction of hallux valgus. Based on former systematic reviews on that topic, the literature search was organised by two independent investigators. MEDLINE was systematically searched for available studies. The keywords used were “hallux valgus”, “bunion”, “percutaneous surgery”, “minimally invasive surgery”, “arthroscopy”, “Bosch” and “SERI”. Studies were assessed using the level of evidence rating. A total of 21 papers were included in this review. These studies described a total of 1,750 patients with 2,195 instances of percutaneous, minimally invasive or arthroscopic hallux valgus surgery. Clinical reports of results after minimally invasive hallux valgus surgery at meetings are common. Published results in peer-reviewed journals are less common and the majority of papers are level IV studies according to the level of evidence ratings. We found one level II and three level III studies. Reported complications seem to be less than one may see in one’s own clinical practice. This possible bias may be related to the fact that most studies are published by centres performing primarily minimally invasive hallux valgus surgery.

Background: The concept of carcinoma in situ was first introduced by Broders in 1932 [1] and has been accepted as a well-established notion and diagnostic category in many organs and systems. However, sebaceous carcinoma in situ (SCIS) has not yet been recognized as a concept and diagnostic entity in general pathology or dermatopathology. Such lesions have been commonly misinterpreted as either a benign neoplasm or sebaceous carcinoma. Tumors that do not necessarily arise in pre-existing sebaceous glands are usually invasive at the time of diagnosis, and like their ocular counterparts, can exhibit pagetoid intraepidermal spread. Cases of purely in-situ extraocular sebaceous carcinoma are extremely rare and yet controversial until now. Recognizing sebaceous carcinoma in situ as a valid concept and diagnostic entity that will certainly help to avoid misinterpretation and subsequently under or over treatment of such lesions. In this article, we provide a case report presentation with histopathological examination and a critical review of the literature.

Background: Appendicitis is the one of the most common emergency abdominal operation in children. It is estimated that appendicitis is diagnosed in about 2 % of children who present to emergency department because of acute abdominal pain1. Timely diagnosis and appendectomy can prevent abscess formation, perforation as well as reducing early and late postoperative complication. Methods: This study is a retrospective review of all children diagnosed with acute appendicitis in our emergency department between January 2015 – 2018. We have compared the clinical features and the results of examinations between two group of patients - those who were diagnosed correctly and have been operated, and those who were misdiagnosed and operated later respectively more than 24 hours after initial control. Results: This study includes fifty-nine children less than sixteen years old, admitted in our clinic and operated due to acute appendicitis. Fifty three (89.9%) of them were hospitalized after the first control, whereas the remining six (10.1 %) were discharged home after the initial control. The misdiagnosed patients were returned in our department less than twenty hours after the first control. Compared with the patients in which the diagnosis was made correctly the misdiagnosed patients in general had lower levels of leukocytes, CRP and temperature. Conclusion: The diagnosis of appendicitis in children can be very difficult because of the atypical features. According to our experience and the data from other studies, still there is not a single test or combination of clinical and laboratory examinations, able to discriminate children with and without acute appendicitis with a high percentage of accuracy.

Acute cholangitis is an infection of the biliary system that typically results from obstruction. Common causes include choledocholithiasis, strictures, foreign bodies (such as biliary stents) parasitic worms (e.g. ascarids) and compression from an external structure. Obstruction allows for higher bacterial concentrations and bacterial proliferation. With biliary stasis and increases in intraductal pressure, bacteria migrate into the venous and lymphatic systems with subsequent bacteremia. The rate of gallstone development is 3-4 % annually in those >60 years old with up to a 15% overall prevalence in the US. In the US, 85% of ascending cholangitis cases are a consequence of choledocholithiasis. The gram-negative bacteria E coli, Klebsiella, Pseudomonas and Enterobacter are the most commonly identified pathogens. Anaerobes are less common. Ascending cholangitis is classically diagnosed by the presence of Charcot’s triad – fever, right upper quadrant pain and jaundice. Though very specific, the presence of Charcot’s triad is only 26% sensitive and thus its absence does not rule out the diagnosis. All patients with suspected ascending cholangitis should undergo appropriate fluid resuscitation, be given broad spectrum antibiotics to cover the likely enteric pathogens, and closely monitored for worsening in their clinical condition. Once initial assessment is complete and resuscitative efforts begun, imaging is often helpful in confirming the diagnosis of ascending cholangitis. After the diagnosis has been confirmed, ERCP and biliary drainage is indicated.

Background: Gastrointestinal complications are frequent in patients with renal disease and are responsible for substantial morbidity and mortality among these patients in developing countries. Many times, these patients are subjected to endoscopic evaluation and mucosal biopsies are taken for definitive diagnosis. Long before the routine uses of dialysis, patients dying of uremia were found to have a high incidence of gastrointestinal abnormalities (1). Matherials and methods: The survey included 240 persons; 120 of them were dialysis patients, while the remaining 120 were healthy individuals who served as a control group. 54 (45%) of the patients with hemodialysis were females while 66 (55%) of them were males with mean age: 58.20 ± 18.00 years. These patients had been in dialysis for more than 12 years at the Clinic for Nephrology in Skopje and the Clinical Hospital in Tetovo. Results: Gastrointestinal complications were present in 20 (37.0%) out of 54 females while 26 (39.4%) out of 66 males presented with duodenal bulbar ulcers. 84 patients [(females-38/54 (70.4%) and males-46/66 (85.2%)] of the total number of 120 examined patients were found to have chronic gastritis. In conclusion, we found that the incidence of PUD was more than 10 times higher in CKD patients than in those without CKD over a 3-year period between 2008-2010. CKD patients receiving HD, NSAID, or clopidogrel had an increased risk of PUD, compared to CKD patients not receiving these treatments.

Introduction: The most commonly used treatment modality for urethral strictures is the direct visual internal urethrotomy method according Sachse cold knife, but with low long-term success rate. Alternative method after failure is isurethroplasty with preputial flap or Buccal mucosa. The aim of this presentation is to report the efficacy of the Internal Urethrotomy with Holmium Laser (Sachse laser). Material and methods: We report three cases of urethral stenosis after trauma which treated with Internal Urethrotomy with Holmium Laser (Sachse laser) after failure of multiple treatments with Sachse cold knife. We evaluated and compared the uroflowmetry parameters before and after Sachse laser. Results: The average of uroflowmetry parameters before incision were: Q max 4.5 ml/sec, Q med 3 ml/sec. Voided Volume 323 cc, while after incision with Sachse laser were: Q max 30 ml/sec, Q med 12 ml/sec. Voided Volume 363 cc.No patients relapsed during follow-up time from 3 to 24 months. Conclusion: Even though these are only a few cases, we think that Sachse laser is a valid alternative after unsuccessful Sachse cold knife and before Urethroplasty, even in patients with urethral stricture after trauma.

Background: C-reactive protein (CRP) is one of the acute-phase proteins which increases during inflammatory conditions. Nowadays, C-reactive protein (CRP) is a commonly used biomarker especially in emergency department (ED) for diagnostics of febrile and infectious patients. It is almost impossible to distinguish the bacterial from nonbacterial (viral) infection by CRP level only - so the detailed history of onset of disease is very important to establish the diagnosis of bacterial infection as a cause of acute abdominal pain. Objective: The aim of this study was to establish the diagnostic value of leucocyte and CRP count in in diagnosing acute abdominal pain. Material and methods: We retrospectively evaluated 159 patients with acute abdominal pain admitted to the surgical department of the Clinical Hospital of Tetova and PHO “Alba – Med” over a period of 2 years respectively from January 20016 to January 2018. All patients included in this study was aged between five to 15 years old. Results: During the study period there were 158 patients (96 were females and 56 males). All the patients suffered from acute abdominal pain, whereas 45 of them had a surgical condition, respectively in 42 of them acute appendicitis as a cause of pain, Meckel’s diverticulitis, jejunal intussusception and ruptured ovarian cyst in three other patients. In 105 patients nonsurgical condition was the reason of acute abdominal pain. CRP was performed within 24 h after admission in all the patients. In the group of patients with surgical disease in 41 of them (91 %) the value of CRP was more than > 5g/L. Conclusions: According to our experience we conclude that the CRP level is not sufficient to predict patients with acute abdominal pain that require surgical treatment.

Background: Acute appendicitis is one of the most frequent causes of abdominal pain. Early diagnosis is the key to success for the surgeon, followed by the treatment with operation or conservative treatment as a new approach, before the stage of gangrenous appendicitis or perforation occurs. Aim: This study aims to establish he role of hyperbilirubinemia as a laboratory marker in prediction of acute appendicitis in the early diagnosis. Materials and methods: This is a cross-sectional study; it included 201 patients admitted in the emergency ward with suspicion for acute appendicitis. All patients that participated in this study have been subject to appendectomy. The blood samples were taken from all patients in order to analyze the level of total/direct bilirubin. Results: The study samples of 201 patients consisted of 67.7% with complicated appendicitis and 32.3% with non-complicated appendicitis. The sensitivity, specificity, PPV, NPV for laboratory marker, as predictor for complicated vs non-complicated cases of appendicitis was as follows: Total bilirubin; specificity (72.3%), sensitivity (54.4%), PPV (80.4%), NPV (43.1%), Conclusion: Elevation of total/direct bilirubin level in patients with clinical signs of acute appendicitis might predict the stage of acute appendicitis, such prediction may help surgeons to provide accurate treatment of the disease without delay in the diagnosis. This accuracy can be further supplemented by using Alvarado scoring model during the clinical approach.

Pyrexia is a protective physiologic response of the body against external and internal aggression. Temperature control is safe in and effective in septic shock but remain controversial in sepsis. Treating pyrexia to reduce oxygen consumption appears to have beneficial in cardiac arrest, low cardiac output and acute brain injury. Multiple therapeutic options are available for managing pyrexia, with precise targeted temperature management. Notably, the use of pharmacotherapy versus surface cooling has not been shown to be advantageous. When these two-therapy failed to control the extra-corporal method of cooling should be started. Renal replacement therapies are not typically indicated for temperature control but, in patients requiring renal support, they contribute to heat loss and participate in pyrexia control. Renal replacement therapies may represent a confounding factor in comparative trials on temperature control.

Introduction: Treatment of acute and chronic wounds are a major challenge. In modern medicine, numerous approaches to wound healing are known. One of them is the use of epidermal autologous grafts. The purpose of this article is to present the use of automated epidermal harvesting system (CELLUTOMETM Epidermal Harvesting System; KCI, an Acelity company, San Antonio, TX, USA) in General Hospital dr. Jože Potrc Ptuj, Slovenija. Case presentation: Treatment of a patient with a chronic wound after ruptured varicose veins on the right shin, a patient with a chronic wound after crash injury and a patient with nonhealing postoperative wound using CELLUTOMETM Epidermal Harvesting System are described. Conclusion: Our results showed the positive effects of epidermal autologous grafts on the healing process of various types of wounds and confirmed the advantages of this system for the production of epidermal autologous grafts.

Background: End Stage Renal disease (ESRD) as it was historically termed is a term that encompasses all degrees of decreased renal function, from damaged–at risk through mild, moderate, and severe chronic kidney failure. ESRD is a worldwide public health problem. In the United States, there is a rising incidence and prevalence of kidney failure, with poor outcomes and high cost (see Epidemiology). Material and Methods: The blood sample for routine analysis (lipidogram) and specific analysis was taken at 08 clock in the morning with the room temperature that variated from 19 to 24°C, before the hemodialysis session, minimum 12 hours of fasting - with tendency to avoid the absorption effect of food by the intestine as well as avoid absorption of lipids and formation of chilomicrones. In all samples regardless of their group, the concentration of ApoC-II and lipids were analyzed in a period of 12 months in a period of 12 months (the measurements were made every three months, it means we totally made 3 measurements in 9 months). Results: The results from patients and controlling group for Apo-C3 and lipid profile (ChT, TG, HDL-ch, LDL-ch) are given in table number 3. A significant statistical difference with p<0.0001 is found from the results of the lipidic profile and ApoC-III of patients with ESRD treated with HD compared with the results of the controlling group for the same parameters. Conclusion: In this study patients with ESRD treated with HD have high parameters of ApoC-III, TG, LDL-ch but low concentrations of HDL-ch due to impaired catabolism of apolipoproteins in this specific group of patients. In all patients symptoms of CDV (myocardial infarction, angina pectoris, ischemia), acute coronary syndrome were noticed.

Background The level of management of traumatic health care services in Albania as a service of the Military University Hospital in Emergency Care differs in relation to other university hospitals across the country, mainly due to changes in the public health of the population. The article aims to present the management of traumatic patients at the Military Hospital in Albania, providing examples of the number of cases that have been addressed in the spread of this disease as epidemiology in Albania. The literature review and data statistics will be carried out by using the hospital records that will be used for further research in Albania. In addition, there is a study of international reports on Trauma management issues, trauma care and quality in Trauma. Much of the results consider the necessity of adopting a comprehensive traumatic system, focusing on quality management and improving trauma care to increase survival and reduce complications to the wounded. Urban conditions and public health policies are the most important factors in developing and implementing programs to improve emergency trauma care services. The heterogeneity of the population and its geographical distribution, the complexity of road accidents, are challenging factors for quantitative research on trauma management and the effectiveness of its care. Staff training in all areas, combined with the existence of modern vehicles and equipment, means of communication and timely transfer of the ambulance, contribute to the treatment of patients with urgent trauma, life saving and prevention of all types of disabilities.