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 mortality 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 bronchiectasis. 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 foulsmelling 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 mortality 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.

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: 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.

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: 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.

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.

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.