Albanian Journal of Trauma and Emergency Surgery

Triage Prehospital EMS and Medical Care

2024-09-29T22:48:51+00:00

Introduction: Prehospital emergency medical services (EMS) are essential to emergency medical care. They provide emergency assessment and treatment for seriously ill or injured patients and transport them by ambulance to an emergency department. Adopting triage methods for systematically prioritizing patients according to how urgent patients need care, including Triage of requests for acute medical treatment, is a promising development in our healthcare system. In Kosovo, there is a gap between the effects of prehospital triage systems and the impact of using the same triage system in two or more EMS settings. In this quality improvement study, implementing the TT app intervention was associated with higher rates of inefficient Triage in prehospital settings. However, supporting EMS professionals in their decision-making by calculating the probability of an individual patient needing specialized care at the scene of injury is a new and promising approach to optimize Triage in the field. If we can fully realize the potential of this approach, it could significantly improve the efficiency and effectiveness of our emergency medical care, leading to better patient outcomes. Standards and most health professionals need to be educated and trained in this critical component of EMS. Education, education, and training for the three levels of health care should be an obligatory component to enhance the quality of emergency medical care for children and adults at risk. It is high time to develop and test a conceptual triage scheme or model that will rely on a triage system that responds to the conditions of our health system. Develop clinical guidelines, algorithms, and triage protocols at the three levels of health care. All healthcare professionals must be educated and trained in ongoing coaching, communication courses, BLS AED, Pediatric, PHTLS, Adult Advanced Life Support, ATLS, and International Trauma Life Support.

Conclusion: Triage is vital in optimizing patient outcomes in the high-pressure EMS world. It is the process of rapidly assessing a patient's condition to determine the urgency of care and the most appropriate destination for definitive treatment. Done effectively, prehospital Triage ensures that patients receive the right level of care at the right time, maximizing their chances of survival and minimizing long-term complications.

Emergency Doctor in the Reanimation Room and Solution of Medical Problems

2024-07-20T11:08:44+00:00

Introduction: Emergency medicine is a dynamic specialty that offers various medical cases and situations. Emergency medicine doctors treat patients from all age groups and with a large spectrum of physical and mental disorders. Emergency medicine is the specialty of treating illnesses or injuries requiring immediate medical attention. Emergency medicine doctors assess and treat patients in the emergency department, regardless of their illness or injury type. Their main focus is to stabilize patients as quickly as possible and determine the best next step in treating many patients simultaneously, with life-threatening conditions being the main priority. Emergency physicians treat all medical conditions of all age groups, such as cardiology, neurological, pulmonological, nephrological, endocrinological, hematological, gastrointestinal, orthopedic, gynecological-obstetrical, dermatological, psychiatric, traumatological, and accidental conditions. Efforts should be made to reduce the accumulation of ED with a solid organizational culture; rather than adopting “generic” approaches, interventions should be selected and implemented to address the unique challenges of each hospital ED. Emergency medicine can potentially improve patient care and outcomes; however, establishing evidence-based protocols and a multidisciplinary approach to patient management are essential. Creating long-term health policies to regulate the referral system through the national plan and document would regulate the three levels of health care to stop the overcrowding of the hospital's ED.

Study Size Impact on Accuracy of the Worldwide Incidence of Pilonidal Sinus

2024-07-20T11:08:49+00:00

Introduction: Significant variations in incidence rates have been observed in the analysis of anecdotal Pilonidal Sinus Disease (PSD) incidents worldwide.

Objective: This study examines the accuracy of PSD incidence estimates and the variations associated with study size from 1833 to the present.

Material and Methods: A comprehensive search was conducted in global literature databases, including PubMed, Embase, Science Direct, and others, to gather any PSD incidence data reported between 1833 and 2023.

Results: The study sizes ranged from 26 to 82,217,837 individuals, with incidence rates varying from 8 to 30,000 cases per 100,000 persons. Notably, in study populations below 200,000 individuals, the incidence rate ranged from 8 to 30,000 cases per 100,000 persons. However, this range narrowed when studying populations exceeding 200,000 persons, with incidence rates ranging from 7 to 300 cases per 100,000 persons.

Limitations: No limitations were identified in this study.

Conclusion: The findings suggest reliable PSD incidences can be calculated with study populations exceeding 200,000 individuals. In such cases, the variability of incidence rates decreases as study size increases, although other known and unknown factors continue to influence the outcomes.

Effectiveness of the Oakland Score for Safe Discharge of Patients with Acute Lower Gastrointestinal Bleeding: A Validation Study

2024-07-20T11:08:48+00:00

Background: Acute lower gastrointestinal bleeding (LGIB) presents a significant challenge in emergency medicine, necessitating tools for effective risk stratification and management. The Oakland Score, developed to predict safe discharge and mortality in LGIB patients, offers potential utility but requires validation in diverse clinical settings.

Material and Methods: This retrospective study analyzed 365 patients presenting with LGIB at Kartal Dr. Lütfi Kırdar City Hospital between January 1, 2021, and January 1, 2022. We evaluated the Oakland Score's effectiveness in predicting safe discharge and mortality, employing statistical analyses to determine the score's predictive accuracy and identify critical thresholds.

Results: Among the study population, 60.27% presented with hematochezia, with a diverse age and gender distribution. Invasive procedures were performed in 42.47% of cases, and cardiovascular diseases were prevalent in 51.78%. The average Oakland Score was significantly lower for discharged patients (18.22) compared to those hospitalized (21.90), with a critical discharge threshold identified at a score of 16. The Oakland Score also demonstrated a sensitivity of 77% and specificity of 52.3% for predicting discharge outcomes, and a critical value of 24 for increased mortality risk, substantiating its predictive value.

Conclusions: The Oakland Score effectively predicts safe discharge and mortality among LGIB patients in a Turkish hospital setting. With defined critical thresholds for clinical decision-making, it stands as a valuable tool for optimizing patient management and resource allocation in emergency departments.

Management of Periarthritis Shoulder by Intra-Articular Steroid Injection and Shoulder Joint Manipulation

2024-07-20T11:08:50+00:00

Introduction: "Periarthritis" and "adhesive capsulitis" have been used synonymously with frozen shoulder. The condition known as "frozen shoulder," which has an unknown cause, is characterized by a delayed, spontaneous restoration of all shoulder joint movements to some extent or entirely over several months to a year. Various treatment methods have been employed to manage periarthritis shoulder, with varying outcomes.

The Aim: To evaluate the functional outcomes and pain relief of periarthritis shoulder treated with intra-articular steroid injection and manipulation under anesthesia.

Material and Methods: A prospective study was conducted on adults with periarthritis shoulder admitted, evaluated, and followed up on 30 periarthritis shoulder cases using intra-articular steroid injection and manipulation over three months.

Results: In our study, most of the patients were females and elderly, with diabetics being more prone to periarthritis of the shoulder. The range of movements improved, and pain was relieved in all 30 patients. Excellent results were found in 26 cases (86.6%) by DASH Score criteria.

Conclusion: Intra-articular steroid injection and manipulation of the shoulder in periarthritis shoulder with follow-up for 12 weeks resulted in the study finding a significant improvement in the range of shoulder movement, pain, and function in patients with shoulder periarthritis.

Keywords: Periarthritis shoulder; intra-articular steroid injection; Range of movement.

Cardiac Arrest in Patients with Acute Myocardial Infarction

2024-07-20T11:08:50+00:00

Background: Sudden cardiac arrest is the third leading cause of death in Europe. A significant number of out-of-hospital sudden cardiac arrests are associated with acute myocardial infarction. Cardiac arrest is a complication of an acute myocardial infarction caused by malignant rhythm disorder, in most cases ventricular tachycardia or ventricular fibrillation. They result in sudden death in 25%-50% of patients with prior acute myocardial infarction. Sudden cardiac arrest in these patients occurs during the first hours after the onset of symptoms.

Aim: show from the total number of out-of-hospital reanimations in the given period in canton Sarajevo the number of successful reanimations (return of spontaneous circulation – ROSC) and the number of successful reanimations in patients that went in to sudden cardiac arrest with prior acute myocardial infarction. Show the out-of-hospital management of these patients.

Material and Methods: retrospective descriptive study that includes all out-of-hospital sudden cardiac arrest in the period from 1 January 2019 to the 31 December 2021 in canton Sarajevo that are associated with acute myocardial infarction in which there was the return of spontaneous circulation (ROSC). All patients from above-mentioned period were included in the study, without exclusion criteria related to their age, gender. Data was extracted from data registry of the Centre for education of the Emergency Medical Center of canton Sarajevo.

Conclusion: Acute myocardial infarction still stays associated with a high level of mortality and represents one of the leading public health problems. Despite all advances in the field of diagnostics and treatment of patients with AMI that resulted in significant reduction of mortality in time.

Correlation Between Systemic Lupus Erythematosus and Renal Damage

2024-07-20T11:08:50+00:00

Introduction: Two of the most frequent Lupus nephritis (LN) diseases are multiple glomerulonephritis and renal fibrosis. Recent studies have verified that 10-30% of patients with SLE after several years (3-6 years) develop LN and end-stage chronic renal disease (ESRD) when there is a need for chronic intermittent hemodialysis (HD) treatment. [1, 2, 3]

The paper aimed to assess renal damage due to LN using the results obtained from the examined parameters in patients with chronic kidney disease (CKD) in the third stage (a and b).

Materials and Methods: This prospective cohort research (cross-section ") study included 100 patients with CKD (55 were men with an average age of 57.00±8.50 years old with chronic renal disease, 20 with diabetes mellitus (DM) and nephropathy diabetics, 15 were arterial hypertension (AHT), 11 were with chronic glomerulonephritis (CGN), 3 with Adult polycystic kidney disease (APCKD) and six patients were with undefined renal disease, while 45 were female with an average age of 55.80 ±10.50 years old), with primary kidney disease: 16-with diabetes mellitus and diabetic nephropathy,11 with HTA…

Statistical analysis of the examined material: The obtained results from the studied patients with CKD and the control group were statistically processed with arithmetic mean value, standard deviation X ± SD, with student, "t" test, Mann-Whitney and Wilcoxon test. The results were processed with the appropriate state-of-the-art statistical program, SPSS V26.

Results: the results obtained at the beginning of the study (for all patients with LN and CKD: women and men) and after 12 months of treatment are presented in tables and graphs 4 and 8.

Conclusion: From the results obtained, we can conclude that LES affects the appearance of renal damage; therefore, early detection and treatment of the initial stages of LN seem to influence the reduction of its activity.

The Assessment of Knowledge, Attitudes, and Practices of University’s Students Towards Covid 19

2024-07-20T11:08:48+00:00

Introduction: The COVID - 19 has been a global public health concern from day one till now.

The Aim is to assess students' knowledge, attitudes, and practices towards COVID-19.

Material and Methods: This is a cross-sectional study. A validated, structured, anonymous, self-administered online questionnaire was used. The inclusion criteria were voluntary students from each Luigj Gurakuqi University faculty member.

Two hundred fifty-seven students completed the questionnaire, which was created with the Microsoft Forms Office program and distributed via WhatsApp. Data were calculated through the SPSS program. Pearson correlation, ANOVA test, and simple independent test –T were applied to elaborate on the data collected. The study period is April-May 2022.

Results: In this study, 257 students participated. Most of the participants were female (N=223; 87%). More than 86% of students responded positively regarding their knowledge about the symptoms of COVID-19. Regarding attitude and practice, 90% of students agreed that hand washing is necessary to prevent infection, while 98% believed wearing a mask would prevent disease.

Conclusions: In general, they show positive attitudes and practices regarding COVID-19. Many say they would not hide it as information; they would seek medical help.

Influence of Prematurity and Glutation S-Transferase Gene Polymorphisms on the Degree of Asthma Control in Children

2024-07-20T11:08:45+00:00

Introduction: asthma is the most common chronic inflammatory disease of the respiratory tract in children. The clinical manifestation of asthma is closely related to the pathomorphological changes presenting the basis of the disease, and it concerns the difficult air flow through the lower airways during the expiratory phase of breathing. Inadequate treatment of children who have asthma affects the appearance of remodeling of the lower airways and, in the most severe cases, permanent reduction of the lung function values.

The Aim is to determine the influence of prematurity and GSTT1 and GSTM1 gene polymorphisms on the degree of asthma control.

Materials and Methods: The research was designed as a clinical, cohort, observational, retrospective-prospective study. It included 200 patients divided into two groups of one hundred respondents each. The first group of respondents consisted of premature children hospitalized at the Department of Neonatal Intensive Care of the CCUS Pediatric Clinic due to respiratory problems caused by immaturity. In contrast, the second group consisted of at-term-born children monitored through the Pulmonary Counselling of the Pediatric Clinic.

Results: The male and female genders were equally represented. In the premature children group, respiratory support was used in 60/100 (60%) cases. GSTT1 polymorphism was proven in 150 respondents, and GSTM1 polymorphism in 98. Fisher's test showed that gestational age at birth significantly influenced asthma control: the test value was 11.281, p=0.019.

Conclusion: gestation weeks at birth have a statistically significant effect on the degree of asthma control at older age. Although poorly controlled asthma and uncontrolled asthma were more prevalent in children with positive GSTT1 and GSM1 gene polymorphisms, we could not demonstrate a statistically significant influence of the mentioned polymorphisms on the degree of asthma control.

Perceptions of Health Personnel Regarding the Utilization of Health Information Systems.

2024-07-20T11:08:46+00:00

Introduction: The deployment of health information systems has been a global response to healthcare's transformation and digitalization. The need and potential of these systems within healthcare have been tremendously driven by the global instability that has affected several interrelated sectors, highlighting the urgency and importance of this research.[1]

Health information systems (HIS) are critical systems deployed to help organizations and all stakeholders within the healthcare arena eradicate disjointed information and modernize health processes by integrating different health functions and departments across the healthcare arena for better healthcare delivery.[2]

This study aims to underscore the invaluable insights of the Shkodra Regional Hospital's healthcare staff regarding Hospital Information Systems. We aim to identify potential problems that may arise before their implementation, such as resistance to change, lack of training, and system compatibility issues, emphasizing the crucial role of healthcare staff in this process.

Material and Methods: 168 participants were involved in this study, representing 42.96% of the total nurses. Data were collected through a 47-item self-administered questionnaire, which included sections on demographics, current system usage, perceived benefits and challenges, and readiness for system adoption. The questionnaire was designed based on the 'Acceptance Model of a Hospital Information System' developed by Handayani et al. [3]

Results: Encouragingly, 88-92% of the study participants expressed their strong readiness and enthusiasm to embrace HIS as part of their work. This overwhelmingly positive attitude bodes exceptionally well for the system's potential success.

Conclusions: The study's findings underscore the significant potential for successfully implementing HIS at Shkodra Regional Hospital. Despite the challenges nurses may anticipate when using HIS, the study revealed a remarkable willingness to adapt. Approximately 90% of the participants expressed their readiness to accept HIS, demonstrating their commendable adaptability and the potential for a smooth transition to the new system.

The Influence of the Cooperation of Hyperhomocysteinemia and Arterial Hypertension. A Risk Factor on the Acceleration of the Progress of Chronic Renal Diseases

2024-07-20T11:08:49+00:00

Introduction: Chronic kidney disease (CKD) is a heterogeneous group of disorders that manifest differently with a multifactorial etiology. In addition to known factors such as diabetes, high blood pressure, genetic predisposition, age, gender, race, physical inactivity, obesity, and MIA, in recent years, high concentrations of homocysteine have also been considered as an independent risk factor in the acceleration of the progression of CKD, which, together with arterial hypertension, apparently affect the acceleration of the progress of chronic renal diseases.

Materials and Methods: In a cohort-prospective study, 100 patients were treated (40 women with an average age of 55.40±8.20 years and 60 men with an average age of 56.00±9.50 years) with CKD in the third stage (stage III and b b) with a GFR of 30- 59 ml/min/ 1.73m² determined according to the formula modification of diet in renal disease (MDRD- GFR in ml/min for 1.73 m²=175 x Serum creatinine (Cr) -1.154 x age-0.203x1.212 (if the patient is black) x 0.742 (if female) treated in the internal medicine clinic at the Clinical Hospital in Tetovo, in the period January-2023-December-2023 randomized according to gender, age, nationality, primary kidney disease…

Results: The results obtained at the beginning of the study for all the examined parameters and those obtained after 12 months, both from the patients with Chronic disease and the control group of healthy individuals, are presented in the text below.

A significant difference was observed between the patients and the control group with p<0.0001.

Conclusion: CKD is a frequent occurrence worldwide (1 in 10 inhabitants or 10 of the world's population suffers from CKD; therefore, it is necessary to implement preventive and therapeutic measures aimed at early detection, prevention, and treatment of that disease as a conclusion of our paper, we can confirm that there is a strong connection between HHcy and high blood pressure and that together they contribute to the acceleration and progression of CKD; therefore their treatment with folate, vitamin B12, vitamin B6 should be started at an early stage of the disease to prevent the rapid progression of CKD.

Perceptions of the third-Year Students Attending the Bachelor Study Programs, Regarding their Readiness to Face the Labor Market. A cross-Sectional Study.

2024-07-20T11:08:50+00:00

Introduction: The educational environment is an essential component of student learning. The study of the academic environment is crucial to providing a learning quality, a student-centered program for the nursing and midwifery fields.

Our study aims to identify the perceptions of the third-year students of bachelor's study programs in nursing, midwifery, and physiotherapy regarding readiness to face the labor market and how they differ based on the study program.

Material and Methods: A total of 132 (73.74%) students participated in this study out of 179 students who had a whole the third year, 28 (87.5) were in bachelor in physiotherapy out of 32 students, 32 (82.05) were in bachelor in midwifery out of 39 students, and 72 (66.66) were in bachelor in nursing out of 108 students. All students continued their studies in the 2022-2023 academic year. Two tools were used in this study: a demographic questionnaire and the assessment of the adequacy level of preparedness for work used by Günner (Güner., 2015a).

Results: Only 57.74% of students are ready to face the labor market. Activities of education and preparation regarding the Contribution of the clinical environment to education, Mentoring, Library resources, Laboratory environments, Technological resources, and Social resources for the nursing study program need to show a connection with the general readiness to work.

Conclusions: The study highlighted students' need for more confidence to face the work, primarily related to clinical training.

Foley Catheter Following Penetrating Neck Trauma. A Definitive Therapy to Stop the Bleeding?

2024-07-20T11:08:45+00:00

Introduction: The incidence of penetrating neck injuries is experiencing an upward trend. Given that hemorrhaging stands as one of the most preventable causes of fatality in traumatic situations, the prospect of employing a foley catheter (FC) to manage bleeding following penetrating neck injuries has led to contemplation on its integration into standardized protocols for bleeding control (BC), both in prehospital and in-hospital settings. Furthermore, inquiries into establishing standardized schedules for its application have arisen.

Material and Methods: A meticulous search strategy was conducted utilizing the NCBI Medical Subject Heading (MeSH) term "foley*" and various combinations such as "foley" AND "trauma"; "foley" AND "neck"; "foley" AND "penetrating"; "catheter" AND "balloon" AND "trauma"; "gunshot" AND "neck"; "hemorrhage*" AND "neck" across multiple databases. These databases include MEDLINE, PubMed, PubMed Central, Scopus, Ovid, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL). Additionally, comprehensive searches using these terms were performed on Google, Google Scholar, and ResearchGate. The references cited in documents retrieved from these searches, covering 1833 to 2023, were thoroughly scrutinized.

Results: 15 relevant articles were identified, and pertinent data were extracted from these studies. Historically, the use of FC was confined to immediate bleeding control; however, it has now extended its application into prehospital, emergency room (ER), and intraoperative settings. The primary success rate of FC stands at n=229 out of 274 cases (84%). FC serves as a valuable tool to bridge the gap in time before reaching the ER or operating room (OR), facilitating necessary radiological studies or interventions, especially when more severe injuries necessitate prioritization. Typically, FC was retained for 24-48 hours, but instances of prolonged applications up to 240 hours have been documented. Notably, it includes the definitive management of venous neck bleeding injuries, contingent upon excluding significant arterial defects through CTA. Late rebleeding stands at a low rate of 6% (14 out of 229 cases).

Conclusion: Using FC is a pertinent strategy in managing neck injuries resulting from bleeding from penetrating wounds. Its substantial primary success rate in prehospital and ER phases surpasses the success rates achieved solely through pressure or chitosan dressing. Post-primary bleeding control, the presence of FC facilitates examinations and radiological interventions. Determining the optimal duration for FC placement remains a subject for consideration, leaning toward 2-3 days, if not longer. FC is progressively solidifying its role in Selective Non-Operative Management (SNOM) for hemorrhagic penetrating neck injuries. Consequently, a Foley catheter should be an essential tool in the possession of every prehospital and ER physician. Further delineation of criteria establishing the suitability of FC placement as definitive SNOM therapy for hemorrhagic penetrating neck injuries warrants consolidation.

Surgical Treatment of Ruptured Splenic Artery Aneurysm. A Clinical Case and Review Literature.

2024-07-20T11:08:47+00:00

Introduction: Ruptured splenic artery aneurysms (SAAs) are rare but life-threatening vascular emergencies. Prompt diagnosis and intervention are crucial for patient survival.

We present a case of a 54-year-old male who presented with We describe the case of a 54-year-old male who presented with an acute onset of diffuse abdominal pain radiating to the left shoulder, tachycardia, and hemodynamic stability without signs of hypovolemic shock.

The diagnostic process includes imaging examinations such as abdominal echo, AngioCT abdomen, and laboratory examinations. After 12 hours of observation, the head of the general surgery service and vascular surgeons consulted, and the decision was made to perform an exploratory laparotomy.

The patient underwent laparotomy, which revealed hemoperitoneum and rupture of the splenic artery aneurysm, requiring Splenectomy.

The patient had an uneventful postoperative course and was discharged home on postoperative day 7.

Ruptured splenic artery aneurysms represent a challenging clinical scenario requiring prompt recognition and intervention. Surgical management remains the cornerstone of treatment, aiming to prevent life-threatening bleeding and preserve splenic function when feasible. Multidisciplinary collaboration and adherence to evidence-based practices are essential for optimizing patient outcomes in this rare but critical condition. Ongoing research and advancements in surgical techniques continue to refine the approach to splenic artery aneurysms, enhancing the quality of care provided to affected patients.

Conclusion: This case report highlights the importance of a high index of suspicion for ruptured SAA in patients with suggestive clinical presentations. Prompt surgical intervention with appropriate technique selection is essential for optimal patient outcomes.

Complications of Implantation of Cardiovascular Implantable Electronic Device

2024-07-20T11:08:46+00:00

Introduction: Cardiovascular implantable electronic devices (CIEDs), including pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices, are crucial for managing various cardiac conditions. However, their implantation is associated with a range of potential complications.

This article investigates the incidence, types, and risk factors of complications arising from CIED implantation.

Around 180.000 pacemakers are implanted every year in the USA [1]. Keeping in mind that pacemakers are implanted mainly in the elderly, the increasing proportion of this age group translates to a progressive increase in yearly implantations.

A review of pacemakers implanted in adults shows an age interval of 69-86 years old, with 30-40% of patients >80 years old [2,3].

In a case series article, 218 patients were included in those undergoing permanent pacemaker implantation in the UHC "Mother Theresa" Tirana.

Data were retrospectively collected from patients who underwent CIED implantation. The primary complications assessed included infection, lead dislodgement, device malfunction, hematoma, and vascular complications. Statistical analysis was performed to identify significant risk factors associated with these complications.

Conclusions: This article underscores the importance of meticulous procedural techniques, thorough patient assessment, and post-implantation monitoring to minimize the risks associated with CIED implantation. Enhanced understanding of these complications can lead to improved patient outcomes and the development of strategies to mitigate risks in clinical practice.

Keywords: permanent pacemaker implantation (ppm), cardiac implantable electronic device (cied), long-term care, postoperative complication

The Role of the Infectious Disease Specialists in the Trauma Surgical Team.

2024-07-20T11:08:46+00:00

Introduction: Infection is a significant cause of posttraumatic morbidity and prolonged hospitalization. Nosocomial infections are a frequent complication of trauma patients admitted to the intensive care unit (ICU). Trauma is predisposed to infections by various mechanisms, while intravascular catheters, endotracheal tubes, and urinary catheters create suitable environments for nosocomial infection during treatment. Following trauma, wound contamination with aerobic and anaerobic bacteria should always be suspected.

Material and Methods: In this paper, we want to review the literature regarding the role of infectious disease (ID) specialists in the trauma team and compare it with the situation in our country.

Discussion: Infections in trauma are developed because of endogenous bacteremia or as a result of exogenous bacteremia. Since infection significantly prolongs the hospitalization of trauma patients, the infection disease specialist plays a crucial role in preventing and treating infections in collaboration with the surgeon and other trauma team members.

The duration of antibiotic treatment is significant. A shorter duration will result in fewer side effects and allergic reactions and reduce long-term antibiotic resistance.

Conclusions: The infectious disease specialist is not a standalone figure but an integral part of the trauma team. Their role is not limited to implementing protocols and using appropriate antibiotics before, during, and after surgical procedures. They also closely follow the patients, identifying those with a greater predisposition to develop infections. This collaborative approach is crucial for successfully preventing and managing infections in trauma patients.

Limitations of Ultrasound Examination in Trauma

2024-07-20T11:08:49+00:00

Introduction: Ultrasound examination plays a significant role in the evaluation of patients with trauma and polytrauma because it is an examination that provides information for many regions and systems, such as in the case of abdominal trauma, cardio-thoracic trauma, and vascular and musculoskeletal injuries. Ultrasound examination is used to rapidly and accurately detect hemorrhages in the pericardial, pleural, and peritoneal cavities, turning it into a necessary examination in Advanced Trauma Life Support (ATLS). Ultrasound is also used in traumas such as pneumothorax, damage to parenchymal organs and abdominal cavity, as well as rib and sternum fractures.

Material and Methods: This study considered and revised a systematic review of radiology and ultrasound specialty journals and clinical textbooks, the bibliographies of all identified articles, and meta-analyses about the role of ultrasound in trauma, especially FAST. Both prospective and retrospective studies for different types of trauma, such as abdominal trauma and thoracic trauma, trauma with unique injuries and polytrauma, and blunt and penetrating trauma, were included.

Conclusions: Although a necessary non-invasive radiological examination, ultrasound has long-term limitations during the evaluation of trauma. Ultrasound limitations are divided into technical limitations, image quality, the inability of sonographic windows to acquire images, echogenic similarity, and lack of differentiation between structures and organs.

Antiphospholipid Syndrome in a Male Patient Presenting with Abdominal Pain

2024-07-20T11:08:49+00:00

Introduction: Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by antiphospholipid antibodies (aPL), leading to a hypercoagulable state and an increased risk of thrombotic events. While abdominal complications have been reported as the initial presentation of APS in some cases, these instances are predominantly observed in female patients. Here, we present a case of a 49-year-old male patient who presented with complaints and a CT scan mimicking intestinal ileus. However, no mechanical or other evident cause of ileus could be found on the explorative laparotomy. After an uneventful postoperative hospitalization and being discharged in good condition, the patient was readmitted within two weeks, and this time, an extensive small bowel resection due to ischemia was done. After going home in a good and stable condition, he presents again, but this time with cerebral ischemia.

Further investigations led to the APS diagnosis. With this case, we want to emphasize the importance of being aware of and considering the diagnosis of APS, especially in cases with repeated, unexplained abdominal pain and non-typical complaints, even in male patients. An early diagnosis could prevent a more complex disease complication.

Conclusion: This case underscores the importance of considering APS in the differential diagnosis of unexplained abdominal pain, particularly in male patients with a history of thrombotic events or elevated aPL levels. Heightened awareness of APS in the emergency setting can facilitate timely diagnosis and appropriate management, ultimately optimizing patient care and outcomes.

Situs Inversus Dextrocardia with Cyanogen Complex Cardiopathy in a 16-Year-Old Albanian Male

2024-07-20T11:08:45+00:00

Introduction: Dextrocardia is rare in the general population and may be associated with significant additional cardiac malformations. It is commonly associated with additional cardiac malformations.

In this report, we have described the follow-up of a patient with Situs inversus dextrocardia and cyanogen complex cardiopathy in a 16-year-old Albanian male. The male patient born on 2007 in Albania, was referred to our ambulatory at 6 months of life by pediatrician cause of cyanosis and cardiac murmur. It was performed the echo Color Doppler examination, with the conclusion: situs inversus dextrocardia, unique ventricle, pulmonary arterial atresia. On 2008, a diagnostic catheterization was performed. The medico-chirurgical consultation has decided to leave the boy in natural history with a periodic follow–up. On 06.2009 in one of the routine examinations, there was make evidence of hypertrophy of the unique ventricle associated with arteria hypertension. From that time the patient is under medical treatment with periodic monitoring.

Conclusions: The regular follow up of complex cyanogen congenital heart disease improve health care towards risqué target group. In heave desaturations patient the hypertension must be valuated as secondary complication of primary problem.

Small Cell Lung Cancer in a Young, Non-Smoker Patient

2024-07-20T11:08:48+00:00

Introduction: A single lung nodule (SPN) is defined as a solitary lung opacification less than 3 cm in size. In particular, small cell lung cancer (SCLC) affects more patients, older and heavy smokers. A contrast-enhanced computed tomography of the chest followed by a f-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and the pathology examinations are the main ones that determine the diagnosis.

Case Report: A young patient, 33 years old, a non-smoking male mining engineer, presented to the clinic with a dry cough that started after a viral situation. No other known comorbidities and family history of lung cancer. A routine chest x-ray was ordered, where an apical round opacity in the apex of the right lung was seen. Sputum for mycobacterium tuberculosis was done and came back negative. A chest scan with contrast showed a solitary pulmonary nodule in the apex of the right lung with well-demarcated contours with dimensions 28 x 22 mm. Given that the dimensions of the nodule were large and not specific for benign pathology, a PET/CT was ordered, which confirmed the nodule resulted in an SUV over that 4.5, which was also not specific for lung TB. The histologic examination of the nodule was done then, and the result, unfortunately, was a small cell lung cancer in the right lung.

Conclusion: SCLC is found to be a mass lesion in the lungs in most cases. Differential diagnosis between lung tuberculosis (TB) and lung cancer in such cases is an excellent dilemma for pulmonologists and radiologists.

The Retroperitoneal Gastrointestinal Stromal Tumor, Simulating a Cystic Pancreatic Neoplasia. A Case Report.

2024-07-20T11:08:47+00:00

Introduction: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors that can arise anywhere within the gastrointestinal tract. Approximately 70 % are in the Stomach, representing 1 – 3 % of all gastrointestinal malign neoplasms. GISTs originate from the Cajal interstitial cells or their stem cell precursors within the myenteric plexus of the muscularis propria.

Histologically, GIST presents three different architectural patterns: a. composed of epitheloid cells embedded in a thin reticular stroma; b. by spindle cells with a fascicular or storiform arrangement immersed in a thin reticular stroma focally myxoid, and c. the mixed forme.

This study describes a 72-year-old man who, in the computed tomography, presented a gross appearance as pancreatic cystic neoplasia. Clinicians should be aware that this condition might be mistaken for a primary pancreatic malignancy.

The diagnostic Workup includes endoscopy with ultrasonography, cross-sectional imaging studies, and histopathological examination.

Conclusions: The reported case illustrates that the retroperitoneum might be the place of initial presentation of a cystic gastric GIST and that only an accurate pathological evaluation can establish the diagnosis and origin. Clinicians must know this condition might be mistaken for a primary pancreatic malignancy. Early surgical resection is the gold standard of treatment for primary GIST.

Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia. A Case Report.

2024-07-20T11:08:47+00:00

Introduction; Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a sporadic but underdiagnosed pulmonary disorder at the benign end of the neuroendocrine cell proliferation spectrum of preinvasive lesions of the lungs. This disease is characterized by hyperplasia of bronchiolar and bronchial pulmonary neuroendocrine cells. DIPNECH can be primary or reactive.

In the WHO - IASLP classification of lung tumors (1999, 2004, 2005, 2015), DIPNECH is considered a preneoplastic lesion in the spectrum of pulmonary tumors. According to the WHO classification, the definition of DIPNECH is purely histological.

The DIPNECH was initially described in 1992 by Aguayo et al., who reported six non-smoking patients with cough, exertional dyspnea, wheezing, less frequent hemoptysis, and a mixed obstructive/restrictive defect on pulmonary function tests. This disease has a predilection for non-smoking middle-aged women (female to male ratio is approximately 10:1)

In this article, we present a 62-year-old, non-smoker woman presented with respiratory symptoms ascribable to DIPNECH. After surgery, the morphological study of lung specimens confirmed the DIPNECH, multiple tumors, one peripheral carcinoid, and obliterative bronchiolitis in the right middle pulmonary lobe.

Conclusions: DIPNECH remains a rare pulmonary condition and is considered a preneoplastic lesion in the spectrum of pulmonary tumors. According to the WHO classification, the definition of DIPNECH is purely histological. While most patients experience a relatively uneventful clinical course, this condition may be associated with tumors, carcinoid tumors, and airway obstruction (Aguayo-Miller disease).

Wernicke’s Encephalopathy from Hyperemesis Gravidarum. A Case Report

2024-07-20T11:08:45+00:00

Introduction: Wernicke's encephalopathy (WE) is a potentially reversible, yet serious neurological emergency due to vitamin B1 (thiamine) deficiency. It is a rare but known complication of hyperemesis gravidarum. Prolonged vomiting in pregnancy results in thiamine depletion. Most frequently Wernicke's encephalopathy is found among persons suffering from chronic alcoholism. It can also occur in any medical condition producing malnourishment and causing thiamine deficiency including gastric bypass, a variety of gastrointestinal disorders, malignant diseases, anorexia nervosa, hyperthyroidism and prolonged intravenous feeding. Magnetic resonance imaging (MRI) is sensitive and specific for diagnosis and follow up evaluation. Most patients present with the triad of ocular signs, ataxia, and confusion. It can be associated with life-threatening complication like central pontine myelinolysis. Although early recognition and treatment with thiamine can reverse the symptoms, the mortality rate remains 10-20% due to underdiagnosis. It is frequently not identified until autopsy. Here we stress upon the importance of early diagnosis and prompt treatment of WE.

The aim of this report is to present case of Wernicke's encephalopathy induced by hyperemesis gravidarum. The course of the disease, clinical signs, diagnostic tools, treatment and its results are presented.

The Liver Abscess after Laparoscopic Cholecystectomy. A Case Report.

2024-07-20T11:08:45+00:00

Introduction: Laparoscopic cholecystectomy is the gold standard in the management of symptomatic gallstones. However, it is estimated that there are 2–15 cases of hepatic abscesses per 100,000 people in the U.S., mostly of bacterial etiology, and approximately half of these are caused by cholangitis.

Given the infrequency of cholangitis-induced pyogenic hepatic abscesses and the 0.4 % incidence of choledocholithiasis in post-cholecystectomy patients, pyogenic hepatic abscesses secondary to post-cholecystectomy choledocholithiasis comprise a rare entity.

A hepatic abscess occurring post-laparoscopic cholecystectomy is a known complication that can manifest months or even years after the surgery.

This case involves a 56-year-old female patient who presented with a 10-day history of abdominal pain and discomfort, primarily in the right hypochondrium, accompanied by fever unresponsive to antibiotics and antipyretics. The appropriate treatment approach was chosen based on clinical signs, abscess size, and the patient's overall condition.

Conclusion: This case shows the late complications arising from gallstone spillage into the abdominal cavity during laparoscopic cholecystectomy. It underscores the importance of careful laparoscopic exploration, especially in gallbladder perforation and stone spillage cases. Detailed documentation of the operative procedure is crucial, as it aids in the prophylactic and symptomatic treatment of long-term complications such as abscess formation.

Primary Pancreatic Lymphoma with Active Gastric Bleeding. A Clinical Case and Review Literature.

2024-08-20T09:56:35+00:00

Introduction: Primary pancreatic lymphoma is a rare clinical entity representing <0.5% of pancreatic cancers and 1% of extranodal lymphomas. Due to the lack of evidence of cases in the literature, their clinicopathological features, differential diagnosis, optimal therapy, and outcomes should be better defined.

We will present a case of a 41-year-old woman who presented symptoms such as nausea, epigastric pain, red blood vomiting, and melena.

At laparotomy, a large necrotic mass was found in the body and tail of the pancreas, infiltrating the stomach and spleen. A biopsy of the mass confirmed large B-cell lymphoma. The patient was diagnosed and started chemotherapy.

Conclusion: Primary pancreatic lymphoma is a rare clinical entity often misdiagnosed as pancreatic adenocarcinoma on presentation. Its clinical manifestations, radiological features, and biochemical signs are usually non-specific. It is based on a precise diagnosis made possible by histologic examination. Combined therapy remains the most optimal treatment approach for PPL but needs further evaluation.