Albanian Journal of Trauma and Emergency Surgery

Liver Trauma Management: Three-Year Experience in a Tertiary Trauma Center.

Agron Dogjani — 2025-07-20

Introduction: Liver injury is a frequent and frequently fatal consequence of both blunt and penetrating abdominal trauma. Due to its extensive vascularization and central position, hepatic trauma necessitates early and multidisciplinary treatment. Improvements in imaging, critical care, and interventional radiology over the past decade have made nonoperative management feasible for select individuals.

Objective: To review the management plan, outcomes, and complications of liver trauma cases in a tertiary trauma center for three years.

Materials and Methods: A retrospective analysis was performed on patients admitted with liver trauma between January 2022 and December 2024. Information on demographics, mechanism of injury, severity of injury (based on the AAST liver injury scale), imaging findings, type of treatment, and outcome was gathered.

Results: 65% of the 186 patients presented with blunt trauma and 35% with penetrating trauma. Nonoperative management was applied in 144 (77.4%) of the cases with a success rate of 94.4%. Surgery was required in 42 (22.6%) cases, often due to hemodynamic instability or high-grade injury. Overall mortality was 9.1%, which was mainly due to severe trauma and concomitant injuries, interventional radiology, i.e., hepatic artery embolization, and enhanced nonoperative management success. Operative patients had higher incidences of complications such as bile leakage and intra-abdominal sepsis.

Conclusion: Nonoperative therapy is effective and safe for most liver injury situations, provided that patient selection is correct. Surgery remains essential for unstable patients. A multidisciplinary, individualized strategy, aided by modern imaging and interventional tools, optimizes outcomes and minimizes morbidity.

Simultaneous Aortic and Mitral Valve Surgery Early Results: A 16-Year Single-Center Experience

Selman Dumani — 2025-07-20

Introduction: The Euro Heart Survey on Valvular Heart Disease reports that approximately 17% of patients with valvular heart disease are affected by two or more valves simultaneously. The most common combination requiring simultaneous surgery is aortic and mitral valve surgery. This procedure remains highly demanding for all surgical teams, even today.

The primary focus of this study is to present, for the first time, the early postoperative results of simultaneous aortic and mitral valve surgery at our clinic. We aim to compare our outcomes with those reported by other cardiovascular surgical centers, with a strong emphasis on patient well-being and survival rates.

Materials and Methods: This is a retrospective study that included adult patients who underwent simultaneous aortic and mitral valve surgery between January 2007 and December 2023 at the Cardiac Surgery Service, UHC "Mother Theresa", Tirana, Albania. The Data collection was performed using operating room registers and hospital medical records. Demographic, clinical, and non-clinical data were gathered for each patient before, during, and after the surgery.

Results: This study included 121 patients, comprising 55 males (45.5%) and 66 females (55.5%). The average age of the study population was 56.41 ± 10.35 years. Most patients underwent elective surgery (111, 91.7%), while 10 (8.3%) were urgent surgical cases. Aortic valve regurgitation was the most prevalent pathology, affecting 58 patients (47.9%). The hospital mortality rate was 6.6% (8 patients). The most common postoperative complications included low cardiac output (17.4%), conduction disturbances requiring permanent pacemaker implantation (8.3%), new-onset atrial fibrillation (8.3%), and postoperative hemorrhage (5.8%).

Conclusions: Our study on simultaneous aortic and mitral valve surgery at our clinic has demonstrated satisfactory early outcomes, including low rates of early mortality and major postoperative complications. These findings offer valuable insights for the medical community and contribute to the ongoing discourse on cardiac surgery outcomes.

Comparative Meta-Analysis of Recurrence Rates in Classical vs. Modified Limberg Flap Techniques for Pilonidal Sinus Disease Surgery: Evidence for Enhanced Efficacy

Dietrich Doll — 2025-07-20

Aim: In the surgery of pilonidal sinus disease (PSD), positioning any incision away from the central axis of the crenae is expected to yield a reduced recurrence rate. If so, it can be anticipated that the modified Limberg flap (MLF) exhibits a lower recurrence rate than the Limberg flap (LF).

Material and Methods: To perform a comparative meta-analysis of the recurrence rates, 1,338 studies encompassing 153,098 patients were identified. Out of these, 210 studies (both randomized controlled and nonrandomized controlled trials) with n=16,588 patients who had undergone either LF or MLF were included in the Kaplan-Meier Survival analysis.

Results: In non-RCT analysis, the LF group exhibited a 5-year recurrence rate of 7.1% (CI 6.3-8.0), while the MLF group showed a 5-year recurrence rate of 4.9% (CI 3.7-6.1) (p<0.0001). After 8 years, which represents the most extended observation period for the MLF group, the recurrence rate was 10.9% (CI 9.6-12.1) for LF and 7.3% (CI 5.4-9.1) for MLF (p<0.0001).

In the RCT analysis, the curves differ as a trend but not significantly, as PT numbers are scarce beyond year 2. The RCT-versus-nonRTC analysis of LF shows significantly higher RR for RCT studies, which is the same for MLF.

Conclusion: This meta-analysis, which focused on recurrence rates associated with Limberg flap variants and analyzed data from 16,588 patients, shows that the modified Limberg flap technique effectively reduces the risk of recurrence compared to the already low recurrence rate associated with the classical Limberg flap. The presence of a scar in the caudal midline, as observed in the classical Limberg variant but not in the modified Limberg, is strongly correlated with a higher recurrence rate. Therefore, the modified Limberg flap variant is recommended in future surgical procedures.

What does this paper add to the literature? This paper contributes significantly to the existing literature by providing robust evidence supporting the modified variant of the Limberg flap technique. While the Limberg flap's recurrence rate is already low, its modification notably diminishes recurrence rates even further. Consequently, the modified Limberg plasty may be considered the emerging gold standard.

Early Results of Simultaneous Aortic Valve and Ascending Aorta Surgery: 16-year Single-Center Experience

Selman Dumani — 2025-07-20

Introduction: Surgical treatment for the aortic valve and ascending aortic aneurysm is currently a frequently performed procedure. It is reported that up to 15% of patients requiring aortic valve surgery also need simultaneous surgical intervention of the ascending aorta.

The main objective of this study is to present, for the first time in our country, the early postoperative outcomes of combined aortic valve surgery and supra-commissural ascending aorta replacement. This study, being the first of its kind in our country, holds significant importance in the field of cardiovascular surgery.

Materials and Methods: This retrospective cohort study included patients who underwent simultaneous aortic valve surgery and supracommissural ascending aorta replacement between 2007 and 2023 at the Department of Cardiac Surgery, UHC ‘Mother Teresa,’ Tirana, Albania. Data were extracted from surgical registries and medical hospital records.

Results: A total of 131 patients participated in the study, consisting of 102 males (77.9%) and 29 females (22.1%). The average age of the cohort was 57.33 ± 11.90 years. The majority of patients (93.9%, 123/131) underwent elective surgery. Severe aortic valve stenosis was the most prevalent primary pathology, affecting 58 patients (44.3%). The in-hospital mortality rate was 2.29% (3/131 patients) …

Conclusion: Simultaneous aortic valve surgery and supra-commissural ascending aorta replacement at our institution is associated with excellent early postoperative outcomes, reassuring us of the effectiveness of this procedure in our practice.

Most Significant Factors Affecting the Survival of Patients with Out-of-hospital Cardiac Arrest

Isuf Bajrami — 2025-07-20

Introduction: Cardiac arrest, the sudden loss of heart function, often strikes without warning. Immediate medical intervention is not only critical, but it is also a lifeline for these patients. Without prompt action, cardiac arrest is usually fatal. Resuscitation. This study explores key factors that influence the survival of patients experiencing cardiac arrest in prehospital settings.

The primary aim of this study is to thoroughly investigate and identify the most crucial factors influencing the survival of patients experiencing cardiac arrest in pre-hospital settings.

Material and Methods: An extensive review of global and local literature focused on studies involving

patients of various age groups who underwent prehospital Resuscitation. Key factors affecting survival outcomes in prehospital cardiac arrest were tracked and analyzed.

Results: Large meta-analyses reveal that data from 37 Emergency Medical Services across Europe indicate a one-year survival rate following Cardiopulmonary Resuscitation of approximately 20.7%. From 2016 to 2023, the Emergency Medicine Center in Pristina resuscitated 576 patients, achieving an average one-year survival rate of 8.8%. Timely defibrillation of ventricular fibrillation is crucial, potentially increasing survival rates by up to 90%. However, each minute of delayed defibrillation reduces survival rates by about 10%. This highlights the crucial role of Emergency Medical Services in ensuring timely intervention. Optimal defibrillation occurs within 3 to 5 minutes after cardiac arrest. Healthcare professionals must be equipped to perform both basic and advanced cardiopulmonary resuscitation techniques to improve outcomes.

Conclusion: The success of resuscitation depends on the time elapsed between cardiac arrest and the initiation of resuscitation measures. Early intervention with basic life support techniques significantly increases the chances of survival. However, it is not solely the responsibility of professionals. The community also plays a vital role. Automated External Defibrillators (AEDs) are a safe and effective method, especially when applied promptly in cases of cardiac arrest.

Freestyle Bioprosthetic Valves: Clinical Outcomes, Surgical Techniques, and Future Directions

Ermal Likaj — 2025-07-20

Introduction: The Freestyle® stentless porcine aortic root (Medtronic, Minneapolis, MN) has emerged as a valuable option for aortic valve replacement (AVR), offering superior hemodynamics compared to stented bioprostheses and eliminating the need for lifelong anticoagulation required with mechanical valves. Derived from a porcine aortic root, the Freestyle valve allows for versatile implantation techniques, including subcoronary, root inclusion, and full root replacement. While the Freestyle valve demonstrates excellent hemodynamics and benefits, as well as acceptable long-term survival, challenges remain regarding structural valve deterioration (SVD) in younger patients and technical complexities during implantation. These technical complexities include the need for precise surgical expertise, the stentless nature of the prosthesis, dense adhesions, and circumferential calcification of the porcine root. Emerging technologies, such as advanced anti-calcification treatments and tissue engineering, may further enhance its durability. In this article, we present two illustrative cases from our institution to highlight these challenges and discuss surgical strategies, as well as synthesize current evidence and discuss future directions for stentless bioprosthetic valves.

Conclusion: The Medtronic Freestyle stentless bioprosthetic valve offers significant hemodynamic benefits and acceptable durability in appropriately selected patients. However, late failure of the Freestyle stentless aortic root bioprosthetic can present as catastrophic pseudoaneurysm formation or severe leaflet degeneration with rupture. Prosthesis excision requires complex surgical strategies, including the need for root replacement and tailored coronary reimplantation.

Rational Antibiotic Use in Emergency Departments: Strategies to Mitigate Resistance Risk

Erkan Boga — 2025-07-20

Introduction: Antibiotic resistance represents a significant global public health issue, exacerbated by the misuse and overuse of antibiotics. In the fast-paced environment of emergency departments (EDs), the frequent need for empirical antibiotics leads to regular deviations from established guidelines, increasing the risks associated with antibiotic resistance. This study evaluates antibiotic prescribing practices in emergency departments (EDs) and examines how adherence to guidelines impacts clinical outcomes and contributes to reducing antibiotic resistance.

Materials and Methods: A retrospective observational analysis was conducted involving 5,000 patient records from January to August 2024 at Esenyurt Necmi Kadıoğlu State Hospital. The data included demographics, clinical presentations, antibiotic usage, laboratory results, and adherence to guidelines. Statistical analyses were performed to assess the associations between prescription practices and patient outcomes.

Results: Guideline adherence was observed in 73.08% of cases, significantly reducing treatment duration (p = 0.013). Antibiotic sensitivity testing indicated a sensitivity rate of 74.04%, with patient age significantly impacting antibiotic efficacy (p = 0.024). Logistic regression showed moderate predictive power for complications (accuracy = 51%). Subgroup analysis suggested a borderline association between guideline adherence and outcomes in patients with poor general health (p = 0.081).

Conclusion: The findings of this study provide hope in the fight against antibiotic resistance. Adhering to antibiotic guidelines in emergency departments (EDs) not only enhances treatment efficiency and recovery rates but also lays a foundation for future research and policy. The significance of thorough microbiological and clinical evaluations in choosing antibiotics is highlighted, setting the stage for larger studies and the exploration of additional variables. By employing this approach, we can effectively mitigate resistance risks and ensure a brighter future for antibiotic use.

Dental Caries in Children and the Role of Silver Diamine Fluoride in Its Prevention

Jetmire Alimani - Jakupi — 2025-07-20

Background: Silver diamine fluoride (SDF) represents one of the most effective agents for the non-invasive management of dental caries, particularly in pediatric patients, where conventional treatment approaches often present significant challenges.

The aim is to present our clinical experience in the non-invasive management of dental caries in preschool-aged children through the application of silver diamine fluoride (SDF) solution.

Materials and Methods: This study involved 16 children, aged between 2 and 6 years, who were diagnosed with dental caries. All participants were managed using a non-invasive approach through the topical application of silver diamine fluoride (SDF) solution, aiming to arrest carious lesions and reduce the need for conventional restorative treatment, which can often be challenging in this age group.

Results: All children were treated with a silver diamine fluoride (SDF) solution using a specialized applicator. In ten cases, the outcomes were highly satisfactory following the initial application. In five children, however, a second application was required after three months due to suboptimal results. Among these, only one child demonstrated insufficient improvement, necessitating a third application six months later.

Conclusion: The findings of our study, consistent with those of numerous other investigations, unequivocally demonstrate that silver diamine fluoride (SDF) is a highly effective agent for both treating and preventing dental caries in preschool children. This success should instill confidence in the dental community about the potential of SDF in managing dental caries.

Isolated Aortic Valve Replacement: Early Results from a 16-Year Experience

Selman Dumani — 2025-07-20

Background: Aortic valve replacement (AVR) has been a routine procedure since the introduction of heart valve prostheses in the late 1960s and early 1970s. It is the most commonly performed heart valve surgery in cardiac surgical practice.

This study aims to present the early postoperative outcomes of isolated AVR surgery performed at the Service of Cardiac Surgery, University Hospital Center "Mother Teresa," Tirana, Albania, from January 2007 to December 2023.

Materials and Methods: Patients who underwent isolated aortic valve surgery were included in this retrospective study. All surgeries were performed at the Service of Cardiac Surgery, University Hospital Center ‘Mother Teresa,’ Tirana, Albania, from January 2007 to December 2023.

Results: The study included 491 patients (311 males and 180 females) with a mean age of 62.28 ± 10.76 years. The majority of patients (72.5%) had aortic valve stenosis. At hospital admission, most patients were classified as New York Heart Association (NYHA) Class III (54.2%) or Class II (38.9%). In-hospital mortality was 1.6% (8/491 patients). The most frequent postoperative complications included new-onset atrial fibrillation (15.5%), conduction disorders requiring permanent pacemaker implantation (6.5%), and low cardiac output syndrome (3.7%). Cardiopulmonary bypass time, aortic cross-clamp time, respiratory Assistance time, intensive care unit stay, and postoperative hospital stay were 83.85 ± 22.63 minutes, 65.22 ± 19.20 minutes, 16.2 ± 42.16 hours, 59.59 ± 65.60 hours, and 9.15 ± 4.45 days, respectively.

Conclusion: The early results of aortic valve surgery at our center are satisfactory and significant. With a low mortality rate and a relatively low incidence of postoperative complications, our outcomes align with international standards, underscoring the safety and effectiveness of AVR in our institution. These findings contribute to the growing body of knowledge in cardiac surgery, providing valuable insights for future research and practice.

Predicting Mortality in Elderly Patients with Hypertensive Crises: Development and Validation of a Risk Model

Erkan Boga — 2025-07-20

Introduction: Hypertensive crises, which are marked by severe increases in blood pressure with or without acute target organ damage, represent a critical condition associated with substantial morbidity and mortality, particularly among older adults. As global life expectancy increases, the prevalence of hypertension and its complications also rises, creating an urgent need for effective strategies for early risk assessment and intervention. This study aims to develop and validate a risk model for predicting mortality in elderly patients experiencing hypertensive crises. Given the high morbidity and mortality rates associated with hypertensive crises in this population, an accurate risk assessment tool could enhance clinical decision-making and improve patient outcomes.

Materials and Methods: A retrospective cohort study was conducted involving 1,500 patients aged 65 and older who presented to the emergency department with hypertensive crises between January and August 2024. Patients with a confirmed diagnosis and complete medical records were included. Data on demographics, clinical findings, laboratory results, and comorbidities were extracted from electronic health records. Univariable and multivariable logistic regression analyses were performed using SPSS version 25 to identify key predictors of mortality.

Results: The dataset was complete, with no missing values. The mean patient age was 82.5 years (±10.3), and the overall mortality rate was 15%. A risk model was developed that categorized patients into low-risk (0.14% mortality), medium-risk (75% mortality), and high-risk (99.87% mortality) groups. Receiver Operating Characteristic (ROC) analysis indicated excellent model performance, with an Area Under the Curve (AUC) of 0.999.

Conclusion: The proposed risk model demonstrates impressive predictive accuracy for mortality in elderly patients experiencing hypertensive crises. However, its retrospective design may limit external validity. This model can help emergency physicians optimize treatment strategies and improve patient outcomes.

Foodborne Toxicity in the Pediatric Population: Etiology, Diagnosis, and Prevention Strategies

Ferizat Dika-Haxhirexha — 2025-07-20

Introduction: Foodborne intoxications persist as a significant and urgent public health concern globally, impacting both developing and developed nations. The incidence, particularly among children, escalates notably during the summer months, underscoring the severity of the issue.

This study aims to present our clinical experience in managing foodborne intoxications in pediatric patients aged between 12 months and 6 years.

Materials and Methods: This retrospective study included 96 children diagnosed with foodborne intoxication, all of whom were treated by the most recent World Health Organization (WHO) guidelines for the management of foodborne illnesses.

Results: Among the 96 children treated between June and August 2024, 56 were female and 40 were male. The mean age of the patients was 3.8 years. The most commonly reported symptoms upon admission were colicky abdominal pain, vomiting, diarrhea, and—in a subset of patients—high-grade fever and chills.

Conclusion: The management of foodborne infections remains a critical global health issue. The unique vulnerability of younger children and the potential for rapid clinical deterioration underscore the need for improved management strategies, highlighting the crucial role of the medical community in addressing this issue.

Risk Scoring for the Diagnosis of Acute Kidney Injury: A Novel Model Developed for Chronic Kidney Disease Patients in the Emergency Department

Erkan Boga — 2025-07-20

Introduction: Chronic kidney disease significantly increases the risk of acute kidney injury, and delays in diagnosing acute kidney injury in emergency departments can lead to adverse clinical outcomes. This study aimed to develop a practical and effective tool for assessing the risk of acute kidney injury in patients with chronic kidney disease.

Materials and Methods: This retrospective cohort study was conducted at a state hospital over eight months in 2024, involving 1,500 patients aged 18 years and older with a confirmed diagnosis of chronic kidney disease. Data were extracted from electronic medical records, encompassing demographic, clinical, and laboratory parameters. Risk factors were analyzed using logistic regression, and significant variables were used to develop a scoring system. The model's performance was evaluated using the area under the receiver operating characteristic curve, as well as sensitivity, specificity,

Results: The developed model achieved an operating characteristic curve of 0.75, with a sensitivity of 68% and a specificity of 72%. In univariate analysis, diabetes and hypertension were significant, but not in multivariate analysis. Subgroup analysis revealed improved model performance in patients under 50 years old and those without diabetes.

Conclusion: This study presents a valuable tool for predicting the risk of acute kidney injury in patients with chronic kidney disease, thereby potentially enhancing clinical decision-making and improving patient outcomes. However, prospective studies and applications across diverse patient populations are necessary to enhance the model’s generalizability.

Determining the Optimal Length of Root Canal Obturations Using GuttaFlow®2 and Thermafill Systems.

Lindihana Emini — 2025-07-20

Introduction: Successful endodontic therapy requires complete mechanical and chemical preparation of the root canal system, followed by three-dimensional obturation. Inadequate obturation, despite proper cleaning and shaping, may lead to treatment failure. This study aims to compare the obturation length achieved using the GuttaFlow®2 and Thermafill systems, evaluating their effectiveness through micro-computed tomography (micro-CT).

Materials and Methods: Eighty extracted human anterior teeth were decoronated 1 mm below the cementoenamel junction and randomly assigned to two groups. Group 1 (n=40) was obturated with GuttaFlow®2 (Coltene/Whaledent, Germany), and Group 2 (n=40) with Thermafill (Dentsply DeTrey, Germany). All samples were scanned using a cone-beam micro-CT system (μCT 35, SCANCO Medical, Switzerland) to assess the length and quality of canal obturation.

Results: Statistical analysis using the Kruskal-Wallis ANOVA test (H=4.0383, p=0.2574) showed no significant difference in obturation length between the two groups. Both cold (GuttaFlow®2) and warm (Thermafill) techniques achieved optimal filling lengths, indicating that obturation quality is not significantly influenced by the type of material or technique.

Conclusion: Both GuttaFlow®2 and Thermafill systems are effective in achieving the desired obturation length. The choice between warm and cold obturation techniques may be based on clinician preference, as neither demonstrated superiority in this study.

Tourniquet Use for Major Hemorrhage in Prehospital and Hospital Settings: A Systematic Review of the Literature

Basri Lenjani — 2025-07-20

Introduction: Major hemorrhage remains a leading cause of preventable death in both civilian and military trauma settings. Tourniquets have emerged as a critical intervention for hemorrhage control; however, their optimal application across various clinical environments requires systematic evaluation.

Objective: To systematically review the effectiveness, safety, and clinical outcomes of tourniquet use for major extremity hemorrhage in prehospital and hospital settings.

Materials and Methods: We conducted a comprehensive systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library databases for studies published between 2000 and 2024. The inclusion criteria covered randomized controlled trials, cohort studies, and observational studies that assessed the use of tourniquets for major limb hemorrhage. Primary outcomes included survival rates, effectiveness of hemorrhage control, and complication rates. Secondary outcomes included time to hemorrhage control and functional results. Data extraction focused on clinical indications, patient demographics, tourniquet specifications, application timing, and adverse events.

Results: Thirty-two studies met the inclusion criteria. Tourniquet use in the prehospital setting was consistently associated with improved survival in patients with severe extremity bleeding, particularly when applied early. Hospital-based tourniquet use has proven effective in surgical or resuscitative contexts but requires careful monitoring to avoid ischemic complications. When used correctly and for limited periods, complication rates remain low.

Conclusions: The current evidence strongly supports the use of tourniquets as an effective and safe intervention for major extremity hemorrhage in both prehospital and hospital settings. The early application improves survival outcomes and helps reduce complications. Implementing standardized protocols, comprehensive training programs, and quality improvement initiatives is crucial to maximizing clinical benefits and ensuring patient safety.

The Relationship Between Osteoporosis and Trauma: A Systematic Review

Rajmonda Tare — 2025-07-20

Introduction: Osteoporosis, a common bone disorder marked by decreased bone density and heightened fracture risk, especially after minor trauma, presents a significant public health challenge. The effects of trauma on patients with osteoporosis, particularly in the hip and vertebrae, result in considerable morbidity, mortality, and healthcare expenses.

This study aims to systematically review the existing literature on the relationship between osteoporosis and trauma. It explores the epidemiology, pathophysiology, clinical presentation, and management of trauma in osteoporotic patients while identifying gaps in preventive strategies.

Material and Methods: A systematic review was conducted using peer-reviewed journal articles focusing on osteoporosis-related trauma. Inclusion criteria included studies evaluating osteoporotic patients with traumatic injuries or those undergoing trauma risk assessments. Data were extracted from randomized controlled trials, cohort studies, and case-control studies, excluding non-human and non-research articles. Statistical analysis and critical appraisal were performed, and the selected studies were ensured to have methodological rigor.

Results: The findings emphasize a strong correlation between osteoporosis and trauma, with osteoporotic patients facing higher fracture rates and more extended recovery periods. The review reveals a significant gap in trauma prevention strategies, as current clinical approaches mainly prioritize pharmacological treatment over comprehensive fracture risk reduction. The increasing incidence of osteoporotic fractures, particularly in aging populations, highlights the need for early screening and multidisciplinary intervention.

Conclusion: Osteoporosis significantly increases the risk of fractures after minor trauma, leading to serious health consequences and economic burdens. However, the existing treatment strategies, though inadequate, provide opportunities for enhancement. An integrative approach that combines pharmacological therapy, fall prevention programs, and patient education could significantly enhance trauma prevention. The future shows promise for developing standardized guidelines for trauma prevention and optimizing clinical pathways for osteoporotic patients.

Total Pancreatectomy with Islet Auto-transplantation in Chronic Pancreatitis is the Call of our Time.

Nerida Dhigoi — 2025-07-20

Introduction: Total pancreatectomy with islet auto-transplantation is a realistic therapeutic choice and an advanced surgical operation for individuals with chronic pancreatitis.

The primary purpose of total pancreatectomy with islet auto-transplantation is to alleviate the debilitating pain caused by chronic pancreatitis and thereby significantly improve the quality of life of patients with chronic pancreatitis. Although the permanent loss of the function of the pancreatic endocrine occurs due to total pancreatectomy, it may be substituted by autologous transplantation of islets.

Patients receiving total pancreatectomy and Islet Transplantation may be less dependent on insulin than patients receiving total pancreatectomy. This process, although not without some difficulties, has consistently demonstrated promising results in reducing pain, improving glycemic control, mitigating diabetic complications, and enhancing the overall quality of life in patients with chronic pancreatitis. In this article, we review the global experience with Total pancreatectomy with islet auto-transplantation and examine the prospects for its implementation in the Albanian health system.

They can alleviate the burden of chronic pancreatitis, improve patients' prognosis, and enhance the country's healthcare system capacity. However, the introduction will also necessitate a strategic transformation of infrastructure, training, and health policy, which is discussed below.

Conclusions: Total pancreatectomy with islet auto-transplantation is a novel, effective treatment option for patients with recurrent acute pancreatitis and those with chronic pancreatitis. Its implementation in Albania, while promising, necessitates strategic reforms in infrastructure, training, and health policy. However, if constructed as a secondary project with the aim of institutional support, these reforms can significantly increase the quality of care for patients with chronic pancreatitis in our country.

Prevalence and Associated Risk Factors for Occupational Burnout Among Healthcare Personnel: A Systematic Review

Silvana Belisha — 2025-07-20

Introduction: Burnout, a global syndrome affecting healthcare systems, is often referred to as the "disease of the 21st century." This review examines the prevalence and contributing factors of this condition among healthcare personnel in Europe. The prevalence of burnout in European countries has been a subject of interest, and the factors contributing to it are being examined. This literature review aims to provide a comprehensive understanding of the scope of burnout and its implications, with a particular emphasis on its global impact.

Materials and Methods: A systematic search of databases (Web of Science, Scopus, PubMed, and others) identified 95 articles, nine of which met the inclusion criteria. Studies published in the last 20 years, particularly those from the past decade, were prioritized for review. The search strategy utilized keywords to identify titles, including "prevalence of boss" and "boss factors." Most articles were published within the last 20 years, with a greater proportion of the most recent articles appearing in the past 10 years.

Results: Burnout prevalence ranged from 16.8% (Montenegro) to 71.36% (Romania), with nursing staff and general practitioners most affected. Risk factors included age, gender, long working hours, high patient loads, and inadequate vacation time. A preponderance of burnout-related concerns was observed among the personnel, particularly those engaged in staff nursing and general practice.

Conclusions: Burnout is prevalent among healthcare professionals, highlighting the need for targeted interventions to mitigate its impact. Addressing risk factors is crucial for improving occupational health and well-being. This study's findings demonstrate that burnout is prevalent among the examined population. The investigation revealed that a significant proportion of the subjects exhibited moderate levels of burnout. The analysis further elucidates that a substantial number of the subjects identified as "high-risk" were influenced by various factors, including, but not limited to, their immediate superiors.

Exploring Unique Insights into Cell Damage Pathways in Celiac Disease

Anna Maria Prenga — 2025-07-20

Introduction: Celiac disease, or celiac sprue, is a T cell-mediated autoimmune disorder of the small intestine triggered by ingesting dietary gluten products in genetically susceptible individuals. The pathologic mechanism involves an immune response targeting gluten peptides, leading to inflammation, villous atrophy, and malabsorption in the small intestine. This research is a significant step in understanding the mechanisms of how CD4+ T cell (white blood cells that are an essential part of the human immune system) responses against gluten can lead to autoreactive B-cell responses and tissue destruction mediated by intraepithelial cytotoxic T cells in the small intestine. Your work in this field is crucial in advancing our understanding and managing celiac disease.

It also discusses the overexpression of IL-15 on enterocytes in active celiac disease. This overexpression of IL-15 is believed to contribute to the pathogenesis of the condition by promoting the survival and activation of intraepithelial lymphocytes, leading to tissue damage.

It addresses challenges in understanding specific phenotypes of celiac disease, such as slow-responsive, potential, and seronegative forms. These forms of the disease present unique diagnostic and management challenges, often requiring a multidisciplinary approach for effective treatment.

Conclusion: The articles provide valuable insights into the cellular mechanisms underlying celiac disease, the immune responses involved, and the impact of gluten on intestinal cells. They also address the practical implications of this knowledge, such as the significance of dietary management in controlling the disease and preventing complications. This research empowers you, the reader, with actionable information that can make a real difference in the lives of those affected by celiac disease.

Contemporary Guidelines for the Treatment and Prevention of Nosocomial Infections: Critical Analysis and Practical Perspectives.

Aferdita Ademi — 2025-07-20

Introduction: Nosocomial infections remain a significant threat to patient safety worldwide, driving morbidity, mortality, and escalating healthcare costs. Despite comprehensive guidelines from the WHO, CDC, and ECDC, variability in recommendations and persistent implementation gaps impede optimal uptake.

Objective: To critically assess current international and regional standards for preventing and controlling healthcare‐associated infections (HAIs) and to propose feasible, context‐specific strategies for local implementation that empower healthcare professionals to reduce infection rates meaningfully.

Material and Methods: We conducted a systematic review of key HAI prevention and management guidelines published between 2013 and 2023. The methodological quality of each document was evaluated using the AGREE II instrument.

Results: All guidelines converge on essential measures: rigorous hand hygiene, standardized environmental disinfection protocols, and robust antimicrobial stewardship programs. However, antibiotic regimens for routine HAIs (e.g., catheter‐associated urinary tract infections) differ markedly, and few guidelines offer clear pathways for implementation in facilities constrained by staffing, equipment, or medication shortages. Interviewees cited critical challenges, including insufficient staffing levels, inconsistent training quality, limited diagnostic capacity, and underdeveloped surveillance systems.

Conclusions: Harmonization of core recommendations is needed to reduce clinician confusion. We propose a practical implementation framework. Tailoring global best practices to local realities promises improved compliance, optimized resource use, and a significant reduction in nosocomial infection burden.

Partial Heart Herniation: An Unusual Manifestation of Trans-Mediastinal Gunshot Injury

Hagar Levy Shachar — 2025-07-20

Introduction: Gunshot injuries to the thoracic cavity are relatively common and considered high risk for cardiac involvement. However, current literature shows that the incidence of cardiac damage does not differ significantly when comparing various aetiologies of penetrating chest injuries [1].

The most common predictive factors for cardiac injury include clinical manifestations, missile trajectory or anatomical wound location, and the number of chest wounds [2]. However, injuries to the heart and mediastinal vessels are often fatal and are therefore considered leading causes of death following trauma [3].

Most patients suffering from an acute traumatic cardiac injury present with hemodynamic instability and cardiac tamponade, which can subsequently lead to high mortality rates [4, 5]. Therefore, a patient with a gunshot thoracic injury, especially transmediastinal, who is hemodynamically stable and shows no clinical signs or symptoms of cardiac injury, may have underlying injuries.

We present a rare case of a stable gunshot trans -mediastinal wound patient, with initial retained haemothorax after thoracentesis, and finally diagnosed with partial heart herniation.

Conclusions: Partial heart herniation following a transmediastinal gunshot wound is a rare and potentially life-threatening condition that may present without classic signs of cardiac injury. This case emphasizes the importance of maintaining a high index of suspicion for occult cardiac trauma in hemodynamically stable patients with thoracic gunshot injuries. Timely imaging, thorough evaluation, and minimally invasive surgical exploration, such as VATS, can play a critical role in diagnosing and managing such atypical presentations, ultimately improving outcomes.

Necrotizing Fasciitis, as a Dramatic Complication of Infectious Diseases, Remains a Significant Challenge for Doctors.

Ermira Muco — 2025-07-20

Introduction: Fasciitis is an inflammation of the fascia, the connective tissue that surrounds muscles, blood vessels, and nerves, which can rapidly progress to necrosis of these structures, leading to life-threatening situations. It is a polymicrobial infection caused by bacterial agents, fungi, viruses, and parasites, resulting in septicemia, multiorgan failure, septic shock, and potentially death. The LRINEC score is a valuable tool in diagnosing necrotizing fasciitis (NF).

Case Presentation: The patient is a 62-year-old woman with a history of Diabetes Mellitus type 2 and Bilinear Myelodysplasia, currently receiving high-dose corticosteroid therapy. She was recently diagnosed with Herpes Zoster affecting the S1, S2, S3, S4, and S5 dermatomes. Initially, she was treated for 8 days with antivirals and antibiotics for symptoms of fever, fatigue, and pain in the gluteal and lumbar regions. However, her condition worsened, prompting her readmission to the hospital, where she developed signs of sepsis. After imaging, laboratory tests, and consultations with surgeons, she was diagnosed with necrotizing fasciitis. Multidisciplinary management and complex therapy led to an excellent outcome.

Conclusion: Necrotizing fasciitis presents a significant diagnostic challenge due to its rarity and its clinical resemblance to other critical conditions. It is an urgent pathology that requires not only surgical intervention but also immediate medical attention. It has always intrigued healthcare professionals both locally and internationally. Early diagnosis remains the primary challenge, and the management of these patients by experienced senior surgeons is crucial for successful outcomes.

A Bilateral Decompressive Craniotomy after Severe Traumatic Brain Injury with Post-Operatory Hydrocephalus and Ventriculitis: A Case Report and Literature Review

Daniel Antonio Encarnación-Santos — 2025-07-20

Introduction: Severe traumatic brain injury is characterized by pathological external forces that disrupt or alter brain function. Globally, an estimated 50 million cases of Severe traumatic brain injury occur annually.

Case presentation: This case study of an 18-year-old male patient, who suffered severe TBI in a motor vehicle accident, provides a valuable insight into the management of such cases.

The patient's initial assessment revealed a Glasgow Coma Scale score of 8, asymmetric but reactive pupils, and bilateral motor strength of 3/5, with no abnormalities noted in the cranial nerves.

Primary diagnosis by CT scan: severe traumatic brain injury with acute subdural hematoma in the right frontoparietal-temporal region, brain edema, and midline dislocation.

Secondary findings: Acute epidural hematoma in the left frontoparietal-temporal region.

Associated injuries: skull fractures, soft tissue contusions, and left lung contusion.

Surgical Procedures: The patient underwent the following procedures: 1. Right decompressive craniotomy for acute subdural hematoma. 2. Left decompressive craniotomy for acute epidural hematoma.

Conclusion: This case underscores the pivotal role of decompressive craniotomy in managing severe traumatic brain injury. Over the past two decades, this procedure has been instrumental in reducing secondary brain injury, enhancing cerebral perfusion, and managing elevated intracranial pressure. It has also been shown to decrease both mechanical ventilation dependence and intensive care unit length of stay, providing reassurance about its effectiveness.

Unexplained Foreign Body in the Abdomen: A Diagnostic Dilemma

Kshitij Jyoti — 2025-07-20

Introduction: Foreign body ingestion or insertion into the gastrointestinal tract is not uncommon, particularly in patients with psychiatric disorders, cognitive impairments, or cases of abuse. However, when such incidents go unreported due to altered mental status or inability to provide an accurate history, they present a significant diagnostic challenge, especially in primary or secondary healthcare facilities lacking advanced imaging modalities.

Diagnosing intra-abdominal foreign bodies can be a significant challenge in primary or secondary care settings, particularly when advanced imaging modalities are unavailable, and the patient cannot provide a reliable medical history.

We present the case of a male patient in his early 60s with a history of hypertension and psychiatric illness who arrived in an altered mental state, accompanied by fever and persistent vomiting for two days. Initial evaluation with a plain abdominal X-ray revealed a large, radio-opaque object in the abdomen.

An emergency exploratory laparotomy was performed, which uncovered an unusual assortment of foreign bodies in the peritoneal cavity, including a pestle, a pencil, and multiple eraser fragments. A tear was identified in the anal canal as the likely point of entry. The patient underwent primary repair of the perforation and a diversion colostomy.

Conclusion: This case highlights the necessity of maintaining a high index of suspicion for intra-abdominal foreign bodies in patients presenting with nonspecific abdominal symptoms, particularly when the history is limited or unreliable due to psychiatric or cognitive impairments. Prompt imaging, even basic radiographs, can provide crucial insights, and early surgical intervention can be life-saving. Surgeons must remain vigilant and receptive in their diagnostic approach, as rare and unexpected findings can significantly change management and outcomes.

Benign Glomus Tumor of the Urinary Bladder: A Case Report and Literature Review.

Lutfi Alia — 2025-07-20

Introduction: Glomus tumors (GT) are sporadic mesenchymal neoplasms found in adults, comprising less than 2% of soft tissue tumors. GT originates from glomocytes, which are modified vascular smooth muscle cells located in the walls of specialized structures of the glomus body—a neuromyoarterial plexus in the dermis of the skin that typically plays a role in thermoregulation. Most GTs are benign, though some cases exhibiting atypical or malignant behavior have been documented. GT usually occurs in the skin and superficial soft tissues, primarily in the extremities, especially beneath the nail bed, and rarely affects internal organs; however, those organs lack glomus bodies. The occurrence of GT in the urinary bladder, which does not contain glomus bodies, is an infrequent occurrence and has been reported sporadically. The gene implicated in the pathogenesis of bladder GT is the glomulin gene (GLMN), situated on chromosome arm 1p21-22. Multiple subungual granular tumors (GTs) have been reported in neurofibromatosis type 1, originating from a mutation in the NF1 gene.

The first case of benign GT of the urinary bladder was described by Tripodi SA et al. in 2013, while malignant GT of the urinary bladder was described by Shim HS et al. in 2005. Depending on the relative prominence of glomus cells, vascular structures, and smooth muscle, the GTs are subcategorized: Solid histotype, Glomangioma, and Glomangiomyoma.

In this study, we report a case of benign GT of the urinary bladder in a 63-year-old man presenting with recurrent hematuria of unknown etiology. The cystoscopy showed a polypoid lesion at the anterior wall of the urinary bladder. The transurethral resection was performed, and the lesion was easily removed. In the microscopic examination of the biopsy, the final pathological diagnosis was a benign glomus tumor of the urinary bladder – a solid histotype. After resection of GT, the patient was followed according to standard follow-up protocol for patients with bladder tumors. One year after resection, the patient was in good health, with no recurrence or metastasis, demonstrating the successful treatment and follow-up of this rare case.

Conclusions: GTs arising in the bladder are extremely rare. It is challenging to diagnose bladder GTs based on their clinical features. The gold standard method for diagnosing GT is histopathological examination and immunohistochemical analysis. Transurethral resection is the most common treatment used for benign or atypical bladder GT. However, it should also be considered in the differential diagnosis for Bladder neoplasms.

Anesthesia Management for a Pediatric Trauma Patient with Coloboma Following a Dog Bite.

Silvana Leka — 2025-07-20

Introduction: The anesthetic care of this pediatric patient with coloboma and indication for surgical intervention due to a dog bite injury is discussed in this case report. Coloboma can be part of several syndromes, and thus, perioperative risk for complications is increased, particularly elevated intraocular pressure during airway manipulation.

Case Presentation: We selected Total Intravenous Anesthesia using a propofol-based general anesthetic without inhalational agents. We did this to maintain hemodynamic stability and circumvent the specific risks associated with coloboma. We selected Total Intravenous Anesthesia because it has been demonstrated to be capable of providing controlled anesthesia without increasing intraocular pressure, a vital consideration in this case.

Discussion: The successful management of this complex case demonstrates the central role of personalized anesthetic planning in obtaining better outcomes for pediatric trauma patients with specific congenital anomalies. Total Intravenous Anesthesia proved effective in maintaining controlled anesthesia while minimizing the risk of raised intraocular pressure.

Conclusion: This case serves as a reminder of the necessity of having an overall understanding of unusual congenital disorders like coloboma in the context of trauma. It is also a reminder of the critical role that the anesthesiologist plays in ensuring perioperative safety and the success of surgery. The contribution of the anesthesiologist is not only necessary but integral to the medical team, and this case serves as a reminder of that fact.

Artificial Intelligence in Pathology: Past, Present, and Future Perspectives

Isma Balaj — 2025-07-20

Introduction: Artificial intelligence (AI) is at the forefront of modern technology, with emerging applications in the healthcare sector now gaining recognition. Pathology is anticipated to be a key area where the impact of AI will be substantial. As more laboratories transition to digital pathology, this will create the essential infrastructure needed to implement these tools, making their application a reality in diagnostic practice. The potential of AI in pathology lies in developing image analysis tools that can support diagnosis or generate new insights into disease biology, beyond what a human observer can achieve. Examples currently exist providing diagnostic support for a limited but growing number of applications, such as tumor detection, automated tumor grading, immunohistochemistry scoring, and predicting mutation status. Several challenges remain, including the validation and establishment of a regulatory framework for these tools, as well as the ethical implications of AI in pathology. These include concerns about patient privacy and consent, along with the potential for AI to worsen existing healthcare disparities. In this article, we offer an overview of AI in histopathology, discuss its possible workflow applications, and highlight significant examples of AI's potential impact in clinical practice. We also explore considerations for implementing AI in practice.

Conclusion: There has been a significant increase in the development and application of AI tools, including image-based algorithms, in pathology services, and they are expected to dominate the field in the coming years. The implementation of computational pathology and the use of pathology-related AI tools can be viewed as a paradigm shift that will transform the management of pathology services. While AI will undoubtedly enhance the efficiency of pathology services, it is crucial to recognize that it will not replace the role of pathologists. Instead, it will augment their capabilities, enabling them better to meet the demands of this era of precision medicine.