Albanian Journal of Trauma and Emergency Surgery http://journal.astes.org.al/AJTES/index.php/AJTES <p>The<em><strong> Albanian</strong><strong> Journal of Trauma and Emergency Surgery</strong></em>&nbsp;<strong><em>(AJTES)</em></strong> is the official publication of the Albanian Society for Trauma and Emergency Surgery (ASTES). It is published twice a year.</p> <p><em>AJTES</em>&nbsp;is an open-access, peer-reviewed journal that promotes interest, knowledge, and quality of care in emergency and trauma surgery.</p> <p>Under the editorship of <em>Prof. Agron Dogjani,&nbsp;MD, Ph.D., FACS, FISS, FICS,&nbsp;</em>the Journal&nbsp;provides an in-depth, national, and international forum for the most authoritative information on major clinical problems in the fields of trauma and emergency surgery, surgical education, and not only...&nbsp;</p> <p>Contributions are reviewed and selected by distinguished doctors from across Albania and worldwide who make up the Editorial Board.&nbsp;</p> <p><strong><em>ISSN:</em></strong> 2616-4922 <em><strong>(Online)</strong></em>; <em><strong>ISSN:</strong></em> 2521-8778 <em><strong>(Print)</strong></em></p> <p><a href="https://journal.astes.org.al/AJTES/"><strong>https://journal.astes.org.al/AJTES/</strong></a></p> <div dir="auto"> <ul> <li class="show"><strong><em>Impact Factor Value </em></strong>based on the International Citation Report (ICR) <ul> <li class="show">for the years&nbsp;2020-2021 = <strong>1.022</strong>;</li> <li class="show">for the years 2021-2022 = <strong>1.131</strong>;&nbsp;</li> <li class="show">for the years 2022-2023 = <strong>1.573</strong>;&nbsp;</li> <li class="show">for the years 2023-2024 = <strong>2.034</strong>;</li> <li class="show">for the years 2024-2025 = <strong>2.375</strong>;</li> </ul> </li> <li class="show"><strong>ICV - Index Copernicus Value</strong> <ul> <li class="show">for the year 2019 = <strong><span style="text-decoration: underline;">77.13</span></strong>;</li> <li class="show">for the year 2020 = <strong><span style="text-decoration: underline;">88.13</span></strong><u>;</u></li> <li class="show">for the year&nbsp;2021 = <span style="text-decoration: underline;"><strong>100.00 </strong></span>&nbsp; &nbsp;</li> <li class="show">for the year&nbsp;2022 = <strong><span style="text-decoration: underline;">91.80</span>&nbsp;</strong>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</li> </ul> </li> <li class="show"><strong>ISRA JIF - </strong><span style="text-decoration: underline;">2,197</span>;</li> <li class="show"><strong>GIF -&nbsp;</strong>2.394;</li> <li class="show"><strong>International License.</strong> CC BY-NC 4.0</li> </ul> </div> en-US <p>Submission of a manuscript implies that the submitted work has not been published before (except as part of a thesis or report, or abstract); that it is not under consideration for publication elsewhere; that its publication has been approved by all co-authors. If and when the manuscript is accepted for publication, the author(s) still hold the copyright and retain publishing rights without restrictions. Authors or others are allowed to multiply article as long as not for commercial purposes. For the new invention, authors are suggested to manage its patent before published.&nbsp;The license type is&nbsp;<a href="https://creativecommons.org/licenses/by-nc/4.0/"><span class="cc-license-identifier">(CC BY-NC 4.0)</span></a></p> admin@journal.astes.org.al (Agron Dogjani) hysnibendo@gmail.com (Hysni Bendo) Sun, 19 Jan 2025 11:53:17 +0000 OJS 3.1.1.4 http://blogs.law.harvard.edu/tech/rss 60 Damage Control Laparotomy in Trauma Patients: A Level I Trauma Center Experience http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/423 <p style="font-weight: 400;"><strong><em>Introduction:</em></strong> The surgical management of traumatic injury is an evolving and controversial topic. We present outcomes of laparotomy performed for blunt and penetrating trauma at a level I trauma center over a nearly 10-year period.</p> <p style="font-weight: 400;"><strong><em>Material and Methods:</em></strong> Retrospective single-center cohort study of patients who received either damage control laparotomy or definitive laparotomy with fascial closure at the time of index procedure. The primary outcome was in-hospital mortality. Secondary outcomes were length of stay, complications, intensive care requirements, and vasopressor use.</p> <p style="font-weight: 400;"><strong><em>Results:</em></strong> Out of 125 included patients, 69 received damage control laparotomy, and 56 received definitive laparotomy.&nbsp; Damage control laparotomy was associated with significantly higher mortality (20.9% vs 1.8%, p=.0015) and length of stay (16.1 vs. 9.3 days, p=.0005) than definitive laparotomy. Complications occurred significantly more frequently among damage control laparotomy patients (53.6% vs. 14.3%, p&lt;.0001). Damage control laparotomy patients were substantially more likely to require intensive care unit admission, mechanical ventilation, and vasopressor support.</p> <p style="font-weight: 400;"><strong><em>Conclusion:</em></strong> Patients undergoing damage control laparotomy are at significantly increased risk for adverse outcomes, including increased in-hospital mortality, prolonged length of stay, more significant complication burden, and increased need for mechanical ventilation and pressure support as compared to patients undergoing definitive laparotomy.</p> Anthony J. Duncan, Wade A. Hopper, Mentor Ahmeti ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/423 Mon, 20 Jan 2025 00:00:00 +0000 Utilizing ATLS® Trauma Management Protocols: The Gold Standard for Safe and Effective Care. http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/446 <p><strong><em>Introduction:</em></strong> Approximately 5.8 million people die each year as a result of injuries. Traumatic injury is the leading cause of death under the age of 45 in the U.S. and worldwide. Traumatic injuries represent a significant global health burden, demanding swift and decisive intervention to mitigate morbidity and mortality. The Advanced Trauma Life Support (ATLS) course has emerged as a cornerstone in trauma management, offering healthcare providers a systematic approach to assessment, resuscitation, and definitive care. This article explores the pivotal role of ATLS protocols as the gold standard for safe and effective trauma management.</p> <p>ATLS protocols prioritize a structured assessment methodology, employing the ABCDE approach to rapidly identify and address life-threatening injuries. By adhering to this systematic framework, healthcare providers can promptly initiate time-critical interventions, minimizing the risk of adverse outcomes.</p> <p>Moreover, ATLS protocols promote standardization of care, ensuring consistent management practices across diverse clinical settings. Through multidisciplinary collaboration and continuous training, healthcare teams are equipped to deliver coordinated and efficient care, optimizing patient outcomes.</p> <p><strong><em>In conclusion,</em></strong> using ATLS trauma management protocols represents more than a guideline; it embodies a commitment to excellence in patient care. By embracing the principles of ATLS, healthcare providers uphold the gold standard for safe, effective, and compassionate trauma management, ultimately saving lives and restoring hope in times of crisis.</p> Agron Dogjani, Edvin Selmani, Edmond Zaimi, Kastriot Haxhirexha, Petrit Biberaj, Basri Lenjani, Kastriot Subashi, Ilir Hasmuca, Erjona Zogaj, Amarildo Blloshmi, Klevis Doci ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/446 Mon, 20 Jan 2025 00:00:00 +0000 A retrospective Study on Intestinal Injury from Blunt Abdominal Trauma http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/404 <p><strong><em>Introduction:</em></strong> Blunt abdominal trauma is the primary cause of morbidity and mortality. Suppose there are no indications of external trauma or changes in the patient's vital signs; blunt abdominal injuries might be complicated to identify at first. It is possible to lose a significant amount of blood without the abdomen appearing significantly different. A direct blow from blunt trauma can result in visceral damage and solid organ rupture, which can cause hemorrhage, peritonitis, and related pelvic injuries. The liver, small bowel, and spleen are the most frequently injured organs.</p> <p><em>Objectives:</em> To find out the etiology, manifestation, anatomical distribution, diagnostic method, management, and outcome of intestinal injuries from blunt abdominal trauma<strong>.</strong></p> <p><strong><em>Material and Methods:</em></strong> About 59 individuals who had laparotomies during a 3-year period to treat intestine damage from traumatic abdominal trauma were included in the research. In a retrospective analysis, the patients' causes, presentations, anatomical distributions, diagnostic techniques, related injuries, courses of therapy, and deaths were all examined.</p> <p><strong><em>Results:</em></strong> About 59 individuals with 60 significant bowel and mesentery lesions from blunt abdominal trauma were conducted. The average age was 36.78 years, and the male-to-female ratio was 5.5: 1. About 60 people sustained severe injuries. Furthermore, there were 50 minor intestinal injuries, which included 48 perforations, 12 major seromuscular injuries, and seven mesenteric, eleven colonic, and one duodenal injury. Thirty-three individuals suffered injuries from automobile incidents. The most frequent damage was a perforation at the small bowel's antimesenteric boundary. For colonic perforations, treatment included protective colostomy after resection, anastomosis, and perforation repair. There were 2 (3.38%) documented fatalities, and 10 (16.9%) individuals experienced significant problems.</p> <p><strong><em>Conclusion:</em></strong> Due to its enormous infectious potential, early detection of intestinal injuries following severe abdominal trauma is crucial, even if it might be challenging. Severe injuries are frequently linked to intestinal perforations and are likely the deciding factors in survival.</p> Muralidharan Kannaian, Bhaskara Rao Bezawada, Vinod K, Subash Chandra Bose ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/404 Mon, 20 Jan 2025 00:00:00 +0000 Aortic Valve Surgery in Patients Over 75 Years Old: Early Results and Predictors of Hospital Mortality http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/412 <p style="font-weight: 400;"><strong><em>Background:</em></strong> Aortic valve surgery is the most essential part of worldwide heart valve surgery. In recent decades, the patient profile has changed even in our country, with the age of patients undergoing aortic valve surgery increasing significantly.</p> <p style="font-weight: 400;">The primary objectives of this study are the early results of aortic valve replacement surgery in patients over 75 years old and the negative predictors that affect hospital mortality.</p> <p style="font-weight: 400;"><strong><em>Materials and Methods</em></strong><em>:</em>&nbsp;This is a retrospective study of 73 patients over 75 who underwent aortic valve surgery in 2014-2021 in our Cardiac Surgery Service, University Hospital Center “Mother Theresa” in Tirana. The patients' data regarding demographic, preoperative, operative, and postoperative variables were collected from the hospital's medical records. The data are presented in mean values and standard deviation. T-test and chi-squared test are also used.</p> <p style="font-weight: 400;"><strong><em>Results:</em></strong> This study involved 73 patients, 50 males and 23 females. The age range was 75-85, averaging 77.12±2.31 years. Hospital mortality was 4.1%. The incidence of major perioperative complications such as low cardiac output, stroke, respiratory problems, bleeding, atrial fibrillation, wound infection, and conduction disturbances was 6.8%, 2.7 %, 4.1%, 2.7 %, 21.9 %, 2.6%, and 4.2 %.</p> <p style="font-weight: 400;"><strong><em>Conclusions:</em></strong> Aortic valve surgery for elderly patients over 75 can be performed well. Concomitant procedures, prolonged extracorporeal circulation, and emergency intervention expose the patient to a high operative risk.</p> Selman Dumani, Laureta Dibra, Ermal Likaj, Saimir Kuci, Edlira Rruci, Aferdita Veseli, Klodian Krakulli, Andi Kacani, Edvin Prifti, Ilir Tanku, Devis Pellumbi, Alessia Mehmeti, Adelina Musliu, Ali Refatllari, Altin Veshti ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/412 Mon, 20 Jan 2025 00:00:00 +0000 Challenges in Burns Management in a Tertiary Care Center in Albania http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/418 <p style="font-weight: 400;"><strong><em>Introduction:</em></strong> Burn injuries represent a significant public health concern globally, with a substantial impact on morbidity and mortality rates, particularly in low- and middle-income countries.</p> <p style="font-weight: 400;">This study provides valuable insights into the epidemiology of burn injuries in Albania. It highlights the critical need for targeted interventions to reduce the incidence and severity of burns in the population.</p> <p style="font-weight: 400;"><strong><em>Materials and Methods:</em></strong> This retrospective cohort study examined burn patients at the Department of Burns and Plastic Surgery at Mother Teresa University Hospital Center in Tirana from January 2022 to January 2024. Data were collected from medical records in Tirana, Albania. Formal approval was obtained from the Ethics Committee of Mother Teresa Hospital. The data were recorded in Excel and analyzed using the SPSS statistics program.</p> <p style="font-weight: 400;"><strong><em>Results:</em></strong> This retrospective cohort study included 303 burn patients admitted between January 2022 and January 2024. Data on patient demographics, burn causes, total body surface area (TBSA), and burn severity were collected and analyzed using SPSS software.</p> <p style="font-weight: 400;"><span data-preserver-spaces="true">The mean patient age was 36.1 years, with children aged 0-10 most affected, especially 2-year-olds. The youngest patient was seven months old, and the oldest was 89. Male patients comprised 60.7% of the cohort. The leading cause of burns was scalding from hot liquids (39.9%), followed by flames (20.4%) and electrical burns (8.2%). The average TBSA affected was 23.06%. The mortality rate was 7.3%.</span></p> <p style="font-weight: 400;"><span data-preserver-spaces="true"><strong><em>Conclusion:</em></strong> Burn injuries present significant physical and psychological challenges. Despite advancements in burn care, the importance of preventive measures and public awareness campaigns must be addressed. These remain the most effective strategies to reduce burn incidence and severity. These findings underscore Albania's need for improved burn prevention and public safety initiatives.</span></p> Vladimir Filaj, Ester Tabaku, Ina Kola, Ferdiola Gjonaj, Vilma Tafilaj, Henri Drinjak ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/418 Mon, 20 Jan 2025 00:00:00 +0000 New Pathogens in Blood Donors and Patients in Albania http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/439 <p><strong><em>Introduction: </em></strong>The emergence of novel pathogens poses a significant and immediate threat to global blood safety, particularly in regions experiencing epidemiological shifts. This study urgently examines the prevalence and impact of newly identified pathogens among blood donors and recipients in Albania, focusing on assessing their implications for public health and transfusion medicine.</p> <p>Results revealed a prevalence of new pathogens among donors and patients, highlighting the potential risk of transmission through blood transfusion. Travel history, socioeconomic status, and urban-rural disparities significantly influenced pathogen prevalence. This study underscores the urgent need for enhanced screening protocols and public health interventions to mitigate the risks associated with emerging pathogens. Our findings contribute to a growing body of evidence emphasizing the crucial role of continuous surveillance and adaptive strategies in transfusion medicine to ensure blood safety and protect vulnerable populations in Albania and beyond.</p> <p><strong><em>Conclusion:</em></strong> The study highlights the presence of emerging pathogens in blood donors and patients in Albania, underscoring their potential to significantly impact blood safety and public health. The findings emphasize the necessity for improved screening protocols, continuous epidemiological surveillance, and targeted public health interventions to address the risks associated with these pathogens. Adopting adaptive strategies in transfusion medicine is critical to safeguarding the health of donors and recipients in the region.</p> Irena Seferi, Viola Shano, Brunilda Dakavelli, Vjollca Duro, Shpetim Qyra, Anyla Bulo ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/439 Mon, 20 Jan 2025 00:00:00 +0000 Current Situation and Management of Pleural Effusion in PHI Clinical Hospital Tetovo http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/422 <p style="font-weight: 400;"><strong><em>Introduction:</em></strong> Pleural effusion is a disturbance in the balance between fluid production and elimination in the pleural space, resulting in abnormal fluid accumulation. It can result from various medical conditions related to the lungs and pleura or systemic diseases. Identifying the etiology of pleural effusion is essential for effective treatment. According to Light's criteria, pleural effusions are transudative and exudative.</p> <p style="font-weight: 400;"><strong><em>Material and Methods:</em></strong> For this research, we collected data from the existing documentation in the Department of Pulmonology and Respiratory Allergology at PHI Clinical Hospital Tetovo from June 2022 to June 2023. This study included 133 patients with dyspnea, persistent chest pain, fatigue, hemoptysis, cough, a history of past illnesses, and other comorbid conditions. The data collection process was rigorous, and we followed ethical guidelines to ensure the reliability of our findings.</p> <p style="font-weight: 400;"><strong><em>Results:</em></strong> The patients included in our study were between 36 to 84 years old. Of them, 72,9% were males, and 27,1% were females. 85,7% were smokers, and 14,3% were non-smokers. 75,0% of patients complained of dyspnea, and 24,8% had hemoptysis. From the ultrasonography findings, 15,0% had an alteration in the left lung, 11,3% in the right lung, 20,3% of patients were punctuated to the left side, and 24,8% were punctuated to the right lung. In comparison, 1,5% were punctuated to both sides. In 2,3% of the subjects, computed tomography described an effusion in the left lung.</p> <p style="font-weight: 400;"><strong><em>Conclusion:</em></strong> The results suggest that pleural effusion is associated with various diseases, especially heart failure and malignant diseases. Our study underscores the importance of early detection of the cause of pleural effusion and the underlying disease for successfully managing and treating the disease. The insights from our research can guide healthcare professionals in developing effective treatment strategies and improving patient outcomes.</p> Ruzhdi Rexhepi, Selma Arifi, Merita Rexhepi, Dejan Dokic, Tatjana Ruskovska ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/422 Mon, 20 Jan 2025 00:00:00 +0000 A Osseointegration of Dental Implants in Atrophic Regions. The use of Densah Burs, Osseodensification Technique, in Sinus Lift Procedures. A Clinical Case and Review Literature. http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/432 <p style="font-weight: 400;"><strong><em>Introduction:</em></strong>&nbsp; Atrophic posterior maxillary regions pose a significant challenge in dental medicine, where dental implant stability is hard to achieve. The innovative osseo-densification, a new biomechanical technique that aims to solve this problem without removing any bone tissue, is a topic of great interest and potential in our field.</p> <p style="font-weight: 400;"><em>Case report:</em> The patient, A.K., a 44-year-old smoking female, was presented to the clinic concerned with the lack of ability to eat from her left side as a result of the extraction of her upper molars. After a 3D radiographic scan was conducted, it was confirmed that there was considerable bone loss in the upper left posterior region and a proximity with the maxillary sinus. As part of the treatment plan, an Osseo-densification technique in crystal maxillary sinus elevation would be used for two implant placements in the first and second molar regions.</p> <p style="font-weight: 400;"><strong><em>Conclusions: </em></strong>The osseo-densification technique in crestal sinus lifting was shown to be a dependable and less invasive option for treating considerable posterior maxillary bone loss. However, conclusive findings are still needed for this technique, emphasizing the need for continuous research and learning in our field.</p> Alba Koshovari; Amela Muca; Leart Berdica, Teona Bushati, Laura Fejza, Oltjon Kaja, Ardita Koci ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/432 Mon, 20 Jan 2025 00:00:00 +0000 Diagnosis and Treatment of Postoperative Myocardial Infarction: A Retrospective Cohort Study on 600 Cardiac Surgery Patients http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/444 <p style="font-weight: 400;"><strong><em>Introduction:</em></strong> Postoperative myocardial infarction (PMI) is a severe complication after cardiac surgery, significantly impacting patient outcomes. Acute PMI after cardiac surgery is an infrequent event that can evolve rapidly and become a potentially life-threatening complication. Multiple factors are associated with acute PMI after cardiac surgery and may vary by the type of surgical procedure performed. Although the criteria defining nonprocedural myocardial ischemia are well established, there are no universally accepted criteria for diagnosing acute PMI. This retrospective study analyzed 600 patients who underwent cardiac surgery at a single center over one year. The incidence, diagnosis, and management of PMI were evaluated, focusing on diagnostic methods, therapeutic interventions, and the role of intra-aortic balloon pumps (IABPs). Our findings provide insights into the anesthesiologist’s role in identifying and managing PMI, highlighting strategies to reduce morbidity and mortality in this high-risk population.</p> <p style="font-weight: 400;"><strong><em>Conclusions:</em></strong> Early detection and tailored management of PMI are vital to reducing complications. Anesthesiologists and intensive care teams are key in optimizing outcomes through advanced support measures like intra-aortic balloon pumps. These findings, which provide practical insights to enhance perioperative care, empower us to manage this high-risk population better.</p> Saimir Kuci, Marsela Goga, Alfred Ibrahimi, Ervin Bejko, Stavri Llazo, Jonela Burimi, Esmerilda Bulku, Andi Kacani, Ermal Likaj, Ali Refatllari, Selman Dumani, Klodian Krakulli, Arber Aliu, Fjorba Mana, Devis Pellumbi, Aferdita Veseli, Edlira Rruci, Laureta Dibra, Arben Baboci, Edvin Prifti, Altin Veshti ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/444 Mon, 20 Jan 2025 00:00:00 +0000 A Comprehensive Systematic Review of Etiology and Risk Factors of Surgical Site Infections http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/388 <p><strong><em>Introduction</em></strong>: Surgical wound infections (SWIs) remain a significant risk to patients due to their high morbidity and mortality rates. Moreover, they pose substantial economic challenges for both developing and developed countries. The global impact of these infections is staggering, with the World Health Organization (WHO) reporting that millions of patients worldwide are affected by hospital-acquired infections annually, with many succumbing to these infections.</p> <p>This study aims to analyze the incidence of surgical site infections (SSIs) based on the type of surgical intervention, identify the most frequent causes of these infections, and explore effective management strategies. The findings of this study will provide valuable insights into the prevention and management of SSIs, thereby enlightening the medical community and empowering them to improve patient outcomes.</p> <p><strong>Material and Methods:</strong> This study, conducted with meticulous attention to detail, focuses on patients operated on in our clinic from January to October 2024. It will reflect the incidence of SSI according to the type of surgical intervention, the most frequent causes of these infections, and the way of their treatment.</p> <p><strong>Results:</strong> From January 2023 to June 2024, 788 patients were hospitalized, and 408 were operated on in the Surgery Department of the Clinical Hospital of Tetovo. Three hundred fifty were male, and 438 were female. The ages of the patients included in the study ranged from 21 to 81.</p> <p>Most of the patients were operated on because of cholecystolithiasis, inguinal, ventral, and umbilical hernias, breast cancer, acute appendicitis, and neoplasia of the colon and ileus. From the total number of operated patients (408), the infection of operative wounds was recorded in 49, representing an incidence of 11.76 %.</p> <p><strong>Conclusion:</strong> The findings of this study underscore the serious global implications of SSIs, including increased morbidity and mortality rates and the strain on healthcare budgets. Therefore, the prevention and reduction of these infections should be a priority for all countries, irrespective of their economic status.</p> Aferdita Ademi, Ferizat Dika Haxhirexha, Agron Dogjani, Kastriot Haxhirexha ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/388 Mon, 20 Jan 2025 00:00:00 +0000 Redo Aortic Valve Replacement After Prior Transcatheter versus Surgical Aortic Valve Replacement: Insights from Western Experience http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/440 <p style="font-weight: 400;"><strong><em>Introduction</em></strong>: The demand for reoperation on the aortic valve in Albania is rising, mirroring the increasing average age of the population and the subsequent rise in patients requiring aortic valve surgery. This trend underscores the need for this informative article, which aims to provide insights into the risks and outcomes of aortic valve reoperations, particularly in light of efforts by interventional cardiologists to expand the indications for TAVR to younger and lower-risk patients. Data from the Society of Thoracic Surgeons (STS) National Database reveal results that warrant attention, with concerns over reoperations after TAVR growing, mainly due to the uncertain feasibility of repeat TAVR.&nbsp;</p> <p style="font-weight: 400;">This article presents a novel perspective on the risks associated with surgical aortic valve replacement (SAVR) after prior TAVR or SAVR. It underscores the urgent need to develop an optimal strategy for managing these patients and offers fresh insight.&nbsp;</p> <p style="font-weight: 400;"><strong><em>Material and Methods</em></strong><em>: </em>Our research, based on a comprehensive analysis of data from the Society of Thoracic Surgeons in the USA's 10-year database, included individuals who underwent bioprosthetic SAVR following prior TAVR and/or SAVR. Our analyses, which included total and isolated SAVR groups, focused on the primary outcome of operative mortality, ensuring the reliability and thoroughness of our study.&nbsp;</p> <p style="font-weight: 400;"><strong><em>Results:</em></strong> The study included 31,106 patients who underwent SAVR. Among them, 1,126 had prior TAVR (TAVR-SAVR), 674 had undergone SAVR followed by TAVR and SAVR (SAVR-TAVR-SAVR), and 29,306 had undergone prior SAVR (SAVR-SAVR). Matched analysis for isolated SAVR cases showed a 1.74-fold higher operative mortality for TAVR-SAVR than SAVR-SAVR (P = 0.020). In our center, 5 cases have been performed in the last two years with excellent results, no losses, and operating times close to the first-time interventions.</p> <p style="font-weight: 400;"><strong><em>Conclusions</em></strong><em>:</em> This study's findings significantly contribute to the field. They could influence clinical practice, particularly for patients with longer life expectancies and anatomy unsuitable for TAVR. They suggest an initial SAVR approach may provide better results even in necessary surgical re-interventions on the aortic valve.</p> Arber Aliu, Klodiana Durici, Ira Lazo, Altin Veshti ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/440 Mon, 20 Jan 2025 00:00:00 +0000 Surgical Approaches for Aortic Root Aneurysm: A Comparative Analysis of the David and Yacoub Techniques http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/426 <p><strong><em>Introduction: </em></strong>This paper compares the David and Yacoub procedures for valve-sparing aortic root replacement, two leading techniques for treating aortic root aneurysms while preserving the native aortic valve. Both methods aim to avoid prosthetic valve replacement and the need for lifelong anticoagulation.</p> <p><strong><em>Material and Methods:</em></strong> We reviewed the technical nuances, clinical outcomes, and long-term durability of each technique, incorporating findings from recent and historical studies. Also, we'd like to present two case reports from our clinic showing the application of the David procedure.</p> <p><strong><em>Results</em></strong>: The David procedure involves complete excision of the aortic root and reimplantation of the native aortic valve within a Dacron graft. It offers superior long-term durability and lower reoperation rates, particularly in younger patients and those with connective tissue disorders. In contrast, the Yacoub procedure entails partial root resection and remodeling with preservation of the sinuses of Valsalva, making it a viable option for older patients or those with isolated root dilation.</p> <p><strong><em>Conclusions:</em></strong> Both the David and Yacoub procedures are advanced techniques for aortic root replacement, each with unique advantages and challenges. The David procedure, with its excellent durability, &nbsp;has consistently delivered successful outcomes. It is especially beneficial for younger patients and those with connective tissue disorders, supporting its role as a preferred approach for long-term outcomes in this population.</p> Ermal Likaj, Alessia Mehmeti, Selman Dumani, Fjorba Mana, Saimir Kuci, Ervin Bejko, Aferdita Veseli ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/426 Mon, 20 Jan 2025 00:00:00 +0000 Types of Road Traffic Accidents and Emergency Medical Care http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/434 <p><strong><em>Introduction:</em></strong> A traffic accident is when only material damage is caused to the vehicle and track environment, and there are no casualties. RTA represents a significant risk for morbidity and mortality in Kosovo, of which head injury and multiple-site injury increase injury severity.</p> <p>The anatomical site, mechanism of injury, time to reach an initial health facility, time of the day, patient condition at ED, type of treatment given, GCS at admission, and days spent in the hospital were among independent predictors of management outcome. Targeted approaches to improving the care of the injured victims may improve outcomes.</p> <p>Thus, the clinician should consider the clinical presentation of RTA and give due attention to the identified contributing factors in managing it. Law enforcers should also emphasize the identified types and mechanisms of accidents. The PubMed database was utilized for article selection, and papers were obtained and reviewed. The ATLS protocol has been developed to manage trauma patients systematically so as not to miss any condition that may kill the patient.</p> <p><strong><em>Conclusions:</em></strong> Triage is essential in managing accidental situations and strengthening the primary, secondary, and tertiary health systems. To design clinical guidelines, algorithms, and triage protocols at the three levels of health care, all healthcare professionals should be educated and trained with continuing courses in triage, communication, and Basic Life Support -AED, ACLS, PHTLS, BTLS, and ATLS.</p> Basri Lenjani, Agron Dogjani, Luljeta Abdullahu, Arlind Zeqiri, Dardan Lenjani, Bujar Imeri ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/434 Mon, 20 Jan 2025 00:00:00 +0000 Selection of Prosthesis in Aortic Valve Surgery: Short Review and Trend in our Practice in 10 Years http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/414 <p style="font-weight: 400;"><strong><em>Introduction:</em></strong> In our country, the predominant condition treated in aortic valve surgery in its early stages was aortic valve disease of rheumatic origin, primarily in patients under the age of 60. In recent decades, due to lifestyle changes, increased average lifespan, and a shift in surgical treatment concepts among the elderly, there has been a noticeable trend towards atherosclerotic aortic valve disease treated surgically. This condition poses challenges in selecting the type of prosthesis for surgical replacement—either bioprosthetic or mechanical. The replacement of the aortic valve, aside from its undeniable benefits for patients, also introduces various complications, such as bleeding related to anticoagulation, thromboembolism, prosthetic endocarditis, and structural degeneration of the prosthesis. These complications vary between the two main groups of prostheses: bioprosthetic and mechanical. In this context, we are confronted with the challenge of selecting the type of prosthesis suitable for each patient.</p> <p style="font-weight: 400;">This paper presents current issues regarding selecting aortic valve prostheses, considering factors related to the prosthesis and the patient. We will also discuss the trends in prosthesis usage in our country over the past decade.</p> <p style="font-weight: 400;"><strong><em>Materials and Methods:</em></strong> We reviewed the types of mechanical and bioprosthetic valves used over the past ten years at our clinic, the Cardiac Surgery Service of the University Hospital Center "Mother Teresa.” We consulted articles, studies, and guidelines for managing heart valve diseases from European and American cardiology associations.</p> <p style="font-weight: 400;"><strong><em>Conclusion:</em></strong> The choice of prosthesis for aortic valve replacement remains a current issue, involving considerations of patient-related and prosthesis-related factors. The decision is based on guidelines recommendations, surgical team judgment, and patient preference, following a detailed explanation of the benefits and risks associated with each type of prosthesis.</p> Selman Dumani, Ermal Likaj, Laureta Dibra, Devis Pellumbi, Adelina Musliu, Fjoralba Qejvani, Altin Veshti ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/414 Mon, 20 Jan 2025 00:00:00 +0000 Basic Medical Emergency Treatment for Maxillofacial Injuries http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/435 <p><strong><em>Introduction:</em></strong> Maxillofacial trauma presents unique challenges due to the complex anatomy of the face, encompassing vital structures. Beyond physical injuries, these cases significantly impact a patient's appearance and function, necessitating a multidisciplinary approach.</p> <p>Challenges: Maxillofacial trauma often co-occurs with other injuries, particularly head, chest, and extremity trauma. This increases complexity, with head injuries observed in 7.6-8.9% of facial fracture cases, frequently associated with lower Glasgow Coma Scores. Cervical spine injuries and airway obstruction are significant concerns.</p> <p>Management: While trauma management has significantly improved mortality rates, maxillofacial injuries in polytrauma patients remain a challenge. Their proximity to the brain, spine, and airway necessitates modifications to standard ABC assessments. These modifications often incorporate DRSABCDE, a comprehensive evaluation that includes airway clearance with C-spine control, breathing, ventilation, oxygenation, circulation, disability-neurologic status, exposure-environment, and body temperature. Each component of DRSABCDE is crucial in the initial management of maxillofacial trauma.</p> <p><strong><em>Conclusion:</em></strong> Continuous education and training in triage, communication, and advanced life support (e.g., BLS-AED, ACLS, PHTLS, BTLS, ATLS) are crucial and empowering for healthcare professionals managing maxillofacial trauma in polytrauma patients. This ongoing learning equips them with the necessary skills and knowledge to handle these complex cases effectively.</p> <p>&nbsp;</p> Ilirian Lenjani, Fatime Lenjani, Mentor Mustafa, Agron Dogjani, Basri Lenjani ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/435 Mon, 20 Jan 2025 00:00:00 +0000 Oligodendrocyte Injury in Multiple Sclerosis. http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/443 <p><strong><em>Introduction: </em></strong>Multiple sclerosis (MS) is a chronic autoimmune disorder of the central nervous system (CNS), marked by inflammation, demyelination, and significant oligodendrocyte injury. This disease arises from a complex interplay of genetic predispositions and environmental triggers that drive immune-mediated damage to oligodendrocytes and myelin proteins.</p> <p>This research paper explores the multifaceted aspects of oligodendrocyte injury in MS, ranging from underlying pathophysiological mechanisms to potential therapeutic interventions and translational implications for clinical practice.</p> <p>Oligodendrocyte damage in MS occurs via multiple mechanisms, including metabolic stress, oxidative damage, and cytokine-induced apoptosis, mainly mediated by interferon-gamma (IFN-γ) signaling. This process exacerbates neuroinflammation and contributes to disease progression. Emerging therapeutic strategies, such as targeting metabolic pathways, reducing oxidative stress, and enhancing autophagy, have demonstrated potential in preclinical studies. Furthermore, stem cell therapies are being explored for their ability to regenerate oligodendrocytes and restore myelin integrity.</p> <p><strong><em>Conclusions: </em></strong>The intricate interplay among oligodendrocyte injury, demyelination, and neuroinflammation is central to multiple sclerosis (MS) pathogenesis. Oligodendrocytes safeguard myelin in the CNS, facing challenges from immune attacks to metabolic stress. Understanding oligodendrocyte dysfunction is vital for targeted therapies that suppress immune damage and promote remyelination and CNS repair. MS's etiology,</p> Mateo Përgjegji, Klei Bame, Ketrina Ceka, Jera Cenalia , Sibora Bërdica , Teona Bushati ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/443 Mon, 20 Jan 2025 00:00:00 +0000 Minimally Invasive Mitral Valve Surgery: Initial One-team Experience and Short Review. http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/413 <p style="font-weight: 400;"><strong><em>Introduction:</em></strong> Minimally invasive mitral valve surgery (MIMVS) is now a widely accepted and more frequently utilized method for patients needing mitral valve surgery. The promoted advantages are less trauma, less bleeding, less pain, and fewer wound infections, allowing faster postoperative and decreased healthcare costs.</p> <p style="font-weight: 400;"><strong><em>Material and Methods:</em></strong> This is a single-center retrospective study. We have collected the records of patients who underwent MIMVS by one team at the Cardiac Surgery Service, UHC” Mother Theresa” Hospital. The patients' data regarding demographic, preoperative, operative, and post-operative variables were collected from the medical records in the hospital. All statistical analyses were performed using IBM SPSS version 24.0 software (SPSS, Inc., Chicago, IL, USA).</p> <p style="font-weight: 400;"><strong>Results:</strong> Surgical technique includes mitral valve repair or replacement through right lateral mini-thoracotomy, through a small 5-7cm incision in the 4th–5th right intercostal space under direct vision Seldinger technique under transesophageal echocardiogram guidance is used for cannulation, first 3 cases of MIMVS was performed with 2 venous cannulas – one percutaneous jugular cannula and femoral one, 8 cases underwent single two-stage femoral venous cannulation for venous drainage, femoral arterial cannulation and vacuum assisted cardiopulmonary by-pass(CPB).</p> <p style="font-weight: 400;"><strong>Conclusion:</strong> Minimal-invasive mitral valve surgery is as safe as the standard approach and allows faster recovery with a shorter length of hospitalization, resulting in decreased healthcare costs. We need a more extensive study to confirm the other advantages, but minimal-invasive should be pushed to become a standard approach for mitral valve surgery. An adequate learning curve is mandatory for all the operative teams to achieve all the benefits for the patients.</p> Selman Dumani, Ermal Likaj, Laureta Dibra, Saimir Kuci, Edlira Rruci, Alfred Ibrahimi, Aferdita Veseli, Fjorba Mana, Devis Pellumbi, Alessia Mehmeti, Ali Refatllari, Altin Veshti ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/413 Mon, 20 Jan 2025 00:00:00 +0000 Traumatic Asphyxia due to Automobile Accident. A Case Report http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/436 <p style="font-weight: 400;"><strong><em>Introduction:</em></strong> Traumatic Asphyxia is probably much more common than the surgical literature shows and should always be kept in mind as a possible complication of injuries of the thorax and /or upper abdomen. Traumatic Asphyxia or Perthe’s syndrome is a result of a sudden and severe trauma of the thorax and /or upper abdomen. We report a case of traumatic Asphyxia due to an automobilistic accident.</p> <p style="font-weight: 400;">Our patient is a 62-year-old male who was brought to the emergency room due to thorax trauma related to a bicycle accident. He got under a van from one side, and while the shaft of the van rotated, it pulled and crushed the patient between the body of the van and the shaft. There was no direct trauma history on the face and neck area of the patient. In our case, we found associated injuries such as a fracture of the right 7<sup>th </sup>rib, displaced fracture of the right tibia, and bilateral pulmonary contusion.</p> <p style="font-weight: 400;">In our case, supportive therapy and specific treatment for the right tibial fracture were performed.</p> <p style="font-weight: 400;"><strong><em>Conclusion: </em></strong>Perthes syndrome should be considered in patients presenting with the associated ecchymoses mask with cutaneous petechial hemorrhages and subconjunctival bleeding as a complication of compression of the thorax. The outcome is variable depending on the severity and duration of compression. When characteristic findings of traumatic Asphyxia are detected in traumatic patients, other organ pathologies should be quickly eliminated, and supportive therapy should be initiated. If any other organ pathology is detected, treatment for the detected pathology should be administered because the prognosis of patients with timely and effective treatment is considerably good.</p> Elona Markeci, Admir Mustafa ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/436 Mon, 20 Jan 2025 00:00:00 +0000 Clinical Management and Surgical Outcomes of Wandering Spleen with Splenic Torsion in Pediatric Patients: A Case Report http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/441 <p style="font-weight: 400;"><strong><em>Introduction:</em></strong> Wandering Spleen is a rare condition in which the splenic ligaments are abnormally loose or absent. This makes the Spleen more mobile and increases the risk of torsion.</p> <p style="font-weight: 400;">This case report outlines the clinical presentation and management of a 10-year-old female patient who presented at our clinic with acute abdominal pain, vomiting episodes, and a severe fever. Imaging tests, such as abdominal ultrasonography and computed tomography, confirmed the diagnosis of splenic torsion by showing a hemorrhagic infarction and a large spleen. We performed a splenectomy to remove the damaged organ, a partial omental resection to remove the dead tissue and removed the mesenteric lymph nodes for further pathological examination.</p> <p style="font-weight: 400;">After the surgical procedure, the intensive care unit carefully observed the patient and treated her with intravenous electrolyte replacement, broad-spectrum antibiotics, pain management, and measures to prevent thrombosis.</p> <p style="font-weight: 400;">This case highlights the critical need for early diagnosis and timely surgical intervention in cases of wandering Spleen to prevent serious complications, including splenic infarction. By presenting this case, we seek to elevate awareness of wandering Spleen among healthcare professionals, mainly within pediatric groups. We emphasize the importance of timely diagnosis and appropriate management to optimize patient outcomes.</p> <p style="font-weight: 400;"><strong>Conclusion: </strong>Early detection and prompt intervention are crucial in preventing severe complications in pediatric patients. This case emphasizes the necessity of rapid diagnosis and increased awareness in clinical practice. Due to the Spleen's impaired viability, a splenectomy was required. Following surgery, we provided comprehensive monitoring and pharmaceutical assistance to control pain, prevent infection, and maintain nutritional stability.</p> Shaban Memeti, Saimir Kuci, Toni Ristevski, Lazar Todorovic, Marijan Kamilovski, Blagica Krsteska, Haris Sulejmani ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/441 Mon, 20 Jan 2025 00:00:00 +0000 Gastric MALT Lymphoma with Giant Ulcer from Untreated H. pylori: Role of Endoscopic Biopsy – A Case Report. http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/437 <p style="font-weight: 400;"><strong><em>Introduction:</em></strong> Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is a rare extranodal non-Hodgkin lymphoma strongly linked to <em>Helicobacter pylori</em> infection. It often presents with nonspecific symptoms like dyspepsia, nausea, and epigastric pain and can mimic other gastric pathologies, such as peptic ulcers or gastric cancer.</p> <p style="font-weight: 400;">This case report is significant as it highlights the importance of thorough biopsy procedures in diagnosing gastric MALT lymphoma. The patient presented with complaints of dyspepsia, nausea, and epigastralgia and had a giant ulcer on endoscopy. Only after biopsies with a large number of samples (over 10) from both normal and abnormal mucosa the diagnosis of MALT lymphoma was established and reconfirmed after immunohistochemistry. The presence of Helicobacter pylori was detected, and after its eradication treatment, the ulcer was more minor and improved from Forrest II-c to III. This case underscores the potential for a wrong diagnosis (undiagnosed MALT-Lymphoma) if biopsy samples are not comprehensive. It also emphasizes the need for suspicion of gastric MALT-Lymphoma and the necessity of more invasive tissue biopsy, such as EUS-FNA, EMR, and ESD, when suspicion persists.</p> <p style="font-weight: 400;"><strong><em>Conclusion:</em></strong> Early diagnosis of gastric MALT lymphoma requires multiple biopsy samples during the initial endoscopy to prevent false negatives. Immunohistochemistry is essential for confirmation, and advanced techniques like EUS-FNA, EMR, or ESD play a significant role when suspicion persists. Timely <em>H. pylori</em> eradication can lead to ulcer healing and better outcomes. Proper endoscopist training is critical to reduce diagnostic delays.</p> Hysni Dede, Rovena Roshi, Gentiana Cekodhima, Manjola Tahiraj, Augusto Orlandi ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/437 Mon, 20 Jan 2025 00:00:00 +0000 Noninvasive Polypoid Malignant Mixed Mullerian Tumor of the Uterus: A Case Report and Literature Review http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/433 <p style="font-weight: 400;"><strong><em>Introduction:</em></strong> Malignant mixed Müllerian tumors (MMMT), also known as carcinosarcomas, are rare and highly aggressive neoplasms of the uterus, accounting for less than 5% of all uterine malignancies. These tumors are biphasic, comprising both carcinomatous (epithelial) and sarcomatous (mesenchymal) components, and are typically associated with poor prognoses due to their rapid progression and high metastatic potential.</p> <p style="font-weight: 400;">In this report, we present a unique case of noninvasive polypoid MMMT of the uterus, highlighting its clinical presentation, diagnostic challenges, and management. We also provide a comprehensive literature review, which enriches our understanding of this case within the broader context of uterine carcinosarcomas.</p> <p style="font-weight: 400;"><strong><em>Results:</em></strong> This is the first documented case in English literature of a polypoid uterine carcinosarcoma without endometrial infiltration. It is significant because it adds to the limited literature on noninvasive polypoid MMMTs, typically aggressive and diagnosed at advanced stages. Uterine carcinosarcomas are generally aggressive, with most cases diagnosed at advanced stages.</p> <p style="font-weight: 400;"><strong><em>Conclusion:</em></strong> Uterine carcinosarcomas are indeed rare, aggressive, and rapidly progressing neoplasms with poor prognoses. It is crucial to include carcinosarcomas in the differential diagnosis of high-grade uterine neoplasms, especially for polypoid tumors. This inclusion is not just essential, but it is the key to ensuring accurate and timely diagnosis, underscoring the significant role of medical professionals in this process.</p> Leon Kaza, Leart Berdica, Teona Teona, Albina Ndoja ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/433 Mon, 20 Jan 2025 00:00:00 +0000 Diagnosing and Treating ANCA-Associated Vasculitis within the COVID-19 Era: A Challenging Case Report http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/445 <p style="font-weight: 400;"><strong><em>Introduction:</em></strong> Anti-neutrophil cytoplasmic antibody (ANCA)- associated vasculitis (AAV) is a rare group of systemic autoimmune diseases that primarily target small blood vessels. Renal manifestations often present as pauci-immune focal and segmental necrotizing crescentic glomerulonephritis (PI-NCGN), which can progress to acute or chronic kidney failure and multiorgan involvement. It is frequently associated with poor outcomes.</p> <p style="font-weight: 400;">We report a case of PR3-positive ANCA-associated vasculitis complicated by rapidly progressive glomerulonephritis, acute kidney injury, and diffuse alveolar hemorrhage during the COVID-19 pandemic. This case highlights the diagnostic challenges of differentiating AAV from conditions associated with SARS-CoV-2 infection, as the clinical and radiological presentations of pulmonary-renal syndromes may overlap.</p> <p style="font-weight: 400;">The findings underscore the importance of maintaining a comprehensive differential diagnosis in patients with pulmonary and renal involvement, particularly in the post-COVID-19 era, to ensure timely and accurate management of rare autoimmune conditions such as AAV.</p> <p style="font-weight: 400;"><strong><em>Conclusion:</em></strong> ANCA-associated vasculitis (AAV) remains a diagnostic and therapeutic challenge, particularly in the post-COVID-19 era, where overlapping clinical and radiological features with SARS-CoV-2 complications can obscure timely identification. This case highlights the critical importance of maintaining a broad differential diagnosis in patients presenting with pulmonary-renal syndromes to differentiate AAV from more common conditions associated with COVID-19.</p> Erjola Likaj, Larisa Shehaj, Deniona Nunci, Lordian Nunci, Irda Rrugeja, Merita Rroji, Saimir Seferi, Nertila Gjonaj, Alma Idrizi, Arjana Strakosha ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/445 Mon, 20 Jan 2025 00:00:00 +0000 Successful Management of Refractory Heart Failure and Multi-Organ Dysfunction in a Patient with CRT-D and Acute Pulmonary Edema: A Case Report http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/442 <p style="font-weight: 400;"><strong><em>Introduction:</em></strong> Heart failure with reduced ejection fraction (HFrEF) is a progressive condition often complicated by acute decompensations that require advanced medical interventions. Cardiac resynchronization therapy with a defibrillator (CRT-D) has significantly improved outcomes in patients with severe heart failure. However, challenges persist when faced with acute events such as pulmonary edema, pneumonia, and multi-organ dysfunction syndrome. Multidisciplinary, intensive care unit (ICU)-based management is critical for these complex cases.</p> <p style="font-weight: 400;">This case report presents the successful management of a 61-year-old female patient with a history of severe HFrEF and implanted CRT-D. Despite severe hypoxemia, hypotension, and metabolic acidosis, a multidisciplinary approach—including mechanical ventilation, intra-aortic balloon pump (IABP), continuous renal replacement therapy (CRRT), and transfusion—enabled recovery. The patient was admitted to the ICU with acute pulmonary edema, pneumonia, and multi-organ dysfunction syndrome, characterized by severe hypoxemia, hypotension, and metabolic acidosis. Over three weeks, the patient regained hemodynamic stability, renal function, and respiratory independence.</p> <p style="font-weight: 400;">This case demonstrates the potential for recovery in patients with severe heart failure complicated by acute pulmonary edema and multi-organ dysfunction when treated with an integrated, multidisciplinary approach.</p> <p style="font-weight: 400;"><strong><em>Conclusion: </em></strong>Advanced critical care strategies, including mechanical ventilation, intra-aortic balloon pump support, and continuous renal replacement therapy, were essential in stabilizing the patient. The outcome underscores the value of personalized, team-based critical care in managing life-threatening complications in heart failure patients with CRT-D.</p> Marsela Goga, Saimir Kuci, Alfred Ibrahimi, Ermal Likaj, Alvi Cela, Romina Teliti, Ormir Shurdha, Erilda Selimi, Jacob Zeitani ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/442 Mon, 20 Jan 2025 00:00:00 +0000 Candiduria in Pediatric Patients: Two Case Reports and a Review of Management Strategies. http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/447 <p><strong><em>Introduction:</em></strong> Urinary infections, while common in intensive care and surgical units, present a unique challenge when fungal pathogens are involved. These fungal urinary infections, known as fungiuria, require a more intricate and prolonged treatment plan involving antifungal medications. This complexity underscores the need for specialized knowledge and skills in managing such cases.</p> <p>This study aims to present two cases of operated pediatric patients who developed urinary fungal infections following Catheterization and simultaneous treatment with two antibiotics.</p> <p><strong><em>Results:</em></strong> Two pediatric patients, aged 12 and 16, underwent surgical procedures in our clinic. The first patient was treated for gangrenous appendicitis complicated by generalized peritonitis. The second patient was treated for a perforation of the small intestine caused by gangrene in a segment of the bowel, resulting from twisting around intestinal adhesions, also complicated by generalized peritonitis.</p> <p>Both patients, aged 12 and 16, developed urinary symptoms four days after surgery. Microbiological analysis confirmed the presence of fungal infections caused by <em>Candida albicans</em>. However, with the administration of antifungal medications, we were able to successfully eradicate <em>Candida albicans</em> from their urinary tracts, as confirmed by follow-up microbiological cultures after several weeks of therapy. This successful outcome should instill a sense of accomplishment in the audience.</p> <p><strong><em>Conclusion:</em></strong> Candidiasis, a significant complication in patients undergoing prolonged Catheterization and simultaneous antibiotic therapy, requires vigilant monitoring. The challenging treatment often necessitates long-term administration of antifungal medications for successful eradication. This underscores the importance of vigilance in monitoring fungal infections in catheterized patients and adopting preventive strategies to minimize their occurrence.</p> Aferdita Ademi, Ferizat Dika Haxhirexha, Agron Dogjani, Kastriot Haxhirexha ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/447 Mon, 20 Jan 2025 00:00:00 +0000 Thymus Hyperplasia and Thymoma Type B in Patients with Myasthenia Gravis: Two case reports and Literature Review http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/428 <p><strong><em>Introduction:</em></strong> The thymus gland plays a pivotal role in immune system regulation, but conditions such as thymic hyperplasia (TH) and thymoma pose distinct clinical challenges due to their rarity and complex presentation in surgical practice. Both conditions can mimic similar symptoms, particularly in patients with Myasthenia Gravis (MG), where surgery serves as both a diagnostic and therapeutic intervention. This report presents the surgical management and outcomes of two MG patients with distinct thymic pathologies: TH and Type B thymoma, alongside a review of the relevant literature.</p> <p>Two MG patients were referred to our clinic for surgical intervention. The first patient underwent a standard sternotomy for the resection of TH, while the second patient underwent a mini-sternotomy for thymectomy targeting a Type B thymoma. Both procedures were completed successfully with uneventful postoperative courses. Surgical resection remains the gold standard for the treatment and definitive diagnosis of thymic gland abnormalities. Advances in surgical techniques, including minimally invasive approaches, offer excellent outcomes with reduced morbidity, providing a viable alternative to traditional methods.</p> <p><strong><em>Conclusion:</em></strong> The cases underscore the critical role of surgical intervention in managing thymic pathologies in MG patients. Both traditional and minimally invasive techniques yield excellent clinical outcomes, reinforcing their importance in the treatment paradigm for thymic hyperplasia and thymoma. Further studies are needed to refine surgical approaches and optimize patient outcomes.</p> Selman Dumani, Altin Kuqo, Ermal Likaj, Saimir Kuci, Majlinda Ikonomi, Laureta Dibra, Alessia Mehmeti, Ejona Celiku, Altin Veshti ##submission.copyrightStatement## http://creativecommons.org/licenses/by-nc/4.0 http://journal.astes.org.al/AJTES/index.php/AJTES/article/view/428 Mon, 20 Jan 2025 00:00:00 +0000