Albanian Journal of Trauma and Emergency Surgery

Splenic Trauma: Rethinking the Classic Approach Through Interventional Radiology

Besmir Bulku — 2026-01-20

Introduction: Blunt splenic injury is a common clinical challenge in polytrauma, with the majority resulting from road traffic accidents or falls. Treated traditionally by splenectomy, treatment guidelines have increasingly shifted towards spleen-preserving methods. Non-operative management, with hemodynamic control and serial imaging as benchmarks, has consistently demonstrated superior rates of success, particularly for low-grade injuries, attesting to its effectiveness.

Materials and Methods: This was a retrospective study involving the review of patient records, imaging studies, and surgical reports on splenic injury management over the last five years (2019–2024) at an Albanian tertiary-level trauma center. We compared outcomes for operative and non-operative management and concluded on the potential role of interventional radiology (IR) in the treatment of severe splenic injuries.

Results: Patients between the ages of 6 and 85 years (mean age 39.2 ± 20.6 years) were enrolled in the study. The non-operative management approach was utilized in 50.6% of patients, and operative management was separated into two subgroups: immediate surgery in 22.9%, and delayed surgery in 26.5%. The overall mortality was 10.8%, and the observed survival was 89.2%.

Conclusion: Non-operative management remains the standard for the treatment of low-grade splenic trauma. However, in more critical trauma, interventional radiology provides a minimally invasive, spleen-preserving solution that fills the gap between observation and surgery.

The role of interventional radiology in managing splenic injuries in the future is not merely promising, but a source of hope and optimism. The establishment of IR services within trauma centers is a clinically sound and cost-saving option that can optimize outcomes and enhance resource utilization.

Profile of Polytrauma Patients Following Motorcycle Road Traffic Accidents Admitted to Intensive Care Unit in Kinshasa

Alex Kalonji — 2026-01-20

Introduction: Road traffic collisions are a significant global health burden, with motorcyclists facing disproportionate risks due to limited protection. In low-resource settings like Kinshasa, this vulnerability is worsened by low helmet use and deficiencies in prehospital care. Characterizing polytrauma profiles is essential to inform targeted prevention and improve critical care strategies.

Objective: To describe the sociodemographic, clinical, and outcome profiles of motorcycle-related polytrauma patients admitted to intensive care units (ICUs) in Kinshasa, providing insights to inform policy and clinical practice.

Materials and Methods: A retrospective, multicenter study was conducted across six ICUs in Kinshasa from January 2021 to December 2023. We included adult patients with polytrauma following motorcycle accidents. Data on demographics, injury mechanisms, clinical presentation, management, and outcomes were analyzed using chi-square and Student's t-tests. Logistic regression identified independent predictors of mortality (p < 0.05).

Results: Of 450 screened cases, 238 were analyzed. The mean age was 36 ± 12 years, with men comprising 82.4%. Drivers accounted for 64.3% of victims, yet helmet use was documented in only 20.2%. Motorcycle–vehicle collisions were the primary mechanism (57.6%). Head trauma (59.7%) and musculoskeletal injuries (70.6%) predominated. Interventions included oxygen therapy (70.6%), fluid resuscitation (64.7%), and surgery (47.1%). The overall mortality rate was 38.7%. Helmet use was significantly protective, associated with a mortality rate of 25% compared to 42% in non-users (p = 0.02), highlighting its impact on outcomes.

Conclusions: Strengthening helmet legislation enforcement and trauma care capacity offers a meaningful opportunity for medical researchers and public health officials to reduce preventable deaths among young males with severe injuries.

Success of Retrograde Filling Retreatments of Teeth with Intraradicular Restorations and Orthograde Restorations of Teeth with Periapical Lesions

Seha Mustafai — 2026-01-20

Imtroduction: Endodontic treatment failure, primarily caused by persistent intracanal microorganisms, necessitates retreatment decisions between conservative orthograde approaches and surgical periapical interventions.

Objective: To compare the clinical and radiographic success rates of retrograde filling following apicectomy in teeth with intraradicular restorations versus orthograde retreatment in teeth with periapical lesions.

Materials and Methods: Forty-eight patients (27 males, 21 females) with endodontically treated teeth exhibiting periapical lesions were recruited at the Clinic for Oral Surgery, Tetovo. Participants were randomly allocated into two groups (n=24 each): Group 1 (control) received conventional apicectomy with orthograde filling material, while Group 2 (study) underwent surgical access with retrograde canal filling using amalgam or glass ionomer cement following 2.5-3 mm apical resection. Clinical and radiographic assessments were conducted at 6 and 12 months post-operatively

Results: At 6 months, Group 2 demonstrated superior healing patterns with 14 complete healings versus 4 in Group 1, though differences were not statistically significant (p=0.03). At 12 months, Group 2 maintained advantages with 14 complete healings compared to 8 in Group 1, with no significant statistical difference (p=0.59). Overall success rate excluding uncertain cases was 79.16%, consistent with literature reporting 72-92% success rates.

Conclusions: Retrograde filling with apicectomy represents a minimally invasive, effective approach for managing endodontic failures in teeth with intraradicular restorations, offering comparable or superior outcomes to conventional orthograde retreatment.

Attitudes of Nurses Regarding Training Opportunities for Using Health Technology in Health Institutions.

Edra Fresku — 2026-01-20

Introduction: The integration of computer technology into healthcare is inevitable, and nurses' involvement is crucial to its practical use. Nursing informatics is a relatively new profession that meaningfully enhances healthcare delivery but is not yet implemented globally, nor consistently within regions of the same country.

Objective: To examine nurses' attitudes toward training courses on the use of health technology in health institutions within the Shkodra Municipality.

Materials and Methods: A cross-sectional, quantitative study was conducted in February and March 2022. Nurses working in the Shkodra Regional Hospital (63%) and health centers within the municipality (37%) were involved. A focus group format was used to assess nurses' attitudes, preparedness, and willingness to adopt health information technology, herein defined as [insert definition or examples of health information technology]. Descriptive statistics were used to quantify demographic and professional information. Cronbach's α and composite reliability were used to assess internal consistency and construct validity.

Results: The questionnaire was completed predominantly by female respondents (63.9%), 61.4% of whom were aged 22–40 years. Most nurses (27.6%) had 1–5 years of work experience. Reliability testing confirmed good convergence validity and internal consistency (Cronbach's α > 0.7). Generally, nurses held positive attitudes toward the use of health technology, with a clear recognition of its potential to significantly enhance healthcare. However, the research also observed that technology applications were formally trained to a lesser extent, and their use in practice remained limited.

Conclusion: Shkodra nurses adopt an optimistic approach to the use of health technology in their daily practice, regardless of demographic and professional factors. The study, however, also highlights the urgency of curricular changes and regular professional development courses to bridge gaps in formal education and training.

The Impact of Fixed Orthodontic Ligatures on Periodontal Health

Amella Cana — 2026-01-20

Introduction: Dental plaque is a primary etiological factor in the development of dental caries and periodontal disease. Orthodontic appliances can complicate oral hygiene, leading to increased plaque retention. This study aimed to evaluate the impact of elastic versus wire ligatures on periodontal health in patients with fixed orthodontic appliances.

Materials and Methods: A total of 24 patients aged 13–18 years participated in this study. All received fixed appliances, with elastic ligatures applied to the right side of the jaw and wire ligatures to the left. Periodontal status was assessed using the Plaque Index (Silness and Löe) and the Gingival Index (Löe and Silness) at three-time intervals: T1, before appliance placement; T2, one week post-placement; and T3, three months post-placement.

Results: At T3, a significant increase in plaque accumulation, gingival inflammation, and bleeding was observed on the side with elastic ligatures compared to the side with wire ligatures, which showed a reduction in these parameters over time.

Conclusion: The type of ligature significantly affects periodontal health in orthodontic patients. Our study found that wire ligatures were associated with better periodontal outcomes than elastic ligatures, shedding light on the importance of selecting suitable ligation methods. These findings underscore the necessity of maintaining rigorous oral hygiene to mitigate adverse periodontal effects during fixed orthodontic treatment, providing valuable insights for orthodontic practitioners and researchers.

Reasons for Tooth Extraction Among Children Aged 5-12 Years in Tetovo.

Armend Demiri — 2026-01-20

Introduction; Due to the high Prevalence of oral diseases, the extraction of primary teeth is a common and major concern in developing countries. These teeth are given the least importance as they are believed to fall out automatically, thus leading to serious problems such as crowding and malocclusion. This study aimed to investigate the main reasons for tooth extraction in children aged 5-12 years.

Materials and Methods: Patients randomly selected for this retrospective study were identified by analyzing the dental records of children aged 5-12 years receiving dental treatment at the 1st Dental Clinic “Vivadent", Tetovo. A total of 325 patients and their panoramic radiographs were seen. The patient's age and gender, number of extracted teeth, and reasons for extraction were recorded.

Results: A total of 325 (27 permanent, 689 primary) extractions were performed in 325 (142 female, 183 male) patients. The reasons for extraction were; caries:512 (72.52%), orthodontics:32 (4.53%), trauma:37 (5.24%, eruption:94 (13.31%), treatment failure:14 (1.98%), ...

Conclusions: The results of this study show that caries is the main cause of extraction in children aged 5-12 years old. This result may be due to the lack of oral hygiene habits in children aged 5-12 years old. These findings are crucial for understanding and addressing the high prevalence of tooth extraction in children.

Management of Dyslipidemia in Patients with Diabetes Mellitus and Cardiovascular Disease

Gazmend Zylbeari — 2026-01-20

Introduction: Diabetes mellitus and cardiovascular diseases remain the leading causes of death worldwide. There are approximately 366 million people with diabetes globally, and by 2030, it is projected that this number will reach 520 million, or 6.3% of the world's population, affected by diabetes. Dyslipidemia and diabetes are the main contributors to cardiovascular diseases. Diabetic dyslipidemia is characterized by disturbances in all lipid fractions (increased triglycerides, increased LDL-cholesterol, and low HDL-cholesterol levels).

Purpose of the study: This study aimed to assess hyperlipidemia as a risk factor for cardiovascular disease in patients with diabetes Mellitus.

Materials and Methods: The study was a prospective cohort ("cross-sectional").

Results: A total of 200 participants were included: 100 patients with diabetes mellitus (60 with type 1 and 40 with type 2), and 100 healthy individuals serving as controls. Among the diabetes patients (100), 45 (45%) were female, with a mean age of 58.00 ± 14.00 years, while 55 (55%) were male, with a mean age of 59.60 ± 12.00 years. The control group comprised 100 voluntary blood donors, 45 (45%) women and 55 (55%) men, with a mean age of 58.40 ± 13.60 years. The results are shown in the following tables (numbers 3-6).

Conclusion: Dyslipidemia and hyperglycemia are the principal risk factors and are independent of the development of premature atherosclerosis and cardiovascular disease. Treating primary or secondary dyslipidemia early is crucial and can significantly help prevent early atherosclerotic processes and cardiovascular diseases. Recent studies on the treatment of dyslipidemia have shown a strong positive effect of statins (40 mg dose), which appear to help prevent cardiovascular disease.

Anatomic Restoration of the Femoral Tunnel in Medial Patellofemoral Ligament Reconstruction. A Clinical Data Study.

Dritan Todhe — 2026-01-20

Introduction: Medial Patellofemoral Ligament (MPFL) reconstruction is the standard of care for recurrent patellar dislocation. However, clinical success is heavily contingent upon precise femoral tunnel placement. Malpositioning can compromise ligament isometry and lead to poor postoperative outcomes. This study evaluates the correlation between anatomical tunnel accuracy and clinical recovery, underscoring the importance of meticulous surgical technique.

Materials and Methods: We retrospectively analyzed 124 patients (124 knees) treated for recurrent patellar dislocation between January 2021 and December 2024. The cohort comprised 31 males and 93 females (mean age 15.4 years). Inclusion criteria included a positive apprehension test, J-sign, and lateral patellar tilt. Postoperative outcomes were assessed using the Lysholm Knee Score. CT and MRI were used to measure the distance from the center of the femoral tunnel to the anatomical isometric point, classifying the positions as isometric or non-isometric.

Results: At a mean follow-up of 18 months, no recurrent dislocations occurred. The mean Lysholm score was 93.8. The average deviation from the isometric point was 4.51 mm; 86 cases (69.4%) were classified as isometric, while 38 (30.6%) were non-isometric. A strong negative correlation was observed between tunnel deviation and Lysholm scores (r = -0.851, P < 0.001). The isometric group demonstrated significantly higher functional scores (95.4 ± 2.2) than the non-isometric group (88.4 ± 3.3; P < 0.001). Furthermore, 58% of the non-isometric group experienced persistent retro-patellar pain, with two patients requiring revision arthroscopy.

Conclusion: Anatomical and isometric restoration of the femoral tunnel is critical for optimal knee function recovery in MPFL reconstruction. Meticulous surgical technique is vital to minimize complications such as residual pain and ensure favorable long-term outcomes.

Perioperative Management of Congenital Atrial and Ventricular Septal Defects: A Five-Year Single-Center Review

Saimir Kuci — 2026-01-18

Introduction: Atrial septal defect (ASD) and ventricular septal defect (VSD) are the most prevalent congenital heart defects in children. Optimized perioperative management remains crucial to minimizing operative risk and preventing postoperative complications, underscoring our collective responsibility to improve patient outcomes.

Materials and Methods: This five-year retrospective review at our tertiary cardiac surgery centre (January 2020 – June 2024) reflects our collective effort to analyse clinical data from pediatric patients undergoing surgical correction for isolated septal defects, to inform clinical practice.

Results: A total of 170 paediatric patients underwent surgical correction during the study period. The cohort included 82 patients (48.2%) diagnosed with ASD and 88 patients (51.8%) with VSD. The broad age range of patients enabled a meaningful evaluation of age-related clinical differences and perioperative outcomes.

Conclusion: This review confirms that ASD and VSD are the most common congenital heart diseases requiring surgical intervention in the pediatric population. Sharing our clinical experience aims to support your efforts in timely surgical correction, guided by accurate clinical and echocardiographic assessment, to prevent disease progression and improve long-term outcomes.

Patient Safety through Hand Hygiene Risk Management

Sažida Delić — 2026-01-20

Background: Patient safety is the responsibility of all participants in healthcare and health services. In clinical hospitals and other healthcare facilities, it is necessary to create conditions in which healthcare is delivered according to a model in which patient safety is the central priority, not only from a medical but also from a socio-economic perspective.

Objective: This study aimed to identify differences in equipment between high- and low-risk clinics and to assess staff hand hygiene practices, including the most common indications and the frequency of antiseptic handwashing, by profession, profile, and clinic risk level.

Materials and Methods: The study included 100 randomly selected participants from healthcare and non-healthcare professions, with 50 from low-risk clinics and 50 from high-risk clinics. The study was conducted anonymously. A modified WHO questionnaire, the Hand Hygiene Knowledge Questionnaire for Health-Care Workers, was used. Descriptive statistics were used in the analysis.

Results: The study partially confirmed the working hypothesis, with the first and second research statements showing statistically significant differences in clinic equipment and staff practices related to hand hygiene. The third statement, which found no statistically significant differences in the frequency of antiseptic handwashing, supports the null hypothesis.

Conclusion: While knowledge of hand hygiene doesn’t always translate into proper practice, ongoing education for healthcare workers and promotion of hand hygiene significantly influence their attitudes and actions. Following established hand hygiene procedures and applying them carefully in daily practice can produce lasting results.

Retinopathy of Prematurity: Discordance in Disease Expression Among Twin Infants

Eglantina Bulica — 2026-01-20

Background: Retinopathy of prematurity (ROP) is a significant cause of preventable childhood blindness. Twin births offer a unique opportunity to evaluate how individual neonatal factors contribute to ROP development, as co-twins typically share similar prenatal and perinatal environments.

Objective: To evaluate how individual neonatal risk factors contribute to ROP severity, differences, and treatment outcomes among preterm twin pairs managed under identical neonatal intensive care conditions.

Materials and Methods: This prospective observational study included 24 twin pairs and two singletons born at 27–34 weeks’ gestation (birth weight 850–2650 g) and was screened in accordance with ICROP3 guidelines. Clinical variables, such as gestational age, birth weight, respiratory support, and metabolic stability, were compared within twin pairs. Discordance was defined as any inter-twin difference in ROP stage, severity, or treatment requirement. Treatment options included intravitreal injection, laser photocoagulation, and vitrectomy.

Results: Seven twin pairs (2.9 %) demonstrated discordant ROP. In each pair, one twin developed any stage of ROP, including aggressive (treatment-requiring) ROP, while the co-twin exhibited mild or no ROP. Discordant pairs were delivered at 28–31 weeks, with mean birth weights of 1496 ± 523g (affected) and 1322 ± 333g (unaffected). One twin pair had the same ROP stage, but regression occurred at different times. Despite similar durations of oxygen therapy, affected infants experienced more episodes of early respiratory instability and metabolic fluctuations. All affected infants required intravitreal anti-VEGF therapy; one needed supplemental laser for recurrence. Two progressed to stage 4 ROP requiring vitrectomy, with one developing secondary glaucoma.

Conclusion: The observed discordance underscores the need for further research with larger sample sizes, inviting the scientific community to contribute to the understanding of ROP variability in twins.

Ischemic Preconditioning as a Myocardial Protection Strategy in CABG: Evidence from a Prospective Clinical Study

Raif Cavolli — 2026-01-20

Introduction: Ischemic preconditioning (IP) is a method that may help protect the human heart from injury during cardiac surgery. It is believed that IP prepares the heart for upcoming prolonged ischemia by activating local protective mechanisms.

Objective: This prospective study aims to evaluate the degree of myocardial protection offered by IP compared to standard cold blood cardioplegia (CBC).

Materials and Methods: Fifty patients with stable angina and coronary artery disease (CAD) scheduled for coronary artery bypass grafting (CABG) were randomized into two groups: IP (n=25) and control (n=25). In the IP group, two cycles of 2-minute ischemia followed by 3-minute reperfusion were applied before aortic cross-clamping. Blood samples were collected through a central venous catheter to measure creatine kinase-MB fraction (CK-MB), creatine phosphokinase (CPK), cardiac troponin I (cTnI), and lactate dehydrogenase (LDH). Postoperative cardiac rhythm was also monitored.

Results: The release of cTnI and lactate was significantly lower in the IP group compared to the control group (cTnI p < 0.0001, CK-MB p = 0.005, CPK p = 0.005). However, there was no significant difference in LDH levels between the groups (p = 0.264). The need for defibrillation after cardiac arrest was lower in the IP group compared to the control group (18% vs. 40%).

Conclusion: The role of IP in cardiac surgery remains uncertain. However, compared to CBC alone in low-risk CABG patients, IP as an adjunct to CBC reduced levels of cTnI, CK-MB, and CPK, and was associated with a lower incidence of postoperative atrial fibrillation.

Serum Procalcitonin Levels as Predictors of Clinical Outcomes in Patients with Secondary Peritonitis

Lakshya Nagpal — 2026-01-13

Introduction: Secondary peritonitis remains a formidable challenge in emergency general surgery, with significant morbidity and mortality. Despite advances in surgical technique, postoperative complications—particularly surgical site infections (SSIs) and respiratory failure—remain common.

This study examines the prognostic utility of serum procalcitonin (PCT) and C-reactive protein (CRP) as biochemical markers for risk stratification and prediction of clinical outcomes in patients with secondary peritonitis.

Materials and Methods: A prospective observational study was conducted from February 2023 to April 2024, including 95 patients diagnosed with secondary perforation peritonitis. Serum PCT and CRP concentrations were measured at admission and 48–72 hours postoperatively. Patients were followed for 30 days. The primary clinical endpoints were ICU admission, mechanical ventilation, prolonged hospital stay, SSI, and 30-day mortality.

Results: The study cohort had an overall mortality rate of 13.7%. Statistical analysis showed that admission PCT levels > 1.28 ng/mL were a highly significant predictor of non-survival. Furthermore, a postoperative PCT threshold of >0.5 ng/mL at 48 hours was strongly correlated with the subsequent development of SSIs. Although elevated CRP levels were associated with adverse clinical trajectories, PCT demonstrated superior discriminative power for specific outcomes.

Conclusion: Serum PCT and CRP are robust predictors of mortality and morbidity in secondary peritonitis. Specifically, a PCT level > 1.28 ng/mL at admission provides critical prognostic information about survival, whereas postoperative PCT levels > 0.5 ng/mL facilitate early identification of SSI risk. These findings suggest that incorporating serial biomarker monitoring into clinical workflows can enhance risk-based decision-making. Larger multicenter trials are warranted to validate these thresholds.

Emergency Care and Interventions for Construction Site Injuries: A Literature Review.

Basri Lenjani — 2026-01-20

Introduction: Injuries plague the construction sector, straining healthcare systems and endangering lives. Empowering workers with hazard awareness and equipping them with first-aid skills can reduce injury rates. Robust accident and emergency systems are lifesaving, yet construction sites remain among the most perilous workplaces, marked by frequent trauma, disability, and loss of life.

This review examines the latest evidence on emergency care for construction-site injuries, highlighting prehospital care, rapid on-site response, and seamless coordination with the trauma system.

The review uncovers common injury patterns, highlights the most effective emergency strategies, pinpoints gaps in training and preparedness, and delivers actionable recommendations. Swift recognition, decisive action, strong teamwork, and vigilant safety practices are essential for minimizing complications and saving lives during construction emergencies. To reduce workplace injuries, regular risk assessments, fitness checks for demanding roles, ongoing safety and wellness training, and the appointment of first-aid marshals are vital.

Ensuring adequate qualified staff, maintaining tidy workspaces, clear walkways, visible signage, proper lighting, and comprehensive emergency response training, such as BLS-D, BTLS, PHTLS, and ATLS, all play a crucial role in building a safer construction environment.

Conclusions: Construction site injuries pose a major public health and safety challenge. Timely emergency care—from basic first aid to advanced trauma treatment—is crucial for reducing illness and fatalities. Strengthening prevention, enforcing safety standards, and embracing new technologies can transform construction site safety. Multifaceted or tailored interventions are most effective, but many studies lack rigor.

A Review of Artificial Intelligence in Predicting Outcomes, Complications, and Survival Following Breast Cancer Surgery

Abdullah Emre Akşun — 2026-01-20

Background: The topic of artificial Intelligence and its application in medicine has gained tremendous popularity, coinciding with advances in its technology. Breast cancer treatments vary, with surgery being one of them.

In this review, we aim to evaluate artificial Intelligence’s ability to predict surgical outcomes, complications, and survival rates after breast cancer surgery by analyzing original research conducted over the last 5 years.

Materials and Methods: A PubMed search was conducted by two authors from January 1, 2020, to April 13, 2025, using the keywords "Artificial Intelligence" and "Breast Surgery". After elimination, 14 of the 215 articles were full-text screened, and nine original articles were selected for inclusion in our review.

Discussion: Artificial intelligence models and systems have had a significant impact on the medical field, and breast cancer surgery is no exception. Several original research studies have explored AI's ability to predict surgical outcomes and postoperative results. In this review, we focus on the postoperative aspects of breast cancer surgery and its application of artificial intelligence.

Of the nine articles included in this paper, all reported multiple statistically significant results (p <0.05). Although no prospective research directly compares artificial intelligence with practicing physicians, artificial intelligence’s ability to accurately predict surgical outcomes, complications, and survival has shown higher accuracy and c-index than commonly used prediction methods, as reported in multiple studies.

Conclusion: Artificial Intelligence can be a valuable asset in helping surgeons and medical doctors worldwide predict prognosis with improved systems and accuracy rates, even surpassing those of currently used conservative systems. There is a lack of information on PubMed regarding the comparison of these two aspects, particularly with larger sample sizes. More research should be conducted on this topic, particularly in comparing Artificial Intelligence systems and models with current systems and evaluation methods.

Drug-Induced Leukopenia after Kidney Transplantation: Insights from Literature and a Clinical Case

Klejda Çollaku — 2026-01-20

Introduction: Leukopenia, particularly neutropenia, is a frequent hematological complication in kidney transplant recipients. It is most often related to immunosuppressive and prophylactic agents. These drugs are essential for preventing graft rejection and infection. However, they may induce myelosuppression. This leads to increased infection risk and often requires therapy modification.

Materials and Methods: We conducted a narrative review of the literature by searching PubMed, Embase, and Scopus for studies published between January 2010 and June 2024. Search terms included “leukopenia,” “neutropenia,” “drug-induced,” “kidney transplantation,” “mycophenolate,” “valganciclovir,” “tacrolimus,” “cotrimoxazole,” and “myelosuppression.” Eligible studies involved adult kidney transplant recipients and reported drug-induced leukopenia.

Results: Eight key studies were identified. Mycophenolate mofetil, valganciclovir, and trimethoprim-sulfamethoxazole were the most frequent causative agents. Tacrolimus was occasionally implicated. Reported incidence of leukopenia ranged from 19% to 83% during the first post-transplant year. Neutropenia occurred in up to 48% of patients. Risk factors included CMV D+/R− serostatus, combination therapy, and higher drug dosages. To illustrate clinical complexity, we present a case of a 36-year-old renal transplant recipient. He developed severe leukopenia and neutropenia two months post-transplant. White blood cell counts normalized following therapy adjustment and G-CSF administration, without subsequent rejection or infection.

Conclusion: Drug-induced leukopenia is a common complication after kidney transplantation. It is seen particularly with mycophenolate and valganciclovir, and less often with tacrolimus. Early detection, individualized dose adjustment, and supportive therapies are essential. These measures balance infection prevention with adequate immunosuppression. Standardized management guidelines are lacking, highlighting the need for prospective studies.

Comparative Hemodynamic Effects of BiPAP and APRV in Patients with ARDS: A Systematic Review

Leon Hajdari — 2026-01-20

Introduction: Positive pressure ventilation is key in the treatment of patients with acute respiratory distress syndrome. Bilevel Positive Airway Pressure and Airway Pressure Release Ventilation modalities aim to improve oxygenation and reduce lung injury, but their hemodynamic effects vary.

Objective: To compare the clinical and hemodynamic effects of Bilevel Positive Airway Pressure and Airway Pressure Release Ventilation in acute respiratory distress syndrome patients.

Materials and Methods: Clinical studies published through November 2025 in the PubMed, Scopus, and Web of Science databases were analyzed. Articles on acute respiratory distress syndrome patients treated with Bilevel Positive Airway Pressure or Airway Pressure Release Ventilation that reported hemodynamic parameters were included. Studies without hemodynamic data, those outside acute respiratory distress syndrome, and non-clinical studies were excluded.

Results: Bilevel Positive Airway Pressure improves alveolar ventilation and oxygenation while modestly reducing left ventricular afterload; cardiac output remains stable in normovolemic patients. Airway Pressure Release Ventilation significantly increases oxygenation and ejection fraction, reduces alveolar shunt, and opens atelectatic alveoli, but is associated with more pronounced decreases in mean arterial pressure and preload. Clinical studies report that Airway Pressure Release Ventilation increases cardiac index and reduces central venous pressure, improving oxygenation while reducing the need for hemodynamic support.

Conclusions: Bilevel Positive Airway Pressure is suitable for moderate acute respiratory distress syndrome and hypercapnic respiratory failure, offering favorable hemodynamics and noninvasive support. Airway Pressure Release Ventilation is preferred in severe acute respiratory distress syndrome with refractory hypoxemia, as it provides superior oxygenation and alveolar recruitment but requires careful hemodynamic monitoring. The choice of modality should balance respiratory benefits with cardiovascular risks.

Exploring Magnesium Membranes as a Promising Alternative in Guided Bone Regeneration: A Literature Review.

Amela Muça — 2026-01-20

Introduction: Alveolar ridge atrophy is an unavoidable consequence of tooth extraction, often resulting in Bone defects complicating ideal implant placement are a significant concern. Guided Bone Regeneration is a widely adopted technique that utilizes barrier membranes to enhance bone regeneration by preventing soft tissue invasion and promoting bone growth.

Traditional resorbable membranes, while eliminating the need for secondary surgeries, often lack sufficient structural rigidity; in contrast, non-resorbable membranes provide stability but require re-entry procedures.

Recently, a resorbable magnesium alloy membrane (NovaMag®) has been introduced, offering both structural support and complete resorption.

A literature search was conducted using PubMed, Scopus, and Web of Science, encompassing in vitro, in vivo, animal, and clinical research. Findings indicate that magnesium membranes display favorable mechanical properties, biocompatibility, and controlled degradation, along with promising clinical outcomes in alveolar ridge preservation, guided bone regeneration, and mandibular reconstruction. Several surface treatments (e.g., MAO, HA, HF) have been investigated to optimize performance and degradation rates.

Conclusions: Magnesium membranes are a promising alternative to collagen membranes in guided bone regeneration (GBR), offering superior mechanical strength and reducing the risk of tearing—an issue commonly observed with collagen membranes, biocompatibility, and full resorbability.

Foot Drop After Hip Replacement: Case Illustration of Iatrogenic Peroneal Nerve Injury and Review of Literature

Aurora Muça — 2026-01-20

Introduction: Iatrogenic peroneal nerve injuries are rare, serious complications of orthopedic procedures, especially hip arthroplasty, hip fracture fixation, or prosthetic implantation. These injuries cause disabling functional deficits if not promptly recognized and treated. Early neurophysiological assessment and referral to a neurosurgeon are critical for recovery. [1-3]

Case Illustration: We report the case of a 60-year-old female patient who sustained a right femoral neck fracture after a fall. She underwent hip arthroplasty with a titanium prosthesis five days post-injury. Postoperatively, she developed complete ipsilateral foot drop and neuropathic pain with electric-shock sensations radiating from the knee to the lateral toes. Immobilization lasted over six weeks. Initial physiotherapy and daily TENS were ineffective.

At two months, electromyography showed absent motor activity in the common peroneal nerve. Repeat ENMG studies confirmed a persistent deficit. MRI excluded spinal pathology. Nutritional neurotrophic supplementation (alpha-lipoic acid and gamma-linolenic acid) administered by a neurologist was ineffective. Given the plateau neurological state, neurosurgeon consultation was recommended, and within a month, the patient underwent peroneal nerve decompression.

Discussion: Iatrogenic peroneal nerve injuries after hip procedures may result from direct trauma, limb positioning, or traction during surgery. [4, 5] Prompt exploration and neurolysis, combined with structured physiotherapy, can enhance functional outcomes.[6] Delayed recognition and mislabeling as neurapraxia remain frequent, leading to disabling deficits. [7, 8, 9]

Conclusion: This case highlights the impact of delayed recognition of iatrogenic peroneal nerve injury after hip arthroplasty. Early suspicion, neurophysiological confirmation, and timely referral to peripheral nerve specialists are essential for optimizing neurological and functional outcomes.

Professional Burnout among Healthcare Personnel: A Comprehensive Review of the Literature

Eva Filaj — 2026-01-20

Introduction: Professional burnout is an escalating concern among healthcare personnel, undermining well-being, care quality, and system performance. Characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, burnout is now a major occupational hazard in healthcare.

Materials and Methods: This article critically reviews international literature on professional burnout, examining its theoretical development and advances in conceptualization and measurement. The review emphasizes frontline professionals, especially physicians and nurses, who face high workloads, emotional demands, organizational pressures, and ethical challenges. The analysis addresses organizational, professional, and individual factors to provide a comprehensive perspective on causes and outcomes.

Results: The literature identifies staffing shortages, administrative burdens, limited institutional support, role conflict, decision fatigue, and personal vulnerability as key causes of burnout among healthcare professionals. Major outcomes include lower job satisfaction, declining mental and physical health, higher staff turnover, and reduced patient safety. The review highlights the frequent use of the Maslach Burnout Inventory and related tools, as well as interventions such as organizational change and resilience-building.

Conclusion: The findings indicate that burnout arises from a combination of organizational, professional, and individual factors, with significant consequences for healthcare quality and worker well-being. An integrated prevention approach is required that combines systemic reforms with individual support. Prioritizing burnout in policy agendas and developing support systems are essential. This review underscores the need for interdisciplinary strategies and identifies future directions for occupational health research.

Bleeding Injuries in Dental Trauma and Emergency Medical Management: A Literature Review

Ilirian Lenjani — 2026-01-20

Introduction: Dental and maxillofacial trauma is often associated with significant hemorrhage due to the rich vascular supply of the oral and perioral tissues. Uncontrolled bleeding can lead to airway obstruction, aspiration, hypovolemic shock, and increased morbidity, particularly in emergency settings. Prompt recognition and effective hemorrhage control using dental-specific emergency protocols are therefore critical.

Materials and Methods: This narrative literature review synthesizes current evidence on the etiology, patterns, and severity of bleeding injuries from dental trauma, as well as contemporary emergency medical management strategies. Emphasis was placed on airway assessment, direct pressure techniques, local and systemic hemostatic agents, dental and maxillofacial immobilization, and timely activation of emergency medical services. Relevant publications were identified through major medical databases and guideline sources.

Results: The reviewed literature indicates that early hemorrhage control, combined with systematic airway evaluation and stabilization, significantly reduces complications in dental trauma. Interventions such as gauze compression, suturing, topical hemostatic agents, splinting of dentoalveolar injuries, and coordinated prehospital–hospital care have shown favorable outcomes. However, many studies are limited by small sample sizes, heterogeneous methodologies, and low levels of evidence, underscoring the lack of universally accepted, standardized protocols.

Conclusion: Hemorrhagic complications following dental trauma represent a potentially life-threatening but largely preventable cause of adverse outcomes. Effective emergency medical management—incorporating early bleeding control, appropriate use of hemostatic agents, structured referral pathways, and trained responders—is essential for improving patient survival and recovery. Strengthening standardized, evidence-based dental trauma protocols and enhancing multidisciplinary training remain key priorities for future clinical practice and research.

Late Management of Orbital Fracture. A Case Report.

Arjeta Grezda — 2026-01-20

Introduction: Orbital fractures are among the most complex injuries managed by maxillofacial surgeons. While delayed surgical intervention can allow edema to subside and facilitate accurate anatomical assessment, it may also increase the risk of permanent complications, such as soft tissue fibrosis and impaired ocular motility.

Case Presentation: We report the case of a 56-year-old male who sustained a left orbital fracture in a motor vehicle accident two months prior. The patient presented with persistent diplopia, hypoglobus, and telecanthus. CT imaging revealed displacement of both the superior and inferior orbital rims, along with inferior displacement of the orbital floor. Surgical correction was performed via a multi-approach technique: frontoethmoidal and upper eyelid crease incisions, intraoral maxillary vestibular access, and infraorbital incision. Reconstruction involved osteotomy and repositioning of displaced orbital segments, using titanium microplates and mesh pre-adapted to a 3D stereolithographic model for precision. The duction test confirmed restored ocular mobility intraoperatively.

Results: Two weeks postoperatively, the patient reported resolution of diplopia and demonstrated full, symmetrical ocular motility. This successful outcome, with no further complications observed, underscores the effectiveness of our surgical approach.

Conclusion: This case underscores the importance of early diagnosis and timely surgical repair in achieving optimal functional and aesthetic recovery in orbital trauma cases. Even with a late intervention, favorable outcomes can be achieved through meticulous anatomical reconstruction and advanced techniques such as stereolithographic modeling.

The Role of Magnetic Resonance Cholangiopancreatography in Diagnosing Biliary Tract Variants and Anomalies: A Case Report of a Choledochal Cyst

Eni Mehmeti — 2026-01-20

Introduction: Choledochal cysts are rare congenital anomalies of the biliary tree with significant risks of cholangitis, pancreatitis, and malignant transformation if not diagnosed early. Magnetic resonance cholangiopancreatography, a noninvasive, radiation-free technique, offers high-resolution multiplanar imaging of the entire biliary tree. This risk-free technique provides a safe diagnosis and extensive preoperative mapping, without the hazards of ionizing radiation and procedure-related complications, such as pancreatitis, that are commonly associated with other diagnostic techniques.

Case Report: A 67-year-old female presented with six months of intermittent right upper quadrant discomfort, some having had episodes of jaundice with pruritus. Laboratory studies were positive for hyperbilirubinemia (3.2 mg/dL) with a cholestatic enzyme pattern (alkaline phosphatase 320 U/L and γ-glutamyl transferase 190 U/L). Abdominal ultrasound revealed gallbladder sludge but was inconclusive for ductal anatomy.". Magnetic resonance cholangiopancreatography revealed an extrahepatic bile duct fusiform dilation up to 2.5 cm, consistent with a Todani type Ib choledochal cyst, with no intrahepatic bile duct dilatation or intraductal stones.

Conclusion: Magnetic resonance cholangiopancreatography is used for the early identification and description of biliary tract abnormalities, like choledochal cysts. Its non-invasive nature and global ductal mapping with a safety profile maximize surgical planning and potentially anticipate severe complications.

Penetrating Neck Injuries from Firearms Accompanied by Laryngeal Injuries, Two Case Studies.

Kledia Pollo — 2026-01-20

Introduction: Penetrating neck injuries (PNIs) from firearms are life-threatening emergencies due to the risk of airway compromise and major hemorrhage. Laryngeal trauma, though uncommon, adds further complexity and can be fatal without prompt intervention.

Case Presentations:

Case 1: A 44-year-old male sustained a gunshot wound to the anterior neck. Imaging revealed fractures and displacement of the right thyroid cartilage, soft tissue hematomas, and subcutaneous emphysema, with an exit wound in the left submandibular area. The patient exhibited stridor, dysphonia, and active bleeding. Emergency airway stabilization and surgical repair led to a full recovery of respiratory and vocal function.

Case 2: A 40-year-old male presented with a trans-neck gunshot wound exiting through the left scapulohumeral region. He had associated clavicular and humeral fractures and signs of hemorrhagic shock. Immediate airway management via intubation and tracheostomy, along with hemodynamic stabilization, resulted in a favorable outcome after 14 days in intensive care.

Successful management of PNIs involving the larynx necessitates a rapid, multidisciplinary approach. Imaging, airway protection, and timely surgical intervention are crucial for preserving laryngeal function.

Conclusion: Firearm-related PNIs with laryngeal involvement demand immediate, coordinated care. These cases highlight the importance of early airway control, accurate diagnosis, and surgical expertise in optimizing outcomes and preserving vital functions.

Delay is Deadly. A Rare Case of Bull Gore Injury with Complete Small Bowel Gangrene

Mehul Kohli — 2026-01-20

Introduction: Blunt abdominal trauma secondary to animal attacks is uncommon but may result in catastrophic intra-abdominal injuries, particularly in rural environments where delayed access to definitive care is frequent. Bull gore injuries, though typically associated with penetrating trauma, may also cause severe blunt visceral ischemia with delayed clinical manifestations.

Case Presentation: We report the case of a 65-year-old male from the Satara district of Maharashtra who sustained blunt abdominal trauma following a bull attack. The patient presented approximately 96 hours after injury with features of generalized peritonitis and septic shock. Initial evaluation revealed hemodynamic instability and laboratory evidence of severe sepsis. Emergency exploratory laparotomy demonstrated complete gangrene of the small intestine with associated ischemic segments of the large bowel, consistent with mesenteric vascular compromise. Extensive bowel resection with stoma formation was performed. Despite aggressive postoperative intensive care, including broad-spectrum antibiotics, vasopressor support, and organ support, the patient developed progressive multiorgan failure and died on postoperative day six.

Discussion: This case highlights the lethal consequences of delayed presentation in blunt abdominal trauma, where evolving mesenteric ischemia may remain clinically silent until irreversible bowel necrosis occurs. Early recognition, prompt imaging, and timely surgical intervention are essential to prevent progression to bowel gangrene and septic shock.

Conclusion: Bull-related blunt abdominal trauma can result in fatal ischemic bowel injury when diagnosis and surgical management are delayed. Enhanced public awareness, early referral pathways, and improved trauma care infrastructure in rural regions are critical to reducing mortality associated with such injuries.

Urgent Duodenectomy in a Patient with Aortoenteric Fistula

Adrián Paredes Segura — 2026-01-20

Background: Duodenal surgery is highly complex, especially in emergency settings such as aortoenteric fistula (AEF). AEF is a rare but life-threatening complication of aortic grafts. When duodenal defects are extensive, partial duodenectomy with pancreatic preservation may offer a safe alternative to primary repair.

Case Presentation: A 57-year-old man had multiple comorbidities and a prior aortobifemoral bypass. He presented with abdominal pain, weight loss, and recurrent gastrointestinal bleeding. Initial studies were inconclusive. CT-angiography later showed a pseudoaneurysm at the proximal graft anastomosis, requiring endovascular repair with aortic endoprostheses and a “kissing-stent.” Persistent anemia led to repeat imaging, which revealed contrast extravasation and a large D2–D3 duodenal perforation with graft exposure, consistent with secondary AEF. The patient underwent urgent D3–D4 duodenectomy with pancreatic preservation, duodenojejunostomy, explantation of the infected prosthesis, aortic repair, and creation of an axillobifemoral bypass. Following a reoperation for postoperative bleeding, he made a full recovery without further complications, demonstrating successful surgical and clinical resolution of this complex case.

Partial D3–D4 duodenectomy is a reliable and effective option. It gives surgeons confidence in managing extensive duodenal defects associated with AEF.

Conclusion: Surgeons should become familiar with partial D3–D4 duodenectomy. It offers a definitive solution for complex duodenal lesions and reinforces expertise in challenging cases.