Albanian Journal of Trauma and Emergency Surgery

Advancing Pilonidal Sinus Care Through Structured International Collaboration: The PiloNERDs Project

Dietrich Doll — 2026-07-20

Pilonidal sinus disease (PSD) is one of the most common benign surgical conditions affecting adolescents and young adults worldwide—yet its management remains surprisingly fragmented. Despite increasing scientific activity across Europe and beyond, surgical techniques, outcome definitions, and follow-up standards still vary widely, limiting meaningful comparison and slowing progress. For a condition of such prevalence and socio-economic relevance, this lack of coordination represents a missed opportunity.

PiloNERDs International (Pilonidal Network for Expertise, Research and Development) was founded to change this. As a clinician-led global initiative dedicated exclusively to pilonidal disease, PiloNERDs provides a structured platform for harmonised definitions, robust long-term outcome assessment, shared registries, multicentre collaboration, and open methodological exchange. By uniting surgeons and researchers across borders, the network transforms individual expertise into collective scientific strength.

This project marks a decisive step from isolated excellence toward coordinated advancement. Through enthusiastic international cooperation, PiloNERDs aims to elevate research quality, accelerate innovation, and establish reproducible standards—ultimately delivering better, evidence-based surgical care for the predominantly young patients entrusted to us.

An Assessment of the Quality of YouTube Videos on the Treatment of Nosebleeds

Resmiye Nur Okudan — 2026-07-20

Background: Epistaxis (nosebleed) is a common clinical condition that is often managed with simple first-aid measures. With the increasing use of online platforms such as YouTube, many individuals rely on video-based content for medical guidance. However, the accuracy and reliability of such information remain uncertain.

Objective: This study aimed to evaluate the quality, reliability, and accuracy of YouTube videos related to the treatment of nosebleeds.

Methods: A cross-sectional observational study was conducted by analyzing 150 videos identified using the keywords “nosebleed treatment,” “epistaxis first aid,” and “how to stop a nosebleed.” After applying inclusion and exclusion criteria, 120 videos were included. Data extracted included views, duration, and source of upload. Videos were categorized as uploaded by healthcare professionals, medical institutions, or laypersons. Quality and reliability were assessed using the DISCERN score and Global Quality Scale (GQS), while accuracy was evaluated using a checklist based on established clinical guidelines.

Results: The mean DISCERN score was 2.8 ± 0.9, indicating moderate reliability, and the mean GQS score was 3.1 ± 1.0, reflecting average educational quality. Videos produced by healthcare professionals demonstrated significantly higher quality scores (p < 0.01). Correct recommendations such as leaning forward and applying nasal compression were present in 62% and 58% of videos, respectively, while only 40% specified the appropriate duration of compression. Notably, 30% of videos included incorrect advice, particularly recommending head tilting backward.

Conclusion: YouTube videos on nosebleed management show considerable variability in quality and accuracy. While professional sources provide more reliable information, a substantial proportion of videos contain misleading or incomplete guidance. Greater involvement of healthcare professionals and improved content regulation are needed to enhance public health education.

The Foreign Body Aspiration in Children in Albania during 2006-2025

Melpomeni Bizhga — 2026-07-20

Background: Foreign body aspiration constitutes a serious and potentially life-threatening emergency in infants and children. Delayed diagnosis and treatment can result in severe respiratory complications and mortality.

Aim: To evaluate the clinical characteristics, diagnostic approaches, treatments, and outcomes of children with foreign body aspiration managed over a 20-year period in Albania.

Materials and Methods: A retrospective review was conducted of 149 children who underwent rigid bronchoscopy for suspected airway foreign body aspiration at the institution from 2006 to 2015, and 230 children from 2015 to 2024. Demographic data, clinical presentations, referral patterns, diagnostic procedures, complications, and outcomes were analyzed.

Results: During 2006-2015, foreign bodies were removed from the larynx, trachea, or bronchial tree in 105 children. The mean age was 23 months, and 60% of patients were male. A choking episode was reported in 51% of cases, resulting in immediate referral to the ENT service, while 49% initially presented to the pediatric service with symptoms such as cough, pneumonia, or asthma. Flexible bronchoscopy was performed first in the latter group. The overall complication rate was 19%, including emphysema, atelectasis, pneumonia, bronchiectasis, pyopneumothorax, and pneumomediastinum. The false-positive rate was 20%. Complications related to flexible bronchoscopy, such as laryngeal edema, hypoxia, and bleeding, occurred in 6% of patients. One death occurred in a child who presented in hypoxic arrest…

Conclusion: Foreign body aspiration in children remains a medical emergency that requires rapid recognition and prompt intervention with rigid bronchoscopy. Delayed diagnosis is associated with increased complication rates and poorer outcomes.

Optimizing Varicocele Treatment: A Comparative Review of Surgical and Minimally Invasive Approaches

Erzen Elezi — 2026-07-20

Background. Varicocele is the most common surgically correctable cause of male infertility, yet the choice of surgical technique remains a matter of ongoing debate. Open (Ivanissevich-type), laparoscopic, and microsurgical subinguinal approaches each carry distinct profiles of recurrence, hydrocele formation, postoperative pain, and recovery. We report a small, single-centre comparative experience and place it within the contemporary evidence base.

Methods. Between January 2024 and January 2026, 16 male patients (aged 18–46 years) undergoing varicocele repair at the Clinical Hospital of Tetovo were studied. Eight were treated with a laparoscopic technique and eight with a conventional open technique. Outcomes recorded were intra- and postoperative complications, postoperative pain, hydrocele formation, time to full recovery, and varicocele recurrence.

Results. No complications were recorded in the laparoscopic group; one patient in the open group developed a postoperative haematoma. Postoperative pain was clearly lower after laparoscopy, and full recovery was shorter than after open surgery. No hydrocele was observed in either group. A mild recurrence occurred in one laparoscopic patient and in one open patient, the latter being more pronounced.

Conclusions. In this limited series, laparoscopic repair was associated with less pain and faster recovery than open repair, with comparable short-term safety. These observations are consistent with the broader literature, in which microsurgical subinguinal varicocelectomy currently shows the lowest recurrence and hydrocele rates and is regarded by many andrology centres as the surgical reference standard. The small sample size precludes firm conclusions, and larger comparative work is needed.

Non-Conventional Risk Factors in Acute Coronary Syndrome

Taulant Gishto — 2026-07-20

Background: Acute coronary syndrome (ACS) remains a major cause of morbidity and mortality. Beyond conventional risk factors, non-conventional lifestyle and psychosocial exposures may contribute to adverse coronary and vascular phenotypes.

Objective: To evaluate the association of selected non-conventional exposures with ACS and to examine their relationships with structural vascular/adipose imaging markers.
Methods: We conducted a case–control study including 300 participants (150 ACS cases and 150 controls without ACS confirmed by coronary angiography or coronary CT angiography) at the University Hospital Center “Mother Teresa”, Tirana (2024–2025). Physical activity, sleep duration, dietary pattern, alcohol use, and psychosocial factors were compared between groups, alongside epicardial adipose tissue (EAT), pericardial adipose tissue (PAT), and carotid intima–media thickness (CIMT; right and left).

Results: Cases were older than controls (66.1 ± 10.7 vs 57.4 ± 10.9 years) and more frequently male (74.7% vs 66.0%). Physical inactivity, short sleep duration, high-fat dietary patterns, and higher alcohol intake were more common among cases (all p < 0.001), whereas Mediterranean diet adherence was markedly lower. EAT and CIMT (right and left) were significantly higher in cases than controls (all p < 0.001), and PAT was also higher among cases (p = 0.004).
Conclusions: In this Albanian cohort, ACS was strongly associated with modifiable non-conventional exposures—particularly short sleep, low physical activity, and unhealthy diet—and with adverse vascular/adipose imaging phenotypes. These findings support integrating key lifestyle and psychosocial factors alongside structural markers in regional cardiovascular risk profiling.

Gestational Age and Pregnancy Outcomes in SARS-CoV-2 - Positive Women: A Retrospective Cohort Study with External Comparison

Vera Beca — 2026-07-20

Introduction: While SARS-CoV-2 infection is known to impact maternal health, the effects of infection timing during pregnancy on maternal and neonatal outcomes remain less well understood.

This study investigates the impact of SARS-CoV-2 infection timing during pregnancy on maternal and neonatal health outcomes.

Materials and Methods: Medical records of 254 women with SARS-CoV-2 infection treated at the "Queen Geraldine" University Hospital of Obstetrics and Gynecology were reviewed retrospectively. Participants were categorized into four groups by gestational age at infection: under 22 weeks, 22–27 weeks, 27–37 weeks, and 37–42 weeks. Outcomes assessed included miscarriage, fetal death, preterm birth, and neonatal birth weight.

Results: We found that the time of SARS-CoV-2 infection during pregnancy had an impact on the health of the mother and the baby. Early-onset infection (under 22 weeks) was linked to significantly higher rates of spontaneous abortion (31.3%) and fetal death (9.4%) (p<0.001 and p=0.017, respectively). Preterm birth occurred in 46.7% of pregnancies, and infection timing also influenced neonatal birth weight.

Conclusion: The timing of SARS-CoV-2 infection during pregnancy is a critical determinant of maternal and neonatal health. Early pregnancy infection increases the risk of complications, indicating the need for enhanced monitoring and individualized care strategies.

Beyond Stone Removal: Modern Challenges and Future Directions in the Management of Urinary Tract Calculi

Florin Deari — 2026-07-20

Introduction: Urinary tract calculi represent one of the most prevalent benign urological conditions worldwide, with a lifetime risk exceeding 50% in some populations. Despite advances in minimally invasive techniques, management extends beyond stone extraction to encompass residual fragments, infectious complications, recurrence prevention, and long‑term patient outcomes.

The Aim is to evaluate the contemporary surgical workload of a regional referral department, describe treatment distribution by stone location, and quantify early postoperative complications.

Methods: A retrospective review was conducted of 168 consecutive patients treated for urinary tract calculi at the Department of Urology, Clinical Hospital of Tetovo, between January 2025 and January 2026. Stones were classified by anatomical site (ureter, kidney, bladder) and managed according to European and American guideline recommendations. Demographic data, treatment modality, and early complications were extracted and graded using a Clavien‑Dindo–compatible system.

Results: The cohort included 126 men (75.0%) and 42 women (25.0%), aged 24–68 years. Ureteral stones (104 cases, 61.9%) were managed exclusively with semirigid ureteroscopy. Renal stones (44 cases, 26.2%) were treated with extracorporeal shock‑wave lithotripsy (24 cases) or flexible ureterorenoscopy (20 cases). Bladder stones (20 cases, 11.9%) were managed by cystolitholapaxy (16 cases) or open cystolithotomy (4 cases). Early complications were minor: prolonged haematuria (9.5%), urinary tract infection (6.5%), mild urethral stricture (1.8%), and incomplete fragmentation requiring re‑treatment (2.4%). No complication exceeded Clavien‑Dindo grade III.

Conclusions: Guideline‑concordant, location‑based strategies yielded a safe complication profile dominated by self‑limiting events. Modern stone care emphasizes infection control, complete stone clearance, and metabolic prevention, underscoring the shift from purely technical removal toward comprehensive long‑term management.

Anatomical Variations of the Vertebral Arteries, and their Impact on Cerebral Circulation

Gazmend Zylbeari — 2026-07-20

Background: The vertebral arteries are integral to the vertebrobasilar system, contributing approximately 20% of cerebral blood flow and ensuring perfusion of the posterior brain and spinal cord. Anatomical variations such as hypoplasia and dolichoectasia may compromise posterior circulation hemodynamics and influence cerebrovascular risk.

Objective: To investigate the prevalence, diameter, and gender distribution of vertebral artery variations and assess their potential clinical implications for posterior cerebral circulation.

Materials and Methods: A retrospective observational study was conducted on 60 patients (25 females, 41.7%; 35 males, 58.3%; mean age 45.0 ± 12.0 years). Radiological evaluation included Magnetic Resonance Angiography, Doppler ultrasonography, and Computed Tomography. Vertebral artery morphology was classified as normal, hypoplastic, or dolichoectatic.

Results: Hypoplasia was the most frequent variation. In females, hypoplasia was observed in 28.0% of left and 40.0% of right vertebral arteries. In males, it was present in 20.0% of left and 22.9% of right arteries. Dolichoectasia was more prevalent in males. These findings highlight gender-related differences and underscore the importance of vascular imaging in patients with posterior circulation symptoms.

Conclusion: Vertebral artery variations are relatively common and clinically significant. Recognition of these variations is essential for accurate diagnosis, risk stratification, and management of cerebrovascular disorders involving posterior circulation.

Management of Acute Myocardial Infarction in the Emergency Department of Elbasan Hospital

Ergys Mici — 2026-07-20

Background: Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality. Early recognition and evidence-based ED management are critical, particularly in regional hospitals.

Aim of the study: To describe clinical management, diagnostic approach, and early outcomes of patients presenting with suspected AMI in the Elbasan Hospital ED.

Methods: Retrospective descriptive study using ED registry data from January 2025 to July 27, 2025. Adult patients with symptoms suggestive of acute coronary syndrome were included. A total of 66 patients were analyzed. Data on demographics, symptoms, initial management, transport, and time intervals were anonymized and aggregated.

Data Collection: Extracted from ED registry: age, sex, residence, presenting symptoms, preliminary diagnosis, initial management, transport mode, referral, and time intervals. Data were anonymized.

Analysis: Descriptive statistics summarized demographics and clinical management. Mean age ± SD was calculated. Frequencies and trends are reported.

Results: Mean age: 66.7 ± 13.8 years. Chest pain, hypotension, and syncope/lipidemia were the most common presenting symptoms. All patients received immediate assessment and stabilization; most were treated in Elbasan ED, while a subset was transferred to tertiary centers.

During the study period, 66 patients were included. The mean age was 66.7 ± 13.8 years, with both male and female patients represented. The majority (61, 92.4%) lived in urban areas, while 5 patients (7.6%) came from rural areas.

Conclusion: Early recognition and standardized ED management of suspected AMI are feasible in a regional hospital. Strengthening pre-hospital coordination, reducing transfer times, and continuous staff training may further improve outcomes.

Lifestyle Behaviors and Health Risk Factors Among Medical Students in Tirana: Potential Implications for Injury Risk and Impaired Performance

Floriana Marku — 2026-07-20

Background: Medical students are exposed to intensive academic schedules, high stress, and irregular daily routines, which may affect lifestyle behaviors. Unhealthy diet, low physical activity, inadequate sleep, and high stress can impair physical and cognitive performance and increase the risk of accidental injuries due to fatigue.

This study aims to assess lifestyle behaviors and health risk factors among medical students in Tirana and to examine their potential implications for academic performance and injury risk.

Materials and Methods: This was a descriptive-analytical, cross-sectional, observational study including 213 students from the University of Medicine in Tirana. Data were collected through a structured online questionnaire (Google Forms). Descriptive statistics summarized sample characteristics, while Spearman’s correlation and logistic regression were used to examine associations between variables. Statistical significance was set at p ≤ 0.05.

Results: A total of 213 medical students participated, with a mean age of 20.2 ± 1.5 years and mean BMI of 22.6 ± 3.4 kg/m². Breakfast skipping (35.2%), insufficient fruit and vegetable consumption, insufficient sleep (≤6 h/night, 60.6%), and high academic stress were common. Only 24.9% reported daily physical activity. Health-promoting behaviors clustered together, with physical activity positively associated with regular breakfast, adequate sleep duration, and daily fruit consumption (p < 0.01). Conversely, unhealthy dietary patterns and insufficient sleep clustered and were linked to adverse health outcomes. Logistic regression confirmed physical activity, fruit consumption, and adequate sleep as protective factors (p ≤ 0.05).

Conclusions: Unhealthy lifestyle behaviors are common among medical students in Tirana. Irregular meals, poor dietary quality, low physical activity, and insufficient sleep may impair cognitive and physical performance and increase the risk of negative health outcomes. Targeted interventions and a purpose-built campus promoting healthy eating, exercise, and stress management are recommended to support student well-being.

Antimicrobial Resistance in Urinary Tract Infections: Clinical Challenges and Strategic Approaches in Contemporary Urological Practice

Aferdita Ademi — 2026-07-20

Background: Urinary tract infections (UTIs) remain among the most prevalent bacterial infections encountered in urology, yet the escalating burden of antimicrobial resistance (AMR) has significantly complicated both empirical and targeted therapeutic strategies. Patients undergoing surgical interventions with prolonged urinary catheterization represent a particularly vulnerable subgroup, often predisposed to resistant infections.

Aim: This study aimed to characterize the frequency, microbiological spectrum, predisposing factors, and treatment outcomes of resistant UTIs in surgically treated patients at the Clinical Hospital of Tetovo, and to contextualize these findings within comparable international cohorts.

Materials and Methods: A retrospective observational analysis was conducted on 164 patients (140 men, 24 women) operated between January 2021 and January 2026. Clinical records, urine cultures, and antibiograms were reviewed. Statistical analyses included proportions with 95% confidence intervals (CIs) and chi‑square/Fisher exact tests, with significance set at p < 0.05.

Results: Resistant uropathogens were identified in 24/164 patients (14.6%; 95% CI 10.0–20.9%). Extended‑spectrum β‑lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae predominated, accounting for approximately three‑quarters of isolates. Multidrug‑resistant Pseudomonas aeruginosa and carbapenem‑resistant Enterobacterales were also observed. All affected patients had prolonged catheterization. Comorbidities were frequent, including cardiovascular disease (62.5%), diabetes mellitus (33.3%), and renal impairment (12.5%).

Conclusions: Resistant UTIs are a clinically significant challenge in surgically treated urology patients, strongly associated with catheterization, prior antibiotic exposure, and recurrent infection. The microbiological and risk‑factor profile aligns with international data. Rigorous culture‑guided therapy and catheter management remain pivotal in achieving favourable outcomes, underscoring the need for robust antimicrobial stewardship in modern urology.

Revolutionizing Prehospital Emergency Medical Services: The Role, Challenges, and Potential of Smartphone Integration. A Literature Review

Farai Nyika — 2026-07-20

Introduction: The integration of smartphone technology into Emergency Medical Services (EMS) represents a paradigm shift in prehospital care, offering novel solutions to enhance clinical decision-making and operational efficiency. However, the implementation of these mobile health (mHealth) tools remains inconsistent, particularly in resource-constrained settings.

Objective: This literature review examines the utilization of smartphones in EMS, evaluating their impact on remote consultations, data access, and inter-agency communication while identifying critical barriers to adoption.

Methods: Employing a qualitative approach, this study utilized content analysis and a desktop review of journal articles and book chapters published between 2020 and 2024.

Results: The review highlights significant benefits, including improved patient outcomes, streamlined workflows, and enhanced coordination between EMS personnel and receiving hospitals. Furthermore, smartphones demonstrate considerable potential for continuous professional development through virtual simulations. However, widespread integration is hindered by systemic challenges, including infrastructure deficits, organizational resistance, inconsistent training, and data security vulnerabilities. These issues are particularly acute in rural and underserved regions.

Conclusion: To fully realize the potential of smartphones in EMS, stakeholders must prioritize the standardization of operational protocols and investment in robust infrastructure. Additionally, developing comprehensive training frameworks is essential to ensure equitable access, mitigate security risks, and optimize the effectiveness of smartphone-based tools in prehospital care.

Contemporary Management and Long-Term Outcomes of Tetralogy of Fallot: A Narrative Literature Review

Arketa Guli — 2026-07-20

Background: Tetralogy of Fallot (TOF) remains the most common cyanotic congenital heart disease and a cornerstone of congenital cardiology. While advances in surgical repair have dramatically improved survival, the condition increasingly presents as a lifelong clinical challenge characterized by evolving complications and ongoing care needs.

This review aims to synthesize current evidence on contemporary management strategies and long-term outcomes in patients with TOF, with particular focus on surgical approaches, late complications, and lifelong follow-up.

Design and Data Sources: A narrative literature review was conducted using a structured search of PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2016 and 2026. Eligible studies included clinical cohorts, registry analyses, systematic reviews, meta-analyses, and international guidelines addressing TOF management and outcomes A thematic narrative synthesis approach was applied to integrate findings across heterogeneous studies. In total, 36 studies met the inclusion criteria and were included in the final synthesis.

Results: Despite excellent survival after repair, long-term morbidity remains significant, driven by right ventricular dysfunction, pulmonary regurgitation, and arrhythmias. Management is individualized, with cardiac magnetic resonance central to follow-up. Neurodevelopment and quality of life are increasingly recognized, while disparities in access to care continue to influence outcomes.

Conclusion: TOF should be regarded as a chronic condition requiring coordinated, multidisciplinary, and lifelong management. Optimizing long-term outcomes will depend on improved risk stratification, timely intervention, and equitable access to specialized care.

Pathologies of the Mediastinum: A Review of Current Concepts and Surgical Management Supported by a Single-Institution Experience

Fatmir Caushi — 2026-07-20

Introduction: Mediastinal pathologies comprise a heterogeneous group of congenital, neoplastic, infectious, inflammatory, traumatic, and iatrogenic conditions affecting one of the most anatomically complex regions of the thorax. Due to the proximity of vital structures, including the heart, great vessels, trachea, and esophagus, their diagnosis and management remain particularly challenging. Recent advances in computed tomography, magnetic resonance imaging, positron emission tomography, histopathological classification systems, minimally invasive biopsy techniques, and thoracoscopic surgery have significantly improved the management and prognosis of mediastinal diseases.

This review summarizes contemporary concepts regarding mediastinal pathology, emphasizing anatomical classification, imaging characteristics, histopathological diagnosis, and surgical management. Major disease entities include thymic epithelial tumors, mediastinal neurogenic tumors, mesenchymal lesions, and rare mediastinal conditions. The review integrates recent international literature and current guidelines together with a single-center surgical experience reported in an institutional series, including thymoma associated with myasthenia gravis, thymic carcinoma, neurogenic tumors, mesenchymal tumors, hydatid disease, vascular trauma, and rare postoperative complications.

Conclusion: Mediastinal diseases encompass a broad and heterogeneous spectrum of pathological entities requiring individualized diagnostic and therapeutic strategies. Advances in imaging, histopathology, minimally invasive biopsy techniques, and thoracic surgery have significantly improved patient outcomes

Early Postoperative Venous Hypertension and Failed Maturation of a Brachiobasilic Arteriovenous Fistula: A Case Report and Focused Literature Review

Grisilda Gjana — 2026-07-20

Background: Venous hypertension is a rare complication that occurs following the surgical formation of arteriovenous fistulas (AVFs) for hemodialysis. Clinical signs in its early stage may resemble cellulitis, ischemic steal syndrome, or thrombosis, thus complicate the diagnosis and lead to improper AVF maturation.

Case presentation: A male patient aged 64 years with end-stage chronic kidney disease underwent left brachiobasilic AVF creation. He started developing swelling, edema, pain, digital cyanosis, and intermittent fever shortly after the operation. Although Doppler ultrasonography showed AVF patency without any signs of thrombosis or stenosis, the flow through the fistula was not sufficient for hemodialysis. Neither clinical treatment nor time could solve his symptoms and improve the maturation of the fistula; hence, the use of a temporary central venous catheter became necessary.

Methods: This paper is a focused PubMed literature search aiming at identifying studies that discuss postoperative venous hypertension as well as complications involving AVFs. Present clinical presentation was compared with those discussed in selected articles.

Results: Persistent venous congestion, cyanosis, and poor AVF maturation strongly suggested postoperative venous hypertension despite preserved thrill and Doppler-confirmed patency. Surgical ligation performed eight weeks after AVF creation resulted in rapid resolution of swelling, cyanosis, and pain.

Conclusions: Early postoperative venous hypertension should be suspected in patients with persistent swelling, cyanosis, pain, or failure of AVF maturation, even in the absence of thrombosis or critical stenosis. Prompt recognition may prevent prolonged morbidity and unsuccessful vascular access outcomes.

Pediatric Vaccination in a Changing World. Impact on Child Health, Vaccine Hesitancy, and Future Perspectives of Immunization

Ferizat Dika–Haxhirexha — 2026-07-20

Introduction: Vaccination remains one of the most effective and cost‑efficient public health interventions, dramatically reducing childhood morbidity and mortality from vaccine‑preventable diseases. However, the global immunization landscape has recently been challenged by pandemic disruptions, misinformation, inequities in access, and resurgent outbreaks.

The Aim is to synthesize current evidence on the health and societal impact of pediatric vaccination, examine determinants of vaccine hesitancy, and highlight future perspectives for immunization programs.

Methods; A narrative review was conducted, integrating epidemiological data, modelling studies, and recent reports from WHO, UNICEF, and peer‑reviewed literature. Particular attention was given to trends in coverage, disease resurgence, and behavioral determinants of vaccine confidence.

Results: Routine immunization has averted an estimated 154 million deaths since 1974, predominantly in children under five. Yet, in 2024, 14.3 million infants received no vaccine doses, and measles re‑emerged in multiple countries, threatening elimination status. Vaccine hesitancy was strongly influenced by misinformation, sociocultural factors, and trust in health systems. Evidence underscores that resilient health infrastructure, equitable access, and credible communication by frontline providers are essential to sustain progress.

Conclusions: Scientific advances alone cannot secure immunization gains. Strengthening public trust, addressing behavioral determinants, and ensuring equitable delivery are critical for the future of pediatric vaccination.

Fixation of Anterior Flail Chest after Isolated Blunt Chest Traumas and Outcome.

Hamdy Dosoky Elayouty — 2026-07-20

Background: Anterior (stove-in) chest injury is a very rare but serious cause of chest wall instability. This study looked at how internal pneumatic stabilization compares to primary surgical fixation in patients with isolated blunt chest trauma.

Methods: We reviewed three cases treated at two trauma centers from January 2000 to January 2026. We used the Thoracic Trauma Severity Score (TTSS) and the Modified Shock Index (MSI) to assess severity. All patients were treated following ATLS guidelines, and management depended on injury severity, patient stability, and available resources. We compared outcomes between internal pneumatic stabilization (mechanical ventilation with PEEP) and open reduction with internal fixation (plates and screws).

Results: In the third case, early open reduction and internal fixation of both rib fractures and a transverse sternal fracture allowed the patient to return to normal activity sooner and leave the ICU by the third day after surgery. These results suggest that clinicians should review their treatment protocols for anterior flail chest and consider early surgical stabilization.

Conclusion: Internal pneumatic stabilization is a useful conservative treatment for anterior flail chest injury, but the small number of cases and the study’s retrospective design limit how much we can conclude. In this series, patients who had early open surgical fixation needed fewer days on a ventilator, spent less time in the ICU, and had fewer ventilator-related complications than those treated with internal pneumatic stabilization.

Closure of Posterior Perforated Duodenal Ulcer Using Endoscopic Assist: A Case Report

Olesea Ignatenco — 2026-07-20

Introduction: Posterior perforated duodenal ulcer penetrating the hepatoduodenal ligament is an exceedingly rare and technically demanding surgical emergency. The intimate proximity of the portal vein, proper hepatic artery, and common bile duct often renders standard perforation closure impossible, necessitating alternative strategies.

Case Presentation: We report an 86-year-old man who presented with diffuse bile peritonitis secondary to posterior duodenal perforation penetrating the hepatoduodenal ligament. Conventional intraoperative exposure failed to identify the perforation site. On-table gastroscopy was performed and successfully localized the defect, guiding primary suture closure. Pyloric exclusion with gastrojejunostomy and feeding jejunostomy was performed for diversion and decompression. The postoperative course was complicated by gastrointestinal bleeding requiring angioembolization, wound evisceration, and hemorrhagic stroke. In the best of our knowledge, it is the first described case in the English medical literature.

Conclusion: Intraoperative endoscopy represents a valuable localization tool in posterior duodenal perforation when conventional surgical exposure is inadequate. Primary closure guided by endoscopic tools, may be safely considered in highly selected patients.

Keywords: perforated duodenal ulcer, intraoperative endoscopy, pyloric exclusion, damage control surgery

Effective Non-operative Treatment of Grade III–IV Splenic Trauma via Selective Arterial Embolization. A Case Report.

Agron Dogjani — 2026-07-20

Introduction: The most frequent solid organ injury in blunt abdominal trauma (BAT) is splenic injury, and it is typically a result of road traffic accidents or falls. While operative management was the standard practice, the trend today is increasingly towards nonoperative management (NOM), including in hemodynamically stable patients with even moderate-to-high-grade injuries. This shift has been facilitated through advances in interventional radiology and imaging that have played a pivotal role in expanding the indications for NOM, keeping medical personnel familiarized and up-to-date.

Case presentation: Here, we report a case of a 21-year-old male with Grade III+ splenic injury with moderate-to-large hemoperitoneum following a road traffic accident on a motorcycle. After initial resuscitation, the patient remained a transient responder. CT with IV contrast showed no indication of ongoing bleeding. With a progressive hemoglobin drop in the background, the patient was successfully treated by selective splenic artery embolization in a private institution, reaffirming the efficacy of the intervention. The patient recovered completely without any requirement for surgery and was discharged on the seventh day.

Conclusion: Selective splenic embolization is an effective and safe adjuvant to NOM in high-grade splenic injuries with transient responders, reducing requirements for splenectomy and preserving immunologic function.

From Skin to Mind: Psoriasis and Its Psychological Burden.

Diana Muja — 2026-07-20

Background: Psoriasis is a persistent immune-driven skin disease shaped by environmental and psychological triggers like infections, stress, and climate. Beyond its physical toll, psoriasis deeply disrupts daily life, straining social connections, family bonds, and professional pursuits. Psychiatric conditions, particularly depression, frequently accompany it, affecting up to 30% of patients.

Case Report: We share the story of a 24-year-old woman battling chronic plaque psoriasis, whose condition resisted topical treatments and led to deepening depression. Through a collaborative approach blending dermatological care and psychiatric support, including systemic methotrexate and antidepressants, she experienced remarkable progress both physically and emotionally.

Conclusions: This case powerfully illustrates the heavy psychological weight carried by those with chronic plaque psoriasis. It calls attention to the urgent need for integrated dermatological and mental health care, ensuring patients receive truly comprehensive support.

Massive Fecal Impaction with Megacolon Mimicking Perforation Peritonitis. A Case Report and Review of Literature.

Basil Babu — 2026-07-20

Introduction: Massive fecal impaction with megacolon represents an uncommon yet serious complication of chronic constipation and can mimic acute abdominal emergencies, including perforation peritonitis.

Case Presentation: A 60-year-old woman with a 5-year history of chronic constipation and irregular laxative use presented with progressive abdominal distension, vomiting, and obstipation. Clinical examination revealed diffuse abdominal guarding and an empty rectum. Imaging findings suggested pneumoperitoneum, prompting emergency laparotomy. Intraoperatively, the cecum, ascending colon, and transverse colon were found to be massively dilated with extensive fecal loading up to the splenic flexure and impending cecal perforation. The radiographic appearance of air under the diaphragm was attributable to the dilated hepatic flexure abutting the diaphragm. Subtotal colectomy with end ileostomy was performed, and postoperative recovery was uneventful.

Conclusion: This case underscores fecal impaction as a potentially life-threatening consequence of chronic constipation, particularly in elderly patients. Misinterpretation of radiological findings can delay diagnosis. Timely recognition and prompt surgical intervention are essential to prevent catastrophic outcomes, including perforation and peritonitis. Increased clinical awareness of these risks is crucial for reducing morbidity.

Gossypiboma Mimicking an Intra-Abdominal Tumor: A Post-Cesarean Case Report and Review of the Literature.

Labeat Haxhirexha — 2026-07-20

Background: Gossypiboma, the retention of a surgical sponge or gauze within a body cavity following an operative procedure, is a rare but clinically significant complication. It may manifest acutely or after a prolonged latent period, presenting diagnostic difficulties even with advanced imaging modalities.

Case Summary: We report the case of a 26-year-old woman who presented with a two-week history of abdominal pain and distension, eight months after an uneventful cesarean section. Abdominal computed tomography (CT) with contrast identified a peri-umbilical mass (92 × 69 mm) with heterogeneous density and characteristics compatible with gossypiboma. Laparotomy was undertaken on the basis of this radiological suspicion; however, no retained surgical material was found. Instead, the operative finding was an inflammatory pseudotumor of the greater omentum, confirmed histopathologically as a chronic fibro-inflammatory process. The patient made an uneventful recovery and was discharged on postoperative day three.

Conclusion: This case illustrates the considerable diagnostic overlap between gossypiboma and other intra-abdominal masses, particularly omental inflammatory pseudotumors. It underscores the critical need for interdisciplinary caution, rigorous intra-operative documentation, and strict surgical sponge-counting protocols to mitigate both clinical and medicolegal risks.

Wunderlich Syndrome in a Patient with Tuberous Sclerosis Complex Presenting with Hypovolemic Shock.

Ergisa Toska — 2026-07-20

Background: Wunderlich syndrome is an uncommon but potentially fatal clinical entity defined by spontaneous, non-traumatic renal or perirenal hemorrhage. It is most frequently associated with renal angiomyolipoma, particularly in patients with tuberous sclerosis complex (TSC), where lesions are often bilateral, large, and highly vascularized, predisposing them to rupture.

Case Presentation: We report the case of a 30-year-old female with a known history of TSC who presented to the emergency department with acute right flank pain and signs of hypovolemic shock. Contrast-enhanced computed tomography (CECT) revealed a large right-sided perirenal and retroperitoneal hematoma with active contrast extravasation, originating from a ruptured renal angiomyolipoma. Multiple bilateral renal angiomyolipomas were also identified. The prompt use of advanced imaging facilitated rapid diagnosis and guided urgent management.

Discussion: This case underscores the pivotal role of CECT as the diagnostic modality of choice in suspected Wunderlich syndrome, allowing precise localization of bleeding, assessment of lesion characteristics, and evaluation of hemorrhage extent. Patients with TSC require close radiological surveillance due to the elevated risk of angiomyolipoma rupture and life-threatening hemorrhagic complications.

Conclusion: Wunderlich syndrome represents a rare but critical urological emergency, particularly in patients with TSC. Early recognition through contrast-enhanced imaging is essential for timely intervention and improved clinical outcomes. Proactive monitoring of renal angiomyolipomas in high-risk populations is imperative to prevent catastrophic events.

Poland Syndrome: A Case Report.

Edvin Selmani — 2026-07-20

Background: Poland syndrome is a rare congenital anomaly characterized by unilateral absence or hypoplasia of the pectoralis major muscle, often associated with ipsilateral thoracic and upper-limb abnormalities. Its etiology remains uncertain, with the most widely accepted hypothesis involving disruption of the subclavian artery supply during embryogenesis. Clinical presentation varies widely, ranging from isolated muscular defects to complex thoracic deformities.

Case Presentation: This report describes an 8-month-old male who presented with anterior chest wall asymmetry. Examination revealed unilateral hypoplasia of the left breast, absence of the anterior axillary fold, and hypoplasia of the pectoralis major and minor muscles.

Discussion: Poland syndrome is typically diagnosed on clinical grounds, with imaging serving to delineate the extent of musculoskeletal involvement and exclude associated anomalies. Management is individualized and depends on the severity of deformity, patient age, and functional or psychological impact. Reconstructive options include autologous tissue transfer, prosthetic implantation, or a combination of both. Early diagnosis and appropriate counseling are essential to optimize long-term outcomes.

Conclusion: Poland syndrome is a very rare congenital anomaly with few reports in the international literature. In adults, it needs breast reconstruction to address the asymmetry of the chest.

High-Flow Nasal Oxygen for ARDS Secondary to Postoperative Pancreatic Fistula After Pancreaticoduodenectomy: A Case Report.

Blerim Arapi — 2026-07-20

Background: Postoperative pancreatic fistula (POPF) remains one of the most serious complications following pancreaticoduodenectomy and may lead to sepsis, respiratory failure, and acute respiratory distress syndrome (ARDS). Respiratory management in these patients is particularly challenging because positive-pressure ventilation may increase the risk of gastrointestinal anastomotic disruption and worsen postoperative outcomes.

Case Presentation: This report describes a case of moderate acute respiratory distress syndrome (ARDS) due to postoperative pancreatic fistula (POPF) in a 68-year-old female following a Whipple procedure for pancreatic head adenocarcinoma. The patient developed progressively worsening hypoxemia, respiratory distress, tachypnea, and hemodynamic instability. Computed tomography revealed bilateral pulmonary infiltrates consistent with ARDS, gastric distention, and intra-abdominal inflammatory changes (due to the presence of POPF). Markedly elevated amylase and lipase levels from drains confirmed the diagnosis of POPF.

Results: Because of the recent gastrointestinal reconstruction and the potential for anastomotic compromise, both continuous positive airway pressure and non-invasive ventilation were not used for this patient. Conservative care included high-flow nasal oxygen (HFNO), broad-spectrum IV antibiotics, gastric decompression, nutritional support, and multidisciplinary care in the intensive care unit. The patient demonstrated continued improvement in respiratory and clinical status without the need for reintubation and or invasive mechanical ventilation. HFNO was progressively weaned; enteral nutrition was reinitiated successfully; and the patient was discharged from the hospital in a clinically stable condition.

Conclusions: This case illustrates that HFNO has the potential to be an effective method of providing respiratory support for ARDS due to POPF after a Whipple procedure, particularly in the patient population at risk of postoperative anastomotic complications from positive-pressure ventilation.

Myxedema as a Reversible Cause of Ischemic Hepatitis: Severe Hashimoto’s Hypothyroidism Presenting with Profound Bradycardia, Hypotension and Marked Hypertransaminasemia

Arlinda Hysenj Llupi — 2026-07-20

Background. Ischemic (hypoxic) hepatitis, the “shock liver” of the emergency setting, follows a fall in hepatic oxygen delivery, usually from cardiac, circulatory or respiratory failure, and produces a steep but short-lived rise in liver transaminases. Severe primary hypothyroidism is a classic yet easily forgotten cause of a reversible low-output circulation, and it can present first in the liver.

Case report. A 65-year-old man with no known thyroid disease presented to the emergency department with severe hypotension (60/40 mmHg) and bradycardia (45 beats/min) and marked hepatocellular injury (aspartate aminotransferase, AST, 1643 U/L; alanine aminotransferase, ALT, 819 U/L), with a minimally raised troponin and acute kidney injury. Lactate dehydrogenase was disproportionately elevated (LDH 1279 U/L; ALT-to-LDH ratio 0.7) and creatine kinase was markedly raised (CK 2946 U/L), while synthetic function was preserved. Viral serology was negative and the liver was structurally normal. As blood pressure recovered, the transaminases fell rapidly and the AST-to-ALT ratio reversed (from 2.0 to 0.3 by day 6). A coarse voice present for several weeks prompted thyroid testing, which showed TSH 80.371 mU/L, suppressed free hormones and anti-thyroid peroxidase antibodies of 848.77 IU/mL, establishing Hashimoto’s thyroiditis. Both the circulation and the liver recovered with fluids and levothyroxine.

Conclusion. In an obtunded, bradycardic, hypotensive patient with marked transaminase elevation and no viral, autoimmune or toxic explanation, severe hypothyroidism should be considered early. The ALT-to-LDH ratio and the reversal of the AST-to-ALT ratio help identify an ischemic mechanism, a markedly raised creatine kinase signals a coexisting hypothyroid myopathy contributing to the AST, and a single thyroid-stimulating hormone can redirect the entire differential.

Valve-Preserving Repair of Traumatic Tricuspid Regurgitation Using the Clover Technique. A Case Report

Klodian Krakulli — 2026-07-20

Introduction: Traumatic tricuspid regurgitation (TR) is a rare complication of blunt chest trauma, often characterized by a long latent period before clinical presentation.

We report the case of a 38-year-old male presenting with severe TR 12 years after a motor vehicle accident. Intraoperative findings revealed a unique longitudinal fissure of the anterior leaflet extending from the annulus to the apex and anterior papillary muscle rupture.

We performed a complex reconstruction by incorporating the anterior papillary muscle into the leaflet, followed by the "Clover technique" to ensure central coaptation.

This hybrid approach allowed for a successful valve-preserving repair, restoring competence in a severely remodeled right ventricle.

Conclusion: Our case mirrors the complex pathology seen in the most difficult scenarios of the Alfieri series, where multiple lesions and RV deterioration preclude classic techniques. By incorporating the papillary muscle into the leaflet, we bridged a massive structural defect that would have otherwise necessitated valve replacement. The subsequent Clover repair provided a functional solution that neutralized the tethering of the posterior and septal leaflets.

High-Flow Nasal Cannula in Respiratory Failure: A Perspective Review

Blerim Arapi — 2026-07-20

Background: High-Flow Nasal Cannula (HFNC) therapy has grown significantly as an alternative non-invasive respiratory support for respiratory insufficiency, both acute and chronic. The treatment entails providing heated and humidified oxygen at high flow rates to enhance oxygenation, minimize anatomical dead space, lower the work of breathing, and increase patient tolerance than conventional oxygen therapy.

Materials and Methods: This narrative review study conducted searches in PubMed and other reputable medical databases to collect literature on the physiological effects, indications, benefits, downsides, and outcomes associated with HFNC for respiratory failure. Data were extracted from randomized trials, observational studies, systematic reviews, and guidelines.

Results: Available evidence suggests that HFNC has significant benefits for treating acute hypoxemic respiratory failure, COPD exacerbations, post-extubation respiratory support, pre-oxygenation for intubation, cardiogenic pulmonary edema, and respiratory insufficiency related to COVID-19. HFNC provides superior oxygenation, secretion removal, respiratory tolerance, and comfort compared to standard oxygen therapy. In selected patients, HFNC may be used to delay or avoid invasive ventilation. Delaying recognition of HFNC failure may impact the prognosis negatively.

Discussion: HFNC is widely recognized because of its physiological superiority and ease of use. HFNC should be carefully selected and continuously monitored, escalating to invasive ventilation early when necessary.

Conclusion: HFNC represents an effective and well-tolerated noninvasive respiratory support strategy, particularly in acute hypoxemic respiratory failure. Appropriate implementation and vigilant monitoring are crucial for maximizing therapeutic benefit and improving patient outcomes.