Albanian Journal of Trauma and Emergency Surgery 2022-01-20T10:28:26+00:00 Agron Dogjani Open Journal Systems <p><em><strong>Albanian</strong><strong> Journal of Trauma and Emergency Surgery</strong></em>&nbsp;<strong><em>(AJTES)</em></strong> is the official publication of the Albanian Society for Trauma and Emergency Surgery (ASTES) that comes out two times a year.</p> <p><em>AJTES</em>&nbsp;is open access, peer-reviewed journal that aims to promote interest, knowledge, and quality of care in emergency and trauma surgery.</p> <p>Under the editorship of <em>Asc.&nbsp;Prof. Dr. Agron Dogjani,&nbsp;MD, Ph.D., FACS, FISS,&nbsp;</em><em>AJTES</em><em>&nbsp;</em>provides an in-depth, national, and international forum for the most authoritative information on major clinical problems in the fields of trauma and emergency surgery, surgical education, and not only...&nbsp;</p> <p>Contributions are reviewed and selected by a group of distinguished surgeons from across Albania and worldwide as well who make up the Editorial Board.&nbsp;</p> <p><strong><em>ISSN:</em></strong> 2616-4922 <em><strong>(Online)</strong></em>; <em><strong>ISSN:</strong></em> 2521-8778 <em><strong>(Print)</strong></em></p> <p><a href=""><strong></strong></a></p> <p><strong>Impact Factor - 1.022&nbsp;&nbsp;</strong>based on ICR for the year 2020-21;</p> <div dir="auto"><em><strong>Impact Factor Value of 1.131</strong> </em>based on&nbsp;International Citation Report (ICR) for the year 2021-2022</div> <p><strong>ICV - Index Copernicus Value - 2019 =&nbsp;</strong><span style="text-decoration: underline;">77.13</span>; &nbsp;<strong>- 2020</strong> = <span style="text-decoration: underline;">88.13</span> &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</p> <p><strong>ISRA JIF - </strong>2,197;</p> <p><strong>GIF -&nbsp;</strong>2.394;</p> <p><strong>International License.</strong> CC BY-NC 4.0</p> A clinical study of risk factors and the management of surgical site infections in general surgical cases at tertiary care center: A two-year observational study 2022-01-20T10:28:26+00:00 C Arunkumar R. Chinnapan <p><strong><em>Background</em></strong>: Surgical site infections penetrate to depths in tissues and cause simple superficial infections to sepsis. The aim of this study is to identify the incidence rate of surgical site infections and their risk factors at the surgical section of a tertiary care center.</p> <p><strong><em>Material and Methods:</em></strong> This retrospective observational study included 245 patients. The CDC class-wise breakup of would infection and the risk factors were recorded.</p> <p><strong><em>Results:</em></strong> The Incidence of surgical site infections was 11.4%. &lt;20year aged patients showed 0% incidence, and &gt; 60-year aged patients showed 22.7% incidence. Malignancy observed as 31.3% incidence than without malignancy (10%) risk factor (p = 0.024). Among the origin, Lumbar sympathectomies and Breast surgery for malignancy showed the highest incidence (43.8%), followed by Genitourinary tract surgeries with 22.9%. Wound infection was more in an emergency (15.4%) than elective procedures (10.4%). The incidence rate increases from 7.9% (&lt;1 hr) to 14.7% (1-2 hrs) regarding the duration of Surgery. The association of wound class with wound infection showed 13% (clean), 3.3% (clean-contaminated), 17.9% (contaminated) the incidence of the study. The antibiotics usage shows a strong association with wound infection (p=0.015). The most common bacteria isolated were&nbsp;<em>Staphylococcus and Streptococcus, Escherichia and Klebsiella species</em> (60% both), followed by <em>Pseudomonas</em>, <em>Citrobacter</em>, and others.</p> <p><strong><em>Conclusion:</em></strong> The factors which showed a strong association with wound infection were increasing age, surgical procedure, site of operation, presence of malignancy, urinary tract infection, lower respiratory tract infections, and exposure to antibiotics. Combination of clinical and microbiological means was the common mode of detection rather than individually.</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## The influence of the Number of Students in Practice Groups about the Practice Beliefs, Knowledge, and Ability. 2022-01-20T10:28:26+00:00 Julian Kraja Zamira Shabani <p><strong><em>Background:</em></strong> Professional practice in the nursing study program was conducted with groups of 10 to 12 students and we have had an excellent experience until 2018. While during the academic year 2019-2020 we were forced to form internship groups of 20 students, which has brought major problems in their progress and management.</p> <p><strong><em>Methods</em></strong><em>:</em> The study was conducted with nursing students in second and third year of study, in bachelor’s degree in "General Nursing".</p> <p><strong>Results</strong>: There were major changes in reported knowledge of professional practice. There are substantial differences between years of study and between groups of 10 and 20 students in practice.</p> <p><strong><em>Conclusions</em></strong><em>:</em> Special attention should be paid to professional practice when designing teaching curricula. It should occupy about 35% of the total curriculum and the practice groups should be as small as possible.</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## Treatment Options for Incisional Hernias. 2022-01-20T10:28:23+00:00 Kastriot Haxhirexha Agron Dogjani Ferizat Dika Haxhirexha <p>Introduction: Despite the many ways and materials available to surgeons today, correction of incisional<br>hernias continues to be a real challenge for surgeons.<br>Aim of the study: To show our experience in the treatment of patients with incisional hernias.<br>Material and methods: subject of this study are 69 patients operated during the period May 2015 to May<br>2020 in the Clinical Hospital of Tetovo.<br>Results: Correction of the incisional hernia in 24 patients was performed by closing the defect without the<br>use of prosthetic materials (herniorrhaphy). In 38 patients, hernioplasty was performed using<br>polypropylene mesh, while in six of them the correction of the defect was performed through composite<br>dual mesh. The incidence of other complications such as operative wound infection, hematoma, seroma,<br>postoperative pain was lower in persons where the incisional hernia was corrected with composite dual<br>mesh<br>Conclusion: Correction of incisional hernias with the use of prosthetic materials marks a lower rate not<br>only of recurrence but also of other postoperative complications.</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## The Role of Serum Ascites Albumin Gradient in the Differential Diagnosis of Ascites. 2022-01-20T10:28:22+00:00 Hysni Dede Rovena Roshi Rovena Bode Enver Roshi Jovan Basho <p><strong><em>Introduction</em></strong><em>:</em> Ascites is of Greek derivation <em>(“askos”)</em> and refers to a bag or sack. The word is a noun and describes pathologic fluid accumulation within the peritoneal cavity. Orientation in finding or excluding portal hypertension through examination of ascitic fluid is the first step towards an accurate diagnosis<strong>.</strong></p> <p><strong><em>Material and Methods:</em></strong> The aim of this study was to evaluate the role of SAAG (Serum Ascites Albumin Gradient) in the differential diagnosis between cirrhotic and malignant ascites. The SAAG is obtained by subtracting the value of serum albumin, the value of ascites albumin (from samples to be taken on the same day) and is a reflection of hepatic sinusoidal pressure.</p> <p><strong><em>Result:</em></strong> All ascitic fluids were analyzed on the laboratory parameters of ascitic albumin values and at the same time serological albumin through the blood was taken for analysis on the same day as the diagnostic paracentesis. The value of SAAG was calculated for each patient between their two groups: 64 patients with cirrhotic ascites and 8 patients with malignant ascites. Higher SAAG values were found in the group of patients with hepatic cirrhosis (2.02 ± 0.42) compared to the group of patients with malignant pathology (0.68 ± 0.19).</p> <p><strong><em>Conclusion:</em></strong> This prospective study showed statistically significant differences (p &lt;0.0001) between cirrhotic ascites and malignant ascites in terms of SAAG, emphasizing the important role of diagnostic paracentesis and in particular the SAAG in the differential diagnosis of ascitic fluid, in accordance with cut-off values ≥1.1 g / dl referring to ascites from portal hypertension, which suggests a nonperitoneal cause of ascites.</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## Actual tendencies of Hallux Valgus surgical treatment. 2022-01-20T10:28:23+00:00 Julian Ruci Edvin Selmani <p>The purpose of this study is to evaluate which of the methods selected in patients with moderate or severe hallux valgus a result in a better correction of hallux valgus angle (HVA) and intermetatarsal angle (IMA) in Scarf osteotomy as compared to Chevron osteotomy.</p> <p><strong><em>Material and methods;</em></strong> In our study, we selected 36 patients, 16 scarf and 20 chevron osteotomies, with all surgical options from skin incision, capsular and bunionectomy to bone reorientation. Deformities of patients were classified as mild, moderate and severe according to clinical and radiological findings. The results were measured using radiographic HVA, IMA and distal metatarsal articular angle (DMAA).</p> <p><strong><em>Results:</em></strong> No statistical differences were found in HVA, IMA and DMAA between scarf and chevron osteotomy in mild to moderate hallux valgus. In severe hallux valgus, Scarf osteotomy corrected HVA better than Chevron, although this group consisted of twelve patients. Two patients in the Chevron group and three in the Scarf group developed subluxation of the metatarsophalangeal joint.</p> <p><strong><em>Conclusion:</em></strong> In patients with moderate and severe hallux valgus the results of Scarf and Chevron osteotomy have no specific difference. Change to IMA angle with the subluxation of the first metatarsophalangeal joint some months after operation were the main cause for insufficient correction. We favor the Scarf osteotomy because it is more profitable, with correction of HVA and IMA.</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## Factors affecting in-hospital Mortality in Patients with Hip Fracture. 2022-01-20T10:28:24+00:00 Danica Popovska Ilir Hasani Alan Andonovski Rezeart Dalipi Teodora Todorova Kornelija Gjorgjieska Simona Karapandzevska Kiril Ushinov Teuta Dalipi Slavcho Stojmenski <p><strong><em>Background.</em></strong> The prevalence of hip fractures is steadily increasing, as the population ages. These fractures are associated with significant morbidity and mortality. Most of these fractures are treated surgically. Factors related to surgical intervention can play a significant role in the outcome.</p> <p>This study examines the association of in-hospital mortality with the timing of surgery, sex, and age of patients treated surgically due to a hip fracture at Clinical Hospital Shtip in a 2-year long period.</p> <p><strong><em>Material and Methods.</em></strong> A total of 348 patients admitted with a diagnosis of hip fracture who were treated surgically were identified. Data about sex and age were collected. The outcome was assessed for groups treated within 24, 48, 72, and more than 72 hours after admission. Descriptive statistical methods, chi-square test, t-test for independent samples, and odds - ratio with 95% confidence interval (CI) were used in statistical analysis.</p> <p><strong>Results. </strong>The delay of surgical treatment beyond 24 hours did not increase the risk of death (OR=0.65, 95%CI=0.23-1.73). Delays beyond 48h and 72h increased the risk of death progressively (OR=1.17, 95%CI=0.50-2.75, and OR=1.65, 95%CI=0.69-3.95 respectively). Mortality was significantly higher in the 76-85-years age group.</p> <p><strong><em>Conclusions.</em></strong> Association between surgical delay and in-hospital mortality in hip fracture patients is disputed. Confounding factors such as age, sex, comorbidities, and type of treatment determine the outcome. Patients with hip fractures, without any additional disease, should be operated on as soon as possible after admission to the hospital. Delay beyond 48 hours may increase the risk for in-hospital mortality.</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## The Progress of Patients with Blunt Abdominal Trauma Depending on the Number of the Damaged Organs. 2022-01-20T10:28:23+00:00 Agron Dogjani Kastriot Haxhirexha Arben Gjata Amarildo Blloshmi Hysni Bendo <p><strong><em>Introduction:</em></strong> Blunt abdominal trauma (BAT) is one of the most common traumatic emergencies and is associated with significant morbidity and mortality, which is associated with a number of causes despite improvements in their management. This study aims to assess 308 cases of BAT and their management depending on the number of Injured organs.</p> <p><em><strong>Material and Methods:</strong></em> The study has a retrospective character and it has been realized within the period of time from January 20016 to December 2018. In our study are included 308 trauma cases admitted at the University Hospital of Trauma in Tirana Albania. All recorded data were grouped as follows; Demographic data, trauma mechanism, admission time in hospital, the mode of management…</p> <p><strong><em>Results:</em></strong> The sample of the population was chosen by chance which means that this study is included all trauma cases presented at the emergency department and hadn’t any study limitation. In our study, based on the mechanism of trauma, motor vehicle accident [191(62%)] was the most common mechanism of injury, and most of the patients in our study were male [231(75%)], female [77 (25%)] with an M:F ratio of 3:1. The spleen [118 (38.3%)] was the most damaged organ after BAT, and the most common surgical procedure performed was splenectomy [53 (35.5%)]. The majority of traumatized patients presented to the Emergency Department in stable hemodynamic condition [145 (47.1%)]</p> <p><strong><em>Conclusions:&nbsp;</em></strong><em>T</em><em>he</em> <em>progress</em><em>&nbsp;</em>of<em>&nbsp;</em><em>patients</em> with BAT has a close relationship with The number of injured organs. The number and presence of EAI organs were important which worsen patient conditions and influence at the prognosis. The time of hospitalization of patients has a lot to do with the result. Early diagnosis and prompt treatment can save many lives.</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## Role of Emergency Medical Services in pre-hospital Management of Road Accidents, appropriate on-site Actions. 2022-01-20T10:28:25+00:00 Isuf Bajrami Milazim Gjocaj Blerim Krasniqi <p><strong><em>Introduction:</em></strong> Around 1.250000 people die each year due to traffic accidents. Traffic accident injuries are the leading cause of death in the most productive age group – 20-45 years old. 20 to 50 million people end up with injuries, disability because of traffic accident injuries.</p> <p><strong><em>Purpose of study:</em></strong> To identify the most common factors of traffic accidents. To compare the number of accidents and casualties at local, regional and global level. To evaluate the way traffic accidents are handled from urgent medicine services and the Emergency Medical Center (EMC) in particular.</p> <p>To improve the quality of management traffic accident from medical teams.</p> <p><strong><em>Material and methods:</em></strong> data for this paper is extracted from EMC and archive protocols in different years, carrying out data analysis. We have cooperated with EMC of University Clinical Center of&nbsp;Kosovo (UCCK), and Kosovo Police – Pristina regional unit. Retrospective method of research and afterwards descriptive and analytical method has been applied.</p> <p><strong><em>Results:</em></strong> According to Police statistics, the largest number of accidents in traffic in Kosovo.</p> <p>The EMC in Pristina had 1024 traffic accident interventions in 2019 but 2020 the traffic accidents are lowest for 181 accidents, because we have the decrease in circulation as a result of the CIVID pandemic 19. The largest number was in August – 198 cases (15.4 %) while the lowest number was in May – 69 (5.4%). Of 604 cases of traffic accidents that have been analyzed, 212 or 35.1 % included persons of age group 16-25. Of the total number, 411 or 68.04 % were males and 193 or 31,9 % were females.</p> <p><strong><em>Conclusion:</em></strong> The main factor of traffic accidents remains human factor. Traffic accidents increase the incidence of death and disability in general population.</p> <p>Enforcing Emergent Medical Services, promoting and educating the population, institutional cooperating, have positive impact in reducing the number of traffic accident, decreasing mortality and disability caused by traffic accidents.</p> <p><em>Proposal of measures:</em> organizing seminars in national level for young people in order to increase the awareness about dangers in traffic, educating children in kindergartens, elementary schools and high schools…</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## Thromboembolism after COVID 19 – our experience with 6 cases. 2022-01-20T10:28:24+00:00 Vania N Anastasova, MD, PhD Elean I Zanzov, MD, PhD Elena S Krasteva, MD, PhD Vesela S Blagoeva, MD <p>Background: The 2020 year was different.&nbsp; WHO announced a global pandemic and till now we have over 2 million fatality rate. The SARS CoV-2 virus causes acute respiratory viral infection and is associated with a wide range of complications.</p> <p>Aim: In this article we are representing six patients with deep venous and arterial thrombosis after Covid-19 and their treatment.</p> <p>Materials and Methods: The patients were treated successively by the Department of Vascular Surgery and the Department of Burns, Plastic, Reconstructive and Aesthetic Surgery of the "St. George" University Hospital, Medical University Plovdiv, Bulgaria.</p> <p>Results: Some of them were treated conservatively and others surgically. The localizations were upper and lower extremity and the hard palate. Amputation of the affected limb, soft tissue defects and conservative treatment was required. The arterial thrombosis were more than venous ones. All the patients were stable at discharge.</p> <p>Conclusion: After COVID-19 complications include Thrombotic events – Acute Limb Ischemia (ALI), Venous Thromboembolism (VTE), Pulmonary Embolism (PE), Disseminated Intravascular Coagulopathy (DIC) Syndrome. Thromboprophylaxis is very important. It dependent on the severity of the infection, the underlying causes and the course of treatment.</p> <p>&nbsp;</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## Management of Perioperative Anemia in Patients that Performed Abdominal Major Surgery. 2022-01-20T10:28:26+00:00 Majlinda Naco Haxhire Gani Vjollca Duro Eden Naco <p><strong><em>Introduction:</em></strong> Anemia is a recognized predictor of adverse postoperative outcomes in patients during abdominal major surgery. The management of perioperative anemia involves many strategies. Pre-operative anemia has adverse outcomes in major surgery and is called the fourth factor. Anemia was then classified into mild, moderate, and severe depending on hemoglobin level. It is present almost in 40% of patients that performed elective major surgery. Patients with preoperative anemia are associated with an increased rate of blood transfusion together with a risk for high morbidity and mortality.&nbsp; The most usual cause of preoperative anemia is iron deficiency, which can be treated with oral/intravenous iron depending on the time scheduled for surgery. A review concluded that anemia recovery earlier with preoperative intravenous iron than with oral iron supplement. A perioperative erythropoietin injection is also a reasonable approach for patients with hemoglobin between 10 and 13 g/dL and if autologous blood donation is performed.&nbsp; The protocol requires a baseline complete blood count and iron studies and all patients should receive iron supplementation during erythropoietin therapy. The next strategy is stabilized macro/ microcirculation to optimize the patient´s tolerance to bleeding. Recent recommendation, in general, suggests no bridging therapy consider it only if high thrombotic risk. Finally, targeted surgery should be used to reduce intraoperative and postoperative bleeding. We recommend a restrictive transfusion strategy. Allogeneic blood transfusion is associated with an increased incidence of nosocomial infections. Postoperative anemia must be treated with the use of intravenous iron. We ought to know fresh frozen plasma used in deficit in factor V, XI, in dose 15-30ml/kg and be aware of its complications as immunomodulation, acute lung injury, and cardiac overload.</p> <p><strong><em>Conclusion:</em></strong> Our goal is to improve patients´ clinical outcomes.</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## Multiseptate Gallbladder. A Case Report. 2022-01-20T10:28:25+00:00 Zamira Shabani Leart Berdica Arketa Pllumi Bledar Shega <p><strong><em>Introduction.</em></strong> Multiseptate gallbladder is a rare congenital malformation of the gallbladder. Septate gallbladder is a rare congenital anomaly. It is anatomical malformations affecting its shape, size, number, and position.</p> <p>Patients with usually admits to the emergency department with differential symptoms such as right upper abdominal pain, nause and vomiting, and abdominal complaints.</p> <p>The aim of this case report is to present a case diagnosed with multiseptated gallbladder. &nbsp;</p> <p>Case presentation. This case was diagnosed cause of the symptomatic clinic and with abdominal ultrasound such multiseptated gallbladder without stones. The case underwent surgical intervention for cholecystectomy. After the surgery intervention the material was sent for the histopathological diagnosis.</p> <p><strong><em>Conclusions.</em></strong> We recommend cholecystectomy in such cases due to possible complications in the future. In our case we evidence that the clinical story of patients is determinant for the treatment.</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## Pilonidal Sinus Carcinoma dying from Squamous Cell Carcinoma within 14 months after Diagnosis. 2022-01-20T10:28:25+00:00 Marius Dettmer Marcel Bonni Konstantinos Degiannis Matthias Maak Dietrich Doll Igors Iesalnieks <p><strong><em>Introduction:</em></strong> The incidence of Pilonidal Sinus Disease (PSD) is increasing worldwide, especially in the developing and developed countries. As long-standing chronic infection may trigger neoplastic transformation, more carcinoma arising from PSD are to be expected with an incidence of 0,1%.</p> <p><strong><em>Methods</em></strong><em>:</em> Case report describing a Squamous cell carcinoma (SCC) arising from PSD</p> <p><strong><em>Results:</em></strong> A 60-year-old male presented with a 6cm x 10cm ulcerating wound in the sacrococcygeal area, which was painful for 3 months. A biopsy initially revealed a highly differentiated squamous cell carcinoma (cT3cN1acM0G1). Soft tissue MRI showed possible infiltration of the coccyx, and a staging CT showed suspicious enlarged lymph nodes within both inguinal regions. The patient underwent a full 20x1,8 Gy chemoradiation with partial response of the primary. Surgical Resection was recommended. The patient did not show up for follow-up after chemoradiation and refused further treatment. He demised after 14 months due to pulmonary metastases.</p> <p><strong><em>Conclusion:</em></strong> Even a curative intended chemoradiation of this highly differentiated tumour led to a dismal outcome of disease after 14 months. Cases of PSD carcinomas often present as atypical cutaneous SCC.</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## Small Intestine Necrosis Presented as acute Abdomen in Elderly Diabetic Type 2 Patient. 2022-01-20T10:28:25+00:00 Aleksandar Mihail Kishman Jovana Stanoeva Aleksandra Pejovska Josev <p><strong><em>Background</em></strong>: Bowel infarction or gangrenous bowel represents an irreversible injury to the intestine resulting from insufficient blood flow. It is considered a medical emergency because it can quickly result in life-treating infection and death. Untreated bowel infarction quickly leads to life-threatening infection and sepsis and may be fatal. The only treatment for bowel infarction is immediate surgical repair and removal of the dead bowel segment. CT scan can help in the diagnosis, but CT angiography is most accurate in its ability to define the lesion. Diabetes mellitus is metabolic disease which presented with lack of insulin secretion (type 1 DM) or defect of insulin effect on tissues (type 2 DM) and both conditions lead to excess sugar in blood. DM can lead to serious medical conditions, which seen often in emergency department presented as acute complications diabetic ketoacidosis/hyperglycemic hyperosmolar condition (DKA/HHC) or acute conditions based on chronic complications. Uncontrolled diabetes mellitus especially in elderly patients with many years on antidiabetic therapy and other comorbidities can cause serious life treating illness and lead to death.</p> <p>&nbsp;<strong><em>Case report</em></strong>: We present case of small intestine necrosis in 78-year-old women with hetero anamnesis for one-week abdominal pain and altered consciousness. The patient is many years diabetic with oral antidiabetic therapy and last four years with Insulin. She was diagnosed with acute abdomen condition and DKA/HHC. Initial glycemic values on admission were measured 38.87mmol/l. CT scan was made. She received emergency treatment for the current hyperglycemic disorder and after stabilization of primary condition she was transfer to operating room where laparotomy was performed. Resection of gangrenous small intestine was made and then continued postoperative care in ICU.</p> <p><strong><em>Conclusion</em></strong>: The case illustrates two emergency conditions in one time in poor regulated DM in elderly patient and possibility of acute presentation on chronic complication of DM.</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## Diaphragmatic Hernia with very late presentation after Penetrating Trauma: A case reports. 2022-01-20T10:28:25+00:00 Ilir Skenduli Fatmir Caushi Arian Mezini Laert Gjati <p>Blunt traumatic rupture of the diaphragm is a serious injury that is often difficult to diagnose. [1]</p> <p>Diaphragmatic injuries were described first by Sennertus in 1541. Riolfi performed the first successful repair in 1886.</p> <p>In 1951, Carter published the first case series, was this injury well understood and delineated. [<a href="">2</a>]</p> <p>Approximately 0.8%-1.6% of patients with blunt trauma show a rupture in the diaphragm. (<a href="">3</a>) Blunt trauma accounts for 75% of ruptures and penetrating trauma accounts for the rest. Approximately 69% of hernias are left-sided, 24% are right-sided, and 15% are bilateral. [3]</p> <p>The occult diaphragmatic injury was uncovered in a patient who has blunt chest trauma, after penetrating trauma. Diaphragmatic injury can be a difficult diagnosis in the setting of trauma and a significant number of injuries are missed on the initial presentation.</p> <p>We will be reporting a 56-year-old female who was admitted to our hospital with a history of cough, pain in the left chest as well as breathlessness of five days duration. She had a history of blunt trauma caused by an accidental gunshot in 1987…</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## Moderate to Severe Hallux Valgus Deformities. Surgical treatment with SCARF Osteotomy Technique. 2022-01-20T10:28:26+00:00 Julian Ruci Eduart Gjika <p><strong><em>Introduction;&nbsp;</em></strong>Many procedures are described in the literature for the surgical management of hallux valgus. There are over 130 surgical procedures described. There is ever rising enthusiasm among orthopedic surgeons regarding diaphyseal osteotomy ever since <em>Burutaran</em> described the procedure in 1973.&nbsp;We report our experience of treating severe cases of Hallux Valgus deformity with a SCARF osteotomy at the last three years follow-up, at patients diagnosed and operated in the University Hospital of Trauma<em>,</em> from January 2015 - February 2018. The technique we are presenting, provides the correction of moderate to severe hallux valgus deformities.</p> <p><strong><em>Material and Methods:</em></strong> Correction of hallux valgus deformities was achieved using a Z step osteotomy cut to realign the first metatarsal bone. A retrospective analysis was undertaken in 38 consecutive patients (54 feet).&nbsp; All results were analyzed by clinical examination, a questionnaire including the AOFAS forefoot score, modified, and plain roentgenograms.</p> <p><strong><em>Results:</em></strong> Hallux valgus and intermetatarsal angle improved at mean 19.6° and 6.9°, respectively. Mean forefoot score improved from 50.1 to 91 points out of 100 possible points. Satisfactory healing time was expressed by an average return back to their attitude of 6-12 weeks, without including physiotherapy. Persistence or recurrence of hallux valgus was seen in 3 patients (8%).&nbsp;The complication rate was 5.4% including superficial wound infection, atrophy of the muscles, traumatic dislocation of the distal fragment.</p> <p><strong><em>Conclusion:</em></strong> Scarf osteotomy is a powerful and versatile procedure to correct hallux valgus deformity, &nbsp;and &nbsp;provides a predictable and satisfying result. Scarfs are not considered as a single osteotomy but as a combination of several procedures and displacement in several planes are possible.&nbsp;</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## Allograft Transplantation and Reconstruction of Bones after Malignant Tumor Resections. 2022-01-20T10:28:23+00:00 Rezeart Dalipi Ilir Hasani Danica Popovska Simona Karapandzevska Kornelija Gjorgjieska <p>Reconstruction surgery after the excision of musculoskeletal tumors has advanced greatly in the last few decades. After resection of a large piece of bone, limb reconstruction (when is necessary) can be easily achieved with mechanical reconstruction with metallic prosthesis, or biological reconstruction with bone. The use of bone in reconstructive orthopedic surgery is to repair skeletal defects and accelerate bone healing. Bone grafts can be used to achieve this. Those can be allografts and autografts.</p> <p>The standard in bone grafting consists of tissue harvested from the patient, autograft, usually from the iliac crest or distal femur and tibia. Allografts are taken from donors or cadavers and they serve as alternatives to autograft in bone reconstruction. In our case, the patients were treated with wide resection of the bone segment. The defect was reconstructed with intercalary bone and osteosynthesis was made with locking plates. A cadaveric graft was used. Autogenous bone is generally used as an optimal graft because it integrates faster and with fewer complications. Allogenous bone can carry the risk of viral infection for the recipient. Anyhow, allografts can serve as the only therapeutic options, besides endoprosthesis devices for large size reconstruction.</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## The new Era of non-Steroidal Mineralocorticoid Antagonists in Treating Heart Failure in Diabetic Kidney Disease Patients. 2022-01-20T10:28:23+00:00 Eqerem Hasani Merita Rroji Myftar Barbullushi <p>Inappropriate activation of the mineralocorticoid receptor (MR) plays a significant role in developing hypertension, the development of cardiac pathological changes, and chronic kidney disease (CKD), where death related to cardiovascular (CV) causes is the primary competing for the outcome to the progress to end-stage renal disease (ESRD) in patients with CKD.</p> <p>Congestive heart failure (CHF) is a frequent comorbidity in patients with CKD. MR overactivation within the heart might cause coronary endothelial dysfunction, myocardial apoptosis, and reactive myocardial fibrosis and thus contribute to cardiac remodeling and its adverse consequences.</p> <p>MR antagonists (MRAs) are evidence-based therapy in symptomatic patients with heart failure and reduced ejection fraction (HFrEF).</p> <p>Finerenone, a novel, nonsteroidal, selective mineralocorticoid receptor antagonist (MRA) with anti-inflammatory and antifibrotic effects, is a promising tool in treating heart failure in patients with T2DM and CKD.</p> <p>It is felt to have higher potency and less hyperkalemia than steroidal MRAs such as spironolactone and eplerenone. It is unclear and a matter of discussion if it could be first-line therapy in this group of patients.</p> <p><strong><em>Conclusion:</em></strong> Nonsteroidal MRAs are currently tested in clinical trials. Based on preclinical and first clinical data, these nonsteroidal MRAs might overcome the limitations of today's steroidal antagonists.</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## How we do it Emergency Department Thoracotomy for Penetrating Pulmonary Trauma. 2022-01-20T10:28:24+00:00 Elias Degiannis Agneta Geldenhuis Konstantinos Degiannis Jason Degiannis Matthias Maak Dietrich Doll <p><strong>Abstract</strong></p> <p>The manuscript specifically concentrates on patients with penetrating thoracic trauma, who having undergone Emergency Department Thoracotomy (EDT) have been diagnosed with injury to the lung. Its purpose is to describe a practical / heuristic approach, enabling the inexperienced in thoracic surgery doctor, to perform a successful EDT and if need arises, a definitive operation in the absence of a Cardiothoracic or appropriately trained Trauma Surgeon.</p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement## A case of perioperative IABP use in a patient with AMI complicated with VSR. 2022-01-20T10:28:22+00:00 Ervin Bejko Stavri Llazo Esmerilda Bulku Jonela Burimi Fation Hamiti Alfred Ibrahimi Saimir Kuci <p class="p"><span lang="SQ">Ventricular septal rupture (VSR) following myocardial infarction may lead to rapid clinical deterioration with pulmonary edema, hypotension, and a high early mortality. Inotropic agents can increase systemic output but at the possible cost of increased myocardial ischemia. In contrast, intra-aortic balloon pump (IABP) can decrease ischemia by raising coronary perfusion pressure and will reduce afterload. We are presenting the case of a 67-year-old male presented in the emergency department with strong chest pain, diagnosed as inferior acute myocardial infarction (AMI), in TTE visualised VSR with left-to-right shunt. After a few hours, the hemodynamic parameters deteriorated, with hemodynamic instability. The patient is placed on regime with IABP on 1: 1 ratio and on high-dose inotropic drug regime. Once hemodynamic stability is ensured, the patient prepares to perform the intervention. The intervention performed was closure of the VSR with patch Dacron via ventriculotomy of the inferior wall of the left ventricle. At all times, the patient remained associated with IABP, except for extracorporeal circulation time. After the intervention, the patient remained for several days bound to IABP, until hemodynamic stability was achieved, and the dose of inotropic drugs was reduced.</span></p> 2022-01-20T00:00:00+00:00 ##submission.copyrightStatement##