Albanian Journal of Trauma and Emergency Surgery 2021-04-23T13:57:26+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. <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. Under the editorship of <em>Asc.&nbsp;Prof. Dr. Agron Dogjani,&nbsp;MD, Ph.D., FACS, FISS.<strong>&nbsp;</strong></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; 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> <p><strong>Index Copernicus Value - </strong>77.13;</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> Emergency Room Thoracotomy (ERT): A retrospective audit of results. 2021-04-22T13:54:50+00:00 Barbaro I Monzon Maria del Carmen Ortega Jacques Goosen Dietrich Doll Maeyane Stephen Moeng <p><strong><em>Background</em></strong>: An Emergency Room Thoracotomy (ERT) is a resource-intensive, high-risk procedure in which rapid decision-making is essential. In a resource-constrained system, identification of the group of patients that could achieve the best outcome will avoid futile use. Incorporating physiological and metabolic parameters at the time of arrival to the emergency department into the management algorithm may assist with better patient selection and could improve outcomes.</p> <p><strong><em>Material and </em></strong><strong><em>Methods</em></strong>: A retrospective review of the results of subjects who underwent Emergency Room Thoracotomy at a Level 1 Academic Trauma Center over a 13-year period (01 January 2005 to 31 December 2017) was conducted. Mechanism of injury, physiological and metabolic parameters, anatomical injuries, Injury Severity Score (ISS), calculated Revised Trauma score (cRTS), volume and type of fluids administered, and mortality were analyzed comparing survivors and non-survivors.</p> <p><strong><em>Results:</em></strong> One hundred and ten (n=110) patients underwent ERT during the study period<strong>. </strong>Variables such as the mechanism of injury, physiological and metabolic parameters, type, and volume of fluids administered did not show any statistically significant influence in the final outcome. Penetrating cardiac and chest trauma had better survival (40.6 % and 20 % respectively) compared to those with thoraco-abdominal, abdominal, pelvic, and femoral vessel trauma. Overall survival was 21,8%.</p> <p><strong><em>Conclusions:</em></strong> In a resource-constrained environment an Emergency Room Thoracotomy should be performed in patients with a thoracic injury, especially cardiac, to achieve the best possible outcome.</p> 2021-01-20T00:00:00+00:00 ##submission.copyrightStatement## Salvage Total Hip Replacement after Failed Internal Fixation of Trochanteric Fracture Femur. 2021-04-22T13:54:49+00:00 Vilson Ruci Edvin Selmani Agron Dogjani <p><strong><em>Background:</em> </strong>Total hip replacement (THR) is one treatment option for failed hip fracture fixation. It is considered as a salvage procedure for older patients, patients with poor bone stock, avascular necrosis of the femoral head, associated with damaged acetabular articular cartilage.</p> <p><strong><em>Patients and Methods:</em> </strong>Total hip replacement was done for forty patients with failed internal fixation of trochanteric femoral fractures, 28 males and 12 females completed the follow up and six patients were lost. The procedure was carried out through a lateral exposure in all cases. Harris hip score (HHS) was used for clinical evaluation preoperatively, postoperatively. Radiographic evaluation comprising anteroposterior radiographic views of the pelvis and femur and a lateral view of the femur were performed at follow-up visits.</p> <p><strong><em>Results: </em></strong>The mean time of follow up was 48 months (range from 36-72 months). The mean Harris hip score was improved from a mean of 24 points preoperative to 88 points at final follow up. Pain relief and gait correction were noted at the final follow up. Twenty-eight patients (70%) could freely walk outdoors using a cane or elbow crutch; eight patients (20 %) had a limited walking ability using two axillary crutches, and four patients (10 %) were able to walk indoors only.</p> <p><strong><em>Conclusion:</em> </strong>Total hip arthroplasty is a good salvage procedure after failed internal fixation of trochanteric femoral fractures. Individual selection of the implant depends upon the age of patient, level of activity, the bone stock of proximal femur, and the condition of the acetabulum. To maintain stability, reattachment of the greater trochanter should be done. To avoid intraoperative fractures of osteoporotic bone, dislocation of the hip should be very careful.</p> 2021-01-20T00:00:00+00:00 ##submission.copyrightStatement## Demographic Profile of Hand Injuries in North India: A Tertiary Care Hospital Experience. 2021-04-22T13:54:50+00:00 Sandesh Bharat Singh Harsha Vardhan Sameer Halageri Arun K Singh Vijay Kumar Brijesh Mishra D N Upadhyaya <p><strong><em>Introduction</em></strong>: Hand injuries are the most complex injuries when compared to other bodily injuries. A better understanding of the biological, behavioral, and socioeconomic risk factors that are associated with hand injuries&nbsp;is therefore needed. This data can help identify individuals at risk and define preventive measures to help reduce the incidence.</p> <p><strong><em>Material and Methods:</em></strong> We present a study of 350 consecutive patients of hand injury treated&nbsp;between 2017- 2018. The demographic profile of the patient along with the type &amp; cause of the injury sustained, hand dominance,&nbsp;type of procedure, and requirement of hospital administration was extracted from hospital records.</p> <p><strong><em>Results:</em></strong> 159 (45.5%) of the patients were in the age group of fewer than 20 years. Out of the 350 patients, 288&nbsp;(82%) were male. 302 (86%) patients were right-handed. The most common mode of injury was machine injury in 205 (59%) patients. 181 (52%) patients had crush injury, 107 (31%) had the sharp cut injury, and 32 (9%) had blast injury. 94 (27%) patients needed hospital admission for management. 119 ( 34%) patients had the injury to the thumb, 89 (25%) had injury to the middle finger. Primary suturing was done in 116 (33%) patients, tendon and nerve repair in 209 (60%), and 177 (51%) patients respectively.</p> <p><strong><em>Conclusions:</em></strong> The study describes the demography and etiology of the&nbsp;cases of hand injury. The study has a limitation of having absence of assessment of functional outcome. There is a necessity of hand trauma registry to quantify the burden of hand injuries and formulate a prevention strategy&nbsp;at the national level.</p> 2021-01-20T00:00:00+00:00 ##submission.copyrightStatement## The Benefits of early Extubation in OR and ICU after Cardiac Surgery 2021-04-23T13:57:25+00:00 Saimir Kuci Alfred Ibrahimi Ermal Likaj Stavri Llazo Ervin Bejko Marsela Goga Selman Dumani Ali Refatllari Jacob Zeitani <p><strong><em>Objective:</em></strong> Operating room (OR) extubation after adult cardiac surgery with cardiopulmonary bypass CPB is rare. We examined the outcome, factors, and benefits of OR extubation.</p> <p><strong>Methods:</strong> We operated on 60 patients in German Hospital Tirana, from January 2019 to September 2020, who had undergone CABG cardiac operations: 52 patients, mitral valve repair 5 patients, aortic stenosis 1patient, Bentall procedure 1 patient, left atrial myxoma 1 patient. The patient's age was from 46-82 years old, there were 24 female patients and 36 male patients, 24 diabetic patients, 36 non-diabetic patients, in all cases we did not apply epidural anesthesia.</p> <p>Anesthesia was used with low doses of fentanyl. in combination with propofol, sevoflurane. In all cases, neostigmine was used for decurarisation.</p> <p>The quality and depth of anesthesia were assessed with obvious signs such as tachycardia, hypertension, sweating. Endogenous stress was also assessed by monitoring glycemia during the intervention.</p> <p>As extubation criteria were assessed the patient's consciousness, respiratory mechanics, hemodynamic stability, diuresis, bleeding from drains.</p> <p><strong><em>Results:</em></strong> 16 patients were extubated in the OR and 44 patients were extubated 15-20 minutes after the intervention in ICU. There was no reintubation. 2 patients were transferred immediately from OR to the pavilion. 35 patients were transferred to the pavilion 3-4 hours after extubation. 23 patients were transferred to the pavilion the next morning. Patients left the hospital after 5-7 days.</p> <p><strong><em>Conclusions:</em></strong> Extubation in the OR in the early postoperative period has now become a routine in all specialized clinics. The time spent in the ICU is very low and the day spent in the ward was 5-7 days. The benefit is in the best and fastest activation of patients in the early postoperative period as well as in reduced intervention costs.</p> 2021-01-20T00:00:00+00:00 ##submission.copyrightStatement## Relation between Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Cerebral Infarct Volume in patients with Ischemic Stroke. 2021-04-23T13:57:24+00:00 Avni Uygar Seyhan Erdal Yilmaz Semih Korkut <p><span style="text-decoration: underline;"><strong>Abstract :&nbsp;</strong></span></p> <p><strong><u>Objectives:</u></strong> The activation of inflammatory processes in ischemic stroke might be important for the pathophysiological processes of ischemic stroke. The correlation between the Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR) and stroke volume is increasingly being recognized as a prognostic biomarker for patient outcome after an ischemic stroke incidence. This retrospective study aimed at determining if there is existed correlation between the NLR, PLR and stroke volume in patients presenting with ischemic stroke at the emergency department. The results will aid emergency doctors to gain an understanding on how to rapidly identify the most high-risk patients based on the NLR and taPLR obtained from routine blood tests permitting rapidly therapeutic interventions and better long-term survival outcomes for patients with ischemic strokes.</p> <p>&nbsp;<strong><u>Methods:</u></strong> A retrospective study was performed between May 2016-2019. Patients 18 years and older of both genders presented to the emergency department with symptoms of ischemic stroke with time of onset of symptoms within the last 24 hours of whom complete blood count (CBC) tests were conducted and ischemic stroke was confirmed by Diffusion weighted Magnetic Resonance Imaging (DWI-MRI) were enrolled. NLR and PLR were calculated from CBC tests and ischemic stroke volume was measured in mm<sup>3 </sup>using Manual Segmentation Process.</p> <p><strong><u>Results:</u></strong> A total of 489 patients were enrolled in this study of which 266 (54.5%) were male and 223 (45.6%) were female. It was observed a statistically significant correlation between the ischemic stroke volume and NLR while no significant correlation was observed between stroke volume and PLR.</p> <p><strong><u>Conclusion:</u></strong> There is a significant weak positive relationship between NLR and ischemic stroke volume. NLR is significantly correlated with cerebral ischemic stroke volume and thus can be utilized as a guide by emergency doctors in the emergency department to predict the severity and the outcome of patients diagnosed with ischemic stroke.</p> 2021-01-20T00:00:00+00:00 ##submission.copyrightStatement## Emergency Medical Care and Management of Sports Injuries on the Football Court 2021-04-23T13:57:24+00:00 Basri Lenjani Premtim Rashiti Gani Shabani Arber Demiri Besarta Pelaj Arban Demi Rilind Sylaj Erza Voca Mulaj Dardan Lenjani <p><strong><em>Introduction;</em></strong> Sports medicine is a clinical subspecialty that deals with the examination, monitoring, diagnosis, treatment, and prevention of injuries that occur during sports events, training and physical activities in pre-hospital settings. Managing dramatic situations with minor and multiple injuries is a challenge that requires a quick approach to a dramatic event in managing minor and multiple injuries on the football field and in other sports in support of SHME at pre-hospital and hospital level.</p> <p><strong><em>Purpose of the paper.</em></strong> Providing emergency medical care at all basic stages of managing minor and multiple injuries on the football field and in other sports in order to implement BLS, ACLS, BTLS, PTLS, ATLS care measures reducing morbidity, disability, and mortality.</p> <p><strong><em>Material and methods.</em></strong> The research is of retrospective, descriptive, qualitative type. The material was taken from the archive of the Emergency Clinic of UCCK for the period January-December 2019. Only the sick or injured in sports matches were taken in the research; Age, gender, type of illness and injury and type of medical care, equipment available, and training and education.</p> <p><strong>Result.</strong> Sports injuries are very costly, and according to the pathology with diseases were 15 cases or 21.4 %, injuries were 55 cases or 78/6 %. Injured by age. The largest number of injured with injuries in the field of football sports the most affected age was the age of 21-25 years with 28 cases or 40.00%, over 25 years were 27 cases or 38.58% and with a smaller number were aged 15-20 years15 cases or 21.42%.</p> <p><strong>Discussion and conclusions</strong>. A very important factor in sports injuries is the provision of optimal medical care for footballers and other sports in head, neck, spine, chest, abdomen, and pelvis and limb injuries and with a joint communication with the cooperation of health care professionals in the selection of priority cases. Education of medical staff, nurses, paramedics with courses, use of medical equipment, BLS, ACLS, BTLS, PTLS, ATLS as well as standard procedures for providing and transporting medical care to the hospital.</p> 2021-01-20T00:00:00+00:00 ##submission.copyrightStatement## Management of COVID-19 Patient in Cardiac Surgery with Cardiopulmonary Bypass. 2021-04-23T13:57:22+00:00 Alfred Ibrahimi Saimir Kuci Ervin Bejko Stavri Llazo Marsela Goga Esmerilda Bulku Jonela Burimi Selman Dumani Ermal Likaj Jacob Zeitani Edvin Prifti <p><strong><em>Introduction;</em></strong> The diagnosis of COVID-19 is quite challenging due to the inconsistent correlation between laboratory findings, radiological imaging, and the clinical picture and contact history of the patient. The patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) face double risk because CBP triggers an intense inflammatory response and the leading cause of mortality in COVID-19 patients is “cytokine storm”. In our institution 15 confirmed cases operated on with open-heart surgery. 9 cases isolated CABG, 4 cases valvular combined with CABG, and 1 valvular disease.</p> <p><strong><em>Materials and method</em></strong><strong><em>; </em></strong>All patients undergoing elective or urgent cardiac surgery at “Mother Theresa” ’s Hospital from 11 March to 30 November 2020 were included in this study. Patients diagnosed with COVID-19 infection via positive throat swab taken due to clinical suspicion postoperatively were reviewed. Patients characteristics, type of intervention, date of COVID-19 diagnosis.</p> <p><strong><em>Results:</em></strong> 9 patients (72%) normal recovery, no respiratory failure, only 3-5 days of fever (max 39,4). 3 of them a moderate respiratory failure. 3 patients with severe respiratory failure. Only 3 deaths (26,6%).</p> <p><strong><em>Recommendation</em></strong>: It's important to a preoperative screening for COVID-19 patients.</p> <p>The outcome of cardiac surgical patients who contracted COVID-19 infection perioperatively is extremely poor. Aggressive respiratory assistance (early intubation), high doses of corticosteroids, and anticoagulation, better results.</p> 2021-01-20T00:00:00+00:00 ##submission.copyrightStatement## Management of Frailty and its Challenges in Geriatric Patients on General Abdominal Anesthesia. 2021-04-23T13:57:23+00:00 Majlinda Naço Haxhire Gani Monika Belba Suzana Mukaj Nertila Kodra Eden Naço Alma Llukaçaj Arvin Dibra <p><strong><em>Introduction:</em></strong> In that material, we are doing to informed for frailty, how we can measure it, surgical outcome and its management from the anesthesiologist. Frailty is a condition of decreased physiological reserves that often increases with increasing age and decided in adverse outcomes.</p> <p>Frailty in elderly surgical patients may be varied from 25,5 -56.1% and is a strong predictor for surgical outcomes.</p> <p>The anesthetist needs to predict how a geriatric patient will tolerate the stress of surgery and to do what is necessary to protect and save elderly lives.</p> <p>In Albania, there are almost 439 000 elderly people in 2021 and suspect to 626 000 in 2051. According to the WHO, 1 in 25 persons performed surgery, so the number of geriatric patients that done surgery will be very high.</p> <p>According to deficits’ in function, mobility, cognition, chronic diseases, and geriatric syndromes we can use the clinical frailty scale, the&nbsp;Edmonton Frailty Scale, or frailty index for calculation of frailty.</p> <p>We need frailty patients to evaluated preoperative risk-classification, intra-operative care, management of general anesthesia, early immobilization as well as treatment of postoperative delirium because frailty increased intra-operative morbidity, increased postoperative complications especially delirium, extends hospitalization, non – home discharge, and mortality.</p> <p>Anesthesiologists would be always aware to prepare the geriatric patients for surgery, to maintain the intra-operative functional reserve of frailty patients, to manage perfect anesthesia, to realized early mobilization, and discharge back home.</p> <p><strong><em>Conclusion:</em></strong> Many geriatric patients have multi-organ problems. Frailty is a practical, unifying concept in the care of these older people that directs attention away from organ-specific diagnoses towards a more holistic viewpoint of the patient and their medical medicament. All geriatric patients need to screen for frailty.</p> 2021-01-20T00:00:00+00:00 ##submission.copyrightStatement## Efficacy and Safety of AZD1222, BNT162b2 and mRNA-1273 vaccines against SARS-CoV-2 2021-04-23T13:57:22+00:00 Ilir Alimehmeti <p>SARS-CoV-2, the beta coronavirus causing COVID-19, was isolated and categorizes as a novel one on January 7th, 2020 in China.[1] To date, official reports depict that SARS-CoV-2 has already infected 88.828.387 persons and caused 1.926.625 deaths worldwide.[2] On January 12th, 2020, China officials made public its genetic sequence, thus paving the way towards the research and development of diagnostic tests and vaccines.</p> <p>With regard to vaccination, e large number of clinical trials were designed and are currently undergoing, of which 189 are listed in [3] However, up to date, only three vaccines have published their respective phase III clinical trial results in peer-reviewed medical journals. [4-6]</p> <p>Vaccines are needed to reduce the morbidity and mortality associated with Covid-19, and multiple vaccine platforms as AZD1222 (AstraZeneca) [4], BNT162b2 (Pfizer/BioNTech) [5] and mRNA-1273 (Moderna) have been involved in the rapid development of vaccine candidates.</p> <p><strong><em>Methodology: </em></strong>In this review, PubMed, Embase, Web of Science, Scopus, medRxiv, and bioRxiv were systematically scrutinized for peer-reviewed and preprint articles on phase III clinical trials of vaccines against SARS-CoV-2. In total, only three peer-reviewed papers fulfilling the search criteria were identified.</p> <p><strong><em>Conclusions;</em></strong> All vaccine candidates should publish in peer-reviewed journals their efficacy and safety well before requesting approval to the national or international authorities…</p> 2021-01-20T00:00:00+00:00 ##submission.copyrightStatement## An Overview of Treatment of Crush Syndrome. 2021-04-23T13:57:26+00:00 Merita Rroji Saimir Seferi Myftar Barbullushi <p>Natural mass disasters directly or indirectly affect huge populations, who need basic infrastructural help and assistance to survive. However, despite the potentially negative impact on survival chances, the authorities often dismiss these health care issues.</p> <p>This impact is of great importance, especially in the emerging world, where the casualty rates are much higher because of inappropriate building materials and lack of appropriate construction standards. Thus, massive destruction can occur with earthquakes of even moderately low magnitude.&nbsp;</p> <p>The first description of the crush syndrome appeared in the modern medical literature after the Messina earthquake in 1909. Since crush syndrome is quite rare in daily practice, mistakes are frequent in treating these cases.</p> <p>This review summarizes the etiopathogenesis of traumatic rhabdomyolysis and crush syndrome based acute kidney injury. The clinical and laboratory features, prophylaxis, and treatment of crush cases are described as well.</p> <p>The importance of early and dynamic fluid resuscitation is indicated for the prophylaxis of acute kidney injury. Treatment of both acute and chronic kidney diseases (CKDs) is especially problematic after disasters because they almost always require complex technology and equipment, whereas specific drugs may be difficult to obtain to treat chronic kidney patients.</p> <p>Although crush syndrome is a major cause of mortality in the rescued victims of massive earthquakes, the number of deaths due to crush syndrome (or fatalities of renal disaster) can be decreased by appropriate management.</p> <p>plaints.</p> 2021-01-20T00:00:00+00:00 ##submission.copyrightStatement## Incarcerated Amyand’s Hernia with Destructive Appendicitis Complicated with Myocardial Infarction. A Case Report and Review of the Literature. 2021-04-22T13:54:48+00:00 Dimitar Hadzhiev Dzhevdet Chakarov dchakarov@abv.dg Evgeniy Moshekov Boris Sakakushev Elena Hadzhieva <p>Amyand hernia is a rare presentation in inguinal hernias (less than 1% of cases with inguinal hernias) which is evidenced when in herniated masses the presence of inflamed appendix is ​​ascertained or not. It was named after a French surgeon, Claudius Amyand (1660-1740), who performed the first successful appendectomy in 1735, where he found an acute appendicitis in a herniated mass. Most cases are diagnosed intraoperatively, as an accurate preoperative diagnosis rarely becomes evident.</p> <p>Management is individual depending on the stage of inflammation of the appendix, the presence of abdominal sepsis and concomitant factors. The decision should be based on factors such as the patient's age, the size and anatomopathological shape of the appendix, and in the case of an inflamed appendix, standard appendectomy and retinal herniorrhage should be the gold standard of treatment.</p> <p>Amyand hernia is usually misinterpreted as a common incarcerata hernia. Symptoms that mimic appendicitis may appear. Treatment consists of a combination of appendectomy and hernia repair. The inflammatory status of the appendix determines the type of hernia repair and the surgical technique. Occasional appendectomy in the case of a normal appendix is ​​not recommended.</p> <p>Amyand hernia is a rare type of inguinal hernia in which the appendix is located in the hernia sac. We present a case of a recurrent incarcerated Amyand’s hernia with complicated appendicitis. The 78 old polymorbide patient with right-sided incarcerated recurrent hernia was emergently operated on and appendectomy and non-mesh hernioplasty performed, on the 3<sup>rd</sup> postoperative day for a heart attack he was placed cardio stimulator with uneventful outcome. Fifteen months follow up did not show complications or complaints.</p> 2021-01-20T00:00:00+00:00 ##submission.copyrightStatement## Out of Hospital Cardiac Arrest: A Case Report 2021-04-22T13:54:49+00:00 Kenan Ljuhar Adem Zalihić Aida Gavranović Basri Lenjani Premtim Rashiti Nuhi Arslani <p><strong><em>Introduction</em></strong><em>:</em> Sudden OHCA (Out of hospital cardiac arrest) is the third leading cause of death in industrialized nations. With more than 60% of cardiovascular deaths resulting from cardiac arrest, it remains the leading cause of death worldwide. Heart rhythms associated with cardiac arrest are divided into two groups: shockable rhythms (ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) and non-shockable rhythms (asystole and pulseless electrical activity (PEA)). VF is the most commonly identified arrhythmia in cardiac arrest patients. Urgent medical treatment includes cardiopulmonary resuscitation and early defibrillation.</p> <p><strong><em>Material and Methods</em></strong>: Materials for this case report are data collected from the medical records of the Emergency Medical Center of Sarajevo protocol of patients.</p> <p><strong><em>Case report</em></strong>: Our case report is presented with 59 years old man who had OHCA in his apartment. The initial rhythm was VF, and cardiopulmonary resuscitation was provided due to the Advanced life support guidelines to shockable rhythms. It was delivered 3 DC Shock-s (200J, 300J, 360 J) with the biphasic defibrillator, it was administered 1mg Adrenalin and performed endotracheal intubation. After the third DC shock, we got the return of spontaneous circulation ROSC. The patient was transferred to the University hospital, were he was stabile, and PCI of the LAD was performed as per the standard protocol. Echocardiography performed in the CCU revealed hypokinesia of RV, with preserved systolic function. On hospital day 7 he had a full neurological recovery. He was conscious, oriented, with normal breathing, blood pressure 125/79mmHg, sPO2 99, ECG: sinus rhythm, fr 87/min, without pathological signs. Echocardiography revealed the reduced systolic function of the left ventricle, with mitral regurgitation MR+2.</p> <p><strong><em>Discussion</em></strong>: Out-of-hospital cardiac arrest (OHCA) is a major health problem in Europe and in the United States. The numbers of patients who have OHCA annually in these two parts of the world have traditionally been reported to be 275,000 and 420,000 respectively. The success of resuscitation depends on many factors: well-organized health care, organization of outpatient emergency services, but primarily when it comes to OHCA, education of the population on Basic life support, and early Cardiopulmonary resuscitation and use of AED (automated external defibrillator).</p> 2021-01-20T00:00:00+00:00 ##submission.copyrightStatement## A case report of Xanthogranulomatous Cholecystitis 2021-04-23T13:57:25+00:00 Ahmed Hassan Abdelmoneim Adham Darweesh Avin Kounsal Abdelwahed Samir Abougazia <p>&nbsp;</p> <p>Xanthogranulomatous cholecystitis is a benign, uncommon type of chronic cholecystitis manifested by focal or diffuse severe inflammatory process of the gallbladder (GB).&nbsp; It is inflammatory disease of the gallbladder characterized by the infiltrations of plasma cells, lipid-laden histiocytes, and the fibroblasts proliferation in GB wall. Gallstones are present in all patients, and like most symptomatic gallbladder diseases, there is a female predominance. It is an active inflammatory process which could leads to significant morbidity. The term Xanthogranulomatous cholecystitis was initially proposed by Goodman and Ishak in 1981. The pathogenesis of XGC is the rupture of Rokitansky-Aschoff sinuses and extravasation of bile into the muscular layer. The rupture of the serosa results in adhesion to the adjacent liver, duodenum, and transverse colon.&nbsp; Macroscopically, it appears like yellowish masses in the wall of the GB. Radiologically it is an important mimic of gallbladder carcinoma.</p> 2021-01-20T00:00:00+00:00 ##submission.copyrightStatement## Acute Erythroleukemia in a Trauma Patient. A Case Report. 2021-04-22T13:54:51+00:00 Eriselda Taulla <p><strong><em>Introduction: </em></strong>Acute erythroid leukemia (AEL) is a rare type of acute myeloblastic leukemia. Acute erythroid leukemia is characterized by a predominant erythroid proliferation, there are 2 subtypes: erythroleukemia (erythroid/myeloid leukemia) and pure erythroid leukemia…</p> <p>Myelodysplastic syndromes (MDS) are a group of biologically and clinically heterogeneous clonal disorders characterized by ineffective hematopoiesis and peripheral cytopenia due to high apoptosis</p> <p>The purpose to presenting this case is how to differentiate an acute erythroleukemia (AEL) from myelodysplastic syndrome (MDS).</p> <p><strong><em>Case report</em></strong><em>.</em> A 74-year-old man came to emergency room after he falling down from the stairs and then was hospitalized with a two weeks history of severe weakness, anorexia, weight loss. He suffered of diabetes mellitus type II insulin dependent, and HTA. The physical examination showed cutaneous and conjunctival pallor, large ecchymosis in the low extremities and hepatosplenomegaly. CBC showed: pancytopenia and macrocytosis, neutrophils 60%, normoblasts 4:100 and reticulocyte count 3%.</p> <p><strong><em>Conclusions</em></strong><em>: </em>The diagnosis was Acute Erythroid Leukemia. The % of myeloblasts in bone marrow was &gt; 20% of non-erythroid cells. Erythroleukemia characterizes from hepatomegaly this is found and in our case. Differential diagnosis is based mainly in bone marrow aspiration, immunophenotyping (flow cytometry).</p> 2021-01-20T00:00:00+00:00 ##submission.copyrightStatement## Treatment of COVID-19 Complications at Home Conditions 2021-04-23T13:57:23+00:00 Saimir Kuci Alfred Ibrahimi Ervin Bejko Stavri Llazo Marsela Goga Ermal Likaj Andi Kacani Alket Collaku Diana Dhimitri <p>This paper reports the clinical characteristics, diagnosis, and treatment of myself after being infected with Covid-19. After comprehensive treatment including nasal cannula oxygen therapy, antiviral and anti-infection therapies, liquid volume management, glucocorticoids, analgesia and sedation, blood tests control, anticoagulation, and thrombus prevention, and electrolyte balance maintenance, after 24 days finally my health situation was good. The purpose of this case report is to provide a reference for the clinical diagnosis and treatment of myself, in-home condition in this critical situation.</p> 2021-01-20T00:00:00+00:00 ##submission.copyrightStatement## Ulcerative Colitis: the Role of Elective and Emergency Surgery 2021-04-23T13:57:21+00:00 Francesk Mulita Fotios Iliopoulos Elias Liolis Levan Tchabashvili Nikolas Drakos Christos Tsilivigkos Ioannis Maroulis <p>Inflammatory bowel disease (IBD) is a group of auto-inflammatory conditions characterized by chronic, remitting, and relapsing inflammation of the alimentary tract. It is comprised of two phenotypically different entities: Crohn’s disease, and ulcerative colitis (UC).&nbsp;The aim of this article is to explore the role of the general surgeon regarding the treatment of patients suffering from UC while presenting a case of a 55-year-old woman with low-differentiated colon adenocarcinoma associated with ulcerative colitis. Patients with UC have a high-risk of developing colorectal cancer. While medical treatment is commonly the initial approach to UC, surgery constitutes a major contributor in dealing with UC.&nbsp;</p> <p>Inflammatory bowel disease (IBD) is a group of auto-inflammatory conditions characterized by chronic, remitting, and relapsing inflammation of the alimentary tract. It is comprised of two phenotypically different entities: Crohn’s disease, and ulcerative colitis (UC).&nbsp;The aim of this article is to explore the role of the general surgeon regarding the treatment of patients suffering from UC while presenting a case of a 55-year-old woman with low-differentiated colon adenocarcinoma associated with ulcerative colitis. Patients with UC have a high-risk of developing colorectal cancer. While medical treatment is commonly the initial approach to UC, surgery constitutes a major contributor in dealing with UC.&nbsp;</p> <p>Case report. A 55-year-old female with hypertension and iron deficiency anemia presented to our emergency department with fever, diarrhea, and epigastric pain for 24 hours which was not associated with heartburn, vomiting, melena, or hematemesis. On examination, the patient’s temperature was 39<sup>o</sup>C, heart rate was 104 beats per minute, blood pressure was 108/65 and the respiratory rate was 20 breaths per minute. Her abdomen was soft, without distension, and with no evidence of palpable mass...</p> 2021-01-20T00:00:00+00:00 ##submission.copyrightStatement##