Albanian Journal of Trauma and Emergency Surgery <p><strong>The</strong><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>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> <div dir="auto"> <ul> <li class="show"><strong><em>Impact Factor Value </em></strong>based on the International Citation Report (ICR) <ul> <li class="show">for the years&nbsp;2020-2021 = <strong>1.022</strong>;</li> <li class="show">for the years 2021-2022 = <strong>1.131</strong>;&nbsp;</li> <li class="show">for the years 2022-2023 = <strong>1.573</strong>;&nbsp;</li> </ul> </li> <li class="show"><strong>ICV - Index Copernicus Value</strong> <ul> <li class="show">for the year 2019 = <strong><span style="text-decoration: underline;">77.13</span></strong>;</li> <li class="show">for the year 2020 = <strong><span style="text-decoration: underline;">88.13</span></strong><u>;</u></li> <li class="show">for the year&nbsp;2021 = <span style="text-decoration: underline;"><strong>100.00 </strong></span>&nbsp; &nbsp; &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;</li> </ul> </li> <li class="show"><strong>ISRA JIF - </strong><span style="text-decoration: underline;">2,197</span>;</li> <li class="show"><strong>GIF -&nbsp;</strong>2.394;</li> <li class="show"><strong>International License.</strong> CC BY-NC 4.0</li> </ul> </div> en-US <p>Submission of a manuscript implies that the submitted work has not been published before (except as part of a thesis or report, or abstract); that it is not under consideration for publication elsewhere; that its publication has been approved by all co-authors. If and when the manuscript is accepted for publication, the author(s) still hold the copyright and retain publishing rights without restrictions. Authors or others are allowed to multiply article as long as not for commercial purposes. For the new invention, authors are suggested to manage its patent before published.&nbsp;The license type is&nbsp;<a href=""><span class="cc-license-identifier">(CC BY-NC 4.0)</span></a></p> (Agron Dogjani) (Hysni Bendo) Sun, 16 Jul 2023 08:08:22 +0000 OJS 60 The ATLS® Course: Empowering Healthcare Professionals for Excellence in Trauma Care. <p>The Advanced Trauma Life Support (ATLS) course has become an indispensable tool in preparing health care professionals to provide optimal trauma care.</p> <p>This article highlights the impact of the ATLS course on empowering healthcare professionals for excellence in trauma care.</p> <p>By providing a standardized framework, enhancing critical decision-making skills, and promoting interdisciplinary collaboration, the ATLS course equips practitioners with the knowledge and skills necessary to effectively respond to trauma emergencies. Additionally, the course prepares healthcare professionals for the unpredictable nature of trauma care through simulation-based training and fosters a culture of continuous professional growth.</p> <p>Through its emphasis on standardization, critical thinking, and continuing education, the ATLS course plays a vital role in improving patient outcomes and establishing a foundation for excellence in trauma care.</p> <p><strong><em>Conclusion:</em></strong> The ATLS course stands as a testament to the commitment of healthcare professionals to provide excellent trauma care. It empowers practitioners with the necessary knowledge, skills, and standardized approach to save lives in the critical moments following traumatic events.</p> Agron Dogjani, Kastriot Haxhirexha, Arben Gjata, Kastriot Subashi ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 Emergency Access and Impact of Injuries Caused by Electrocution and Lightning <p>Electrical injury is a physiological reaction caused by electric current passing through the body. Electric injuries can be caused by the impact and exposure to electric current or lightning either at home or at work.</p> <p>The injury depends on the density of the current, tissue resistance, and duration of contact. Very small currents may be imperceptible or produce a light tingling sensation. Injuries can range from minor,&nbsp; moderate, to severe, and fatal injuries are just as likely to occur at home as in the workplace, with around 20 Australians dying each year from electric shock.</p> <p>The purpose of this paper is to study how well-trained healthcare professionals in both pre-hospital and hospital settings are in treating patients in the case of electric shock and injuries caused by lightning, including the triage, assessment, monitoring, treatment, and transport with medical care in pre-hospital settings</p> <p>The research was conducted based on data obtained from assessments of health care professionals based on anamnestic data, the status of vital parameters, monitoring, medical procedures, system-level injuries, type of health care delivery, and location<strong>. </strong></p> <p><em><strong>Conclusions;</strong></em> Given the discrepancies found in reporting pathological conditions and injuries pertaining to electrical burn wounds, a standardized system for classifying these pathological conditions is suggested. Although electric shock-related mortality is not the leading cause of death in high-prevalence areas, awareness needs to be raised.</p> <p>&nbsp;</p> Basri Lenjani, Agron Dogjani, Nehat Baftiu, Luljeta Abdullahu, Nimet Orgusha, Dardan Lenjani, Zenel Lenjani ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 Characterization and Prevalence of Pediatric Ramp Lesions Associated with Anterior Cruciate Ligament Tears. <p><strong><em>Background:</em></strong> Ramp lesions correspond to posterior meniscocapsular tears of the medial meniscus and are common with anterior cruciate ligament (ACL) tears. They cannot be recognized easily on preoperative magnetic resonance imaging (MRI) scans and are difficult to visualize even using standard arthroscopic approaches. We aim to (1) characterize and evaluate the prevalence of ramp lesions in pediatric patients at a major tertiary children's hospital, providing important insights into demographics, diagnosis, treatment, and functional disability and (2) evaluate the efficacy of MRI in its diagnosis.</p> <p><strong><em>Materials and Methods:</em></strong> We retrospectively reviewed patients under 21 years old undergoing posterior medial meniscal injuries and anterior cruciate ligament ruptures with arthroscopic examination and positive ramp lesions from 2018 to 2021. Patient demographics (including gender and age), initial presentation, physical examination findings, mechanism of injury, pre-operative radiologic findings, and treatment were collected and reviewed via electronic medical record. Exclusion criteria included patients over 18 years old, patients, that did not have an MRI, and patients that were not treated surgically.</p> <p><strong><em>Results:</em></strong> There were 117 patients that met the inclusion criteria out of 690 patients. The mean age at diagnosis was 15.6±1.6 years and the mean BMI was 26.7±6.4. 83% of injuries occurred secondary to sporting activities. Ramp lesions were only detected on preoperative MRI in 63% of cases, suspected in 3%, and not detected in 33%. The sensitivity of the MRI was 63%.</p> <p><strong><em>Conclusions</em></strong>: Ramp lesions were found in 117/690 (16.9%) of patients undergoing ACL reconstruction. MRI had a low sensitivity rate of 63%. During ACL reconstruction, a careful review of the posteromedial compartment is important to recognize less obvious trauma. Lack of treatment may lead to continued instability and risk of complications in these patients.</p> Neritan Borici, Ekene Ezeokoli, Nathaniel Gray Loyd, Scott McKay ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 The Application of MatriDerm in Soft Tissue Defects with Bone Exposure <p style="font-weight: 400;"><strong><em>Background</em></strong> Treatment of patients with post-traumatic severe and chronic wounds poses many challenges. A large number of dermal analogs have been invented in an effort to overcome these challenges. Matriderm, a biosynthetic dermal analog, is made from bovine collagen and elastin. The aim of our study was to prove the effectiveness of MatriDerm® combined with skin grafting versus skin grafting alone in these difficult-to-heal wounds.</p> <p style="font-weight: 400;"><strong><em>Material and Methods:</em></strong> &nbsp;Twenty-two patients with post-traumatic defects with bone exposure and chronic wounds treated in the Clinic of Plastic Reconstructive and Aesthetic Surgery of the University Hospital “St. George” were included in this prospective study. The mean age of the patients was 58 years. The patients were divided into two groups: the experimental and the control group. The patients in the experimental group received a Matriderm appliance and a split-thickness skin graft, while those in the control group received only a split-thickness skin graft. All patients gave their informed consent to participate in the study.</p> <p style="font-weight: 400;"><strong><em>Results:</em></strong> The hospitalization period in the experimental group was 3 weeks and 5 days and in the control group 8 weeks. The period of complete healing was shorter in the experimental group patients (5 weeks) compared with control group patients (9 weeks) with a difference reaching statistical significance (P&lt;0.05). Matriderm enables effective healing and improves elasticity in the treatment of patients with post-traumatic severe and chronic wounds.</p> <p style="font-weight: 400;"><strong><em>Conclusions:</em></strong> With our study, we confirm the evidence of the clinical use of MatriDerm® technology in the healing of soft tissue wounds and prove the effectiveness of combining MatriDerm® and skin grafting for the first time. Moreover, we observed a reduction in wound contraction and an improvement in elasticity, quality of scar tissue, and dermal architecture.</p> Elena Sergeeva Krasteva, Vanya Nikolaeva Anastasova, Elean Ivanov Zunzov, Petar Kiskinov ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 Ventral Hernias in Kalyana Karnataka Teaching Hospital: A Prospective Study. <p>A ventral hernia is a protrusion of the abdominal viscus through the anterior abdominal wall occurring at any site other than the inguinal and femoral areas and is a common problem encountered by surgeons.</p> <p><em>Aims &amp; Objective: </em>Due to the lack of prospective cohorts to determine the natural history of untreated ventral hernias, most surgeons recommend that these hernias be repaired as soon as they are discovered. The purpose of this study was to determine the proportion of ventral hernias occurring in both sexes, various age groups, various risk factors, and complications, as well as their clinical presentations and treatment.</p> <p><strong><em>Material and Methods: </em></strong>During the period August 2020 to August 2021 (12 months), a prospective study was conducted at our tertiary care hospital. The study included 50 cases of anterior abdominal hernias excluding groin hernias and posterior abdominal wall hernias. A detailed history and a thorough clinical examination were used to collect data. In the proforma, data was entered, tabulated, and analyzed using statistical software (SPSS 2015).</p> <p><strong><em>Results: </em></strong>Ventral hernias accounted for 5% of surgical admissions. Among the ventral hernias, para umbilical hernias were the most prevalent (48%). An infra umbilical midline herniation accounted for 36% of cases, followed by an umbilical region herniation in 18% of cases. Constipation and obesity were found to be the major risk factors. Most defects are small (&gt;2cm). 48% of inlay mesh repairs were made.</p> <p><strong><em>Conclusion:</em></strong> 50 cases of ventral hernias were studied in the present study, which was conducted in our tertiary care hospital. Five percent of all admissions to the surgical ward were due to ventral hernias. The females to males ratio was 1:17, and the mean age was 41. The mean total duration for surgery in sublay group was 75.4±9.23 minutes compared to 63.7±10.58 minutes in onlay group, which was statistically significant (p&lt;0.05).</p> <p>&nbsp;</p> Sunil Kumar Patil, Anil Reddy, Mohd Shafiuddin, Abu Hasim Abdul Aziz, H M Abhijith ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 Staged Crystalized Phenol Treatment in Pilonidal Disease: A Retrospective Cross-Sectional Study <p><strong><em>Background: </em></strong>In recent years, minimally invasive techniques with less tissue excision, rather than surgical treatments including wide tissue excisions, are preferred in the surgical treatment of pilonidal sinus. Crystallized phenol treatment is a widely used minimally invasive method. The aim of this study is to examine the results of applying crystallized phenol in a two-stage manner.</p> <p><strong><em>Material and Methods: </em></strong>In this study, demographic information, pilonidal sinus characteristics, and results of crystallized phenol treatment of primary pilonidal sinus patients treated with crystallized phenol at Ankara Yıldırım Beyazıt Education and Research Hospital General Surgery Clinic between January 2016 and July 2021 were retrospectively analyzed.</p> <p><strong><em>Results: </em></strong>The average age of 185 patients who underwent phenol treatment for pilonidal sinus was 26.75±6.21 years. 53.2% of the patients were ≤25 years old. 80.5% of the patients were male. 65.0% of all patients had a BMI &lt;30 kg/m2. The follow-up period for patients was 31 months (min 6, max 60). The patients had 1-3 pits. In the final evaluation of patients who received crystallized phenol treatment twice, abscesses developed in 3 patients (1.6%) and recurrences occurred in 8 patients (4.3%). A statistically significant relationship was found between age and recurrence (p=0.027) and between BMI and recurrence (p=0.003). The incidence of recurrence increased significantly as the number of pits increased (p&lt;0.001).</p> <p><strong><em>Conclusions: </em></strong>In our study, we did not encounter any serious complications with the application of crystallized phenol in two stages. We observed that our patients returned to their routine lives painlessly in the early period and that our recurrence rates were low. Based on our findings, we can say that the application of crystallized phenol as a minimal invasive procedure is still a safe and valid method for the treatment of pilonidal sinus.</p> İlkay Güler, Şener Balas, Harun Karabacak ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 Different Pain Types at Coccygodynia and its Relation with Vitamin D Level <p><strong><em>Background;&nbsp;</em></strong>&nbsp;Coccygodynia is a musculoskeletal disease that affects quality of life. The main complaint of coccygodynia is nociceptive and/or neuropathic pain. Vitamin D deficiency has been associated with the development of pain in various diseases.&nbsp;</p> <p><strong><em>Aims</em></strong><strong>;</strong>&nbsp;In this study we aimed investigate the pain types (nociceptive, neuropathic, mixed) and the relationship between pain types and Vitamin D level in patients with coccygodynia.&nbsp;</p> <p><strong><em>Study design;&nbsp;</em></strong>Observational study</p> <p><strong><em>Materials and Methods;</em></strong>&nbsp;A total of 54 patients diagnosed with coccygodynia were included.&nbsp; Pain intensity, disablity and pain type were evaluated by Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), and the PainDETECT questionnaire, respectively. All participants had their vitamin D levels measured.&nbsp;</p> <p><strong><em>Results;</em></strong>&nbsp;Neuropathic pain was detected in 27.8% of the patients with coccygodynia. Vitamin D was determined to be insufficient or deficient in 81.5% of the patients. A statistical significant correlation was found between neuropathic pain and prolongation of coccygodynia and increased ODI values (p&lt;0.05). The Vitamin D values were determined to show statistically similar distribution in the nociceptive, mixed type, and neuropathic pain groups (p=0.532).&nbsp;</p> <p><strong><em>Conclusion;&nbsp;</em></strong>The frequency of neuropathic pain in coccygodynia increases with increasing disability and disease duration. Although vitamin deficiency or insufficiency is common in coccygodynia, it is not associated with the type of pain.</p> Emel Güler, Hanzade Aybuke Unal ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 Influence of Healthcare on the Outcome of the Treatment of Patients with Stoma. <p><strong><em>Background:</em></strong> Although stoma is a crucial surgical procedure, this operation has a physical and psychosocial impact on the patient, their habits and quality of life, which they should be properly educated on.</p> <p><strong><em>Objectives:</em></strong> The purpose of the work is to analyze the impact of health care, key factors and problems that affect the final outcome of treatment in patients with a stoma, as well as suggestions and guidelines for improvement.</p> <p><strong><em>Material and&nbsp;Methods:</em></strong> The results of 10 studies were reviewed including clinical trials, randomized prospective and retrospective studies published between 2011 and 2021.</p> <p><strong><em>Results:</em></strong> Education of patients, their families, and medical staff is crucial in improving the quality of life of patients with stoma but also in reducing potential complications of stoma, along with stoma marking. It is also necessary to pay special attention to psychosocial problems in patients, as well as stoma problems in Bosnia and Herzegovina.</p> <p><strong><em>Conclusion:</em></strong> More needs to be invested in educating staff, patients and their families about stoma, and integrating stoma patients into society in order to improve their life quality.</p> Hadžan Konjo, Amina Lučkin, Adna Spahović, Alma Mizdrak, Zineta Mulaosmanović, Tea Mušić ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 Bedside Ultrasonographic Assessment of the Optic Nerve Sheath Diameter to Assess Intracranial Pressure in Patients Given Ketamine in Emergency Department <p style="font-weight: 400;"><strong><em>Background</em></strong><em>:</em> There is an ongoing debate if ketamine exerts any effect on intracranial pressure (ICP). ICP can be evaluated noninvasively by means of optic nerve sheath diameter (ONSD) measurement. In the present study, we aimed to determine if ketamine has any perceivable effect on ICP using ONSD.</p> <p style="font-weight: 400;"><strong><em>Material and Methods:</em></strong> In this single-center observational study, we prospectively enrolled patients who were admitted to the ED and received intravenous ketamine for induction, analgesia, procedural sedation for any procedure (ie, fracture reduction, laceration repair, pacemaker implantation). ONSD was used to rate ICP changes noninvasively both before and after ketamine application.</p> <p style="font-weight: 400;"><strong><em>Results:</em></strong> There were a total of 75 patients with a mean age of 59.8 ± 20.5 years. The majority of patients were applied Procedural Sedation (53.3%). In patients who were administered ketamine for induction, the median ONSD before and after ketamine were 5.10 (IQR: 1) mm and 5.00 (IQR: 1.30) mm, respectively. There occurred no significant diameter change (p=0.832). In patients who were administered ketamine for analgesia, the median ONSD 3.70 (IQR: 0.40) mm and 3.65 (IQR: 0.23) mm prior to and after the procedure, respectively. There occurred no significant diameter change (p=0.549). In patients who were administered ketamine for procedural sedation, the median ONSD before and after the procedure were 4.05 (IQR:0.67) mm and 3.97 (IQR: 0.69) mm, respectively. This time, however, ONSD was significantly reduced after ketamine administration (p=0.001).</p> <p style="font-weight: 400;"><strong><em>Conclusions:</em></strong> In this patient population, ketamine did not cause any incremental effect on ONSD, a surrogate marker of ICP.</p> Erdi Akça, Fevzi Yılmaz, Bora Baltacıoğlu, İffet Tiftikçi, Engin Deniz Arslan, Cemil Kavalcı, İnan Beydilli ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 Pulmonary Rehabilitation for Chronic Lung Diseases. <p>Chronic Obstructive Pulmonary Disease (COPD) is now the main cause of disability in the developed world. The advance of COPD is related to increasing breathlessness, disability, and periodic hospitalizations.&nbsp; An aging population in the developed world and increasing cigarette consumption in developing countries expand the global impact of this condition. The disorder associated with COPD leads to a decrease in physical activity and failure of functional independence.</p> <p><em>The aim o</em>f this study was to evaluate the effects of PR in patients with normal exercise capacity on health-related quality of life and exercise capacity.</p> <p>The mean FEV1/FVC was 59.4± 14.1%, and the mean FEV1 was 64.8± 23.0% as expected. Most topics had mild to moderate COPD. The P<sub>Imax</sub> and P<sub>Emax </sub>were normal. These subjects had no previous participation in home-based or hospital-based PR. All the subjects had normal maximal V˙O2 and work rate before PR.</p> <p>After PR there were still considerable improvements in maximal V˙O2 (mean increase of 101.3 mL/min, p &lt;0.001) and work rate (mean increase of 8.2 watts, p&lt;0.001). Ventilation, heart rate, and mean blood pressure were constant following PR. The maximum oxygen pulse at maximum exercise was significantly increased with PR (p&lt;0.02). The SpO2 and end-tidal PCO2 at peak exercise did not significantly improve after PR.</p> <p>&nbsp;Although dyspnea scores at rest were low and did not improve significantly with PR, dyspnea at end-exercise was significantly improved after PR (p=0.01). PR should be the responsibility of the clinical management of patients with COPD, even for those with normal exercise capacity. However, the benefits of disease progression, hospitalization, and survival for these patients remain unknown.</p> <p>The main role in the management of any chronic disease, including lung disease, is to improve the quality of life (QL) in patients.</p> <p><strong><em>Conclusion; </em></strong>Although strongly recommended by scientific societies pulmonary rehabilitation programs still need to be more widely implemented. PR programs have shown a high level of evidence of benefits in chronic respiratory patients, particularly those with COPD.</p> Ledi Neçaj ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 MRI in Evaluation of Rectal Cancer pre- and post-Chemo-Radiation Treatment. <p>Rectal cancer is associated with a high risk of metastases and local recurrence; local recurrence rates after surgical treatment being up to 32%. An accurate local staging at the time of initial diagnosis is therefore very important. Magnetic Resonance Imaging (MRI) is already established as an accurate tool for the preoperative staging of rectal cancer and has resulted in marked improvements in staging accuracy.</p> <p><strong><em>Material and Methods: </em></strong>This study used MRI in comparing the morphologic features of rectal cancer before and after 8 weeks of chemo-radiation treatment (CRT) and to correlate the post treatment MRI appearances with the histological findings in resected tumors. 45 patients with histo-pathologically proven rectal adenocarcinoma received standardized 8 weeks chemo-radiation therapy and subjected to MRI before and after treatment for clinical staging. A correlation between pathological response and MRI findings was done.</p> <p><strong><em>Results: &nbsp;</em></strong>The MRI diagnostic accuracy to diagnose T2 is 74.2% with relatively low specificity (64.7%). The diagnostic accuracy of MRI in evaluation of stage T3 and T4, the MRI sensitivity was 96.2% however of low specificity 26.3%. The diagnostic accuracy was 66.7%. Additionally, in evaluation of T2 stage, the sensitivity of MRI was very low 27.3% and specificity relatively high 94.7%. Diagnostic accuracy was 70%.</p> <p>Post RCT, based on downstaging after CRT, the sensitivity of MRI to show no tumor was very low 0% with diagnostic accuracy 88.9%. However, to evaluate stage T2, the sensitivity was 84.6% with low specificity 66.7% and the diagnostic accuracy was 74.2%.</p> <p><strong><em>Conclusion:</em></strong> MRI had an accuracy average of 81.6% in T stage and 68.9% in N stage in re-staging rectal tumors after CRT. Over-staging results of majority of the inaccuracy. The statistical agreement between post-CRT MRI and the pathologic staging involving T and N stages was not satisfactory. In view of the above, Post CRT, restaging rectal cancer remains a challenge.</p> Adham Darweesh, Amal Al Obaidli, Alaa Kambal, Hassan Aboughalia, Walid El Ansari, Reda Ramadan, Mohamed Abu Nada, Ahmed Hassan Abdelmoneim ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 Evaluation of ALK, EGFR and PD-L1 Mutations in Pulmonary Carcinomas through Immunohistochemistry <p class="Body"><strong><em><span lang="FR">Introduction:</span></em></strong> <span lang="EN-US">Lung cancer, with about 2.2 million new cases and 1.8 million deaths, is the second most commonly diagnosed cancer and the leading cause of cancer death in 2020. Immunohistochemistry (IHC) now is used not only to diagnose and classify lung tumors into subtypes, but also to determine the eligibility of patients for different molecular-targeted therapies. </span></p> <p class="Body"><strong><em><span lang="FR">Objectives :</span></em></strong><span lang="EN-US"> Study of ALK, EGFR and PD-L1 mutations in Pulmonary Carcinomas through immunohistochemistry examinations to help determine the prognosis and cases that may benefit from target therapy. Detection of possible links between ALK, EGFR, PD-L1 and other variables such as age, sex, histological entity and degree of tumor differentiation. </span></p> <p class="Body"><strong><em><span lang="EN-US">Materials and Methodology:</span></em></strong><span lang="EN-US"> The study is retrospective and includes 266 patients diagnosed with lung cancer who underwent biopsy at the American Hospital in the period 2016-2020. Tissues obtained were subjected to IHC examination using antibodies against factors EGFR, ALK, PD-L1, etc. </span></p> <p class="Body"><strong><em><span lang="EN-US">Results:</span></em></strong><span lang="EN-US"> The study showed that out of 266 patients, 24% of lung cancer cases are females and 76% are males. The average age was 61.8 years. No statistically significant relationship was found between ALK, PD-L1 and EGFR with variables such as age, gender and degree of differentiation of adenocarcinomas. No significant link was found between ALK and PD-L1 and the histological entity, but a significant link was found between EGFR and histological type of pulmonary carcinomas. </span></p> <p class="Body"><strong><em><span lang="FR">Conclusions :</span></em> </strong>Lung cancer is one of the most common cancers, found mainly in men, but also in women. Nowadays, IHC helps not only to diagnose lung cancer, but also to determine patients who can respond to target therapy and their prognosis. Therefore, the use of IHC to detect ALK, EGFR, PDL-1 mutations and their links to patient characteristics is becoming increasingly necessary.<br><br><br></p> Teona Bushati, Leart Berdica, Jeta Memçaj, Ilirian Laçi, Ilirian Ibrushi ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 The Origin of Pilonidal Sinus Disease – 10 wrong Theories and one Recent Discovery <p><strong><em>Introduction: </em></strong>In the last two centuries, many theories have been proposed to explain the origin of pilonidal sinus disease (PSD) – congenital and acquired.</p> <p><strong><em>Materials and Methods:</em></strong> A PubMed literature review was conducted and looked at different proposed theories on the origin of PSD; this overview was then compared to research results from more recent studies.</p> <p><strong><em>Results: </em></strong>Initially it was postulated, that PSD was of embryonic origin. This however changed during World War II as more 78.000 American soldiers were diagnosed and treated for PSD. Thereafter, the perception of the origin of PSD changed to an acquired one. New data has shown that short hair fragments, which have fallen from the scalp may be the origin of PSD – therefore disproving the theory of folliculitis and fatty gland obstruction.</p> <p><em><strong>Conclusion:</strong> </em>These new findings may explain why recurrences/new diseases occur within follicle-free areas – such as scars and without any preceding infection. This may aid in the prevention of PSD.</p> <p>&nbsp;</p> Marius Dettmer, Konstantinos Degiannis, Myriam Braun-Münker, Dietrich Doll, Matthias Maak ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 Comparative Analysis of Knee Replacement Surgery who follow up by Physical Therapy and Intra-articular Steroid Injections for Obese Patients. <p>Knee osteoarthritis (KOA) is the most common chronic articular disease, and its prevalence has doubled since the mid-20th century. It affects 16% of the adult population over 50 years of age in the post-industrial era [<a href="">1</a>].</p> <p>Obesity is one of the only modifiable risk factors for both incidence and progression of Osteoarthritis (OA).[2]</p> <p>Although OA was previously regarded as a disease of the elderly, its development starts much earlier than originally thought, and OA is ranked among the top 20 diseases in the 40–45 years age group [3].</p> <p>This review aims to provide a comprehensive analysis of the outcomes of knee replacement surgery following up physical therapy, versus intra-articular steroid injections for obese patients (BMI &gt;30)</p> <p>The study design employed in this review is narrative, and articles published after 2010 from PubMed were considered for inclusion. The review examines the impact of each intervention on the complete regain of knee function in this specific population.</p> <p>Through the analysis of relevant studies, this review seeks to inform clinical decision-making and guide the management of obese patients with knee osteoarthritis.</p> <h3><em>Conclusion</em><em>.&nbsp;</em></h3> <p>Based on the reviewed literature, knee replacement surgery appears to offer a better chance of achieving complete regain of knee function in obese patients (BMI &gt;30) undergoing physical therapy compared to intra-articular steroid injections. However, the findings are limited by the availability of studies and the heterogeneity in the research methodologies.</p> <p>&nbsp;</p> Eugerta Avdulaj ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 Scrotal Kaposi's Sarcoma in HIV-negative Patient: A Case Report and Review of the Literature. <p><strong><em>Background</em></strong>: Kaposi's sarcoma (KS) is an indolent angio-proliferative tumor proliferation with spindle cells originating from endothelial and immune cells infected with human herpes virus type 8. (HHV-8: also known as Kaposi sarcoma herpes virus [KSHV]). HHV-8 was identified as the causative agent of KS. This virus is present in 95-98% of cases with KS. Kaposi's sarcoma was first described by a Hungarian dermatologist 1872 named Moritz Kaposi.[1]</p> <p>The lesions are characterized by the proliferation of spindle cells of endothelial origin, which present different degrees of abnormal vascularization, inflammatory infiltrates, and fibrosis. Kaposi's Sarcoma (KS) is a malignancy that generally affects the skin, and can be systemic with internal organ involvement. It originates from the vascular endothelium. KS's relationship with human immunodeficiency virus (HIV) infection is well known.</p> <p>In this article, we will present a 73-year-old male patient with 3 purple scrotal lesions up to 0.5 cm in size.</p> <p><strong><em>Conclusion;</em></strong> Kaposi's sarcoma of the scrotum in a negative patient is a rare pathology. However, in cases of scrotal lesions that last over time, a differential diagnosis should be made and Kaposi's sarcoma should be taken into consideration. Also, a screening for other accompanying lesions, especially a detailed examination of the gastrointestinal tract is important in cases of Kaposi’s sarcoma of the scrotum.</p> Teona Bushati, Leart Berdica, Albina Ndoja, Erion Sukaj, Ilirian Ibrushi, Leon Kaza ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 The Key Role of Splenectomy in Fever of unknown Origin which Resulted to be B-cell primary Splenic Lymphoma. <p><em><strong>Background: </strong></em>The term ‘fever of unknown origin’ (FUO) was first introduced by <em>Petersdorf and Beeson </em>in 1961, and it is defined as recurrent fever &gt;38.3°C, lasting for &gt;3 weeks, remaining undiagnosed after 1 week of in-hospital evaluation. The etiologies of classic FUO include mainly infections, malignancies, non-infectious inflammatory diseases, and miscellaneous causes, while some cases remain undiagnosed. Primary splenic lymphoma (PSL) is a rare malignant lymphoma. In many cases, splenectomy is the treatment of choice for massive splenomegaly.</p> <p><em><strong>Case presentation:</strong></em><strong>&nbsp;</strong>A 54-year-old woman presented with a history of high fever up to 39°C, sweating, fatigue, and weight loss for one month. She had been treated by her family physician with antibiotics (cephalosporin) for 10 days but without improvement. On admission, the patient had palpable splenomegaly but no palpable lymphadenopathy. The patient had increased markers of inflammation. The indicators of autoimmune disease were all negative. Screening for specific infectious diseases and the blood cultures all came out negative. Abdominal computerized tomography (CT) revealed an enlarged spleen. The splenectomy was performed and the spleen was sent for histological analysis. Meanwhile, the patient was subject to a complex treatment. Histological and immunohistochemical analysis confirmed the diagnosis of diffuse large B-cell non-Hodgkin lymphoma with diffuse red pulp infiltration. Afterward, the patient underwent systemic chemotherapy.</p> <p><em><strong>Conclusion:&nbsp;</strong></em>We strongly suggest that clinicians should have a high index of suspicion for malignancies in cases with FUO. Sometimes splenectomy can be the key to solving the problem.</p> Ermira Muco, Renato Osmenaj, Rovena Bode, Amarildo Blloshmi, Jona Prendi, Leart Berdica ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 Chylothorax Management Four Years Post Spine Surgery: A Successful Conservative Treatment <p><strong><em>Background:</em></strong> Chylothorax is a pathological condition associated with a high mortality and morbidity rate. The first observation of chylothorax associated with thoracic vertebral injury was documented by Krabbell in 1885. Since then, several cases have been described in the literature.</p> <p>Non traumatic chylothorax several years after spine surgery is a rare condition. We described a case of a patient who sustained a thoracic spine fracture-dislocation and presented with a right sided chylothorax as a late complication to his thoracic spine trauma.&nbsp;A right thoracentesis was performed, providing partial relief of respiratory symptoms. The collected fluid was sent to the laboratory for further examination. Biochemical analysis of the milky pleural fluid confirmed the suspicion of chylothorax, with elevated levels of triglycerides and lymphocytes. These findings supported the diagnosis of chylothorax.</p> <p><strong><em>Conclusion</em></strong><strong><em>:</em></strong> Non-traumatic chylothorax occurring several years after spine surgery is a rare condition, and there is limited literature available on this particular pathology. The diagnosis can be simplified through laboratory examination of the milky fluid. Conservative treatment is typically the approach of choice in the majority of cases, involving total parenteral nutrition and the insertion of a chest tube into the chest cavity, followed by chemical pleurodesis.</p> Ilir Skenduli, Arjan Mezini, Fatmir Caushi, Arben Tanka, Laert Gjati ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000 Fournier's gangrene in Patients Operated for Hemorrhoidal Prolapse in the Surgical Emergency Department. <p style="font-weight: 400;">Fournier's gangrene (FG) is a well known often fatal fasziitis of the pelvic floor following ano-rectal, urologic and gynecologic infections. Although rarely it is described as a complication of operative anal procedures and predisposing factors such as diabetes, alcoholism, immune-defects and consumptive diseases.</p> <p style="font-weight: 400;">Current literature only briefly mentions the potential risk of FG after such a common surgical procedure. However, devastating complications occur more often than expected. This catastrophic complication without a predisposing factor is discussed along with a review of the literature.</p> <p style="font-weight: 400;">The objective of this article is to provide updated and relevant information regarding the recognition, diagnosis and management of FG, from the general surgeon to the emergency department.</p> <p style="font-weight: 400;">This article refers to two complicated cases of Fournier's gangrene. The patients underwent emergency surgical intervention with the diagnosis of hemorrhoidal prolapse with rectal bleeding and accompanying anemia…</p> <p style="font-weight: 400;"><strong><em>Conclusion;</em></strong> The gold standard for treatment was found to be a combination of surgical debridement, broad-spectrum antibiotics, and the administration of intravenous fluids. Further, patient survival was found to be directly related to the time from diagnosis to treatment when they underwent surgical debridement.&nbsp;</p> <p style="font-weight: 400;">The General surgeon must be vigilant for this condition and be aware of risk factors, prognostic indicators, and proper treatment protocols to recognize FG early and initiate appropriate management.</p> Enton Bollano, Krenar Lilaj, Dariel Thereska, Agron Dogjani ##submission.copyrightStatement## Thu, 20 Jul 2023 00:00:00 +0000