By, Prof. Asoc. Dr. Voltisa GJERGJI

EDITORIAL

In this issue of Medicus journal we collected articles which are focused on health patterns, health care and economy, as well as health behaviours. A study from Germany shows models of care for elderly people and the alternative policy strategies such as to stay at home with the help of live-in care. Another study reports on the attitudes (acceptability, preferences, and needs) of Albanian physiotherapists and the general population toward telerehabilitation. This cross-sectional observational study is conducted among the physiotherapists and the general population asking them about their experiences with telerehabilitation in physiotherapy in order to evaluate how recognized and applied is this field in Albania. (more…)

https://doi.org/10.58944/mlqe7095

By, Prof. Dr. Kerstin WÜSTNER

Abstract

There are different models of care for elderly people in Germany. Policy strategies provide support, but this is weak for some models, such as live-in care. The latter is an option to stay at home with the help of live-in care. There is no public support for this model, so individuals have to organise it themselves or refer to offers from live-in care agencies that provide carers. (more…)

https://doi.org/10.58944/brui6174

By, Dr. Sc. (c) Iva RRUGIA, PhD Jasemin TODRI, Aden GRIPSHI

Abstract

Background: COVID introduced a new approach to healthcare services. The pandemic showed that the need to rely on online services is very significant. Tele-rehabilitation, as the delivery of rehabilitation services via information and communication technologies, is a well-known concept for developed countries but not for Albania. Objective: To investigate (more…)

https://doi.org/10.58944/xkoq6863

By, MD Armida HIDA

Abstract

Introduction: Rheumatoid arthritis (RA) is an autoimmune and chronic disease. Worldwide, the annual incidence of RA is 1%. Epidemiological data for Albania are similar to other countries, still some districts might be more affected. There are no previous studies in the population indicating the prevalence or incidence of rheumatoid arthritis in the Elbasan district. (more…)

https://doi.org/10.58944/hbom7065

By, MD Esi DUKA, Prof. Dr. Najada COMO, Dr. Sc. Esmeralda META

Abstract

Introduction: Pneumomediastinum is a rare complication that occurs in patients with Pneumonia caused by COVID-19 and is more frequent in patients with ARDS that may or may not be related to the use of invasive mechanical ventilation. Pneumomediastinum is an indicator of clinical deterioration with potentially threatening consequences for the patient. (more…)

https://doi.org/10.58944/ujjk6442

By, Assoc. Prof. Hafez AL-MOMANI

Abstract

Introduction: The most prevalent neurodegenerative illness and kind of dementia is Alzheimer’s disease (AD). It shows up as a reduction in short-term memory and cognitive function that affects day-to-day functioning. The majority of Alzheimer’s cases are idiopathic, but a tiny percentage of hereditary instances provide gene identification, which when (more…)

https://doi.org/10.58944/jsur6977

By, Dr. Sc. (c) Vilma ÇADRI, Prof. Asoc. Dr. Ariana STRAKOSHA, Dr. Sc. Nevi PASKO, Dr. Sc. Elvana RISTA

Abstract

Background: Chronic Kidney Disease (CKD) is increasingly recognized as a systemic condition affecting not only renal function but also various extra-renal systems, including the central nervous system. Cognitive impairment (CI) has emerged as a significant concern in CKD patients, manifesting as a spectrum ranging from mild cognitive deficits to clinically (more…)

https://doi.org/10.58944/xsii1006

By, Prof. Dr. Pëllumb PIPERO Comorbidities are concomitant diseases and may include physical or mental health and may refer to the coexistence of two or more pathologies, which appeared at the same time, or at different times, affecting a system or different systems. Comorbidities have a great effect on the life of patients because the presence of a social disease can lead to an increase in the inability to work, reducing the cost of living, the management of the disease becomes more complex and significantly reduces the productivity of a society. Within the last decade, the group of co-morbidities has become a growing health problem, as well as the leading causes of death on a global level and will continue to challenge healthcare professionals in the upcoming years. While previously individuals had a known chronic pathology, currently people live with more than one chronic pathology, known as comorbidity or multimorbidity. The terms comorbidity and multimorbidity are often used interchangeably to refer to co-occurring conditions, however, they have an important distinction. While both terms state the occurrence of multiple conditions within the same individual, comorbidity refers to one or more additional conditions in reference to an index condition such as comorbidity in diabetes mellitus. In comparison, multimorbidity describes that no one condition is holding priority over any of the co-occurring conditions. Therefore, the complexity of comorbidity and multimorbidity has brought great challenges to the health care system, health care professionals and the person living with them.

https://doi.org/10.58944/gedb7074

By, Dr. Sc. Esmeralda META, MD. Afrim YZEIRI, MD. Stavri LLAZO, MD. Elona NAQELLARI, MD. Jonela BURIMI, MD. Dejvi HAXHIAJ, Dr. Sc. Eva DURAKU, MD. Deniona NUNCI, MD. Nikolin MITROLLARI, MD. Endri KATRO Abstract Introduction: The Covid 19 pandemic confronted us with a series of multidisciplinary pathologies, beginning with the virus and followed by a cascade of SIRS and multiorgan failure. During the treatment therapy of antivirals, anticoagulants, corticosteroids and antibiotics, we also encounter medications’ interactions. Method: We described a case report of a 74-year-old man, who during the course of hospitalization had several complications. Results: He developed respiratory failure, delirium, SIRS, as well as retroperitoneal hematoma (HRP) as a complication of anticoagulant therapy. It was followed by hemorrhagic shock, respiratory distress and the patient was submitted under mechanical ventilation with step-by-step resuscitation. The patient made clinical and laboratory improvement by being extubated and thereafter was rehabilitated pulmonary and physically. On the 42nd day of hospitalization the patient was discharged from the hospital. Pulmonary and locomotor rehabilitation of the patient was established 2-3 weeks after hospital discharge. Conclusion: Establishing a retroperitoneal hematoma diagnosis requires clinical intuition. Some signs which can raise an alert for a retroperitoneal hematoma can be hypotension, tachypnea and back and abdominal pain in patients who are under anticoagulant therapy. Key Words: Covid 19, complications, retroperitoneal hematoma.

https://doi.org/10.58944/xmta4019

By, MSc. Florian QORDJA, MSc. Sulejman HAXHI Abstract Introduction: Increasing positioning security is one of the main challenges of radiotherapy. The main movements of the prostate during radiotherapy are as a result of poor positioning of the patient, as well as by bladder and rectum volumes. These movements can be detected using various visualization techniques such as CBCT and radiographic images before each treatment session. Purpose: The purpose of this work is to highlight the role of radiotherapy technician in the management of the patient’s movements during prostate treatment. Methods: 8 patients after customized positioning and immobilization performed the treatment with Varian TrueBeam HD linear accelerator. CBCT’s were performed on different days during the course of treatment as well as radiographic images on other days to verify the position. These positions were compared with the positions planned by the simulation scanner and the daily movements of the patient and the prostate were corrected, thus creating a new isocenter. In cases where and with the new isocenter the prostate and seminal vesicles are located outside the planned PTV, it is performed a new simulation CT scan and a new treatment plan. Results: From 8 patients with primary prostate cancer, 42 CBCT controls and 207 MV-KV controls were considered. Patients required an average movement of 0.27 cm in the vertical direction, 0.28 cm in the longitudinal direction, and a displacement of 0.17 cm in the lateral one. Regarding the rotation of the bed according to the X; Y; Z axes, we have an average Pitch of 1.32°, Roll of 0.5° and Rotation of 0.63°. Conclusions: 50% of these patients, needed a rescanning and replanning of treatment, and 12.5% more than one rescan. Key words: Prostate cancer, Radiotherapy technician, Movement, CBCT, Radiographic imaging.

https://doi.org/10.58944/zxbh5669

By, Dr. Sc. Brunilda ZLLAMI, MD. Stavri LLAZO, Dr. Sc. Entela BASHA, Prof. Asoc. Dr. Voltisa GJERGJI Abstract Introduction: Abdominal pain is a nonspecific symptom which can be caused by a constellation of pathologies. It can be related sometimes to pathologies that affect the brain and mind. Among pathological conditions that can cause paroxysmal gastrointestinal symptoms are porphyria, abdominal migraine, cyclical vomiting, intestinal malrotation and peritoneal bands. Among them, rare, but important to recognize is abdominal epilepsy. Abdominal epilepsy is more a diagnosis of exclusion, and it is considered to be part of the group of temporal lobe epilepsies, which usually occur in children. However rare, there is recorded documentation of its occurrence even in adults. Method: We present two adult case reports with abdominal symptoms who have undergone several investigations before the diagnosis. Results: In these patients the pellicular combination of the irregular paroxysm of abdominal pain, combined with symptoms involving the central nervous system and the exclusion of pathologies that can produce similar symptoms can guide the physician to the diagnosis of abdominal epilepsy. Discussion: It should be suspected abdominal epilepsy when we encounter unexplained and recurrent gastrointestinal symptoms such as severe paroxysmal pain, hunger, flatulence, nausea and sometimes diarrhea. Symptoms are associated with central nervous system symptoms such as lethargy, confusion or alteration of consciousness and are improved with antiepileptic therapy. This diagnosis is usually associated with electroencephalography changes. The symptoms are quite vague and for this reason it is difficult to make a diagnosis. Keywords: abdominal epilepsy, unexplained abdominal pain, EEG, adults, antiepilepsy drug therapy, case report

https://doi.org/10.58944/zvlb1349

By, Dr. Sc. Anila DINE, Msc. Alma PULA, Msc. Redina AGOLLI, Msc. Ladiola STEFANIDHI, Msc. Stela DODAJ, Msc. Etleva RUSTAMI Abstract Background and aims: Drooling is the involuntary spillage of saliva from the mouth and is apparent in approximately 75% of individuals with PD and was historically interpreted as resulting from hypersecretion of saliva because of autonomic dysfunction. Alteration in salivary gland function is believed to arise from PD-associated changes in the autonomic nervous system and possibly involves the salivary para-sympathetic ganglia. Irrespective of the amount of saliva produced, drooling probably occurs because of PD-related inability to efficiently swallow with normal frequency, an inability to fully close the mouth, and an anterior flexed head position. Recognizing and managing sialorrhea is an important issue to ensure quality of life for patients with PD. The study aims to identify prevalence of drooling at patients hospitalized at neurology department in Tirana and increasing awareness about the importance of sialorrhea treatment in PD patients. Methods: In this retrospective study we investigated the prevalence of drooling in PD patients. We investigated the distribution of drooling according to sex and age and also the impact of drooling in this population by neurological examination and questionnaires given to them in a 6-month time distance. In addition, we studied the impact of gender in drooling in this population. Results: Our results show that most of the patients participating in the study showed signs of drooling. A significant correlation exists between drooling and stages of disease. Furthermore, in males, the correlation between the prevalence of drooling was found to be clinically significant compared to females. Conclusion: Our findings suggest that drooling is a major concern in the course of PD and should be addressed and treated early in patients with PD. Key word: Parkinson Disease, prevalence, sialorrhea, quality of life

https://doi.org/10.58944/bnkz6371

By, Dr. Sc. Lumturi MERKURI, Prof. Asoc. Dr. Fatjona KAMBERI, Msc. Doreada MIO, PhD Jonilda GABRANI Abstract Introduction: Self-care concept is not a new idea, but during the scientific era that strengthened the authority of health care providers, the use of self-care became less valued. Self-care has major benefits for individuals and health care systems. Many factors influence self-care and several tools have been developed to measure an individual’s ability to self-care. Health workers play an important role helping people understand and use self-care practices. Aim: To provide an overview on self-care approach to better understand different aspects of self-care as important intervention for improving health and well-being. Methodology: A series of recently published articles in PubMed, Google Scholar, Scopus, Web of Science as well as WHO guidelines related to self-care were identified and used for this review. A database of selected articles was created, and a reference list compiled. Results: The effectiveness of self-care interventions has been found in several published articles. In patients with various diseases, higher levels of self-care are associated with better health outcomes, including reduced hospitalizations, costs, and mortality. Various studies report that self-care is influenced by several factors such as: age, education, socio-economic and health education level, geographic environment, and family support. WHO has developed competency standards for health workers to support people’s ability to self-care. Conclusions: Humanitarian crises-armed conflict, natural disasters, major disease outbreaks have a significant impact on global health and require innovative strategies that go beyond the health sector. There is growing evidence of the effectiveness of selfcare interventions for improving health and well-being. Health workers have a key role in implementing and promoting self-care interventions. Keywords: self-care, health, wellbeing, quality of life, self-care measurement.

https://doi.org/10.58944/qltp2509

By, Dr. Sc. Migena QATO, Prof. Dr. Najada COMO, Dr. Sc. Esmeralda META, Msc. Afrim YZEIRI, Prof. Asoc. Dr. Albana GJYZELI Abstract Introduction: The SARS COV 2 epidemic has caused thousands of deaths due to different mechanisms of organ injury, starting from the respiratory and cardiovascular system and followed with significant involvement of kidneys, liver, pancreas and several metabolic dysfunctions which all caused a rapid progression of disease leading to death within the second week of hospitalization. Method: We present the case of a 67-year-old woman who died within 24 hours of admission due to a rapid deterioration of her clinical condition with several successive complications. Results: The patient developed a fulminant clinical course, starting with flu-like prodromal symptoms proceeding to altered mental status, metabolic acidosis, acute respiratory distress syndrome (ARDS) and renal failure within 3 days. The rapid involvement of several vital organs predicted a poor diagnosis since the first evaluation in admission which resulted to be irreversible. Conclusion: The predictors of poor prognosis and severity may help clinicians to apply therapeutic regimens in order to avoid disease progression to multiorgan damage and potentially death. Key words: Covid-19, multi-organ dysfunction, cascade, case report.

https://doi.org/10.58944/ugnr5139

By, MD. Rajmonda BALLKOÇI, MD. Amarildo BLLOSHMI, MD. Arben DHIMA Abstract Introduction: When detecting bone metastases bone scintigraphy has been long used as the most sensitive radiological modality, especially in lytic metastases, to assess the spread of disease in skeletal structures. Currently bone scintigraphy and CT remain the gold standard for bone metastasis detection in oncological patients in our nation. Method: We describe the case of a 45-year-old man who was diagnosed with large B-cell lymphoma and was having a whole-body PET/CT scan for staging purposes. The overall report identified the pathological lymph nodes, in more than one region of lymph node stations. These nodes had increased in size compared to the previous study of the patient. Diffuse skeletal pathological uptake of the radiotracer indicated diffuse bone marrow infiltration, while the CT images alone showed no evidence of typical lytic bone lesions. Other findings included splenomegaly and secondary splenic infiltration. Discussion: One of the primary diagnoses for which PET/CT is particularly effective is lymphoma, when it comes to identifying intra and extraosseous recurrence. This is particularly true when it comes to identifying marrow infiltration. Few centers in Kosovo and Albania have used the combined PET/CT modality in the last two years, besides the importance of including it as part of the imaging protocol in the follow-up of the patients with lymphoma, or oncologic patients in general. Keywords: Case report, PET/CT, scintigraphy, metabolically active, bone lesions, lymphoma.

https://doi.org/10.58944/mvay1572

By, Dr. Sc. Etleva RUSTAMI, MSc. Alma PULA, Dr. Sc. Anila DINE

Abstract

Introduction: Nursing education in EU countries follows EU requirements and directives. Even Albania, as a candidate country in relation to nursing and midwifery education must start planning to implement these standards. EU directives require that 50% of the nursing education curriculum to be converted into hours of laboratory and clinical practice, which should be carried out in specialized hospital units. The non-compliance of the Albanian Nursing Education’s programs with these standards has become an issue for our graduates and makes the equivalentation of the nursing program abroad difficult. Aim: To sightsee the nursing programs offered by Higher Education Institutions in Albania and to analyze how they meet the standards defined in the EU directives. Method: The data was collected from a review of the programs of some Higher Education Institutions in Albania, during the academic year 2019-2021. Results: The results obtained from the analysis of the programs offered by the Higher Education Institutions showed that they do not meet the EU recommendations. The number of hours of nursing lab and clinical practice, as well as the operation of practice are below the standards defined in these directives. Conclusion: This study clearly shows the challenges faced by Higher Education Institutions in Albania. The implementation and coordination of Nursing programs with EU directives is a crucial task. The standardization would enable not only solving the nowadays problems referred by students but would also enable in the future mobility for all lecturers, researchers and nurses who have studied in Albania. Keywords: EU directives, nursing, Higher Education Institution, nursing clinical and laboratory practices. How to cite: Rustami, E., Pula, A., & Dine, A. (2023). Challenges of fulfilling European Union Directives: The importance of clinical practice at the Bachelor Nursing Study Program. Medicus, 7(1), 52–62.

https://doi.org/10.58944/kpoy2458

Table of Content

By. Prof. Asoc. Dr. Voltisa LAMA Self-care is a means whereby people take much greater responsibility for their own health and refers to the activities that individuals, families and communities undertake with the intention of enhancing health, preventing disease, limiting illness, and restoring health. These activities are derived from knowledge and skills from the pool of both professional and lay experience (Adamsone et al., WHO 1983). Health education enhances the competence of self-behavior in the population and makes people more willing to get appropriate health professional services when needed. Nowadays culture and lifestyle play a major role in self-behavior. For example, excessive phone use by children and youths is decreasing their self-awareness of the importance of physical activity and maintaining a good body posture in favor of being comfortable and enjoying spending more time online using technology equipment. Making healthy lifestyle choices, avoiding unhealthy lifestyle habits, maintaining personal health regime, self-recognition of symptoms, self-monitoring, self-management, modeling good boundaries, taking care for physical and emotional balance and making responsible use of prescription and non-prescription medicines are core self-care responsibilities. Some of the articles in Medicus 7, Issue 1 journal are focused on the effects of health education. Text neck pain was a common symptom related to excessive smartphone usage among third-year students of the Bachelor programs at the European University of Tirana. Still, students were not self-concerned, as using technology as a means of common and trendy free time activity was very important for them. The main source of information for sex education turned out to be the Internet, according to a study that included 200 young people 18-23 years old. Another article focused on self-care in patients with chronic diseases tried to determine self-care maintenance, monitoring, and management, as well as the importance of the dyad patient-caregiver in the context of Albania. Health education in self-care is crucial as it would benefit from prevention and early management of illness and it would nourish healthy-oriented behaviour. Individuals are active agents in managing their own health and well-being (WHO, 2023). In the context of a safe, supportive, and educational environment that gives knowledge and accurate information, self-care gives power to individuals.

By. Lindita CIPA, Msc.. Maddalena De MARIA, PhD

Abstract

Background: Multiple chronic diseases mostly affect people over 65 years old, when age-related changes, complicated by physical, cognitive, and emotional problems accelerate functional decline. This increases the elderly population to a high risk of deterioration of their health condition and predisposes them to various chronic diseases. Objective: Patient self-care and the caregiver’s contribution to patient self-care is the main purpose of this study. Observation of the patient to reduce the burden of the disease and obtain better results for their life. Methods: Is a multicenter transversal study at zero time, the study provides for the administration of a validated questionnaire in the Albanian language and is addressed to a sample of 30 patient-caregiver dyads in the Albanian population, using specific tools to evaluate the management of the chronic pathology and the patient’s self-care skills and the caregiver care framework. Results: Patients were mainly male (53%) with an average age of 74 years. The average reported self-care for maintenance score was 57.63, for monitoring the score was 55.00 and for management was 59.11. For the caregivers, the most prevalent subjects were female (60%) with an average age of 60 years old. The average reported score for the contribution of caregivers at self-care maintenance was 47.08, at self-care monitoring was 55.00, and at self-care management was 59.00. Discussion: This study seeks to determine self-care maintenance, monitoring, management, and confidence by including sociodemographic and clinical variables to assess care outcomes in dyads in the context of multiple chronic conditions. Keywords: chronic illness, chronic disease, nursing care, self-care. How to cite: Cipa, L., & De Maria, M. (2023). Self-care in chronic diseases. the patient-caregiver dyad in the Albanian reality. Medicus, 7(1), 7–17.

https://doi.org/10.58944/rmxz4676

By. Kristi CELA, Phd(c), Esida HOXHA, Phd(c), Kujtim MULGECI, Msc

Abstract

Introduction: The use of a mobile phone is almost an essential activity for seven billion individuals in the world who currently own these devices. With an average daily usage time of seven hours, there is a risk for mobile phone addiction with individuals having a persistent desire and craving to use mobile phones which causes social and functional impairment. Purpose: The purpose of this study was to find a correlation between excessive smartphone usage and neck pain among university students at the European University of Tirana. Methodology: This is a cross-sectional study. The study was conducted during a period of 1 month, from January 2023 to February 2023 and the data was collected from the third-year students of the Bachelor programs in the European University of Tirana. The subjects were selected based on their response to participating in the study and 138 participants (n=138) volunteered to participate. Results: A weak correlation between phone time and neck pain was found with a Pearson correlation coefficient of 0.073, this correlation was not significant (sig value 0.197). Although there was a significant correlation (sig 0.001) between neck flexion angle and neck pain with a Pearson correlation value of 0.303. Non-parametric test analysis showed that we have differences on neck pain values across the two groups with female students experiencing higher level of pain than male students. Conclusions: As we are advancing towards digitalizing most of our daily activities smartphones have become an extended part of human beings. Regular neck posture correction and advice on how to properly position the neck while using smartphones should be taken into account. Keywords: Smartphones, pain, neck pain, back pain, students. How to cite: Cela, K., Hoxha, E., & Mulgeci, K. (2023). “Text Neck” Pain and Excessive Smartphone Usage Among Students. Medicus, 7(1), 18–28.

https://doi.org/10.58944/xfkb9949

By, Kujtim MULGECI, Msc, Kristi CELA, Phd(c)

Abstract

Introduction: Sex education relates to the dissemination of information regarding the human reproductive system, sexually transmitted diseases, pregnancy, childbirth, puberty, menstruation, and menopause. In Albania, sex education began to become part of the education system for the first time in 1995. Purpose: The purpose of this study is to determine the level of education for sexual health among young adults and to ponder upon the effects of current sex education available for them and the possibilities of improvement. Methods: The study included 200 subjects 72.9% female (n=146) and 27.1% male (n=54) with age range from 18 to 23 years old. Results: The main source of information for sex education turns out to be the Internet (53.8%). This form of education has had a considerable effect on the subject’s sexual life, as half of the subjects think this information is enough for them. 67% of the sample (n=134), think that they need more information regarding sex education. Regarding the knowledge about sexually transmitted diseases, it turns out that the subjects are more informed about HIV/AIDS (96%). They were less informed about condyloma acuminata, HPV, chlamydia, and syphilis. The most used protective method is the condom (66.5%), followed by emergency pills (11.2%) and oral contraceptives (7.6%). Conclusion: Sex education among young adults in Albania results promising, as this sample of young adults was knowledgeable about STT and protection. Keywords: sex education, sexually transmitted diseases, protective measures. How to cite: Mulgeci, K., & Cela, K. (2023). Sex education among Young Adults. Medicus, 7(1), 29–40.

https://doi.org/10.58944/xsvf4184

By, Prof. Dr. Bardhyl ÇIPI, Prof. Dr. Naim HALITI, Dr. Admir SINAMATI

Abstract

After the end of the war in Kosovo in 1999, forensic medicine examinations of Albanian victims began to be carried out, mainly by foreign teams, but a part of them also by two teams of forensic medicine doctors from Albania assisted by Kosovar forensic doctors. Methods: As it is known, forensic medicine is a science that is more involved than other disciplines in the events that occur in any period of time, having a close relationship with criminology (the science of the scientific study of criminal phenomena), where the latter receives data highly valued by forensic medicine. Precisely, in such a broad perspective, are also analyzed the forensic data of the cases examined by us. At the beginning of this study, the impressions of the situation in Kosovo after the war are given with pictures of the corpses killed by the Serbian army and paramilitaries, followed by the results of the examinations of many corpses or their remains by us during our stay there. Then some other forensic documents are analyzed, including the book: “Quai des ombres” (Paris 2012) by Professor Lecomte, director of the Medical Institute of Paris, in which, among other things, she shows her memories of the examinations she carried out, of the corpses of Kosovar victims immediately after the end of the Kosovo war. Results: From everything that was seen and examined by us, as well as from the analysis of other materials, the idea was reinforced that the tragic events that preceded the war in Kosovo can be considered as one of the most culminating points of the genocide murders to the Albanian people from its neighbors. But in contrast to all the previous genocidal murders, accurately proven by the numerous forensic examinations of the Albanian victims, the Albanian people reacted more decisively and persistently by creating the KLA (Kosovo Liberation Army) that fighted with the Serbian army and paramilitaries. On the other hand, these massacres were recognized and shocked the entire civilized world, especially the USA, which quickly intervened and freed Kosovo once and for all from the Serbian yoke. Conclusion: It is concluded that: Forensic medicine in its broadest sense constitutes very important evidence for the detection of genocidal murders. In the recent genocide against the people of Kosovo, the forensic evidence, undoubtedly invalidates forensic arguments of Serbia in an irrefutable manner, the completely unimportant, often even false, according to which the Albanians were who have killed the Serbs. Keywords: Kosovo, forensic evidence of genocide, Serbian genocide against Albanians of Kosovo, Kosovo war. How to cite: Çipi, B., Haliti, N., & Sinamati, A. (2023). Forensic medicine examinations of some Albanian victims after the end of the Kosova War of 1999. Medicus, 7(1), 41–51.

https://doi.org/10.58944/pfuq2820

By, Eduard KAPAJ, MD, Ervin TOÇI, MD, Dr. Sc, Sonila KAPAJ, MD, Arben MITRUSHI, MD, Prof. Asoc. Dr.

Abstract

Purpose: This study aimed to determine the level of smears inadequate for Pap test in a population of women in Fier Prefecture in Albania. Material and methods: This is a cross-sectional study including 1254 women who showed up for a Pap test at the gynecology service at the Fier Regional Hospital during 2013 and 2014. The women presented to our service either on their own initiative to perform the Pap test or were recommended by the family doctor for this examination. Standard criteria were applied to classify a cervical smear as inadequate for interpretation. Reasons for the inadequate taking of Pap smears are discussed. Results: A total of 234 patients (96.2% females) were included. The average age of women in our study was 39.8 years ± 10.7 (34.2% were 31-40 years old and 27.1% were 41-50 years old). Overall, 9.6% of the cervical smears were taken inadequately (there was a need to repeat the obtaining of the smear). Almost all materials were obtained from the exocervix and endocervix (in 98.1% of cases for which there is information on this variable). The absence of endocervical cells was the most frequent reason for classifying a smear as unsuitable for interpretation. Insufficient equipment, scarce material for cytological analysis and poor technical preparation can lead to the non-detection of abnormalities and errors in the microscopic analysis of smears. Conclusions: Each member of the team is responsible for the accuracy of the results, but also for the adequacy of the sample. Inadequate smears could lead to the need for repeat tests and increased health care costs. Regular internal control, work quality monitoring as well as continuous training of all experts involved in obtaining, storing and interpreting cervical smears could reduce the level of inadequate Pap smears. Keywords: Albania, adequacy, cervical cancer, cervical smear, Pap test. How to cite: Kapaj, E., Toçi, E., Kapaj, S., & Mitrushi, A. (2023). The level of inadequate pap smears collected by the Gynecology Service of Fier Regional Hospital in Albania. Medicus, 7(1), 63–71.

https://doi.org/10.58944/odvy1139

By, Msc. Selda SOKOLI (VEIZAJ), Phd Aida ZOTAJ (LAKO), Phd Process Esida HOXHA

Abstract

Non-specific neck pain is one of the common musculoskeletal problems that affects most working age. Non-specific neck pain causes problems as it relates to disability. Pain is the typical worrying sign for the patient. The prevalence is highest in middle age, with women being affected more than men. The prevalence of nonspecific neck pain varies, with a mean point prevalence of 7.6% (range 5.9–38.7%) and a mean lifetime prevalence of 48.5% (range 14.2–71.0%). Methods: The aim of this study was to perform a systematic review of the literature of the effectiveness of manual therapy and mobilization for non-specific neck pain. A literature search of PubMed and CINAHL was performed. Inclusion criteria included randomized controlled trials of manual therapy and mobilization interventions in acute neck pain. Like Outcomes were used pain relief, disability/function, (Disability) and patient satisfaction. The PEDro scale was used for quality assessment of eligible studies. Results: The search identified 29 articles and 6 full-text articles were assessed. Two studies met the inclusion criteria. According to the pedro scale the study of Ruud Groeneweg et al met all the criteria and was evaluated with 11 points. Conclusion: Both articular mobilization and manual therapy are effective in non-specific neck pain. In future studies, a larger number of studies should be taken into consideration to increase the level of reliability. Keywords: Non-Specific neck pain, RCT (Randomized controlled trial), reviews study, manual therapy, PEDro scale. How to cite: Sokoli, S., Zotaj, A., & Hoxha, E. (2023). The effectiveness of mobilization and manual therapy on non-specific Neck Pain – a literature review. Medicus, 7(1), 72–80.

https://doi.org/10.58944/pzlc7093

By, Dr. Sc. Dorina DERVISHI, MD. Blerina SARACI, MD. Sara ZAVALANI, Dr. Sc. Elvana RISTA

Abstract

Introduction: Ceftriaxone is a third-generation cephalosporin, which has a broad spectrum of activity against Gram-negative and Gram-positive bacteria. It can sometimes induce biliary sludge or stone formation because of the interaction with Calcium ions. The aim of this study is to describe the epidemiology of the side effects after ceftriaxone therapy in hospitalized pediatric patients and to follow up on the group of suspected Ceftriaxone-induced adverse effects. Methods: This prospective study was conducted in different Pediatric Services of the University Hospital Center “Mother Theresa”, Tirana, during the period October 2021-March 2022. We studied the ultrasonographic data of 80 patients admitted to these services, who had been on Ceftriaxone therapy. Results: All the females aged from 5-10 years old, and males aged from 6-12 years old, underwent ultrasound examination for other reasons and 21.25% of the cases resulted with pseudolithiasis, while 3.75% with nephrolithiasis. According to the total number of cases, 70.6% of them were asymptomatic. Only 29.4 % of the patients referred right upper quadrant pain and 1 of them showed nausea. The symptoms began from the 5th to the 7th day and lasted 20 days. The ultrasound imaging performed from the 5th to the 10th days after Ceftriaxone administration, showed gallbladder sludge and pseudolithiasis in the symptomatic patients, ranging from 8-12 mm, and renal microlithiasis <3mm. These patients were followed with an ultrasound exam after 1 month. Conclusion: From all pediatric patients treated with Ceftriaxone and followed with ultrasonography, 21.25% resulted with collateral associated gallbladder pseudolithiasis as a side effect from ceftriaxone therapy, found by ultrasonographic evaluation. None of the cases was complicated with gallbladder hydrops, pancreatitis or hydronephrosis. After the Ceftriaxone therapy was discontinued, the condition resolved spontaneously. Keywords: ceftriaxone, gallbladder pseudolithiasis, nephrolithiasis, ultrasound. How to cite: Dervishi, D., Saraci, B., Zavalani, S., & Rista, E. (2023). Ceftriaxone-associated side effect findings in children’s abdominal ultrasonography. Medicus, 7(1), 81–88.

https://doi.org/10.58944/lfgj6773

By, Feim Gashi PT, Cand PhD

EDITORIAL

The Chambers of Health Professionals in the Republic of Kosovo are independent organizations that present and protect professional interest of its own members, ensure high standards of the Code of Ethics and medical Deontology, promote and protect the activity of health professionals in public and private health institutions, as well as provide continuous professional education with the aim of providing health services and other services that are related with health care, with as high quality as possible. The Chambers of Health Professionals were founded based on the Law No. 04/L-150 Law on Professional Chambers. In total there are 5 Chambers of Health Professionals: Kosovo Doctors Chamber, Kosovo Chamber of Dentists, Kosovo Chamber of Pharmacist, Nurses, and other health professionals. Kosovo Chamber of Physiotherapist was founded in 2015, even though its full competences were delegated on 1st of January 2018. Until now there are 1020 physiotherapists that have become members of this Chamber and are licensed from this Chamber. The structure of the chamber consists of the organs of the chamber that includes the Parliament of the Chamber, The Councils, and commissions (temporary and permanent). The Councils of the Chamber are: • Leading Council of Kosovo Chamber of Physiotherapists • Supervision Council of Kosovo Chamber of Physiotherapists • Ethic Council of Kosovo Chamber of Physiotherapists The Commissions of the Chamber are: • The Commission of ethic’s matters of the KCHPT • The Commission of membership, licensing, and re-licensing of Physiotherapists in KCHPT • The Commission of continuous professional education of Physiotherapists in KCHPTH • The Commission of Specialized Education of physiotherapists in KCHPTH • The Commission of Budget and Finance in KCHPTH • The Commission of Solidarization and Mutual Aid in KCHPT All chambers of Health Professionals’ work are based on Law and Regulations. In accordance with them, those chambers own their own list of registration of: • The register of members of the Chamber • The register of licenses issued, and licenses revoked from the Chamber • The register of disciplinary measures imposed on Chamber members Kosovo Chamber of Physiotherapists – KCHPTH, towards the physiotherapists that have accomplish the terms and conditions according to Law of Chambers of Health Professionals provides these services: • Membership in the Chamber • License for the proper health profession by the proper Chamber • Re-licensing • Organizes trainings for continuous professional education such as congresses, conferences, workshops, round tables • Accredits the programs for continuous professional education • Facsimile Equipment from the Chamber • Equipment with Identification Card of the Chamber • Issues a certificate for the ethical professional past • Issues other certificates based on the request of members of the Chamber (for example proof that he/she is a member of the Chamber, a member of the assembly, etc.) The Chamber of the Physiotherapists of Kosovo, in 2019, became a full member of the World Physiotherapy, as well as the World Physiotherapy-Europe Region, where from the same year KCHPT works according to all the rules and standards in accordance with these organizations. Besides harmonizing all the regulations of the scope of Physiotherapy with the countries of the region, it is also doing the same with Physiotherapy World-Region of Europe, with the main purpose that a physiotherapist licensed in OFTK is equal with all the physiotherapists of the world. Us, as a Chamber, cooperating with the World Physiotherapy-European Region, through hard work have managed that starting from 2023, in our territory the level of the study will be raised from three-year of the studies to four-year Bachelor study system (240 ECTS). The main purpose of all this was that in this way it will be achieved the minimum Physiotherapy competencies recommended by World Physiotherapy. Besides this, our commitment has also been focused for the possibility of the creation of specializations in the field of physiotherapy, as well as the framing of physiotherapeutic services at the primary health level, which is a very big challenge for us, and we remain hopeful that we can achieve it very quickly with European standards. KCHPT, in addition to creating high standards for physiotherapists, also takes care to offer to patients an easy and innovative approach. Through technology, they can provide information on every licensed physical therapist in the city they live in, so they can have safer services. The Chamber of Physiotherapists of Kosovo has cooperation with the Chambers of the region and Higher Education Institutions that deal with the field of Physiotherapy, with which we are all open to continuous cooperation for the benefit of this profession.

By, Olvis PETRE, MD, Irma TASHI (BANI), MD, Jola HASANI, MD, Justi SHESTANI, MD, Silvana BALA, MD, Prof. Dr., Hasan HAFIZI, MD, Prof. Dr.

Abstract

Objective: This review’s purpose is to summarize the current state of knowledge on the systemic implication of chronic pulmonary obstructive disease Background: The ‘systemic repercussions’ of COPD are of great importance. These include accidental weight loss, skeletal muscle dysfunction, and a higher risk of cardiovascular disease, osteoporosis, and depression. Frequently affecting the patient’s health and prognosis, these extrapulmonary COPD characteristics demand thorough screening and proper management to give the most effective medical care. Methods: We conducted a search of papers describing COPD as a systematic disease on the MEDLINE database. Discussion: Local and systemic inflammation, oxidative stress, and changes in the neuro-humoral states are some of the likely candidate pathways by which these extrapulmonary complications of COPD are affected, even though the mechanisms for the association of COPD with systemic disorders have not been fully clarified. The processes and mechanisms behind the extrapulmonary symptoms of COPD will likely become more transparent with further research. Conclusion: COPD management should be based on a clear understanding of COPD-related comorbidities and their impact on COPD itself. How to cite: Petre, O., Tashi (Bani), I., Hasani, J., Shestani, J., Bala, S., & Hafizi, H. (2022). Chronic obstructive pulmonary disease: A view on comorbidity phenotypes. A literature review. Medicus, 6(2), 7–22.

https://doi.org/10.58944/vazq8669

By, Kristi ÇELA, Msc.

Abstract

Introduction: According to Institution of Statistics of Albania 75% of Albanian population lives and is considered a rural population. Based on studies for the general health of the population it is noted that rural and suburban population reports a lower prevalence for good general health compared to the population on urban areas. Even more specifically musculoskeletal issues are seen to have a connection with rural settings but the physiotherapeutic services are missing. Purpose: The purpose of this study is to establish the need of physiotherapeutic services on rural and suburban Albania based on the level of knowledge of this population for the medical services, benefits provided from physiotherapeutic interventions and the level of patients with musculoskeletal issues that have never received such services. Methodology: This study included 490 subjects, 230 males and 260 females from the age of 18 to 80+, all living and receiving medical services on similar settings and backgrounds. Results: 65% of the total population had suffered at least one musculoskeletal issue during the past 3 months. From 320 subjects that had these issues only 6% where recommended to visit a physiotherapist after visiting their local doctor. Only 49% of the whole population knew about physiotherapeutic services .91% of the population preferred to have access of physiotherapeutic services on their local health center and 81% claimed that traveling to urban areas was an extra expense for their health care. Conclusions: Based on the data extracted from the study Albania would benefit from providing public physiotherapeutic services in rural and suburban areas to promote public health for the population. This would give employment opportunities for younger physiotherapists and prevent the higher densities of professionists on a single area. How to cite: Çela, K. (2022). The need for public physiotherapeutic services in rural and suburban Albania. Medicus, 6(2), 23–33.

https://doi.org/10.58944/lvak5140

By, Rezarta STENA, Msc. Klara HYSENAJ, Msc. Armelda TETA, Msc. Esida HOXHA, Msc.

Abstract

Introduction: Scoliosis is a lateral deformation of the spine in the shape of the letter “S” or “C”, which can be located in different segments of it. Idiopathic scoliosis is the most common form encountered in 80% of scoliosis cases. Its nature or cause is not exactly known, so the classification is related to the age at which the deformity is detected. Purpose: Recognition and application of some specific physiotherapeutic methods as part of the international treatment of scoliosis which physiotherapists should include in their practices to improve the conservative management of adolescents with idiopathic scoliosis in Albania. Methodology: The study presents a theoretical-scientific overview, based on evidence. The search in the database PubMed, Google Scholar, Scopus, and guidelines of physiotherapy evidence included the period 2016-2022, using the keywords: ‘scoliosis’, ‘physiotherapy’, ‘Schroth technique’, and ‘Lion method’. Articles that were not in the English language were excluded. The basis for data processing for this study was 8 articles, which met all the criteria. Results: Specific physiotherapeutic methods proved to be very efficient in the latest studies by reducing the scoliotic deformity angle (Kob) by 5-10°, improving the posture with symmetry of the scapular and pelvic circumference, increasing the articular amplitudes of the back and improving the functions respiratory. Conclusion: All physiotherapists in Albania should know these methods from a theoretical-practical point of view and include them in their professional practices to improve the conservative management of adolescents with idiopathic scoliosis. How to cite: Stena, R., Hysenaj, K., Teta, A., & Hoxha, E. (2022). Recognition and evaluation of specific physiotherapeutic techniques in the conservative treatment of adolescents with idiopathic scoliosis. A literature review. Medicus, 6(2), 34–40.

https://doi.org/10.58944/ffzw5771

By, Iva RRUGIA, Msc.Sara ZAVALANI, MD

Abstract

Introduction: Type 1 Diabetes Mellitus (T1DM) is an autoimmune disease caused by an absolute deficiency of insulin because of the destruction of β cells islet of the pancreas. Aerobic exercise and diet are the two main points of diabetes treatment. Methods: The data for this study comes from un online survey of 50 people with health diseases, conducted between June 8 and July 12, 2021. More precisely, the data of our study are un mail-only data, with people selected randomly from a database maintained by B-Sport Plus Project. The database contains questions about physical activities in diabetic patients. Results: Among the 50 interviewers with type 1 diabetes, the largest age group covers those younger than 18 years old. 31% of the patients answered that health conditions limit their daily activity. 47% of them spent 1-2 hours on sports and recreational activities per day. 47% of the patients reported they do multiple sports activities, the others do leisurely walking (walking their dog), bicycling, skating, swimming and curling, gardening and light housework, dancing or other moderate exercise classes, weight training and running, brisk walk. 62% of them reported that they are willing to exercise 1-2 hours per day. 33% of the patients reported they do not participate in sport and recreational activities from lack of time, the others from financial constraints, family and friends influence, lack of self-confidence, illness/injury, problems with transportation. Conclusion Aerobic exercise can improve the sensitivity of Insulin, blood glucose and lipid metabolism, thereby reducing insulin dosage and improving glycemic control. WHO recommends at least 150 minutes of moderate physical activity per week. T1DM patients, physiotherapists or fitness trainer, kinesiologist and endocrinologist need to fully understand how the physical activity effect on metabolism and implement individualized aerobic exercise programs. How to cite: Rrugia, I., & Zavalani, S. (2022). Approach of physical activity in type 1 diabetic patients. Medicus, 6(2), 41–50.

https://doi.org/10.58944/jzyw2858

By, Bardhyl ÇIPI, MD, Prof. Dr.

Abstract

The preservation of secrecy occupies an important place for the respect of freedoms and human rights, which is also foreseen in the Albanian Constitution. In the Albanian Penal Code, several articles have been presented that punish the violation of the confidentiality of correspondence etc. This principle is also very important in medicine. In fact, in the last years, the risk of its violation has become greater due to the development of electronic media, computers, faxes, voice messages etc. Under these conditions, a new medical legislation has begun to be developed in many countries, for these issues. But the field of medical confidentiaity after death is not studied enough. It is important to know the different aspects of this issue in our country, because recently there have been many publications in our country, accompanied by discussions and criticisms, especially regarding the illnesses and deaths of some public figures. In this presentation, among others, some ethical, philosophical and legal data on this issue are analyzed, which are mainly related to the interests of the deceased person, the time that has passed since death, the negative impact of not saving medical data on his memory, followed by the presentation of some well-known cases etc. In conclusion, it is emphasized that medical confidentiality after death, especially that of a public person for our country, is a very delicate issue that requires great care in cases of its announcement. How to cite: Çipi, B. (2022). Medical confidentiality in general and that after the death of the patient. Medicus, 6(2), 51–62.

https://doi.org/10.58944/oqta1952

By, Ismet NIKA, MD, Dr. Sc.

Abstract

Gallbladder perforation occurs very rarely. The most frequent causes of this complication are: acute calculous gangrenous cholecystitis, and acalculous cholecystitis, but very rarely, perforation of the gallbladder may occur without obvious clinical and radiological signs of perforation of the gallbladder. Here I am describing the case of a 76-year-old woman. The patient was presented to the Emergency Department of Durres Regional Hospital with the diagnosis of acute generalized abdomen. The etiological diagnosis was established during the surgical intervention. This clinical case is rare, but it shows that this diagnosis should be taken into consideration by surgeons, in elderly patients who present acute generalized abdomen with unclear etiology in the preoperative period. How to cite: Nika, I. (2022). A case report of spontaneous gallbladder perforation in Durrës Hospital. Medicus, 6(2), 63–67.

https://doi.org/10.58944/hbpz9130

By, Fatjona KAMBERI, Prof. Asoc., Enkeleda SINAJ, Prof. Asoc. Dr. Brunilda SUBASHI, Msc. Glodiana SINANAJ, Dr. Sc.

Abstract 

The COVID-19 pandemic brought the social aspect of the nursing profession into even sharper focus. Nursing discipline is a social virtue that extends beyond only delivering care. Historiography has been impacted by social change. The objectives are to assess how society views professional nurses and to assist in explaining the nursing social component from the perspective of the relevant nurses. The methodology will be based on Grounded Theory, a design framework with sociological roots that is commonly employed in qualitative research. Expected outcomes will help to shape the future of nursing education and profession by identifying variables that define the social component of nursing and determining barriers and other profession-related determinants. How to cite: Kamberi, F., Sinaj, E., Subashi, B., & Sinanaj, G. (2022). Prospective research view on the Methodological Framework and protocol for Social Nursing Components. Medicus, 6(2), 68–80.

https://doi.org/10.58944/hnew5560

By, Dardan BAFTIU, MD, Erjona ABAZAJ, Prof. Asoc.

Abstract

Introduction: Nowadays the prevalence of obesity especially maternal obesity prevalence has increased substantially and provides a major challenge to public health. Besides that, weight gain during pregnancy may result in negative outcomes for women and neonatal. Objective: We evaluated maternal obesity prevalence and outcomes during and after pregnancy at the Regional Hospital of Ferizaj. Methods: A total of 258 pregnant females who delivered their babies at the Regional Hospital of Ferizaj between March 2018 and March 2020 were included in this study. Based on the body mass index (BMI) of maternal, the patients were divided into groups: underweight, normal weight, overweight, obese I, obese II, and obese III/ morbid obese. The effects of obesity on fetal and maternal outcomes were investigated. Results: Overall 258 pregnant women were included in our study, the average age was 28.7±3.4, with min age of 19 and a max of 41 years old. The prevalence of BMI over the normal weight among pregnant women resulted in 70.5% (182/258). Most of the maternal were overweight at 29.6% (54/182), obese class I at 27.5% (50/182), obese class II at 25.3% (46/182), and obese class III at 17.6% (32/182), with a significant association between them χ2=2.8, p<0.02. Adverse obese maternal effects and perinatal consequences or other problems were significantly more frequent than in normal-weight maternal. Besides that, in this study, the low-birth-weight infant rate was higher in the low BMI pregnant cases with a strong significant association (χ2=37.8 p value < 0.0001). Conclusion: The finding of this study conclude that obesity plays a significant risk factor and it is a strong association with complications in pregnancy and newborns. Further studies are recommended to explore the obesity problems to develop guidelines and strategies and to minimize the adverse effect of this risk for developing maternal and newborn complications. How to cite: Baftiu, D., & Abazaj, E. (2022). Assessment of maternal obesity and perinatal consequences. Medicus, 6(2), 81–88.

https://doi.org/10.58944/zwnb9780

By, Eduard KAPAJ, MD, Arben MITRUSHI, MD, Prof. Asoc, Ervin TOÇI, MD, Dr. Sc. Sonila KAPAJ, MD

Abstract

Purpose: Cervical cancer continues to remain a major concern for public health globally. The aim of this study was to determine the positivity level of the Pap test and the prevalence of cervical potentially pre-malignant and malignant lesions in a group of adult women aged 18 years and older in Fier Prefecture in Albania. Material and methods: This cross-sectional study included 1254 women who showed up for a Pap test at the gynecology service at the Fier Regional Hospital during 2013 and 2014. Basic socio-demographic data (age, place of residence, marital status)  as well as data related to women’s gynecological history, including information related to menopause status, current pregnancy, menstrual cycle (regular or irregular), data on previous diseases of the genital tract, previous cytological examinations, and previous biopsies was collected. Adequate cervical smears were interpreted, allowing the calculation of the prevalence of various cervical lesions. Binary logistic regression was used to identify factors associated with a positive Pap test result. Results: The average age of women in our study was 39.8 ± 10.7 years. About two-thirds of women resided in urban area, 99.1% were married at the time of the survey and 17.8% were in menopause. Only 1.8% of women had been subjected to a cytological examination in the past. Among the 1134 adequate cervical smears the level of positive Pap test result was 8.7% and the prevalence of LSIL, HSIL and ASC-US was 4.1%, 1.6% and 3%, respectively. No cases of squamous carcinoma were detected. Age was positively, strongly and significantly associated with a positive Pap result: compared to 21-30 years old women, those aged 31-40, 41-50 and >50 years were significantly 1.98, 6.09 and 14.07 times more likely to have a positive Pap test reading.  There was a tendency for the Pap test positivity to be higher among urban woman, probably due to earlier initiation of sexual activity and more sexual partners compared to rural women. Only 2% of women had had cytological examinations in the past. Conclusions: The prevalence of abnormal Pap test among adult women in Fier prefecture was relatively high even though comparable to national and international studies. There is need to increase the awareness of women about cervical cancer and their participation in cervical cancer screening programs. How to cite: Kapaj, E., Mitrushi, A., Toçi, E., & Kapaj, S. (2022). The level of pap test positivity and the factors associated with it among adult women in Fier, Albania. Medicus, 6(2), 89–101.

https://doi.org/10.58944/crpq4079

By, Ada SIMEONI, MD. Gertiana MULLALLI-BIME, MD, Dr. Sc.

Abstract

Introduction: Perinatal brain injury is the third leading cause of child mortality globally. Purpose: Evaluation of perinatal risk factors for encephalopathy in neonates in order to prevent deaths and disabilities Method: This is a prospective, case-control study conducted in the Maternity Hospital “K. Gliozheni” during the time period 2012 – 2016. 65 newborns at term ≥37 weeks diagnosed with encephalopathy according to the Thompson classification >5 within 12 hours of birth were compared with a control group, infants without encephalopathy in a 1:1 ratio selected casual and gender-appropriate. Results: Total antepartum risk factors were found in (70.8%) of cases and (18.5%) of controls (p<0.01). Sentinel events were found in 38.5% of cases and in 9.2% of controls. (p<0.01). Acute intrapartum events in total were found in (38.5%) of cases and (9.2%) of controls (p<0.01). 43.1% of babies had a combination of antepartum and intrapartum factors (p<0.01). Significant and independent predictive factors of risk for neonatal encephalopathy resulted: from maternal factors, mother’s age >35 years (p=0.03). Of the intrapartum factors: pregnancy with twins (p<0.01), hypertension/preeclampsia (p<0.01), non-reactive FHR before delivery (p<0.01). From intrapartum factors: breech birth (p=0.01), emergency cesarean section (p=0.01), meconial amniotic fluid (p=0.02), prolonged birth (p=0.01). Conclusion: Knowledge of perinatal risk factors associated with neonatal encephalopathy is essential for developing interventions to prevent neonatal death and disability. How to cite: Simeoni, A., & Mullalli-Bime, G. (2022). Neonatal encephalopathy in the term newborn. Medicus, 6(2), 102–111.

https://doi.org/10.58944/ijpm6621

By, Erjona ZOGAJ, Msc. Najada KALLASHI, MD, Dr. Sc. Vidi DEMKO, MD, Dr. Sc. Rushan MUHAMETI, MD. Marsela FERHATI, Msc. Ina TABAKU, Msc.

Abstract

Introduction: CT scan is a very important image modality for examining the patient due to information we receive from it in a very short time. Receiving high quality images is challenging but the evolution of the CT scan has helped the radiology technician a lot. In this article we are going to focus on metal reduction artifacts. In polytrauma hospitals, when orthopedic, neurosurgical, and surgical clinics are mostly with patients that have implant on them, having tools to reduce the artefacts from metals is crucial to not miss anything in regions around. Aims and Objectives: The aim of this article is to show the effectiveness of I-MAR as an important tool to use in patients with implant on, especially in thorax and neck regions. Material and methods: In this article, we are showing 2 study case images from 2 patients who received from our CT scan in radiology department of University Trauma Hospital. Siemens CT go. Top is a 128-slice scan with two beam sources. Conclusion: After comparing the raw dates images and images with I-MAR on, we concluded that I-MAR is a very useful algorithm to reduce artifacts. By using it we can receive more information about soft tissues around implant and the regions nearby affected by artifacts. Using this algorithm helps the technician receive a better quality image. How to cite: Zogaj, E., Kallashi, N., Demko, V., Muhameti, R., Ferhati, M., & Tabaku, I. (2022). The reduction of metal artifacts in Thorac and neck regions in CT Scan. Medicus, 6(2), 112–119.

https://doi.org/10.58944/aflg6610

By, Eneida HOXHA, MD, Somida KUKA, MD, Ledio COLLAKU, MD, Dr. Sc., Elvana RISTA, MD, Dr. Sc., Jorida DJAMANDI, MD, Jona MUSABELLIU, MD, Margarita GJATA, MD, Prof. Dr.

Abstract

Background: Embolic events are frequent and life-threatening complications of infective endocarditis (IE), related to the migration of cardiac vegetations. The risk of embolism is very high in IE, with embolic events occurring in 20-50%of patients. The brain and spleen are the most common sites of embolism in left-sided IE. Stroke is a severe complication and is associated with increased morbidity and mortality rates. Case presentation: A 73-year-old male presented to the Emergency Department, in May 2022 with right hemiparesis, aphasia and fever (38 0C). He reported a history of recurrent fever lasting two days. His pre-existing comorbidities included Diabetes Mellitus, Arterial Hypertension and Atrial Fibrillation on anticoagulation therapy with Acenocoumarole and INR levels within normal range. His past medical history was significant for an Aortic Valve Replacement, in September 2021 and a subsequent hospitalization in January 2022 with Prosthetic Valve Endocarditis. At the time, he presented with a recurrent fever up to 38.8 0C, no significant findings in the transthoracic  echocardiogram (TTE) and positive blood cultures for Enterococcus faecalis. It was started an antibiotic therapy. Laboratory and imaging studies in his latest admission revealed a cardioembolic stroke. Conclusion: Infective endocarditis can present with a wide variety of symptoms and early diagnosis can be challenging. Establishing the diagnosis early in the course of the disease would enable a prompt implementation of empiric antibiotic therapy, potentially preventing serious complications. Keeping a high index of suspicion when evaluating patients at high risk for IE, might lead to more favorable outcomes of major complications associated with it. How to cite: Hoxha, E., Kuka, S., Collaku, L., Rista, E., Djamandi, J., Musabelliu, J., & Gjata, M. (2022). Cardioembolic stroke at prosthetic valve endocarditis. Medicus, 6(2), 120–127.

https://doi.org/10.58944/zaoh3902

EDITORIAL The role and the importance of Kosovo Chamber of Physiotherapy on the improvement of physiotherapy profession …………………………………………………5 Feim Gashi PT, Cand PhD. Chronic Obstructive Pulmonary Disease: A View on Comorbidity Phenotypes. A literature review ……………………………………..7 Olvis PETRE, MD, Irma TASHI (BANI), MD, Jola HASANI, MD, Justi SHESTANI, MD, Silvana BALA, MD, Prof. Dr., Hasan HAFIZI, MD, Prof. Dr. The need for public physiotherapeutic services in rural and suburban Albania …….23 Kristi ÇELA, Msc. Recognition and evaluation of specific physiotherapeutic techniques in the conservative treatment of adolescents with idiopathic scoliosis. A literature review ………………………………………………………………………………………….34 Rezarta STENA, Msc., Klara HYSENAJ, Msc., Armelda TETA, Msc., Esida HOXHA, Msc. Approach of Physical Activity in Type 1 Diabetic Patients …………………………………41 Iva RRUGIA, Msc., Sara ZAVALANI, MD Medical confidentiality in general and that after the death of the patient ……………51 Bardhyl ÇIPI, MD, Prof. Dr. A Case report of Spontaneous Gallbladder Perforation in Durrës Hospital ………….63 Ismet NIKA, MD, Dr. Sc. Prospective research view on the methodological framework and protocol for social nursing components ………………………………………………………68 Fatjona KAMBERI, Prof. Asoc., Enkeleda SINAJ, Prof. Asoc. Dr., Brunilda SUBASHI, Msc., Glodiana SINANAJ, Dr. Sc. Assessment of maternal obesity and perinatal consequences ………………………………81 Dardan BAFTIU, MD, Erjona ABAZAJ, Prof. Asoc. The level of Pap test positivity and the factors associated with it among adult women in Fier, Albania …………………………………………………….89 Eduard KAPAJ, MD, Arben MITRUSHI, MD, Prof. Asoc, Ervin TOÇI, MD, Dr. Sc., Sonila KAPAJ, MD Neonatal Encephalopathy in the Term Newborn ……………………………………………..102 Ada SIMEONI, MD, Gertiana MULLALLI-BIME, MD, Dr. Sc. The Reduction of Metal Artifacts in Thorac and Neck Regions in Ct Scan …………112 Erjona ZOGAJ, Msc., Najada KALLASHI, MD, Dr. Sc., Vidi DEMKO, MD, Dr. Sc., Rushan MUHAMETI, MD, Marsela FERHATI, Msc., Ina TABAKU, Msc. Cardioembolic Stroke at Prosthetic Valve Endocarditis …………………………………….120 Eneida HOXHA, MD, Somida KUKA, MD, Ledio COLLAKU, MD, Dr. Sc., Elvana RISTA, MD, Dr. Sc. Jorida DJAMANDI, MD, Jona MUSABELLIU, MD, Margarita GJATA, MD, Prof. Dr.

Table of Content

by, Prof. Asoc. Dr. Voltisa Lama

Editorial

The clinical case report has a long-standing tradition in the medical (more…)

by, Dr. shk. Blertina DYRMISHI, Dr. shk. Elvana RISTA, Dr. Taulant OLLDASHI

Abstract

The thyroid nodules are frequent in the general population. The nodules are more prevalent in women and the prevalence of thyroid nodules increased with age and detection are increased in people who underwent thyroid ultrasound, even for diagnostic imaging unrelated to the thyroid. (1) Most thyroid nodules are benign and around 5% of all nodules are cancer. Approximately 90 % of thyroid cancer are differentiated thyroid cancers. Metastasis to the thyroid are rarely observed in clinical practice. The incidence of metastasis to the thyroid gland is 0.36 % in all thyroid malignancies. How to cite: Dyrmishi, B., Rista, E., & Olldashi, T. (2022). Metastatic renal cell carcinoma to the thyroid gland. Medicus, 6(1), 7–10.

https://doi.org/10.58944/jtcw1930

by, Dr. Lumturi MERKURI, Dr. Dorina DERVISHI

Abstract

Background: Although cancer is the disease for which people need palliative care the most, the number of diseases and conditions requiring palliative care has increased and will continue to grow. Palliative care improves health, reduces unnecessary hospitalization as well as overuse of health services. There are several barriers to palliative care access and the main are those related to the public such as: lack of public awareness on palliative care, on their benefits; cultural and social barriers. How to cite: Merkuri, L., & Dervishi, D. (2022). Knowledge, attitudes and behaviors of the community about palliative care. Medicus, 6(1), 11–18.

https://doi.org/10.58944/ruyj5628

by, Dr. Eneida HOXHA, Dr. shk. Elvana RISTA, Dr. Somida KUKA, Dr. shk. Ledio ÇOLLAKU, Dr. Jona MUSABELLIU, Dr. Ilir GJERMENI, Prof. Dr. Margarita GJATA

Abstract

Background: Antiphospholipid syndrome (APS) is an autoimmune disease characterized by recurring venous and/or arterial thrombosis and the presence of circulating antiphospholipid antibodies. APS occurs as a primary condition or secondary to other autoimmune disorders, mainly systemic lupus erythematosus (SLE). The diagnosis of APS is made on the basis of suggestive clinical findings and the presence of one or more of the following antiphospholipid antibodies (LAC, aCL antibody or aβ2GPI antibody present on two or more occasions, at least 12 weeks a part). A clinically significant aPL profile has been detected in approximately 30 % of patients with SLE. Case presentation: We are presenting a rare case of a 23 years old male with complaints of dyspnea, retrosternal discomfort, fatigue, general weakness, joint pain over a period of 3 months. The patient reported a single syncopal episode, 3 months prior to admission as his first clinical manifestation. He was at first diagnosed with Thrombocytopenia in 2007 and Systemic Lupus Erythematosus (SLE) in 2020. During his hospitalization, the patient experienced recurrent headaches, dizziness and episodes of elevated blood pressure (170/100 mmHg), as well. Moreover, laboratory and imaging examinations showed bilateral pulmonary thromboembolism and positive Anticardiolipin antibodies, positive ANA, positive SSA & SSB. Conclusion: Given the lack of typical clinical findings in the early stages of the disease, establishing a diagnosis of APS can be challenging. Although APS is one of the most common thrombocytopenias, unfortunately, it remains underdiagnosed. Clinicians should investigate for the presence of antiphospholipid antibodies, as early diagnosis may influence the course of the disease. How to cite: Hoxha, E., Rista, E., Kuka, S., Çollaku, L., Musabelliu, J., Gjermeni, I., & Gjata, M. (2022). Secondary antiphospholipid syndrome at a young male. Medicus, 6(1), 19–28.

https://doi.org/10.58944/iyyl9934

by, Msc. Remina KARRIQI

Abstract

Introduction: Cervical Spondylosis (SC) is the most common disorder of the cervical spine. Intervertebral discs can degenerate as a result of natural aging. Other degenerative changes include osteophyte formation, facet joint hypertrophy, longitudinal ligament calcification, and ligament flava thickening. Aim: The aim of this study is to show the different methods of physiotherapy used for the rehabilitation of cervical spondylosis and to compare among them the combined methods to see which of the methods is most effective in terms of relieving the main symptoms of cervical spondylosis. Methods: In this study we investigated 33 studies that have used different treatment methods of patients with cervical spondylosis. The elected studies ranged from 2002 to 2020. For this review articles have been taken from official sources like PubMed, Google Scholar, Medscape and Cochrane library. Results: During the analysis it was observed that the combination of different therapeutic methods is more effective than a single method. Combining exercise therapy with other methods seems to be the most effective program for relieving the symptoms that come from cervical spondylosis. Conclusion: We concluded that exercise therapy combined with other methods is one of the most effective methods in the rehabilitation of cervical spondylosis How to cite: Karriqi, R. (2022). Rehabilitation on cervical spondylosis. Medicus, 6(1), 29–38.

https://doi.org/10.58944/xelx5939

by, Msc. Arjet PERVIZI

Abstract

The way of building relationships and choosing a partner in life can not be something random between two people who decide to spend part of their lives together. Of course, many of our experiences in life lead us to certain choices. Sigmund Freud, the founder of psychoanalysis, goes further when he says that partner selection is determined by the early relationship between child and parent. Even Freud in his essay “On some neurotic mechanisms in jealousy, paranoia and homosexuality” (1922) says that “these jealousies take root in the depths of the unconscious, take back the earliest movements of infantile affectivity and originate from the Oedipus complex” (p. 217). The roots for this are found in the triangle of the child-mother-father relationship and the phallic stage where the child shows the most pronounced closeness to the parent of the opposite sex (all this a necessary and indispensable process). The way of expressing love between parents and consequently the expression as triumphant in front of the child with the word “I took mom/dad” can affect that in adulthood, the individual develops pathological behavior. Every behavior, from what we explained to the choice of the object of love, has its roots in early relationships. How to cite: Pervizi, A. (2022). Psychoanalytic view of neurotic forms of love object choice. Medicus, 6(1), 39–47.

https://doi.org/10.58944/jwfs6038

by, Msc. Alesia ÇELA

Abstract

Introduction: Hemophilia is a congenital X-ray disease associated with bleeding in which blood does not clot. It is categorized as a hemostasis problem. Hemostasis, the cessation of blood flow as a result of damage to a blood vessel, is normally divided into two processes, primary hemostasis and secondary hemostasis. In hemophilia, the secondary hemostasis (which results in the formation of a clot in the fibrin) is in this case broken. So, low coagulation is due to an abnormal protein plasma clotting abnormality in factors VIII and IX that are involved. Aim: The aim of this study is to show that combined rehabilitation based in exercises is more effective just a simple therapy to improve hemophilia and reducing the symptoms. Methods: In this review study 30 studies were obtained which have used different physiotherapeutic methods in the treatment of hemophilia A. The elected studies ranged from 2001-2019. The literature is based on official sources as Cochrane library, Pubmed, MEDLINE, DOAJ, Medscape, Clinical trial.gov, and some articles like is Official Journal of WFH , BMJ Open. Results: During the study it was observed that the combined physiotherapeutic rehabilitation had more efficiency than a simple treatment method. Conclusion: Physiotherapeutic rehabilitation with combined methods based on exercises gives better and positive results in the treatment of hemophilic patients. How to cite: Çela, A. (2022). Impact of physiotherapy in patients with hemophilia A. Medicus, 6(1), 48–62.

https://doi.org/10.58944/osmn6941

by, Prof. Dr. Pirro PRIFTI, Dr. shk. Ismet NIKA, PhD Indrit BIMI

Abstract

Poisoning due to lead occurs mainly by ingestion of food or water contaminated with lead. However accidental ingestion of contaminated soil, dust or lead based paint may also result in poisoning. Lead is thought to be quickly absorbed in the bloodstream and is believed to have adverse effects on certain organ systems like the central nervous system, the cardiovascular system, kidneys, and the immune system. How to cite: Prifti, P., Nika, I., & Bimi, I. (2022). Chronic lead poisoning problems – a literature review. Medicus, 6(1), 63–76.

https://doi.org/10.58944/tpdc3654

by, PhD Lutfi ALIA

Abstract

Fractal analysis is an objective approach that in oncopathology is one of the important fields of application. In this study is present fractal methodologies at histological level that have been successfully applied to characterize pathological features and able to perform differential diagnosis and prognosis in oncopathology. The basic principles and prospects of fractal geometry in pathology are promising. In particular, fractal analysis is emerging as a powerful tool to perform differential diagnosis and prognosis of patients in cancer and other malignancies as well to improve the effectiveness and safety of patient care. All fractal objects have Fractal Dimension FDs, commonly calculated with box counting. Morphometry, the measure of shapes of the structures, can be added to every imaging technique in order to obtain objective indexes. In this field, fractal analysis has been applied to histopathology, cytopathology, and electron microscopy with great success. Performing fractal analysis of tissue samples, it’s possible to make a differential diagnoses between the early stage of tumours and flogosis, or among the different types of Basal Cell Carcinoma, and different grade of Invasive Bladder Carcinoma, well as to investigate the subtle alterations of the nuclear patterns in human breast tumours, or to evaluate other tumours. How to cite: Alia, L. (2022). The application of the fractal analysis in oncopathology. Medicus, 6(1), 77–84.

https://doi.org/10.58944/xled6943

by, Dr. Juliana LAJTHIA, Dr. shk. Esmeralda META, Prof. Dr. Majlinda IKONOMI

Abstract

Pap test is already part of the successful examinations in the early detection of cervical cancer. The objective of this 1-year retrospective study (2019-2020), is to assess the importance of periodic Pap tests, the distribution of squamous and glandular anomalies, as well as determining the predominant categories for each anomaly, in 4123 cases of Hygeia hospital, in Albania. The age group 60- 69 years was with the most anomalies. 72.8% of women included in the study tested negative for intraepithelial lesion or malignancy. There was an increase in the positive percentage of Pap tests with epithelial cell abnormalities with increasing age group up to the age of 70 years (p <0.001). With epithelial cell abnormalities 97.7% of them were of squamous origin (ASC-US 86.2%) and 2.3% of them were of glandular origin. The Pap test should be a routine test for all sexually active young women, for early precancerous detection of the cervix. It is a valid, inexpensive, uncomplicated, noninvasive screening test for the detection of premalignant and malignant lesions of the cervix7. The American Cancer Society recommends that all women should begin screening for cervical cancer 3 years after the onset of coitus. How to cite: Lajthia, J., Meta, E., & Ikonomi, M. (2022). Screening for cervical cancer as an organized or opportunistic challenge. Medicus, 6(1), 85–91.

https://doi.org/10.58944/hgsx7129

by. Prof. Asoc. Dr. Voltisa LAMA Over the past almost two years the health system was focused to respond and resolve the COVID-19 pandemic. It is not yet the end of the pandemic, still, we need to see the future and learn how to adapt and how to equip the health system to respond more efficiently to possible other medical challenges in a new era. One of the topics of discussion is how will evolve medical care post-COVID. The COVID-19 pandemic is a global experience that tested the ability of national health systems to withstand health shocks while maintaining routine functions. The pandemic exposed long-standing gaps in the health system and further accelerated the crisis. The healthcare workforce faced with dedication the overload of patients in hospital and outpatient services. On the other hand, the people faced fear, uncertainty, illness and death, social disconnection, and economic difficulty. There have been lessons learned during the pandemic years and the pandemic had definitely changed the vision of healthcare’s future. There is a need to address several post-COVID challenges, firstly how to transition from COVID care to traditional healthcare services. People need the care of other pathologies, some of them newly emerged while the pandemic postponed preventative screening and medical appointments has hindered surgeries and delayed testing on biopsy tissue, as well as other chronic conditions which were placed in the secondary issues because coronavirus world health emergency took the first place. Despite medical and fatal complications attributed to coronavirus, clinicians noted that they resulted not only from the virus, but also from the coronavirus’s deteriorated effect on chronic and/or underlying undetected conditions which were specific to individuals. Secondly, there were variable effects of the SARS-COV-virus in patient groups with similar characteristics and this polymorphic nature of patients’ clinical course has inspired research about the molecular factors that contribute to disease progression and differentiated response in each individual patient. Humanity’s struggle with the coronavirus has fostered a new appreciation of the principles of personalized medicine, especially the value of diagnostic tools that could have helped target prevention strategies to at risk populations. Thus, the vision of the future is a personalized medicine approach, which holds promises of prediction, prevention and treatment of illnesses that is targeted to the needs of the individual. Despite the impact of the COVID-19 crisis it does present the healthcare system with an opportunity to redesign itself. The next decade probably will bring a medical care model transformation. By 2030, the primary focus of healthcare will shift from a “one size fits all” approach towards risk definition, patient stratification and personalized health promotion and disease prevention strategies, which are especially valued for aging societies. The technological advances in laboratory sciences and the data-rich era will lead to biomarker testing recommendations, disease screening protocols, and targeted therapies for patients into standard practices.

by. Dr. Genc NURJA & Prof. Asoc. Dr. Arsen SEFERI &  Dr. Artan SIMAKU

Abstract

The COVID-19 pandemic continues to prevail as a catastrophic wave infecting over 111 million people globally, claiming 2. 4 million lives to date. Aged individuals are particularly vulnerable to this disease due to their fraility, immune dysfunction, and higher rates of medical comorbidities, among other causes. Apart from the primary respiratory illness, this virus is known to cause multi-organ dysfunction including renal, cardiac, and neurologic injuries, particularly in the criticallyill cohorts. Elderly patients 65 years of age or older are known to have more severe systemic disease and higher rates of neurologic complications. Treatment of neurologic dysfunction of COVID-19 is based on existing practice standards of specific neurologic condition in conjunction with systemic treatment of the viral illness. The physical, emotional, psychologic, and financial implications of COVID-19 pandemic have been severe. Long-term data are still needed to understand the lasting effects of this devastating pandemic. How to cite: Nurja, G., Seferi, A., & Simaku, A. (2021). Covid-19 and neurologic complications in elderly patients. Medicus, 5(2), 7–14.

https://doi.org/10.58944/xvty2369

by, Dr. Elvana RISTA, Msc. Vilma CADRI, Msc. Kristi SALIAJ, Dr. Blertina OLLDASHI, Msc. Eneida HOXHA, Prof. Dr. Nestor THERESKA

Abstract

Hyperkalemia is a common finding in patients in hemodialysis and is typically classified as mild, moderate or severe. Severe hyperkalemia is a complex and life-threatening clinical entity, closely associated with increased mortality rates. It generally presents with ascending muscle weakness and paralysis, cardiac arrhythmias and specific ECG changes. Herein, we present the case of a 30-year-old patient with end-stage renal disease, on hemodialysis. He presents to his hemodialysis session with complaints of progressive weakness and paralysis of his lower extremities, palpitations and dyspnea. His last session was 5 days prior to his ER presentation, after having missed 2 sessions. Laboratory studies revealed a serum potassium level of 10.9 mg/ dL. Intravenous calcium infusion was administered urgently and subsequently underwent urgent hemodialysis. The next day he underwent another session due to the post-hemodialysis rebound effect, but on physical examination the lower limb paralysis had improved and normal, sinus rhythm was present. Considering its silent development and ambiguous clinical presentation, hyperkalemia should invariably be considered in patients with CKD presenting with cardiac and neurological symptoms. Reported cases of severe hyperkalemia with potassium concentrations higher than 10 mg/dL, as in the case of our patient, are sparse and represent rapidly deteriorating, life-threatening conditions, requiring emergent medical interventions to prevent fatal cardiac arrhythmias. How to cite: Rista, E., Cadri, V., Saliaj, K., Olldashi, B., Hoxha, E., & Thereska, N. (2021). Case report: A patient with extreme hyperkalemia beats all the odds. Medicus, 5(2), 15–22.

https://doi.org/10.58944/lqfc6472

by. Prof. Asoc. Dr. Voltisa LAMA

Abstract

Aims: There are few data concerning first signs and developmental trajectories of people with gender-variant behaviours and this paper aims to describe them in a clinical sample. Method: This paper presents a chart review of 44 children and adolescents assessed for gender dysphoria in Child and Adolescent Psychiatry and Psychotherapy, at the University Hospital Hamburg, Germany. I used information from these charts to reconstruct the course of cross-gender behaviour and identity in these patients from birth up to the time of assessment and organised it in a model. I looked into the pattern of development being representative of this sample and examined continuity/variability within individuals over time. Results: First signs at behavioural level appeared in most cases since the beginning and were consistently reported during preschool years (84%). A prior period of gender typical behaviour before onset of cross-gender behaviour was rare. Conclusion: A particular finding in this clinic based sample is that gender identity expressed around the age of 3-5 years was not reversed later in life. There was a common pattern of development in majority of cases: first signs in kindergarten age and strongly re-emergence around puberty, which might have implications in referral times of this group in the clinic. How to cite: Lama, V. (2021). A developmental model of gender identity course based on Hamburg sample of children with gender dysphoria. Medicus, 5(2), 23–34.

https://doi.org/10.58944/wyad5244

by. Prof. Dr. Bardhyl ÇIPI

Abstract

“DNA fingerprinting” through the taking of blood and other secretions of the human body is considered as one of the most revolutionary advances in forensic identification and is of particular interest to forensic medicine. Although DNA identification has to do with personal identity, it is possible to test the material for this examination, from respective laboratories, together with the DNA on the whole. In contrast to fingerprinting (the science of fingerprints, used in forensic practice to identify a person, since the early 1900s), the forensic use of DNA samples for identification requires more care because it risks compromising the privacy and individual freedoms. It is therefore necessary that these examinations strictly respect the ethical rules of consent and confidentiality. In our country, where DNA examinations for resolving criminal and civil cases have started to be performed by the scientific police institute, only after the 2000s, this type of examination was not provided in the 1995 Code of Criminal Procedure. Article 199 of this code only stated that in relation to blood sampling, it can be performed even without the will of the person, if there is no risk to health. Then in 2017, in an amendment of this code, in article 201/a, is presented the detailed procedure that must be observed for taking samples of blood and other tissues of the human body for performing DNA analysis, where first of all, the consent of the person to be examined must be respected, without excluding the possibility of taking them compulsorily. In this study, the authors, after the presentation of some features of DNA uses in forensic sciences, analyze in detail the important issue of consent and confidentiality, which reflect the principle of independence of the person in the fields of medical sciences, compared to that of consent and confidentiality in criminal matters, including that of DNA analysis. In conclusion, it is emphasized that the application in Albania of DNA analysis in criminal and civil cases requires great care in implementing the procedures set out in the relevant legislation, including the principles of consent and confidentiality in obtaining and storing their data respecting human rights and preserving human dignity. How to cite: Çipi, B. (2021). Legal, social and ethical analysis on compulsory DNA collection in the Forensic Sciences of Albania. Medicus, 5(2), 35–48.

https://doi.org/10.58944/mwxe8354

by. Prof. Dr. Pirro PRIFTI

Abstract

Introduction Shock Syndrome is an acute progressive circulatory insufficiency where the Heart is unable to circulate the blood in time unit, for supplying with O2 to the cells and to take out from them CO2 and other final and intermediate toxic metabolites. Shock is acute inadequate organ perfusion to meet the tissue’s oxygenation demand. Shock means the Acute suffering of cells and organ`s tissues of organism. The term refractory shock is applied when, in spite of apparently adequate therapy, the shock state continues. There are three types of refractory shock: Refractory (or Irreversible) shock, Refractory (Septic) shock, Refractory (Cardiogenic) shock (RCS). Diagnosis Evaluation should focus on the identification of the primary cause and reversible secondary contributors, such as hypovolemia, pump failure, or obstruction that is causing shock. Differential diagnosis must be done with: septic shock, vasodilatory shock and cardiogenic shock. Treatment Coronary PP > 50 mm Hg, Improve myocardial function, C.I. < 3.5 is a risk factor, 2.5 may be sufficient. Fluids first, then cautious pressors. Remember aortic DIASTOLIC pressures drives coronary perfusion (DBP-PAOP = Coronary Perfusion Pressure). If inotropes and vasopressors fail, intra-aortic balloon pump Temporary circulatory support with extracorporeal membrane oxygenation (ECMO). Sol. natrium bicarbonat 8.4% (PH ≤7.2). Recomandation Refractory shock which is mainly caused by cardiogenic shock and Septic shock are severe conditions which cause increased mortality in patients with such conditions. Advances in the treatment of these serious conditions have enabled the healing of these patients and the relative reduction of Mortality. How to cite: Prifti, P. (2021). Refractory shock. casuistics. Medicus, 5(2), 49–73.

https://doi.org/10.58944/vlww4764

by. Msc. Naim MEDIU, Dr. Ridvana MEDIU, Prof. Asoc. Dr. Ridvan ALIMEHMETI

Abstract

Introduction Colorectal cancer (CRC) is a multi-factorial disease with high malignancy, and the fourth leading cause of cancer death worldwide. This study was performed to assess the epidemiological, patients’ profile and clinic-pathological characteristics of CRC in Regional Hospital, Durres. Methods This is a retrospective study where being included all patients diagnosed with CRC at Surgery ward in Durres hospital from January 2016 to December 2020. A statistical software SPSS version 21.0 was used for data analyze. Results During five years of CRC cases investigation, a total of 136 patients were treated in regional hospital of Durres city. Of these, 97 (71.3%) patients had cancer of colon and others patients 39 (28.7%) had rectal cancer. Most of the patients (47%) resulted with left-side tumors and (24.3%) with right-sided tumors. Male with CRC resulted 62.5% and female 37.5% with ratio man versus female 1.66. The commonest symptoms were abdominal pain or discomfort 39.7%, diarrhea or constipation 27.9%, changing in bowel habits 16.9%, rectal bleeding and anemia 15.4%. About the stage of CRC, in stage I resulted 24.3% in stage II 42.6%, stage III 14% and stage IV 19.1%. CRC in descending colon and rectum were commonest in females (22.05%) while in males the ascending colon is the commonest (26%). Conclusion During this retrospective study, the cancer of colon cancer resulted more frequent versus or than rectum cancer. Males were the most predominant gender in this study and left side-tumors more frequently occurred on patients over 60 years old. We have found varied clinical presentation among our patients, but abdominal pain or discomfort and diarrhea or constipation were the commonest symptoms. Patients with CRC on the sate II has a predominance in number compared to patients diagnosed with other stages of tumors. How to cite: Mediu, N., Mediu, R., & Alimehmeti, R. (2021). Colorectal cancer, patient’s profile and clinical presentation in Albania. Medicus, 5(2), 74–82.

https://doi.org/10.58944/jkjl7662

by. Msc. Gjon PREÇI, Prof. Asoc. Dr. Iliriana ZEKJA, Prof. Dr. Jera KRUJA, Dr. Kilda GUSHA

Abstract

Introduction Depression is a prevalent mental healthcare problem and a common cause of disability worldwide. As people age, their physical and mental health conditions begin to deteriorate. Late-life depression affects about 6 million Americans ages 65 and older. The aims study was to evaluate the prevalence of depression and associated risk factors in older people living in Shkodra district. Methods This is a cross-sectional study based on a mental health screening among the elderly in Shkodra district. All elderly over 60 years who accepted voluntarily to coming in community center of mental health screening and to be part of this study were recruited for at least 3 years. A standardized questionnaire which measures depression and associated factors were filled for each of them. The software SPSS version 20.0 was used for data calculation. P-values less than <5% were taken as significant. Results Over all 138 patients with depression were conducted in this study, the average was 72}11.02std, with min age 61 years old and max 92 years old. Related to the severity of depression, as mild depression resulted 37.7% of participants, moderate 42.08% and severe 20.3%. Almost 42.7% of participant were male and 57.3% were female statistic significant between them p =0.03. Regarding the living area 65.9% living in rural area and 34.1% in urban area without significant association. A significant association were seen between age, gender and sedentary living and depression in multivariate analysis. Conclusion Older adults are more vulnerable and severely affected by the mental health especially the depression. Early recognizing of problem due to depression and motivation to participating for a healthy live after retirement may improve their mental life and of quality of life. How to cite: Preçi, G., Zekja, I., Kruja, J., & Gusha, K. (2021). Epidemiological profile of patients with depression in Shkoder, Albania. Medicus, 5(2), 83–91.

https://doi.org/10.58944/xvio9750

by. Msc. Kujtim MULGECI

Abstract

Introduction: Diabetes Mellitus is one of the leading causes of end-stage renal disease (ESRD) worldwide. Good glycemic control plays a key role in reducing the progression of macro and microvascular damage in patients on hemodialysis. Aim of the study: To investigate the prevalence of Diabetes Mellitus in patients with chronic hemodialysis. Evaluation of the prevalence of comorbidities such as Arterial Hypertension, Chronic Heart Failure and Neuropathy in patients with diabetes mellitus undergoing chronic hemodialysis. Methodology: This is a cross-sectional study involving 70 adult patients (age > 18 years) who underwent hemodialysis for at least three months, three times a week and who consented to participate in the study. The study was conducted for a period of one month, January-February 2021, at the Mother Teresa Hospital Center, Tirana, hemodialysis ward. Demographic data (gender, age), good quality HD, height, weight before and after dialysis, causes of kidney failure, other diseases such as Diabetes Mellitus, cardiovascular disease and neuropathy were obtained using medical records of patient records. Results: The study included 70 patients. Of them 65.7% were male. The mean age of patients treated with chronic HD was 52 } 15. The prevalence of Diabetic nephropathy in our study was 15.7%. In the group of patients where the primary disease for ESRD was Diabetes, the percentage of concomitant diseases was: Hypertension 10%, Chronic Heart Failure 10% and Neuropathy 5.7%. In the rest of the patients the percentage of concomitant diseases was: Hypertension 55.7%, Chronic Heart Failure 45.7% and Neuropathy 7.1%. Patients with DM had 6 months to 10 years of HD treatment time. Conclusions: We do not have a statistically significant relationship between the occurrence of diseases such as Arterial Hypertension, Chronic Heart Failure and Neuropathy and patients with DM treated with chronic hemodialysis. How to cite: Mulgeci, K. (2021). Diabetic patients on hemodialysis. Medicus, 5(2), 92–103.

https://doi.org/10.58944/byah5825

by. Luigi PIRTOLI MD, PhD, Lutfi ALIA MD, PhD, Simone ZACCHINI MD, PhD

Abstract

Who faces a neoplastic disease is more bewildered than in the past, in spite of the improvement of the possibility of cure and priority attributed to this subject by the health institutions and medicine, compared to few decades ago. Nevertheless, disorientation is increasing due to many factors, also beyond those of the scientific and welfare context of cancer and is related to the general background of crisis. The landscape of crisis involves the changes occurring in both epistemic and contextual values, and methodology of science at large, as well as those particular of the medical field, including oncology. The perceived ltoss of reliability of universal laws and the limits of general theories, in favor of the conception that elementary events concurr to outcomes, makes the scientific appraisal more probabilistic than deterministic. This framework of “complexity” is characterized by non-linearity in the causal links, opacity of the investigated subject, and emergence of the phenomena we observe and analyze. In oncological medicine, the present deterministic “gold standard” of the random comparative trials, grounding the so-called evidence-based medicine (EBM), and the guidelines for clinical management – although being the most reliable resource – are critically considered. In fact, new “systems biology” approaches. How to cite: Pirtoli, L., Alia, L., & Zacchini, S. (2021). Oncology and a time of crisis. science, complexity, ethic values, and incertitude. an argumentative essay. Medicus, 5(2), 104–117.

https://doi.org/10.58944/yecp1983

Table of Content

by, Najada KALLASHI, Erjona ZOGAJ

Abstract

Hybrid image is defined as the merging of two or more imaging technologies into a single, new image form. Typically, this new form is synergistic – that is, more powerful than the sum of its parts. Although some modalities of hybrid images can be used simply to describe anatomy, the most distinctive feature of hybrid images is its potential to show in vivo molecular processes within the anatomical context. Existing hybrid imaging modalities include ultrasound (US) / magnetic resonance imaging (MR), MR imaging/angiography, computed tomography (CT) / angiography, photon emission computed tomography (SPECT) / CT, and positron emission (PET) / CT. Most of these modalities have the potential to aid in the development of personalized molecular medicine. How to cite: Kallashi, N., & Zogaj, E. (2021). The importance of hybrid image. Medicus, 5(1), 5–11.

https://doi.org/10.58944/ezee7244

by, A. STRAKOSHA, A. DEDEJ, F. NASTO, S. LAKO, L. BERDICA, N. THERESKA

Abstract

Introduction and Aims C3 glomerulopathy include several rare forms of glomerulonephritis with underlying defects in the alternative pathway of complement cascade. It is characterized by predominant C3 deposition in glomeruli due to abnormal activation of the alternative pathway of the complement system. C3 GN has been reported to be associated with several systemic diseases. Methods we will describe a case presenting C3 GN in a patient with monoclonal gammopathy of renal significance (MGRS) Results A 61 years old man patient presented with gross hematuria, anemia, renal disfunction (creatinemia 2,4 mg/dl), proteinuria 814 mg/24 h. The patient was transplanted two years ago and he was taking corticosteroids, MMF, tacrolimus, and entecavir for hepatitis B . Serum protein electrophoresis; hypogammaglobulinemia with a small homogeneous spike-like peak. Serum Kappa free light chains 32,4 mg/dl, serum Lambda free light chains 9.3 mg/dl.Ratio 3,4. Autoimmune tests ANA, ANCA, Anti ds DNA C3 and C4 were negative.Urine Kappa Light Chains 26,4 mg/24 h,urine Lambda Light Chains 6,6 mg/24h.Urine Kappa/Lambda ratio 4. After consultation with hematologist results of the bone narrow biopsy came for monoclonal gammopathy, and the FISH conclusion is the presence of t(11,14)(q13,q32)which originated from IgH / CCND1 retraction and 1q21 acquisition. Renal biopsy is C3 glomerulopathy with mesangial and diffuse endocapillary proliferation under light microscope and diffuse deposition of C3 and no immunoglobulin under an immunofluorescence microscope. Conclusions Monoclonal gammopathy of renal significance MGRS is a term to describe a group of hematological disorders associated with kidney disease that fail to meet the standard definitions for MM or lymphoma. In such cases, the renal impairment is often linked to the underlying hematological disorder. The intention was to make a clear distinction between MGUS, a benign asymptomatic condition, and MGRS, which may be associated with significant morbidity and mortality. How to cite: Strakosha, A., Dedej, A., Nasto, F., Lako, S., Berdica, L., & Thereska, N. (2021). C3 glomerulonephritis in post transplanted patient with MGRS (a case report). Medicus, 5(1), 12–16.

https://doi.org/10.58944/unoz4007

by, MD. Amarilda Arapi, MD. Emiljana Toslluku

Abstract

The COVID-19 pandemic, is an ongoing pandemic caused by corona virus.It can lead to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).As of 9 March 2021, more than 117 million cases have been confirmed, with more than 2.6 million deaths attributed to COVID-19, making it one of the deadliest pandemics in history. As the pandemic evolves rapidly, there are data emerging to suggest that pregnant women diagnosed as having coronavirus disease 2019 can have severe morbidities (up to 9%). The aim of this article is to bring attention to all steps that should be followed in obstetric patients with positive COVID-19. This is a literature review, refering to international guidelines and international collegues experiences , especially from Wuhan and USA. In contrast to earlier data that showed good maternal and neonatal outcomes, the latest data suggest that pregnant woman can have severe morbidities. Exposure to virus predisposes both mother and fetus to an increased risk of infection and severe adverse maternal and perinatal outcomes. The anesthesia management of the patient with a suspected or confirmed COVID-19 infection presents a major challenge for anesthesia professionals because of the pathophysiologic and confirmed rapid human-to-human transmission of the virus through symptomatic and asymptomatic carriers. As with SARS and MERS, the most critical goal in the OR is to prevent cross-contamination by implementing stringent anesthesia guidelines and infection control strategies in the perioperative setting. Pregnant women with suspected or confirmed COVID-19 should be triaged and their condition categorized as mild, severe, or critical. Asymptomatic and mild cases should be isolated at home, and be taken care throw all the process until the day of the delivery. Severe and MOF patients should be taken care in the hospital by a multidisciplinary group. Vaginal delivery is recommended in stable patients because viral shedding and vertical transmission have not been reported. There are international recommendations starting to continuous CTG monitoring due to possible increased risk of fetal distress, monitor temperature, and respiratory rate. Under normal labor progression, vaginal examinations should be minimized. Neuraxial analgesia is not contraindicated, and by providing good analgesia, it may reduce cardiopulmonary stress from pain and anxiety. Although evidence of mother-to-child transmission is lacking, early cord clamping may be discussed with the patient. The patient could informedly decide on skin-to-skin contact with the newborn, ensuring precautions for respiratory droplets with the use of a mask as well as hand and skin hygiene. Cesarean section should follow usual obstetric indications. The potential risk of vertical transmission is not an indication for cesarean section. Because of pulmonary complications known in COVID-19, regional anesthesia is recommended unless there are no contraindication. Before neuraxial anesthesia must be done blood count test, especially to asses the platelet count. If general anesthesia is required , the anesthesia machine must be prepared with an HMEF between the circuit and the patient’s airway. The most experienced anesthesia provider should be dedicated to the intubation. The anesthetist should manage the pain, preferably with NSAIDS , the PONV using antiemetics and VTE prophylaxis. COVID-19 is highly contagious, and this must be taken into consideration when planning intrapartum care. Rational use of personal protective equipment is key in preventing infection in attending professionals. The first of all is “Primum non nocere’”, it should be done the best for the pregnant patient and for the newborn protecting the personnel. There are still limited data on the care and management of the parturient with COVID-19. It is paramount that our profession shares our experiences and practices to help guide our multidisciplinary approach in delivering the best care possible to these women. How to cite: Arapi, A., & Toslluku, E. (2021). Anesthesia management in obstetric patients with positive COVID-19. Medicus, 5(1), 17–28.

https://doi.org/10.58944/dcqi8299

by, Phd. Klotilda Vrenjo, Phd. Oltiana Petri, Phd. Esmeralda Thoma

Abstract

Hypocalcemia is one of the major health problems worldwide, as it causes a variety of diseases in the population such as Osteoporosis, Multiple Sclerosis, Renal diseases, Early breast cancer, etc. In Albania, there is a lack of checkups for any age group or category, as these checks are not provided for free by the state, but more importantly, people are not informed that there are important health examinations that must be carried out as early as possible, possibly since childhood, in order to be healthy adults in the future. Consequently, a great deal of work is needed to identify, as well as to draft national strategies to optimize consumption, as well as to set up a national database of adult calcium intake. This needs to be done simultaneously even for Mg, Na, K, and vitamin D. How to cite: Vrenjo, K., Petri, O., & Thoma, E. (2021). Review on the importance of the routine measurement of calcium in individuals engaged in sports. Medicus, 5(1), 29–32.

https://doi.org/10.58944/dlme5737

by, Leonard Molla, Krenar Preza, Artan Simaku

Abstract

Low back pain is one of the leading causes of primary care and emergency room visits and job-related disability in many countries [1]. Back pain is sorted into three categories, differentiated by the duration of symptoms. Acute back pain, which is the focus of this article, is classified as pain lasting 6 weeks or less, subacute back pain is pain that has been present between 6 and 12 weeks, and chronic back pain is pain that persists longer than 12 weeks. Etiologies of low back pain include (but are certainly not limited to) mechanical injury (e.g., muscle sprain or spasm, ligament strain, facet joint disruption), arthritis, sciatica (lumbar radiculopathy), spinal fracture, malignancy, connective tissue disease, infection (e.g., vertebral osteomyelitis, epidural abscess), cauda equina syndrome, metabolic causes (e.g., hyperparathyroidism), abdominal or retroperitoneal visceral or vascular processes, psychogenic pain, and malingering. Careful history-taking and physical examination are crucial to diagnosing the etiology of back pain. This review presents the current state of science regarding the diagnosis and treatment of low back pain. How to cite: Molla, L., Preza, K., & Simaku, A. (2021). Low back pain diagnostic approach. Medicus, 5(1), 33–38.

https://doi.org/10.58944/bcsf1353

by, Msc. Mimoza LLAVDANITI, Dr. Jetmira SHEHU

Abstract

Covid 19, a multisystem disease first reported in the state of China in December 2019, would soon be knocking on the doors of Europe. The main focus was the damage that SARS-COVID 2 brought to all systems and organs, but few would stop at the impact of this new stressor on the world of human psychology. The disease itself with its unknowns, limited tests, still experimental treatment, isolation and hygienic rules, stigma, job loss as well as the financial burden of the disease, are negative factors that accompany the disease. How to cite: Llavdaniti, M., & Shehu, J. (2021). Mental health and issues of psychiatric problems in patients with covid-19. Medicus, 5(1), 54–58.

https://doi.org/10.58944/hhlx7675

by, Msc. Kristi Cela

Abstract

Introduction: The prevalence and incidence of LBP are unchangeable almost every year worldwide, being described as a pain that causes instability and inability to work, disrupts the quality of life, and is the reason for more frequent medical visits. The purpose of this study:The purpose of this study is to identify and study the prevalence of nonspecific Low Back Pain among the Physical Therapy students of the Faculty of Technical Medical Science in the University of Medicine Tirana. Methodology: This is a Cross-sectional study. This study included 80 students (73 females and 7 males) of Physical Therapy on their Science Master Degree, first-year (n=42) and second-year (n=38). Students filled out a questionnaire and to be participants in this study they must fulfill some criteria defined by the study. Results: By the end of the study was discovered that the prevalence of nonspecific Low Back Pain among students was 73%. The mean value of pain intensity according to the Visual Analogue Scale was 3.77. Where 36% of the subjects experienced mild pain, 55% e moderated pain and 9% a severe pain. Disability according to the Oswestry Disability Index was 19% (minimal disability) Conclusions In conclusion according to this study Physical Therapy students in Albania have a high prevalence of Low Back Pain among them. Low Back Pain can be an occupational risk and may cause disability on this student group. Risk factors and the causes of Low Back Pain remain to be studied. How to cite: Cela, K. (2021). Prevalence of non-specific low back pain on physiotherapy students. Medicus, 5(1), 39–53.

https://doi.org/10.58944/duix6111

Table of Content

By Dr. Lumturi MERKURI, Dr. Marjeta DERVISHI

Abstract

HIV infection continues to be a global public health problem, despite advances in HIV prevention, diagnosis, treatment, and care. Data from the UNAIDS report, 2020, estimates that in 2019, globally 38 million people were living with HIV, and 690,000 people died of AIDS. The European HIV/AIDS Surveillance, 2019, shows that the number of new HIV cases has increased and HIV infection remains a problem in the European region as well. Epidemiological data of the Institute of Public Health, in Albania 2019, report 1298 cases of HIV infection with an increasing trend of cases. How to cite: Merkuri, L., & Dervishi, M. (2020). The epidemiological situation of HIV/AIDS in Albania. Medicus, 4(2), 5–12.

https://doi.org/10.58944/ssie9291

By, Nazmie Ceni, Renata Ceni, Astrit Bimbashi

Abstract

Vaginal birth after cesarean section (VBAC) describes a vaginal delivery in a woman who has given birth via cesarean section in a former pregnancy. Patients desiring VBAC delivery undergo a trial of labor (TOL), also called a trial of labor after cesarean section (TOLAC). While TOL is an accepted and generally safe practice, serious potential complications include uterine rupture or uterine dehiscence and associated maternal and/or neonatal morbidity. Providers caring for patients with prior cesarean section need to counsel patients regarding the potential risks and benefits of TOL and the factors which affect the likelihood of successful vaginal delivery. These providers must be knowledgeable regarding intrapartum management of patients undergoing TOLAC and able to recognize and appropriately manage potential complications. This activity reviews the evaluation and management of patients undergoing vaginal birth after cesarean delivery and highlights the role of interprofessional team members in collaborating to provide well-coordinated care and enhance outcomes for affected patients. How to cite: Ceni, N., Ceni, R., & Bimbashi, A. (2020). Natural birth after cesarean section. Medicus, 4(2), 13–19.

https://doi.org/10.58944/vens5905

By, Dr. Fatbardh Ramadani

Abstract

Type 2 diabetes has an insidious onset with a long latent period of dysglycemia. The incidence of diabetes mellitus today is epidemic. 90-95% of patients are patients with type 2 diabetes. The disease develops slowly, and has a long asymptomatic phase. Clinics are opened for 5-10 years. A patient with diabetes, due to complications of the disease, dies prematurely from his peers without diabetes. Evidence suggests that early detection of diabetes with appropriate screening methods, especially for people at high risk for diabetes, will help prevent or delay vascular complications and thereby reduce the clinical, social, and economic burden of the disease. Ideal screening models have not yet been found for early detection of the disease, for the detection of the stage of increased fasting glucose and the phase of impaired glucose tolerance. The final answers to the question have not yet been obtained: who will perform the screening, where will it be performed and how? How to identify risk groups? How to conduct screening in transitional family medicine? There is also evidence to suggest that intervention in the prediabetic phase is superior to the diagnosis of diabetes. The family doctors played a key role in the early detection of the disease. How to cite: Ramadani, F. (2020). Early detection of diabetes mellitus in transition countries – Kosovo. Medicus, 4(2), 20–25.

https://doi.org/10.58944/hfto2058

By, Prof. Dr. Aleksandër DHIMA Abstract This study deals with the achievements of medical anthropology, as one of the subdivisions of Anthropology, little or not known until now in Albania. It relies, first of all, on the health culture of the people and their social construct in relation to health, which is dictated – among others- by cultural norms and local decision-making institutions. The article further discusses the connections of Anthropology with medical practice, the areas of application of medical anthropology and the current agenda of its action. The second part is dedicated to the Anthropology of COVID-19. According to the author, this new pandemic has hit human populations, perhaps like never before, at least in terms of the extent shown by previous models and forecasts, changing their environmental balance. It brings the personal experiences of 15 medical anthropologists, who have researched specific aspects of the pandemic in different areas of the globe. Their involvement in the analysis of the facts so far and in terms of the socio-cultural response of different population groups to it deserves special attention, as well as the interaction of emergencies involving universal health care, climate change, and civil liberties. How to cite: Dhima, A. (2020). Contribution of medical anthropology in the treatment of Health Care. Medicus, 4(2), 26–36.

https://doi.org/10.58944/pete6027

By, Lutfi ALIA

Abstract

It is an urgent need to improve early diagnosis of ESCC, beacauses is one of most agressive cancer. The quantitative image analysis, can aid in the identification of ESCC. Despite much research effort, the major prognostic factor of ESCC remains the pathological stage of the disease as defined by the TNM classification, whereas tumour grading is of limited value in this respect, mainly due to its low reproducibility. A better means for disease prognostication based on improved understanding of the pathogenetic mechanisms is urgently required. Materials and methods: The material of the present study was derived from a series of 1876 oesophageal surgical specimens taken from a total of 700 patients, who underwent oesophageal resection for an invasive ESCC in Anyang Tumour Hospital, Henan Province of China. Among. The cases of ESCC, previously subjected to extensive testing for Human Papillomavirus (HPV) involvement and expression of p53 gene. All cases are analysed by histopathology and by in situ hybridisation (ISH) and PCR, and a group of 272 patients was randomly selected for analysis of the primary tumour, adjacent mucosa and regional lymph nodes, in the quantitative image analysis. All cases and HPV data were subjected to extensive univariate and multivariate analysis to disclose independent predictors of progressive disease. Results: For the analyses, the ESCCs were graded into two categories: well – moderately and poorly-differentiated. HPV DNA was detected in 116 (18.9 %) of the carcinomas by ISH and in 15.2 % by PCR. In univariate analysis, lymph node status was significantly (p < 0.01) predicted by the following nuclear parameters: nuclear area, G0/G1 ratio, HPV DNA status, integrated optical density (IOD), mean optical density (MOD) and S-Phase. In multivariate analysis, 6 variables remained as independent predictors of disease progression (p < 0.05 level), the three most significant ones being nuclear perimeter, nuclear roundness and equivalent diameter (p < 0.01). Conclusions: A series of quantitatively measured nuclear parameters seem to be a close correlation with ESCC differentiation and progression in univariate analysis and some of these variables proved to be significant independent predictors of disease progression in multivariate modelling as well. These data clearly advocate the use of quantitative image analysis in searching for additional prognostic factors of ESCC. How to cite: Alia, L. (2020). Morphological, Quantitative Image Analysis and molecular biology of oesophageal squamous cell carcinoma (ESCC), with special reference to tumor progression and human papillomavirus (HPV) involvement. Medicus, 4(2), 37–51.

https://doi.org/10.58944/jeyc1034

By, Prof. Pirro Prifti, Dr. Roland Shuperka, Sofiela Telo

Abstract

This Article shows real cases of patients with Pulmonary Cancer admitted and treated in University Pulmonary Hospital of Tirana `Shefqet Ndroqi` during three last years : 2013-2014-2015. All data are confirmed from Statistics division of University Pulmonary Hospital of Tirana `Shefqet Ndroqi`. All data are compared with international standard data of potential possibilities of causing Pulmonary Cancer by gas Radon, in Albanian population during these three years of study to the smoking and non-smoking people. Is known the importance of gas Radon to cause of Pulmonary Cancer to the smoking and non –smoking people. As for internationally standard data, Pulmonary Cancer is caused by gas Radon in proportion of 3 people about 1.000 to the contingent to the smoking people, and in proportion of 0.7 people about 1.000 people to the contingent of non-smoking people. All data extracted from statistics office of University Pulmonary Hospital of Tirana `Shefqet Ndroqi` during three last years : 2013-2014-201, are compared with 0.4 pCi/L(picocyri/liter) that is lowest level of gas Radon Concentration that can be potentially cause Pulmonary Cancer of 3/1000 to the smoking people and of 0.7/1000 non-smoking people This Article do presents differences about real patients with Pulmonary Cancer admitted and treated during years 2013-2014-2015 with Pulmonary Cancer can be caused theoretically in Albania population by Gas Radon to the smoking people and non smoking people. How to cite: Prifti, P., Shuperka, R., & Telo, S. (2020). The impact of radon gas on pulmonary cancer in Albania. Medicus, 4(2), 52–99.

https://doi.org/10.58944/lzvc3934

By, Željko Kaluđerović

Summary

In this paper, the author explores the reception of the non-human living beings in modern philosophical and practical approaches. The analysis is aimed at examining both the views of the representatives of classical anthropocentrism, as well as the theses of the representatives of various non-anthropocentric teachings. Anthropocentrism is, in short, a worldview that is based on Aristotle’s vision of man as a special being among other natural beings. Advocates of the questioning of the dominant anthropocentric perspective of the cosmos, on the other hand, are trying to establish the new relation by relativizing the difference between humans and non-human living beings, by attributing specifically human qualities and categories, such as dignity, moral status and rights, as well as feelings, memories, communication, consciousness and thinking to non-human living beings. Non-anthropocentrism, consequently, believe that it is necessary to relax the usual strict hierarchy among beings in nature, that is, the discrediting of animals in relation to man, and that within the applied ethics, alias bioethics, it is possible, even necessary, to establish the so-called “animal ethics”. How to cite: Kaluđerović, Ž. (2020). Bioethical consideration of the status of animals. Medicus, 4(2), 100–114.

https://doi.org/10.58944/syyv3802

Table of Content Medicus 4.1 Clinical Cases

By, Kristi SALIAJ, MD. Prof. Dr. Arben BABOCI, MD. Elvana RISTA, MD. Dr. Sc. Altin VESHTI, MD. Dr. Sc. Saimir KUCI

Introduction

Coarctation of the aorta is one of the most commonly encountered congenital heart defects (CHD), in the pediatric population. It is defined as a hemodynamically significant stenosis of the descending aorta, typically at the site of insertion of ductus arteriosus. It has an estimated incidence of 4-6 cases per 100,000 births, accounting for 5-8% of all congenital heart defects [1-4]. According to The New England Regional Infant Cardiac Program (NERICP), coarctation of the aorta is the fourth most common defect requiring surgery during the first year of life [5]. It can present as an isolated lesion or coexist with other cardiac or extra-cardiac congenital defects. The most common one include bicuspid aortic valve, patent ductus arteriosus, ventricular septal defect, mitral stenosis, berry aneurysms in the circle of Willis [6-8].  Clinical presentation is heterogenous, varying from asymptomatic to congestive heart failure, acute pulmonary edema and cardiogenic shock, depending on the degree of coarctation, the development of collateral circulation and age at presentation [9]. During the neonatal period patients may present with circulatory collapse and pulmonary edema, reduced or absent peripheral pulses, tachypnea, lethargy and progressive metabolic acidosis [9-13]. In early childhood, they present primarily with symptoms of congestive heart failure (CHF) including tachypnea, irritability, sweating, feeding difficulties and failure to thrive [9-13]. In adolescence and adulthood patients may be asymptomatic, presenting with non-specific symptoms including exercise intolerance, fatigue and cramps in the lower limbs, recurrent headaches, epistaxis, vertigo, tinnitus, high blood pressure and difference in blood pressure between arms and legs and reduced or absent peripheral pulses [9-13]. Treatment options for coarctation of the aorta include both surgery and catheter-based procedures. Several surgical techniques have been developed including extended resection with end-to-end anastomosis, prosthetic patch aortoplasty, subclavian patch aortoplasty, interposition grafting and extraanatomic bypass grafting [9-11,13-18]. Catheter-based approaches include balloon angioplasty and stenting. The choice is based on the age at presentation, the type of coarctation and the presence of associated anomalies, as well as other patient specific characteristics [9-11,18-23]. How to cite: Saliaj, K., Baboci, A., Rista, E., Veshti, A., & Kuci, S. (2020). Surgical management of coarctation of the aorta in the pediatric population: A Fifteen-Year experience. Medicus, 4(1), 5–14.

https://doi.org/10.58944/nxdt8964

By, Prof. Asoc. Dr. MD. Voltisa LAMA, MSc. Ortenca VISHA

Abstract

Introduction: Most homicide perpetrators in Albania (according to data from Tirana Central Prison Directory, 2015) were males (n=1170) and only 20 were females. Intimate partner homicides comprise the largest category of female-perpetrated homicide, 8 out of 20 female offenders were convicted because of intimate partner homicide. Aims: The present study examined the life experiences of Albanian women, who are serving prison sentences for killing their male intimates between 2010 and 2014. “We are here due to a damned minute!” said one of the women blaming the triggering event. Several psychosocial factors which are hidden can interact in chain of events that may extend back from a triggering event to long-term processes that began in their childhood. These case studies shed light on those direct or indirect factors contributing to the murder. Method: On July 2015 the convicted women responded to open-ended interview questions, providing narrative accounts of their personal experiences from childhood to the act of killing. Questions were related to childhood experiences, relations and possible support from their biological family, possible traumatic events, relations to former partners, family dynamics with the murdered partner and children, attitudes toward their duties in the family and children’s responsibilities, insight for the causes of murder, social systems they looked for help, their feelings, circumstances and motivational contexts of intimate homicide, as well as regret. Results: Our in-depth interviews revealed that there was a similar profile of female homicide offenders who killed their intimate partners: they grew up in harsh psychosocial circumstances during their childhood, most of them having some type of trauma, economically disadvantaged families, victims of abuse, undereducated, with limited opportunities and unemployed in the long-term prior to being incarcerated. The findings suggest that those psychosocial factors have played a role in the commitment of the crime. How to cite: Lama, V., & Visha, O. (2020). Narratives of Albanian female offenders who killed their intimate partners during 2010-2014. case report series. Medicus, 4(1), 15–28.

https://doi.org/10.58944/kdcc6046

By, Sara PJETRUSHAJ, Prof. Asoc. Dr. Erika MELONASHI

Introduction

The concept of “Trauma” is very popular, even among those who are unfamiliar with most psychological concepts. Although definitions may vary, the term usually refers to an experience or event, that causes distress to the person, to the point that it impacts their ability to cope and function, and can also cause intense psychological and emotional reactions, affecting their well-being (APA,2013). Trauma, including one-time events, but not limited to, not only leaves long-lasting and repetitive effects on the survivor but also affects everyone differently. According to the nature and type of trauma, and how it correlates with the personality of the individual who has experienced it, the way those effects manifest can be obvious, and can clearly impact cognitive functioning, in a way that we can clearly measure and diagnose it as Post Traumatic Stress Disorder (PTSD). However, trauma, might also be subtle and quiet, in cases where the symptoms do not specifically fall under the diagnostic criteria checklist, since these effects might be insidious, can be easily overlooked and, in turn, become destructive for the individual experiencing them (SAMHSA, 2014). The immediate reactions following the traumatic event are usually quite complicated and are shaped by the survivors’ personal experiences, and their ability to. How to cite: Pjetrushaj, S., & Melonashi, E. (2020). “Midsommar”: Unraveling the impact of early-life trauma through art. Medicus, 4(1), 29–41.

https://doi.org/10.58944/jono2775

By, Dr. Sc. Elton SPAHIU, Prof. Asoc. Dr. Ferdinand MARA

Abstract

School-age children’s health may be improved through physical education programs that include resistance training. Obesity in children has been linked to health issues like type II diabetes and hypertension. Designing and implementing efficient and useful therapies for the management of overweight children and who are prone to experiencing medical issues is a serious concern. Adults who are overweight generally embrace resistance training as a safe and efficient way to lose weight. Therefore, the aim of our study was to look into the effects of a 6-month resistance training program in overweight or obese children. Fifty children (n = 28 girls and 22 boys; mean age = 7.38 years) took part in a six-month periodical resistance training program 2 days per week. Body mass index (BMI), strength, anthropometric measures, and activity levels of subjects were assessed prior to and following the training program. No training injuries or severe muscular pain were reported at any point of the exercise regimen, although the individuals did experience substantial variations in height, weight, body mass index, and total fat mass. Substantial increases occurred in 1-rep maximal squat (72%), number of push-ups (80%), countermovement jump (10%), and static jump (9%). Although it is likely that some of the observed changes were the result of growth and maturation throughout the course of the research period, the data show that the resistance training program induced large and persistent increases in body mass index, measures of strength, and body fat. These findings indicate that the participant’s training program was well received by the participants and had a significant impact on their body mass index and strength. In youngsters who are overweight or obese, a periodic undulation program enhances strength, decreases body fat percentage, provides variety, and notably increases lean body mass. How to cite: Spahiu, E., & Mara, F. (2020). Effects of a 6-month resistance training program on Overweight Children. Medicus, 4(1), 42–52.

https://doi.org/10.58944/uhgg1154

By, Franceska DERVISHALIAJ

Abstract

Background: At the base of this study there is the rehabilitation of spastic tetraplegia observed in a pediatric setting. Spastic tetralgia is a severe form of cerebral palsy (PCI), including all four limbs and is characterized by rigidity or permanent contraction of the affected muscles. The latter is a persistent but not immutable disorder of posture and movement due to alterations in brain function due to pre-, peri- or post-natal causes before the growth and development of the central nervous system is completed. Objective: To demonstrate how a treatment of at least 6 months can give satisfactory results, even in pathological conditions such as tetraplegia. Attention is paid to treatment methods, and therefore to the rehabilitation of this pathology from the point of view of physio-kinesitherapy. Methodology: An investigation and an experimental study was conducted using interviews and treatments of referred patients 2-10 years old. The interviews were carried out with parents coming from Tirana and the suburbs. Data collected showed us the specific needs of each child living with the family and it was created a tailored rehabilitation plan for each of them. Results: Despite suffering from a severe condition, there have been significant improvements in the generic framework, especially on the activities of daily life, thus alleviating the difficulties these children are facing. The handling of each child with empathy and personalized care is needed to obtain satisfactory results. Conclusion: Results showed how all the children taken in charge had an improvement in their quality of life. Their communication and even collaborative skills have improved. How to cite: Dervishaliaj, F. (2020). Rehabilitation of spastic tetraplegia in pediatrics: Advantages of hydro-kinesitherapy. Medicus, 4(1), 53–62.

https://doi.org/10.58944/wwvz6561

By, Msc. Iva RRUGIA

Abstract

Introduction: The study on the analysis of the need for continuing education in Albania aims to approach its realism in Albania scientifically within the framework of the CME’s purpose. The study begins with an explanation of operational terms based on the existing theoretical framework, following the models of CME reality in the United States and European Union countries. Material and methods: The study has outlined some research questions related to the objectives of CME, how CME is implemented in countries where it is functional, what role QKEV (Quality Control of Continuing Education) plays in Albania, and what challenges CME must address. Results and discussion: Different professionals have different training needs regarding continuing education, which are evident in their clinical daily practice. These needs vary depending on their age, the institution they work at, years of experience, and acquired skills. Conclusion: There is still much to be done in continuing education, which means moving beyond the formal form of continuing education to have a direct impact on the professional growth of professionals and provide quality services for patients. How to cite: Rrugia, I. (2020). Analysis of the training needs of healthcare professionals (physical therapists, nurses, midwives) in Albania. Medicus, 4(1), 63–69.

https://doi.org/10.58944/bynr1457

By, MD. Esmeralda META, MD. Prof. Dr. Arjan HARXHI, MD. Prof. Asoc. Dr. Najada ÇOMO, MD. Migena QATO, MD. Ermira GOXHA

Abstract

Fever is one of the accompanying symptoms of HIV, mainly in the advanced stages of the disease, but its occurrence is related to a number of factors such as CD4+ Lymphocyte level, accompanying opportunistic infections; causative microorganisms ect. Fever accompanies HIV from the initial stage of the “acute retroviral syndrome” infection and during the evolution of the pathology towards the AIDS stage, even in IRIS. Fever-related opportunistic infections are divided into two groups by infectious or non-infectious causes3,4. In our study, we included 355 HIV-positive cases who had febrile episodes in different stages of immunodeficiency. In the HIV stage (to which we referred lymphocytes CD4+ over 500 cells/mm3, and without AIDS-related opportunistic infections) there were 39 cases. In the AIDS stage, there were 143 cases with a CD4 + level of 200-400 cells/mm3: pulmonary manifestations 85 cases, gastrointestinal 58 cases. With a level of CD4+ lymphocytes below 200 cells/ mm3 123 cases; pulmonary involvement 45 cases, intestinal 32 cases, CNS 11 cases, hematological.13 cases, disseminated 15 cases, FUO 7 cases. With CD4+ level below 50 cells mm3, 50 cases: non-Hodgkin’s lymphoma 9 cases. MAC 3 cases, TBC.19 cases, CNS lymphoma. 6 cases, retinal CMV 3 cases, Kaposi’s sarcoma 10 cases. How to cite: Meta, E., Harxhi, A., Çomo, N., Qato, M., & Goxha, E. (2020). Febrile syndrome in HIV positive patients. Medicus, 4(1), 70–76.

https://doi.org/10.58944/vthx4596

By, Msc. Fluturim NELA, Msc. Sulejman HAXHI

Abstract

Introduction: Requests for radiological examinations are the first step in selecting patients to undergo radiological examinations. The range of radiological equipment, protocols and examinations is very wide. Also, technological developments at very fast rates, as well as improvements in study protocols lead to innovations and updates in medical radiology. The starting point of this literature review study is our personal clinical experience, where we have often encountered requests for radiological examinations formulated without minimal clinical information. Purpose: This paper highlights the multifaceted benefits of having ample clinical information in order to select an optimal, widely accepted, and most importantly effective protocol to achieve the required imaging diagnosis. It is also of great importance for clinicians of various fields that their recommendations for radiological examinations can give the expected answers so that imaging diagnosis together with clinical and laboratory data reach an accurate diagnosis and optimal treatment for the patient. Methods: The selected sources were critically evaluated for their relevance and reliability in order to provide a complete perspective on the subject. The literature was selected on PUBMED and Medline. Results: From the several study groups that were engaged in finding data we found out that clinical information improved the accuracy of interpretation, clinical relevance, and confidence of reporting; however, reporting time was not substantially affected by the addition of clinical information. Conclusions: The findings of this literature review suggest that clinical information has a very positive impact on the correct selection of the examining protocol, on patient management, and most importantly on radiological reporting. It is in the best interest of radiologists and technicians to communicate the importance of clinical information as a very efficient tool for reporting examinations and to respond to radiological examination requests of referring clinicians as rigorously as possible. Further work is recommended to establish standards so that the requirements criteria for radiological examinations are specific, clear, and well-orientated across the wide range of examination techniques found in the diagnostic field. How to cite: Nela, F., & Haxhi, S. (2020). The importance of accurate clinical information in requests for Radiological Examinations: A comprehensive analysis. Medicus, 4(1), 77–83.

https://doi.org/10.58944/hlbz6867

Table of Content

by, Prof. Dr. Lutfi ALIA

Abstract

Difuse idiopathic pulmonary neuroendocrine cell hyperplasia (more…)

by, MD. PhD. Can. Sahadete SHALA, PhD. Lumturi MERKURI, MD. PhD. Can. Astrit GASHI,Msc. Can. Jehona LUTA

Abstract

Hypertensive disease in pregnancy is a group of high blood pressure (more…)

by, MD. Hodo CELO, MD. Altin GOXHARAJ, MD. Bledi CELO, Prof. Dr. Isuf KALO,

Abstract

Following the cessation in our country of the incidence and prevalence (more…)

by, Prof. Dr. Pirro PRIFTI

Abstract

Aim of this study is fast Recognition, Management of situation of (more…)

by, Prof. Dr. Bardhyl ÇIPI

Abstract

Cases of bad medicine by using wrong procedures have been (more…)

by, MD. Eglantina DEMA

Abstract

1.Preface: Menopause is defned retrospectively as the time of (more…)

by, MD. Daniela NAKUCI, MD. Erisa KOLA, PhD. Leart BERDICA, Prof.Dr. Mehdi ALIMEHMETI

Abstract

Background: Mycosis funguides (MF) is a rare malignant skin (more…)

by, MD. Fjona NASTO, MD. Arjeta DEDEJ, Prof. Dr. Nestor THERESKA,

Abstract

Te dialysis population have a risk 5-10 fold higher for developing (more…)

by, Dr. Lumturi MERKURI

Abstract

Public health is facing threats from diseases that are periodically (more…)

Table of Content

by, A. Ivanaj, A. Cili, A. Perolla, P. Pulluqi, E. Calliku T. Caja, E. Pepa, R. Roxhani, T. Dedej

Abstract

CAR T-cell therapy. A type of treatment in which a patient’s T cells (more…)

by, A. Cili, A. Perolla, E. Calliku, P. Pulluqi, T. Caja, A. Ivanaj

Abstract

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm (more…)

by, A. Cili, L. Lacej, E. Pepa, R. Tozharaku, A. Ivanaj

Abstract

Multiple myeloma (MM) is the major malignancy of plasma cells. (more…)

by, A. Çyrbja, T. Caja, A. Cili, A. Perolla, P. Pulluqi, E. Calliku, A. Ivanaj

Abstract

Mieloma Multiple është një hemopati malinje e karakterizuar nga një (more…)

by, A. Hate, A. Cili, A. Perolla, T, Caja, P. Pulluqi, E. Calliku, A. Pushi, A. Ivanaj

Abstract

Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma with (more…)

by, A. Perolla, P.Pulluqi, A.Ivanaj, E.Calliku, A.Cili, T.Caja

Abstract

In order to determinate an accurate order of nucleotides in our (more…)

by, A. Papa, A. Cili, P. Pulluqi, A. Perolla, T. Caja, E. Calliku dhe A. Ivanaj

Abstract

Leukemia Akute Limfoblastike eshte nje lloj tumori ne te cilin ndodh (more…)

by, Genta Smaja, A. Cili, T. Caja, P. Polluqi, A. Perolla, E. Calliku, and A. Ivanaj

Abstract

The incidence of acute lymphoid leukemia is increasing worldwide. (more…)

by, Albana A. Fico, Alban Ylli, Elizana Petrela, Bajram Dedja

Abstract

The most frequent diseases, which started to massively affect the health (more…)

Content

by, Prof. Dr. isuf Kalo

Abstract

Quality in health as a concept, as a demand and as a measurable (more…)

by, Prof. Dr. Eduard Kakarriqi

Abstract

The two “kingdoms” of medicine are community medicine (more…)

by, Prof. Dr. Flamur Tartari Md

Abstract

Congenital posterior urethral-perinal fistula is a rare anomaly of which (more…)

by, Dr. Maksim Gjoni

Abstract

Preeclampsia (PE) continues to be a serious complication of pregnancy (more…)

by, Prof. Asoc. Dr. Voltisa Lama

Abstract

Introduction: Chiari type I malformation has been described (more…)

by, Dr. Alma Cili, Prof. Dr. Arben Ivanaj

Abstract

Imatinib was the first signal transduction inhibitor used in a clinical (more…)

by, Dr. Qamil Dika, Prof. Dr. Isuf Kalo, Dr. Marsida Duli

Abstract

The private sector plays an increasingly important role in health (more…)

by, Dr. Marsida Duli, Dr. Qamil Dika

Abstract

Nowadays Chronic Kidney Disease (CKD) has increasingly come (more…)

by, Dr. Shefqet Deliallisi

Abstract

One hundred years ago, the application of the “Flexner” report (more…)