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.

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.

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.

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

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

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.

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.

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.