The University of Medicine, Tirana (UMT) (Albanian: Universiteti i Mjekësisë, Tiranë) is a public university of Health and Medical Sciences located in Tirana, Albania.
BACKGROUND:Oral and ocular medications are frequently used in the treatment of allergic rhinitis (AR). As part of the update of the Allergic Rhinitis and its Impact on Asthma (ARIA)-EAACI guidelines, this manuscript presents the ARIA-EAACI 2024-2025 recommendations for oral and ocular treatments. METHODS:The ARIA-EAACI 2024-2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) evidence-to-decision framework. Several sources of evidence were used to inform panel judgements and recommendations, including systematic reviews, mHealth and pharmacovigilance data as well as a survey on costs. RESULTS:Eight guideline questions concerning oral treatments for AR and three questions concerning ocular treatments were addressed. These questions led to the recommendations. Overall, these questions concern the choice between different classes of medication. They also discuss the role of oral antihistamines (OAH), leukotriene receptor antagonists (LTRA), ocular antihistamines (OcAH) and ocular mast cell stabilisers. Four questions had not been previously evaluated in ARIA guidelines, while, for the other four, there was a change in the strength or directionality of the recommendations. Overall, these guidelines recommend using intranasal corticosteroids over OAH and using OAH over LTRA. Moreover, they suggest using OAH over OcAH and suggest being against adding LTRA to OAH. Finally, considerations for choosing between different individual OAHs are presented. CONCLUSION:This ARIA-EAACI 2024-2025 article supports patients, their caregivers and healthcare professionals in choosing oral and ocular treatments for AR. Decisions on treatment should consider the clinical variability of the disease, patients' values and the affordability of medications.
Menopause transition or perimenopause is the transitional period preceding menopause, marked by hormonal variability and menstrual irregularity. This period is associated with a wide range of clinical findings due to reduced levels of estrogen. The skin, in particular, is affected by the decline in estrogen, specifically 17β-estradiol and dehydroepiandrosterone, along with an increase in cortisol. The sudden onset of various menopause symptoms can be distressing for many women and significantly impacts their quality of life. The genitourinary syndrome of menopause, a typical result of hypoestrogenism, is characterized by signs and symptoms relevant to urogenital atrophy. In this discussion, we focus on the aesthetically relevant symptoms of perimenopause and the approach to management. Most of these findings, including hot flashes, rosacea flares, worsening skin quality with dryness, sagging, and increased wrinkling, dyschromia, hair thinning, and cellulite, can be effectively managed. The provider should be aware of the emotional changes that occur during perimenopause and ensure that patients have a healthy and balanced motivation for seeking treatment. We discuss valid treatment options such as hormone replacement therapy, minimally invasive procedures, and topical products, including the new dermocosmetic regimens. Because many of these treatments are geared toward maintaining results, consistency is paramount for achieving successful outcomes.
Background: Gossypiboma, the retention of a surgical sponge or gauze within a body cavity following an operative procedure, is a rare but clinically significant complication. It may manifest acutely or after a prolonged latent period, presenting diagnostic difficulties even with advanced imaging modalities. Case Summary: We report the case of a 26-year-old woman who presented with a two-week history of abdominal pain and distension, eight months after an uneventful cesarean section. Abdominal computed tomography (CT) with contrast identified a peri-umbilical mass (92 × 69 mm) with heterogeneous density and characteristics compatible with gossypiboma. Laparotomy was undertaken on the basis of this radiological suspicion; however, no retained surgical material was found. Instead, the operative finding was an inflammatory pseudotumor of the greater omentum, confirmed histopathologically as a chronic fibro-inflammatory process. The patient made an uneventful recovery and was discharged on postoperative day three. Conclusion: This case illustrates the considerable diagnostic overlap between gossypiboma and other intra-abdominal masses, particularly omental inflammatory pseudotumors. It underscores the critical need for interdisciplinary caution, rigorous intra-operative documentation, and strict surgical sponge-counting protocols to mitigate both clinical and medicolegal risks.
Abstract Background Risk stratification for angiographic coronary artery disease (CAD) in hemodialysis remains difficult. Methods We analyzed 49 hemodialysis patients undergoing coronarography (42 CAD+, 7 normal). CAD+ was any 1/2/3-vessel involvement; "Normal coronary artery" was negative. From the record we structured ischemic history (MI, PCI) and standard labs; continuous variables were standardized. Univariate screening used Fisher’s exact and Mann–Whitney U. Multivariable analysis used ridge logistic regression with 5-fold stratified cross-validation; discrimination by ROC/PR, calibration by Brier score/Hosmer–Lemeshow, and clinical utility by decision-curve analysis. Results The cohort was 67.3% male and 32.7% smokers; prior MI and PCI occurred in 57.1% and 63.3%, respectively. Smoking prevalence was 38.1% in CAD+ vs 0% in normals. Key continuous contrasts (median [IQR], CAD+ vs normal): • Dialysis vintage (months): 22.0 [4.5–105.0] vs 24.0 [2.0–24.0]; p=0.33; Uricemia (mg/dL): 7.65 [6.15–8.90] vs 5.90 [5.10–7.15]; p=0.038; Hemoglobin (g/dL): 10.70 [9.65–11.55] vs 10.90 [10.40–11.85]; p=0.579; Albumin (g/dL): 3.30 [3.10–3.70] vs 3.15 [2.92–3.38]; p=0.391; Calcium (mg/dL): 8.05 [7.55–8.85] vs 8.40 [8.10–9.12]; p=0.178 In the multivariable model, smoking, prior MI/PCI, higher uricemia, and longer dialysis vintage were associated with higher odds of CAD+, while higher calcium, and trends toward higher hemoglobin/albumin, were protective. The cross-validated model achieved ROC AUC = 0.93, with acceptable calibration and positive net benefit across clinically reasonable thresholds versus treat-all/none strategies. Conclusions In hemodialysis patients, ischemic history, smoking, uric acid, and dialysis vintage are key correlates of angiographic CAD, while higher calcium and better hematinic/nutritional markers trend protective. A penalized, cross-validated model provided strong discrimination (AUC 0.93), supporting these predictors for risk stratification pending validation in larger, balanced cohorts.
Abstract Introduction Pathogenic variants in the AIP gene are the most frequent genetic cause of familial isolated pituitary adenomas. Most germline AIP variants reported to date are point mutations or small insertions/deletions. Detection of large deletions, which are rare and probably underrecognized, needs appropriate techniques. Whether large AIP deletions are associated with a distinct clinical phenotype remains unclear, and this question is addressed in the present study. Methods A literature review was performed using major databases to identify all reported patients with pituitary tumours associated with large AIP deletions. These data were combined with unpublished cases from our AIP database. Demographic, clinical, hormonal and tumour characteristics were analysed and compared with published cohorts of patients with other pathogenic/likely pathogenic AIP variants. Results Twenty-five affected patients from 12 independent kindreds with large AIP deletions were identified. Median age at diagnosis was 19 years (range 10–46), with 60% male. Macroadenomas were present in 80% of patients, while growth hormone excess occurred in 84%. Comparison with large multicentre cohorts carrying other pathogenic AIP variants showed no significant differences in age at diagnosis, sex distribution, tumour size, hormonal phenotype or frequency of gigantism. As an illustrative example, we present an Albanian family with a novel exon 3–4 deletion associated with familial acromegaly. Conclusions Large AIP deletions do not show a clinically distinct phenotype compared with other pathogenic AIP variants. Recognition of familial cases and genetic testing are important for early diagnosis in at-risk relatives.
