Introduction: Orbital fractures are among the most complex injuries managed by maxillofacial surgeons. While delayed surgical intervention can allow edema to subside and facilitate accurate anatomical assessment, it may also increase the risk of permanent complications, such as soft tissue fibrosis and impaired ocular motility. Case Presentation: We report the case of a 56-year-old male who sustained a left orbital fracture in a motor vehicle accident two months prior. The patient presented with persistent diplopia, hypoglobus, and telecanthus. CT imaging revealed displacement of both the superior and inferior orbital rims, along with inferior displacement of the orbital floor. Surgical correction was performed via a multi-approach technique: frontoethmoidal and upper eyelid crease incisions, intraoral maxillary vestibular access, and infraorbital incision. Reconstruction involved osteotomy and repositioning of displaced orbital segments, using titanium microplates and mesh pre-adapted to a 3D stereolithographic model for precision. The duction test confirmed restored ocular mobility intraoperatively. Results: Two weeks postoperatively, the patient reported resolution of diplopia and demonstrated full, symmetrical ocular motility. This successful outcome, with no further complications observed, underscores the effectiveness of our surgical approach. Conclusion: This case underscores the importance of early diagnosis and timely surgical repair in achieving optimal functional and aesthetic recovery in orbital trauma cases. Even with a late intervention, favorable outcomes can be achieved through meticulous anatomical reconstruction and advanced techniques such as stereolithographic modeling.
Rib fractures are one of the most common traumatic injuries and may result in significant morbidity and mortality. Despite growing evidence, technological advances and increasing acceptance, surgical stabilization of rib fractures (SSRF) remains not uniformly considered in trauma centers. Indications, contraindications, appropriate timing, surgical approaches and utilized implants are part of an ongoing debate. The present position paper, which is endorsed by the World Society of Emergency Surgery (WSES), and supported by the Chest Wall Injury Society, aims to provide a review of the literature investigating the use of SSRF in rib fracture management to develop graded position statements, providing an updated guide and reference for SSRF. This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of experts then critically revised the manuscript and discussed it in detail, to develop a consensus on the position statements. A total of 287 studies (systematic reviews, randomized clinical trial, prospective and retrospective comparative studies, case series, original articles) have been selected from an initial pool of 9928 studies. Thirty-nine graded position statements were put forward to address eight crucial aspects of SSRF: surgical indications, contraindications, optimal timing of surgery, preoperative imaging evaluation, rib fracture sites for surgical fixation, management of concurrent thoracic injuries, surgical approach, stabilization methods and material selection. This consensus document addresses the key focus questions on surgical treatment of rib fractures. The expert recommendations clarify current evidences on SSRF indications, timing, operative planning, approaches and techniques, with the aim to guide clinicians in optimizing the management of rib fractures, to improve patient outcomes and direct future research.
Background Healthcare workers (HCWs) are a priority group for coronavirus disease 2019 (COVID-19) and influenza vaccination. We evaluated sociodemographic and occupational factors, attitudes, and knowledge associated with the uptake of primary and booster doses of COVID-19 and seasonal influenza vaccines among HCWs. Methods Between February 2022 and February 2023, we administered a structured questionnaire to HCWs in 3 Albanian hospitals who were enrolled in a multiyear cohort study. The questionnaire assessed participants' knowledge, confidence, and attitudes toward COVID-19 and seasonal influenza vaccines, and included questions on COVID-19 and influenza vaccination history, perceptions of vaccine safety and effectiveness, and factors influencing vaccine decision-making. Results We included 1456 HCWs. Their median age was 44 (interquartile range: 33-53) and 77.3% were female. Overall, 20.7% were physicians, 47.0% nurses or midwives, and 21.5% support staff. In all, 93.6% received a COVID-19 primary vaccine series, 20% a COVID-19 booster, and 23.7% received an influenza vaccine in the 2022-2023 season. In the multivariable analysis, male HCWs were more likely to receive COVID-19 boosters (adjusted odds ratio [aOR] 2.08; 95% confidence interval [CI]: 1.55-2.80). However, they were less likely to receive influenza vaccines (aOR 0.69; 95% CI: .51-.95). Medical doctors were more likely to receive COVID-19 vaccine doses, while nurses had higher uptake of the influenza vaccine (aOR 1.87; 95% CI: 1.30-2.68). Confidence in the safety and effectivity of both vaccines was positively associated with vaccine uptake. Conclusions Among HCWs, primary series COVID-19 vaccine coverage was high, but COVID-19 booster doses and seasonal influenza vaccines were low. Findings related to age and sex differences among HCW groups with low vaccine uptake, as well as their knowledge and attitudes toward vaccines, should inform targeted strategies to improve COVID-19 and influenza vaccine uptake, particularly among younger HCWs, female HCWs, and nonphysicians.
Unhealthy diets, overweight, and obesity have become significant public health challenges, particularly among adolescents whose dietary patterns are shifting away from traditional Mediterranean diets toward increased fast-food consumption (FFC). Industrialisation, urbanisation, and globalisation have transformed food environments, making ultra-processed, energy-dense foods such as fast food more accessible and affordable than fresh, nutritious alternatives. A total of 296 adolescents aged 12–18 years participated in the study. Data were analysed using Partial Least Squares Structural Equation Modelling, integrating habitual automaticity, environmental cues, and contextual triggers alongside traditional TPB constructs. The results show that higher maternal education reduces the use of fast food as a meal replacement; however, it does not significantly impact overall consumption frequency, indicating that external social and environmental factors may outweigh parental influence. Moreover, FFC persists regardless of adolescents’ exposure to advertising or promotions, underscoring the habit-driven nature of this behaviour. These findings emphasise the need for habit-focused interventions rather than relying solely on traditional awareness campaigns to curb adolescent fast-food consumption. Given the influence of behavioural automaticity and contextual triggers, policymakers should prioritise systemic interventions that reshape food environments, ensuring that healthier, sustainable options become the default choice in schools, public spaces, and urban settings.
