Background: Foreign body aspiration constitutes a serious and potentially life-threatening emergency in infants and children. Delayed diagnosis and treatment can result in severe respiratory complications and mortality. Aim: To evaluate the clinical characteristics, diagnostic approaches, treatments, and outcomes of children with foreign body aspiration managed over a 20-year period in Albania. Materials and Methods: A retrospective review was conducted of 149 children who underwent rigid bronchoscopy for suspected airway foreign body aspiration at the institution from 2006 to 2015, and 230 children from 2015 to 2024. Demographic data, clinical presentations, referral patterns, diagnostic procedures, complications, and outcomes were analyzed. Results: During 2006-2015, foreign bodies were removed from the larynx, trachea, or bronchial tree in 105 children. The mean age was 23 months, and 60% of patients were male. A choking episode was reported in 51% of cases, resulting in immediate referral to the ENT service, while 49% initially presented to the pediatric service with symptoms such as cough, pneumonia, or asthma. Flexible bronchoscopy was performed first in the latter group. The overall complication rate was 19%, including emphysema, atelectasis, pneumonia, bronchiectasis, pyopneumothorax, and pneumomediastinum. The false-positive rate was 20%. Complications related to flexible bronchoscopy, such as laryngeal edema, hypoxia, and bleeding, occurred in 6% of patients. One death occurred in a child who presented in hypoxic arrest… Conclusion: Foreign body aspiration in children remains a medical emergency that requires rapid recognition and prompt intervention with rigid bronchoscopy. Delayed diagnosis is associated with increased complication rates and poorer outcomes.
Background: The vertebral arteries are integral to the vertebrobasilar system, contributing approximately 20% of cerebral blood flow and ensuring perfusion of the posterior brain and spinal cord. Anatomical variations such as hypoplasia and dolichoectasia may compromise posterior circulation hemodynamics and influence cerebrovascular risk. Objective: To investigate the prevalence, diameter, and gender distribution of vertebral artery variations and assess their potential clinical implications for posterior cerebral circulation. Materials and Methods: A retrospective observational study was conducted on 60 patients (25 females, 41.7%; 35 males, 58.3%; mean age 45.0 ± 12.0 years). Radiological evaluation included Magnetic Resonance Angiography, Doppler ultrasonography, and Computed Tomography. Vertebral artery morphology was classified as normal, hypoplastic, or dolichoectatic. Results: Hypoplasia was the most frequent variation. In females, hypoplasia was observed in 28.0% of left and 40.0% of right vertebral arteries. In males, it was present in 20.0% of left and 22.9% of right arteries. Dolichoectasia was more prevalent in males. These findings highlight gender-related differences and underscore the importance of vascular imaging in patients with posterior circulation symptoms. Conclusion: Vertebral artery variations are relatively common and clinically significant. Recognition of these variations is essential for accurate diagnosis, risk stratification, and management of cerebrovascular disorders involving posterior circulation.
Introduction: Mediastinal pathologies comprise a heterogeneous group of congenital, neoplastic, infectious, inflammatory, traumatic, and iatrogenic conditions affecting one of the most anatomically complex regions of the thorax. Due to the proximity of vital structures, including the heart, great vessels, trachea, and esophagus, their diagnosis and management remain particularly challenging. Recent advances in computed tomography, magnetic resonance imaging, positron emission tomography, histopathological classification systems, minimally invasive biopsy techniques, and thoracoscopic surgery have significantly improved the management and prognosis of mediastinal diseases. This review summarizes contemporary concepts regarding mediastinal pathology, emphasizing anatomical classification, imaging characteristics, histopathological diagnosis, and surgical management. Major disease entities include thymic epithelial tumors, mediastinal neurogenic tumors, mesenchymal lesions, and rare mediastinal conditions. The review integrates recent international literature and current guidelines together with a single-center surgical experience reported in an institutional series, including thymoma associated with myasthenia gravis, thymic carcinoma, neurogenic tumors, mesenchymal tumors, hydatid disease, vascular trauma, and rare postoperative complications. Conclusion: Mediastinal diseases encompass a broad and heterogeneous spectrum of pathological entities requiring individualized diagnostic and therapeutic strategies. Advances in imaging, histopathology, minimally invasive biopsy techniques, and thoracic surgery have significantly improved patient outcomes
Background: Wunderlich syndrome is an uncommon but potentially fatal clinical entity defined by spontaneous, non-traumatic renal or perirenal hemorrhage. It is most frequently associated with renal angiomyolipoma, particularly in patients with tuberous sclerosis complex (TSC), where lesions are often bilateral, large, and highly vascularized, predisposing them to rupture. Case Presentation: We report the case of a 30-year-old female with a known history of TSC who presented to the emergency department with acute right flank pain and signs of hypovolemic shock. Contrast-enhanced computed tomography (CECT) revealed a large right-sided perirenal and retroperitoneal hematoma with active contrast extravasation, originating from a ruptured renal angiomyolipoma. Multiple bilateral renal angiomyolipomas were also identified. The prompt use of advanced imaging facilitated rapid diagnosis and guided urgent management. Discussion: This case underscores the pivotal role of CECT as the diagnostic modality of choice in suspected Wunderlich syndrome, allowing precise localization of bleeding, assessment of lesion characteristics, and evaluation of hemorrhage extent. Patients with TSC require close radiological surveillance due to the elevated risk of angiomyolipoma rupture and life-threatening hemorrhagic complications. Conclusion: Wunderlich syndrome represents a rare but critical urological emergency, particularly in patients with TSC. Early recognition through contrast-enhanced imaging is essential for timely intervention and improved clinical outcomes. Proactive monitoring of renal angiomyolipomas in high-risk populations is imperative to prevent catastrophic events.
Background: Venous hypertension is a rare complication that occurs following the surgical formation of arteriovenous fistulas (AVFs) for hemodialysis. Clinical signs in its early stage may resemble cellulitis, ischemic steal syndrome, or thrombosis, thus complicate the diagnosis and lead to improper AVF maturation. Case presentation: A male patient aged 64 years with end-stage chronic kidney disease underwent left brachiobasilic AVF creation. He started developing swelling, edema, pain, digital cyanosis, and intermittent fever shortly after the operation. Although Doppler ultrasonography showed AVF patency without any signs of thrombosis or stenosis, the flow through the fistula was not sufficient for hemodialysis. Neither clinical treatment nor time could solve his symptoms and improve the maturation of the fistula; hence, the use of a temporary central venous catheter became necessary. Methods: This paper is a focused PubMed literature search aiming at identifying studies that discuss postoperative venous hypertension as well as complications involving AVFs. Present clinical presentation was compared with those discussed in selected articles. Results: Persistent venous congestion, cyanosis, and poor AVF maturation strongly suggested postoperative venous hypertension despite preserved thrill and Doppler-confirmed patency. Surgical ligation performed eight weeks after AVF creation resulted in rapid resolution of swelling, cyanosis, and pain. Conclusions: Early postoperative venous hypertension should be suspected in patients with persistent swelling, cyanosis, pain, or failure of AVF maturation, even in the absence of thrombosis or critical stenosis. Prompt recognition may prevent prolonged morbidity and unsuccessful vascular access outcomes.
Introduction: The integration of smartphone technology into Emergency Medical Services (EMS) represents a paradigm shift in prehospital care, offering novel solutions to enhance clinical decision-making and operational efficiency. However, the implementation of these mobile health (mHealth) tools remains inconsistent, particularly in resource-constrained settings. Objective: This literature review examines the utilization of smartphones in EMS, evaluating their impact on remote consultations, data access, and inter-agency communication while identifying critical barriers to adoption. Methods: Employing a qualitative approach, this study utilized content analysis and a desktop review of journal articles and book chapters published between 2020 and 2024. Results: The review highlights significant benefits, including improved patient outcomes, streamlined workflows, and enhanced coordination between EMS personnel and receiving hospitals. Furthermore, smartphones demonstrate considerable potential for continuous professional development through virtual simulations. However, widespread integration is hindered by systemic challenges, including infrastructure deficits, organizational resistance, inconsistent training, and data security vulnerabilities. These issues are particularly acute in rural and underserved regions. Conclusion: To fully realize the potential of smartphones in EMS, stakeholders must prioritize the standardization of operational protocols and investment in robust infrastructure. Additionally, developing comprehensive training frameworks is essential to ensure equitable access, mitigate security risks, and optimize the effectiveness of smartphone-based tools in prehospital care.
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.
Background. Ischemic (hypoxic) hepatitis, the “shock liver” of the emergency setting, follows a fall in hepatic oxygen delivery, usually from cardiac, circulatory or respiratory failure, and produces a steep but short-lived rise in liver transaminases. Severe primary hypothyroidism is a classic yet easily forgotten cause of a reversible low-output circulation, and it can present first in the liver. Case report. A 65-year-old man with no known thyroid disease presented to the emergency department with severe hypotension (60/40 mmHg) and bradycardia (45 beats/min) and marked hepatocellular injury (aspartate aminotransferase, AST, 1643 U/L; alanine aminotransferase, ALT, 819 U/L), with a minimally raised troponin and acute kidney injury. Lactate dehydrogenase was disproportionately elevated (LDH 1279 U/L; ALT-to-LDH ratio 0.7) and creatine kinase was markedly raised (CK 2946 U/L), while synthetic function was preserved. Viral serology was negative and the liver was structurally normal. As blood pressure recovered, the transaminases fell rapidly and the AST-to-ALT ratio reversed (from 2.0 to 0.3 by day 6). A coarse voice present for several weeks prompted thyroid testing, which showed TSH 80.371 mU/L, suppressed free hormones and anti-thyroid peroxidase antibodies of 848.77 IU/mL, establishing Hashimoto’s thyroiditis. Both the circulation and the liver recovered with fluids and levothyroxine. Conclusion. In an obtunded, bradycardic, hypotensive patient with marked transaminase elevation and no viral, autoimmune or toxic explanation, severe hypothyroidism should be considered early. The ALT-to-LDH ratio and the reversal of the AST-to-ALT ratio help identify an ischemic mechanism, a markedly raised creatine kinase signals a coexisting hypothyroid myopathy contributing to the AST, and a single thyroid-stimulating hormone can redirect the entire differential.
Background: Tetralogy of Fallot (TOF) remains the most common cyanotic congenital heart disease and a cornerstone of congenital cardiology. While advances in surgical repair have dramatically improved survival, the condition increasingly presents as a lifelong clinical challenge characterized by evolving complications and ongoing care needs. This review aims to synthesize current evidence on contemporary management strategies and long-term outcomes in patients with TOF, with particular focus on surgical approaches, late complications, and lifelong follow-up. Design and Data Sources: A narrative literature review was conducted using a structured search of PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2016 and 2026. Eligible studies included clinical cohorts, registry analyses, systematic reviews, meta-analyses, and international guidelines addressing TOF management and outcomes A thematic narrative synthesis approach was applied to integrate findings across heterogeneous studies. In total, 36 studies met the inclusion criteria and were included in the final synthesis. Results: Despite excellent survival after repair, long-term morbidity remains significant, driven by right ventricular dysfunction, pulmonary regurgitation, and arrhythmias. Management is individualized, with cardiac magnetic resonance central to follow-up. Neurodevelopment and quality of life are increasingly recognized, while disparities in access to care continue to influence outcomes. Conclusion: TOF should be regarded as a chronic condition requiring coordinated, multidisciplinary, and lifelong management. Optimizing long-term outcomes will depend on improved risk stratification, timely intervention, and equitable access to specialized care.
Background: Acute coronary syndrome (ACS) remains a major cause of morbidity and mortality. Beyond conventional risk factors, non-conventional lifestyle and psychosocial exposures may contribute to adverse coronary and vascular phenotypes. Objective: To evaluate the association of selected non-conventional exposures with ACS and to examine their relationships with structural vascular/adipose imaging markers. Methods: We conducted a case–control study including 300 participants (150 ACS cases and 150 controls without ACS confirmed by coronary angiography or coronary CT angiography) at the University Hospital Center “Mother Teresa”, Tirana (2024–2025). Physical activity, sleep duration, dietary pattern, alcohol use, and psychosocial factors were compared between groups, alongside epicardial adipose tissue (EAT), pericardial adipose tissue (PAT), and carotid intima–media thickness (CIMT; right and left). Results: Cases were older than controls (66.1 ± 10.7 vs 57.4 ± 10.9 years) and more frequently male (74.7% vs 66.0%). Physical inactivity, short sleep duration, high-fat dietary patterns, and higher alcohol intake were more common among cases (all p < 0.001), whereas Mediterranean diet adherence was markedly lower. EAT and CIMT (right and left) were significantly higher in cases than controls (all p < 0.001), and PAT was also higher among cases (p = 0.004). Conclusions: In this Albanian cohort, ACS was strongly associated with modifiable non-conventional exposures—particularly short sleep, low physical activity, and unhealthy diet—and with adverse vascular/adipose imaging phenotypes. These findings support integrating key lifestyle and psychosocial factors alongside structural markers in regional cardiovascular risk profiling.
Background: Urinary tract infections (UTIs) remain among the most prevalent bacterial infections encountered in urology, yet the escalating burden of antimicrobial resistance (AMR) has significantly complicated both empirical and targeted therapeutic strategies. Patients undergoing surgical interventions with prolonged urinary catheterization represent a particularly vulnerable subgroup, often predisposed to resistant infections. Aim: This study aimed to characterize the frequency, microbiological spectrum, predisposing factors, and treatment outcomes of resistant UTIs in surgically treated patients at the Clinical Hospital of Tetovo, and to contextualize these findings within comparable international cohorts. Materials and Methods: A retrospective observational analysis was conducted on 164 patients (140 men, 24 women) operated between January 2021 and January 2026. Clinical records, urine cultures, and antibiograms were reviewed. Statistical analyses included proportions with 95% confidence intervals (CIs) and chi‑square/Fisher exact tests, with significance set at p < 0.05. Results: Resistant uropathogens were identified in 24/164 patients (14.6%; 95% CI 10.0–20.9%). Extended‑spectrum β‑lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae predominated, accounting for approximately three‑quarters of isolates. Multidrug‑resistant Pseudomonas aeruginosa and carbapenem‑resistant Enterobacterales were also observed. All affected patients had prolonged catheterization. Comorbidities were frequent, including cardiovascular disease (62.5%), diabetes mellitus (33.3%), and renal impairment (12.5%). Conclusions: Resistant UTIs are a clinically significant challenge in surgically treated urology patients, strongly associated with catheterization, prior antibiotic exposure, and recurrent infection. The microbiological and risk‑factor profile aligns with international data. Rigorous culture‑guided therapy and catheter management remain pivotal in achieving favourable outcomes, underscoring the need for robust antimicrobial stewardship in modern urology.
Background: Medical students are exposed to intensive academic schedules, high stress, and irregular daily routines, which may affect lifestyle behaviors. Unhealthy diet, low physical activity, inadequate sleep, and high stress can impair physical and cognitive performance and increase the risk of accidental injuries due to fatigue. This study aims to assess lifestyle behaviors and health risk factors among medical students in Tirana and to examine their potential implications for academic performance and injury risk. Materials and Methods: This was a descriptive-analytical, cross-sectional, observational study including 213 students from the University of Medicine in Tirana. Data were collected through a structured online questionnaire (Google Forms). Descriptive statistics summarized sample characteristics, while Spearman’s correlation and logistic regression were used to examine associations between variables. Statistical significance was set at p ≤ 0.05. Results: A total of 213 medical students participated, with a mean age of 20.2 ± 1.5 years and mean BMI of 22.6 ± 3.4 kg/m². Breakfast skipping (35.2%), insufficient fruit and vegetable consumption, insufficient sleep (≤6 h/night, 60.6%), and high academic stress were common. Only 24.9% reported daily physical activity. Health-promoting behaviors clustered together, with physical activity positively associated with regular breakfast, adequate sleep duration, and daily fruit consumption (p < 0.01). Conversely, unhealthy dietary patterns and insufficient sleep clustered and were linked to adverse health outcomes. Logistic regression confirmed physical activity, fruit consumption, and adequate sleep as protective factors (p ≤ 0.05). Conclusions: Unhealthy lifestyle behaviors are common among medical students in Tirana. Irregular meals, poor dietary quality, low physical activity, and insufficient sleep may impair cognitive and physical performance and increase the risk of negative health outcomes. Targeted interventions and a purpose-built campus promoting healthy eating, exercise, and stress management are recommended to support student well-being.
Introduction: While SARS-CoV-2 infection is known to impact maternal health, the effects of infection timing during pregnancy on maternal and neonatal outcomes remain less well understood. This study investigates the impact of SARS-CoV-2 infection timing during pregnancy on maternal and neonatal health outcomes. Materials and Methods: Medical records of 254 women with SARS-CoV-2 infection treated at the "Queen Geraldine" University Hospital of Obstetrics and Gynecology were reviewed retrospectively. Participants were categorized into four groups by gestational age at infection: under 22 weeks, 22–27 weeks, 27–37 weeks, and 37–42 weeks. Outcomes assessed included miscarriage, fetal death, preterm birth, and neonatal birth weight. Results: We found that the time of SARS-CoV-2 infection during pregnancy had an impact on the health of the mother and the baby. Early-onset infection (under 22 weeks) was linked to significantly higher rates of spontaneous abortion (31.3%) and fetal death (9.4%) (p<0.001 and p=0.017, respectively). Preterm birth occurred in 46.7% of pregnancies, and infection timing also influenced neonatal birth weight. Conclusion: The timing of SARS-CoV-2 infection during pregnancy is a critical determinant of maternal and neonatal health. Early pregnancy infection increases the risk of complications, indicating the need for enhanced monitoring and individualized care strategies.
Introduction: Vaccination remains one of the most effective and cost‑efficient public health interventions, dramatically reducing childhood morbidity and mortality from vaccine‑preventable diseases. However, the global immunization landscape has recently been challenged by pandemic disruptions, misinformation, inequities in access, and resurgent outbreaks. The Aim is to synthesize current evidence on the health and societal impact of pediatric vaccination, examine determinants of vaccine hesitancy, and highlight future perspectives for immunization programs. Methods; A narrative review was conducted, integrating epidemiological data, modelling studies, and recent reports from WHO, UNICEF, and peer‑reviewed literature. Particular attention was given to trends in coverage, disease resurgence, and behavioral determinants of vaccine confidence. Results: Routine immunization has averted an estimated 154 million deaths since 1974, predominantly in children under five. Yet, in 2024, 14.3 million infants received no vaccine doses, and measles re‑emerged in multiple countries, threatening elimination status. Vaccine hesitancy was strongly influenced by misinformation, sociocultural factors, and trust in health systems. Evidence underscores that resilient health infrastructure, equitable access, and credible communication by frontline providers are essential to sustain progress. Conclusions: Scientific advances alone cannot secure immunization gains. Strengthening public trust, addressing behavioral determinants, and ensuring equitable delivery are critical for the future of pediatric vaccination.
Background. Varicocele is the most common surgically correctable cause of male infertility, yet the choice of surgical technique remains a matter of ongoing debate. Open (Ivanissevich-type), laparoscopic, and microsurgical subinguinal approaches each carry distinct profiles of recurrence, hydrocele formation, postoperative pain, and recovery. We report a small, single-centre comparative experience and place it within the contemporary evidence base. Methods. Between January 2024 and January 2026, 16 male patients (aged 18–46 years) undergoing varicocele repair at the Clinical Hospital of Tetovo were studied. Eight were treated with a laparoscopic technique and eight with a conventional open technique. Outcomes recorded were intra- and postoperative complications, postoperative pain, hydrocele formation, time to full recovery, and varicocele recurrence. Results. No complications were recorded in the laparoscopic group; one patient in the open group developed a postoperative haematoma. Postoperative pain was clearly lower after laparoscopy, and full recovery was shorter than after open surgery. No hydrocele was observed in either group. A mild recurrence occurred in one laparoscopic patient and in one open patient, the latter being more pronounced. Conclusions. In this limited series, laparoscopic repair was associated with less pain and faster recovery than open repair, with comparable short-term safety. These observations are consistent with the broader literature, in which microsurgical subinguinal varicocelectomy currently shows the lowest recurrence and hydrocele rates and is regarded by many andrology centres as the surgical reference standard. The small sample size precludes firm conclusions, and larger comparative work is needed.
Background: Epistaxis (nosebleed) is a common clinical condition that is often managed with simple first-aid measures. With the increasing use of online platforms such as YouTube, many individuals rely on video-based content for medical guidance. However, the accuracy and reliability of such information remain uncertain. Objective: This study aimed to evaluate the quality, reliability, and accuracy of YouTube videos related to the treatment of nosebleeds. Methods: A cross-sectional observational study was conducted by analyzing 150 videos identified using the keywords “nosebleed treatment,” “epistaxis first aid,” and “how to stop a nosebleed.” After applying inclusion and exclusion criteria, 120 videos were included. Data extracted included views, duration, and source of upload. Videos were categorized as uploaded by healthcare professionals, medical institutions, or laypersons. Quality and reliability were assessed using the DISCERN score and Global Quality Scale (GQS), while accuracy was evaluated using a checklist based on established clinical guidelines. Results: The mean DISCERN score was 2.8 ± 0.9, indicating moderate reliability, and the mean GQS score was 3.1 ± 1.0, reflecting average educational quality. Videos produced by healthcare professionals demonstrated significantly higher quality scores (p < 0.01). Correct recommendations such as leaning forward and applying nasal compression were present in 62% and 58% of videos, respectively, while only 40% specified the appropriate duration of compression. Notably, 30% of videos included incorrect advice, particularly recommending head tilting backward. Conclusion: YouTube videos on nosebleed management show considerable variability in quality and accuracy. While professional sources provide more reliable information, a substantial proportion of videos contain misleading or incomplete guidance. Greater involvement of healthcare professionals and improved content regulation are needed to enhance public health education.
Background: Psoriasis is a persistent immune-driven skin disease shaped by environmental and psychological triggers like infections, stress, and climate. Beyond its physical toll, psoriasis deeply disrupts daily life, straining social connections, family bonds, and professional pursuits. Psychiatric conditions, particularly depression, frequently accompany it, affecting up to 30% of patients. Case Report: We share the story of a 24-year-old woman battling chronic plaque psoriasis, whose condition resisted topical treatments and led to deepening depression. Through a collaborative approach blending dermatological care and psychiatric support, including systemic methotrexate and antidepressants, she experienced remarkable progress both physically and emotionally. Conclusions: This case powerfully illustrates the heavy psychological weight carried by those with chronic plaque psoriasis. It calls attention to the urgent need for integrated dermatological and mental health care, ensuring patients receive truly comprehensive support.
Introduction: Posterior perforated duodenal ulcer penetrating the hepatoduodenal ligament is an exceedingly rare and technically demanding surgical emergency. The intimate proximity of the portal vein, proper hepatic artery, and common bile duct often renders standard perforation closure impossible, necessitating alternative strategies. Case Presentation: We report an 86-year-old man who presented with diffuse bile peritonitis secondary to posterior duodenal perforation penetrating the hepatoduodenal ligament. Conventional intraoperative exposure failed to identify the perforation site. On-table gastroscopy was performed and successfully localized the defect, guiding primary suture closure. Pyloric exclusion with gastrojejunostomy and feeding jejunostomy was performed for diversion and decompression. The postoperative course was complicated by gastrointestinal bleeding requiring angioembolization, wound evisceration, and hemorrhagic stroke. In the best of our knowledge, it is the first described case in the English medical literature. Conclusion: Intraoperative endoscopy represents a valuable localization tool in posterior duodenal perforation when conventional surgical exposure is inadequate. Primary closure guided by endoscopic tools, may be safely considered in highly selected patients. Keywords: perforated duodenal ulcer, intraoperative endoscopy, pyloric exclusion, damage control surgery
Background: Anterior (stove-in) chest injury is a very rare but serious cause of chest wall instability. This study looked at how internal pneumatic stabilization compares to primary surgical fixation in patients with isolated blunt chest trauma. Methods: We reviewed three cases treated at two trauma centers from January 2000 to January 2026. We used the Thoracic Trauma Severity Score (TTSS) and the Modified Shock Index (MSI) to assess severity. All patients were treated following ATLS guidelines, and management depended on injury severity, patient stability, and available resources. We compared outcomes between internal pneumatic stabilization (mechanical ventilation with PEEP) and open reduction with internal fixation (plates and screws). Results: In the third case, early open reduction and internal fixation of both rib fractures and a transverse sternal fracture allowed the patient to return to normal activity sooner and leave the ICU by the third day after surgery. These results suggest that clinicians should review their treatment protocols for anterior flail chest and consider early surgical stabilization. Conclusion: Internal pneumatic stabilization is a useful conservative treatment for anterior flail chest injury, but the small number of cases and the study’s retrospective design limit how much we can conclude. In this series, patients who had early open surgical fixation needed fewer days on a ventilator, spent less time in the ICU, and had fewer ventilator-related complications than those treated with internal pneumatic stabilization.
Background: Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality. Early recognition and evidence-based ED management are critical, particularly in regional hospitals. Aim of the study: To describe clinical management, diagnostic approach, and early outcomes of patients presenting with suspected AMI in the Elbasan Hospital ED. Methods: Retrospective descriptive study using ED registry data from January 2025 to July 27, 2025. Adult patients with symptoms suggestive of acute coronary syndrome were included. A total of 66 patients were analyzed. Data on demographics, symptoms, initial management, transport, and time intervals were anonymized and aggregated. Data Collection: Extracted from ED registry: age, sex, residence, presenting symptoms, preliminary diagnosis, initial management, transport mode, referral, and time intervals. Data were anonymized. Analysis: Descriptive statistics summarized demographics and clinical management. Mean age ± SD was calculated. Frequencies and trends are reported. Results: Mean age: 66.7 ± 13.8 years. Chest pain, hypotension, and syncope/lipidemia were the most common presenting symptoms. All patients received immediate assessment and stabilization; most were treated in Elbasan ED, while a subset was transferred to tertiary centers. During the study period, 66 patients were included. The mean age was 66.7 ± 13.8 years, with both male and female patients represented. The majority (61, 92.4%) lived in urban areas, while 5 patients (7.6%) came from rural areas. Conclusion: Early recognition and standardized ED management of suspected AMI are feasible in a regional hospital. Strengthening pre-hospital coordination, reducing transfer times, and continuous staff training may further improve outcomes.
