The COVID-19 pandemic has significantly affected Albania, with over 319959 cases and 3625 deaths by December 2023. Despite a national vaccination campaign initiated in January 2021, only 44.1% of the eligible population had completed the full vaccination regimen by late 2023. In this study, we aim to estimate the effectiveness of COVID-19 vaccines in preventing severe outcomes and in assessing association of prior SARS-CoV-2 infection among adults hospitalized with COVID-19 in Albania. A test-negative case-control study was conducted using SARI sentinel surveillance data from July 2022 to July 2023. The study included 1858 hospitalized SARI patients aged 18 and older, with 410 testing positive for SARS-CoV-2 (cases) and 1448 testing negative (controls). Vaccine effectiveness was calculated using logistic regression, adjusting for age, sex, comorbidities, and hospital stay duration. The overall adjusted vaccine effectiveness (VE) for preventing hospitalization was 30.1% for those fully vaccinated with two doses and 31.4% for those with a booster. VE against severe outcomes was 30.6%, increasing to 37.8% after a booster. The highest VE was observed in patients aged 80 and above, reaching 52.5% after a booster. Prior SARS-CoV-2 infection combined with vaccination was associated with higher VE to 76.2%. However, many VE estimates had wide confidence intervals overlapping zero, indicating considerable uncertainty and lack of statistical significance in some subgroup results. This study provides real-world evidence of an association between COVID-19 vaccination, particularly with booster doses, and lower odds of severe outcomes. VE was highest among elderly patients and in those with prior SARS-CoV-2 infection, emphasizing the importance of booster campaigns in vulnerable populations.

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. Method: We described a case report of a 23-year-old man with Pneumomediastinum, infected with COVID-19 in conditions of respiratory failure due to interstitial pneumonia. Case presentation: A 23-year-old man, who had no pre-existing health conditions presented to the Infectious Diseases service with complaints of difficulty in breathing, dry cough, chest pain, muscle pain, joint pain, loss of taste, sore throat, pronounced body weakness, diarrhea. Symptoms started 11 days ago. On admission the patient refers that he doesn’t suffer from any other disease. The patient was not vaccinated against COVID-19. At the time of admission to the hospital, the objective examination revealed cervical subcutaneous emphysema and harsh respiration in both lungs. The nasopharyngeal swab test (RT-PCR) for Covid-19 was positive from the Institute of Public Health. The CT scan of the chest confirmed the presence of pneumomediastinum major, subcutaneous emphysema and bilateral ground glass opacities. Conclusion: Pneumomediastinum is a rare complication of pneumonia caused by Covid-19 in which the etiopathogenesis consists of severe pulmonary involvement that may or may not be affected using invasive mechanical ventilation. Timely diagnosis of pneumomediastinum in patients with Covid-19 would prevent the occurrence of life-threatening complications. Keywords: Covid-19, pneumomediastinum, ARDS, Macklin effect, vaccine.

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.

The 30th Albanian Surgical Conference (ACS 2023) and the 7th Albanian Congress of Trauma and Emergency Surgery (ACTES 2023) represent a significant milestone in the medical community. These concurrent events provide a platform for the exchange of knowledge, collaboration, and the advancement of surgical science in Albania. ACS 2023 & ACTES 2023 gather experts, scholars, practitioners, and enthusiasts from the field of surgery, both in traumatic and non-traumatic areas, in the vibrant city of Tirana. The comprehensive program encompasses a diverse range of surgical topics, from abdominal and chest injuries to vascular injuries, emergency surgery, and the challenge of nurse services in the new millennium. The theme of this year's events, "Surgery and not only...," reflects the commitment to innovation, best practices, and groundbreaking discoveries. The programs include plenary sessions with renowned experts, scientific presentations, panel discussions, networking opportunities, an industry exhibition, poster awards, cultural and social activities, and Continuing Medical Education (CME) credits. Participants can expect a professionally enriching experience that also offers personal rewards. ACS 2023 & ACTES 2023 value the role of each attendee in contributing to the advancement of surgical knowledge and patient care. The events promise to chart new horizons in the field of surgery and foster international collaboration. The 30th Albanian Surgical Conference and the 7th Albanian Congress of Trauma and Emergency Surgery are poised to create lasting memories, and their success hinges on the active participation of every attendee. It is an opportunity to inspire, collaborate, and make a lasting impact on surgical care worldwide.

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.

Introduction:The first data for COVID-19 in pregnancy showed mild to moderate forms of the disease while current data speaks of severe forms in these subjects. Here we present a case of a severe form of COVID-19 in a gemelar pregnant woman complicated with pneumomediastin and pneumothorax,during her hospital stay, in a late stage of disease. Case presentation: A 38 year-old multiparous woman was referred to university hospital at 25 weeks of gemelar pregnancy. On admission, the patient presented with signs of moderate respiratory insufficiency, which after 12 hours progressed further to severe ARDS. She tested pozitiv for SARS COV 2 on quantitative real-time polymerase chain reaction. Under these conditions it was decided that the pacient undergo a caesarean section for termination of pregnancy. Remdesivir200 mg/day and tocilizumab 8 mg/kg were administered,based on national guidelines. The patient's fever subsided, but her SpO2 remained at 94%, even with a 15 L/min oxygen mask. After 12 days the patient complains of a severe back pain and her respiratory condition rapidly worsened,reduced saturations up to 80% being under O2 therapy with facial mask with 15 l/min. Chest CT findings confirmed pneumomediastine and pneumothorax,which deteriorated the patient”s status. Thereafter tube thorakostomy was performed. There was a clinical and ABG analysis parameter”s improvement.The patient was discharged 34 days after cesarean delivery with a proper general health. Conclusion: Our case highlights even more convincingly the fact that in pregnancy, can be severe to life-threating forms of Covid 19. Pneumothorax and pneumomediastinum are complications that can be encountered even in the late stages of severe forms with COVID 19 in pregnancy. Early diagnosis of these complications is essential in adequate management and treatment to avoid fatal outcome.

BackgroundThe Solidarity trial among COVID-19 inpatients has previously reported interim mortality analyses for four repurposed antiviral drugs. Lopinavir, hydroxychloroquine, and interferon (IFN)-β1a were discontinued for futility but randomisation to remdesivir continued. Here, we report the final results of Solidarity and meta-analyses of mortality in all relevant trials to date.MethodsSolidarity enrolled consenting adults (aged ≥18 years) recently hospitalised with, in the view of their doctor, definite COVID-19 and no contraindication to any of the study drugs, regardless of any other patient characteristics. Participants were randomly allocated, in equal proportions between the locally available options, to receive whichever of the four study drugs (lopinavir, hydroxychloroquine, IFN-β1a, or remdesivir) were locally available at that time or no study drug (controls). All patients also received the local standard of care. No placebos were given. The protocol-specified primary endpoint was in-hospital mortality, subdivided by disease severity. Secondary endpoints were progression to ventilation if not already ventilated, and time-to-discharge from hospital. Final log-rank and Kaplan-Meier analyses are presented for remdesivir, and are appended for all four study drugs. Meta-analyses give weighted averages of the mortality findings in this and all other randomised trials of these drugs among hospital inpatients. Solidarity is registered with ISRCTN, ISRCTN83971151, and ClinicalTrials.gov, NCT04315948.FindingsBetween March 22, 2020, and Jan 29, 2021, 14 304 potentially eligible patients were recruited from 454 hospitals in 35 countries in all six WHO regions. After the exclusion of 83 (0·6%) patients with a refuted COVID-19 diagnosis or encrypted consent not entered into the database, Solidarity enrolled 14 221 patients, including 8275 randomly allocated (1:1) either to remdesivir (ten daily infusions, unless discharged earlier) or to its control (allocated no study drug although remdesivir was locally available). Compliance was high in both groups. Overall, 602 (14·5%) of 4146 patients assigned to remdesivir died versus 643 (15·6%) of 4129 assigned to control (mortality rate ratio [RR] 0·91 [95% CI 0·82–1·02], p=0·12). Of those already ventilated, 151 (42·1%) of 359 assigned to remdesivir died versus 134 (38·6%) of 347 assigned to control (RR 1·13 [0·89–1·42], p=0·32). Of those not ventilated but on oxygen, 14·6% assigned to remdesivir died versus 16·3% assigned to control (RR 0·87 [0·76–0·99], p=0·03). Of 1730 not on oxygen initially, 2·9% assigned to remdesivir died versus 3·8% assigned to control (RR 0·76 [0·46–1·28], p=0·30). Combining all those not ventilated initially, 11·9% assigned to remdesivir died versus 13·5% assigned to control (RR 0·86 [0·76–0·98], p=0·02) and 14·1% versus 15·7% progressed to ventilation (RR 0·88 [0·77–1·00], p=0·04). The non-prespecified composite outcome of death or progression to ventilation occurred in 19·6% assigned to remdesivir versus 22·5% assigned to control (RR 0·84 [0·75–0·93], p=0·001). Allocation to daily remdesivir infusions (vs open-label control) delayed discharge by about 1 day during the 10-day treatment period. A meta-analysis of mortality in all randomised trials of remdesivir versus no remdesivir yielded similar findings.InterpretationRemdesivir has no significant effect on patients with COVID-19 who are already being ventilated. Among other hospitalised patients, it has a small effect against death or progression to ventilation (or both).FundingWHO.

COVID-19 vaccination leads to lower infection, morbidity, and mortality rates. However, COVID-19 infection leads to the development of coagulopathy-related manifestations in the form of both venous and arterial thromboembolism. This study aimed to assess the severity and mortality predictors of COVID-19 patients with thrombotic events in hospitalized patients in Albania. This is a retrospective study conducted in the “Mother Tereza” University Hospital of Tirana. Data were retrieved from the electronic databases of the hospital and only COVID-19 cases admitted to the infectious department during August–December 2020 were selected. Patients who, at admission, had a C-reactive protein (CRP) (mg/L) more than double and a D-dimer (ng/mL) more than triple according to international standards were included in the study. We performed univariate and multivariable logistic regression analysis, calculating unadjusted and adjusted odds ratios (ORs). A p-value < 0.05 was considered statistically significant. The study population included 60 hospitalized persons with a mean age of 64.4 years. Increased lactate dehydrogenase (LDH) (OR = 2.93; 95% CI = 0.82–10.42, p-value = 0.1) and increased creatine kinase (CK) (OR = 2.17; 95% CI = 0.63–7.46, p-value = 0.22) were related with increased probability of death. Moreover, a decreased number of lymphocytes was associated with increased mortality but with no statistical significance (OR = 0.40; 95% CI = 0.11–1.40, p-value = 0.15). The survival rate was higher for patients without comorbidities (p = 0.045). These results could serve as a baseline and as a reference for healthcare personnel who provides services to hospitalized patients with COVID-19. Further studies should take into consideration the vaccination of the population as well as including more hospitals and patients.

On March 9, 2020 the first two cases of Sars-Cov-2 were identified and hospitalized in Albania. In this paper we present a retrospective analysis of 3000 consecutive COVID-19 confirmed cases in Albanian adults admitted at the Infectious Diseases Service which includes three tertiary care wards, part of Tirana University Hospital Center “Mother Teresa”. The period included in this analysis is from March 2020 – April 30, 2021. The paper provides a general overview including demographic distribution, symptomatic diversity and clinical signs manifested among cases, as well as the association observed with underlying pathologies. The analysis included 1944 males and 1056 females. Overall, the age groups included range from 15 to 99 years (median 65 years; mean value 63.4±13.4 years). There were no statistically significant age differences between males and females (mean ages were: 63.5±13.1 in females and 63.3±13.5 in males; median ages were: 64 years in females and 65 years in males; P=0.67). There was evidence of a statistically significant difference between sexes regarding the presence of symptoms, which were more predominant in males (P<0.001). On the whole, we observed 19 cases with specific signs and symptoms, most of them (82.9%) among patients who reported the presence of such symptoms 5-14 days before hospitalization. The comorbidities encountered were ranked according to systems and organs, classifying them in 22 categories, among which the most frequent were hypertension (52%) and diabetes mellitus (26.4%). Age was a strong risk factor for severe illness, complications, and death. Analyzing symptom onset with total symptoms and comorbidities, it showed that some patients were affected for many days with few symptoms and few comorbidities. It seems they started as mild cases for many days unpredictably precipitating. There were also a few cases with many comorbidities, but a few symptoms upon hospital admission.

Aim: Measles is a highly contagious disease caused by the measles virus. Albania is one of many European countries that have successfully interrupted endemic transmission of this disease. However, during the years 2018-2019, an outbreak of measles occurred in Albania. The aim of this study was to describe the clinical features and complications of hospitalized measles patients in Tirana, Albania, as related to age-group and risk factors. Methods: All patients hospitalized for over 24 hours from January 2018 to December 2019 at the Service of Infectious Diseases, University Hospital Centre “Mother Teresa” in Tirana were included in this study. We included patients over 14 years old as this is an Infectious Diseases Service for adult patients only. Clinical and laboratory data were analysed. Results: Of the 318 hospitalized patients (139 females), about 35%, 26%, 17%, 14%, and 7% were 15-24, 25-34, 35-44, 45-54, and over 55 years old, respectively. Females constituted 37% of the total number of patients. The average and median ages were 30.9 years and 28.5 years, respectively. Average time from the first symptom to the hospital presentation was 3.8 days. Contact with other patients with measles was noted in 21% of the patients. Body rashes were identified as maculopapular in 96% of the patients. Pathognomonic enanthema or Koplik spots and conjunctivitis were detected in 62% and 52% of the patients, respectively. Measles-related complications were noted in 53% of the patients; pneumonia/pneumonitis, hepatitis, neurological complications were presented by 24%, 26%, and 3% of the patients, respectively. Average duration of hospitalization was 5.4 days, whereas mortality was 0.3%. Conclusion: This study provides valuable evidence about the distribution and clinical features of measles in Albania. Measles is a highly contagious disease and, as long as the measles virus is circulating, the risk of transmission remains high.

Introduction: Despite the fact that there has been a steady rise in new infections rate since the first reported case in 1993, Albania remains a low prevalence country. This was the first cascade study for Albania. The aim was to construct a cascade of care for newly human immunodeficiency virus (HIV)-diagnosed individuals in 2016 in Albania. Material and methods: This retrospective descriptive study was conducted at the HIV/AIDS Ambulatory Clinic, Infectious Disease Service, University Hospital Centre of Tirana. Medical records of patients diagnosed and enrolled in care in 2016 were retrospectively screened and data on gender, age, HIV clinical stage, CD4+ T cell count, viral load measurement, and treatment history, with antiretro-viral treatment (ART) and adherence to treatment were collected. Results: Out of 127 new HIV cases reported, 100 (78.7%) entered care. The median age was 39 years (range, 20-75 years; male, 82%). Seventy one percent started ART within a median of 56 days (range, 1-317 days) from diagnosis, 34 (47.9%) patients received tenofovir disoproxil fumarate/emtricitabine + efavirenz (EFV), and 27 (38%) zidovudine + lamivudine + EFV. Among those who started ART, 19.7% were late presenters and 54.9% were very late presenters. Viral load after initiation of ART was assessed in 25 cases, with 56% of patients achieving an undetectable HIV-RNA. Conclusions: A large proportion of people living with HIV were lost at each step of the cascade. Efforts in Albania should be focused on scaling up HIV testing, promoting adherence to ART, improving access to diagnostics, and better ART regimens as well as proper monitoring of therapy.

Antimicrobial resistance is a major matter of public health concern. The aim of this study is to determine the frequency of antibiotic resistance of E.Coli in fecal flora of healthy children in Tirana - Albania. Samples were taken from about 342 children (excluding all subjects who have been ill / taken antibiotics for the last two weeks) from the kindergartens / schools of Tirana aged 1 year to 10 years (average age 5,24 +/- 1,44). Rectal swab were plated on MacConkey agar with 10 mg/l ampicillin. Isolated resistant colonies Lac+ were identified like E. Coli (or coli - shape) and were studied further. Antibiotic resistant Escherichia Coli was present in 81 (%) per cent of children studied, and 32 (%) per cent resistance was transferable. 49 % of children that not used antibiotic (with no history of antibiotic consumption) during last year, carried resistant E. Coli and transferable R plasmids were present in 28% of them. 46 % of children that not frequent day/care center carried antibiotic E. Coli and transferable R plasmid were present in 20 % of them. Multiple regression analysis revealed that age, fathers education's, mothers education's sex and number of children in family could be identified as an independent risk factor for the emergence of resistance in the population studies. Normal fecal flora in the population we studied seems to play an important role as reservoir of antibiotic resistance gene.

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 etc. 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.

This study aimed to investigate relationship between Hepatitis C Virus (HCV) infection in hemodialysis patients . This is retrospective study based on epidemiological, clinical, therapeutic data of HCV positive patients with CHKD (chronic kidney disease) undergo hemodyalisis, followed up in Infectious diseases service of University Hospital Cente “Mother Theresa” in Tiran, Albania. Out of 900 patients who were hemodialysed in three dialysis centers, 55 of them resulted with anti HCV Ab positive; 27 male and 28 female ( F / M 1.16 ratio ), with mean age 46.27 years, (24 – 79 years old) , average time in hemodialysis 10.5 years. The highest rates were age groups 26 30, 46 55 years. We distinguished 19 clinical sings , and 9 underlying associated diseases . 49.09% of them predominated with Genotype 1; Regimen of treatmenet was Peg INF α-2a. where only 23.64 of them discontinued therepy due to severe side effects. Morbidity and mortality of HCV is higher in pantients with chronic kidney diseases than in general population.