Background: In developing countries, Helicobacter pylori infection is very common and begins in the very early childhood. Aim: To determine the prevalence of H pylori infection in Albanian children aged 8-10 years comparing with the data of the study in 1994 and to identify factors associated with H pylori infection. Methods: The prevalence of H pylori infection was studied in 308 asymptomatic children between of 8 and 10 years from mixed urban and rural areas. Of two different districts of Albania. H pylori status was evaluated by stool antigen test (SAT). Urea-breath test were used in 1994 study. Demographic information, socio-economic feature, and living and hygiene condition, such as type of the house, number of person/children living in the house, practices related to water use and toilet facility were evaluated by a detailed questionnaire completed by the teachers with the cooperation of parent of each children. Results: The overall prevalence of H pylori infection was 58%. Compared to the data of the 1994 study, there were a significant drop to 33%. There were no significant difference between males and female in both studies. The children who grew up in villages had a higher prevalence than those grew up in the city (p<0.001). There were no significant difference in H pylori infection prevalence between the three socio-economic classes. The prevalence were inversely associated with clean water index, crowding index and toilet facility, p<0.001 respectively. Conclusions: This study confirms the nearly two-fold reduction in the prevalence of H pylori infection in Albanian children 8-10 years of age between 1994 and 2014, consequence of improvement in standard of living and hygiene practices. The childhood is a period of major risk for acquisition of H pylori. Keywords: Helicobacter pylori, socioeconomic status, household condition, clean water.

Background: Hepatocellularcarcinoma represent a challenging malignancy of worldwide importance. Aim: To assess the incidence and the potential impact of the risk factors. Methods: It was a hospital-based case-control study of 648 HCC patients between January 2000 and November 2014. The age-adjusted incidence rates were calculated for 5-years period. Liver cirrhosis was designed by biopsy or in the presence of unequivocal clinico-biochemical and ultrasonographic data. HCC was defined in cirrhotic subjects by CT or MRI. For subjects without cirrhosis cytological confirmation was mandatory. Results: Studypopulation comprised 527 ( 77.1% ) males and 157 ( 22.9% ) female, given M:F ratio of 3.4:1. The mean age of all patients was 60.4 years, with majority of them ( 70% ) between 50 and 70 years. Underlying cirrhosis was present in 89.3% of cases, and 68% of them were Child-Pugh class A. The overall ageadjusted incidence rates started to increase in 2010, from 6.6 and 7.4 per 100 000 population in 2000 and 2005 respectively, to 8.9 in 2010 and 9.3 in 2014, nearly 4 times higher in man than in women. The greater incidence occurred in patients 60 and 70 years of age. 50.9% of all cases were associated with HBV infection, 21.8% with concomitant HBV infection and alcoholism, 13.8% with alcoholic alone, 8% with HCV infection, and 4.9% were HCC patients with not a reliable risk factor. Conclusions: The incidence rates of HCC has almost doubled in Albania between 2000 and 2014. HBV infection and heavy alcohol consumption significantly influenced for the increased incidence of HCC in our country.

BACKGROUND:Eosinophilic ascites is the most unusual presentation of eosinophilic gastroenteritis (EGE), caused by edema and eosinophilic inflammation of the small bowel wall's serosal layer.CASE REPORT:We report the case of a 37-year-old woman, who presented with diffuse abdominal pain, nausea, abdominal distension, moderate ascites and diarrhea of two weeks duration. The rest of physical and clinical examination was unremarkable, and her past medical history was uneventful. Magnetic Resonance Imaging showed the presence of ascites and diffuse thickening of small bowel wall, but did not detect a primary malignancy in the abdominal cavity; and no signs of portal hypertension or liver damage. Laboratory test results revealed essential peripheral blood eosinophilia, elevated serum IgE and marked increase of eosinophils in the abdominal fluid. Treatment with corticosteroids normalized laboratory tests results, and the ascites resolved immediately.CONCLUSIONS:EGE is a rare entity and it should be kept in mind in patients of unexplained ascites. The absence of primary malignancy on imaging, coupled with marked increase of fluid esinophilia and immediate response to treatment with steroids, confirm indirectly the diagnosis of EGE. Hippokratia 2014; 18 (3): 275-277.

AIM:Overweight and obesity has emerged as a significant global health problem in the pediatric population. Childhood non-alcoholic fatty liver disease (NAFLD) has become a common and important liver disease. Although mostly benign, some children with NAFLD develop fibrosis and in some case cirrhosis. The aims of this study were to determine the prevalence of NAFLD/non-alcoholic steatohepatitis (NASH) in overweight Albanian children, to evaluate the demographic and biochemical details and to assess the association between the severity of fatty liver changes and demographic and biochemical abnormalities.METHODS:A total of 80 school aged children, 24 overweight (85th≤BMI≤94th percentile) and 55 obese (BMI≥94th percentile), aged 10.43±2.2 years (M±SD) were included in the current study, in January-December 2010. Their age was in the range of 7-15 years. Their sex distribution was 36 female and 44 male. The children were enrolled to the Tirana schools and none of them were part of any weight or diet programmer. Children who were found to have TBC, evidence of HBV or HCV, infections, drug toxicity, autoimmune hepatitis, inborn error of metabolism or concomitant cortisteroid therapy were excluded. Laboratory parameters were measured at the time of bioclinical examinations. Fatty liver was diagnosed by ultrasonography detection of the most characteristic features of fatty infiltration. The scoring system was used in order to graduate the severity of the disease. The child was considered to have mild, moderate and severe fatty liver changes if the overall score was 1-3, 4-6 and 7-9, respectively. Multivariate regression analysis was used to assess the association between the different variables and the severity of NAFLD.RESULTS:NAFLD was present in 55/80 (68.7%) of the overweight children, 34 (61.8%) boys and 21 (38.2%) girls. Mild, moderate and severe degree of fatty liver were found in 35 (43.7%), 19 (23.7%) and 1 (1.3%), respectively. Nash was seen in 13 (23.7%) of the children's with NAFLD. Univariate analysis revealed that weight, BMI, waist, fasting blood insulinemia, triglycerides, total cholesterol and HOMA-IR were significantly associated with the presence of NAFLD (P<0.001). Multivariate analysis revealed a consistent and strong positive association between severity of fatty liver and weight, BMI, waist, fasting blood Insulinemia, cholesterolemia, triglyceridemia and HOMA-IR (P<0.001).CONCLUSION:NAFLD/NASH was frequent among our cohort of overweight children (68.7% and 23.7%). Weight, waist, BM, hypercholesterolemia, hypertriglyceridemia, fasting serum Insulinemia and HOMA-IR are independent predictors of liver steatosis in overweight children. Hyperinsulinemia and insulin resistance, especially when are associated with elevate values of ALT level, are strong independent risk factors in developing NAFLD/NASH.

OBJECTIVE AND METHODS:The prevalence of viral hepatitis markers and of alcohol intake was evaluated in 106 and 99 Albanian patients with the diagnosis of viral and/or alcoholic chronic liver disease who were consecutively admitted to the University Hospital Center of Tirana, during 1995 and 2005, respectively.RESULTS:A slight decrease in HBsAg (78 vs. 70%) and HBeAg (18 vs. 12%) prevalences were observed in patients admitted to the hospital during 2005 compared with those admitted during 1995, respectively. In both periods of time, hepatitis B virus (HBV) DNA (genotype D) tested positive in all HBsAg-positive patients and in 36% of HBsAg-negative patients. Anti-hepatitis C virus (HCV) prevalence (mainly observed after 30 years of age) was 14 versus 11%; anti-hepatitis Delta virus (HDV) prevalence (more frequently present in young age group patients) was 9 versus 7% during 1995 and 2005, respectively. Among patients who reported alcohol intake, alcoholic liver disease (HBsAg and anti-HCV negative) was diagnosed in 35 and in 57% of patients admitted during 1995 and 2005, respectively (P = 0.05).CONCLUSION:In Albanian patients with chronic liver disease, we have found that: (i) HBV remained the most important aetiologic factor of chronic liver disease; HDV and HCV prevalences were still low, (ii) in HBsAg-positive patients, HBeAg-negative chronic hepatitis prevailed, (iii) in HBsAg-negative patients, HBV DNA prevalence was high, (iv) during the last decade, an increased prevalence of alcohol intake in the aetiology of chronic liver disease was observed.

Objective of the study: To report on the results of two projects on chronic hepatitis B in Western Balkans lead by Ioannina, Northwest Greece and Tirana, Albania.Methods: In two Prospective projects, HEPAGA I and HEPAGA II which lasted 4 years. In HEPAGA I, serum samples from 410 Albanians were tested for HBV. In HEPAGA II, health care consumption was recorded in hospitalized patients with chronic hepatitis B.Results: HEPAGA I showed that 11.89% of the Albanians was HBsAg(+) and only 21.19% had HBV immunoprotection. HEPAGA II study included 101 patients. There was a significant difference in hospitalization costs per patient between centers. The Greek patients were significantly older (p = 0.027) and there was a significant correlation between age >50 years and hospitalization costs (p=0.035). In Greece, hospitalization costs, number of patients admitted and number of hospitalization days per patient were in a remarkable position compared to other causes of hospitalization.Conclusions: The HEPAGA I study showed a decrease in the prevalence of chronic HBV infection in Albania compared to that of the previous decade. The HEPAGA II study demonstrated that health care consumption due to HBV infection is still an important determinant of the overall health consumption in Western Balkans. (C) 2009 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

AIM:To assess the prevalence and socio-demographic distribution of hepatitis B virus (HBV) infection in Albania.METHODS:Blood samples from 410 unselected schoolboys, 666 students, 500 military personnel, 1286 casual blood donors, 378 voluntary blood donors and 640 pregnant women (total 3880 non-vaccinated residents of rural and metropolitan areas from all over Albania; 2354 (60.7%) male and 1526 (39.3%) female; mean age of 26.3 years) were tested during 2004-2006 for hepatitis B surface antigen (HBsAg) and antibodies to hepatitis B virus (anti-HBs) by ELISA.RESULTS:The HBsAg and anti-HBs prevalence were 9.5% and 28.7%, respectively. The highest HBsAg prevalence was evident in the younger age group, such as in schoolchildren (11.8%) and the military (10.6%). Consequently, the anti-HBs prevalence increased with age, from 21.2% in schoolchildren (mean age: 15.7 years), to 36.3% in pregnant women (mean age: 26.3 years) and 29.7% in voluntary blood donors (mean age: 40.1 years). There were no significant differences between males and females.CONCLUSION:Despite the estimated two-fold reduction of HBsAg prevalence in the general population from about 18%-19% to 9.5%, Albania remains a highly endemic country (i.e. over 8% of HBsAg prevalence rate).

SUMMARY In 1991, a serious political and socioeconomic crisis in Albania caused a massive migration of refugees to Northwestern Greece (Ioannina region) and to the Apulia region of Southern Italy. Seroepidemiological data on viral hepatitis marker distribution of among refugees indicated a high HBV infection endemicity in these Albanian refugees. More updated epidemiological information on hepatitis B marker prevalence of the young, non-vaccinated Albanian population became available through the national Greek- Albanian collaborative study on prevention of viral hepatitis and hepatocellular carcinoma (known with the acronym as the HEPAGA study). This study showed that 11.89% of the tested Albanian group was HBsAg(+) while only 21.19% of the group were immunoprotected against HBV. A critical point for all countries to reach or fail to reach the 1997 WHO targets is their social and political commitment to preventive medicine and vaccines, besides their effort to inform and educate both the general public and medical societies. In Southeastern Europe, where acute and chronic HBV infection is a major health problem, selected riskgroup vaccination policy will have no impact on this infection and will not be able to control further transmission from this HBsAg(+) young, carrier pool. In addition, the increasing number of immigrants from high to intermediate or low endemicity regions such as Greece and Italy forms a new dynamic epidemiology of hepatitis B transmission. Sustaining available vaccination programmes against HBV is one of the greatest challenges for the near future. Other challenges are increasing vaccine coverage, continuous support in order to maintain a sustainable supply of vaccine and other related facilities and, finally, to successfully monitor the effectiveness of currently implemented vaccination programmes. Key words: Hepatitis B, refugees, epidemiology, vaccination, Albania, Greece

SUMMARY Aim: The aim of the study was to screen for hepatitis B virus (HBV) in a well-defined, young, population in the area of Tirana, Albania (the HEPAGA project). Patients-Method: This study was conducted under the auspices and with grants from the Greek Ministry of Development and the Albanian Ministry of Education and science. This collaborative study lasted for two years (20012002) and was successfully completed on both sides. Serum samples from the non-vaccinated, young population (ages 14-20) living in a well-defined area of Tirana were collected during the period from September 2001 to February 2002 and were stored at -20 o C until assayed at the Blood Bank of the Ioannina University Hospital. Every sample was examined for HBV immunology profile using routine methods. In case of gray zone results double testing was performed. In cases of insufficient serum we tested, in priority, HBsAg, then HBcore antibody (anti-) and then antiHBs. Results were then sent back to Albania where Albanian