and Ministry of Health of 15 -17 November 2018 2018 November 15 -17 Albania , Hotel Plaza, Under the of Ministry Auspices of Education & Sport

MEDICAL CONGRESS IN ALBANIA CONGRESS MEDICAL INTERNATIONAL MULTIDISCIPLINARY MULTIDISCIPLINARY INTERNATIONAL

International MultidisciplinaryInternational

IMCA 2018

A

I

AL N

IC A

D B

E L th M A

L N

A I

N

S O

I S T

IMCA

A E

N R

th Medical Congress in Albania in Congress Medical 4

R

E G

T N I N O

C 4 Organised by: Organised HOSPITAL AMERICAN www.spitaliamerikan.com in Healthcare and Patient’s safety” Patient’s and Healthcare in “Continuous Quality Improvement Improvement Quality “Continuous

4th INTERNATIONAL MULTIDISCIPLINARY MEDICAL CONGRESS IN ALBANIA “CONTINUOUS QUALITY IMPROVEMENT IN HEALTHCARE AND PATIENT’S SAFETY” 15 -17 NOVEMBER 2018 HOTEL PLAZA, TIRANA, ALBANIA Message from the CEO of American Hospital

Dear friends and distinguished delegates of IMCA 2018

On behalf of my dedicated colleagues at the American Hospital of Albania I feel honored to invite and welcome you to our 4th International Medical Multidiciplinary Congress.

Following the great experience with the successful congress of last year and the excellent feedback we had from participants regarding speakers and topics, we feel more thrilled and motivated for the upcoming event of 2018.

As CEO of the American Hospital I am thankful to our experienced and talended physicians, skilled nurses and dedicated organizative staff that together have laid the background for the continuing success and I believe that compassionate medical staff combined with the best technology make American Hospital very special.

Here at American Hospital we operate under the simple philosophy that our people make the difference. As we celebrate our 12th year we keep the focus on the future of medical science, best human resources and innovations on our field to offer our patients the highest quality of care and widest range of services. During this invaluable journey I had the honor to work with hundreds of physicians, nurses, technicians; all committed and energetic. As we move forward together, it is our privillege and responsability to expand and share knowledge among medical experts and to do this in an international level such as the Medical Multidisciplinary Congress.

We look forward to exploring developments of medicine under the light of our focus on quality, growth and better practice.

Join us, save the date, 15th-17th of November 2018

SERVICE, EXPERIENCE, HEALTH Klodian ALLAJBEU, M.D. CEO American Hospital American Hospital, Embrace life!

042 35 75 35 3 Message from the IMCA President

Dear colleagues, friends and IMCA participants, Following the immense success of the third International Medical Congress in Albania, it is an honor, pleasure and privilege, on behalf of the Organizing and Scientific Committees, to welcome you to join the fourth “IV International Medical Congress”, here in Tirana, Albania from 15th to 17th of November 2018. Once again this Congress will be organized by the American Hospital. The success of the third Congress was honorably attributed to more than 100 outstanding foreign speakers from 20 countries and 2300 participants, local and international, across Thanks Note for the American Hospital Balkans, Europe, USA, Asia, with excellent sessions on various topics. The main focus of the This great success and tremendous hard existence to the trust you have put on it for a fourth Congress will be “Continuous quality improvement in Healthcare and patient’s work for IMCA will not have be done without healthier life. Founded in 2006, the American safety”. The open plenary session will be focused on: “Recent trends in mini-invasive the unconditional support of the American Hospital marked the first cornerstone of surgery” The Congress will continue to promote research and best quality in and Hospital to be lighted every single day by the private hospital service in Albania. The patient safety through multi-disciplinary clinical sessions, including mini-invasive treatment the needs of its patients and its healthcare hospital started work with a team of more in different surgical and non-surgical medical specialties and modern treatment protocols, system, with the responsibility of being than 100 medical doctors, nurses and different aspects of innovative techniques and strategies in head and neck surgery, general leader and the ambition of bringing in workers graduated and trained in Albania, surgery, neurosurgery, urology, orthopedic, colorectal surgery, intensive care and anesthesia, every novelty of medicine, it aims to Europe, Turkey, UK, USA and it counts now advanced imaging, nuclear medicine and laboratory; IVF and gynecology; ophthalmology, deliver the very best health care in a safe, 6 hospitals in Albania & Kosova with 1400 dermatology and aesthetic medicine, internal medicine, etc. There will be 2 round tables with compassionate environment. Relying workers, who show greater experience focuses in “Successful strategies for improving the health care system in Albania” and strongly in an multinational distinguished and commitment. In its early activities the “Medical ”. The best innovations and new experiences will come through team and supported by the best technology Hospital focused on patients with cardiac various Workshops and Satellite Symposia on Brest Cancer, Hands on Laparoscopic Surgery in and research work, it has dedicated its issues from across Albania and the region. Gynecology, Video Session, Live surgery Session ect. Nursing Forums and Trauma Simulation Workshop will continue the successful education strategy among nursing staff. The IMCA 4 will host Poster Gallery presentations. That has proven to be a popular feature of the Congress as Currently, the hospital counts: well. Posters may present original research, best practices, descriptions of clinical programs ●● + 1000 CABG ●● Advanced General Surgical ect. By participating in this event, the Congress attendees will have the chance to benefit from (Coronary Artery Bypass Grafting) Procedures and Specialties. scientific exchange during clinical sessions with colleagues from different backgrounds. Our ●● +135 Kidney Transplant, ●● Laser Therapy for Advanced common goal remains sharing the best achievement in modern medicine and continuing Laryngeal Cancer ●● +125 Cornea Transplant education strategy among medical professionals to reach higher standards and improve our ●● Advanced Treatment Treatments clinical performance. We hope that you will enjoy our capital, Tirana and his many cultural ●● Cochlear Implant with the support of Head and Neck Vienna University traditions, well recognized characteristics of hospitality with amazing gastronomic and ●● Modern Laboratories in Albania delicious food as well. This is a wonderful event energized by dedication of our staff; you will ●● Liver Transplant find it both informative and inspiring. I warmly welcome and look forward to meeting all of you ●● Five Regional Hemodialysis Centers, ●● In Vitro interventions with modern with 400 beds in 15th to 17th November 2018, in our beautiful city of Tirana! Cyrillic design ●● Dialysis service in most districts, ●● Advanced Procedures in Gynecology plus in hospitals ect. Yours sincerely and IVF Lindita Shosha Mano (MD. PhD) Consulent General Surgeon-Coloproctologist American Hospital, Tirana, Albania President of IV IMCA 2018 [email protected] Fore more visit: www.spitaliamerikan.com

4 5 Faculty Faculty

Philip F Caushaj (USA) N. E. Samalavicius (Lithuania) John Minarcik (USA) Nikolaos Sofikitis (Greece) Niketa Koliqi (Albania) Entela Puca (Albania)

Runolfurur Palsson (Iceland) Ugo de Sanctis (Italy) Fatos Olldashi (Albania) Edvin Selmani (Albania) Alfred Nona (Albania) Emiljana Huti (Albania)

Iris Allajbeu (Albania) Mentor Petrela (Albania) Lutfi Alia (Italy) Ayse Balat (Turkey) Ates Kadioglu (Turkey) Albana Shahini (Albania)

Dragoslav Mladenovik (FYROM) Edmond Puca (Albania) Alfred Aga (Albania) Rok Civljak (Croatia) Marta Civljak (Croatia) Svetlana Nela (UK)

6 7 Faculty Faculty

Lindita M. Shosha (Albania) Brunilda Zllami (Albania) Nereida Xhabija (Albania) Teuta Haveri (Albania) Anila Godo (Albania) Konstantinos Pantos (Greece)

Leart Bërdica (Albania) Joseph Nunoo Mensah (UK) Albana Daka (Albania) Elton Peçi (Albania) Edlira Cako (Albania) Gjergj Çaushi (Albania)

Christos Maroudis (Greece) Carmelo Rizzo (Italy) Besnik Kojcici (Albania) Teona Bushati (Albania) Emeka Nkenke (Austria) Aliki Stathopoulou (Greece)

Arben Kojqiqi (Albania) Arben Beqiri (Albania) Marco Jacobbi (Italy) Rainer Rienmüller (Austria) Shpetim H. Telegrafi (USA) Giovanni Anselmetti (Italy)

8 9 Faculty Faculty

Gjergji Semini (Albania) Manos Pramateftakis (Greece) Dukagjin Blakaj (USA) Andreas Demetriades (Scotland) Gani Bajraktari () Antonio Longo (Italy)

Denis Berdajs (Austria) Ernst Orthner (Austria) Safet Beqiri (Germany) Spiros Lazarou (USA) Xavier Delgadillo (Switzerland) Vasileios Drakopoulos (Greece)

Dimitrios Loutradis (Greece) Edvin Prifti (Albania) Fleur Kilburn-Toppin (UK) Andrea Casini (Italy) Florin Ramadani (Kosovo) Jose Wiley (Greece)

Sokol Xhepa (Albania) Cen Bytyqi (Kosovo) Margherita Borsa (Italy)

10 11 About IMCA How IMCA was born? What to expect from IMCA 2018? IMCA About IMCA – serves as an innovation-hub for the future in the Following the great success of the “3rd International Medical Congress in medicine field. The necessity at the stage that the American Albania” will have the support of the Ministry of Health & Ministry of Education Hospital had reached after 12 years of experience, brought and Sports. Main Focus this year is “Continuous quality improvement in the necessity that this colossal work and experience must Healthcare and patient’s safety”. Plenary Session will be focused on “Recent be presented to the medical world in Albania and beyond. trends in mini-invasive surgery”. The idea and the design of the congress is a courtesy of Lindita Shosha Mano MD.PhD with great support from THE CONGRESS INCLUDES American Hospital CEO, Klodian Allajbeu, M.D and with the tremendous hard work of the Medical Doctors team. 28 Multidisciplinary clinical sessions The American Hospital Group has established a new strategy for the coming years to training of medical staff (continuing • Innovative surgical techniques in • Video session general surgery education) by joining medical education with hospital • 2nd Albanian Colorectal Summit • Neurosurgery achievements. This was the most appropriate time to launch an international multidisciplinary Congress touching • Cardiology Satellite symposia all medical disciplines and transforming the knowledge into • Cardio Thoracic Surgery • Brest cancer, practical knowledge from different perspective. Given that • Urology • Modern Management of infertility the American Hospital has international staff, a significant • Orthopedic Different workshops on: number of Key Lectures are invited at the congress to • Plastic surgery enhance these experiences, to face different results and • The use of ultrasound in breast • Innovative trends on diagnosis and musculoskeletal & pediatric imaging join energies to reach the best performance in all areas. It Is not just a medical congress, it is a treatment in Ophthalmology • Nutrition profile for hospitalized & challenging environment where the most enhanced and complex ideas are transformed into real • Special topics on ICU and ambulatory patient live experiences form the best doctors. perioperative medicine • “Neonatal resuscitation • Advanced imaging History of IMCA • Clinical Laboratory Management in Nursing Forum 1 & 2 As we highlighted IMCA is not just a medical congress, it is a challenging environment where the and out Hospital most enhanced and complex ideas are transformed into real live experiences form the best doc- • Modern methods of diagnosis and Round Tables tors all over the world. This contemporary genesis started on April 2015 focused on “Continuing treatment in obstetrics “Successful strategies for improving the health care system in Albania” and Education Among Health Care Professionals” with the 1st Congress to continue with 2nd Congress • Gynecology & IVF “Medical Tourism in Albania” on September 2016 focused on Oncology offered specific information, improvements and pro- • Pediatrics and newborn care fessional medical service information according healthcare standards. These two International • Prevention and diagnosis in internal The IMCA 4 will host Poster Gallery Medical Congresses in Albania were a tremendous success and were followed from the immense medicine presentations. That has proven to be a success of the third IMCA 2017 focused on“Innovation in Medicine”. This success was honorably • Histopathology popular feature of the Congress as well. attributed to more than 100 outstanding foreign speakers from 20 countries and 2300 partici- Posters may present original research, • Hematopathology best practices, descriptions of clinical pants, local and international, across Balkans, Europe, USA, Asia, with excellent sessions on var- • Nephrology programs ect. ious topics. Clinical guidelines and quality measures have become increasingly important as the practice of evidence-based medicine has become the standard of care. We are proud to mention that each year there are about 2000 participants and over 100 professional Faculties and key This year IMCA is expected to gather more than 100 outstanding foreign speakers and over lectures from all around the world. It is a privilege having the chance to listen from the elite figures 2000 participants from Balkan, Europe, UK and USA, with excellent sessions on various in USA, Europe, Asia, UK, Balkan and at the same time participants have the chance to enhance topics, workshops, symposia, round tables and we are delighted to notify that in the Fourth their personal career by getting extra credits on their profession. We are looking forward for the 4th International Medical Congress you will have the chance to earn Extra CREDITS for your International Medical Congress to be held on November 15-17, 2018 in Tirana. professional career.

12 13 Professional Congress Organizer & Scientific Secretariat Plenary Session

TIONAL M NA ED R I E C T A L N I

C A O IMCA I N N G A R B ESS IN AL IMCA - International Medical Congress in Albania American Hospital I Rruga Lord Bajron, Tirana 1001 Phone +355 (0)42 35 75 35 Mobile +355 (0)68 40 32 151 Email [email protected] [email protected] Web imca.al Facebook | Instagram | LinkedIn

The participants’ registration fee includes:

• Admission to all scientific sessions • Admission to scientific poster area and the commercial exhibition • Congress materials (congress bag, final program, badge) • Certificate of Attendance Congress Venue • Coffee Breaks The Plaza Tirana offers 760 m2 of meeting prices. Our Concierge will be delighted to • Simple Lunch and function space, hosting up to 350 guests. provide you with directions and reserve • Opening Ceremony & Welcome Reception Hotel facilities include the main event your place in our private parking area. room: Queen Geraldine, Dora D’Istria, • Closing Ceremony Marin Barleti, Jeronim De Rada Are you coming by plane? Guests can choose between several Location of Hotel PLAZA options to arrive from the Airport “Nënë The 4th International Medical Multidisciplinary Congress With a prime location at the center of the Tereza” to The Plaza Tirana: is under the accreditation of Albanian National Center of city, The Plaza Tirana is perfectly placed to Hotel Shuttle Service (reservations and access the main tourist attractions, muse- prices on request) Accreditation (QKEV). ums and monuments in Tirana as well the shopping and business district. A taxi can be taken from the airport, give the following address: 28 Nentori Street in Are you coming by car? the center of Tirana, next to the Skander- beg Square. If you are visiting Tirana by car follow the signs to the city center ( Bus Transport: departures every hour to Square). At the roundabout exit at the National Museum, 500m from the hotel. Mosque of E’Them Bey. The hotel is on the Journey time can last from 25 to 35 min. right at 28 Nëntori Street. Wifi: Wifi@Plaza Parking If you are visiting Tirana by car, you do not Contact Plaza: have to worry about the parking area. The Rruga 28 Nentori, 1001 Tirana Albania Plaza Tirana offers you the possibility to Phone: +355 (0) 422 112 21 use our private garage at very competitive Email: [email protected]

14 15 ORGANIZING COMMITTEE OF IMCA VI

President of the “Organizing Committee” Klodian Allajbeu (CEO, American Hospital)

Lindita Shosha (President of IV IMCA) Fatos Olldashi (Vice President of IV IMCA) Edmond Puca (General Secretary of IV IMCA) Albana Mehmeti (Organizing Secretary of IV IMCA) Onejda Ymeraj (Coo & Head of Commercial Department) Mario Karaj (American Hospital, General Manager) Dhurata Hysa (American Hospital 1, Branch Manager) Gentjan Cako (American Hospital 2, Branch Manager) Nertil Xhaferi (American Hospital 3, Branch Manager) Igli Larashi (American Hospital Pristina, Branch Manager) Robert Metaj (American Hospital Fier, Branch Manager) Geljant Kaleci (PR&Marketing) Edion Pojani (Networking Department Manager) Loren Haxhi (Webmaster) OPENING HOURS PREVIEW CENTER Thursday, November 15 08:00 - 21:00 Friday, November 16 07:30 - 18:00 SCIENTIFIC COMMITTEE Saturday, November 17 07:30 - 18:30

President of the “Scientific Committee” Lindita Shosha Mano (Albania) IF YOU ARE A CHAIRPERSON • Please locate your session room in due time and be at your session at last 15 minutes Lindita Shosha (Albania) Mentor Petrela (Albania) prior of the session Philip Caushaj (USA) Anila Godo (Albania) • We may remind you that speakers need to strictly observe the time schedule. Fatos Olldashi (Albania) Ariana Strakosha (Albania) • Please fill the questionnaire which be handed to you after the respective session. Edmond Puca (Albania) Rudin Domi (Albania) Alfred Aga (Albania) Asead Abdyl (Albania) Iris Allajbeu (Albania) Nereida Xhabija (Albania) Narimantas Samalavicius (Lithuania) Artur Xhumari (Albania) IF YOU ARE A SPEAKER IN SESSION Arben Kojqiqi (Albania) Novruz Caushaj (Albania) • Please locate your session room in due time and be at your session at last 20 minutes Brunilda Zllami (Albania) Teuta Haveri (Albania) Joseph NunioMensah (UK) prior of the session Juxhin Gjoshe (Albania) Ugo de Sanctis (Italy) Entela Puca (Albania) • For sessions starting at 09.00, the presentations should be delivered the previews day. Marco Jacobbi (Italy) Edlira Cako (Albania) • In order to avoid any delays, speakers are kindly requested to hand in their presenta- Besnik Kojcici (Albania) tions on USB Emiljana Huti (Albania) Blerim Arapi (Albania) Leart Berdica (Albania) Teona Bushati (Albania) Albana Daka (Albania) Gjergj Caushi (Albania) Elton Peçi (Albania) Sotiraq Lako (Albania) Albana Shahini (Albania) Niketa Kolici (Albania) IF YOU ARE PRESENTING A POSTER • Each poster will be displayed in electronic screen for the entire duration of the congress Fiona Nasto (Albania) Klaus Boeheim (Austria) at Queen Geraldine Poster Area. Edvin Selmani (Albania) Alfred Nona (Albania) Christos Maroudis (Greece) Gjergji Belba(Albania) • If you have any questions regarding your poster(s), please do not hesitate to contact Nestor Therecka (Albania) Gjergji Semini (Albania) the staff at the registration desk.

16 17 Session Plenary Plenary Plenary Session PRECONGRESS TRAINING COURSE PRECONGRESS TRAINING COURSE SATELLITE SYMPOSIA ON HEMATOPATHOLOGY WORKSHOP RAD-AID

SATELLITE SYMPOSIA ON HEMATOPATHOLOGY I THE PLAZA HOTEL TIRANA “The use of ultrasound in breast, 15 November 2018 / 10:00-12:30 / Dora D’Istria Hall Chair: John Minarcik (USA), Teona Bushati (Albania), Sotiraq Lako (Albania) musculoskeletal & pediatric imaging”

Chronic Myeloproliferative Syndromes - John Minarcik (USA) THE PLAZA HOTEL TIRANA The multifaceted chronic myeloid disorders – Adela Perrolla (Albania) 15 November 2018 / 10:00-12:30 / Jeronim De Rada Hall Myelodysplastic syndromes - Fisnik Kurshumliu (Kosovo) Chair: Eralda Mema (USA), Iris Allajbeu (Albania) Understanding pediatric Myelodysplastic Syndromes – Donjeta Bali (Alia) (Albania) Bone Marrow Biopsy, Accurate Evaluation - Teona Bushati (Albania) Ultrasound Guided Breast Interventions - Michelle Dorsey (USA) A Practical Guide to Ultrasound Evaluation in the Symptomatic Female Breast - Yiming Gao (USA) Introduction to MSK ultrasound: Didactic and Case based learning Mark - C. Langston (USA) SATELLITE SYMPOSIA ON HEMATOPATHOLOGY II 15 November 2018 / 13:00-15:00 / Dora D’Istria Hall “The use of ultrasound in breast, musculoskeletal Chair: John Minarcik (USA), Leart Bërdica (Albania) & pediatric imaging” - – Practical Session Acute Myeloid Leukemias - Fisnik Kurshumliu (Kosovo) Plasma cell neoplasm - Leart Bërdica (Albania) 15 November 2018 / 13:00-15:00 / Jeronim De Rada Hall Hematopoietic Stem and Progenitor Cells: concepts, definitions. Hematopoietic Stem Cell Chair: Eralda Mema (USA), Iris Allajbeu (Albania) Transplantation as therapy, the new reality in Albania - Sotiraq Lako (Albania)

18 19 Plenary Session PRECONGRESS TRAINING COURSE WORKSHOP NUTRITION SATELLITE SYMPOSIA BREAST CANCER THE PLAZA HOTEL TIRANA 16 November 2018 09:00-11:30 Marin Barleti Hall

Chair: Fleur Kilburn Toppin (UK), Iris Allajbeu I - “Nutrition profile for hospitalized & ambulatory patient” (Albania), Eralda Mema (USA) THE PLAZA HOTEL TIRANA • Imaging the axilla - Fleur Kilburn Toppin (UK) 15 November 2018 / 10:00-12:30 / Marin Barleti Hall Chair: Albana Daka (Albania), Carmelo Rizzo (Italy) • Benign breast disease: clinical, radiologic and pathologic correlation Eralda Mema (USA) Management of food regimes in hospitalized patients - Albana Daka (Albania) The modern aspects of Clinical Nutrition in the prevention and cure of Chronic diseases - Carmelo Rizzo (Italy) • MDT (multidisciplinary team ) Role in Neoadjuvant Treatment of Breast Epigenetic and nutrigenetic diet in obesity - Margerita Borsa (Italy) Cancer - Emiljana Huti (Albania)

II - “Nutrition profile for hospitalized & ambulatory patient” • Automated whole breast ultrasound (ABUS)- A new screening tool for 15 November 2018 / 13:00-15:00 / Marin Barleti Hall women with dense breasts?- Iris Allajbeu (Albania) Chair: Albana Daka (Albania), Carmelo Rizzo (Italy) • Causes and management of breast pain in our daily practice Detection of food intolerances in Albania. Our experience - Albana Daka (Albania) Albana Shahini (Albania) Management of Obesity - Entela Puca (Albania) • Frozen biopsy of Sentinel Lymph Node in breast cancer patient after Food and nutrition therapy in hospitalized patients. Neoadjuvant Chemotherapy in Albania.- Majlinda Ikonomi (Albania) Our experience based on JCI guidelines - Jona Kajtazi (Albania) The importance of body composition analysis in the process of weight loss - Valbona Isufaj (Albania) • Fine-needle aspiration cytology vs core needle biopsy in breast lesions. Intestinal microflora, disesase prevention due to quality of nutrition –Kristaq Sini (Albania) A review. - Teona Bushati (Albania)

• Challenges in therapy for HER 2 + BREAST CANCER. Esmeralda Sera (Albania) 20 Session WORKSHOP Plenary NEONATAL RESUSCITATION

SATELLITE SYMPOSIA “MODERN MANAGEMENT OF INFERTILITY” THE PLAZA HOTEL TIRANA 17 November 2018 / 12:00-14:30 / Dora D’Istria Hall

Chair: Christos Maroudis (Greece), Corina Manolea (Romania), Elton Peçi (Albania)

• Individualized management of poor ovarian response - Corina Manolea (Romania)

• Investigation of the infertile couple- Genc Kabili (Albania)

• Artificial Reproductive Techniques- Elton Peci (Albania)

• The role of Hysteroscopy in the management of Infertility - Christos Maroudis (Greece) • Fertility Preservation - Arisa Cane (Albania) 17 November 2018 / 15:30-18:00 • Surgical retrieval, processing and selection of sperm for ICSI in Azoospermia: What should We Doctors know? - Gjergji Semini (Albania) Queen Geraldine 1 Hall • Intrauterine insemination treatment in subfertility - Dritan Subashi (Albania) THE PLAZA HOTEL TIRANA • The role of Laparoscopy in the management of infertility - Christos Maroudis (Greece) Resuscitation of Newborn: A practical workshop for nurses • Intracytoplasmic Sperm Injection - Besfort Ferhati (Albania) Svetlana Nela (UK) • Recurrent pregnancy loss - Jonela Lulo (Albania) 22 23 Information Practical Practical Practical info about Tirana Basic data about Albania

Tourist information centre GEOGRAPHIC LOCATION The official tourist information centre stands just behind the National Albania is a country in south-eastern Europe with a coastline that runs from the Adriatic History Museum. As well as housing an ever-increasing stock of printed Sea to Ionian Sea. It is situated in the south-west of the Balkan Peninsula, between Greece materials on what to see and do in Tirana, this is also a good place to to the south, the Republic of Macedonia to the east and Montenegro and Kosovo to the come for books and leaflets on Albania’s other major tourism attractions. north. Tirana itself is positioned just west of the centre of the country, with the Adriatic One Info Point is inside Tirana International Airport Mother Tereza, where one can find coast only 30 km away. maps and information on Tirana. You can find some additional info points in the main squares and crossroads in Tirana. When coming from the airport, the first one a visitor is POPULATION likely to find will be at Zogu i Zi. These info points are in the form of large green and white The Albanian population is approximately 2.88 million inhabitants, with about 113 bus stops. They display maps of Tirana, giving directions to the main attractions. inhabitants per square meter. The Albanian population is generally young and it is distinguished for its vitality. The most populated parts of the country are the area around Currency Exchange the capital Tirana, the port of Durrës and generally in the western lowlands of the country. Exchanging currency in Albania is straight forward. There are many licensed exchange Albania is a country with a relatively homogeneous population. Minorities represent about shops in Tirana with several located near the centre, some behind the National History 3 percent of the population. The largest one is the Greek minority (located in the southern Museum, and others near the . We advise you to always ask for a receipt part of the country, in the provinces of Dropull, Pogon and Vurg). Other minorities include for your transaction. Macedonians, located in the areas of the Great Prespa Lake, as well as Montenegrin, Roma etc. The largest populations are concentrated in the cities of Tirana, Durrës, Elbasan, Useful numbers in Albania Shkodra, Vlora, Korça etc. Other cities of tourist importance include Berat, Gjirokastra, Airport +355 4 2381 600 During your stay in Tirana, Saranda, Kruja and Pogradec. Lost Luggage +355 4 2381 681 the following information might be useful. Police Information 122 Congress Secretary Office number +355674050505 Police Emergency 129 Taxi (English Speaking) http://citytaxi.al/ Traffic Police 126 Rent a Car http://www.albarent.al/en Fire Department 128 Hotels http://www.plazatirana.com/ Emergency number 112 About Albania http://www.albania.al 24 hour Pharmacy +355 4 2222 241

Albania Public Holidays 2016 New Year (1/2 January), Summer Day 14 March Catholic Easter Day (27 March) Orthodox Easter Day (1 May) Labour Day (1 May) Ramadan Bajram or Eid al-Fitr Festival (end of Ramadan) 5 June Kurban Bajram or Greater Eid Festival (12 september) Independence Day (28 November) Liberation Day (29 November) National Youth Day (8 December) Christmas (25 December)

24 25 Information Practical Practical

Tirana officially has 750,000 inhabitants (though the real number may be much higher), ECONOMY

Practical covers 42 square kilometres and lies at 110m above sea level, though two mountains of Since the fall of communism, the development of the Albanian economy has been fueled Information 1612m and 1828m also rise within the municipality. The city has some 30,000 students of primarily by the service and construction industries, though tourism has recently played which nearly half attend the . an increasing role in the economy and is growing rapidly. Many people are curious to explore a country whose borders were closed to travel for many years. Given the continued development of both summer and winter resorts, people all over the world have LANGUAGE begun to think of Albania as a tourist destination. The official language is Albanian. It constitutes a unique and original branch RELIGIONS of Indo-European family. The Albanian There are four official religious beliefs in Albania. These belong language is an ancestor of the Illyrian to the Sunni Muslim, Orthodox Christian, Catholic Christian and language and it is one of the oldest Bektashi Muslim. Followers of Islam are found throughout the languages spoken in the European country. Catholics are concentrated mostly in the northern part of continent. Its vocabulary contains the country, the Orthodox in the south and center of the country, words from other languages such as and the Bektashi sect of Sufism is found in Persian ,Turkish, Greek, Latin and Slavic some specific regions such as Skrapar, Krujë, languages, but it has preserved its Elbasan, Mat, Mallakastër, Korçë, etc. Freedom originality as an unique language. The of religion is a right guaranteed by the Albanian is recognized for its Constitution. Besides official religions, it has two distinct dialects, which are: “Gheg” also followers of other as those of Baha’is, and “Tosk”. The Shkumbin River, which Christian Evangelicals, Jehovah’s Witnesses, divides the country into two almost equal etc. Additionally there are also atheists and non- parts, is the natural border of these two religious people. dialects. Gheg is spoken in the north, Albania became unique in Europe in 1967, when all religious while Tosk is spoken in the south. The activity was banned by closing down churches, mosques, has 36 letters. religious schools and tekkes. For about 23 years, Albania was the only atheist country in the world. In 1990, after CLIMATE a democratic movement, the freedom of religion was Albania has a Mediterranean climate with each restored and churches and mosques were rebuilt, season offering distinct- yet pleasant weather. as well as many other religious buildings. Albania Some features of the climate vary by region: The has several places of religious pilgrimage. The coastal areas have a Central Mediterranean climate most important are those in honor of Shna with mild, wet winters and hot, dry summers. The Nues (St. Anthony) on 13 June at the Church of alpine areas have a Central Continental climate Lac, the pilgrimage of Abas Ali on 19 August in with cold, snowy winters and temperate summers. Tomorr Mountain, the one in honor of St. Mary The lowlands have mild winters, on 15 August in some of the churches across the averaging about 7°C, and summer country, the pilgrimage in honor of Sari Salltik in temperatures average 24°C. Lowland Kruja and others. rainfall ranges from 1,000 mm to more than 1,500 mm annually, with greater INTERESTING FACTS rainfall in the north. Nearly 95% of Tirana’s name is mentioned for the first time in a rainfall occurs in the winter and rainfall Venetian document of 1418. The first record of its in the upland mountain ranges is population was compiled by the invading Ottomans in 1431–1432, revealing some 1,000 heavier. Despite the rain, houses and 7,300 inhabitants. A century and a half later, in the registration of 1583, Tirana enjoy a great deal of sunshine. The had 20,000 inhabitants. In 1769, Tirana and surroundings exported 2,600 barrels of olive overall climate is pleasant and is oil. At the beginning of the 20th century Tirana area had 140,000 olive trees and 400 oil favorable for outdoor activity. On mills, while the market numbered 700 shops. In 1990, the city had 250,000 inhabitants, average, Albanians enjoy a great deal while it now numbers more than 750,000, perhaps as much as one million, due to a of sunshine, second only to Spain (in demographic shift with people from all over the country heading towards the capital. Europe) in average annual sunny days.

26 27 at Glance Program at a Glance Program th Program at Glance at 15-17 November-4 IMCA 2018 16 November 2018

15 November 2018 8:00 REGISTRATION OPENED

QUEEN DORA D’ JERONIM MARIN Venue 9:00 REGISTRATION OPENED GERALDINE 1 ISTRIA DE RADA BARLETI QUEEN DORA D’ JERONIM MARIN Venue GERALDINE 1 ISTRIA DE RADA BARLETI Summit II Colorectal Colorectal 9:00 - 11:30

Neurosurgery Breast cancer Breast

Cardiology and Cardiology cardiac surgery 1 surgery cardiac Satellite Symposia Satellite RAD-AID Workshop Workshop Workshop Workshop

NUTRITION 10:30 - 15:30 10:30

11:30 - COFFEE BREAK on Hemapatology

Satellite symposia symposia Satellite 12:00 - surgery in Albania Round table Round cardiology & cardiology 12:00 - 14:30 Orthopedic & Orthopedic Interventional Interventional Cardiovascular Cardiovascular Plastic surgery Plastic General Surgery General Successful strate Successful gies for Improving Improving for gies health care system system care health WELCOME CEREMONY 16:00 - 16:30 16:00 14:30 - BUFFET LUNCH BREAK- POSTER GALERY 15:30 QUEEN GERALDINE 2 & Pediatry Pediatry Laboratory Neonatology 15:30 - 18:00 Anesthesiology Anesthesiology & Intensive Care & Intensive Advanced Imaging Advanced surgery” mini-invasive mini-invasive 16:30 - 20:30 16:30 Plenary session

“Recent trends in trends “Recent 20:30 AWARDS & GALA DINNER - (QUEEN GERALDINE HALL)

28 29 at Glance Program Program

Thursday, 15 November 2018

Program 17 NOVEMBER 2018 at Glance at

09.00 – 20.00 8:00 REGISTRATION OPENED Registration opened Dora D Istria Main Hall QUEEN DORA D’ JERONIM MARIN 10.00 – 12.30 Precongress Training Course Venue GERALDINE 1 ISTRIA DE RADA BARLETI Dora D’Istria Hall Satellite symposia on Hematopathology I • Chronic Myeloproliferative Syndromes John Minarcik (USA)

• The multifaceted chronic myeloid disorders Adela Perrolla (Albania) CHAIR: • Myelodysplastic syndromes John Minarcik (USA), Pathology

Anatomical Fisnik Kurshumliu (Kosovo) Nephrology

9:00 - 11:30 Teona Bushati (Albania),

Nursing Forum 1 Forum Nursing Sotiraq Lako (Albania)

Intern Medicine 1 • Understanding pediatric Myelodysplastic Syndromes Donjeta Bali (Alia) (Albania) 11:30 - COFFEE BREAK 12:00 • Bone Marrow Biopsy, Accurate Evaluation Teona Bushati (Albania)

13.00 – 15.00 Precongress Training Course Dora D’Istria Hall Satellite symposia on Hematopathology II • Acute Myeloid Leukemias Fisnik Kurshumliu (Kosovo) Modern of Infertility of 12:00 - 14:30 Management Management • Plasma cell neoplasm Round table 2 Round Medical Tourism, Medical Tourism,

Nursing Forum 2 Forum Nursing CHAIR:

Intern Medicine 2 Leart Bërdica (Albania) Satellite symposia Satellite JSI & patient safety JSI & patient John Minarcik (USA), Leart Bërdica (Albania) • Hematopoietic Stem and Progenitor Cells: concepts, 14:30- BUFFET LUNCH BREAK- POSTER GALERY definitions. Hematopoietic Stem Cell Trans- 15:30 QUEEN GERALDINE 2 plantation as therapy, the new reality in Albania Sotiraq Lako (Albania) Urology & Obstetric Gynecology Gynecology WORKSHOP WORKSHOP 15:30 - 18:00 Ophthalmology Neonatal resuscitation Neonatal resuscitation 18:00 - CLOSING CEREMONY & IMCA AWARDS 18:30 Best Poster & Oral Presentations

30 31 at Glance Program Program Session Plenary Plenary

Thursday, 15 November 2018 Thursday, 15 November 2018 Plenary Session Program at Glance at

Precongress Training Course Precongress Training Course 10.00 – 12.30 10.00 – 12.30 Workshop RADAID I “The use of ultrasound in breast, Workshop Nutrition I “Nutrition profile for Jeronim de Rada Hall Marin Barleti Hall musculoskeletal & pediatric imaging” hospitalized & ambulatory patient” • Ultrasound Guided Breast Interventions • Management of food regimes in hospitalized patients Michelle Dorsey (USA) Albana Daka (Albania)

• A Practical Guide to Ultrasound Evaluation • The modern aspects of Clinical Nutrition in CHAIR: in the Symptomatic Female Breast CHAIR: Albana Daka (Albania), the prevention and cure of Chronic diseases Eralda Mema (USA), Yiming Gao (USA) Carmelo Rizzo (Italy) Iris Allajbeu (Albania) Carmelo Rizzo (Italy) • Introduction to MSK ultrasound: • Epigenetic and nutrigenetic diet in obesity Didactic and Case based learning Margerita Borsa (Italy) Mark C. Langston (USA) Precongress Training Course 13.00 – 15.00 Precongress Training Course Workshop Nutrition II “Nutrition profile for 10.00 – 15.00 Marin Barleti Hall Workshop RADAID II “Hand on ultrasound in breast, hospitalized & ambulatory patient” Jeronim de Rada Hall musculoskeletal & pediatric imaging” • Detection of food intolerances CHAIR: • Practical session: Hand on ultrasound in breast, in Albania. Our experience Eralda Mema (USA), musculoskeletal & pediatric imaging Albana Daka (Albania) Iris Allajbeu (Albania) • Management of Obesity Entela Puca (Albania)

• Food and nutrition therapy in hospitalized CHAIR: patients. Our experience based on JCI guidelines Albana Daka (Albania), Jona Kajtazi (Albania) Carmelo Rizzo (Italy) • The importance of body composition analysis in the process of weight loss Valbona Isufaj (Albania)

• Intestinal microflora, disesase prevention due to quality of nutrition Kristaq Sini (Albania)

32 33 at Glance Program Program Session Plenary Plenary

Thursday, 15 November 2018 Friday, 16 November 2018 Plenary Session Program at Glance at

16.00-16.30 9.00-11.30 OFFICIAL WELCOME CEREMONY QUEEN GERALDINE HALL QUEEN GERALDINE 1 Colorectal Summit II Hall 16.30-18.30 Plenary session I QUEEN GERALDINE HALL “Recent Trends in Mini-Invasive Surgery” • Total Mesorectum Excision - Which approach in • Minimal Surgery, Minimal Tissue 2018? - Joseph Nunoo Mensah (UK) John Minarcik (USA) • Laparoscopy in the management of stage III • Mini-invasive surgery for rectal and pelvic diverticultis – Xavier Delgadillo (Switzerland) organs prolapses: Longo’s Techniques Antonio Longo (Italy) • Endoscopic Pilonidal sinus treatment (EPSIT): new approach to an old disease • Lung Oncology. Contemporary Manos Pramateftakis (Greece) CHAIR: practice and advances John Minarcik (USA) Arben Kojqiqi (Albania) • Laparoscopic Right Colectomy for Colon Antonio Longo (Italy), Cancer: Colon mobilization and Vessel ligation Mentor Petrela (Albania) • ART and long term outcome of the descendants Vasileios Drakopoulos (Greece) Dimitris Loutradis (Greece) • Hemorrhoids and ODS: unique cause unique • Alloplastic reconstruction in treatment - Antonio Longo (Italy) Hemifacial Microsomia (HFM) Spiros Lazarou (USA) CHAIR: • Usage of different advance flap or “Z”- plasty in the Lindita Shosha Mano • Surgeon of Art and the Art of the Surgeon’s treatment of colorectal patients – The necessity of (Albania) education of colorectal surgeons in different surgical Mentor Petrela (Albania) Joseph Nunoo Mensah (UK) techniques from plastic and reconstructive surgery 18.30-20.30 Plenary session II Manos Pramateftakis Dragoslav Mladenovik (Macedonia) QUEEN GERALDINE HALL “Recent Trends in Mini-Invasive Surgery” (Greece) Antonio Longo • Ulcerative Colitis. Indications For Surgery & • Contemporary Endovascular Interventions 2020 (Italy) Surgical Techniques- Joseph Nunoo Mensah (UK) Jose Wiley (USA) • Minimally Invasive diagnostic and curative • 50 years of Phacoemulsification procedures with precancerous colonic lesions Ugo De Sanctis (Italy) Leart Bërdica (Albania) • Local Control Assessment of Spine Metastases after CHAIR: • Rectal cancer in Albania, where do we stand Post-operative Stereotactic Radiosurgery Following Jose Wiley Elvisa Kozma (Albania) (USA) Limited versus Extensive Spine Surgery: A Retrospec- Safet Beqiri tive Review and Future prospective trails including • Clinical presentations and the treatment (Germany) Immune therapy Dukagjin Blakaj (USA) modalities of polymicrobial necrotizing fasciitis, Manos Pramateftakis (Greece) • The role of balloon pulmonary angioplasty (BPA) Fournier’s Gangrene of the anal- genital area in the treatment of patients with inoperable chronic Lindita Shosha Mano (Albania) thromboembolic pulmonary hypertension (CTEPH) • How surgeon and operative room team experience Safet Beqiri (Germany) can influence oncological and operative outcomes in • Minimally invasive approach to rectal can- robotic surgery? - Cristina Falavolti (Italy) cer: laparoscopic TME and pelvic IONM Manos Pramateftakis (Greece)

34 35 at Glance Program Program Session Plenary Plenary

Friday, 16 November 2018 Friday, 16 November 2018 Plenary Session Program at Glance at

9.00-11.30 9.00-11.30 Cardiology & Cardiac Surgery 1 Neurosurgery Dora D’Istria Hall Jeronim De Rada Hall • Complex Percutaneous Coronary Interventions 2020 • Concurrent Traumatic Cranio-Spinal Injury: Lessons Jose Wiley (USA) from A Systematic Review and Meta-Analysis Andreas Demetriades (Scotland) • Elective transfer from Cardiopulmonary Bypass to Centrifugal Pump Support in Very High Risk • Adjuvant Radiation Therapy and ENI in Olfactory Arben Kojqiqi (Albania) Neuroblastoma - Dukagjin Blakaj (USA)

• CTO ( Chronic Total Occlusions) • Is there a role for stereotactic radiosurgery in treatment and approach the management of large brain metastases? CHAIR: Sulejman Cela (USA) Artur Xhumari (Albania) Jose Wiley • Updates on Myocardial Revascularization • Thoracholumbar Fracture (USA) Arben Kojqiqi Gani Bajraktari (Kosovo) Fatos Olldashi (Albania) (Albania) Sulejman Cela • A systemic review and meta-analysis: Bentall vs. • Failed back surgery related syndromes (FBSRS) (USA) David procedure in Marfan and in acute type A Ridvan Alimehmeti (Albania) Denis Berdjas dissection - Denis Berdjas (Switzerland) (Swtzerland) CHAIR: • The role of Percutaneous Vertebroplasty +/- biopsy • Quality assurance and Risk management in Heart Mentor Pertrela in the treatment of spinal pathological fractures surgery - Fatos Kojqiqi (Kosovo) (Albania) Artan Bano (Albania) Andreas Demetriades • Percutaneous Coronary Intervention (Scotland) • Emerging medicolegal concerns in Spinal Surgery: for Left Main Coronary Artery Disease Fatos Olldashi A concise reflection from a modest UK experience Blendi Horjeti (Albania) (Albania) Dritan Pasku (England) Emeka Nkenke • Noncoronary Sinus Aneurysm (Austria) • Surgical management of Subaxial Uliks Ekmekçiu (Albania) Cervical Fractures: Our experience Irgen Hodaj (Albania)

• Endovascular thrombectomy for a c u t e i s c h e m i c s t r o k e : O u r e x p e r i e n c e Arben Rroji (Albania)

• Corrective surgery in cleft patients Emeka Nkenke (Austria)

• Minimally invasive surgery and microscopic reconstruction for treatment of head and neck pathology - Alfred Aga (Albania)

• Tumors of glomus caroticum Halil Krasniqi (Kosovo)

36 37 at Glance Program Program Session Plenary Plenary

Friday, 16 November 2018 Friday, 16 November 2018 Plenary Session Program at Glance at

9.00-11.30 Breast Cancer 12.00 - 14.30 Oncology & General Surgery Marin Barleti Hall Satellite Symposia Queen Geraldine 1 Hall • Imaging the axilla - Fleur Kilburn Toppin (UK) • Devil stands in details – when colon is not long enough in laparoscopic LAR! Tips and tricks of a • Benign breast disease: clinical, radiologic and safe anastomosis - Arben Beqiri (Albania) pathologic correlation - Eralda Mema (USA) • ERCP and laparoscopic cholecystectomy – standards • MDT (multidisciplinary team ) Role in in management of common bile duct stones associated Neoadjuvant Treatment of Breast Cancer with cholelythiasis – Sabri Tmava (Kosovo) Emiljana Huti (Albania) • Colon Trauma- Xavier Delgadillo (Switzerland) • Automated whole breast ultrasound (ABUS)- A new screening tool for women with dense breasts? • Multidisciplinary approach and surgical Iris Allajbeu (Albania) treatment strategy in blunt abdominal trauma Lindita Shosha Mano (Albania) CHAIR: • Causes and management of breast pain in our daily Fleur Kilburn Toppin (UK) practice - Albana Shahini (Albania) • Minimal Invasive Transoral Endoscopic Iris Allajbeu (Albania) Eralda Mema (USA) Surgeries for oro-hypopharyngeal cancer in Japan • Frozen biopsy of Sentinel Lymph CHAIR: Yohei Kawasaki (Japan) Node in breast cancer patient after Arben Beqiri N e o a d j u v a n t C h e m o t h e r a p y i n A l b a n i a . (Albania) • Intraoperative radiotherapy (IORT) for loco Majlinda Ikonomi (Albania) Lindita Shosha Mano regionally persistent or recurrent head and neck (Albania) cancer: Current clinical data and future study • Fine-needle aspiration cytology vs core Xavier Delgadillo of immune therapy in combination with IORT needle biopsy in breast lesions. A review. (Switzerland) Dukagjin Blakaj (USA) Teona Bushati (Albania) Vasileios Drakopoulos (Greece) • Early and late outcome, mortality and major • Challenges in therapy for morbidity after lung cancer surgery for primary HER 2 + BREAST CANCER. carcinoma - Fadil Gradica (Albania) Esmeralda Sera (Albania) • Retroperitoneal sarcoma: Case report and review of the literature - Henri Kolani (Albania)

• EBUS or EUS - B FNA? - Eritjan Tashi (Albania)

• Salivary gland neoplasms: A review study of 8 years in two major hospital centers in Albania - Brunilda Gashi Cenkoglu (Albania)

• Implementation of Imrt At Hygeia Hospital Tirana in Advance stage of Lung Cancer Ledio Bregu (Albania)

38 39 at Glance Program Program Session Plenary Plenary

Friday, 16 November 2018 Friday, 16 November 2018 Plenary Session Program at Glance at

Interventional cardiology 12.00 – 14.30 12.00 – 14.30 Orthopedic & Plastic Surgery & Jeronim De Rada Hall Dora D’Istria Hall Cardiovascular surgery • Prevalence of complications in patellofemoral • Surgical revascularization of the diabetic foot stabilization operations - a retrospective analysis Sokol Xhepa (Albania) Florin Ramadani (Kosovo)

• Hybrid foot vein arterialization in no-option patients • Why should “do not use PLLA SCREWS in Knee with critical limb ischemia: a preliminary report Surgery”? - Radu Prejbean (Romania) Andrea Casini (Italy) • Innovations and new trends in foot and ankle • Pulmonary endarterectomy for distal chronic surgery - Ernest Orthner (Austria) thromboembolic pulmonary hypertension Andrea M. D’Armini (Italy) • Plantar Fascitis: Heel pain current concept and treatment - Gjergji Caushi (Albania) • Minimally invasive Cardiac Surgery: Albanian experience - Edvin Prifti (Albania) • Adolescent Idiopathic Scoliosis: Operative indications, techniques and outcomes CHAIR: • Surgical aspects and late outcomes of the total Kamil Cagri Kose (Turkey) Andrea Casini (Italy) coronary endarterectomy and “Dome arterial Sokol Xhepa (Albania) rebuilding - Edvin Prifti (Albania) • Direct Anterior Approach for Total Hip Arthroplasty CHAIR: Edvin Prifti (Albania) Tonin Alia (Albania) Andrea M. D’Armini (Italy) • Carotid artery stenting: evolution of different Florin Ramadani (Kosovo) Radu Prejbean (Romania) • Mini-invasive technique in treatment of pediatric flat devices - Alban Malaj (Italy) Gjergj Caushi (Albania) Ernest Orthner (Austria) foot - Edvin Selmani (Albania) • In-hospital mortality rate in patients with ruptured abdominal aneurysm treated with open surgical • Surgical treatment of Gastrocnemius recession repair - Elmi Olluri (Albania) in patients with acute and chronic heel pain Paolo Ronconi (Italy) • Modern techniques ın treatıng varıcose veıns Bledar Hodo (Albania) • Total HIP replacement due to Secondary Osteoarthritis - Cen Bytyqi (Kosovo) • Acute myocardial infarction with arterial thrombosis events in a young woman • Osteochondral transplantation technique pitfalls in diagnosed with antiphospholipid syndrome knee osteochondral defects (MOSAICPLASTY/ Daniela Teferiçi (Albania) OATS technique) - Ledian Fezollari (Albania) • Total HIP replacement due to Secondary Osteoarthritis - Cen Bytyqi (Kosovo)

• Multiple tendon transfer Merle d’Aubigné modified by Tubiana in the treatment of irreversible radial nerve paralysis. The evaluation of the long-term results - Arian Celaj (Albania)

40 41 at Glance Program Program Session Plenary Plenary

Friday, 16 November 2018 Friday, 16 November 2018 Plenary Session Program at Glance at

Round Table 1 15.30-18.00 12.00 – 14.30 Advanced Imaging “ Successful strategies for improving health care Queen Geraldine 1 Hall Marin Barleti Hall system in Albania” • From Image to Clinical Thinking or about • Successful strategies for improving the health care Physician’s Wisdom - Rainer Rienmuller (Austria) system in Albania - Rudina Degjoni (Albania) • Ultrasound Workup of the Infertile Male CHAIR: • Secrets of Success in Medicine Shpëtim Telegrafi (USA) Rudina Degjoni Rainer Reinmuller (Austria) (Albania) • Ultrasound‐Guided Renal Transplant Biopsy Klodian Allajbeu • Strategic Approach to improving the (Albania) Adriatik Daku (Albania) quality of care and ensuring patient safety Rainer Reinmuller • Trans arterial chemoembolization in treatment (Austria) Erion Dasho (Albania) of hepatocellular carcinoma , first experience in Special guest: • Smoking-Cessation Intervention for Hospital Albania – Fatmir Bilaj (Albania) Mrs. Ogerta Manastirliu Patients: Lessons learned from a pilot study (Albania), Ministry of Health Marta Civljak (Croatia) • Elastography and E-thyroid application as and Social Protection additional tools in differentiating thyroid nodules CHAIR: • To reduce the antibacterial resistance it is our daily Albana Shahini (Albania) Rainer Rienmuller responsibility – Tritan Kalo (Albania) (Austria) • The importance of Radiologic examinations in the Iris Allajbeu (Albania) differential diagnosis of chest tumors in children Shpëtim Telegrafi Marjeta Tanka (Albania) (USA) • Efficacy of percutaneous CT-guided drainage in the management of abdominal and pelvic abscesses Denis Qirinxhi (Albania)

• Radiology examinations in diagnoses of carotid artery stenosis - Klodian Çaçi (Albania)

• Selective coxofemoral US screening in infants with associated risk factors for DDH Blerina Saraci (Albania)

• Contrast-Induced Nephropathy: Novel insights into prevention and management Matilda Imeraj (Albania)

42 43 at Glance Program Program Session Plenary Plenary

Friday, 16 November 2018 Friday, 16 November 2018 Plenary Session Program at Glance at

15.30-18.00 15.30-18.00 Pediatric and Neonatology Anesthesiology & Intensive Care Dora D’Istria Hall Jeronim de Rada Hall • Stem cells and their use in the clinical practice of • The history of thoracic anesthesia. Airway man- oncology and hematology - Anila Godo (Albania) agement for trachea and bifurcation resection Safet Beqiri (Germany) • Use of Positive Airway Pressure (CPAP) in the Birth Room for the Prevention of Respiratory Distress • The Importance of Dorsal Ganglion Root and the shape Eduart Tushe (Albania) of intervertebral foramina, in the treatment of post trau- matic and post-operative Pain - Apostol Vaso (Albania) • Retinopathy of prematurity: diagnosis and treatment • New concepts and debates on Sepsis Giovanni Anselmetti (Italy) Blerim Arapi (Albania) • Neonatal Respiratory Morbidity after Elective • Desmopressin for Cardiac Surgery Cesarean Delivery at Term Newborns: A prospective Gentian Huti (Albania) study - Niketa Kolici (Albania) • Postoperative complications following Neuro- • Immunization of Preterm child. What does it differ surgical procedures in American Hospital Tirana in its schedule? – Gjeorgjina Kuli (Albania) Rudin Domi (Albania) CHAIR: • Neurological disorder during neonatal period • Extracorporeal Membrane Oxygenation (ECMO) as Anila Godo extracorporeal life support device in intensive care (Albania) Aida Bushati (Albania) Giovanni Anselmetti unit - Rinard Kortoci (Albania) • Developmental assessment of Preterm children, CHAIR: (Italy) Safet Beqiri (Germany) • The continous renal replacement therapy indica- Niketa Kolici General considerations – Migena Kika (Albania) Tritan Shehu (Albania) tions in ICU, the American Hospital experience (Albania) Blerim Arapi (Albania) • The neonatal hearing screening (NHS): the Asead Abdyli (Albania) challenge of professionals, the health system or the • Anesthesiology and Intensive Care - Ismet Jusufi population - Birkena Qiriazi (Holland) (Kosovo) • Chest pain and syncope in children; Is it cardiac or • Spinal anesthesia for cesarean section--safe and not?- Numila Kuneshka Maliqari (Albania) effective. Our experience in American Hospital 2 Mustafa Bajraktari (Albania) • Infants’ Morbidity in Albania Elda Skenderi (Kosovo) • What’s new for antiplatelet therapy in patients with coronary stents undergoing non-cardiac surgery • Esophageal Atresia in University Marjeta Bilaj (Miraka) (Albania) Clinical Centre of Kosovo 2012-2017 Pëllumb Haxhikadrija (Kosovo) • Non-surgical complications related to hysteroscopic surgery - Jonida Peçi (Albania) • Children convulsions and mouth trauma during the opening of the mouth - Edmont Laho (Albania) • Prediction of postoperative respiratory complications following upper abdominal surgery in patients with chest x-ray abnormalities, obesity and smoking as the strongest preoperative risk factors and impact on hos- pital utilization, healthcare costs and patient mortality Edlira Kazazi (Albania)

44 45 at Glance Program Program Session Plenary Plenary

Friday, 16 November 2018 Saturday, 17 November 2018 Plenary Session Program at Glance at

15.30-18.00 9.00-11.30 Laboratory Nursing Forum 1 Marin Barleti Hall Queen Geraldine 1 Hall • Deputy Director of Laboratories Accreditation • Evidence based medicine vs. Evidence Division - Aliki Stathopoulou (Greece) based practice in the context of patient safety Marta Civljak (Croatia) • Our experience in the management of American Laboratory Network - Albana Daka (Albania) • Fall risk assesment in hospitalized patients in American Hospital and inspection of measures for fall prevention • Management of medical laboratories as an Italian and patient safety - Edlira Cako (Albania) experience - Carmelo Rizzo (Italy) • WHO Checklist - Saving Lives in Theatres CHAIR: • Internal Quality Control – the Way to Achieve Svetlana Nela (UK) Aliki Stathopoulou Laboratory Goal – Valid Patients’ Results (Greece) • Continuous education among nursing staff- Albana Daka Patrycja Łuszkiewicz (Poland) management of hyperglycemia in hospitalized patients (Albania) in non-critical care setting. - Etleva Gjoshe (Albania) Carmelo Rizzo • Preanalitical errors in Clinical Biochemistry and (Italy) Immunology Laboratory as an experience of • Effects and consequences that health personnel American Hospital - Brunilda Hyseni (Albania) have due to the night –shifts work system Skender Dule (Albania) • Identifying pre-analytic errors and minimizing them Dafina Trimaci (Albania) • Atrial fibrillation as a complication in cardiac disorders in patients hospitalized without rhythm disorder as • Appropriate collection of Microbiology CHAIR: primary diagnose - Evalina Xhameta (Albania) Specimens to avoid preanalyticaly errors Marta Civljak (Croatia) Oltiana Petri (Albania) Edlira Cako (Albania) • Management of Needle Stick Incidents Svetlana Nela (UK) in American Hospital Healthcare Staff Arjeta Deda (Kola) (Albania) • Prospective study on cardiac screenings at the American Hospital - Sidorela Beqiraj (Albania) • The Vessel Coronary Bypass in a paraplegic patient Arbenora Stafa (Albania) • The crucial role of monitoring in ICU in patient with cerebral coma - Case report Kimete Metalia (Albania) • RIRS as innovative surgery and advantages compared to open surgery - Elisa Gjika (Albania) • Managing and Treatment of cases with measles in Kukes - Ylber Visha (Albania) • Parathyroidectomy as a treatment of Secondary hyperparathyroidism in hemodialysis patients Anduela Zeka (Albania)

46 47 at Glance Program Program Session Plenary Plenary

Saturday, 17 November 2018 Saturday, 17 November 2018 Plenary Session Program at Glance at

12.00-14.30 15.30-18.00 Workshop Nursing Forum 2 Queen Geraldine 1 Hall Queen Geraldine 1 Hall Neonatal Resuscitation • Resuscitation Services: What, Why, How Resuscitation of Newborn - a practical workshop for nurses Svetlana Nela (UK) - Svetlana Nela (UK) • Management of nursing care of the central catheter • Introduction and practical workshop of based on evidence - Edlira Cako (Albania) fundamental principles of newborn resuscitation, particular in setting with lack of advanced • A novel cardiopleg solution in combination with equipment and medical support. minimal extracorporeal circulation system MiECC in CHAIR: CABG surgery – Bejtush Rrahmani (Switzerland) Svetlana Nela (UK) • A short presentation on anatomy and physiology of newborn. • Adeguate Portacath Management and its Role on Patient Safety during Chemotherapy Treatment at American • 4 stage approach in the airway management, Hospital Chemotherapy Unit – Ilda Zaimi (Albania) breathing assessment and chest compression when dealing with an unwell newborn child using current • The performance of nursing care for vascular access European guideline. among Hemodialysis patients in hospital of Vlore Rezarta Lalo (Albania) • Identified extravasation, treatment and innovations for prevention in ICU - Case Report Lize Paplekaj (Albania)

CHAIR: • Blood transfusion and nursing care Edlira Cako (Albania), Rezarta Cela (Albania) Svetlana Nela (UK) • Evaluation of the compliance of health care workers with hand hygiene in American Hospital as the main method for the hospital acquired infections prevention Arjeta Deda (Kola) (Albania) • Comparing the Patient Health Questionnaire-9 (PHQ-9) and Beck Depression Inventory (BDI-II) in assessment of depression in people living with HIV/AIDS in outpatient clinic in Albania, 2018 Redona Dudushi (Albania) • The role of nurse during In Vitro Fertilization Melaize Kamberaj (Albania) • Case report- FOSSA CRANI POSTERIOR TUMORS Emiljana Llausha (Albania) • Physical therapy in the postoperative of proximal femur fractures - Selda Veizaj (Albania) • Strengthening the role of nurses and mames, essential for improving health - Mimoza Llavdaniti (Albania)

48 49 at Glance Program Program Session Plenary Plenary

Saturday, 17 November 2018 Saturday, 17 November 2018 Plenary Session Program at Glance at

9.00-11.30 Satellite symposia Anatomical Pathology 12.00-14.30 Dora D’Istria Hall Genecology & Obstetric Dora D’Istria Hall “Modern management of Infertility • Online Medical School Pathology Education John Minarcik (USA) • Individualized management of poor ovarian response - Corina Manolea (Romania) • Focus on new entities in who 2016 classification of Renal Cell Tumors - Lutfi Alia (Italy) • Investigation of the infertile couple Genc Kabili (Albania) • Ki67 in non-Hodgkin Lymphomas Leart Bërdica (Albania) • Artificial Reproductive Techniques Elton Peci (Albania) • Predictive immunohistochemistry in lung cancer Teona Bushati (Albania) • The role of Hysteroscopy in the management of CHAIR: Infertility - Christos Maroudis (Greece) • Merkel cell carcinoma of unknown primary site. Christos Maroudis Review of the literature and Case presentation (Greece) • Fertility Preservation - Arisa Cane (Albania) Mehdi Alimehmeti (Albania) Corina Manolea (Romania) • Surgical retrieval, processing and selection of sperm • Selected Lymphoma Cases – approach to diagnosis Elton Peçi for ICSI in Azoospermia: What should We Doctors Fisnik Kurshumliu (Kosovo) (Albania) know? - Gjergji Semini (Albania) CHAIR: • Clinic-pathological findings of primary sarcomas of the • Intrauterine insemination treatment in subfertility John Minarcik (USA) lung. Our experience - Daniela Xhemalaj (Albania) Dritan Subashi (Albania) Lutfi Alia (Italy) Leart Bërdica (Albania) • Endometrial cancer in Albania • The role of Laparoscopy in the management of Armela Priftaj (Albania) infertility - Christos Maroudis (Greece) • Evaluation of cytopathology for qualitative diagnosis • Intracytoplasmic Sperm Injection of mediastinal and hilar lymphadenopathy based on Besfort Ferhati (Albania) EBUS-TBNA - Alma Andoni (Albania) • Recurrent pregnancy loss - Jonela Lulo (Albania) • Low-grade endometrial Stromal Sarcoma: A case report - Gizela Pumo (Albania) • Salivary gland neoplasms: A review study of 8 years in two major hospital centers in Albania Brunilda Gashi Cenkoglu (Albania) • Spectrum of fibroepithelial lesions of the breast Aida Dragoshi (Albania) • Microinvasive squamous cell carcinoma arising within seborrheic keratosis. A case report Iris Dino (Albania)

50 51 at Glance Program Program

Saturday, 17 November 2018 Saturday, 17 November 2018 Plenary Session Program at Glance at

15.30-18.00 9.00-11.30 Gynecology & Obstetric Intern Medicine 1 Dora D’Istria Hall Jeronim De Rada Hall • Medical Practice in Gynecology – • The future of Internal medicine in Europe New trends & Bioethical approaches Runolfurur Palsson (Iceland) Kostantinos Pantos (Greece) • Adherence to Guidelines for Antimicrobial treatment • Minimally invasive surgery and technology. and Patient outcomes - Rok Civljak (Croatia) Recent developments and future directions • Purpuric lesions of Meningococcal and Christos Maroudis (Greece) Pneumococcal sepsis in immunocompetent adults • Embryo Biopsy and Preimplantation Genetic Tritan Kalo (Albania) Testing; The experience of American Hospital • Disturbances of electrolyte homeostasis and the Tirana - Elton Peci (Albania) associated with anti-hypertensive pharmacologic • Breast Cancer in Pregnancy. A literature Review treatment - Elona Greca (Albania) Christina Tsionou (Greece) • Adherence to treatment, Albanian context • Endometriosis – what’s new on our challenge CHAIR: Eugen Sotiti (Albania) Leon Kaza (Albania) Runolfur Palsson (Iceland) CHAIR: Rok Civljak (Croatia) • Abdominal Epilepsy: An underestimated diagnosis Kostantinos Pantos • The importance of endoscopic surgery Brunilda Zllami (Albania) Brunilda Zllami (Albania) (Greece) in reproductive fertility therapies Tritan Kalo (Albania) • Disseminated intravascular coagulation in acute Christos Maroudis Stefanos Chandakas (Greece) (Greece) promyelocitic leukemia. Pathogenesis, clinic and Elton Peçi • Importance of diagnostic laparascopy in gynecology: treatment. Our experience - Xheni Ngjela (Albania) (Albania) a case report - Ana Sula (Albania) • Trichinellosis as an neglected disease. (Review- • Pelvic organ prolapse and Sui - One surgery throught lecture) - Arben Pilaca (Albania) Arben Haxhihyseni (Albania) • Chemotherapy Induced Polyneuropathy • The first clinical pregnancies following In Blerim Myftiu (Kosovo) Vitro Fertilization and Embryo Selection using • Cerebral Infarction in Young Adults. Experience in Time-lapse technology in Albania: Case reports the American Hospital 3 - Zamir Ndroqi (Albania) Besfort Ferhati (Albania) • Helping to improve healthcare in Albania • Postpartum Pain Management: What to use and How Dhimitraq Dhame (Albania) to use it? - Arjan Shtylla (Albania) • Cesarean Section ectopic pregnancy, Case report - Zef Delia (Albania) • Polycystic Ovary Syndrome (PCOS) criteria for diagnostic and management Juxhin Gjoshe (Albania)

52 at Glance Program Program

Saturday, 17 November 2018 Saturday, 17 November 2018 Program at Glance at

12.00-14.30 15.30-18.30 Intern Medicine 2 Ophthalmology Jeronim De Rada Hall Jeronim De Rada Hall • Rapidly progressive glomerulonephritis: diagnosis • Correction of myopia with excimer laser and treatment - Runolfurur Palsson (Iceland) Ugo De Sanctis (Italy) • Vaccination of Healthcare Workers and Patient • Posterior Uveal Tumors: Facts and Perspectives Safety - Rok Civljak (Croatia) Edoardo Midena (Italy) • Thyroid cancer and Total thyroidectomy • Statistical study on Cornea profil and parameters Agron Ylli (Albania) between generations in Albania. Is there a predict for Future Keratokonus? - Teuta Haveri (Albania) • Bacterial Resistance, Myth or Reality? Myftar Barbullushi (Albania) • Retinopathy of Prematurity: Diagnosis and treatment Giovanni Anselmetti (Italy) • Erythema nodosum, a rear presentation of Toxoplasmosis - Tritan Kalo (Albania) • Prophylactic effect of oral acetazolamide CHAIR: CHAIR: against increased intraocular pressure (IOP) in Rok Civljak • Approach to the patient with fever of unknown Ugo De Sanctis the period immediately after cataract surgery (Croatia) origin - Edmond Puca (Albania) (Italy) Runolfurur Palsson in eyes with primary open-angle glaucoma Marco Jacobbi (Iceland) • Weight loss and the improve of metabolic Mimoza Meco (Albania) (Italy) Edmond Puca syndrome after bariatric surgery in Obese patients Giovanni Anselmetti • Mini invasive Retinal surgery; Advantages and (Albania) Mirjeta Guni (Albania) (Italy) disadvantages Myftar Barbullushi - Marco Jacobbi (Italy) • Prevalence of Subclinical and Overt Hypothyroidism Teuta Haveri (Albania) • Fungus Ball of the lachrymal system presenting with in Infertile Woman - Ersida Golemi (Albania) (Albania) Epiphora - Alfred Aga (Albania) • Differential diagnosis of Ascitic Fluid. • Piggy back implantation in nanophtalmic eye Experience on their Etiology in our service Mimoza Meco (Albania) Hysni Dede (Albania) • Ocular manifestation of systemic diseases Case • Cannabis versus Cocaine abuse. What are the report - Suzana Zhuka (Albania) differences?- Sonila Tivari Bitri (Albania) • Branch Retinal Vein Occlusion, Case Report - • How much determinant is mental health related Manushaqe Batku (Ristani) (Albania) to alcohol abuse ? Familial predisposition versus environmental predisposition • Optic nerve atrophy as an indicative Esmeralda Thoma (Albania) sign of intracranial tumor - CASE report Anila Gambeta (Albania)

54 55 at Glance Program Program

Saturday, 17 November 2018 Saturday, 17 November 2018 Program at Glance at

9.00-11.30 12.00-14.30 Round table 2 Nephrology Marin Barleti Hall Marin Barleti Hall “Medical tourism, JCI and patient safety” • Prophylaxis in urinary tract infection in children: • Medical Tourism: The upcoming future health what we know about it ? - Ayse Balat (Turkey) development - Kostantinos Pantos (Greece) • Outcome of the living kidney donor • The Role of Training in Medical Tourism Ariana Strakosha (Albania) and its connection to Quality Assurance Maria D. Georgia (Greece) • Trends in The Prevalence of End-Stage Renal CHAIR: Kostantinos Pantos Disease in Albania - Fiona Nasto (Albania) (Greece) • The development of Health Tourism in Albania: The new strategy of Health Care Services • Indications and timing of Renal Replacement Klodian Allajbeu Rudina Degjoni (Albania) CHAIR: Therapy in Acute Kidney Injury (Albania) Ayse Balat Maria D. Georgia Elvana Rista (Albania) (Greece) • Albania in the market of Reproductive Tourism (Turkey) Fatlinda Tahiri (Albania) Nestor Thereska • Impact of anemia after Renal Transplantation on (Albania) patient and Graft Survival - Arjeta Dedej (Albania) • American Hospital and Patient Safety Ariana Strakosha Bledar Kola (Albania) (Albania) • The new approach to the diagnosis and treatment Fiona Nasto of hypertension among dialysis patients • Continuous Quality Improvement in Healthcare and (Albania) Vilma Cadri (Albania) Patient’s Safety - Gazmend Bojaj (Albania) • Cardiorenalmetabolic syndrome in Hemodialysis patients - Suela Mumajesi (Albania) • The correlation of B2M with dyslipoproteinemia in patients with Chronic Renal Insufficiency Merita Raci Qyqalla (Albania) • Barriers and opportunities to improve Management and Outcomes of patients with Diabetic Kidney Disease - Nevi Pasko (Albania)

56 57 Saturday, 17 November 2018 Program at Glance at

15.30-18.00 Urology THE PLAZA HOTEL TIRANA Marin Barleti Hall

• Mysteries in Varicocele Pathophysiology TIONAL M NA ED R I Nikolaos Sofikitis (Greece) E C T A L N I • Current status of the surgical management

C A of Peyronie’s disease: Update O IMCA I N N G A R B Ates Kadioglu (Turkey) ESS IN AL • What’s New in Urologic Diagnostic Ultrasound?- Transperineal Sonocystography, Male and Female SonoUrethrograms - Shpëtim Telegrafi (USA) AMERICAN HOSPITAL The Future of Medical Education • The Congenital Abnormalities of Genitourinary tract in Albania- Flamur Tartari (Albania) • Pelvic floor muscle training of females with stress urinary incontinence improves the sexual life of the MEDICAL STUDENT couple - Gjergj Semini (Albania) CHAIR: • Placenta Previa Percreta: A Case Report of Successful BURSARY OPPORTUNITY Nikolaos Sofikitis Management via open surgery and TUR-B of retained (Greece) placentae Ates Kadioglu - Xhevdet Çuni (Kosova) 5 Bursary (100 Euro / Month) (Turkey) • Nutrition therapy in kidney disease. Experience in Shpetim Telegrafi treatment of these patients at American Hospital (USA) Albana Daka (Albania) Gjergji Semini (Albania) • Bipolar plasma enucleation of the prostate As part of the contribution in the future of new (B-TUEP) vs transvesical open prostatectomy generation of doctors, the American Hospital is happy for enlarged prostate: initial experience in a single centre with 3-year follow-up to launch a new investment project in the education of Christina Falavolti (Italy) medical students. 5 scholarships of 100 euros / month • Urologic Trauma in children: Special considerations are awarded for winning candidates. These scholarships Astrit Mustafaj (Albania) will be awarded at the 4th International Medical • Sex cord stromal tumors of the testis: Unique Congres. Opening Ceremony on November 15 at 16.00. color-Doppler sonographic appearance Shpëtim Telegrafi (USA) The candidates who have completed the first and second • Use of buccal graft for treatment of panurethral years of Medicine, submit the notarized documentation stricture. One stage dorsal graft,the Kulkarni to the Congress office by 31 October 2018. technique - Gezim Galiqi (Kosova) • My experience in Monopolar TUR-P in Albania and Kosovo- Is it still a good option? Ajet Xhafa (Kosova) Email : [email protected] / Mob: +355 68 40 32 151 58 Pre-Congress Satellite Symposia

OP001 - The multifaceted chronic myeloid disorders 5% of childhood haematological malignancies, that remain difficult to diagnosis. A.Perolla, I.Akshija, P.Pulluqi, A.Pushi, A.Ivanaj, E.Calliku, A.Cili, T.Caja p-MDS can be associated with other rare conditions, such as inherited bone mar- Hematopathology The chronic myeloid disorders are divided in myelodysplastic syndromes (MDS) row failure disorders and other rare congenital disorders. While it develops in and myeloproliferative disorders (MPD). There are a group of disorders with over- older pts (greater than 60 years old) most of the time, it can occur at any age, such lapping features of MDS and MPD. as a greater incidence occurred in children younger than 1 year of age possibly Myelodysplastic syndromes (MDS) are a heterogenous group of clonal hemato- reflecting congenital bone marrow failure syndromes. There is lack of epidemio- poietic disorders characterized by peripheral cytopenias bur with a usually hyper- logical data on p-MDS in the literature. Refractory cytopenia of childhood (RCC) Hematopathology cellular bone marrow, encountered in elderly age is the most frequent pediatric MDS variant, showing specific histopathological Myeloproliferative Disorders (MPD) are a heterogeneous group of disorders char- features and its clinical implications are uncertain. Over 2/3 of pediatric MDS pts

Pre-Congress Satellite Symposia Symposia Satellite Pre-Congress acterized by cellular proliferation of one or more of hematologic cell lines in the will become long-term survivors, although significantly inferior outcome is seen peripheral blood. The type of the disorder is often based on the predominant cell in t-MDS. Making a review of contemporary literature on causes, classification, line affected, but sometime due to the abnormalities in more than one cell line, the diagnose and differences with adults MDS, we wanted to materialize these disor- diagnosis could be very difficult just with one full blood count (FBC). ders with some our cases, how they are presented and their dynamics. Diagnosis The MPD classification has changed over the years from FAB classification to WHO of p-MDS often requires analysis by a team of experienced paediatric haematolo- 2002 and WHO 2008, with the actual changes in the 2016 revision of WHO classi- gists and hematopathologists, but not only. Understanding better the disease and fications of myeloid neoplasms, incorporating inside the new clinical, prognostic, the recommendations for management, in conjunction with multiple molecular morphologic, immunophenotypic and genetic data that have emerged during the studies and with the rapid advancement of the technologies, we hope to diagnose, last decade. The World Health Organization has recently reclassified hematologic characterise and treat these disorders more effectively in the future. disorders and included a category of MDS/MPD overlap syndromes, which include chronic myelomonocytic leukemia, atypical chronic myelogenous leukemia, ju- OP003 - Acute Myeloid Leukemias venile myelomonocytic leukemia, and MDS/MPD unclassifiable, which includes F.Kurshumliu the provisional entity refractory anemia with ringed sideroblasts associated with Acute myeloid leukemias are clonal neoplastic proliferations of hematopoietic marked thrombocytosis (RARS-T). These latter 4 disorders remain largely enig- precursor cells causing excessive myeloblasts and other immature myeloid cells matic in their pathogenesis, have a poor prognosis, and limited therapeutic options. Review of literature and the recent WHO classification. Morphologic and clinical In Chronic Myeloid Leukemia (CML) we encounter as predominant feature leu- features of each entity. Myeloid markers: CD34, CD117, CD13, CD14, CD15, kocytosis with a left side shift but some time we encounter also thrombocytosis CD33, CD19, CD99, MPO, PAS and a mild anemia. In the Polycythemia Vera (PV) the predominant feature si the Concise diagnosis relies on clinical and laboratory data and morphologic evalua- elevation of the red blood cells and of the Hb and hct but those patients could pres- tion of the peripheral blood and bone marrow aspirate. ent also with leukocytosis and thrombocytosis. In the Essential Thrombocytemia (ET) the patients present with elevated number pf platelets but at the same time OP004 - Myelodysplastic syndromes they could have polycythemia and leukocytosis. In Primary myelofibrosis (PMF) F.Kurshumliu we see the evidence of extramedullary hematopoiesis, but in the early stages we Myelodysplastic syndromes are clonal disorders of multipotent bone marrow stem can encounter normal to elevated number of platelets and also the number of WBC cells with cytopenia(s) and dysplasia in one or more of the major myeloid cell lines, and PLT can be variable. ineffective or disorderly hematopoiesis and increased risk of development of acute In front of all this multifaceted presentation the accurate diagnosis is very import- myeloid leukemia. Review of literature and the recent WHO classification. Mor- ant but we also should keep in mind the transformation of these diseases in acute phologic and clinical features of each entity. Mean survival of refractory anemia: leukemia or in each other. 10 years, refractory anemia with ringed sideroblasts: 7 years; RA with multilineage dysplasia: 3 years; refractory anemia with excess blasts or chronic myelomonocyt- OP002 - Understanding Pediatric Myelodysplastic Syndromes. (Review) ic leukemia: 1 year; therapy related MDS: 5 months. Death often due to AML or D.Bali (Alia) bleeding / infection. Concise diagnosis relies on clinical and laboratory data and Paediatric myelodysplastic syndromes (p-MDS) are a heterogeneous group of clon- morphologic evaluation of the peripheral blood and bone marrow aspirate. al disorders with an annual incidence of 1-4 cases/million, accounting for less than

60 61 Pre-Congress Satellite Symposia

OP005 - Chronic Myeloproliferative Syndromes Monoclonal gammopathy of undetermined significance (MGUS)

J.Minarcik Osteosclerotic myeloma (POEMS syndrome) Hematopathology The concepts as well as the clinical and laboratory appearances of the chronic my- Displaying the morphologic and immunohistochemistry features of each entity. eloproliferative syndromes often simply referred to as myeloproliferative diseases It is extremely important nowadays to evaluate not only well established plasma or myeloproliferative disorders and often preceded by the adjective “chronic”, cell neoplasms but also subclinical or coincident plasma cells neoplasms with oth- are quite easy to understand if you simply remember the tri-linear nature of bone er hematologic complex disorders. marrow maturation: red, white, and platelets. If you would like to think of these Hematopathology syndromes as being benign, and chronically persistent, usually many years, al- OP007 - Hematopoietic Stem and Progenitor Cells: concepts, definitions. He- though two of them have more than slight chances of developing into full-blown matopoietic Stem Cell Transplantation as therapy, the new reality in Albania

Pre-Congress Satellite Symposia Symposia Satellite Pre-Congress acute myelogenous leukemias, that would be the best way to understand them. S.Lako The four classical syndromes are: Hematopoietic stem cells (HSCs) have unique functional properties, including 1. Polycythemia Vera self-renewal and multi-lineage differentiation potential, and are thought to be fully 2. Essential Thrombasthenia (Essential Thrombocytosis) responsible for lifelong hematopoiesis. However, recent studies have shown that 3. Chronic Myelogenous Leukemia, more commo ly called CML (also called HSCs divide much more slowly than thought, and, therefore, that daily hemato- Chronic Granulocytic Leukemia or CGL) poiesis is maintained not by HSCs but by hematopoietic progenitors with limited 4. Myelofibrosis (often the phrase “with Myeloid Metaplasia is added) self-renewal. Among hematopoietic stem/progenitor cell (HSPC) markers, CD34 is The appearances of these four disorders are quite readily recognizable in the labo- well known for its unique expression on HSPCs. For this reason, it is used to enrich ratory by thesignificantly increased numbers of red cells, white cells, or platelets, donor bone marrow (BM) with HSPCs prior to BM transplantation. Recent studies in the absence of known pathophysiological reasons for these elevations, so these suggest the existence of a population of dormant human HSCs that are CD34 neg- disorders still remain a truly mysterious spontaneous proliferation situation Also, ative (CD34neg) but become positive (CD34pos) just prior to cell division. Study- proliferation of one of the three maturation lines is often associated with prolif- ing this negative population is challenging because a defined marker for its enrich- erations of the other one or two lines. Marrow appearances reflect theperipheral ment is still lacking and also because it demonstrates extremely poor homing and blood elevations. Numerous chromosomal and genetic abnormalities are noted, engraftment capabilities compared with its CD34pos counterpart. Hematopoietic some often fairly characteristic of the disease, and although the benign sponta- stem cell transplantation (HSCT) is the transplantation of multipotent hematopoi- neous mysterious proliferation of red cells and platelets is characteristically not etic stem cells, derived from bone marrow, peripheral blood, or umbilical cord associated with the development of acute leukemias, the neutrophil or granulocyte blood. It is most often performed for patients with certain cancers of the blood, but myeloproliferative disorders present a fear for the development of acute myelog- its use has expanded beyond cancer, to autoimmune diseases, hemoglobinopathies enous leukemias, which are called blast crises. A fibrotic bone marrow, myelofi- ect. It may be autologous (the patient’s own stem cells are used) and allogeneic (the brosis, which is the most serious of all the disorders, necessitates the production stem cells come from a donor). For the first time in Albania, the American Hos- of marrow in places other than the marrow hence the term myeloid metaplasia or pital aims to realize the autologous HSCT for malignant haematological diseases. extramedullary hematopoiesis. The most spectacular advances in the treatment of the most common and most serious myeloproliferative disorder, CML, has been OP008 - Bone Marrow Biopsy, Accurate Evaluation based on the understanding of its characteristic chromosomal translocation. T.Bushati, L.Berdica The procedure known as trepanning, or trephination, of bone is the oldest surgical OP006 - Plasma cell neoplasm practice that continues to have clinical relevance in modern times. Sampling of the mar- L.Berdica, T.Bushati row consists of aspiration of the cellular component, acquisition of tissue fragments, These are various disorders characterized by monoclonal proliferation of immuno- or both. Currently, inspection of bone marrow is considered one of the most valuable globulin producing cells resembling lymphocytes or plasma cells. diagnostic tools for evaluating hematologic disorders. [5] Indications have included Method: Review of literature for the last WHO classification. diagnosis, staging, and therapeutic monitoring for lymphoproliferative disorders. WHO Classification (2008) Plasma cell myeloma Bone marrow biopsies should be done only after examination of peripheral blood, Plasmacytoma to avoid performing unnecessary biopsies. A blood sample should be taken at the Monoclonal immunoglobulin deposition diseases time of the bone marrow biopsy, for complete hematopoietic evaluation. It is pref-

62 63 erable to take both an aspiration and core biopsy simultaneously. A good sample OP009 - Title: “The use of ultrasound in breast, musculoskeletal and pediat- Pre-Congress Workshop is mandatory for accurate evaluation and interpretation. The method of evalua- ric imaging- Hands on Workshop” tion should be systematic, complete, and cover the following points: adequacy of Breast Imaging RADAID specimens; estimation of cellularity; identification of number, maturation pattern, Lecture: Ultrasound imaging of breast pathology: basic overview, peals and pitfalls. and morphology of megakaryocytes, myeloid cells, and erythroid cells; estimation Lecture: Breast Intervention: Ultrasound guided breast biopsy, how we do it. of M:E ratio; and identification of abnormal cells, cellular reactions, infectious - US-guided biopsy practice: Hands-on training workshop will discuss proper agents, or abnormal stromal reactions. Bone marrow findings should be interpret- technique and demonstrate biopsy procedure step by step using phantom tissue in Hematopathology ed in conjunction with signalment, history, physical findings, and laboratory re- a simulated environment. The participants will have the opportunity to practice US sults. Reference or institutional laboratories should be contacted for proper han- guided biopsies and improve their technique.

Pre-Congress Satellite Symposia Symposia Satellite Pre-Congress dling of bone marrow specimens for special procedures, such as histopathology, Musculoskeletal Imaging cytochemistry, immunopathology, and electron microscopy. - Lecture: Introduction to musculoskeletal ultrasound: didactic and case based learning - Hands-on practice workshop: Demonstration of proper technique in US scan- ning of the MSK system. Attendees will have the opportunity to practice MSK ultrasound on a normal individual in a simulated setting and ask questions. Pediatric Imaging Lecture: The use of ultrasound in the pediatric population- an overview. The lecture will discuss the role of ultrasound in imaging the pediatric population and optimization techniques. It will be a combination of didactic session and case based learning with image interpretation by direct participation.

OP010 - Introduction to MSK ultrasound: Didactic and Case based learning Mark C. Langston • Pros and cons of ultrasound • Equipment and technique • Muscles and tendons • Joints and bursae • Nerves • Soft tissue masses Hands-on practice workshop: Demonstration of proper technique in US scan- ning of the MSK system. Attendees will have the opportunity to practice MSK ultrasound on a normal individual in a simulated setting and ask questions.

OP011 - Ultrasound Guided Breast Interventions M.Dorsey A general review of topics related to ultrasound guided breast procedures will be given which will include: • Ultrasound scanning techniques for procedures • Indications for ultrasound guided procedures • Overview of different biopsy devices • Procedure for performing ultrasound guided interventions (including biopsy, aspiration and wire localization)

64 65 Pre-Congress Workshop • Indications and procedure for clip placement OP013 - Detection of food intolerances in Albania. Our experience • Specimen evaluation/radiography A.Daka

• Post biopsy management Purpose of the study: Food intolerance is a chronic reaction of the organism to Nutrition • Contraindications and complications of ultrasound guided procedures one or several food / chemical elements that are consumed in quantity and for a • Determining radiologic-pathologic concordance long time. Food intolerance may also occur 72 hours after taking food. It is more

RADAID (This presentation was prepared by Michelle Dorsey, MD in her personal capacity. The opinions ex- pressed in this presentation are the author’s own and do not necessarily reflect the views of the Depart- determined by cells and antibodies than by IgE (intestinal Th cells) that appear ment of Veterans Affairs, or the United States government.) hours or days after receiving the substance reoccurrence. It is a symptomatic dis-

Pre-Congress Workshop Pre-Congress play related to the repeated stimulation of the food or chemical substance in time. OP012 - A Practical Guide to Ultrasound Evaluation in the Symptomatic Fe- Study of a group of 1416 adults and 150 children. Examination was made with ve- male Breast nous blood with tubes K3EDTA with CYTOTEST kits - cytological examination Y.Gao with blades labeled with food or chemical allergens (31 foods and 20 chemical ele- This presentation will focus on ultrasound evaluation of women presenting with ments in food preservatives), depending on leukocyte suppression and erythrocyte breast symptoms. We will discuss pros and cons of breast ultrasound as an imaging rolls break determine the degree of intolerance from 1 to 4. modality, and consider its outcomes. Results by type of intolerance in% are: We will review normal breast anatomy on ultrasound and how to optimize tech- Type of Intolerance: nical parameters. We will outline how to appropriately evaluate breast symptoms • 65% intolerance from milk in women of different age groups, and illustrate common benign and malignant • 38% intolerance from wheat pathology, as well as discuss appropriate management. • 43% -intolerance from tomatoes • 37% -intolerance from coffee • 35%- intolerance from yeast • 12% -intolerance from the egg • 12% -intolerance from the olive • 7%- intolerance from legumes The degree of intolerance in this group is: 90% of the rank 2-3 and 10% of the rank 4. The treatment of food intolerance is done with an “elimination diet” in which the resulting positive foods have been suspended for a period of time depending on the degree of intolerance. Suspension also affects the entire biological food family due to the possibility of “cross-reaction”.

OP014 - Management of food regimes in hospitalized patients A.Daka Providing healthy and nutritious meals to SA hospital patients can help greatly in the rapid improvement of the health status of these individuals. The hospital food service is an integral and very important part of the treatment and care of the patient. Providing a healthy and nutritious diet is part of an effec- tive and high quality hospital treatment. Significant problems in nutritional care include: limited food choices, food service delivery, and lack of help for people who can not feed themselves. Malnutrition in patients may cause counter-indications such as: • Wound healing of wounds

66 67 • Decrease and loss of muscle mass but if you are still feeling restless, fatigued or sluggish — food may not be the is- Pre-Congress Workshop • Increased prevalence of anti-drug medicines sue. Your body is a complete operating system that needs more than just “fuel” to

• infections function. Trying to fully explain and encapsulate the fundamentals of nutrition and Nutrition • Dehydration its role in contemporary society, from mastering the basic science of nutrient me- • Diarrhea tabolism and function to applying nutritional concepts to combat human disease.

Nutrition • Constipation Topics discussed include obesity and diabetes; cardiovascular diseases; paediatric • Poor metabolic profile and adolescent disorders; disorders of the alimentary tract; nutritional manage- • Apathy and depression ment during cancer; skeletal and joint disorders; nutrition in surgery and trauma; Pre-Congress Workshop Pre-Congress Nutritional purposes behavioural, psychiatric, and neurologic disorders; other systemic disorders; and The standard hospital’s menu should meet the following nutritional goals: food additives, hazards and nutrient-drug interactions. This new approach ex- • Energy and protein on a daily basis. plores concepts and practical concerns in nutrition and the nutritional management • Micronutrients (vitamins and minerals) achieved on average on a weekly basis. of disease, including functional foods and nutraceuticals in health promotion; pre- Nutritional profile of adult patients hospitalized biotics and probiotics as modulators of the gut microbiota. There are four broad categories of hospitalized patients: 1. Patients from a nutritional point of view are in good health with healthy appe- OP016 - Management of Obesity tites and dietary needs that are equal to the standard of the population. To these E.Puca, S.Bitri, A.Daka, E.Puca patients being treated for: Obesity is a chronic, multi-factorial complex disease chracterized by an increase of • light diseases and optional operations; body fat stores that requires long-term care. The prevalence of obesity, measured • uncomplicated cases of births; by body mass index, has risen to unacceptable levels in both men and women • diseases requiring short-term hospitalization. around the world. Overweight and obesity is a global problem. This presentation 2. Patients considered to be at risk from a nutritional point of view, who: aims to provide a practical approach of the recent guidelines for the management • There has been a sudden loss of weight, unexpectedly. of the obesity. In clinical practice, the body fatness is estimated by BMI. The • They have a physical disability that does not allow them to eat or determinants of obesity are multifactorial and are influenced by early life envi- drink normally, which is tired of consuming food and loses interest in it. ronments as well as genetics. A comprehensive history, physical examination and • Have acute or chronic diseases or receive medical treatment that affects the appetite. laboratory assessment relevant to the patient’s obesity should be obtained. Obe- • They have communication and cognitive difficulties, which does not allow them sity is directed linked with type 2 diabetes mellitus, insulin resistance, gallstones, to order a certain kind of food they can consume. fatty liver disease, hypertension, dyslipidemia. These factors contribute to car- 3. Patients with high nutritional needs, including: diovascular disease that is a leading cause of death. Appropriate goals of weight • Those with additional nutritional needs due to cachexia, trauma, surgery and / management should include induction of weight loss, maintenance and prevention or burns. of weight regain. Management of co-morbidities and improving quality of life of • Those who are malnourished. obese patients are also included in treatment aims. It is an obligation for all health • Women in lactation. care providers to participate in obesity management and includes: dietary rec- 4. Patients with special needs, including: ommendations -balanced hypocaloric diets result in clinically meaningful weight • Need for therapeutic diets loss, physical activity -aerobic training is the optimal mode of exercise for re- • Need for soft and liquid diet. ducing fat mass , while a programme including resistance training is needed for increasing lean mass in middle-aged and overweight/obese individuals. Pharma- OP015 - The Modern Aspects of Clinical Nutrition in the Prevention and cure cotherapy can help patients to maintain compliance and ameliorate obesity-related of Chronic Diseases health risks. Surgery is the most effective treatment for morbid obesity in terms of C.Rizzo long-term weight loss. As a conclusion the only way for obese people to improve Nutrition is an important aspect of staying healthy but it’s not solely responsible health is to lose weight and physicians have a responsibility to recognise obesity for making sure the body operates as it should. You very well could be fueling the as a disease and help obese patients with appropriate prevention and treatment. body with all the right foods, eating appropriate portions and exercising regularly

68 69 OP017- Food and nutrition therapy in hospitalized patients. Our experience system in the development of certain diseases such as obesity, allergies, autism or Pre-Congress Workshop based on JCI guidelines. metabolic disorders in general.

J.Kajtazi This presentation discusses mechanisms that explain the relationship between nu- Nutrition The American hospital network offers as an integral part of its services in its three trition, metabolism and intestinal microflora. branches, nutrition therapy for all hospitalized patients with various health problems. Foods act in the human body in accordance with the metabolism, which is deter-

Nutrition A variety of food choices, appropriate for the patient’s nutritional status and con- mined by its DNA. This presentation suggests that in this intestinal-nutrition-me- sistent with his or her clinical care, is available. tabolism microfloral relationship, intestinal microflora since multiple studies, is Appropriate food and nutrition are important to patients’ well-being and recovery. defined as the identity card of each individual as a consequence of the individu- Pre-Congress Workshop Pre-Congress Food choices take into consideration the patient’s age, cultural and dietary prefer- al’s metabolic individuality. The composition and balance in its biological species ences, and planned care, which may include special dietary needs such as: is determined by the metabolism of each human being. When the composition, Nutritional purposes quantity and quality of the foods do not match the metabolic characteristics of the The standard hospital’s menu should meet the following nutritional goals: individual, they cause metabolic disorders. These metabolic disorders that alter • Energy and protein on a daily basis. intestinal microflora affect positively or negatively through its metabolic activity. • Micronutrients (vitamins and minerals) achieved on average on a weekly basis. So, metabolic nutrition emerges as the main mechanism, as the only link, between Food regimes currently on our nutrition guideline: food, intestinal microflora, and disease prevention. • liquid diet • soft diet OP019 - Epigenetic and nutrigenetic diet in obesity • normal diet M.Borsa • clear liquids diet Epigenetic studies the inheritable modifications that modify gene expression with- • liquid cold diet out altering the DNA sequence. • low cholesterol diet Nutrigenomics studies the correlations between foods and changes in DNA. • hyper-protein diet The nutrigenetics studies genetic polymorphisms allowing to elaborate nutritional • hyper-caloric diet schemes adapted to the individual needs. • hemodialysis diet The nutrigenetic diet can prevent chronic diseases. • diabetic diet Methods; In order to identify the correlations between polymorphisms and • hospitalized children’s diet obesity, DNA, with buccal swab, was taken from 198 patients; 86 were obese. All these diets are formulated depending on the patient’s diagnosis. Based on the Genotyping of the genes ACE, MTHFR, PPARγ, APOC3, LPL 5HTT was performed patient’s assessed needs and plan of care, the patient’s physician or other qualified and was valuated the deviation of the allele frequencies found with those in the literature. caregiver orders food or other nutrients for the patient. Patients at nutrition risk A shift was observed for some genes such as TT polymorphism of MTHFR gene, receive nutrition therapy. On initial assessment, patients are screened to identify Pro-Ala for PPARγ, CG for APOC3, GG for LPL, SS for the 5HTT gene. those who may be at nutritional risk. These patients are referred to a nutritionist Discussions: Some genetic polymorphisms had a good correlation with obe- for further assessment. When it is determined that a patient is at nutritional risk, sity and had allele frequencies higher than European frequencies. Based on a plan for nutrition therapy is developed and carried out. The patient’s progress the genetic profile found, a specific diet was developed. Knowledge - ofnutri is monitored and recorded in his or her medical record. Physicians, nurses, the genes was therefore important for preventing obesity. A pattern of nutrigenes dietetics service, and, when appropriate, the patient’s family, collaborate to plan could also identify individuals with an increased risk of obesity. Nutrigenetic and to provide nutrition therapy. diet represented a nutritional support for prevention and treatment of obesity.

OP018 - Intestinal microflora, disease prevention due to quality of nutrition OP020 - The importance of body composition analysis in the process of weight loss K.Sini V.Isufaj, A.Daka The study of the relationship between intestinal microflora, metabolism and health Body Composition Analysis (Impedence Measurement) is a method that analyzes has attracted the attention of many recent studies that pay particular attention to the body composition in a few seconds through two (50- and 100-kHz ) frequen- the potential role of intestinal microflora as an important part of the digestive cies-between two electrodes. A single component is not a sufficient parameter to

70 71 Session Plenary Plenary

evaluate progress during a weight reduction process - during a food regime. In OP021 - Mini-invasive surgery for rectal and pelvic organs prolapses: Lon- fact, body weight is just a multitude of different body components where we will go’s Techniques distinguish: Prof. Antonio Longo (Italy) • The fat -that represents the skin and body internal organs. • Muscular mass -consisting of skeletal and non-skeletal muscles, muscular tis- OP022 - Lung Oncology. Contemporary practice and advances

Nutrition sue or organs. A.Kojqiqi • Total bodily water- that constitutes 60-62% of the weight in males and 56- Lung cancer remains number one killer in the world. According to World Health Orga- 58% of the weight in females. nization (WHO) 7.6 million deaths globally each year are caused by cancer. Lung Can- Pre-Congress Workshop Pre-Congress • The metabolic active fraction of muscle mass, represents the body component cer being number one killer with 1.4 million deaths per year. According to American involved in the enzymatic processes, the transport and the absorption of food Cancer Society, 14% of newly diagnosed cancers are lung cancer. In UK scientist esti- ingredients. mate that by 2040 lung cancer in male will increase by 8% and in female by 350%. In A clinical case Woman patient, aged 22, height 160 cm, following the personal- Albania in 2017, WHO reports 1200 deaths from lung cancer or 5.9% of total deaths. ized diet regime after performing the Food Intolerance Analysis. Non small cell lung cancer – squamous cell accounts for 80% of all lung cancers. Date Weight BMI % Fat Muscular Treatment of lung cancer is individual and depends in many factors. Significant num- Mass Fat in the body Basal metabolism01.05.2018 94 kg ber of patients diagnosed with lung cancer have concomitant pulmonary conditions 11.06.2018 89 kg 35.3 50.4 21.1 such interstitial lung fibrosis or chronic obstructive pulmonary emphysema. Coexist- 7 178 cal ing pulmonary disease may affect the treatment strategy for NSCLC therefore survival 16.07.2018 85.5 kg 33.9 49.6 22.2 rate.Surgical treatment is considered best option for most lung cancers diagnosed at 7 1663 cal early stages. Video- assisted thoracoscopic surgery (VATS) and thoracotomy are two By comparing two body composition analyzes, we see that educating a healthy surgical techniques available to patients diagnosed with lung cancer.Results depends nutrition within the two-month time frame has yielded not only a loss of weight from hospital to hospital, surgeons experience and cancer stage. Few randomized stud- but also an improvement in body composition. ies suggest that, VATS lobectomy is superior to thoracotomy lobectomy. It shortens So we see that basal metabolism has increased by 85 calories; Muscle mass has chest drain duration, shortens hospital stay and improves 4 year survival. increased by 1.1% and fat % was reduced by 0.8%. In conclusion we might say that Impedence Measurement is one of the best meth- OP023 - ART and long term outcome of the descendants” ods to monitor body weight not only as a non-invasive method but is very accu- D.Loutradis rate and very close to gold standard (DEXA). The true weight loss refers to the Assisted reproduction technologies (ART), such as IVF and ICSI are widely used elimination of fat mass in particular and not just the weight loss in kg as well as to solve human infertility. ART has provided great benefits for millions of couples hypertrophy refers to the increase of muscle mass rather than the fat mass. who have struggled with infertility disorders Since the birth of Louise Brown in 1978, there has been a tremendous growth in the use of ART. As the offspring of ART have become a substantial proportion of the population, the safety of ART has gained increasing attention . Concern has emerged that children conceived by ART might be exposed to greater health risks than naturally conceived (NC) children. Ovulation induction medications, in vitro culture of embryos, vitrification and the potential use of genetically and structurally abnormal sperm during ICSI are independent risk factors. In this presentation we discus the following subjects :Neonatal outcomes, Birth defects Growth and gonadal development Physical health Neurological and neuro- developmental outcomes, However .special focus is concentrate our investiga- tion to the proteomic ,metabolomics profile of children born after ICSI compared with naturally conceived (NC) controls in search of cardiometabolic risk markers and Epigenetic abnormalities.

72 73 Session Plenary Plenary

Proteomics of Children Born After Intracytoplasmic Sperm Injection Reveal Indices 0_009) and NGAL (P = 0_028) levels than controls. When divided by gender, RBP-4 Plenary Session of an Adverse Cardiometabolic Profile: The ICSI group had shorter gestation, more ce- remained higher in IVF girls (P = 0_002), whereas NGAL was higher in IVF boys (P sarean sections, smaller birth weight/length, and advanced maternal age. No major dif- = 0_021). Linear regression analysis had revealed that the differences are attributed to ferences were observed regarding biochemical markers. Proteomic analysis revealed the IVF procedure per se. In our study, IVF children had significantly higher RBP-4 19 over- and three underexpressed proteins in ICSI. Most overex- pressed proteins are and NGAL levels than controls, sug- gesting early metabolic derangements that could implicated in acute-phase reaction, blood coagulation, complement pathway activa- be attributed to an epigenetic phenomenon. These results are in accordance with our tion, and iron and lipid metabolism, suggesting a subclinical unfavorable cardiomet- earlier findings of higher blood pressure and triglycerides in IVF children than con- abolic profile.This study applies proteomics in ICSI-conceived children, providing trols. Further prospective studies in IVF children will determine the natural course of evidence for an early adverse cardiometabolic profile and supporting the necessity of their metabolic profile. their long-term monitoring. Altogether, ART is likely to cause some epigenetic changes in the offspring, which Gender dimorphic increase in RBP-4 and NGAL in children born after IVF: an epi- might be the molecular basis of complex traits and diseases. However, it is still unclear genetic phenomenon? Children born after IVF had significantly higher RBP-4 (P = whether the small differences observed in several studies represent a real difference 0·009) and NGAL (P = 0·028) levels than controls. When divided by gender, RBP-4 between ART-conceived and NC children. Larger studies with long-term follow-up remained higher in IVF girls (P = 0·002), whereas NGAL was higher in IVF boys (P are needed to fully answer these questions. = 0·021). Linear regression analysis had revealed that the differences are attributed to the IVF procedure per se. In our study, IVF children had significantly higher RBP-4 OP024 - Local Control Assessment of Spine Metastases after Post-operative and NGAL levels than controls, suggesting early metabolic derangements that could Stereotactic Radiosurgery Following Limited versus Extensive Spine Sur- be attributed to an epigenetic phenomenon. These results are in accordance with our gery: A Retrospective Review and Future prospective trails including Im- earlier findings of higher blood pressure and triglycerides in IVF children than con- mune therapy trols. Further prospective studies in IVF children will determine the natural course of D.Blakaj their metabolic profile. Adjuvant conventional radiation therapy has been the historical standard after sur- Plasma Metabolomic Profiling Suggests Early Indications for Predisposition to La- gical decompression and stabilization for spinal metastases. In the era of modern, tent Insulin Resistance in Children Conceived by ICSI. Auxological and biochemical more advanced radiation techniques, however, stereotactic radiosurgery (SRS) is parameters of 42 6.862.1 yrs. old ICSI-conceived and 42 age-matched controls were increasingly being utilized in the post-operative setting for more durable local measured. Significant differences between the groups were determined using univari- control, primarily in the setting of more radioresistant histologies such as renal ate and multivariate statistics, indicating low urea and low-grade inflammation mark- cell carcinoma. The objective of our study is to review our institutional experience ers (YKL-40, hsCRP) and high triiodothyronine (T3) in ICSI- children compared to using SRS in the post-operative setting, following either complete vertebrecto- controls. Moreover, plasma metabolomic analysis carried out for a subgroup of 10 my (VT) or more limited surgery, for spinal metastases and to assess local tumor ICSI- and 10 NC girls using Gas Chromatography-Mass Spectrometry (GC-MS) indi- control and survival. We retrospectively identified 47 patients treated with spinal cated clear differences between the two groups, characterized by 36 metabolites linked surgery followed by SRS between 2010 and 2016. Patients with significant delays to obesity, insulin resistance and metabolic syndrome. Notably, the distinction between to SRS (>2 months) and inadequate radiographic follow up (from completion of the two girl subgroups was accentuated when both their biochemical and metabolomic SRS to death were evaluated. Descriptive statistics and log rank tests were used measurements were employed. The present study contributes a large auxological and to evaluate these end points. The majority of tumors were renal cell carcinoma biochemical dataset of a well-defined group of pre- pubertal ICSI-conceived subjects (NZ9, 43%). Post-operatively, most tumors were treated with either 27Gy in 3 to the research of the ART effect to the offspring’s health. Moreover, it is the first time fractions (NZ13, 62%) or 18Gy in 1 fraction (NZ4, 19%). Four tumors (19%) that the relevant usefulness of metabolomics was investigated. The acquired results are showed evidence of radiographic progression by the end of the study - 1 patient consistent with early insulin resistance in ICSI-offspring, paving the way for further in the VT group and 3 patients in the sub-VT group. None of the patients with systematic investigations. These data support that metabolomics may unravel meta- progression required intervention. Radiographic progression free survival was not bolic differences before they become clinically or biochemically evident, underlining significantly different between the two groups (46.7 vs. 19.6 months, pZ0.677). its utility in the ART research. Eight patients (40%) of 20 patients died during this study. All deaths were attrib- Gender dimorphic increase in RBP-4 and NGAL in children born after IVF: an epi- utable to systemic progression and not local failure. The mean overall survival genetic phenomenon? Children born after IVF had significantly higher RBP-4 (P = after SRS was approximately 35 months (range 5.2-55 months). This was not sta-

74 75 Session Plenary Plenary

tistically different between those treated with VT versus those treated with more OP027 - Minimally invasive approach to rectal cancer: laparoscopic TME Plenary Session limited surgeries (36 vs. 23.1 months, p Z 0.756). Extent of surgery did not appear and pelvic IONM” to significantly impact time to radiographic progression, intervention-free survival M.Pramateftakis or survival after SRS, however we recognize that this may be due to low sample Laparoscopic colorectal surgery has gradually increased over the last two decades, and size. Although we are still waiting for the data to mature and are continuing to more centers are now adopting laparoscopy as their primary approach to colorectal collect data, this is one of the largest series to date looking specifically at the cancer. The general benefits of laparoscopy are well known, and these benefits are extent of surgery prior to post-operative SRS and how it relates to local control present when adopting the approach for colon and rectal cancer too. Total Mesorectal outcomes using radiographic follow-up in the management of spinal metastases. Excision (TME) has become accepted universally as the preferred technique for sur- gical excision of rectal cancer, as it results in low rates of local recurrence. TME is a OP025 - Minimal Surgery, Minimal Tissue very specific procedure within the pelvic fascie, and it has been proposed in the past J.Minarcik that it should follow specific dissection steps, which organize a sequence of techniques Not surprisingly, the driving force in medicine is often economics, rather than to remove the rectum, starting with a proximal vascular division and completing the patient outcomes and safety. In the case of minimally invasive surgeries and procedure with either reaching the anorectal junction, or completing a distal resection. minimally sized biopsies however, our progress has been driven by both con- Laparoscopic TME is also feasible and has been shown to achieve similar oncologic siderations. In the United States, the decreased patient morbidity and the great- results to traditional TME. As with open TME, standardization of steps and approach ly shortened length of stay (LOS) has put increased pressure on the pathologist in laparoscopic TME are crucial for excellent oncological results.When operating in to make accurate diagnoses with minimal tissue. Many surgeons are still under the lesser pelvis, there is risk of damage to the nerves of the hypogastric plexus, result- the impression that we can diagnose any disease by looking at one or two cells, ing in malfunction of the urogenital systems. Partial incontinence or decreased sexual and cannot understand our reasons for always requesting more tissue, more tis- functions can affect significantly the quality of life for patients. Over the last decade, sue, more tissue, often in high anxiety situations, such as the intraoperative state. we implement intraoperative neuromonitoring of the hypogastric plexus branches Although advances in radiology, blood tests, and genetics have greatly en- (pelvic intraoperative neuromonitoring, pIONM), in order to identify as many neural hanced and sometimes even superseded tissue examination, most pathologists branches as possible and limit the risk of neural damage. As a result, we maximize must be confident with small needle aspirations and small core tissue biopsies. the chances of improved postoperative quality of life for our patients. Neuromoni- We have learned to become best pals with our radiology friends, and our ra- toring can be performed in either open or laparoscopic surgery.Laparoscopic TME, diologists have now taken on the role of many surgeons. Many open biopsies combined with laparoscopic pIONM, are two very important elements of minimally previously performed by surgeons and specialists have now been delegated to invasive rectal cancer surgery which offer patients excellent postoperative results from not only interventional radiologists but none interventional radiologists as well. an oncological, as well as functional point of view. The pathologist has been spending more and more time in the CT room help- ing to guide their radiology friends into the situation where adequate tissue is OP028 - Surgeon of Art and the Art of the Surgeon’s present for an accurate diagnosis. Immediate impressions, such as the nine ver- M.Petrela sus malignant, or small malignant cells versus large malignant cells can then be further evaluated with the aid of immunohistochemistry as well as regu- OP029 - The role of balloon pulmonary angioplasty (BPA) in the treatment of lar common stains, and an increasing need for molecular pathology evaluation. patients with inoperable chronic thromboembolic pulmonary hypertension We will be showing the common classical appearances of aspirations and minimal (CTEPH) biopsies seen in the neck, chest, abdomen, and pelvis. S.Beqiri Pulmonary endarterectomy (PEA) is the goldstandard treatment of patients with OP026 - Contemporary Endovascular Interventions 2020 chronic thromboembolic pulmonary hypertension (CTEPH). J.Wiley Since 1/3 of all CTEPH patients are not amenable to surgery, treatment alterna- Peripheral Arterial Disease (PAD) affects 155 million people worldwide. In 2015 it tives are needed: currently, riociguat, a soluble guanylate cyclase stimulator, is was responsible for 52,500 deaths up from 16,000 deaths in 1990. It is associated with available in many countries as the only approved drug for inoperable CTEPH pa- a 20% risk of a coronary event in 10 years and a 5-year mortality rate of 30%. In this tients. Further, balloon pulmonary angioplasty (BPA) is an evolving intervention- talk we will focus on novel approaches in the endovascular management of PAD. al approach for selected, inoperable CTEPH patients. Since the first series of 18

76 77 Session Plenary Plenary

patients presented in 2001, substantial improvements to the technique have been OP031 - Correction of myopia with excimer laser Plenary Session made. Nowadays, BPA is performed regularly in various centers worldwide. In U.Sanctis, T.Haveri addition, hybrid procedures combining PEA with intraoperative BPA for carefully Myopia is a refractive error with an increasing prevalence worldwide. Vision cor- selected patients have been described. rection with excimer laser is the preferred ethod of treatment for light and moder- Being one of the leading high-volume CTEPH centers worldwide, the Department ate myopia. The 2 main procedures currently being performed are photorefractive of Thoracic Surgery at the Kerckhoff-Klinik reported promising improvements in keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK). pulmonary hemodynamics and physical capacity after BPA. Complication rates Each technique has its advantages, but they appear to yield similar visual out- vary inbetween different studies including vascular injury, bleeding and- reper comes. Laser vision correction for myopia was considered a paradigm shift be- fusion edema, being the most important. Mortality rates up to 10 % have been cause healthy eyes could now undergo a surgical procedure to permanently and described, but may actually be less than 2 %. Until today, there is no standardized safely correct the error by altering the center of the cornea, which was previously BPA technique: patient and target-vessel selection, imaging modality, monitoring off limits because of the potential for loss of transparency. and clinical follow-up vary among different centers. The accuracy, predictability and safety of both PRK and LASIK have further im- However, data from national and international registries are still outstanding and proved in recent years. The occurrence of corneal haze after PRK has been reduced standardization of indication, definition of complications and the interventional with the intraoperative use of mitomycin C. Femtosecond lasers create LASIK concepts are needed to generate more evidence. flaps with better uniformity and predictability than mechanical microkeratomes. Moreover, the correction of high-order aberrations and high quality of vision can OP030 - Alloplastic reconstruction in Hemifacial Microsomia (HFM) be achieved using wavefront guided and wavefront optimized ablation profiles. S.Lazarou, N.Demetriades, J.Polley, J.Gitrotto Skeletal reconstruction in severe grades of HFM continues to be challenging. Traditional techniques of autografts and osseous distraction for reconstruction of the glenoid fossa, condyle and ramus often fall short of expectations and can create new problems. This Intercontinental study analyzes the role of alloplas- tic skeletal rehabilitation in severe HFM.10 consecutive skeletally mature HFM patients with failed traditional reconstructions were successfully treated with virtually planned alloplastic reconstructions (11 joints) and simultaneous orthog- nathic surgery. The glenoid fossa, condyle, and ramus on the affected sides were reconstructed with custom designed titanium implants. All patients achieved oc- clusal stabilization, normalization of posterior facial height and sagittal mandib- ular projection, and maintenance or improved interincisal opening. There were no major complications or repeat surgeries. Follow-up ranges 8-54 months. Theoretically autogenous reconstructions in HFM are preferred. In reality, however, traditional reconstructions are often unsuccessful at achieving ideal face proportions and often create secondary problems including ankylosis. The central problem is that traditional techniques in severe grades of HFM cannot supply adequate 3-dimen- sional bone and do not create a stable fossa to assure a secure centric relation (CR). Alloplastic reconstruction allows for precise vertical reconstruction of the ramus and condyle, and sagittal repositioning of the mandibular body. The glenoid fossa com- ponent is firmly anchored to the skull base assuring a stable CR on the reconstructed side. The longevity of these exact alloplasts for TMJ reconstruction exceeds 25 years. With the consistent functional and aesthetic success obtained in this series of dif- ficult HFM patient’s with alloplastic reconstruction, the question becomes: Is this still a Sin, Salvage technique, or should this become our Final Solution?

78 79 II Colorectal II Colorectal Summit

OP032 - Hemorrhoids and ODS: unique cause unique treatment OP034 - Usage of different advance flap or “Z”- plasty in the treatment of Summit A.Longo colorectal patients – The necessity of education of colorectal surgeons in dif- II Colorectal II ferent surgical techniques from plastic and reconstructive surgery OP033 - How surgeon and operative room team experience can influence on- D.Mladenovik cological and operative outcomes in robotic surgery? Different surgical techniques are used in the treatment of anal fistula, anal stenosis, C.Falavolti, E.Shehu, R.Giovannone, P.Alijani, T.Petitti, M.Buscarini anal fissure and colostomy stenosis. Part of the techniques are based on the knowl- To investigate the impact that surgeon and operative room team experience rule in edge and practical skills of the surgeons, with advancement flaps or “Z”-plasty, robotic radical prostatectomy outcomes. Material and Methods: we retrospectively “V-Y”, “Y-V” and “W”-plasty. Recurrence anal fissure after LIS or anterior anal collected data of 150 robotic radical prostatectomies (RALPs) performed by the same fissures in women, for the treatment to be successful, requires treatment with cuta- surgeon in two different hospitals in different periods of his robotic experience. The neous advancement flaps. Different advancement flaps (mucosal or cutaneous) are first and the last 50 RALPs performed in a dedicated center of robotic surgery at Uni- used alone or in combination with LIFT, fistulotomy etc., for treatment of anal fis- versity of Southern California were included respectively in group 1 and group 2 (the tulas. Surgical treatments might be repeated and should be considered safe as they total number of cases performed in the USC series was 577). The first 50 RALPs preserve sphincter complex. Anal stenosis is a serious condition as complication performed 5 years later at University Campus Bio-Medico of Rome were included of previous surgical treatment. There is no other surgical procedure that could treat in group 3. In the last case series both first assistant and nursing team were at the this condition, with different cutaneous advancement flap (diamond, romboid, beginning of their robotic experience. All patients underwent RALP according to V-Y, Y-V, rotation flap). Numerous surgical techniques are used in the treatment Montsouris’s technique with the same daVinci® Surgical System. Monovariate anal- colostomy stenosis. Simple and successful treatment is possible with “Z”-plasty ysis was performed comparing each group in terms of oncological and surgical out- method, which has minimal complication rate and most importantly, it does not comes. Multivariate logistic regression models were used to assess the risk of posi- require laparotomy. If we have in consideration that pilonoidal disease is most tive margin. Results: patients’ mean age, preoperative and postoperative PSA value frequently treated by general and colorectal surgeons, and knowing the fact that differences are similar for each group (p= 0.658). The mean docking time (DT) is defects that appear after excision should be treated with different flaps, impose the similar in group 2 and 3 (respectively 18.3 and 17.8 minutes): it decreases signifi- need of good knowledge and skills in plastic and reconstructive surgery. Evidence cantly (p<0.001) compared to group 1 (47 minutes). The mean operative time (OT) show that good results in treatment of some colorectal disease are achieved with is lower in group 1 and 2 (208 minutes and 105 minutes respectively) compared to different flaps and plasty, which is particularly the case in anal stenosis, where it is group 3 (294 minutes). The mean estimated blood loss (EBL) is higher in group 1 and the only method of treatment. My observation based on my practical experience in the number of transfusions decreases in group 2. Transfusions are never required for the treatment of different condition in colorectal surgery, and knowing that small patients of group 3. The probability to have positive surgical margins (PSM) increas- number of colorectal surgeons use plastic and reconstructive surgical procedures, es from pT2a-b-c to pT3b tumors. Discussion: surgeon, assistant, and nurses have a lead me to conclusion that colorectal surgeons should improve their theoretical cardinal role in operative and surgical outcomes. Although the surgeon is at the end and practical skills in specific plastic and reconstructive surgery. of his learning curve in group 3, the mean OT is longer than other groups most likely because there is not a dedicated team but the linear regression model shows an im- OP035 - Rectal cancer in Albania, where do we stand provement of 3.7 minutes after each procedure for surgeries of the group 3 instead of E.Kozma, K.Mati, F.Jorgoni an improvement of 1.2 minutes in group 1. We can assume that group 3 learning curve Rectal cancer constitutes 3% of all malignant tumors in Albania. The major- in terms of operative times is faster than that in group 1 because surgeon is expert ity of diagnosed patients live in urban areas, 7 times more than in rural area. and influences the operative room team for faster improvement. The longest operative The aim of this study was to evaluate treatment of rectal cancer in our country duration in group 3 is not correlated with higher PSM rate. Tumor stage is the princi- and how different clinicopathological factors can influence on disease outcome. ple parameter that influences oncological outcome. Patient age and preoperative PSA Between January 2012 and December 2017, a total of 230 patients with rectal can- value do not influence postoperative margin status. Docking time seems becoming cer were treated in our Oncology Service. All of them had a multimodality treatment. quicker with surgeon experience: it is similar between group 2 and 3 while is lon- We analyzed retrospectively treatment of patients by stage and if clinicopathological ger in group 1. EBL depends on surgeon’s ability and it is correlated with patient’s factors could have an influence on disease. The association between these variables hospitalization. In conclusion, about 50 procedures are required to reach satisfactory were tested by the Pearson Chi Square test, T-test and Binary Logistic Regression test. operative outcomes although the learning curve continues for hundreds procedures Median age of patients was 59,8 years. 43,6% of them were females and 56,4% males.

80 81 II Colorectal II Colorectal Summit

Classification of patients by stage was impossible because 68.4% of them were classified idly cause multiple organ failure and death. The origin of the disease is proctogen- Summit as Nx. Use of neoadjuvant concurrent chemoradiotherapy has increased from 18.5% in ic, urologic, gynecologic. Risk factors are diabetes, alcoholism, arterial occlusive II Colorectal II 2012 to 70% in 2017. Local relapse was seen in 22.6% of patients and distant metastasis disease, chronic consumptive disorders , obesity. Was first identified in 1883, in 44.7%. The most common site of distant metastasis was the liver in 72,7% of treated from the French venereologyst Jean Alfred Fournier. Occurs in older men, but can cases followed by lung and bone metastasis in 45% and 15 % of patients respectively. occur in women and children.. Males are affected 40 times more than females. From analyzed clinicopathological factors only primary tumor (T) p<0.005 and increased Despite of advanced management mortality is averages 20-30%. levels of postoperative CEA p<0.000 had a significant influence on distant metastasis. The aim of this study is to share the outcome analyzed in the management of the Treatment of rectal cancer during years has improved. The optimal number of examined patient, concerning both diagnosis and radical emergency surgery treatment in lymph nodes is needed for an accurate staging and appropriate treatment of patients. The the first risky stage. extent of the primary tumor and postoperative CEA are predictors of disease outcome. The patient male 64 yrs old, presented with severe perineal sepsis. CT pelvic findings; free air with edema and subcutaneous emphysema near gluteal bilateral OP036 - Total Mesorectum Excision - Which approach in 2018? sulcus anteriorly, left perianal space, inter and extern levator muscle with data of J.Mensah anal fistula, inflammation toward bilateral scrotum , abscesses. Microbiological findings: Escherichia coli, gram - bacteria. The source of the gangrene was proc- OP037 - Ulcerative Colitis. Indications For Surgery & Surgical Techniques togenic.Biochemistry ; glycaemia 280, wbc 17.000, hg 10.4, htc 30%,CRP 39, J.Mensah azotemia 71, bilirubin 2.54, sediment 75,treated with broad-spectrum triple anti- microbial therapy, (cefriaxone+metronidazole+levofloxacin).Surgery; temporary OP038 - Minimally Invasive diagnostic and curative procedures with precan- colostomy, broad aggressive debridement, necrectomy extensive region perineal, cerous colonic lesions. perianal, gluteal, exhaustive cleaning. Biopsy: severe acute inflammation pro- L.Berdica, T.Bushati cess, with sites of abscess, necrosis, bacterial colonic sites, and thrombosis of the Minimally invasive diagnostic and curative procedures done in a screening arterial vases. The predisposing factors: diabetes mellitus type 2,obesity,arterial mode in large populations helped a lot in the diagnosis and cure of the ear- hypertension+ atrial fibrillation , bronchial asthma, IBS. The mean hospital stay ly precancerous lesions of the colon. The trinome endoscopic gastroenterol- was 15 days… ogist, surgeon and pathologist are the doctors who take care of the timely and Conclusions: Necrotizing fasciitis of the perineum & genitalia is a severe condition accurate and rapid delivery of these pre-cancerous and cancerous lesions. with a high morbidity and mortality. Management is based on radical emergency Preoperative and postoperative biopsies performed in a 10-year period at aggressive surgical debridement in the first risky stage followed by elective the American hospital as well as a literature review. Results: Precise and de- approach in a second stage for the repair of functional lesions , triple broad-spec- tailed description possibly accompanied by a photograph of the lesions seen trum antibiotics, and intensive supportive care. during endoscopy helps many pathologists to properly configure the lesions Sorensen, MD; Krieger, JN; et al. (2009). “Fournier’s gangrene: Population based they see in the microscope by drastically reducing negative falls of preop- epidemiology and outcomes”. The Journal of Urology. 181 (5): 120,. doi:10.1016/j. erative biopsy and consequently reduced the number of repeat endoscopies. juro.2009.01.034. PMC 3042351 . PMID 19286224 Recognition of macroscopic lesions and their potential for invasive carcinoma makes it possible to obtain many tissue samples especially from large polyps hav- OP040 - Endoscopic Pilonidal sinus treatment (EPSIT): new approach to an ing structural heterogeneity. Obtaining a single sample by accepting the homoge- old disease neity of the pathologies is wrong and increases the level of false negative diagno- M.Pramateftakis ses and clinical-pathological discordances. Pilonidal sinus is a very common disease with unpleasant and often debilitating symptoms. Classical surgical techniques are characterized by either prolonged OP039 - Clinical presentations and the treatment modalities of polymicrobial healing periods and postoperative pain, or ugly scarring of the pilonidal region. necrotizing fasciitis, Fournier’s Gangrene of the anal- genital area. The commonest approach to pilonidal sinus was the wide excision with second- L.Shosha Mano, S.Marsid, B.Marjeta, Dh.Arben ary healing of the wound or marsupialization of the wound edges. This approach Fournier’s gangrene is a mixed infection caused by both aerobic and anaerobic leaves a wide wound that usually takes weeks to heal, and that healing process is bacterial flora. The development and progression is often fulminating and can rap- particularly unpleasant for the patient. In more complex cases, like wide multiple

82 83 Cardiac Surgery 1 Cardiac Surgery Cardiology & & Cardiology

tracts or recurrent disease, advancement flaps can be used to cover the defect, eg OP043 - Elective transfer from Cardiopulmonary Bypass to Centrifugal Summit Limberg flap or the Karydakis flap. These flaps do not leave a secondary healing Pump Support in Very High Risk II Colorectal II wound, but nevertheless have the risk of wound failure with dehiscence, or in rare A.Kojqiqi, S.Westaby, Silva, C.Grebenik cases even flap necrosis. Operating on patients with advanced heart failure is high risk but this group has EPSIT is a newer minimally invasive technique, which makes use of the Meinero much to gain if they survive. Some patients deteriorate in to cardiogenic shock scope, primarily designed for the minimally invasive treatment of complex peri- postoperatively. In established low cardiac output state the intra aortic balloon anal fistulas, in a technique known as VAAFT. For EPSIT, the surgeon uses the pump (IABP) proves ineffective and recovery may take days or weeks. In border- already present opening of the pilonidal sinus tract in order to enter the tract. The line survival situations we elected to wean directly from cardiopulmonary bypass operation consists of two phases. In the first one, the tract course is identified and (CPB) to a short term centrifugal blood pump.in high risk patients, Levitronix all hair removed. In the second phase, the treatment phase, the internal epithelium CentriMag implantation is undertaken during 30 minutes of myocardial reperfu- of the tract is cauterized using diathermy. sion before discontinuing CPB. Conduits for the inflow and outflow cannulas are In our experience, EPSIT allows patients to be discharged on the same day of used to improve the safety of decannulation. After protamine the sternum is closed the operation, with minimal discomfort and/or pain and they are able to return to to allow extubation during support.in 7 high risk patients, 6 had IABP during their normal daily activities the day after the operation. It is a technique that, even anaesthetic induction. One had aorto-iliac occlusion and 2 had extensive infarc- though has not been tested in time yet, it is an “attractive” option mainly due to tion with septal rupture. Duration of support ranged from 2-8 days. Six were dis- the minimal postoperative discomfort and the lack of large postoperative wounds, charged from hospital. One died from hepato-renal failure.As risk profile increases resulting to an excellent cosmetic result. we need reliable short term support to contain mortality. The pump unloads the stunned ventricle, boosts coronary and systemic blood flow thereby promoting OP041 - Laparoscopic Right Colectomy for Colon Cancer: Colon mobiliza- myocardial recovery with high success rate. These devices must be made available tion and Vessel ligation in all cardiac surgical centres. V.Drakopoulos OP044 - Percutaneous Coronary Intervention for Left Main Coronary Artery OP042 - Laparoscopy in the management of stage III diverticultis Disease X.Delgadillo (Switzerland) B.Horjeti, D.Zijabeg, E.Demiri, L.Percuku We are presenting two cases of patients with left main coronary artery disease (LMCAD) treated in our service with percutaneous coronary intervention (PCI). The presence of significant left main coronary artery disease is a rare finding (4 – 6% of all patients who undergo coronary arteriography) but a very critical con- dition placing the patient at high risk for life-threatening events. For many years, coronary artery bypass grafting (CABG) has been considered as golden standard of treatment of the patients with left main coronary arte- ry disease with excellent proven results (Taggart et al, Sabik et al.) on survival and quality of life. Advances in intervention techniques and stent technology required evaluation of the role of PCI whether it does provide a true alternati- ve to CABG. Recent randomized trials (Syntax, Precombat, Nobel and Ex- cel), focused on the safety and efficacy of stenting the LMCA comparing with CABG have showed comparable results in selected groups of patients.

OP045 - A systemic review and meta-analysis: Bentall vs. David procedure in Marfan and in acute type A dissection D.Berdajs, U.Schurr, M.Grapow, O.Reuthebuch, F.Eckstein This systemic review of the literature and meta-analysis examined the current

84 85 Cardiac Surgery 1 Cardiac Surgery Cardiology & & Cardiology state of the evidence in long-term outcomes for and/or against aortic valve re- Which markers are important in quality assurance ? implantation (RAV) vs. composite graft (CVG) intervention in acute type A dis- How is established quality assurance and risk management in our place? section and in Marfan patients. Descriptive statistics were used to summarize What do we have to do to achieve better medical care ? Cardiology & baseline characteristics of patients across studies. A random effects meta-regres- Cardiac SurgeryCardiac 1 sion was performed across study arms with logit-transformed proportions weight- OP047 - Updates on Myocardial Revascularization ed by study size for each of these outcomes. The results are presented as odds G.Bajraktari ratios with the RAV procedure as compared to the CVG procedure, including The 2018 ESC/EACTS Guidelines on myocardial revascularization show nume- 95% confidence intervals and p-values. Further outcomes are summarized with rous news, as well as the upgrades and downgrades of the class of recommendati- medians, interquartile ranges (IQR), ranges and the numbers of patients at risk. ons form the previous guidelines. The new introduced recommendations of these For TypeA dissection 27 retrospective studies that included a combined 3,058 pa- guidelines, recommend the calculation of the Syntax Score in left main or mul- tients were analyzed. In-hospital mortality was in favor of the RAV procedure 2% tivessel revascularization, radial access as standard approach for coronary angio- vs. 8.4% in CVG. Survival rate at mid-term was 98.8% (CI 91.7-100%) in RAV graphy and PCI, DES for any PCI, revascularization strategy of stabilized NSTE- and 81.3% (CI 78.5-83.9%) in CVG. Freedom from valve-related reintervention ACS treatment according to principles for SCAD, use of the radial artery grafts was 100% (CI 93.7-100%) for RAV and 94.6% (CI 86.7-99.1) for CVG. In Marfan over saphenous vein grafts in patients with high-degree stenosis and CABG prefe- cohort 20 retrospectivewith long-term follow-up were included. The in-hospital rence in patients with CAD, heart failure and LVEF ≤ 35%. These guidelines show mortality rate favoured the RAV procedure with an odds ratio of 0.23 [95% CI 0.09- that the PCI as alternative to CABG in patients with CAD, heart failure and LVEF 0.55, P = 0.001]. The survival rate at mid-term for the RAV cohort was 96.7% (CI ≤ 35%, prioritized completeness of revascularization, when considering CABG vs 94.2-98.5) vs. 86.4% (CI 82.8-89.6) for the CVG group and 93.1% (CI 66.4-100) for PCI, NOAC over VKA in patients with non-valvular AF requiring anticoagulation the RAV group vs. 82.6% (CI 74.9-89.2) for the CVG group for the long term. Free- and antiplatelet treatment, annual operator volume for left main PCI of at least 25 dom from valve-related reintervention (median percentages) for the long term was cases per year, should be considered. On the other hand, the routine of non-IRA 97.6% (CI 90.3-100%) for the RAV procedure and 88.6% (CI 79.1-95.5) for a CVG. lesions in myocardial infarction with cardiogenic shock, and the BRS for clinical This systematic review of the literature stresses the advantages of the RAV pro- use, are not recommended. The 2018 Guidelins for myocardial revascularization cedure in patients with Marfan syndrome in regard to long- and short-term results upgrades the class of recommendations from IIa to I: PCI of bifurcation lesions in the RAV procedure reduces in-hospital as well as long-term deaths and protects the main vessel only, followed by provisional balloon angioplasty with or without against aortic valve reintervention. For an acute type A aortic dissection in the stenting of the side branch, immediate coronary angiography and revasculariza- mid-term period the RAV provides a superior outcome over CVG, both in terms of tion, in survivors of out-of-hospital cardiac arrest an ECG consistent with STEMI, aortic-valve-related reintervention and survival rate. and access of all patients for the risk for the risk of contrast-induced nephropathy. Furthermore, these Guidelines upgrade the class of recommendations from IIb to OP046 - Quality assurance and Risk management in Heart surgery IIb regarding OCT for stent optimization. F.Kojqiqi On the other hand, these guidelines downgrade from Class I to Class IIa regarding Provide high quality medical services, was and still is a requirement for doctors distal protection device for PCI of SVG lesions, and from Class I to Class IIb re- and clinics to be measured. Now is no longer sufficient only to formulate high garding using of Bivalirudin for PCI in NSTEMI-ACS. Further downgrades, from standards, but providing medical services must be also documented in order to IIa to IIb class of recommendations, these guidelines show regarding Bivalirubin be comparable. Increasing economic constrains with increasing competitive si- for PCI in STEMI and PCI for MVD with diabetes and SYNTAX score <23. tuation on the one hand and increased claim of the patients on the other hand, ESC = European Society of Cardiology; EACTS = European Association for doctors and clinics are forced to introduce and permanently establish quality Cardio-Thoracic Surgery; PCI = percutaneous coronary interventions; DES = management systems. Improving Patient Care in addition to an improved medi- drug-eluting stents; NSTE-ACS = non-ST-elevation acute coronary syndrome; cal reputation, it also has economic benefits. Documentation and evaluation of SCAD = stable coronary artery disease; CABG = coronary artery by-pass grafting; the rendered services, namely quality assurance, as well as the recognition and CAD = coronary artery disease; LVEF = left ventricular ejection fraction; NOAC prevention of risk situations, risk management, have essential role in medical = non-vitamin K oral anticoagulants; VKA = vitamin K antagonist; IRA = infarct care and as well in the patient expectations. The goal of medical quality assu- related artery; BRS = bioresorbable scaffolds; SVG = saphenous venous grafting; rance is to improve the quality of treatment and as result, patient satisfaction. STEMI = ST-elevation myocardial infarction; MVD = multivessel disease;

86 87 Cardiac Surgery 1 Cardiac Surgery Cardiology & & Cardiology

OP048- Complex Percutaneous Coronary Interventions 2020 here an unruptured aneurysm of noncoronary sinus associated with bicuspid aortic Jose.M.Wiley valve. SVA are more frequent at males than females (ratio 4/1). Early diagnosis Albert Einstein College of Medicine, Division of Cardiology, Montefiore-Ein- and treatment can save lives of people. They are caused from the separation bet- Cardiology & steinCoronary Artery Disease (CAD) is a world epidemic affecting 110 million ween annulus fibrosus and aortic media. They are present when elastic tissue is Cardiac SurgeryCardiac 1 people and causes over 8.9 million deaths annually. It is the most common cause abnormal. Some diseases like endocarditis, syphilis, atherosclerotic disorders and of death in the world and contributes to 15.9% of total deaths in the United States. chest trauma can cause sinus aneurysm. Most of them are multiple. 20% of people over the age of 65 have CAD. In this talk we will focus on catheter SVA has potential risks like rupture, heart failure and sudden death. Unruptured based interventions of patients with severe CAD including Complex High Risk SVA usually are asymptomatic. When it rupture it goes in three stages. First is (and Indicated) Patients (CHIP) chest pain, which is followed by dyspnea and cough and then edema and oliguria. (1) Two-dimensional transthoracic echocardiography (TTE) may detect as many OP049 - „CTO ( Chronic Total Occlusions) treatment and approach“ as 75% of all patients with SVA. Transesophageal echocardiography also can give S.Celaj information about sinus aneurysm. (2,3,4,5) Chronic Total Occlusion (CTO‘s) represent a significant number of coronary arte- Treatment is made by surgery. It consist on aortic valve replacement or repair. ry disease and most of the go untreated. Current data favor the intervention and re- Primary suture closures (pledget) and patch closures (if ruptured). (5) Sinus of vascularization. The techniques and tool make this complex procedure more likely Valsalva aneurysm(SVA) is rare cardiac anomalies. Aneurysms may be congenital to be a successful one so there is a need to discuss and learn CTO’s. This lectures or acquired. Some diseases like endocarditis, syphilis, atherosclerotic disorders aim is to provide insight into new techniques and discuss the data on CTO. and chest trauma can cause sinus aneurysm. SVA are more frequent at males than females (ratio 4/1). Early diagnosis and treatment can save lives of people. OP050 - Noncoronary Sinus Aneurysm U.Ekmekçiu, K.Gjoka, A.Gjoka, E.Hasimi, M.Lezha, A.Goda Sinus of Valsalva aneurysm(SVA) is rare cardiac anomalies. Aneurysms may be congenital or acquired. The right coronary sinus aneurysm is the most common anomaly, second noncoronary sinus aneurysm and third left sinus. Aneurysms can be diagnosed by echocardiography, Computed Tomography Angiography or Car- diac catheterization. SVA are more frequent at males than females (ratio 4/1). Ear- ly diagnosis and treatment can save lives of people (1, 2). They are caused from the separation between annulus fibrosus and aortic media. They are present when elastic tissue is abnormal. Some diseases like endocarditis, syphilis, atherosclero- tic disorders and chest trauma can cause sinus aneurysm. (3, 4, 5) Our patient was hospitalized because of his chest pain and low effort dyspnoea. He has 3 years with those complaints. At physical examination he was without abnor- malities. ECG shows only negative T at AVL. Effort test result positive for ische- mia With ST depression 1mm at V4-V6 and inferior leads. At echocardiography we saw that aortic valve was bicuspid and dilatation of noncoronary sinus (figure 1). Cardiac catheterization result with atherosclerotic disorder and aneurysm of noncoronary sinus (figure 2). CT Angiography was very helpful (figure 3,4). We saw the aneurysm of noncoronary sinus. At this point patient was transferred at heart surgery for intervention. SVA is a rare congenital anomaly. It is usually silent when it is unruptured. 65- 85% of aneurysm origianate from the right sinus. 10-30% originate from nonco- ronary sinus and < 5% from the left sinus. They are usually associated with ven- triculoseptal defect, bicuspid aortic valve and aortic regurgitation. We presented

88 89 Neurosurgery

OP051 - Minimally invasive surgery and microscopic reconstruction for base, a discussion of practical aspects of delivering the treatment and future chal- treatment of head and neck pathology lenges. We aim to give guidance on some of the areas not clearly described in the Neurosurgery A.Aga, A.Kaba, E.Vajushi, M.Mirakaj, T.Minarolli, B.Agalliu clinical trials (based on evidence where available, but if not, on our own expe- A variety of diseases can affect the head and neck region. Focusing on the most rience and practice) and highlight areas of uncertainty requiring further researc frequent pathologies, we will discuss in this study the application of the minimally invasive surgery for treatment of sinonasal disease, laryngeal lesion and microsur- OP054 - The role of Percutaneous Vertebroplasty +/- biopsy in the treatment gical reconstruction in advanced head and neck cancer that have been performed of spinal pathological fractures. in our department during the last 5 years. A.Bano The most common pathology in the sinonasal region is sinusitis. After initial skep- Many treatment methods have been reported aiming to control pain and instability ticism, now days, functional endoscopic sinus surgery is consider the gold stan- resulting from pathological spinal fractures. Radiotherapy offers pain relief; ho- dard treatment. Tumors arising from sinonasal region and trauma to the nose are wever, this method provides minimal vertebral stabilization. Surgical management other afflictions of the nose that can be solved with minimally endoscopic sinus provides spinal stabilization+/-decompression, but procedures are often complica- surgery. For pathology of the larynx the treatment of choice has changed signifi- ted affecting final outcomes. Vertebroplasty is a minimal invasive procedure and

cantly with the advent of transoral laser (CO2) assisted microsurgery (TLM). We an alternative therapy to both radiotherapy and surgery, providing stabilization can use this treatment for benign pathology as cyst or polyps and for carcinoma in and pain relief. situ or early invasive squamous cell carcinoma. Series of cases with Percutaneous VP in patients with pathological fractures and In advanced head and neck cancer, the advent of free tissue transfer has offe- with or without established diagnosis of malignancy have been studied. Prognosis, red several options that allow the restoration of both the structural and functional Tomita, Tokuhashi, SINS score, Karnofsky performance and neurological status defects. Microsurgical reconstruction is used for complex reconstructive surge- of the patients have been evaluated preoperatively. One to ten levels in one to two ry problems when other options (primary closure, healing by secondary inten- sessions VP, in unilateral, bilateral, intra and extrapedicular approaches have also tion, skin grafting and local or regional flap transfer) are not adequate. It might be been studied. Analysis with the changes of visual analogue score (VAS), vertebral a suitable procedure because the hospitalization and complication rate is reduced body (VB) height and kyphotic angle have been measured pre and postoperatively. and with minimal donor site morbidity. Application of different minimally invasi- Results: VAS score and the level of mobility improved significantly. Further ver- ve approach and microsurgical reconstruction, are an important surgical challenge tebral body collapse and cement leakage can be prevented using VP- slow cement to everyday practice of an ENT surgeon. We have had the opportunity to perform injection technique. a several variety of surgical techniques with outstanding results. We want to share These results indicate that VP could be a safe and effective procedure as a palliati- our innovative experience in the treatment of these pathologies here in Albania. ve treatment of the spinal tumor patients.

OP052 - Concurrent Traumatic Cranio-Spinal Injury: Lessons from A Sys- OP055 - Is there a role for stereotactic radiosurgery in the management of tematic Review and Meta-Analysis large brain metastases? A.Demetriades A.Xhumari, A.Aliraj, A.Mano, G.Brace, B.Myzeqari, I.Mucollari, M.Petrela Stereotactic radiosurgery (SRS) is widely used for brain metastases, typically admi- OP053 - Endovascular thrombectomy for acute ischemic stroke: Our experience nistered in a single session but is relatively contraindicated for large lesions (>30 mm). A.Rroji, E.Enesi, F.Bilaj , K.Caci , G.Huti , D0.Qiringji ,J.Musteqja, M.Petrela It can be difficult to balance tumor control while avoiding damage to eloquent tissue Since November 2014, nine positive randomised controlled trials of mechanical when single-fraction SRS is utilized for large lesions or those in close proximity to cri- thrombectomy for large vessel occlusion in the anterior circulation have led to tical structures.Treating a lesion in 2 to 6 fractions with stereotactic radiosurgery (hy- a revolution in the care of patients with acute ischaemic stroke. Its efficacy is pofractionated SRS [HF-SRS]) potentially provides the ability to treat a lesion with a unmatched by any previous therapy in stroke medicine, with a number needed to total dose of radiation that provides both adequate tumor control and low toxicity rates treat of less than 3 for improved functional outcome. With effectiveness shown (radiation necrosis).The purpose of this study is to report on the safety and efficacy of beyond any reasonable doubt, the key challenge now is how to implement acces- hypofractionated stereotactic radiosurgery treatments for large lesion or located near sible, safe and effective mechanical thrombectomy services. This review aims to or within highly eloquent brain, in the X-Knife Unit, Service of Neurosurgery “Prof. provide neurologists and other stroke physicians with a summary of the evidence Kurti”, University Hospital Centre, Tirana,in the period 2013 to 2017.

90 91 Neurosurgery

OP056 - Emerging medicolegal concerns in Spinal Surgery: A concise reflec- formed with comparative analysis between radiation of the primary site and ENI. tion from a modest UK experience Median follow-up time in this cohort was 59 months (range 5.2-236). The me- Neurosurgery D.Pasku dian overall survival (OS) and disease free survival (DFS) for the entire cohort Medical malpractice litigation increasingly affects the delivery and cost of health was 15 years and 7.6 years, respectively. The five-year cumulative OS and DFS care. Spinal surgery is on the top of the legal claims with around 20% of the spinal was 83% and 72%, respectively. Ten patients (26%) had ONBs classified as EKS surgeons facing a claim annually. The total cost of clinical negligence in Eng- and 29 patients (75%) had AKS tumors. The 5 year OS for ONBs with LHG land was 2,2 Billion pounds for the year 2017-2018. It is known that, 40-50% of was 100% compared to 65% for those with ONBs with HHG (p=.017). 66% the adverse outcomes are preventable. The prevention starts from the first contact of the EKS patients were also LHG compared to only 28% LHG in AKS pa- with the patient providing optimal communication, empathy and compassion. The tients (p=.057). The 5 year OS/DFS was 100%/100%, 100%/66%, 100%/75%, reasons for the increase number of medicolegal claims are different, including in- and 59%/47% for EKS/LHG, EKS/HHG, AKS/LHG, and AKS/HHG, respecti- appropriate patient expectations, miscommunication, lack or insufficient consent vely (p=0.07). Five patients in the EKS group received surgical resection alone, information, adverse event, faulty surgical technique etc. On the other side, the and there were no observed deaths or recurrences with a median follow up of increase in the number of medicolegal experts and lawyers specialized in medical 44 months (range 5-235 months). 31 (79%) patients in the entire cohort presen- negligence play another important role increasing obviously the number of the ted with node-negative disease. 13 (56%) of the node-negative patients received claims. Nowadays, Cauda Equina Syndrome is the leading topic of the litigations, ENI. There were six nodal-failures in the entire cohort, with one failure 16 years involving the medical staff from General Practitioners to the Spinal Surgeons. Ob- following treatment (median 59 months, range 6-165 months). In node-negative viously, the boom of the legal claims is leading to a defensive practice, which is patients the 10 year nodal-failure rate was reduced from 38% (3/8) in patients trea- emerging in UK against a background of a recent doubling of clinical negligence ted with primary site radiation alone to 0% (0/9) with the addition of ENI (p=.04). costs against National Health Service (NHS) hospitals. The mentality of the de- In this retrospective review, patients with both AKS and HHG have significant fensive practice is expanding further because of the new guidelines provided by worse clinical outcomes compared to EKS and LHG. In EKS patients, surgery NICE (National Institute of Care Excellence) alone resulted in long term OS and DFS. For patients with node negative disease The need for better clinical and surgical performance does require improvement in at presentation (other than those with EKS who did not undergo radiation), ENI re- informed consent in the Post-Montgomery era. Ideally a reasonable doctor should sulted in significant reduction in the regional failure. In select patients presenting inform and consent a reasonable patient. In the same time, we all are confident EKS and LHG ONB, surgical resection alone can be considered. Furthermore ENI that, every Spinal intervention is a team work and minimizing the legal claims should be standard of radiation therapy and long term follow up is recommended. means perfection of the team approach. OP058 - Corrective surgery in cleft patients OP057 - Adjuvant Radiation Therapy and ENI in Olfactory Neuroblastoma E.Nkenke D.Blakaj Today, the primary treatment of cleft patients during the first months follows strict Olfactory neuroblastoma (ONB) is a rare head and neck cancer originating concepts and is very successful. However, by the end of adolescence sometimes from neural crest cells of the olfactory membrane located in the roof of the na- problems occur that have an impact on function as well as esthetics. The most sal fossa. Several retrospective studies have shown surgical resection, followed common issues are an insufficient projection of the maxilla, the whistling defect by adjuvant radiotherapy, to be superior to either modality alone. However, of the upper lip and an esthetically compromising shape of the nose. even with bi- or even tri-modality therapy ONB patients with high Hyams gra- Typically, these different aspects are addressed surgically at the age of 15 or older. de (HHG) and advanced Kadish stages (AKS), C or D, have worse clinical out- The maxilla is brought the intended position by orthognathic surgery. Today, the comes compared to low Hyams grade (LHG) and early Kadish stages (EKS), A preferred procedure is distraction osteogenesis which results in only minimal re- or B. This study evaluates clinical outcomes in ONB patients, comparing adju- lapse once the correct position of the maxilla is achieved. vant radiation therapy versus surgery alone in EKS. In addition we evaluated The correction of the upper lip requires a procedure that is comparable to the in- the impact of adjuvant radiotherapy including elective nodal irradiation (ENI). itial closure of the upper lip. The orbicularis oris muscle has to be operated on as Forty-one ONB patients treated with surgical resection at our institution from well as the white roll and the vermillion. This comprehensive approach leads to an 1996 to 2017 were identified. Two patients died following surgery and were ex- unobtrusive appearance of the upper lip. cluded from the analysis. Univariate, multivariate, and survival analysis was per-

92 93 Neurosurgery

The most complex procedure is the cleft rhinoplasty. Successful surgery often Patients and methods: We included all patients which underwent resection of a requires open surgery and involves lengthening of the collumella. Placing a col- glomustumor at the department of vascular surgery and kidney transplantation at Neurosurgery lumella strut is one of the keys to a longlasting and stable result of this kind of Düsseldorf UniversityHospital between January 1988 and June 2008 in this retro- rhinoplasty. The combination of orthognathic surgery and plastic surgery proce- spective Study. At follow – up examination we documented the patient’s history dures to the upper lip and the nose improve the facial appearance of the patients and performed a physical exam and duplex sonography. significantly and strengthens their self esteem. Furthermore each patient completed the questionaire QLQ-C30 of the Eu- ropean Organisation for Research and Treatment of Cancer (EORTC) OP059 - Thoracholumbar Fracture and the questionaire module for head and neck QLQ – H&N35 to assess F.Olldashi quality of life [Aaronson 1993]. Thoracic and lumbar fractures account 50% for all spinal traumatic fractures. In- Our material of 36 patients consisted of 13 men (36%) and 23 women (64%) at an cidence of Th-L fracture is 4 per 100 000 person-year and peak age 18-35. The average age of 48,33 years (range 17 – 78). Before surgery 16 patients presented causes of thoracolumbar fracture are different depending on patient‘s age. High with a local neck swelling, 5 patients each had difficulities swallowing or hoarseness. energy trauma, fall from height Sport accident Violent act Osteoporosis Tumors Preoperatively we found a Horner’s Syndrom in one patient. 22 tumors were found Other underlying conditions that weaken bone. The treatment can be surgical and on the right side of the neck (52,38%) and 20 on the left (47,62%). Six patients non-surgical. There exist many surgical methods to treat. The goal is to optimize showed bilateral tumors (16,67%), 3 of which were bilaterally excised. The other neural decompression while providing stable internal fixation over the least num- three are still under surveillance without surgery at the other side. Altogether we ber of spinal segments. Short-segment constructs through a single-stage approach performed surgery of 39 Glomustumors in 36 patients. In all cases ( primary surgery (anterior or posterior) have become viable options with advances in instrumenta- 34 times, re – do surgery 5 times) we excised the tumors macroscopically in toto. tion and techniques. In this retrospective study we analyze 562 patients between 56 Parts of the vagus nerve had to be resected in 3 patients (7,69%), resection of blood February 2006 and July 2018 who had sustained fracture dislocation of the thora- vessels were unavoidable during 10 operations (ICA with autologous vein columbar spine and received single stage posterior surgery. interposition 7 times (17,95%); ECA with high ligation in 3 cases (7,69%)). There was The implant failure rates for patients treated with pedical screw fixation: 2 levels no perioperative mortality. In two patients we had to perform immediate revisions (one up and one below fracture) 4% 3 levels (with fracture included) 3.5% 3 (5,13%): in one case due to haemorraghe, in the other case due to the early levels (2 up and one below without fracture included) 3.2% 4 levels 3.5 %. The- obliteration of a venous interposition graft. One Patient experienced a stroke with re was no significant difference on implant failure rate between the two groups. motor aphasia and transient hemiplegia as the only central neurological deficiency. This study suggests that spinal fixation without fusion in posttraumatic fracture Peripheral neurological lesions could be found as follows: vagal nerve 4 times; may be an adequate option in specific group of patients. Young patient and neuro- recurrent nerve 8 times (twice transient); fascial nerve 3 times (one case transient); logically intact, with posterior ligamentous complex preserved. hypoglossal nerve 3 times; glossopharyngeal nerve 3 times; ganglion stellatum with Horner’s syndrom in 4 cases. According to the above men OP060 - Tumors of glomus caroticum H.Krasniqi, M.Ben Oun, A.Zenuni, M.Elian, N.Bikov OP061 - Surgical management of Subaxial Cervical Fractures: Our experience Tumors of the Glomus caroticum are rare paragangliomas with an incidence of I.Hodaj, F.Olldashi 0,012% [Schipper 2004] originating from sympathetic fibres of the carotid bifur- This was a retrospective review of the surgical management of subaxiale cervical cation. fractures in the Neurosurgery Clinic of the University Hospital of Trauma during Growth is slow, and they frequently become symptomatic through local compression the period of 2006-1July 2018. In the following 12 year, in our clinic have been and infiltration of neighbouring vascular and neural structures. Surgical resection is treated about 290 cases, from which 232 males and 58 females. The patients age the therapy of choice. In most cases they are considered to be benign but in some range from 14-78 old, with an average of 35 years old. Trauma is usually caused case reports the authors assign a malignant character due to their infiltrative growth by car accident, falls from altitude, jumps into the sea with head, fall from stairs and tendency to disseminate metastasis. or bicycle. The neurological state of the hospitalized patients has been conducted Aim of this study is to present patients with a glomustumor treated at our department based on ASIA scale. 151 of patients were hospitalized with ASIA E, 64 ASIA: A, of vascular surgery at the Düsseldorf university hospital and to discuss rates of 9 ASIA: C, 6 ASIA: D, 8 ASIA: B, 45 patients were hospitalized with the central reoccurrance and dignity during follow up. cord syndrome and 7 patients with brown sequard syndrome. Only 268 patients

94 95 Satellite Symposia Satellite Breast Cancer

were treated with anterior and 22 with posterior approach. 82 patients underwent OP063 - Causes and management of breast pain in our daily practice anterior corpectomy and 186 were treated only with anterior decompressive di- A.Shahini Neurosurgery scectomy. In 108 patients PEEK CAGE and 160 patients iliac bone was used. Breast pain is very common in our daily practice. Female since their teenage start to The surgical management of subaxiale cervical fractures aims the decompression experience at least once time an episode of breast pain during the life. Based on the of the nerve structure and fixation of the cervical spine in the correct and stable structure of their breast and a good understanding of hormonal and growth factor position. This procedure may be realized with anterior approach, which is an ef- of breast development and function is key to the rational and systemic evaluation fective, safe, and less expensive method in our case. In addition, anterior approach and treatment of patients. Breast diseases especially the benign ones are present at is associated with minimum of complications and high probability of bony fusion. the time of examination in the majority of patients. The more common lesion are fibrocystic changes, periductal fibrosis, hamartomas, lipomas, phyllodes and neuro- OP062 - Failed back surgery related syndromes (FBSRS) fibromatomas but in our study one of them was diagnosed with breast cancer also. R.Alimehmeti In American Hospital nr 1 at the Imaging Department the majority of female pa- Failed back surgery syndrome (FBSS) occurs whenever spine surgery is followed tients (girls and women) und presented for breast pain, underwent the exam- by unmet expectations of the patients in terms of pain relief and functional reco- inations. A total of 480 consecutive patients were presented with breast pain at very of the preoperative condition. FBSS has been studied by different groups of least once at the American Hospital from January 1, 2015 to January 31, 2017. specialist and the prevalence as well as the related clinical phenomena are very Social and demographic data were collected on all patients. All patients who pre- different, but useful to know in order to overcome unsuitable clinical situations. sented with a complaint of breast pain were evaluated to determine the effica- Studying these patients we have come across some syndromes that deserve to be cy of their workup. Additionally, all patients who complained of a breast mass checked and recognized before and after spine surgery. We call these FBSRS.Phy- but were found to have pain with no mass were evaluated in a similar fashion. sical neurological examination before the operation of a spine condition would ge- 85% of patients (408 of 480) presented with a complaint of breast pain in a hormonal nerally reveal nerve root compromise that corresponds with radiological findings. cycle model. In addition, 46 patients who complained of a painfull breast “mass” During clinical practice in our pain clinics with FBSS patients we have checked really were found to have only breast pain. Of the 480 patients with breast pain, 3 and found the presence of peripheral entrapment neuropathies; single or multiple (<1%) were found to have breast cancer. Of the 42% patients found to have breast myofascial pain disorders; sacro-iliac (instability) syndrome; psyco-soci-ecomo- benign tumors, most were fibroademoma and cysts. 428 patients were under the nical syndrome. age of 40 years. No breast cancer patient was under age 40 but 34% of them have The identification of the abovementioned syndromes alone or combined gave us at least a benign lesion. 34 patients were between 40-49 years. 21 patients were the opportunity to treat them accordingly. All the patients diagnosed and treated 50 years or older and 3 were found to have breast cancer. Most patients underwent for treated entrapment neuropathies and myofascial pain had a significant impro- workup for their breast pain with 85% undergoing breast imaging (mammogram vement of clinical conditions. and/or ultrasound), based on the age of patients, 2% undergoing a biopsy, and 18% In the everyday practice the spine surgeon should be able to reveal and carefully having blood drawn for laboratory tests. Only 2 of them underwent Breast MRI. examine the patient for situations that may be concomitant with the nerve root Breast pain is a very common complaint in every day outpatients seen in our Hospi- syndromes. Explaining to the patients before surgery their existence and the ne- tal. In patients at least 40 years mammography should be performed at least once in cessity in treatment increases the reliability and strengthen the reputation of the every two year and under 40 years old ultrasound should be performed at least once spine surgeon. Early diagnosis and treatment of FBSRS improves the outcome and a year if they complain breast pain. Diagnostic imaging and laboratory tests do not prevents from chronicization of pain and related phenomena. appear beneficial in patients with breast pain. Anti-inflammatory drugs are the treat- ment of choice to release breast pain combined with antibiotics and vitamin therapy.

OP064 - MDT (multidisciplinary team ) Role in Neoadjuvant Treatment of Breast Cancer E.Huti, I.Allajbeu, A.Daku, B.Cekrezi, R.Koza. Kapaj, D.Godaj, L.Berdica, T.Bushati Neoadjuvant chemotherapy originality has been used to downstage patients with inoperable locally advanced breast cancer but now neoadjuvant therapy is inte-

96 97 Satellite Symposia Satellite Breast Cancer

gral to the treatment of patients with early stage disease. Administration of neo- tuzumab and platinum salts. Beyond the established knowledge for the role of adjuvant therapy has benefits and limitations; therefore, patient selection - iscru trastuzumab in adjuvant setting, there is increased interest for current and future cial for optimizing outcomes. In this review, we will discuss multidisciplinary perspectives, with additional agents available.

Breast CancerBreast considerations in treating patients with neoadjuvant therapy and highlight areas The APHINITY trial, announced in last year’s ASCO, demonstrated that the addi- Satellite Symposia of controversy and ongoing research. Surgical resection of breast cancer remains tion of pertuzumab to trastuzumab is associated with a significantly higher rate of the cornerstone of therapy for patients diagnosed with early-stage breast cancer. invasive-disease–free survival than trastuzumab alone. Systemic therapy can reduce the risk of relapse in patients with early breast cancer EXTENET study investigated the efficacy and safety of 12 months of neratinib by killing cancer cells that have escaped the breast or local lymph nodes. Generally, after trastuzumab-based adjuvant therapy in patients with early-stage HER2-pos- systemic therapy administered either before or after surgery provides equal benefit itive breast cancer. Longer follow-up is needed, to ensure that the achieved im- in terms of disease-free survival and overall survival for patients with early-stage provement in breast cancer outcome, in favor of neratinib, is maintained. Neoadju- breast cancer. Research in the fields of surgical, medical, and radiation oncology vant treatment in HER-2 (+) breast cancer, can contribute to surgical downstaging, has changed the landscape of neoadjuvant therapy in breast cancer, yet many ar- in addition to providing an in vivo assessment of tumor response to chemotherapy. eas of controversy still exist. When considering whether a patient is a candidate As such, it has been established as effective therapeutic approach of choice, which for neoadjuvant therapy, the initial assessment should be multidisciplinary in nature significantly improves pCR rates. The pooled analysis of 12 international trials, re- by a multidisciplinary team requiring surgeons, clinical and medical oncologists, vealed that the more aggressive subtypes, such as triple-negative and HER2-posi- radiologists, pathologists and nurses in patient care. When discussing neoadjuvant tive tumours, had increased frequencies of pathological complete response. treatment, it is crucial that provisional histological grade (i.e. derived from the core Within the HER2-positive population, pathological complete response was more biopsy specimen), hormone receptor and HER2 results, and radiological results are common for hormone-receptor-negative tumours than for hormone-receptor-pos- available at the MDT meeting . MDT discussions should include the proposed sur- itive tumours, and with the addition of trastuzumab. In September 2013, based on gical plan after treatment, which will be determined by the tumour response to neo- the results from neoadjuvant trials, the FDA granted accelerated approval to neo- adjuvant chemotherapy which is assessed by evaluating the clinical and radiological adjuvant pertuzumab in combination with trastuzumab-based chemotherapy for response during and after therapy, and the pathological response after surgery. patients with localized, locally advanced, inflammatory, or early HER2-positive breast cancer. It has been demonstrated that increased expression of immune-as- OP065 - Benign breast disease: clinical, radiologic and pathologic correlation sociated genes and extensive lymphocyte infiltration in the breast tumour before E.Mema neoadjuvant treatment are associated with high likelihood of a pathological com- What are the typical imaging patterns that distinguish a benign lesion from malig- plete response in HER2-positive and triple-negative tumours. nancy in ultrasound imaging? These data provide strong support for a contribution of the immune-cell microen- When can you call a new lesion a BIRADS 2 or 3 without subjecting the patient vironment to the activity of chemotherapy in vivo. to a biopsy? Overall, the heterogeneous sensitivity to HER2-targeting drugs has prompted The lecture will review imaging patterns of benign breast disease including initial investigations into the mechanisms of response and resistance to trastuzumab. presentation, imaging characteristics and management. to Identification of useful biomarkers for selection of the drug or drugs best suited It will be a combination of didactic session and case based active learning with to individual tumour characteristics is essential. participation from the audience. OP067 - Imaging the axilla OP066 - Challenges in therapy for HER 2 + BREAST CANCER F.Kilburn Toppin E.Sera Evaluation of regional lymph node status is important for staging, treatment plan- The natural history of the disease has been changed since 2005 and the develop- ning and prognosis in breast cancer patients. ment of the HER2-targeted monoclonal antibody trastuzumab, which was the first Pre-operative axillary ultrasound and ultrasound-guided biopsy are routinely used drug approved for HER2-positive disease. to detect nodal metastases, allowing patients to proceed directly to axillary lymph Trastuzumab is a recombinant humanized monoclonal antibody against the extra- node dissection thereby avoiding sentinel lymph node biopsy. cellular juxta-membrane region of ERBB2, with high sensitivity. An attenuation However, following recent clinical trials and with improvement in systemic and of DNA repair activity was reported as the mechanism for synergy between tras- radiation therapies, the role of staging sonography has been questioned.

98 99 Satellite Symposia Satellite Breast Cancer

In this lecture, the current role of axillary staging will be reviewed, the impact of in the diagnosis. Aims: to calculate our sensitivity and specificity, also patho- nodal status on treatment planning discussed, and the future for nodal staging in logic features of patients with sentinel node biopsy in the neoadjuvant setting. the advent of evolving surgical management of the axilla and a trend towards less 48 patients with breast cancer after NAC were examined with SLNB during 2016-

Breast CancerBreast aggressive surgery will be considered. 2017 in our hospital. Methylene blue dye and radioisotope technique were used Satellite Symposia for detection of SLN. OP068 - Automated whole breast ultrasound (ABUS)- A new screening tool Clinico-pathologic characteristics were correlated with the diagnosis of SLN bi- for women with dense breasts? opsy. Identification rate and false negative rates of SLNB were determined using I. Allajbeu univariate analysis. 33 out of 48 patients had positive SLNB during frozen biopsy New different imaging techniques such as AB-MRI and ABUS can increase can- and underwent axillary lymphnode dissection. 7 out of 15 negative SLNB patients cer detection rate and reduce advanced stage interval cancers in women with dense resulted with micrometastasis in the final pathologic examination. breasts in addition to standard mammography screening.Screening with mammog- All the positive cases in frozen biopsy were positive in the definitive patho- raphy has been implemented in many countries across the world with most offering logic examination. Sensitivity was 82.5% and specificity was 100% with a 2-yearly examinations between the ages of 50–69 years. However, women are at negative predictive value and accuracy of 53.3%and 85.4% respectively. The different risks of breast cancer due to age, breast density, inherited predisposition false negative rate was significantly higher in patients with complete and near- and personal lifestyle/hormonal risk factors. Mammography is not equally effective ly complete pathologic response (5 patients) in the lymphnode and breast in all women and some women would benefit from a more effective test especially if mass cancer (12.5% vs5 %,). Triple-negative breast cancer (TNBC) patients they are younger or have dense breast tissue. Preliminary results from overseas stud- showed a higher false negative rate than non-TNBC patients (10% vs. 7.5%,). ies suggest that the addition of ABUS or AB-MRI will result in earlier detection of SLNB has been recently used in NAC patients with breast cancer in Albania. It has breast cancer or detect more aggressive disease in those women with dense breasts. challenges especially in triple negative patients with nearly complete pathologic Many studies have demonstrated that ultrasound is a good screening tool for women response. There is a strain and consume in efforts in the pathologic team for per- with dense breast tissue due to its accessibility, relatively low cost, good patient tol- forming SLNB and on our results and given current controversies the decision to erance and lack of ionizing radiation. In contrast to hand held ultrasound(HHUS), do or not ALD may be better made in a multidisciplinary setting. ABUS has a standardized acquisition protocol that can be performed by medical personnel after short training without the need for highly trained radiologists during OP0670 - Fine-needle aspiration cytology vs core needle biopsy in breast the examination. 3D ABUS acquires large 3D volumes that overlap and can be eval- lesions. A review uated multiplanar: coronal, transverse and sagittal. This practice enables temporal T.Bushati, L.Berdica comparison which is a key factor in breast cancer screening. It can also depict can- Diagnosis of breast lesions is routinely performed by the assessment of a surgeon, cers in the coronal plane due to the retraction sign. Breast cancer often appears as a radiologist and pathologist. In this setting, fine-needle aspiration cytology (FNAC) stellate lesion with desmoplastic reaction disrupting the normal parallel soft tissue and core needle biopsy (CNB) are the current methods of choice for pathological plane by producing a contraction of breast tissue towards the mass. diagnosis, both with their specific advantages and limitations. Evidence-based This presentation is a review of the literature about this new developing technique literature discussing which of both modalities is more accurate in breast lesion based on the experience of the Cambridge Breast Unit as part of a large multi- diagnosis is sparse and there is no consensus among different specialised breast centric prospective study on risk adaptive breast cancer screening which aims to cancer centres. This study reviews FNAC and CNB for diagnosing breast lesions, assess and test the feasibility of different imaging techniques in addition to stan- comparing methodological issues, diagnostic performance indices, possibilities dard mammography in a screening setting. for additional prognostic and predictive tests and cost effectiveness. Overall, CNB achieved better sensitivity and specificity especially in those lesions that were not OP069 - Frozen biopsy of Sentinel Lymph Node in breast cancer patient after definitively benign or malignant, non-palpable and/or calcified lesions. Although Neoadjuvant Chemotherapy in Albania FNAC is easier to perform, interpretation requires vast experience and even then, M.Ikonomi, B.Cela, A.Bodeci, E.Cuedari, A.Kristo, F.Proko, Dh.Tarifa it is more often inconclusive requiring additional CNB. The authors conclude that SLNB has now become a standard surgical procedure for axillary staging in overall CNB is to be preferred as a diagnostic method. clinically node-negative primary breast cancer. However, the effectiveness of SLNB after neoadjuvant chemotherapy is less clear and often poses challenges

100 101 General Surgery Oncology & & Oncology

OP071 - Devil stands in details – when colon is not long enough in laparoscop- observed in our sample with the minimum age 5 month and maximum of 83 years ic LAR! Tips and tricks of a safe anastomosis old. However, most of the cases were found in the 5th, 6th and 7th decades of life. Oncology &

General Surgery General A.Beqiri , A.Catona The data obtained in the present sample shows a slight tendency for these diseases Every time you are doing a left colectomy for a descending colon cancer after to occur more in males. This trend is contrary to other studies reported in litera- taking down IMA and IMV and mobilizing splenic flexure you run into some risk ture. These results could be explained by the fact that men tend to seek healthcare of tension on the low anastomosis. The transverse colon will not reach the rectum providers more often, because of the privilege they have in the Albanian society. without tension on the middle colics. As also shown in other studies, in both the major and minor salivary glands, the In this lecture we discus all options available to get through this difficult situation commonest type of benign tumour is pleomorphic adenoma. in colorectal surgery. Our experience with laparoscopic colorectal surgery at American Hospital is OP073 - Intraoperative radiotherapy (IORT) for locoregionally persistent or demonstrated as well as part of the progress made in this institution in the last year. recurrent head and neck cancer: Current clinical data and future study of immune therapy in combination with IORT OP072 - Salivary gland neoplasms: A review study of 8 years in two major D.Blakaj hospital centers in Albania. When feasible, patients with locoregionally recurrent cancer of the head and neck B.Gashi Cenkoglu, E.Kola, M.Alimehmeti, A.Aga, L.Berdica should undergo salvage surgery, but locoregional control (LRC) is unacceptably Salivary gland tumors most often present as painless enlarging masses. Malignant sal- low with surgery alone. ivary gland tumours are rare and constitute less than 0.5% of all malignant neoplasms. Adjuvant chemoradiation has been shown to improve LRC and progression-free Most are located in the parotid glands and are benign. The principal pitfall in their survival. 1 The role of intraoperative radiotherapy (IORT) remains unclear. There management lies in the difficulty in distinguishing benign from malignant tumors. have been several institutional reports using intraoperative radiotherapy, but LRC Clinical examination and conventional imaging techniques alone usually cannot dis- rates are wide ranging (11-87%), likely due to variable patient selection criteria.2-5 tinguish between benign and malignant diseases nor subclassify the pathologic pro- We report our institutional outcomes using IORT for patients with recurrent head cess. Hystopathologic examination in Hematoxylin-Eosin staining is still the gold and neck cancer and plans for future investigator initiated trial with immune ther- standard used for the diagnosis. In addition immunohistochemistry can reinforce the apy and IORT. diagnostic accuracy and be helpful in determining parameters such as the cell nature We identified 101 patients with head and neck cancer treated with IORT in our de- and differentiation status, cell proliferation and tumor protein expression. partment from 2005-2016. Of those, 61 were salvage treatments for locoregional Benign tumours and early low-grade malignancies can be adequately treated with disease recurrence. Of the salvage patients, 44 had squamous cell carcinoma. We surgery alone, while more advanced and high-grade tumours with regional lymph- retrospectively evaluated disease control and survival outcomes for the cohort. node metastasis will require postoperative radiotherapy. We then evaluated clinical outcomes based on surgical margin status and whether This retrospective analysis was done to evaluate the clinical presentation, site dis- patients received adjuvant chemotherapy. tribution and treatment in salivary gland tumours highlighting some of the more Of the 61 salvage patients, 43 were treated for a recurrence at or near the primary important aspects in their diagnosis and management. The incidence and distribution site, 16 in the neck, and 2 in both. All but two patients had previously undergone of all types of salivary gland tumours were analysed and data for comparison with a course of external beam radiation (median dose 66 Gy). 23 patients underwent other epidemiological studies from different geographical sites were provided. adjuvant EBRT after IORT (median dose 45 Gy). There were 4 patients who died A retrospective study of the biopsy examinations of salivary glands pathologies within 91 days of IORT, including one patient with carotid blowout and one pa- during the period 2010-2017 was carried out. Evaluation of information was done tient with a tracheoesophageal fistula. The use of IORT for recurrent head/neck based on hystopathological diagnosis, location, age and gender. cancer at our institution has resulted in effective locoregional control and favor- There were examined 182 biopsies of which 118 were performed on males and 64 able overall survival when compared to historical controls. The effect of surgical on females. Topographically, the greatest frequency appeared to be in the paro- margin status on PFS and OS trended toward statistical significance. In most cas- tis gland. According to the type of lesions, 37 of them were not neoplastic, 104 es, toxicities were acceptable, but there were two grade 5 toxicities which may benign neoplasms and 41 malignant neoplasms. The neoplastic lesions were pre- have been directly related to IORT. We plan to conduct a prospective trial to the sented with a prevalence of male sex. The most frequent lesions turned out to be effects of immune therapy with surgery and IORT for salvage head and neck can- pleomorphic adenoma (n=79). Ages affected by salivary glands pathologies were cer patients in the near future.

102 103 General Surgery Oncology & & Oncology

OP074 - EBUS or EUS - B FNA OP075 - Early and late outcome, mortality and major morbidity after lung E.Tashi . A.Andoni, D.Xhemalaj, A.Teferici, E.Nushi, E.Dilka , D.Todri, O.Sina, cancer surgery for primary carcinoma Oncology &

General Surgery General S.Golgota, J.Shehu, E.Avllai, I.Peposhi, P.Kapisyzi F. Gradica; L. Lisha, Dh. Argjiri, A.Cani, F. Kokici, F.S.Gradica;D.Xhemalaj, Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is indi- Dr.Y. Vata, Dr.L.Shpataraku, Dr. A.Vyshka, D.Thereska cated for lymph node staging in lung cancer patients and diagnosis of: intrapulmo- Background: Radical surgical resection of lung cancer with or without adju- nary lessions (IPL),hiliar and mediastinal lymphadenopathy, mediastinal tumors. vant treatment is still a prerequisite for cure. Advances in operative and postop- 5 different IPL were diagnosed used EBUS-TBNA and EUS-B FNA- (Esopha erative care led to a decline in complications and mortality rates during the last geal ultrasound of the EBUS scope). Case 1:A 62 year old man with with main decades. In spite of different additional modes of treatment, survival is still poor. complain of left arm pain.Chest X ray(CXR) revealed a left upper lobe increased Methods: We analyzed 968 patients who underwent lung resection for bron- intensity.Contrast enhanced chest CT (CECT) demonstrated a posterior left up- chial carcinoma, with non-small cell lung cancer during a 12-year period (Jan- per lobe mass infiltrating the upper ribs and the vertebrae .Flexible bronchoscopy uary 2004-Janary 2018). Postoperative events studied were divided into ma- (FB) was normal.Histologic confirmations of adenocarcinoma and diagnosis of jor and minor complications or death during the first 30 days after surgery. pancoast tumor was made through EUS - B FNA.Patient was further referred for Of 968 patient, 690 (70.5%) were male and 278 (28.7%) female. Mean age Chemo and Radiotherapy. 65.5±9.4 years (range 15 - 87 years). Lobectomy was the most used surgical Case 2:A 67 year old man with complains of weight loss and fatigue shows in modality in 566 (58.5%) patients, meanwhile pneumonectomy was performed chest X ray a right upper lobe mass which was confirmed with CECT.Mass was in 112 (11.6%) of patients. Minor complications during surgery occurred in 45 adjacent in the middle part of trachea.Diagnosis of adenocarcinoma was estab- (11.7%) of patients. Continuous air leakage was the most complication after sur- lished through EBUS transtracheal aspiration and core biopsy.Patient was further gery in 25.3%, followed by lung atelectasis in 21.3% and cardiovascular compli- referred for chemotherapy. Case 3:A 72 year old man presented with dyspnea to cations in 17%. Of the life threatening complications respiratory failure was the hospital .A mass in the left upper lobe adjacent to oesophagus and trachea was most events in 20.0% of patients, followed by broncho-pleural fistula in 18.7% noted in CXR and confirmed by CECT.Diagnosis of adenocarcinoma was made and pulmonary edema in 15% of patients. The 30 day mortality rate was 3.8% through EUS-B FNA after unsuccessful attempts to move the EBUS scope in tra- (37) patients, 1.2% after single lobectomy and 13.4 % after pneumonectomy. chea due to mass compression of it. Case 4:A 65 year old man presented to hospi- our results show low mortality and morbidity after lung cancer surgery. However, tal with headache. Head CT and after that CECT showed 3 lesions in the cerebrum patients with reduced lung capacity, older age and those undergoing pneumonec- and a mass in the left upper lobe,adjacent to archus aortae with subcarineal lymph- tomy should be treated with great care. Pneumonectomy radical sinister ,left hilar adenopathy.FB was normal.A imunohistochemistery diagnosis of squamous cell bronchial cancer.Broncho pleural fistulae other patients and left pleural emphysema. carcinoma was made through EBUS TBNA core biopsy of the station 7.Patient was referred for further chemotherapy. Case 5:A 58 year old woman with chief OP076 - Retroperitoneal sarcoma: Case report and review of the literature complain of dyspnea was admitted for further evaluation.Clinically and radiolog- H.Kolani, E.Celiku, E.Gega, E.Celiku ically was suspected for sarcoidosis.FB was normal and excessive coughing with The evaluation and treatment of retroperitoneal sarcomas are challenging because oxygen desaturations occured during the procedure.It was not possible to pass the the tumors are relatively rare and frequently present with advanced disease in an EBUS scope through the vocal cords and a histologic confirmation of sarcoidosis anatomically complex location.We present the case of a 34 year old male diag- was made with EUS-B FNA of the station 7 and 4L. All 5 patients underwent FB nosed with retroperitoneal sarcoma. before EBUS or EUS-B but only EBUS or EUS-B was helpful for a definitive The bibliography used was taken from PubMed. Herein, we report retroperitoneal diagnosis.No complication occurred during these procedures. sarcoma measuring 20X15X16 cm encasing the inferior pole of the left kidney Conclusions: EBUS and EUS-B procedure enables real-time aspiration of IP- and adherent to adjacent structures. We performed an organ-preserving surgical L,and can be done under conscious sedation.The use of the oesophageal route is removal The patient was discharged after an uneventful postoperative hospital safer in patients with excessive cough, raised intracranial tension,hypoxemia,and stay.A postoperative 16 month, follow-up CT was recommended to the patient. in those with lesions compressing the trachea. The evaluation and treatment of retroperitoneal soft tissue sarcomas remain chal- Clinical Implications: EBUS and EUS-B in combination are a highly effective di- lenging. The most important factor in the long-term success in the treatment of agnostic procedure for both benign and malignant chest diseases. These modalities primary tumors is complete surgical resection. It is important that patients with can be used as standard first step for diagnostic evaluation. these tumors be evaluated and treated at centers with multidisciplinary treatment

104 105 General Surgery Oncology & & Oncology

planning and expertise in treating these rare tumors. Local recurrence remains a concealed hemorrhage are frequent causes of increased morbidity and mortality, difficult problem, with increased associated morbidity and psychological stress for especially in patients who survive the initial phase after an injury. By 2020, 8.4 Oncology &

General Surgery General affected patients. We hope that with improved education, early referral of patients million people will die yearly from injury.Injuries from traffic collisions will be with retroperitoneal soft tissue tumors will become the norm, and patients will the third most common cause of disability worldwide and the second most com- derive the benefits of multidisciplinary evaluation and treatment of their disease. mon cause in the developing world. To share the outcome analyzed, the accuracy of symptoms, signs, laboratory tests, OP077 - Implementation of Imrt At Hygeia Hospital Tirana in Advance stage imaging studies for identifying intra-abdominal injuries & the strategy of surgery of Lung Cancer treatment in a patient with blunt abdominal trauma. L.Bregu, E.Telhaj, E.Bakiu The patient male 53 yrs old presented for angina pectoris, UGIB , dyspnea, slight- We present the implementation of IMRT technique in 7 patients with ad- ly abdominal tenderness in another hospital. He was treated with 6 units of blood, vanced stage of lung cancer, between May 2017 and June 2018. IMRT tech- fresh plasma, antibiotics, albumin, diuretics . Mechanism of injury; working with nique was used in order to achieve the desired high dose in the primary tu- scythe. After 5 days, was transferred to our hospital suspected for AMI and se- mor and mediastinal lymph-nodes, for better local control and life expectancy. vere anemia. Associated disease: AH, DM, CRI, post MI . Clinical findings: tired, 7 patients of mean age of 68 years (60-81 years), Karnofsky 80-100%. All Pa- pallor, difficulty breathing , dyspnea, AH 140/70, CF 97/min, Sa O2 98%, no ten- tients were stage IIIB because of contralateral mediastinal or hilar adenopathy (no derness in abdomen, no blood per rectum. Biochemistry: Wbc 15,800, Hg 8,9 gr/ candidate for surgery). There were 2 SCLC, 2 adenocarcinomas, 2 squamous cell dl, Htc 25%,CRP 14,9mg/dl, Urea 180m g/dl, Creatinin 4,84 mg/d, Bilirubin 0,6 carcinoma and 1 patient with no biopsy. mg/dl, Sediment 75mm/hrs, Glycaemia 172 mg/dl, HbA1c 7,3%.CKMB 51UI/L, The dose used was 56 Gy for SCLC and 60 – 68 Gy for NSCLC to the tu- Troponin 8,1ug/l. ECG : anterior & inferior Q wave, diffuse ST-T alteration. CT mos and pathologic mediastinal, hilar or supraclavicular lymph-nodes. findings: bilateral basal pleural effusion, pulmonary edema with basal atelectasis, 2 patients received concomitant radiotherapy with chemotherapy, 3 patients re- reactive multiple mediastinal lymphadenopathy, enlarged heart with deviation of ceived radiotherapy after chemotherapy treatment, and 2 patients received only apex, enlarged spleen with heterogenic parenchymal in favor of bleeding/hemato- radiotherapy treatment. IMRT technique, inverse planning, “step and shoot” ma of spleen. Free hematic peritoneal effusion,. Diffuse densification of mesenteries with 9-12 fields, 6 Mv energy was used. Acute toxicity during IMRT was adipose tissue, reactive multiple mesenteries lymphadenopathy, hydrops of the gall GI –GII esophagus radiomucositis, and GIII leucopenia for just one patient. bladder. Surgery ; spleenectomy, cholecystectomy, peritoneal lavage, treated with The dose given to the tumor and lymph-nodes was high (60-68 Gy) com- broad-spectrum antimicrobial therapy, blood and fresh frozen plasma transfusion, paring with 3DCRT. The doses to the organs at risk were lower compar- dialysis, diuretics, TPN, clexane, ect. The risk factors: AMI, + post MI, ARI+post ing with 3D. One month after the radiotherapy there were no side effects. Af- CRI, DM type 2, obesity, pulmonary edema. The mean hospital stay was 9 day. ter 3 months from radiotherapy there was a very good response of the disease The presence of intraperitoneal fluid or organ injury on ultrasound and Ct scan IMRT is a safe technique which allow you to give higher doses to the tumor and is more accurate than history and physical examination findings. The absence of adenopathy in order to have a better local control of the disease and better life abdominal tenderness to palpation does not rule out an intra-abdominal injury. expectancy. This technique gives less doses to the organs at risk resulting in less Combinations of clinical findings, lab test, advanced imaging results, Iis the most toxicity than 3DCRT. These patients need more follow up to see the final role of useful to determine which patients requires further evaluation, conservative or this advanced technique. surgical treatment.Multidisciplinary approach is necessary for resolving delayed and complicated cases. OP078 - Multidisciplinary approach and surgical treatment strategy in blunt abdominal trauma OP079 - ERCP and laparoscopic cholecystectomy – standards in manage- L.Shosha Mano, S.Marsid, Dh.Arben, D.Adriatik, N.Fiona, Gj.Etleva, K.Rinard, ment of common bile duct stones associated with cholelythiasis K.Roland, B.Marjeta, A.Enkelejda, N.Alfred S.Tmava, I.Fazliu, J.Ismet, F.Mucolli Z.Zeka, A.Hasani Blunt abdominal trauma presents a diagnostic challenge. Usually results from ERCP and laparoscopic cholecystectomy is a golden standrard in the management motor vehicle collisions, assaults, recreational accidents, or falls. The most com- of common bile duct stones and gallbladder stones ERCP could be performed prior, monly injured organs are the spleen, liver, retroperitoneal, small bowel, kidneys, during or after laparoscopic cholecystectomy in CBD stones associated with chol- bladder, colorectal, diaphragm, and pancreas. Missed intra-abdominal injuries and elythiasis. ERCP is also standard for the management of residual stones after lap-

106 107 General Surgery Oncology & & Oncology

aroscopic cholecystectomy. The study was conducted during January 2011 to june ELPS and TOVS were performed for 97 oro-hypopharyngeal cancers including 2018 included 262 ERCP procedures in the Department of General Surgery- Unit the patients after chemoradiotherapy and who had lymph nodes metastases. The Oncology &

General Surgery General of Endosopic Surgery / Amerikan Hospital in Prishtina. In 132 patients ERCP was 5-years disease-specific survival after ELPS or TOVS is 95.4%. For advanced performed for CBD stone clearance. In 60 patients preoperatively diagnosed with cancer Hypopharynx partial resection and forearm flap reconstruction were per- cholelythiasis and common bile duct stones, ERCP was performed one day before formed by ELPS, the local control and oral intake are good. laparoscopic cholecystectomy. In 72 patients ERCP was performed for residual The rate of reoperation in cases of ELPS and ELPS after Chemoradiation were CBD stones after LC. In 8 patients ERCP failed and open surgery was performed. studied. The rate of reoperation after 5-years was 4.14% in ELPS, yet that of ELPS In 132 cases with stones in CBD endoscopic stone removal was successful in after Chemoradiation in 1 year reached about 50%. The result indicated that even 124 of the patients ( 95.4% ), failed in 8 cases ( 6.6%). Patients with therapeutic though the tumor was controlled locally, it’s difficult to control the distal recurrence. ERCP, sphinmcteroptomy and stone removal were discharged on 2nd or 3rd day Transoral surgery is a less invasive treatment than conventional surgery and be- after the procedure. For the management of bile duct stones both before and after coming a major strategy. ELPS is effective for hypopharyngeal cancer and TOVS laparoscopic cholecystectomy ERCP is a golden standard procedure. In case of is effective for oropharyngeal and supraglottic cancer. It’s important to use these preoperative diagnosed common bile duct stones ERCP prior of laparoscopic cho- methods properly. lecystectomy is prefered procedure in our practise . ERCP is the definitive choice of procedure for the diagnose and management of the biliary duct injuries during laparoscopic cholecystctomy.

OP080 - Colon Trauma X.Delgadillo

OP081 - Minimal Invasive Transoral Endoscopic Surgeries for oro-hypopha- ryngeal cancer in Japan Y.Kawasaki, H.Saito, Sh.Suzuki, T.Yamada Narrowband imaging (NBI) enables us to detect early laryngo-pharyngeal can- cers. Robotic surgery (TORS) is used in Europe and US for oro-hypopharyngeal cancers. But TORS is not still authorized for the craniocervical region in Japan. In substitution of TORS, two surgery methods of Endoscopic Laryngeal Pharyngeal Surgery (ELPS) and Trans Oral Video Surgery (TOVS) are developed. Only a case without lymph node metastases was operated before, but in last years even the case with lymph nodes metastases is operated using ELPS or TOVS actively. ELPS: A curved rigid laryngoscope (Nagashima Medical Instrument company, Ltd., Tokyo, Japan) is inserted to provide a working space in the pharyngeal lu- men before inserting an endoscope with a movable tip (Olympus Medical Systems Corp., Tokyo, Japan). We use an electrosurgical knife (Olympus Medical System) and curved forceps (Nagashima Medical Instruments) to remove the tumor using en bloc resection. TOVS: TOVS was developed as a new transoral surgery system for laryngo-pha- ryngeal lesions by Shiotani et al. The most appropriate surgical view can be obtained using an FK-WO retractor (Olympus Medical System) with endoscope with movable tip (Olympus Medical System). For incision and dissection, the operator manipulates bimanual laparo- scopic instruments such as a hook-type electrode (Karl Strorz), forceps (Karl Storz).

108 109 & Cardiovascular Surgery Cardiology Interventional

OP082 - Carotid artery stenting: evolution of different devices system was proposed as the last attempt to avoid major amputation, obtaining A.Malaj acceptable limb salvage rate at one year. Despite these apparently positive results, According to the World Health Organization, every year, 5 million peoples die the procedure has never gained wide acceptance, essentially due to the complexity for stroke and another 5 million are permanently disabled. Although there are of the technique, the diverse approaches and the lack of a clear technical stan- many causes of acute stroke, a common treatable cause of acute stroke is athe- dardization. In this study we describe our experience in treating no-option CLI romatous narrowing at the carotid bifurcation. Carotid endarterectomy is still the patients with a hybrid foot vein arterialization (HFVA) technique combining open

Interventional Cardiology Surgery Cardiovascular & standard of car, even if carotid artery stenting (CAS) has become an effective, plus endo approaches. Particular attention will be used in describing step-by-step less invasive alterantive. Unfortunately, CAS procedure is not yet perfect; regar- the technical approach. dless the use of an embolic protection device (EPD), percutaneous treatment has A prospective cohort study was conducted on all patients diagnosed with no-op- been correlated with a risk of cerebral ischemic events related to distal emboli- tion CLI by a multidisciplinary team between May 2016 and January 2018. In- zation. One of the main issue concerning the treatment of carotid artery stenosis clusion criteria were: 1) patients presenting CLI with Rutherford 5 or 6 lesions; is about the use of stents which could offer the best navigability through the le- 2) severe diffuse disease of the foot arteries considered untreatable my means of sion and the smallest “maximum unprotected circular area”, ensuring the lowest angioplasty or distal bypass; 3) left ventricular ejection fraction > 30. risk of neurological complication both intraprocedurally and in the long term. A consecutive series of 35 patients with 36 no-option CLI limbs underwent HFVA. Mathias, in his 1977 report of the first canine carotid angioplasty, proposed the Patients were 80% male with an average age of 69±12 years; 80% had diabetes idea of performing carotid angioplasty in patients with carotid artery disease. mellitus, 75% were smokers and 33% had chronic kidney disease. The patien- The first carotid artery angioplasty performed in a human being was reported by ts had Rutherford classification 4 (11%) grade 5, 32 (89%) grade 6. Clinically Kerber and colleagues in 1980 following the invention of stent technology and they presented with severe and invalidating ischemic rest pain (average VAS score dedicated devices for the carotid artery. Carotid artery stenting has been propo- 9.3/10) and low levels of TcPO2 (6.0±5.2 mmHg). sed as a possible early alternative in selected patients after onset of ipsilateral Limb salvage plus wound healing was achieved in 20/36 limbs (55%); limb salva- neurologic symptoms. It is well known that treatment of acute stroke is time-de- ge with a not healed wound in 5/36 limbs (14%); major amputation was performed pendent in patients with acute ischemic stroke caused by high-grade stenosis of in 11/36 patients (31%). In 2 limbs major amputation was related to infectious the internal carotid artery, but intensive medical treatment in conjunction with complications affecting the foot stump. intervention to improve stroke severity and clinical outcomes has not been establi- HFVA is a promising technique able to achieve a 70% rate of limb salvage at one shed. Two major clinical concerns exist: (1) the risk of hemorrhagic infarction year. Further studies are needed to better identify patients that can benefit of this after cerebral revascularization in the acute stage and (2) application of carotid approach and standardize the technique. stenting in the acute embolic stage, which may be associated with continued embolic risk after carotid artery stenting compared to carotid endarterectomy, OP084 - Pulmonary endarterectomy for distal chronic thromboembolic pul- which removes the symptomatic plaque. Since the invention of endovascular te- monary hypertension chniques and devices for carotid artery revascularization, many RCTs have com- A.M.D’Armini, M.Morsolini,G.Mattiucci, V.Grazioli, M.Pin, A.Valentini, G.Sil- pared the safety and efficacy of CEA with that of carotid artery stenting (CAS). vaggio, C.Klersy, R.Dore Different endovascular devices are being used in treating the carotid stenosis with Chronic thromboembolic pulmonary hypertension can be cured by pulmonary different results. endarterectomy. Operability assessment remains a major concern, because there are no well-defined criteria to discriminate proximal from distal obstructions, and OP083 - Hybrid foot vein arterialization in no-option patients with critical surgical candidacy depends mostly on the surgeon’s experience. The intraopera- limb ischemia: a preliminary report tive classification of chronic thromboembolic pulmonary hypertension describes A.Casini 4 types of lesions, based on anatomy and location. We describe our recent experi- Revascularization, either surgical or percutaneous, is the treatment of choice in ence with the more distal (type 3) disease. preventing amputation and resolve rest pain in patients with critical limb ischemia More than 500 pulmonary endarterectomies were performed at Foundation (CLI). Despite the advancement of the techniques, 10 to 50% of CLI patients are I.R.C.C.S. Policlinico San Matteo (Pavia, Italy). Because of recent changes in the considered not suitable to any revascularization treatment due to unreconstructable patient population, 331 endarterectomies performed from January 2008 to Decem- vascular disease. In these “no-option” patients the arterialization of the venous ber 2013 were analyzed. Two groups of patients were identified according to the

110 111 & Cardiovascular Surgery Cardiology Interventional

intraoperative classification: proximal (type 1 and type 2 lesions, 221 patients) and • Radiofrequency ablation (RFA) distal (type 3 lesions, 110 patients). • Endovenous laser therapy (EVLT) The number of endarterectomies for distal chronic thromboembolic pulmonary In general, vein ligation is reserved for cases of chronic venous insufficiency hypertension increased significantly over time (currently 37%). Deep venous (CVI) involving reflux in the saphenous system that causes severe symptoms. thrombosis was confirmed as a risk factor for proximal disease, whereas patients Sclerotherapy is performed by injecting or infusing a sclerosing substance into the with distal obstruction had a higher prevalence of indwelling intravascular de- refluxing vessel to produce endothelial destruction and fibrosis of the treated vessel.

Interventional Cardiology Surgery Cardiovascular & vices. Overall hospital mortality was 6.9%, with no difference in the 2 groups. EVLT is performed by passing a laser fiber from the knee to the groin and then de- Postoperative survival was excellent. In all patients, surgery was followed by a livering laser energy along the entire course of the vein. Destruction of the vascu- significant and sustained improvement in hemodynamic, echocardiographic, and lar wall is followed by fibrosis of the treated vessel. RFA is performed by passing functional parameters, with no difference between proximal and distal cases. a special radiofrequency (RF) catheter from the knee to the groin and then carrying Although distal chronic thromboembolic pulmonary hypertension represents the out controlled and preset heating of the targeted vessel until thermal injury causes most challenging situation, the postoperative outcomes of both proximal and distal shrinkage. Endoscopic techniques are used to find and ligate perforating veins. cases are excellent. The diagnosis of inoperable chronic thromboembolic pulmonary hypertension should be achieved only in experienced centers, because many patients OP086 - Acute myocardial infarction with arterial thrombosis events in a who have been deemed inoperable might benefit from favorable surgical outcomes. young woman diagnosed with antiphospholipid syndrome D.Teferiçi, D.Kosovrasti, A.Gjana, M.Basho, M.Cafka OP085 - Modern techniques ın treatıng varıcose veıns Antiphospholipid syndrome (APS) is an acquired autoimmune disorder that ma- B.Hodo nifests clinically as recurrent venous or arterial thrombosis and/or fetal loss.It is Varicose veins are dilated, bulging and twisted veins that are formed due to cir- characterized by the presence of antiphospholipid antibodies, such as: lupus anti- culatory problems of the venous system. Varicose veins have weakened walls and coagulant, anticardiolipin and anti-β2-glycoprotein I. Acute myocardial infarction valves causing them to dilate and become twisted. The abnormal valves combined (AMI) is rarely associated with this syndrome with a frequency of approximately with gravity causes pooling of the blood that gives rise to the swelling (dilating) 4%. Case: A 26 year old woman, suffering from diabetes mellitus (DM) type I sin- of the veins. Varicose veins are visible in more than 20% of men and over 40% of ce 7 years, was firstly hospitalized in Endocrinology Department as a destabilized women. Varicose veins can lead to venous thrombosis , swollen and painful ank- DM. She had a history of 3 spontaneous abortions. During its stay in Endocrino- les, feet and legs, skin changes on the lower legs and even ulcers on the lower legs. logy patient complained chest pain associated with changes in ECG (negative T The treatment therapy is decided according to the Clinical, Etiology, Anatomic, Pa- waves at V1-V4) and elevation of troponin I. 2D echo revealed a apical discinesia thophysiology (CEAP) classification . No oral medication has yet been proven use- and left apical ventricle thrombus measured 3cm2. She was diagnosed as an ante- ful for the treatment of venous disease. Graduated compression is the cornerstone rior NSTEMI and underwent a coronarography procedure that showed one vessel of the modern treatment of venous insufficiency. Surgical or endovenous therapy disease, thrombotic material in proximal LAD.(Fig) Based on these results triple is commonly reserved for those with discomfort or ulcers refractory to medical therapy was started ( IV heparin, aspirin and clopidogrel). During her hospitaliza- management. The primary goal of such therapy is to improve the venous circula- tion in ICU, the patient complained parestesia and pain in her right leg. An angio tion by correcting venous insufficiency by removing the major reflux pathways. CT of chest, abdomen and lower lims vessels revealed: lienal infarction , bilate- Graduated Compression;The standard approach has been to use gradient com- ral parencimal renal infarction and thrombotic occlusion of right and left popliteal pression stockings that provide 30-40 or 40-50 mm Hg of compression at the an- arteries. Bilateral Embolectomy to Fogarty probe was effectuated to the patient . kle, with gradually decreasing compression at more proximal levels of the leg. Based on the above mentioned history and events, there was strong suspicion of a Venoablation, is reserved for those with discomfort or ulcers refractory to medical primary APS. We performed haematological tests for thrombotic disorders, which management. The primary goal of surgical and endovenous approaches is to cor- resulted: positive anti-cardiolipine IgG (42 U/ml) , negative anti-cardiolipine IgM rect venous insufficiency by removing the major reflux pathways. Techniques for (10 U/ml),positive anti-B2-glycoprotein (43 U/ml), negative ANTI-ds- DNA/IgG venoablation include the following: (27.2 EU/ml), high C3( 161 mg/dl)) with normal C4 (28.8 mg/dl), negative anti- • Ligation with stripping ANCA screen (34.4 U/ml), antinuclear antibodies (ANA)- slightly positive (+). 10 • Simple ligation and division days after she was diagnosed as anterior AMI with LV thrombus her echocardio- • Sclerotherapy (with or without ligation) gram showed a reduced apical thrombus measured 0.65cm2 with normal EF of LV.

112 113 & Cardiovascular Surgery Cardiology Interventional

It was performed another angio CT,which showed no evidence of thrombus in ve skin deficits in the mammary area at the physical examination. None of the both popliteal arteries.The patient clinical performance improved. 12 weeks after 26 pre-puberal patients who underwent MT had asymmetric breast development, her discharged, anti-cardiolipine IgG and anti-B2-glycoprotein, persisted elevated shoulder movement deficit, scoliosis and no lactation problems were reported in (49 and 46 respectively). So we concluded that the main diagnose was primary APS. those 3 patients who had pregnancy. In Group II, all patients underwent right MT Discussion:The antiphospholipid syndrome is rarely initiated in the coronary arte- on the 3rd or 4th intercostals space through subclavian vein and femoral vein and ries. The clinical criteria for its diagnosis were: evidence of thrombosis and repeated artery cannulation. With arrested heart the MV was replaced in 13 patients and re-

Interventional Cardiology Surgery Cardiovascular & fetal loss. Laboratory criteria included presence of anticardiolipin antibodies IgG pair in 19. Two patients in Group II underwent videoscopic mitral valve repair in a and anti- B2-glycoprotein accompanied by the absence of biomarkers of systemic 24 years old female and mitral valve replacement in a 58 years old lady.All but one lupus erythematosus. Conclusion:Primary APS should be suspected when there patients in Group III underwent upper MST, just one underwent right MT on the are clinical symptoms such as coronary occlusive event and recurrent fetal loss, in second intercostals space. The youngest patient was a 17 years old female and the young females, without any underlying condition causing hypercoagulability. oldest 64 years. All patients survived and were discharged on the 5th postoperative day. Only one patient developed femoral thromboembolism and later cholecystec- OP087 - Minimally invasive Cardiac Surgery: Albanian experience tomy and another one was idenfied bleeding. The vast majority of patients in all E.Prifti groups were satisfied with the cosmetic result of surgery and the satisfaction rate The minimally invasive cardiac surgery (MICS) consisting in various techniques was greater in MT patients. Patients in Group I, II and III were compared with ma- such as a right-anterior mini-thoracotomy (MT) or mini-sternotomy (MST) are tch patients undergoing conventional cardiac surgeryMinimally invasive cardiac the techniques of choice especially in females patients requiring cardiac surgery. surgery is a safe and effective procedure with comparable functional results to a Such techniques have been developed during the last decade, however their em- classic surgical approach with a high rate of subjective satisfaction between our ployment is very selective because it depends on surgeons’ training and quality. patients. Such operations, rarely employed even in Europian countries now are We are presenting our experience with MICS in terms of hospital outcome and feasible with excellent outcome even in our country. patient’s satisfaction. Between February 2010 and August 2018, 133 (Group I) patients with congenital heart defects and 32 (Group II) patients with MV disease OP088 - Surgical aspects and late outcomes of the total coronary endarterec- and 10 patients with AV disease nunderwent MICS. Patients were all managed tomy and “Dome arterial rebuilding” under the same postoperative practice guidelines: 1-Early extubation (<6 hours E.Prifti, K.Krakulli, M.Bonacchi, G.Giunti, A.Veshti after surgery) 2- early discharge from the intensive from the ICU (< 24 hours The aim of this study was to evaluate the early and late outcome in a series of ). In Group I, 65 patients had atrial septal defect type ostium secundum, 12 had patients undergoing an original total arterial reconstruction technique for coro- subaortic ventricular septal defect, 10 atrial septal defect sinus venosum type, 6 nary endarterectomy (CE).Between 2003-2018, 508 consecutive patients (mean posterior extension ventricular septal defect, 30 patients had a patent ductus arte- age 59.5±12.3years) underwent an original CE called “coronary dome arterial re- riousum, and 10 patients aortic coarctation. In Group II, 19 MV regurgitation and building”. 174 patients had a prior PTCA. Following extensive arteriotomy and 13 MV stenosis and in Group III all patients had AV stenosis. All patients were atheroma remotion, the dome of the coronary artery was reconstructed with an followed with a physical examination 1-month, 1-year and 3-years after surgery adequate flap. 40 patients underwent CE in multiple distributions. Mean 2.2±0.3 to assess the quality of the cosmetic result. Late results of surgical repair and pa- arterial grafts per patient were employed. 37% patients underwent total arterial tient’s satisfaction were also evaluated by means of direct contact with a patient myocardial revascularization. The mean follow-up was 45±23months. 115 of the- or a phone interview.All patients survived surgery. In Group I all patients were se patients were treated in Albania. Hospital mortality was 3.5%(n=18) and 4.4% discharged home in good clinical conditions, without residual intracardiac shunts had a perioperative AMI. Within one year after surgery all patients underwent at the pre-discharge echocardiography. 64 patients underwent right MT in the 2th ergometric test and 75% underwent coronary angiography. 37 endarterectomized or 4th intercostals space, 40 patients underwent left MT and 29 upper MS. During vessels were occluded. At follow-up, survival was 95.4% , with most (93%,) of the operation, induced ventricular fibrillation (IVF) was employed in 64 patients, the patients symptoms free. In symtomatic patients (n=43,), re-catheterization while the aorta was cross-clamped in the remaining patients. None of the patients showed a progression of disease in the nonendarterectomized vessels and/or in the required to be converted to a classic full sternotomy or a larger thoracotomy. vein grafts, and 100% patency in bypass grafts to endarterectomized vessels. The Median follow-up time was 25 months (range 1-96 months). 18 out of 64 (28%) Cox model revealed the left ventricular ejection fraction <35%(p=0.016), age>70 undergoing MT complained temporary (<6 months after surgery) mild sensiti- years(p=0.025), NYHA grade>III(p=0.0019), non total arterial myocardial reva-

114 115 & Cardiovascular Surgery Cardiology Interventional

scularization(p=0.002) and the preoperative presence of more than one ischemic treatment; 5.4% with both treatment. The cost / patient often more than $ 100,000. area(p<0.001) as strong predictors for poor overall cumulative free-event survival. the vein was better than the prosthesis. Surgery after failed endo had very poor re- Actuarial survival at 7 years was 96% and free revascularization procedure survi- sults. Quality of life immediately after the intervention was equal. Cost of surgery val was 92.5%.This technique enhances the probability to achieve a complete and was higher at first. Cost of the endo treatment was higher later on. Better results arterial revascularization in patients with an unfavourable anatomical substrate surgery after 2 years. with acceptable operative risk and good long-term results. In our Service, during the period 2012 – 2017, max 20 patients / year. We perfor-

Interventional Cardiology Surgery Cardiovascular & med bypass over the knee with prosthesis and bypass under the knee with compo- OP089 - In-hospital mortality rate in patients with ruptured abdominal aneu- site graft (prosthesis + vein) or with vein associated with minor amputations. In- rysm treated with open surgical repair trahospital mortality was zero. No endovascular treatment was performed because E.Olluri, G.Bajraktari, E.Olluri, I.Jusufi the budget is low. Ruptured abdominal aortic aneurysm (AAA) is one of the most challenging sur- We need to establish a diabetic foot register, to improve the cooperation between gical emergencies, with a very high mortality rate. The 30-days mortality rate of endocrinologist - radiologist - vascular surgeon – orthopaedic surgeon. Even with patients treated with open surgery repair is about, and it doesn’t differ significantly a low budget we can perform surgical treatment (Prosthesis + vein + heparin + between surgical and endovascular repair. The aim of this study was to determine antibiotics + locoregional - spinal anaesthesia) to lower at maximum major ampu- the in-hospital mortality rate of patients with ruptured abdominal aneurysm trea- tations and the mortality of the patients with diabetic foot complications. ted with open surgical repair. This retrospective single-center study was conducted in “American Hospital Ko- sova”, in Prishtina from…July 2016 .. to…January 2018….. The operations were performed by a single experienced operator. Eight patients (72±11 years old, one female patient) were treated during this period of time. Three patients had diabe- tes, 7 were treated for arterial hypertension, and 2 of them were smokers. The time from the beginning of the symptoms to the surgery was 15±22 hours, the operative surgery procedure time was 157±20 minutes, and the hospitalization time was 17±7 days. One of 8 patients (12.5%) died during their in-hospital stay. This pa- tient also was successfully operated and the cause of death was not from AAA, but due to cardiac complications at the 21st day after the operation. We present the very satisfied results of the surgical treatment of ruptured abdominal aortic aneurism with a very low mortality rate. The low mortality rate of this challenging surgical operation in our center could be addressed to the experience of the operator.

OP090 - Surgical revascularization of the diabetic foot S.Xhepa, E.Nuellari, P.Gjergo, A.Kenga, D.Kosovrasti, M.Sopiqoti, E.Bejko, S.Llazo Diabetes is the main cause of loss of lower limbs. Every year, more than 1 million people suffering from diabetes, lose their lower limbs. Every 20 seconds a limb is lost as a result of this disabling illness. Which is the best treatment? Conservative, surgical or endovascular with the purpo- se to avoid major amputations and to reduce the mortality. What is discussed? BASIL trial - Bypass versus Angioplasty in Severe Ischemia of the Leg: Surgical treatment - Synthetic or venous graft? Endovascular treatment - Subintimal or Intraluminal? 2.5 million patients were ob- served. 412 051 patients - 16.5% had amputations, 34.8% major, 65.2% minor; 211 534 - 8.5% were revascularized: 43.5% with surgery and 51.1% with endovascular

116 117 Plastic Surgery Orthopedic &

OP091 - Multiple tendon transfer Merle d’Aubigné modified by Tubiana in allowed to stand within 3 days and walk with partial weightbearing (40% of normal the treatment of irreversible radial nerve paralysis. The evaluation of the weightbearing) on crutches for 6 weeks followed by gradual return to full weightbearing. Orthopedic & Orthopedic Plastic SurgeryPlastic long-term results. At the time of last follow-up that ranged from 50 to 130 months, in the goup with primary A.Çelaj , B.Guce childhood septic arthritis of the hip the Harris Hip Score (HHS) showed excellent func- Tendon transfer techniques for irreversible radial nerve palsy have progressively tional outcome in three cases (30%) treated with Total Hip Replacement, good in 6 cases improved over time. The irreversible radial nerve palsy is treated with multiple (60%), fair in one case (10%) and was no poor functional outcome. Trendelenburg sign tendon transfers to improve the extension movements of wrist and finger joints. become negative in all but two patients. Leg length discrepancy improved from a preop- Many different techniques are used to address this problem. erative mean of 2.89 cm to postoperative mean 0.82 cm. The mean preoperative Harris The purpose of this paper is to give our experience in the treatment of irreversible hips score of 55 points improved to 89 points at the final follow-up in group with primary radial nerve paralysis using Merle d’Aubigné technique modified by Tubiana, and childhood septic arthritis of the hip. In the group of 34 patients with THR suffering of hip the evaluation of the long-term results of this treatment osteoarthritis secondary to DDH 24 patients were rate as excellent, 7 as good, 1 as fair and There have been 14 cases of irreversible radial nerve paralysis treated during the 1as poor. In the group with Rheumathoid arthritis the Hip revision at 5 years was higher. period 2010-2017. The average postoperative follow-up period was 36 months. One patient suffer periprosthetic fracture of proximal femur. Meta-analysis of 4 studies The restriction on day-to-day activity was evaluated according to the DASH rating that reported comparative data revealed increased odds of early revision among RA patient system as well as the MRC modified evaluation system for muscle strength assess- ment. Short-term and long-term treatment results were evaluated. OP093 - Mini-invasive technique in treatment of pediatric flat foot Patients have had very good treatment results. 11 of them returned to the previous E.Selmani, F.Brahimi, L.Duraj work, 3 were subject to the intervention for the tenolysis cause of the extensor Goal: Mini-invasive techniques and implants are a trend now for correction of contracture following the incorrect rehabilitation. pediatric flat foot deformities. This paper aims to show mid term results of a new Conclusions of this paper suggest that the tendon transfer Merle d’Aubigné mod- technique used for the first time in Albania with bio absorbable screws in sinus tarsi. ified by Tubiana is a successful procedure for treating patients with irreversible In this study we included the first 40 cases (20 patients) operated in Albania with paralysis of radial nerve paralysis and with less complications. diagnosis Painful Pediatric Flat Foot with BFFI (bio absorbable flat foot implant). The age of patients varied from 9 to 14 years old. Follow-up was until 3 year. Clinical OP092 - Total HIP replacement due to Secondary Osteoarthritis functional and radiological evaluation was document before and after the treatment. C.Bytyqi, A.Tolaj, N.Salihaj, D.Bytyqi, B.Shabani, H.Qorraj 38 out of 40 feet had excellent clinical and radiological results with complete cor- Total hip replacement is considered one of the most successful surgical procedure for many rection of flatfoot deformities. 2 feet ( 1 patient) had good result but not full cor- hip disorders providing pain relief and improvement of function in patients with end-stage rection because of late presentation and old age (14 years old) which is in the lim- hips arthritis that is non responsive to other methods of treatments. The primary aim of this its of the techniques indications. Additional shoe insoles were needed for this case. study was to determine the clinical and radiologic outcomes 50 to 130 months follow-up Mini-invasive technique using BFFI is an excellent choice of implant and for cor- of patients diagnosed with secondary hip osteoarthritis due to DDH, Rheumathoid arthritis rection of painful flat foot deformity in children. Age limit between 9 and 14 years and childhood septic arthritis and subsequently treated with total hip replacement (THR). old should be respected. In severe cases augmentation of this technique with ad- We analyse 54 THR performed due to secondary degenerative hip osteoarthritis from vancement of tibialis posterior tendon is indicated. January 2008 to January 2012 in Prishtina University Hospital - Orthopaedic Clinic. Ten hips in 10 patients age from 19 to 25 years suffering septic arthritis in infancy were fol- OP094 - Innovations and new trends in foot and ankle surgery lowed from 50 to 130 months. We also reviewed data from a consecutive series of 34 hips E.Orthner with secondary osteoarthritis of the hip due to DDH and 10 hips due to Rheumathoid In the last 10 – 15 years there was a big change in foot and ankle surgery. Now, due to arthritis (RA). Radiographs were collected preoperatively and through follow-up to as- modern technology implants with special designed implants for foot surgery gives us the sess degree of dysplasia (Crowe classification) for DDH cases. All patients were treated ability to reconstruct cases which some years ago could be treated by special shoes only. operatively with Total Hip replacement because of painful joint degeneration. Harris hip The innovation of special plates with locking screws, special designed double headed score and limb-length discrepancy were assessed clinically. Remodelling of the femo- screws and especially many different plates for different kind of fusions and recon- ral head, hip stability, and arthritic changes in the hip were evaluated radiographically. structions made the results more reproduceable and saver.Total ankle arthroplasty is Only four operation were performed through a posterolateral approach. All patients were now generally accepted and gives more and more better results than fusions and we have

118 119 Plastic Surgery Orthopedic &

learned, that correction osteotomies can prevent fusions. Biomaterials as interposi- more than 1 in 10 persons is affected in their lifetime. More than 90% of these tional graft, as artificial surface for arthritic joints as well gives us the optionto prevent cases will resolve with conservative treatment. Heel pain can result from mechan- Orthopedic & Orthopedic Plastic SurgeryPlastic fusions, even in arthritic joints. Better understanding in biomechanics opened the door for ical-related change, spondyloarthropathies, or neural-related conditions. Mechan- functional reconstructions without fusions in flatfoot surgery. Minimal invasive surgery in ical derangements cause classic proximal plantar fasciitis, distal plantar fasciitis, diabetic feet is as well a new trend in foot surgery as partially in Charcot feet too. An plantar fascia ruptures, and stress fractures of the calcaneus. Rheumatologic con- overview of all these new trends will be presented. ditions cause a wide variety of presentations of pain around the heel. Neurologic conditions from impingement of nerves about the foot and ankle can cause sub- OP095 - Prevalence of complications in patellofemoral stabilization opera- stantial pain in the heel.Current treatment involve tions - a retrospective analysis -conservative treatment like stretching exercise, orthotics, casting, anti-inflamato- F.Ramadani ry drugs , extracorporeal shock wave therapy, botulinum toxin Type A injection, Trochleaplasty has established itself in recent years as a therapeutic supplement heel fat pad atrophy treatment. in patellofemoral stabilization (PFS). Due to the invasiveness of the intervention, - the surgical treatment for these patients is applied when the conservative meth- one could expect an increased incidence of complications compared to conven- ods have failed and the heel pain persist for more than 1 year. Current surgical tional methods. The aim of the study is to evaluate this. option are : open partial plantar release with release of the first branch lateral 85 patients were retrospectively examined who received PFS in the period from plantar nerve, open plantar release with proximal and distal tarsal tunnel release, January 2014 to July 2017. Excluded from the study were 5 patients who did endoscopic plantar release, gastrocnemius recession. not complete the follow-up treatment at our clinic. The clinical and radiological data (X-ray, MRI, rotation CT) were analyzed preoperatively and postoperatively. OP097 - Adolescent Idiopathic Scoliosis: Operative indications, techniques The follow-up period was 21.47 ± 12.84 months. Twenty-six men and 54 women and outcomes (age 11 to 48 years, 21.97 ± 7.28 years) were recorded, 21 of whom were operated K.Cagri Kose on both sides. The smoking rate was 53.75%. Twenty-seven Tochleaplasties were Scoliosis is one of the most commonly encountered spinal deformities. Adolescent performed with additional stabilization procedures. 58 patients received MPFL idiopathic scoliosis is the most frequent type among all types of scoliosis. This talk plastic, of which 12 had additional surgery. 18 patients were already pre-oper- discusses the basic knowledge and recent innovation of surgical treatment for scoli- ated. 19 patients had a traumatic genesis, in 61 patients luxation occurred habit- osis. Surgical treatment for scoliosis is indicated, in general, for a curve exceeding ually. The leg axes showed a varus of 1.49 ± 1.4 ° and a valgus of 3.38 ± 2.99 45 to 50 degrees by the Cobb’s method and with keeping in mind: a-curve deree, °. The tuberosity tibial trochlea groove was 1.29 ± 0.43 cm and the Tuberosity b-pulmonary function and c- curve progression. Anterior, posterior, combined fu- Tibiae Posterior Cruciate Ligament space 2.15 ± 0.59 cm. Furthermore, the Pa- sion methods, choice of fixation tools, growth guidance and motion preserving treat- tella Tilt was measured at 23.79 ± 12.04 ° and the Insall Index at 1.16 ± 0.18. ment alternatives will be discussed in this talk with the aim of giving the audience After the Dejour dysplasia classification, we enrolled 20 patients with Dejour A, a general perspective on the surgical treatment of adolescent idiopathic scoliosis. 28 with Dejour B, 14 with Dejour C and 8 patients with Dejour D. In 10 pa- tients there was no malformation of the trochlea. The femoral antetorsion was OP098 - Osteochondral transplantation technique pitfalls in knee osteochondral 24.5 ± 9.43 °. There were 4 cases of arthrofibrosis (3 were smokers - 75%), 3 defects (MOSAICPLASTY/OATS technique) of which were revised. 1 superficial wound infection is cured conservatively. L.Fezollari, Gj.Caushi, V.Ruci, A.Duni, E.Cami, K.Sejdini, S.Memini, L.Duraj, Based on our previous experience with trochleaplasty, no increased risk of compli- I.Hasmuca, D.Habili, A.Hysenaj , A.Mici, A.Dizdari , Y.Zama cations can be derived compared to other stabilization procedures. The MOSAICPLASTY technique involves obtaining small osteochondral cylin- The results in the literature as well as our evaluations give reason for the fact that drical grafts from the less weight-bearing periphery of the femur at the patellofem- the trochleaplasties as addition to other stabilizing interventions, should belong to oral joint, and transporting them to the prepared defect site. With a combination the standard procedures. of 2.7 mm, 3.5 mm, 4.5 mm, 6.5 mm, and 8.5 mm grafts, the site is filled with 70–90% transplanted hyaline cartilage. Fibrocartilage “grouting” growing upward OP096 - Plantar Fascitis: Heel pain current concept and treatment from the prepared cancellous bed will complete the MOSAICPLASTY graft. Gj.Çaushi, R.Çipi, D.Todhe Placing the grafts perpendicular to the surface, at the level of the original articular Although the exact incidence of plantar heel pain is unknown, it is estimated that surface, is paramount to the success of the operation.

120 121 Plastic Surgery Orthopedic &

The best candidate for osteochondral autologous transplantation (OATS) is the of the medial head of the internal gastrocnemius , allowing an immediate load in the young (20-30 years), thin (<25 BMI) patient who suffers a symptomatic, -trau post-operative. On the average, we obtain around 20 degrees more of tibio- tarsal Orthopedic & Orthopedic Plastic SurgeryPlastic matic, unipolar, small (<2 cm2), and type IV outerbridge chondral defect expos- movements , thus allowing a reduction in functional overload in the phase of propul- ing subchondral bone , confirmed previously with an MRI. Infectious or tumor sion of the step and a decrease in tensions in the Achilles tendon and the plantar fascia. defects. Generalized arthritis, rheumatoid and/or degenerative in type. Those pa- The biomechanical aspects of this mechanism and the remote results are evaluated. tients under the age of 50 with early unicompartment arthritis where the donor This method is particularly effective in treating such diseases even on professional site cartilage is thin and the cartilage surrounding the defect is of poor quality. In sports athletes. The clinical and distant baro-podometric results that are particularly malaligned or unstable joints (varus or valgus, patellar-subluxation), restoration effective are presented in the study. or joint mechanics needs to be addressed separately, or at the time of, the MO- SAICPLASTY procedure. Patellar realignment, ACL, PCL, meniscal repair, and OP100 - Why should “do not use PLLA SCREWS in Knee Surgery”? osteotomies can be done concurrently. Cartilage transplantation can be performed R.Prejbeanu either arthroscopically or open, including the miniopen technique. Some surgeons ad- Millions of bioabsorbable screws are implanted in the knee during the years vise that those unfamiliar with the procedure should begin with the all open technique .Although bioabsorbable screws promise to degrade couple years after surgeries. and after several cases, move to an arthroscopic procedure. It is advisable to give in- But this process are sometimes with some problems. travenous antibiotics 30 minutes before the surgery. The type of anesthetic used, either In some cases problems such as tunnel enlargement, synovitis, cyst or abcess general or regional, largely depends on patient preference. Both methods have been formation, have been reported. used with success. The application of a tourniquet is advised. The patient’s position on Most cases with problems are reported on poly-L-lactic acid-based screws. the operating table should allow the knee to flex over 120 degrees for recipient side The adverse reaction was reported in the tibia and the femur and with the applica- management. The contralateral extremity is usually placed in a stirrup or in lithoto- tion of several types of graft (BTB or hamstrings) my. As with the diagnostic procedure, arthroscopy is begun through the anterolateral The numbers of reports in literature are minor but we thing that are underestimat- portal. In addition to other pathologies, the cartilage lesion is evaluated thoroughly. If ed (less than 10 in 5 years). the cartilage repair is to be performed, then portals are introduced more centrally than The information related to all clinical implications of biodegradable screws are usual. If concomitant pathology is going to be addressed, usually the mosaicplasty pro- scarce and suffers from the phenomenon of publication bias. cedure is performed last to avoid any possible malposition or movement of the plugs during the other procedures. When all the holes are filled and the grafts seated, put the OP101 - Direct Anterior Approach for Total Hip Arthroplasty knee through a range of motion and varus, valgus stress . Close the portals and drain T.Alia, E.Ostreni the joint through the superior portal. Postoperatively, remove the drain at 24 hours. This article describes the surgical technique for total hip arthroplasty using the The patient is discharged and advised to remain partial weight-bearing for 2–6 weeks, single-incision direct anterior approach. With the use of a dedicated set of in- or non-weightbearing for osteochondritis dessicans. Range of motion and isometric struments, it utilizes a straight skin incision. Splitting muscles without detach- quadriceps exercises and swimming are encouraged during this period. Barring com- ment provide an effective exposure for carrying out primary or revision total hip plications, return to full activities can be accomplished in 2–4 months. arthroplasty, avoiding the first surgical entrance in the revision cases. Excellent visualization of the acetabulum is afforded. The authors believe that this technique OP099 - Surgical treatment of Gastrocnemius recession in patients with acute is perhaps more technically demanding than the approaches used today due to the and chronic heel pain somewhat limited surgical exposure. Morbidly obese or very muscular patients as P.Ronconi, E.Priftaj well as patients with a short femoral neck or acetabular protrusion can represent Many surgical techniques have been described in recent years in the treatment of particular difficulties. The authors’ practice has overcome them and turned this both posterior and anterior heel pain. The authors present a tricipital fascial release technique from a contraindication into a preferred solution. The direct anterior ap- technique of the medial head of the gastrocnemius, (Gastrocnemius Recession) proach has significant advantages, including minimal soft tissue trauma, resulting according to Barouk, demonstrating its effectiveness in the treatment of these pa- in faster postoperative mobilization, rehabilitation and shorter hospital stay. The thologies, particularly in Achillis insertional enthesopathies and in the resolution of small incision scar also results in better cosmesis. The anterior approach provides chronic plantar fascites. The surgical technique, which can be performed in Day Sur- a safe and effective approach to total hip arthroplasty with limited morbidity. gery, consists in performing a fascial resection at the level of the proximal insertion

122 123 Table 1 Table Round Round

OP102 - Strategic Approach to improving the quality of care and ensuring to hospital policies which ban smoking. Many researchers have concluded that Round Table 1 patient safety smoking interventions delivered in hospitals and other settings treating patients E.Dasho with chronic medical illness might be particularly effective. Effective programs The quality of health care service is defined as “the ability to continuously guar- share these common elements: systematic identification of smokers at (or short- antee patient satisfaction through the provision of effective, effective and efficient ly after) admission; a bedside counseling session by a nurse or specially trained health services, provided according to the most up-to-date guidelines and stan- counselor, often supplemented by written or audiovisual material; physician ad- dards that meet the patient’s needs and professionally fulfill service providers.” vice to stop smoking; and continued contact, usually by telephone, for at least On the other hand, patient safety is defined as “preventing medical mistakes and three months after discharge. unwanted effects of treatments while providing health care”. Croatia has a long tradition in strengthening tobacco control and smoking ces- There are numerous recommendations about measures that can be taken to im- sation interventions. However, system-level intervention to facilitate delivery of prove the quality of service and patient safety in healthcare institutions. Among tobacco-cessation counseling and medication in hospital setting and after hospital them can be distinguished: discharge were never developed in Croatia.For that reason a pilot project at the 1. Harmonize the processes within the hospital with the demands coming from the University Clinic for Infectious Diseases in Zagreb was established, which started external environment at the end of 2014, and finished in June 2016. The main aim of the project was to 2. Establish quality and safety in the management team agendas center introduce smoking cessation interventions at hospital setting and post discharge, 3. Implementing systems that support quality improvement at the organization level increase quit rates and intervention implications. 4. Delegating responsibilities on quality and safety as well as capacity building at All smoking patients that were hospitalized in chosen departments of the Clinic departmental and clinic level were offered to take part in this project. Patients that were willing to attend the 5. Drafting and implementation of Clinical Practice Protocols and Guidelines project signed the informed consent. The interventions used were: bedside coun- based on Quality and Safety Evidence seling, motivational interview and physician advice to stop smoking supplement- 6. Implementation of information systems that support the implementation of ed by written material. After hospital discharge, patients were contacted by tele- guidelines, protocols and patient pathways phone four times: one, three, six months after discharge and in June 2016. During 7. Continuous monitoring and evaluation of quality and safety and continuous the first three telephone contacts patients were asked about their smoking status. provision of feedback to providers Smokers were offered additional counseling on how to quit smoking, and those Total Quality Management and Conversion of Hospitals to Highly-Confident Or- who have quit smoking were supported to maintain nonsmokers. In June 2016, all ganizations are processes and minds that are not limited to a particular activity or participants were contacted and asked about the satisfaction with interventions for structure. Hospitals and other health care institutions need to establish a sustain- smoking cessation they received at hospital and post discharge. able base before targeting quality management by approximating Total Manage- Results of this pilot study will be presented. ment and transforming into Highly-Confident Organizations. Prerequisites include the goal of “zero damage”, a culture that promotes patient safety and a sustainable OP104 - Secrets of Success in Medicine quality improvement process. R.Rienmueller

OP103 - Smoking-Cessation Intervention for Hospital Patients: Lessons OP105 - Successful strategies for improving the health care system in Albania learned from a pilot study R.Degjoni M.Čivljak The health care in Albania as a public good need to build a performance healthcare According to many researches, the majority of smokers would like to stop smok- system that offers new integrations service. Through new successful strategies the ing, and each year about half try to quit permanently. Yet, only about 6 percent of health care will offer for all the Albanian people the new standard of the quality smokers are able to quit in a given year. Most smokers will need to make multiple of care. Improving successful strategies in Albania, shall adopt a new integrated attempts before they are able to quit permanently. This is because smokers not healthcare approach that will coordinates the health care policies in the area of only become physically dependent on nicotine. There is also a strong emotion- good coordination between public and private health care sector. The health care al (psychological) dependence. Nicotine affects a smoker’s behavior, mood, and services demands in Albania have intensified the call for more quality and efficient emotions.A hospitalized smoker must abstain temporarily from tobacco use due use new strategic resources through integrated delivery services (Fleury, 2006).

124 125 Table 1 Table Round Round

The successful strategies for improving the health care system in Albania, encom- risks and advantages, and think about that balance, and also spend time with Round Table 1 passes many aspects of health including the infrastructure development, modern patients explaining why they’re not prescribing them.” In order to reduce and to medical technology, human resources, institutional capacities, improvement of a better control with regards to appearance of antibacterial resistance, the anti- safety and quality of services. The principles upon which the strategy is found- microbial stewardship is one of the cornerstones of our actions: Strategic goal 1 ed are the high standards through effective, efficient providing for equal access - Optimize choice and duration of prophylactic antibiotic therapy. Strategic goal grounded in the principles of quality of care. Integrated health systems in public 2- Optimize choice and duration of empiric antibiotic therapy. Strategic goal and private sector are widely considered to provide superior performance in terms 3 - Improve antibiotic prescribing practices by educational and administrative of quality and safety as a result of effective communication (Gillies et al. 2006). means. Strategic goal 4 - Establish a system to monitor and provide feedback on The purpose of this study is to identify the key principles for successful strat- the occurrence and impact of antibiotic resistance. Strategic goal 5 - Define and egies to improve the effect of the development of quality in health care sys- implement institutional or healthcare delivery-system guidelines for important tem. Those strategies related to implementing and evaluating initiatives types of antibiotic use. Proposal methods to control antimicrobial use to prevent with vision to growth up integration services in Albania (Lavis et al. 2004). or control antimicrobial resistance: 1 -Optimal use of all antimicrobials; 2 - Se- The methods of this paper based on systematic review for evidence based on ac- lective removal, control or restriction of antimicrobial agents or classes; 3 - Ro- tivities of public and private hospitals in Albania. Using the methods, we will tational or cyclic antimicrobial use; and 4 - Use of combination antimicrobial use the activity realized in public and private hospitals by reflecting their indi- therapy to prevent the emergence of resistance. cators to ensure practice relevancy. The successful strategies for improving health care system for years 2013 - 2018 will research for relevant public and private hospitals. Research of the successful strategies will include the integrat- ed care, organizational hospitals, coordination and health services integration. With evidence informed decision making as an expectation in healthcare man- agement and care policies (Cookson 2005), there is a need to seek out and ap- ply current knowledge on health systems integration to advance effective service delivery. Systematic reviews will serve a tool for decision making for health planners and policy makers (Cookson 2005). A systematic review will con- ducted with the goal of summarizing the current health care Albanian hospital market on successful strategies for health care integration system. It focused on definitions, processes and impact of integrated health service delivery systems.

OP106 To reduce the antibacterial resistance it is our daily responsibility. T.Kalo Dr M Chan, Director-General WHO, World Health Day 2011 in her speech “No action now means no cure tomorrow”, said that: “In the absence of urgent cor- rective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated. The responsibility for turning this situation around is entirely in our hands.” Two years later the Great Britain Government’s Chief Medical Of- ficer, Prof. Dame Sally Davies, wrote down in “The Independent”, 11 of March 2013 that: “Antimicrobial resistance is a ticking time-bomb not only for the UK and, the problem of microbes becoming increasingly resistant to the most powerful drugs should be ranked alongside terrorism and climate change on the list of critical risks to the nation…We are going to have to up our education, so that the doctors and nurses and vets who prescribe antibiotics do it knowing the

126 127 Advanced Advanced Imaging

OP107 - Ultrasound‐Guided Renal Transplant Biopsy thyroid nodules. Mostly they are benign but recently it has seen an increase in Imaging

Advanced A.Daku, B.Cekrezi, A.Dedej, F.Nasto, L.Berdica, I.Allajbeu number of malignant thyroid nodules so the need of differentiating them is man- Renal transplant biopsies are performed routinely for evidence of renal transplant datory. dysfunction or as part after transplant management at our institution to screen High-resolution equipment (US) and fine-needle aspiration cytology (FNAC) are for early rejection. Renal transplant biopsy performed with ultrasound guidance very helpful at this point. Although US has a high sensitivity for the detection of using a 18‐gauge spring‐loaded biopsy gun is widely accepted as the safest and thyroid lesions, its specificity is limited. most efficient technique. Minor complications occur in up to 10%, most common- US criteria for differentiating between malignant and benign nodules with the aid ly hematuria, arteriovenous fistula (AVF) and/or small hematoma . Identification of the following features: irregular margins, micro calcifications, marked hypoe- of risk factors would guide clinical decision making related to the safety of a renal chogenicity, intranodular vascularization greater than perinodular vascularization, transplant biopsy and potentially decrease the incidence of major complications. interval growth of diameter. This study included a retrospective cohort of all pediatric and adult renal trans- Based on this principle, ultrasound elastography (USE) was introduced as a plant biopsies performed at a single, large transplant institution from 2007 to 2017. non-invasive technique which obtains information on tissue stiffness. In recent The cohort included patients of all ages with biopsy indication for either cause or years, USE has been investigated in numerous studies testing its ability to differ- protocol among both inpatients and outpatients. Our radiologist performed all bi- entiate benign from malignant thyroid nodules. A new quantitative scoring method opsies with continuous ultrasound guidance . Two or multiple biopsies performed called elasticity contrast index (ECI) was developed also lately. The ECI index on the same patient on different dates within the cohort were counted individually. is obtained with the E-Thyroid software, a Steady-State Quasi-static physiologi- Anticoagulant and antiplatelet medications including warfarin, clopidogrel and cal excitation technique which exploits the carotid pulsation as strain inductor to aspirin are stopped for 5-7 days prior to the biopsy. reach a quantitative stiffness evaluation. Outpatients are prepped on the day of the biopsy in a short‐stay unit. All biopsies Statistical analysis based on ROI Curve showed that the most accurate cut-off were performed under the supervision of radiologists, almost invariably with the value for ECI index was 3; the median value of malignant nodules was 4.1, and it participation of a radiology and nephrology fellow. was 1.85 in benign lesions Logic P6 Pro ultrasound machines with 4‐mHz vector, and/or 9‐12 mHz linear Discussion In the assessment of thyroid nodules, our results suggest that Quasi- probes were used for all biopsies. All of our 12 renal transplantation biopsies demon- static Ultrasound Elastography with the E-Thyroid method may achieve good ac- strated sufficient pathologic data, and all of them were successful according to curacy and low inter-observer variability. The low inter-observer variability could histopatologic criteria Two patients (0.7%) had a hemorrhagic complication but not be due to variability in images that were selected for measurement with E-Thyroid requiring transfusion and another four patients (1.4%) experienced a minor self-lim- and to the variability related to the ROI positioning. As a potential limitation, we iting complication . In conclusion, we advocate the cortical tangential approach by found that differences related to carotid artery pulsation depending on age, athero- using an 18-gauge automated biopsy device when performing US-guided renal sclerosis and hypertension could affect ECI results. transplant biopsy. Uniform application of this technique by a cohort of radiologists Another possible limitation is an isthmic nodule position, away from the carotid. in a Ultrasound section resulted in a 95% collective success rate according to Banff The degree of the operator’s hand compression can also influence the ECI- re 97 criteria, without need for immediate pathologic review of specimen adequacy sult; further testing to better evaluate this variable is warranted. USE techniques and with few complications. The results of this single center retrospective cohort including E-Thyroid can be considered as an additional tool for differentiating demonstrate a low complication rate of renal transplant biopsies using contin- thyroid nodules. Moreover, its high sensitivity, specificity, negative and positive uous sonographic guidance for needle placement. This single‐center cohort we predictive values could be of relevant clinical utility in the pre-surgical selection demonstrated a similar rate of major complications compared with prior published of patients with indeterminate cytology and in guiding follow up of lesions nega- reports . Several very clinically important conclusions were drawn relating to re- tive for malignancy at FNA4 . nal transplant biopsy complications. Training is warranted to achieve good and reproducible results Its high sensitivity, specificity, negative and positive predictive values could be of relevant clinical OP108 - Elastography and E-thyroid application as additional tools in differ- utility in the pre-surgical selection of patients with indeterminate cytology. entiating thyroid nodules The most accurate cut-off value for ECI index was 3; A.Shahini, Sh.Telegrafi,Iris Allajbeu Commonly during thyroid ultrasound we faced of a great number of incidental

128 129 Advanced Advanced Imaging

OP109 - Selective coxofemoral US screening in infants with associated risk therapy for patients with HCC who are no longer candidates for resection or abla- Imaging

Advanced factors for DDH tion. There are 12 patients with HCC that are treated with TACE from November B.Saraci, A.Avdulaj, E.Ceka, E.Zekollari 2017 until now. Selective catheterisation of the celiac trunk was achieved with a Developmental dysplasia of the hip (DDH) supposes an abnormal development of 5F catheter, and a micro-catheter was inserted through the 5F catheter to visualise the femoral head and acetabulum. The incidence of DDH ranges from 1.5 to 20 per the vessels supplying the tumour. 1000 births. Multiple risk factors have been described: breech positioning in utero, Initially we injected through micro-catheter 100mg of doxorubicin mixed with female sex, oligohydramnios, family history, and first born. The left hip is affected intravenous contrast, followed by a mixture of lipiodol and particles. more frequently than the right. The size of tumour ranged fro 3-15cm. The patient age range from 56-80 year old, In our country have been described different screening strategies, including clini- mean age 67. In 8 patient the tumour was localised in the right lobe of the liver. cal examination alone, selective US screening and universal US screening. Complete necrosis of the tumour was achieved in 4 patients, 8 patients had partial Selective ultrasound is indicated in patients with associated risk factors or abnor- necrosis of the tumour with viable tumour. No acute complication happened during mal clinical examinations the procedures. 10 patients developed post-chemo-embolisation syndrome com- Our purpose is to review selective coxofemoral US for DDH in 100 infants with plained of pain, fever and vomitus. 1 patient was complicated with liver abscess . associated risk factors who presented in the Mother Theresa University Pediatric TACE in an effective procedure for treatment of patients with unresectable HCC, Hospital in Tirana. improving quality of life and survival rate. Further study should be conducted in The recommended imaging modality for the initial workup depends primarily on the future tin our country to evaluate survival rate of these patients and comparison patient age; US is the reference standard for evaluating the coxofemoral joint in an with other treatments. infant before 6 months, when capital femoral epiphyseal ossification usually occurs. OP112 - Radiology examinations in diagnoses of carotid artery stenosis. OP110 - Efficacy of percutaneous CT-guided drainage in the management of K.Çaçi, A.Rroji, E.Enesi, F.Bilaj, B.Arapi, D.Qirinxhi, B.Gega abdominal and pelvic abscesses In this presentation we report our experience in American Hospital 3 Tirana, in di- D.Qirinxhi, A.Rroji, E.Enesi, F.Bilaj, A.Avdulaj, B.Bulku agnoses of carotid artery stenosis. Estimation of different radiologic exams (Dop- Despite recent advances in the diagnosis and management of abdominal and pelvic pler ultrasound, CT Angiography, MRI Angiography,) in comparison to DSA, their abscesses, these infections still cause substantial morbidity and mortality. Manage- reliability and validity in the diagnoses. A retrospective evaluation of different ment of these infections requires prompt recognition, early localization, and effective types of radiologic exams in 20 patients treated with Carotid arterial stenting. Ul- drainage, as well as appropriate antimicrobial use. trasound systolic and diastolic velocity criteria in addition with atherosclerotic We present the data of 5 patients who had abdominal abscess or fluid collections, plaque evaluation by Ultrasound, CT and MRI; and grade of stenosis by Angio and underwent treatment by percutaneous CT-guided drainage. Results were as- CT/MRI are very reliable methods in selecting patients for angioplastic carotid sessed by reduction of dimensions, relief of symptoms and signs (including ab- stenting.Doppler Ultrasound is the first line of radiologic exams in diagnoses of dominal pain and fever) and imaging findings. critic carotid stenosis. It is reliable in extracting the patients with critic carotid Morbidities such as hematoma, wound infection, sepsis or peritonitis were followed extracranial stenosis but further evaluation with angio CT and/or Angio MRI is up to six months after the procedure.The average age of the patients was 61 years necessary before carotid arterial stenting. (range 45 to 70), including 1 (20%) men and 4 (80%) women. The common signs and symptoms were pain and fever. OP113 - The importance of Radiologic examinations in the differential diag- Abscess diameter ranged between 5 and 11 cm. All the five ca es were successfully nosis of chest tumors in children treated by percutaneous CT-guided drainage. M.Tanka, F.Tuka, D.Alushani, S.Buba, E.Malo Chest tumors in pediatric children differ vastly from that of the adult patient as OP111 - Trans arterial chemoembolisation in treatment of hepatocelullar car- both common and uncommon lesions may manifest differently in younger children cinoma , first experience in Albania compared to adults. On the other hand the type of pathologies found in children’ s F.Bilaj, A.Rroji, E.Enesi, D.Qirinxhi, K.Caci, M.Pustina, Leka chest comprise a wide spectrum of lesions, some of which have the same appear- In this presentation we report the first experience in Albania , treatment of unre- ance as those from other tissue types and some are unique to the pediatric lung. sectable HCC through TACE. This procedure is an well-established loco-regional Diagnostic imaging remains crucial in characterizing the lesion in chest tu-

130 131 Advanced Advanced Imaging

mors and making the correct differential diagnosis as well, thus helping in pa- engaging in unprotected sexual intercourse for 1 year. Although many assume that Imaging

Advanced tient’s management and in reaching the best outcomes. Conventional chest ra- infertility is predominantly related to the woman, the cause of infertility can rest diography is the most common imaging modality used in children followed by with either the female or the male partner. Among infertile couples, the cause of cross sectional procedures which better localize and characterize the lesion. infertility involves the male partner in approximately 50% of cases and is the Herein we present our experience with pediatric patients presented with different sole cause of infertility in 30%. Male infertility is usually caused by conditions respiratory symptoms who were eventually diagnosed with chest tumors deriving affecting sperm production, sperm function, or both, or blockages that prevent the from different tissue types. After undergoing the necessary radiologic examina- delivery of sperm. Infertility is classified as primary when there has never been a tions an accurate diagnoses was reached which provided clinicians and surgeons pregnancy for the couple. Secondary infertility refers to the situation in which a with valuable information indispensable to patient’s treatment and management. prior pregnancy was possible involving at least one partner of the couple. The diagnostic workup of male infertility should include a thorough medical and OP114 - Contrast-Induced Nephropathy: Novel insights into prevention and reproductive history, physical examination, and semen analysis, followed by im- management. aging. Ultrasound and MRI are the techniques commonly performed. M.Imeraj The practicing radiologist should be familiar with the evaluation of the infertile Contrast-Induced Nephropathy (CIN) is the impairment of renal function—measured man and the common radiologic findings and disease processes associated with as either a 25% increase in serum creatinine (SCr) from baseline or a 0.5 mg/dL (44 infertility. This presentation will review the ultrasound workup of infertility in µmol/L) increase in absolute SCr value—within 48-72 hours after intravenous contrast a male. The cause of impaired sperm production and function can be related to administration in the absence of an alternative explanation. Despite technological ad- congenital or acquired factors that act at the pretesticular or posttesticular level or vances, CIN remains responsible for a third of all hospital-acquired acute kidney injury directly at the testicular level. (AKI). The proliferation of imaging methods and interventional procedures involving The imaging of common conditions associated with infertility, obstructive and administration of intravascular Contrast-Media (CM) has significantly increased the non-obstructive oligo-azoospermia, including cryptorchidism, varicocele, tes- number of patients exposed to CM and thus the number at risk for CIN. Patients with- ticular microlithiasis, primary testicular failure, ejaculatory duct obstruction, out risk factors the incidence may be as low as 2% and those with risk factors, such as seminal vesicle agenesis , will be shown, as well as other conditions that can be diabetes, the rate rises to 9%, and to as high as 90% in patients with diabetic nephropa- incidentally seen. thy. Here, we present the case of a 69-year old male diabetic patient with no significant Scrotal ultrasonography is the most common initially performed noninvasive ex- prior renal disease who developed severe oliguric acute renal failure requiring dialysis amination used to image the male reproductive system, including the testes and after the use of contrast for a percutaneous coronary intervention, no appropriate pre- extratesticular structures such as the epididymis. vention measures were taken before the procedure. This case suggests that, when CM- This examination can be used to evaluate potential testicular abnormalities, calcu- based examinations cannot be replaced by other techniques in patients at risk of CIN, late the testicular volume, and identify peritesticular abnormalities such as varico- focus should be directed towards analysis of number and type of risk factors, adequate cele, epididymal and prostatic abnormalities, and erectile dysfunction. Transverse estimation of GFR, institution of proper preventive measures including hydration and and longitudinal US of the testes and color flow Doppler US of testicular and post-procedural observation combined with surveillance of serum creatinine for 1-3 spermatic cord vascularity are performed. days. In CIN causes in-hospital morbidity, increased mortality, prolonged hospitaliza- Testicular volume measurements, which can correlate with semen profiles, also tion, increased health care costs, and potentially irreversible decline in renal function. should be obtained . Perfusion mapping, performed with the use of color Doppler Keyword: Contrast-Induced Nephropathy (CIN),renal function, risk factors,preven- ultrasound, has shown that in patients suffering from severe oligo and azoosper- tion,management. mia, sperm quality and quantity depend on tissue perfusion within the testicle. Testicular arterial blood flow was found to be significantly decreased in men with OP115 - From Image to Clinical Thinking or about Physician’s Wisdom varicocele, and may be a reflection of the impaired microcirculation. Transrectal R.Rienmueller US and MRI can be used to evaluate the prostate and possibly identify more cen- tral sources of spermatic. OP116 - Ultrasound Workup of the Infertile Male Sh.Telegrafi Infertility is defined herein as the inability to achieve pregnancy after frequently

132 133 Pediatric and Pediatric and Neonatology

OP117 - Neurological disorder during neonatal period groups and ethicists. Here, we summarize the different types of stem cells that A.Bushati have been described: their origins in embryonic and adult tissues and their dif- Neonatology Pediatric andPediatric Neurological disorder in babies appear in many different clinical forms and are caused ferentiation potential in vivo and in culture. We review some current clinical ap- from varies causes. In some cases these problems are congenital or occur before birth. plications of stem cells, highlighting the problems encountered when going from In other cases, prematurity or traumatic birth may lead to cerebral lesions associated proof-of-principle in the laboratory to widespread clinical practice. While there is with neurological problems that may be permanent. still much to be learned about how genetics factors interact. There is a growing The most common forms of neurological disorder during neonatal period are: Asphyx- realization of the importance of environmental factors in regulating stem cell be- ia occurs when the baby is lacking oxygen before, during or after delivery. convulsions haviour and this is being explored by studying stem cells in vivo and recreating ar- are very common problems in babies and their importance due to their cause.Hem- tificial niches in vitro. New therapies, based on stem cell transplantation or endog- orrhages may occur in different parts of the brain and their importance depends on enous stem cells, are emerging areas, as is drug discovery based on patient-specific affected and size of the affected area. Intraventricular hemorrhages are the most com- pluripotent cells and cancer stem cells. What makes stem cell research so exciting mon forms which is divided into 4 ranks, depending on the location and the amount is its tremendous potential to benefit human health and the opportunities for inter- of blood depending on the importance of the lesion and the long-term consequences. disciplinary research that it presents. Cerebrovascular malformations: malformations of certain brain parts such as Galen’s veins that cause serious brain damage. Hydrocephalia: occurs when there is an in- OP119 - The neonatal hearing screening (NHS): the challenge of profession- crease in intraventricular fluid volume within the brain of the child. Neural tube de- als, the health system or the population fects: these defects affect the brain and spinal cord and may be represented by Spina bi- B.Qirjazi, E.Toci, E.Tushe, E.Roshi , A.ML Bussé, A.Goedegebure, H.LJ Hoeve, fida. Periventricular leukomalacia: often occurs with unknown causes. It is developed G.Carr, M.Toll, H.J de Koning, H.J Simonsz as a result of the damage or death of the white matter cells from the weakness of these A cost-effectiveness model is being developed as a part of a -big Europe cells. It is usually associated with premature births prior to 30 weeks gestational, early an Project, EUSCREEN, and its initial prediction for the most cost-effective junction of hyaline membranes, severe births or intrauterine infections. Hypotonia: a neonatal hearing screening (NHS) in Albania is tested in EUSCREEN pro- situation where babies have generalized hypotoni, gastric disorder, and swallowing gram and the implementation study. An implementation plan was developed (exclude Spinal Atrophy as well as other metabolic pathologies characterized by hypo- with objectives, target population, protocols, training of screening nurses, de- tonia). Neuromuscular Congenital Defects: Consider the myastenic crises in the cases vices, care pathways and follow up strategies. NHS started on January 1st, of Congenital Myastenia. In all of these situations, an assessment is required of neu- 2018 in Tirana, Pogradec and Kukës, representing both urban and rural ar- rologists and a multidisciplinary support of the baby. In clinical practice, the neurolo- eas with a variety of socio-economic groups. Using data from screening pro- gist is an actor who comes into play with delay, as the events have occurred and are grammes across Europe and taking local conditions into account, the provision- handled by the staff of intensive neonatal therapies. Neurologist pediatrician should al cost-effectiveness model evaluated several NHS scenarios for comparison. evaluate the child’s neurological condition, recommend the most likely treatments, During the period of Jan 2018- May 2018 over 4,000 babies have been part of the pro- and try to apply prognosis, but the infants are unpredictable at the end. Neonates have gram in 4 areas, while the screening and data evaluation is going on. The babies who very good cerebral regenerative ability and the first morphology through imaging does failed the hearing screening are sent for audiological diagnose and the ones identi- not always predict future functions, possibly due to cerebral immaturity. Neurological fied with hearing problems are now under the follow up of a multidisciplinary team. problems in babies may arise for various reasons and have a variety of effects in the A NHS program is Albania is feasible and a ‘must’ if we aim the rehabilitation of a life of their baby and their families. Unfortunately, many of the brain injuries occurring hearing loss in the most appropriate way. The key to a successful implementation of in babies are due to neglected care or birth defects. So it is very important for medical the overall hearing loss pathway is the informed participation of the parents in such a staff to recognize the risks and to take the necessary steps to minimize the risks and to program; this would reduce the ‘leaked cases’ and will make possible not only comple- act quickly to reduce the possibility of severe long-term injuries. tion of the screening itself but also the active rehabilitation of the hearing loss process.

OP118 - Stem cells and their use in the clinical practice of oncology and hematology OP120 - Children convulsions and mouth trauma during the opening of the mouth A.Godo, M.Kreka, S.Dedej, E.Nastas, M.Xhafa, D.Bali, M.Kapllanaj E.Laho, F.Brazhda In recent years, there has been an explosion of interest in stem cells, not just with- It is to present the progression of convulsions in seizure pediatric dis- in the scientific and medical communities but also among politicians, religious ease and the trauma of these during the aid provided by the family members.

134 135 Pediatric and Pediatric and Neonatology

This is a retrospective study during the period 2005-2011. In this paper are surfactant, the need for intubation, the occurrence of pneumothorax, intracranial studied and collected cases involving febrile convulsions and convulsive bleeding and the presence or absence of the respiratory distress. In the experi- Neonatology Pediatric andPediatric diseases in the Pediatric Service at the Regional Hospital Center Elbasan. mental group, surfactant use was 52% lower (OR for difference = 0.3 to 0.9) and In this study, apart from the epidemiological and clinical data of convulsive cases, also need for intubation (OR = 0.33 CI 95% = 0.13 to 0.88). For other variables are studied the trauma and damage of children from the wrong aid given by the of interest the changes were not significant. The use of CPAP at the delivery room relatives of the child with convulsions. was accompanied by a reduction of 50% in the surfactant use, which in economic There were 12,214 children hospitalized with various disease. 263 cases or 2, 15% terms means about € 35,000 saving per year. The need to intubate 24 hours after of total hospitalized had the admission diagnosis of febrile seizures. 48 out of them birth was reduced by 30%. CPAP use in the delivery room is a method that reduces (18%) of them had recurrent episodes of seizures. costs and the disease rate. The age group more affected was 1-4 years old (45%). It turned out that 263 cases were mostly convulsions under the age of five. Out of 11 cases, injured OP122 - Infants’ Morbidity in Albania children have been exposed, along with prolonged convulsions, and oral dam- E.Skenderi, A.Sulovari, S.Dodaj, J.Alibehaj, P.Traja, A.Rekaj ages as a result of the wrongful and damaging assistance of the parents or rel- Early in life children have little immunological memory and a developing im- atives who can extract the tongue by means of circumstantial means. Like mune system which increases their vulnerability to infectious diseases. There broken teeth, 5 children aged 1-5 years old, 4 cases with tongue injury 2 cas- is a lack of information concerning infant innate responses during the first year es with hemorrhagic injury of mouth mucus and a case of language scarring. of life, however the immune system is rapidly evolving in response to repeat- Febrile seizures are common in children mainly represented with infections. The ed immune challenges. Maternal lymphocytes do not normally cross the placen- most affected age group resulted that over 1 year. In the case of children with tal barrier and only low levels are present in breast milk, therefore infants are auxiliary arm convulsions to dominate convulsions with valium rectal should not susceptible to infections requiring T-cell-mediated immunity. It is increasingly cause the child to force the tongue force but have a thin plastic tube to place it evident that cellular responses are an important component of the immune re- carefully between the teeth without its ability to make the flexion of the head . sponses to natural infections. The infant immune system actively eliminates self-reactive T cells, thus vaccine-specific T cells may be deleted without a de- OP121 - Use of Positive Airway Pressure (CPAP) in the Birth Room for the posit of memory. Aim: To assess the prevalence of infectious diseases in infants. Prevention of Respiratory Distress Method & Material: This a retrospective study. There were enrolled all children aged E.Tushe 1-12 months hospitalized in the General Pediatric Ward, in the University Hospital There are evidences that the use of CPAP for prophylaxis reduces the possibility of Center “Mother Teresa” during one year period 2017. The studied parameters were transitory respiratory distress at a term newborn infant or at a late preterm infant age, gender, seasonality and location of infection. Information was extracted from and reduces the need for surfactant use, the time of hospitalization and the need clinical records. Results: The total number of children hospitalized during 2017 in for intubation and mechanic ventilation in preterm with lower gestational age. the General Pediatric Ward was 2572, 806 (31%) were infants aged 1-12 moths. The purpose of the study was to find out the influence of the CPAP use in sur- Male gender was the most affected, resulted in 505 children (62%). Winter and factant consumption and in the prevention of respiratory distress.Our study was spring were the seasons with the greatest prevalence in infant morbidity; 210 chil- retrospective for 2 periods of time (2011 and 2016/17) for newborns born at Koco dren (34%) and 246 children (37%) respectively. 426 children (53%) had respira- Gliozheni Hospital, Tirana. In the first period (2011) in the delivery room was tory infectious diseases, 268 children (35%) had diarrhea, and 112 children (14%) used only ventilation with self-inflating bag for resuscitation, while in the second had other diseases (urinary infections, otitis media and different viral infections). period of time the use of T-piece for over 15 minutes was set as standard for every Conclusion: Infants are highly susceptible to infectious diseases, partly due to newborn that has the risk to develop respiratory distress.From the newborn regis- the immaturity of their immune system, resulting in high morbidity. In devel- try in the NICU were selected those who were candidates to develop a respiratory oping countries infants are exposed to many infections in early life; respirato- distress, including all the newborns with an age of 27 to 32 weeks. Newborns ry infections and diarrhea remain the leading cause of morbidity. Levels of with malformation and genetic anomalies were excluded. The study included 226 gonadotropins and sex hormones are differentially elevated in males and- fe children (P1 = 87 and P2 = 139 neonates). The following groups were compared males in the first few months of life, furthermore a number of -immune re according to the gestational age, birth weight, birth way, Apgar score, duration of sponse genes are encoded on the X chromosome, leading to sex differences in ruptured membranes and mortality. As an interest variable were chosen the use of immunity and predisposing male gender to higher morbidity during infancy.

136 137 Pediatric and Pediatric and Neonatology

OP123 - Retinopathy of Prematurity: Diagnosis and treatment ments during the first weeks of life etc ,increase the risk of neurodevelopmental G. Anselmetti problems. The main disorders associated with prematurity include cerebral palsy Neonatology Pediatric andPediatric The Author describes the latest instruments and procedures used for the diagnosis especially spastic diplegia, intellectual disability, hearing loss, visual impairment and the treatment of Retinopathy of Prematurity (ROP). RetCam120 is the funda- associated with retinopathy of prematurity, learning disorders and expressive and mental tool, necessary to have the first diagnosis. Fluorescent Angiography (FAG) receptive language disorders. There is now increasing evidence of sustained ad- is then needed to evaluate the extension and the Stage of the disease. Worldwide verse outcomes into school age and adolescence especially behavioral problems. guidelines agree in saying that Laser Photocoagulation is the best treatment. The There are many techniques to determine low birth weight, preterm infants’ normal purpose is to block the expansion and the evolution of the ROP. To do so, we need developmental progress, such as observing spontaneous movements during the to treat all ischemical areas we found with FAG, which are prior and back the shunt. first weeks of life, neurologic exams, questionnaires to the parents, and develop- mental and intelligence psychometric tests. OP124 - Immunization Of Preterm Child. What Does It Differ In Its Schedule? Developmental screening with reliable and valid measures should occur at 9, 18, Gjeorgjina Kuli-Lito and 30 months of age as for every child and at any time when concerns are arised. Preterm and low birth weight infants are at increased risk of infections in general Screening for developmental disorders can be inaccurate, both in terms of missing and suffer from an increased frequency and severity of vaccine preventable infec- significant delay and over-recognition. tions. The need for timely vaccination of preterm infants is therefore great. The major clinical outcomes that are important for preterm infants and their However, vaccination is more likely to be delayed in preterm than in term infants. families are survival and normal long term neurodevelopment. In line with the Unfortunately, the evidence base for immunisation of preterm infants is limited. need to reduce infant mortality, the need to reduce developmental complications Most studies are small and differ in demographics, inclusion and exclusion crite- in premature infants should be considered by health system policymakers. ria, vaccine combinations used, and schedules. Data on long term protection and Early detection can lead to early intervention vaccine efficacy are particularly scant. A number of different immunisation schedules have been used in preterm infants. OP126 - Neonatal Respiratory Morbidity after Elective Cesarean Delivery at It seems likely that an accelerated 2‐3‐4 month schedule will achieve protective Term Newborns: A prospective study concentrations earlier in such infants than a more extended schedule, which is N.Kolici, E.Gjybegaj, G.Bime, A.Subashi, V.Lekgjika, K.Hyka important given their susceptibility to infection. Cesarean delivery rates have tendencies to rise year up to year. Per se is a risk However, such schedules may be less immunogenic overall and require an early factor of respiratory morbidity in term neonates and its timing is an adding factor additional or booster dose to ensure persistence of protection. of increased rates of respiratory complications. This review focuses on established vaccines and the evidence base for their use in As overall cesarean delivery rates have continued to rise, there has been growing preterm infants. interest in the rates of elective cesarean delivery (ECD), and its relative benefits and harms for the mother and particularly for newborn. Available data suggested OP125 - Developmental Assessment Of Preterm Children, General Consid- that chances of respiratory morbidity are higher in babies born by elective cesare- erations an delivery than by vaginal delivery. M.Kika, R.Mullaj, E.Halili, S.Baballari; F.Dragoti, E.Malile A.Demaj, A.Shtylla Also the risk is higher in babies born less than 39 weeks gestational age. The birth of a preterm child is an event that usually results in implications re- The objective of this study is to determine respiratory morbidity and cor- garding development. The consequences of preterm birth can be substantial with relate gestational age and respiratory morbidity in term babies born by ECD. a wide range of possible motor, neurodevelopmental and behavioural sequelae. Prospective study during January 2017- June 2018 in American 3 Hospital, Tirana, Standardized tests for assessing development are used primarily to identify in- Albania. We analyzed clinical records of all term babies born by ECD in our clinic. fants suspected of delayed development who would benefit from early inter- Results: We analyzed 1410 of clinical records of babies born during January 2017- vention. It is predicted that 4.2% of all surviving preterm babies will have June 2018. A total of 1038 were born by cesarean delivery. Cesarean rate in our clinic a severe disability at 18 years, and that 18.5% will have a milder disability. result very high near 73.9 % and ECD result in 93.8% of them, in term pregnancies. Natal morbidity increases as gestational age decreases, and risk factors such as Respiratory morbidity, as transient tachypnea treated in Hood chamber, was found intraventricular bleeding, very low birth weight, low Apgar scores at the fifth in 8.6% of term neonates born by ECD versus 1.7 % of term neonates born by minute, male gender, and lack of surfactant therapy, lack of spontaneous move- vaginal delivery RR 5.28 CI(1.85-15.6). No need for CPAP treatment in all cases.

138 139 Pediatric and Pediatric and Neonatology

In 37-38 week GA we found 11.3% respiratory morbidity vs 0.6 % in up to 40 sified in five types, esophageal atresia with distal fistula, esophageal atresia with- week GA, RR 18.6 CI (4.5-85.5). In 38-39 week GA we found 10 % respiratory out fistula, fistula without esophageal atresia, esophageal atresia with proximal Neonatology Pediatric andPediatric morbidity vs 0.6 % in up to 40 week GA, RR 16.5 CI (3.9-69.5). fistula and esophageal atresia with proximal and distal fistula. It is often associated We had RR 2.38 (0.5-10.7) for respiratory morbidity in ECD babies at 37- with other congenital anomalies especially cardiovascular anomalies, urinary tract 38 weeks GA vs delivered vaginally at this age. In ECD babies at 38-39 anomalies etc. The aim of research: The aim of research was to determine the in- weeks GA respiratory morbidity was RR 5.8 (1.3-24.1) vs delivered vag- cidence of Esophageal Atresia, prevalence of tracheoesophageal fistula, the occur- inally at this age. This study suggest that respiratory morbidity increas- rence of associated anomalies, assesment of mortality and survival rate, the most es in ECD and as gestation progresses the respiratory morbidity decreases. common complications and their recurrence, the gender distribution, number of Keywords: ECD, respiratory morbidity, GA, Term Neonate operative undergoings for one patient, average age of the mothers and the average of the days that survived patients stayed in the hospital. OP127 - Chest pain and syncope in children; Is it cardiac or not? This research was taken place in the Neonatology Clinic, in University Clinical N.Kuneshka Maliqari Centre of Kosova. This study is a descriptive retrospective study. There were 32 cas- Chest pain in children is one of the most common reasons for an unsched- es with Esophageal Atresia that we studied. The cases are of the 2012-2017 period. uled visit to the primary care physician’s office and the emergency department. Prevalence was 2.67 in 10.000 alive newborns. There were 81.2% of males with Although chest pain does not indicate serious disease of the heart or other systems in esophageal atresia and 18.8% of females. 96.9% of the cases had the type C and most pediatrics patients, in contrast to chest pain in adults, it can be alarming to the child 3.1% of the cases had the type E. Complications occurred in 78.1% of the cases. and parents. Chest pain occurs in all ages with an average age of presentation at 13 years. The most common complications were sepsis (56%) and pneumonia (48%). Other The three most common causes of chest pain in children (45%-65%) are costochondri- anomalies were present in 46.9% of the cases. The most common anomalies were tis, a pathologic condition of the chest wall and respiratory disease. Cardiac causes rep- cardiac (46.7%) and gastrointestinal (33.3%). 87.5% of the cases were operated, resent 5% of the causes. The first goal of evaluating children with a complaint of chest 82.1% one time, 17.9% two or more times. The average days of hospitalisation pain is to rule out a cardiac cause of chest pain, which is usually the main concern to the were 33.3. The average age of the mothers was 30.5 years. The survival rate was parents. If the three common causes of chest pain are not found by clinical examination, 62.5%. The data from our sample were similar with the data from other studies. the clinical should obtain chest x-ray films, an ECG and direct attention to the cardiac The prevalence of Esophageal Atresia was 2.67 in 10.000 alive newborns. Male/ causes: congenital heart disease (aortic stenosis, severe pulmonary stenosis, Eisen- female ratio was 4.3. The most common type was type C and the other one was menger’s syndrome) pericarditis, myocarditis, arrhythmias (WPW, long QT syndrome). type E. Our sample did not have other types. Complications existed in 3 out of 4 Syncope. Most incidents in children and adolescents are benign, resulting from vaso- cases. The most common complications were sepsis and pneumonia. Half of the vagal episodes; in contrast to adults, in whom most cases are caused by cardiac prob- cases had other anomalies, the most common were cardiac and gastrointestinal lems. The evaluation of pediatric patients with syncope may extend to other family anomalies. The average days of hospitalisation were 33.3, the least was 14 days members when a genetic condition is suspected or identified. The cardiac causes of and the most was 107 days. The average age of the mothers was 30.5 years, which syncope are: myocardial dysfunction, arrhythmias long QT syndrome, WPW, obstruc- was higher than the average age of all the mothers at birth. There were more pa- tive lesion etc. Because physical examinations of patients are almost normal long after tients with other associated anomalies operated two or more times than the pa- the event, accurate history taking is most important. Serum glucose and electrolyte tients with isolated Esophageal Atresia. Survival rate was not that high. Two out are of limited value, because the patients are seen hours or days after the episode. of three patients survived. It dependes from gestational age, associated anomalies, It is important to acknowledge the severe effects of syncope that are mainly related to weight at birth, APGAR Score and complications. cardiac conditions which can lead to sudden death. Generally, recovery from syncope can be resolved within minutes to hours.

OP128 - Esophageal Atresia in University Clinical Centre of Kosovo 2012-2017 P.Haxhikadrija Esophageal Atresia is the most common congenital disease of Esophagus. Its prev- alence is 1.7 in 10.000 newborns. In more than 90% of the cases, esophageal atresia is associated with tracheoesophageal fistula. Based on the fistula, it is clas-

140 141 Anesthesiology & & Anesthesiology Intensive Care

OP129 - The Importance of Dorsal Ganglion Root and the shape of interver- There is an immense number of published scientific articles on sepsis syndrome. tebral foramina, in the treatment of post traumatic and post-operative Pain. Several debates and controversies are recently reported. Infection treatment, ag- A.Vaso gressive fluid administration, optimizing hemodynamic, and supportive care of ot-

Intensive Care Intensive In all our cases, studying the mechanisms of phantom pain at patients which hap- her organs and nutrition are the hallmarks of sepsis treatment as Sepsis Surviving Anesthesiology & pen to have also infected post-operative wounds of the stump, we observed that Campaign defined. Administration of hydrocortisone in septic patients without the neuroma of the stamp correlates with lesions of the area surrounding the fora- adrenal dysfunction is a matter of debates. mina responsible for the dermatom which corresponds to that neuroma. The ad- Administration of steroids carries the risk of potentiate the infection, but on the ministration of lidocaine, not only relieved the stump pain, but also improved the other side the adrenal dysfunction during sepsis is well reported. Recently the healing process of the wound. Based on this observation, we have assessed with polyclonal immunoglobulins seem to reduce the mortality of septic shock. The CT-Scan all our neuropathic pain patients, with infected post-operative wounds, efficacy of drotrecogin alpha activated has been demonstrated, but several trials diabetic wounded foot, diabetic and vascular gangrene, post-operative neuroma raised controversies regarding this treatment. New treatments as for example TNF and postoperative allodynia, in order to study the peri nervous area in the vertebral segment blocking agents (lenercept, afelimomab) are under conducting studies foramina. (in every case) It resulted the presence of a correlation between pain The administration of Vit C seems to have promising results. The illness promo- reliever, regional neuro-vegetative reaction, healing proces and lidocaine admi- ting dysbiosis must be corrected using microbiomes. Gut injury is one of proposed nistration in the affected corresponding foramina. We emphasize that changing the model for causing or promote sepsis. Vasopressin has gain popularity although feature of the foramina, in fact we are changing the projection of a process. noradrenaline remains the first line choice. The ICU physicians need to have knowledges regarding Sepsis Surviving Campaign. Although the novel therapies, OP130 - The continous renal replacement therapy indications in ICU, the the sepsis treatment hallmarks are aggressive fluid administration, stable hemody- American Hospital experience namics, supportive care of other organs, and infection treatment. A.Abdyli, G.Huti, B.Arapi, R.Kortoci, J.Peci, A.Papa, R.Domi CRRT remains one of the commonest procedures in intensive care unit (ICU) and OP132 - Prediction of postoperative respiratory complications following up- despite the treatment approaches, the mortality of acute kidney injury remains per abdominal surgery in patients with chest x-ray abnormalities,obesity and still high up to 50% when encountered in ICU. Hemofiltration is one the options smoking as the strongest preoperative risk factors and impact on hospital of renal replacement therapy (RRT) offering several beneficiaries to the patients. utilization,healthcare costs and patient mortality Material and Methods: We summarized the literature data and compared with our E.Kazazi, A.Marta, R.Saliu ICU experience close American Hospital, Tirana. PRCs following upper abdominal surgery as atelectasis,pneumonia,pulmonary ede- During the period November 2017-June 2018, we have applied CRRT (using Pris- ma,acute respiratory failure varies from 6%-60% depending on risk factors and pa- ma flex) in 34 patients mainly for acute renal failure, but in 4 patients for sepsis tient population studied.We aimed to determine the influence of chest x-ray abnormal- and inflammatory conditions. There were recorded all the hemodynamic parame- ities,obesity and smoking as the main preoperative risk factors on PRCs. ters, urinary output, creatinine clearance, blood levels of creatinine and BUN. Materials and Methods: This is a prospective study of 110 patients that are preo- Results: The listed literature indications of CCRT are several affecting the patients’ peratively enrolled from year of 2014 to 2016 using these variables:chest x-ray morbidity and mortality. Out of 34 patients, only 2 of them remained hemodialysis abnormalities,obesity,smoking,age,clinical signs,ASA class,FEV1 and FEV1/FVC depended. Every intensivist must know in detail CCRT modes, the indications, ratio,cardiovascular disease,positive cough test,placement of a nasogastric tube.All and advantages over the intermittent renal replacement therapy. patients are reassessed with pulmonary examinations after operation and 25(mean age 62 years,males 52%)suffered a PRC within 7 days of surgery. They were compli- OP131 - New concepts and debates on Sepsis cated with pneumonia(15),atelectasis(4),pulmonary edema(4) and acute respiratory B.Arapi, G.Huti, A.Abdyli, R.Kortoci, A.Papa, J.Peci, M.Dhima failure(2). All patients have received appropriate doses of pancuronium according to Sepsis presents one of the major issues of modern practice in Intensive Care the protocols.Patients were followed at postoperative days 1,2,3,7 and at discharge Unit (ICU). This syndrome contributes in increased morbidity, mortality, and from hospital at a maximum postoperative day 12 for PRCs. prolonged hospital stay. Nowadays the multi-resistant drug pathogens are dra- We presented a strong association among 3 preoperative risk factors in patients who matically increasing, and the medical efforts in ICU as well. This material undergo upper abdominal surgery. tends to summarize all the new concepts and debates on sepsis topic in ICU. Chest x-ray abnormalities is the most significant factor that when is associated with

142 143 Anesthesiology & & Anesthesiology Intensive Care

smoking and obesity PRCs are more likely to happen.Obesity doesn’t induce any PRC OP135 - Non surgical complications related to hysteroscopic surgery in patients ASA 2 younger than 60 years without risk factors.PRCs are recorded in J.Peçi, A.Papa, B.Arapi, G.Huti, R.Domi all patients over age of 60 with 3 predisposing factors and other systemic disease. Like every surgical intervention, also the hysteroscopic interventions can be as-

Intensive Care Intensive sociated with complications; surgical and non surgical. Surgical hysteroscopic Anesthesiology & OP133 - Desmopressin for Cardiac Surgery interventions generaly are easy and safe, resulting very rare in complications. Alt- G.Huti, B.Arapi, A.Abdyli, R.Domi, R.Kortoci, J.Peci, A.Papa hough hysteroscopy is not used as much as it should be used. Recognition of this Bleeding is one of the commonest complication after cardiac surgery. It presents complications will reduce their incidence and related consequences, transforming a great challenge to the surgical team and can contribute in increased mortali- hysteroscopy in a much more safe intervention. In this article we focuse on the non ty and morbidity after cardiac surgery. The patients are often under clopidogrel surgical complications of surcical hysteroscopy reported in the literature and those and in emergency surgery there is no time to stop this drug. In this situation the performed in the American Hospital Tirana durin 2012 – 2018. risk for postoperative bleeding can be increased and it is recently reported in the In these 6 years, 390 hysteroscopic interventions were performed. In 311 of them literature that desmopressin can reduce bleeding and transfusion requirements. monopolar hysteroscope was used and in the remaining 79 cases, bipolar hyste- This is a descriptive, non-randomized, prospective study. roscope was used. Overall 8 major complications and none minor complication 31 patients are enrolled in the study, scheduled for urgent CABG and under clopi- were registered. In the groupe of bipolar hysteroscopy no complication was noted. dogrel. We use desmopressin 0.4 mg.kg-1 to reduce postoperative bleeding. There The incidence of these complications among our interventions is comparable with were recorded all the hemodynamic parameters, hematocrit, hemoglobin levels, the one reported in the literature. Implementation of a protocol in the management bleeding amount in first 24 hours, and the transfusion requirements after cardiac of distension media and the communication between surgeon and aneshesiology is the key in reducing the complications. surgery. Out of 31 patients, 3 of them required blood transfusion after the surgery. The- OP136 - What’s new for antiplatelet therapy in patients with coronary stents re were not recorded any cardiac, pulmonary, and metabolic disturbances. undergoing non-cardiac surgery. Desmopressin seems to reduce bleeding after cardiac surgery, minimizing blood M.Bilaj, B.Jata, A.Nona, B.Arapi, G.Huti, R.Kortoçi, A.Bako, R.Kaza, I.Kulari transfusion, costs, and enhance the patients prognosis. Recently the correct preoperative management of APT in patients undergoing NCS is often debated. Patients with recent coronary stent implantation (CSI) un- OP134 - Anesthesiology and Intensive Care dergoing NCS are challenging for anesthesiologist.The last up-date ACC/AHA I.Jusufi, A.Hasani, Z.Zeka, F.Mucolli guidelines recommend delaying NCS ,14 day after balloon angioplasty, 30 days Cell salvage is the process by which blood from the surgical field is collected, fil- after BMS and at least 3 months and ideally 6 months after DES placement. tered, and washed to produce autologous blood for transfusion back to the patient. Current recommendation are based on evidence suggesting reduced risk of STH A recent Cochrane review reported that cell salvage reduced the requirements for with new generation DES stent. allogeneic transfusion by 40% without causing cardiovascular, neurological, and The goal of this presentation is to recognize the risks/benefit of continuing and immunological adverse clinical outcomes. Cell-salvaged blood contains no plate- discontinuing of APT in such patients and to present our experience at American lets or coagulation factors; therefore, in cases of massive haemorrhage, it is likely Hospital. A retrospective study of 60 patients undergoing NCS between,2014- that the patient will require allogeneic (donor) blood components, for example, 2016 was performed. The patients were selected depending on the type and timing platlets, fresh-frozen plasma, and cryoprecipitate. of surgery and CSI. Retrospective comparative study. Two groups 40 patients undervent cardiac sur- There were 34 men and 26 females , average age 64y.(range 38-85y),emergency gery. First group 40 patients april-june 2017 without cell saver and second group surgery12 pt.(20%),elective surgery 48pt.(80%). The regime of APT was defined 40 patient april-june 2018 with cell saver. The aim was maintening of hemoglobin from cardiologist ,surgeon, and anesthesiologist according to last up-date ACC/ level of 9.0. At the first group we saw that we had 63 doses of heterologue blood AHA and ESC/EAPCI guidelines, depending to comorbidity ,the type of surgery, transfused. In the second group treated with salvaged blood we had only 6 units timing of CSI, risk and benefits of APT. of heterologue blood transfused. There is a very significant diference. Bridging therapy with LMWH was used. Standard GA was performed and re- The cost of treatment is cheaper.The risk of complication from heterologue trans- gional anesthesia was selected in some elective cases. Standard ASA monitoring fusion is reduced in maximum. and invasive BP monitoring were performed.The main features of anesthetic stra-

144 145 Anesthesiology & & Anesthesiology Intensive Care

tegy were to preserve the hemodynamic stability ,to prevent STH and bleeding. OP138 - Extracorporeal Membrane Oxygenation (ECMO) as extracorporeal In our study blood transfusion was required in 18 pt. (30%);The 10% of pt. under- life support device in intensive care unit. went re-exploration for bleeding. R.Kortoci, B. Arapi, R. Kaza, A. Bako, M. Bilaj

Intensive Care Intensive There was no operative death.No patients suffered from immediate STH in- ECMO is mode of extracorporeal life support that helps to increase oxygenati- Anesthesiology & tra-operatively. Patients were extubated in OR and average hospital stay was one on, ventilation and/or cardiac output through cannula connected to a circuit that week. Anesthesiologist play an important role in balancing the surgeons consent pumps blood across an oxygenator and back to the patient. Cardiopulmonary di- of bleeding and cardiologist concern of acute STH. seases outcome has been charged (positive) since when ECMO is used in “good We recommended that such surgical procedure should be performed in hospital hands”.We are talking about the cardiopulmonary diseases that are refractory to where catheterization laboratories are available 24/7, and the best communication the conventional therapy. There are promising data for using ECMO in acute hyp- between member of the team and the patient is crucial, to balance of risk and be- oxemic respiratory failure, cardiac arrest and cardiogenic shock and also potential nefit in all situation. indications continue to increase. This presentation try to discusses an existing literature. Of course the possible implementation in our Institution as leader in OP137 - Spinal anesthesia for cesarean section--safe and effective.Our expe- medicine of Albania. rience in American Hospital 2 M.Bajraktari, A.Koçi, E.Bekteshi, E.Bregasi OP139 - Postoperative complications following Neurosurgical procedures in Spinal anesthesia is a safe and effective anesthetic technique for cesarean section, American Hospital Tirana considering its simplicity, rapidity, accompanied maternal awareness and distri- R.Domi, B.Arapi, G.Huti, A.Abdyli, R.Kortoci, J.Peci, A.Papa, E.Agaci bution of anesthetic agents. It has distinctive advantages over general anaesthe- Neurosurgical procedures are of great importance for the anesthesiologist and sia1. Anaesthetic drugs and gases are costly and the latter often are difficult to often present a great challenge to them. These includes neurosurgery for brain transport. The costs associated with spinal anaesthesia are minimal. Spinal ana- tumors, and for neurovascular diseases. These patients are in majority admitted esthesia produces few adverse effects on the respiratory system as long as unduly in intensive care unit (ICU), and commonly the complications can be faced in 24 high blocks are avoided3. As control of the airway is not compromised, there is a hours after the surgery. Material and Methods: This is a descriptive and retro- reduced risk of airway obstruction or the aspiration of gastric contents. spective study conducted in American Hospital. We have recorded all the patients This advantage may be lost if too much sedation is given. Spinal anaesthesia pro- scheduled for neurosurgical and neurovascular procedures during the period Ja- vides excellent muscle relaxation for lower abdominal and lower limb surgery11. nuary 2018-June 2018, to evident the encountered postoperative complications. Blood loss during operation is less than when the same operation is done under Results: There were 51 patients undergone to neurosurgical and neurovascular general anaesthesia. procedures during the period January 2018-June 2018. 18 patients had a neurova- Hypotension associated with spinal anesthesia is a major concern in obstetrics. scular procedure mainly consisted in embolization of aneurisms, thrombectomy, Preventive methods for post-spinal hypotension include intravenous fluid preloa- and carotid stent replacements. None of these patients had new deficit persisting ding, bolus or continuous injection of vasopressors. Intravenous fluid preloading pre-procedure neurological deficits. 33 patients have had open craniotomy for brain reduces the incidence and severity of maternal hypotension during spinal anesthe- tumors, mainly for supratentorial tumors. No cardiovascular and pulmonary com- sia administered for cesarean section. lthough fluid preloading prevents maternal plication was recorded after the surgery, except one patients died from acute pul- hypotension, it is not advisable to delay spinal anesthesia for preloading a fixed monary embolism. There were recorded 2 patients with new postoperative deficit volume of intravenous fluid. (vocal cord paralysis, anisocoria, and hemiplegia). The patients were discharged on Ephedrine, the drug of choice to prevent maternal hypotension during spinal an- the 6-th postoperative day under neurologist and physiotherapist supervision. The esthesia for caesarean delivery, acts by maintaining the uteroplacental blood flow. check up within the first postoperative month was unremarkable. The neurosurgical Phenylephrine is also effective in reducing maternal hypotension during this pro- procedures are a great challenge to the anesthesiologist. The multidimensional team cedure. Both the vasopressors are acceptable for preventing hypotension. Howe- (neurologists, neurosurgeons, anesthesiologists, intensivists, and physiotherapeutic ver, in the absence of maternal bradycardia, phenylephrine is the preferred drug care) can guarantee the successful treatment of these patients and can reduce post- for the management of hypotension during regional anesthesia for caesarean sec- operative complications. The anesthesiologist must know the procedures details and tion, because of its improved fetal acid-base status. all the anesthetic implications for neurosurgical procedures.

146 147 Laboratory

OP140 - The history of thoracic anesthesia. Airway management for trachea OP141 - Our experience in the management of American Laboratory Network and bifurcation resection A.Daka S.Beqiri During a 15-year period at the American Hospital, the Department of Clinical -

Intensive Care Intensive Only the most simple intrathoracic operations were feasible before the 1930s. The Biochemical, Microbiological and Pathological Laboratory has successfully per- Anesthesiology & development of methods for securing the airway, isolating the lungs and selec- formed the laboratory support of ambulatory patients in the prevention and diag- tively ventilating one or both lungs have made lung separation safe and relative- nosis of various pathologies. The first laboratory network in Albania, certified by ly easy to achieve: 1949: Bjorck and Carlens described a double-cuffed, double ISO 15189; 2012, the highest quality standard. The laboratory offers a wide range lumen tube intended for intubation of the left lung; 1958: routine use of double of laboratory examinations: 1600 different examinations referring to world liter- lumen tubes for all intrathoracic operations, Jenkins and Clark;1959: White and ature and realization according to all international standards. Since its inception Bryce-Smith subsequently described double-lumen tubes for intubation of the this laboratory has been conceived and built with the latest technology in the field right-main bronchus. 1984: the use of high frequency jet ventilation, Hildebrand; of fully automated laboratory, of the most popular companies Roche Diagnostics, application of different types of bronchial blockers. Anesthetic management for Sysmex, Biomeriuex, Sebia etc. Currently, our list of associates has increased with trachea and bifurcation resection is a challenge that requires close cooperation the American giant in the field of laboratory technology, Abbott. The laboratory between thoracic surgeon and the anesthesiologist: endotracheal intubation with network is actually extended to 21 branches throughout Albania and still grow- subsequent crossfield ventilation is a widely chosen airway technique for tracheal ing. In the new premises we offer professionally constructed spaces to provide resections. For resection of the bifurcation, an extra-long endotracheal tube, that optimal conditions for patient services. Medical laboratory services are essential can be advanced into the left mainstem bronchus during initial dissection, is the to patient care and therefore should meet the needs of all patients and clinical per- most preferable approach. During the resection and anastomosis, ventilation of sonel responsible for human health care. ISO 15189, the first quality management the lung using crossfield technique with a separate sterile endotracheal tube al- ISO system for medical laboratories, provides a framework for the design and lows deflation of the diseased lung and easy placement of the anastomotic sutures. improvement of process-based quality management systems in all our medical In some cases, it is necessary to combine this procedure with high frequency jet laboratories. This accreditation has been a valuable help for all our laboratories ventilation (HFJV). The techniques and results of trachea resection for stenosis or centers to comply with regulatory requirements, to meet the expectations of our tumor have improved over time. Recent series have shown that trachea resection clients and, most importantly, to improve and maintain our service to patients. is relatively safe in experienced centers and can be associated with good long-term survival in selected patients. OP142 - Situation of Accreditation of Medical Laboratories in Greece The operative mortality rate ranges between 1 and 10 %, and re-operation rate A.Stathopoulou ranges between 1 and 12.3 %. Anastomotic fistula and dehiscence can be- pre The Hellenic Accreditation System (ESYD) is the sole National Accredita- vented by maximal mobilization of the trachea and precise preparation close to tion Body for Greece, recognised by government, to assess against interna- the lateral border without use of electrocautery. Departments of Thoracic Surgery tionally agreed standards, organisations that provide certification, testing, need very close cooperation with experienced and specialized centers. inspection and calibration services. ESYD is appointed as the National Ac- creditation Body by national Laws and the EU Regulation (EC) 765/2008. Moreover, ESYD is full member of the International Laboratory Accreditation Col- laboration-ILAC and of the International Accreditation Forum-IAF and signatory to the relevant Mutual Recognition Arrangements (MRAs) and Multilateral Agree- ments (MLAs). In the frame of EA’s Cross Border Accreditation Policy, ESYD also provides accreditation services in Albania, Lebanon, Armenia and Kazakhstan. Until now, 98 Clinical Laboratories have been accredited against the internation- ally recognized standard ISO 15189:2012 “Medical Laboratories – Requirements for quality and competence”, while 25 laboratories are in the process of Accredi- tation. From the accredited laboratories, 70% are Private Diagnostic Centers Lab- oratories, 22% are Hospital Laboratories and 8% belong to Institutes or Universi- ties. ESYD provides ISO 15189 accreditation to organizations performing various

148 149 Laboratory

types of tests and, more specifically, ESYD operates ISO 15189 accreditation in Storage of sample

Laboratory the following technical fields: The pre-analytical errors may occur in each phase . - Clinical chemistry Anyway studies show that 46-68 % of these errors occur during the Pre-analytical phase - Hematology In these study we used data collected from each branch of American Hospital. - Clinical toxicology We considered the results in a retrospective study of a 6-month period. - Molecular biology We collected data from results between: November 2017 – April 2018 in each - Human Genetics branch of American Hospital. We collected 65378 Laboratory samples, and the - Anatomical Pathology and Cytology results were: - Immunology 720 samples were inappropriate for screening or, 1.1 % of the whole samples were - Microbiology incl. Virology not tested at the laboratory. - Medical imaging 480 or 0.73% Hemolysed samples According to the EC REGULATION No 765/2008 “The particular value of accredi- 160 or 0.25% were clotted samples tation lies in the fact that it provides an authoritative statement of the technical compe- 80 or 0.12 % resulting insufficient samples tence of bodies whose task is to ensure conformity with the applicable requirements”. During this six month period from: November 2017 – April 2018 1.1 % of whole The need to drive up the quality of care for patients, whilst delivering efficien- samples collected were inappropriate for testing. cy and productivity, is a key principle for regulators of healthcare services. Ac- Abstract type: Oral presentation creditation can be used as a tool to support the commissioning or specification of medical laboratory services that are technically competent, safe and reliable, and OP144 - Management of medical laboratories as an Italian experience. that continually improve the experience for patients. In Greece, Accreditation is C.Rizzo increasingly being recognized as a valuable tool, across a wide range of Govern- The 21st century challenge is to redesign healthcare systems to be safe, efficient, ment policy areas, as it provides independent assurance of quality and safety that effective, timely, equitable and patient-centered. Although laboratory medicine is supports commissioning decisions to deliver better care and value for patients. integral to many of these objectives involving prevention, diagnosis, treatment, and managing disease of patients, it suffers from poor visibility as a medical dis- OP143 - Preanalitical errors in Clinical Biochemistry and Immunology Lab- cipline and as a profession and fewer rewards for educational efforts when com- oratory as an experience of American Hospital pared to other medical disciplines. B.Hyseni Clinical laboratories have undergone major changes due to technological progress Laboratory testing improves diagnosis and treatment outcomes in primary health and economic pressure in Italy this past decade. While costs of laboratory testing care facilities. Basic laboratory tests may assist in better diagnosis and early man- continue to be the dominant issue within the healthcare service worldwide, quality, agement. The correct values of Laboratory testing have an important role in di- effectiveness and impact on outcomes are also emerging as critical value-added agnosis The period from taking the sample from the patient and performing the features. Our Italian laboratories network are therefore promoting a network of correct test till the clinics takes the result includes three Phases excellence by investigating markers of effectiveness of laboratory services and 1 – Preanalitical Phase, the most important one includes sharing their experience of using them in clinical practice. In the present study we The correct test required report preliminary data on indicators of quality in all phases of the so-called total The correct identification of patient and sample testing process, the key to evaluating all phases of the total testing process, includ- Collection of sample ing the appropriateness of test requests and data interpretation. Performing the test required 2 – The analytical phase, includes all the process that is performed at the autoa- OP145 - Identifying pre-analytic errors and minimizing them nalizator. D.Trimaci 3 – The postanalytical phase, includes The clinical laboratory plays a vital role in the diagnosis, treatment and prognosis The retesting, if required of the patients. It is very important that the lab provides the reliability of the results. The reporting to the clinicict Significant breakthroughs in instrument automation, sample collection, transport Interpretation of the relut and delivery of reports have led to improved performance of the laboratories. The

150 151 Laboratory

laboratory analysis process is divided into three important phases: pre-analytical, ral; Specimen Storage; Specimen Disposal. Clinicians (including healthcare assis-

Laboratory analytical and post-analytical phase. The pre-analytical phase includes a number tants, nurses, doctors and professionals allied to medicine) have the responsibility of processes that are difficult to define, as they are developed in different places of using the correct procedure during the collection and safe transportation of sam- and at different times. The pre-analytical phase includes all the processes, from the ples to the laboratory. Microbiological tests are not as standardized as some other time of the test request to the physician, until the sample is introduced for analysis. lab tests; the way in which a sample is processed and the results are interpreted de- The main processes to be considered in the pre-analytical phase study are: selec- pend significantly on the information provided with the specimen. Collaboration tion of tests, patient preparation, collection, handling and transport of samples. between Clinic- laboratory must be very strong. Aerobic bacteria - cotton, Dacron Most errors affecting the results of laboratory tests occur at the pre-analytical stage or alginate is acceptable Anaerobic bacteria – tissue or aspirate is recommended. (42-68.2% of the total error), while a high error rate (18.5-47% of total errors) is Resist placing swabs into Surgery. Only anaerobic transport. Chlamydia - Dacron also found in the post- analytical. or alginate not cotton. Cytobrush is specimen of choice. No wooden shafts Fun- The objectives of the study were: gi- swabs not recommended Viruses- cotton or Dacron not alginate. No wooden 1. to perform the categorization of the pre-analytic errors shafts or charcoal The laboratory must receive a specimen that is representative of 2. to determine the frequency and the percentage of errors the disease process. Also, there are sites of infections where the specimen is like- 3. to take remedial measures to prevent and improve the pre-analytical errors in ly to become contaminated during collection: Middle ear → External ear canal; the future. Lower respiratory tract → Oropharynx; Nasal sinus → Nasopharynx; Bladder → The study was conducted at the Central Laboratory of the American Hospital. Fle- Urethra and perineum; Endometrium → Vagina; Superficial wounds → Skin and botomies of outpatient and inpatient were performed by nursing staff. The study membranes; Fistulae → GI tract.Contamination of samples, especially those from was conducted during the period (April 2016 to April 2017) in 51,000 samples. normally sterile sites such as blood or cerebrospinal fluid, leads to misleading re- By arriving at laboratory labs, the laboratory technician visually checks them for sults, inappropriate antibiotic usage and unnecessary laboratory work. Prolonged a problem and records them to the pre-analytical errors register. Incorrect samples periods of storage at ambient temperature and delay in transport of specimens presented the following criteria: incorrect blood-anticoagulant volume, incorrect to the laboratory may increase the number of contaminants present. The biggest identification, hemolysis, lipemic, and coagulant. problem is accepting every specimen. This occurs mainly because laboratorians Of the 51,000 samples analyzed, it was found that 1020 samples were rejected due either are afraid or have no support to say “no” to physician or to reject the speci- to non-completion of the preliminary conditions. men that was inappropriately selected, collected or transported. This is indicating • Percentage of pre-analytical errors in our laboratory was found 2.0% that there is little support for promoting quality in microbiology. Pre-analytical laboratory error plays an important role in achieving accurate re- sults. This stage is responsible for most laboratory errors. Applying ideal phlebot- OP147 - Internal Quality Control – the Way to Achieve Laboratory Goal – omy practices, patient preparation, sample handling and transportation is a prereq- Valid Patients’ Results uisite for the efficacy and accuracy of laboratory test results. The frequency, type, P.Łuszkiewicz and percentage of these errors should be identified and corrective actions should Internal Quality Control is a key process to the release of patient results, in order be taken to minimize them. to improve their quality. Two components are needed to report valid patients re- sult: Analytical System and Quality System. Based on required Quality Specifi- OP146 - Appropriate collection of Microbiology Specimens to avoid preana- cations (Performance Goals) for each analyte Total Allowable Eror(Tea) needs to lyticaly errors be defined. Every laboratory measurement is subject of two errors- random error O.Petri, A.Daka, A.Angjeli, I.Marku, V.Isufaj, B.Hyseni, L.Marku expressed as Standard Deviation and systematic error expressed as Bias. Combi- Microbiological laboratory testing has a key role in the management of patients nation of these two errors is expressed as Total Analytical Error(TAE). The judg- with infection and guiding optimal antimicrobial therapy. Microbiology labora- ment of validity of any patient result is based on comparison of Total Allowable tory results that are accurate, significant and clinically relevant depend almost error and Total Analytical Error. The am is to get TAE

152 153 Nursing Nursing Forum 1 Forum

OP148 - Parathyroidectomy as a treatment of Secondary Hyperparathyroid- Materials and methods : This study is conducted as a case report. The data are Forum 1 Nursing ism in Hemodialysis patients obtained from the medical file, nursing file, anamnesis data , notes by doctor’s A.Zeka, E.Hysa, Y.Ruko, E.Alla and the staff who took care about him during hospitalization. Patient I.M, age72 Renal hyperparathyroidism (HPT) is a common complication of chronic kidney from examinations carried out in the hospital especially coronarography conclud- disease characterized by elevated parathyroid hormone levels secondary to de- ed than he is diagnosed SAK x 3 vessels followed by CABG x 3 vessels By the rangements in the homeostasis of calcium, phosphate, and vitamin D. Patients coronarography results than: LMCA ; calcified tiles that it causes stenosis of the with (HPT) experience increased rates of cardiovascular problems, bone disease extensor 90 %, LAD : long atherosclerotic plaque that begins in the commune and soft tissue/vascular calcification. It is recommend that screening and - man trunk and extends along the proximal segment of the LAD , causing stenosis 75 % agement of (HPT) be initiated for all patients with chronic kidney disease stage 3 other segments with wall irregularity. LCX : stenosis 50 % – 75 % in the origin; (GFR <60 Ml/min1.73m2).Improving medical management with vitamin D ana- other segments with wall irregularity. RCA : stenosis 75 % in the origin ; other logs, phosphate binders, and calcimimetric drugs has expanded the treatment op- segments with wall irregularity descendent posterior branch present stenosis 90 tions for patients with (HPT), but some patients still require a parathyroidectomy % in the origin. The nurse care about this patient because of the paraplegia and to mitigate the sequelae of this challenging disease. co morbidity is a bit special. In the post-operative period the nursing care should We report here a case of severe secondary hyperparathyroidism (SHPT) in a he- be more detailed, continuous monitoring of vital signs to avoid cardio-pulmonary modialysis patient treated with phosphate binders, calcitriol and calcimimetics but complications, respiratory exercises and physiotherapy, pressure ulcers care and still the Parathyroid hormone (PTH) was 2575 and was nessecery parathyroidec- the passive mobilization of decclive and upper extremities was decisive to insure a tomy. The patient is 53 years old and has 10 years in hemodialysis. Before the fast recuperation, the patient was realeased by the hospital the eighth day after the parathyroidectomy he had this laboratory results: PTH 2575 pg/ml(normal range surgery with the adeguate recomandations 15-65), hypercalcemia 11.4 mmol/l(normal range:8.8-10.2) ,phosphorus level 7.58mg/dl(normal range 2.7-4.5) and vitamin D 14 mg/ml. Thyroid ultrasound OP150 - Management of Needle Stick Incidents in American Hospital Health- revealed a parathyroidien adenoma.In 30 November of 2017 he had the surgery care Staff and after the parathyroidectomy he had these lab. PTH 566.5pg/ml, calcemia A.Deda ( Kola), E.Cako, A.Plaku, J.Pellumbi 7.1mmol/l, phosphorus level 3.3mg/dl and vitamin D 26 ng/ml. Our patient had Workplace exposure with exposure to the skin, mucus to accidental needle stick clinically significant improvement after the surgery PTH, calcemia and phospho- constitutes a serious problem for the health of health care staff. Accidental blood rus levels were lower than before the operation.In dialysis patients with severe contact as a result of drilling with sharps, needles / scalpels increases the likeli- secondary hyperparathyroidism (SHPT), medical treatment may fail and parathy- hood of HBV, HCV and HIV transmission to health personnel. As far as health- roidectomy (PTX) is indicated for definitive treatment. Severe hypocalcemia from care-related issues are a concern, the Albanian Government has drawn up a guide hungry bone disease or postoperative hypoparathyroidism may occur during the and relevant forms to report and management of health care associated incidents, postoperative period.After the surgery is required special attention in the postop- giving priority to patients and not involving enough staff and occupational risk of erative period even though the patient had less pruritus and less bone pain. exposure. This paper aims to highlight incidents of incidents during working hours of the OP149 - The Vessel Coronary Bypass in a paraplegic patient staff in AH and measures taken to further monitor and prevent the transmission of A.Stafa , V.Cami , E.Leka, V.Memeti , A.Camaj ,V.Fasho , E.Barjami , A.Kumaraku infections by the patient to the staff members Is the paralysis of both feet which appear after the backbone of the spinal part This topic is a transversal, descriptive study. damage that divides in two parts the upper motor neurons. Coronary Bypass : Is The study was conducted in AH for the period January 2017 - July 2018. During the surgical procedure which is done with the aim of eliminate angina and reduc- this period in SA with 550 staff under the dependence of the Head Nurse Office, ing the risk of myocardial necrosis from coronary hypo perfusion. 13 cases of needle stick where reported during the care of the patients (0.023%). During this procedure shunts are placed taking arteries (mammary artery) or Statistical comparison with other hospitals in Albania is impossible due to lack of veins (saphena magna) of the patients to insure the myocardial blood perfusion. data but compared to the WHO statistical data 0.057% of personnel exposed to This paper aims to present a clinical case hospitalized in cardio surgery ward for needle stick are far below. 3 cases were reported in 2017 and 9 cases in 2018. Of intervention. The patient was diagnosed with SAK x 3 vessel, the patient was also which 6 reported cases have been in contact with blood of the HCV patient, 4 cas- paraplegic from 20 years and has many co morbidities es of HBV and 2 cases are not known whether the patient has been infected or not,

154 155 Nursing Nursing Forum 1 Forum

because the after needle stick is carried out while sharps containers closure and Conclusions: Increase the awareness of health personnel about the fall of the patient Forum 1 Nursing transportation to the temporary storage site. 1 case reports HBV patient’s blood by carrying out education on this subject. To ensure the safety of the patient, ap- conjunctivas exposure. For all cases was followed the protocol-reporting, regis- propriate rules and protocols should be established in accordance with the law and tration, examination, follow-up with analysis for 6-month regarding HCV blood regulations . The patient and relatives should be educated about the fall prevention. contact. HBV blood contact reporting, registration, examination, immunization, and follow-up for 3-6 months. None of them resulted in suspected viral infection OP152 - RIRS as innovative surgery and advantages compared to open surgery. received by the staff within this period. Accidental sharps exposure and needle E.Gjika, E.Rapo, D.Hysa, A.Bicaku , E.Alimema, E.Memia, E.Hoxhaj, K.Duli stick at work is a rare phenomenon in AH and totally avoidable. In case of acciden- Retrograde intrarenal surgery (RIRS) is the latest revolutionary kidney stone tal puncture during the care of AH staff, it is subject to all necessary precautionary removal technology. It treats the condition without the need of open surgery care procedures after exposure. or percutaneous nephrolitotomy, but instead uses a flexible laser urethereosco- py. This is the fastest way to fragment and remove stones. RIRS is used as a primary treatment in patients with kidney stones smaller than 2cm. Recent de- OP151 - Fall risk assesment in hospitalized patients in American Hospital velopments and innovations in flexible ureterorenoscopes and auxiliary -devic and inspection of measures for fall prevention and patient safety es have made this procedure easier and more effective with increasing levels of E.Cako success. This procedure was first performed at the American hospital in 2015. “Fall” is a condition when a person has a loss of control and balance due to illness The presentation of RIRS advantages compared to open surgery and nursing care and consequently finds himself in the ground immediately. According to the Joint procedures with patients undergoing intrarenal retrograde surgery (RIRS) as a Commission International (JCI) (2016), the fall of the sick is one of the areas of new method at the American Hospital II. This paper is conducted as prospective, primary concern in the objectives associated with the safety of the patient. Also in case-control study. The study was performed on forty-one operations carried out at our country regarding the prevention of the fall of the patient has been published the American Hospital II during the period from 2016 - May 2018 and the results the relevant instruction and is also designated as one of the objectives regarding was compared to those who underwent open surgery. Out of 41 patients, 19 were the safety of the patient. Female and 22 were Male. The average age of the patient was 47.6 years. The factors associated with the fall are divided into; individual risk factors and The average weight was 79.5 kg. The average stone size was 1.1cm. The postoper- environmental risk factors. Individual risk factors: walking and balance problems, ative recovery period of the patients who underwent this intervention is an average hypotension, dizziness, previous history of fall, use of psychoactive drugs, fear, of 2.3 days in the hospital. All patients were placed on a DJ stend which was kept impairment of ability, muscle and neurological disability, dementia and vision for an average of 28 days. Secondary surgeries were made in only 2 cases. Special problems. Environmental Hazard Factors: Wet floors, door thresholds, bathrooms, cases are 2 patients with 1 unique ren. The role of the nurse is very important lack of places to catch a person near the bed or toilets, poor lighting, placement of and begins the moment the patient is admitted into the hospital and continues non-static objects on the floor and the surrounding environment, use of inappropri- through the preoperative and postoperative period, until the moment the patient is ate shoes.In our country there is no statistical data about hospitalized patients fall. discharged from hospital. Conclusion: Compared to open surgery, RIRS has less From fallen patient; a large number ends to the death of the person,or with severe postoperative consequences for the patient, shorter hospitalization, faster post- pelvic fractures/ femoral head fractures, with other fractures and intracranial trau- operative recovery and the faster daily activity return. Keywords: RIRS, kidney ma. In the United States, according to the 2007 report of the Joint Commission on stone, flexible ureterorenoscope. Stand DJ Accreditation of Healthcare Organization (JCAHO) in American hospitals, the falls are noticed in 0.17-2.5% of the number of patients, while in Germany was OP153 - Continuous education among nursing staff- management of hyper- 3.7%. According to JCI (2016) to help prevent the fall of the patient, it is necessary glycemia in hospitalized patients in non-critical care setting to make the assessment of the risk factors in relation to the medications it uses E.Gjoshe; M.Lusha; R.Kosta. and the other risks, then their avoidance. An effective fall prevention program can Diabetes is a prevalent metabolic disorder that affects more than 415 million people reduce more than 50% the number of fallings. globally. People with diabetes are more likely to be hospitalized and to have longer The study is retrospective. The number of fallen patients in our hospitals within a durations of hospital stay than those without diabetes, usually admitted to a hospi- year is 12 (0.09%) of 12731 hospitalized cases. Of these 41.6% are Females and tal, for treatment of conditions other than the diabetes. The prevalence of diabetes 58.4% are Male. The average age of the fallen patients in the study is 52.6 years. rises with increasing age, as does the prevalence of other diseases; both factors in-

156 157 Nursing Nursing Forum 1 Forum

crease the likelihood that an older person admitted to a hospital will have diabetes. ber 2017 period, it was evidenced that the most atrial fibrillation population is: Forum 1 Nursing Hyperglycemia, defined as a blood glucose greater than 140 mg/dl (7.8 mmol/l), Male gender, 70-79 age group, Acute coronary syndrome (SAK), The most fre- is reported in 22-46% of non- critically ill hospitalized patients. Extensive data quent type of AF was persistent. Most of them were converted with amiodarone ( indicates that inpatient hyperglycemia, in patients with or without prior diagnosis 90%). The most effective treatment is cardio-version in persistent and paroxysmal of diabetes, is associated with an increased risk of complications and mortality. AF in the paroxysmal and permanent AF. Atrial Fibrilation is the most common More recently the American Diabetes Association has relaxed the recommenda- complication in patients after coronary stent placement, with adequate manage- tion to a target glucose between 140 mg/dl (7.8 mmol/l) and 180 mg/dl (10.0 ment and treatment often without major consequences for the patient. mmol/l) mg/dl for most general medicine and surgery patients in non-ICU settings. Insulin is the best way to control hyperglycemia. Implementing a standardized OP155 - The crucial role of monitoring in ICU in patient with cerebral coma sc insulin order set promoting the use of scheduled basal and nutritional in- - Case report sulin therapy is a key intervention in the inpatient management of diabetes. K.Metalia, A.Zalla, J.Myftari, M.Shehi, B.Myrto Recognizing the importance of glycemic control, viewing the management In critical care the monitoring is essential to the daily care of ICU patients, as the opti- of inpatient hyperglycemia as a quality-of-care measure, the AACE, ADA and mization of all parameters is the key to improve patients survival. This monitoring to the the ESE, joined forces to develop an updated consensus statement on inpa- patients of ICU usually includes : Continous Vital Sigs monitoring, fluide balance, daily tient glycemic management. The central goals were to identify reasonable, weight , acid-base equilibrium, neurologic status and value of bispectral index (BIS) in achievable, and safe glycemic targets and to describe the protocols, proce- assessing the depth of sedation in sedated and mechanically ventilated ICU patients . dures, and system improvements needed to facilitate their implementation. However the most decisive endpoint is the oxygen support through tissues and monitor- This material is worked focusing on the need for continuous education of the nurs- ing in real time oxygen saturation, also measuring pO2 through blood sample of blood ing staff. For the development of this material are used certified medical literature gas analyse. So, the oxygenation and oxygen perfusion of tissues allows ICU staff to per- from The American Diabetes Association (ADA), American Association of Clini- form and manage adequately in time several complications. Regarding to patients under cal Endocrinologists (AACE) and European Society of Endocrinology (ESE). mechanic ventilation includes serial assessments of gas exchange, respiratory system mechanics. The maintenance of normal temperature is critical and should be regularly OP154 - Atrial fibrillation as a complication in cardiac disorders in patients monitored . Nutrition and acid base equilibrium stays on ICU staff focus in order to reach hospitalized without rhythm disorder as primary diagnose a full patient recovery. This paper aimed to present the importance of adeguate moni- E.Xhameta, I.Bozha, M.Xhixha, F.Hoxha, A.Zekthi, E.Gojdeshi toring in ICU unit of a comatose patient in the recuperation after a cerebral STROKE. Atrial fibrillation is the most common complication of heart disorders it is an ir- regular and often rapid heart rate that can increase risk of stroke, heart failure and OP156 - This paper is conducted as case report, the patient was hospitalized other heart-related complications. in ICU during the period 22/05/2017-15/06/2017 Atrial fibrillation symptoms often include heart palpitations, shortness of breath Woman 65 years old , hospitalized in ICU with diagnosis : Cerebral coma , Acute and weakness. It may lead to complications. Atrial fibrillation can lead to blood hepatic failure , Acute pulmonary failure , Acute renal failure , sepsis . clots forming in the heart that may circulate to other organs and lead to blocked Stayed under ICU monitoring for 25 days . The condition was severe when she blood flow (ischemia). came at ICU, intubated ,without feedback but improved over the days . She stayed Treatments for atrial fibrillation may include medications and other interventions intubated for 16 days ,then percutaneous tracheostomy procedure was carried out to try to alter the heart’s electrical system. The patient discharged from hospital with normal liver function , normalize renal Purpose: The purpose of this topic is to identify the atrial fibrillation as complica- and pulmonary function , conscious ,normal hemodynamic status , with no motor tion in patients hospitalized in cardiology ward for heart disorders without rhythm deficits but has been mobilized with the help of staff . Initially fed in the parenteral disorders as primary diagnose. route then by SNG and finally by the mouth. As a result of the staff’s work the -pa This is a retrospective analytical nursing study of 6 months duration to evaluate the tient left the hospital in the improved condition with no deficiencies and decubitus risk factors for atrial fibrillation as complication in patients with cardiac disorders Monitoring is an ongoing and continuous process , provided by complex devices and the role of nursing care in patients with atrial fibrillation. In this study we have that require special training and experience to operate . Practitioners should be analyzed 60 cases where the diagnosis was confirmed by appropriate examinations familiar with the physiology and technology underlying these monitoring tech- Results: In 60 cases of atrial fibrillation analyzed in our study in the July-Decem- niques and be aware of the pitfalls in interpretation of monitored data .

158 159 Nursing Nursing Forum 1 Forum

OP157 - Evidence based medicine vs. Evidence based practice in the context cy of diagnosis, CCHD is missed 1 in 3 newborns. Pulsoxymetry screening is Forum 1 Nursing of patient safety a low cost, non invasive and painless bedside diagnostic test that can be com- M.Čivljak pleted by a technician just in 45 seconds. Many studies sow that pulsoxymetry Ensuring the safety of patients is a high visibility issue for those delivering health screening for CCHD has a less than 1%chance of giving false positive results. care in complex, pressurized and fast-moving environments.Acording to the WHO, Purpose-The aim of our study is to increase the pre-detection rate of newborns patient safety is the absence of preventable harm to a patient during the process of with CCHD before the symptoms appear. health care and reduction of risk of unnecessary harm associated with health care to an We prospectively enlisted well newborn term and near term infants from Jan- acceptable minimum. An acceptable minimum refers to the collective notions of given uary 2017 to June 2018.Near 24 hours of life , trained nursing staff performed current knowledge, resources available and the context in which care was delivered pulse oxymetry on the right hand and either foot, using an EDEN- H100B pulse weighed against the risk of non-treatment or other treatment. The practice of evidence oxymeter. Those with saturations >95% with 3% difference between hand and based medicine is hub to ensure that hospitals and other health care organizations foot measurements passed. Infants with saturations < 86% failed. Infants with protect their patients from errors, injuries, accidents, and infections. Evidence based saturations between 86-94% or ≥3% difference in saturations were tested again medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern up to 2 additional screens in room air with standard sea level protocol. Providers evidence in making decisions about the care of individual patients. The practice of were notified and echocardiograms ordered for all infants deemed to have failed. evidence-based medicine means integrating individual clinical expertise with the best A total of 1205 infants compleded the protocol. During 2017-0.7% of CCHD available external clinical evidence from systematic research. Cochrane Reviews are screening were made before 24 hours of life, 33.3% after the first 24 hour and internationally recognized as the highest standard in evidence-based health care and 26.7% of newborns have been discharged without CCHD screening. During 2018- they are regularly updated in order to incorporate new research, so that profession- 1.5% of CCHD screening were made before 24 hours of life, 34.3 % after the first als can base treatment decisions on the most up-to-date and reliable health evidence. 24 hour and only 2.3% of newborns habee been discharged without CCHD screen- There are five types of Cochrane reviews: 1) Intervention reviews (assess the benefits ing.We had only 1 case with CCHD (one ductus dependent) the CCHD screen- and harms of interventions used in healthcare and health policy; 2) Diagnostic test ac- ing could not discover. None of the infants fall the CCHD screening. Additional curacy reviews (assess how well a diagnostic test performs in diagnosing and detecting research is needed specifically addressing sensitivity and positive predictive value a particular disease); 3) Methodology reviews(address issues relevant to how system- for screening at moderate altitudes. atic reviews and clinical trials are conducted and reported); 4) Qualitative reviews Most of CCHD are ductus dependent and 30% could not discover by CCHD (synthesize qualitative evidence to address questions on aspects of interventions other screening. A second screening should be done at a second moment, maybe be- than effectiveness); 5) Prognosis reviews (address the probable course or future out- fore discharge. The sensitivity of our puls oximeter should be revised. come/s of people with a health problem) EBM has made a clear and probable perma- Key words: neonates, CCHD, pulse oximeter. nent mark on the face of medicine.Although evidence practice has gained momentum in many disciplines,it has especially attracted attention in nursing. Using the evidence OP159 - Effects and consequences that health personnel have due to the night to guide practice streamlines nursing care. Threfore the search of Cochrane library will –shifts work system. be conducted. The search strategy will combine terms for “patient safety” and “nurs- S.Dule ing”, in the title, abstract or keyword fields. The results of this search will be presented. Awareness of health personnel about the effects and consequences of working Abstract type: Oral presentation. on the shifts system and especially on night-shifts and the improvement of their quality of life. OP158 - Prospective study on cardiac screenings at the American Hospital Methodology: Knowing the Jet-Lag phenomenon: changing day-to-day and S.Beqiraj, M.Lleshi sleepy biorhythms. Who works on the shift system and in night-shifts, fights CHD (Congenital Heart Defects) is a potentially devastating diagnosis that ac- against his inner clock or his biorhythm. counts for 24% of infant deaths due to congenital malformations. CCHD(Crit- - Recognizing the effects of the work on the shift system and on the night shift in ical Heart Congenital Defects) affect 1.2 infant for 1000 live births in which physical and mental health of the health personnel as well as their impact on their surgical or catheter bassed therapy within the first year of life is mandotary. social life. The AHA (American Heart Association) has endorsed newborn pulsoxymetry - Determining and consuming a healthy dietary diet for the staff working on the shift screening to capture these infants prior to hospital discharge.Despite the urgen- system and the night- shifts in accordance with the biorhythm of their organism.

160 161 Nursing Nursing Forum 1 Forum

- Drafting and adaptation of the service plan according to the legal criteria and OP161 - Managing and Treatment of cases with measles in Kukes Forum 1 Nursing specific data of the health care staff working on the shift -system and on the night Y.Visha shifts. - Optimal fit of the lifestyle of the healthcare staff working on the shift-sys- This topic is taken in the study not only of the fact that measles is a viral disease vi- tem and in the night-shifts. rus, previously eradicated and returned to January 2018 and its complications have Any active healthcare provider on the shift-system and especially on nightly shifts high mortality but through population awareness, we aim to enable prevention of can significantly improve his or her life by identifying factors and causes first and her. The survey includes the period from 01.01.2018 to 31.05.2018, the source of then avoiding and minimizing the effect and consequences on physical, mental data served by the Department of Infectious Diseases at Kukes Hospital, Health health and social life and personal. Centers. It has been worked and studied since risk factors up to prevention and Conclusions:Working on the shift-system and especially in the night-shifts is a treatment. Notes on the age of patients, place of residence, gender, vaccination, tough job because at night the performance and human body skills are lower. complications, duration and results of hospital treatment were recorded. Although it is already known that work on the shift-system and especially on night Analysis of Measles cases,management at Kukes Hospital and Health Centers. shifts brings a high health risk, it is very little to mitigate its negative effects. From the outbreak of measles were affected 221 people of different age What each health worker should know is that work on the shift-system and espe- groups from these 73 cases were treated at home and 148 patients were hospi- cially the night shift significantly affects the whole day’s curtain. talized, male gender dominated 67%, age group affected was 16-20 years old, It condemns health and well-being and diminishes participation in social life. 44%, according to residence in the village was 73%, the month with the af- As a result of work on the shift system and especially in night shifts, it can affect fected was March 49%. Complications of upper respiratory tract occupy 30%. the loss of appetite, sleep disorders, nervousness of the gastrointestinal tract, the It was initially displayed in border villages with Kosovo. Hospital stay is not long appearance of tumors but also their social isolation. - Age generally reflects the period of post vaccination but with some unvaccinat- As the health personnel who work on the shift system and especially on the night ed cases. The population should be clarified and made aware of the importance shifts tell us and practice it, it is very difficult to find enough time for the partners, of vaccination, side effects, allergy to the eggs, widespread rumors about a link the family, and the society. between this vaccine (MMR) and autism. Nurses have a non-replaceable role in In cooperation and understanding, employers and health personnel can significant- vaccination, they should be trained for professional upgrading in order to be able ly mitigate the consequences of the work on the shift-system and especially on the to apply rigorously the vaccine calendar, cold chains, population awareness, life- night-shifts. Key words: Work on the shift system, work at night, Jet-Lag phe- long counseling healthier. Sero-epidemiological surveys are very important for nomenon, physical and mental health, high health risk, diet dairy, and service plan. assessing current gaps in seroprevalence of specific disease-specific antibodies.

OP160 - WHO Checklist - Saving Lives in Theatres S.Nela Remains one of the most significant public health issues with millions of people harmed worldwide. A considerable proportion of this harm is preventable. In 2009 World Health Organization Introduced theatres checklist and correct im- plementation of that principle demonstrated a significant reduction of complica- tion during surgery An interactive presentation will look at three stages of the checklist - before anaes- thesia, before incision and before the patient leave the surgery. Using real clinical cases and involving severe harm before, during and after sur- gery the audience will have an opportunity to “learn from mistakes”, reflecting on how correct use of checklist could help to prevent it. The audience will be introduced to the effect of the human factor in medicine and the role of each team member in the prevention of avoidable harm in theatres.

162 163 Forum 2 Forum Nursing Nursing

OP162 - Evaluation of the compliance of health care workers with hand hy- system (MiECC) and a dose/volume dependent cardioplegic solution. We present Nursing Forum 2 giene in American Hospital as the main method for the hospital acquired in- preliminary results. fections prevention. Since May 2017 we combined MPS and MiECC in cases with isolated CABG. A.Deda ( Kola), A.Shkembi (Plaku), E.Cako, J.Pellumbi Cardioplegic arrest was accomplished using warm blood Cardioplegia with 20 Nosocomial infections are defined as health care workers errors that remain an import- mEq/l potassium (K)/L blood (arrest agent) as well as 1.6 g/L (Mg) and 40 mg ant health problem. They are the cause of hospitalization, cost of treatment, antibiotic lidocain/L blood (additive medication) for a durable arrest. Data were collected resistance, and health legal issues growth. All health care staff should take responsi- prospectively. bility for preventing hospital infections, as that directly affects the quality of hospital Until December 2017 82 patients (24 female (17.07%), mean (standard devia- care. Hand hygiene is the simplest and most effective procedure for preventing hospi- tion, SD) age 66.9 (8.4 years)) were operated accordingly. 90% (n = 74) had a tal acquired infections and as such remains the subject of promotion and continuous three-vessel coronary artery disease and in 32% (n = 26) a left main trunk stenosis education of the AH staff. Concerning this topic, American Hospital became part of an was present. Majority of the patients received 4 or more distal anastomoses (4: n awareness campaign on the World Hand Hygiene Day on 05.05.2018 with the motto = 36 (44%); 5: n = 15 (18%)). Mean (SD) aortic clamping time and extracorporeal “Did You Performed Hand Hygiene?”, the same day 300 self-administered question- perfusion time were 67.5 (22.6) and 101.1 (31.9) minutes, respectively. 30-day naires were distributed to be completed by staff related to this topic. This study aims to mortality was 0% (n = 0). Median (IQR) high sensitive cardiac troponin T (hs-cT- assess the knowledge about Hand Hygiene and to identify the degree of compliance of nT) on the first postoperative day (POD) was 262 (194;402)ng/L and median (IR) health professionals with the five moments that require Hand Hygiene. peak hs-cTnT was 264 (194;402)ng/L. Median (IR) creatine kinase- myocardial The study carried out has descriptive and observational character. The question- type (CK-MB) on the first POD was 14.2 (10.5;22.7) μg/L and median peak CK- naire designed for assessing the knowledge of the staff in the SA was randomly MB was 14.2 (10.7;23.2).Median (IR) creatine kinase (CK) on the first POD and distributed to the staff in service in the hospital wards. Staff are supervised over median (IR) peak CK were 517.5 (389.3;849.8)U/L and 597.5 (455;943), respec- three hours during the official schedule for a four months period (March-June tively. The combined use of this cardioplegic formula with MPS® and MiECC in 2018). The observation was based on the compliance with five hand hygiene CABG is safe and feasible. With the final chemical formula cardiac arrest could moments and the degree of compliance was calculated. Analysis and Results: be reliably achieved. Remarkably low postoperative enzyme values indicate safe There were a total of 8,120 indicators of hand hygiene. 68% was found to be cardiac protection during surgery. in line with WHO indications. Occupational hygiene compliance was found to be 71% for nurses, 48% for doctors, and 37% for nurse aide. The hand hygiene OP164 - Management of nursing care of the central catheter based on evidence compliance was high (91%) before aseptic procedures and lower (56%) after E.Cako touching the patients surrounding surface in the hospital. It turned out that 54% Bloodstream infections, wich is related to the central venous catheter is one of of respondents where nurses, 23% midwifes, 15% doctors, and the rest, phys- the major infections of hospital-acquired infections with the hight diseases and iotherapists, imaging technician and sanitary staff. The data obtained was- ana mortality . In hospital that perform acute treatments ,Techniques are often used lyzed in Excel. 86% of respondents reported that they had received training on that require the use of venous catheter especially in intensice care. This review “Hand Hygiene” the last year. Hand hygiene and hygiene compliance of health- has been done with the intention that nursing staff and all the other health pro- care personnel is the first step in the Hospital Infection Control Program to pre- fessionals ,based on the evidence provide alternatives for applying and improv- vent hospital acquired infections. Based on the data provided by this study, it is ing treatement, to be effiecient , to improve safe, quality and cost effective care. planned continuous mandatory education 4 times per year on this topic, in addi- In this review was examined systematic review and evaluation to the preven- tion decontamination solutions containers where placed also in corridors, contin- tion of the infection in the blood stream, wich have been accessible and reached uous assessments, observation and extraction of results will be done periodically. very effiecient, well-evaluated and accepted conclusions by field specialists. Alternatives were introduced wich includes the procedure for diagnosing, treating, OP163 - A novel cardioplegic solution in combination with minimal and treating the central venous catheter. These are the main principles regarding extracorporeal circulation system MiECC in CABG surgery the entry of the central venous catheter, Taking blood samples from the catheter, B.Rrahmani, L.Koechlin, U.Zenklusen, T.Doebele, B.Gahl, F.S.Eckstein, O. Reuthebuch Taking blood samples from the catheter for blood culture. Keeping the catheter For better outcome in coronary artery bypass grafting (CABG) we combined the open(Swallowing , loching and closing of the catheter) myocardial protection system (MPS) with the minimal extracorporeal circulation Non – intra catherized catheter system, change of infusions sets and treat of the

164 165 Forum 2 Forum Nursing Nursing

area around catheter. Based on the questions raides at the conclusion of the as- OP166 - Adeguate Portacath Management and its Role on Patient Safety Nursing Forum 2 sessment of the national situation and clinical applications ,several proposals were during Chemotherapy Treatment at American Hospital Chemotherapy Unit presented. This review will help develop and treat more effectively with this topic. I.Zaimi, A.Isufaj Key words: Central venous, Catheterization, catheter-related infections, critical Portacath has recently been used as a preferred route for the administration of care, nurse based on evidence . chemotherapy, continuous therapy, in patients who have problems with peripheral veins. It is also very comfortable for the patients themselves because its puncture OP165 - Case report- FOSSA CRANI POSTERIOR TUMORS is not painful, the diaphragm is placed directly below the skin on the chest, and the E.Llausha, V.Muca, E.Benxha, E.Perlica, E.HAxhiu, E.Kurti, O.Hoxha, M.Mazia, catheter is placed in the superior cava vein at the entrance of the right atrium. It E.Piroli may be placed in radiology under CT by a radiologist doctor or through surgery in Nervous system tumors can originate in every part of its structure. There are pri- the operating room. The procedure lasts for about an hour. Through the portacath mary tumors that originate from oligodentrocytes, neuroblasts etc. The tumors can be given fluids or medications that would be very irritating to a peripheral that most often compromise the mental functions, cause aphasia and epileptic cri- vein due to their concentration or chemical composition. The normal lifespan of sis are multiforme glioblastoma, meduloblastoma, meningioma. These are also the door ranges from 3-5 years to being properly maintained. Studies show that the most common tumors. The main treatment of intracranial tumors is surgery, the use of portacath in the treatment and management of cancer patient’s results in total removal of the tumor is mostly done in cases of meningioma and neurino- shorter hospital stay, less time spent trying to access the vein, less trauma for the ma. Prognosis of these tumors is based in the types of the tumors that is removed small veins. Despite its importance and the profits of the patient’s is required by and its infiltrative activity, which is perscribed by histopathologyc examination. the staff good knowledge of portacath, manipulation and maintenance. Presenting a case that was hospitalized in our hospital diagnosed with “ Fossa Crani This paper aims to present the adequate management of portacath and its impor- Posterior Tumor” probably tectal glioma , and nursing care during the hospitalization tance in the patient safety receiving chemotherapy through it at American Hospital of the patient. This topic is conducted as a case report, the patient was hospitalized in II as an innovative method. It is descriptive-prospective study. It was conducted our hospital in July 2018. The information was taken by the medical files, the patient’s on 43 patients who received chemotherapy through the portacath at the American anamnesis, nursing care reports and medical notes. Male patient, 22 years old. He Hospital II January 2012- May 2018. Results: Out of 43 patients receiving che- came to our hospital for surgery after being diagnosed in Kosovo, with a formation in motherapy via Portacath, 10 were males (23.3%) and 33 females (76.7%). The fossa crani posterior 20*18 in size, after a MRI was done. The patient refers headache average age of 48.11 years. To all the patients was applied the porthacath care for a couple of months. He tried to treat it with analgesic but without improvement. At according CDC guidelines and protocols and after the chemotherapy session were first his condition had no other symptoms, normal vital parameters, no nuchal rigidity, closed with heparinized normal saline solution. After the end of the chemotherapy or any sensor and motor dysfunction. The patient undergoes surgery in 05.07.2018 treatment, they come to our unit every 3 weeks for portacath care. The complica- with median suboccipito -nuchal incision, where the formation was removed and a tions presented by the patients were minimal as a rush at the drilling site, one pa- cranial drain is placed. He stayed one night at the ICU and then he was transferred tient had tissue necrosis at the site of the portacath insertion and as a consequence at ward. A large amount of drainage has been noticed, so a CT scan post-surgery was he had the flaming of the port, this was noted by us when the patient comes for the done. We could see cerebral swelling and fourth ventricle›s hydrocephaly, which is first chemotherapy cycle the necrosis was present without the application of the seen in other CT scans done in the following days. Because of the drain, the patient chemotherapy through it. The nurse’s role involves careful monitoring and punc- was not mobilized, but he does passive movements of his extremities in bed. He had tuation of the portacath diaphragm, the management of chemotherapy through normal vital parameters, bradycardia 55-60/min. The patient had episodes of altered it, as well as after-chemotherapy maintenance of the chath. In our experience the consciousness. portacath patients had minimal complications and only one of them or 0.023% was During drainage, he complains of severe headache, despite his treatment. His con- subject of surgical removal and plastic surgery in the insertion zone. dition worsens with altered consciousness so he was transferred for revision at the operation room in 13/07/2018.There a clot was seen, the external drain is removed and OP167 - Identified extravasation, treatment and innovations for prevention an internal valve is placed to readjust intracranial pressure. in ICU - Case Report The following days the patient was stable. He was mobilized, the surgical wound is L.Paplekaj, E.Ismolli, A.Shehu, D.Pirra, I.Sulaj treated properly and he was discharged from hospital at 18/07/2018. After receiving Extravasation is the flow of infusions potentially harmful for the tissues out of the the biopsy result, the patient was recommended another neurosurgery consultation. veins, around the infusion site. Extravasation during the intravenous drug administra-

166 167 Forum 2 Forum Nursing Nursing

tion, constitutes a serious problem where regardless the drug, quantity or location the reported in 1978. Initially, IVF was indicated to bypass infertility in women with Nursing Forum 2 area could be red or irritated associated with pain and inflammation, and in the worst bilateral tubal occlusion. In later years, the indications and the use of IVF has mul- case the area could be necrotic!Presentation of two cases of extravasation treated in tified. Today IVF is used also in non-subfertile patients in order to avoid specific intensive care unit, American Hospital. Prevention of complications and extravasa- genetic diseases. IVF has been considered to be a medical procedure; however, tion wound healing in a short time without functional consequences for the patient nurses have had and always will have a central role. The specialist nurse is in This paper is conducted as a case report, our study includes two patients with ex- a unique position of being involved in patient care throughout the all the IVF travasation hospitalized in ICU in the AMERICAN Hospital between July 2017- cycle. This brings potential benefit for the couple, ensuring good continuity of July 2018. Male, Age 78, Diagnosis: STROKE, the patient was agitated. The fluid care which can increase their confidence, and may reduce their stress Acting as extravasation occurred in the first day after hospitalization, it was noticed 30 min coaches, guides, and support, in vitro fertilization (IVF) nurses assist patients in from iv starting. streamlining the processes involved in IVF. They coordinate diagnostic and treat- The fluid contained electrolytes the IV line was placed in the right- handdor ment schedules and educate patients and their partners about medication admin- sum. Immediately was done the first treatment and reported to the doctor the istration, testing preparation, and specimen collection. In this lecture we want to further treatment was conduct after the prescription with high productivity and stress the role of IVF nurse and to present our experience at IVF department of in a short period of time without functional consequences for the patient. Sec- American Hospital Tirana nr 2. ond Case: Female, Age 54, Diagnosis: “Chronic renal failure” under hemodi- alysis treatment for 6 months, comorbidity- Diabetes Mellitus under oral hy- OP169 - Strengthening the role of nurses and mames, poglicemiante treatment. The patient has hospitalized in QSUT where she has essential for improving health. a contrast extravasation after a contrast Head CT- scan. She was transferred M.Llavdaniti, K.Gudha, Ll.Koti for further treatment immediately in AMERICAN Hospital, complaining sev- For the first time in history, the population of people over the age of 60 exceeds the er pain and burning of the antecubital site where the IV cannula was placed. In number of children under 5 years of age.. The impacts of this change in terms of our hospital the patient underwent a CT- scan of the area to see the density and healthcare requirements and cost are enormous. Economic growth, modernization, the extension of the extravasation. Was consulted the Angio-surgeon. The re- urbanization have maximized the entry point for the spread of unhealthy lifestyles. sult was: Diffuse necrosis extended to the bone area. Was started immediately By 2050 it is projected to double the percentage of the global population over the the treatment after the doctor prescription for 3 months (2 weeks in our hospital age of 60 by 12-22%. Old age is characterized by complex health condition. and the rest was in another facility SUQU) tenting to avoid the amputation. But Nurses bring care to the communities where they are needed. They help to promote unfortunately for the patient this process was finalized in arm amputation. Af- and maintain the health, wellbeing of an aging population within the community. ter the amputation the patient continues the HD treatment in American Hospital. Contribute to reducing the mortality of newborn babies and mothers with their The treatment of advanced extravasation represents difficulties in healing and is role as innate care providers and neonatal care providers. They offer a wide range a challenge for the medical staff and the patient. Based on this study, it should be of hospital services, ranging from accident and emergency to palliative care. They given more importance to prevent the extravasation as a medical error using ap- are major factors in crisis and post-crisis situations, offering services ranging from propriate endovenous line gain procedures, after placement care. mental health trauma management and rehabilitation to post-emergence recovery. Respond to the health needs of people in all environments and throughout life ex- OP168 - The role of nurse during In Vitro Fertilization pectancy. Based on the facts, dynamics and global health trend, WHO and partners M.Kamberaj, I.Beta, S.Dashi, K.Dhima are undertaking actions and aligning strategies with global health trends. The role Infertility is defined as the failure to achieve a pregnancy following at least of nurses and midwives is critically evaluated in the achievement of global man- 12 months of unprotected sexual intercourse. Artificial reproductive techniques dates: Universal Health Coverage and Sustainable Development Goals. Nursing (ART) represents all treatments or procedures that include the in vitro handling and well-regulated nursing professions can transform the way health care is orga- of both human oocytes and sperm, or embryos, for the purpose of establishing nized, the way health care is provided. The World Health Assembly to increase a pregnancy. They are considered the most complex treatment of infertility. In the contribution of nurses and midwives to their achievements to make improve- vitro fertilization (IVF) is a process that includes controlled ovarian hyperstimu- ments in their education and services comprehensively including: health educa- lation, surgical removal (retrieval) of oocytes, fertilization in the laboratory, and tion, disease prevention, treatment and rehabilitation, palliative care, May 2000, transcervical transfer ofembryos into the uterus. The first live birth after IVF was has sought the preparation of action plans for the strengthening of nurses and

168 169 Forum 2 Forum Nursing Nursing

midwives. The Assembly provides the global strategic directions for strengthening uate depression in patients. The PHQ-9 it’s never used in Albania. The PHQ-9 Nursing Forum 2 nurses and midwives 2016 to 2020, to develop, implement and evaluate nursing is based directly on the nine diagnostic criteria from the Diagnostic and Sta- and midwifery achievements to ensure possible, accessible, acceptable, qualitative tistical Manual of Mental Disorders. Total scores on the Patient range from and safe interventions of nursing and of midwives at the global, regional and local 0-27 with five severity categories: ranges from 0 to 27 with severity- catego level. Vision overview, guiding principles, themes of “Strategic Global Strategies ries including: minimal depression, mild depression, moderate depression, for Strengthening Nursing and Midwives, 2016 - 2020”. Contribute to incorporat- ing the themes of the global strategy into our national health policies into national OP171 - Blood transfusion and nursing care and regional strategic policies for the development of nursing and midwives. R.Cela, M.Gremi, L.Ismaili, A.Dada The blood (lat. Sanguis) is a liquid conjunctiva, which with the help of the heart OP170 - Comparing the Patient Health Questionnaire-9 (PHQ-9) and Beck and blood vessels maintains the functions of other body organs through the trans- Depression Inventory (BDI-II) in assessment of depression in people living port of oxygen and nutrients. The human body contains on average 5 to 6 liters of with HIV/AIDS in outpatient clinic blood. If you’ve experienced severe blood loss or low blood levels, a blood trans- In Albania, 2018 fusion can help restore the blood you’ve lost. It’s a routine procedure that adds R.Dudushi, M.Dervishi, R.Bani, S.Bino, A.Harxhi donated blood to your own. However, it’s important that the blood is accurately According to CDC, (2017), HIV disease continues to be a serious health concern matched to your blood type. If the blood type is not a match, you can experience for parts of the world. Globally there were about 1.8 million new cases of HIV in a transfusion reaction. These reactions are rare, but they can be harmful to your 2016. About 36.7 million people were living with HIV around the world in 2016, kidneys and lungs. In some cases they can be life threatening. It is the duty of and 19.5 million of them were receiving medicines to treat HIV. An estimated the transfusion therapy practitioner to be knowledgeable of the inherent risks of 1 million people died from AIDS-related illnesses in 2016. As reported by HIV the adverse reactions to transfused blood products, their appropriate intervention, annual rapport of Institute of Public , (2017) the total number of and measures of prevention. is a retrospective descriptive study involving 100 reported people living with HIV in Albania is 1090 cases, at the same time projec- patients,(march2017-march 2018) who received blood transfusion. Of the 100 pa- tions estimate that the number of people living with HIV / AIDS in Albania is 1500 tients only 5% have a light reaction with dermatological symptoms. And 2% had cases.(UNAIDS, SPECTRUM 2016). ARV therapy have increased the lifetime the most severe reaction with dermatological and respiratory signs. of those living with HIV/AIDS, with expanded longevity and life expectancy, Close monitoring of all transfusion patients is imperative because the acuity and nevertheless, there is also a greater chance that a person living with HIV/AIDS final outcome of certain transfusion reactions is proportional to the volume of the may experience psychological symptoms associated with advanced HIV and/or blood transfused. may suffer from symptoms of depression. Due to the increase of HIV cases every year in Albania, mental health providers should supposed to come across clients OP172 - The performance of nursing care for vascular access among Hemo- who presents with HIV or AIDS. An important task of the mental health provider dialysis patients in hospital of Vlore is to use valid and reliable measure of depression in people living with HIV. The R.Lalo, J.Pazaj, M.Saro purpose of this article is to determine whether or not the Patient Health Question- Chronic hemodialysis treatment requires vascular access. Studies have shown that naire is a valid and reliable measure of depression in persons living with HIV. the most of readmissions of the hemodialysis patients have been due to problems The Patient self-assessment instruments are useful in screening, tracking, and at a vascular access site and the quality of care for it has been given little attention. documenting the course of depressive symptoms with minimal clinician time. To evaluate the performance of nursing care for the vascular access site in patients The research question in the article; is the Patient Health Questionnaire (PHQ- undergoing chronic hemodialysis in the Center of Hemodialysis in Regional Hos- 9) an effective assessment tool in measuring depression in persons with HIV/ pital of Vlore. AIDS? Research Hypothesis; is the PHQ-9 will over-identify persons who have This observational study was conducted among 50 patients undergoing chron- HIV/AIDS as being depressed when compared to the results of the BDI-II. ic hemodialysis in the Vlore’s Hospital during february-april 2018. Data were The study was conducted in Ambulatory Clinic at Infection Diseases Hospi- collected using a demographic questionnaire and a checklist related to vas- tal in Tirana. Two hundred sixty four people living with HIV were interviewed cular access care techniques. The score of performance of care was calculated using Patient Health Questionnaire (PHQ-9) and BDI-II. The PHQ-9 is a based on the second part of the checklist. To calculate the quality, zero scores nine item depression scale that is frequently used in the medical field to eval- were given for nonadherence and score 1 to adherence. The data were ana-

170 171 Workshop Neonatal Resuscitation lyzed using Chi-square and t-tests and descriptive statistics by SAS version 9.1. OP175 - Resuscitation of Newborn - a practical workshop for nurses Nursing Forum 2 Results: A total of 34 patients underwent hemodialysis through arteriovenous S.Nela fistula (AVF) and 16 patients through subclavian catheters (CVC). 24.5% of pa- Newborn resuscitation remains a challenging and in many cases an unpredicted tients with a CVC had the history of catheter infection. 47.3% of patients did not event. One of the significant problems surrounded resuscitation attempts is a poor perform regular limb exercises on the concerned extremity. Although the overall practical skill, team coordination and inconsistent knowledge of current guide- lines. Method: Introduction and practical workshop of fundamental principles of quality of care was at a moderate level, the performance of nursing care was better newborn resuscitation, particular in setting with lack of advanced equipment and in patients with CVC than in patients with AVF (p = 0.001). Needling near the medical support. fistula, and incomplete priming of the filter and the tubes were the most frequent The workshop will include a short presentation on anatomy and physiology of inappropriate actions. The moderate performance of care, can illustrate the need newborn, following by 4 stage approach in the airway management, breathing as- for retraining the hemodialysis nursing staff and developing a standard protocol sessment and chest compression when dealing with an unwell newborn child using for vascular access to improve care techniques. current European guideline. Result: The station will provide an overview of the practical implementation of OP173 - Physical therapy in the postoperative of proximal femur fractures resuscitation guidelines of a newborn, and will identify further learning needs of S.Veizaj, A.Lako, E.Mone candidates. Simulation practice may help junior staff to gain confidence and estab- lished their role in the resuscitation team. The purpose of this randomized study is to evaluate the effect of physical therapy

after osteosynthesis, restore daily physical activity Randomized experimental study for a period of 1 year. I got together cases and patients that involved in the first group, conducted only osteosinthesis because of the circumstances they was diverted at home, by not submitting to physiotherapy sessions while in the second group after ostesynthesis patients underwent physio- therapeutic protocols. Like outcomes measures included the range of motion espe- cially in the genus articulation and visual analogic scale (VAS) Degrees of motion in the first group was very limited in the both articulation the pain was also under the values five ,while in the second group it was noticed improvement of range of motion and the scale of pain in the fifth session of physiotherapy Conclusion: In the group that applied the physiotherapeutic treatment protocols, we had a noticeable improvement of the pain and the range of motion. The patients quickly retuned to daily life

OP174 - Resuscitation Services: What, Why, How S.Nela Sudden death in hospital setting remains a significant concern in public health and pa- tients safety disciplines. Adequate systems in prevention, staff training, equipment procurement, as well as careful monitoring and audit help to improve hospital survival. the proposed strategy is designing a designated resuscitation services department run by the team of independent non-medical resuscitation practitioners who are experts in a field. This model has been implemented in a teaching hospital and provides resuscitation services for adult, children and trauma patients. A short interactive presentation will demonstrate how setting up a designated re- suscitation services department, can help to improve management of unexpected cardiac arrests, design strategy for mandatory and non-mandatory training for hos- pital staff while reducing costs on resuscitation equipment in the acute hospital.

172 173 Anatomical Anatomical Pathology

OP176 - Spectrum of fibroepithelial lesions of the breast OP178 - Endometrial cancer in Albania

Pathology A.Priftaj, E.Thoma, E.Kolici, I.Kola

Anatomical A.Dragoshi, K.Tendl, L.Monschein Fibroepithelial breast lesions are biphasic tumors composed of both epithe- The endometrium is the tissue lining the inner cavity of the uterus. Endometrial lial and stromal components and include the common FA and the rarer PT. cancer is the most common gynecologic cancer in the world, that affects mainly Fibroadenoma (FA) Most common benign, solid breast neoplasm, well-circum- women over 55 years old. The aim of this study is to highlight the epidemiological scribed. Hormonally responsive, grows during pregnancy and late luteal phase, re- data concerning to endometrial cancer in Albania.This study was conducted at UHC gresses after menopause. Proliferation of intralobular stroma, polyclonal or monocl, ”Mother Teresa”, at Laboratory of Pathology of the Oncologic Hospital. It was con- epithelial component is polycl. MED12 mut; invasive carcinomas < 0,5 % of Fas. ducted during the years 2012-2016 and is a retrospective study. The diagnosis of the Phyllodes Tumour (PT) Neoplastic stromal cells surrounding nonneoplastic epitheli- patients hospitalized was: endometrial cancer. The diagnosis was made based on al-lined clefts, epith component mostly polycl; variable genetic changes, increases with clinical and histopatological findings. The data were statistically analyzed. The data grade; < 1 % of all breast tumours; 35-55 yrs; more common in Asian populations were collected from the medical records of 172 women hospitalized at Oncologic (about 7 % of BTs); > 90 % benign, < 5 % distant metastases, residual margin is predic- Hospital of the UHC “Mother Teresa” during the years 2012 – 2016. During 2012 tor of higher likelihood of recurrence (~ 25 % recur at grade higher than original PT); were diagnosed 25 cases, in 2013 were diagnosed 20 cases, 52 cases in 2014, 42 metastases- only stromal component, LN metas very rare, most common bone and lung cases in 2015 and 31 cases during 2016. Type 1 is the most prominent type of cancer First Patient : ♀, 23 yrs, visual inspect: normal; palp: 2 Tumors retromamm Imag- and it accounts for about 88 % of endometrial cancer. Most of them are diagnosed at ing Extern US (04/17): 3 lesions of left breast; susp: FA, BIRADS 0 US + MR stage 1. The mean age of patients was 62,5 years old. The majority of women diag- (June 17); Core-NB(June 17); Excision (11/17). Dx: benign PT,FA Second Patient nosed with endometrial carcinoma are peri or post menopausal, between the ages 50 : ♀, 54 yrs, uterus myom.; malign PT(left breast); Initial diagn: 11/15; rapidly -70. The number of endometrial cancer cases has been increasing through the years. growing (12/15 -16 cm DM, 01/16 -30 cm DM); skin ante perforat; multiple lung Endometrial cancer Type I is the most common form of endometrial cancer. Most metast; St.p. R HT CoreNB 02/16; Mastectomy 02/16 PT present distinct chal- of the cases are diagnosed at stage I, which gives more survival chances for patients lenges relating to their diagn, classific, predicted behavior, and clinical manage- diagnosed with endometrial cancer. ment. Grading of PTs should aim to achieve accuracy and consistency at the be- nign and malign ends of the spectrum. Definitive distinction between cellular FA OP179 - Salivary gland neoplasms: A review study of 8 years in two major and benign PT may not be crucial, in light of similar reported recurrence rates. hospital centers in Albania. The role of adj. rad. therapy in borderline and malign tumors remains to be de- B.Gashi Cenkoglu, E.Kola, M.Alimehmeti, A.Aga, L.Berdica fined. Routine axillary dissect is not recomm. Salivary gland tumors most often present as painless enlarging masses. Malignant salivary gland tumours are rare and constitute less than 0.5% of all malignant neo- OP177 - Evaluation of cytopathology for qualitative diagnosis of mediastinal plasms. Most are located in the parotid glands and are benign. The principal pitfall and hilar lymphadenopathy based on EBUS-TBNA. in their management lies in the difficulty in distinguishing benign from malignant A.Andoni, D.Xhemalaj, E.Tashi, I.PeposhiK, P.Kapisyzi tumors. Clinical examination and conventional imaging techniques alone usual- Aim / EBUS is a relatively new method to guide TBNA of mediastinal lymphnodes. ly cannot distinguish between benign and malignant diseases nor subclassify the We wanted to evaluate the diagnostic value of cytology obtained through this method. pathologic process. Hystopathologic examination in Hematoxylin-Eosin staining We reviewed all the cases that underwent the EBUS-TBNA in University Hospital for is still the gold standard used for the diagnosis. In addition immunohistochemistry Pulmonary Disease “Shefqet Ndroqi “ from 2016 to july 2018. Case examples are giv- can reinforce the diagnostic accuracy and be helpful in determining parameters en of the common indications for endobronchial ultrasound‐guided transbronchial nee- such as the cell nature and differentiation status, cell proliferation and tumor pro- dle aspiration which are: lung cancer staging; diagnosing central pulmonary masses; tein expression. Benign tumours and early low-grade malignancies can be ade- sarcoidosis; and inflammatory/benign thoracic lymph nodes. The technique is widely quately treated with surgery alone, while more advanced and high-grade tumours used , even though we have a modest experience in our practice, and we wanted to with regional lymphnode metastasis will require postoperative radiotherapy. evaluate our cytology findings., combined with EBUS-TBNA, cytological -diagno This retrospective analysis was done to evaluate the clinical presentation, site dis- sis is sensitive. The value of cytological examination of EBUS-TBNA should be ac- tribution and treatment in salivary gland tumours highlighting some of the more knowledged as a simple procedure, fast and safe, that provides a qualitative diagnosis important aspects in their diagnosis and management. The incidence and distribution of mediastinal and hilar lymphadenopathy ,with reasonable sensitivity and specificity. of all types of salivary gland tumours were analysed and data for comparison with

174 175 Anatomical Anatomical Pathology

other epidemiological studies from different geographical sites were provided. consisted of lobectomy (n=4) or pneumonectomy (n=1).Patients received chemotherapy

Pathology A retrospective study of the biopsy examinations of salivary glands pathologies or neoadjuvant chemotherapy in all cases.Until now only one patient with synovial Anatomical during the period 2010-2017 was carried out. Evaluation of information was done sarcoma of lung died,12 months after diagnosis,whereas all the others are alive and based on hystopathological diagnosis, location, age and gender. in healthy conditions. Primary sarcomas of the lung are rare and aggressive tumors. There were examined 182 biopsies of which 118 were performed on males and 64 Complete surgical resection with free margins, and chemotherapy increase the survival. on females. Topographically, the greatest frequency appeared to be in the paro- tis gland. According to the type of lesions, 37 of them were not neoplastic, 104 OP181 - Selected Lymphoma Cases – approach to diagnosis benign neoplasms and 41 malignant neoplasms. The neoplastic lesions were pre- F.Kurshumliu sented with a prevalence of male sex. The most frequent lesions turned out to be Lymphoma diagnosis relies on complex clinical, morphological, immunohisto- pleomorphic adenoma (n=79). Ages affected by salivary glands pathologies were chemical and molecular methods. In limited resource settings, proper diagnosis observed in our sample with the minimum age 5 month and maximum of 83 years and classification is greatly influenced by clinical-pathological correlation and -ra old. However, most of the cases were found in the 5th, 6th and 7th decades of life. tional utilization of available laboratory methods. The data obtained in the present sample shows a slight tendency for these diseases Retrospective study of selected lymphoma cases. to occur more in males. This trend is contrary to other studies reported in litera- Hodgkin’s Lymphoma, B and T-cell Non-Hodgkin’s Lymphoma. ture. These results could be explained by the fact that men tend to seek healthcare Concise diagnosis relies on clinical and laboratory data with precise morphologi- providers more often, because of the privilege they have in the Albanian society. cal and immunohistochemical interpretations of the tissue samples. As also shown in other studies, in both the major and minor salivary glands, the commonest type of benign tumour is pleomorphic adenoma. OP182 - Low-grade endometrial Stromal Sarcoma: A case report G.Pumo, L.Berdica, T.Bushati, A.Priftaj, D.Xhemalaj, J.Coku OP180 - Clinic-pathological findings of primary sarcomas of the lung. Endometrial stromal sarcoma (ESS) is a rare malignant tumor of the endometri- Our experience um, occurring in the age group of 40–50 years. Endometrial Stromal Sarcomas D.Xhemalaj, L.Berdica,F.Caushi ,H.Hafizi ,P.Kapisyzi, S.Bala, M.Alimehmeti, (ESSs) are very rare malignant tumors that constitute approximately 10% of all G.Pumo, A.Doniku uterine sarcomas but only around 0.2% of all uterine malignancies [1]. Primary sarcomas of the lungs are very rare tumors, derived from immature mes- The annual incidence of ESS is 1–2 per million women accounting for 400 to 700 new cas- enchimal cells and with unclear biological behavior. They comprise about 0.5% of es each year in Europe [2]. ESS can be mistaken for leiomyoma. Its clinical recognition all lung malignancies. Primary pulmonary sarcoma cannot be diagnosed unless an may be difficult, and the diagnosis is often made postoperatively after histolog- alternate primary source has been thoroughly ruled out by clinical and radiograph- ical examination We report a case of low-grade ESS in a 49-year-old woman, ic examinations. The aim of the study: To identify the primary sarcoma of the presenting as rapid enlargement of two uterine fibroid nodules associated with lung:1)clinico-pathologic features of them. 2)Treatment and follow- up. irregular and excessive vaginal bleeding. Hysterectomy was performed. Histo- Cohort study from January 2011 up to December 2017. Kaplan-Meier is used for pathological examination and immunohistochemistry confirmed LGESS. As the overall survival. Records of all patients hospitalised for lung cancer in our hospital. tumor is rarely encountered, management protocols are still questionable. In our Results: Primary sarcoma of the lung founded n=7 (38 %) and metastatic sarcoma of case, we tried a different post-surgical protocol and the patient is being closely the lung n=18 (62 %) .Primary sarcomas of the lung comprise less than 1% (n=7) of followed up. Although rare, ESS should be considered in the differential diagno- all primary lung carcinomas (n=1210). Mean age 52 ± 6,5 years (range 39- 64 years). sis of all women who present with a rapid enlargement of a uterine leiomyoma. Female to male ratio was 6:1.Main clinical complaints were:cough, dyspnea,chest pain. The mean diameter of the tumors was 6.8 cm.In all cases, tumours only invaded the pul- OP183 -Microinvasive squamous cell carcinoma arising within seborrheic monary parenchyma. No bronchial lumen invasion. Two patients has lymph node N1 in- keratosis. A case report volvement. No patient had N2 involvement. Histologic types confirmed on the basis of I.Dino, L.Berdica, T.Bushati, A.Dafa, J.Memini, D.Billa Hematoxyline- Eosine and various immunohistochemical stains were : 2 cases- Malig- Seborrheic keratosis (SK) is a benign hyperplastic tumor of the epidermis occur- nant Fibrous Histiocytoma(MFH) , 3 case -Synovial Sarcoma (SS),1- case Folicular ring in about 20 percent of the elderly population. There are several types of SK; Dentritic Cell Sarcoma (FDCS) and 1 case- Malignant Schwannoma (Malignant Pe- reticulated, acanthotic, pigmented, clonal, irritated, hyperkeratotic, or flat. Squa- ripheral Nerve Sheath Tumor). Surgery was performed in 71 % (n=5) of patients and mous cell carcinoma (SCC) is a malignant neoplasm with differentiation into the stratified squamous epithelium. 176 177 Anatomical Anatomical Pathology

Squamous cell carcinoma (SCC) arising within seborrheic keratosis (SK) is rare. A small team of commandos such as an anatomist, a pathologist, a pharmacologist,

Pathology Our case is a 73-year-old man presented with rapidly growing pinkish nodu- a biochemist, and most importantly a physiologist, working together as a retired Anatomical lar lesion with microerosions on its surface on his left temporal skin region of group of volunteers could drastically abolish medical student lifelong slavery and several time duration. Clinically a skin cancer was suspected and an excision turn the situation into a superior free online medical school knocking down, with with wide margins was performed. The biopsy revealed seborrheic keratosis in a sledgehammer, jail box walls and credit slavery. reticulated patern but also atypical squamous cell cluster was seen in the central low area. These cells showed mitotic figures nuclear atypia, and microinvasion, OP185 - Ki67 in non Hodgkin Lymphomas in favor of microinvasive SCC. In our patient the clinical fact that the lesion L.Berdica, T.Bushati was present for about two years, rapidly enlarged with microerosions suggested ki67 is a nuclear and nucleolar protein antigen present in all proliferating cells that the SCC arose within SK. Squamous cell carcinoma (SCC) arising within during the active part of the cell cycle: G1, S, G2, and mitosis. Its expression seborrheic keratosis (SK) is rare, but when this occurs it can be very devastat- is evaluated immunohistochemically by dividing the number of cells that stain ing for the patient. Therefore a biopsy of any suspect or changing seborrheic positively for Ki-67 with the total number of cells in the sample; this is referred keratosis is essential. And a thorough clinical follow-up is also very needed. to as the proliferation index (PI). Review of literature for the correlation between PI and grade of non Hodgkin Lymphomas. Studies reported that proliferation OP184 - Online Medical School Pathology Education markers can significantly distinguish between high- and low-grade NHL . In- J.Minarcik correlations using the Kiel classification [14], mean PI was 39.5% in low-grade My 15 year trek started with a search for myself and is now leading to a search lymphomas (assessed by proliferating cell nuclear antigen staining) and 75.7% in for a few good men. When my wife passed away it was difficult to find a good high-grade lymphomas; in correlations using the Working Formulation, mean reason for myself to live so I started my trek by giving up my private practice MIB-1 was 29.7% in low-grade lymphomas, 53.1% in intermediate-grade of pathology and started teaching at various American and Caribbean medical lymphoma, and 75.1% in high-grade lymphomas. The group of intermedi- schools. I do not like to take the same trails every day and realizing that there ate-grade lymphomas was the most heterogeneous. The Ki-67 PI has already been were many yearly repetitions, I made about 600 short common histology and his- applied as a diagnostic criterion for Burkitt and atypical Burkitt lymphomas, in topathology videos that hopefully would outlast me. The journey has ultimately which its value approaches 100%. There was no association between Ki-67 PI led me to teaching an entire pathology course at an American accredited med- and survival. Although not significant on multivariate analysis, the Ki-67 PI added ical school, talking to paying classroom students at the same time I am wear- significantly to the prognosis of patients with DLBCL and a low IPI or bulky dis- ing a wireless headset to synchronize my words and images with a live free on- ease. These data suggest that tumors that reach bulkiness with a low PI still have line audience as well, and over a terabyte of free pathology educational videos. a very good prognosis.Different types of lymphoma are associated with signifi- Today in 2018 there are numerous free user-friendly methods for broadcasting cantly different Ki-67 PIs. Using a 45% Ki-67 cut- off value, can help clinicians globally, many webinar varieties as well as cool tricks from Facebook and Google differentiate indolent from aggressive lymphomas, although 10–20% of patients as well. But the main thing to remember is that when you are standing up in front in each category are beyond this cut-off value. A cut-off of 70% distinguished -pa of a classroom the only thing that enables you to simultaneously stand up in front tients with DLBCL with good and poor outcome. The Ki-67 PI appears to have a of the world as well, is a wireless headset and perhaps a friendship with some of predictive value for overall survival in patients with DLBCL who have a low IPI your computer geek IT people. I have made a list of over 100 major advantages of or bulky disease. online teaching over classroom life teaching, and I have actually often referred to auditoriums as walled “jail boxes”. Besides the obvious convenience advantages OP186 - Focus on new entities in who 2016 classification of Renal Cell Tumors. you must clearly understand that if the essence of education is seeing and hearing L.Alia, S.Tripodi clearly, these two items are really the predominant advantages over jail boxes. Renal cell tumors represent a group of histopathologically and molecularly het- The institutional and personal freedoms which you will experience are great- erogeneous tumors, with different sets of genetic and epigenetic abnormalities. ly overshadowed by the profound economic benefits to your audience. In Recently, an increased understanding of the morphology, immunohistochemistry, the United States middle-class students are routinely driven into credit slav- genomics, and epidemiolo-gy of renal cell tumors has resulted in the identification ery for many years the majority of this money going to bankers and to the up- of novel histotypes. keep of those jailhouse walls rather than to the hard-working professors. Accordingly, the World Health Organization (WHO) classification of renal cell

178 179 Anatomical Anatomical Pathology

tumors has been modified. The present review summarizes the knowledge of the USA. The etiology is not precisely known, but based on case reports, the risk factors

Pathology new and current subtypes of renal cell tumors, and discusses the emerging/provi- include: ultraviolet exposure, Merkel Cell polyomavirus DNA infection, immuno- Anatomical sional renal cell carcinomas in the new 2016 World Health Organization classifi- suppression (HIV-patients, post transplant pts under immunosuppresive therapy).4,5 cation, which focuses on features of their molecular pathological epidemiology. MCC is characterized by a high incidence of early locoregional relapse and The WHO classification will require additional revisions to enable the classifica- distant metastases25. Merkel Cell Carcinoma is rarely suspected at the time of tion of renal cell tumors as clinically meaningful subtypes in order to provide a clinical presentation. The clinical and pathologic diagnosis of MCC can be chal- better understanding of the unique characteristics of renal cell tumors. lenging, especially when it presents as nodal metastasis. As a “small round blue The majority of the International Society of Urological Pathology (ISUP) Van- cell tumor,” it can be difficult to differentiate from other small cell neoplasms couver classification of renal neoplasia, was adopted for the revised 2016 WHO of different primary origin. Diagnosis is based on typical histology representa- classification of renal cell tumors. The various subtypes of renal cell tumors are tion on hematoxylin-eosin stained slides along with the results of immunohis- based on a combination of descriptive features. The major subtypes are clear cell tochemistry. The tumour expresses both epithelial and neuroendocrine markers, RCC (CCRCC), papillary RCC (PRCC) and chromophobe RCC (ChRCC) which so exhibits both epithelial and neuroendocrine differentiation. Despite aggressive comprise 65 – 70 %, 15 – 20 %, and 5 – 7 % of all RCCs, respectively. The names multimodality treatment, Merkel Cell Carcinoma outcome is primarily based on of these subtypes are based on their predominant architectural or cytological mor- the stage of disease at presentation, with both increasing tumor size and lymph phology (e.g. CCRCC, ChRCC, and renal oncocytoma, PRCC), or on the site node positivity being associated with a worse prognosis15. Moreover, the mor- of the tumor (e.g., collecting duct and renal medullary carcinomas) but are also tality rate of MCC is considerably higher than that of cutaneous melanoma. classified on other criteria such as association with renal disease (e.g., acquired Although it has been identified in various anatomical sites, LN metastatic MCC cystic disease-associated RCC; ACD – associated RCC; genetic or biochemical in the absence of a primary site is extremely rare and for this reason there is no alterations (respectively microphthalmia transcription factor (MiT), family trans- standard approach to its management5. location RCC (TRCC), fumarate dehydrogenase and succinate dehydrogenase – We report a case of a 39 year-old male, diagnosed with HIV infection 8 years ago, deficient RCC (SDH – deficient RCC), and familial trait (e.g. hereditary leiomyo- who presented to the hospital with an enlarged lymphnode in the left inguinal matosis and RCC – associated RCC (HLRCC – associated RCC). area, which revealed to be metastatic Merkel Cell Carcinoma in the absence of a The 2016 WHO classification also identified emerging / provisional new entities primary skin lesion. that are rare and yet fully characterized by morphology, immunohistochemistry, and molecular analyses, although requiring more deeper knowledge of their bi- OP188 - Predictive immunohistochemistry in lung cancer ological features and diagnostic criteria. Conclusions and Future Directions: T.Bushati, L.Berdica This review introduces and briefly summarizes the molecular pathologi- The identification of certain genomic alterations (EGFR, ALK, ROS1, BRAF) cal epidemiology of both new and current subtypes of renal cell tumors, as or immunological markers (PD-L1) in tissues or cells has led to targeted treat- well as emerging / provisional RCCs, in the new 2016 WHO classification. ment for patients presenting with late stage or metastatic lung cancer. The increased understanding of morphological, immunohistochemical, mo- Immunohistochemistry is a widely available technique that is less challenging lecular, and epidemiological features of renal cell tumors allows classifica- and can provide clinically meaningful results quickly and cost-efficiently in tion of renal neoplasms into subtypes / entities with distinct characteristics. comparison with other techniques. In addition, immunohistochemistry allows In the near future, the WHO classification will need further revisions to allow a for the evaluation of cellular localization of proteins in the context of tumor reliable, clinically meaningful structure. In an era of precision medicine, pathologists are required to classify lung cancer into specific subtypes and assess biomarkers relevant to molecu- OP187 - Merkel cell carcinoma of unknown primary site. Review of the liter- lar-targeted therapies. ature and Case presentation This review summarizes the hot topics of immunohistochemistry in lung can- M.Alimehmeti, E.Kola cer, including adenocarcinoma vs squamous cell carcinoma; neuroendocrine Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine tu- markers; primary lung carcinoma vs metastasis, ALK, ROS1, and EGFR; (iv) mor of the skin. MCC was described first by Toker in 1972 as trabecular carcinoma PD-L1 (CD274); (v) Major pitfalls in evaluating immunohistochemical results of the dermis with high lymphatic metastatic risk.1 The incidence of this rare tumor are also described. is increasing rapidly; the American Cancer Society estimates 1500 new cases in the

180 181 Symposia IVF Satellite Satellite

OP189 - Fertility Preservation pregnancies using Time-lapse embryo scope to select best embryos for transfer in

Satellite A.Cane, B.Ferhati, E.Peçi, G.Kabili, E.Mancellari Iran. A case with mild male factor infertility was admitted to IVF program, after Symposia IVF Symposia The indications for fertility preservation has increased dramatically in the last three non successful cycles of IUI. After controlled ovarian stimulation, Intracyto- years. They can be medical or non medical. plasmatic sperm injection was performed to retrieved mature oocytes. Six zygotes In the medical group of indications are included many oncological and non-onco- were placed individually into the micro wells of equilibrated embryo scope dish

logical diseases that may affect current or future fertility, either by their progres for Time-lapse observation, and incubated at 37°C, 6% CO2. On day 5, single or by their gonadotoxic treatment. In the non medical group of indications for fer- embryo transfer (SET) took place based on kinetic parameters of the embryos. tility preservation, are included the so called social indications. These indications Clinical pregnancy was confirmed 6 weeks after SET. The second case with endo- are coming from womens that want to postpone childbearing for various personal metriosis and tubal factor, and a history of two previous ICSI failures was admit- reasons. In their situation the biggest threat to their fertility is age related depletion ted. 14 MII oocytes underwent ICSI, and incubated in Time-lapse incubator. The of ovarian reserve. Women are increasingly seeking “time out” until they reach the rest of procedures were followed as described for case 1. Chemical pregnancy was right stage in their life to have a baby, often postponing childbearing because of confirmed 15 days after SET. This approach may help embryologist is selecting the lack of a partner, the lack of a stable partner, or career or financial issues. The the best embryo non-invasively for SET; thus, increasing the chances of implanta- age at which women attempt their first pregnancy has been steadily rising during tion, while reducing multiple pregnancy complications. the past 40 years. In all these situations there is a need for an adequate fertility preservation approach. The improvement in the survival rates of cancer patients OP191 - The role of Laparoscopy in the management of infertility and recent advancements in assisted reproductive technologies (ART) has facili- Ch.Maroudis, E.Peçi, G.Kabili tated the development of methods and strategies to preserve fertility in patients Due to widespread availability of assisted reproductive technologies, the need for with cancer. In the methods and strategies aimed to preserve fertility are included reproductive surgery in infertile women has declined in recent decades. Howev- pharmacological protection of the ovary against the gonadotoxic compounds used er, surgery still has a place in the management of infertile women. For example, in anti-cancer treatment and ovarian transposition when indicated, sperm freez- young women with pelvic adhesions or blocked fallopian tubes that impair their ing, embryo-freezing, mature (MII) oocyte freezing, cryo-preservation of ovarian fertility may benefit from early surgical intervention. On the other hand, women tissue. Some of these fertility preservation methods are also used in women with over the age of 35 with a long history of infertility or those who require a laparot- medical indications other than cancer and in women who seek fertility preserva- omy for correction of their disorders are better treated with in vitro fertilization. tion for social reasons. Since decades, freezing of sperm and embryos has been Compared to laparotomy, reconstructive surgery by laparoscopy is preferable. In established as an important part of clinical practice in assisted reproductive tech- fact, most procedures that previously required a laparotomy can be performed by nologies. The progress in the domain of oocyte freezing was more slowly, being laparoscopy with equal or better results. In addition, laparotomy causes more ad- still considered until lately as an experimental procedure. Only in the recent years hesion formation. The incidence of adhesion formation after a single laparotomy is oocyte freezing is introduced in the clinical practice and is getting more and more 47% after appendectomy and up to 91% after pelvic surgery. Almost all patients will widely used. However, many experts believe that there is now enough evidence develop adhesions after myomectomy by laparotomy, whereas the adhesion rate is to support the use of ovarian-tissue cryopreservation as a valid and effective tech- about 70% after laparoscopic myomectomy. Laparoscopic surgery lessens adhesion nique rather than as an experimental approach. In this lecture, we want to resume formation due to minimal handling of the internal organs and elimination of op- the basic principles, methodology, and practical experiences (worldwide and ours) erative site contamination with glove powders or lint. In addition there is a lower as well as safety concerning different methods of fertility preservation. incidence of infection, and the relatively closed environment of laparoscopy helps to maintain tissue moistness. Moreover, patients prefer the faster recovery time with OP190 - First clinical pregnancies following In Vitro Fertilization and Em- laparoscopy. Laparoscopy should only be performed after complete investigation of bryo Selection using Time-lapse technology in Albania: Case report infertility such as semen analysis, hysterosalpingogram and assessment of ovula- B.Ferhati, E.Peçi tion. In the era of assisted reproductive technology, laparoscopy is not a routine test. Embryo selection is the most crucial part of in vitro fertilization (IVF) programs. However, it is indicated in young women with an abnormal hysterosalpingogram The, morphology-based grading score is until now the standard method for em- or a history of salpingitis, sexually transmitted disease, previous pelvic surgery, or bryo selection. Time-lapse imaging of embryos is another non invasive method endometriosis. In this lecture we want to resume the role that laparoscopy alone, or recently introduced for their selection. We report the first ongoing and chemical combined with hysteroscopy, has in the management of infertility.

182 183 Symposia IVF Satellite Satellite

OP192 - The role of Hysteroscopy in the management of Infertility a very popular treatment procedure used to treat unexplained subfertility (usually

Satellite Ch.Maroudis, E.Peçi, G.Kabili combined with superovulation) and male factor subfertility. It is also the mode of Symposia IVF Symposia Infertility related to uterine cavity abnormalities has been estimated to be the cause treatment for various ejaculatory and coital problems. Intrauterine insemination in 10% to 15% of couples seeking treatment. The abnormalities that affects uterine (IUI) is generally considered to be an intermediate step of low to moderate com- cavity can be congenital like uterine septum, uterus didelphys, unicornuate uterus plexity before the application of more sophisticated assited reproductive technol- etc, or acquired like endometrial polyps, submucosal myomas and intrauterine ogies (ART) like in vitro fertilisation (IVF) or intracytoplasmatic sperm injection adhesions etc.The modalities used to assess the uterine cavity are Transvaginal (ICSI) The rationale behind IUI is to increase gamete density at the site of fertilisa- ultrasonography (TVUSG), 3D Transvaginal ultrasonography (3D TVUSG), Hys- tion. IUI gained its popularity because it is simple, non-invasive and cost-effective terosalpingography (HSG), Saline infusion sonography (SIS), Magnetic Resonant technique. The main reason for the renewed interest in IUI was associated with the Imaging (MRI), and Hysteroscopy. Transvaginal Ultrasound is the gold standard refinement of techniques for the preparation of washed motile spermatozoa in the for global uterine screening and has a cardinal importance for diagnosis of myo- early years of IVF. Semen preparation techniques were developed to separate the metrial disorders and uterine congenital malformations.Hysteroscopy, with direct motile morphological normal spermatozoa. Leucocytes, bacteria and dead sper- view of the uterine cavity offers a significant advantage over other blind or indirect matozoa produce oxygen radicals that negatively influence the ability to fertilize diagnostic methods. Hysteroscopy is considered nowdays the gold standard for the the egg. The yield of as many motile, morphologically normal spermatozoa might evaluation of the endometrium and cervical canal. The safety and the efficacity of influence treatment choices and therefore outcomes. In this lecture we want to hysteroscopy in treating those gynecologic conditions that affects uterine cavity resume the role that IUI has in the managmenet of subfertility. is already proven. In this lecture, we will focus on the role of hysteroscopy in the management of infertility. OP195 - Artificial Reproductive Techniques E.Peçi, G.Kabili OP193 - Individualized management of poor ovarian response Infertility is a reproductive disorder defined clinically as the failure to achieve a C.Manolea clinical pregnancy following at least 12 months of unprotected sexual intercourse. Poor ovarian response (POR) has been recognized since the inception of assisted Since the first successful IVF pregnancy, delivered in 1978, several artificial -re reproduction. Four decades later, with the incidence of poor responders being on productive techniques have been developed that enhance our ability to overcome the rise, little has been done to improve prognosis in women who exhibit a low re- sponse to ovarian stimulation. Treatment of poor responders is associated both with infertility and / or to treat several genetic conditions. Up to date, 40 years after an increase in cycle cancelation and in dropout rates, with proven psychological this succes, it is estimated that 8 million babies are born following artificial repro- effects on the couple and their desire to pursue further treatment. Poor responders ductive techniques. Artificial reproductive techniques represents all treatments or encompass a whole spectrum of women with different history, genetics, age and procedures that include the in vitro handling of both human oocytes and sperm, ovarian parameters, but not all of them necessarily have a bad overall performance or embryos, for the purpose of establishing a pregnancy. This includes in vitro during IVF, mostly when individualized management is applied. Typically, when fertilization and embryo transfer (IVF – ET), gamete and embryo cryopreserva- exposed to conventional ovarian stimulation, irrespective of the analogue protocol, tion and pre-implantation genetic testing (PGT). Artificial reproductive techniques these women will offer a low number of eggs per cycle started, -usually insufficient does not include assisted insemination (artificial insemination) using sperm from to secure a live birth. Obtaining the optimal numbers of eggs and embryos thought either a woman’s partner or a sperm donor. to be enough for achieving a pregnancy in each particular case should be the goal In vitro fertilisation (IVF) is a process that includes controlled ovarian stimu- of treatment in these women. In this presentation, categorization of poor responders lation, oocyte pick up - OPU, fertilization in the laboratory, and transcervical and individualized management will be discussed, focusing on the strategy of serial transfer of embryos into the uterus. IVF was indicated to bypass infertility in consecutive Ovarian Stimulation, with accumulation of embryos, as well as the use women with bilateral tubal obstruction. In later years, the indications and the use of pretreatments or add-on`s thought to improve prognosis. of IVF has multified. Today IVF is used also in non-subfertile patients in order to avoid specific genetic diseases by genetically testing (PGT) the embryos before OP194 - Intrauterine insemination treatment in subfertility transfer into the uterus. In this lecture, we want to resume the basic principles, D.Subashi, J.Lulo, E.Peçi, G.Kabili, B.Ferhati indications and recent trends, and as well the safety concerning different artifi- Intrauterine insemination with homologous (IUI-H) or donor semen (IUI-DS) is cial reproductive techniques.

184 185 Symposia IVF Satellite Satellite

OP196 - Investigation of the infertile couple considered the most efficient method for surgical sperm retrieval among patients

Satellite G.Kabili, E.Peçi with non-obstructive azoospermia. Symposia IVF Symposia Infertility is defined as the inability to conceive after 1 year of unprotected inter- Assisted reproductive technologies employ sperm sorting techniques to select via- course. It is a common condition with psychological, medical and economic im- ble sperm from the semen samples. Currently, standard sperm sorting methods in- plications. Over the years, the incidence of infertility is increasing due to environ- clude density gradient centrifugation, direct swim-up, and conventional swim-up. mental effects, chemical exposure and delayed childbearing. In addition, there has The multiple centrifugation steps during these methods, have been shown to dete- already been an increase in the demand for infertility services. The main reason for riorate DNA integrity and damage sperm quality mainly through the production of this is the tendency of women to delay childbearing because of career work. Other reactive oxygen species. Newer technologies, such as microfluidics, electrophore- factors include an increase in the variety and effectiveness of assisted reproductive sis, motile sperm organelle morphology examination, and birefringence may offer technology (ART) treatments, an increased public awareness of these treatments, a chance to improve the selection of sperm with higher DNA integrity, normal an increase in tubal factor infertility as a consequence of sexually transmitted dis- morphology, and motility as well as improved artificial insemination outcomes. eases, and a relative scarcity of babies placed for adoption because of effective New technologies are being developed to assist in the preparation and selection contraception and increased availability of abortion services. of spermatozoa in assisted reproductive technologies. To date progress has been Infertility may be primary (no previous pregnancies) or secondary (previous preg- proved to be frustrating and the developed methods have provided variable bene- nancy, irrespective of outcome). There are various causes leading to difficulty in fits in improving outcomes after ART. Maybe new strategies are required to iden- conceiving, and very often several causes can be present at the same time. The tify the properties of those spermatozoa which naturally do reach the oviduct in differential diagnoses of infertility encompass five principal categories: male fac- order to develop more effective tests of semen quality. tors, cervical factors, ovulatory dysfunction, problems with the uterus or female pelvic organs or both, and unexplained causes. In addition, immunologic factors OP198 - Recurrent pregnancy loss that involve antiovarian or antisperm antibodies may adversely affect fertility by J.Lulo, A.Kruja, E.Peci, G.Kabili impairing fertilization, destroying gametes, and interfering with embryo cleavage Spontaneous pregnancy loss is relatively common; reaching 15 – 25 % of all or implantation. The extent of their significance is controversial. clinically recognized pregnancies resulting in pregnancy failure. For recurrent The correct evaluation of the infertile couple is the first step, and probably the pregnancy loss (RPL) different definitions are being proposed. When defined as 3 most important, towards the right treatment. In this lecture, we want to resume the consecutive pregnancy losses prior to 20 weeks from the last menstrual period, it basic principles of the investigation of an infertile couple. affects approximately 1% to 2% of women. Recurrent pregnancy losses can have a significant psychological toll on affected OP197 - Surgical retrieval, processing and selection of sperm for ICSI in Azo- couples, and many efforts are being made to improve treatments and decrease the ospermia: What should We Doctors know? time needed to achieve a successful pregnancy. Gj.Semini, F.Dimitriadis This review article highlights the various etiologies implicated in RPL, includ- Azoospermia occurs in about 5% of infertile men and poses a real challenge to the ing factors known to be causative (uterine anomalies, antiphospholipid syndrome, fertility urologist. While there are options to create happy families for azoosper- hormonal and metabolic disorders, and genetic abnormalities), as well as those mic couples, such as the use of donor sperm and adoption, most couples still desire implicated as possible causative factors (chronic endometritis, inherited thrombo- to have their own biological offspring. Nevertheless, sperm may be present in the philias, luteal phase deficiency, and high sperm DNA fragmentation levels). The epididymis or the testes depending on the type of azoospermia. Advances in urolo- appropriate diagnostic evaluation, therapy, and prognosis are also addressed. gy and fertility laboratory technologies allow surgical sperm retrieval in azoosper- mic men and achievement of live births for many, but not all azoospermic couples. A variety of surgical and non-surgical options exists for sperm retrieval in the setting of obstructive or non-obstructive azoospermia. The available techniques include percutaneous options such as percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA), as well as open techniques that include testicular sperm extraction (TESE) and microsurgical epididymal sperm aspiration (MESA). Microdissection testicular sperm extraction (microTESE) is

186 187 Gynecology & Obstetric

OP199 - Importance of diagnostic laparascopy in gynecology: a case report Untreated pain may raise the risk for complications of increased opioid use, post-

Obstetric A.Sula, D.Bajraktari, Ch.Maroudis partum depression, and chronic pain development. During the postpartum period, Gynecology & Gynecology Laparoscopy is a diagnostic method that has currently become consolidated for thera- 90% of mothers in Albania begin breastfeeding, mandating consideration of the peutic use. It consists of endoscopically viewing the abdominal cavity. The aim here effects of all prescribed medications on the mother-infant pair. Non pharmacologic is to show the importance of diagnostic laparoscopy and the intraoperative findings as well as drug therapies are important components of postpartum pain manage- in the Gynecology Clinic in American hospital in a young age patient with pelvic ment. Women experience pain in different ways in the early postpartum period, pain. Patient 15 years old presented at gynecology department with pelvic pain. and pain management should be considered on a case-by-case basi. Knowing Patient was followed in another hospital for suspect cyst rupture. After 2 days the that pain can interfere with a woman›s ability to care for herself and her infant, patient decided to come at our clinic where she was diagnosed with e pelvic mass, it›s important that ob-gyns talk with their patients about the level of pain they›re suspect cyst rupture and little free fluid in douglas. No change in hemoglobin lev- experiencing and create a tailored plan that works for them. It is also critical to el during the last days. Despite treatment with analgesics patient referred pain, for counsel the mother on the side effects of any drug prescribed, particularly if the this reason with the family consensus it was decided not to remain conservative and mother is breastfeeding. follow up but to perform a diagnostic laparoscopy During Laparoscopy a right ovar- ian ruptured hemorrhagic cyst and torsion was seen. Small amount of blood was OP202 - First clinical pregnancies following In Vitro Fertilization and Em- seen in douglas. The most interesting finding was the left ovarian agenesis. Detor- bryo Selection using Time-lapse technology in Albania: Case report tion of right ovary and cystectomy was performed. Blood in douglas was aspirated. B.Ferhati, E.Peçi Result: Diagnostic laparoscopy saved the only ovary the patient had. In some the cas- Embryo selection is the most crucial part of in vitro fertilization (IVF) programs. es when the diagnose is not confirmed the diagnostic laparoscopy is the gold standard The, morphology-based grading score is until now the standard method for em- and a lifesaving procedure. bryo selection. Time-lapse imaging of embryos is another non invasive method recently introduced for their selection. We report the first ongoing and chemical OP200 - PELVIC ORGAN PROLAPS AND SUI - ONE SURGERY pregnancies using Time-lapse embryo scope to select best embryos for transfer in A.Haxhihyseni, D.Verçuni Iran. A case with mild male factor infertility was admitted to IVF program, after This study aims to see the result of an incontinence procedure performed at the time three non successful cycles of IUI. After controlled ovarian stimulation, Intracyto- of prolapse repair in women with pelvic organ prolapse (POP) and stress urinary in- plasmatic sperm injection was performed to retrieved mature oocytes. Six zygotes continence (SUI). SUI and POP probably share some of the same etiological mech- were placed individually into the micro wells of equilibrated embryo scope dish

anisms. Stress urinary incontinence (SUI) is a common complaint in women with for Time-lapse observation, and incubated at 37°C, 6% CO2. On day 5, single pelvic organ prolapse (POP]. No agreement exists concerning treatment strategies. embryo transfer (SET) took place based on kinetic parameters of the embryos. All women that were asked to participate, agreed to do so. During the study period, Clinical pregnancy was confirmed 6 weeks after SET. women not included in the study, but also presenting with combined TVT and POP, The second case with endometriosis and tubal factor, and a history of two previ- were operated on with prolapse repair first and TVT later if needed. Women with ous ICSI failures was admitted. 14 MII oocytes underwent ICSI, and incubated in POP and SUI had surgery with a tension-free vaginal tape (TVT) at the time of pro- Time-lapse incubator. The rest of procedures were followed as described for case lapse repair (n=17; group I) . During the period of this study were confirmed SUI 1. Chemical pregnancy was confirmed 15 days after SET. without POP and had a TVT performed (n=15). The main evaluation of all women This approach may help embryologist is selecting the best embryo non-invasively was 1 year after surgery. Results:On-treatment analysis resulted in 96% (16/17) cure for SET; thus, increasing the chances of implantation, while reducing multiple of SUI in group I and 93.3%(14/15) cure rate in group 2 and after one year are the pregnancy complications. same percentage. No differences were found between the two treatment strategies, but almost one third of women were cured of SUI by prolapse surgery alone. OP203 - Breast Cancer in Pregnancy. A literature Review Ch.Tsionou OP201 - Postpartum Pain Management: What to use and How to use it? Breast Cancer in Pregnancy. A literature Review A.Shtylla Teferici, A.Kruja Breast cancer during pregnancy is a rare but very disturbing event. Cancer is fre- In the early postpartum period, pain and fatigue are the most prevalent complaints quently in an advanced stage and have poor biologic factors and poor outcome. and can interfere with the mother’s ability to care for herself and her newborn. We have to take into account several factors, as not to compromise treatment and

188 189 Gynecology & Obstetric

not to harm the fetus. Presurgical diagnosis is mandatory and very critical to make OP206 - Polycystic Ovary Syndrome (PCOS)

Obstetric the right therapeutic decisions. Timing is very important, so we avoid adverse ef- criteria for diagnostic and management. Gynecology & Gynecology fects of chemotherapy in mother and newborn. Surgical treatment of choice is mas- J.Gjoshe, E.Gjoshe tectomy but lumpectomy in the 3rd trimester is considered. Axillary dissection for PCOS is a common metabolic and hormonal disorder affecting 12-20% of women the clinically or cytology approved axillary nodes, sentinel node biopsy needs case in reproductive age manifested by menstrual disorders and clinical/biochemical by case clinical decision. Chemotherapy should not administered in first trimester manifestations of hyperandrogenism and polycystic ovary morphology in ultra- and radiotherapy is not allowed during pregnancy. Chemotherapy is administered sound evaluation. Currently, we need a clear consensus among different medical before 35 weeks of pregnancy and pregnancy termination as soon as the embryo specialties. Diagnosis and treatment of PCOS can differ depending on the medical has lung maturity. Survival is the same as in non pregnant of the same stage. professional consulted (e.g. endocrinologist, gynecologist or general practitioner ). There are limited clinical guidelines for assessment or management of PCOS. OP204 - Minimally invasive surgery and technology. Recent developments Interdisciplinary care involves collaboration between those different specialties in and future directions. order to confirm diagnosis and assessment of PCOS Ch.Maroudis Rotterdam criteria (2003 also called the ESHRE/ASRM consensus) for diagnosis In recent years, the use of minimally invasive surgery has expanded greatly, hav- of PCOS are the most accepted diagnostic criteria across Europe, Asia and Aus- ing significant advantages over previous surgical techniques. tralia. Treatment of PCOS aims to improve biochemical and clinical hyperandro- The most important of those advantages is the reduction of trauma to the patient genism, reproductive function, psychological features and metabolic (diabetic and due to the minimization of surgical incisions. This advantage has been so import- cardiovascular) outcomes. ant so as to lead to 7.5 million laparoscopies being performed worldwide in 2015. The proliferation or minimally invasive surgery has been facilitated by important OP207 - Medical Practice in Gynecology – New trends & Bioethical approaches advancements in medical technology, which effectively address the technical and K.Pantos clinical challenges associated with minimally invasive techniques. Laparoscopic investigation and correction of undiagnosed endometriosis may enable natural However, there are still several issues that hold back its employment in more ap- conception avoiding IVF overuse for unexplained infertility patients plications. Some of those issues are the limited field of view; reduced maneuver- Having reached the end of the infertility investigation in years of unexplained infertili- ability of the tools; lack of haptic feedback; loss of depth perception; extended ty, infertile couples express desire to explore options or assistance towards an alternative learning curve; prolonged operative times and higher financial costs. approach in addressing infertility. Several of those issues are gradually being tackled by further developments in Laparoscopic surgery is commonly employed for the investigation of unexplained in- technology, allowing the introduction of minimally invasive procedures in hospi- fertility but its role in improving pregnancy rates is still elusive. Our retrospective tals around the world. study, included 81 out of 120 patients (67.5%) that underwent laparoscopy and were diagnosed with endometriosis with more than 8 years of unexplained infertility and OP205 - Embryo Biopsy and Preimplantation Genetic Testing; The experi- more than 4 previous failed IVF attempts. Within the first postoperative year, 47 out ence of American Hospital Tirana of 81 patients (58.02%) with failed past IVF history achieved a natural conception. E.Peci, G.Kabili, B.Ferhati, E.Mancellari, A.Cane Our research aims to raise practitioners’ awareness regarding the potential laparos- The integration of embryo biopsy and Preimplantation Genetic Testing (PGT) into copy holds when faced with undiagnosed endometriosis. Restoring fertility, address- the field of In Vitro Fertilisation (IVF) has progressed rapidly, due to the advances ing the previous multiple failed IVF attempts, attenuating financial costs and unbur- in the genetic technology and the increasing number of its indications. We can see dening patients from the psychological distress, are considerations of paramount now PGD (preimplantation genetic diagnosis) as an alternative to prenatal diagno- importance. Furthermore IVF should be the final tool in addressing infertility sis for the detection of genetic disorders in couples at risk of transmitting a genetic avoiding its overuse. disorder to their offspring. Moreover, preimplantation genetic screening (PGS) is Innovative techniques in reproductive endocrinology. Women aged over 40 are being proposed to improve the effectiveness of IVF by screening for embryonic worldwide the most rapidly growing age category having children. It is not surpris- aneuploidy. In this article, apart from a general review of the state of art in the field ing that patient populations in IVF centers have been aging in parallel, further driven of PGT, we will also present the results of our 65 cases of embryo biopsies fol- by the fact that young and uncomplicated IVF patients now conceive rapidly, while old- lowed by PGT Up to date, this is the first case series of PGT reported in Albania. er and more difficult patients require more attempts and thus proportionally accumu-

190 191 Gynecology & Obstetric

late. In today’s world it is possible for women of almost any age to give birth to chil- OP209 - The importance of endoscopic surgery in reproductive

Obstetric dren. Older women, always face, also, the difficult choice: poor chance with own fertility therapies Gynecology & Gynecology versus better chance with donor oocytes. Determining accurately the functional S.Chandakas ovarian reserve is the challenge to meet in order to properly counsel a woman as to Infertility treatment commonly involves assisted reproductive technology to im- her pregnancy potential. prove the chances of conception, but there are also a variety of structural causes of Ovarian rejuvenation is a newly introduced procedure that may revive ovarian female factor infertility that have surgical solutions.Reproductive surgery involves function in women unable to conceive because of early menopause, advanced maternal surgery in the field of reproductive medicine, including a wide range of operations age or low oocyte reserve involving platelets injected into ovaries (Platelet Rich Plasma designed for different purposes and it is performed with minimally invasive tech- treatment). Our observation focused on the return of menses and re-establishment of niques such as hysteroscopy or laparoscopy. ovulation patterns. Either by reversal of apoptosis and activation of remaining primor- The role of laparoscopic and hysteroscopic surgeries in the management of infertil- dial follicles or by activating stem cells into giving birth to “new primary ovarian ity are usually suggested to help diagnosis a cause. It’s performed only after other follicles”, PRP could revive dysfunctional ovaries of menopausal women. infertility testing has been completed, or if symptoms warrant testing.Laparoscopy: So though PRP may be promising, it needs to be placed in its proper context, avoiding It is performed by using a small but significant telescope named ‘Laparoscope’ to the temptation of encouraging its use as a safe and effective therapy with anti-aging which a light source and camera are attached. It enables doctors to see ovaries, out- properties that women so much want to hear about, even though we have noted patient side of uterus and fallopian tubes inside the abdomen. The main purpose of laparos- attitudes seeking PRP increased rapidly. copy is to determine the causes of infertility, symptoms like pelvic pain & abdominal pain and to check if there are any scar tissues or blockage in the fallopian tubes. This OP208 - Endometriosis – what’s new on our challenge technique is used to treat cysts, endometriosis and fibroids. L.Kaza Laparoscopic surgery may be used to surgically treat some causes of female infertil- Endometriosis is a debilitating disease with features of chronic inflammation, it ity. It is recommended: Hydrosalpinx is suspected. This is a specific kind of blocked affects 10 - 15% of women of fertile age being one of the most common benign fallopian tube. Removing the affected tube can improve IVF success rates.Endo- gynecological disease. It is estimated that 180 million women worldwide betwen metrial deposits are suspected of reducing fertility. Surgery may be able to unblock 14 – 49 years are affected by this condition, and most of them have not been or repair a fallopian tube. An ovarian cyst is suspected of causing pain or blocking diagnosed and treated. The presence of disease increases up to 30% in patients the fallopian tubes. Removal of a large endometrial ovarian cyst may reduce your with infertility and up to 45% in patients with chronic pelvic pain. In Albania we ovarian reserves A fibroid is causing pain, distorting the uterine cavity, or blocking don’t have any data regarding the incidence of endometriosis. Psychological and your fallopian tubes.Laparoscopic adhesiolysis in cases of adhesions affecting the other social barriers stops women from seeking medical help for endometriosis abdominal organs Laparoscopic metroplasty in bicornuate and didelphic uteri. The symptoms, like dyspareunia and pelvic pain. Moreover there are no professional hysteroscopic procedure involves insertion of a telescope through the cervix into or patient associations, no national guideline exist and there is a lack of aware- the uterine cavity and enables the surgeon to inspect the lining of the uterus and ness among health care professionals about endometriosis. There are an increasing to diagnose and treat disorders in the uterine cavity including polyps, fibroids ad- number of studies and other publication all over the world about the disease but in hesions/scar tissue and congenital structural abnormalities as septate uterus. Both spite of this the diagnosis and treatment of endometriosis remains a real challenge. hysteroscopic polypectomy and hysteroscopic myomectomy appeared to enhance In our lecture we will make a literature review about new publications on endome- fertility compared with infertile women with normal cavities. Despite concern that triosis with special attention to new insights in terms of definition, pathogenesis, hysteroscopic resection of a large myoma might ablate a large surface area of the diagnostic imaging and treatment. Focus will be on patient oriented care and less endometrial cavity, the reproductive benefit appears greater than the risk. During a invasive treatment modalities. Delays in diagnosis and non standardised treatment hysteroscopic metroplasty, a lighted instrument is inserted into the vagina, through especially with unnecesary, incomplete and repeated surgeries often take place the cervix and into the uterus. Another instrument is also inserted to cut away and resulting in significant impairment in quality of life. Referral centers for endo- remove the septum. The result of this procedure significantly increases the pregnan- metriosis care and centers of excellence in endometriosis surgery plays e key role cy rate. Reproductive surgery not only can help diagnose infertility issues, but also in endometriosis management plan and the need for creation of such centers in can complement other assisted reproductive technologies, including IVF but also Albania will be discussed in our report. increase pregnancy rates after the procedures as well.

192 193 Session Plenary Plenary

OP210 - Cesarean Section ectopic pregnancy, Case report OP212 - Trichinellosis as an neglected disease. (Review- throught lecture)

Obstetric Z.Delia, E.Peçi, A.Gjoni, A.Koçi, A.Dhima A.Pilaca Gynecology & Gynecology The implantation of embryo at the level of C-Section scar represents a very rare Trichinellosis, caused by Trichinella, is an emerging or re-emerging zoonotic par- form of ectopic pregnancy. asitic disease, which is distributed worldwide with major socio-economic impor- The incidence of this condition is on rise because of the increasing incidence of tance in some developing countries. C-Section delivery. CSEP (C-Section Ectopic Pregnancy) is a potentially life It is a worldwide food-borne parasitic disease caused by eating raw or under- threatening condition because in case of delayed diagnosis and management it cooked meat containing the infective larvae of Trichinella nematodes. Pork may lead to uterine rupture, massive intra-abdominal bleeding and death. and its products are the main sources of infection. Trichinella has a wide range The most frequent signs are abdominal pain and vaginal bleeding. The diagnosis of hosts and can infect more than 150 species of animals, including humans. is made by ultrasonography, MRI and/or laparoscopy. It is evaluated that around 11 million people may be infected by Trichinella. There is not yet a standard protocol for the management of CSEP because of the In 2014, the Food and Agriculture Organization of the United Nations (FAO) and rare incidence. In the literature different methods are prescribed; administration of the World Health Organization (WHO) composed a list of 24 parasites ranked ac- methotrexate, laparoscopy, uterine curettage and laparotomy with edge resection cording to nine global criteria, Trichinella spiralis ranked the first in international at the level of the CS scar. trade At present, Albania is one of a few of countries with the non cases declared In this article we present the successful surgical management after that methotrex- of trichinellosis. It is possible? While since 2009 years, trichinellosis was includ- ate treatment had failed in the case of an ectopic pregnancy implanted at the level ed in the “list containing 26 kinds of the most hazardous zoonoses”. Trichinellosis of C-section scar. also have important influence on animal production, food safety and trade. Since the main source of trichinelosis is the consumption of pork and its by-products, OP211 - Cesarean Section ectopic pregnancy and Albania is a country where pork is consumed, I think we can not exclude the Z.Delia, E.Peçi, A.Gjoni, A.Koçi, A.Dhima possibility of having our cases. Evaluating in this regard I think to keep a lecture The implantation of embryo at the level of C-Section scar represents a very rare about Trichinellosis, becouse think it is underestimated disease. form of ectopic pregnancy. The incidence of this condition is on rise because of the increasing incidence of C-Section delivery. CSEP (C-Section Ectopic Pregnancy) OP213 - Chemotherapy Induced Polyneuropathy is a potentially life threatening condition because in case of delayed diagnosis B.Myfti, F.Sermaxhaj, Z.Hundozi and management it may lead to uterine rupture, massive intra-abdominal bleeding IPolyneuropathy is one of the major complications of chemotherapy treatment. and death. The most frequent signs are abdominal pain and vaginal bleeding. The Incidence of chemotherapy-induced polyneuropathy is above 55%. Its occur- diagnosis is made by ultrasonography, MRI and / or laparoscopy. There is not yet rence depends on the factors related to the patients’ features, as well as on the a standart protocol for the management of CSEP because of the rare incidence. type, duration and total accumulative dose of respective chemotherapy med- In the literature different methods are prescribed; administration of methotrexate, ication. The goal of our investigation is to enroll Kosovan patients that will laparoscopy, uterine curettage and laparotomy with edge resection at the level of undergo chemotherapy treatment, by performing the neurological examina- the CS scar. In this article we present the succesfuel surgical management after tion and electroneuromyography before and after their respective treatments, that metothrexate treatment had failed in the case of an ectopic pregnancy implant- so as to evaluate the effects of chemotherapy on peripheral nervous system. ed at the level of C-section scar. Patients involved are between 18-60 years old, without any known condition that might cause polyneuropathy, and without clinical and/or electrophysiolog- ical changes that might confirm polyneuropathy prior to involvement in ours study. We have involved 20 patients diagnosed with malignant disease who are candidates for chemotherapy. After the diagnosis, patients have underwent clin- ical evaluation (motor strength testing, superficial sensitivity evaluation, vibra- tion sensitivity, deep tendon reflexes condition and autonomous symptoms), and electroneuromyography. This electrophysiological examination have con- sisted from sensory conduction studies of right median, ulnar and sural nerves, as well as from motor conduction studies of right median, ulnar, tibial and pe-

194 195 Medicine 1 Medicine Intern Intern

roneal nerves. Summary of clinical and electrophysiological findings are com- OP215 - Helping to improve healthcare in Albania Intern

Medicine 1 bined and graded based on Total Neuropathy Score (TNS). Similar examination Dh.Dhame was performed after the fourth chemotherapy cycle, and patients were evalu- Suicide Attempts in the Saranda-Delvina population, the period 2008-2017. ated based on the type and cumulative doses of respective chemotherapy drug. Lack of data on the Incidence of Suicidal Attempts in the area motivated the quest. Involvement of the patients is continuing. Preliminary results show clinical and elec- Aim: to give the characteristics of coincidence and epidemiology according to: trophysiological findings present at around 80% of the patients. Oxaliplatin, carbopla- time, residence, sex, age, attempts. tin and taxanes are the most frequent agents used for the treatment, so they are mostly The study includes 175 new cases of suicide attempts, of the population under responsible for the development of polyneuropathy. Number of the patients involved review, extracted from 5393 daily emergency Hospital Cards “Stefan Mekshi”, would be much higher and results more grounded until the date of the Congress. Hospital Saranda, years 2008-2017. Polyneuropathy is one of the most frequent and devastating complications of the Saranda-Delvina Region Population: 129224 inhabitants, dt.01.01.2010, Vlora Re- chemotherapy treatment. We will be in situation to compare our cohort results gion Council. Processing: computer by purpose. Presentation: tabular, graphical. with other studies performed earlier. Different chemotherapy agents within our The average incidence of suicide attempts is 13,54 cases/100,000 inhabitants/year. study will enable to compare their respective side effects in our patients. By months: the lowest chance in October, the highest in May and December. 85.7% are female results. Male/female ratio 1/6. Most frequent, in total, age group OP214 - Abdominal Epilepsy: An underestimated diagnosis 15-19 years - males: 20-24 years old, women 15-19 years old. B.Zllami, E.Basha, S.Llazo; B.Popa, B.Cekrezi, J.Kruja According to residence: Suicidal Attempts were encountered in 31 residential cen- Abdominal epilepsy is one of the rare and tricky causes of abdominal pain, ofted ters. The highest incidence in the village of Shëndelli, 70 others mark the zero underestimated to adults. Making diagnosis for AE can be very challenging and ac- chance. Explains trends by purpose. Evidently problematic housing centers and cording to ILAE, abdominal epilepsy is considered to be part of simple or complex those where they live healthy. It paves the way for the psycho-social research of partial seizures; This rare epileptic phenomenon should be suspected in patients the phenomenon in the area and emphasizes that policy makers should put the nec- with unexplained paroxysmal abdominal pain, loss or alteration of consciousness, essary care to prevent suicidal attempts, this social and medical problem. The ana- migraine‐like symptoms while the diagnosis can be confirmed with EEG epilepti- lytical evidence of the attempts of aid helps the reception-emergency staff at work. form abnormalities, or even a good response to antiepileptic drugs. Abdominal ep- ilepsy can be masked or misdiagnosed as a physical or psychological disorder like OP216 - Disturbances of electrolyte homeostasis and the associated with an- this case and be subjected to a number of expensive, time-consuming,investigation ti-hypertensive pharmacologic treatment The pathophysiology of this epilepsy is not well understood although several E.Greca, N.Marku mechanisms have been proposed, mainly that abdominal epilepsy results from This study is made to evaluate the relationship of antihypertensive pharmacolog- abnormal brain activity arising from temporal lobe which involves the amygda- ic treatment on electrolyte homeostasis .Hypertension is a major health problem la, which then relays neurotransmission to gastrointestinal tract via dense direct because of its high prevalence and its association with increased risk of cardiovas- projections to the dorsal motor nucleus of the vagus nerve through which gastro- cular disease . Medication regimens may have adverse consequences because of intestinal symptoms are said to originate. The hypothalamus is also thought to the increased potential for adverse multi-drug interactions. These drug-induced activate sympathetic pathways from amygdala to gastrointestinal tract to induce disorders are relatively common, typically including hyponatraemia, hypokalae- gastrointestinal symptoms. mia, hyperkalaemia . Objective of this study is to evalutate the electrolyte dis- We evaluated ( and review the literature) three adult patients presented with ab- turbance on hypertensive patient,the role of sodium ,pottassium and chlor on dominal symptoms, and met the criteria for the diagnosis of abdominal epilepsy antihypertensive pharmacologic treatment ,the percentage of other disease on hy- and have and with excellent outcome with AED treatment. pertensive patient and the correlation of thiazedic diuritic ,loop diuritic , b-block- Abdominal epilepsy is a rare case of abdominal symptoms in adult and of- ers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers ten missed. Patients have several investigation, sometimes even explorative on electrolyte disturbance. This is case control study .There are two hypothesis to surgeries and often considered with psychiatric diagnosis, where presented be made before this study The zero Hypothesis : There is no relationship between with these complains. But despite the abdominal epilepsy, is a very rare case electrolyte and antihypertensive treatment of abdominal symptoms, should be considered in patients with recurrent at- Alternative Hypothesis There is relationship between electrolyte and antihyper- tacks of severe abdominal pain after exclusion of other common conditions. tensive treatment The case and control group is the same ,they are patient that

196 197 Medicine 1 Medicine Intern Intern

stay in Internal Medicine department on QSUT .It is taken in consideration the tionship. the majority of patients are poorly adherent to treatment b The reasons of Intern

Medicine 1 same group and are taken the value of electrolyte before the patients use an- poor adherence are reported as follows: 26, 3% not following regular treatment – tihypertensive medication and this represented the control group.The same pa- forgotten pills, nummer of pills/day; improvement of sympotoms; 24.2% because tient are taken the value of electrolyte after use antihypertensive on hospital this of symptoms improvement and/or lack of symptoms, implying lack of awareness represanted the case group.They are 80 patient on this study .The data are taken about the disease, lack of information. 21.1% patient physician relationship issues, through patient anamnesis on deparment of internal medicine ,through electrolyte poor communication, poor access, changing physician. 12.7% economic reasons. value and creatininee and urea value .The date of treatment is found on medical 9.5% modifying treatment by pharmacists due to high cost of treatment. 6.3% oth- files .The date are taken on 10 Jule - 10 Setember 2016 . The blood- isexam er reasons. Patients with higher education reported better adherence in the general ined on laboratory of QSUT .The data that are taken are anlysed with SPSS 30 medicine and poorer in psychiatric settings. Also patients without “experience” Electrolyte disturbances are frequently observed in relation to antihypertensive about the disease report poorer adherence. therapy. These treatment-related complications are clinically significant and should Adherence to treatment is strongly related with patient, provider and health care be considered in the optimal selection and modification of the treatment. Hypona- system factors. While the factors are qualitatively comparable, this observation traemia and hypokalaemia are two of the commonest side effects when diuretics are involves a significant degree of local factors differing from other studies. There used. The occurrence of diuretic-induced hypokalemia is dose dependent, while the are also typical local factors involved. risk of hyperkalaemia in subjects receiving potassium-sparing diuretics, b-block- ers, ACE inhibitors and ARBs, increases when renal function is impaired .Partic- OP218 - Adherence to Guidelines for Antimicrobial treatment and Patient ular attention should be given in the elderly and the diabetic patients who comprise outcomes the majority of hypertensive individuals.These adverse effects may be corelated R.Civljak, with careful monitoring, dosage adjustment and replacement of electrolyte losses. There is relationship between electrolyte disturbance and antihypertensive OP219 - The future of Internal medicine in Europe therapy and the result of my study goes parallel with some study on world . R.Palsson European healthcare systems are facing major challenges. The prevalence of OP217 - Adherence to treatment, Albanian context many chronic diseases has increased in parallel with greater longevity of our pop- E.Sotiri; F.Elezi; T.Mana; S.Bitri; I.Çako; A.Çomo ulations, resulting in a heavy burden on the medical services. Furthermore, exces- Drugs don’t work in patients who don’t take them (C. Everett KOOP). We can sive focus on specialization has led to fragmented care which is associated with in- expand this concept to: treatment don’t function if the patient doesn’t follow it. efficiency and rising costs. In order to cope with the needs of our patients, a proper Adherence to medication and treatment has e significant role in the outcomes of balance between general and specialized internal medicine services must be estab- physician work and patient wellbeing. An interplay of factors influence this topic. lished. The comprehensive approach offered by internists makes them best suited Patient background, socioeconomic status, access to healthcare and medications, for coordinating efficient, patient-centered care for diverse populations. Emphasis physician’s attitude, stigma, denial, etc. are some of the factors influencing treat- should be placed on high-value care, interventions to improve quality and safety, ment adherence. Our culture is more associated with treatment compliance, the and health promotion strategies. Finally, education and training of future internists patient passively follows physician orders. This attitude does not provide qualita- needs to be addressed. European internal medicine organizations have advocat- tive follow up and best results. Analyzing the factors and understanding in depth ed harmonization of postgraduate training and qualification in internal medicine the situation will help us to improve patient care. across Europe. The recently published European Curriculum of Internal Medicine Analyzing the factors influencing treatment adherence in the Albanian context. will be introduced. 95 patients suffering from chronic diseases and/or in need long term treatment who have had changes in the treatment modalities have been interviewed about OP220 - Purpuric lesions of Meningococcal and Pneumococcal sepsis in im- treatment follow up. Interviews are conducted in the hospital emergency settings, munocompetent adults where patients are seeking help for symptoms worsening. T.Kalo , E.Puca, N.Gjermeni, E.Muça, M.Qato, A.Ndreu, P.Pipero, Dh.Kraja Patient data such as: years of suffering from the disease; number of pill taken Purpuric lesions in Pneumococcal and Meningococcal sepsis (PLPMS) are a sig- daily; frequency of pills taken daily; education; awareness about the disease; time nificant manifestation of the severe evolution of disease in any patient suffering of spent to physician’s office; access to physician; scoring of physician patient rela- such infections. In some specific cases the purpuric lesion goes towards a fulminant

198 199 Medicine 1 Medicine Intern Intern

lesion in which beside the purpuric and ecchymotic skin lesions, fever, hypotension sed levels of plasminogen, a2 antiplasmin and plasminogen activator inhibitor 1 Intern

Medicine 1 the disseminated intravascular coagulation (DIC) is usually present. It is a life-threat- (PAI 1). One of the most important factors responsible for exaggerated fibrinolysis ening medical emergency condition which requires a prompt diagnosis and treat- in these patients is the expression of ANEXIN II and TAFI by the leukemic cells. ment. Common causes include: Neisseria meningitidis, Streptococcus pneumoni- The epidemiologic data are gathered from the database of the department of he- ae, Haemophilus influenzae, Staphylococcus aureus, and fungal or viral infections. matology between 2000-2017. There are 48 cases with APL. M/F ratio is 53% We would like to present in that prospective study seven cases of to 47%. Average age os 45 years.Clinically they were presented with signs of PLPMS, a rare observation in our practice with immunocompetent adults. DIC with hemorrhagic phenomena (metroraghia, epistaxis, petechie, echimo- In the period of time between January 2013 and May 2018, seven (7) patients sis) and also an increased tendency for bleeding mainly at the sites of manipu- of an average age of 21 years old, four females and three males, have been di- lation. Trombocytopenia, low levels of fibrinogen and PT were the main labo- agnosed with Meningococcal and Pneumococcal sepsis and purpuric lesions at ratory findings in these patients. 2/3 of them were presented with pancytopenia. the Service of Infectious Disease of UHC “Nënë Tereza”. They were all screened The treatment is based on immediate beginning of specific chemotherapy (3+7, for any immune-compromising diseases, including HIV/AIDS infection. All ATRA) which reduces the leukemic mass leading to DIC improvement. On the patients experienced systemic symptoms such as: fever, chills, malaise/fatigue, other hand the supportive care is also important. We use fresh frozen plasma, anorexia, headache and arthralgia. Because of the severity of clinical signs, hy- platelets and red blood cells transfusions in order to achieve safe levels of fibrino- potension and meningeal involvement, 5 of the seven patients were initially gen (100 mg/dl) and platelets (50000/mm3) observed and treated in the Intensive Care Unit. Neisseria meningitidis (in four cases) and Streptococcus pneumoniae (in three cases) were isolated in blood OP222 - Cerebral Infarction in Young Adults. Experience in the American in all cases, in skin lesions in only three cases (two with N. meningitidis sep- Hospital 3. sis, and in one case with S. pneumoniae) and in cerebro-spinal fluid (CSF) in Z.Ndroqi, E.Karame only two cases with N. meningitidis sepsis. The outcome of disease was ex- Cerebral Infarction In Young Adults. Experience in the American Hospital 3. cellent in all cases after an antibacterial treatment with Ceftriaxone in sev- Introduction Cerebrovascular diseases are among the biggest problems of public en cases because of a high sensitivity in the antibiogramme and intensive care. health , with a major economic and global impact. They occupy the first place in An early diagnosis, an intensive follow-up and treatment of any case of Meningo- diseases with permanent disability and in developing countries they take the sec- coccal and Pneumococcal sepsis complicated with purpuric lesions, improve the ond place in overall mortality (the first are CV disease). In developed countries chances for a successful outcome in those patients. due to organized measures, mortality has dropped to 4th or 5th place with a re- duction over 50% in 20 years. It is shown an increased number in young adults OP221 - Disseminated intravascular coagulation in acute promyelocitic leu- with 11% for ischemic STROKE. It is dramatic in youngs because affects people kemia. Pathogenesis, clinic and treatment. Our experience who were healthy. It has a high mortality rate, risk for cardiovascular events and Xh.Ngjela, P.Pulluqi, M.Shani, E.Calliku severe life - threatening consequences. Disseminated intravascular coagulation is characterized by systemic activation of Direct and indirect costs are much more high for younger than for older people. blood coagulation, which results in generation and deposition of fibrin, leading to Cerebrovascular disease occupy 5-10% of STROKE cases under 50 years, and microvascular thrombi in various organs and contributing to multiple organ dys- remains one of the 10 major causes of deaths at these ages. Often the causes of function syndrome. Derangement of the fibrinolytic system in some cases may these disease remain undefined with a variety of diagnostic and etiologic prob- cause severe bleeding. In hematologic malignancies DIC is often seen in acute lems . There are differences in incidence, clinic, risk factors and prognosis among promyelocitic leukemia. STROKE up to 50 years old and over 50 . There are two main elements in the pathogenesis of DIC caused by APL. Hyper- In developing countries this ratio is higher with 19-30% . STROKE incidence in young coagulability and hyperfibrinolysis. adults is increasing in recent years, even in countries with higher incomes , and occupy In hypercoagulation the main factors are elevations of TAT and fibrinopeptide A 10-15% of STROKE .There is a gap in knowledge in middle income countries. The levels. Leukemic cells produce different types of coagulation factors such as tissue reasons for this growth tendency are many as the increasement of risk factors in factor (TF), CP and microparticles (MPs). The coagulation cascade is activated by youngs as diabetes, obesity, tabacco, alcohol, drugs, lifestyles. The cause remains TF-factor VIII complex which activates factor X and leads to thrombi formation. undetermined at about 1/3 at younger ages and at least in half below 30 years old. Hyperfibrinolysis in patients with APL is explained by hypofibrinogenemia, decre- In our study in 2013, in 584 cases with STROKE (14% hemorrhagic) 5.47% were

200 201 Medicine 2 Medicine Intern Intern

under the age of 45. A prospective study of about 15 cases reported at our hospital OP223 - Thyroid Cancer and Total Thyroidectomy Intern

Medicine 1 from January 2017 until now with infarction up to 50 years old. Demographic A.Ylli,R.Sanxhaku, D.Ylli, M.Lekbello, E.Duva, G.Husi, V.Hoxha, E.Puca, Th.Fureraj data, ecological and risk factors are analyzed. Clinical signs, causes of STROKE, Thyroid cancer is the most common endocrine malignancy. The incidence of subtypes and vascular lesions are investigated. thyroid cancer has increased over a period of several decades in many countries Are given in the tables. STROKE of young adults are studied in younger worldwide, particularly among women. than 50, in some studies even younger than 45 years. They vary from 5% to The treatment of choice for patients diagnosed with thyroid cancer is surgery, 20% of all STROKE. We have 15 cases , that gives us valid data for the eti- when possible. Usually, surgery is followed by treatment with radioiodine and ological differences. The incidence was 12.1 from 100.000 in young Italians. thyroxine therapy. Generally, radiation therapy and chemotherapy do not have a Modifiable risk factors are the same for under and over 50 years old. The prominent role in the treatment of thyroid cancer. Surgery is the definitive man- prevalence is not the same. In our cases more frequent were HTA, dyslipidemia, agement of papillary thyroid cancer. For patients with thyroid cancer >4 cm, or obesity, smoking. The most frequent etiologic causes were atherosclerosis , cardi- with gross extrathyroidal extension (clinical T4), or clinically apparent metastatic oembolism, small vascular disease , dissection and some uncommon causes such disease to nodes (clinical N1) or distant sites (clinical M1), the initial surgical as vasospasm, vasculitis, fibromuscular dysplasia, protrombotic disorders. procedure should include a near-total or total thyroidectomy and gross removal The best organization of prophylaxis reduce stroke victims.On the other hand we of all primary tumor. For patients with thyroid cancer >1 cm and <4 cm without have organized the comprehensive STROKE unit, that is the life span avoiding extrathyroidal extension, and without clinical evidence of any lymph node me- expensive burden for family and society. tastases (cN0), the initial surgical procedure can be either a bilateral procedure (neartotal or total thyroidectomy) or a unilateral procedure (lobectomy). If surgery is chosen for patients with thyroid cancer <1 cm without extrathyroidal extension and cN0, the initial surgical procedure should be a thyroid lobectomy unless there are clear indications to remove the contralateral lobe. In these presentation we will bring our experience according the surgical approach to papillary thyroid cancer. In more than 95 % of cases with multinodular goiter total thyroidectomy is per- formed. We will discuss whether we should always have an aggressive approach to thyroid cancer when the latest guidelines suggest to perform lobectomy rather than total thyroidectomy in low risk patients.

OP224 - Approach to the patient with fever of unknown origin E.Puca, E.Puca Fever is a common problem for which patients seek medical advice. Fortunately, in most cases, fever is self-limiting or the etiology of fever is promptly established. Sustained, unexplained fever despite a comprehensive work up is recognized as fever of unknown origin (FUO), which frequently poses a clinical challenge. Fe- ver of unknown origin is a long-term febrile syndrome whose aetiology remains unknown even after an accurate and appropriate diagnostic procedure is followed either as in hospital or as in out-patient practice. FUO remain one of the most common and difficult diagnostic problems faced daily by clinicians. Its definiton is difficult, as it is a moving target, given the constant advancement of imaging and biomarker analysis. Therefore, the prevalence of FUO is unknown. The most causative agent of FUO are infections in 30-40% of cases; malignancy in 20- 30%; autimmune in 10-20; and a diagnosis is not determinated in 5-15% of cas- es. The etiologic clues obtainable from the history, bedside physical examination findings and pertinent laboratory tests are discussed. A thorough history, physical

202 203 Medicine 2 Medicine Intern Intern

examination and standard laboratory testing remain the basis of the initial evalua- OP226 - How much determinant is mental health related to alcohol abuse ? Intern

Medicine 2 tion of the patient with FUO. The differential diagnoses of FUO are grouped into Familial predisposition versus environmental predisposition. infections, malignancies, autoimmune diseases, and other miscellaneous. Newer E.Thoma; K.Vrenjo;S.Bitri; A.Nake, Z.Sulaj diagnostic modalities including updated serology, viral cultures computed tomog- Alcohol abuse is one of the five most important causes of the global burden of disease. raphy (CT), magnetic resonance imaging (MRI) and positron emission tomogra- The aim of this study is to find out if there is any correlation between alcohol abuse phy (PET) scan have important role in the assessment of these patients with FUO. and mental health.This is a retrospective study, conducted in UHC “Mother Teresa” Tirane, during January 2012- June 2013. The diagnosis was made based on clinical OP225 - Prevalence of Subclinical and Overt Hypothyroidism in Infertile history of the patients and laboratory findings. All the statistical data were analyzed Woman based on SPSS 20.0 program. In this study were enrolled 328 patients. 98 % of them E.Golemi, J.Dautllari,E.Kolici, A.Ylli were male. The mean age of these patients was 42.9 ±10.8 years old. The average Hypothyroidism has a significant effect on fertility causing anovulatory cycles, daily doses of alcohol consumption is 240.0±41.8ml, for patients under 30 years old, luteal phase defect, hyperprolactinemia and sex hormone imbalances .The thy- and increases with age. (Kruskal-Wallis Test, H=11.5, p=0.06). 36 % of the patients roid gland and gonadal axes interact continuously before and during pregnancy. had familial predisposition for alcohol abuse vs 34.5% which had environmental pre- disposition (χ2 = 4.5 p=0.03). 50% of the patients had both predispositions. 107 pa- Hypothyroidism influences ovarian function by decreasing levels of -sex-hor mone-binding globulin and increasing the secretion of prolactin. There is de- tients had a dual diagnosis in the moment of hospitalization.66 patients had comorbid psychiatric diagnosis, from which 45.5 % had anxiety disorders (χ2 = 17.3, creased synthesis of factors VII, VIII, IX, and XI and estrogen break through goodness of fit bleeding secondary to anovulation, which may explain the frequent, prolonged, p<0.01). Although many studies conducted abroad, highlight the close relationship between mental health and addiction in general, but specifically with alcohol abuse, and heavy menstruation. in this study we didn`t determined this. It might be because of the under diagnosed, Thyroid hormones are vital for the production of both estradiol and progesterone or misdiagnosed mental health disorders in Albania, but as well as misreporting of lack of which may cause infertility independent of hyperprolactinemia. Thyroid alcohol abuse from patients. supplementation restores prolactin levels and normalizes ovulatory function.Al- so,Thyroid antibody positivity separately increases the risk of thyroid dysfunc- OP227 - Differential diagnosis of Ascitic Fluid. Experience on their Etiology tion following delivery and during the postpartum period. Prevalence of thyroid in our service. autoimmunity is significantly higher among infertile women than among fertile H.Dede, J.Basho women, especially among those whose infertility is caused by endometriosis or Ascites is of Greek derivation (“askos”) and refers to a bag or sack. The word is ovarian dysfunction. a noun and describes pathologic fluid accumulation within the peritoneal cavity. To study the Prevalence of Subclinical and Overt Hypothyroidism in Infertile Women. There are many diseases that accompany ascites. A total of 350 infertile women (primary and secondary infertility) from 2014- Identification of different etiologic factors of ascites in our service during the -pe 2018 were investigated for thyroid stimulating hormone ( TSH) and anty- thy- riod of inclusion of the study and the statistical comparison of case studies with roid peroxidase.Infertile women were examinated for thyroid function, echo of general epidemiology. thyroid gland, TSh,FT4, FT3, AntiTPO, AntiTG and other causes of infertility. The prospective study includes 42 patients with ascitic fluid, hospitalized at the Other tests were performed: PRL, Fasting Insulinemia, Fasting Glucose, Ab- Department of Gastro-Hepatology QSUT, in the period September 2017 - Febru- dominal Echography, Histerosalpingography, AMH. ary 2018. The study showed that 76% (32 cases) of the patients involved in the Of 310 infertile women, 27.2% were clinic and subclinical hypothyroid- study with ascetic fluid were due to hepatic decompensated cirrhosis ,of which ism and 73.8% were euthyroid.Antithyroid peroxidase TPO was elevated in 60% (25 cases) of alchoolism, 12% (5 cases) of viral B or C (4 cases B and 1 case 90% and Anti Tg in 10%.After treatment for hypothyroidism, 82.5% of in- C), 2% (1 case) alchool + viral and 2% (1 case) either alchool or viral (autoim- fertile women conceived within 8 weeks to one year.All Infertile women re- mune cirrhosis). 17% (7 cases) of patients had ascites of neoplastic origin, 10% sponded to treatment with levothyroxine and TSH level returned to normal. (4 cases) with HCC, 5% (2 cases) with peritoneal carcinoma and 2% (1 case) with Conclusion: Measurment of TSH and Antithyroid-peroxidase( anti TPO) should be ovarian cancer. 7% (3 cases) of the patients involved in the study had other causes done at early stage of infertility chech-up.Oral autoimmune hypothyroidism tret- of ascitic fluid : 5% (2 cases) with Budd-Chiari syndrome and 2% (1 case) acute mant for 2 months to one year can be of great benefit to conceive in infertile women. pancreatitis- severe form. Regarding the gender of patients with ascitic fluid, 83%

204 205 Medicine 2 Medicine Intern Intern

(35 cases) were male and 17% (7 cases) females, of which more than half had non and obesity-related complications were present. It has resulted in significative Intern

Medicine 2 cirrhotic causes of ascitic fluid (2 cases with peritoneal carcinoma, one case with weight loss in all the patients and improvement of glycemia, lipid profile and ovarial cancer and one with Budd-Chiari syndrome) and the rest of the women had blood pressure. cirrhotic causes of ascetic fluid (3 cases with viral decompensated cirrhosis). Even in our country, the most common cause of ascites is the decompensation of hepatic OP229 - Bacterial Resistance, Myth or Reality? cirrhosis, with the highest percentage of ethylic cirrhosis (all patients are males) M.Barbullushi, A.Daka Diagnosis of female cases with ascitic fluid should be oriented, among other Bacterial resistance is considered one of the greatest threats to global health, things, towards non-cirrhotic causes, especially when hepatic viral markers have food safety, and the existence of society itself. Resistance to antibiotics is en- been negative. creasing to dangerous levels in all parts of the world. Bacterial resistance occurs naturally, but the abuse of antibiotics in humans and animals is speeding up the OP228 - Weight loss and the improve of metabolic syndrome after bariatric process. Antibiotic resistance accelerates by misuse and excessive use of antibi- surgery in Obese patients. otics, as well as poor prevention and control of the infection. Steps can be tak- M.Guni, F.Shehi, A.Hysa, Gj.Semini, A.Catona en at all levels of society to reduce impact and limit the spread of resistance. Our study evaluates the weight loss and the improve of other components of Without urgent and concrete actions, we are going for a post-antibiotic age, in metabolic syndrome after bariatric surgery (Sleeve gastrectomy and ROUX-en which common infections and light injuries can once again kill as in the middle Y gastric bypass) in 15 patients who underwent this procedure within a 1 year ages. The world urgently needs to change the way it describes and uses antibiot- period (2017) in our hospital.This retrospective study included 15 patients, 8 ics. Even if new drugs are developed, unchanging the current approach, antibiotic underwent laparoscopic sleeve gastrectomy (LSG) and 7 Roux-en Y gastric resistance will remain a major threat. Changes in access to national and global bypass (RYGB). The median patient age was 38 years (range 21–55), median levels are now a necessity for our existence. To prevent and control the spread of BMI was 43.6kg/m2 (range 35-63.4 kg/m2 ), Median BMI for RYGB 50.7 6kg/ antibiotic resistance, the nephrology association would react through a powerful m2 and median BMI for LSG 37.8 6 kg/m2 . 11 where females, 4 males, 8 of national action plan to maintain antibiotic resistance and control; them had BMI 35-40 6kg/m2 and had obesity related complications (HTA, DM • Studying its national dimension Type 2, Sleep apnea, Dyslipidemia) 7 of them had BMI over 40 with or without • Studying national causes in relation to its dimensions obesity related complications. 9 of them had HTA, 4 of them had Diabetes, • Awareness of doctors and pharmacists for its treatment 12 dyslipidemia, 4 had sleep apnea under CPAP treatment. The patient where • National guidelines for the use of antibiotics in the treatment of urinary infections followed for a period of 6 months . Patients were assessed at baseline and on the 1st week , 3rd, 6th postoperative month. Pre- and postoperative workup in- OP230 - Vaccination of Healthcare Workers and Patient Safety cluded physical examination, Body Mass Index (BMI), psychological and nutri- R.Civljak tional evaluation, and routine laboratory work including complete blood counts (CCB), fasting glucose, urea, creatinine, electrolytes and lipid panels. The main OP231 -Rapidly progressive glomerulonephritis: diagnosis and treatment outcome measures were percentage weight loss (PWL) and excess weight loss R.Palsson (EWL). Successful weight loss was defined as excess weight loss >50% at 6 Rapdily progressive glomerulonephritis (RPGN) is a medical emergency. RPGN months for both groups. is a clinical syndrome characterized by rapid decline in renal function and a ne- Both RYGB and LSG resulted efficient in weight loss and improving metabolic phritic urine sediment. Kidney biopsy usually reveals diffuse glomerular crescents syndrome. Median EWL was 66.5% (range 24–100% ) after 6 months ; 61.6% (affecting >50% of glomeruli). Anti-neutrophil cytoplasmic antibody (ANCA)-as- for patients who underwent RYGB and 71% for patient who underwent LSG sociated vasculitis is the most common cause of RPGN, while anti-glomerular and median PWL at 6 months was 24.8 (range 15.8–32.3). However, PWL basement membrane disease is the most aggressive type. Urgent diagnosis fa- was higher in patients who underwent RYGB 30% compared to those of LSG cilitated by serologic testing and kidney biopsy is essential for successful out- group (22.1). Glucose levels and lipid profile where improved in all patients. come in patients with RPGN. Immunosuppressive therapy using a combination of Bariatric surgery remains an effective method for sustained weight loss in obese glucocorticoids and cyclophosphamide has markedly improved patient and renal adults, candidates included patients with a body mass index (BMI) >40 kg/m2 or survival and remains the mainstay of treatment. In recent years, rituximab has patients with a BMI >35 kg/m2 after conventional weight loss treatment failed emerged as an effective alternative to cyclophosphamide, particularly in patients

206 207 Medicine 2 Medicine Intern Intern

with ANCA-associated vasculitis. The lecture will focus on the presenting fea- matologic diseases, Inflammatory bowel diseases, Medications, Autoimmune Intern

Medicine 2 tures, diagnostic evaluation and treatment of RPGN. disorders, and Malignancies. Often the lesions are bilaterally distributed. The purpose of that study was to find out the place of EN among the other man- OP232 - Cannabis versus Cocaine abuse. What are the differences ? ifestations of Toxoplasmosis in immunocompetent adults followed up in our Ser- S.Tivari Bitri; E.Puca, E.Sotiri, E.Thoma,E.Puca, E.Huti vice and in American Hospital nr 3. In a period of time of 5 (five) years, between Substance use disorders represent a significant public health problem -world January 2014 and January 2018, we have diagnosed and followed ambulatory wide. Various epidemiologic studies suggest that the lifetime prevalence for up 10 (ten) cases of Erythema nodosum due to Toxoplasma gondii among the marijuana and cocaine dependence may be round 1.4% and 1.0% respec- other patients diagnosed with EN. 8 (eight) cases were diagnosed at Universi- tively. In Albania cannabis is the main illicit substance consumed, followed ty Hospital Center “Nënë Teresa”, and 2 (two) cases were diagnosed at Ameri- by cocaine and 3,4-methylenedioxy-Nmethylamphetamine (MDMA/ecsta- can Hospital nr. 3 in Tirana, Albania. They were of an average age of 27 years sy). Fortunately, not every initial substance use, can lead to addiction. Bet- old, six females (60% of cases) and four males (40% of cases). They were all ter understanding of the differences between cocaine and cannabis abuse screened for other conditions such as: Group A streptococcus infection, Tubercu- can help for a more effective primary and secondary preventive strategies. losis, EBV infection, HIV 1+2 infection, Leptospirosis, Sarcoidosis, IBD, Rheu- To compare the epidemiologic variations and the time course differences from the matologic diseases and Malignancies. They represented only 3% of all patients first substance use to treatment contact, in cocaine and marijuana addicted patients. clinically and serologically diagnosed, followed up and treated for Toxoplasmosis This is a prospective and retrospective study conducted in American Hospital,Tirana in those two hospital centers. Eight of those ten patients received Spiramycin/ , Albania during September 2014-November 2017. A total of 92 outpatients (cocaine, Rovamycin, 3 times x 1.5 MUI per day, for a period of time of four weeks, and n = 34; cannabis, n = 58) were enrolled in the study. They were asked about age at first only two of them received Bactrim/SMX-TMP, 2 times x 0.96 mg per day for use of alcohol and illicit drug use, age at regular use of these substances (defined as 3 the same period of time of four weeks. They were all followed up for a period or more times per week), and age at first treatment contact regarding each substance. of time of 6 months after finishing their treatment. The outcome was excellent Cocaine patients were older (P<.001) than marijuana patients (P = .04). Age in all ten cases, and we haven’t observed any case of recidivism among them. at first use, age at regular use, and age at first treatment were statistically- lat Toxoplasmosis must be included in the list of the screening of other pathologies, as er for cocaine patients than marijuana patients (P < .001). Cocaine abusers re- a potential cause of any case of Erythema nodosum in immunocompetent patient. sult to progress more rapidly toward regular use and treatment for their disorder. Cocaine addicted patients urge to medical treatment sooner and easier than can- nabis abusers. Nevertheless, we should take in consideration that about 45% of cocaine addicted patients had previous history of cannabis abuse. Furthermore, the clinical complication of cocaine overdose, seems to have a greater impact in the decision of the patient to address treatment programs.

OP233 - Erythema nodosum, a rear presentation of Toxoplasmosis. T.Kalo, P.Dano, E.Muça, S.Dedja, E.Puca, K.Mëlyshi, G.Stroni Erythema nodosum (EN) is the most frequent clinico-pathological variant of the panniculitides. EN is characterized by red or violet subcutaneous nod- ules that usually develop in a pretibial, ankles and knees location, that resolve without scarring over a 2- to 8-week period. Lesions can also appear on the thighs, trunk and upper extremities, but absence of nodules on the legs is atyp- ical. The process may be associated with a wide variety of infectious diseas- es such as: Group A streptococcus, Tuberculosis, Systemic fungal infections (histoplasmosis, coccidioidomycosis, and blastomycosis), Epstein-Barr vi- rus, Toxoplasmosis, and noninfectious conditions such as: Sarcoidosis, Rheu-

208 209 Ophthalmology

OP234 - Fungus Ball of the lachrymal system presenting with Epiphora The major diagnostic concern is to differentiate melanomas from benign nevi. A.Aga, T.Haveri The contribution of more advanced technological diagnostic techniques has im- proved the reliability of final diagnosis. The treatment of primary pigmented Ophthalmology Usually fungus ball is found in paranasal sinuses, mostly in the maxillary sinus . We report a case of fungus ball of the lachrymal sac and ducts. The paranasal tumors is mainly local radiotherapy , integrated by other methodologies. Local sinuses did not have fungal involvement .Fungus ball was diagnosed during the tumor control is quite high compared to other areas of human oncology, but it is procedure of endoscopic dacrocystorhinostomy. necessary to manage treatment-related eye complications (radiation chorioreti- To our knowledge, this is the first reported case of the Fungus ball of the lachrymal nopathy and maculopathy) , and to follow-up the patient for metastatic disease. sac and ducts presenting with epiphora. We suggest to use the preoperative CT scans in one patient who has blockages of OP237 - Retinopathy of Prematurity: Diagnosis and treatment nasolachrymal passages (or who has epiphora) ,especially in patient with previous G. Anselmetti interments’ history. CT scan is necessary for a more accurate diagnosis and to The Author describes the latest instruments and procedures used for the diagnosis prevent unnecessary procedures. and the treatment of Retinopathy of Prematurity (ROP). RetCam120 is the funda- mental tool, necessary to have the first diagnosis. Fluorescent Angiography (FAG) OP235 - Optic nerve atrophy as an indicative sign of intracranial tumor is then needed to evaluate the extension and the Stage of the disease. Worldwide CASE report guidelines agree in saying that Laser Photocoagulation is the best treatment. The A.Gambeta, T.Haveri purpose is to block the expansion and the evolution of the ROP. To do so, we need Optic atrophy is a final result of many disease which causes axons degeneration to treat all ischemical areas we found with FAG, which are prior and back the shunt. in retinogeniculate pathway. It manifests with changements in the color and the structure of the optic disc (cupping) associated with variable degrees of visual OP238 - Branch Retinal Vein Occlusion, Case Report dysfunction. The axons of the optic nerve are heavily myelinated by oligoden- M.Batku Ristani, T.Haveri drocytes, and the axons, once damaged, do not regenerate. Many pathologies can Retinal vein occlusion are the second most common retinal vascular disease af- causes damages in different part of optic nerve. Pathologic optic atrophy are clas- ter diabetic retinopathy. Their prevalence is encountered at 0,6 % in patients sified in anterograde (that starts from the retina or choroidal and spread through older than 43 years old. Arterial compression on the vein is believed to be the the optic nerve) or retrograde in which degeneration starts from the proximal por- main cause of BRCVO. Other conditions that predispose for endothelial vascular tion of the axon and proceeds toward the optic disc (eg, optic nerve compression damage are arteriosclerotic, hypertensive, inflammatory and thrombophilia via intracranial tumor). 38 years old man, living outside Albania, complaining loss conditions. Compression of the vein may lead to turbulent flow in the vein. of vision from 6 months. No history of trauma or systemic disease. In his living The turbulent flow in combination with the preexisting endothelial vascular country was diagnosed for glaucoma and treated with Betoptic. Presented in our damage from the different conditions creates a local environment favorable hospital for a second opinion. A careful examination was performed reveling VA = to intravascular thrombus formation. Once the venous flow is compromised CF of the left eye and optic atrophy with normal intraocular pressure= 12 mmHg. or interrupted, retinal ischemia ensues downstream from the site of occlusion. Not presenting a typical aspect of glaucoma, patient was advised: Visual field ex- Retinal ischemia stimulates the production of vascular endothelial growth amination and OCT of optic nerve and brain MR examination. MR examination factor (VEGF). VEGF secretion causes breakdown of the blood-retinal barrier, reveal a big intracranial tumor causing compression on optic nerve and causing contributing to the formation of macular edema. Macular edema cause the loss optic nerve atrophy. Patients was immediately advised to neurosurgery department of vision which is the main complains of the patient. The non-perfusion retinal for treatment. Optic atrophy is a common finding of many pathologies. Very care- areas stimulate VEGF production which stimulates creating the new vessels, ful examination, including MR is required to rule out any serious disease that can more fragile than can break and cause further hemorrhages. Neovascularization compromise patients life. are long term complication of BRCVO which can lead to NVX glaucoma with permanent loss of vision and long lasting head and eye ache. The main treatment OP236 - Posterior Uveal Tumors: Facts and Perspectives is the anti VEGF injection that blocks the main cause of complication also FFA E.Midena and argon laser treatment to treat ischemic areas and long term complication. Posterior uveal tumors are mostly represented, in daily clinical practice, by mela- Describing one case, 56 years old, F, presenting with sudden loss of vision. Opti- nomas, even if metastatic lesions are becoming increasingly frequent. cal coherence tomography was done to visualize central massive macular edema

210 211 Ophthalmology

and to measure its thicknes.3 consecutive injection of intra vitreal anti VEGF are ative inflammation at the sclerotomy sites,reducing patient discomfort and has- applied with interval 4-6 weeks. The resolving of edema is followed through OCT tening postoperative recovery. It also avoids induced astigmatism, allowing more examination performed 3 weeks after injection. FFA performed 4 months after last rapid visual recovery. Disadvantages: More frequently hypotony and endophthal- Ophthalmology injection; ischemic areas were evidenced and treated with argon laser. mitis.The risk of these complications can be reduced by creating a tunnel or angu- Macular edema is rapidly started to absorbed and visual acuity increase from 0,1 lar incision in a different plane relative to the conjunctiva, and performing fluid-air to 0,4 after 1st injection until 0.9 after last injection. Total hemorrhage absorption exchange at the end of the surgery. occurred 10 weeks after 1st injection. Neovascularization are not seen even 4 years after treatment. BRCVO remains a OP240 - Prophylactic effect of oral acetazolamide against increased intraoc- very frequent cause of loss of vision in adults, especially with systemic disease. ular pressure (IOP) in the period immediately after cataract surgery in eyes Vascular endothelial growth factor (VEGF) secretion is the main mechanism and with primary open-angle glaucoma a potent inductor of vascular permeability and intraocular neovascularization. M.Meço, Teuta Haveri Therefore, VEGF inhibition is an excellent treatment modality for macular edema, To confirm the prophylactic effect of oral acetazolamide against increased intraocu- improving visual acuity and avoiding long term complications. lar pressure (IOP) in the period immediately after cataract surgery in eyes with pri- mary open-angle glaucoma (POAG), and to evaluate the appropriate administration OP239 - Mini invasive Retinal surgery; Advantages and disadvantages time of oral acetazolamide to prevent IOP elevation. Sixty eyes of 60 patients with M.Jaccobbi, T.Haveri, M.Meco medically well-controlled POAG scheduled for phacoemulsification surgery were Pars plana vitrectomy was introduced almost 40 years ago. In the 1980s and randomly assigned to one of three groups: 1) oral acetazolamide administration (500 1990s, three-port PPV with 20 G instruments was generally applied. In 2002, mg) at 1 hour preoperatively (preoperative administration group), 2) oral acetazol- 25-gauge transconjunctival suture less vitrectomy (TSV) was introduced. This amide administration (500 mg) at 3 hours postoperatively (postoperative adminis- system permits three-port PPV using micro cannulas, trocars, and 25-G instru- tration group), or 3) no acetazolamide administration (non-administration group). mentation without requiring sutures to close the sclerotomies. Subsequently, IOP was measured using a rebound tonometer at 1 hour preoperatively; at the con- a similar technique but with 23-G instruments was developed. Currently, 25- clusion of surgery; and at 1, 3, 5, 7, and 24 hours postoperatively. The incidence of and 23-gauge systems constitute the two most popular TSV techniques. Here eyes with IOP elevation greater than 100% above the preoperative IOP was examined. a review on advantages and disadvantages of small-gauge vitreous surgery. In all groups, mean IOP was significantly elevated from 3 to 7 hours postoperatively, TSV consists of a 23-G or 25-G microcannular system and a wide array of vitreoret- and then decreased at 24 hours. At 1 and 3 hours, mean IOP was significantly lower inal instruments specifically designed for this operating system: the microcannula, in the preoperative administration group than in the postoperative administration or the insertion trocar has a sharp tip that forms a continuous bevel with the microcan- no administration group (P=0.0031). At 5, 7, and 24 hours, the IOP was significantly nula, allowing easy entry through the conjunctiva into the eye. A wide array of vit- lower in both the preoperative and postoperative administration groups than in the reoretinal microsurgical instruments complying with 25-G standards has been de- non-administration group (P=0.0224). The incidence of IOP elevation greater than signed : vitreous cutters, illumination probes, intraocular forceps, micro vitreoretinal 100% was lower in the preoperative administration group (3.3%) than in the postoper- blades, tissue manipulators, aspirating picks, aspirators, soft-tip cannulas, curved ative administration group (23,3%) or non-administration group (26.6%; P=0.0459). scissors, extendable curved picks, intraocular laser probes, and diathermy probes. Eyes with POAG experienced short-term IOP elevation from 3 to 7 hours after TSV seems to be particularly advantageous for procedures that dont require ex- phacoemulsification surgery. Oral acetazolamide administration at 1 hour preopera- tensive intraocular tissue dissection or manipulation. 25-gauge surgery is ide- tively significantly reduced the IOP elevation from 1 to 24 hours, while administration al for vitreous and preretinal hemorrhages in proliferative diabetic retinopathy, at 3 hours postoperatively reduced the IOP elevation at 5 hours or more after surgery. rhegmatogenous retinal detachment, proliferative vitreo-retinopathy, giant retinal breaks, and cases in which vitrectomy and phacoemulsification are combined OP241 - Piggy back implantation in nanophtalmic eye with intraocular lens implantation.If scleral buckling or silicone oil tamponade M.Meco, U.Desanctis,.T.Haveri is anticipated, standard 20-G vitrectomy is preferred. TSV is preferred in pediat- We present a case report of treating high hypermetropia, with piggy back im- ric cases,in newborn and premature eyes that are significantly smaller than adult plantation in a nanophtalmic eye Phacoemulsification with standart proc dure, eyes and the use of standard vitreo-retinal instruments may be technically difficult. followed by piggy back implantation AR40e pw+30/+16D, to correct high hyper- TSV-based surgery has the potential to shorten operative time, reduce postoper- metropia, in a 21 years old patient. Correction of high hypermetropia with good

212 213 Ophthalmology

results was achieved, by this technic : postoperative refraction of sph-1.0 OD and Corneal thickness 2nd group presents the lowest values (524.24±45.57) than 1st sph-0.5 OS . For high refractive errors, piggy back implantation is a good option (545±45.57) and 3rd (549.42±43.89). The difference is statistically significant -be with safe profile. Calculation of IOL was one of the challenging steps. Anterior tween the 1st and 2nd age group (p≤0.001) and between 1st and 3rd (p=0.02). Ophthalmology chamber deepth, and angle parameters ,did better then preoperative, but still re- Central corneal thickness is higher in 1st age group (549.42±43.89) than 2nd main shallow/narrow. (524.24±51.48), difference statistically significant (p≤0.001). 3rd group- mea surements (533.87±69.49) are lower than 1st , a difference significant (p=0.06) OP242 - Ocular manifestation of systemic diseases - Case report Corneal radius K1 The patients younger than 14 year old presents lowest values S.Zhuka (Nuellari); M.Silaj; T.Haveri (49.64±51.45 D) than 3rd (51.75±51.19) and 2nd group (56.67±71.94.Corneal The eye is a target organ for many systemic diseases: vascular, neoplastic, autoim- radius K2 1st group has lower values (45.04±3.49), than 3rd (49.07±42.06) and mune, infection, metabolic the most frequent being diabetes, HTA, anemia, rheu- 2nd group (50.23±49.60)Corneal astigmatismus is higher in the patients under matologic diseases. Symptoms varying from redness and pain to various focus on 14 years old (2.60±4.54) compared with 3rd (0.47±3.38) and 2nd (0.95±2.44), the retina and vitreous and sudden loss of vision. In this paper we would like to differences that are statistically significant (p=0.003; p≤0.001). The maximal val- present a case in 53 year’s old, male, presenting with loss of vision in the left eye. ue of cornea’s posterior face is lower in the young patients (under 14 years old) No previsious history of systemic disease.A very careful examination is performed (59.10±179.92) than in 3rd group (99.34±211.61), and the 2nd (186.93±253.70) to the patient including VA, measuring intraocular pressure, pupil dilated fundus Keratokonus early signs are, high values in corneal radius and posterior face of the examination which revealed an abnormal macular reflex and slightly pale optic cornea, accompanied with lower values of corneal thickness and also high and asym- nerve. Optical Coherence tomography was recommended to the patient. In this ex- metric astigmatisms. In this statistical study we found that 1st group of patients (up amination sub retinal liquid was seen. In FFA examination there were no leakage to 14 years old) present high values of corneal astigmatisms,low values of corneal seen in the macula and coloring of optic nerve. Patient was advised to complete radius and posterior face of the cornea and high values of corneal thickness.To detect serologic and radiologic examinations including MR head/orbit. early cases of progressive keratokonus, regularly applied,topography examination In ultrasound examination of the neck a tumors of parotis is evidenced and patients every 6 months, is strongly recommended in children with high astigmatismus. was advised to see an maxilla facial surgeon, to continue the treatment. Eye manifestation of systemic disease may vary and presenting from simple to OP244 - Title: 50 years of phacoemulsification complicated clinical situation. An careful and complete radiologic and serologic Ugo de Sanctis, T.Haveri examination is advised in each situation, case by case, to evidence the cause and Phacoemulsification, now the treatment of choice and standard of care in cataract advise patient to the main treatment. surgery, was by no means an overnight success. On the contrary, phaco met with considerable professional scepticism and institutional resistance in the early days. OP243 - Statistical study on Cornea profil and parameters between genera- First introduced in the US by Dr Charles Kelman in 1967, the technique has im- tions in Albania. Is there a predict for Future Keratokonus? proved dramatically over the years. The evolution of phaco machines and a better T.Haveri, K.Kojqiqi understanding of fluidics have decreased the occurence of intraoperative and post- The number of patients in pediatric age, presenting high values of astigmatismus (4 operative complications. The capsular opening with the continuous curvilinear and 5 diopters) has considerably increased. It is also not rare to examine children capsulorhexis technique, that now can be created also with thermal instruments with evidenced progressive keratokonus. Trying to understand if the latest are only and laser, allows optimal centration and effective positioning of the intraocular sporadic cases or is a real change in cornea profile between generations that could lenses (IOL) in the posterior chamber. The availability of foldable IOL and of new predict a keratokonic future generation, we collect data from patient of different ages generation formulas to calculate IOL power have reduced the surgically induced and make a comparison statistical study A total number of 701 eyes are examined, pa- astigmatism to 0.1-0.2 D and the biometric error to 0.3-0.4 D. The preexisting tient that undergone three dimensional corneal topography ( Oculus Pentacam HR). refractive errors and presbyopia can be corrected with toric and multifocal IOL Parameters recorded were : Corneal pachymety : central and thinnest point, main increasing the spectacle independency after surgery. perpendicular corneal radius (K1/K2) and maximal value Kmax , corneal astigmatis- mus and values of posterior face of the cornea. Patients are divided in 3 main groups : 1st Group 1 (< 14 years old) 215 eyes/2nd Group 2 (14 – 40 years) 397 eyes/3rd Group 3(> 40 years) 81 eyes.

214 215 Nephrology

OP245 - Outcome of the living kidney donor el dysfunction (BBD), etc.), the socio-economic status, disease awareness, and A.Strakosha, A.Dedej, F.Nasto, N.Pasko, V.Cadri,N.Thereska compliance of the patient. Although long-term antibiotic prophylaxis are mainly Nephrology Renal transplantation from living kidney donors is still relatively marginal in most recommended in infants and children with risk factors, at least until the underlying of the European countries. pathology resolved or the danger has passed related to it, irrespective of the pres- The living donor strategy implies correct and objective information about dona- ence (anatomic malformations, VUR, BBD, uretero-pelvic junction obstruction, tion risks and completely free acceptance of the living candidate of the donation. neurogenic bladder) or absence of risk factors, it is common to prescribe long-term In this study, we reviewed the consequences of kidney donation on the living do- antibiotic prophylaxis in those children. Moreover, differences in methodology, nor health, considering very short term (linked to the surgery), short term and subgroups, gender, severity of VUR, and baseline renal scarring between available long term (risk of mortality, chronic kidney disease, proteinuria and hypertension) studies in literature make difficult the comparison of each others. We will discuss consequences of kidney donation. mainly the aim and duration of prophylaxis, mostly used prophylactic agents, what we know about prophylaxis, whether we may stop the prophylaxis, and any op- OP246 - Impact of anemia after Renal Transplantation tion(s) other than prophylaxis under the light of available data. on patient and Graft Survival A.Dedej, A.Strakosha, F.Nasto, N.Therecka OP248 - Indications and timing of Renal Replacement Therapy Anemia often occurs in renal transplanted patients both in the early posttransplant in Acute Kidney Injury. phases and in the later stages. This complication has several major causes and E.Rista factors, among which the most important are: renal function failure, immunosup- Acute Kidney Injury (AKI) during a hospitalization is associated with high rates of pressive therapy, iron deficiency , RAS system blockers and infections. prolonged hospital stay, morbidity and mortality. Reported mortality rates among Our study included 100 patients who performed the transplant during the patients in the intensive care unit, who develop AKI requiring Renal Replacement period January 2007 to December 2017. Patients with Hb <11gr / dl lev- Therapy (RRT), range from 40-60%. els were considered anemic. 13% of the population in the study were with The initiation of dialysis in AKI prevents uremia and death from adverse compli- anemia. Our study found: A statistically significant difference in surviv- cations of acute renal failure. al times in subjects with Hb <11gr / dl versus those with Hb> 11gr / dl (33.5 Urgent indications include refractory fluid overload, severe hyperkaliemia, severe ± 2.4) vs. (57.0 ± 1.3) (Log-rank test p = 0.043 A statistically significant dif- metabolic acidosis, signs of uremia such as pericarditis, encephalopathy, decline ference in the survival rates of the graft in persons with Hb <11gr / dl versus of mental status unexplained from other problems, certain alcohol and drug in- those with Hb> 11gr / dl (33.5 ± 2.4) vs (57.5 ± 1.1) (Log rank test p = 0.021) toxications. The timing of renal replacement therapy is very important. Earli- Conclusion: Our study showed that post-transplant anemia is associated with er RRT offers rapid correction of electrolyte and acid-base status, better control worse performance of the graft and lower recipient survival than with anemia of complications of uremia and excessive fluid accumulation but there are some recipients. potential concerns regarding initiating RRT too early in the absence of clear in- dications. Patients receiving RRT will require a central catheter, will inevitably OP247 - Prophylaxis in urinary tract infection in children: have blood exposure to foreign surface of the extracorporeal circuit, will definite- what we know about it? ly need anticoagulation regimens and most importantly will face iatrogenic epi- A.Balat sodes of hemodynamic disturbances which may disrupt kidney recovery process. Urinary Tract Infections (UTIs) are one of the most common bacterial infections The issue of appropriate timing and indicating when to start RRT is cur- in infants and young children, and recurs in 10–30 %. There is a strong correlation rently a high research priority in the field of critical care of kidney disease. between UTI, vesicoureteral reflux (VUR), and renal scarring. Unfortunately, 7-17 It has to be underlined that RRT is a tool in the armamentarium when treating % of end stage renal disease is associated with VUR. critical patients. Beyond that, AKI serves as an indicator of disease severity as It has been expected that prevention of UTI by antibiotic prophylaxis will prevent well. Thus it is of paramount importance to identify and aggressively treat the renal scarring. However, the follow up of children with VUR and/or recurrent underlying cause of AKI. A lot has been learned of AKI during these years, hence UTIs has been debated for many years. The recommendations of the research- the initiative 0by25 of the International Society of Nephrology. It means no pa- es and practical approach may vary according to the patient’s characteristics (re- tient all over the world should die of AKI by year 2025. Indications for RRT are current acute pyelonephritis, the severity of underlying pathology, bladder-bow- clearer than its timing in the setting of AKI. RRT is a lifesaving procedure in

216 217 Nephrology

critical patients who develop AKI. Aggressive treatment of the underlying cause remove organic waste. Proper kidney function may be disrupted, however, when is paramount to improve patient outcomes. 0by25 objective is totally achievable. the arteries that provide the kidneys with blood become narrowed, a condition Nephrology called renal artery stenosis. OP249 - Trends in The Prevalence of End-Stage Renal Disease in Albania Given the fact that chronic kidney failure is a frequent disease in our country, we F.Nasto, A Strakosha, N.Pasko, A.Dedei, V.Cadri, E.Rista, N.Therecka. have found it reasonable to study some clinical biochemical parameters with these The chronic kidney disease (CKD) is a common and serious health problem that patients, considered as important risk indicators for atherosclerosis and cardiovas- places a large burden on the Albanian healthcare system. It is associated with cular disease. several other chronic diseases like diabetes and cardiovascular disease and has The purpose of this study was to evaluate the correlation of B2 microglobulin become the leading cause of morbidity in Albania. In order to initiate appropriate (B2M) with triglycerides (Tg), cholesterol, LDL-C, HDL-C, serum albumin management of CKD, it is important to have data on incidence and prevalence (ALB), phosphor (P) and calcium (Ca) in chronic HD patients. of the disease. The aim of this study was to evaluate the epidemiologic profile In this study we included 60 individuals, 40 HD patients (23 F and 17 M) and 20 of CKD stage 5 patients and associated risk factors for end stage renal disease in healthy individuals (12 F and 8 M). Albanian population. Patients were treated with hemodialysis for more than 6 months, which is con- The study was conducted in collaboration with the other centers that provide care sidered as chronic HD. In both groups, triglycerides (Tg), cholesterol, HDL-C, for the ESRD patients. Basic demographics data, the clinical and laboratory profile LDL-C, serum albumin (ALB), phosphor (P) and calcium (Ca) were determined at the time of initiation of renal replacement therapy (RRT), cause of CKD, and the in relation to B2M. dialysis modality used were recorded for all patients. Based on our findings, serum concentration of B2M, Tg, LDL and P in HD pa- A total number of 1400 subjects (64.8% M and 35.2% F) treated for end stage-re- tients were significantly higher than in controls (20.24 vs 2.11 mg/L, p<0.01; 2.80 nal disease during 2017 were included in the study. The main RRT modality used vs 1.18 mmol/L, p<0.01; in Albania was hemodialysis (68.5%), followed by kidney transplant (26.1%) and 2.9 vs 2.41 mmol/L, p=0.01; and 1.69 vs 1.18 mmol/L, p<0.01), but not of Cho- peritoneal dialysis (5.4%). We found a prevalence of 316 patients/pmp and inci- lesterol (4.06 vs dence rate of 77.5/pmp that corresponds approximately to 217 new patients every 3.22 mmol/L, p=0.22). Concentration of ALB, HDL and Ca were significantly year. Regarding the etiology of CKD, tubulointerstitial diseases were the most fre- lower in hemodialysis patients than in controls (31.87 vs 40,50 g/L; p<0.01; 0.76 quent cause, affecting (26.1%) of patients followed by chronic glomerulonephritis vs 1.29 mmol/L; p<0.01 and 2.28 vs 2.27 mmol/L, p<0.01). B2M correlated pos- (20.4%), diabetes (7.2%) and heritable diseases (4.9%). We observed an important itively only with P (r=0.19), whereas negatively with HDL (r= -0.19), ALB (r= increase of diabetic patients on RRT, 7.2% in 2017 versus 4.3% in 2007. Since -0.29) and Ca (r= -0.18). 2007, we found also a linear increase of prevalence of end-stage CKD on RRT, Based on the results obtained in this study the value of B2M correlates negatively 316 patients/pmp in 2017 versus 118.5 patients/pmp in 2007. This multi centered with HDL, albumin and calcium while positively with phosphor. study has provided for the first time an estimation of the number of patients with Referring to negative correlation of B2M with HDL-C and ALB we can conclude ESRD receiving RRT in Albania. that B2M is an important risk predictor for cardiovascular events in HD patients. The study shows that the prevalence and annual acceptance rate for RRT have increased significantly over the past decade. OP251 - Barriers and opportunities to improve Management and Outcomes Renal transplantation remains the preferred therapy for CKD patients but due to of patients with Diabetic Kidney Disease the limited number of donors, dialytic therapies are still the most common modal- N.Pasko, A.Strakosha, V.Cadri, S.Mumajesi, N.Thereska, L.Kapidani ities that are actually used. The prevalence of diabetes in Albania has increased rapidly in recent years and is likely to continue to increase in the future. Our local data revealed that 7.9% of OP250 - The correlation of B2M with dyslipoproteinemia in patients with patients undergoing dialysis in Albania have diabetic nephropathy as a cause of Chronic Renal Insufficiency renal failure. Actually, there is no data on renal impairment in diabetics in Alba- M.Raci Qyqalla nia. As result, the primary aim of the present study was to assess diabetic patients Renal insufficiency is poor function of the kidneys that may be due to a reduction referred to the nephrology clinic in UHC Tirana. A total of 98 diabetic type 2 pa- in blood-flow to the kidneys caused by renal artery disease. Normally, the kidneys tients (57.2% males and 42.8% females) hospitalized in UHC Tirana from January regulate body fluids and blood pressure, as well as regulate blood chemistry and 2016 to January 2017, were included in this study. Their mean age was 60.4 ±

218 219 Nephrology

15.8 years. The mean duration of diabetes was 8.2 ± 6.9 years. We found that only hemodialysis, even in low to middle socio-economics patients. A close monitor- a few patients, 24.3% had a blood pressure of <130/80 mmHg. Mean body mass ing of hemodialysis patients must be done to identify high-risk patients, for early Nephrology index (BMI) in type 2 patients was 26.45±0.17kg/m2 (male: 25.14±0.8 kg/m2 and interventions and goal-directing therapy, as well as primary preventive measures. female: 28.29±0.35 kg/m2). At the time of presentation in the clinic, glycated he- These can be prevented or delayed by a tailored program, medical history, be- moglobin (HbA1c) was 8.1±1.9% and fasting blood glucose of 190.5±38.6 mg/dl. haviors, life style modification and an interdisciplinary collaboration to improve The prevalence of macroproteinuria, microproteinuria and normoproteinuria were factor identifications and better controll of Cardiorenal Syndrome and MetS. 56.4%, 33.8% and 9.8%, respectively. Unfortunately, the availability of effective therapeutic strategies for sustained There was no significant difference between males and females in the prevalence weight loss and management of Metabolic Syndrome remains limited. Finally, of macroproteinuria or microproteinuria (p>0.005). We found that 3.3% had CKD life-style modification and diet remains, the crucial factors to improve outcomes stage 1, 5.2% had CKD stage 2, 22.7% had CKD stage3, 26.3% and 42.5% had in the hemodialysis patients. CKD stage 4 and 5 respectively. Duration of diabetes, poor control of glycemia and hypertension, have been asso- OP253- The new approach to the diagnosis and treatment of hypertension ciated with progression of CKD. The results of this study emphasis the fact that among dialysis patients early diagnoses of diabetic nephropathy is missed in our country due to the lack V.Cadri of screening methods which further will lead to enhancement of the burden on the Hypertension is common, but its diagnosis and management among patients on health care system. chronic dialysis is challenging. Large observational studies and small randomized controlled trials during 2006-2015 in hemodialysis patients guided dialysis provid- OP252 - Cardiorenalmetabolic syndrome in Hemodialysis patients ers to focus on moving away from dialysis unit blood pressure measurements BPs S.Mumajesi, V.Cadri, M.Imeraj, N.Pasko, N.Thereska, M.Barbullushi and focusing on out-of-dialysis-unit BPs. Hemodialysis patients are very difficult to manage due to many co-morbidities. We believe that out-of-dialysis- unit BPs measurements are better for predicting Different cardio-vascular events and Metabolic Syndrome (MetS) are often asso- mortality and prognostication for hemodialysis patients and their diagnosis.Once ciated with this subgroup of patients. diagnosed, management of hypertension requires adequate control of excess sodium Cardiorenal syndrome is a very complex disease, in which both kidneys and heart and fluid volume. Achieving and maintaining dry weight among patients on hemo- are involved and created a feed-back cycle with worsening the progression and dialysis is obtained by individualizing dialysate sodium concentrations and ensuring carries a bad prognosis. dialysis sessions at least 4hours in duration. On the other hand, MetS is an independent risk factor, often associated with car- Paradoxically, among patients on dialysis, excessive antihypertensive drug use has dio-vascular complications. It has been served as the primary driver of the dramat- been associated with poor BP control. In contrast to their effects in the general hy- ic rise of Cardiorenal syndrome. pertensive population, emerging evidence suggests that B-blocker might offer the A retrospective study was conducted. 112 pts. were enrolled, with low to mid- greatest cardio protection in hypertensive patients on dialysis. dle socio-economic status. ATP III was used to determine MetS. Statisti- Our aim is to provide new implementation of diagnostic and therapeutic techniques cal analysisis included Student’s t-test, bivariate and multivariate reggresion. that improve long term cardiovascular outcomes in patients on hemodialysis. 83 patients were included in the study. The mean age was 48.5 ± 25.5yrs. 65 % were male and 35 % were female. Time on dialysis 9.5 ± 7,5 yrs. Cardiorenal Syndrome was founded in 57.8% (43 pts) of pts. Metabolic syndrome was founded in 73.4 % (61 pts) of pts. No differ- ences between sexes was found. Time on dialysis was insignificant. Both metabol- ic and cardiorenal syndrome has a high prevalence. A strong relationship between cardiorenal syndrome and MetS was found with a p=0.015817. Anemia had also a high prevalence 72.3 % (60 pts), with a strong association with cardiorenal syndrome p=0.024261, but we didn`t found any cor- relation between MetS and anemia. Cardiorenal syndrome and MetS were both presented with a high prevalence in

220 221 Urology

OP254 - My experience in Monopolar TUR-P in Albania and Kosovo- Is it A kidney-friendly diet limits certain foods to prevent the minerals in those foods Urology still a good option? from building up in your body. A.Xhafa, B.Bimbashi, A.Beqiri Healthy diet basics With all meal plans, including the kidney-friendly diet, we Transurethral resection of prostate (TUR-P) has been for many years the gold need to track how much of certain nutrients our patients take in, such as: standard for treatment of the Benign Hyperplasia of the Prostate (HBP). In the • Calories last period with the evolution of the lasers vaporization or resection of the pros- • Protein tate has started to be used in many more centers worldwide. We presented the • Fat outcomes of Monopolar TUR-P from a single surgeon in Albania and Kosovo. • Carbohydrates From 2013-2018 period 83 patients was treated with Monopolar TUR-P. The To make sure our patients with kidney diseases are getting the right amounts of mean age of the patient was 67.5 (49-93). 8 patients had urethral catheter and 4 these nutrients, we prepare food regimes to eat and drink with the right portion sizes. of them came in a post renal kidney insufficiency before surgery.4 patient was Each food regime has explained how much protein, carbohydrates, fat and sodium diagnosed with High Grade Prostate CA before the operation and the resection are in each serving of a food. This can help patients of American Hospital pick was done to avoid the urethral catheter during the alternative therapy. In 15 pa- foods that are high in the nutrients they need and low in the nutrients they should tients a biopsy was done because of an increase of the PSA levels before the limit, even after the hospitalization period. surgery. The characteristics of the patient preoperatively is shown in the table 1. The patients was operated by a single surgeon in three different centers with Storz OP256 - Urologic Trauma in children: Special considerations. monopolar in two centers and one Wolf monopolar in one center. There was no major A.Mustafaj, A.Hodaj, F.Tartari, Grigorios complication as death during or after the surgery. The operation time was 59.4 min The pediatric urologic trauma in children remain rare occurrences with the emer- and the mean hospital stay was 2.2 days. The mean tissue resected was 31 (2-120) gency department of a hospital or ambulatory care center. grams. The operation time was 59 min (20-112). There was a improvement in the Q The aim of this abstract is to therefore cover common emergent and urgent padi- (max) and Q(ave) from 11,3 and 2.4 to 27.4 and 7.6 respectively. In 4 patients and atric urologic consultations from birth to childhood ( Trauma). low-grade Prostate cancer was detected and they were treated after the intervention. Searching the information for the trauma of kidney and the bladder in the past. In three patients a urethral stricture was developed and one of them was re-operat- Children in particular are at on increased risk of renal injury due to several unique ed and the other was treated with Bogey dilatators. Only in one patient there was a anatomical features of the pediatric axial skeleton and surrounding soft tissue. need of blood transfusion because of the low level of the hemoglobin preoperatively. The perirenal fat the smaller paraspinal and the abdominal muscles contribute In the last decade because of the development of the new technology such as bi- to the increased susceptibility to renal trauma in the pediatric trauma. The 10% polar and lasers there is a debate of the gold standard in the treatment of LUTS. -12% of renal injuries are associated with some preexistingrenal anomaly. The My opinion is that Monopolar TUR-P is still a good standard and if the surgeon indications for surgery are similar to that in adults, that is ongoing hemodynam- has the experience in the area large prostate can be treated without no major or ic instability, a pulsatile or expanding retroperitoneal hematoma , or, rare, pen- minor complications. Especially in the countries such is Albania and Kosovo this etrating trauma. An initial tral of bedrest, urethralcatheter drainage, and serial treatment might be still the gold standard because of the low costs in public or hematology is thus warranted in most stable patients with high-grade injuries. private practice. The bladder trauma ia a relatively rare event approximately 5% - 7% of pediatric patients. Pelvic fracture is associated in more than 95% of cases. Bladder rupture OP255 - Nutrition therapy in kidney disease. Experience in treatment of can occur either in an intraperitoneal or extraperitoneal fashion and , has the sim- these patients at American Hospital. ilar to the management in adults. A.Daka, F.Tartari, V.Isufaj, L.Marku, I.Marku, B.Hyseni Patients who fail conservative management usually present with ongoing hem- What you eat and drink affects your health. Staying at a healthy weight and orrhage secondary to an expanding hematoma requiring transfusion, persistent eating a balanced diet that is low in salt and fat can help you control your urinary extravasation despite upper tract diversion, or abdominal and flank pain. blood pressure. If you have diabetes, you can help control your blood sug- The intraperitoneal injury is the best treated by laparotomy and repair of the lacer- ar by carefully choosing what you eat and drink. Controlling high blood pres- ation using multiple layers of absorbable suture. Most extraperitoneals lacerations sure and diabetes may help prevent kidney disease from getting worse. respond well to catheter drainage and a trials of observational therapy. Antibiotic A kidney-friendly diet may also help protect your kidneys from further damage. prophylaxis has been shown to reduse potential infective complications in both.

222 223 Urology

OP257 - Current status of the surgical management of Peyronie’s PVR rate at 1, 3, 6, 12, 18, 24, 30 and 36 mo. Data were compared using the t-test. Urology disease: Update Categorical data (percentages) were compared using the chi-square test or Fish- A.Kadıoğlu , B.Ermeç, E.Salabaş er’s exact probability test. P-values <0.05 were considered statistically significant. Surgery is the standard treatment for patients in the chronic phase of Peyronie’s In our series, OP procedure required significantly shorter operative time than disease. Reconstructive surgeries function by either shortening the convex side of B-TUEP technique (WMD - 41.5 min, p<0.05). Postoperative bladder irrigation the tunica albuginea (Nesbit procedure, Yachia technique and penile plication) or time (WMD – 27.5 h p< 0.05), Hb value (WMD - 0.91 g/dl, p> 0.05), catheterization lengthening the concave side by incision of the plaque with subsequent graft- time (WMD – 38.14 h p< 0.05), and hospital stay (WMD – 16.82 h, p< 0.05) were ing. Tunical shortening procedures are ideal for men with good erectile capacity, significantly shorter in B-TUEP group. According to Clavien–Dindo Grade System, penile curvatures less than 60° and predicted postprocedural length loss of less we observed higher number of Grade II-III complications in OP group. Both treat- than 20% of erect penis length. Tunical lengthening procedures with grafting are ments resulted in statistically significant improvements of all clinical parameters indicated in patients with severe penile length loss, curvatures greater than 60° evaluated during postoperative assessments compared to the baseline in both groups and prominent hourglass deformities. Saphenous vein and tunica albuginea are the (p< 0.05). During the follow-up, there were no significant differences between the most commonly used autologous graft materials. Cadaveric or bovine pericardi- groups in terms of Qmax score, QoL score, IIEF-5 Questionnaire score, PSA, and um and 4-layer small intestinal submucosa are promising nonautologous tissues. prostatic volume. A total of 211 (87.9%) out of 240 patients were followed for 3 Penile implantation of a prosthesis is the standard procedure in men with erectile years. We needed to re-operate 9 pts (7.5%) in OP group (2 cases of bladder neck dysfunction who do not respond to conservative treatment. If residual penile cur- contracture, 5 cases of residual adenoma, and 2 urethral strictures) and 6 pts (5%) vature is less than 30° after implantation, no further treatment is required. Howev- in B-TUEP group (4 cases of bladder neck contracture and 2 urethral strictures). er, residual curve of greater than 30° can be straightened with manual modeling. In this study, we showed that B-TUEP has early and intermediate efficacy and Additional procedures such as penile plication, the Nesbit procedure, or grafting safety equivalent to OP for the treatment of large BPH. Furthermore, B-TUEP can be performed if modeling fails to correct the residual deformity. technique showed shorter postoperative bladder irrigation time, catheterization time, and hospital stay. OP258 - Bipolar plasma enucleation of the prostate (B-TUEP) vs transvesical open prostatectomy for enlarged prostate: initial experience in a single centre OP259 - The Congenital Abnormalities of Genitourinary tract in Albania with 3-year follow-up. F.Tartari, D.Shahini C.Falavolti, E.Shehu, B.C Gentile, L.Albanesi, G.Rizzo, P.Tariciotti, G.Mirabile, General considerations of congenital anomalies are : M.Buscarini, R.Giulianelli Genetic factors For many years, open prostatectomy (OP) was the primary treatment option in Polygenic patients with large (> 80 ml) benign prostatic hyperplasia until it was gradually Enviromental factors replaced by transurethral endoscopy. We already demonstrated that button bipolar Most maternal infections that cause fetal malformations result in intrauterine enucleation of the prostate (B-TUEP) is a safe and effective endoscopic procedure growth retardation and congenital abnormalities. for the treatment of bladder obstruction secondary to benign prostatic hyperplasia These include: (BPH). Aim of this study was to evaluate overall efficacy and safety of B-TUEP vs Cytomegalovirus OP for BPH. Secondary end point was to compare retrospectively intraoperative and Herpes Simplex type 2 perioperative results to assess whether B-TUEP technique improved baseline values. Toxoplasma and syphilis We retrospectively collected data of 240 consecutive patients (120 pts. underwent Malformations can also be caused by various drugs. The teratogenic potential of OP and 120 pts were treated with B-TUEP) from May 20012 to December 2013 at a chemical attracted world-wide attention 40 years ago with the discovery of limb our centre. Included criteria were patients who presented preoperative Internation- defects secondary to maternal ingestion of thalidomide. The congenital anomaly al Prostate Symptom Score (IPSS) ≥12 points, Quality of life (QoL) < 4, maximal of genito-urinary tract are associated with multiple defects in other organs. While urinary flow rate (Qmax) <15mL/s, post-void residual urine volume (PVR) > 50 growth deficiency,Craniofacial anomalies,Hypoplasia of the distal phalanges are mL, and prostate volume ≥ 80 gr on transrectal ultrasounds. A total of 211 (87.9%) common, Hypospadias, Cryptorchism, Micropenis, Genital Ambiguity and Renal out of 240 patients were followed for 3 years. Malformation. During the follow-up, we analysed Qmax score, I.P.S.S. score, QoL score, PSA and

224 225 Urology

Alcohol may be the most common teratogenic drug causing significant fe tal risk. or venereal deseases involving big parts of urethra. Different procedures are uses Urology The major defect of the fetal alcohol syndrome is on growth and congenital anom- to treat this difficult condition as two stage Johanson procedures with first stage aly. (Are found renal anomalies and many syndrome association.) implementing of buccal graft ,or late buccal graft.The Kulkarni technique which Cigarette smoking has also been reported to cause intrauterine growth retardation. we are using in most cases of this condition gots the advantage of one stage pro- Recently toluene has been confirmated as teratogenic causing growth retardation , cedure with very good results. microcephaly, craniofacial anomalies, cryptorchism and renal anomalies. Genital Representing our experience with treatment of panurethral strictures with one stage malformation and hypoplasia may be seen, when the malformations are docu- dorsal graft with Kulkarni technique. Since 2015 we are using one stage dorsal graft mented to be secondary to intrauterine radiation exposure, there is always con- for panurethral strictures with different etiologies most common lichen sclerosus comitant congenital anomalies. of urethra. In this study we enrolled 16 patient treated with Kulkarni technique for In our study we have discuss about special cases in our experience in Albania. long penile urethra stricture more than 10 cm. We used double graft of buccal mu- Each case has its own feature but it’s all has in center the relation between differ- cosa harvested from both sides of the inner part of cheeks or lower lip. The mean ent malformations. We have found 4.2% of premature children (weight <3000gm) leng of graft was more than 10 cm and most of the time was harvested from the have had hypospadias.17% of twins births have had hyspodias 12.2 of them had lower lip the longest part,while the shorter one was taken from the inner part of the ( weight of 2200 – 2400gm). 28 children (weight of 1700-1800gm). From 164 cheek. The patients where done with lithotomy position, under general anesthesia. children who had hyspodias we found the story of hormonal drugs (progesterone) A vertical perineal incision proceded with opening of whole urethra after on the usage of their others 13 copies were over 35 years old. right side of it and invertion of penis in the perineum to proceed with implementa- In our study we found that 9.2% of premature children ( 37 weeks) were associated tion of dorsal bucal graft. The catheter was left in place for 3 weeks and after that with cryptorchidismus uni or bilateral. aurethrography was performed. We treated 16 patient with this technique with 85 An increase in the number of abnormalities of the urinary tract were found in the % of success in a follow up of more than 3 years. There was no fistula in either of children born during the second trimester in 1986 ( after Chernobyl- radioactivity the patients and in 2 patient there was a meatal stenosis which was resolve with influence) intermittent bougie. In one patient an internal urethotomy was needed after the At the same occasion 23 children with hypospadias and associated abnormalities procedures which resolve the sitricture of the anastomosis in the bulbar segment. of the urinary tract. Kulkarni technique for substitution of long strictures of urethra of different etiol- In the first place of the above was ogies ,most common lichen sklerosus, remains an excellent option for one stage cryptorchidism’s procedure, with low complication and very good long term results. micropenis herniaingunoscrotalis OP257 - Pelvic floor muscle training of females with stress urinary inconti- megaureter bilateralis ( 9 boys) nence improves the sexual life of the couple posterior uretral valvul ( 11 boys) S.Georgios, F.Maria, S.Sotirios, D.Fotios, M.Charalampos, L.Pedro, M.Dede, Prostatic utriculus ( 13 boys) M.Marlon, T.Panagiota, S.Nikolaos, Z.Athanasios We have discuss in our study even the case of congenital fistula of anterior urethra. Sexual dysfunction among women with stress urinary incontinence (SUI) is com- Congenital fistula of anterior urethra is very rare congenital anomaly. The diagno- mon. Pelvic floor muscle training (PFMT) has been recommended as the first step sis is very easy to be established, just by digital examination, or insertion of a thin for conservative management of SUI. The aim of this study was to assess the catheter or injection of colour solution through the external opening of the urethra. PFMT outcome in females with SUI, on their sexual life and their male partners. Treatment is simple and results are excellent. A group of 70 women (Group A) suffering from urodynamic SUI, aging 38 to 52 years, underwent successfully PFMT for 6 months. The program consisted of four OP260 - Use of buccal graft for treatment of panurethral stricture. One stage office biofeedback sessions and home therapy. The control group (Group B) -in dorsal graft,the Kulkarni technique. cluded 70 age-matched women with urodynamic SUI who did not undergo PFMT. G.Gezim,T.Shpetim, A.Koni, B.Grizhja, A.Pesha, GJ.Kaci,Ferko Shkelqim5, All women completed a 3-day-bladder diary. The number of incontinence episodes A.Ndoj and the number of pads used were evaluated. All women were assessed with the Use of buccal graft remains the gold standartfor treatment of urethral strictures Female Sexual Function Index (FSFI) in the beginning and at the end of the study. involving great parts of urethra, when the etiology of strictures is lichen sklerosus All the male partners fulfilled the Male Sexual Health Questionnaire (MSHQ) and

226 227 Urology

the Likert visual scale (1 to 5 points). There were no statistical differences between technique for assessing the integrity of the vesicourethral anastomosis after RP. Urology the two groups at the beginning of the study. At the end of the-6-month treatment, 2- Male Sono-Urethrogram- An ideal diagnostic method for suspected AUS must within Group A, post-treatment mean value (3.7 ± 2.1) in incontinence episodes be able to diagnose the stricture, accurately determine its site, length and diameter, was significantly lower than pre-treatment (6.1 ± 3.7). Furthermore, within Group describe the extent of periurethral fibrosis and identify other urethral conditions. A, post-treatment number of used pads (2.9 ± 1.2) was significantly smaller than These characteristics should be described pre-operatively to enable an efficient pre-treatment (4.1 ± 1.8). Within Group B, at the end of 6 months observation, and suitable management plan. SONO-UG is a straightforward, reproducible and there was no significant difference in incontinence episodes and in used pads. The low cost imaging modality that generates absolutely no radiation exposure and following table demonstrates the differences in total FSFI score, FSFI domains avoids the other disadvantages of RUG. SONO-UG is extremely accurate in the scores, satisfaction domain of MSHQ, frequency of sexual intercourse and sex- diagnosis and characterization of AUS. 3- Female Sono-Urethrogram .Female life satisfaction between the two groups. The improvement of urodynamic SUI urethral strictures are rare, and often present a diagnostic challenge. While eval- in women after a PFMT implementation is associated with improvement in the uation has been described with cystoscopy, voiding cystourethrogram and video couple’s sexual life. urodynamics(VUD), no universally accepted diagnostic criteria exist.Translabial US is a novel and accurate technique to assess for female urethral stricture. Our OP261 - Mysteries In Varicocele Pathophysiology technique allows for detailed anatomic images of stricture and peri-urethral tissues N.Sofikitis without use of X-ray radiation and Iodinated contrasts or need for urethral dilation Left varicocele is considered as the main cause of male infertility. However there and may have a role in post-operative follow up. are several unanswered questions concerning the varicocele pathophysiology: a) why does a primary left varicocele affect the left endocrine and exocrine testicular OP263 - Sex cord stromal tumors of the testis: Unique color-Doppler sono- function? b) does a primary left varicocele affect the right endocrine and exocrine graphic appearance testicular function?, c) why does obesity have a protective role on the development Sh.Telegrafi, A.Hoxha of varicocele? d)why do some men with left varicocele become eventually azo- Sex cord stromal tumors of the testis, also known as non-germ cell tumors, are com- ospermic, whereas, why are men with left varicocele occasionally able to father prised of Sertoli cells (sex cord) or Leydig cells (stroma). They are a rare entity, making several children? e) why does left varicocele affect bilateral Sertoli cellular secre- up ~ 3% of testicular masses, and are benign in 90% of cases. They are usually small tory function? f) why does left varicocele affect enzymatic spermatozoal systems in size (< 1 cm), non-palpable and discovered incidentally when working up infertility, in both testes? g) why do some men with left varicocele improve one or two or pain, contralateral testicular pathology or other issues.1 These masses are hormonally three standard parameters of semen analysis post-varicocelectmy, whereas, why active in ~ 30% of cases, leading to precocious puberty in children and gynecomastia in do not other men with varicoceles improve any sperm parameters post-varicoce- adults.2-6 While they can appear at any age, they mostly have a bimodal age distribution lectomy? h) does performance of left varicocelectomy improve pregnancy rates? occurring before puberty at age 5 to 10 years or in adulthood at 20 to 60 years.7 We The above unanswered questions allow us to conclude that varicocele remains an retrospectively analyzed data from 300 scrotal sonograms performed with gray scale and enigma-disease. color Doppler at our institution between 2010 and 2016 to identify patients believed to have sex cord stromal tumors. OP262 - What’s New in Urologic Diagnostic Ultrasound?- Transperineal Data reviewed included tumor size, laterality, unilaterality, echogenicity, vascular pattern, Sonocystography, Male and Female SonoUrethrograms resistive index, tumor markers and follow-up versus pathology if surgery was performed. Sh.Telegrafi, G.Galiqi Of the 300 sonograms reviewed, 13 patients were identified who had imaging consistent 1-Transperineal Sonocystography (TPSC) is equivalent to Fluorocystography with sex cord stromal tumors. Patient age ranged from 22 to 69 years, with a median age (FC) in detecting anastomotic leaks after radical prostatectomy (RP) It pro- of 41 years. vides a safe, inexpensive, and effective alternative to traditional FC for evaluat- All tumors were unilateral with the majority measuring < 1.0 cm in diameter (69%, 9/13). ing the integrity of the vesicourethral anastomosis after RP. Our study suggests In regards to B-mode characteristics, 12 of 13 (92%) tumors were hypoechoic (all but 1 that, on the basis of cost, availability of equipment, absence of radiation and were homogenous). contrast medium exposure, avoidance of inserting a probe into the rectum, direct All lesions were described as uniformly hypervascular with 11 of 13 ( 84%) revealing visualization of the anastomosis, and precise quantification of the extravasation a hypertrophic feeding vessel from the testicular artery. 10 of 13 (76%) tumors had re- and perianastomotic hematoma volumes, TPSC should emerge as the preferred sistive indices > 0.48, which through various studies has been shown to be indicative

228 229 Urology

of benign lesions.10-12. Pathology in 9 patients who underwent a radical orchiectomy blood transfusion. Use of newer intervention techniques and alternate surgical ap- Urology revealed Leydig cell tumors. The remaining patients were followed with serial ultra- proaches may decrease morbidity and blood loss. Urologists are usually consulted sounds for a median of 10 mos (range 1 to 41 mos), demonstrating stable lesions in after a life-threatening emergency situation has already arisen.The accreta type is all cases. All tumor markers were within normal limits at the time of first ultrasound. most common and easier to manage. The unique finding of our study is that many of these masses have a hypertro- The increta and percreta varieties are less common, difficult to manage and associ- phic feeding vessel from the testicular artery (84%, 11/13) with resistive indices ated with severe maternal morbidity and mortality as a result of postpartum haem- > 0.48 (76%, 10/13), an outcome noted in literature to be characteristic of be- orrhage [5]. Though the cause of placenta percreta as reported by Morken et al, [6] nign lesions, although never before discussed in regards to testicular masses.10-12 is unknown, several risk factors have been associated with this condition notably, Given the above findings, our study offers one more characteristic to help diagnose these placenta praevia, a previous caesarean section, multiple pregnancies, a history of mostly benign masses, which can be approached with conservative treatment such as dilatation and curettage, high parity and increasing maternal age. testis-sparing surgery with enucleation or surveillance with ultrasound follow-up. Our The patient therefore had some risk factors previous caesarean section and history study as well as all others, does not help differentiate sex cord stromal tumors with ma- of curettage and the placenta was found adherent to the previous scar, a finding lignant potential from those that are benign. Despite these limitations, our study is one of that was not evident for placenta percreta in the first and the second ultrasounds. the largest in this rare tumor and the first to extrapolate the presence of testicular artery A previous scar is a major risk factor as the deciduas basalis in this zone is ex- feeding vessels to the diagnosis of these tumors. pected to be poorly vascularised and presents as a zone of weakness for subse- quent placental villi penetration [6]. A 37-year-old woman (gravida 3) with twin OP264 - Placenta Previa Percreta: A Case Report of Successful Management pregnancy was referred from Gjakova Maternity to our UCC in Prishtina due to via open surgery and TUR-B of retained placentae abnormal placentation suspicious for placenta increta diagnosed during a routine Xh.Çuni, F.Zeqiri, I. Haxhiu,A.Veliu, I.Miftari, H. Aliu, P.Nuraj, S.Mehmeti, A.Fetahu sonographic examination at 27 weeks of gestation. Results of routine laboratory The incidence of abnormal placentation is relatively low, and demographic data test during this pregnancy were all normal. She is blood group 0 Rhesus positive a b o u t i t i s l i m i t e d t o s m a l l s e r i e s a n d c a s e r e p o r t s . and tested negative for HIV and cystoscopy was not performed. The pregnancy The average incidence is estimated at 1 in 7000 deliveries. Placenta percreta rep- was without complications up to the day of presentation. The patient’s obstetric resents 5 to 7% of all abnormal placentation. Placenta previa and its associated history was significant for 2 prior pregnancy delivered by cesarean and now she pathologies are specific abnormalities of human placentation. Diagnosis and ade- had a twin pregnancy ; boy and girl and her desire was to have a planned cesare- quate management is important as they present a major threat to the patient’s life an delivery at the end of pregnancy. On admission, the patient presented spotting and future fertility. Diagnostic confirmation is histological, based on the absence without abdominal pain. Routine abdominal ultrasound showed normal gestation- or poor development of the basal layer of the endometrium. However, clinical al development and the presence of numerous retroplacental vessel, confirmed the diagnosis and treatment is usually the order of events and the various degrees of prior ultrasound diagnosis of placenta previa suspicious for placenta increta. Five villus infiltration can be seen macroscopically, confirmed by histology and classi- days after admission suddenly she felt a strong abdominal pain accompanied by fied into accreta, increta, and percreta. vomiting and haematuria. Urgent abdominal ultrasound showed intraperitoneal Placenta previa refers to a placenta that is abnormally adherent to the uterus. There bleeding and in the process, perforation of the uterus was suspected and a emer- are three main entities (accreta, increta, and percreta), which are defined by histo- gency laparotomy was performed. After opening the abdominal wall, intra-ab- logical degree of placental invasion into the myometrium. dominal inspection showed the presence of haemoperitoneum of about 150 cc and Placenta percreta is a rare complication of pregnancy and delivery and carries a circular infiltration of trophoblastic tissue on the anterior uterine wall extending grievous consequences to the mother. It occurs mostly in the third trimester and through the three layers of the uterus (endometrium, myometrium, and serosa) presents with severe postpartum hemorrhage and placenta retention [1]. Bladder and in the area of the bladder. Diagnosis of placenta percreta was macroscopically invasion by the placenta (placenta percreta) is a potentially life-threatening ob- confirmed. The male fetus weight 780 gr was dead while the girl fetus weight stetric complication, albeit a rare one. The diagnosis is usually established when about 800 gr died after an hour. The intraoperative management of placenta per- attempts are made to separate the adherent placenta from the bladder. This maneu- c r e t a i n d i c a t e d t h e r a d i c a l s u r g e r y ( h y s t e r e c t o m y ) a s r e s u l t o f s e v e r e h a e m o r r h a g e . ver causes massive hemorrhage that is often quite challenging to control. A firm After hysterectomy the urology service was then consulted. Intraoperatively, an preoperative diagnosis allows adequate preparation and organization of multidis- 8cm cystotomy was noted at the urinary bladder dome. We explored the bladder ciplinary help for what may be a difficult surgical procedure requiring massive cavity with the focus above plica interureterica where was observed the presence

230 231 Table 2 Table Round Round

of villus infiltration. Hemostatic sutures were applied in the area of the bleeding at OP265 - American Hospital and Patient Safety Urology the site of the placental bed using 1.0 / 2.0 vicryl. The urinary bladder wall after B.Kola hemostatic suttures was closelly monitored. The bladder was then closed in with As part of Joint Commission International Accreditation Standards for Hospitals, running absorbable sutures, a 24-Fr haematuric catheter was placed, and the blad- improving patient safety practices and protocols is very important for continuous der was irrigated to ensure water-tight closure. The procedure was subsequently quality improvement. These policies are part of patient care improvement program terminated after placement of a drain anterior to the suture line of the bladder and and go hand by hand with other policies that ensure a safe, effective and well-man- closure of the abdomen. The total blood loss was app. 2.500 mL. Intraoperative aged organization. Their purpose is to promote specific improvements in patient allogeneic red blood cells (app.2850 mL) and free-frozen plasma were transfused. safety and include: The surgical procedures lasted approximately 6 hours and patient was transferred Correct identification of every patient. Wrong-patient errors occur in virtually all in ICU in stable condition and was monitored closely.The abdominal drain was aspects of diagnosis and treatment. Patients may be sedated, disoriented, not fully removed after 5 days. The postoperative phase was uneventful and the patient was alert, or comatose; may change beds, rooms, or locations within the hospital; may discharged after 10 days in stable condition. The haematuric catheter was removed have sensory disabilities; may not remember their identity; or may be subject to after 4 weeks and the patient has not experienced further urinary difficulties. other situations that may lead to errors in correct identification. The intent of this The operative team contained a gynecologist, vascular surgeon and urologist. Af- goal is twofold: first, to reliably identify the individual as the person for whom the ter nine weeks the cystoscopy shows the presence of retained placenta previa per- service or treatment is intended; second, to match the service or treatment to that creta in bladder wall (about 2 cm) which have been care out by TUR-B. individual. The major complication of placenta percreta is severe bleeding. This can be as- Improvement of effective communication which should be timely, accurate, com- sociated with hypovolemic shock and subsequent death[7]. Management of pla- plete, unambiguous, and understood by the recipient, reduces errors and results centa precreta may be achieved with intraoperative ligation or embolization of in improved patient safety. Communication can be electronic, verbal, or written the internal iliac arteries, immediate hysterectomy or therapy with methotrexate Patient care circumstances that can be critically impacted by poor communication and preservation of bladder tissue whenever possible. Reconstructive surgery if include verbal and telephone patient care orders, verbal and telephone communi- necessary may be postponed until after the patient is hemodynamically stabilized. cation of critical test results, and handover communications. In the presence of bladder wall invasion and in the setting of uncontrolled uterine Safe practices for effective communication include limiting verbal communica- bleeding following delivery, every attempt should be made to preserve the blad- tion of prescription or medication orders to urgent situations in which immediate der, as this has been demonstrated to be a reasonable possibility provided that the written or electronic communication is not feasible, the development of guide- integrity of the ureters is established during and after the operation lines for requesting and receiving test results, writing down, or entering into a Although removal of the posterior bladder and distal ureters has been advocated if computer, the complete order or test result by the receiver of the information, use invasion is found at time of delivery, resection of the bladder base with distal ure- of standardized, critical content for communication between the patient, family, ters can be performed, but it carries the risk of coagulopathy, transfusion reaction, health care practitioner, and others involved in the patient’s care during handovers sepsis, adult respiratory distress syndrome, multiorgan failure and vesicovaginal of patient care and use of standardized methods, forms, or tools to facilitate con- failure due to aggressive blood transfusion and extensive surgery. Regardless of sistent and complete handovers of patient care. the decision whether to remove the bladder, anterior bladder wall cystotomy is Improve the safety of high-alert medications. Appropriate drugs management is particularly helpful for defining dissection planes and determining whether pos- critical to ensuring patient safety. Any medication, even those that can be pur- terior bladder wall resection is required. Post-operative infection O’Brien et al chased without a prescription, if used improperly can cause injury. reported a 28% post-operative infection rate The early diagnosis of placenta pre- However, high-alert medications cause harm more frequently, and the harm they via is usually made by ultrasound [8], although in recent years there has been an produce is likely to be more serious when they are given in error. This can lead to interest in the use of MR imaging [9,10]. Despite the early and accurate prenatal increased patient suffering and potentially additional costs associated with caring diagnosis, hysterectomy remains the most common surgical procedure in cases of for these patients. PPH for placenta previa percreta. Most cases of placenta percreta that involve the Ensure safe surgery. Significant patient injury and adverse and sentinel events bladder are recognized only at the time of delivery. When it involves the urinary resulting from wrong-site, wrong-procedure, and wrong-patient surgery are ongo- bladder, a multidisciplinary approach utilizing a team surgeons representing urol- ing concerns for hospitals. Such events can result from ineffective or inadequate ogy, radiology, and obstetrics gynecology is the key to successful management. communication between members of the team cond

232 233 Table 2 Table Round Round

OP266 - Albania in the market of Reproductive Tourism 89%). Encouraging healthcare professionals to understand and learn about the im- Round Table 2 F.Tahiri, A.Cane, E.Peci portance of these wider aspects of care is crucial if care is to become more patient Medical tourism is taking place when patients intentionally leave their country centred and if quality improvement initiatives are to have any real impact. New of residence outside of established cross-border care arrangements in pursuit of policies within the NHS acknowledge the need for multiprofessional team work- non-emergency medical interventions abroad that are commonly paid for out-of- ing and decision taking based on expertise pooled between all those concerned in pocket. Though travelling abroad for health benefits is not a recent concept, it has the care of a patient—a substantial change in the prevailing culture in health care. been gaining more momentum and media interest in the last decades. Medical Importantly, there is an imperative for clinicians to see quality improvement as an tourists are presently traveling to faraway countries for cosmetic surgery, dental organisational as well as a professional and clinical issue. The aim is to establish procedures, bariatric surgery, assisted reproductive technology, ophthalmolog- a culture in which quality improvement is central to the work of all so that the “10 ic care, orthopaedic surgery, cardiac surgery, organ and cellular transplantation, Cs” of clinical governance can become embedded in that culture gender reassignment procedures, and even executive health evaluations. They are The first objective was to explore the potential for starting a range of healthcare driven by different reasons: quality of service, geographical proximity, cultural workers from different professional groups to learn together the attitudes, skills, proximity, destination image, destination environment climate, tourism attrac- and knowledge needed to enable them to support CQI in the workplace to the tions, price, avoidance of waiting periods, and loose law restrictions benefit of patient care. One of the main reasons with a globally tremendous increase in demand is the The overall evaluation strongly supported the success of the programme in this need for assisted reproduction technologies (ART). Although the supply of facili- area since 92% of respondents indicated that participation in the programme had ties is lagging far behind for different reasons. enhanced their understanding of CQI, 96% said it was likely to enhance multipro- Out of numerous european countries, for example the Czech Republic, Greece or fessional working, and 97% of respondents said participation in the programme Turkey, one of the main destinantions for assisted reproduction is Albania. Within would be likely to improve their clinical practice in the future. Europe, Albania seems to be in a favorable position because of lower restrictions, Local programme organisers were aware that health professionals harbour nega- lower price and the availability of decent quality specialized ART facilities. tive stereotype prejudices about one another which can be diminished by multi- Like other bigger players in the reproductive tourism market, Albania should be professional learning.5 Favourable traits are difficult to acquire but, once acquired, able to take advantage of its success in IVF. are not easily lost for health and social care in Kosovo.

OP267-Continuous Quality Improvement in Healthcare and Patient’s Safety OP268 - Medical Tourism: The upcoming future health development G.Bojaj, B.Obertinca, G.Hasani, G.Burazeri K.Pantos The National Health Service in Kosovo has recently adopted a policy aimed at Cross-border movement of couples in our era of globalization is an inevitable fact. embedding continuous quality improvement (CQI) at all levels and across all ser- In the context of what we call “medical tourism”, In Vitro Fertilization (IVF) is vices. The key goal is to achieve changes in practice which improve patient out- “Spearhead” in attracting couples from abroad. comes. The medical community in developed countries has started to recognize medical This paper describes the use of a training course for multiprofessional groups of tourism as a real phenomenon that involves the profession, practitioners, medical orga- participants tailored to offer them relevant knowledge, management and team nizations and patients. Medical tourism has captured the interest of the media and working skills, and approaches to personal and career development. These were internet through articles, guidebooks, broadcasts and other documents posted on the intended to assist them in changing their practice for the benefit of patients. The Web sites on medical tourism which are being published and produced with increas- participants rated the course highly in fulfilling its objectives. One cohort followed ing frequency. Nevertheless the best advertisement is word by mouth, volunteered up for 6 months named changes in practice which related specifically to learning networks and testimonials of patients. from the course. The insurance industry has become an active participant in medical tourism and This paper shows the important contribution of multiprofessional learning to CQI enable or encouraging patients to have expensive surgical procedures and assisted and presents a useful method of evaluating links between learning and performance. reproductive services at low-cost offshore medical facilities in an effort to reduce Methods: A nationwide survey was conducted in Kosovo in 2016, including a the financial burden of employee healthcare, sending patients not only to nearby representative sample of 1340 primary health care users aged ≥18 years (49% countries for this purpose, but also to more distant medical tourism destinations. males aged 50.7±18.4 years and 51% females aged 50.4±17.4 years; response rate: Furthermore, the medical tourism industry is fueled and driven by patients who

234 235 Table 2 Table Round Round

feel disenfranchised by the healthcare system in their home country. These in- immediate future goals (more patients, more reviews, less expenses, better repu- Round Table 2 formed patients seek outside the organized medical system to find services that tation, better capacity). are affordable, timely, or simply available, but also search for providers who offer But why should a hospital train their people? them high qualified medical institutions with reputed results, globally competitive There are many reasons why should a hospital train its people. Training makes and in low cost, combining their travel with short holidays. people more engaged to the hospital plans. Training makes people more responsi- The constituents of success, seem to be: 1. the scientific progress through research ble and concerned about their job. Training helps people understand the impact of projects and continued enquiry leading to advancement in the field of infertility their actions in the hospital business. It helps people understand how to follow the management, 2. the clinical improvement of quality and efficiency of IVF treatments protocols and why, understand the risks of not following the international practic- and its expansion in the grater population of fertile couples providing solutions asso- es and protocols. Following processes has an impact in cost cutting as the human ciated with genetic origin, 3. business agreements and partnerships between health resources are being exploited as they should and not seeing several people doing professions from different countries facilitating cross border movements, and 4. the same thing while other hospital sectors suffer. academia through educational processes that enhances the partnership of institutions How should a hospital plan its training plan? of different countries in education and as such creates employment opportunities A healthcare provider has to note all its weaknesses and the sectors that need some for new professions. optimization. It also needs to set some targets it wishes to reach after training. Ie The Diaspora, also, constitutes a valuable State asset, and an awareness campaign : a hospital that trains its people in a foreign language, obviously wishes to target around the world should make the difference in recognizing the unique opportu- foreign patients from this country. A hospital that has issue with after care and nity, as well as investment opportunities that medical tourism has to offer in all negative patients feedback needs to” repair “its international image for attracting countries. The exploitation policy of a global medical tourism framework brings more foreign patients. physicians, investors, organizations and governments closer providing unlimited ca- How do I know that training works? pabilities, high quality competitiveness, which just waits for the right coordina- The easiest way to know if a training program has worked is by measuring the tion and proper guidance to provide reliable synergies, beneficial cooperation and new results for each targeted area. Following that the hospital management should de- business perspectives. cide where training has worked, where retraining is required and what are the measurable benefits from the last training program regarding : financial results, OP269 - The Role of Training in Medical Tourism and its connection to Qual- international public image, employees and patients satisfaction and other. ity Assurance Maria.D.Georga OP270 - AThe development of Health Tourism in Albania: The new strategy The development of medical tourism is in the agenda of several destinations any- of Health Care Services more. Unfortunately the majority of destinations and healthcare providers believe R.Degjoni that the most important is to show how nice country they are, with so many “good Health tourism in Albania has the great potential for development. Analyzing the Doctors”, nice hospitals etc. geographical position data, medical accommodation and well-being, the private The above perception usually leads to illusionary or inexistent strategies or disap- and public hospital services, can be said that the disturbing population needs to be pointment as they realize that just having some plus does not make you an appro- interested in the strategic development of health tourism. Albania, provide mainly priate destination in medical tourism. sun, sea and tourism. Many manage to see some first foreign patients but lower numbers during the fol- There is a good potential for health tourism development. Albania offer good op- lowing years and many see a dramatic decrease to the number of foreign patients portunities for wellness tourism, medical spa and rehabilitation for social tourists, followed by several negative patients’ reviews. A main reason that healthcare pro- but the infrastructure and services need some new strategy development and im- viders fail is the lack of training and the international practices protocols applica- provements. In terms of the country’s economic development, the development tion within their medical businesses. The reasons of not training their people are of new tourism strategies can be a development point of the Albanian economy. many. Some do not believe in training, some see training as an expense and not The conceptual system of health tourism is that foreign patients prefer the country as an investment with serious return for their business, some find it nonsense to mainly because of the fact that they can use highly professional therapeutic ser- invest in people since they will “just go or ask for more money”. vices at relatively low prices (Kincses, 2009). The goal will be to place Albanian Another very important is that hospital management does not link training with on the Balkan map of care with the highest destination for health tourism.

236 237 Poster Program Poster Scientific Scientific

The reassessment of quality service aspects and the fact that the few Balkan coun-

Round 4th IMCA Scientific Poster Program Table 2 tries (Gallup, 2013) have their experience in health tourism gives our country the opportunity to create a competitive and intensified environment in health tourism The role of biopsy in the evaluation of malignant formations before surgery. for the coming years. Consequently, if Albania takes advantage of its current geo- A. Sina¹, J. Isaku², J.Profili³, Gj.Tosku4, A. Arapi5 graphic opportunities, there will be many opportunities to develop the country into The imaging of acute tubular necrosis (ATN) in the transplanted kidney. its health tourism services provider. A. Daku, A. Dedej, F. Nasto, L. Berdica, I. Allajbeu. A. Hodaj The purpose of this study is to identify the effect of the development of health Acute renal failure due to lymphomatous infiltration of the kidneys. tourism in Albania. These factors relate to country’s geographical background, A. Daku, I. Allajbeu, A. Dhima, B. Tocillaj, B. Cekrezi, F. Tuka who reflects Albanian as a good place to design a new strategy for development of health tourism. Headaches in the Emergency Room. This abstraction analyzes the mains actions for the development of health tourism A. Quka, O. Cibuku, I. Zekja, I. Xhura, J. Kruja in Albania. The usual method is to consider that the target groups of medical ser- Quality indicators for detecting pre-analytical errors in the medical laboratory. vices are mostly represented by hospitals that have quality and quantity in provid- Albana Daka ing health services and to consider that the target groups of using the new tourism Virtual care: A promising facility to access Healthcare in Albania. health services are mostly represented by those who will choose to use the new Albana Greca Sejdini1; Klerida Shehu2 health tourism services in Albania. The few mains actions for the development of health tourism are: Urticaria-like skin changes in Mycoplasma Pneumonia infection – Case report. (i) the definition of a national strategy for Albania’s competitive position in the Albina Ponosheci-Biçaku, Hamdi Ramadani, Ardian Biçaku, Shemsedin Dreshaj European medical tourism market (Tamminen, 2004), with a particular focus on Right ventricular dyssynchrony in idiopathic pulmonary arterial hypertension: health services; determinants and impact on pump function. (ii) including in the national strategy the need for certification and cooperation Alfred Nona, Bekim Jata, Indrit Temali, Edjon Hajro, Sejdin Meco with international health institutions in order to create a strong brand and reputa- The danger for Colorectal cancer in Ulcerative colitis; causes and management tion of Albania as an attractive medical tourism destination; therapeutical strategies. A Devaja, F. Hoxha, F. Kavaja, Sh. Hashani, Rr. (iii) Establishing modern practices in quality assurance, licensing and testing, par- Musa, B. Braha, N.Musli, D. Ibrahimi ticularly in outpatient care, including a register of patients and processes; Pulmonary Embolism - The importance of fast diagnosis in emergency department. (iv) specialization of the provided service; Almenda Zaka MD, Mikel Koti, Areti Pojani, Amarildo Hidri (v) the use of international networks to attract patients; (vi) the combination of the medicinal product with the support services needed for Follicular occlusion triad. Amarda Gica patients visiting the site; An overview of the Iron status and its markers in Hemodialysis. Ani Bulla (vii) evaluating and generating the new image of the health tourism in Albania. Array Comparative Genomic Hybridisation result communication in a series of In addition, other important factors that can contribute decisively and act as a pediatric Albanian patients: genetic counseling. supporting force in national efforts to strengthen medical tourism in the country Anila Laku-Babameto, Dorina Roko include the natural and cultural heritage, the climate, the country’s high traffic as a tourist destination, the Mediterranean diet (Ginter and Simko, 2011), moderniza- Anesthetic management in a Wolf Parkinson White patient undergoing elective tion of infrastructure and high-quality hotel infrastructure. surgery. Bako A., Bilaj M., Kortoci R., Kaza R., Jaupi A., Nona A. Medication and repositioning manouvers in inner ear diseases. Anjeza Kuci, Besim Boci. Jetmira Fejza Anosmia and a new therapy of treating it. Anjeza Kuci, Besim Boci Ponseti Method. Anxhela Ahmataj; Zamir Demiraj Revision of the knee prosthesis and nursing care. Anxhela Qato, Miranda Marku, Sidorela Salla

238 239 Poster Program Poster Scientific Scientific

Hysteroscopy and endometrial carcinoma. Real time PCR HBV – DNA relation with HBeAg status, in patients HbsAg Plenary Session

Scientific Arben Haxhihyseni, Daniela Verçuni Positive: six months study in American Hospital.

Poster Program Dafina Trimaçi, Albana Daka, Luljeta Marku, Irena Marku, Brunilda Hyse- The effect of the nurses’ knowledge and practices in the peripheral intravenous ni, Oltiana Petri, Esmeralda Angjeli catheterization and in the development of infections/complications related with catheterization. Arbëresha Gurguri1, Fatjona Kamberi2 Pathophysiological and morphological alternations in the lungs in a rat experi- mental model of acute pancreatitis. Dariel Thereska, Arben Gjata, Nikollaq Viral infectious as skin diseases. Ardiana Sinani1, Artan Osmenllari1 Kacani, Enton Bollano, Devid Belalla The Importance of Nursing Education in Hospital Waste Management as a Meth- Primary Chondrosarcoma of the thyroid cartilage. Case report and review of od for Hospital Infections Prevention. literature. Daniela Nakuci1, Leart Berdica3, Teona Bushati3 Ardita Shkembi (Plaku), Arjeta Deda ( Kola), Edlira Cako, Jonida Pellumbi Multiple, multifocal Warthin’s Tumor: Case report and a review of literature. The Health Personnel Knowledge Assessment regarding the use of gloves in Daniela Nakuçi1, Leart Berdica 3, Teona Bushati 3 public and private hospitals of Tirana. Ardita Shkemi ( Plaku), Edlira Cako, Arjeta Deda, Jonida Pellumbi Hyperprolactinemia as e Side Effect of Methyldopa in a dialysis patient in our Center of hemodialysis at “American Hospital Durres”. Sula D, Nasto F, Bol- An evaluation of the epidemiologic situation of the hydatidiform mole in Al- leku E, Demaj E, Shkurti E, Strakosha A, Barbullushi M bania. Armela Priftaj1 , Esmeralda Thoma2, Emirvina Kolici2, Irena Kola2, Viola Shkira3 The prevalence of Intradialytic Hypertension in the hemodialysis population of Ameri- can Hospital Tirana 3. Denada Haxhiu, Alma Idrizi, Gilda Kuka, Nestor Thereska Systemic lymphadenitis due to cat scratch disease. Arsilda Gjataj, Rovena Capo, Esmeralda Meta, Ermira Muco, Klodiana Shkurti, Dhimiter Kraja, FAST: Ultrasound Method for Trauma. Dorian Meta Arjan Harxhi Evaluation of thyroid function in pregnant women. Nursing care for acute myocardial infarction. Aurel Doda, Gisela Albrahimi Dorina Minxuri1, Nora Haliti1, Steljan Buzo2, Lorena Budo3 Follow up of complete blood count elements (RBC, WBC, HGB, HCT) at the Predictive markers of Alcoholic Liver Disease in patients with Alcoholic Depen- patients with Lung Cancer before and after chemotherapy. Bekim Mustafa, dence. Dorina Osmanaj, Skerdi Prifti, Ilir Akshija Adem Musliu Rolanda Belegu Arbër Musliu Risk factors for Community Acquired Acute Kidney Injury. Edi Rembeci Identification of hemoglobinopathies at American Hospital laboratory.Brunilda Trauma: causes, types and management. Edmon Murati Hyseni, Irena Marku, Lulieta Marku, Albana Daka All - inside Arthroscopic meniscal repair. Parathyroid hormone levels in hemodialysis patients. Brunilda Mehilli, Anila Edvin Selmani, Fatmir Brahimi, Leard Dura Rrupulli, Mereme Tusha Long term results of Clubfoot treatment with Ponseti Method. Edvin Selmani, Case report Pelvic inflammatory disease (PID) Nursing Care.Pino B; Fasko B;- Fatmir Brahimi, Leard Duraj Sula L;Tani M; Ismahili A; Nikoci E; Çaça I; Ibrahimllari L; Leka R; Elmadhi F Physiological jaundice and phototherapy treatment in newborns in the Ameri- Ultrasonography of the hip in reducing the rate of late DDH. Cen Bytyqi, Faton can Hospital Tr 2. Eglantina Hysaj, S. Qibini, E. Vila, E. Koci, M. Karaj, S. Morina, Arben Grazhdani, Davud Xhigoli, Haki Prebreza, Dafina Bytyqi Domi, M. Miraka, L. Gremi, L.Sadiku Cerebral toxoplasmosis in HIV/AIDS patient. Çiljeta Malaj, Brunilda Zllami, Traumatic Disarticulation Associated with Injury of Vasa and Distal Reconstruc- Besnik Filaj, Edmond Puca tion – Case Report. Elmi Olluri, Elton Olluri Possible use of Urotensin II receptor in detecting prostate cancer upgrading and Low mortality rate of ruptured abdominal aneurysm as a result of the short time upstaging. C. Falavolti1, E. Shehu1, B.C Gentile2, L. Albanesi2, G. Rizzo2, P. of the operative procedure. Elmi Olluri Tariciotti2, G. Mirabile2, S. Nardone2, M. Buscarini3, R. Giulianelli2 Traumatic rupture of the infrarenal inferior vena cava: Successful emergency Fusion Biopsy for detecting prostate cancer. Is it really better? C. Falavolti1, E. reconstruction with polytetrafluoroethylene graft, CASE REPORT OPEN AC- Shehu1, R. Giovannone1, P. Alijani1, R. Giulianelli2, T. Petitti3, M. Buscarini3 CESS. Elmi Olluri, Jusuf Taner, Lulzim Emini, Elton Olluri

240 241 Poster Program Poster Scientific Scientific

Transcutaneous bilirubinometry- its role in early detection of neonatal jaundice. Muco1, Jonida Mehmeti1, Artan Bego2, Arta Kushi1, Neada Hoxha1, Edmond Plenary Session 1 1 1 1 1 1 1 3 Scientific Elona Gjybegaj ; N. Kolici ; G. Bime ; A. Subashi ; V. Lekgjika ; K. Hyka Puca , Marsela Sina

Poster Program Upper leg femoral bone architecture and its imitations in coherent constructions. Hot Lingual Thyroid. Ersida Golemi, Anjeza Kuci Elona HASALLA, Ilia Mazniku, Blerta Hasalla, Sulejman Baha, Ilda Taka Urethral stricture lenght ≥2 cm is significantly associated with lower urethroplas- A Case Report, as a correlation between Right Cardiac Hart Failure and Myelop- ty success rate. Results of our large case series. Ervin Shehu, Cristina Falavol- roliferative Syndromes, Developed on the basis of Polycythemia Vera and Severe ti, Roberto Giulianelli, Tommasangelo Petitti, Maurizio Buscarini Pulmonary Hypertension-post Pulmonary Embolism. Elton Qeli Bipolar plasma enucleation of the prostate (B-TUEP) in Benign Prostate Hyper- Biotin interference with routine clinical immunoassays. E. Koliçi, N. Koliçi, R. trophy Treatment. Medium-term results. E. Shehu, C. Falavolti, B.C. Gentile, Kolpepaj, A. Zyli, A. Nake, Z. Imeraj, D. Kerri, L. Zikaj, A. Nurce, E. Thoma G. Mirabile, L. Albanesi, P. Tariciotti, G. Rizzo, M. Buscarini, R. Giulianelli Glycated albumin as a biomarker for glucose control. E.Koliçi , N. Koliçi, R. IMRT Quality Control for Head and Neck Treatment. Ervis Telhaj, Ledio Kolpepaj , Z. Imeraj, D.Kerri, L. Zikaj, A Zyli M. Kollçaku Bregu, Erjona Bakiu Health Related Quality of Life and associated factors in hemodialysis patients. Some enzymatic changes in AUD patients in Albania. Esmeralda Thoma1,, Stefo E., Pasko N., Saliaj M., Sulaj E., Strakosha A Sonila Bitri2, Admir Nake, Elvira Cela3, Irena Kola1 The importance of microscopy of sputum in lung parasitosis. Afiani E. ¹, Shehu² Evaluation of patient transport’s safety inside the operating theatre and health- U., Nasto F., Dhima A., Daka A. care worker’s. Eva Kajti, Süreyya Karaöz Adenosquamous Carcinoma of the Duodenum, a Rare Entity. Case report and Awareness of type 2 diabetes and hypertension: a cross-sectional study. Fatjona review of literature. Erion Sukaj, Teona Bushati, Leart Berdica Kamberi, Evis Alushi, Velide Pulomemoj, Jonida Celoaliaj Granulomatous epididymo-orchitis, as a complication of intravesical Bacillus Some “ugly” cases “that were treated at the thoracic Surgery of University Hospital” Calmette- Guérin (BCG) therapy for urothelial bladder cancer. A case report and “Shefqet Ndroqi “in Tirana Albania. F. Gradica, L. Lisha, Dh. Argjiri, A. Cani, F. review of literature. Erion Sukaj, Leart Berdica, Teona Bushati Kokici, Dr. Xhemalaj, I. Avdiu, A. Vyshka, E. Bollano, D. Thereska, H. Nino Paratesticular adenomatoid tumor. Case presentation and review of the literature. Urinary incontinence incidence in women with uterine prolapse treated in “Queen Erisa Kola1, Leart Berdica 2, Teona Bushati2, Jonida Hysko Geraldine” University Hospital. Fatjon Balla1, Evis Binaj1, Bashkim Ismaili2 Riga-Fede-like disease in a 85-year-old diabetic patient. Case presentation and review The Model of Interdisciplinary Collaboration in Clinical Microsystems: a Planned Ac- of the literature. Erisa Kola1, Teona Bushati2, Leart Berdica2, Jonida Hysko1 tion Approach to Change in Residential Care for persons with disabilities. Suela Ndoja Efficacy of the McKenzie Method in patients with Low Back Pain.Erisa Mane, Tobacco smoking among medical students in Faculty of Medicine, University of Igla Mukaj, Anxhela Avduli Prishtina. Festa Serhati Ureteral endometriosis a missed and complicate diagnosis: case report. Kurushi Improving the quality of laboratory hospitals in Albania: Time for Change. E, Tahiraj M, Cekodhima G,Cela B,Alimehmeti M, Ikonomi M Flutra Harxholli (Beqo), Rudina Degjoni The importance of nurse education in MMR Vaccine administration and parent’s Use in Clinical Practice by Nursing Staff of Proper Body Mechanics: Cross-Sec- education not to avoid it. Ermira Brahimi, Eledia Bajrami, Fabiola Keci tional Study. 1Gentjana Haskja, 2Fatjona Kamberi, Squamous cell carcinoma of right parotid gland as metastases from temporal Bladder cancer initial approach. Gjergji Semini1, Grigorios Daligaros2, Ko- region cutaneous carcinoma in HIV person. A case report. Muco E1, Mehmeti standinos Zotos3, Athanasios Lazaridis4, Fotios Dimitriadis J2, Cekodhima G3, Marjeta Kermaj4, Kushi A1, Hoxha N1 Retrieval, processing and selection of sperm for ICSI: What should an urologist Ramsay-Hunt Syndrome in an auricular Herpes Zoster. A rare clinical case. know? Gjergji Semini, Fotios Dimitriadis Ermira Muco1, Klevis Thomai2, Jonida Mehmeti3, Elsa Muzha4, Arta Kushi1, The effect of Tolterodine Er on Female Sexual Function.Semini Gjergji1&3, Fili- Neada Hoxha1 poni Maria2, Skouros Sotirios3, Dimitriadis Fotios4, Mamoulakis Charalam- Brucellosis presenting as fever of unknown origin in a cirrhotic patient. Ermira pos5, Lantin Pedro6, Areti Pojani1, Martinez Marlon6, Tsounapi Panagiota7, Sofikitis Nikolaos3, Zachariou Athanasios3 242 243 Poster Program Poster Scientific Scientific

The endometrial biopsy usinG “NOVAK “ PROBE, for endometrial pathologies Profilacy nursery, treatment, evaluation, provision, education.Lindita Saja Plenary Session

Scientific diagnostics. Gjergji Theodhosi; Fatmir Kopani; Lin Kurti Oral higiene and food intake during pregnancy. Lorena Haxhihyseni, Arben Poster Program Bronchiolitis obliterans organizing pneumonia masquerading as severe persistent Haxhihyseni, Daniela Haxhihyseni asthma: A case report. Gjustina Loloci Acne and her impact on the quality of students’ life. Angioedema and severe abdominal distention: a case report. Gjustina Loloci Loreta Kuneshka1, Numila Maliqari2 Cross-reactivity to acetaminophen and NSAIDs: a case report. Gjustina Loloc Diagnosing and treating vasculitis. Lumnije Pelaj Surgical treatment of a Ruptured Pancreaticoduodenal Artery Aneurysm. Henri Cervical cancer screening in Albania, what we do and what we should do? Kolani, Ejona Celiku, Earta Gega, Etmont Celiku Majlinda Ikonomi1, Shahin Kadare2, Arben Pepa3, Blerina Cela3, Mirela Rista1, Dhurata Tarifa3 DNA-HPV screening like method for detecting the cervical problems. Ilda Ndreko, Ariola Kosta Zeqirllari Case report of Arthrogryposis Multiplex Congenitalia (AMC). D. Bajraktari, J.Gjoshe, A.Sula Cardio-hepatic syndrome and its influence on acute decompensated heart failure patients in a single tertiary cardiology center. I. Sharka, S. Myftiu, B. Comparison of Conventional IVF versus ICSI in non-male factor in IVF out- Dida, J. Rustema comes. Marsel Haxhia The cases treated with Colorectal Cancer in the hospital Center “Xhaferr Kongo- Some data about the prevalence of HCV infection in different high risk groups in li” in the period time of 2014-2016. Ina Zhika1, Orida Qeva2 Albania. Mimoza Basho¹, E. Kureta¹, Sh. Qyra¹, Brunilda Vila¹ J.Basho2 Microinvasive squamous cell carcinoma arising within seborrheic keratosis. A - Emicizumab prophylaxis, a new standard in the management of Patients with case report. Iris Dino1, Leart Berdica1, Teona Bushati1, Artan Dafa2, Jorida Hemophilia A with the inhibitor. Mirela Xhafa 2 2 Memini , Dorina Billa Crocodile tear syndrome following bilateral facial paralysis caused probably by A six month study of pulmonary cancer in Albanian women. Jolanda Nikolla, Diabetes Mellitus Neuropathy, A case report. Mirjeta Guni, Irsa Burda, Klo- Bledi Cekrezi, Esmeralda Sera tilda Resuli, Adela Shkurti, Marjeta Kermaj, Mariola Kapia, Zamir Ndroqi Lymphocytic depleted Hodgkin disease associated with HIV. Case presentation and Risk factors for coronary artery disease in patients undergoing elective coronary review of literature. Jonida Hysko1, Leart Berdica2, Teona Bushati2, Erisa Kola angiography in American Hospital. Mirjeta Guni, Almenda Kote, Oltiana Demiri, Luljeta Marku, Indrit Temali, Sejdin Meco, Edjon Hajro Demographic, Clinical and Laboratory Characteristics of Epstein Barr Virus Hepa- titis in Immunocompetent Patients. Klodiana Nasto, Edmond Puca, Elda Qyra, Post-Traumatic Stress Management (PTSD). Natasha Merko Migena Qato, Monika Dede, Joana Majko, Iris Koshovari, Pellumb Pipero Ethical nature residence to patients. Natasha Merko, Ajsela Haxhiu, Lindita The importance of calcium daily intake in adults. Klotilda Vrenjo, Laura Mezini Saja, Klejdi Latifi, Elona Dervishi,Tereza Nikolla, Minushe Tori, Albana Ndoj Principles of doing a good and mininvasive technique in peritrochanteric frac- Mitral Ring Annuloplasty for Ischemic Mitral Insufficiency.Xhabija N, Tuncay ture, proximal femoral nail. Fezollari L, Caushi Gj, Duni A, Ruci V, Cami E, N, Sula F, Kacani A Selmani E, Sejdini K, Memini S, Demiraj Z, Bassi G, Gega A Malignant spontaneous facial Staphylococcal infection in an immunocompetent Treatment of Benign Prostate Hyperplasia in the Primary Health Center. adult. N. Gjermeni, N. Como, A. Gjermeni, E. Muco, D. Petani, N. Sulstaro- Ledian Hoxha va, E. Zogu, E. Koci, Dh. Kraja Inborn error of Metabolism. Pyruvate carboxylase (PC) deficiency. A case report. The relationship between the comorbidity and the socialdemographic character- 1 1 istics, lifestyle factors, in patients hospitalized in the internal medicine clinic, Niketa Kolici , Elona Gjylbegu , V. Lekgjika, K. Hyka Q.S.U. TIRANA. Ledio Collaku1, Margarita Resuli1, Artenca Collaku2, Renal Tissue Fibrinolysis in case of Experimental Diabetes Mellitus. Olenovych O.A. Enver Roshi3, Mihal Tase1 Identification of pathogenic microorganisms of food products in Tirana. Petri O, Hospital Infections (Is) Profilacy- Nursery, Treatment, Evaluation, Provision, Daka A, Isufaj V, Angjeli E. Education. Lindita Saja, Ajsela Haxhiu, Natasha Merko, Klejdi Latifi

244 245 Poster Program Poster Scientific Scientific

Defining the Human Microbiome in the future of nutrition and health.Petri O, Novelties in IVF. Diamantis Daphnis, Genc Kabili Plenary Session

Scientific Daka A, Isufaj V. Staphylococcus aureus, infection of surgical wounds. Poster Program A multimodal Treatment in Pediatric Patients with Wilms’ Tumor: a single insti- Zahide Sulejmani, Eugena Erindi tute experience. Orges Spahiu 1, B. Shima 1, M. Xhafa 2, D. Bali 2, M. Kaplla- ENDOCRANIAL HYPOTENSION. Discussion of a clinical case, etiopathoge- naj 2, D. Nika 3, O. Spahiu1 netic and radiologic aspects. Zamir Ndroqi, Eva Karame Skeeter syndrome, a case report. Ornela Marko Orthostatic Hypotension. Diagnostic, treatment and our clinical cases. Zamir Usefulness of Gensini score and Impact of lipid profile to severity of coronary Ndroqi, Eva Karame artery disease. Premtim Rashiti, Basri Lenjani, Idriz Balla, Leonora Svarça , Traumatic and non-traumatic injuries. Surgery and rehabilitation. Zojë Demaj Albiona Rashiti Bytyçi, Shpend Elezi Case report The substantial role of antihypertensive and anti-ischemic therapy in Pacemaker and nursing care. Roxhensa Nexhipi, Erlinda Hasa, E. Myrtezaj , dominating symptoms in patients with CAD when a complete revascularization A. Zaimi, Xh. Ahmeti, D. Merkaj has been performed- Case report - Sejdin Meco, I. Temali, Bekim Jata, E. The role of Information Management and Communication Technologies in Alba- Hajro, A. Zaka nian public hospital care. Rudina Degjoni Epidemiology of ITP in Albania 2014-2017,updates in diagnose and therapies - COPD Disorders and Worsening Prevention. Ruzhdi Rexhepi, Merita Rexhepi, Marsela Shani Shkurta Memishi, Rivajete Kadriu Intensive care management of HELLP syndrome and acute renal failure. A case re- Is mitral valve repair a better choice in patients with left ventricular dysfunction? port. Bilaj (Miraka) M., Arapi B., Huti G., Laho S., Zllami B., Sula A., Lila K. Sabjan Memishaj, Raif Cavolli Anesthetic technique in patient with acromegaly and sleep apnea (OSA) sched- Metastatic carcinoid tumor in an elderly patient - Case Report. Sabo Ademi, Kleva uled for Transsphenoidal Surgery (TSS). A case report. Bilaj (Miraka) M., Bako Qeraj, Dhurata Tarifa, Flutura Proko, Manjola Luzi,Mirlinda Likmeta A., Kortoçi R., Kaza R., Aga A., Caka E., Jaupi A. Our experience with laparoscopic Nissen fundoplication in treatment of hiatal Thoracolumbar burst fractures: Fixation types, levels, methods to save motion hernias in American Hospital of Prishtina. Tmava S. Fazliu I. Ismet J. Mu- segments. Kamil Cagri Kose colli F. Zeka Z Hasani A. Management of rıght ınternal juguler vein thrombosis after long term dialysis Acute airway obstruction caused by massive subcutaneous emphysema. Sadri catheter instertion. Bledar Hodo, Fjona Nasto, Ina Kulari 1 Hulaj , Sejran Abdushi The association between consumption of sugar containing beverages and the Our modest experience in the treatment of Upper Urinary Tract Tumors. Ferko prevalence of Non-Alcoholic Fatty Liver disease among middle-aged and elderly Sh., Balla I., Megjiti M., Xheta A., Mema B. population: The Rotterdam Study”. Juna Musa, Trudy Voortman, Oscar Franco, Jana Nano Co infection HIV-1/HIV-2 in ALBANIA. Shpëtim Qyra, Basho M, Qyra B, Dervishi M, Bani R, Durro V, Koraqi A Endometrial thickness as a predictive factor in IVF pregnancy outcomes. Golemi Denisa1, Peci Elton1, Cenameri Saimir1 Delirium Tremens during with drawl in patients with Alcohol Use Disorders. Sonila Tivari Bitri, Esmeralda Thoma, Eugjen Sotiri, Brunilda Zllami, Entela Puca Eosinophilic Granulomatosis with ployangiitis And Diffuse Gastrointenstinal Involvement. Ilektra (Kacareli) Xhafa, Altin Hysa, Arben Dhima, Florian Sclerosing poorly differentiated liposarcoma. Case presentation and review of Dashi, Eltion Xhafa literature. Teona Bushati Erisa Kola Jonida Hysko Leart Berdica Noncoronary Sinus Aneurysm. Uliks Ekmekçiu, Klodiana Gjoka, Aldo Gjoka, Endri Hasimi, Mimoza Lezha, Artan Goda Fibromyalgia – acupuncture. Urim Shehu Adolescent Idiopathic Scoliosis. Valbona Iljazi, Harun Iljazi, Artid Duni

246 247 Presentation Poster

PP001 - The imaging of acute tubular necrosis (ATN) in the transplanted kidney ed with kidney failure and the nephrotic syndrome concurrent with a diagnosis of Poster A.Daku, A.Dedej, A.Nasto, L.Berdica, A.Allajbeu, A.Hodaj lymphoplasmacytic lymphoma. His kidney biopsy and MRI findings showed two Presentation Acute tubular necrosis (ATN) is very rare complication but the most common cause distinctive pathologic findings associated with lymphomatous disease. Kidney in- of acute kidney after renal transplantation. ATN is usually caused by a lack of oxy- volvement in lymphoma is a well-recognized phenomenon, but the presence of sev- gen to the kidney tissues (ischemia of the kidneys) but may also occur if the kidney eral distinct pathologic processes is rarely seen. Because biopsy is performed infre- cells are damaged by a poison or harmful substance. We discussed our patient with quently in lymphoma patients, however, it is likely that cases with multiple forms of hyperacute acute tubular necrosis that occurred a few hours (3-4 hour) after surgery kidney involvement are overlooked. manifested with sudden anuria , high creatinine levels but with normal. Doppler ultrasound features. We wanted to discuss the importance of multidisciplinary eval- PP003 - Headaches in the Emergency Room uating of transplanted patients. Our patient was a young man (35 years old) that was A.Quka, O.Cibuku, I.Zekja, I.Xhura, J.Kruja followed up with peritoneal dialysis for a couple of years. After routine clinical and Headache remains an important symptom which leads the patients to the ER service. laboratory analyses were performed everyday Renal Doppler ultrasound, abdominal The aim of this study was to evaluate the burden of the patients presenting with CT even abdominal MRI for evaluating the complication and following the necrotic this main symptom and try to evaluate their further management (diagnostic tests, process. First 12 hours of surgery no any pathologic features was determined in hospitalization rate, causes and treatment) in the ER. We prospectively collected Doppler ultrasound . After 12 hours we dedicated free liquid around the transplanted the data of patients complaining of headache as the main symptom, admitted in the kidney with some thin septa’s occurred due to reactive changes and post-operative neurological ER unit, UHC Mother Teresa for three consecutive months, January, processes. Also there was presence of high echogenicity of corticomedullary differ- 2018 –March 2018 and evaluated their management in the ER. 2695 patients were entiation and high flow resistance compatible with high resistive index (RI > 0.78) admitted in the neurological ER service, and 22.15% (597) of them complained in Doppler US. These features was persistent by 3-4 days later and we saw a massive of headache as the main symptom, 374(62.6%) women and 223 (37.4%) males. retroperitoneal complicated liquids and some parenchymal disorders at the upper Mean age was 49.1±13.4 years. Primary headache was observed in 285 (47.7%) pts: pole due to operative ligation and reactions of acute tubular necrosis. After 10 days Migraine 151(25.3%)pts, Tension type headache 117 (19.5%)pts, Trigeminal neu- all the laboratory analyses was improved and the features in Doppler ultrasound and ralgia in 11(1.8%)pts with and 7(1.1%)other primary headaches . Secondary head- MRI was regressed compatible with other cases discussed in literature Our patient aches were observed in 312 (52.3%)pts: Subarachnoidal hemorrhage 35 (5.9%)pts, was a young man (35 years old) that was followed up with peritoneal dialysis for Other types of stroke 78pts (13.1%), Infections 65(3.8%)pts, Primary brain tumors a couple of years. After routine clinical and laboratory analyses were performed 15(2.5%)pts, Secondary brain tumors 19 (3.2%) pts, uncontrolled arterial hyper- everyday Renal Doppler ultrasound, abdominal CT even abdominal MRI for evalu- tension 51 (8.5%)pts, Trauma and other types of secondary headache 49(8.2%)pts. ating the complication and following the necrotic process. Brain CT scan was performed in 411(68.8%)pts, brain CTA was performed in 153 (25.6%)pts. Hospitalization rate was 59.1%(353pts). Most pts were treated in the PP002 - Acute renal failure due to lymphomatous infiltration of the kidneys ER with NSAID (85.59%) combined with benzodiazepines (59.5%). Opioids and A.Daku, I.allajbeu, A.dhima, B.Tocillaj, B.Çekrezi, F.Tuka steroids were used less frequently. Pts presenting with headache as the main primary Kidney involvement is an under-recognized complication of both Hodgkin and symptom occupy an important part of the neurological care in the ER service and non-Hodgkin lymphoma 1. The diversity of lymphoma-related renal manifestations more than half of them in our study had primary headaches or uncontrolled arterial makes diagnosis difficult: while abrupt worsening of kidney function may be the first hypertension. A better identification and follow up of pts with primary headaches, sign of malignant disease, renal effects can be subtle or even silent. The etiologies infections and uncontrolled arterial hypertension, by the primary care physician or of renal involvement are similarly varied. Here we discuss a case of non-Hodgkin local neurologist, may lead to reduction in the number of pts presenting in the ER lymphoma and associated kidney failure from several distinct malignancy-related and thus avoid unnecessary tests and reduce the neurologist working time in the ER. mechanisms. We then take the opportunity to review the Radiological spectrum in MRI of lymphoma-related kidney involvement. The clinical features and speacially PP004 - Quality indicators for detecting pre-analytical errors in the medical the abdominal MRI findings at the time of the renal biopsy performed at hospital. laboratory. Lymphoma-associated kidney involvement occurs by a variety of mechanisms, A.Daka which differ widely in prevalence and clinical presentation. The multiple lesions Mistakes in laboratory medicine are divided into three major categories: seen in abdomen specially near to iliac level on our patient’s biopsy present an ex- 1.Pre-analytical about 62% (46 - 68%) cellent opportunity to review and the pathogenesis of lymphomatous renal disease. 2.Analytical about 15% (7-13%) Treatment for all forms of lymphoma-related kidney injury focuses on therapy for 3Post-analytical about 23% (18 - 45%) the underlying malignancy. While kidney involvement portends a greater degree Some examples of pre-analytical phase errors: of metastatic disease, adequate data on prognosis are lacking. Our patient present- 248 249 Presentation Poster

•Incorrect patient identification; search revealed a total of seven articles regarding virtual hospitals in Albania serv- Poster •Incorrect sampling labels; ing as second opinion choice in high demands specialties. No study though was Presentation •Taking the wrong samples; found regarding a structured e-communication between online patient and doctors. •Incorrect storage; Telemedicine was the only structured virtual service found to serve as a second •Inadequate or long-lasting transport conditions; opinion facility for Albanian doctors and patients in high demanding specialities. •Non-conformities of serum / plasma - lipemia, haemolysis, bilirubinemia. Patient-centred care in Albania is going through a number of challenges requiring Examples of methods used for quality control improved health provider’s skills and knowledge, and increased patient partici- QC within the laboratory pation in medical care activities. Structured virtual healthcare systems could be QC between laboratories a great opportunity to assist patients anytime anywhere without in-clinic visits. Integrated KC (External) Checks on metering systems PP006 - Urticaria-like skin changes in Mycoplasma Pneumonia infection – Controls of electronic systems Case report Calibration control A.Ponosheci-Biçaku, H.Ramadani, A.Biçaku, Sh.Dreshaj Repeat analysis from patient samples Acute urticaria is a common and disturbing disorder in children and has a versatile eti- Monitor patient outcomes ology. The association between urticaria and infectious diseases has been discussed for Inadmissible values >100 years. Many bacterial infections have been associated with urticaria manifesta- Sampling Management in the American Hospital Laboratory Network tion, such as Helicobacter pylori, Streptococcus, Staphylococcus, Mycoplasma pneu- Priority samples in the proceeding: monia, Salmonella, Brucella, Mycobacterium leprae, Borrelia, Chlamydia pneumonia, •Department of Emergency / ICU and Yersinia enterocolitica. The eradication of the infection could, in fact, lead to the • Pavilions resolution of urticaria. Mycoplasma pneumonia is a common respiratory pathogen that • Dep. Dialysis / Dep. Cardiology produces diseases of varied severity ranging from mild upper respiratory tract infec- • Department of chemotherapy tion to severe atypical pneumonia. Although rarely fatal, M.pneumoniae is an import- •Operator samples ant cause of acute respiratory tract infection, especially as a potential etiology of the •Outpatient Samples clinical entity termed “atypical pneumonia”. Apart from respiratory tract infections, •It is important to keep records of any errors in the pre-analytical stage. this organism is also responsible for producing a wide spectrum of non-pulmonary •Drafting remedial strategies according to different departments, depending on the manifestations including neurological, hepatic, cardiac diseases, hemolytic anemia, reasons for the refusal of the samples. polyarthritis and erythema multiforme. We present a case with urticarial changes in the Periodic training of medical staff is an essential step in reducing the number of skin associated with M.Pneumoniae infection. wrong samples to increase the quality of the testing process in the clinical labora- Patient 8 year old boy was admitted in Clinic of Infectious Disease on July with tory and to promote patient-focused medical service. complains of temperature, cough and urticarial-like skin changes. Disease start- ed 5 days before with temperature, after 2 days started cough and urticarial-like PP005 - A PROMISING FACILITY TO ACCESS HEALTHCARE IN changes in the skin. Patient was treated with corticosteroids and antihistaminic, ALBANIA but changes didn’t withdraw. Patient was admitted in our clinic and started treat- A.Greca, Sejdini, K.Shehu ment with antibiotics (third generation cefalosporine (Ceftriaxone) and aminogly- The new world with new high-tech capacities is making people keener to assess cosides (Genatmicine)) and after 48 hours changes in the skin withdraw. Chest the healthcare systems most suitable to their daily lifestyle. VIRTUAL CLINICS X-ray revealed bilateral bronchopneumonia. Serology for Mycoplasma Pneumo- are becoming a great opportunity to consult a doctor or any other healthcare pro- niae was requested which resulted IgM positive and IgG negative. vider immediately anytime from any location. This study aimed to review all the Our patient lead to resolution of urticaria-like skin changes after antibiotic treat- available data regarding e-communications options and services, and to provide ment and auscultatory pulmonary changes started to improve. specific recommendations for e-Healthcare in Albania. Children with urticaria who are not responding to antihistamine treatment and A comprehensive review of the peer-reviewed and grey literature of the existing abstinence from food allergens should be encouraged to undergo serologic ex- e-communications between patients and healthcare providers was conducted to aminations for M.pneumoniae to diagnose this antibiotic-responsive disorder. provide specific recommendations. Prospective studies and well-structured research are obviously needed to better clar- A comprehensive search of the Pubmed, and Google Scholar databases was per- ify the real role of bacteria in the pathogenesis of urticaria and their relative preva- formed to identify publications related to virtual care services and structures. This lence. Key words: Mycoplasma Pneumoniae, urticaria, pneumonia, infection, skin

250 251 Presentation Poster

PP007 - Right ventricular dyssynchrony in idiopathic pulmonary arterial hy- ficulty of differentiating reactive change from dysplasia. Surgical procedure plays Poster pertension: determinants and impact on pump function. an important role in the management of UC both because of the premalignant Presentation A.Nona, B. Jata, I.Temali, E.Hajro, S.Meco nature of the disease, and because of the periodic failure of medical management. Right ventricular (RV) dyssynchrony has been described in pulmonary arteri- The management effect of Ulcerative colitis through biological therapies, surgical al hypertension (PAH), but no evidence is available on its morphologic deter- procedures, and different surveillance tools, have significantly reduced the risk of minants and its effect on systolic function. The aim of this study was - toeval CRC in patients with UC. Performance of surveillance programs demonstrated uate the morphologic determinants of RV dyssynchrony by echocardiographic that cancer was detected at an early stage in 80% of surveyed and treated patients, and cardiac magnetic resonance imaging and its effect on systolic function. compared with only 41% of non-surveyed UC patients. During colonoscopy sur- In 60 consecutive idiopathic PAH (IPAH) patients with narrow QRS, RV dys- veillance is suggested that over 30 biopsies are required to give a 95% chance of synchrony was evaluated by 2D speckle-tracking echocardiography, calculating detecting dysplasia. Low-grade dysplasia (LGD) is detected during surveillance, the standard deviation of the times to peak systolic strain for the four mid-basal there is a 9- 10 times the risk of developing cancer and over 12 times the risk RV segments (RV-SD4). Patients were grouped by the median value of RV-SD4 of developing an advanced lesion. 5-ASA reduced the risk of CRC by approxi- (19 milliseconds) and compared for RV remodeling and systolic function param- mately 50%, similar to the regular use of nonsteroidal anti-inflammatory drugs. eters, WHO class, pulmonary hemodynamics and 6-minute walk test (6MWT). Surgical Procedure shows delayed perineal wound healing is well documented as Despite similar pulmonary vascular resistance and mean pulmonary arterial pres- a problem. Only 61% had a healed perineal wound by a month period, and by 200 sure, patients with RV-SD4 at >19 milliseconds had advanced WHO class and days this had increased to 80% but 4% never healed. worse 6MWT, RV hemodynamics, RV remodeling and systolic function parame- The key element is the utilization of maintenance of chronic ulcerative colitis ters compared with patients at ≤19 milliseconds. The morphologic determinants of therapies could be a consequential strategy for reducing CRC risk in UC patients. RV dyssynchrony resulted RV end-diastolic area, LV diastolic eccentricity index Throughout the surveillance, UC-CRC shows characteristic clinicopathological and RV mass volume ratio (r = 0.69, r(2) = 0.47, p < 0.0001). Finally, we found features. Analysis and data of the correlation between these genetic features and a significant inverse correlation between RV mid-basal segments post-systolic clinicopathological features might be utilizable to develop incipient therapies and shortening time and cardiac index (r = -0.64, r(2) = 0.41, p = 0.001), accounting to reduce the peril of UC-CRC in the future. for the significant correlation between RV-SD4 and cardiac index (r = 0.57, r(2) = 0.32, p = 0.003). In IPAH with narrow QRS, RV dyssynchrony is associated with PP009 - Pulmonary Embolism - The importance of fast diagnosis in emer- RV dilation and eccentric hypertrophy pattern, suggesting a role of segmental wall gency department stress heterogeneity as the major determinant of mechanical delay. Post-systolic A.Zaka, M.Koti, A.Pojani, A.Hidri shortening, as inefficient contraction, contributes to pump dysfunction. Why Pulmonary embolism, “easily” diagnosed by well-defined criteria, turns into a challenge for the emergency care unit. PP008 - The danger for Colorectal cancer in Ulcerative colitis; causes and A 54-year-old man, who had undergone Achilles tendon rupture surgery 6 weeks management therapeutical strategies ago presented in American Hospital Emergency with the main complaints: chest A.Devaja, F.Hoxha, F.Kavaja, Sh.Hashani, Rr.Musa, B.Braha, N.Musli, D. Ibrahimi pain after using arm and scapular muscles for going upstairs at the second floor The most serious and life-threatening consequences of Ulcerative colitis is the de- at home. velopment of Colorectal cancer. The danger and risk elements of colorectal cancer in The patient underwent Achilles tendon rupture surgery 6 weeks ago, had been ulcerative colitis increases with extent and duration of disease, a household history under profilactic treatment with Fraxiparine s/c until 4 days before presenting in of sporadic colorectal cancer, the greater anatomical extent of colonic involvement, ER. He was under treatment for High blood pressure (irbesartan), Dislipidemia young age at diagnosis, the severity of histologic bowel inflammation and presence (statins), Tachycardia (B-blockers) for two years. The ECG showed a sinusal of primary sclerosing cholangitis. Thus, knowledge of risk factors for CRC is im- tachycardia and S1Q3T3 pattern. portant to identify UC patients who need observing colonoscopy surveillance and in He referred that his mother died at 52 years of age from Massive pulmonary em- some cases surgical procedures. CRC on the ground of UC develops from non-dys- bolism.After the cardiologist, pneumologist consults, blood test results and pul- plastic mucosa to indefinite dysplasia, and finally to invasive adenocarcinoma. -Ge monary Angio CT the patient resulted Massive Pulmonary Embolism and was netic alterations and 5-aminosalicylates might represent a favorable therapeutic. admitted to the ICU. After the consent of relatives, trombolisis with Actylase was Colonoscopy surveillance is based and performed on the high-risk factors that successfully performed, resulting in a normal pulmonary Angio CT afterwards. identify patients who are likely to develop CRC. A study of multiple biopsies, Hematologist consultation and thrombophilia panel was performed and the result surgery, chemoprevention or other substance to reduce or prevent the development was: MTHFR (C677T) Homozygous mutation. Anticoagulation with of cancer. Surveillance is performed during the remission state to reduce the dif- Acenocoumarol was began and should continue entire life.

252 253 Presentation Poster

After laboratory and imaging examinations, and consultations with the cardiolo- tion is facilitated by the action of hepcidin, recurrent blood loss, and low response Poster gist, pneumologist, the last consultation with the hematologist closed the Arch of from erythropoietin therapy. Increased prevalence of comorbidity in anemic CKD Presentation “Triumph” and decided the final treatment for the patient. In their role as first-line patients, has become challenging diagnosis of iron deficiency. The purpose of the providers, emergency physicians are responsible for initiating investigations and study is to make analysis about anemia, Iron status and its markers in our patients interventions to diagnose and/or treat patients in the acute phase (including initial under treatment with hemodialysis and compare them with contemporary litera- resuscitation and stabilization), coordinating care with physicians from other spe- ture data. This is a retrospective descriptive study over 69 hemodialysis patients. cialities, and making decisions regarding a patient’s need for hospital admission, Markers such as ferritin, hemogram, TSAT, serum iron were analyzed and as- observation, or discharge. sessed how going relationship between them, nutritional status and inflammation. Functional anemia in our sample had 12% of patients, also observed a strong pos- PP010- Follicular occlusion triad itive correlation between serum iron and TSAT (p <0:05); ferritinemia and years A.Gica in dialysis in patients without inflammatory condition; significant negative cor- Follicular occlusion triad is a symptom complex consisting of 3 conditions having relation between hemoglobin, erythrocytes and PCR (p <0.05); strong correlation similar pathophysiology. It includes Hidradenitis suppurativa, Acne Conglobata and between serum iron and albuminemia <3.5gr (p = 0.01) also between serum iron dissecting Cellulitis of the scalp.I want to present the case of a 24 year old truck and glycemia (p = 0.035) driver, who presented to our hospital with a history of recurring boils on his axillar Conclusions: Ferritinemia is not a reliable marker in evaluating iron status in pa- region and other parts of the body. The boils started gradually, enlarged and broke tients under hemodialysis. Serum iron undergoes significant fluctuations depend- down with pain, discharge and difficulty in movements of the arms.His complains ing on the nutritional status. New parameters and markers should be evaluated to started 5 years ago, followed with acne on his face and with cysts on his head. He has achieve a more adequate iron deficiency anemia treatment. been treated with short courses of antibiotics, but only got worse. The scalp showed some large fluctuant nodules, with intercommunicating sinuses and pustules, fol- PP012 - Array Comparative Genomic Hybridisation result communication in lowed with alopecia. Acne scars, cysts and nodule - reminiscent of acne conglobata a series of pediatric Albanian patients: genetic counseling - on the lower half of the face, multiple nodules, cysts in erosion and band like scars A.Laku-Babameto, D.Roko in the axillary region were seen.The liver function were within normal limits, so was Array Comparative Genomic Hybridisation (aCGH) is an innovative and power- the renal function, HbA1c was 5.06, the swabs of culture from the axillary region ful technology whose implementation is allowing an extraordinary change in the resulted + for S. agalactiae. Fungal stain from the scalp was negative.The patient diagnosis of various diseases, especially in the diagnostic of intellectual disability, was obese; he was advised to follow a strict diet chart to lose weight. It was started autism and malformation syndromes. It allows whole genome analysis at a higher treatment with oral cephalosporin’s and oral isotretinoin 0.5mg/kg orally, and local resolution than was previously possible by karyotyping alone. Our aim was to treatment. The patient is under treatment and follow-up.Hidradenitis suppurativa or analyze, by aCGH, a series of patients affected with development delay/intellec- acne inversa is a chronic, inflammatory, recurrent, debilitating skin disease that usu- tual disability, autism spectrum disorders or multiple congenital anomalies and to ally presents after puberty with painful, deep-seated, inflamed lesions in the apocrine provide pre- and post-test genetic counseling after aCGH results. Currently there gland-bearing areas of the body, most commonly the axillae, inguinal and anogenital are no universal guidelines for aCGH result communication. regions. Acne conglobata is a severe form of acne vulgaris characterised by suppura- We assessed 23 patients with development delay/intellectual disability, autism, tive cystic lesions on the face with interconnecting sinuses. The lesion can develop multiple congenital anomalies and dysmorphic features. DNA isolated and purified in other sites like the buttocks, thighs, upper arms, neck and the trunk. Dissecting from peripheral blood was examined for copy number variations (CNVs) using 2 x cellulitis of the scalp is a rare disease of the scalp, characterized by tender suppurat- 150K microarray CGH. Final analysis was performed using Cytosure Interpret and ing nodules over the scalp with intercommunicating sinuses that heal with scarring Agilent Genomic Workbench 5.0.14, with reference to genome assembly NCBI alopecia. The disease tends to be chronic and is difficult to treat. Build 37 (hg 19). All the cases were analysed in a private genetic diagnostic center. Results. aCGH assessment identified in several patients submicroscopic changes (microdeletions or microduplications) that could explain the clinical phenotype. PP011 - AN OVERVIEW OF THE IRON STATUS 14 pathogenic variants and 2 variants of unknown significance were detected. AND ITS MARKERS IN HEMODIALYSIS Pathogenic variants were identified in 4 patients with a duplication and a deletion, A.Bulla 1 patient with a microdeletion, 2 patients with a microduplication, 1 patient with Anemia is a frequent complication of chronic kidney disease (CKD) mainly in a deletion and 2 patients with two deletions. 3 of the 14 variants were identified in those under treatment by hemodialysis. In CKD it is caused by the shortening of previously described and known syndromes (Angelman, Williams and DiGeorge the erythrocyte life, erythropoietin deficiency, reduction of intestinal iron absorp- syndromes) and in 1 patient with autism. This study demonstrated the utility and

254 255 Presentation Poster

importance of genetic testing through aCGH in the diagnosis, management and rium of the electrolytic circulation, between endo and perilymph and there are Poster pre- and post-test genetic counseling of patients with development delay/intellec- cases in wich it is accompanied with BPPV, because of a dislocation of the Presentation tual disability, congenital anomalies and dysmorphic features and their families. otoconia into the semicircular canals, most of the cases in the posterior semi- Communication of aCGH results varies according to their pathogenicity. Patients circular canal in canalolithiasis or the fixation in the cupula in kupulolithiasis. receiving ‘variants of uncertain clinical significance – likely benign or known We find vertigo in both pathologies and they may coexist in the same patient. benign polymorphism’ pose communication challenges to clinicians and fami- we have taken 20 patients in our study diagnosed with Menier s disease, in 5 of lies. Key words: Array Comparative Genomic Hybridisation (aCGH), multiple wich with BPPV, diagnosed in Dix Hallpike maneuver We did the repositioning congenital anomalies, benign polymorphism, genetic counseling. maneuver depending on the SCC, Epley or Seumont We did a recheck after 1 week and after 2 weeks and and mean while treated the patients with the therapy of PP013 - Anesthetic management in a Wolf Parkinson White patient undergo- Menier s disease. Results: There were two cases in wich, even though we did the ing elective surgery reposisining maneuver, the vertigo persisted, most of the cases in cupulolithiasis A.Bako, M.Bilaj, R.Kortoci, R.Kaza, A.Jaupi, A.Nona there are cases in patients with Menier s disease in wich we find also the coesis- Wolff-Parkinson-White (WPW )-Syndrome is a ventricular pre-excitation syn- tence of BPPV, where we perform the repositioning maneuver to fix the otoconia, drome resulting from aberrant conduction pathway. Patients with WPW-Syn- There are difficult cases, in wich the vertigo persists but but the gravity of the ver- drome can present with an acute episode of tachycardia(re-entrant tachycar- tigo is smaller after reposisioning maneuvers although we perform correctly the dias or AF) or for an incidentally discovered WPW pattern on ECG. There is repositioning manouvers the vertigo persists in some severe cases in patients that also a risk of ventricular fibrillation and sudden death. ECG findings include a also have Menier s disease and we are still trying hard on these cases short PR interval (<0.12 s), slurred slow rising onset of QRS complex (called delta-wave or pseudo-Q¬) and prolonged QRS complexes (>0.12 s). Depend- PP015 - Anosmia and a new therapy of treating it ing on severity of symptoms and risk factors,it can be chosen either electro- A.Kuci, B.Boci physiologic study with possible ablation or antiarrythmic agents treatment. Anosmia is the loss of sense of smell wich may be partial or total. The ethiology The anaesthetic management in these patients is challenging as life-threatening of anosmia is from the head trauma in 15%, 25 % from the nose problems like in arrythmias can occur perioperatively. When is possible, regional anaesthetic CRS, or cronic rhinosinusitis, URVI or a viral infection of the upper respiratory technique can be performed, as a safer alternative to general anaesthesia, as it tract in 20%, 1 % is the congenital anosmia, 2 to 5 % is Parkinson disease or Alz- avoids polypharmacy and intubation stress. A 55-year-old man, who was a known heimer, idiopathic anosmia in 25 % of the cases, etc we have taken in our study WPW patient treating with Flecainide 100mg/d was posted for elective compli- 10 patients suffer from anosmia or hyposmia. 5 from cronic rhinosinusitis, 2 from cated anal fistula intervention. He had history of past rheumatic fever. A 18G URVI, 3 from allergic rhinitis with nasal poliposis. They have problem with the endovenous line was secured preoperatively. Fluid preloading was given to pre- smell from a period of at least 3 months and they have not been treated before for vent reduction in atrial filling that occurs during regional anaesthesia, decreasing the smell problems, They have been treated with coticoid nasal spray, sistemic suchway sympathomimetic requirements which may trigger arrhythmogenecity. corticosteroids and zinc 150 mg for a period of 3 months. Conclusions: after the At the time of surgery he was asymptomatic with moderate exercise tolerance. HR treatment we found improvement in 3 of the cases with cronic rhinosinusitis and was 83 beats/min, regular and BP was 123/75 mmHg. ECG showed WPW pattern( in 2 suffering from URVI, in 5 others we did not find significant improvement shortened PR interval , pseudo Q and T inversions in chest leads). Echocardiogra- there are new treatment in patients with anosmia including corticosteroids and zn phy showed normal cardiac function with EF of 60%. Patient was explained spinal tablets giving significant improvemet anaesthesia and consent was taken. In OR standard monitors ECG, NIBP, Pulse Oximetry were applied. Availability of anti-arrhythmic drugs and defibrillator was PP016 Ponseti Method confirmed. Subarachnoidal block was achieved in L3-L4 space with 13.5 mgof A.Ahmataj, Z.Demiraj 0.5% hyperbaric Bupivacaine. During operative time the patient was hemodinam- We present Ignatio Ponseti’s approach to idiopathic about clubfoot management ically stable. A patient with WPW syndrome can be managed successfully under and its biological basis. The key principles of the Ponseti method of treatment are: spinal anaesthesia. Through understanding of pathophysiology of WPW, intensive 1. All deformity components are corrected simultaneously except equinus, which preoperative evaluation and meticulous intraoperative monitoring is essential. is corrected last, usually by percutaneous Achilles tenotomy. 2. The correction is maintained by external foot rotation around the head of the talus. PP014 - Medication and repositioning manouvers in inner ear diseases 3. The excavates is corrected by supination of the first ray of the foot. A.Kuci, B.Boc, J.Fejza 4. The corrections are performed weekly and after 4-5 weeks of treatment a percu- Menier s desease or endolymphtic hydrops, happens because of a disekuilib- taneous Achilles tenotomy is performed in local or general anaesthesia.

256 257 Presentation Poster

5. After 3 months of plaster cast immobilization, a Denis Brown brace is used to keep Poster the correction until 4-5 years of life. Ponseti Method, Clubfoot, Achilles Tenotomy. PP019 - The effect of the nurses’ knowledge and practices in the peripheral in- Presentation travenous catheterization and in the development of infections/complications PP017- Revision of the knee prosthesis and nursing care related with catheterization Q.Anxhela, M.Miranda, S.Sidorela A.Gurguri, F.Kamberi The knee joint is one of the most compound articulation of human body. It makes Peripheral intravenous catheterization is one of the most common invasive proce- possible two specific movements like flexion-extension and the intern-extern -ro dure to provide access of the administration of drugs ,fluids and parenteral nutri- tation. Knee prosthesis makes possible the replacement of damaged part of the tion in hospitalized patients.This procedure is associated with a high relatively risk bones with an artificial joint consisting of plastic and metallic parts. for complications ,with serious consequences in patients’ health and increase the Presentation of knee prosthesis revision and post-operation nursing care to prevent costs of healthcare.Aimed at assessing the impact of knowledge and practices of complications and quick patient’s recovery. staff nurses on peripheral IV catheterization and its complications in the Depart- Material & Methods: This is considered as a prospective study with a descriptive ment of Pathology and Surgery of Vlora Hospital. character. The patient’s individual clinical files have been the main source of quan- In the analytical, observational study, 54 randomly selected nurses who complet- titative and qualitative data gathered for this purpose. Albanian and foreign liter- ed an anonymus questionnaire for the IV peripheral catheterization and related ature has also been used.We proudly present a successful case in patient A.P,50 complications , and 14 of them were observed during the course of the procedure years old, with knee prosthesis revision, which was taken over from orthopedic in 30 hospitalized patients during the period of conducting the study .The statistical doctors of American Hospital. The patient presented to our department with some analysis included the calculation of averages ,frequencies and percentages symptoms like temperature, pain, discomfort. As a result of this study is made while the Chi-Square test was used for the relationship between the variables . possible a fast recovery of patient’s health. Adhering to the pre-op and post-op The data collected showed that the majority of nurses (67%) had average knowl- protocols is an important factor to a fast rehabilitation and recovery process. Pre- edge and average practice (83%) about peripheral IV catheterization and the relat- vention of post-operation complications. Management of pain and quick patient’s ed complications.There was a significant relationship between the gender of the recovery. Knee prosthesis, Revision, Recovery. nurses and the level of knowledge (p=0.0236) while there have been observed some important relationships between specific questions with demographic vari- PP018 - Hysteroscopy and endometrial carcinoma ables of nurses.Regarding nursing practice,there were significant relationships A.Haxhihyseni, D.Verçuni between the number of complications with the number of attempts and the ap- One-third of patients who visit a gynecologist are there because of abnormal uter- pearance of the edema , output of the catheter with the number of attempts, re- ine bleeding (AUB), which is believed to account for more than 70% of gynecolog- spectively (p=0.005 and p=0.003). Complications were observed in 68.97% of ic consults in perimenopausal and postmenopausal women. the American College the insertions ,with erythema,pain ,edema,fever being the commonest (23.81%). of Obstetricians and Gynecologists (ACOG) Practice Bulletin on AUB now states Nurse’s knowledge about peripheral IV catheterization procedure affects that a negative blind endometrial biopsy is not a stopping point in persistent bleed- the occurrence of complications related to the technique.Increasing knowl- ing. In postmenopausal patients, any bleeding is “uterine cancer until proven other- edge and focusing on specific measures that are overlooked in practice are wise,” although the incidence of malignancy will range from 1% to 14%. In 2012, essential to improving the procedure with a direct impact on reducing com- the ACOG Practice Bulletin acknowledged, “the primary role of endometrial sam- plications,cost of care and enhancing health care quality. Knowledge, prac- pling in patients with AUB is to determine if carcinoma or pre-malignant lesions are tices, peripheral intravenous catheterisation, nurse, complications, patient. . present.”. So, hysteroscopy has becoming very importend in process of diagnosti- cation of AUB.We have analize 237 hysteroscopy done for AUB in our privat clin- PP020- Viral Infectious as skin diseases ic, in one stop diagnostic procedure. We used Bettocchi hysteroscope for all cases. A.Sinani, A.Osmenllari We use no any anesthesia for 205 cases. During diagnostic hysteroscopy, when we Onychomadesis is the proximal separation of the nail plate from the nail matrix hade the doubt for malignancy we get material for biopsy in the same procedure. due to a temporary cessation of nail growth. We hade only 32 cases with anesthesia and we diagnosed 14 cases of malignancy, It might be a periodic idiopathic shedding of the nails beginning at the proxi- 5 with endometrial ca of all surface of uterine cavity and 9 partial endometrial mal end, possibly caused by the temporary arrest of the function of the nail carcinoma. All the cases had a follow up of three years after intervention. 2 cases matrix. It can occur in children of all ages including neonate, and one cause is was lost. 12 cases followed up for three years had’nt had signs of malignency. hand foot and mouth disease. Hand foot and mouth disease (HFM) is a com- Conclusion: Hysteroscopy is the exact and definitive diagnostic and operational mon mild and short-lasting viral infection most often affecting young children. technique. It can be performed without anesthesia in more than 80% of cases. In our dermatology clinic, comes 2 siblings, 3 and 5 years old girls, .the biggest

258 259 Presentation Poster

sister had 1 week with fever, while the little girl had 4 days with fever. In the ob- compared the period January- June of 2017 and 2018. It is observed an apparent Poster jective examination of skin was observed red macules and papules in the hands difference on average 1754 kg for the first 6 months of 2017 compared to 3500 Presentation and feet . Small vesicles and ulcers in and around the mouth, Clinical diagnosis kg for the first 6 months of 2018. It is noticed that hemodialysis units produce was: hand foot mouth disease. After 2 months girls come again for re-check. The the largest quantity of medical waste about 40% of the total quantity and opera- 3 years old girl on her foot fingernails, in two of them had started proximal separa- tion rooms with 20% of the total quantity, the rest by the wards and polyclinics. tion of the nail plate from the nail matrix, while the five year old girl in one of her AH gives a great importance to the differentiation of waste, staff education related to hand fingernail had started separating the nail plate from the nail matrix. Clinical this topic and follow-up of the whole process. dignosis: onychomadesis , the cause of which could have been the hand foot and The topic related to differentiation of hospital waste, transport and documentation mouth disease that both girls had passed two months ago. involves some mandatory staff training 4 times per year evaluated with periodic Clinical dignosis: onychomadesis, Onychomadesis is a periodic shedding of the questionnaires compilation and quantity monitoring month by month Key words: nails beginning at the proximal end, possibly caused by the temporary arrest of the Hospital Waste, Education, Blue Book function of the nail matrix, which is usually confused with fungal nail infection, and most of the patients are self treated without any improvement, the history of PP022 - The Health Personnel Knowledge Assessment regarding the use of the disease is very important for accurate diagnosis of the disease, as in the above gloves in public and private hospitals of Tirana case, where the cause of onychomadesie in both girls was hand foot mouth disease. A.Shkemi (Plaku), E.Cako, A.Deda, J.Pellumbi Correct use of hand sanitation and medical gloves use is known as a procedure PP021 - The Importance of Nursing Education in Hospital Waste Manage- that directly affects the prevention of hospital infections. To achieve this goal, it is ment as a Method for Hospital Infections Prevention necessary to use them correctly. Incorrect use of gloves becomes the cause of the A.Shkembi (Plaku), A.Deda ( Kola), E.Cako, J.Pellumbi spread of hospital infections, which poses a risk to patient safety. After a survey Lack of differentiation of waste generated in the health care institutions and un- conducted for several months in public and private health care units related to controlled elimination constitutes a risk both for the health care staff and the popu- the use of gloves we came to these conclusions: an inappropriate use of gloves: lation. WHO determines that hospitals as care centers and hoteliers produce a large putting them outdoors outside the patient’s room, not eliminating them directly amount of urban and recyclable waste (80%) and only 20% of the total amount of after use, using the same gloves from one patient to the other patient, no hygiene waste produced in these units are classified as specific hospital waste (15% inef- of the hands after removing the gloves, a frequent phenomenon especially in the fective-pathological waste, 3 % pharmacological waist, 1% sharps and 1% heavy public sector, etc. For this reason, it was necessary to distribute a self-administered and radioactive metals). The American Hospital as a large hospital center produces questionnaire to evaluate the staff’s knowledge of this process. approximately 3,000 kg of hospital waste (infectious, drilling, pathological) every Evaluation of the health care staff knowledge regarding the use of medical gloves, month, as it needs to control the rigor of waste recycling. During the period Janu- and identifying areas for improvement of this process in the context of providing ary-June 2017, by the head nurse office was monitored closely the differentiation a secure health service and prevention of infections associated with health care. of the hospital waste where there was a lack of information of the staff about this This topic is transversal study, case-control. The group of cases consists of staff topic regardless the training they received related to this topic in the orientation working in public hospitals and the group of controls at private hospitals. The in- period and twice per year and the instructions posted at each point of collection in dicators related to the use of gloves were assessed according to WHO guidelines. every ward, were noticed elimination of waste in inappropriate bins for the type, In total, 130 questionnaires were provided in public units and 270 in private the elimination of sharp residues in infectious waste bins, the filling of waste bins ones. The showed that the group of cases consisted of 34% of doctors and 66% over ¾ of their capacity. For this reason, education was planned on this subject of nurses, while the group of controls was 19%, 81% nurses. The data was ana- with all the staff depending on the head nurse office, the pre-education knowledge lyzed in Excel and compared to the two interest groups where it can be seen that: was evaluated, the presantation in the power-point worked according to Training related to the use of gloves have taken in the orientation period 63% WHO guideline (Blue Book) for waste differentiation was presented and after ed- the group of cases compared to the 95% control group Training regarding the ucation gained knowledge was valued also.The study is transversal, descriptive. use of gloves has taken in the last year 39.4% the group of cases compared to The study includes 200 nurses, nurse aide, and technical imaging AH who have the 90% control group, which results that doctors had not received training. undergone to pre-testing and post-testing. In the questionnaire compiled with 28 The Case Group argues that one of the reasons for not using gloves is the lack of infor- questions in the pre-test were given on average 19 correct answers, while in the mation and the fact that often there is a lack of material base in 78% of respondents. post test 27 correct answers. Continuous work monitoring was carried out through- Based on the study conducted noticed a very big difference in knowledge and out 2017 and it was noticed that the problems related to waste differentiation practical application handles between public and private hospitals in Tirana. Most were minimized, this had a significant effect on the quantities of waste produced of the respondents in the public hospitals, asserts that are not trained in the stage

260 261 Presentation Poster

orientation (last year) associated with the use of gloves and one of the factors missed abortion. Most prevalent time that it happened was from 8 to 10 weeks of Poster leading to incorrect use is the fact that they often do not able gloves. Required by pregnancy. The curettage was the mode of treatment for all the patients. In 97,1 % Presentation the respective authorities to give greater importance to training and providing dis- of the cases was diagnosed partial mole and in 2,9 % of them was diagnosed total posable materials. Gloves, Questionnaire, Nosocomial Infections, Patient Safety. mole.Hydatidiform mole is relatively common in Albania. It is usually presented as spontaneous abortion, one of the commonest gynecological emergencies. hy- PP023 - The role of biopsy in the evaluation of malignant formations before datidiform, mole, pregnancy surgery A.Sina, J.Isaku, J.Profili, Gj.Tosku, A.Arapi PP025- Systemic lymphadenitis due to cat scratch disease Transparietal biopsy of thoracic and abdominal lesions is a rapid, safe method for A.Gjataj, R.Capo, E.Meta, E.Muco, K.Shkurti, Dh.Kraja, A.Harxhi their accurate diagnosis and for an appropriate treatment strategy.It is carried out Cat-scratch disease is an infection caused by Bartonella henselae, a fastidious under the direction of various imaging techniques, like as ultrasound , CT etc.We gram-negative bacillus acquired from exposure to an infected kitten or cat. The commonly used semiautomatic coaxial biopsy needles 18 G. most common manifestation of human disease is lymphadenitis. Objective: The objective of this presentation is to show the importance of the use of This is a descriptive clinical case of a patient diagnosed and treated at Infectious biopsy procedure prior to surgical interventions for suspected neoplasic formations. Diseases Service, University Hospital Center of Tirana in June 2017. A 50 years A 60 – year- old male with a 3 weeks history of cough with haemoptysis chest pain, old, female patient, was presented for a consultation at ID Service because of hematuria, weight loss and fever.Laboratory data showed an erythrocyte sedimentaon a chronic dolent lymphadenopathy localized in right axillar region accompanied rate of 45 mm/hr, the other laboratory data were normal.CT revealed a large speculated with fatigue and malaise. mass measuring 4.5cm x 4cm whith a central destrucve cavity, in the 1 and 2 segments On physical examination she presented a palpable dolent lymph node, with clear of the lung. Mediasnal lymph nodes ranged in size up to 1cm. During the biopsy proce- borders, well localized in right axillar region with diameter round 2 cm. The clin- dure under CT was occasionally observed a small heterogenic mass in the right kidney ical history had started 6 months ago. Lymphadenopathy persisted and a biopsy of approximately 2.2cm which it suggested for neoplasm. So we decited to perform a CT lymph node was recommended by oncologist. The histopathological examination whith ivc and biopsy of the lung lesion -resulted inamatory lesion. Renal mass biopsy revealed: reactive hyperplasia with a small granulomatous lesion. In her epidemi- under CT-resulted Clear Cell Renal Carcinoma. Transparientale biopsy should be used ological history the patient referred for a cat scratch in her right hand one month rounely in all cases where suspicious evidenced neoplasc formaons, for an accurate before the appearance of lymphadenopathy. histilogical diagnosis , so that the paent will undergo to the best way of treatment leav- She hadn’t taken any local or systemic treament. On admission the labs data revealed ing no room for negligence as occurs in formaons whith strong imaging features for lympho-monocitosis 56%, and hypergammaglobulinemia 21,7% in electrophoresis benignity or atherwise that the naent should not undergo to an unnecessary surgical of proteins. Toxoplasmosis serology, non treponemal syphilis tests, HIV and Gam- intervention incases formations are in ammamatory nature, lymphoma and in all cases ma interferon for TB resulted negative. Serology ELISA Bartonella Hensalae IgM were surgery is not indicated.biopsy , CT, malignant formations, diagnosis. and IgG resulted positive, titre 1:1280. Fundus oculi was normal. Abdominal echography revealed hepatosplenomegaly and PP024 - An evaluation of the epidemiologic situation of the hydatidiform in CT scan performed was confirmed the lymphadenopathy in laterocervical region mole in Albania and axillar region. In these conditions the patient was treated for cat scratch disease A.Priftaj , E.Thoma, E.Kolici, I.Kola, V.Shkira with antibiotics for 2 weeks: doxycycline 100 mg tablet bid, rifampin 200mg, tablet A molar pregnancy, also known as hydatidiform mole, is a complication of preg- bid and ciprofloxacin 200mg tablet, bid. nancy characterized by the abnormal growth of trophoblasts, the cells that normal- After the treatment the patient presented good clinical conditions, reduced lymph- ly develop into the placenta.There are two types of hydatidiform mole, complete adenopathy which was confirmed with CT scan performed (no lymphadenopathy). hydatidiform mole and partial hydatidiform mole. The diagnosis of our patient as a cat scratch disease presented with chronic and The aim of the study is to evaluate the epidemiologic situation of hydatidiform systemic lymphadenitis and lymphomonocitosis, was concluded based on clinical mole in Albania.This is a retrospective study. This study wasperformed over a findings, epidemiological history, serology, histopatological examination. one year period, January 2016– December 2016, at SUOGJ “ Mbreteresha Ger- CSD remains an infection caused by B.Henselae and in most of the cases with atyp- aldine’.During this period were diagnosed 70 patients with the diagnosis of hy- ical manifestations. The majority of cases of CSD occurring on normal hosts do not datidiform mole. The age of the patients was between 18 and 47 years old, with a require anti-infective therapy for resolution of infection. mean age of 29.7 years. The bacillus is susceptible to several antibacterial agents in vitro, including pen- The majority of patients come from rural area (58% of the cases). The most fre- icillin, cephalosporin, aminoglycosides, tetracycline, macrolides, quinolones, tri- quent clinical finding was vaginal bleeding and the most common diagnosis was methoprim and sulfamethoxazole and rifampin.

262 263 Presentation Poster

PP026 - NURSING CARE FOR ACUTE MYOCARDIAL INFARCTION and cisplatin in recommended therapeutic doses. The hematological parameters Poster A.Doda, G.Albrahimi were obtained before and after therapy using SWELAB hematological analyzer. Presentation Myocardial infarction (MI) or acute myocardial infarction (AMI) commonly The level of hematological parameters were determined in both men and women knows as heart attack happens when there is marked reduction or loss of blood population in different stages of disease before and after chemotherapy. flow through one or more of the coronary arteries, resulting in cardiac muscle Statistically differences were confirmed between the groups with respect to red ischemia and necrosis. In such case the role of the nurse is very important starting blood cells ( p < 0.001),white blood cells ( p < 0.01) hemoglobin ( p < 0.001) and with the promotion the pursuit and treatment of the disease, and until recovery. hematocrit ( p < 0.05). Based on the research of the hematological parameters it The aim of this study is to determine the risk factors and nursing care plan for was concluded that the cancerous cells itself are not the factors that contribute to those patients with acute myocardial infarction. the decrease of complete blood count of the patients, with the condition that the Methods: The study is prospective, made from 2 October 2017 to 20 May 2018 patients don’t have any other disease. between > 40 ages which are presented in urgency need in the Hospital of Durres The decrease it comes only after the use of chemotherapy. with AIM, and the nursing care starting with pain relife in examination and all measures for stabilising the patient. PP028 - Management of rıght ınternal juguler vein thrombosis after long Results: From 50 patients showed with AMI 29 were males and 21 were females. term dialysis catheter instertion From them 35 were old people and 15 adults. 12 from all of them are died and 38 B.Hodo, F.Nasto, I.Kulari are saved. Where the resceptive nursing care is given at each stage of AMI from Long term central venous catheters are impotant in dialysis patients. Thrombosis emergence and until stabilization and health education for the care that has to be. inside and outside the catheter lumen is an important complication that can lead to Most AMI occur due to coronary artery disease. Risk factors include high blood increased morbidity and mortality. The aim of this case prezentation is about how pressure, smoking, diabetes, lack of exercise, obesity, high blood cholester- to manage this situation and treat the patient. ol, poor diet, and excessive alcohol intake, among others.The complete block- Our patient is 61 years old male, he is attending dialysis programme for about 1 age of a coronary artery caused by a rupture of an atherosclerotic plaque is year. We ınserted a long term catheter in the right internal jugular vein. 2 weaks usually the underlying mechanism of an AMI. AMI are less commonly caused later the patient came to us complaining that he felt a pain and a swelling on the by coronary artery spasms, which may be due to cocaine, significant emotion- neck posterior to the catheter starting 3 days ago. We performed a venous dop- al stress, and extreme cold, among others. A number of tests are useful to help pler ultrasound and found out an acute thrombosıs of right internal jugular vein with diagnosis, including electrocardiograms , blood tests, and coronary angiog- and right subclavian vein. After that we performed a cadiac echocardiography and raphy. Commonly used blood tests include troponin and less often creatine ki- there was no thrombus in right atrium neither in the begining of vena cava supe- nase. Nursing care for the AIM concludes of seven care plans: acute pain, ac- rior. The catheter works normally and the patient is attending dialysis regularly. tivity intolerance, anxiety, risk for decreased cardiac output, risk for ineffective There was no syptoms of superior vena cava syndrome. tissue perfusion, risk for excess fluid volume, deficient knowledge. Acute myo- We treated the patient outdor with warfarin (inr 2-3), LMWH and acetylsalisylic cardial infarction, risk factors, nurse care, care plans, coronary artery, urgency. acid 100mg. There was no problem during the follow up. 2 months after the treat- ment the thrombus was totally resolved . we planned to treat the patient 1 year PP027 - Follow up of complete blood count elements (RBC, WBC, HGB, with warfarin and acetylsalisylic acid. HCT) at the patients with Lung Cancer before and after chemotherapy B.Mustafa, A.Musliu, R.Belegu A.Musliu PP029- Identification of hemoglobinopathies at American Hospital laboratory Lung cancer is the leading cause of cancer-related deaths of men and women in the B.Hyseni, I.Marku, L.Marku, A.Daka world. The aim of this study that was conducted in the period October 2016-Octo- Hemoglobinopathy is a kind of genetic defect that results in abnormal structure of one ber 2017 (12 months) was to evaluate patients with lung cancer and to analyze the of the globin chains of the hemoglobin molecule. Hemoglobinopathies are inherited changes of several specific blood count elements ( such as RBC,WBC,HGB,HCT) single-gene disorders; in most cases, they are inherited as autosomal co-dominant before and after chemotherapy with carboplatin and cisplatin . traits. Common hemoglobinopathies include sickle-cell disease and thalassemias. The study group included 85 patients that were clinically confirmed with both In our country it has been estimated as 300000 to be carriers of hemoglobinopa- types of lung cancer, from which 84.70% (72/85) with non-small cell lung can- thies, which makes approximately 8 % of the population is a value trending to grow. cer (NSCLC) and 15.30% (13/85) were with small cell lung cancer (SCLC).They Haemoglobin (Hb), is responsible for the transport of gases throughout the body. were compared with a control group of 30 patients with nonmalignant pulmonary HbA is heterotetramer of 2 alfa and 2 beta globin subunits, with one heme embed- diseases. Patients were classified in two age groups, those older and those younger ded in each chain. Normal Hb composition than 70 years. These patients were assigned to chemotherapy with carboplatin •After a first year of the life HbA1 increase to more than 95% accompanied by a

264 265 Presentation Poster

decrease in HbF less than 1% and HbA2: 2.5-3.5%. -in eight patients was 5 years. Poster • HbA2 is considered as an essential maker for diagnosis of B-Thalassemia. -in eleven pacients was 4 years Presentation In our laboratory, we use alkaline hemoglobin electrophoresis in iden- -in twelve patients was two years tifying hemoglobinopathies such as sickle cell anemia and thalassemia. - in seventeen patients was 1 year In general on alkaline electrophoresis in order of increasing mobility are hemo- - in 59 fifty nine patients was less then a year and four patients were seasonal patients. globins A2, E=O=C, G=D=S= Lepore, F, A, K, J, Bart’s, N, I, and H. use of iso The PTH level was positively correlated with the duration of hemodialysis. electric focusing to determine quantitative differences in globin chain synthesis PTH is the major determinant of rates of bone remodeling and turnover in hemodialy- and high performance liquid chromatography that separates hemoglobin’s based sis patients with end-stage renal disease; accurate assessments of plasma PTH levels on their various affinities for the column are essential not only for estimating the bone metabolism of renal osteodystrophy but Objectives: To analyze and detect new patients with hereditary hemoglobinopa- also for appropriately monitoring the treatment of secondary hyperparathyroidism. thies. in the routine laboratory of American Hospital This was a prospective study performed in 3522 samples. During 01.01.2017- PP031 - Case report Pelvic inflammatory disease (PID) Nursing Care 30.07.2018. From 3522 patients 202 cases were found with high levels of HBF, B.Pino; B.Fasko; L.Sula; M.Tani; A.Ismahili; E.Nikoci; I.Çaça; L.Ibrahimllari; approximately 5.7 % the highest prevalence was found in 21-30 years old, or R.Leka; F.Elmadhi 30.69%. Patients with high HBA2 levels were 392 cases or 11.1 %.The highest Pelvic Inflammatory Disease (PID) is an infection of the female reproductive sys- prevalence were found in age group of 21-30 years old or 31.3%. tem that affects sexually active women and reproductive aged women exposed to Patients with high HBS levels were 48 cases or 1.3%.The highest prevalence were a series of risk factors. PID includes a spectrum of upper genital tract infections, found in age group of 21-30 years old or, 45%. usually involving more than one organ, representing a combination of endome- We found two cases with abnormal high levels of HBE or, 0.05%. tritis, salpingitis, oophoritis and pelvic peritonitis, where salpingitis is the most Identification of Abnormal Hemoglobin Bands. Information and Orientation to the common form and almost always present. For this reason, the term “acute sal- Specialist and Prenatal Information of Diagnosing and Preventing. pingitis” is often used. PID infections can result from ascent of cervical sexually transmitted infections and other pathogens to the upper genital tract. Multiple pathogens are usually detected simultaneously during PID. PP030 - Parathyroid hormone levels in hemodialysis patients The purpose of this case study is to mainstream evidence based nursing to en- B.Mehilli, A.Rrupulli, M.Tusha sure timely and effective diagnosing and interventions of PID, aiming to reduce If someone developed kidney disease, PTH may be produced in large quantities the number of their sequelae, its associated long-term consequences in women’s due to low levels of calcium in the blood. The PTH wants to keep the calcium health, shortening of hospital stay, and further on increasing woman’s awareness level in the blood normal by increasing calcium absorption from the food, but regarding reproductive health issues. also takes calcium out of the bones. The root cause of high PTH is triggered by This is a case study which examined 3 (three) cases treated at the American Hos- damaged kidneys. Once kidneys are impaired, they usually fail to keep balance of pital II, during the period 01.01.2017-30.05.2018. electrolytes like phosphorus and calcium, easing causing low calcium and high Early diagnosis is crucial to prevent PID sequelae and other dysfunctions which phosphorus level in blood. Also calcium and PTH has a close relation. As we men- require surgical interventions to be properly addressed. Out of three cases, tioned above, PTH will be elevated when low levels of calcium are in the blood. two of them indicated that the infection had an ascent tendency causing sal- To measure the PTH levels in hemodialysis patients and relate with the duration of pingitis, accompanied by a fever of + 390C, strong pelvic pain, increased se- hemodialysis. 138 stable hemodialysis patients, 36 (26%) women 102 (74%) men cretions but they were successfully managed by medical treatment. These with a mean age of 66.1±10.7 of years were included in the study. The average du- women asked for medical services 3 weeks- 2months following the first symp- ration of hemodialysis was 2–13 years, with two or three dialysis session per week. toms whereas the other case, despite similar reported symptoms, it resulted in Blood samples were obtained prior to a dialysis session, after an overnight fast. peritonitis and tubular abscess requiring radical hysterectomy. One drawback The serum PTH concentrations were determined using an immunologic analyzer is related to her asking for medical help only 2 years following the symptoms. (SnibeMaglumi 800). PID, Diagnostics, Nursing Car. Results: Six (4.34%) patients exhibited elevated PTH levels (>250 pg/ml). -in two patients the duration of hemodialysis was 13 years PP032 - Ultrasonography of the hip in reducing the rate of late DDH -in five patients was 10 years C.Bytyqi, F.Morina, A.Grazhdani, D.Xhigoli, H.Prebreza, D.Bytyqi -in three patients was 8 years Developmental dysplasia of the hip (DDH) is the most common hip disease in -in seven patients was 6 years and childhood and refers to a spectrum of anatomical abnormalities of the hip. Early

266 267 Presentation Poster

detection and treatment is very important and lead to significant reduction of op- tatectomy specimens is common and universal. Inaccuracy of Gleason score and Poster erative treatment. The aim of this paper is to review effectivity of the general and PSA as pathological predictors exists and there is the need of new parameters to Presentation selective sonography in decreasing the rate of late DDH. better assess prostate cancer aggressiveness. Urotensin II (UTII) is a potent vaso- Most developing countries reports an incidence of 1.5 to 20 cases of DDH per constrictor peptide and its receptor (UTII-R) is involved in prostate tumorigenesis 1000 births. Ultrasonography of the hip has gained wide acceptance as the best in terms of tumor cells proliferation and invasion. In this study, we evaluated the method for diagnosis and treatment monitoring of DDH. Several hip sonography correlation between UTII-R expression and tumor upgrading from needle biopsy method have been defined: Graf, Harcke, Terjersen and Suzuki. The Graf method to postoperative specimen and upstaging. is a quantitative method of evaluation, while Harcke method is qualitative. We retrospectively collected prostatic needle biopsies and radical prostate samples Introduction of general and selective ultrasound screening programme reduce the of 141 patients affected by prostatic adenocarcinoma Gleason ≥6, treated between rate of the number of patients who require operative treatment of DDH. A recent 2006 and 2011 at single high volume center. For each patient, clinicopathologic data decision analytic model emphasized the importance of hip screening to avoid late were collected. The immunohistochemical staining was performed through auto- hip secondary osteoarthritis. There exists still controversy about hip screening mated system using the kit Urotensin II Receptor Detection System. Immunostained programmes: clinical or ultrasonographic. Also controversy exists about ultraso- slides were independently and blindly evaluated by two uropathologists. nographic selective - high risk babies or general screening. A new score based on UTII-R color intensity, intracytoplasmic location, and dimen- The best conclusion of this kind of review article is according Hakan Omeroglu sion of UTII-R granules was calculated. Modelling and statistical analyses were car- using motto from Reinhard Graf “better ultrasound today than a limp tomorrow” ried out using R version 3.1.0. Multivariable logistic regression models were used and Alain “prevention is winning wars eleganty without bloodshed”. to explore the independent role of UTII-R expression in predicting Gleason Score upgrading and upstaging. Diagnostic validity of the model-based scores was evalu- PP033 - Cerebral toxoplasmosis in HIV/AIDS patient ated by ROC curve analysis and measured using the Area Under the Curve. Ç.Malaj; B.Zllami; B.Filaj; E.Puca Gleason score (GS) upgrading was observed in 55 patients (38.56%). The most fre- Toxoplasmosis is the leading cause of focal central nervous system (CNS) disease quent pattern of upgrading (n=20, 36.4%) was from a biopsy GS of 3+4 to a pros- in AIDS. CNS toxoplasmosis in HIV-infected patients is usually a complication of tatectomy GS of 4+3. Although patients with GS upgrading were characterized by the late phase of the disease. Typically, lesions are found in the brain and their ef- higher PSA values, this difference did not reach statistical significance (p=0.215); fects dominate the clinical presentation. A 53 years old male (A.D) presents to the PSA was a predictor of upgrading with a 16% increase in the odd of upgrading for emergency departament of SATR2 with weakness, difficulty in walking, diffuse every unit increase in PSA values. UTII-R emerged as an independent predictor of tightening headache with occipital predominance, intensity 10/10 (without history upgrading. Higher score of UTII-R expression was found in 73 patients (51.7%), of head trauma), temperature 37,8 °C, profuse vomiting, watery diarrhea (with- UTII-R granules of neoplastic cells were always bigger and located in more api- out blood, without mucus). Brain MRI revealed multiple bilateral ring-shaped cal position compared to benign prostate cells. UTII-R expression was observed in brain lesions, enhanced after injection of a contrast agent. Toxoplasma serolo- 50 (80.6%) patients with pT3 cancer (n=70) and this correlation lead to an almost gy revealed raised IgG antibody levels and HIV serology resulted positive. On five-fold increase in the odds of having an extracapsular prostate cancer (p<0.001). initial evaluation a diagnosis of acute encephalitis was made. After the results Conclusion: Our study suggests that UTII-R expression and microscopic features are of the head MRI and blood analysis, the most probable diagnosis was Cerebral significant related with prostate cancer upgrading and upstaging. UTII-R represents toxoplasmosis in HIV (+) patient. The patient was treated with antibiotics and a potentially useful diagnostic and prognostic marker for prostate cancer patients. antiretroviral therapy, followed in dynamics and had a good clinical outcome. The decision to treat a patient for CNS toxoplasmosis is usually empiric. Primary PP035 - Fusion Biopsy for detecting prostate cancer. Is it really better? therapy is followed by long-term suppressive therapy, which is continued until C.Falavolti, E.Shehu, R.Giovannone, P.Alijani, R.Giulianelli, T.Petitti, M.Buscarini antiretroviral therapy can raise CD4+ counts above 200 cells/µL. Early diagnosis Ultrasound (US)-guided biopsy is still the standard of care in prostate cancer de- with neuro-imaging techniques and prompt institution of appropriate therapy re- tecting but things are changing thanks to multiparametric MRI (mpMRI) that is in- sults in remarkable improvement. Toxoplasmosis; HIV/ AIDS creasingly performed before prostate biopsy. On baseline biopsies, the sample sites should be bilateral from apex to base and additional cores should be obtained from PP034 - Possible use of Urotensin II receptor in detecting prostate cancer suspect areas by DRE/TRUS. European guidelines are changing and strongly rec- upgrading and upstaging ommend to include systematic biopsies and targeting of any mpMRI lesions seen. C.Falavolti, E.Shehu, B.C Gentile, L.Albanesi, G.Rizzo, P.Tariciotti, G.Mirabile, A standardized template is not available yet. Aim of our study was to show if fusion S.Nardone, M.Buscarini, R.Giulianelli biopsy is really more accurate than the traditional biopsy. Materials and methods: Discrepancy between the Gleason score on needle biopsy and the grading of pros- We prospectively enrolled 56 patients who underwent fusion biopsy at our institu-

268 269 Presentation Poster

tion from January 2018 to May 2018 (table 1). All biopsies were performed by the analysis during the period of 01 January to 30 June 2018.The HBV DNA test is Poster same operator (C.F.). Procedures consisted of samples obtained by targeted magnet- performed on a blood sample(serum or plasma) using a Polymerase Chain Reac- Presentation ic resonance/ultrasound fusion prostate biopsy plus random samples obtained from tion (PCR) technique.This method is able to detect a wide range of HBV DNA. both lobes (right and left) in a traditional modality (ultrasound-guided only). In 24 HBeAg test is perfomed on blood samples (serum) using ELFA method. cases our procedure was a repeat biopsy after previous ultrasound-guided biopsy Out of 226 HBsAg positive patients, HBV-DNA was detected in 130 patients (57.5 resulted negative but with still PSA value increasing. We collected data about pre-bi- %) Among these, 28 (21.5%) patients were HBeAg positive, and 102 (78.5%) opsy PSA value and size of the prostate. For each lesion seen at the mpMRI, we were negative for HBeAg. HBV-DNA positive patients showed male predomi- analyzed the location and the size. We counted the number of cores sampled during nance because off life style; 92 (70.7%) patients were male and 38 (29.3%) pa- the biopsy for each site and related the histological report. A statystical analysis was tients were female. Real time PCR method of detection of HBV-DNA is very performed using logistic regression to verify the modification of positivity risk in important in patients who are HBeAg negative . HBV DNA is applied to monitor specific conditions. We used also the t-test to verify the differences between groups. treatment response to antivirals and to control reactivation of HBV cases. HBeAg Results: Patients mean age was 64 y.o. (range 48-80). In our series transitional zone status did not necessarily reflect HBV DNA level in the serum. It was seen that of the prostate was less affected by cancer than peripheral zone (p=0.066). The more HbeAg can miss some cases of Hepatitis B. HBV DNA was a more reliable indi- the gland was big the less the cancer was easily detected and it was statistically cator of the presence of virus than HBeAg and is better to use for the monitoring significant. Previous biopsies did not affect the probability to find a prostate cancer and menagment of Hepatitis B Infections. during the fusion biopsy. Number of cores obtained did not significantly change the probability to find prostate cancer and there was no significant difference between PP037 - Pathophysiological and morphological alternations in the lungs in a targeted samples and randomized samples. Thus, the probability to find prostate can- rat experimental model of acute pancreatitis. cer in randomized cores was so low that the US-guided biopsies in both lobes did not D.Thereska, A.Gjata, N.Kacani, E.Bollano, D.Belalla improve cancer detection in the same patient. We did not find any significant differ- It is well described that the secretagogue-induced pancreatitis model of experi- ences in cancer detection according to the different sites of the prostate. Discussion: mental acute pancreatitis, leads to a remote lung injury. This injury usually con- Fusion prostate biopsy is still considered a novel procedure but it is spreading all sists of intralobar and interlobular edema, focal hemorrhage, atelectasis and in- over the world. Our data suggest that the probability to find prostate cancer in target- flammation. ed cores is significantly higher than in randomized cores and that adding randomized In humans, increased alveolar capillary permeability, histologic changes and in- US-guided biopsies does not improve the probability to find the cancer. More data terstitial edema are present in lung during AP, like in adult respiratory distress are needed to achieve stronger results to completely avoid the randomized biopsies syndrome (ARDS).In a rat experimental model of cerulein-induced AP, these im- and significantly reduce reduce the cores number of each procedure. portant factors of MODS are quite similar and represent almost the same char- acteristics as they do in human AP. The aim of our study was to investigate the PP036 - Real time PCR HBV – DNA relation with HBeAg status, in patients histomorphological and MPO changes in the lungs in an experimental rat model HbsAg Positive: six months study in American Hospital of AP. We selected the cerulein-induced pancreatitis model to induce mild acute D.Trimaçi , A.Daka, L.Marku, I.Marku, B.Hyseni, O.Petri, E.Angjeli pancreatitis in rats.In lung, we considered the evaluation of histological parame- Real time PCR HBV – DNA relation with HBeAg status, in patients Hb- ters including; edema, atelectasis, hemorrhage and microthrombi. sAg Positive: six months study in American Hospital , Central Laboratory We also analysed MPO ( a peroxidase enzyme, most present in neutrophil granulo- Hepatitis B has global distribution.The hepatitis B virus is a big concern and the cytes) activity, as a marker of polymorphonuclear leukocyte (PMN) infiltration in reason of chronic and acut liver disease, in Albania. Diagnosis and monitoring response to an inflammatory process. Animals were divided into 2 groups with 8 the treatment of Hepatitis B virus infection is based on HBV-DNA detection and rats each, and were sacrificed after 24 hours.Compared the control group with the quantification .HBV-DNA or viral load test provides important information about AP group, we noted the reproducing of the majority of pathophysiological events your health.HbeAg is an indicator of active viral replication, that plays an im- and morphological alternations in the lungs, that have been observed during the portant role.If HBeAg is detectable in a blood sample, this means that the vi- early phase of AP in humans. rus is active in the liver( virus can be transmitted to others) The objective of We can also underline here, the importance of MPO activity measurement in the this study was to detect HBV-DNA by real time PCR method in HBsAg pos- prediction of the severity of the desease. Compared the control group with the AP itive patients, to compare the results of HBVDNA detection with HBeAg and group, we noted the reproducing of the majority of pathophysiological events and to monitor the response after antiviral therapy in chronic hepatitis B patients. morphological alternations in the lungs, that have been observed during the early Study was conducted in Central Laboratory of American Hospital. In this study, phase of AP in humans. We can also underline here, the importance of MPO activ- 226 sera of HBsAg positive patients , were done also HBV-DNA (real time PCR) ity measurement in the prediction of the severity of the desease.

270 271 Presentation Poster

PP038 - Primary Chondrosarcoma of the thyroid cartilage. Case report and of this lesion is characteristic and absolute pathognomonic composed of oncocytic Poster review of literature epithelial cells lining ductal , papillary and cystic structures in a lymphoid stroma, Presentation D.Nakuci, L.Berdica, T.Bushati with germinal centre formation. The aim of this article is to provide a description of Chondrosarcoma of the head and neck region is a rare malignancy, representing one peculiar and rare clinical case because of the bilateral and multifocal features of approximately 0.1% of all head and neck neoplasms. the lesions, as well to provide a current review of the most relevant literature. The 5-year survival rate of chondrosarcoma is 70-80 % ,showing relatively good prognosis.The age of the patients ranged from 40 to 77 years , with a male PP040 - Hyperprolactinemia as e Side Effect of Methyldopa in a dialysis pa- predilection 88.6 %. The pathogenesis of chondrosarcoma of the thyroid carti- tient in our Center of hemodialysis at “American Hospital Durres” lage is unknown , but lately is seen a relationship between chondrosarcoma and D.Sula, F.Nasto, E.Bolleku, E.Demaj, E.Shkurti, A.Strakosha, M.Barbullushi multiple hereditary exostoses, chondromyxoid fibroma and radiation may- con Hyperprolactinemia is a common endocrinological disorder caused by several tribute to tumorygenesis. Lymph node and distant metastasis are relatively low physiological and pathological conditions. Several drugs may cause e significant at 5.6% and 6.7%, respectively. Chondrosarcoma as a primary tumor that had increase in prolactin serum concentration associated with other symptoms. Some spread out of the endolarynx is considered to be insensitive to both radiation antihypertensive drugs are responsible for drug- related hyperprolactinemia. Al- therapy and chemotherapy. Surgery is the treatment of choice in order to exi- pha-methyldopa causes moderate hyperprolactinemia by inhibiting the enzyme cise all tumor extension to negative margins. The main location of thyroid carti- l-aromatic amino acid decarboxylase (which is responsible for converting L-dopa to lagechondrosarcoma is the right ala of the thyroid. The principal symptoms is a dopamine) and by acting as a false neurotransmitter to decrease dopamine synthesis. neck painless mass. The tumor was histopathologically found to consist of chon- A 37 year old female in our dialysis center with diagnosis: End- stage renal disease drocytes in a hyaline cartilage matrix. The criteria for pathological diagnosis of due to Polycystic Kidney Disease in treatment with renal replacement therapy with chondrosarcoma include the presence of a number of cells with large , irregular Hemodialysis since 2014 , Arterial Hypertension and Secondary anaemia , present- and/or multiple nuclei, giant cartilage cells with large single or multiple nuclei. ed to our hospital with amenorrhea for several months and galactorrhea for two The basis for 3 grades of Chondrosarcoma, is important because the grade I and I-II weeks. Cranial X-ray showed us a normal pituitary fossa and prolactin blood levels have an excellent prognosis , and tumor grade III have an unpredictable prognosis. were extremely high 9375 uiU/ml (up to 20-shold to normal level ) . We switched The aim of this report is an example of a case of chondrosarcoma arising in the the therapy to another antihypertensive drug. A month later there was a interruption thyroid cartilage , and a literature review on this rare neoplasm in this location for of galactorrhea and prolactin blood levels were reduced to 3840 Uiu/ ml .Three an optimal management in the future. months later prolactin blood levels were at normal range. Hyperprolactinemia may cause a significant increase in prolactin serum concentration associated with galac- PP039 - Multiple, multifocal Warthin’s Tumor : Case report and a review of torrhea , gynecomastia and amenorrhea. Even though it is a very rare side effect of literature Methyldopa we should consider hiperprolactinemia at every patient who manifest D.Nakuçi, L.Berdica, T.Bushati these complains. Hyperprolactinemia, galactorrhea, methyl- dopa, hemodialysis. Salivary gland tumors represent approximately 3% of all head and neck tumors . About 70-80% of these neoplasms occur in the major salivary glands , with the PP041 - The prevalence of Intradialytic Hypertension in the hemodialysis parotid gland being the site most often affected. Warthin’s tumor is the second com- population of American Hospital Tirana 3 monest benign neoplasm representing almost 6-10 % of all salivary gland tumor. D.Haxhiu, A.Idrizi, G.Kuka, N.Therecka Method: Case report diagnosed with frozen biopsy firstly. Warthin’s tumor has an A paradoxical increase in blood pressure during chronic hemodialysis sessions, excellent prognosis because has a low rate of recurrence after surgical treatment also known as intradialytic hypertension, is a well-known but uncommon com- and malignant transformation occurs in less than 1 % of cases. It arises in 6th and plication. This phenomenon has a complex mechanistic background and predicts 7th decade but it can be virtually diagnosed at any age with a range 2.5-9.2 years. cardiovascular mortality. The aim of this study is to determine the prevalence of Warthin’s tumor has a close correlation with smoking habits .The great major- intradialytic hypertension and to evaluate the potential role of intradialytic sodium ity of patients with this tumor had a history of over 20 year of smoking. Radi- gradient on predialytic systolic blood pressure values. ation exposure has been suggested to be associated with tumorigenesis , also a Materials and methods: A cross-sectional study involving 58 chronic hemodialysis relationship between EBV infection and Warthin’s tumor has been reported but patients on 3 times weekly hemodialysis treatment for at least 6 months at Amer- has not been substaniated. The tumor is located in the superficial parotid gland ican Hospital Tirana 3, was conducted between September 2017 and December with a predilection for the inferior lobe (tail ) only 10% it is found in a deep lobe. 2017. Intradialytic hypertension was defined as a >10 mmHg increase in SBP in at Warthin’s tumor present as an asymptomatic lesion with slowly growing round or least four of six prior consecutive hemodialysis sessions. oval mass, on palpation the swelling was soft and fluncuant. Microscopic pattern The prevalence of intradialytic hypertension was 13.8 %. 38 patients were men

272 273 Presentation Poster

and 20 women, the mean age was 58.1 ± 11.54 years. 83% of patients were on an- the day of hCG administration and / or on the day embryo transfer as the maximal Poster tihypertensive therapy. DBW was 71.3 ± 12.7 kg, IDWG was 2.7 ± 0.85 kg, Kt/V echogenic distance between the junction of the endometrium and myometrium Presentation was 1.42 ± 0.24. 50 patients had a decrease or no change of SBP and 8 patients in the mid-sagittal plane. A thin endometrium is associated with lower IVF–ICSI had increase of SBP during hemodialysis. The differences in NaG values were pregnancy rates, but a consensus is still lacking on what the precise definition significantly greater in patients with intradialytic hypertension (1,14 ± 2,38vs of thin endometrium is. In this study we analysed 155 women undergoing fresh 1,85 ± 3,67). This study shows that the predialytic SBP has a medium association IVF–ICSI cycles treatment between 2017 and 2018. This is a retrospective study with the dialytic NaG (P=0.03). We found a weak positive association between and is conducted in Reproductive Medical Center in American Hospital, Tirane. the age of the patients and the values of predialytic SBP (P=0.006). Patients with The aim of the study is the identification of epidemiological cut-off values for intradialytic hypertension tended to be older, had lower interdialytic weight, more EMT in clinical outcome pregnancies (intrauterine pregnancy, ectopic pregnancy, positive NaG and lower serum creatinine as compared with those without intradi- spontaneous abortion and live birth). alytic hypertension. PP044 - Novelties in IVF PP042 - Case report of Arthrogryposis Multiplex Congenitalia (AMC) D.Diamantis, G.Kabili D.Bajraktari, J.Gjoshe, A.Sula Since 1978 when Louise Brown was born, more than 5 million children world- Arthrogryposis is a general or descriptive term for the nonprogressive contractures wide have been born through IVF. The last few years there have been promising affecting one or more areas of the body prior to birth (congenitally). Prenatal diag- developments in the area of Assisted Reproduction including new laboratory tech- nosis is usually set during the second trimester of pregnancy. Patient GM, 26 years niques and methods with aim to increase the % of success in IVF. Some of them old, G1, no consanguinity had an ultrasound at 12th week. NT 1.3mm, nasal bone are: In Vitro Oocyte Maturation (IVM), IMSI, Oocyte and Embryo Vitrification, was present, and no limb deformity was suspected. No abnormality in fetal mor- Embryoscope, Metabolomics, PGD/PGS, Low Stimulation Protocols, Endometri- phology was observed. At 16th week triple test was done as a prenatal diagnostic al Scratching. IVF, novelties, new techniques. test. The ultrasound findings were: Hyperflexed hands, bilateral radial agenesia. The deformed legs were not suspected. Triple test resulted low risk. The parents PP045 - FAST: Ultrasound Method for Trauma were informed about the abnormalities found by ultrasound. Amniocentesis was D.Meta recommended, but they decided to interrupt the pregnancy and after that a genetic It is often the case when problems of patients are misinterpreted as a result of exam of the fetus was done. After the induced of late abortion, resulted e fetus with misinterpreting the information, which is collected in the field, particularly for all four limbs deformation. Ther were also missing 2 fingers in the right hand and trauma. Moreover, not being familiar with the systems used in EU may also be of 1 finger in the left hand. Retrognatia was also present. While waiting for the another reason. One of the main problems with regard to Trauma (especially the genetic results, we may refer to the statistic of AMC as follow: Over 350 genes abdominal ones and not only) is the haemorrhage, which may be avoided by the have been identified as responsible for different types of arthrogiposis. It affects FAST method and a well-trained nursing staff where an ultra sound can be made approximately 1 in 3000 individuals. The number of males and females affected in real time in order to determine the diagnosis straight away. Diagnosis and treat- by AMC is approximately equal. Some times it is associated with other system de- ment are essential for optimum results and maintaining the integrity and patient’s fects as nervous system or cardio-vascular system. The main prenatal ultrasound life.The early identification of abdominal traumas and the real-time determination exams are performed in 12w, 22w, 32w. In our case this severe limb abnormality of the traumatic event and its consequence consist an increasing challenge both was impossible to diagnose at 12 week. At 16th week the ultrasound is optional. If real and indispensable. The first line of life is precisely the efficient and profes- the ultrasound at 16th week was not performed, we could delay to solve the case. sional response to trauma.There has been an increase in the post trauma surviv- The fetus 16 weeks with AMC is in the picture below. al index and even during the hospitalization phase in 60% of patients who have received treatment service with the use of FAST. On the other hand, in patients, PP043 - Endometrial thickness as a predictive factor in IVF pregnancy outcomes who were not treated with the FAST method, there has been observed a drastic D.Golemi, E.Peci , S.Cenameri decline of 40% in the percentage to survive the trauma and complications were The monitoring of endometrium during in vitro fertilization (IVF) and intracyto- encountered while giving first aid. The nurse is required to have some specific plasmic sperm injection (ICSI) with embryo transfer treatment has become part ultrasound knowledge in order to be part of the FAST program, as the appropriate of standardization of this medical procedures. The endometrial characteristics diagnosis and the high level of knowledge has a direct effect on the patient’s life. include endometrial pattern, endometrial blood flow, and endometrial thickness They should be trained and capable of managing hemodynamic problems, inten- (EMT) All of them have been regarded as prognostic factors of IVF–ICSI treat- sive care techniques and drug administrations, as well as manipulations such as, ment. Usually we use Transvaginal ultrasonography (TVU) to measure EMT on intubation or cardiocentesis.

274 275 Presentation Poster

PP046 - Evaluation of thyroid function in pregnant women Patients treated with Hemodialysis had a higher number of risk factors ( P<0,4). Poster D.Minxuri, N.Haliti, S.Buzo, L.Budo The identification of risk factors that predispose to AKI is a crucial aspect of Presentation Pregnancy causes significant changes in the thyroid gland and its function. During care. It should help primary care and hospital providers identify high risk pa- pregnancy, the thyroid gland increases by 10% in size in areas with iodine and 20% tients. Comorbit conditions like diabetes, cardiac failure increased the risk for up to 40% in regions with iodine deficiency. The production of thyroid hormones, hemodialysis treatment. thyroxine (T4) and triiodothyronine (T3) increase by approximately 50%. Conse- quently, around the 8th week of pregnancy, FT4 levels are increased and TSH lev- PP048 - Trauma: causes, types and management els decrease, resulting in a different reference interval compared to non-pregnant E.Murati women. Given these changes, it is recommended to use the reference values of Trauma is a physical injury such as a wound to living tissue caused by an extrinsec the specific trimester according to local protocols and in cases where there are no agent. Polytrauma and multiple traumata are medical terms describing the condition studies, it is recommended to use the reference values according to international of a person who has been subjected to multiple traumatic injuries, such as a serious protocols.The aim of this study was to evaluate thyroid function in pregnant wom- head injury in addition to a serious burn. Agents causing trauma are mostly motor en who have had no thyroid problems and evaluate possible thyroid pathologies vehicle crashes ( around 75% of cases), also falling from heights, injuries by solid manifested during pregnancy. 85 pregnant who did not have thyroid disease before objects, wounds by fire weapons, wounds by sharping objects, injuries from chemical pregnancy were screened during the first trimester of pregnancy. TSH, FT4 and substances, burn injuries etc. Traumatic injuries often include severe disfunctions that FT3 were measured by ELISA sandwich method in venous blood samples accord- lead to death such as compromising Airways by damaging their integrity that is really ing to kit instructions. The normal range for TSH was 0.4 to 4.5 μIU / ml while life threating. Hemodynamic instability by heavy hemorrhage caused by trauma, dis- for FT3 1.21 - 4.18 pg / ml and FT4 0.7-1.9 ng / dl. The mean value for TSH in ability, loss of orientation and concious level are also alterated in traumatic disorders. pregnant women screened was 2.57 ± 5.22 μIU / ml while for FT3 1.0 ± 2.76 pg / Trauma management is providing the medical assistance to the patient as soon as ml and FT4 0.7 ± 0.8 ng / dl. In 38% of them TSH resulted above the upper limit possible. In any case, it is crucial the follow up and monitoring vutal parameters. In (4.5 μIU / ml) FT3 was decreased ( <1.21 pg/ml), while FT4 was found under the cerebral traumas should be followed the concious level and not applying painkillers or lower limit (0.7 ng/dl) in 35% of women analysed. sedative medications. In thoracal traumas should be monitored breathing, in any case, Conclusions: During pregnancy the thyroid gland changes (especially in the first to exclude pneumothrax. In abdominal trauma is important the level of pain an. Ex- trimester ), which affects both mothers and babies health. tremity traumas often cause CRASH syndrome that leades to several compliactions. It is recommended to evaluate TSH in all pregnant women in the first trimes- The golden standard in trauma mangement is “get the RIGHT patient, to the RIGHT ter of pregnancy and the reference value of specific trimester according to lo- hospital, at the RIGHT time” Trauma mortality is spread from a few minutes to several cal protocols should be used. Anti TPO antibodies positive women should check weeks. Aortic injury and severe craniocerebral trauma leads to death in a few min- TSH every 4 weeks. thyroid function, pregnant women, TSH, FT4, FT3, ELISA. utes. Hemorragic shock, intracranial hematoma can cause death in a few hours (called golden hour). MODS and sepsis leads to failure after few days or weeks. The statistics PP047 - Risk factors for Community Acquired Acute Kidney Injury of patients managed at Albanian Traumatic Hospital is around 148615 patients from Rembeci E 2103-2018, 3024 hospitalized in ICU. Craniocerebral traumas 4597 cases, vertebral The disease burden of community-acquired AKI in our country is not well under- colone fractures 2363 cases, extremity fractures 5392 cases, thoracic fractures 280 stood. In fact it is known little about it. The aim of this study is to identify and cases. trauma, management, care, monitoring evaluate the risk factors for developing AKI in our community. This is a cross-sec- tional study conducted with a small size sample, 76 adult patients. These patients PP049 - All - inside Arthroscopic meniscal repair were identified with AKI at hospital admission. AKI was defined according RIFLE E.Selmani, F.Brahimi, L.Duraj Classifications. This champion was selected among patients hospitalized in the Although the outside-in method has been used to treat injuries of the meniscus, this Nephrology Clinic, UHC “Mother Tereza” during 2017. The data was collected method has drawbacks including the need to make a skin incision and portals for through medical files. Most of the patients with AKI were males (66%), with the arthroscopy, pain caused by strangulation of the subcutaneous tissue and joint cap- average age of 64 years old. Nephrotoxic drugs were the most frequent precipi- sule, and protrusion of the knots. To resolve these problems, we present an all-in- tating factor (51%) followed by sepsis (47%) and hypovolemia (41%). A total of side method that enables simple suture of injuries to the anterior segment of the 40% of patients had acute on chronic kidney disease, 32% were with diabetes, meniscus through arthroscopic portals placed only on the anteromedial and lateral 14% with cardiac failure and 63% with arterial hypertension. Mostly (93%) had sides without using a specific instrument. This simple, low-invasive technique may more than one precipitating factor for developing AKI. Almost 89% of patients be useful for suturing marginal injuries of the meniscus. This is a case report of a 34 were treated in a conservative way . years old athletic male with longitudinal tear in the red zone of medial meniscus.

276 277 Presentation Poster

We use all inside meniscal repair technique with meniscal cinch suture (Arthrex) ered included babies who showed physiological jaundice without having to un- Poster Results were excellent in 2 year follow up. dergo treatment, and infants who needed treatment. It was also analyzed the time Presentation when the jaundice has reached its peak as well as its duration. PP050 - Long term results of Clubfoot treatment with Ponseti Method This study included 539 babies born in 18 months. From the quantitative data E.Selmani, F.Brahimi, L. Duraj analysis, 521 (96.6%) of them had physiological jaundice within the first week of Nonoperative treatment of clubfoot is accepted by most orthopaedic surgeons as life and did not need therapeutic treatment. Only 18 (1.83%) of them needed in- the initial treatment. The Ponseti method has become popular worldwide. In our tensive phototherapy. Of these, out 18 of patient10 of them (1.46%) had a 24-hour institution Kite methode has been the standart initial treatment.Thirteen years ago intensive phototherapy treatment. It is noticed that babies who needed more than we introduced the Ponseti method in our institution so in this paper we are present- 24 hours of intensive phototherapy were premature babies. ing the early results of idiopathic clubfoot treatment with Ponseti method. Methods: We are presenting the first 200 (120 babies) clubfeet treated by Pon- PP052 - Traumatic Disarticulation Associated with Injury of Vasa and Distal seti method.During the period 2005-2010.We studied the rate of recurrence de- Reconstruction – Case Report fined as the need to perform posteromedial release within the periode of minimum E.Olluri follow up of 8 years.Pirani Score was measured before and after the treatment. Traumatic Disarticulation associated with fractures of foot bones, injury of neuro- Tibialis anterior tendon transfer or repeated Achilles tenotomy was not consid- vascular structures and tissue structures is a severe traumatic injury which causes ered a recurrence but part of the protocol. In our serie of 200 clubfeet only 10 loss of extremity in 95% of cases even if it is treated by modern methods. (5%) had a recurrence that needed posteromedial release (PMR).This was a baby Purpose of this article is to show modalities of reconstruction of arteries at that whose parents were not compliant with foot abduction brace and did not show up level. Different authors present the cases with traumatic disarticulation, as well regularly on scheduled visits.Achilles tenotomy was needed in 188 feet (94%) as injury of two arteries, dorsal pedal artery and posterior tibial artery and their and was performed at age 2 to 3 months.The average duration of cast was 10 reconstruction at that level, a very rare condition in the literature. weeks. Pretreatment Pirani score was 5.2.Twelve feet needed a second Achilles The patient is a male, aged 45, brought to the Emergency Center, after being in- tenotomy and 8 feet needed tibialis anterior tendon transfer to third cuneiform. jured in a construction workplace, in a serious condition of a traumatic shock. Ponseti method is the method of choice in most protocols worldwide.The success After resuscitation, the patient is operated, and now, after one year half, he enjoys rate of our serie is 98% We hope that this will become the standart protocol in our the two extremities. Traumatic disarticulation, even accompanied by injury of the Institution where Kite method has been the standart treatment.Compliance with vascular structures at that level, is capable of being treated. First aid and rapid the postcorrection abduction bracing protocol is crucial to avoid recurrence of a transit from the site of injury to the emergency center increases the likelihood of clubfoot deformity. Cast, Clubfoot, Ponseti. success of the operation. These cases are still a special challenge for modern vas- cular surgery worldwide and loss of the extremity has a high rate. Disarticulation, PP051 - Physiological jaundice and phototherapy treatment in newborns in Reconstruction, Arteries the American Hospital Tr 2 E.Hysaj, S.Qibini, E.Vila, E.Koci, M.Karaj, S.Domi, M.Miraka, L.Gremi, L.Sadiku PP053 - Low mortality rate of ruptured abdominal aneurysm as a result of The jaundice drops yellowish skin and mucous membranes when the bilirubin the short time of the operative procedure level is 5-7 mg / dl and is among the most common conditions in the newborn. E.Olluri The jaundice may be physiological or pathological, but in most cases the newborn Ruptured abdominal aortic aneurysm (AAA) is one of the most fatal surgical baby is physiologic, which goes through it within a few days, without the need for emergencies, with an overall mortality rate of 90%. Most AAAs rupture into the treatment. It should be kept in mind that due to the potential of bilirubin newborn retroperitoneal cavity, which results in the classical triad of pain, hypotension, and babies require a close clinical and laboratory follow-up to understand those cases a pulsatile mass. However, this triad is seen in only 25–50% of patients, and many where the baby may be in danger. Hyperbilirubinemia may lead to encephalop- patients with ruptured AAA are misdiagnosed. It is likely that different sites of athy. Therefore, we need to keep in mind the timing and indication signs, the rupture of AAA determine a variety of common and uncommon clinical presenta- measures to be taken for early and effective treatment, the importance of early tions, the recognition of which can save many lives. This article shows the short breastfeeding and the timely prevention of possible complications. time of the operative procedure and the rate of mortality which is 0% in “Ameri- To identify the causes of neonatal jaundice and to take corrective therapeutic mea- can Hospital”. Aneurysm of the abdominal aorta is very often diagnosed when not sures necessary for its treatment. present, and when present the symptoms may be so obscure that the nature of the Methodology: This retrospective study included all infants born in January 2017 trouble is overlooked.” to June 2018 at the American Hospital Tirana 2. The variables that were consid- These words of Sir William Osler1 still resonate today despite remarkable advanc-

278 279 Presentation Poster

es in medicine since Osler’s time. the most frequent reason for blood draws in neonates. Transcutaneous bilirubi- Poster Abdominal aortic aneurysm (AAA) is a common and life threatening disease that nometry is a noninvasive method for predicting bilirubin levels. Although the TcB Presentation affects 5–9% of the population over the age of 65 years.2 AAA is more common in measurements correlate well with serum bilirubin levels it can not be used directly male smokers with a positive family history of aortic aneurysms.3 Most patients to make decision about transfusion or phototherapy. This is a retrospective study. with AAA are asymptomatic unless they develop a complication. Rupture, the We start using transcutaneous bilirubinometer in March 2018, and we have com- most common complication of AAA, is one of the most fatal surgical emergencies; pared blood draws for serum bilirubin in the same period March – June 2017 and it has an overall mortality rate of approximately 90%, but in our hospital mortality March- June 2018. We have excluded from our datas preterm babies less than 35 rate of these patients was 0%. 4 Most clinicians know that patients with ruptured weeks, and babies with other serious pathologies. We have used KJ-8000 Trans- AAA present with a classical triad of back pain with or without abdominal pain, cutaneous jaundice meter for TcB measurements. If TcB > 13 we have controlled hypotension, and a pulsatile abdominal mass.5 However, this triad is present in with serum bilirubin.From March to June 2017 in American Hospital Tirana 3, only 25–50% of patients,6 7 and many patients present with symptoms and signs have been born 321 babies. There are 80 blood draws for bilirubin levels for 33 that suggest a different diagnosis. This is why misdiagnosis of ruptured AAA oc- neonates that have been screening for. We had 13 cases of phototherapy. During curs in 30% of patients.7 It is likely that different sites of rupture of AAA deter- the same period in 2018 in our hospital have been born 323 babies. There are 91 mine a variety of common and uncommon clinical presentations seen in patients blood draws for 62 neonates to whom we had measured serum bilirubin levels. with ruptured AAA. 14 babies need phototherapy.At the end of this study we noticed that using TcB The purpose of this article is to shorten the time of the operative procedure be- have significantly reduced blood sampling, without increasing the risk of missing cause this had an impact in lowering the mortality rate. abdominal aortic aneu- neonates with hyperbilirubinemia. TcB is a good tool for screening neonates to rysm; ruptured aneurysm; aortic rupture; rupture; emergency; surgery; determine when a laboratory measurements of serum bilirubin is needed.

PP054 - Traumatic rupture of the infrarenal inferior vena cava: Successful PP056 - Upper leg femoral bone architecture and its imitations in coherent emergency reconstruction with polytetrafluoroethylene graft, CASE RE- constructions PORT OPEN ACCESS E.Hasalla, I.Mazniku, B.Hasalla, S.Baha, I.Taka E.Olluri, J.Taner, L.Emini, E.Olluri Based on a morphologic-radiological evaluation of 30 right and left femoral bones, Great vessel and cardiac chamber injuries may occur during accidents, open heart which then became subject of a study of the trabecular architectural to the upper surgery or during operations in aorta. Control of bleeding in such cases is a surgi- edge of femoral artery, all femoral bones were analyzed only at their upper end. cal challenge. Case Report: Herein, we report a case of a 33 yearold patient who The upper femoral vein includes the femoral head, femoral neck and part of the developed severe hypovolemic shock following blunt trauma to the right flank. trochanteric region. The patient showed a large collection of intraabdominal blood on CT scan and Regarding the topic taken in consideration: The main aim of this study is to high- underwent an emergency laparotomy. In addition to complete rupture of the right light the specific bone structure of the upper femoral fragment, the process of kidney, a 7cm long rupture of the infrarenal vena cava (IVC) was demonstrated. passing the body weight from the vertebral column, the sacro-jaak articulation During surgery, after clamping of improvement of hemodynamic parameters, vas- and then all over the head, the femoral neck in the inferiority of the femur, bone cular surgeons chose to reconstruct the IVC with polytetrafluoroethylene graft. trabecula and the effect of osteoporosis on them. The patient was discharged home on postoperative day12. Four years after surgery, During a period of two years, May 2015-May 2017, were analyzed 30 up- there was radiological evidence of blood flow in the IVC, with a functional pros- per femoral vein fragment, radial and clinical extremities and in 10 cases in thetic graft. Salvage of patient with rupture of vena cava is very rare considering the shintigraphic study plan. Based on the total number (30 cases) taken into the fact that a majoirty of patients die before coming to the hospital. Emergency consideration, 10 individuals are children were the ante version, retroversion and polytetrafluoroethylene graft repair of the inferior vena cava might be successful, cervical diaphragm angles have been evaluated, which, if are not corrected at with excellent longterm functional results. childhood age, may be cause of secondary coxarthrosis. 1-In these radiological studies, it was found that the last femoral proximal anato- PP055 - Transcutaneous bilirubinometry- its role in early detection of neona- my is not accidental. It corresponds to the function of the extremity in transmitting tal jaundice human body weight from the vertebral column to support inferiority in the ground, E.Gjybegaj; N.Kolici; G.Bime; A.Subashi; V.Lekgjika; K.Hyka weight relief this bone segment and its protection from osteoporotic fractures. It is estimated that about 50% of newborns have an episode of jaundice in the first 2-To small children correcting the antivision angle should be made after the age days of life. 6% may develop hyperbilirubinemia. Visual assessment of neonatal of eight, while cervical-diaphysis angle correction should be expected until the jaundice is known to be unreable, that’s why determination of serum bilirubin is age of 12 years.

280 281 Presentation Poster

3-The application of antiosteoporotic drugs should be applied regularly in the is also being studied as a treatment for multiple sclerosis. In some cases, extra Poster three years of premenopausal up to 3 years after menopause. biotin causes falsely high results on tests. The objectives is to identify automated Presentation 4-Only in this way we can protect individuals from osteoporotic fractures of the immunoassay systems vulnerable to biotin interference and describe how to upper femoral extremity, which are common in medical practice. estimate and minimize the risk of biotin interference in vulnerable assays. In the perspective of my education as a professor of descriptive anatomy and the It is a theoretical, epidemiological study, after studying articles from magazines need to deepen the study, in this basic course, for students of «Faculty of Medical such as: Journal of: Cardiology, Interantional Society of Pharmaco-epidemiology; and Technical Sciences «; I thought that in this session of the annual Scientific Pub Med. The data in the manufacturer’s “Instructions for Use” for each of the Conference I should come up with the topic above: methods utilized by immunoassay system were evaluated. Purpose; The expansion of scientific knowledge which isn`t found in the academic Many labs use immunoassay-based screening methods. This testing method mea- program of our faculty. sures the presence and concentration of a small molecule in a solution . Although Deepest knowledge of the structure and bone composition of the upper femoral interferences have been well documented. The streptavidin-biotin interaction pro- extremity, especially its trabecular intercourse, which also serves as an index of vides an efficient and convenient method to manipulate assay components and is the senile osteoporosis phenomenon. currently used in several immunoassay platforms.High levels of biotin can impact Making a comparison of biological compositions with coherent engineering con- tests used to diagnose conditions such as Thyroid disease ( TSH and FT4, FT3), structions and their theoretical and practical evaluations. heart disease( troponin) , pregnancy( β–human chorionic gonadotropin ), anemia (Ferritin) , cancer biomarkers and other hormonal related diseases. PP057 - A Case Report, as a correlation between Right Cardiac Hart Fail- The list of affected immunoassays varies for each analytic platform, and fora ure and Myeloproliferative Syndromes, Developed on the basis of Polycythe- given test the manufacturer-supplied product information must be consulted to mia Vera and Severe Pulmonary Hypertension-post Pulmonary Embolism. determine if biotin is an interferent. Solutions proposed by local clinical labora- E.Qeli tories include diluting the specimen with a validated assay diluents. All of these Polycythemia Vera is a part of Myeloproliferative Syndromes, which is charac- solutions will increase the costs associated . For many laboratories, the current terized by a pathological raising of RBC (red blood cells), but sometimes it can solution is simple : It is recommended that patients abstain from taking biotin for also be associated with pathological raising of WBC (white blood cells) and PLT at least 48 hours before specimen collection. The most effective approach, how- (platelets). It affects mainly people over 60-ties, with a higher prevalence at male ever, is an extensive communication campaign to educate physicians and patients. gender (Incidence 1.9/100.000 persons each year). Keywords:biotin, streptavidin/biotin, immunoassay Patients suffering from Polycythenia Vera go through several complications, i.e, Systemic thrombosis-stroke, cardiac ischaemia, deep vein thrombosis, pulmonary PP059 - Glycated albumin as a biomarker for glucose control embolism, etc. All these happen, because of the higher viscosity of the blood. E.Koliçi, N.Koliçi, R.Kolpepaj, Z.Imeraj, D.Kerri, L.Zikaj, A.Zyli, M.Kollçaku This case report, describes a 66 years old man, who has been diagnosed years ago Glycated albumin is albumin that has been glycated. Albumin is the most common as Polycythemia Vera, under close attention and treatment by the hematologist. type of protein found in blood (~80% of circulating proteins) and is replaced in During a casual trip in France, 6 months ago, while visiting his family members, the body about every 20-25 days. Glycated hemoglobin (A1C) is the reference he goes through an Acute Cardiorespiratory Insufficiency, on the basis of an Acute test for long-term glucose monitoring, and it exhibits an association with diabetic Pulmonary Embolism. This may have been a possible complication of the My- chronic complications.The aim of this review was to discuss the physiological and eloproliferative Syndrome, that he suffers. After that, he developed Severe Pul- biochemistry characteristics of the GA, as well as its clinical utility in Diabetes monary Hypertension (post Pulmonary Embolism) and clinically developed also mellitus (DM). signs and symptoms of Right Cardiac Failure. Actually, he is under follow-up and Methods It is a review, after studying articles from magazines such as: Journal treatment for the Right Cardiac Failure and started also on oral anticoagulation. He of: Endocrinology, Interantional Society of Pharmaco-epidemiology; Pub Med. is, in the same time, followed up and attended by Hamatologist and Cardiologist Result; Glycated albumin is measured by a standardized enzymatic methodology, and he has got a good recovery of the clinical picture. easy and fast to perform. These laboratory characteristics have ensured GA as a marker of monitoring and screening for DM, as well as a predictor of long-term PP058 - Biotin interference with routine clinical immunoassays outcomes of the disease. The primary difference between glycated albumin and E.Koliçi, N.Koliçi, R.Kolpepaj, A.Zyli, A.Nake, Z.Imeraj, D.Kerri, L.Zikaj, glycosylated hemoglobin is the life span of the albumin and the hemoglobin re- A.Nurce, E.Thoma spectively. Biotin is in many multivitamins. It’s also sold in formulas that are marketed to Since red blood cells live for a period of three to four months, hemoglobin glyca- improve hair and nail growth. Most people need 30 micrograms in their diets ev- tion can only be measured as frequently as that three to four month time period. ery day. Doctors sometimes prescribe high doses of biotin to treat nerve pain .It As mentioned above, glycated albumin lives for 20-25 days, allowing its measure-

282 283 Presentation Poster

ment every three weeks to one month.GA plays a dual role in diabetes complica- ic species in humans is S. stercoralis. The term “hyper infection” is often used Poster tions. It acts as an indicator or marker of intermediate glycation and as a causative to denote autoinfection, a phenomenon in which the number of worms increases Presentation agent of the damage of diabetes complications. Glycated albumin has been specif- tremendously and the worms are detectable in extra intestinal regions, especially ically implicated as a casual factor in atherosclerosis and kidney damage. the lungs. It begins with the filariform larvae penetrating the skin and migrating It is also linked to diabetic nephropathy, diabetic retinopathy, and the onset of through blood to the lungs. Unlike other nematodes, S stercolaris can autoinfect Alzheimer’s disease. Conclusions; Plasma glycated albumin is better correlated to the same host and persist for decades. An important tool to diagnose lung parasit- fasting plasma glucose than HbA1c, and it is a more sensitive indicator of short- osis is microscopy of sputum. term variations of glycemic control than HbA1c is during treatment of diabet- A 59 year old man, presented with gastrointestinal pain, severe diarrhea and dif- ic patients.Glycated Serum Protein serves as an accurate intermediate marker of ficulty in breathing for about 3 weeks. No fever. . The patient has been under glycemia in instances where HbA1c may be of limited value such as pregnancy, treatment with corticosteroids for renal disease. On physical examination the skin reduced RBC lifespan and hemodialysis. was pale and petechial purpuric eruptions were present at the lower extremities. Patient had respiratory failure. A chest radiograph showed consolidation of the PP060 - Health Related Quality of Life and associated factors in hemodialysis parenchyma at the upper lobes bilaterally and pleural effusion. A lung CT-scan patients showed migrating consolidations of parenchyma. Stefo.E, N.Pasko, M.Saliaj, E.Sulaj, A.Strakosha No blood eosinophilia was observed. Microscopy and culture of stool for ova and Quality of life is an important indicator of a person’s health and well-being as well parasites resulted negative. Microscopy of the sputum showed the presence of the as a parameter to calculate person’s illness and survival. Diminished health-related filariform larvae, identified as S.stercolaris. Sputum culture showed co infection quality of life (HRQoL) is common among hemodialysis patients. In this context, with klebsiella oxyttoca. As Ivermectine could not be found in Albania, the patient identification of factors that affect the quality of life of these patients takes on received treatment with albendazole, which unfortunately lasted only five days particular importance. because of the fatal outcome. Purpose: There is currently little data on the health related quality of life Disseminated strongyloidiasis frequently develops in patients with immunodefi- (HRQOL) of Albanian ESRD patients undergoing HD and this study sought to ciency caused by poor nutrition, drug therapy (including steroid therapy) for au- examine the patterns of HRQOL and its associated factors within this population. toimmune diseases, chronic alcoholism, advanced age, diabetes mellitus, collagen This is a cross-sectional study involving 70 patients who had over three months disease, and post-surgery status. Under such conditions it may become a very se- of hemodialysis. KDQoL-36 questionnaire was used to assess their health-relat- vere disease such as respiratory distress or sepsis, with a fatal outcome. ed quality of life. Clinical and laboratory data were collected for each patient. The diagnosis of strongiloidiasis is established by demonstrating the S.stercolaris These data were analyzed in relation to the five components of KDQoL-36. larves in stool, sputum or body fluids. Sputum examinations: Bronchial washings Out of 110 patients included in this study, 70 of them (64%) were males and and broncho alveolar lavages (BALs) frequently reveal filariform and/or rhab- 40 (26%) females. Their average age was 54.5 ± 12.3DS and on the average 4 ditiform larvae. Microscopy of the sputum is a very important, not expensive and ± 4.7ds years in dialysis. The average values for the five components of KD- quick examination to help in establishing the correct diagnosis as soon as possible QoL-36 resulted respectively: SF-12 physical component 40.47; SF-12 mental notably in countries where this disease is very rare. component 42.70; Burden of chronic renal disease 22.16; Symptoms and Prob- lems 81.29; The effect of chronic kidney disease 60.40. There was a statistically PP062 - Adenosquamous Carcinoma of the Duodenum, a Rare Entity. Case significant correlation between all five components of KDQoL-36 and Diabetes report and review of literature Mellitus, hemoglobin levels and both Simptoms/Problems, SF-12 mental com- E.Sukaj, T.Bushati, L.Berdica ponent , gender and Simptoms/Problems also Burden of chronic renal disease. Adenosquamous carcinomas (ASC) of the duodenum are extremely rare neo- Our study demostrated that Albanian HD patients have very low average value plasms. Histologically the neoplasm shows evidence of glandular and squa- of the component “Burden of chronic renal disease” and a satisfactory average of mous differentiation, and both components show malignant characteristics. the component “Simptoms and Problems”. Factors associated with poorer HRQoL Here we report a case of ASC of the second part of the duodenum in a 82-year-old included female gender, DM, anemia. Other modifiable factors should be further man who underwent an endoscopy examination which revealed an infiltrative, investigated to improve HRQoL for HD patients. ulcerated lesion covered with blood clots. Adenosquamous carcinomas (ASC) have been reported throughout gastrointesti- PP061 - The importance of microscopy of sputum in lung parasitosis nal tract, including the gastroesophageal junction and the anal canal. Only a few E.Afiani; Shehu.U; F.Nasto; A.Dhima; A.Daka cases of ASC of the small bowel and duodenum have been reported in the litera- Strongyloidiasis is an intestinal infection caused by 2 species of the parasitic ture. A review of the literature and discussion about the histogenesis is included. nematode Strongyloides. The most common and clinically important pathogen-

284 285 Presentation Poster

PP063 - Granulomatous epididymo-orchitis, as a complication of intravesi- ary, whether benign or malignant are very rare. The elements of the spermatic duct Poster cal Bacillus Calmette-Guérin (BCG) therapy for urothelial bladder cancer. A system, whether inside the testis or outside it in the epididymis and spermatic cord, Presentation case report and review of literature exhibit only 1/20th of that of the germinal epithelium. In accordance with the me- E.Sukaj, L.Berdica, T.Bushati sodermal, or mesothelial origin of the whole spermatic duct system, tumors of the Bladder cancer is an important epidemiological pathology. It is treated by primary epididymis and spermatic cord are - with few exceptions - mesenchymal tumors, surgical intervention TUR-BT and continuous monitoring of disease relapses. The the most frequent of these being the so-called adenomatoid tumor, a benign slowly Bacillus Calmette-Guérin (BCG) intravesical installation is a standard therapy and growing tumor. So far only 40 cases have been described in the world literature. remains the most effective adjuvant treatment for non-invasive urinary bladder Adenomatoid tumors usually present as extra testicular masses, they are the most cancer. It is used to reduce the incidence of recurrence and extend the recurrence common paratesticular neoplasm and account for approximately 30% of all parat- time, as indicated by many clinical studies. Although commonly tolerated, BCG esticular masses. The adenomatoid tumor of the epididymis is a neoplasm located therapy is not without side effects, which are rare but serious, where local and in the paratesticular region, however it can be found infrequently in other sites. systemic complications associated with BCG may appear after insertion. While Mesothelial origin has been mentioned and inflammation has played some role these events are rare, with a cumulative incidence of less than 5%, the wide range in the development of these tumors. It can minimally invade adjacent structures, of presentations and possible severity poses a challenge for the clinician. These though it is benign without metastatic potential. Some reports have mentioned ma- side effects include local infections, granulomas in the peripheral organs, reactive lignant behavior, but it is very rare. Physical examination and testicular ultrasound arthritis, hypersensitivity reactions, and sepsis from BCG. Tuberculosis-like gran- comprise important role in the diagnosis. However they can present clinically ei- ulomatous inflammation in the uro-genital tract is a serious complication of BCG. ther as an incidental finding or a slow growing scrotal mass. According to that , This may occur after a long interval of discontinuation of BCG intravesical ther- ultrasound features are not specific to distinguish definitely intratesticular adeno- apy. The pathogenic mechanisms behind the development of complications after matoid tumors from malignant testicular masses. Consquently, a surgical approach the introduction of BCG are not completely clear and there is a considerable de- is almost always considered for both diagnostic and therapeutic purposes, bate if it represents a form of hypersensitivity reaction based on the histological as the treatment of choice. finding of granulomas in the absence of recoverable microorganisms, or an active The aim of this article is to present a case of a 49 year old male who was presented mycobacterial infection. In addition, predisposing factors for the development of to the hospital for a enlarged mass in the right epididimus, growing in size last a BCG intravesical complication are not well known. months.Frozen section biopsy and permanent section with H&E stain were per- There is evidence that some conditions may favor hematogenic bacilli delivery, formed to reach the diagnosis. but there are still limited data on other possible risk factors, namely the presence of immunosuppression. Here we are presenting a clinical case of a 68-year-old PP065 - Riga-Fede-like disease in a 85-year-old diabetic patient. Case pre- patient who presented at the urologist with testicular pain, 4 years after a previous sentation and review of the literature TUR-BT surgery and BCG intravesical therapy courses. An orchiectomy interven- E.Kola, T.Bushati, L.Berdica, J.Hysko tion was performed due to the possibility of a tumor being present. Riga-Fede disease (RFD) describes a benign, ulcerative lesion resulting from the Histology confirmed granulomatous epididymo-orchitis. This case shows that due repetitive trauma of contact of the oral mucosal surface of the tongue with the to delay and gradual start up of symptoms, BCG infections are difficult to diag- teeth. Although the name applies primarily to small children, similar clinical and nose. The report and review should remind surgeons to consider BCG infection in histopathological findings can also be found in adults. Early recognition of this their differential diagnosis when treating patients who appear after BCG therapy. entity is important because it may be the presenting sign of an underlying neuro- Clinicians should be aware of the potentially long periods of tranquility for BCG logical disorder. infections and their complications, as well as acute infectious BCG presentations. However this condition has rarely been described in elderly people, despite the fact that the lesions are microscopically identical, the causes of trauma differ in PP064 - Paratesticular adenomatoid tumor. Case presentation and review of the adult population. Risk factors include the presence of broken teeth or ill-fitting the literature prosthetic material in the oral cavity or diabetes mellitus increasing the possibility E.Kola, L.Berdica, T.Bushati, J.Hysko for denture stomatitis and denture hyperplasia. Adenomatoid tumor of the epididymis is an uncommon tumor of the paratesticular The differential diagnosis of Riga-Fede disease includes infectious diseases such tissue. Although its etiopathogenesis remains unclear, there appears to be a meso- as syphilis, tuberculosis or ulcerative candidiasis, and neoplasms such as lympho- thelial involvement. mas or sarcomas. We report the case of a 85-year-old woman who was presented Method - Case report diagnosed with frozen section biopsy and permanent sec- at the hospital because of a painful ulcer in the ventral surface of the tongue, sus- tion, H&E stain. Discussion-Tumors of the epididymis, both primary and second- picious clinically for malignant proliferation.

286 287 Presentation Poster

PP066 - Efficacy of the McKenzie Method in patients with Low Back Pain examination diagnosed extrinsic ureteral endometriosis. After six months the pa- Poster E.Mane, I.Mukaj, A.Avduli tient was suspected again for extrinsic ureteral obstruction and is under examina- Presentation The McKenzie Method is an assessment and treatment system for backache pa- tions for further diagnosis and treatment. tients. The choice of exercises is based on flexion, extension or lateral shift. The Although the preoperative diagnosis is essential for an appropriate surgical ap- goals of the therapy are pain reduction, centralization of the symptoms, and com- proach, the diagnosis of ureteral endometriosis is sometimes negligible and missed plete recovery of the patient. because of the unclear clinical signs and because they do not display typical symp- The main purpose of the study is to identify the efficacy of the McKenzie for LBP. toms. In these conditions recurring cases become frequent, making the treatment The specific objectives we have achieved through this study are: difficult and complicate. 1.Characteristics and use of McKenzie in LBP 2.Comparison of the method with other treatment techniques PP068 - The importance of nurse education in MMR Vaccine administration 3.Recognizing the efficasy of the McKenzie method and parent’s education not to avoid it Methods: The study was a Systematic Review, meta-analytic type, consisting of E.Brahimi, E.Bajrami, F.Keci 6 randomized control trails (RCT) of the last ten years using the McKenzie meth- Vaccinations is one of the most important medical achievements, and due to them od for LBP, comparing with placebo, chiropractic, bed rest, electrophysics agent, many serious contagious diseases today are under control. The vaccine is a prod- Back School and exercise therapy . Data was extracted from medical websites uct made up of a very small amount of microorganisms that can be viruses, dead and scientific journals. The evaluation was realized with the PEDro scale, which or weakened bacteria that are designed to stimulate our immune system to pro- shows the validity of each study. duce antibodies. The MMR vaccine is a polyvalent vaccine that protects against Results: The literature used in this study claimed that the McKenzie method pro- three diseases, Measles , Mumps and Rubella. These diseases affects respiratory vides an effective contribution to the rehabilitation and recovery of chronic and system, which can cause complications such as pulmonary and encephalitis in- acute non-specific LBP. The most accomplished studies are those with more de- fection. Salivar glands and hearing disorders, pancreatitis, and testis. Rubella tailed treatment protocol, long sequences, follow-up and many evaluations. The usually affects school age, accompanied by high fever and stains on the body. positive impact of the McKenzie therapy gives a significant difference in improve- To present the reasons which makes the parents to exclude their children from dhe ment of the function, pain reduction, and general condition of the patient. aministration of this vaccine. Listen and explain them carefully because they are The studies included in the review, and other RCT studies suggest that McKenzie exposed to different views on their vaccinations and their safety. What they hear therapy is more effective than most comparative treatments. from friends, discussions, TV, or the Internet (autism) After analyzing and discussing the selected literature, we conclude that the McK- It is a study conducted in children born in our hospital; from January 2017 to June enzie method is very effective to LBP management. Scientific research on this 2017 are 180 births, of which 49 children were vaccinated in our hospital with topic is limited, so it is suggested to increase research by different medical staff MMR vaccine during the same period in 2018. In the statistic includes children at and authors, especially now that the LBP incidence has increased. the age of 1 (the first dose of MMR.) The nurse’s role consists in: Care for the child to be in good health. Parent’s psy- PP067 - Ureteral endometriosis a missed and complicate diagnosis: case report chological disclosure and preparation regarding vaccinations and their care after Kurushi E, Tahiraj M, Cekodhima G, Cela B, Alimehmeti M, Ikonomi M vaccination. Preliminary application of the vaccine. Parents explanation and the Ureteral endometriosis is a rare and under diagnostic condition, defined as “the si- answer to each dilemma they may have. Firmly repeating that - the components lent killer” of the kidney. The incidence of ureteral endometriosis vary from 0, 1% of the vaccine are safe and carefully tested.-the vaccines do not cause autism. to 1 %. Although it is relatively a rare and uncommon pathology, affecting a very There haven’t been cases of complications after MMR vaccination. Allergic babies small number of women of reproducing age, it is of particular importance because have undergone the vaccine under a doctor’s supervision for a longer period of time. of its silent and severe loss of renal function towards renal failure. Despite its pre- Inferiority has a key role in the delivery of vaccines. His role is paramount, given sentation, both intrinsic and extrinsic ureteral endometriosis, present a diagnostic that the vaccination is carried out by a nurse. Starting from the conditions of vac- and therapeutic challenge. cination, the way of preparation, and the very way of applying according to the The purpose of our presentation is to turn the attention of the clinicians toward type of vaccine. rare conditions in order to provide an accurate approach for differential diagnosis and lead to accurate therapeutic procedures. we will represent a case report of a 42 PP069 - Squamous cell carcinoma of right parotid gland as metastases from years woman diagnosed with extrinsic ureteral obstruction and hydronephrosis of temporal region cutaneous carcinoma in HIV person. A case report the right kidney, suspected for metastasis from cervical or endometrial carcinoma. E.Muco, J.Mehmeti, G.Cekodhima, M.Kermaj, A.Kushi, N. Hoxha She undergoes surgical procedures that relieve the obstruction. The pathological Squamous cell carcinoma (SCC) is the second most common form of skin can-

288 289 Presentation Poster

cer, is an uncontrolled growth of abnormal cells arising from the squamous cells PP071 - Brucellosis presenting as fever of unknown origin in a cirrhotic patient Poster in the epidermis, the skin’s outermost layer. Primary squamous cell carcinoma E.Muco, J.Mehmeti, A.Bego, A.Kushi, N.Hoxha, E.Puca, M.Sina Presentation (SCC) originating in the parotid is rare. More commonly, SCC is metastatic to the Human brucellosis is a zoonosis caused by intracellular gram-negative bacteria of intraparotid and periparotid lymph nodes from cutaneous malignancy of the face the genus Brucella. Brucellosis is also an emerging zoonotic infection in devel- and scalp. The elevated risks of salivary gland and nasopharyngeal cancers among oping countries and carries significant morbidity and mortality. It is a well known people with AIDS suggest that immunosuppression and oncogenic viral infections fact that liver cirrhosis has a high risk of bacterial infections, but only a few cases are etiologically important. This is the report of a 64 year old male patient hospital- have been reported in advanced liver cirrhosis. ized in Infectious Disease Service Tirana, Albania. In his medical history he revealed Aim. To report a case of a 58 year old man who presented with fever of unknown of recurrent lung infections, weight lost in the last months, oral candidiasis. Three origin and resulted acute Brucellosis. The patient, a 58-year-old diabetic man from months earlier he had a skin lesion removal from the right temporal region. We got Scodra, with ethylic cirrhosis was admitted at infectious disease clinic in July the histopathology response (the patient did not return for the biopsy result) which 2017 complaining high temperature, fatigue, sweats. He was a farmer living in had been with squamous cell carcinoma, with free from cancer cells of the exac- the countryside. His lab examinations revealed low count for all three blood se- tions margins. His examinations resulted with positive for HIV, low CD4 (+) count, ries, RBC 2.63x106/mm3, HGB 8.7 g/dl, WBC 3.2x103, PLT 92x103/mm3, pro- anemia. During his hospitalization he developed a lesion at the parotid gland, near thrombin level 39.4%. Abdominal ultrasound resulted with shaded liver margins, his previous biopsy site. The radiological examinations CT scan showed a solid cys- enlarged spleen, no as cites. Fibrogastoscopy showed esophageal varicose vein, tic formation 28x22 mm with infracentymeter bilateral cervical lymph nodes, with erosive gastritis, and mycotic esophagitis. He had low albumin level, 47.1%, high bone impermanent of parietal region (prop able after the surgery), no other findings gamma globulin level, 27.7%; elevated liver enzymes ALT 58U/l, AST 54U/l, in other organs. A second biopsy also resulted with squamous cell carcinoma well GGT 368 U/l, bilirubin 2.0 mg/dl. Standard agglutination test SAT was positive at differentiated. He underwent radiotherapy and started antiretroviral therapy, his post a titer of 1:640. He started treatment with intravenous ciprofloxacin (200 mg every treatment period up to now days is satisfactory and continues his periodic examina- 12 hours) and oral doxycycline (100 mg every 12 hours) for three weeks. This was tions near the ambulatory clinic of Infectious Diseases in Tirana, Albania. Because followed by oral ciprofloxacin 500 mg every 12 hours and oral doxycycline 100 of its aggressive form a follow up of a squamous cell carcinoma is necessary to eval- mg every 12 hours for 3 additional weeks.The treatment was well tolerated, with uate possible metastasis, to do proper immunodeficiency patient information about no side effects.Diagnosing acute brucellosis in a cirrhotic patient is a hard task, her severiness, and treated adequately. because the laboratory data may be attribute to cirrhosis itself. On the other side the treatment is a challenge for the reason that the use of conventional antibiotics PP070 - Ramsay-Hunt Syndrome in an auricular Herpes Zoster. A rare clin- is contraindicated or limited when there is a presence of severe co morbidities like ical case. liver cirrhosis which have a high risk of toxicity. E.Muco, K.Thomai, J.Mehmeti, E.Muzha, A.Kushi, N.Hoxha Herpes zoster is seen as a disease of older people (most commonly over 60 years PP072 - Hot Lingual Thyroid old), and incidence and severity increases with age which may be due to a de- E.Golemi, A.Kuci cline in cellular rather than humoral immunity. Ramsay Hunt syndrome is an acute Lingual thyroid or ectopic thyroid is defined as the presence of the thyroid tissue peripheral facial neuropathy associated with Herpes Zoster of the ear canal or in the midline at the base of the tongues anywhere between the circumvallate auricular. Type 2 syndrome is reactivation of geniculate ganglion that can cause papillae and the epiglottis. It is a rare anomaly with a reported incidence 1:3000 deafness, vertigo and ear pain. of the thyroid cases seen with overall prevalence of 1 in 100.000. Other sides of Aim. Presenting the clinical, diagnostical, therapeutical datas of a case with Ram- local thyroid deposition include the cervical lymph nodes, submandibular glands say-Hunt Syndrome. and the trachea. Case report: The patient, a 72 year old man, presented to the Infectious Disease Diagnosis of lingual thyroid is usually made clinically and radionuclide scanning Service with nausea, vertigo, right ear pain. He had Herpes Zoster vesicles in is used to confirm the diagnosis. male, A.D., presented with history of dysphagia, the external ear, face and mouth in C2 and mandible nerve dermatome. Ocu- foreign body sensation, dysphonia as well as palpitations, heat intolerance, dia- lar examination resulted with normal conjunctiva and sclera. An otorhynolar- phoresis, easy fatigability and has fine hand tremors. ingology consult and PTA (pure tone audiometry) revealed with hearing loss In the oropharinxoscopy examination we found normal examination of the cavum of the right ear. All other laboratory findings were normal. Treatment with oral oris, palatum, uvula, pharynx. At the base of the tongue in laryngoscopy we saw a acyclovir and prednisone was successful in improving the patient outcome fleshy erythematous swelling that moves with tongue protrusion that differs a lot Early diagnosis and treatment help preventing irreversible complications affecting from lingual papillae. We performed an ultrasonography of the neck that reveled the facial and other cranial nerves involved. non visualization of the thyroid in its normal anatomic location. TSH levels was low 0.01 uIU/ml( 0.1-4), FT4 was high 32 ng/ml( 8-18), other chemical parameters were

290 291 Presentation Poster

normal. Radionuclide scan with 99 mTc reveled the location of the ectopic thyroid. PP074 - Bipolar plasma enucleation of the prostate (B-TUEP) in Benign Pros- Poster We confirmed the diagnose: Lingual thyroid with hyperthyroidism. We initiate the tate Hypertrophy Treatment. Medium-term results Presentation treatment with ATS ( Methymasole) to stabilize the level of thyroid hormones for E.Shehu, C.Falavolti, B.C.Gentile, G.Mirabile, L.Albanesi, P.Tariciotti, G.Rizzo, 3 weeks. We stabilize the thyroid hormones levels and performed the total ectopic M.Buscarini, R.Giulianelli thyroidectomy. The biopsy resulted negative for malinjancy. After the surgery we Numerous endoscopic techniques have been described for treating bladder outlet initiate the treatment with levothyroxine. obstruction (BOO) due to benign prostate enlargement (BPE). Classic transure- thral resection of the prostate (cTURP) has long been accepted as the gold stan- PP073 - Urethral stricture lenght ≥2 cm is significantly associated with lower dard to treat symptomatic disease of prostates weighing 30-80g. urethroplasty success rate. Results of our large case series. Plasma-button bipolar enucleation of the prostate (B-TUEP) is considered a suc- E.Shehu, C.Falavolti, R.Giulianelli, T.Petitti, M.Buscarini cessful treatment option. Aim of this study was to assess safety, efficacy, and -me Urethral stricture is a relatively common disease in men and remains a recon- dium term durability of B-TUEP for treating BOO. structive difficulty for urologists. It is associated with an unequivocal negative Between July 2011 and March 2012, 50 consecutive patients underwent B-TUEP impact on the quality of life. The etiology is variable and the incidence is increas- at our institution, by a single surgeon (R.G.). All patients were pre-operatively ing in recent years with more frequent application of endoscopic instruments and assessed with maximum urinary flow rate (Qmax), single-question quality of indwelling catheters. Some of the most common etiologies of stricture disease life (QoL), International Prostate Symptoms Score (I.P.S.S.) and the Internation- include lichen sclerosis (LS), trauma, iatrogenesis, and infection [1-2]. Urethro- al Index of Erectile Function (IIEF-5) questionnaires. Patients were tested with plasty is considered the gold standard treatment for definitive correction of the Transrectal Ultrasound gland volume evaluation (TrUS), prostate-specific antigen disease reaching a success rate of 90%. Most of these strictures are short enough to (PSA) and post-voided residual of urine (PVR) [Fig.1]. The same postoperative make end-to-end urethral opposition. Normally, grafts are used when the strictures parameters were evaluated at 3-, 6-,12-, 18-, 24-, and 36-mo. are too long or when patient already underwent a previously failed reconstruction We observed a significant improvement occurred at 12, 24 and 36 months in terms attempt. The buccal mucosa is the most commonly used graft source [3]. of Qmax (22.3 ± 4.74 mL/s, 23.2 ± 0.30 mL/sec and 23.6 ± 1.26 mL/sec, respec- The aim of this study was to investigate the correlation between urethral stricture tively, p<0.01), and QoL (5.28±0.97, 5.69±0.90 and 5.73±0.87). IPSS and IEEF etiology and length with the success rate in a large single-center series using the scores also improved significantly (p<0.05). Postvoid residual drastically de- same surgical technique. creased (p<0.001). We retrospectively collected the data of 448 consecutive patients affected by ure- Prostate-specific postoperative antigen level was 0.76±0.61 ng/mL, 0.7±0.51 thral stricture who received surgery at University of Southern California of Los ng/mL and 0.62±0.18 ng/mL, at 12, 24 and 36 months respectively Angeles (USC) and University of Rome (UCBM) from 1998 to 2014. Patients . Two patients (4 %) had persistent BOO and requiring reoperation. were categorized based on the length of stricture in three different groups: group A After 3-yr follow-up, B-TUEP represents an effective, durable and safe surgical 1-1.9 cm; group B 2-3 cm and group C >3.1 cm. Urethral stricture etitologies and intervention. Voiding parameters such as Qmax, QoL score, IPSS, PVR improved features (site and length) are showed in table 1. Patients underwent urethroplasty significantly (p < 0.05) from baseline, starting from 3-mo after B-TUEP and according to the same technique. continuing during the follow-up, until they reached a plateau after 36 months. We performed end-to-end anastomosis for stricture <2 cm (group A) and ventral B-TUEP technique uses the large surface of the button that creates the conditions buccal mucosa graft urethroplasty for patients with stricture >2cm (groups B and C). for a fast enucleation process, continuous vaporization and concomitant haemo- Comparative outcomes between the groups (by lenght) were assessed using analysis stasis. This study demonstrates that B-TUEP can be considered an alternative en- of a chi-square test. A logistic regression was used to calculate the odd ratio of suc- doscopic treatment for symptomatic BPE. cess compare to the length. Statistical analysis was performed using STATA version 14.0 with 0.05 set as the level of significance. PP075 - IMRT Quality Control for Head and Neck Treatment Database was analyzed to understand the impact of different urethral stricture E.Telhaj, L.Bregu, EBakiu lengths and etiologies on success rates. We collected data about one-year follow-up. Radiotherapy is a clinical modality that serves in the treatment of patients with All patients underwent urethral-cystoscopy and flowmetry. cancerous diseases by ionizing radiation. In most cases, the radiotherapy treatment Success was set as absence of urinary flow obstruction. performed in 3D mode and IMRT, and some treatments are perform with particle Urethral strictures characteristics are showed in table 1. Statistical results indicated energy (electrons, protons, neutrons, etc.). that iatrogenic urethral strictures showed better urethroplasty results. Success rate The radiotherapy with external beam usually is perform with more than one ex- significantly decreases for patients affected by urethral stricture ≥2 cm (p< 0.05) ternal beam of treatment in order to have a uniform dose distribution to the tumor (Table 2). No matter the cause of urethral stricture. Urethroplasty success rate sta- target and as little as possible dose around the healthy organs. tistically depends on stricture length that must be < 2 cm. Recommended that the dose uniformity in the tumor target should be in the

292 293 Presentation Session Plenary Plenary Poster

upper limits of up to + 10% and in the down limit of up to -5% of the given PP077 - Evaluation of Patient Transport’s Safety Inside the Operating The- Poster Plenary Session dose. Algorithms of treatment planning systems give an accurate calculation of atre and Healthcare Worker’s Presentation the dose from 2% until 4% of MU valid this 1σ (1 SD or 1 standard deviation). E.Kajti, S.Karaöz However, this limit of inaccuracy is most likely valid for most radiotherapy treat- The aim of this study was to evaluate the safety of transportation of patients and ments. Since the IMRT treatments in the head - neck area are near the high - risk healthcare workers experiences inside the operating theatre. organs, in these conditions the needed, a very strict control of the treatment plan This is a Cross-sectional descriptive research. The research was performed at Çak- before the patient start the photon radiation treatment. mak Erdem Private Hospital between 01/04/2016-30/04/2016. During research In order to avoid the wrong treatment of the patient, treatment planning should time 152 patients being operated at this operating theatre were chosen as popula- evaluated, for the second time by an independent calculation from the first meth- tion without sampling. The researcher collected the data by observing the trans- od. The purpose of the comparison between initial and verifying dose calculation portation process according to established form and also realized a questionnaire is to evaluate how accurate the first dose calculation outcomes (calculation from with the healthcare workers. Statistical analyses were performed with IBM SPSS SPT treatment system based on algorithms). 20.0 (SPSS Inc., Chicago, IL, USA). According to the research almost all safe- If the avoidance between the calculations is large then a third dose calculation ty standards were properly performed, excluding leaving the patients unattended step should take to obtain the exact value that will give to the patient, for example (%17.2-35.5), introducing itself (% 0.0-4.6) and patient handover (% 5.9-34.9). through direct measurements by means of phantoms of the type PMMA (poly- Healthcare workers mostly complain of personnel shortage (% 24.0) and are wor- methylmethacrylate) before that the patient start radiotherapy. ried during transportation of patients (% 60.0). According to our protocols and procedure result that comparison between initial In this study almost all safety standards were properly performed, very few com- and verifying dose calculation are for upper limits to +8% and for lower limit not plications occurred so according to that transportation of patients was found less as -3%. safe. Nurses were not active during transportation. We suggest for all healthcare workers to be trained in and perform studies about transportation of patients. PP076- Some enzymatic changes in AUD patients in Albania E.Thoma, S.Bitri, A.Nake, E.Cela, I.Kola PP078 - Some “ugly” cases “that were treated at the thoracic Surgery of Uni- AUD is a clinical diagnosis, which is made after the patients meets two of the 11 versity Hospital” “Shefqet Ndroqi “in Tirana Albania criteria outlined by DSM-V. The aim of this study is to evaluate the changes of A.Gradica, L.Lisha, Dh. Argjiri, A. Cani, F.Kokici, Xhemalaj, I.Avdiu, A.Vyshka, some enzymes, i.e AST, ALT, GGT, LDH, ALP and CK to the patients hospitalized E. Bollano, D.Thereska, H.Nino with the AUD diagnosis. Matherials and method: This is a study performed in To introduce some special cases of respiratory tract diseases, both clinically and UHCT” Mother Teresa” in Tirana/Albania, which is the only center for diagnosis therapeutically Materials and methods: We have chosen patients treated in a period and treatment of patients with AUD diagnosis in Albania. of 2011-2018. It is understood that the number of patients treated with such no- This is a prospective study, that was performed during the years 2013-2017. 320 zology is very high for these years but we will only introduce some special cases. patients are enrolled in this study. The diagnosis of these patients was made based 1-Giant soft -tissue liposarcoma of the chest wall and soft tissue non Hodgkins on clinical history of the patients, after performing AUDIT questionnaire, and lab- lymphoma of the chest wall. Results: Although the cases have been very difficult, oratory examination. The enzymes discussed above, were measured during the short-term and long-term operator and postoperator period has been very good. In first day of hospitalization. All the data that were collected, were analyzed with the case of survival liposarcoma of chest wall it has been over 4 years with mul- the program SPSS 20.0. timodal terapy and in the case of Limphomes non Hodgkins survival is 3.5 years. In this study were enrolled 320 patients; all of them were male. The median age of Medically surgical treatment in a particular patients should be done at the right patients was 42 years old. The standard deviation of age was 10.8. We have noticed and moment time , it is the key to success. Huge liposarcoma of chest wall.1.Be- a positive correlation statistically significant between AST(rho=0.21,95%CI=0.09- for resection tumor mass; 2-after resection and reconstruction of chest wall 3-5 0.30,p<0.01), ALT(rho=0.09,95%CI=-0.01-0.20,p=0.08), months after surgical and radiotherapy treatment. GGT(rho=0.15,95%CI=0.03-0.27,p=0.01), LDH (rho=0.3,95%CI=0.05- 0.63,p=0.02) and the time of alcohol abuse; meanwhile CK(rho=0.1,95%CI=- PP079 - Urinary incontinence incidence in women with uterine prolapse 0.15-0.33,p=0.5) and ALP (rho=0.12,95%CI=-0.004-0.24,p=0.06) were not statis- treated in ’’Queen Geraldine’’ tically significant in correlation with the time of alcohol abuse. F.Balla, E.Binaj, B.Ismaili As it is already confirmed from different studies, consuming alcohol can damage Urinary incontinence is a loss or leakage involuntary of urine. virtually every organ of the body. Thus, it is very important to measure different There are different types of urinary incontinence in women: enzymatic activities to diagnose the problems caused by alcohol in the right time. Stress urinary incontinence occurs with increases in abdominal pressure such as

294 295 Presentation Session Plenary Plenary Poster

coughing, running, lifting ,sneezing. It happens more often in women over the activity, maintaining a normal body weight and avoiding tobacco use are ways Poster Plenary Session age of over 45 as a result of pelvic floor muscle and ligament weakening, which to prevent or delay the onset of type 2 diabetes and to decrease the risk for high Presentation support the vesicular sphincter. In women with uterine prolapse we encounter fre- blood pressure. Methods This is a cross sectional study including 42 individ- quent urinary incontinence of stress. uals selected randomly on May 12, 2017 in a public plaza in the city of Vlora, Objective: To perform a retrospectiv evaluation of the incidence of urinary in- Albania. The aim was to screen for type 2 diabetes and hypertension by measur- continence in patients with uterine prolapse hospitalized in ’’Queen Geraldine’’ ing glycemia and blood pressure. Also, individuals were asked whether they were University Hospital over the period January 2016-June 2018. suffering from diabetes, hypertension, or other chronic illness. Results Mean This study is retrospectiv and extends over the period January 2016 - June 2018 age was 63.35 years, SD±12.78, age range [20-90]. 33%(n=14) were female and and includes 260 patients hospitalized in “Queen Geraldine” university hospital 67%(n=28) were male.35.71% of participants have level of glycemia in a range with uterine prolapse with or without urinary incontinence and treated in our hos- [100-129]mg/dl and 15% had level of glycemia in a range [160-189]mg/dl. 50% pital. Diagnosis of urinary incontinence is based on anamnesis data, vaginal ex- of individuals had level of systolic blood pressure in range [120-139] mmHg and amination, simple tests (voiding diary, urinalysis, postvoid residual volume, cough level of diastolic blood pressure in range [80-89]mmHg and 29% respectively stress test, Pad test), advanced urodynamics testing( cystometry, uroflowmetry ), [140-159]mmHg and [90-99] mmHg, Image 1. 12% of participants reported that history for surgical interventions, systemic disease such as diabetes, vascular dis- have type 2 diabetes, 19% reported that had hypertension and 60% reported that ease or chronic pulmonary disease, neurologic disorders such as multiple sclero- does not suffer from any chronic disease. sis , medications used by the patient. The results suggest that part of the individuals in the study had high levels of Imaging examinations (ecography, magnetic resonance) may be needed in unclear blood glucose and hypertension while referring to not suffering from these dis- cases. In 260 patients hospitalized in our Hospital with uterine prolapse diagnosis, eases. Screening for diabetes and hypertension is the first step to treatment and 185 vaginal hysterectomies were performed and 60 patients with urinary incon- often reveals individuals who are at risk for. Therefore, screening campaigns in tinence were diagnosed for the period January 2016-June 2018. In 2016, 24/93 the population are very important for the awareness of individuals about diabetes patients with uterine prolapses exhibited urinary incontinence, with an incidence and hypertension of 0.258. In 2017, 20/109 patients with uterine prolapsis presented urinary incon- tinence, with an incidence of 0.183. In the first six months of 2018, 16/58 patients PP081 - Tobacco smoking among medical students in Faculty of Medicine, with uterine prolapses exhibited urinary incontinence, with an incidence of 0.586. University of Prishtina There is an increased incidence of urinary incontinence in the first 6 months of F.Serhati 2018 and vaginal hysterectomy from year to year. Two of the vaginal hysterecto- Tobacco smoking is very frequent in Kosovo. Although the National Institute of mies of 2018 are associated with TOT plastica. For the three years the incidence of Public Health of Kosovo had the data about the smoking prevalence in general urinary incontinence in women with uterine prolapsis is 0.230 (60/260). population, it had no recent data about smoking among medical students, which in It is noticed that urinary incontinence is most common in women aged 50-59, with the future will have an important role in informing the population against smoking a frequency of 0.55. Discutions: Urinary incontinence is a clinical sign that affects and its negative health effects and eventually in treating them. many women as they grow older. In SUOGJ ‘’ Queen Geraldine ‘’ there is a high The aim of the study: Determination of prevalence and the amount of tobacco incidence of vaginal hysterectomies since in Albania the incidence of women with smoking among the students of Faculty of Medicine in University of Prishtina uterine prolapsis (with / without urinary incontinence) has increased. The increase according to gender, department of studies, year of studies, determination of the in incidence of urinary incontinence comes as a result of growing age, meno- amount of smoking, quitting attempts and ex-smokers. We also determined the pause, chronic constipation, Caucasian race, pregnancy, vaginal births, obesity, knowledge of negative effects of tobacco smoking, second-hand smoking,- ad smoking, lack of physical activity as well as deviation of patients from regional vertisement of tobacco smoking and the participation of students in campaigns hospitals in our maternity. against smoking. Urinary incontinence, uterine prolapse, TOT sling, vaginal hysterectomy,Queen This was a transversal study with a descriptive component, realized with the help Geraldinë Universitary Hospital, Incidence. of a survey. The survey had 17 questions and the students answered anonimously. The participation of students was random and structured depending on the general PP080 - Awareness of type 2 diabetes and hypertension: a cross-sectional study number of students per gender, year and the number of students per department. 800 F.Kamberi, E.Alushi, V.Pulomemoj, J.Celoaliaj students participated on the survey, 693 of them completed the survey correctly. Worldwide, raised blood pressure is estimated to cause 7.5 million deaths, about 12.1% of the students were smokers. 5.7% of the total number of females and 12.8% of the total of all deaths and type 2 diabetes prevalence has been rising 23.1% of the total number of males, were smokers. More students in higher years more rapidly in middle- and low-income countries. Healthy diet, regular physical of studies were smokers (6th year students-22%). 45.2% of smokers smoke 1-10

296 297 Presentation Session Plenary Plenary Poster

cigarettes a day. 65.5% of the smokers smoke in daily basis. 39% of the smokers new national laboratory plans should be consistent and unlimited in the methods Poster Plenary Session intend/have tried to quit smoking. 5% of all the students that participated in the of change. Coordination within, and between hospitals should also be a priority of Presentation survey were ex-smokers. 12.4% of the students are “continuously” exposed to sec- the study. Labor standardization and quality control remain challenging, making ondary smoking. 98.8% have knowledge of the negative effects of smoking. 40.9% hospital accreditation a difficult goal at the moment. of the students took part actively or passively in campaigns against smoking. 10.4% We show how changing public hospital laboratories implies professional engage- have in possesion something with a smoking-related logo and 52% of them admit- ment of hospitals managers to be the initiators of today’s change of public labs. We ed to have noticed advertisement of tobacco smoking in tobacco selling points. reflect on how lab professionals need to produce accurate, sensitive and specific Our findings were very similar with developing countries but differ from devel- patient information using new technology driven by clinical decision-making. We oped countries, where the overall prevalence of smoking is lower. Approximately will recommend how the role of laboratory professionals and public-private lab 1 of 10 Medical Faculty students are smokers, 1 of 5 males and 1 of 20 females. partnerships today creates the conditions for changing public laboratories in the 2 out of 3 smokers smoke in daily basis. Exposure towards secondary smoking country. Through this we will show what the links are to be followed to increase is high. Knowledge of negative effects of tobacco smoking is high. 1 out of 3 the patient’s diagnostic care and improve the quality of care. smokers tried/intented quitting. There are 3 times more smokers than ex-smokers. This research is promising for health professionals as it reflects that hospital labo- Tobacco smoking is advertised among population. Nearly half of the students par- ratory services are a vital component that provides optimal results not only for the ticipated in campaings against smoking. patient but also for the hospital. This is promising because the public lab serves to improve the health of the population and provides them with real-time perform- PP082 - Improving the quality of laboratory hospitals in Albania: Time for ing pre-surgical examinations by determining their condition. Patient results are Change achieved by providing the necessary laboratory information. They measure and F.Harxholli (Beqo), R.Degjoni provide vital information by helping clinicians in making medical decisions. Every year in Albania, about five (5) million laboratory examinations are carried Our research recommends to health care providers that laboratory services are out only in the public hospital sector. Public hospital laboratories provide diag- (i) vital component for providing optimal patient outcomes; (ii) result in hospital nostic information and assurance that the tests performed are accurate, performed decision-making; (iii) provide time, patient and outcome; (iv) provide accurate in a timely manner and are the right person. Completion of the examination pro- information; (v) Provide evidence-based decision-making information; (vi) are duces reliable test results, and enables doctors to perform patient diagnosis and objective evidence on which accurate diagnosis is established; (vii) meet stan- therapeutic decisions are appropriate as they are based on the appropriate level of dards and protect the health of the population; (viii) establish new standards of laboratory resources. The provided laboratory information enables doctors to re- accreditation; (ix) continuing qualification competence; (x) establish cooperative ceive evidence-based therapeutic decisions for their patients. Hospital laboratory relationships with all health care structures in the country. services are the most effective, less invasive source of objective information used in hospital decision making. The hospital lab has a direct impact on many aspects PP083 - Use in Clinical Practice by Nursing Staff of Proper Body Mechanics: of patient care, including but not limited to patient safety, stay days, bed use, and Cross-Sectional Study patient satisfaction with the hospital service provided. G.Haskja, F.Kamberi Hospital technology is changing and meanwhile the quality of hospital services Musculo-skeletal disorders are important problems of Public Health especially for will change. The emergence of new illnesses, the treatment of population morbidi- certain occupations involving the nursing profession. Body mechanics includes ty, encourages the need for the creation of a more sophisticated hospital laboratory coordinated efforts of the musculoskeletal and nervous system to maintain equi- with the use of new diagnostic technology. The morbidity changes in the country librium the position and extent of the body during flexion, movement and activity and the speed with which they are spreading in the population are indications in everyday life. Knowledge of the proper use of body mechanics should be very of the need for faster and safer patient diagnosis. Thus, the hospital laboratory good by nursing staff, this reducing the risk of injury and related problems with the should be seen as an indispensable partner in providing the patient’s quality of life, profession. This cross-sectional study was conducted at the Vlora Regional Hospi- maintaining public health, reducing hospital costs, and increasing hospital perfor- tal in November 2017 – February 2018 to determine the knowledge of nursing staff mance. Subjects (n=40), public hospitals in Albania out of which (n=5) university on the proper practise of body mechanics in daily clinical practice. 53 out of 54 hospitals, (n=11) regional hospitals and (n=24) municipal hospitals provide labo- nurses participated in the study. The nursing staff’s knowledge of body mechanics ratory services require the need for investment to improve the infrastructure, the and it’s practice was evaluated by a structured literature questionnaire. Statisti- environment and the public laboratory system in the country. The study of (n=40) cal analysis included the calculation of averages, frequencies and percentages. subjects of public hospital laboratories indicates the importance of improving lab- Most nurses were women (n=38.72%) aged 25-30, while men were 15 (28%) aged oratory infrastructure and improving diagnostic services. The implementation of 31-35 years. Most of them had a working experience of 5-10 years ( n=21, 40%).

298 299 Presentation Session Plenary Plenary Poster

There was a significant statistical difference between nurses in different depart- tial specimen, if the clinical suspicion is worse than reported by the pathologist’s Poster Plenary Session ments in relation to the level of the nurses (p=0.0019). This, in the Department report, or to ensure the absence of muscle invasion [13]. The reTUR could remove Presentation of Surgery, Pathology and Renal Surgery, most nurses have good knowledge of any residual disease (up to 75% of Ta and T1 patients) and resample the initial Body Mechanics ( 81%, 77% and 58%). The best practices of MT have nurs- resection area [14,15]. After the removal of residual lesions, upstaging from Ta es with 1-5 years of experience while others have average practice. The best to T1 or T1 to T2, has been observed in up to 28% of initial Ta/high grade tumors practices were identified in the Surgery Department (p=0.0076) by 81%. Statisti- [14,16] and 9.5% of initial T1 tumors [17], respectively. In cases where muscularis cal link was detected between use of the body mechanics and back pain, p<0.05. propria is missing in the first transurethral resection of bladder tumors (TURBT) The results showed that most nurses had knowledge and practice of proper body specimens, the upstaging to muscle-invasive disease has been reported in up to mechanics as well as previous backache experiences. Educational programs to in- 45% of T1 patients, after undergoing a reTUR [18].The reTUR is well accepted as crease the awareness of nursing staff about the importance of proper use of body- beneficial procedure. It may increase recurrence-free survival (RFS) [19,20], pro- work mechanics during work are essential to avoid problems associated with the gression-free survival (PFS) [19], cancer-specific survival (CSS) and overall sur- lack of proper body mechanics. vival (OS) [19] after intravesical Bacillus Calmette Guerin (BCG) immunotherapy bladder installations [17]. Recent studies, which include patients with T1 stage of PP084 - Bladder cancer initial approach bladder cancer treated with/without BCG installations, undergoing a reTUR, did Gj.Semini, G.Daligaros, K.Zotos, A.Lazaridis, F.Dimitriadis not show any improvement in PFS and CSS rates, when bladder wall muscle was The urinary bladder cancer (BC) is the eleventh most common cancer in both included in the primary TURBT [21,22]. Therefore, the reTUR procedure may not genders worldwide [1]. About 2,4% of total population will be diagnosed with be necessary for this group of patients, if muscle is present in the primary histo- bladder cancer in their lifetime [2].Men are affected 3 to 4 times more frequent- pathology report. ly than women, having also the double of the mortality rate [3,4].In advanced countries about 90% of bladder neoplasms are urothelial carcinomas, occurring at PP085 - Retrieval, processing and selection of sperm for ICSI: What should the urothelial cells of the bladder wall [4,5,6]. These lesions can also affect other an urologist know? areas of the urinary tract, such as the renal pelvis, ureters and urethra [3,4].The Gj.Semini, F.Dimitriadis habit of tobacco smoking, with the presence of polyaromatic hydrocarbons carcin- Azoospermia occurs in about 5% of infertile men and poses a real challenge to the ogens in tobacco products, is the most important cause of bladder cancer [3,4,7]. fertility urologist. While there are options to create happy families for azoosper- Other causative factors are: advanced age, family history, occupational exposure mic couples, such as the use of donor sperm and adoption, most couples still desire to types of organic chemicals (found in textile dyes, rubber, petroleum products, to have their own biological offspring. Nevertheless, sperm may be present in the metals, processed leather and paints), arsenic exposure, previous chemotherapy epididymis or the testes depending on the type of azoospermia. Advances in urolo- and pelvic radiotherapy, chronic bladder inflammation/infections [3,4,8].Bladder gy and fertility laboratory technologies allow surgical sperm retrieval in azoosper- cancer signs/symptoms may include painless gross or microscopic hematuria (the mic men and achievement of live births for many, but not all azoospermic couples. most common) and irritative bladder symptoms {more often in patients with car- A variety of surgical and non-surgical options exists for sperm retrieval in the cinoma in situ (CIS)}. Rare findings are pelvic/bone pain, lower extremity edema, setting of obstructive or non-obstructive azoospermia. The available techniques flank pain and palpable mass [3,4]. The diagnosis depends mainly on cystoscopy include percutaneous options such as percutaneous epididymal sperm aspiration examination [9]. European Association of Urology (EAU) strongly recommends (PESA) and testicular sperm aspiration (TESA), as well as open techniques that performing cystoscopy in patients with symptoms suggestive of bladder cancer include testicular sperm extraction (TESE) and microsurgical epididymal sperm or during surveillance period after initial resection surgery. It cannot be replaced aspiration (MESA). Microdissection testicular sperm extraction (microTESE) is by cytology or by any other non-invasive test [10].Initial treatment for most BCs considered the most efficient method for surgical sperm retrieval among patients involves transurethral resection (TUR) in order to remove all suspected lesions with non-obstructive azoospermia. and obtain material for histological examination. The histopathology report will Assisted reproductive technologies employ sperm sorting techniques to select via- determine the cell structures, tumor margins, depth of invasion, pathology stag- ble sperm from the semen samples. Currently, standard sperm sorting methods in- ing (using the TNM classification), tumor grading (WHO grading in 1973 and clude density gradient centrifugation, direct swim-up, and conventional swim-up. in 2004) and special tests or markers [11].The treatment for primary high risk The multiple centrifugation steps during these methods, have been shown to dete- non–muscle-invasive BCs (NMIBC), such as high-grade (HG) or grade 3/Ta and riorate DNA integrity and damage sperm quality mainly through the production of T1 tumors, often includes a repeat TUR (reTUR) of bladder tumors within 2–6 reactive oxygen species. Newer technologies, such as microfluidics, electrophore- weeks of initial resection [12]. A reTUR is recommended by the EAU guidelines sis, motile sperm organelle morphology examination, and birefringence may offer if the first resection was incomplete, if bladder muscle was not present in the ini- a chance to improve the selection of sperm with higher DNA integrity, normal

300 301 Presentation Session Plenary Plenary Poster

morphology, and motility as well as improved artificial insemination outcomes. decide for the treatment of those patients, our aim is te try to precise the nature of Poster Plenary Session New technologies are being developed to assist in the preparation and selection theose changes of the endometrium and for this purpose, using endometrial biop- Presentation of spermatozoa in assisted reproductive technologies. To date progress has been sy.Normally we use the probe proposed by Novak. This is an instrument fine and proved to be frustrating and the developed methods have provided variable bene- elegant, used in asepsia conditions. The instrument is a narrow tube with channel fits in improving outcomes after ART. Maybe new strategies are required to iden- or duct in the inner part, a little flexed like the form of cervical channel.This in- tify the properties of those spermatozoa which naturally do reach the oviduct in strument is recommended to use unsing the ultrasound control and so using local order to develop more effective tests of semen quality. anesthesia, we reach the endometrium arriving to the endometrium, throw the cer- vical channel. So we can obtain some strips or fragments of endometrium which PP086 - The effect of Tolterodine Er on Female Sexual Function are immediately posed in conservative solution and deposited for histopatholog- S.Gjergji, F.Maria, S.Sotirios, D.Fotios, M.Charalampos, L.Pedro, A.Pojani, ical examination.During 4 years : 2014-2017 we realized endometrial biopsies in M.Marlon, T.Panagiota, S.Nikolaos, Z.Athanasios 42 patientes with problems associated with endometrialm hyperplasia . Their ages Overactive bladder (OAB) is a common condition requiring long term therapy were from 38-65 years and among them resulted: with anticholinergics to maintain symptoms relief. The aim of the study was to = 12 patientes with endometrial hyperplasia and secondery repeated amenorrhea; determine the effect of tolterodine extended release (ER) used for OAB treatment = 23 patientes with glandulo-cystic endometrial hyperplasia; on sexual function of women. = 4 patientes with neoplastic changes of endometrium; We evaluated 158 women with a comprehensive history, physical examination, = 3 patientes with mainly endometrotic and inflammatory endometrial changes. urodynamic studies and Female Sexual Function Index (FSFI-Gr) questionnaire. The treatment is realized oriented from the etipathogenetic factor . We are con- 73 patients of group A (Control Group) received no treatment and 85 patients of vinced that this precise diagnostic evaluation, is the best moment for good results Group B received tolterodine ER 4 mg once daily, for three months. All women of the treatment. But also the possibility for early evaluation of endometrial ma- were assessed with the Female Sexual Function Index (FSFI-Gr) in the beginning lignancies. and at the end of the three months’ study. After three months treatment with tolterodine ER there was a statistically signifi- PP088 - Bronchiolitis obliterans organizing pneumonia masquerading as se- cant improvement on women sexual function (Table). Statistical analysis revealed vere persistent asthma: A case report that mean total FSFI in Group B, was significantly different before and after three Gj.Loloci months in Group B, 26,5±1,5 compared to pre-treatment values 17,4±1,4, p<0,01. A Bronchiolitis obliterans organizing pneumonia (BOOP), bronchial asthma, cor- statistically significant increase was also noted in domains of desire (pre-treatment ticosteroid therapy. Background: Bronchiolitis obliterans organizing pneumonia 2,5±0,2 to 4,5±0,2 post-treatment), arousal (3,1±0,2 to 4,4±0,3 respectively), lubri- (BOOP) is a clinic pathological entity characterized by: 1) a pneumonia-like clin- cation (3,4±0,3 to 4,3±0,3 respectively), orgasm (3,5±0,3 to 4,5±0,3 respectively), ical presentation and a history of rapidly progressive dyspnea; 2) visualization of satisfaction (2,6±0,2 to 4,2±0,3 respectively) and pain (2,4±0,2 to 4,6±0,4 respec- patchy infiltrates on chest computed tomography; and 3) histopathological evi- tively), after three months treatment with tolterodine ER. In Group A there were dence of intraluminal organization, especially in alveolar ducts. A 55 year old no statistically significant changes in pre and post treatment values (p>0,05). The woman presented at our hospital with progressive moderate dyspnea, dry cough, current study demonstrates that treatment of OAB with tolterodine ER was found to wheezing and malaise. She had a past history of Bronchial Asthma and was treat- have a significant positive effect on the sexual function of female patients with OAB. ed for the last 12 months with inhaler corticosteroid and bronchodilator, without clinical improvement. Lung function tests showed a moderate obstruction. Arterial PP087 - The endometrial biopsy usinG “NOVAK “ PROBE, for endometrial blood gas analysis showed a Pa O2 of 8.9 k Pa (67 mmHg), a Pa CO2 of 4.9 k Pa pathologies diagnostics (37 mmHg), and a pH of 7.44. Usual laboratory tests were unremarkable, except Gj.Theodhosi, F.Kopani, L.Kurti for: white blood cell count 15,000 cells mm3 with 4% eosinophils and erithrosed- Endometrial pathologies are very often treated in gynecological clinical practice imentation rate 65mm/h. The tuberculin skin test was negative. Chest computed and their precise diagnostic is always necessary, to realise their correst treatment. tomography scan confirmed the presence of patchy bilateral alveolar opacities We think that especially when is precised an endometrial hyperplasia, associated with an air bronchogram. A transbronchial biopsy showed inflammatory alveolitis, or not with dysfunctional uterine bleeding, we need a further evaluation of the sit- with the presence of discrete buds of granulation tissue within alveoli. The results uation before beginning the treatment.After evaluating the clinic data, we realise of serological tests for connective tissue disease and atypical pneumonias were an ultrasound examination, studying the uterine and ovarian structure and espe- negative. The tests for viral infections were positive for cytomegalovirus. Oral cially to evaluate the thickness and structural elements of the endometrium. The corticosteroid (prednisone) was commenced and after two weeks we observed a thickness of the endometrium in particular pathologies may arrive 20 .Before to symptomatic improvement and a little clearing of the radiograph infiltrates. She

302 303 Presentation Session Plenary Plenary Poster

remained well and her chest CT scan was normal at 6 months of treatment, while Angioedema or gastrointestinal pathology (Celiac disease etc.).We didn’t bring Poster Plenary Session on a tapering dose of prednisone. BOOP was first described by Epler. It may be to evidence the etiology of abdominal swelling and distention. The etiology of Presentation idiopathic, or secondary to various causes, including reaction to different drugs, abdominal swelling and persistent severe distension is not clear; it might be an bacterial or viral infections, diseases of the connective tissue, radiation therapy, insufficiency of abdominal mesenteric arteries. myelodysplastic syndrome and human immunodeficiency virus (HIV) infection. We presented a case of Bronchiolitis Obliterans Organizing Pneumonia masquer- PP090- Cross-reactivity to acetaminophen and NSAIDs: a case report ading as severe persistent asthma. The patient’s clinical presentation in the current Gj.Loloci study of subacute onset of cough and dyspnea, and her response to corticosteroid Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are responsible therapy were typical of BOOP. for 21–25% of reported adverse drug events which include immunological and The most common chest radiograph abnormalities are those of diffuse, patchy, non-immunological hypersensitivity reactions. NSAID hypersensitivity is partic- ground glass or alveolar densities. This disease usually runs a benign course, with ularly manifested by bronchial asthma, rhinosinusitis, anaphylaxis or urticaria and complete response to corticosteroid therapy in most patients. Chest CT scan is an variety of late cutaneous and organ-specific reactions. Hypersensitivity to Acet- important examination in the differential diagnosis of asthma. aminophen (ACT) is rare and causes urticaria, angioedema, and anaphylactic re- actions. The NSAIDs-induced hypersensitivity reactions involve different mech- PP089 - Angioedema and severe abdominal distention: a case report anisms and present a wide range of clinical manifestations from anaphylaxis. The Gj.Loloci mechanism of multiple drug-induced reactions is not clear. IgE-mediated mecha- Idiopatic Urticaria and Angioedema, insufficiency of abdominal mesenteric arteries nism seems to be unlikely because patients may react to NSAIDs with completely Background: Urticaria affects about 20% of people at some point in their lives. It is different chemical structures. Mechanisms related to inhibition of COX-1, as in also known as hives or nettle rash. The short-lived swellings of urticaria are known case of cross-reactive types of NSAIDs hypersensitivity, have been suggested. as weal and typically any individual spot will clear within 24 hours. Angioedema A 10 years old boy with past history of adverse drug reaction was presented at is a form of urticaria in which there is deeper swelling in the skin, and the swelling our hospital to perform an oral challenge test with acetaminophen. Due to a viral may take longer than 24 hours to clear. In women with persistent angioedema with condition, after receiving ibuprophen 400mg and acetaminophen 500mg, he expe- an unknown cause who are unresponsive to antihistamines and steroids, and nor- rienced periorbital angioedema and erythema, dry cough, without G-I symptoms, mal C1 inhibitor activity and quantity, and a negative family history of angioede- and respiratory manifestation. He was treated with prednisolone 25mg. After sev- ma, it is unclear whether they have idiopathic angioedema or systemic disease. eral months he received ibuprofen 400mg and acetaminophen 500mg due to an- A 53 years old woman presented at our hospital with a generalized erythema, face other viral condition, and he manifested the same symptoms as the first episode. angioedema, dyspnea, dysphagia, abdominal swelling and prominent distention, The third episode happened after taking acetaminophen 500mg and mefenamic dolorous abdomen. She referred to have 9 month history with hives, dyspnea, dys- acid 500mg with all over mentioned symptoms and rhinorrhea. One month ago phagia, abdominal swelling and dolorous abdomen, especially in standing position he presented to our hospital, after receiving acetaminophen 1500 mg and metam- and during walking. Despite the treatment with antihistamine and corticosteroids, izole 400mg with symptoms such as dry cough, dyspnea, periorbital angioede- hives persisted, almost every day and some episodes included face angioedema, ma, erythema, and ciliary injection. He was treated with prednisolone 25mg and dyspnea, dysphagia, abdominal swelling and very severe distention. Physical ex- adrenaline aerosol. He had also a four years history of rhinitis. Usual laboratory amination revealed dolorous and swollen abdomen, and also a swollen face. The tests were normal. SPT were positive to D. Pter, D. Farinea, Alternaria, Cladospo- pharynx was edematous. She was not taking any drugs and had no history of in- rium. Specific IgE antibodies against these allergens were positive. We decided fections. Usual laboratory tests were unremarkable. Blood test and bone morrow to perform oral challenge test with acetaminophen, and the result was positive in exam were normal. Antigliadin antibodies, anti-tissue transglutaminase IgM and a dose of 650mg, the clinical manifestation was periorbital angioedema and ery- anti-tissue transglutaminase IgA, SPT for food and inhalant were negative. C1 thema, dry cough, dyspnea, chest tightness, hypotension. The symptoms resolved Esterase inhibitor, C4, C3, C1q was normal. The gastroenterologist confirmed no with the administration of 1/3 epinephrine 1mg/1ml s/c, prednisolone 25mg i/v gastrointestinal pathology, he also recommended abdominal CT with contrast. The and antihistamine 180mg. High prevalence of atopic background was reported. result of CT was: calcification in sickle in the wall of the abdominal aorta at the or- A stepwise approach to the diagnosis of hypersensitivity to NSAIDs is proposed, igin level of celiac trunk. She came out of hospital with the diagnosis of Idiopathic including clinical history, in vitro testing and/or provocation oral test alternative Urticaria and Angioedema, and treated with corticosteroids and antihistamines. drug depending on the type of the reaction. Aspirin sensitivity has not frequently She also was treated with α-blockers but abdominal swelling persisted. been described in younger age groups. This patient also had several unusual fea- We presented a case of a 53 years old woman with recurrent angioedema unre- tures in what he presente.. sponsive to antihistamines. The laboratory test ruled out all the types of Hereditary

304 305 Presentation Session Plenary Plenary Poster

PP091 - Surgical treatment of a Ruptured Pancreaticoduodenal Artery Aneurysm percentage of women carried the HPV. Approximately 10% of women in this narrow Poster Plenary Session H.Kolani, E.Celiku , E.Gega, E.Celiku study carried the HPV. From a questionnaire we concluded that women with the most Presentation The evaluation and treatment of retroperitoneal sarcomas are challenging be- vulnerable are fertile age, having first sexual contact < 20 years old , having more than cause the tumors are relatively rare and frequently present with advanced dis- one sexual partner and having other diseases in genital tract. ease in an anatomically complex location. We present the case of a 34 year old male diagnosed with retroperitoneal sarcoma. The bibliography used was taken PP093 - Eosinophilic Granulomatosis with ployangiitis And Diffuse Gastroin- from PubMed. Summary: Herein, we report retroperitoneal sarcoma measuring tenstinal Involvement 20X15X16 cm encasing the inferior pole of the left kidney and adherent to adja- I.Kacareli Xhafa, A.Hysa, A.Dhima, F.Dashi, E.Xhafa cent structures. We performed an organ-preserving surgical removal The patient Eosinophilic granulomatosis with polyangiitis (EGPA), formerly named Churg- was discharged after an uneventful postoperative hospital stay.A postoperative 16 Strauss syndrome, is a rare systemic small- and medium-sized-vessel vasculitis, char- month, follow-up CT was recommended to the patient. The evaluation and treat- acterized by the presence of severe asthma as well as blood and tissue eosinophilia. It ment of retroperitoneal soft tissue sarcomas remain challenging. The most import- is one of the less common vasculitides with a prevalence that ranges from 10.7 to 13 ant factor in the long-term success in the treatment of primary tumors is complete cases/million inhabitants. Characteristic histopathologic features include necrotizing surgical resection. It is important that patients with these tumors be evaluated and vasculitis in veins or arteries with infiltration mainly by eosinophils in vessels and treated at centers with multidisciplinary treatment planning and expertise in treat- surrounding tissues. Gastrointestinal (GI) involvement has been reported to occur in ing these rare tumors. Local recurrence remains a difficult problem, with increased approximately 50% of EGPA patients; however, there are few reports of histologic associated morbidity and psychological stress for affected patients. We hope that evidence of GI involvement. Symptoms include abdominal pain, vomiting and diar- with improved education, early referral of patients with retroperitoneal soft tissue rhea. Few reports have described the actual pathology as it is difficult to document, but tumors will become the norm, and patients will derive the benefits of multidisci- the small bowel is most commonly affected, followed by the stomach and colon. We plinary evaluation and treatment of their disease. report the case of a patient on tratement for asthma since 20 years, with acute abdom- inal pain, nausea, 2 weeks after cholecystecomy for cholelithiasis. A 65- year-old man PP092 - DNA-HPV screening like method for detecting the cervical problems with a past medical history for asthma on tratement with inhalator glucocorticoids and I.Ndreko, A.Kosta Zeqirllari salbutamol, presented to our Emergency Room with acute abdominal pain and nausea, Cervical cancer is one of the most common female malignancies with high mor- 2 weeks after another episode of abdominal pain, in which he went into laparoscopic tality rates in developing countries. HPV is the most common sexually transmitted cholecystectomy for cholelithiasis. He had a history of severe rhinosinusitis 21 years infection. More than 150 types of the virus exist including approximately 40 types ago, and one year later episodes of wheezing and asthma exarcerbation. On presen- that infect the human genital tract. Of these, there are oncogenic or high risk types tation, the patient was having abdominal pain associated with intermittent abdominal that are associated with cervical, vulvar, vaginal and anal cancers and low risk types distention and lower extremity purpuritic lesion, with a 12 kg weight lost for a period that are associated with genital warts. HPV 16 is the most oncogenic, accounting of 4 months. Physical examination was otherwise within normal limits. Elevated in- for halb of all cervical cancers, HPV 16 and 18 together account for approximately flammatory markers, eosinophilia of 6.21*10`3/ul( 38.6%) , IgE 575.2, Rheumatoid 70% of cervical cancers. The aim of this study was to determine the prevalence of Factor 290.7 UI/ml ; were detected. Thoraco-abdominal CT revealed: Diffuse sub- the HPV in an active sexually population, without problems identified before of the pleural biapical interstitial thickening, with reticulonodular opacities of inflammatory cervix. It”s important to detect HPV carried women, to do further tracking to prevent origin, small centrilobular ‘ground glass’ nodules , duodeno-mesenteric inflammation serious cervical problems to detect and treat them in a timely and a proper manner. with duodenal wall edema, periduodenal minimal liquid, mesenterial edema and liq- Methods: The duration of the study was 3 months (October-December 2017). Sexu- uid , ileal predominately. Endoscopic biopsies revealed diffuse eosinophilic infiltra- ally active women being studied. The material was taken by the patient themselves or tions. Inferior extremity ENMG showed: Chronic multiplex axonal mononeuropathy. during a vaginal visit from the endocervix. Women who have performed total hyster- All findings were consistent with EGPA involving GI tract, associated with chronic ectomy have been excluded. By this analysis, ADN-HPV was identified for 13 ma- multiplex axonal mononeuropthy. The patient went on medication with glucocorticoid jor risk types (16,18,31,33,35,39,45,51,52,56,58,59,68). The data was collected from (1 mg /kg weight, with a tappering dose) and immunosupresor drug(AZA). After 1 a questionnaire filled by the women. The study included 275 women of whom 225 month he showed 70% remission. conducted the analysis and 50 of them rejected it. 97 of them received the material The respiratory tract is almost constantly involved, but any organ system can be themselves after the instructions and 128 received the material after a vaginal visit by affected. The diagnosis of EGPA in the GI tract requires high clinical suspicion as the doctor. 204 of them were negative and 21 were positive. All of them positive per- histologic documentation of vasculitis may be unavailable and eosinophilia may formed Pap Test and Colposcopy. 2 of them resulted ASCUS in pap test and normal in be the only finding. Improved awareness of GI EGPA may allow for timely man- colposcopy and only one resulted HSIL in pap test and Displasi in colposcopy. A high agement of this disorder.

306 307 Presentation Session Plenary Plenary Poster

PP094- Cardio-hepatic syndrome and its influence on acute decompensated ment, blood in feces that makes stools look black, bright red blood coming from Poster Plenary Session heart failure patients in a single tertiary cardiology center the rectum, pain and bloating in the abdomen, a feeling of fullness in the abdomen, Presentation I.Sharka, S.Myftiu, B.Dida, J.Rustemaj even after not eating for a while, fatigue or tiredness, unexplained weight loss. Cardio-hepatic syndrome (CHS) is a newly emerging definition for acute liver injury Bowel cancer may be diagnosed by obtaining a sample of the colon during a sig- in acutely decompensated heart failure (ADHF) patients (pts); it may be associated moidoscopy or colonoscopy. This is then followed by medical imaging to deter- with cardio-renal syndrome (CRS); recent data have demonstrated the implication mine if the disease has spread. Screening is effective for preventing and decreasing of CHS in HF management and prognosis; the aim of the study was to evaluate the deaths from colorectal cancer. Treatments used for colorectal cancer may include presence of CHS in ADHF patients in a tertiary cardiology center; main predictors some combination of surgery, radiation therapy, chemotherapy and targeted ther- of CHS occurrence and the influence of CHS during in-hospital management of apy. This research is descriptive with retrospective components and the data are ADHF patients. we prospectively analyzes clinical and laboratory records on 365 taken from the book of protocol of the people with Colorectal Cancer treated in consecutive ADHF patients from 2013 to November 2017; liver function tests were the hospital Center “Xhaferr Kongoli” in the period time of 2014-2016. This study used for the screening of CRS (a ratio of ALT/LDH <1.5 was considered a cardio- involved 32 patients. From 32 patients 10 are males (31 %) and 22 are females genic injury), a MELD score evaluation was performed on a daily basis; ADHF (69%). From these 19 patients or 59% are from the city and 13 patients or 41 % are patients were stratified into three levels: I (CHS absent), II (CHS present), III from village. The most affected age is over 60 years old with 17 patients (53%), (CHS & CRS present); a composite endpoint (use of intravenous inotropes, diuret- 45-54 years old with 7 patients (22%), 55-64 years old with 5 patients (16%), 35- ic resistance, a prolonged in-hospital treatment > a week, cardiac death) was de- 44 years old with 3 patients (9%). Discussion: Based on the date obtained from fined a complicated clinical course; a Cox proportional hazards model was used to patients treated for colorectal cancer we conclude that: define the relation of CHS presence to the complicated in-hospital clinical course. 1.The most frequently affected age group is over 60 years old. CHS was present in 237 (64.9%) pts; between CHS and non CHS patients there 2. The most affected sex are females were no significant differences in age (63.4 ±0.3 vs 62.3±0.7, p>.05), sex (males) 3. It is more spread in urban areas than rural ones (57.3% vs 56%, p>.05), diabetes (31.4% vs 29.2%, p>.05); but there were sig- nificant differences in MELD score (39.4±7.7 vs 16.2±8.5, p<.0001); re-hos- PP096 - Title: Microinvasive squamous cell carcinoma arising within sebor- pitalizations for AHF 4 (2 to 6) vs 2 (0 to 3), p<.05; cardiac index <1.5 l/min/ rheic keratosis. A case report m2 (61.5% vs 17.6%, p<.0001); PASP (53±18 vs 38±12 mmHg, p<.001); use I.Dino, L.Berdica, T.Bushati, A.Dafa, J.Memini, D.Billa of inotropes (61.1% vs 19.7%, p<.0001);); Charlson Comorbidity index (CCI) Iris Dino2, Leart Berdica1, Teona Bushati1, Artan Dafa2, Jorida Memini2, Dorina ≥4 (67.4% vs 46.2%, p<.001); diuretic resistance (26,8% vs 8.6%, p<.0001). Billa2 Seborrheic keratosis (SK) is a benign hyperplastic tumor of the epidermis Main predictors of CHS occurrence in Cox regression were: low cardiac index; occurring in about 20 percent of the elderly population. There are several types high PASP; re-hospitalization for AHF; diuretic resistance; HR (95%CI) of level of SK; reticulated, acanthotic, pigmented, clonal, irritated, hyperkeratotic, or flat. II to I of ADH patients was 1.86 (1.24 - 2.67, p=.0025) and level III to I was 3.69 Squamous cell carcinoma (SCC) is a malignant neoplasm with differentiation into (2.14 - 6.87, p<.0001). cardio-hepatic syndrome seems to be a clinically important the stratified squamous epithelium. Squamous cell carcinoma (SCC) arising with- member of the constellation of end-organ involvements in ADHF patients, which in seborrheic keratosis (SK) is rare. presence offers significant clinical and prognostic implications in our daily cardi- Our case is a 73-year-old man presented with rapidly growing pinkish nodular ology practice; identifying patients more susceptible to CHS would help to reduce lesion with microerosions on its surface on his left temporal skin region of several clinical complications in HF management and thus lower costs of treatment im- time duration. Clinically a skin cancer was suspected and an excision with wide posed by a prolonged hospitalization; further studies are needed to help clinicians margins was performed. The biopsy revealed seborrheic keratosis in reticulated in CHS treatment guidelines. patern but also atypical squamous cell cluster was seen in the central low area. These cells showed mitotic figures nuclear atypia, and microinvasion, in favor PP095 - The cases treated with Colorectal Cancer in the hospital Center of microinvasive SCC. “Xhaferr Kongoli” in the period time of 2014-2016 In our patient the clinical fact that the lesion was present for about two years, rap- I.Zhika, O.Qeva idly enlarged with microerosions suggested that the SCC arose within SK. Squa- Colorectal cancer (CRC), also known as bowel cancer and colon cancer, is the mous cell carcinoma (SCC) arising within seborrheic keratosis (SK) is rare, but development of cancer from the colon or rectum . A cancer is the abnormal when this occurs it can be very devastating for the patient. Therefore a biopsy of growth of cells that have the ability to invade or spread to other parts of the body. any suspect or changing seborrheic keratosis is essential. And a thorough clinical Symptoms of colorectal cancer include: changes in bowel habits, diarrhea or con- follow-up is also very needed. stipation, a feeling that the bowel does not empty properly after a bowel move-

308 309 Presentation Session Plenary Plenary Poster

PP097 - A six month study of pulmonary cancer in Albanian women advances in chemotherapy, antiretroviral drugs, and supportive care protocols and Poster Plenary Session J.Nikolla, B.Cekrezi, E.Sera improved outcomes the prognosis for these patients still remains poor. Aim of the Presentation Pulmonary cancer is a lethal disease, growing up in Albania especial- study: We provide the case of a 34-year-old male HIV infected who was presented ly in women.It is very important its diagnostication in early stages of disease. at the hospital for a enlarged mass in the sinister axillar region which revealed to Objectives: A survey of behavior of the primary and secondary pulmonary cancer be an enlarged lymphnode. Histopathologic examination and additional immu- in Albanian women,considering:age,diagnostic methods, smoking UPA /year,stag- nostains confirmed the diagnosis of Lymphocytic depleted Hodgkin Lymphoma. es,histologic type,karnofski performance and treatment. Materials and methods: This is a 6-month retrospective study.We evaluated the PP099 - “The association between consumption of sugar containing bever- number of women with primary and secondary pulmonary cancer from the period ages and the prevalence of Non-Alcoholic Fatty Liver disease among mid- of January-June 2018. dle-aged and elderly population: The Rotterdam Study” Results:54 cases in total.30(57%)primary cancer and 24(43%)secondary pulmonary J.Musa, T.Voortman Oscar Franco Jana Nano cancer. The greatest number of cases was between 60-70 years 21(40%).The main diag- Non-alcoholic fatty liver disease (NAFLD) affects ~22-30 % of adult population nostic method was thoracic scanner(CT) 28(52%). Women nonsmokers 48(89%),smok- worldwide, and its prevalence is rapidly increasing. Many risk factors account ers 6(11%),average UPY 30.Histological types:epidermoides 3(5.5%),adenocarci- for this trend, among which lifestyle and nutrition. We therefore examined the nomas 20(37%),bronchiole-alveolar 2(3.7%),mix 3(5.5%),NSCLC 2 (3.7%).Stages: association between intake of sugar containing beverages and non-alcoholic fat- I-5 (9%),II-4(8%),IIIA-4(8%),IIIB-5(9%),IV 36(66%).Karnofski performance:High ty liver disease in a large population based cohort study, the Rotterdam study. -32(59%),Medium-17(32%),Low-5(9%).Treatment:Operated 8(15%),chimiotherapy Methods: The Rotterdam Study (RS) is a large, prospective, population-based 45(83%),1 (2%)treated abroad. Secondary pulmonary cancer from:5 (9%) mesotelio- cohort study, conducted among middle-aged and elderly inhabitants of the Om- ma,mediastinum 2 (3.5%), trachea 2 (3.5%),mammary 4 (7.4%),thymus 3(5.5%),uterus moord district in Rotterdam,Sugar containing beverages was estimated using a 3(5.5%) and 1(1.8%)respectively colo-rectal,ovary,cerebry,thoracic pareth and melano- food frequency questionnaire for habitual dietary intake for different visits of the ma. Nonsmokers women are the main group.The most frequent histological type was Rotterdam Study. the adenocarcinomas.Mesotelioma was the first from the secondary pulmonary cancer This study included 4368 participants. NAFLD was defined by the presence of liv- followed by mammary cancer. The time of the diagnostication of pulmonary cancer is er steatosis on abdominal ultrasound, in the absence of secondary causes as exces- delayed despite good performance of cases.The role of tobacco is not very evident but sive alcohol consumption ( >14 alcoholic beverages weekly), hepatitis B surface consideration should be given to the short time of study. antigen and or hepatitis C virus positivity, and use of fatty liver inducing pharma- cological agents (i.e amiodarone, tamoxifen, corticosteroids, and methotrexate). PP098 - Lymphocytic depleted Hodgkin disease associated with HIV. Case We investigated the association of sugar containing beverages and the prevalence presentation and review of literature. of NAFLD by using logistic regression. In addition, we also investigated the as- J.Hysko, L.Berdica, T.Bushati, E.Kola sociation of SCBs and Fatty Liver Index (FLI) by using linear regression. Results: Lymphomas represent the third most frequent neoplasia on a worldwide scale and 55.9 % percent of the study population consisted of women. Mean (±SD) age of constitute 3 % of malignant tumors. Hodgkin disease was described first by Thom- participants was 70±8.76 years and mean BMI was 26.8±4.25 kg/m2. Participants as Hodgkin’s and Samuel Wilks in the first half of the 19th century. They are now were predominantly of Caucasian ethnicity (95.5%). After adjusting for age, co- regarded as encompassing two clearly defined entities according to the WHO clas- hort, gender, total energy intake (kcal), education level, smoking, physical activity, sification: nodular lymphocyte-predominant Hodgkin Lymphoma (NLPHL) and alcohol intake, HOMA-IR, Diet quality score, BMI (model 2) the odds ratio of fat- classical Hodgkin Lymphoma (CHL). Case report diagnosed with H&E stain and ty liver disease was not different across sugar-sweetened beverages consumption Immunochemistry. Lymphocyte-depleted classical Hodgkin lymphoma (LDCHL) categories. Regular sugar-sweetened beverage consumption was not associated is the rarest subtype of classical Hodgkin lymphoma (CHL), comprising less than with greater risk of fatty liver for second tertile (OR 1.08, (0.88-1.33) and for third 1% of all Hodgkin lymphomas.Its rarity and heterogeneous morphological char- tertile (OR 1.18 (0.96-1.45) compared with the reference category. Moreover, we acter makes the clinicopathological identification difficult. HIV-infected patients did not find an association between SCBs (continuous) and risk of NAFLD (OR appear to be at increased risk for developing lymphomas and especially Hodgkin 0.98 (0.88-1.09). However an inverse association was found between higher intake Lymphomas when under treatment with antiretroviral therapy (HAART). In ad- of SCBs and higher of fatty liver index (β regression 1.3 (0.22-2.4)) Even when dition to that EBV was detected in almost all cases of LDCHL occurring in these we categorized the FLI<60 and FLI≥60. the direction of association remained the patients, thus accounting as an etiological factor in the pathogenesis of the disease. same. In this large, cross-sectional study of middle- aged and elderly adults, we AIDS-related lymphomas tend to present with advanced-stage disease, and an ag- found no association between SCBs intake and prevalence of non-alcoholic fatty gressive clinical course. Although the optimal treatment of these neoplasms recent liver disease.Regular sugar containing beverages consumption was not

310 311 Presentation Session Plenary Plenary Poster

PP100 - Thoracolumbar burst fractures: Fixation types, levels, methods to by hypocalcemia in adults”. This review based on data obtained from articles pub- Poster Plenary Session save motion segments lished in accredited scientific journals. Presentation K.Cagri Kose There were used data from studies conducted in people over 18 years old. The ear- Thoracolumbar area is subject to the highest stresses in the human spine and is the ly detection of calcium deficiency through routine examinations (either designed place where wost of the traumatic fractures occur. Although fractures at this loca- by the family physician) can be very profitable in reducing or preventing problems tion are quite frequent the management of thoracolumbar burst fractures remains caused by hypocalcemia in the older ages. challenging. An ideal treatment should effectively correct the deformity, induce The long-term prospective cohort type studies are required, considering the health neurological recovery, allow early mobilization and return to work, and be asso- and financial benefits of early detection of hypocalcemia. These studies need to -in ciated with minimal risk of complication. This talk aims to demonstrate evidence vestigate dietary oral intake of calcium, its optimal dosage and vitamin D supple- regarding anterior, posterior or combined treatment of thoracolumbar fractures ments. It is necessary also the magnesium blood level, if it absent depending the and to discuss newer alternatives as percutaneous spinal fixation and temporary age, gender and socio-economic status of people and considering the atmospheric fixation of levels including short or long fusion constructs. Vertebral augmentation conditions of Albania. A greater work needs to decide national strategies and a of traumatic fractures will also be discussed. national database about optimizing calcium daily intake by adults.

PP101 - Demographic, Clinical and Laboratory Characteristics of Epstein PP103 - Principles of doing a good and mininvasive technique in peritrochan- Barr Virus Hepatitis in Immunocompetent Patients teric fracture, proximal femoral nail K.Nasto, E.Puca, E.Qyra, M.Qato, M.Dede, J.Majko, I.Koshovari, P.Pipero L.Fezollari, GjCaushi, A.Duni, V.Ruci, E.Cami, E.Selmani, K.Sejdini, S.Memini, Epstein-Barr Virus (EBV) infection has the potential to establish life-long, benign Z.Demiraj, G.Bassi, A.Gega infections in their hosts. Abnormal liver blood tests are common in Epstein - Barr The unstable patterns include reverse obliquity fractures, transtrochanteric frac- virus infection, but symptomatic hepatitis is rare. This study describes demograph- tures, fractures with a large posteromedial fragment implying loss of the calcar ics, clinical and laboratory characteristics of EBV hepatitis. buttress, and fractures with subtrochanteric extension. To verify the demographics, clinical and laboratory features in patients diagnosed These fractures, in general, should be treatedwith an intramedullary nail because with EBV hepatitis. Retrospective review of all immunocompetent patients diag- of the more favorable biomechanical properties of an intramedullary nailcom- nosed with EBV hepatitis, hospitalized at Mother Theresa Universitary Hospital pared with a sliding hip screw. An intramedullary nail is located closer to the of Tiranaover a 5 year period. Fifteen of 99 patients (15.1%) treated for EBV, had center of gravity than is a sliding hipscrew, and therefore the lever arm on the fem- EBV Hepatitis. Median age was 26 years (range 14 – 40). oral fixation is shorter. Intramedullary nails can more reliably resistthe relatively Male /female ratio 2: 1. At the presentation 100% hadfever, sore throat 60%, head- high forces across the medial calcar that are typically borne by the implant in an ache 40%, nausea 13.3%. AST median value 210 U/L, ALT medianvalue 522 U/L, unstable fracture. bilirubin median value 0.9 mg/dl, ALP and GGT levels were also increased. All Theintramedullary position of the implant also prevents shaft medialization, which the patients had hepatosplenomegaly at the presentation and 86.6% had lymphade- is a common complication associatedwith the transtrochanteric and reverse obliq- nopathy. Lymphocytosis was present in 66.6% of the patients. uity fracture patterns. The ideal starting point is slightly medial to the exact tip of Hospitalization time median value was 11 days. Laboratory changes lasted for a the greater trochanter. A starting point that is slightly medial to the exact tip of the median 20 days. Temperature lasted for a median of 4 days. Liver involvement in trochanter prevents varus reduction of the proximal fragment or a high lag-screw acute EBV infection represents mild and self-limited hepatitis and can present as position in the femoral head. cholestatic hepatitis with or without features of infectious mononucleosis. Beware of the Anterior Bow of the Femoral Shaft The concern with using a straight intramedullary nail in a bowed osteopenic femur PP102 - The importance of calcium daily intake in adults is that the nail can impinge on, and in some cases even perforate, the anterior fem- K.Vrenjo, L.Mezini oral metaphyseal cortex distally.Most commercially available intramedullary nails Hypokalcemia is one of the major health problems in the world, knowing that it have a radius of curvature of between 1.5 and 2.2 m, ideally it should be 2 m.If causes a variety number of diseases such as Osteoporosis, Multiple Sclerosis etc. resistance is encountered during insertion of a long intramedullary nail for fixation The purpose of the study: The purpose of this study is the importance of calcium of an intertrochanteric fracture, the surgeon should obtain a lateral radiograph of intake, depending by age, gender or socio-economic status and to determine an the distal part of the femur rather than trying to impact the device with ahammer. optimal calcium daily dosage depending the atmospheric conditions of Albania. Do Not Use a Hammer to Seat the Nail. Material and Method: This study is a review type of literature and it performed on It is important to achieve a vertical trajectory with nail insertion. It iscritical that the information required on Internet. The asked issues were “The problems caused the nail be inserted by handwith slight rotational motions. A hammer is not recom-

312 313 Presentation Session Plenary Plenary Poster

mended since its use can lead to iatrogenic femoral fracture. Reaming the intra- PP105 - The relationship between the comorbidity and the socialdemograph- Poster Plenary Session medullary canal to a diameter that is 1 mm larger than the diameter of the selected ic characteristics, lifestyle factors, in patients hospitalized in the internal Presentation intramedullary nail. medicine clinic, Q.S.U. TIRANA Unstable peritrochanteric fracture axially or rotationally- select long nail and lock L.Collaku, M.Resuli, A.Collaku, E.Roshi, M.Tase the nail distally. Most unstable fractures of the proximal part of the femur require The purpose of this study was to describe the relationship between age, other so- a long intramedullary nail because it preventsa subsequent fracture in the sub- cio-demographic characteristics such as sex, origin, employment, as well as char- trochanteric area and it should be locked distally. Avoid Varus Angulation of the acteristics related to lifestyle (smoking, alcohol), and multimorbidity and comor- Proximal Fragment. One way to assess varus or valgus position during surgery is bidity in patients hospitalized in Albania. to look at the relationship between the tip of the greater trochanter and the center This was a study conducted at the Department of Internal Medicine and Hyperten- of the femoral head. These two points should be coplanar. If the center of the fem- sion of the Mother Theresa University Hospital Center in Tirana. This study was oral head is distal to the tip of the greater trochanter, the reduction is in varus. If the performed during the period August 2013 - June 2014 and included 974 patients center of the head is proximal to the greater trochanter, the reduction is in valgus. (454 or 46.6% males, and 520 or 53.4% females).​​ In generally most surgeons choose a nail with a 130_ neck-shaft configuration. The overall average age of the study population was 61.3 ± 13.5 years. About 57% Varus and high lag-screwplacement are associated with an increased frequency of patients were hospitalized due to an emergency situation, while the remaining of failure of fixationwith an intramedullary nail and slidinghip screw.Varus an- 43% were hospitalized by planning. Regardless of the type of hospitalization, the gulation of the proximal fragment increases the lever arm on the fixation since it average hospitalization period was 11 ± 6 days. The average value of the total makes the femoral neckmore horizontal and therefore functionally longer when number of pathologies (including the major diagnosis and possible accompany- body weight is applied. This also results in the femoralhead fixation being placed ing diseases) was significantly higher in elderly patients (≥61 years) compared to more superiorly in the head than is ideal and increases the risk of the device cut- younger patients (≤60 years of age): mean values were 4.8 vs. 3.6, respectively tingout of the femoral head. (P <0.001). The average number of diseases was higher in females compared to Avoid Fracture DistractionWhen Nailing males (4.4 versus 4.1, respectively; P = 0.03). The average number of diseases was Fractures that are internally fixedin distraction are at risk for nonunionand even- higher among individuals from Tirana compared to patients from other districts of tual hardware failure. The nail breaks through its weakest point, whichis the large the country (4.4 vs. 4.1, respectively; P = 0.03). The average number of diseases aperture in the nail for thelag screw.To eliminate distraction,the traction on the was higher among smokers compared to non-smokers (4.7 versus 4.2, respective- lower limbshould be released during surgery priorto insertion of the distal locking ly; P = 0.01). There was no evidence of any statistically significant change in screwsand fluoroscopy should be used toconfirm that there is bone-on-bonecontact. the average number of diseases among patients reporting alcoholic beverages and those not consuming alcoholic drinks (P = 0.34). PP104 - Treatment of Benign Prostate Hyperplasia in the Primary Health Center Conclusions: In Albania, the burden of comorbidity and multimodality is high in L.Hoxha both men and women, especially in the old-age subgroup. As expected, there was In the Seventh Primary Health Service are being studied over 300 patients with a higher number of pathologies, or higher multimorbidity in patients > 61 years of prostatic benign hyperplasia during the perid 2016-2017. During this time all the age. However, future studies should be performed about the extent, distribution and patients are completed with basic ultrasound and urine and PSA (prostatic specif- risk factors of comorbidity and multimorbidity in the general population of Albania. ic antigen) Levels examinations. All patients are treated with alfa blockers such as tamsulosin when the dimension of prostate galndula was below 40 cc that is PP106 - Hospital Infections (Is) Profilacy- Nursery, Treatment, Evaluation, 45 % and with both finasteride and tamsulosin when the dimension of prostate Provision, Education glandula was above 40 cc that is 60%. This because all patients with finasteride L.Saja, A.Haxhiu, N.Merko, K.Latifi treatment without tamsulosin co adjuvant therapy suffered from disorders during The infection bites are all hospital facilities that serve to spread the infection, just urination and ejaculation. So a co therapy between finasteride and tamsulosin was as medical staff Infectious Infections (IS) or nosocomial infections are circulating used. The outcome was very good. and acquired in the hospital During the hospitalization of patients, therefore, re- There was a reduction in prostate volume and size. Only few patients were de- ceiving another infection plus during hospital stay. There are no incubation peri- tected with prostate cancer during digital rectal examination and sent to hospital ods either at the incubation time or at the time of laying. Infection begins with the for further treatment. Patients with PSA level normal were 75% and those with onset of temperature on the third day after laying (48 hours to 72 hours) Nozoko- abnormal elevated level 25% . But all of them with high level of PSA were with mial infection is an indicator of the quality of service! The source of infection is all urine infection associated and therefore were treated with antibiotics appropriate hospital facilities that serve the spread of infection, as well as medical personnel. for type of infection. For the reduction of morbidity, mortality in hospital beds, IS reduces the quality

314 315 Presentation Session Plenary Plenary Poster

of life If they are poor and are also very costly High nosocomial infections are PP108 - Oral higiene and food intake during pregnancy Poster Plenary Session indicators of the quality of service L.Haxhihyseni, A.Haxhihyseni, D.Haxhihyseni Presentation Incidence and cost: Infants receiving hospital attend 2 to 12% (on average 5%) To emphasize the importance of dental checkups during pregnancy, to increase oral of the patients. IS have mortality of about 1% and contribute to a 3% mortality hygiene and improve the nutritional structure and the daily quality and amount of increase in other diseases. Causal pathogens, gram-negative bacilli occupy the food during pregnancy. bulk of the list of pathogenic germs of IS Knowing the protective measures for IS Materials and Methods: The study was conducted on a population of 41 pregnant reduces the risk of occurring nosocomial infections in the patients and the health women selected randomly in the “Tradition”Obstetric-Gynecoligic Clinic, aged worker. Minimizes the rate of nosocomial infection and protects the health person- between 20 and 40, with Albanian nationality. Two dental visits were performed nel and visitors from the risk of infection. These infections are very problematic during pregnancy. The first visit to the first trimester of pregnancy in which the -pa Because they are very risky around the globe, awareness, implantation of the pris- tient completed the formular, questionary; completion of the personal information ons on the recognition and protection of hospital infections, and risk management, by the operator to have a statistical study of changes in oral cavity during preg- their reporting indeterminacy at the right time of the incidents, the evaluation of nancy, and we gave to pregnats who partecipate, food education and oral hygiene the working conditions increase sharply Staff orientation in hospital care by im- instructions through viewing a educational video material for pregnancy and oral plementing specific guidelines. From the observation, ISs in hospitals are present hygiene, to foster awareness. The second visit was made to the third trimester of and problematic, but that much work and care by staff can be eliminated. More pregnancy in which oral oral hygiene was performed and was valutated education- information is available from the staff. Awareness and engagement in all structures al motivation either of the oral hygiene practices performed at home as well as of for this classroom the correct diet regime. Results: Only 19% had basic education and only 29% of them have good oral PP107 - Profilacy nursery, treatment, evaluation, provision, education hygiene, while 26% follow a balanced diet regime with an adequate caloric in- L.Saja take. 62% of them receive super-calorie diets of carbohydrates, which overwhelm Awareness of professionals, relatives and visitors to Hospital Infections. The infec- weight with macrosomic babies. 54% represent cramps and dental plaques, of tion bites are all hospital facilities that serve to spread the infection, just as medical which 22% did not have made any stomatologic visit. We are aware that this study staff Infectious Infections (IS) or nosocomial infections are circulating and acquired needs to be expanded. Basic oral hygiene education is insufficient. More educa- in the hospital during the hospitalization of patients, therefore, receiving another tional work must be done from Women’s Centers to increase oral hygiene levels infection plus during hospital stay. There are no incubation periods either at the and improve the structure and amount of food taken during pregnancy. incubation time or at the time of laying. Infection begins with the onset of tempera- ture on the third day after laying (48 hours to 72 hours) Nozokomial infection is an PP109 - Acne and her impact on the quality of students’ life indicator of the quality of service! The source of infection is all hospital facilities L.Kuneshka, N.Maliqari that serve the spread of infection, as well as medical personnel. For the reduction of Acne vulgaris is a common chronic skin disease involving blockage and/or inflam- morbidity, mortality in hospital beds, IS reduces the quality of life If they are poor mation of the pilosebaceous units (hair follicles and their accompanying sebaceous and are also very costly High nosocomial infections are indicators of the quality of gland). Acne can present as non-inflammatory lesions, inflammatory lesions, or a serviceInfants receiving hospital attend 2 to 12% (on average 5%) of the patients. IS mixture of both, affecting mostly the face but also the back and the chest. Since it have mortality of about 1% and contribute to a 3% mortality increase in other diseas- is mostly shown on the face, it gives a negative impact in the mental health and the es. Causal pathogens, gram-negative bacilli occupy the bulk of the list of pathogenic quality of the patients’ life. To evaluate if the quality of life is linked with acnes germs of IS. Knowing the protective measures for IS reduces the risk of occurring and their clinical severity. 612 students, chosen from the Medical University and nosocomial infections in the patients and the health worker. Minimizes the rate of Polytechnic University of Tirana, were asked for their disturbance of acnes. The nosocomial infection and protects the health personnel and visitors from the risk of sample was chosen randomly from 1200 students who were diagnosed with acne infection. These infections are very problematic Because they are very risky around by the dermatologist. Cardiff Acne Disability Index (CADI) was used to evaluate the globe, awareness, implantation of the prisons on the recognition and protection the quality of their life in correlation with this disease and Global Acne Grading of hospital infections, and risk management, their reporting indeterminacy at the System (GAGS) was used to evaluate the clinical degree of the disease. Students right time of the incidents, the evaluation of the working conditions increase sharply gave their approval to be part of this study. Results and discussion: After calcu- Staff orientation in hospital care by implementing specific guidelines. From the -ob lating and processing the database the results showed that there was correlation servation, ISs in hospitals are present and problematic, but that much work and care between the clinical severity and the negative quality of the life (r = 0.831, P = by staff can be eliminated. More information is available from the staff. Awareness 0.027, CI 95% 1.53- 3.13). The youngest ages, students from 18 to 20 years old and engagement in all structures for this classroom live a life of a lower quality compared to the older students aged 21-23 years old.

316 317 Presentation Session Plenary Plenary Poster

(p< 0.05) CI 95% (1.31- 3.54) The clinical severity of acne influence negatively opportunistic screening. These data have been dispersed according to age and cy- Poster Plenary Session on the quality of life. Lots of other factors may affect. For example, females are tology diagnosis and were compared between the two groups. In the opportunistic Presentation more sensitive than males. Age is also another factor, the younger the patient is, group it was calculated specificity, sensitivity and predictive value. the more acne affect their quality of life. The sensitivity and specificity in both groups were 92% and 90% respectively. The ASCUS/SIL rate was 4.46 in the organized group and 4.92 in the opportunistic PP110 - Diagnosing and treating vasculitis group. Quality assurance for Pap-Smears is designed to minimize underdiagnosis L.Pelaj in pathology and cytopathology. HPV rate in the ASCUS group was 60%. Vasculitis is a disease characterized by inflammation of the blood vessels -(arter Conventional papsmear is a good diagnostic tool in both, opportunistic and orga- ies, veins and capillaries), characterized by leukocyte infiltration into the wall of nized system. HPV testing can serve as a triage for ASCUS group. The screen- the blood vessel. Inflammation can result in obesity, narrowing or even complete ing should be designed well in order to evaluate its performance and indicators. closure of the blood vessel - restricts or prevents blood flow to the blood vessels, respectively in the body tissue, and may result in ischemia or damage to the body. PP112 - Intensive care management of HELLP syndrome and acute renal There are many types of vasculitis, and they can vary greatly in symptoms, severity, failure. A case report and duration. Most types of vasculitis are rare and causes are not generally known. M. Bilaj Miraka, B.Arapi, G.Huti, S.Laho, B.Zllami, A.Sula, K.Lila In a few cases, however, the origins may be traced to recent or ongoing infections, Hellp syndrome (HS) was named by Dr.L.Weinstein in1982 and characterized by such as those caused by certain viruses. Occasionally, an allergic reaction to a med- triad(H,EL,LP).The global mortality rate of HS has been reported to be as high ication may trigger vasculitis. I.e. there are genetic, but not hereditary components. as 25%.HS is life-threatening obstetrical complication with high risk of maternal Sometimes vasculitis can develop after an infection has come and gone. Usually mortality. We described the case of HS and ARF with special focus on diagnosis, in these cases, the infection triggers an abnormal response in the person’s immune multisystemic complications and treatment in our ICU at American Hospital1. system, damaging the blood vessels. Vasculitis also may be related to other diseases The patient 28 y-old, woman was admitted to the American Hospital1- ICU for ARF of the immune system that the person has had for months or years. For example, it following postpartum massive hemorrhage (CBC: Hb=3.3;Hmt=10%;PLT=62) 4,5 could be a complication of rheumatoid arthritis, lupus, or Sjögren’s syndrome. hours after emergency cesarean section (C/S )in local hospital of Durres. Due to In this paper have been applied: empirical method through which have been re- signs of retroperitoneal hematoma, abruptio placentae, intrauterine fetal death ,the searched different cases relating to age and time when were happen and their treat- woman secondigravide, 30-31week gestation underwent urgent C/S under GA. 24 ment ways as well as comparative method by which are compared the previous hours later, all symptoms and signs of HS manifested and HS was diagnosed. Bio- cases with recent cases and their drug treatment ways. The clinical symptoms of the logical criteries are well defined as HS class(II),according to the Mississipi classi- patient have been crucial in raising doubts about taking the necessary actions to car- fication and the Tennessee system classification. During her stay at ICU she devel- ry out laboratory tests by which diagnostics have been performed in time, as well as oped pulmonary edema, ARF and cerebral infarction in 5th postoperative day. She the definition of adequate therapy and continuous follow up of the patients with the was performed early hemodialysis for ARF and pulmonary edema. During her stay aim of preventing the rapid development of the disease and maintaining the quality in ICU she was treated with supportive treatment, hemotransfusion, neurological of the patient’s life. Considering that temporal vasculitis is a rare case, in this paper treatment ,corticosteroids and symptomatic treatment. The patient was transferred it will be described and will be exposed a practical case of temporal arteritis, which in10th postoperative day in the ward. The patient was discharged from hospital and was diagnosed and is still care out by the American Hospital in Pristina. was transferred in local hospital in 16th postoperative day in a good hemodynamic condition. ICU management is an essential part of patient management with HS PP111 - Cervical cancer screening in Albania, what we do and what we should do? association with multisystemic disorders. This case presented effective manage- M.Ikonomi, Sh.Kadare, A.Pepa, B.Cela, M.Rista, Dh.Tarifa ment of patient with HS complicated with ,pulmonary edema,ARF and cerebral Check-ups and periodic health examinations aim prevention and early diagnosis infarction. Pulmonary edema is managed with early hemodialysis ,corticosteroid for in individuals without symptoms. There is lack of evidence for health check and thrombocytopenia and hemolysis and neurological management. The diagnosed of most part of the criteria specified for screening are not met. Primary - manage HS and rapid initiation of treatment are fundamental for improvement the maternal ment of the cases discovered from the screening program, disease staging found prognosis. Hellp syndrome, intensive care,acute renal failure during the screening program, post-surgical treatment of cases discovered from the screening program, follow-up of the target population and insurance from can- PP113 - Anesthetic technique in patient with acromegaly and sleep apnea cer, evaluation and interpreting of the results of the screening program are part of (OSA) scheduled for Transsphenoidal Surgery (TSS). A case report the performance indicators and their impact in the screening process. M. Bilaj Miraka, A.Bako, R.Kortoçi, R.Kaza, A.Aga, E.Caka, A.Jaupi We analyzed the data collected during a Pilot screening study and the data from an TSS in patient with acromegaly and OSA association with intraoperative and

318 319 Presentation Session Plenary Plenary Poster

postoperative challenges for anesthesiologist. Adenomas producing acromegaly compared with the ICSI group (59.9% vs. 51.3% and 45.7% vs. 21.5%, respec- Poster Plenary Session are rarer. The primary treatment is surgery with/without radiotherapy. Endoscopic tively).According to our study, the routine use of ICSI improves fertilization rate Presentation TSS guidance and airway management is important, in such patients. We de- but not implantation and chemical pregnancy rates and is not recommended in scribed safe profile of successful management of a patient with acromegaly and non-male factor, normozoospermic patients. OSA scheduled for TSS under GA. The patients M.L. 56 y-old admitted in our hospital for TTS, macroadenoma PP115 - Epidemiology of ITP in Albania 2014-2017,updates in diagnose and of pituitary gland and acromegaly. In the PMS she has suffered from OSA, therapies hypertension, CMP, DM(II) , thyroid disorders, dislipidemia. The preanesthetic M.Shani assessment and hormone function test concluded with elevation of growth hor- ITP is a hematologic disorder characterized by isolated thrombocytopenia with mone (GH). The patient was evaluated as a possible difficult airway management. no evident clinical cause present in the organisem.Most of the cases seem to be Facies acromegalia, macroglosis, prognathism, enlargement of jaw, hands and related with antibodies against platelets.Normal values for adults are between feet, Mallampati score (II-III), acromegaly airway grade (II-III), indirect laryn- 150000 450000 per mm. Values of platelets below 50.000 per mm risk for trau- goscopy concluded probably difficult intubation. In OR, we were prepared for a matic hemorragies, meanwhile values below 20.000 per mm have the risk of spon- difficult intubation also providing appropriate devices for the case. Standard ASA taneous hemorragies. According to American Society of Hematology (ASH) the monitoring and invasive monitoring of BP . Anesthesia induces with 02 + fentanyl incidence of ITP is calculated up to 50-100 new cases per 1.000.000 persons. + lidocaine + propofol + vecuronium. Was used large face mask and blade nr.4 In Hematology service, Mother Teresa Univeristy Hospital, have been treated of laryngoscope.Trachea was intubated with introducer help. However fiberop- 349 cases with ITP for the period between 2014-2017,or in total 2.9% of all tic intubation was under consideration. Maintenance of anesthesia was performed hemopathies treated in this period. In nowdays the pathogenesis of ITP is not with remifentanyl 0.25-2 mcg/kg/min and propofol. Prophylactic antibiotics and considered anymore idiopathic but autoimmune because of the antiplatelet anti- hydrocortisone 100mg were administrated after induction. Endoscopic TSS lasted bodies found present in around 60% of the cases.In most of the cases they belong 3h and the patient was transferred in ICU for follow-up. The next day the patient to IgG class against glycoprotein IIb-IIIa or Ib-IX of the thrombocitic membrane. was transferred in surgical ward.The patient discharged from hospital in 5-th post- Platelet coating with these antibodies makes them clogged by splenic macrophages operative day. TTS in patient with pituitary gland tumors, acromegaly and OSA leading to their secuestration. The clinic is dominated by hemorrhagic phenomena frequently poses challenges for anesthesiologist. The careful preanesthetic evalua- whose roughness correlates with the number of platelets. Platelets under 10,000 tion, airway management ,postoperative analgesia, appropriate fluid and hormone increase the risc of hemorrhage in the large cavities of the body like the brain, the replacement and monitoring for postoperative complication is fundamental for eye, the abdomen or the pulmonary cavity. Treatment options include corticother- successful outcome and increasing survival apy, IVIg, splenectomi, Rituximab, TPO-RA-s and in other specific cases Azathio- prine, Cyclosporine, Cyclophosfamide, Danazol, Mychophenalat and Vincristine. PP114 - Comparison of Conventional IVF versus ICSI in non-male factor in IVF outcomes PP116 - Some data about the prevalence of HCV infection in different high M.Haxhia risk groups in Albania Conventional IVF and ICSI are two common techniques to achieve fertilization. M.Basho, E.Kureta, Sh.Qyra, B.Vila, J.Basho IVF has long been used for treatment of infertility, although it is not an effective Hepatitis C virus infection is a major health problem, affecting about 3% of the treatment in severe male infertility. The ICSI procedure was developed for couples world’s population. Depending on the country, hepatitis C virus infection can be with male factor infertility. There has been an increased use of ICSI regardless of concentrated in certain populations. It is most common in high-risk group of pop- the cause of infertility. Currently, ICSI is used in 65% of IVF cycles in Europe and ulation for example, among people who inject drugs, polytransfused and hemo- in 76% of cycles in the USA. Despite its increase use, there is no clear evidence dialysis persons. Even in Albania viral hepatitis C remains a significant problem of a benefit in using ICSI over conventional IVF. A retrospective study of 360 IVF for public health. There are multiple of genotypes of the HCV virus and their cycles in which were used conventional IVF only,ICSI only or combination of the distribution varies by region. two procedures, performed at Hygeia Hospital Tirana between 2013-2017. Fertil- To appropriate the prevalence of HCV infection in different high risk groups in ization rate, pregnancy rate and live birth rate were evaluated.In conventional IVF Albania. This was a retrospective study performed in different periods of time and group, fertilization rate was significantly lower than in the ICSI group (77% vs. groups of high risk of Albanians (roma population, co-infections HCV/HIV, poly- 87%) and implantation rates were significantly higher than ICSI group (51.25% in transfused, hemodialysis, IDU, MSM, hospital staff, prisoners). IVF group and 42.62% in ICSI group). Immunoenzimatic method ELISA was used for testing of the sera. Chemical and clinical pregnancy rates were statistically higher in IVF group as There were different values of seropozitivity of HCV in different high- risk groups

320 321 Presentation Session Plenary Plenary Poster

of Albanian people. It was 2.9 % in 201 prisoners (2007), 0.6% in 480 hospital PP118 - Crocodile tear syndrome following bilateral facial paralysis caused Poster Plenary Session staff (2004), 0.7% in 273 roma population (2015). It was high in IDU: 29.4% in probably by Presentation 163 persons tested in 2006- 2007. Seropozitivity of HCV was 3.5% in 200 men M.Guni, I.Burda, K.Resuli, A.Shkurti, M.Kermaj, M.Kapia, Z.Ndroqi who have sex with men (MSM) (2008), 4.2% in 280 co-infected HIV positive Bogorad’s Syndrome or gusto lacrimal reflex (Crocodile tear syndrome) is a rare patients (2010-2015). complication of the facial paralysis that was first described in 1913. It consists in High seropositivity values were seen in polytransfused and hemodialysis persons. unintended lacrimation of the patient that happens meanwhile eating or drinking. Positivity was 24.1 % and 28.9 % of polytransfused in 195 tested in 2010-2011 This condition is considered to follow a facial paralysis. and 135 tested in 2005 respectively. In hemodialysis ptc. the prevalence of HCV A 53 year old female patient (Sh. D) presented at our hospital with these chief was 31.4 % and 35.6 % of 105 tested in 2008 and 222 tested in 2010-2011, respec- complaints: lacrimation during speaking or eating, inability to close the eyelid, tively. Depending on the genotypes in Albania, genotype 1 was in 62.8 % of 350 difficulty chewing and eating, failure to make facial expressions. sample tested in 2010-2014, followed by genotype 2 in 18.3 % of them. Genotype The disease began one month before with a pain located at the right retroauric- 3 and 4 were 14.9 % and 4%, respectively. More frequent is genotype 1, subtype ular and mastoid regions, which lasted for 1-2 days. After that she had difficulty 1b. Genotype 1 is predominant in polytransfused and hemodialysis individuals. to close the right eyelid, the fluids flew out from the right angle of her mouth, Genotype 3 is predominant in IDU. Albania represents a high prevalence of HCV couldn’t taste the food and blow the chicks. Does not report fever. among different high risk groups in Albania. It varies from 0.6% in hospital staff, After one week she complained for occipital headache and involvement in the 4.2 % in co-infeceted HCV/HIV to 35.6 % in hemodialysis persons. In Albanian disease of the left side of the face, with bilateral symptoms of facial paralysis. population, more frequent is genotype 1, subtype 1b. She presented for the first time difficulty in swallowing and eating and also lacrimation during eating, drinking or speaking (Crocodile Tear syndrome) with PP117 - Emicizumab prophylaxis, a new standard in the management of Pa- improvement in food taste. The clinical examination revealed bilateral peripheral tients with Hemophilia A with the inhibitor. facial paralysis (the seventh cranial nerves with topics outside Fallopian canal). M.Xhafa Lacrimation and difficulty during speaking and chewing. Other cranial nerves The current treatment of A hemophilia is based on the replacement of the deficient normal in clinical examination. Without clinical symptoms for Herpes Zoster or factor VIII and can be done either because of a need when bleeding episodes other viral infections. She was diagnosed with type 2 Diabetes Mellitus , 8 years occur or as a preventative manner (prophylaxis). In general, without prophylaxis, ago with uncontrolled glucose levels. The HbA1c was 12%. The patient was patients with severe hemophilia will develop complications during their life, and diagnosed with diabetic peripheral neuropathy and has been under acid alfa lipoic the management of cases with Hemophilia A with inhibitors remains as one of the 600 mg since 3 months. The distal sensitivity is lowered during monophilament biggest challenges nowadays. Emicizumab (ACE910) is recombinant humanised test suggesting for peripheral polyneuropathy, without motor deficiencies and bi-specific monoclonal antibody. It bridges activated factor IX and factor Xto pathological reflexes. Lab results: Antibodies anti Borrelia Burgdoferi resulted restore the function of missing activated factor VIII, which is needed for effective negative without increased levels of inflammation markers. ENG: Reduced am- hemostasis. There are no structural homology to FVIII, not expected to induce plitudes of both peripheral facial nerves with significant axonal loss. Head MRI: FVIII inhibitors or be affected by presence of inhibitors, administered subcutane- Without pathologies of the brain and cranial nerves. Physiotherapy and kinesis ously once weekly and well tolerated. therapy for the facial muscles was suggested and methylprednisolone 16 mg was Emicizumab is improved agent for bleed control/prevention, reduced burden of started with gradual dose reduction. In the next visit ( 1 weak after), facial diplegia treatment, reduced need for CVADs, less frequent administration, no thromboem- was improved, with a better muscular tonus and facial mimic but the lacrimation bolic or thrombotic microangiopathy events. The results of recent studies are very during speaking and chewing persisted.Our patient presents a rare case with bi- promising and fruitful for prophylaxis with emicizumab even for pediatric age. lateral facial paralysis in basis of a chronic Diabetes neuropathy, without other Pediatric dose confirmed to be the same as adult dose. traumatic or infection factors that was complicated with gusto-lacrimal reflex or Our goal is to improve the lives of patients by providing a treatment for a safer Crocodile tear syndrome. One week after the lacrimation (in both eyes) during future. In patients with hemophilia A with inhibitors, a significantly lower rate eating and chewing persisted with a slightly clinical improvement of facial pa- of hemorrhagic phenotype was observed when there was applied profylaxis with ralysis. The patient is still in follow up. emicizumab rather than when there was applied prophylactic treatment with by- pass therapy or not applied prophylaxis at all, improving the quality of life of this PP119 - Risk factors for coronary artery disease in patients undergoing elec- contingent. We believe that the improvement on patients’ health under prophylaxis tive coronary angiography in American Hospital and the close contact with medical staff, are essential for a more qualitative and M.Guni, A.Kote, O.Demiri, L.Marku, I.Temali, S.Meco, E.Hajro safe life for patients with hemophilia. Cardiovascular disease (CVD) is the leading cause of death globally, and claimed

322 323 Presentation Session Plenary Plenary Poster

an estimated 18 million lives in 2015 . Age, gender, smoking, obesity, dyslipid- organism that bring instant feedback. This reaction is called “attack or run” Poster Plenary Session emia, hypertension and Diabetes mellitus are established risk factors for CVD. and is a healthy reaction.In PTSD disorder this reaction is damaged and the Presentation Little is known about the relative contribution of these risk factors in our country. person feels almost paralyzed and terrified before a dangerous situation. This Patients referred for coronary angiography at American Hospital 3 between Janu- turns this experience into a trauma.The treatment of persons with PTSD is: ary 2017 to March 2018 were included in this study. Risk factors for CAD (Age, Psychotherapy (speech-support therapy) Pharmacotherapy Or the combination Gender, Diabetes Mellitus, Dyslipidemia, HTA, Smoking, Alcohool) and thyroid of bothTo prevent exposure to stress at work and PTSD, •Data were received function were assessed in a multivariate logistic regression model. from psychologist, WHO, sociologist, keyword, reference monograph. They Among 586 participants, 365 (62.3 %) had CAD and 37.7% had a normal angi- have been taken by the American Society for Stress Management in the Care ography. In our study, most of the patients with CAD had one or more risk factors. Worker. The Public Public USA. Managing Posttraumatic Stress in NATOS The strongest association was found for gender ; 83% of patients wih CAD were Peacekeeping Operations.Included in the study of over 40 cases carried out in male , age 45-64 50% (4% of patients with CAD were under 45 years old, 50% different peace-loving operational missions and the key role in stress manage- 45-64 years and 45% were over 65 years). Dyslipidemia 52% and current/previ- ment, PTSD is the person, mission, and stress-borne system.Politraum, selec- ous smoking 66%. tion, urgency, contuzio, vlc, hematoma.stresLiteratur:1. Stress Menagement 37% of patients with CAD reported previous Diabetes compared to 16% of those Booklet UN Department of Operations pp. 19-27.2. Peter Tyrer “How to cope who had normal angiography. In multivariate analysis, male gender, age over 45, with stress” p. 31-34. 3. Terry Pettijohn “Psychology, Causes of Stress” SHL previous Diabetes, High LDL and current/previous smoking were significant pre- LILO Tirana, 1996 p. 422-427, 430-433. 4. Stress Menagement for Health dictors of CAD. 3% of patients with CAD had hypothyroidism and 5% hyperthy- Course Signs and Syndromes of Stress, http://www.stresshelp.tripod.com. roidism, in patients without CAD the prevalence of hypothyroidism was higher 5. Theothori Karaj “Stress Psychology” Mokra 2005, p 21, p.27, (7%). Gender, Age, Smoking,Dyslipidemia and Diabetes were strong and signifi- 6. Erica Braley “Stress Relief” SHB “Shandelor Stress” 2004, pp. 13, 14, 17, 20. cant risk factors for CAD in our patients. Public health interventions to reduce the 7. Stress Menagement for Health Care Biochemical and Physilogical Changes, w prevalence of smoking and Diabetes are urgently needed. PP121 - Ethical nature residence to patients PP120 - Post-Traumatic Stress Management (PTSD) N.Merko, A.Haxhiu, L.Saja, K.Latifi ,E.Dervishi, T.Nikolla, M.Tori, A.Ndoj N.Merko The word ethics derives from the old Greek ethos - morality, ethics and ethics - Posttraumatic Stress (PTSD) is the totality of pathological behaviors that occur Ethics is ethics on morality (do not, the Latin moris, which means habit, adet). after experiencing a real or imaginary trauma or polythema. In human beings, give a clear description of the concepts and terms of ethics in the nursing sphere. posttraumatic stress disorder is still present as a result of continuous wars, Ethics is a very wide field and has been a major pillar of medicine in all periods accidents, natural disasters, various threats to life and let the consequences. of history around the world, whose recognition and study is very much needed in Stress has a significant impact on quality of life, is the main factor in lowering practicing the profession for all health workers. In the focus of this the importance effectiveness at work. Its proper management ensures dignity and- well-be of ethics in general is emphasized, which has an impact on the work of health ing. Studies show that we are very little informed. In foreign literature, stress personnel. To assess the knowledge, attitudes and experiences of nurses regarding management, anxiety, Depression, phobia occupies a considerable place in health care ethics and legal rules in the field of psychiatry. : Providing ways to studies, psychological publications. Stress management success is informing formulate answers to questions and guide actions. Provides a framework for solv- and training individuals who are exposed to stress risk Applying appropriate ing issues, problems and conflicts. The essential issue of this paper is the ethical stress control strategies. Knowing the causes, symptoms, diagnosis, treatment, nursing attitude towards SUT patients. prevention, education, information. Counseling is a health promotion. Anyone Material and Methods - The study is of a qualitative nature, the study included a can be affected by PTSD, regardless of age, gender, social status. What is Post total of 24 nurses of SUT Reception and Emergency Reception, and their survey Traumatic Stress Disorder: Post Traumatic Stress Disorder (PTSD)? PTSD is was conducted by questionnaires consisting of 10 questions. an anxiety disorder preceded by a traumatic event during which the life of the Outcomes - Nurses with regard to ethical knowledge have claimed that they have individual or others is put at real risk. The traumatic event may be: a situation the highest ethical responsibilities in the field of nursing, and that they have ac- of war, earthquake, violence, abuse, accident, overwhelming events. Physical, quired this knowledge from work experience, undergraduate studies and training psychological, physical loss, loss of one’s body organs. The most frequent and courses . Ethics plays an important role in the professional work of health thoughts after the traumatic events are: ‘I’m crazy’ ‘was my fault’ ‘I can not personnel, so any health staff should be respected and always working according stand’, ‘why this happened’ ... and so many such self-defaming thoughts. (Bru- to ethical working norms. In this paper, special attention has been paid to the net, Akerito, Bimes, 2003) The state of fear produces some changes in the knowledge, experience and ethical attitudes of nursing care professionals. The

324 325 Presentation Session Plenary Plenary Poster

importance and the irreplaceable role of health care professionals, patient care, a PP123 - -Malignant spontaneous facial Staphylococcal infection in an immu- Poster Plenary Session capable, motivated, aware is a prerequisite for the development and well-function- nocompetent adult Presentation ing of their practical work in health institutions in providing the necessary services N. Gjermeni, N.Como, A.Gjermeni, E.Muco, D.Petani, N.Sulstarova, E.Zogu, of the patients, while always respecting ethical norms. Keywords: communication, E.Koci, Dh.Kraja conflict, solutions, nursing ethics, role of nurses. Malignant Facial Staphylococcal Infection is a very rarely Infectious Disease. It is a serious illness, a dangerous one, because of the complications which often PP122- Mitral Ring Annuloplasty for Ischemic Mitral Insufficiency lead to death. Sometimes, by different authors, it is named facial septic cellulitis Xhabija N, Tuncay N, Sula F, Kacani A or sudden sepsis. The disease usually starts scratching a staphylococcus infection, Ishemic mitral regurgitation which is one of the complications of the coronary sometimes a small one, over the upper lips. artery diseases, is a pathology that a lot of discussions are made on the treatment Aim: To notice the opportunity of this disease to appear spontaneous in patients options. Surgical treatment of the ıschemic mitral regurgitation excist a higher with facial atheroma. E.SH patient, 45 years old, hospitalized at our service, on rate of operative mortality compared with normal coronary baypass surgery and 02.12.2017 with diagnosis: Suspect Malignant Facial Staphylococcal Infection. surgical treatment of the mitral regurgitations because of other ethiological rea- Medical complaints: high temperature, toxic septic syndrome, pain, swelling and sons. Besides its high operative mortality rate, it also contains a high morbidity redness of the face (more evident on the left side of the face) making it difficult to rate when compared with other pathologies. see. He had a small atheroma (millimetric) in the level of the left plica nasolabia- This study consists of 60 patiens, with mitral insufficiency (grade 2 and more) and lis, for a year. 5 days before the atheroma began to increase and than was inflamed. coronary artery disease, in Ankara University, Cardiovascular Surgery Department, Suddenly, one morning, he waked up with high temperature, and a progressive between December 1999 and December 2003. Three different surgical prosedure pain and facial swelling, described above. Was found neutrophylic leukocytosis were performed to these patiens. 41 of them (%68.3) were male and 19 of them (% (21.000 mm3), ESR (33 mm/h),CRP 56, Blood cultures: Staph.aureus. This case 31.7) female. The mean age was 64.75+6.85. 10 patients (%16.6) have gone under was treated with vancomycin, ceftriaxone, and suportiv medication, that improves MVR and CABG, 20 patients (%33.4) gone under CABG alone, CABG and Ring toxic septic syndrome in 2 days, and local syndrome in one week. After that 4 Annuloplasty was performed to 30 patients (%50). When we look at mitral insuf- days later noticed an irritation of the local condition (swelling and periorbital red- ficiency degrees of the patients, in 30 patients (%50) there was a 2nd degree, in 27 ness,and left eye closure)because of the obturation of the lacrimal duct of this patients (%45) there was 3th degree and in 3 patients (%5) there was 4th degree side. The dranaige was made by the maxillofacial surgeon and then the antibiotic mitral insufficiency. When we compare the preoperative NYHA classifications of theraphy continued adding metronidazole. The aspiration in histopathological ex- the patiens, 25 patients (%41.6) were in NYHA II, 28 patients (%46.7) were in amination noticed the presence of atheroma; microbical cultures resulted sterile. NYHA III and 7 patients (%11.7) were in NYHA IV. We followed up the patients After 2 weeks of treatment in the hospital and 2 weeks of ambulatory treatment at a mean time of 704+36 days. Hospital mortality rates were %50 in MVR+- was reached the full treatment of the case. Malignant Facial Staphylococcal Infec- CABG, %15 in CABG and %16.6 in CABG + Ring Annuloplasty. When we look tion may appear in people with facial atheroma spontaneously. A possible compli- at the survivals of three different prosedures, group CABG and group CABG cation may be the obturation of the lacrimal duct. The management of such cases + Ring Annuloplasty haven’t got any statistical difference. (p=0.4614) There is requires the intervention of maxillofacial surgeon. statistical difference between group MVR + CABG and group CABG. (p=0.118) When comparing group MVR + CABG and group CABG + Ring Annuloplasty, PP124 - Inborn error of Metabolism. Pyruvate carboxylase (PC) deficiency. there is difference statistically (p=0.0368). We searched the effects of preoperative A case report NYHA, mitral insufficiency and risk factors on survival rate. NYHA hasn’t got any N.Kolici, E.Gjylbegu, V.Lekgjika, K.Hyka significant effect, but preoperative mitral insufficiency and serebro vascular events Pyruvate carboxylase (PC) deficiency is a rare disorder, with an approximate inci- in preoperative risk factors have got great effect on survival. When we look at the dence of 1 in 250,000 births that can cause failure to thrive, developmental delay, differences in ejection fractions at different times, we saw that in group CABG + recurrent seizures, and metabolic acidosis. PC is a biotin-dependent mitochondrial Ring Annuloplasty, EF has got a significant increase in 4 years period (p=0.0469). enzyme that plays an important role in energy production and anaplerotic path- When we searched for the changes in NYHA, group CABG + Ring Annuoloplas- ways. PC catalyzes the conversion of pyruvate to oxaloacetate. Oxaloacetate is 1 ty and group CABG have got statistical decrease and only group CABG + Ring of 2 essential substrates needed to produce citrate, the first substrate in glucone- Annuloplasty has got statistically significant decrease in the forth year (p=0.024). ogenesis. Loss of PC activity and the citric acid (Krebs) cycle lead to decreased In this new knowledges, coronary bypass and mitral ring annuloplasty is a better glutamate production, important in the nervous system. Three clinical types are and preferable choice in the surgical treatment of the ıschemic mitral insufficiency. recognized: type A (infantile form), in which most affected children die in infancy or early childhood; type B (severe neonatal form), in which affected infants have

326 327 Presentation Session Plenary Plenary Poster

hepatomegaly, pyramidal tract signs, and abnormal movement and die within the itation under the slight diethyl ether anesthesia. The kidneys were removed for Poster Plenary Session first three months of life; and type C (intermittent/benign form), in which affected further study of renal tissue fibrinolysis. Total, enzymatic and non-enzymatic fi- Presentation individuals have normal or mildly delayed neurologic development and episodic brinolytic activity (TFA, EFA and NEFA respectively) was determined in the renal metabolic acidosis. The diagnosis of PC deficiency rests on analysis of amino acids tissue of experimental rats according to lysis of azofibrin (Simko Ltd., Ukraine). and organic acids and detection of deficiency of PC enzyme activity measured in As the results of investigation showed, TFA in renal tissue of alloxan-induced fibroblasts. PC is the only gene in which mutation is known to cause PC deficien- diabetic rats was reliably increased (by 32,3%, P<0,001), mostly represented by cy. Treatment of manifestations: Intravenous glucose-containing fluids, hydration, the intensification of non-enzymatic tissue fibrinolysis, which was found tobe and correction of the metabolic acidosis are the mainstays of acute management. 1,8 times higher than corresponding control index (Р<0,001), whereas enzymatic Case report: Followed pregnancy. 5th birth Gestational age 38 week 2/7. Mother renal fibrinolysis was found to be reduced (by 8,4%, Р<0,05). The structure of 38 years old women with a continuous fatigue, iron deficiency anemia throughout renal TFA of alloxan-induced diabetic rats was significantly changed (since its in- pregnancy. The 4-th birth was an urgent S/C because of instable status of the crease was partaken by both – reduction of enzymatic and elevation of non-enzy- mother (hypotention) and insecure status of the fetus. It is referred that the 4-th matic fibrinolysis), dominantly contributed by non-enzymatic fibrinolytic activity child has some development retardation without any certain diagnosis. Post S/C (64,5%). The obtained findings are indicative of the significant elevation of renal condition, spinal anesthesia. APGAR 8/8. Baby gets colored with little difficulty tissue fibrinolytic activity in the rats with alloxane-induced diabetes, promoting with free O2. Birth weight 2810g, Length 48 cm, P cranial 36 cm, P thorax 31 cm, the progression of diabetic renal dysfunction. P abdominal 28.5 cm. IP 2.54 . Venous blood gases at birth PH 7,34, PCo2 40,5, Po2 20,9, Hb15, PP126 - Identification of pathogenic microorganisms of food products in Ti- Glukose 65, Lactat 2,2, Bil 3, BE -3,8, HCo3 20,4. rana The baby has maintained oxygenation and the vital parameters but the crying O.Petri, A.Daka, V.Isufaj, E.Angjeli was complainant. In the 3d hour after birth, baby starts nasal flaring, grunting, Foodborne diseases are caused by the consumption of foods that are contaminated deep subcostal chest retractions, SPo2 85%, hypertonia and somehow fixed eye with bacteria, protozoa, viruses, mold and toxin produced by them. The aim of the (signs of encephalopathy) and is admitted in NICU. Objective examination. study is in food products in day care centers and markets of Tirana, one of the main Big head in regard to the trunk. Pc/Pa 1.36. Large front fontanel. Opened su- problems with impact on Public Health. tures and the posterior fontanel is palpable. The baby looks plethoric, tends to This study was performed during November 2010 till March 2013. be in opisthotonus position, hypertonic. Tachypnea but low demand for O2. It We collected in total 2145 samples from food products and environmental samples is noticed in Venous blood gases deep metabolic acidosis and high lactate. from14 markets and 24 day care centers in Tirana. In day care centers the organ- Venous blood gases 2-nd PH 7.15, PCO2 22.5, PO2 49.9, Hb17, Glukose 48, ism that had the highest frequency was found Enterobacteriace (30.2%) followed Lactat 17, Bil 42, BE-21, HCO3 11 by Mesophilic Aerobic Bacteria (21.3%) and Mold (20.8%). In the markets the Cor in rhythmic tone. Fc 160/min. The abdomen at the level of thorax. Peripheral pulses. prevalence of Mesophilic Aerobic Bacteria (36.8%) was the highest, followed by Enterobacteriace (30.2%), Mold (24.9%) and coliform bacteria (24.7%). PP125 - Renal Tissue Fibrinolysis in case of Experimental Diabetes Mellitus The most polluted from the group products resulted Dairy products group (in O.A. Olenovych both day care centers and markets) with significance with other products group The disorders in the system of hemostasis are known to play an important role χ2 = 99.3 for the value of p <0,01. Bottled water samples resulted out of norm 77 in the pathogenesis of diabetic angiopathies. Destabilisation of hemocoagulation (17.3%) of them. We found mycotic pollution in dried fruits/ snack and cereals in and fibrinolysis, along with other factors, promotes the progression of renal dys- 87 (26%) samples. function, thus influencing metabolic processes in the body, which are significantly We concluded that Mesophilic Aerobic Bacteria; Coliform bacteria and yeasts disturbed in case of diabetes mellitus (DM). dominated in the market, compared with day care centers, with significant differ- Considering that, the objective of this study was to establish the character of renal ence of p <0,01. These results show to us how important are the hygiene preven- tissue fibrinolytic activity in alloxan-induced diabetic rats. tive measures to the day care centers and markets. The experiments were carried out on 20 matured nonlinear male rats, weighted 0,1-0,2 kg, under the standard conditions of vivarium. For the experimental mod- PP127 - Defining the Human Microbiome in the future of nutrition and health eling of DM 10 animals were administered alloxan intraperitoneally in a diabeto- O.Petri, A.Daka, V.Isufaj genic dose of 160 mg/kg; 10 animals served as control group. 10 days after the Your body is home to about 100 trillion bacteria and other microbes, collec- beginning of pathology formation blood samples were taken from tail vein of rats tively known as your microbiome. for measurement of glucose concentration. Euthanasia was performed by decap- The human microbiota consists of the 10-100 trillion symbiotic microbial cells

328 329 Presentation Session Plenary Plenary Poster

harbored by each person, primarily bacteria in the gut; the human microbiome treatment based on Wilms’ Tumor Study 9101 (UKW3) protocol. Poster Plenary Session consists of the genes these cells harbor. Patients were analyzed for overall survival and event free survival and these out- Presentation Microbiome projects worldwide have been launched with the goal of understand- comes were correlated with age, sex, stage at presentation and histology. ing the roles that these symbionts play and their impacts on nutrition and human Of the 5 patients, 3 were males and 2 were females, with a mean age at diagnosis health. The drastic reduction in sequencing costs experienced over the past few 57 months (range 33-100 months). Four patients were diagnosed as Stage III and years has made it possible to identify specific microbial taxa found within the one patient as Stage IV. There were 2 (40%) cases of favorable histology and 3 human gut that are difficult or impossible to culture. The gut microbiome plays an (60%) cases of unfavorable (anaplastic) histology. Four patients underwent initial important role in digestion and nutrition. nephrectomy, one received a fine needle aspiration biopsy, followed by pre-opera- The evidence is mounting for the inextricable link between a host’s microbiota, tive chemotherapy. digestion, and metabolism.Gut microbiota also seem to play an important role in All the patient received Radiation therapy, in four patients Whole Abdomen and obesity.The correlation between microbes and obesity is perhaps best illustrated in one patient Whole Flank. The median follow-up of the patients was 15 months through weight loss. (range 9-20 months). Currently all the patients are alive. There were no treatment-re- As different groups of human subjects were placed on either a fat-restricted or car- lated deaths. The overall survival and event-free survival at 1 year was 100 % and bohydrate-restricted diet, their abundance of Bacteriodetes increased as their body 80 %, respectively. weight decreased, transitioning from the signature ‘obese’ microbial community The outcomes of WT patients in our institution are the first data that we have on to a ‘lean’ community. this pathology in Albania. Our results are in line with the literature data. The im- Thus, the modulation of a patient’s microbiota might be a therapeutic option for pact of the factors such as unfavorable histology, higher clinical stages or delay of promoting weight loss in obese patients or promoting weight gain in underweight the radiotherapy will be the goal in our future research activity. children. Surprisingly, the microbes that we ingest with our food might be provid- ing our individual microbiome with new genes to digest new foods. PP129 - Skeeter syndrome, a case report Given the relative stability of the human gut microbiota, one key question is O.Marko whether it is sufficiently plastic to allow well-defined interventions to improve People, who are bitten by mosquitoes, usually develop a typically (normal) reac- health. The gut microbiota is fairly stable over time once established, at least com- tions at bite place. But sometimes, infrequently, it may be developed a clinically pared to the differences between individuals. relevant allergic reaction, most commonly large local one. It happened due to an However, a number of studies demonstrate that external forces can alter the com- immune response to proteins (polypeptides) in mosquito saliva. munity of microbes located in the GI tract and antibiotics are an important ex- Methods: A 27 years old woman came in hospital with a large local reaction with ample. Although the tools we have available are still imperfect, the prospects for erythema, edema, itching, pain and blisters of 2-4 cm in left leg. It was accompa- developing a mechanistic understanding of the factors that underlie the plasticity nied with general weakness, flush and nausea. She was bitten just at that place by of the microbiome and then for manipulating the microbiome to improve nutrition a mosquito three days before and swelling began within 2 hours. The lady was a and health seem increasingly bright. foreing citizen in vacation in our country. Based especially on clinical presenta- tion of disease and on high level of specific IgE for mosquito identified by RAST PP128 - A multimodal Treatment in Pediatric Patients with Wilms’ Tumor: a (blood allergy test), we diagnosed our patient with Skeeter Syndrom. She was single institute experience treated with oral non-sedating anti-H1 ( bilastine) and a topical glucocorticoid O. Spahiu, B. Shima, M. Xhafa, D.Bali, M.Kapllanaj, D.Nika , O.Spahiu cream for 10 days and analgesic as needed for 2-3 days. After treatment, the lady Wilms’ Tumor or Nephroblastoma is the most common malignant renal tumor in was in good health. pediatric age group, and the fourth most common childhood cancer. It is classically The prevalence of an allergic reaction due to mosquito bite is unknown worldwid. managed by multimodal treatment which involves surgery, radiotherapy and che- The allergens present in mosquito saliva, sensitized people that are bitted by them. motherapy. This tumor is an embryonic kidney cancer that occurs mainly in young There are two types of reaction at bite place:1.Typical (normal) reaction. 2. Large children. Approximately 80 % of WT cases occur before the age of five years. There local reaction (Skeeter Syndrome) Few persons develop an allergy from mosquito, is paucity of data about the epidemiology, pathology, treatment and prognosis of commonly a large local reaction (termed Skeeter Syndrome) and typically consist this disease from Albania. We conduct the present study to analyze the outcome of on an itchy or even painful area of redness, warmth, swelling and/or induration multimodality treatment of Wilms Tumor at our institute. that ranges from a few cm to more than 10cm in diameter. Large local reactions Five patients with histopathological proven diagnosis of Wilms’ tumor and had develop within hours of the bite, progress over 8 to 12 hours or more, and resolve received treatment at the University Hospital “Mother Teresa” in Albania, from within 3 to 10 days. Systemic reactions, including anaphylactic shock, are rare. December 2016 to September 2018 were included for analyses. Patients received Skeeter Syndrome is oftenest in young children with low or absent natural immu-

330 331 Presentation Session Plenary Plenary Poster

nity and in visitors or immigrants to a geographic area with indigenous mosquitoes the result was 42.1% F (8) and 57.8% M (11). From the 19 patients under study, they Poster Plenary Session and to which they don’t have natural immunity. concluded that: 94.7% had VVIR pacemaker and 5.2% DDDR, with baseline FC 70 Presentation The early recognition of Skeeter syndrome is important to give the right manage- beats/ min. The main cause was BAV I 42.1%, BAV II 10.5% regurgitation of tricuspid ment and to prevent unnecessary diagnostic tests and treatments that can increase valve 36.8% and AF 10.5%. The most affected age is ≥ 50 and it is more used at the the risk of adverse reactions and costs. Treatment of large local reactions to mos- ages 70-80 with 36.8%, M sex with 57.8%. quito bites is symptomatic. Staying in hospital lasts 3-4 days if we have complications or accompanying diseases. Bedding depends on the patient’s health condition. The most common complication is PP130 - Usefulness of Gensini score and Impact of lipid profile to severity of wound hematoma followed by infection. coronary artery disease From the study of pacemaker we have improvement of life and avoiding of unexpect- P.Rashiti, B.Lenjani, I.Balla, L.Svarça, A.Rashiti Bytyçi, Sh.Elezi ed deaths with the major cause BAV. With local anesthesia where the patient passes This study aimed to investigate correlation between lipid profile with severity directly after the procedure in the room, with a 3-4 day dieting and te most common of coronary artery disease (CAD) assessed by coronary angiography and Gen- complications, hematomas. sini score. We enrolled patients undergoing elective coronary angiography for CAD survey. Total cholesterol, triglyceride, high-density lipoprotein cholesterol PP132 - The role of Information Management and Communication Technol- (HDL), low-density lipoprotein cholesterol (LDL). Demographic characteristics ogies in Albanian public hospital care age, sex, Body Mass Index (BMI), Waist circumference (WC), history of diabetes R.Degjoni mellitus, systemic hypertension, and family history of CAD were collected. The The requirement for the development of information systems in the country of Albania severity of coronary atherosclerosis in the CAD group was defined by using the is considered necessary as it is directly related to the improvement and efficiency of Gensini score system. health services provided by public hospitals. Forty patients (48%) were smokers, fifty-nine patients (70%) had hypertension, Maintaining and improving the health of human life requires the organization and op- twenty-six patients (31%) had diabetes mellitus and twenty-two patients (26.8%) eration of a social system called the “health system” in which the practice of medical had dyslipidemia. Family history for CAD was positive in 40 patients (48%). We science is carried out. found correlations between Gensini score and HDL and LDL. The research is concerned with the design and development of public health infor- From forty-five (58%) documented angiographycally CAD cases, 18 (40%) had matics systems in the hospital care of Albania. The project that addresses existing one vessel disease, 15 (33.3%) had two vessel disease and 12 (26.7%) three vessel approaches aimed to prevent the public hospital health care environment in Albania disease. Thirty seven patients have (42%) had no coronary artery disease (Gensini will operate on the basis of a new model of management of hospital technology and score =0), seventeen patients (37.8%) had mild coronary artery disease (Gensini information communication. score <32), thirteen patients (28.9%) had moderate coronary artery disease (Gen- The information system to be built in the public hospital will have an important role to sini score= 32-58) and fifteen patients (33.3%) had severe coronary artery disease play in relations between patients, clinical and administrative staff. Users will be aware (Gensini score ≥58). There was a positive significancy between HDL cholesterol of the role of the hospital’s IT and communications technologies and will significantly and total cholesterol with Gensini score and plasma triglyceride was negative reduce waiting times. They will also improve communication in the hospital’s micro significancy with Gensini score among Kosovar patients. and macro environment, improve patient awareness and reduce bureaucracy in the hospital environment. PP131 - Pacemaker and nursing care Public health informatics, health management, health care system in Albania, public R.Nexhipi ,E.Hasa, E.Myrtezaj ,A.Zaimi ,Xh.Ahmeti, D.Merkaj health care, Information and Communication Technologies (ICT) Pacemaker is a device which is placed on people who have a symptomatic bradycar- The applications of health informatics aim at introducing information methods dia. This device is usually placed under the left or right chinchillus (the fibers and the and systems in the administration, planning and evaluation of health care units, electrodes are inserted into the heart). and particular: Through this device, impulses are sent to the heart as long as the heart needs it so that it (i) in the management of health units hospitals, is pumped properly. The procedure is performed with local anesthesia with a 3 cm cut. (ii) in the design of public health informatics system, Pacemaker lifespan is 5 to 10 years, depending on how often its activity is required. (iii) in the evaluation and control of public health systems. The purpose - The identification of the factor that causes the pacemaker to be set and The public hospitals have a common vision and goal, collecting and analyzing health the return to a normal life in these patients, preventing and treating the pacemaker. care information so that they can make decisions and carry out assumptions based on In the study conducted in the period between March 2017 and June 2018 in SA3, a the interpretation given by that information. retrospective method was used. From 19 patients with pacemaker taken in the study, The study was conducted the tertiary health care provided at the University Hospital

332 333 Presentation Session Plenary Plenary Poster

Centre QSUT, located in the capital Tirana, where more than one fifth of the popula- PP134 - Is mitral valve repair a better choice in patients with left ventricular Poster Plenary Session tion lives. The structure of the questionnaire, due to its qualities, is the most critical and dysfunction Presentation delicate work that is crucial to the success of our research. S.Memishaj, R.Cavolli In the survey, in order to effectively implement the data analysis, a questionnaire with This study was undertaken to determine whether the choice of mitral valve pro- fifteen (15) questions has been prepared. They are sample (n=115) employment from cedure as treatment for ischemic mitral regurgitation (IMR) affected survival, different areas of public hospital, of which (n=62) medical staff, (n=20) administrative and discover which patients were predicted to benefit from mitral valve repair staff, (n=25) nursing staff, (n=7) technology staff, (n=1) the manager of hospital, in and which from replacement in patients with left ventricular dysfunction (LVD). order to implement the data analysis of ICT effectively. A total of 149 consecutive patients underwent either mitral valve repair (MVre, n The questionnaires include data about the necessity of IMCT in the distributed Alba- = 78) or mitral valve replacement (MVrp, n = 71). We retrospectively reviewed nian public hospital care. the clinical material, operation methods, echocardiography check during opera- In this way we will have an overview of the needs and design the core of the system. tion and follow-up. Patients’ details and follow-up outcomes were compared us- The mean age of the participants was 43.3 ± 10.8 years. ing multivariate and survival plots analyses. Exclusion criteria: Exclusion criteria The age group of 26-35 years old was 36 (31.3%), the age group of 36-45 years old were mitral stenosis, aortic or tricuspid valve replacement, previous valve repair was (n=31) or 27%, the age group 46-55 was (n=27) or 23.5% and the 56-65 age group or replacement, emergency operation and non-ischemic mitral valve disease. was (n=21) subjects or 18.2%. Depending on gender, female was (n=68) or 59.1%, End Points: The primary end-points were to evaluate early and midterm survival, while male was (n=47) or 40.9%. In the questions of whether the quality of public echocardiographic modifications of left ventricle and the presence of any grade of hospital services will change with the operation of ICT, (n=71) or 61.7% of the respon- IMR. Pre and intraoperative data: No significant statistical difference was found dents fully agree, (n=35) or 30.4% agree and (n=4) or 3.5% are neutral. It is suggested between the two groups except previous PCI data (p<0.027). Postoperative data to introduce information health system for the reasons to improve the performance and were: in-hospital (< 30 day) mortality, AMI, CVA, IABP support, acute renal the quality of public health care in Albania. failure, acute respiratory failure, bleeding (mL/12 h), sepsis or endocarditis, ICU stay (h) , in-hospital stay (d). No significant statistical difference was found -be PP133 - COPD Disorders and Worsening Prevention tween the two groups. Early mortality was 2.5% in MVre group and 4.2% in MVrp R.Rexhepi, M.Rexhepi, Sh.Memishi, R.Kadriu group. Follow-up mitral regurgitation grade, left ventricular ejection fraction, left Smoking cuts or reductions in less than 10 cigarettes a day, as well as increased atrial dimension were significantly improved in the MVrp group compared with physical activity are key to prevent further COPD deterioration, chronic obstruc- the MVre group (P < 0.05). Survival Plots at 1, 3, and 5 years were similar be- tive pulmonary disease (COPD) is a largely chronic disease, a significant number tween MVre and MVrp group. Logistic regression revealed poor survival in pre- of patients suffer from recurrent aggravation as a consequence of not being vacci- operative low left ventricular ejection fraction (< 30%) patients. 7 patients were nated by the influenza virus and pneumococcus. lost to follow-up in MVre group, and 5 patients were lost in MVrp group. Long The COPD is the third cause of death worldwide. Frequent 3 to 5 years of severe term follow up data indicates that mitral valve repair provided less long-term ben- deterioration relate to a result of a decline in life expectancy. This discussion dis- efit than mitral valve replacement in the LVD patients. cusses current knowledge on various aspects of COPD deterioration. Often it is discussed about the impact of risk factors and causes such as smoking, PP135 - Metastatic carcinoid tumor in an elderly patient - Case Report heavy air pollution, bacterial and viral infections simultaneously and combined, S.Ademi, K.Qeraj, Dh.Tarifa, F.Proko, M.Luzi, M.Likmeta also taking into account the merit and other comorbidities present in a third age Years old man with no smoking history .Commorbidities: Enlarged prostate PS=1 organism. Severe deterioration should be treated with β-agonists and anticholiner- .Presented for the first time in August 2014 with anorexia, nausea and addominal gic, as well as systemic corticosteroids. pain.Thorax-abdominal-pelvic CT Scan with iv contrast: Circumferencial distal While antibiotic therapy should only be given to patients with proven bacterial jejunal small bowel thickening; 6.0x12.7x12.4 cm complex abscess collection infection (Pneumosllajd) or empirical form in the supposed cases. For the last time within the right midabdomen. Mild abdominal/pelvic ascites. in our clinic we apply non-invasive ventilation which is giving satisfactory results. Multifocal liver metastasis: Rlobe 42x38 mm, 53x32 mm, 22x21 mm, 10x10 mm Other aspects include pharmacotherapy, including bronchodilators, inhaled cortico- and subcapsular 19x20 mm. Extensive bilateral pulmonary emboli involving both steroids, phosphodiesterase inhibitors 4, long-term antibiotics and mucolytics upper and lower lobes beggining at the level of the distal right main and left pul- Treatment of hypoxemia and hypercapnia reduce the degree of COPD deterioration. monary arteries. 1.8x2.0 cm posterior RML lung mass consistent with neoplasm. To achieve this goal, patient education and smoking cessation programs, as well A 2mm subpleural nodule RUL, 3mm pleural nodule RLL. as pharmacological and non-pharmacological treatments of patients are mandatory. A 5mm subpleural nodule LLL The patient underwent surgery and the biop- sy revealed carcinoid tumor of the jejunum, G II. Chromogranin A level 8 ng/

334 335 Presentation Session Plenary Plenary Poster

ml.Octeotride scan: 5 tracer avid lesions in the liver .October 2014 he began Nissen fundoplication in comparsion with conventional surgery requires more Poster Plenary Session Sandostatin LAR 30 mg IM Q4 weeks, (Fundaparinux 2.5mg subQ daily, Tam- techniqual skills and endosopic experience surgerons. Presentation sulosine 0.4 mg PO bid for the commorbidities).After 4 cycles: Radiological partial response, Chromogranin A level 11 ng/ml.Continued other 4 cycles with PP137- Acute airway obstruction caused by massive subcutaneous emphysema Sandostatin LAR 30 mg IM Q4 weeks and after those Radiological Stable dis- S.Hulaj, S.Abdushi ease.Continued Sandostatin LAR 30 mg IM Q4 weeks until June 2016 since it Acute upper airway obstruction is a potentially life-threatening event. It is rarely was Radiological Stable disease.The patient didn’t show up from June 2016 un- caused by subcutaneous emphysema. til December 2016.December 2016: Thorax-abdominal-pelvic CT scan – Multi- We report a case of massive post traumatic subcutaneous emphysema associated ple hepatic lesions (the largest in the R lobe 4.5x3.8 cm). New right middle lobe with severe airway obstruction and hypoxia. It was relieved with simple emer- nodule 1 cm.Chromogranin A level 17 ng/ml.Octeotride scan: 5 tracer avid le- gent intervention, inserting four needles on chest skin. After which a dramatic sions in the liver increased in number and intensityRechallenged treatment with improvement and provided effective decompression of subcutaneous emphysema Sandostatin LAR 30 mg IM Q4 weeks After 4 cycles –Evaluation with Thorax was seen. Sometimes simple interventions can save lives. Abdomen-pelvic CT Scan with revealed Stable disease. Continued treatment with Sandostatin LAR 30 mg IM Q4 weeks since it was Radiological Stable disease PP138 - Case report The substantial role of antihypertensive and anti-isch- until January 2018 January 2018- Disease progression: Thorax-Abdominal-pelvic emic therapy in dominating symptoms in patients with CAD when a complete CT Scan 2.7x2 cm RML nodule; 4mm nodule inRUL; 5mm nodule in LUL; 4 revascularization has been performed- Case report mm nodule in LLL; R hilar 1cm ln; multi hepatic mets- the largest in the R lobe S.Meco, I. Temali, B.Jata, E.Hajro, A.Zaka 5.4x4.6 cm; R adrenal 1.4x0.7cm nodule; 2.6x2.1cm left iliac sclerotic bone lesion Female patient, 75 years old presents with unstable angina. Low threshold angina Chromogranin A level 48 ng/ml 5 tracer avid lesions in the liver, the largest 5.4cm. and often in rest, with tachycardia, refractory hypertension and dyspnea. On thera- The patient emigrated to the USA where it was reccomended to begin treatment py with anti BP, no DM. Positive hereditary for CAD and dyslipidemia. with Everolimus and until now is stable disease No other accompanying diseases. ECG in rest: SR , HR approx 110/min and ST-T depression on anterior V1-V6. ( fig1)Obvious asymmetric hypertrophy of LV. No PP136 - Our experience with laparoscopic Nissen fundoplication in treat- modifications of wall motions. FE within normal range. ment of hiatal hernias in American Hospital of Prishtina Mitral and aortal valve shows mild-moderate sclero-calcifications, RM, grade 1-2. S. Tmava, I Fazliu, J.Ismet, F.Mucolli, Z.Zeka, A.Hasani (fig2)Having typical ischemic complaints and additional risk factors, CAG was In our settings 16 patients underwent laparoscopic Nissen fundoplication with recommended.Result show 2 vessels CAD, critical sub-occlusive lesions in os- documented gastroesophageal reflux diseas. Patients was before treated with anti- tial Lad and medial segment on LCx. RCA without critical stenosis.(fig3)It was reflux medical therapy but the disease was refractory in this setting. proceeded with PCI in LAD and LCx- respective DES on LCx and TC- LAD Subsesquently all patients underwent endoscopic examinations, hiatal hernia oc- proximal with maximal result, lesion in LAD mid-distal segment was evaluated curred and diagnosed in endoscopic examination. approximately 70%, in a long and tortuous segment(more than 40mm) A full gastric fundal dissection was performed, with division of at least 4 short Hospital discharge 3 days after with aspirin 100mg, clopidogrel 75mg, metopr- gastric vessels. The crura were approximated with 2-3 sutures, and a floppy fun- olol 100mg, atorvastatin 20mg, amlodipine 5 mg and oral PPI.Patient regularly doplication was performed with 2-3 stitches, All procedures was performed lapa- presented at hospital during the first three month with no complaints and improve- roscopicaly. There were no major operative complications. ment of physical activity and BP and HR parameters under control. During 6th Contact drainage was done in all patients. The average operative time was 180 month, after emotional stress, the patient, re-presented complaints; chest pain, minutes (range 110-285). Oral intake was started when flatus begun (usually on dyspnea on rest and mild effort with BP fluctuation and HR increase. 3/day after surgery) . Patients were discharged an average of 5 days postopera- Dynamic T waves negative on V1-V5 during effort, No kinetic and segmentar tively after barium swallow . In early period of follow-up (mean 5 months range modifications on rest.CAG control performed: stents in LAD and LCx was PAT- 7-14 months) 11 of 16 patients had complete abolition of reflux symptoms, 1 ENT, and no progression in lesion on LAD medial. Fig 5. Negative cardiac en- patient developed severe disfagia and baloon dilatation treatment was needed zymes, ABP Holter shows high values up to 210/110mmHg.Next step: Therapy 3 month after the surgery. 4 patients complained of mild disfagia and bloating , modification for better BP control and anti-ischemic drugs.Irbesartan 150mg was succsessful medical treatment after with Metoclopramid was achieved started for 1 week followed by 300mg/day under BP monitoring. Conclusion: standard laparoscopic Nissen fundoplication is very effective Amlodipine dose increased to 10mg/day and metoprolol to 2 x 100mg, ranolazine procedure in treatment of GERD and hiatal hernias, allows a rapid recovery after 500mg 2 x1tab day.Next month check resulted in much improved situation, nor- surgery and good postoperative results. However, the results of laparoscopic mal ECG parameters, HR approx. 65min and BP under 145/95mmHg and ABPM

336 337 Presentation Session Plenary Plenary Poster

in normal parameters. important role of anti-hiperthensiv and anti-ischemic drugs samples at the nationalreference laboratory of HIV/AIDS. Poster Plenary Session on management of symptoms in patients with stable CAD is well establish on All the diagnosed persons with HIV/AIDS in Albania are infected with HIV-1. In Presentation guide lines and our patient. order to study the presence of the HIV-2 infection as a co-infection with HIV-1, 300 samples of persons infected with HIV-1 were tested in the laboratory of immunology PP139 - Our modest experience in the treatment of Upper Urinary Tract Tumors at the Institute of Public Health. The test performed for this study was New Lav Blot Sh. Ferko, I.Balla, M.Megjiti, A.Xheta, B.Mema II BIO-RAD. The obtained results showed that 8.66% of the persons infected with Our modest experience in the treatment of Upper Urinary Tract Tumors(UTUC) HIV-1 were also infected with HIV-2. Ferko Sh¹, Balla I, Ndoj A, Megjidi M, Xheta A, Pecnikaj S, Mihali A, etc These are the epidemiological data about the patients infected with HIV-1: 80.8% These are relatively rare tumors of urinary tract: 10 % of renal tumors and 5% of were males and 19.2% females, 53.8% had gotten the infection outside the country all urothelial tumors in the urinary tract. and 46.2% inside the country. Epidemiology: Incidence in the western countries is approximately2/100000 pop- The patients were aged between 23 and 66 years old with the age-group 25-34 be- ulation. Mean age is 65 years. Male to female ratio is 3:1, and twice more common ing the most affected. 65.4% of the persons infected are hospitalized in the QSUT in white people than in African descendent.40% of them are invasive. clinics, 23% of the diagnosed were voluntaries and 11.6% were blood donors. This Etiology: Tobacco is the strongest factor, drinking coffee slightly increases risk, study shows that HIV-2 infection is currently circulating in Albania. analgesic abuse is known also etc. HIV-2 infection hasn’t been found as an only infection but it is rather found as a Transitional cell carcinoma accounts 95%, squamous cell carcinoma 1-7%, ade- co-infection with HIV-1. nocarcinoma 1%. Presentation: The most clinical sign is hematuria micro or gross, The identification of HIV-2 infection is important for the algorithm of HIV/AIDS flank pain, lumbar mass etc. diagnosis, clinical manifestations and the epidemiologic data. Treatment: Nephroureterectomy with excision of the bladder cuff is the standard treatment for all forms of UTUC. Laparoscopic is being used often, segmental PP141 - Delirium Tremens during with drawl in patients with Alcohol Use ureterectomy with ureteral reimplantation for low grade tumors of distal ureter. Disorders Renal –sparing surgery (segmental ureterectomy, endoscopic or percutaneous re- S.Tivari Bitri, E.Thoma, E.Sotiri, B.Zllami, E.Puca section) is used for small, low grade superficial lesions and unique kidney. Lab About 50% of persons with alcohol-use disorders have symptoms of alcohol with- studies Urinalysis, basic metabolic panel etc. drawal , when they reduce or discontinue their alcohol consumption. In about 3 Imaging studies Intravenous pyelography, uro CT, urine cytology, ureteroscopy. to 5% of cases it is present delirium tremens. Withdrawal delirium is a severe life Our experience In last 10 years we had 7 cases of UTUC, 5 of them were males threatening complication which begins usually the third day of abstinence and last and 2 female. 1 patient has pyelon tumor and 5 others had ureteral lesions. 5 had from 1 to 8 days. Early recognitions and treatment, is crucial for a good prognosis. hydronephrosis from obstruction caused by the tumor. In one case tumor invaded Aim: Through this case study we want to share our medical approach in the diag- the periureteral fat tissue and the iliac bone . nosis and treatment of Delirium Tremens in a patient with Alcohol use Disorders. 2 of them were located on the right side. 4 of them went on chemotherapy. Follow Case report presentation up was made with cystoscopy and pulmonary and abdominal CT scan. 1 patient We present the case of a 61 year old patient with a history of 35 years of severe passed away one day postoperatively, maybe from thromboemboly because hemo- alcohol abuse. The last year he continued to increase his consumption of alcohol static sutures were placed on IVC. to 30-35 Unite /per day. Some days before hospitalization he tried to reduce the amount of alcohol intake, but he developed neurological complication treated in PP140 - Co infection HIV-1/HIV-2 in ALBANIA emergency service. After that episode, he was referred to our addiction service, for Sh.Qyra, M.Basho, B.Qyra, M.Dervishi, R.Bani, V.Durro, A.Koraqi alcohol detoxification. The main cause of the HIV / AIDS pandemy in the world is virus type 1 (HIV-1). The third day of abstinence the patient manifested symptoms related to Delirium Another type of HIV virus, the human immunodeficiency virus type 2 (HIV-2) Tremens (CIWA Ar score 19 at the first evaluation), high level of blood pressure, was isolated in 1985 from two African patients with AIDS who did not show sero- tachycardia, nausea, vomiting. He manifested also psychomotor agitation, severe logical reactivity to HIV-1. The virus was found to be quite common in West Af- hand tremor, visual and auditory hallucinations, disturbance of memory, of atten- rican countries and to a lesser extent in other regions with historic socioeconomic tion and of orientation. We applied high doses of i/v benzodiazepines, electrolytes, connections. In Europe, most reported HIV-2 infected subjects have been African thiamine and rehydrating solutions. immigrants or, less frequently, Europeans who had lived in West Africa for a while Propofol ( 0.6 mg per kilogram of body weight),was administred the first hours, or who had had sex with people from that region. because the patient did not have response to high doses of diazepam. The fifth day To investigate the presence of the HIV-2 infection as a co-infection with HIV-1, in of hospitalization the general situation improved and in the 12-th day we intro-

338 339 Presentation Session Plenary Plenary Poster

duced relapse prevention therapy with Accomprasate. ical and molecular genetic characteristics, it can be subtyped in four categories: Poster Plenary Session The mainstay of the pharmacologic treatment of withdrawal delirium is depres- atypical lipomatous tumor or well-differentiated LPS, dedifferentiated LPS, myx- Presentation sants such as benzodiazepines. oid/ round cell LPS, and pleomorphic LPS.Recently, several studies have showed But a detailed physical examination, appropriate medical tools and a care- new variants, mainly as a result of the effective interactions between genetics and ful treatment are the gold standard for a better outcome and healthier patients. pathology. Key words : Delirium Tremens, alcohol use disorders, alcohol withdrawl That has also lead to new diagnostic entities.Sclerosing poorly differentiated lipo- sarcoma represents an unusual morphological variant of poorly differentiated li- PP142 - The Model of Interdisciplinary Collaboration in Clinical Microsys- posarcoma associated with aggressive behaviour. These tumours are characterized tems: a Planned Action Approach to Change in Residential Care for persons morphologically by dense stromal sclerosis containing singly scattered pleomor- with disabilities phic atypical cells with lipoblastic features. S.Ndoja Advances in molecular pathology, have led to significant improvements in the Persons with special health and social care needs often require a broad continuum differential diagnosis between dedifferentiated liposarcomas and poorly differen- of services from multiple professions across various systems due to their complex tiated sarcomas, especially by the detection of MDM2 and CDK4 overexpression health conditions and the impact of those conditions on their daily function. These and/or amplification15,25. However the most important factor in the diagnosis services may include specialized medical needs, therapeutic services and home/ and prognosis as well, is anatomic location with a poor prognosis for retroperito- residential health care), family or caregiver support services, equipment, early in- neal tumors. We present a case of a 49-year old women who was presented to the tervention, and special education. hospital with a solid, enlarged mass measuring 30x20cm in the abdominal area, Thus, interdisciplinary teamwork has been identified as an essential component to growing rapidly in size last months. the provision of services to persons with disabilities in order to manage the mul- tiple, complex needs that require the knowledge and skills from many profession- PP144 - Noncoronary Sinus Aneurysm als from a variety of micro/systems. To describe the efficacy of Interdisciplinary U.Ekmekçiu, K.Gjoka, A.Gjoka, E.Hasimi, M.Lezha, A.Goda Collaboration Model in Clinical Microsystems as a Planned Action Approach to Sinus of Valsalva aneurysms is an uncommon but well known cardiac condition. It Change in Residential Care for Persons with Disabilities. counts 0, 09 % of cardiac anomalies. Sinus of Valsalva Aneurysms can cause aortic Methodology: a case study of interventions designed as a Planned Action Ap- insufficiency, cardiac arrhythmia, coronary artery flow compromise or aneurysm proach to improve interdisciplinary teamwork focusing on specifics of teamwork and rupture. We present here a 56year old man with 3 years history of chest pain activities such as: sharing of patient files, case-discussion approaches, meeting and exertional dyspnea. Electrocardiography shows only negative T at AVL lead. style or frequency, individual plan of care, follow up and review the plan, final Transthoracic echocardiography shows noncoronary sinus aneurysm. Computed reporting of progress/regress. Tomography angiography confirmed the diagnosis. Cardiac catheterization shows Conclusion and results: Despite any difficulty encountered that is compounded by also coronary artery atherosclerotic disorder. Patient underwent to heart sur- the multifactorial nature of teamwork (skill mix, setting of care, service organiza- gery. Noncoronary Sinus of Valsalva aneurysm, Transthoracic echocardiography, tion, individual relationships and management structures); effective collaboration Computed Tomography Angiography, Cardiac catheterization of teamwork in the clinical microsystems is integral to improving the quality of patient outcomes, enhancing patient and workplace safety, and increasing job sat- PP145 - Fibromyalgia – acupuncture isfaction among health and social care professionals (Oandasan et al., 2004) U.Shehu The outcomes provide some evidence as an effective way of delivering interdisci- Acupuncture and chyropractic activation is often used to treat fibromyalgia plinary team work including the participation of service user. (FM) and a wide range of painfull disorders but it is still large doubts on acu- But it now needs to be validated with other types of interdisciplinary teams to puncture effects. determine their level of transferability to other teams and contexts. It also needs to The purpose of this study is to evaluate the effects of this therapy on the pain, specify it as a systematic framework around which of given activities, or charac- sleep quality and quality of life (QoL) on fibromyalgia patients. Methods: We teristics, of interdisciplinary working can be structured. studied valuated the outcomes of the effects of the acupuncture treatment on 20 patients from wich 16 were women and 4 men. PP143 - Sclerosing poorly differentiated liposarcoma. We discussed with the patients on pain relief terms and quality of life. Range of Case presentation and review of literature age was 25 to 45 years. These patients had undergone different medical treat- T.Bushati, E.Kola, J.Hysko, L.Berdica ments for this condition (FM) before undergoing acupuncture treatment. Liposarcoma is the most common soft tissue sarcoma and accounts for approxi- They underwent acupuncture treatment 3 sesions a week for 7 weeks, in total 21 mately 20% of all mesenchymal malignancies.According to its clinicopatholog- sesions, infraroughe therapy 10 minutes per sesion between acupuncture treat-

340 341 Presentation Session Plenary Plenary Poster

ment and chiropractic activator therapy.the patients were called and evaluated Poster Plenary Session again after 6 months after finishing the treatment. In the measurement of pain PP147 - Staphylococcus aureus, infection of surgical wounds Presentation changes we used VAS ( Visual Analogue Scale) also in sleep quality as it affects Z.Sulejmani, E.Erindi the quality of life. Surgical Site Infection (SSI) is the most common healthcare associated infection that In most of the patients who underwent acupuncture therapy and adjustment could be averted by antibiotics prophylaxis against the probable offending organ- chiropractic therapy there was mild to good response of the patients com- isms. As Staphylococcus aureus has been playing a substantial role in the etiology of plaints to therapy. In the follow up period ( 6 months after ending up the ther- SSIs. The clinical sample was collected from patient suspected to be suffering from apy protocol) the patients still didn’t complain about the pain and fatigue. We SSI. The sample from the post-surgical wound was inoculated on Builo-9 ml sterile still need to go on with this treatment for longer time and larger groups of pa- buffer after that on Blood agar and MacConkey’s agar. The plates were incubated tients in order to abtain more significant and countable results that should help aerobically at 37oC for 24 hours. The colonies suggestive of Staphylococcus au- the medical team in an appropriate approach in the treatment of fibromyalgia. reus was identified by standard procedures. In this case presantation the patient, ap- pears on 10.03.2018 at the QSUT surgical clinic with abdominal pain. It is suspected PP146 - Adolescent Idiopathic Scoliosis that peritonitis and gangrenous appendix. In the same day the surgical intervention V.Iljazi, H.Iljazi, A.Duni is carried out appendectomy and then drainage. Immediately after the intervention, Adolescent Idiopathic Scoliosis is the most common type of spinal deformity con- treatment with Gentamicine, Cephazoline and Metronidazole begins. On the fourth fronting orthopedic surgeons, affecting children between ages 10 to 18. [1] Scoliosis day showed temperature and inflammation of the wound. is a three-dimensional spine deformity characterized by lateral and rotational curva- The microbiological examination resulted in Staphylococcus aureus and antibiotic ture of the spine. sensitivity test was performed: Cefoxitine(R), Ciproflocaxine(S), Clindamycine(S), Adolescent Idiopathic Scoliosis has a prevalence 0.47–5.2 %. The female to male Gentamycine(S), Eritromycine(S), Oxacillin (R), Penicillin(S) Vancomyin(S).Sur- ratio ranges from 1.5:1 to 3:1 and increases substantially with increasing age. [2] gical antibiotic prophylaxis should be initiated at the moment of anesthetic adminis- The risk of progression is 10 times more in females than in males [3]. In general, tration and continued for 24 hours. Adolescent Idiopathic Scoliosis curves progress during the rapid growth period of Staphylococcus aureus being the predominant organism causing SSIs. Regular the patient. Most curves slow their progression significantly at the time of skele- monitoring of the MRSA, involved in the SSI of a particular setup is the basic tal maturity, but curves greater than 60°, continue to progress during adult-hood requirement to trim down the incidence of the postoperative wound infections by [4]. The Adams forward bend test has variable sensitivity and specificity depending proper antibiotic prophylaxis. upon the. [5] The interpreter error of scoliometer measurement is approximately 2°.The Diagno- PP148 - Endocranial Hypotension. Discussion Of A Clinical Case, Etiopatho- sis is confirmed from Cobbs angle ≥10°. genetic And Radiologic Aspects. Z.Ndroqi, E.Karame Through this study will get data regarding the age of detecting the Adolescent Idio- Acute headache is a commonly symptom in ED. In differential diagnosis when CT is pathic Scoliosis in Albania, the gravity of the disease at the time of diagnosis.used negative included Endocranial Hypotension - EH. EH diagnosis is not considerable to is the Clinical Record Review of patients diagnosed with Spine Deformities at the differenciate an acute, prolonged headache. The incidence is not rare, spontaneous EH National Ortho-Prosthetic Center from 2006-2013; Analysis of the age and sex of 5 in 100.000 people. Procedures that cause EH are common and are increasing, such patients, time of diagnosis and degree of deformities. There were 149 patients; 124 as PL for anesthesia, surgery, traumas. The lcs in EH leaks out of the spinal canal, with female and 25 male. or without cause. Intracranial and brain pressure is negative, more from hypovolemia At this specialized center 83% of patients with spine deformities were females; of lcs than low pressure. Most patients ( 72%) had curves 20-40 degree; 12% had curves over 40 degrees; The main EH characteristic is headache, that emphasize in standing and facilitate in 60% of cases with AIS were diagnosed at age 13-14 years old and 20 % were older supine position ,and uniform pachimeningeal thickening in MRI. A. Z 49 years old, than 14 years. consulted at the Polyclinic, presented with headache stronger in orthostatic position, This study concludes the late diagnosis of Adolescent Idiopathic Scoliosis in Alba- with oxcipital and nucal predomination, vertigo, vomiting, visual turbidity, diplopia, nia. Early diagnosis It will allow conservative treatment and better outcome, preven- difficulty to gets up of bed, walk, severe pain of cervicothoracal column, augmented tion of severe scoliotic deformities, which may have a psychological impact. The by cough, laughter, defecation, strain. He was operated for epigastrial hernia with spi- need for screening programs in elementary schools should to be considered. nal anesthesia 4 weeks ago. The forward bend test and scoliometer measurements should be included in screen- MRI -Pachimeningeale bifrontal thickening, hyperintens signal as lcs in posterior tho- ing, and screening personnel should be trained. Adolescent Idiopathic Scoliosis, racal epidural space. Diagnose: EH from the leakage of lcs after spinal anesthesia. EH screening, Adams forward bend test, scoliometer.

342 343 Presentation Session Plenary Plenary Poster

was described by the neurologist Schaltenbrand in 1938 and MRI findings in 1991. to differentiate syncope from non syncopal causes .The first step is to examinate Poster Plenary Session There are several causes of lcs leakage outside the spinal canal as PL, dural anesthesia, postural BP. Up to 40% of people experience syncope which reoccurs in 14%.It Presentation shunt procedures, craniospinal trauma, strong physical exercise. EH can be also spon- may cause serious injury in elderly. Vasovagal syncope is the first cause of syncope taneous, as a dural defect, holes in dura where lcs licks. and OH the second. Non neurogenic OH is common in the young, neurogenic. OH Some conjuctival diseases can cause “locus minoris resistant” in menings. is frequent in older.The common symptoms of OH are light-headedness, dizziness, In our case the patient was operated with spinal dural anesthesia. There are an epidural visual disturbance that abate after sitting. fluid collection in vertebral column. BP measured via the supine stand test. In our cases one had a multisystemic atrophia When a patient is presented with orthostatic headache, facilitated in extended posi- and aortic stenosis, another cranial trauma with skull fractures that occures in 5% tion ought to considerate EH and search it in MRI. A headache can happens after PL of patients. Guideliness define OH as a reductation of SBP of at least 20 mmHg or but it is not strong and prolonged. Monro-Kellie hypothesis explains that the sum of DBP of 10 mmHg within 3 min of standing. OH increases the risk for CV mortality. cerebral, lcs and intracranial blood volume are constant. Lcs reducing volume causes CV, kidney function,polypharmacy increase the risk for OH. Most of OH has non increase of volume in one or both of the other components. neurogenic etiology as hypovolmia, cardiac failure, dehydration, some mediations, The volume increasements in MRI are pachimenings with diffuse thickness. In spon- etc. Neurodegenerative disorders have the greatest risk for NOH as dementia 30- taneous EH, a conjunctival disease affects spinal dura up to 3/4 of cases. Some studies 50%, PD 37-58%, multisystemic atrophy 75%. noted problems with the venous drainage. Discopathies can cause dural ruptures. EH Authonomyc neuropathies from some desease have risk for OH. Loss of conscience is more frequent in younger, average 42.3 years old. in OH lasts for a few seconds, without confusion after this. The clinic and EEG can The decrease of lcs volume and pressure may cause truncus and cerebellum downward differentiate epilepsy. Almost 20% of people had a syncope which may be cardiac in foramen magnum with cerebral symptoms. or noncardiac. Vasovagal cardiac reflex syncope is most commonly in neurologic Intracranial vessels and meninges are sensitive from withdrawal in orthostatism. When practice. The loss of conscience is from cerebral hypoperfusion (bradycardia and the disease is not treated it complicates with stupor and herniation. Ought to differ- arterial collapse). entate SAH and meningitis, tumors, stroke. Up to 94% of cases with spontaneous EH at the first time are not diagnosticated. An average time to diagnosis is 13 months. In PP148 - Traumatic and non-traumatic injuries. Surgery and rehabilitation our case 4 weeks. Z.Demaj Describe traumatic and non-traumatic injuries of articulations and bones, medical PP149 - Orthostatic Hypotension. Diagnostic, treatment and our clinical cases. care, surgery and rehabilitation after surgery. Describe nursing care and the im- Z.Ndroqi, E.Karame portance of physiotherapy in recuperation. Between January 2016 and December Orthostatic hypotension -OH occurs when the body can’t compensate the drop of 2017 we analyzed a total of 335 patients treated in the department of orthopedic cardiac output with standing. After moves upright, 300-800 ml of blood pulse in surgery of a private hospital in Tirana. legs and splanchnic veins. Baroreceptors sense low BP, low inhibition in the sym- All patients were 16-90 years old. According to our Hospital protocols (keeping patic system, triggering tachycardia and vasoconstriction to restore normotension the privacy of all patients) we analyzed the data of patient regarding the diagnosis .In 65 years and older OH has a prevalence 5-30%. It’s important to distinguish of hospitalization (cause of injuries), age, gender distribution. All of 335 patients syncope and non syncopal cases. Syncope is a spontaneous, reversible loss of taking the study result that the largest part are male (195 of 335) and the others conscience and postural tonus, often the first indicator of OH. Syncope related female (140 of 335) . with OH happens in standing. Regarding to the type of injuries and intervention, result that 82 of the 335 cases Neurogenic OH is a subtype from defectous vasoconstration, inappropriate re- presented are for ACL reconstruction ,for a diagnostic arthroscopy (knee pain) are leased of norepinephrine and is often in neurodegenerative deseases or disautono- 116 cases presented from 335 patients, for meniscopaty and rupture of meniscal mia. Neurogenic OH is often asymptomatic althought patients represent syncope. are 90 cases presented from 335. Among many cases in hospital, we study some of them with signs, demographic The patients presented in the hospital for hip fracture were 15 of 335 cases and data, risk factors (HTA, DM, anemia, dehydration, heart desease, arrythmia, cardiac they had done a total hip replacement. failure, medications, obesity, duration, frequency, timing of desease, clinical exam- Other cases presented were: gonartrosis 27 of 335 cases (total knee replacement ination, BP in supine and in standing position after 3-5 min and analyses ( ECG, surgery) and arthroscopy of shoulder 12 of 335 cases. At the end of the study, we biochemical profile, cardiac evaluation, MRA, echo doppler of heart and vessels, found that the most numerous cases presented to the hospital are due to sports ECG and BP holter, EEG) and Orthostatic Hypotension Questionnaire. trauma, home incidents (old age), and degenerative bone diseases. Are in the tables. Sudden loss of consciousness with drops are frequent in medical ACL, trauma, hip fracture, coxartrosis, gonartrosis, arthroscopy, surgery, menisco- practice.The first is to evaluate cardiac and neurological problems.It’s important paty, nursing care, physiotherapy.

344 345 Tirana About About

Monarchy About Tirana Good To Know On 8 February 1920, the Congress of Lushnjë proclaimed Tirana as the temporary capital of Albania, which had gained independence in 1912. In 1923, the first regulatory city plan Tirana is the capital and the largest city of Albania. It has a very old history, dating back to was compiled by Austrian architects. Then the construction in Central Tirana was part of the Palaeolithic, some 10,000 to 30,000 years ago. The oldest settlements are found close the cooperation package between of Albania and Fascist Italy. Ahmet Zog was the to Mount and Pëllumbas Cave, while Tirana and its suburbs are filled with Illyrian top- leader of Albania from 1922 to 1939. He first served as Prime Minister (1922–1924), then onyms. The called the settlement Tërana. But the city itself is relatively new, about as President (1925–1928), and finally as King (1928–1939). The centre of Tirana was the 400 years old, founded in 1614 by Sulejman Pashe Bargjini a feudal lord from this region. project of Florestano di Fausto and Armando Brasini well known architects of the Benito Its geographic location, between mountains and sea, in the very heart of Albania, has made Musoloni period in Italy. this city very attractive to the Albanians, encouraging them to move here.

Origin of Name Although a new and modern capital city the origins of Tirana as an inhabited centre are old with several theories and myths associating its current name with ancient words. One version is that its name derives from the word Theranda that Greek and Latin sources employed when refer- ring to the area after the term te ranat, Albanian for ‘that which has fallen’, a reference to the soil and substrate swept down by water from Dajti Mountain. Another theory is that it comes from the word Tirkan, the name used by the sixth century Byzantine historian Prokop to refer to a castle, first built in the first century BC, on Mount Dajti, and the ruins of which are still there. Some say it comes from tyros, the old Greek word for ‘dairy’, with the hypothesis that it was in the fields here that local shepherds gathered to trade dairy products.

Brasini laid the basis for the modern-day arrangement of the ministerial buildings in the city centre. The plan underwent revisions by Albanian architect Eshref Frashëri, Italian ar- chitect Castellani and Austrian architects Weiss and Kohler. Modern Albanian parliamenta- ry building served as a club of officers. It was there that, in September 1928, Zog of Albania was crowned King Zog I, King of the Albanians.

City foundation (Ottoman impact) Modern Tirana was founded in 1614 by Sulejman Bargjini Pasha, a local ruler from Mullet who constructed a mosque, a bakery and a hamam (Turkish sauna). The city began to grow at the beginning of the 18th century but it remained an unimportant town until it was pro- claimed Albania’s capital in 1920. The choice was made due to its central geographical po- sition in the country, on the fault-line between the northern Ghegs and the southern Tosks. It wasn’t until the late 1920s when, under Italian influence, the centre of the city took on the appearance of a capital city.

346 347 Tirana About About

Italian architecture About Tirana Well-known architects of the Mussolini period in Italy, Florestano de Fausto and Armando Brasini, were the masterminds behind the construction of the main square, which today bears the name of the Albanian National Hero Skanderbeg, the huge boulevard, ministry buildings, national bank, the town hall and the Palace of Brigades (former royal palace, to- day the presidential palace). In 1939, Tirana was captured by Fascist forces that appoint- ed a puppet government. The Italian architect Gherardo Bosio was asked to elaborate on previous plans and introduce a new project for the area of the present-day Mother Teresa Square. By the early 1940s, the southern end of the main boulevard and the surrounding buildings were finished and renamed with Fascist names.

Modern Tirana Today, Tirana is the centre of the political, economic, and cultural life of the country with about 1,000,000 inhabitants. In the last few years the city has seen substantial changes in its appearance. The dull communist-style apartment blocks have been painted over in bright colours with abstract patterns by an artist turned mayor (, the current prime minster). This is not only a quick fix but also an uplifting experience for inhabitants and visitors alike. Furthermore, Tirana has seen improvements in its development with modern infrastructure, contributing to the city’s metropolitan look. Tirana is changing day by day. The is newly restored and was inaugurated on 10 June 2017

Communist style From 1944 to 1991, the city experienced ordered development but with a decline in archi- tectural quality. Massive socialist-style apartment complexes and factories began to be built, while Skanderbeg Square was redesigned, with a number of buildings being demol- ished. For instance, Tirana's former Old Bazaar and the Orthodox Cathedral were razed to the ground for the erection of the Soviet-style Palace of Culture. The Italian-built munici- pal building was detonated and the National History Museum was constructed in its place, while the structure housing the during the period of monarchy was turned into a children’s theatre (Puppet Theatre today). The northern end of the main bou- levard was renamed Stalin Boulevard and a statue of the Soviet leader erected in the city square. As private car ownership was banned, transport for the masses consisted mainly of bicycles, trucks and buses. After Hoxha's death, a pyramidal mausoleum was constructed in his memory by the government. Now, it is known as the Pyramid, but has little to do with Enver Hoxha, having been turned in a cultural centre of Tirana.

348 349 Tirana About About About Tirana TIRANA Tirana is a charming and intriguing city. It has unique monuments and history. It is a melting pot of cultures dating way beyond the Ottoman times through the Italian occupation and a long-lasting totalitarian regime. Lonely Planet and other prestigious New Bazaar travel platforms and magazines describe Tirana as an intriguing, vibrant and lovely city, but complicated and unique in its kind. Expect to be surprised by the variety and contrasts you will find here. Relics of the old regime, grey and abandoned set against new colourful constructions. This is our city, this is Tirana!

Skanderbeg Monument and Square he New Bazaar is located at Avni Rustemi Sqaure, only 8 minute walk from the center of Tirana and quickly became the newest attraction of the city. Before the Inauguration, even though it kept the same name, the New Bazaar area was a Tchaotic place where vendors were selling their products not in good conditions. New Bazaar was a much needed investment for the city, replacing the decrepit one. It hosts some contemporary painted buildings, but it respects tradition, and is giving back to the city the beauty and authenticity. The New bazaar is already turned into a major attraction of the city due to the unique facades that have preserved the Italian architectural style, the decoration with Albanian motives, as well as public spaces to enjoy fresh food and rest. From the inauguration day the visitors in this area are increased, not only for the beautiful buildings but for also for the nice café and open bars. Local market offers a variety of fresh vegetables, fruits, seafood and meat. It is a nice place for people to spend time with their family or friends. During weekends various activities are organized here such as fairs, kanderbeg Monument in Skanderbeg Square has been regarded for more than half concerts and open theatres for kids. a century as the very centre of Tirana. It commemorates the 15th century nobleman, and hero of the nation for resisting the Ottomans. He is our King Arthur, our William The Pyramid STell. The sculpture, created by Odhise Paskali, is 11 metres (36 ft) tall, and was t is absolutely an important tourist attraction. As a inaugurated in 1968 on the 500th anniversary of the death of Skanderbeg. The square that symbol of a notorious communism, it resisted some bears his name is a meeting place for all Albanians. It is the place where many of the most attempts to be destroyed by previous governments. important cultural sites of Tirana and Albania are located—the National Museum, the Clock But it is still there, unrestored, a symbol of the mixed Tower, Et’hem Bey Mosque, Palace of Culture, National Library, Theatre of Opera and Ballet, I and contradictory history of Tirana. It was inaugurated on and Bank of Albania—while at his back are lined up most of the government buildings. October 14, 1988, as the mausoleum of the dictator, Enver Scanderbeg square had a huge restoration and it reopened on 10th of June, 2017. The Hoxha. The pyramid form was designed by a group of elements of the new square are: almost 28 000 square meters paved with tiles from all the architects led by the daughter and son-in-law of the dictator. places where Albanians live. This stoned pavement has a form of shallow pyramid with the Construction began in 1986 and ended in 1988. It did indeed highest point in the middle at about 1.80 m. The square has more than 100 fountains with serve as a mausoleum for Hoxha, until 1991, after which it fresh water, to keep the place cool during the hot summer. The Scanderbeg Square, The became a conference and fair centre. It took its name”The National Opera, National Museum and National Bank surround the stone pavement, while Pyramid” during the student revolt of December 1990, both behind these buildings, there are planted trees from all over Albanian territory. Mini- parks, from its form but also as a symbol of dictatorship. Today, benches, flowers, platforms for taking photos or altar for getting married, are part of the it is officially known as the Pjeter Arbnori International square. There are 32 square meters planted with different aromatic trees and 90 000 square Cultural Centre, and stands out as a remarkable piece of meters walking area, while the underground parking can allow about up to 300. architecture and legacy from communism.

350 351 Tirana About About About Tirana

Postblloku National (Checkpoint) Historical ostblloku (Checkpoint), the Memorial to Communist Isolation, commemorates the country’s political prisoners who suffered under the Hoxha regime. It is situated on Museum the main boulevard opposite the government building. Co-created by the writer and former dissident Fatos Lubonja and the artist Ardian Isufi, the monument is made f you are keen to know the turbulent history of the Albanians, this is the place to visit. P The National History Museum is the most important museum in Albania and contains up of three main elements including one of the small concrete defensive bunkers that litter the country, several concrete supports from the mine at the notorious Spaç labour camp a well-documented history of the country. where thousands of political prisoners suffered between 1968 and 1990 and a brightly IThe museum is divided into eight pavilions: Antiquity, Middle Ages, Renaissance, painted section of the Berlin Wall from Postdamer Platz that once split Germany in two. Independence, Iconography, National Liberation Anti-fascism War, Communist Terror, and Mother Teresa. The Pavilion of Communist Terror hosts images, documents and videos of the persecution suffered by the Albanians during the communist regime. A visit here can take up to three hours, so pace yourself! Independence monument

he monument placed in next to the capital’s central boulevard was inaugurated on 28th November 2014 Clock Tower Tas a symbol of Albania’s century of independence. The monument, some 6.5 metres high, 5.5 metres wide and weighing 15 tons, was he Clock Tower is a cultural monument created by artists Visar Obrija and Kai Kiklas in that has shown the time in Tirana since Austria. This monument is a symbol of Albanian 1822. It stands beside Et’hem Bey nation’s resistance in difficult times and wars. It Tmosque, built by the same person. You is in a shape of an open tower, symbolizing the can climb its 90 stairs and on reaching the top opening of Albania toward independence. ”It have a magnificent view of the main square in represents two shapes that together make an Tirana and beyond. The Clock Tower comprises a open air and round tower. One part is the ceiling, major part of the emblem of Tirana Municipality and the other the floor. If you join together they and together with the mosque forms a unique create one rectangular tower. architectural ensemble.

352 353 Tirana About About About Tirana House of Leaves

Et’hem Bey Mosque

he House of Leaves is a museum dedicated to the Sigurimi, the Albanian secret t’hem Bey Mosque was built in the 18th century and is located right by the Clock service during the Communist regime. The museum is located on the site of what Tower at the edge of Skanderbeg Square. It is one of the most relevant landmarks used to be Dr. Basho’s Women’s Clinic until it was turned into the headquarters in the city. The mosque was built over 20 years at the end of the 18th century by Tof the Central operations of the technical-scientific unit of the Directorate of the EMolla Bey, Haxhi Ethem Bey and Suleijman Pasha and was one of the buildings that State Security, the Sigurimi, in the 1940s. made up the old center of Tirana which included the Bazaar and two mosques. The House of Leaves is a great place to learn more about the regime’s infamous and The mosque, like all other places of worship, was closed during the communist regime notorious obsession with surveillance. You will be able to learn more about the techniques of Enver Hoxha but survived the purging of the regime during the “Cultural Revolution” and tools used and also how the general population felt. because it was a national monument. The mosque reopened in 1991 when 10,000 people came in carrying flags.

The Cloud of Sou Fujimoto

he Cloud of Sou Fujimoto is a famous 3D semi-transparent white pavilion in a grassy area in front of the National Gallery that is not only a monument to see “Cosmic S” but also an interactive space where you can sit down and read or watch the world t is called “Cosmic S” Tgo by, or a a creation of Helidon space for events. The Xhixha and stands in the structure is made middle of a circular flower of steel bars built in I garden in the perimeter line rectangular shapes of which several fountains and has a few steps have been built. It situated at and platforms. This “Zogu i Zi”. The work consists is not a permanent of two vertically displaced structure, it was pyramids. The author himself before in Kensington has conveyed some thoughts Gardens in London, about the work by adding that so it will probably be he devotes it to Tirana and the dismantled in 2019. changes she is undergoing.

354 355 About Tirana Experience Tirana in 24 hours Under auspices of Ministry of Health & Do you only have one day to see Tirana? Here is what we suggest for you to do to gain an impression of the capital of Albania. Ministry of Education and Sports

Scanderbeg square If you have just arrived in the main square of Tirana, you can visit the National History Museum, Et’hem Bey Mosque and the Clock Tower. Also you can have a look at the main government buildings alongside the main boulevard Deshmoret e Kombit (Martyrs of the Nation)

A short trip to Blloku area Visit the bunker- a Memorial of Communism, and also a piece of the Berlin Wall, to be found at the entrance to the Blloku Area. Then stroll down to the villa of Enver Hoxha the dictator. You can drink excellent cof- fees, macchiato, cappuccino, hot chocolate, fresh fruit juices and cocktails at the many colourful and lively bars in this area. You could also catch the external lift to the revolving bar on top of Sky Tower from where you have a wonderful panoramic view of Tirana.

A Traditional lunch Don’t leave Albania without trying Al- banian food. You can select from huge menus at many restaurants in the city and try Albanian food such as byrek, fergesa e Tiranes or tave dheu. But you can also find typical Italian food, from salads and meat dishes, fish to pizza. Albanian food is excellent.

Afternoon walk to the lake or take a cable car to Mountain Dajti After a good lunch you can walk to the artificial lake, which is very close to the Blloku. This is the main park and most popular at the week- end. We suggest you visit Mount Dajti, 20 min- utes from city, or drive 13 minutes to get the cable car. From Mountain Dajti you can have a magnificent view across the whole of Tirana. TIONAL M NA ED R I E C T A L N I INTERNATIONAL MULTIDISCIPLINARY

C A O IMCA I N N G A R B ESS IN AL MEDICAL CONGRESS IN ALBANIA

BOTOX, FILLER, THERMAGE PRP, MESOTERAPI LIFTING ME FIJE

ELIMINIM TATUAZHI ELIMINIM I VARIÇEVE ME LAZER

FRAXEL DEPILIM I PËRHERSHËM ZELTIQ ME LAZER CONGRESS PARTNERS: LPG (Lipomassage)

Cel: 069 60 75599 (pranë Spitalit Amerikan 3) Rr. “Sabaudin Gabrani”, Godina Nr. 2