Swedish American Hospital

Single-shot pulsed-field ablation (PFA) catheters show promising safety and efficacy for achieving pulmonary vein isolation (PVI) in atrial fibrillation (AF). However, additional PFA applications are sometimes required after standard PFA delivery to achieve PVI. This study aimed to evaluate the real-world frequency and location of acute residual pulmonary vein (PV) connections using 3-dimensional electroanatomic mapping (3D-EAM) during index PFA. Patients undergoing index PVI with a single-shot PFA catheter and receiving postablation 3D-EAM were prospectively studied. First-pass isolation (FPI) rates and distribution of residual PV connections were assessed. A total of 535 patients from 48 international centers (89 operators) were included (paroxysmal AF 375; persistent AF 160). Mean procedure time was 75.9 ± 31.9 minutes, and mapping time was 8.4 ± 5.2 minutes. Ablation was performed with a pentaspline, variable conformation PFA catheter in 72.7% of cases and a fixed-loop PFA catheter in 27.3%. Bilateral FPI was achieved in 75.1% of patients (paroxysmal AF 77.1% vs persistent AF 70.6%; P = .126). The individual PV FPI rate was 92.7% (1834 of 1978 PVs). Excluding common PVs, residual PV connections were more frequent in superior PVs (superior 8.9% vs inferior 3.8%; P < .001), specifically in the left superior PV (10.1%). Predictors of FPI included standard 4-vein anatomy (odds ratio, 1.83; 95% confidence interval, 1.09-3.07; P = .021) and the pentaspline catheter (odds ratio, 3.53; 95% confidence interval, 1.81-6.87; P < .001). Using 3D-EAM, an acute residual connection of at least 1 PV was observed in a quarter of patients after standard PFA delivery and was most common in the left superior PV. Potential mechanisms include reversible electroporation, highlighting the potential need for additional lesions and the value of a mandatory post-PFA "waiting period."

Tumor necrosis factor (TNF)-alpha inhibitors are effective biologics in the treatment of inflammatory bowel disease; however, they increase susceptibility to opportunistic infections. We report a case of a 74-year-old female with Crohn's disease who developed concomitant pulmonary tuberculosis (Mycobacterium tuberculosis [MTB]) and Histoplasmosis capsulatuminfection while on adalimumab. Co-infection is rare in patients on TNF-alpha inhibitor therapy, and most cases have been reported in patients with human immunodeficiency virus (HIV). This was a challenging case for diagnosis and treatment due to indistinguishable presenting symptoms of both infections, similar laboratory and radiographical findings, and a clinical course complicated by drug-drug interactions and worsening of symptoms despite therapy.

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; The 30th Albanian Surgical Conference (ACS 2023) and the 7th Albanian Congress of Trauma and Emergency Surgery (ACTES 2023) represent a significant milestone in the medical community. These concurrent events provide a platform for the exchange of knowledge, collaboration, and the advancement of surgical science in Albania.&#x0D; ACS 2023 &amp; ACTES 2023 gather experts, scholars, practitioners, and enthusiasts from the field of surgery, both in traumatic and non-traumatic areas, in the vibrant city of Tirana. The comprehensive program encompasses a diverse range of surgical topics, from abdominal and chest injuries to vascular injuries, emergency surgery, and the challenge of nurse services in the new millennium.&#x0D; The theme of this year's events, "Surgery and not only...," reflects the commitment to innovation, best practices, and groundbreaking discoveries. The programs include plenary sessions with renowned experts, scientific presentations, panel discussions, networking opportunities, an industry exhibition, poster awards, cultural and social activities, and Continuing Medical Education (CME) credits.&#x0D; Participants can expect a professionally enriching experience that also offers personal rewards. ACS 2023 &amp; ACTES 2023 value the role of each attendee in contributing to the advancement of surgical knowledge and patient care. The events promise to chart new horizons in the field of surgery and foster international collaboration.&#x0D; The 30th Albanian Surgical Conference and the 7th Albanian Congress of Trauma and Emergency Surgery are poised to create lasting memories, and their success hinges on the active participation of every attendee. It is an opportunity to inspire, collaborate, and make a lasting impact on surgical care worldwide.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Spinal tuberculosis (TB), also known as Pott's disease, is a severe form of extrapulmonary TB that affects the vertebral bodies and intervertebral discs. While the typical presentation involves the contiguous involvement of multiple vertebrae, atypical forms, such as non-contiguous multilevel spinal TB (NMLST), can occur. However, diagnosing spinal TB poses challenges due to its gradual onset, nonspecific symptoms, and varying imaging results. The timely diagnosis and treatment of spinal TB are critical to prevent serious consequences, including vertebral damage, irreversible neurological impairment, or even death. In this report, we present the case of a 58-year-old South Asian female who presented with several months of back pain, fatigue, and weight loss. Despite initially negative TB test results, spinal magnetic resonance imaging (MRI) raised suspicion of NMLST, which was later confirmed by bone biopsy. This case highlights the complexities of diagnosing and managing atypical spinal TB presentations while discussing the case findings and reviewing relevant research.

Introduction: When detecting bone metastases bone scintigraphy has been long used as the most sensitive radiological modality, especially in lytic metastases, to assess the spread of disease in skeletal structures. Currently bone scintigraphy and CT remain the gold standard for bone metastasis detection in oncological patients in our nation. Method: We describe the case of a 45-year-old man who was diagnosed with large B-cell lymphoma and was having a whole-body PET/CT scan for staging purposes. The overall report identified the pathological lymph nodes, in more than one region of lymph node stations. These nodes had increased in size compared to the previous study of the patient. Diffuse skeletal pathological uptake of the radiotracer indicated diffuse bone marrow infiltration, while the CT images alone showed no evidence of typical lytic bone lesions. Other findings included splenomegaly and secondary splenic infiltration. Discussion: One of the primary diagnoses for which PET/CT is particularly effective is lymphoma, when it comes to identifying intra and extraosseous recurrence. This is particularly true when it comes to identifying marrow infiltration. Few centers in Kosovo and Albania have used the combined PET/CT modality in the last two years, besides the importance of including it as part of the imaging protocol in the follow-up of the patients with lymphoma, or oncologic patients in general. Keywords: Case report, PET/CT, scintigraphy, metabolically active, bone lesions, lymphoma.

In recentyears, many epidemiological studies have investigated the relationship between solid fuel combustion and diabetes mellitus (DM). This meta-analysis was performed to explore the potential association between solid fuel combustion and DM. A comprehensive literature search was conducted to identify all relevant studies published prior to January 14, 2022. The pooled odds ratios (OR) with 95% confidence intervals (CI) were used to estimate the effect of solid fuel combustion on DM. The I square value (I2) was used to assess heterogeneity. Due to the heterogeneity of the studies (I2 = 66.70%), a random-effect model was used as the pooling method. A total of 9 articles (10 available datasets) were used for this systematic review and meta-analysis, involving 45,620 study subjects. The results of the meta-analysis showed a statistically positive relationship between household solid fuel combustion and the risk of DM (OR = 1.46, 95% CI = 1.09-1.97). Subgroup analysis based on fuel type revealed a statistically significant association in the mixed solid fuel group (OR = 2.03, 95% CI = 1.59-2.59), but not in the single biomass group (OR = 1.04, 95% CI = 0.73-1.49). This meta-analysis suggests that solid fuel combustion may be associated with an increased risk of DM.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is known to have a wide spectrum of effects on the respiratory, cardiac, neurological, hematopoietic, gastrointestinal, ocular and urological systems, but there is very little information on its effects on the human ovary. Our aims are to describe a unique case that developed amenorrhea during and after SARS-CoV-2 infection and to push researchers to do more researches to understand the effects of SARS-CoV-2 infection on the ovaries. A 27-year-old female patient presented with amenorrhea. She had fever on the second day of the menstrual cycle, and her cycle had been interrupted on the same day. The patient had a sub-febrile temperature, myalgia, fatigue, sweating, loss of appetite, and mild sleep disorder. Based on clinical, laboratory, and reverse transcription polymerase chain reaction (RT-PCR) data of a nasopharyngeal swab sample, she had a positive result for SARS-CoV-2 infection. Till now there are limited publications on the effect of SARS-CoV-2 infection on the ovaries. In particular, the potential adverse effects of SARS-CoV-2 infection on fertility are unclear. Coronavirus disease 2019 (COVID-19) patients need to be followed up for a long time, and clinicians need to pay attention to menstrual disturbances, especially in young female patients. More evidence, through both epidemiologic and clinical studies, as well as long-term follow-up studies, is needed to understand the impact of this infection on the human ovary, especially in reproductive-aged women.

Perinatal brain injury is the third leading cause of child mortality globally. Purpose: Evaluation of perinatal risk factors for encephalopathy in neonates in order to prevent deaths and disabilities Method: This is a prospective, case-control study conducted in the Maternity Hospital “K. Gliozheni” during the time period 2012 – 2016. 65 newborns at term ≥37 weeks diagnosed with encephalopathy according to the Thompson classification &gt;5 within 12 hours of birth were compared with a control group, infants without encephalopathy in a 1:1 ratio selected casual and gender-appropriate. Results: Total antepartum risk factors were found in (70.8%) of cases and (18.5%) of controls (p&lt;0.01). Sentinel events were found in 38.5% of cases and in 9.2% of controls. (p&lt;0.01). Acute intrapartum events in total were found in (38.5%) of cases and (9.2%) of controls (p&lt;0.01). 43.1% of babies had a combination of antepartum and intrapartum factors (p&lt;0.01). Significant and independent predictive factors of risk for neonatal encephalopathy resulted: from maternal factors, mother’s age &gt;35 years (p=0.03). Of the intrapartum factors: pregnancy with twins (p&lt;0.01), hypertension/preeclampsia (p&lt;0.01), non-reactive FHR before delivery (p&lt;0.01). MEDICUS No. 6, ISSUE 2/ 2022 103 From intrapartum factors: breech birth (p=0.01), emergency cesarean section (p=0.01), meconial amniotic fluid (p=0.02), prolonged birth (p=0.01). Conclusion: Knowledge of perinatal risk factors associated with neonatal encephalopathy is essential for developing interventions to prevent neonatal death and disability.

AIM: To reevaluate the correlations between ultrasound (US) features of thyroid nodules (THNs) and grades of Bethesda classification, to select correctly the patients who must undergo fine needle aspiration (FNAB). MATERIAL AND METHODS: In this study, we have included 260 cytologies of thyroid gland between the period of 2014–2018. The procedures are performed at radiology department of Hygeia Hospital. In our study are excluded the cases with a high risk of hemorrhage and the patients which did not accept the anesthetic procedure because of anxiety. The study includes only the first punctions with their respective Bethesda classification and not repeated FNAB cases. First using the z test, we compared the percentage occupied by the Bethesda categories that are indicative of surgery (BIV + BV + BVI) at US features that suspect malignancy (hypoechogenicity, microcalcifications, abnormal contours, central vascularization), with the percentage occupied by group (BIV + BV + BVI) at the US features which indicate benignity (hyperechoic, no microcalcifications, peripheral vascularization, cystic-solidocystic, spongiform, normal contours). Furthermore, We have evaluated utilizing the odds ratio if there was a correlation between TR4 and TR5 categories in ACR/TIRADS classification and the categories (BIV+BV+BVI) for any statistical significance. The significance of the dimensions of the nodule was tested as an indicator for surgical intervention. For this purpose, the percentage occupied by the nodules with a diameter larger than 1.5 cm at (BIV + BV + BVI) group was compared with the percentage occupied by nodules smaller than 1.5 cm at BIV + BV + BVI. In addition, we observed if there was a strong statistical connection between nodules larger than 1.5 cm and the Bethesda categories that suggested malignancy. There was no statistical test made for the features “taller than wide” and microcalcifications because of the small number of cases. It was also made a comparison of percentages (BIV + BV + BVI) even for three clinical features: Men versus women, solitary nodule versus multinodular goiter, left lobe versus right lobe. We compared the percentages occupied by the (BIV + BV + BVI) group of categories in patients over 45 years old with the percentages occupied by this group at patients younger than 45 years old. We also noted which of Bethesda categories is more frequent. CONCLUSIONS: The features that are more indicative for FNAB are hypoechogenicity, consistency, intranodal vascularization, and extralobar positioning. If a THN has one of the above features and has a dimension of more than 10 mm, it has an indication for FNAB. Indications for FNAB increase with the increasing of the abovementioned features of a THN. The combination of US features that suggest malignancy, TR4 and TR5, with BIII category is a strong indicator for surgical intervention. The results of this study are similar with the results of prior studies, and we could not distinguish any specific US feature that has an absolute indication for FNAB. The appropriate determination of the US features of a THN in correlation with the patient’s clinic information will determine the proper indication for a FNAB.