Pediatric Burns in University Clinical Centre of Kosovo From 2011-2015.

The objective of this study was to describe the epidemiology of burn-related injuries in children <15 years in Kosovo, and compare incidence and cause of burns with our previous study conducted over the period 2005-2010 on children with burn injuries of the same age group. This was a retrospective study of pediatric patients (n=277) admitted to the University Clinical Centre of Kosovo between 1 January 2011 and 31 December 2015. We analyzed data on gender, age, cause, location, burn size (TBSA), depth of injury, seasonality, duration of hospitalization and treatment of burn-related injuries, collected from the medical records available in the archives of the University Clinical Centre of Pristina. The patients were categorized into three age groups: infants and toddlers (0-2 years), early childhood (3-6 years) and late childhood (7-15 years). Data were analyzed applying descriptive statistics, Chi-square. P-values less than 0.05 were considered significant. During the study period 2011-2015, in our population, burns in children were predominant in boys, with 166 cases (59.9%), while 111 patients were girls (40.1%). The incidence of extensive burns in childhood remains high, although we have seen a slight decrease compared to the previous 5-year study period.

Cette étude rétrospective décrit l'épidémiologie des 277 enfants kosovars brûlés (âge <15 ans) hospitalisés entre le 1er janvier 2011 et le 31 décembre 2015 dans le CTB du CHUI de Pristina, puis la compare aux données relevées entre 2005 et 2010. Nous avons analysé l'âge, le sexe, la cause, la surface, la profondeur, la localisation, la saisonnalité, la durée d'hospitalisation, le traitement. Les données ont été extraites des dossiers. Nous avons répartis les enfants en 3 classes d'âge: nouveaux- nés et nourrissons (<2 ans), petits enfants (3 à 6 ans) et grands enfants (7 à 15 ans). Les garçons étaient plus souvent atteints (166-59,9%) que les filles (111-40,1%). L'incidence demeure élevée, bien qu'en légère diminution comparativement à celle de la période précédente.

Life cycle assessment of roads: Exploring research trends and harmonization challenges.

The transparency, heterogeneity and hypotheses considered in the calculation of the environmental impacts of roads are still barriers to the identification of low-carbon solutions. To overcome this problem, this study presents an analysis of 94 papers obtained in a systematic literature review of the Scopus, Science Direct, Mendeley, Springer Link, and Web of Science databases. From a total of 417 road case studies, only 18% were found to be fully transparent, reproducible, and likely to present reliable results. The road design parameters of the speed limit were provided in 11% of the cases, and the average annual daily traffic data were provided in 42%. Limited data were found for the dimensions of road elements such as the number (77%) and width of lanes (33%), shoulders (15%), footpaths (5%), berms (1%) and foreslope (4%). The source of the life cycle inventory was presented in 57% of the case studies, impact assessment method was indicated in 22%, and the software utilized was listed in 50%. A lack of information was noted in the description of the types of materials employed in road projects. In addition, the large heterogeneity in the definitions of the functional unit, system boundary and in the reference study period of repair, replacement, rehabilitation or end-of-life for both flexible and rigid pavement does not support the identification of the most environmentally friendly solutions. Based on the results of the analysis, several recommendations for design parameters and life cycle assessment aspects are proposed to support a harmonized calculation of the environmental impacts of road projects.

Genetic deletion of fibroblast growth factor 14 recapitulates phenotypic alterations underlying cognitive impairment associated with schizophrenia.

Cognitive processing is highly dependent on the functional integrity of gamma-amino-butyric acid (GABA) interneurons in the brain. These cells regulate excitability and synaptic plasticity of principal neurons balancing the excitatory/inhibitory tone of cortical networks. Reduced function of parvalbumin (PV) interneurons and disruption of GABAergic synapses in the cortical circuitry result in desynchronized network activity associated with cognitive impairment across many psychiatric disorders, including schizophrenia. However, the mechanisms underlying these complex phenotypes are still poorly understood. Here we show that in animal models, genetic deletion of fibroblast growth factor 14 (Fgf14), a regulator of neuronal excitability and synaptic transmission, leads to loss of PV interneurons in the CA1 hippocampal region, a critical area for cognitive function. Strikingly, this cellular phenotype associates with decreased expression of glutamic acid decarboxylase 67 (GAD67) and vesicular GABA transporter (VGAT) and also coincides with disrupted CA1 inhibitory circuitry, reduced in vivo gamma frequency oscillations and impaired working memory. Bioinformatics analysis of schizophrenia transcriptomics revealed functional co-clustering of FGF14 and genes enriched within the GABAergic pathway along with correlatively decreased expression of FGF14, PVALB, GAD67 and VGAT in the disease context. These results indicate that Fgf14(-/-) mice recapitulate salient molecular, cellular, functional and behavioral features associated with human cognitive impairment, and FGF14 loss of function might be associated with the biology of complex brain disorders such as schizophrenia.

Surgical treatment of burns sequelae. our experience in the Department of Plastic and Reconstructive Surgery, Pristina, Kosovo.

Burn injuries are very frequent in Kosovo, leading to long-lasting physical, functional, aesthetic, psychological and social consequences directly proportional to the time of healing; the longer it takes for the burn wound to heal, the more serious are the sequelae. The objectives of the present study are to review the epidemiological, clinical and therapeutic aspects of burn patients presenting with post-burn sequelae and treated at the Department of Plastic and Reconstructive Surgery, Pristina, Kosovo, from January 2005 until December 2011. This study included 188 patients with burns sequelae. The following variables were considered: age, sex, anatomical location, pathological types, and surgical procedure. There were 82 men (43.6%) and 106 women (56.4%), ranging in age from 0 to 67 years (mean age 33.5 years), most of the patients were children (139 = 73.9%). Burn contractures were observed in 135 (71.8%) patients, hypertrophic scars in 32 (17%), keloids in 10 (5.3%), alopecia in 6 (3.2%), syndactyly in 12 (6.4%), ectropion in 4 (2.1%) and ear deformity in 1 (0.53%) cases. To correct the deformities the most common choice was the Z-plasty technique, used in 31.4% of cases, followed by Z-plasty+full thickness skin grafts in 21.8%, full thickness skin grafts in 18.1%, tissue expansion in 8%, Z-plasty+local flaps in 4.8%, flaps (local, fascio-cutaneous, radial forearm) in 6.9% and direct closure in 6.4%. Timely wound closure and the development of an individual programme for surgical treatment of burns sequelae are crucial for optimal outcomes in patients with burns.

Les brûlures sont très fréquentes au Kosovo: elles sont à l'origine de séquelles fonctionnelles, esthétiques, psychologiques et sociales qui sont directement proportionnelles à la durée de la cicatrisation. Les objectifs de cette étude sont d'examiner les aspects épidémiologiques, cliniques et thérapeutiques chez les patients présentant des séquelles de brûlures dans notre département de chirurgie plastique et reconstructive de Pristina de Janvier 2005 à Décembre 2011. Cette étude réunit 188 patients. Les facteurs suivants ont été examinés: âge, sexe, localisation anatomique, profondeur de la brûlure, et technique chirurgicale. On dénombre 82 hommes (43.6%) et 106 femmes (56.4%), âgés de 0 à 67 ans (âge moyen: 33.5 années), la plupart des patients étaient des enfants (139 = 73.9%). Les rétractions ont été observées chez 135 patients (71.8%), les cicatrices hypertrophiques dans 32 cas (17%), les chéloïdes dans 10 cas (5.3%), l'alopécie dans 6 cas (3.2%), la syndactylie dans 12 cas (6.4%), l'ectropion dans 4 cas (2.1 %) et une seule déformation de l'oreille (0.53%). Pour les corriger, la méthode la plus fréquente était la plastie en Z utilisée dans 31.4% des cas, suivie par la plastie en Z +greffe de peau totale (21.8%), greffe de peau totale seule (18.1%), expansion (8%), plastie en Z +lambeau local (4.8%), lambeau [de voisinage, fascio-cutané, anti brachial] (6.9%) et suture directe (6.4%). La fermeture de la plaie dans les meilleurs délais et la mise au point d'un programme chirurgical individuel permettent d'obtenir des résultats optimaux dans les séquelles de brûlures.

[Membranous glomerulonephritis: better therapy with autoantibody monitoring?]. / Membranöse Glomerulonephritis: Differenziertere Therapien durch Autoantikörperbestimmung?

Membranous nephropathy is the most common cause of nephrotic syndrome in adults. Binding of circulating autoantibodies to the glomerular filtration barrier leads to the development of this autoimmune disease. The clinical symptoms range from small proteinuria to severe nephrotic syndrome with enormous oedema, not controllable hyperlipidaemia and increased disposition for infection. One third of patients reach complete or partial remission of proteinuria under symptomatic treatment, which includes ACE-inhibitors and AT-I-blockers, loop diuretics and statins. Untreated the disease leads to loss of renal function over 5-10 years in 20-30% of patients. A risk score based on proteinuria and renal function is used to guide the decision when to start with an immunosuppressive therapy. A better adapted diagnostic and therapy of membranous nephropathy may be possible through measurement of circulating autoantibodies directed against a podocytic phospholipase-A(2) receptor.

Rituximab in adult patients with immunosuppressive-dependent minimal change disease.

BACKGROUND: Minimal change disease (MCD) is one of the leading causes of nephrotic syndrome. Steroid therapy is effective in achieving remission, but relapses, steroid dependence, and steroid resistance are therapeutic challenges. The use of second-line agents such as cyclophosphamide is associated with toxicity and adverse effects. Therefore, we studied the effect of rituximab (RTX) on proteinuria in adult patients with immunosuppressive (IS)-dependent MCD. METHODS: In this single-center, prospective, open series study, 6 consecutive patients with IS-dependent MCD and frequent relapses on different IS regimens - one of them after previous RTX treatment - were included. Patients were treated with a single dose of RTX (375 mg/m²). An additional dose of RTX was administered depending on B-cell count and proteinuria. RESULTS: 5 out of 6 patients achieved complete remission at the end of the follow-up; the other patient had a partial remission. All patients are free of additional IS agents and other medications were remarkably reduced. Three patients had a relapse, which was successfully treated with a further RTX treatment. CONCLUSIONS: RTX could be an alternative in the therapy of patients with IS-dependent MCD, leading to successful cessation of other IS treatment.

Electrical Burn Injuries. An Eight-year Review.

Electrical injuries are very aggressive pathological lesions with heavy functional and aesthetic consequences. The primary cause of their gravity is the progressive tissue necrosis that occurs with the continuous extension of wound necrosis, even leading to loss of the entire injured extremity. The goal of this study is to analyse the role of the inefficiency of the electric energy system in the incidence of electrical injuries in Kosovo during the period December 2000 to 2007 suffered by a total number of 182 patients treated in the Department of Plastic and Reconstructive Surgery, Pristina, Kosovo. Electrical injuries accounted overall for 17.25% of all patients admitted with burns; 35.72% of the burns were due to high voltage and 64.28% to low voltage; among the patients with contact burns the amputation rate was 28.58%, and four patients (7.14%) died. These results suggest that the aggravation of the electric energy system led to an increase in the number of patients with electrical injuries.