Maternal and Perinatal Outcomes of Pregnant Patients with Coronavirus Disease 2019: Data from a University Hospital Setting in Tirana, Albania, May 2020 to November 2021.

Scientific evidence suggests an increased risk of maternal and obstetric complications in pregnant patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study is aimed at evaluating perinatal and maternal outcomes among patients with coronavirus disease 2019 (COVID-19) in a university hospital setting. This was a prospective cohort study of 177 pregnant women with confirmed SARS-CoV-2 infection at a tertiary hospital between May 2020 and November 2021. Both symptomatic and asymptomatic women with a positive reverse transcription-polymerase chain reaction test result at any time during pregnancy were included in this study. For the purpose of this study, we classified COVID-19 cases into two groups: mild and severe cases. The two groups were then compared to predict how the clinical presentation of COVID-19 affected adverse maternal and perinatal outcomes. Gestational age ≥ 20 weeks at the time of infection was significantly associated with the occurrence of severe forms of the disease (relative risk (RR) 3.98, p = 0.01). Cesarean section was the preferred mode of delivery, with 95 women (62.1%) undergoing surgery. A total of 149 neonates were delivered to women who had confirmed SARS-CoV-2 infection at any time during the course of pregnancy of which thirty-five (23.5%) were admitted to the neonatal intensive care unit (NICU). Severe forms of COVID-19 increased the risk of premature delivery (RR 6.69, p < 0.001), emergency cesarean delivery (RR 9.4, p < 0.001), intensive care hospitalization (RR 51, p < 0.001), and maternal death (RR 12.3, p = 0.02). However, severe forms of SARS-CoV-2 infection are not directly responsible for low birth weight or the need for neonatal resuscitation. Our findings suggest that pregnant women presenting with severe COVID-19 disease are at an increased risk of adverse maternal and perinatal outcomes, such as premature delivery, cesarean section, admission to the ICU, and maternal death. Infection after the 20th week of gestation increases the risk of developing severe forms of the disease.

Provider Perspectives on Safety in Primary Care in Albania.

PURPOSE: The purpose of this study was to determine the safety attitudes of specialist physicians (SPs), general physicians (GPs), and nurses in primary care in Albania. DESIGN: The study was cross-sectional. It involved the SPs, GPs, and nurses from five districts in Albania. A demographic questionnaire and the adapted Safety Attitudes Questionnaire (SAQ)-Long Ambulatory Version A was used to gather critical information regarding the participant's profile, perception of management, working conditions, job satisfaction, stress recognition, safety climate, and perceived teamwork. METHODS: The onsite data collectors distributed questionnaires at the primary care clinics and then collected them. Descriptive statistics were used to summarize the responses. The significance of mean difference among SPs, GPs, and nurses was tested using analysis of variance. FINDINGS: Five hundred twenty-three questionnaires were completed. The concept of patient safety in relation to job satisfaction received the highest ratings. Stress recognition had low ratings. There was a high level of teamwork in SPs, GPs, and nurses. Healthcare staff agreed that it was difficult to discuss errors in their primary healthcare center. Physicians in contrast to nurses were most likely to affirm that they do not make errors in hostile situations. CONCLUSIONS: Errors are difficult to discuss. It was clear that primary care staff, such as physicians, never considered the likelihood of errors occurring during tense situations. CLINICAL RELEVANCE: Staff at primary healthcare centers are used to adverse events and errors. Despite the demand for safety improvement and the existing evidence on the epidemiology of outpatient medical errors, most research has only been conducted in hospital settings. Many patients are put at risk and some are harmed as a result of adverse events in primary care. Adequate communication and technical skills should be utilized by primary care providers (PCPs) for improvement of patient safety. The patient safety measures should include assessment of the safety attitudes of PCPs.

An Investigation into the Prevalence of Enamel Hypoplasia in an Urban Area Based on the Types and Affected Teeth.

Enamel hypoplasia (EH) is a qualitative defect, and it can have a significant impact on oral health. The aim of this study was to evaluate the prevalence of enamel hypoplasia in urban area in Albania. METHODOLOGY: In total, 234 children of both sexes aged 8-12 years old were randomly selected in five schools in Tirana, Albania. They underwent an intra-oral examination. Diagnostic criteria were in accordance with a European meeting on MIH held in Athens, 2003, and the FDI. Medical history was retrieved using questionnaires, and data obtained from clinical examination were recorded. RESULTS: The prevalence of enamel hypoplasia was 12.8%. The most commonly occurring enamel hypoplasia was the mild type (58.62%). The mandibular first molar showed the highest prevalence of enamel hypoplasia (19.5%), and the maxillary canines and premolars were the least affected (2.3%). In this study, medical story did not have a significant effect on enamel hypoplasia. CONCLUSIONS: The prevalence of enamel hypoplasia remains high at 12.8%. Interestingly, the features of enamel hypoplasia were consistent across both sexes, with no correlation found between them. The predominant occurrence of mild enamel hypoplasia underscores the importance of implementing oral hygiene strategies in schools to mitigate its progression.

Contrast-Induced Nephropathy in Interventional Cardiology: Incidence, Risk Factors, and Identification of High-Risk Patients.

AIM: This study aimed to study contrast-induced nephropathy (CIN) or more recent nomenclature contrast-associated acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary procedures, evaluating CIN incidence, risk factors (RFs), and high-risk patients with CIN.  Methods: This is a prospective, observational, unicentric trial of patients who underwent coronary angiography and/or percutaneous coronary intervention (PCI) in the University Hospital Center (UHC) "Mother Teresa" in Tirana, Albania, during 2016-2018. CIN was defined as an increase of 25% and/or by 0.5 mg/dL of serum creatinine (SCr) and high-risk patients with CIN as an increase by 50% and/or by 2 mg/dL and/or need for dialysis compared to the basal pre-procedural values. We evaluated RFs for CIN: preexisting renal lesion (PRL), heart failure (HF), age, diabetes mellitus (DM), anemia, and contrast quantity.  Results: The incidence of CIN resulted in 14.4%. HF, PRL, and age ≥65 years resulted in independent RFs for CIN, whereas anemia, DM, and contrast quantity >100 mL did not. PRL proved to be the most important RF for CIN, whereas HF was the only independent RF for high-risk CIN patients. CONCLUSIONS: The incidence of CIN coincides with the results in the literature. PRL, HF, and age ≥65 years resulted in independent RFs for CIN; more and larger trials are needed to evaluate DM, anemia, and contrast quantity related to their impact on CIN. High-risk patients with CIN represent the most problematic patients of this pathology.

Comparison of hypertonic vs isotonic fluids during resuscitation of severely burned patients.

BACKGROUND: The hypertonic lactate saline (HLS) solutions with mild concentration of sodium have been used in some burn centers to maintain plasma volume without infusing larger fluids volumes. To evaluate the fluid requirements during resuscitation with lactated Ringer's solution and to realize resuscitation with HLS, we suggest the following clinical trial. Specific objectives include fluid loads, sodium loads, and fluid accumulation. METHOD: This prospective study included 110 patients with severe burns. The first group included patients resuscitated in the beginning with lactated Ringer's solution, according to Parkland formula for adults and Shriner formula for children. In the other group, the patients were resuscitated with HLS solution. Patients are divided in 2 groups for comparison. RESULTS: There is difference between sodium loads (P = .03), fluid load in the first hour (P = .001), sodium load in the first hour (P = .001), and net fluid accumulation (P = .0025). There is a difference regarding plasma sodium and plasma osmolality in the first hour (P = .003, P = .002). There is difference regarding sodium given (P = .001) and sodium excreted (P = .001) in 2 groups. CONCLUSIONS: Hypertonic resuscitation consists in giving a higher fluid and sodium load in the first hour of therapy that is accompanied with a decrease in fluid requirements and fluid accumulation for the first 24 hours of burn shock.

The Use of Psychoactive Substances and Illegal Drugs in the Albanian Society.

BACKGROUND: To create a representative picture of the prevalence and the total number of drug users in Albania from 2012 to 2016, and compare those numbers to previous years with other available data. METHODS: The required data for the conductance of this study was collected from three different fronts, namely The Institute of Forensic Medicine (IFM), Clinical Toxicology and Addictions Service, University Hospital "Mother Theresa" Tirana (CTS) and Methadone Maintenance Treatment Centers. The study targets all individuals who have consumed at least once abusive drugs and psychotropic substances during the period 2012-2016 in the Republic of Albania. A total of 7050 reported cases over the given period were reviewed. RESULTS: Overall, Cannabis Sativa was the highest consumed drug, present in 62.58% of the cases. Other substances with a noticeable prevalence of use were heroin (15.02%) and cocaine (5.1%). It was found out that there were 36 drug-related deaths from 2012 to 2016. During this period of time, only 9 individuals resulted positive for Sexually Transmitted Infections (STI), of which, one positive for Hepatitis C and the remaining 8 positives for HIV. About 25% of drug users in Albania belong to the young subgroup of the population (13-32 years old). CONCLUSION: Overall, taking into consideration all three databases, the number of drug users has significantly increased. There are more officially reported drug users today compared to 2012, however, different trends are observed during different periods. Youngsters are more eager and tempted to use and experiment more with safer and less harmful drugs like cannabis, meanwhile, as age increases, there is a tendency to shift towards more potent and dangerous drugs. Prevention and reducing the prevalence of use of psychoactive drugs is one of the main goals of public health.

Epidemiology and outcome analysis of sepsis and organ dysfunction/failure after burns.

BACKGROUND: The aim of this prospective study in adult population is to give frequency data (prevalence, incidence) of burn wound sepsis and its consequences (organ dysfunction/failure); to analyze the evolution of the SOFA cumulative score during the disease and relationship between the SOFA score in the 3rd, 7th, 14th and 21th day after burn with mortality. METHOD: A prospective cohort study was performed among adult patients (age ≥20 years) admitted in the ICU, with major and moderate burns. Sepsis, organ dysfunction, organ failure and mortality were calculated as Cumulative Incidence (CI) and as Incidence rate (IR). Data from patients with sepsis were compared with those without sepsis. Evaluation of SOFA evolution was done with delta score and the influence of the SOFA score in mortality was calculated with AUC of the ROC curve. RESULTS AND CONCLUSIONS: Period prevalence of sepsis in our adult burned population was 26%. Incidence proportion as CI was 0.3 or 30 patients per 100 adults. Incidence rate (IR) was 6 patients with sepsis per 100 patient-years. Overall morbidity was 88.1% while overall mortality was 11.9%. Mortality in patients with sepsis was 34.4%. Incidence of MOD was 63% while incidence of MOF was 37%. Respective mortality as CI was 7% and 81% while mortality rate as IR was 1.4 per 100 patient-years in patients with MOD and 16.2 per 100 patient-years in patients with MOF. SOFA-3 should be considered a "reliable indicator" at separating survivors from non survivors and SOFA 7, 14, and 21 should be considered excellent in predicting mortality.

Vaginal Infections of Albanian women Infected with HPV and their impact in intraepithelial cervical lesions evidenced by Pap test.

BACKGROUND: Cervical cytology is the best single method for large screening of the population in identifying precancerous lesions of the uterine cervix. AIM: To estimate the frequency of human papillomavirus (HPV) positivity in a group of Albanian women, the prevalence of vaginal coinfections, and the relationship of coinfections with HPV, as well as their role in metaplasia or cervical intraepithelial lesions (CIN). MATERIALS AND METHODS: In this retrospective study, 2075 vaginal smears were examined. The Papanicolaou stain was used for all slides. The New Bethesda System 2001 was used for the interpretations of the smears. Data analysis was completed using the Statistical Package for the Social Sciences version 19.0. RESULTS: Prevalence of HPV positivity was 43.9% with an average age of 35.48 ± 9.27 years. Candida coinfection resulted in 57.8% of HPV positive women with a significant relationship between them. Gardnerella coinfection resulted in 36 (23%), mixed flora in 34 (8%), and Trichomonas vaginalis in 50% of HPV positive woman. Among the women with positive HPV, 19% had CIN, 8% had metaplasia, and 1% had metaplasia and CIN; 9% of the women with HPV had CIN1 and one of the coinfections. CONCLUSIONS: There is a strong relationship between CIN1 and HPV positivity as well as between CIN1 and coinfections. HPV infection is a major factor contributing to metaplasia, and bacterial coinfections in HPV positive women have a statistically significant impact in the development of metaplasia.

Prevalence and factors associated with potentially inappropriate prescriptions among older patients at hospital discharge.

RATIONALE, AIMS AND OBJECTIVES: Explicit criteria have been used worldwide to identify suboptimal prescribing such as potentially inappropriate prescriptions (PIPs). The objective of our study was to determine prevalence, types and factors associated with PIPs in older people discharged from an Albanian hospital. METHOD: Retrospective, cross-sectional study conducted among patients aged 60 years and more discharged from the Cardiology and Internal Medicine departments of the University Hospital Center 'Mother Theresa' Tirana during 2013. PIPs were identified by using Beers (2012 update) and STOPP criteria (2008 and 2014 versions). Chi-square analysis and Student Test were performed. Crude and adjusted odds ratios with their 95% confidence intervals were estimated by logistic regression analysis. RESULTS: Medical files for 319 patients were assessed. The median number of drugs prescribed was 7.8 (SD 2.2). PIPs prevalence at hospital discharge was 34.5% (95% CI 27.5-42.2%; 110 patients) according to both Beers and STOPP version 1 criteria. STOPP version 2 identified 201 (63.0%) patients with at least one PIP (95% CI 55.2-70.2%; 312 PIPs). The drugs more frequently involved in PIPs were aspirin, spironolactone, benzodiazepines, digoxin and methyldopa. The odds of having a PIP were higher in patients discharged from Internal Medicine (P < 0.005). The PIP index was 0.056%, 0.054% and 0.125% respectively for Beers, STOPP 2008 and STOPP 2014 criteria. A significant positive correlation was found between the number of prescribed drugs and PIP occurrence. CONCLUSIONS: Our study found that between one and two out of three older patients has at least one PIP among the treatment prescribed at hospital discharge, depending on the tool used for detection. The high frequency of PIPs suggests the urgent need for interventions to reduce them.

Ocular and cutaneous manifestation of leptospirosis acquired in Albania: A retrospective analysis with implications for travel medicine.

UNLABELLED: Albania is an attractive tourism destination with an increasing volume of travel. As a Mediterranean country some tropical infectious diseases are present in certain areas of Albania, including leptospirosis, which is a zoonotic infectious disease prevalent around the world. The goal of this retrospective study is to describe the ocular and cutaneous manifestations of leptospirosis in Albanian patients and raise awareness to travelers travelling in and out of the country. METHODS: We retrospectively studied 107 cases of leptospirosis, treated at "Mother Teresa" University Hospital Center, in Tirana, Albania between January 2009 and December 2014. All cases included in the analysis had a clinical and epidemiological presentation suggestive of leptospirosis, confirmed with ELISA (enzyme linked immunoassay) positive for IgM antibodies against Leptospira. RESULTS: There were 89.7% males (n = 96) and 10.2% females (n = 11). Mean age at the time of diagnoses was 43.7 ± 17.8 years old (range 17-78). All patients were native and residents of Albania. Conjunctival suffusion was present in 81.3% of the cases, whereas subconjunctival hemorrhage was seen in 12 patients (11.2%). Uveitis was seen in 38.3% of the cases and all patients with uveitis presented a severe systemic disease. A cutaneous rash was present in 58.8% of patients. Other cutaneous manifestations include jaundice in 62.6% and intense pruritus in 5.6% of cases. CONCLUSIONS: Ocular and cutaneous involvement happens more frequently in patients with Leptospirosis, than it was thought to be. Therefore the clinician should be more careful in his systemic evaluation of the disease.

Incidence and Impact of Patient-Prosthesis Mismatch in Isolated Aortic Valve Surgery.

AIM: The mains topics of this work are the incidence of patient-prosthesis mismatch and the influence in the early results of isolated aortic valve surgery. METHODS: In 193 patients isolated aortic valve surgery was performed. The study population was divided in three subgroups: 20 patients with severe, 131 patients with moderate and 42 patients without patient-prosthesis mismatch. The indexed effective orifice area was used to define the subgroups. Operative mortality and perioperative complications were considered the indicators of the early results of aortic valve surgery. RESULTS: The incidence of severe and moderate patient-prosthesis mismatch was respectively 10.3% and 67.8%. Hospital mortality and perioperative complications were: mortality 5% vs. 3.1% vs. 2.4% (p = 0.855), low cardiac output 5% vs. 6.9% vs. 4.8% (p = 0.861); pulmonary complications 5% vs. 3.1 vs. 0.0% (p = 0.430); exploration for bleeding 5% vs. 0.8% vs. 2.4% (p = 0.319); atrial fibrillation 30% vs. 19.8% vs. 11.9% (p = 0.225); wound infection 5% vs. 0.8% vs. 0.00% (p = 0.165), respectively for the group with severe, moderate and without patient-prosthesis mismatch. CONCLUSIONS: Patient-prosthesis mismatch is a common occurrence in aortic valve surgery. This phenomenon does not affect the early results of aortic valve surgery.

Is residual renal function and better phosphate control in peritoneal dialysis an answer for the lower prevalence of valve calcification compared to hemodialysis patients?

INTRODUCTION: Cardiac valve calcification (CVC) has long been regarded as a consequence of abnormal calcium-phosphate metabolism in uremic patient associated with increased cardiovascular mortality in this population. We evaluated the association between residual renal function (RRF), phosphate level and valve calcification in peritoneal dialysis (PD) and hemodialysis (HD) patients. METHODS: We studied 30 stable PD patients (60 % males; mean age 57 ± 12.36 years) and 34 HD patients (58.8 % males; mean age 50.8 ± 10.4 years) on renal replacement therapy (RRT) from 6 up to 36 months. The presence of CVC was assessed by standard bi-dimensional echocardiography. RRF was calculated by standard technique. RESULTS: Valve calcification was more frequently found in HD compared to PD patients (70.6 vs 29.4 %, p = 0.007). Significantly lower phosphate [1.38 ± 0.41 versus 1.99 ± 0.35 mmol/L (p < 0.0001)], a higher RRF [4.09 ± 2.09 ml/min vs 0.62 ± 0.89 ml/min (p < 0.0001)], and older age [57 ± 12.36 years vs 50.8 ± 10.4 years (p = 0.033)] were observed in PD as compared to HD patients. The logistic regression analysis for the presence of valve calcification when adjusted for age and diabetes, with type of therapy, serum phosphate, RRF, CRP, and serum albumin as variables in the model, revealed significant association between the presence of valve calcification and age and RRF. The correlation between phosphate levels and RRF was even stronger in PD patients than in HD patients (r = -0.704; p = 0.0001) vs (r = -0.502; p = 0.02). CONCLUSIONS: Our study shows that the residual renal function in PD patients contributes significantly to the maintenance of phosphate balance and may explain the lower prevalence of valve calcification in PD patients compared with HD patients in the period up to first 3 years under renal replacement therapy.

Epidemiology of infections in a burn unit, Albania.

BACKGROUND: Many types of nosocomial infections (NIs) can be present in the burned patient. The purpose of this study is to calculate the rates for NI in the Intensive Care Unit of the Service of Burns and Plastic Surgery in University Hospital Centre (UHC) in Tirana, Albania. METHOD: The study is prospective, clinical and analytical. The study is continued/longitudinal because monitors all patients with severe burns during a specified time period (1year). For data analysis was used SPSS 19.0. RESULTS: The infection prevalence rate was 12 infected patients per 100 patients. The colonisation prevalence rate was 43 colonised patients for 100 patients. The most frequent infection microorganisms were Pseudomonas aeruginosa and Staphylococcus aureus (67% and 24%). Incidence of BSI was 3 BSI for 1000 hospitalization days. Incidence of catheter-related bloodstream infection (CRBSI) was 11.7 BSI for 1000 catheter days. Colonisation of the tip of the central catheter (CTC) was 15.6 for 1000 catheter days. CONCLUSIONS: The epidemiology of burn wound infections as well as the definitions have changed due to important changes in burn wound treatment but further studies should be done documented the factors that can reduce the burn wound infection rates.

Prevalence and correlates of hypertension in a transitional southeastern European population: results from the Albanian Demographic and Health Survey.

We assessed the prevalence and socioeconomic and behavioural correlates of hypertension in the young to middle-aged population of Albania, a transitional post-communist country in the Western Balkans. We analysed a sample of 2,837 men and 3,580 women aged 15 to 49 from the 2008/2009 Albanian Demographic and Health Survey. Hypertension was defined as SBP≥140 mm Hg, or DBP≥90 mm Hg, or if the subjects were under treatment for hypertension. Data on demographic and socioeconomic characteristics and behavioural factors were also collected. Logistic regression was used to assess the association of hypertension with covariates. Hypertension was significantly higher among men (27.3%) than women (20.0%), and significantly increased with age. The harmful effect of excessive weight and obesity on hypertension was stronger among women than among men and this effect increased with age, especially in women. Smoking and alcohol were risk factors for hypertension in men, but not women. Education had a protective effect on hypertension in women but not in men.

Epidemiology and mortality of burned patients treated in the University Hospital Center in Tirana, Albania: an analysis of 2337 cases during the period 1998-2008.

BACKGROUND: The basis for qualitative changes concerning everyday clinical practice are created from epidemiological studies, which not only generalize situations but at the same time provide specific details of the country's features; especially during periods of social transition. The aim of this study was to present demographic and epidemiological features of severe burns treated in the Service of Burns in UHC (University Hospital Center) in Albania and to analyze burn mortality as an important outcome measure. METHOD: The data used was obtained by the analysis of the medical records of 2337 patients hospitalized in Burns Service ICU near in Tirana, Albania during 1998-2008. Statistical analysis is done with SPSS 15 software. Descriptive analyses, inferential statistics and Chi-square test and Kendall's tau_b are calculated. Logistic regression is used for the prediction of death probability by two risk variables, BSA burned and age. RESULTS: The severe burn incidence was 7 patients per 100,000 persons/year. The overall mean estimated BSA (%) is 22.8±14.7. The main causes of the burn were found to be the scalds in 61.8% of the cases followed by flame (23%), chemicals (10.7%) and electrical injury in 4.5% of the cases. The mean hospital period is 11.6±10. The overall mortality is 10.5%. Based on probability of death, we noticed that older age and larger burn size were associated with a higher likelihood of mortality. CONCLUSIONS: The long-term studies and the comparison of our results with the ones of other burn centers has allowed us to determine the actual level of care and as well as to build up contemporary protocols in order to improve the treatment with the objection of decreasing the mortality.

The combination of infiltrative bupivacaine with low-pressure laparoscopy reduces postcholecystectomy pain. A prospective randomized controlled study.

OBJECTIVE: To evaluate the efficacy of combined infiltrative bupivacaine with low intraperitoneal pressure insufflation in reducing the post-laparoscopic pain in patients undergoing laparoscopic cholecystectomy (LC). METHODS: This randomized prospective single-blind study included 473 patients undergoing LC. The study took place at University Hospital Center Mother Teresa, Tirana, Albania between January 2006 to September 2009. The patients were divided in 4 groups: Group 1 (n=120) with intra-abdominal insufflation pressure 15 mm Hg and no infiltrative bupivacaine (HPNBG); Group 2 (n=122) with intra-abdominal insufflation pressure 15 mm Hg and with 5 ml infiltrative bupivacaine 0.5% in abdominal minincisions (HPBG); Group 3 (n=110) with intra-abdominal insufflation pressure under 10 mm Hg and no infiltrative bupivacaine (LPNBG); and Group 4 (n=121) with intra-abdominal insufflation pressure under 10 mm Hg and infiltrative bupivacaine (LPBG). RESULTS: There were statistically significant differences (p=0.003) between groups regarding incisional pain intensity, between LPBG and HPNBG (p=0.001), between LPBG and HPBG (p=0.037), between LPBG and LPNBG (p=0.001), as well the shoulder-tip pain intensity (p=0.001); between LPBG and HPNBG (p=0.001), between LPBG and HPBG (p=0.001), and between LPBG and LPNBG (p=0.031). We found statistically significant differences related to pain beginning time (ANOVA test, p=0.027); between LPBG and HPNBG (p=0.041), between LPBG and HPBG (p=0.031), and between LPBG and LPNBG (p=0.05). CONCLUSION: The combination of infiltrative bupivacaine with low intraperitoneal pressure insufflation shows to be more efficient in reducing the post-laparoscopic pain, compared with other regimens.

Pharmacological conversion of recent atrial fibrillation: a randomized, placebo-controlled study of three antiarrhythmic drugs.

OBJECTIVE: In this study, we randomly compared single oral doses of flecainide, amiodarone and propafenone versus placebo for the conversion of recent atrial fibrillation (AF) (within 48 hours). METHODS: This is a randomized prospective, placebo-controlled single-blind study that included 160 consecutive patients with recent AF who were randomly assigned to single oral doses of flecainide (3 mg/kg of weight, n=40), amiodarone (30 mg/kg weight, n=40), propafenone (8.5 mg/kg of weight, n=40) or placebo (n=40). The primary end-point was conversion rate at 24 hours after the drug intake. The association between antiarrhythmic use and conversion rate was tested with multiple logistic regressions. RESULTS: The primary end-point was achieved in 87.5% of patients with flecainide, 85% of patients with amiodarone, 85% of patients with propafenone and 17.5% of patients with placebo (p<0.001 compared with placebo for all 3 drugs). Conversion rate within 3 hours after drug intake was greater with propafenone (57.5%) or flecainide (45%) compared with amiodarone (0%) or placebo (10%). Between 6 and 24 hours, significantly more patients were converted to sinus rhythm with amiodarone than with flecainide or propafenone. The use of antiarrhythmic drugs was a significant predictor of conversion to sinus rhythm compared to placebo (adjusted OR=19.53, 95% CI 3.14-121.55, p<0.001). No serious side effect occurred. CONCLUSION: In patients with recent-onset AF, oral flecainide, amiodarone or propafenone are superior to placebo in restoring sinus rhythm within the 24-hour period following the drug intake.

Dexamethasone efficacy on bacterial meningitis--a retrospective analysis of Albanian adult patients.

BACKGROUND: Research on the effects of corticosteroids in bacterial meningitis (BM) yielded conflicting results. While some studies reveal that corticosteroids improve the outcomes in BM treatments, others provide strong evidence that patients do not profit from this treatment. We investigated the factors that may impact the dexamethasone efficacy in patients with BM. METHODOLOGY: In this retrospective study, we analyzed the medical records of patients with probable acute bacterial meningitis hospitalized between 2002 and 2008 at the Infectious Diseases Department, University Hospital Centre "Mother Theresa" of Tirana, Albania. They were all treated with dexamethasone. For study purposes, patients were divided into two subgroups: 1) Severely ill patients (Glasgow Coma Scale [GCS] or= 13. RESULTS: Sixty-seven patients analyzed had a mean age of 43.8 +/- 17.0 years old, forty-five (67.2%) of whom were males. The mean recovery time (RT) was 3.5 +/- 1.3 days, and four (6%) died. In the severely ill subgroup (GCS