What is the Role of Complications and Comorbidities in Combined Pulmonary Fibrosis and Emphysema Syndrome

Objective: Combined Pulmonary Fibrosis and Emphysema (CPFE) and Idiopathic Pulmonary Fibrosis (IPF) are separate entities characterised by distinct clinical, functional, radiological, and pathological characteristics. Comorbidities and complications are commonly seen in both diseases. Our purpose was to investigate which comorbidities are more common and what is their impact in the outcome of CPFE and IPF. The demographic and clinical data were also studied. Materials and Methods: This is a retrospective cohort study. We have reviewed the medical records of the patients diagnosed with interstitial lung diseases in University Hospital of lung diseases “Shefqet Ndroqi”, in Tirana, in the period from January 2012 till April 2016. The subjects (51 in total) were further divided in two groups: the patients diagnosed with CPFE (25) 49% and the others (26) 51% with IPF. For testing the impact of comorbidities in CPFE syndrome, we have used linear regression with multiple factors using EViews 7 program. "The Student test" is used to evaluate the importance of comorbidities and complications in CPFE and IPF. The demographic and clinical data are expressed in average values using standard deviations ± SD. Results: All of the patients had comorbidities and complications. In CPFE syndrome predominate male smokers or ex-smokers. UPY is higher in CPFE. The time from the appearance of symptoms to the diagnosis is longer in CPFE than in IPF patients. Comorbidities have more impact in CPFE syndrome (p = 0.01). In IPF we didn"t find any significant relationships in comorbidities, but we have to remind that the number of patients was  small. Conclusion: Comorbidities are frequent in CPFE and IPF patients. Some of them, especially lung cancer, influence strongly in the survival rate and some others, like respiratory insuficiency, may play an important role in the outcome of the disease. However, further research is needed to clarify the impact of comorbidities in CPFE syndrome. Keywords: Combined Pulmonary Fibrosis and Emphysema, Idiopathic Pulmonary Fibrosis

Clinical and epidemiological evaluation of Tuberculosis in Albania during the period 2009-2018

Aim: To estimate the clinical and epidemiological pattern of Tuberculosis (TB) in Albania over the period 2009-2018. Methods: A retrospective analysis of clinical and epidemiological data based on TB individual notification forms during the period 2009-2018. Results: During the 10-years period, TB incidence increased from 14 to 15.5, but without a significant increasing trend. The total number of TB cases increased from 440 to 447. The proportion of extra-pulmonary TB decreased from 32% to 25% in 2018 (p=0.015), with and average mean change of 29 cases. Males prevail among TB cases and male-to-female ratio ranges from 2:1 to 3:1. Drug susceptibility testing (DST) was carried out depending on the availability of the reagents and there were 54%, 18% and 96% culture cases confirmed positive in 2009, 2014 and 2019, respectively. The overall treatment completion rate was 85% and 88.2% in 2009 and 2018, respectively. However, there was a significant drop in cured cases from 26% in 9.3%, whereas the percentage of deaths has increased from 0.5% in 4.1%. All treatment outcomes exhibited a significant change (p<0.001).   Conclusion: TB continues to be a public health challenge in Albania regardless of the seemingly generally stable epidemiological situation

Clinical and epidemiological evaluation of Tuberculosis in Albania during the period 2009-2018

Aim: To estimate the clinical and epidemiological pattern of Tuberculosis (TB) in Albania over the period 2009-2018. Methods: A retrospective analysis of clinical and epidemiological data based on TB individual notification forms during the period 2009-2018. Results: During the 10-years period, TB incidence increased from 14 to 15.5, but without a significant increasing trend. The total number of TB cases increased from 440 to 447. The proportion of extra-pulmonary TB decreased from 32% to 25% in 2018 (p=0.015), with and average mean change of 29 cases. Males prevail among TB cases and male-to-female ratio ranges from 2:1 to 3:1. Drug susceptibility testing (DST) was carried out depending on the availability of the reagents and there were 54%, 18% and 96% culture cases confirmed positive in 2009, 2014 and 2019, respectively. The overall treatment completion rate was 85% and 88.2% in 2009 and 2018, respectively. However, there was a significant drop in cured cases from 26% in 9.3%, whereas the percentage of deaths has increased from 0.5% in 4.1%. All treatment outcomes exhibited a significant change (p<0.001).   Conclusion: TB continues to be a public health challenge in Albania regardless of the seemingly generally stable epidemiological situation.     Conflicts of interest: None declared

Sex-differences in socioeconomic status and health-seeking behaviour among tuberculosis patients in transitional Albania in 2012-2013

Aim: There is little scientific evidence about the main determinants of sex discrepancies in tuberculosis rates in Albania. The aim of this study was to assess the sex-differences in socioeconomic characteristics, knowledge and attitudes about tuberculosis and access to health care among tuberculosis patients in Albania, a transitional country in the Western Balkans.Methods: Our analysis involved all the new cases of pulmonary tuberculosis diagnosed in Albania during the period June 2012 – June 2013 (N=197; 69% males; overall mean age: 44±19 years). The recording and reporting system of tuberculosis cases was performed according to the WHO and EuroTB Surveillance guidelines. Information on socioeconomic characteristics of the patients, knowledge and attitudes about tuberculosis and access to health care was also collected. Logistic regression was used to assess the correlates of sex-differences among tuberculosis patients.Results: In multivariable-adjusted models, female sex was positively related to unemployment (OR=3.7, 95%CI=1.8-7.7), bad living conditions (OR=3.0, 95%CI=1.4-6.5), a longer distance to health care facility (OR=3.0, 95%CI=1.4-6.3), a lower level of knowledge about tuberculosis (OR=3.1, 95%CI=1.3-7.1) and a higher level of stigma against tuberculosis (OR=3.6, 95%CI=1.6-7.9).Conclusion: Our study informs about selected correlates of sex-differences in tuberculosis rates in post-communist Albania. Future studies should more vigorously explore determinants of sex-differences in tuberculosis rates in countries of the Western Balkans

Sex-differences in socioeconomic status and health-seeking behaviour among tuberculosis patients in transitional Albania in 2012-2013

Aim: There is little scientific evidence about the main determinants of sex discrepancies in tuberculosis rates in Albania. The aim of this study was to assess the sex-differences in socioeconomic characteristics, knowledge and attitudes about tuberculosis and access to health care among tuberculosis patients in Albania, a transitional country in the Western Balkans. Methods: Our analysis involved all the new cases of pulmonary tuberculosis diagnosed in Albania during the period June 2012 – June 2013 (N=197; 69% males; overall mean age: 44±19 years). The recording and reporting system of tuberculosis cases was performed according to the WHO and EuroTB Surveillance guidelines. Information on socioeconomic characteristics of the patients, knowledge and attitudes about tuberculosis and access to health care was also collected. Logistic regression was used to assess the correlates of sex-differences among tuberculosis patients. Results: In multivariable-adjusted models, female sex was positively related to unemployment (OR=3.7, 95%CI=1.8-7.7), bad living conditions (OR=3.0, 95%CI=1.4-6.5), a longer distance to health care facility (OR=3.0, 95%CI=1.4-6.3), a lower level of knowledge about tuberculosis (OR=3.1, 95%CI=1.3-7.1) and a higher level of stigma against tuberculosis (OR=3.6, 95%CI=1.6-7.9). Conclusion: Our study informs about selected correlates of sex-differences in tuberculosis rates in post-communist Albania. Future studies should more vigorously explore determinants of sex-differences in tuberculosis rates in countries of the Western Balkans

Value of bronchoscopy in the diagnosis of sputum smear negative pulmonary tuberculosis

Background: Bronchoscopy has been found to be applicable in diagnosing suspects of pulmonary TB which have no sputum or sputum smear negative for acid fast bacilli. Additionally, it is helpful in the diagnosis of endobronchial tuberculosis, allowing early detection of broncho stenosis.Methods: A prospective study, where bronchoscopy was conducted in 167 patients with acid-fast bacillus sputum smear negative. The average age of the patients was 44.1±19.4, from age 15 to 87 years old, higher frequency in age from 20-40 years old and 55-64 years old.Results: From 167 patients in the study, endoscopic presentation resulted: normal in 7 (4.2%) cases, bronchitis - 60 (35.9%) cases, oedematous-hyperaemic -62 (37.1%) cases, caseous inflammation - 7 (4.2%) cases, ulcerative lesions - 3 (1.8%) cases, tumoral lesions - 21 (12.6%) cases and fibrous stenotic changes in 7 (4.2%) patients. From 44 (26.3%) patients to whom was obtained biopsy, the histological examination has resulted: 24 (54.5%) cases with TB granuloma, 14 (31.8%) - epithelioid granulomas and in 6 (13.6%) cases resulted non-specific inflammation. The examination of bronchial washing for acid-fast bacillus smear concluded the diagnosis in 40.4% of cases, the examination for acid-fast bacillus smear collected after diagnostic FBS has been decisive in 53.9% of cases. The examination for acid-fast bacillus culture resulted positive in 70.5% of bronchial washing and in 61.2% of sputum collected after FBS.Conclusions: Fibreoptic bronchoscopy plays the key role to the patients with suspected tuberculosis which are acid-fast bacillus smear negative or that have no sputum

Prevalence of chronic obstructive pulmonary disease (COPD) in Albania

Aim: The objective of this study was to determine the prevalence of COPD and its associated factors among adults in Albania. Methods: This was a cross-sectional study conducted in Albania in 2013-14. A nation-wide representative sample of 1200 adults aged ≥40 years was selected using multistage cluster sampling technique. All participants were interviewed about socio-demographic characteristics, respiratory symptoms, smoking status and clinical characteristics. Spirometry was performed according to standard methods. COPD was defined as post-bronchodilator FEV1/FVC ratio <70% predicted. Results: Of the 1200 adults invited to participate, 939 adults or 78% (467 men and 472 women) were eligible for the study. The overall COPD prevalence (GOLD stage 1 or higher) was 12.4%; it was higher in men (17.4%) than in women (7.7%). Using Lower Limit of Normal (LLN), the prevalence of COPD was 9.9%, again higher in men (13.2%) than women (6.6%). The prevalence of doctor-diagnosed COPD was 1.3% (1.9% in men, 0.6 % in women). Male sex, smoking and increasing age were significantly associated with COPD diagnosis. Conclusion: The overall prevalence of COPD in Albania was 9.9% using BOLD standards. Smoking and increasing age were the main risk factors for COPD. The study highlights the importance of raising awareness of COPD among health professionals

Prevalence of chronic obstructive pulmonary disease (COPD) in Albania

Aim: The objective of this study was to determine the prevalence of COPD and its associated factors among adults in Albania. Methods: This was a cross-sectional study conducted in Albania in 2013-14. A nation-wide representative sample of 1200 adults aged ≥40 years was selected using multistage cluster sampling technique. All participants were interviewed about socio-demographic characteristics, respiratory symptoms, smoking status and clinical characteristics. Spirometry was performed according to standard methods. COPD was defined as post-bronchodilator FEV1/FVC ratio <70% predicted. Results: Of the 1200 adults invited to participate, 939 adults or 78% (467 men and 472 women) were eligible for the study. The overall COPD prevalence (GOLD stage 1 or higher) was 12.4%; it was higher in men (17.4%) than in women (7.7%). Using Lower Limit of Normal (LLN), the prevalence of COPD was 9.9%, again higher in men (13.2%) than women (6.6%). The prevalence of doctor-diagnosed COPD was 1.3% (1.9% in men, 0.6 % in women). Male sex, smoking and increasing age were significantly associated with COPD diagnosis. Conclusion: The overall prevalence of COPD in Albania was 9.9% using BOLD standards. Smoking and increasing age were the main risk factors for COPD. The study highlights the importance of raising awareness of COPD among health professionals.   Conflicts of interest: None declared

[Al-Tabari's Character in The Knowledge of Qiraat and His View of Al-Ahruf Al-Sab’ah] Ketokohan Al-Tabari dalam Ilmu Qiraat dan Pandangan Beliau Terhadap Al-Ahruf Al-Sab’ah

Imam al-Tabari's expertise in the science of qiraat can be seen in some of his views on the issues of qiraat and his style of debate on the error of qiraat in his interpretation of Jami 'al-Bayan' an Ta'wil Ay al-Qur'an. The debate of qiraat scholars on al-ahruf al-Sab'ah has been done by several scholars through the books of Ulum al-Quran and Ilmu Qiraat. However, when listing the opinions of these figures, al-Tabari's views were not discussed in depth while he had great character as al-Qurra 'as well as being famous as an al-Mufassir. Therefore, this study aims to investigate the relationship between Imam al-Tabari and the science of qiraat and the science of tafsir al-Qur’an. It also aims to study al-Tabari's expertise in the science of qiraat as well as analyze his views on the main issue in the science of qiraat which the meaning of al-Ahruf is al-Sab'ah. This information is collected and analyzed by discussing al-Tabari's views in this qiraat knowledge debate, then making a conclusion and conclusion on his views. All data were analyzed using inductive and deductive methods. The results of the study show that al-Tabari's expertise in the science of qiraat cannot be denied by anyone. However, his view in the chapter of al-Ahruf al-Sab'ah is seen to contradict the view of the majority of scholars by saying that the reading error among the qurra 'does not exclude the writing of Mushaf ‘Uthmani based on only one letter from al-Ahruf al-Sab'ah. While the remaining six letters have been dropped and it is not obligatory to do good deeds with it based on the ijma ’of the companions on the writing of the ‘Uthmani mushaf. Kepakaran Imam al-Tabari dalam ilmu qiraat dapat dilihat pada beberapa pandangan beliau terhadap isu-isu qiraat dan gaya perbahasan beliau terhadap khilaf qiraat dalam tafsirnya Jami’ al-Bayan ‘an Ta’wil Ay al-Qur’an. Perbahasan ulama qiraat tentang al-ahruf al-Sab’ah telah dilakukan oleh beberapa pengkaji melalui kitab-kitab Ulum al-Quran dan Ilmu Qiraat. Namun ketika menyenaraikan pendapat-pendapat tokoh-tokoh tersebut pandangan al-Tabari tidak dibahaskan secara mendalam sedangkan beliau mempunyai ketokohan yang hebat sebagai al-Qurra’ disamping masyhur sebagai seorang al-Mufassir. Oleh itu, kajian ini bertujuan untuk menyelidiki perkaitan di antara Imam al-Tabari dengan ilmu qiraat dan ilmu tafsir al-Qur’an. Ia juga bertujuan mengkaji kepakaran al-Tabari dalam ilmu qiraat serta menganalisis pandangan beliau terhadap isu pokok dalam ilmu qiraat iaitu maksud al-Ahruf al-Sab’ah. Maklumat  ini dikumpul dan dianalisis dengan membahaskan pandangan al-Tabari dalam perbahasan ilmu qiraat ini, seterusnya membuat satu rumusan dan kesimpulan terhadap pandangan beliau. Kesemua data dianalisis menggunakan metode induktif dan deduktif. Hasil kajian menunjukkan bahawa kepakaran al-Tabari dalm ilmu qiraat tidak dapat dinafikan oleh sesiapa. Namun pandangan beliau dalam bab al-Ahruf al-Sab’ah dilihat menyalahi pandangan majoriti ulama dengan mengatakan bahawa khilaf bacaan di kalangan qurra’ tidak terkeluar dari penulisan Mushaf ‘Uthmani berdasarkan satu huruf sahaja daripada al-Ahruf al-Sab’ah. Manakala baki enam huruf lagi telah digugurkan dan tidak diwajibkan beramal dengannya berdasarkan ijma’para sahabat terhadap penulisan mushaf ‘Uthmani.   &nbsp