CHRONIC HEPATITIS C WITH SIGNIFICANT MORBIDITY AND END-ORGAN DAMAGE DEVELOPMENT DURING PEG-INTERFERON ALPHA-2A/RIBAVIRIN THERAPY

Objective: To report a case of significant morbidity and end-organ damage development during Peg-interferon Alpha-2a/Ribavirin therapy. Case report: A 27-year-old woman patient with chronic hepatitis C diagnosis, genotype1b, Anti HCV positive, and HCV-RNA 6. 05 x 105 IU/mL, presented to our clinic in order to initiate the approved treatment regimen with subcutaneous peginterferon alfa 2a (PEG-INF-a2a, s.c.) plus oral ribavirin. There were no evident abnormalities in the patient’s physical examination and laboratory data prior to the treatment, except for general asthenia and arthralgias and, above normal biliriubin levels plus positive smooth muscle antibodies (SMA). The patient was started on 180 mcg PEG interferon alpha-2a s. c. once a week with ribavirin 1000 mg/day. Four months later, despite undetectable HCV-RNA, she developed anemia, neutropenia, thrombocytopenia, and high transaminase levels, due to which the staff opted for a half-dose of Peg-interferon Alpha-2a/Ribavirin. After that, she suffered deterioration in liver function (Child class C, MELD score = 23.4) in association with non-invasive predictors of liver fibrosis, and with common radiologic changes of liver cirrhosis. Conclusion: Patients with preexisting auto antibodies and chronic hepatitis C, especially women, may be predisposed to autoimmune hepatitis during interferon and ribavirin therapy. These patients require careful monitoring if IFN is considered as first line treatment

Overview on health status of the Albanian population

The Albanian population is rapidly aging (in 2020, almost 15% of the population was ≥65 years) as a result of a steady increase in life expectancy (74.4 years in men and 78.7 years in women in in 2021), a gradual decrease in fertility rate (1.6 children per woman of childbearing age in 2020), and emigration of particularly young adults. This demographic transition experienced in the past three decades has inevitably led to a significant change in the epidemiological profile of the Albanian population, characterized by a remarkable shift towards non-communicable diseases (NCDs), particularly cardiovascular diseases (CVD), cancer, chronic respiratory diseases, and diabetes. The main risk factors in the Albanian population consist of high blood pressure (top risk factor, accounting for about 34% of the overall mortality), nutritional-related risks (second, constituting about 25% of the overall mortality), and smoking (third risk factor, accounting for about 20% of the overall mortality). The national “Health Strategy, Albania 2021-2030” is a political document of the Albanian government that aims to define and achieve the objectives of the program for the protection and improvement of the health of the Albanian population. Following the national “Health Strategy, Albania 2021-2030”, two new action plans were recently developed: the “Action Plan on NCDs, Albania 2021-2030” and the “Action Plan on Health Promotion, Albania 2022-2030”

CHRONIC HEPATITIS C WITH SIGNIFICANT MORBIDITY AND END-ORGAN DAMAGE DEVELOPMENT DURING PEG-INTERFERON ALPHA-2A/RIBAVIRIN THERAPY

Objective: To report a case of significant morbidity and end-organ damage development during Peg-interferon Alpha-2a/Ribavirin therapy. Case report: A 27-year-old woman patient with chronic hepatitis C diagnosis, genotype1b, Anti HCV positive, and HCV-RNA 6. 05 x 105 IU/mL, presented to our clinic in order to initiate the approved treatment regimen with subcutaneous peginterferon alfa 2a (PEG-INF-a2a, s.c.) plus oral ribavirin. There were no evident abnormalities in the patient’s physical examination and laboratory data prior to the treatment, except for general asthenia and arthralgias and, above normal biliriubin levels plus positive smooth muscle antibodies (SMA). The patient was started on 180 mcg PEG interferon alpha-2a s. c. once a week with ribavirin 1000 mg/day. Four months later, despite undetectable HCV-RNA, she developed anemia, neutropenia, thrombocytopenia, and high transaminase levels, due to which the staff opted for a half-dose of Peg-interferon Alpha-2a/Ribavirin. After that, she suffered deterioration in liver function (Child class C, MELD score = 23.4) in association with non-invasive predictors of liver fibrosis, and with common radiologic changes of liver cirrhosis. Conclusion: Patients with preexisting auto antibodies and chronic hepatitis C, especially women, may be predisposed to autoimmune hepatitis during interferon and ribavirin therapy. These patients require careful monitoring if IFN is considered as first line treatment

Chocolate intake is associated with a lower body mass index in adult men and women in transitional Albania

Aim: In light of the controversial evidence regarding health effects of chocolate intake, we aimed to assess its association with body mass index (BMI) among adult individuals in Albania, a transitional post-communist country in South Eastern Europe which has traditionally employed a Mediterranean dietary pattern.     Methods: A cross-sectional study was conducted in 2003-2006 involving a population-based sample of 737 Tirana residents aged 35-74 years (469 men, 268 women; overall response: 70%). Of these, 565 individuals (373 men and 192 women) provided data on chocolate intake and anthropometrics (77% of the sample). A 105-item food frequency questionnaire, including chocolate consumption, was administered to all individuals. Nine categories were used to assess the average frequency of intake of each food item in the past 12 months. In the analysis, chocolate intake was dichotomized into: consumption of <1/month vs. ≥1/month. A physical examination included measurement of weight and height. Furthermore, information on socio-demographic characteristics and classical risk factors was collected. Multivariable-adjusted general linear model was used to calculate the mean BMI values by chocolate intake groupings.   Results: Upon simultaneous adjustment for socio-demographic characteristics, classical risk factors and nutritional factors, there was an inverse association between BMI and chocolate intake in both sexes (sex-pooled mean BMI: 26.1 among participants who consumed chocolate <1/month vs. 27.0 in those with an intake of ≥1/month; P<0.001).   Conclusions: This study points to a beneficial effect of moderate chocolate intake on lowering BMI, which deserves further vigorous investigation and replication in prospective studies in Albania and other populations

Chocolate intake is associated with a lower body mass index in adult men and women in transitional Albania

Aim: In light of the controversial evidence regarding health effects of chocolate intake, we aimed to assess its association with body mass index (BMI) among adult individuals in Albania, a transitional post-communist country in South Eastern Europe which has traditionally employed a Mediterranean dietary pattern.     Methods: A cross-sectional study was conducted in 2003-2006 involving a population-based sample of 737 Tirana residents aged 35-74 years (469 men, 268 women; overall response: 70%). Of these, 565 individuals (373 men and 192 women) provided data on chocolate intake and anthropometrics (77% of the sample). A 105-item food frequency questionnaire, including chocolate consumption, was administered to all individuals. Nine categories were used to assess the average frequency of intake of each food item in the past 12 months. In the analysis, chocolate intake was dichotomized into: consumption of <1/month vs. ≥1/month. A physical examination included measurement of weight and height. Furthermore, information on socio-demographic characteristics and classical risk factors was collected. Multivariable-adjusted general linear model was used to calculate the mean BMI values by chocolate intake groupings.   Results: Upon simultaneous adjustment for socio-demographic characteristics, classical risk factors and nutritional factors, there was an inverse association between BMI and chocolate intake in both sexes (sex-pooled mean BMI: 26.1 among participants who consumed chocolate <1/month vs. 27.0 in those with an intake of ≥1/month; P<0.001).   Conclusions: This study points to a beneficial effect of moderate chocolate intake on lowering BMI, which deserves further vigorous investigation and replication in prospective studies in Albania and other populations

Overview on health status of the Albanian population

The Albanian population is rapidly aging (in 2020, almost 15% of the population was ≥65 years) as a result of a steady increase in life expectancy (74.4 years in men and 78.7 years in women in in 2021), a gradual decrease in fertility rate (1.6 children per woman of childbearing age in 2020), and emigration of particularly young adults. This demographic transition experienced in the past three decades has inevitably led to a significant change in the epidemiological profile of the Albanian population, characterized by a remarkable shift towards non-communicable diseases (NCDs), particularly cardiovascular diseases (CVD), cancer, chronic respiratory diseases, and diabetes. The main risk factors in the Albanian population consist of high blood pressure (top risk factor, accounting for about 34% of the overall mortality), nutritional-related risks (second, constituting about 25% of the overall mortality), and smoking (third risk factor, accounting for about 20% of the overall mortality). The national “Health Strategy, Albania 2021-2030” is a political document of the Albanian government that aims to define and achieve the objectives of the program for the protection and improvement of the health of the Albanian population. Following the national “Health Strategy, Albania 2021-2030”, two new action plans were recently developed: the “Action Plan on NCDs, Albania 2021-2030” and the “Action Plan on Health Promotion, Albania 2022-2030”

Predictors, severity and associate factors of acute pancreatitis: A tertiary hospital’s experience

Aim: Acute pancreatitis is a common disorder that occurs following an acute response to a pancreatic injury. The aim of this study was to assess predictors of severity and associated factors, as well as the association of different classification systems of severity among pa-tients with acute pancreatitis (AP).Methods: A retrospective case series study was conducted in Albania including 150 patients with AP between March 2021 and March 2022. Variables such as baseline characteristics, la-boratory findings, and calculated scores of known severity classifications were analyzed. Pa-tients were graded as having mild, moderate, or severe acute pancreatitis based on the Revi-sion of the Atlanta Classification (RAC). Ordinal logistic regression was used to model the relationship between the ordinal variable (RAC categories) and the explanatory variables men-tioned above.Results: Women with AP had a higher average age than men with AP (62.5 vs. 57.5 years old, respectively, p<0.05). Additionally, the alcoholic etiology in males prevailed in 100% of cases, while the biliary etiology was more common in females (64.2% compared to 35.8% in males, p<0.001). Ordinal logistic regression showed that a one unit increase in the CT Severi-ty Index (CTSI) and Bedside Index for Severity in Acute Pancreatitis resulted in a 0.968 and 0.430 times increase, respectively, in the ordered log-odds of being in a higher RAC classifi-cation category. The presence of Systemic Inflammatory Response Syndrome (SIRS) (vs. non-present) resulted in a 2.98 higher ordered logit. Conversely, a one unit increase in satura-tion level decreased the ordered log-odds by approximately 0.4 times.Conclusion: The severity of acute pancreatitis is a medical event that requires accurate pre-diction, for which many classification systems have been compiled, with the RAC being the most recent consensus. CTSI, the presence of SIRS, and saturation levels are significantly as-sociated with RAC, without excluding the discussion on the predictive value of laboratory findings, such as glycemia, azotemia, and creatinine

Predictive Value of the Model of End-Stage Liver Disease in Cirrhotic Patients with and without Spontaneous Bacterial Peritonitis

Objective. We aimed to assess the predictive value of the model of end-stage liver disease (MELD) in hospitalized cirrhotic patients with and without spontaneous bacterial peritonitis (SBP) and fatal outcome. Methods. A cross-sectional study included 256 consecutive patients (199 men and 57 women) diagnosed with cirrhosis and ascites who were hospitalized at the University Hospital Center in Tirana from January 2008 to December 2009. SBP was defined as a neutrophil count of ≥250 cells/mm3 in ascitic fluid. MELD score was based on laboratory parameters determined by UNOS Internet site MELD calculator. Results. In multivariable-adjusted logistic regression models controlling for age, sex, diabetes, and etiology, there was evidence of a positive association of SBP with MELD score: the odds ratio (OR) for SBP for one unit increment of MELD score was 1.06 (95% Cl = 1.02–1.09). MELD score was significantly higher in fatal cases than nonfatal patients (mean age-adjusted score was 32.7 versus 18.4 overall; 34.8 versus 18.0 in SBP patients, and 32.0 versus 18.5 in non-SBP patients; all P < 0.001). Conclusions. In this Albanian sample of hospitalized cirrhotic patients, MELD score was confirmed as a significant predictor of both SBP and fatal outcome

Dietary mineral intake and lung cancer risk: the Rotterdam Study

Objective: Limited data are available on the role of mineral intake in the development of lung cancer (LC). We investigated whether dietary calcium, copper, iron, magnesium, selenium and zinc intake were associated with LC risk. Methods: We analyzed data from 5435 participants of the Rotterdam Study, a prospective population-based cohort study among subjects aged 55 years and older. At baseline (1990–1993), diet was measured by a validated food frequency questionnaire. LC events were diagnosed on the basis of pathology data and medical records. Hazard ratios (HRs) on LC for energy-adjusted mineral intake were calculated using Cox regression models while adjusting for potential confounders. Results: During a follow-up period of 22 years, we identified 211 incident cases of LC. A higher zinc intake was associated with 42 % reduction in risk of LC (top tertile vs. first tertile: HR 0.58, 95 % CI 0.35; 0.94, P-for trend = 0.039). Similarly, high intake of iron was associated with reduced risk of LC (top tertile vs. first tertile: HR 0.58, 95 % CI 0.37; 0.92, P-for trend = 0.02

Phytoestrogen supplementation and body composition in postmenopausal women: A systematic review and meta-analysis of randomized controlled trials

Phytoestrogen-based medications are commonly used by menopausal women, and especially by obese postmenopausal women, to relieve menopausal symptoms. Substitution of animal with soy protein is often used in weight loss regimens, yet the effect of phytoestrogens, the main constituent of soy foods, on body composition is not completely understood. We conducted a systematic review and meta-analysis to investigate the associations between phytoestrogen supplementation and body weight and the main parameters of body composition in postmenopausal women. A literature search was done using 5 electronic databases from inception to April 2018. Randomized controlled trials (RCTs) with postmenopausal women comparing phytoestrogen supplementation followed by usual diet and placebo were included in the present meta-analysis. From 5932 references, we identified 23 RCTs that met our inclusion criteria, with a total of 1880 postmenopausal women. No association was observed between phytoestrogen supplementation and body weight, body mass index, waist and hip circumference, total fat mass or percentage of body fat. However, the use of phytoestrogens supplementation was associated with a slight decrease in waist-hip ratio; the pooled mean difference was −0.01 cm (95%CI: −0.01 to −0.006). In subgroup analysis, we found a modest decrease in body weight with phytoestrogens supplementation compared with placebo in healthy postmenopausal women [pooled mean difference of changes −0.28 kg (95%CI: −0.52 to −0.04)] and in RCTs with a median number of participants of 66 or less [pooled mean difference of changes −0.49 kg (95%CI: −0.87 to −0.11)]. In contrast, phytoestrogen supplementation was associated with increased body weight in postmenopausal women with preexisting metabolic disorders (prediabetes, type 2 diabetes, prehypertension and hyperlipidemia) [pooled mean difference of changes: 0.78 kg(95%CI: 0.53–1.03)]. In addition, there were some indications that some types of phytoestrogens, such as daidzein, but not soy products or isoflavone mix, could lead to modest adverse changes in body composition in menopausal women. Therefore, future studies should investigate the potential adverse effects of phytoestrogen supplementation on body composition among postmenopausal women