Trends and demographic characteristics of hemorrhagic stroke in Albania during the period 2004-2015

Aim: Our aim was to describe the trend over time and the demographic distribution of hemorrhagic stroke in Albania in the past decade. Methods: This study included all patients diagnosed with hemorrhagic stroke and admitted during the period 2004-2015 at the University Hospital Center “Mother Teresa” in Tirana (988 cases overall; 34% women; overall mean age: 57.8±19.3 years). Information about selected demographic characteristics was also collected for all study participants.   Results: The proportion of older patients (≥70 years) was slightly, but not significantly, higher in women than in men (32% vs. 27%, respectively; P=0.163). Furthermore, the proportion of Tirana residents was similar in both sexes (47% in men vs. 45% in women). Overall, there was evidence of a significant linear trend over time (Mann-Kendall test: P<0.01), indicating a gradual increase in the number of hemorrhagic stroke cases in Albania for the period 2004-2015. Conclusion: This study provides useful information about the increasing trend of hemorrhagic stroke in Albania, a transitional country in Southeastern Europe which is characterized by rapid changes including unhealthy dietary habits.&nbsp

Trends and demographic characteristics of hemorrhagic stroke in Albania during the period 2004-2015

Aim: Our aim was to describe the trend over time and the demographic distribution of hemorrhagic stroke in Albania in the past decade.Methods: This study included all patients diagnosed with hemorrhagic stroke and admitted during the period 2004-2015 at the University Hospital Center “Mother Teresa” in Tirana (988 cases overall; 34% women; overall mean age: 57.8±19.3 years). Information about selected demographic characteristics was also collected for all study participants.  Results: The proportion of older patients (≥70 years) was slightly, but not significantly, higher in women than in men (32% vs. 27%, respectively; P=0.163). Furthermore, the proportion of Tirana residents was similar in both sexes (47% in men vs. 45% in women). Overall, there was evidence of a significant linear trend over time (Mann-Kendall test: P<0.01), indicating a gradual increase in the number of hemorrhagic stroke cases in Albania for the period 2004-2015.Conclusion: This study provides useful information about the increasing trend of hemorrhagic stroke in Albania, a transitional country in Southeastern Europe which is characterized by rapid changes including unhealthy dietary habits. 

Acute flaccid paraplegia: neurological approach, diagnostic workup, and therapeutic options

AbstractAcute flaccid paraplegia is a clinical occurrence with extreme importance, due to the dramatic presentation, the severity of the underlying disorder, and the generally poor prognosis that follows such a condition. Among etiological factors, the traumatic events are of particular interest, with the clinical treating dealing with a severely ill patient, following fall from height, motor vehicle collisions, and direct shocks applied over the vertebral column. The non-traumatic list is more numerous; however the severity of the acute paraplegia is not necessarily of a lesser degree. Viral infections, autoimmune disorders, and ischemic events involving feeding spinal arteries have been imputed. However, chemical and medications injected during procedures or accidentally intrathecal administration can produce acute flaccid paraplegia. A careful neurological assessment and complete electrophysiological and imaging studies must follow. In spite of the poor prognosis, different therapeutic options have been proposed and applied. Neurosurgical and orthopedic interventions are often necessary when trauma is present, with high dose glucocorticoids treatment preceding the intervention, in a hope to decrease edema-related compression over the spinal cord. Immunoglobulins and plasmapheresis are logical and helpful options when a polyradiculoneuritis produces such a clinical picture. The role of decompression, as neurosurgical exclusivity, has been considered as well

Right Hemispheric Leukoencephalopathy as an Incidental Finding Following a Lightning Strike

BACKGROUND: Lightning injuries may produce a variety of medical conditions, and specific neurological complications have been identified, with the character of immediate aftershock effects or even long-term consequences.AIM: The authors describe the incidental finding following a routine unenhanced brain MRI performed to a young female patient, suffering from a headache.CASE REPORT: Diffuse white matter changes with the character of a leukoencephalopathy were seen, which strictly interested only the right cerebral hemisphere. The parents referred that she suffered from an indoor lightning strike at age of seven months, although she survived with almost no external burns or signs, and recovered uneventfully at that time. A discussion over the effects of electrocution and lightning strike on the human body in general, and over the nervous system, is made. Particular attention must be shown when making the differential diagnosis of leukoencephalopathies with a strictly one-hemisphere extension since several other conditions might resemble each other under the radiological aspect, here including brain viral infections, genetic disorders, and so on.CONCLUSION: The particularity of the long-term aftershock effects of the lightning strike on the central nervous system raise again the necessity of collecting data and duly reporting every electrical accident, lightning events included

Practical needs and considerations for refugees and other forcibly displaced persons with neurological disorders: Recommendations using a modified Delphi approach

Background: There are \u3e70 million forcibly displaced people worldwide, including refugees, internally displaced persons, and asylum seekers. While the health needs of forcibly displaced people have been characterized in the literature, more still needs to be done globally to translate this knowledge into effective policies and actions, particularly in neurology. Methods: In 2020, a global network of published experts on neurological disease and refugees was convened. Nine physician experts from nine countries (2 low, 1 lower-middle income, 5 upper-middle, 1 high income) with experience treating displaced people originating from 18 countries participated in three survey and two discussion rounds in accordance with the Delphi method. Results: A consensus list of priority interventions for treating neurological conditions in displaced people was created, agnostic to cost considerations, with the ten highest ranking tests or treatments ranked as: computerized tomography scans, magnetic resonance imaging scans, levetiracetam, acetylsalicylic acid, carbamazepine, paracetamol, sodium valproate, basic blood tests, steroids and anti-tuberculous medication. The most important contextual considerations (100% consensus) were all economic and political, including the economic status of the displaced person\u27s country of origin, the host country, and the stage in the asylum seeking process. The annual cost to purchase the ten priority neurological interventions for the entire displaced population was estimated to be 220 million USD for medications and 4.2 billion USD for imaging and tests. Conclusions: A need for neuroimaging and anti-seizure medications for forcibly displaced people was emphasized. These recommendations could guide future research and investment in neurological care for forcibly displaced people

Inapplicability of advance directives in a paternalistic setting: the case of a post-communist health system

<p>Abstract</p> <p>Background</p> <p>The Albanian medical system and Albanian health legislation have adopted a paternalistic position with regard to individual decision making. This reflects the practices of a not-so-remote past when state-run facilities and a totalitarian philosophy of medical care were politically imposed. Because of this history, advance directives concerning treatment refusal and do-not-resuscitate decisions are still extremely uncommon in Albania. Medical teams cannot abstain from intervening even when the patient explicitly and repeatedly solicits therapeutic abstinence. The Albanian law on health care has no provisions regarding limits or withdrawal of treatment. This restricts the individual's healthcare choices.</p> <p>Discussion</p> <p>The question of <it>'medically futile' </it>interventions and pointless life-prolonging treatment has been discussed by several authors. Dutch physicians call such interventions '<it>medisch zinloos</it>' (<it>senseless</it>), and the Netherlands, as one of the first states to legislate on end-of-life situations, actually regulates such issues through appropriate laws. In contrast, leaving an 'advance directive' is not a viable option for Albanian ailing individuals of advanced age. Verbal requests are provided during periods of mental competence, but unfortunately such instructions are rarely taken seriously, and none of them has ever been upheld in a legal or other official forum.</p> <p>Summary</p> <p>End-of-life decisions, treatment refusal and do-not-resuscitate policies are hazardous options in Albania, from the legal point of view. Complying with them involves significant risk on the part of the physician. Culturally, the application of such instructions is influenced from a mixture of religious beliefs, death coping-behaviors and an immense confusion concerning the role of proxies as decision-makers. Nevertheless, Albanian tradition is familiar with the notion of '<it>amanet</it>', a sort of living will that mainly deals the property and inheritance issues. Such living wills, verbally transmitted, may in certain cases include advance directives regarding end-of-life decisions of the patient including refusal or termination of futile medical treatments. Since these living wills are never formally and legally validated, their application is impossible and treatment refusal remains still non practicable. Tricks to avoid institutional treatment under desperate conditions are used, aiming to provide legal coverage for medical teams and relatives that in extreme situations comply with the advice of withholding senseless treatment.</p

General neurology: Current challenges and future implications

Background and purpose In the coming decades, the world will face an increasing burden of neurological disorders (ND) and an urgent need to promote brain health. These challenges contrast with an insufficient neurological workforce in most countries, as well as decreasing numbers of general neurologists and neurologists attracted to work in general neurology (GN). This white paper aims to review the current situation of GN and reflect on its future. Methods The European Academy of Neurology (EAN) task force (TF) met nine times between November 2021 and June 2023. During the 2023 EAN annual meeting, attendees were asked to answer five questions concerning the future of GN. The document was sent for suggestions and eventually approval to the board and the presidents of the 47 national societies of the EAN. Results The TF first identified four relevant current and future challenges related to GN: (i) definition, (ii) practice, (iii) education, and (iv) research. The TF then identified seven initiatives to further develop GN at both the academic and community level. Finally, the TF formulated 16 recommendations to promote GN in the future. Conclusions GN will remain essential in the coming decades to provide rapid, accessible, and comprehensive management of patients with ND that is affordable and cost-effective. There is also a need for research, education, and other initiatives aiming to facilitate improved working conditions, recognition, and prestige for those pursuing a career in GN

The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis

Background A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. Methods In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. Findings Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity (I 2 of > 75%) between estimates for almost half of the outcomes. Interpretation To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. Funding Public Health Wales. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licens

ACCIDENTUL VACULAR CEREBRAL ISCHEMIC, ALBANIA, 2004-2015

Background: The aim of this study was to describe the distribution of ischemic stroke in Albania, a former communist country in South Eastern Europe which is characterized by a rapid socioeconomic and political transition including also tremendous changes in lifestyle. Methods: This was a case-series study including all patients with ischemic stroke (N=4021; 40.6% females; overall mean age: 66.5±13.3 years) admitted during the period 2004-2015 at the University Hospital Center “Mother Teresa” in Tirana, which is the only tertiary care facility in Albania. In addition, information about selected demographic characteristics of all the patients was collected.    Results: The proportion of older women (70 years and above) was significantly higher compared to men (55% vs. 41%, respectively, P0.2). Conclusion: This is one of the first reports informing about the distribution of ischemic stroke in Albanian patients. Future studies in Albania should inform about the nationwide magnitude, distribution and the main risk factors of stroke in this transitional population.   Keywords: Albania, cerebrovascular disease, ischemic stroke, South Eastern Europe, Western Balkans.        Context: Scopul acestui studiu a fost acela de a descrie distribuția accidentului vascular cerebral ischemic &icirc;n Albania, o fostă țară comunistă din Europa de Sud-Est, care se caracterizează printr-o tranziție socio-economică și politică rapidă incluz&acirc;nd, de asemenea, schimbări importante &icirc;n stilul de viață. Metode: S-a realizat un studiu tip serii de cazuri care a inclus toți pacienții cu accident vascular cerebral ischemic (N = 4021; 40,6% femei; v&acirc;rsta medie generală: 66,5 &plusmn; 13,3 ani), internați pe parcursul perioadei 2004-2015 &icirc;n Centrul "Maica Tereza" a Spitalului Universitar din Tirana, singurul centru de &icirc;ngrijiri terțiare din Albania. De asemenea, au fost colectate informații cu privire la caracteristicile socio-demografice ale tuturor pacienților. Rezultate: Proporția femeilor &icirc;n v&acirc;rstă (70 de ani și peste) a fost semnificativ mai mare comparativ cu a bărbaților (respectiv de 55% față de 41%, P &lt;0,001). Pe de altă parte, s-a constatat că există o proporție mai mare a bărbaților care locuiesc &icirc;n Tirana, comparativ cu femeile (respectiv 35% față de 30%, P = 0,002). Făc&acirc;nd abstracție de o valoare maximă din anul 2014, nu au existat dovezi privind o tendință semnificativă &icirc;n timp, pentru perioada 2004-2015 (testul Mann-Kendall: P&gt; 0,2). Concluzii: Aceasta este unul dintre primele rapoarte informative privind distribuția accidentului vascular cerebral ischemic &icirc;n r&acirc;ndul pacienților albanezi. Studiile viitoare din Albania ar trebui să furnizeze informații privind importanța, la nivel național, a distribuției și a principalilor factori de risc ai accidentului vascular cerebral in populație. Cuvinte cheie: Albania, boli cerebrovasculare, accident ischemic, Sud-estul Europei, Balcanii de Vest &nbsp; &nbsp; &nbsp; &nbsp