Cardiac side effects of propranolol in infants treated for infantile haemangiomas

OBJECTIVES

This study aims to add proof to the safety profile of propranolol as first-line choice in treating infantile haemangiomas, in particular related to its cardiac side effects the main hindering reason for parents and physicians to start and comply with treatment.

METHOD

This is a prospective observational and analytic study with a sample of 476 patients diagnosed with infantile haemangioma and treated with systemic propranolol during the time interval January 2011 to December 2021. We studied clinical propranolol adverse events experienced in hospital or outpatient and measured the impact of propranolol on blood pressure and heart rate.

RESULTS

This study showed that symptomatic adverse events caused by propranolol were mild and severe adverse events were rare. The most common clinical side effects were paleness, sweating, reduced feeding, and agitation. Only in 28 (5.9%) cases these symptoms were severe enough to review treatment, 1.8% had severe respiratory symptoms, 2.7% experienced hypoglycaemia, and 1.2% had heart-related symptoms. Mean blood pressure reduction with treatment was statistically significant only after achieving the maintenance dose 2 mg/kg body weight. Blood pressure under the 5th percentile was registered in 2.9% of cases, but only four patients had symptomatic hypotension. While heart rate reduction was noticed with the first dose, only two experienced symptomatic bradycardia.

CONCLUSION

We conclude that propranolol is not only an excellent drug in treating infantile haemangioma, but it has also a very safe profile, with mild side effects and very rare severe cardiac adverse events, easily overcome with treatment interruption.

Information Technology in Health-Care Systems and Primary Health Care

BACKGROUND: Health information technology (HIT) is being increasingly necessary to manage the ever-increasing amount of data generate by the health system in general, including primary health care (PHC). AIM: This study aimed to provide an overview of HIT being currently use in the health systems and PHC as well as to highlight the advantages and disadvantages of HIT options. METHODS: This is a narrative literature review of papers, documents, and websites that address and discuss HIT for the health systems. The analysis of the retrieved materials provided an overview of the importance of HIT for the health system, the various options of health technology currently available, as well as the future trends. Strengths and weaknesses have been highlighted as well. RESULTS: HIT is being increasingly used in the health sector, as an indispensable tool to handle the extraordinary amount of data being generated by the health system but also as an instrument to improve the quality of health care through the reduction of medical errors and health care-associated costs, improvement of patient follow-up and monitoring, and also as a tool that informs and guides clinical decision-making. A large variety of HIT options is available, including telehealth, telemedicine, mobile health, electronic medical records, electronic health records, personal health records, electronic prescriptions (e-prescriptions), wearables, metadata, and even artificial intelligence. Each HIT option has its own advantages and disadvantages. PHC could benefit from the implementation of various HIT options. CONCLUSIONS: The decision which HIT option(s) to employ will depend on many factors, but the process needs to employ small steps, strong political will, cooperation, and coordination between all stakeholders.

The 6th Albanian Congress of Trauma and Emergency Surgery

After a three-year quarantine from the deadliest global pandemic of the last century, ASTES is organizing to gather all health professionals in Tirana, The 6th Albanian Congress of Trauma and Emergency Surgery(ACTES 2022) on 11-12 November 2022, with the topic Trauma & Emergency Surgery and not only...with the aim of providing high quality, the best standards, and the best results, for our patients ...ACTES 2022 is the largest event that ASTES (Albanian Society for Trauma and Emergency Surgery) has organized so far with 230 presentations, and 67 foreign lecturers with enviable geography, making it the largest national and wider scientific event.The scientific program is as strong as ever, thanks to the inclusiveness, where all the participants with a mix of foreign and local lecturers, select the best of the moment in medical science, innovation, and observation.The scientific committee has selected all the presentations so that the participants of each medical discipline will have something to learn, discuss, debate, and agree with updated methods, techniques, and protocols.I hope you will join us on Friday morning, and continue the journey of our two-day event together.

Correlates of Lifetime Physical Abuse Among Schoolchildren Aged 15 Years in Post-communist Albania

Aim: Our aim was to assess the prevalence and correlates of lifetime physical abuse among schoolchildren in Albania, a post-communist country in South Eastern Europe which is currently undergoing a rapid socioeconomic transition.

Methods: The third wave of Health Behavior in School-Aged Children (HBSC) in Albania was conducted in 2017–18 including a nationwide representative sample of 1,708 schoolchildren aged 15 years (54% girls; response rate: 95%). Children were asked to report on lifetime physical abuse and a wide range of socio-demographic factors, lifestyle factors and health status characteristics. Binary logistic regression was used to assess the independent association of lifetime physical abuse with covariates.

Results: Overall, the prevalence of lifetime physical abuse was about 32% (30% in boys vs. 32% in girls). In multivariable-adjusted logistic regression models, independent positive correlates of lifetime physical abuse among Albanian schoolchildren included lifetime smoking (OR = 1.5, 95% CI = 1.1–2.2), lifetime alcohol consumption (OR = 1.6, 95%CI = 1.2–2.1), irritability (OR_{[dailyvs.rarely/never]} = 2.0, 95%CI = 1.3–3.0), and especially lifetime witnessed domestic violence (OR = 4.2, 95%CI = 2.2–7.9). Conversely, a higher score on life satisfaction was inversely related to lifetime physical abuse (P < 0.01).

Conclusion: Our study provides novel evidence about the magnitude and selected independent correlates of lifetime physical abuse among schoolchildren in Albania, a country still embedded in an everlasting transition which is associated with tremendous changes in family structure, community links and societal norms and values. Irrespective of a wide range of sociodemographic factors and health characteristics, lifetime smoking, alcohol consumption, irritability, a lower score on life satisfaction and, particularly, witnessed domestic violence were strong and significant correlates of lifetime physical abuse among Albanian schoolchildren aged 15 years.

Lifestyle and Health Risk Behaviours among Elbasan Students

AIM: The purpose of this study is: (1) to help monitor the Albanian students’ lifestyle, the way they spend their free time, the weight that studying, networks, screens and sports have in their life; (2) to assess their health risk behaviours, such as tobacco and drug use, weapon carrying and sports betting; (3) to identify differences in behaviour by gender, grade, socioeconomic and demographic status; (4) to understand the influence of parents on their children.METHOD:  The study was conducted in May 2013, as a classroom survey of students in urban and rural schools of Elbasan. A questionnaire was distributed to the 8th   to 12th grade students to be completed by them anonymously.RESULT:  There are a low number of the students that are interested to books and study and meantime, a large number of them spend their free time in front of a screen or hanging out in bars with friends. Moreover, a considerable number of them are engaged in health risk behaviours.CONCLUSION: In students’ lifestyle exist serious problems and these data also provide inside into ways to shape a public health response. We need to change the way society views and treats these problems.

An epidemiological study on trigger factors and quality of life in psoriatic patients

Objective:

to evaluate the role of stress, tobacco, drugs, infections, allergies, heredity, alcohol, hormones and skin aggressions as trigger factors and the impact on quality of life in a sample of psoriasis patients.

Methods:

a transversal study performed in 90 patients affected by psoriasis between January and November 2012 at the “Nene Tereza” University Hospital, Tirane, Albania, based on two scored questionnaires.

Results:

more than 70 % of patients reported that stressful events caused a flare- up of their psoriasis (p< 0.05). More than 60% of males and 20% of females were smokers (p< 0.05). About 20% of our patients were taking one or more of the medications listed in the questionnaire (p> 0.05). About 20% of patients reported having had recurrent infections (p<0,05). About 80% of males patients consumed alcohol (p<0,05). More than 40% reported a relative with psoriasis. Statistical comparison of the group that reported skin aggressions with the group that did not revealed a significant difference (p<0,05). Only a few of them reported to have allergies (p>0,05). About 36% of females reported that hormonal changes (puberty and menopause) exacerbated their psoriasis (p<0,05). More than 40% of patients reported that psoriasis seriously affects their quality of life.

Conclusion:

stress, tobacco, infections, heredity, alcohol, hormonal changes and skin aggressions were confirmed as trigger factors for psoriasis in the present sample. Allergies and the investigated drugs seemed not to have any influence in flare-ups. We found that psoriasis had a serious impact in the quality of life in over of 40% of the patients interviewed.

Pediatric visceral leishmaniasis in Albania: a retrospective analysis of 1,210 consecutive hospitalized patients (1995-2009)

Background

Little information is available about infantile visceral leishmaniasis (VL) in Albania as regards incidence, diagnosis and management of the disease.

Methodology/Principal Findings

Demographic data, clinical and laboratory features and therapeutic findings were considered in children admitted to University Hospital of Tirana from 1995 to 2009, and diagnosed as having VL. The diagnosis was based on bone-marrow microscopy/culture in 77.5% of patients, serology in 16.1%, and ex juvantibus in 6.4%. A total of 1,210 children were considered, of whom 74% came from urbanized areas. All patients were in the age range 0–14 years, with a median of 4 years. Hepatosplenomegaly was recorded in 100%, fever in 95.4% and moderate to severe anemia in 88% of cases. Concomitant conditions were frequent: 84% had bronchopneumonia; diarrhea was present in 27%, with acute manifestations in 5%; 3% had salmonellosis. First-line therapy was meglumine antimoniate for all patients, given at the standard Sb^v dosage of 20 mg/kg/day for 21 to 28 days. Two children died under treatment, one of sepsis, the other of acute renal impairment. There were no cases of primary unresponsiveness to treatment, and only 8 (0.67%) relapsed within 6–12 months after therapy. These patients have been re-treated with liposomal amphotericin B, with successful cure.

Conclusions

Visceral leishmaniasis in pediatric age is relatively frequent in Albania; therefore an improvement is warranted of a disease-specific surveillance system in this country, especially as regards diagnosis. Despite recent reports on decreased responses to antimonial drugs of patients with Mediterranean VL, meglumine antimoniate treatment appears to be still highly effective in Albania.

Albania is a developing country that is rapidly improving in social, economic and sanitary conditions. The health care system in still in progress and the impact of some infectious diseases remains poorly understood. In particular, little information is available on incidence, clinical features and response to treatment of visceral leishmaniasis (VL) in childhood. We performed a retrospective analysis of data recorded from 1995 to 2009 at the national pediatric reference hospital of Tirana where any child suspected for VL is referred for specific diagnosis and treatment. Epidemiology, clinical features and management of the disease were considered. The main findings can be summarized as follows: i) The incidence of the disease in Albanian children (25/100,000 in the age group 0–6 years) is much higher than in developed Mediterranean countries endemic for VL; ii) The disease is associated with poor sanitary conditions as suggested by the high rate of severe clinical features and frequency of co-morbidities; iii) The cheapest drug available for Mediterranean VL treatment (meglumine antimoniate) is highly effective (99% full cure rate) and well tolerated. Limitations were identified in the low standard laboratory diagnostic capability and unsatisfactory medical surveillance in less urbanized areas. An improvement is warranted of a disease-specific surveillance system in Albania.