Clinical Decision-Making for Appendectomy in Kosovo: A Conjoint Analysis.

Objective: The objective was to investigate the association of clinical attributes with decision making for performing appendectomy and making preoperative preparations for appendectomy. Method: A conjoint analysis with 17 clinical scenarios was executed with surgeons employed at public hospitals in Kosovo. Setting: The study was conducted at two public hospitals in Kosovo that have benefited from quality-improvement interventions. Participants: The participants included 22 surgeons. Outcome measures: The primary outcome was the overall effect of clinical attributes on the decision to perform appendectomy and make the preoperative preparations for appendectomy. Results: In the regression analyses, several attributes demonstrated statistically significant effects on the clinical decision to perform appendectomy and on the practice of preoperative preparation. Conclusions: We found that several factors influenced the decision to perform appendectomy and the practices for preoperative preparation. Nevertheless, the small sample size limited our efforts to interpret the results. These findings could assist Kosovo in the design and implementation of future similar studies and in fostering quality improvement measures that address clinical decision making and the lack of process standardization in the delivery of surgical care.

Case report of ectopic hepatic tissue, a rare finding during a laparoscopic cholecystectomy.

INTRODUCTION: Ectopic hepatic tissue is due to an uncommon failure of embryological liver development. The incidence of ectopic liver has been reported to be anywhere from 0.24% to 0.47% and a prevalence rate of 0.47% as diagnosed at laparotomy or laparoscopy. We report a case of Ectopic Hepatic tissue attached to the gallbladder wall that was discovered during a laparoscopic cholecystectomy. CASE REPORT: A 47 year-old women presented to the surgery department with abdominal acute pain. The patient was taken for a standard laparoscopic cholecystectomy. The gallbladder was retracted cephalad while Hartmann's pouch was retracted laterally. It was then noted that an ectopic tissue was present on the gallbladder wall. The patient recovered well after surgery, had no complications and was discharged the day after surgery. DISCUSSION: Ectopic hepatic tissue is a rare condition. The real incidence of ectopic hepatic tissue attached to the gallbladder wall is difficult to assess but is reportedly 0.24-0.47% of the population. Ectopic hepatic tissue attached to the gallbladder usually remains asymptomatic and is occasionally discovered during laparoscopy, as was the case with the patient in the present report. In this case presented, the histopathological examination of specimen was confirmed to be ectopic liver tissue without hepatocellular carcinoma. CONCLUSION: It is important to be vigilant of ectopic hepatic tissue, their complications, and the potential surgical, including increased operative time and the need to follow up on such patients to rule out any possible complications.

The Link Between HIV Knowledge and Prophylaxis to Health Professionals.

BACKGROUND: Healthcare workers have a high risk of professional exposure, especially in developing countries. AIM: This paper aims to determine whether there is a link between knowledge and HIV prophylaxis on HIV prevention in Albanian healthcare system employees. MATERIAL AND METHODS: This study was attended by professionals of the Albanian health care system who also attended second cycle studies at the Faculty of Medical Sciences (FMS) at the University of Medicine, Tirana. The study was conducted through a standard questionnaire with 24 questions, previously created by the Vojvodina Institute of Public Health in Serbia. RESULTS: A group of 219 respondents participated in the study, of which 83.3% were women and 16.7% males. The risk of HIV transmission from syringe injection is > 75%, for 55.9% of the respondents. This result is statistically significant compared to other categories (p < 0.01). There is an increase in awareness of the use of gloves before manipulation and use of syringes, with increased work experience (p = 0.01). The use of specific containers for the elimination of syringes after manipulation is a more common practice by the most experienced professionals at work and results in a significant change (p = 0.02). CONCLUSION: This study showed that there is not enough information from health professionals about potentially infectious fluids for HIV transmission. Younger professionals are less informed about HIV transmission and prophylaxis. These data indicate that there is a need for deepening of university curricula about the risks and exposure to biologically infectious fluids.

Case report of cholelithiasis in a patient with type 1 Gaucher disease.

INTRODUCTION: Patients with type 1 Gaucher disease have been reported to be more likely to have cholelithiasis. PRESENTATION OF CASE: A case of cholelithiasis in a patient with type 1 Gaucher disease; which is very intriguing to show this comorbidity. The case was the only known case with this pathology in time of diagnosis in our country (Kosovo). The patient is a 21-year old girl a known case of type 1 Gaucher disease, at the age of 8 years. The patient underwent elective laparoscopic cholecystectomy. Chronic inflammatory changes and adhesions were obvious during surgery. DISCUSSION: Type 1 Gaucher disease patients have several risk factors for gallstone formation: increased biliary excretion of glucosylceramide, advanced liver disease and cirrhosis, splenomegaly, inborn error of metabolism, chronic systemic inflammation, T cell dysfunction, and insulin resistance" to risk factors. CONCLUSION: Gallstones and cholecystitis should be considered when abdominal symptoms and liver dysfunctions are seen in these patients. More studies are needed in especially Kosovo.

Surgical treatment of hepatic echinococcosis in Prizren (Kosovo).

Management option of hepatic echinococcosis represents a major challenge for a surgeon. The aim of the study was to evaluate surgical treatment of patients with hepatic echinococcosis at the surgery department of the regional hospital in Prizren (Kosovo). The medical records of 22 patients operated for hepatic echinococcosis in our department during a four year study period (2009-2013) were retrospectively reviewed. Apart from the total of 5850 operated patients, 22 cases were diagnosed for liver echinococcosis (0.4%). The most affected age group was from 26 to 50 years (54.5%). Female gender, 16 cases (73%), and patients living in rural places, 14 patients (64%), dominated significantly. The most affected region was Municipality of Dragash. All patients underwent ultrasonography, 13 patients underwent CT scans and 5 patients MRI of abdomen. The mean preoperative ultrasonographic diameter of cysts was 9.5 cm and maximal 21 cm. Cysts were most often localized in right hepatic lobe (77%) and subcostal laparotomy was most commonly performed (82%). The performed surgical procedures were: endocystectomy and partial pericystectomy with omentoplication according to Papadimitris (73%), endocystectomy and capitonnage and endocystectomy with external drainage (14%). The laparoscopic approach was used only in one patient. In conclusion, hepatic echinococosis was not common among operated patients at our surgery department. Subcostal laparotomy with endocystectomy and partial pericystectomy with omentoplication according to Papadimitris was most commonly used. Exact distribution of echinococcosis is needed to be analyzed with a larger cohort study including all surgery units in the country and with a longer monitoring.