Authors: Fatjona Kraja, Erald Karaulli, Athina Papallopullo, Edit Zaganjori, Florina Hoxha, Adrian Hoti

Published in AJMHS Vol 71, 2026 (Ahead of Print)

Keywords: radiotherapy, early breast cancer, guidelines

Background: Adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) reduces ipsilateral breast tumor recurrence (IBTR), but the absolute benefit varies with baseline risk. With modern systemic therapy and molecular profiling, a subset of patients has sufficiently low local-recurrence risk to consider RT de-escalation or omission.
Methods: We analyzed evidence from randomized trials in older, hormone-receptor–positive (HR+) early breast cancer, prospective cohort studies and current guidelines. Key outcomes were IBTR, distant relapse, overall survival (OS), and toxicity/quality-of-life (QoL).
Results: Two randomized trials validate RT omission in elderly, low-risk HR+ disease receiving endocrine therapy. CALGB 9343 (age ≥70, T1N0, ER+) showed higher 10-year IBTR with omission (≈10% compared with 2% with RT) without OS difference. PRIME II trial (age ≥65, ER+, ≤3 cm, N0) confirmed as a 9–10% absolute increase in 10-year IBTR without OS loss. Biologically selected cohorts suggest omission can transcend age criteria. For women ≥55 years with luminal A tumors (ER+, HER2–, grade 1–2, Ki-67 ≤13.25%) who are treated with endocrine therapy alone in the LUMINA trial, 5-year locoregional recurrence was ~2–3% with great distant control without RT. On-going randomized trials as PRECISION and EXPERT are comparing genomic testing such as Oncotype DX, Prosigna/PAM50 to guide RT omission.
Randomized and prospective data support RT in most DCIS, yet small, low-grade, wide-margin screen-detected lesions of low risk could be suitable for surveillance or surgery alone. Active-surveillance trials are also underway on this topic. On the other hand, de-escalation alternatives like ultra-hypo fractionated whole-breast RT and partial-breast irradiation have local control with reduced burden of treatment.
Conclusions: RT omission is safe for carefully selected elderly patients with small, node-negative, ER+ tumors on endocrine therapy, with no OS penalty. Biology and genomics can further help in patients’ selection. Shared decision-making, adherence to endocrine therapy and multidisciplinary review are essential.

https://doi.org/10.65413/.........

Abstract Full Text (PDF)

Authors: Irida Kecaj, Ergita Nelaj, Ilir Gjermeni, Kei Xhixhabesi, Ina Refatllari

Published in AJMHS Vol 71, 2026 (Ahead of Print)

Keywords: Heart failure, vulnerable phase, decongestion, GDMT

Abstract: 
Heart failure remains a significant challenge for healthcare systems globally, associated with high hospitalization and mortality rates. Episodes of acute decompensation require immediate evaluation and hospital treatment; however, the greatest risk for adverse events occurs after discharge from the hospital. The first 3 months after discharge, known as the "vulnerable phase," are characterized by a high incidence of rehospitalization and mortality, making it a critical period for therapeutic intervention. This narrative review was based on a structured literature search in the PubMed/MEDLINE databases, focusing on European Society of Cardiology (ESC) guidelines and recently published clinical trials, with the aim of identifying consensus on the management of the vulnerable phase and analyzing its applicability in our clinical practice.
This article summarizes the latest evidence on the importance of optimizing guideline-directed medical therapy, not only during the acute phase, but also in the period before and immediately after hospital discharge. Beyond the traditional focus on short-term acute stabilization, the pre-discharge phase is a key window for hemodynamic stabilization, decongestion, management of comorbidities, and titration of oral therapy. In parallel, early post-discharge follow-up based on clinical assessment, multidisciplinary coordination, patient education, and laboratory biomarkers improves risk stratification. Implementation of this integrated approach shifts the focus from isolated short-term management to strategies that significantly reduce adverse events during this transitional period.
Keywords: Heart failure, vulnerable phase, decongestion, GDMT

https://doi.org/10.65413/.........

Abstract Full Text (PDF)

Authors: Evis Binaj

Published in AJMHS Vol 71, 2026 (Ahead of Print)

Keywords: Postmenopausal bleeding; Endometrial carcinoma; Endometrial intraepithelial neoplasia; Endometrial hyperplasia; Histopathology; Albania

Abstract: 
Background: Postmenopausal bleeding (PMB) warrants prompt evaluation because it may indicate endometrial carcinoma and may also reflect premalignant endometrial disease. International estimates vary by geography and referral setting, while Albanian evidence is limited and has yielded markedly different hospital-based estimates.
Objective: To estimate the frequency of histologically confirmed endometrial carcinoma among women presenting with PMB, describe the histopathological spectrum, explore clinical and ultrasound characteristics associated with carcinoma, and reassess earlier Albanian hospital estimates using prospective consecutive ascertainment.
Methods: This prospective hospital-based observational cohort included all eligible consecutive women presenting with PMB at Queen Geraldine Obstetric–Gynecologic Hospital, Tirana, Albania, from January 2024 through December 2025. Clinical and transvaginal ultrasound variables were recorded before histopathological classification. The final cohort comprised 221 women with complete outcome data. Carcinoma frequency and histopathological proportions were reported with 95% confidence intervals (CIs). Exploratory between-group comparisons used Welch’s t test, Mann–Whitney U test, or Fisher’s exact test as appropriate.
Results: Endometrial carcinoma was diagnosed in 24/221 women (10.9%; 95% CI 7.4–15.6). Atypical hyperplasia/endometrial intraepithelial neoplasia (EIN) occurred in 22.2% (95% CI 17.2–28.1) and hyperplasia without atypia in 28.5% (95% CI 23.0–34.8). Women with carcinoma were older, had more years since menopause, higher BMI, lower parity, longer bleeding duration, greater endometrial thickness, lower Doppler resistance and pulsatility indices, and higher vascularisation scores (all p≤0.020). Heterogeneous endometrium (OR 11.98, 95% CI 3.92–36.59), an intrauterine mass (OR 7.85, 95% CI 3.14–19.64), and high vascularisation (OR 23.97, 95% CI 7.70–74.60) were strongly associated with carcinoma.
Conclusions: Approximately one in nine women evaluated for PMB in this tertiary cohort had endometrial carcinoma, a frequency substantially lower than a previous 2018 Albanian hospital estimate and broadly consistent with international pooled evidence. The high burden of atypical hyperplasia/EIN indicates that PMB pathways must address both invasive malignancy and clinically important precursor lesions.

https://doi.org/10.65413/.........

Abstract Full Text (PDF)

Authors: Fabio Luciani, Filadelfo Coniglione, Carla Sgroi, Bora Kerpi, Ermal Pashaj, Paolo Piva, Arvin Dibra, Ernesto Bruno

Published in AJMHS Vol 71, 2026 (Ahead of Print)

Keywords: Sonosurgery, Odontotomy, Third Molar, Oral Surgery

Abstract: 
Objectives: The aim of this preliminary study is to compare piezosurgery with sonosurgery, to verify the possibility of having alternatives in the use of the current reference standard (high-speed handpiece), evaluating the intraoperative time required for odontotomy cutting and postoperative pain control. 
Methods: Our experimental protocol involved the selection of 15 patients aged 21 to 27 years with at least one lower third molar requiring surgical extraction with odontotomy. The 15 patients were divided into three equal groups: the first group was treated with a high-speed handpiece, the second group with piezosurgery, and the third group with sonosurgery. To assess pain control during the postoperative period, each patient was asked to record the perceived intensity on a pain scale ranging from 0 (no pain) to 10 (excruciating pain). 
Results: High-speed handpiece reported the fastest intraoperative times, but with less satisfactory pain control, especially in older patients; Sonosurgery, on the other hand, recorded the longest intraoperative times, but a better analgesic response at every age. Finally, Piezosurgery obtained intermediate values in terms of cutting speed and pain control. According to our preliminary data, sonosurgery appears to be an effective alternative for third molar extractions. The high-speed handpiece, thanks to its effectiveness in cutting hard tissue, confirms its validity due to its increased speed of execution. 
Conclusions: Further studies will be needed to confirm our hypotheses and to further explore the properties and specificities of surgery with sonic instruments. 

https://doi.org/10.65413/.........

Abstract Full Text (PDF)

Authors: Daorson Aliu, Teuta Kryeziu-Aliu

Published in AJMHS Vol 71, 2026 (Ahead of Print)

Keywords: Air pollution; Public health; Exposure assessment; Urban environment.

Abstract: 
Background: Air pollution is a major environmental and public health concern in Kosovo, particularly in urban areas during the winter season. Fine particulate matter (PM₁₀ and PM₂.₅) poses significant health risks due to its ability to penetrate deeply into the respiratory system. 
Aims: This study aimed to assess the levels, seasonal variation of PM₁₀ and PM₂.₅ concentrations in selected urban areas of Kosovo, and to compare them with international air-quality standards. 
Study Design: Three urban regions Prishtina, Peja, and Gjilan were selected based on demographic significance, degree of urbanization, and availability of continuous monitoring data. 
Methods: Daily PM₁₀ and PM₂.₅ measurements for the year 2024 were analysed data from the Kosovo Hydro-Meteorological Institute. Annual and seasonal averages were calculated and compared with World Health Organization (WHO) and European Union (EU) air-quality standards. Pearson correlation analysis was applied to evaluate the relationship between PM₁₀ and PM₂.₅ concentrations. 
Results: All studied regions exceeded WHO annual guideline limits for PM₁₀ (15 µg/m³) and PM₂.₅ (5 µg/m³), while remaining within EU permissible limits. Prishtina recorded the highest annual mean concentrations (PM₁₀: 28.3 µg/m³; PM₂.₅: 18.21 µg/m³). Seasonal analysis showed that winter pollution levels were more than twice as high as summer values, with particularly elevated levels observed in Gjilan. A very strong positive correlation between PM₁₀ and PM₂.₅ and higher level of significance of  p<0.01, which  suggests common emission sources, including traffic, construction activities, and solid-fuel combustion for heating. 
Conclusion: Urban areas in Kosovo experience persistent air pollution that exceeds WHO recommendations, especially during winter. These findings highlight the need for enhanced air-quality monitoring, stricter emission control policies, and targeted public health interventions.

https://doi.org/10.65413/.........

Abstract Full Text (PDF)

Authors: Amarilda Hysenshahaj, Jolanda Hyska, Alban Ylli, Dorina Toçi

Published in AJMHS Vol 71, 2026 (Ahead of Print)

Keywords: ischemic heart disease; epidemiology; incidence; Albania; cardiovascular diseases.

Abstract: 
Background: Cardiovascular diseases remain the leading cause of mortality worldwide, with ischemic heart disease as the main contributor. In Albania, circulatory system diseases account for more than half of total mortality; however, updated national epidemiological data on IHD remain limited. Reliable incidence estimates are essential for monitoring trends, identifying high-risk populations, and informing public health interventions.
Aims: This study aimed to describe the epidemiological profile of ischemic heart disease in Albania during 2024 and to assess incidence patterns according to sex, age group, and geographic region, as well as short-term changes compared with 2023.
Study design: This study is a national descriptive cross-sectional epidemiological analysis based on routinely collected hospital surveillance data.
Methods: Data on newly diagnosed ischemic heart disease cases were collected from all hospital services in Albania. Only first-ever cases were included. Incidence rates per 100,000 population were calculated using population data from the 2023 national census (INSTAT). Analyses were stratified by sex, age group, and region, with comparisons between 2023 and 2024 to assess patterns by person, place, and time.
Results: In 2024, the national incidence of ischemic heart disease was 201.3 per 100,000 population, showing a slight decrease compared with 203.2 per 100,000 in 2023. Males accounted for 69% of all newly diagnosed cases and exhibited an incidence approximately 2.3 times higher than females (279.8 vs. 124.1 per 100,000). Incidence increased markedly with advancing age in both sexes, with the highest rates observed among individuals aged 65–79 years. Significant regional variation was identified, with the highest incidence recorded in Lezhë and Berat regions, while Kukës, Gjirokastër, and Fier demonstrated the lowest rates. Although national incidence remained relatively stable, localized increases were observed in several regions, particularly among males.
Conclusion: Ischemic heart disease remains a major public health challenge in Albania, with marked disparities by sex, age, and region. Although national incidence has stabilized, the high burden among men and older adults underscores the need for strengthened prevention, improved surveillance, and targeted interventions to support evidence-based cardiovascular health policy.

https://doi.org/10.65413/.........

Abstract Full Text (PDF)

Authors: Seçil Kartal Tunç, Hüseyin Narcı , Cüneyt Ayrık

Published in AJMHS Vol 71, 2026 (Ahead of Print)

Keywords: Procedural sedation and analgesia, emergency department, emergency medicine specialists

Abstract: 
Objective: Procedural sedation and analgesia (PSA) is integral to emergency department (ED) practice; however, variability in protocol implementation, monitoring standards, and safety practices may compromise patient outcomes. This study aimed to comprehensively evaluate the institutional infrastructure, clinical practices, pharmacologic preferences, safety attitudes, and sedation monitoring practices of emergency medicine specialists regarding PSA in Turkish EDs.
Methods: This national cross-sectional survey was conducted among emergency medicine specialists across Türkiye, including tertiary care hospitals, training and research hospitals, and state hospitals in multiple cities, between July 1 and August 1, 2018. A structured electronic questionnaire assessed institutional PSA infrastructure (availability of written protocols, monitoring equipment, and difficult airway equipment), PSA frequency, protocol availability, monitoring practices, pharmacologic preferences, complication experiences, and use of sedation depth assessment tools. The questionnaire was distributed to emergency medicine specialists via professional association mailing lists using a convenience sampling approach. Participants' demographic characteristics, clinical attitudes, and procedural practices were analyzed descriptively.
Results: A total of 405 emergency physicians (mean age 36.1 ± 4.7 years; 53.8% male) participated. The sampling frame targeted emergency medicine specialists actively practicing in Türkiye at the time of the survey. Of 943 specialists contacted, 405 completed the survey, yielding a response rate of 44.4%. Regarding attitudes and practices, the majority reported high procedural confidence, yet significant gaps were identified in adherence to structured protocols and objective monitoring. PSA was performed frequently, with 72.6% reporting more than five procedures per week. Despite this high procedural volume, 79.8% reported the absence of a written PSA protocol at their institution. While standard monitoring infrastructure was widely available (90.6%), adequate difficult airway equipment was reported by only 66.7% of respondents. Midazolam was the predominant sedative, and fentanyl was the leading analgesic. More than half of physicians (55.1%) reported experiencing at least one PSA-related complication, most frequently hypotension, respiratory depression/apnea, and hypoxia. Notably, 82.5% did not use any validated sedation depth assessment scale.
Conclusion: Although PSA is routinely performed in Turkish EDs and basic infrastructure appears largely sufficient, substantial deficiencies persist in protocol standardization, airway preparedness, and objective sedation assessment. These findings highlight a critical need for structured institutional PSA protocols and routine implementation of validated sedation monitoring tools to enhance patient safety and reduce practice variability.

https://doi.org/10.65413/.........

Abstract Full Text (PDF)