Introduction: Cardiac arrest, the sudden loss of heart function, often strikes without warning. Immediate medical intervention is not only critical, but it is also a lifeline for these patients. Without prompt action, cardiac arrest is usually fatal. Resuscitation. This study explores key factors that influence the survival of patients experiencing cardiac arrest in prehospital settings. The primary aim of this study is to thoroughly investigate and identify the most crucial factors influencing the survival of patients experiencing cardiac arrest in pre-hospital settings. Material and Methods: An extensive review of global and local literature focused on studies involving patients of various age groups who underwent prehospital Resuscitation. Key factors affecting survival outcomes in prehospital cardiac arrest were tracked and analyzed. Results: Large meta-analyses reveal that data from 37 Emergency Medical Services across Europe indicate a one-year survival rate following Cardiopulmonary Resuscitation of approximately 20.7%. From 2016 to 2023, the Emergency Medicine Center in Pristina resuscitated 576 patients, achieving an average one-year survival rate of 8.8%. Timely defibrillation of ventricular fibrillation is crucial, potentially increasing survival rates by up to 90%. However, each minute of delayed defibrillation reduces survival rates by about 10%. This highlights the crucial role of Emergency Medical Services in ensuring timely intervention. Optimal defibrillation occurs within 3 to 5 minutes after cardiac arrest. Healthcare professionals must be equipped to perform both basic and advanced cardiopulmonary resuscitation techniques to improve outcomes. Conclusion: The success of resuscitation depends on the time elapsed between cardiac arrest and the initiation of resuscitation measures. Early intervention with basic life support techniques significantly increases the chances of survival. However, it is not solely the responsibility of professionals. The community also plays a vital role. Automated External Defibrillators (AEDs) are a safe and effective method, especially when applied promptly in cases of cardiac arrest.

Introduction: Gunshot injuries to the thoracic cavity are relatively common and considered high risk for cardiac involvement. However, current literature shows that the incidence of cardiac damage does not differ significantly when comparing various aetiologies of penetrating chest injuries [1]. The most common predictive factors for cardiac injury include clinical manifestations, missile trajectory or anatomical wound location, and the number of chest wounds [2]. However, injuries to the heart and mediastinal vessels are often fatal and are therefore considered leading causes of death following trauma [3]. Most patients suffering from an acute traumatic cardiac injury present with hemodynamic instability and cardiac tamponade, which can subsequently lead to high mortality rates [4, 5]. Therefore, a patient with a gunshot thoracic injury, especially transmediastinal, who is hemodynamically stable and shows no clinical signs or symptoms of cardiac injury, may have underlying injuries. We present a rare case of a stable gunshot trans -mediastinal wound patient, with initial retained haemothorax after thoracentesis, and finally diagnosed with partial heart herniation. Conclusions: Partial heart herniation following a transmediastinal gunshot wound is a rare and potentially life-threatening condition that may present without classic signs of cardiac injury. This case emphasizes the importance of maintaining a high index of suspicion for occult cardiac trauma in hemodynamically stable patients with thoracic gunshot injuries. Timely imaging, thorough evaluation, and minimally invasive surgical exploration, such as VATS, can play a critical role in diagnosing and managing such atypical presentations, ultimately improving outcomes.

Introduction: Surgical treatment for the aortic valve and ascending aortic aneurysm is currently a frequently performed procedure. It is reported that up to 15% of patients requiring aortic valve surgery also need simultaneous surgical intervention of the ascending aorta. The main objective of this study is to present, for the first time in our country, the early postoperative outcomes of combined aortic valve surgery and supra-commissural ascending aorta replacement. This study, being the first of its kind in our country, holds significant importance in the field of cardiovascular surgery. Materials and Methods: This retrospective cohort study included patients who underwent simultaneous aortic valve surgery and supracommissural ascending aorta replacement between 2007 and 2023 at the Department of Cardiac Surgery, UHC ‘Mother Teresa,’ Tirana, Albania. Data were extracted from surgical registries and medical hospital records. Results: A total of 131 patients participated in the study, consisting of 102 males (77.9%) and 29 females (22.1%). The average age of the cohort was 57.33 ± 11.90 years. The majority of patients (93.9%, 123/131) underwent elective surgery. Severe aortic valve stenosis was the most prevalent primary pathology, affecting 58 patients (44.3%). The in-hospital mortality rate was 2.29% (3/131 patients) … Conclusion: Simultaneous aortic valve surgery and supra-commissural ascending aorta replacement at our institution is associated with excellent early postoperative outcomes, reassuring us of the effectiveness of this procedure in our practice.

Introduction: Nosocomial infections remain a significant threat to patient safety worldwide, driving morbidity, mortality, and escalating healthcare costs. Despite comprehensive guidelines from the WHO, CDC, and ECDC, variability in recommendations and persistent implementation gaps impede optimal uptake. Objective: To critically assess current international and regional standards for preventing and controlling healthcare‐associated infections (HAIs) and to propose feasible, context‐specific strategies for local implementation that empower healthcare professionals to reduce infection rates meaningfully. Material and Methods: We conducted a systematic review of key HAI prevention and management guidelines published between 2013 and 2023. The methodological quality of each document was evaluated using the AGREE II instrument. Results: All guidelines converge on essential measures: rigorous hand hygiene, standardized environmental disinfection protocols, and robust antimicrobial stewardship programs. However, antibiotic regimens for routine HAIs (e.g., catheter‐associated urinary tract infections) differ markedly, and few guidelines offer clear pathways for implementation in facilities constrained by staffing, equipment, or medication shortages. Interviewees cited critical challenges, including insufficient staffing levels, inconsistent training quality, limited diagnostic capacity, and underdeveloped surveillance systems. Conclusions: Harmonization of core recommendations is needed to reduce clinician confusion. We propose a practical implementation framework. Tailoring global best practices to local realities promises improved compliance, optimized resource use, and a significant reduction in nosocomial infection burden.

Introduction: Major hemorrhage remains a leading cause of preventable death in both civilian and military trauma settings. Tourniquets have emerged as a critical intervention for hemorrhage control; however, their optimal application across various clinical environments requires systematic evaluation. Objective: To systematically review the effectiveness, safety, and clinical outcomes of tourniquet use for major extremity hemorrhage in prehospital and hospital settings. Materials and Methods: We conducted a comprehensive systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library databases for studies published between 2000 and 2024. The inclusion criteria covered randomized controlled trials, cohort studies, and observational studies that assessed the use of tourniquets for major limb hemorrhage. Primary outcomes included survival rates, effectiveness of hemorrhage control, and complication rates. Secondary outcomes included time to hemorrhage control and functional results. Data extraction focused on clinical indications, patient demographics, tourniquet specifications, application timing, and adverse events. Results: Thirty-two studies met the inclusion criteria. Tourniquet use in the prehospital setting was consistently associated with improved survival in patients with severe extremity bleeding, particularly when applied early. Hospital-based tourniquet use has proven effective in surgical or resuscitative contexts but requires careful monitoring to avoid ischemic complications. When used correctly and for limited periods, complication rates remain low. Conclusions: The current evidence strongly supports the use of tourniquets as an effective and safe intervention for major extremity hemorrhage in both prehospital and hospital settings. The early application improves survival outcomes and helps reduce complications. Implementing standardized protocols, comprehensive training programs, and quality improvement initiatives is crucial to maximizing clinical benefits and ensuring patient safety.

Introduction: The Freestyle® stentless porcine aortic root (Medtronic, Minneapolis, MN) has emerged as a valuable option for aortic valve replacement (AVR), offering superior hemodynamics compared to stented bioprostheses and eliminating the need for lifelong anticoagulation required with mechanical valves. Derived from a porcine aortic root, the Freestyle valve allows for versatile implantation techniques, including subcoronary, root inclusion, and full root replacement. While the Freestyle valve demonstrates excellent hemodynamics and benefits, as well as acceptable long-term survival, challenges remain regarding structural valve deterioration (SVD) in younger patients and technical complexities during implantation. These technical complexities include the need for precise surgical expertise, the stentless nature of the prosthesis, dense adhesions, and circumferential calcification of the porcine root. Emerging technologies, such as advanced anti-calcification treatments and tissue engineering, may further enhance its durability. In this article, we present two illustrative cases from our institution to highlight these challenges and discuss surgical strategies, as well as synthesize current evidence and discuss future directions for stentless bioprosthetic valves. Conclusion: The Medtronic Freestyle stentless bioprosthetic valve offers significant hemodynamic benefits and acceptable durability in appropriately selected patients. However, late failure of the Freestyle stentless aortic root bioprosthetic can present as catastrophic pseudoaneurysm formation or severe leaflet degeneration with rupture. Prosthesis excision requires complex surgical strategies, including the need for root replacement and tailored coronary reimplantation.

Introduction: Burnout, a global syndrome affecting healthcare systems, is often referred to as the "disease of the 21st century." This review examines the prevalence and contributing factors of this condition among healthcare personnel in Europe. The prevalence of burnout in European countries has been a subject of interest, and the factors contributing to it are being examined. This literature review aims to provide a comprehensive understanding of the scope of burnout and its implications, with a particular emphasis on its global impact. Materials and Methods: A systematic search of databases (Web of Science, Scopus, PubMed, and others) identified 95 articles, nine of which met the inclusion criteria. Studies published in the last 20 years, particularly those from the past decade, were prioritized for review. The search strategy utilized keywords to identify titles, including "prevalence of boss" and "boss factors." Most articles were published within the last 20 years, with a greater proportion of the most recent articles appearing in the past 10 years. Results: Burnout prevalence ranged from 16.8% (Montenegro) to 71.36% (Romania), with nursing staff and general practitioners most affected. Risk factors included age, gender, long working hours, high patient loads, and inadequate vacation time. A preponderance of burnout-related concerns was observed among the personnel, particularly those engaged in staff nursing and general practice. Conclusions: Burnout is prevalent among healthcare professionals, highlighting the need for targeted interventions to mitigate its impact. Addressing risk factors is crucial for improving occupational health and well-being. This study's findings demonstrate that burnout is prevalent among the examined population. The investigation revealed that a significant proportion of the subjects exhibited moderate levels of burnout. The analysis further elucidates that a substantial number of the subjects identified as "high-risk" were influenced by various factors, including, but not limited to, their immediate superiors.

Introduction: Foodborne intoxications persist as a significant and urgent public health concern globally, impacting both developing and developed nations. The incidence, particularly among children, escalates notably during the summer months, underscoring the severity of the issue. This study aims to present our clinical experience in managing foodborne intoxications in pediatric patients aged between 12 months and 6 years. Materials and Methods: This retrospective study included 96 children diagnosed with foodborne intoxication, all of whom were treated by the most recent World Health Organization (WHO) guidelines for the management of foodborne illnesses. Results: Among the 96 children treated between June and August 2024, 56 were female and 40 were male. The mean age of the patients was 3.8 years. The most commonly reported symptoms upon admission were colicky abdominal pain, vomiting, diarrhea, and—in a subset of patients—high-grade fever and chills. Conclusion: The management of foodborne infections remains a critical global health issue. The unique vulnerability of younger children and the potential for rapid clinical deterioration underscore the need for improved management strategies, highlighting the crucial role of the medical community in addressing this issue.

Background: Aortic valve replacement (AVR) has been a routine procedure since the introduction of heart valve prostheses in the late 1960s and early 1970s. It is the most commonly performed heart valve surgery in cardiac surgical practice. This study aims to present the early postoperative outcomes of isolated AVR surgery performed at the Service of Cardiac Surgery, University Hospital Center "Mother Teresa," Tirana, Albania, from January 2007 to December 2023. Materials and Methods: Patients who underwent isolated aortic valve surgery were included in this retrospective study. All surgeries were performed at the Service of Cardiac Surgery, University Hospital Center ‘Mother Teresa,’ Tirana, Albania, from January 2007 to December 2023. Results: The study included 491 patients (311 males and 180 females) with a mean age of 62.28 ± 10.76 years. The majority of patients (72.5%) had aortic valve stenosis. At hospital admission, most patients were classified as New York Heart Association (NYHA) Class III (54.2%) or Class II (38.9%). In-hospital mortality was 1.6% (8/491 patients). The most frequent postoperative complications included new-onset atrial fibrillation (15.5%), conduction disorders requiring permanent pacemaker implantation (6.5%), and low cardiac output syndrome (3.7%). Cardiopulmonary bypass time, aortic cross-clamp time, respiratory Assistance time, intensive care unit stay, and postoperative hospital stay were 83.85 ± 22.63 minutes, 65.22 ± 19.20 minutes, 16.2 ± 42.16 hours, 59.59 ± 65.60 hours, and 9.15 ± 4.45 days, respectively. Conclusion: The early results of aortic valve surgery at our center are satisfactory and significant. With a low mortality rate and a relatively low incidence of postoperative complications, our outcomes align with international standards, underscoring the safety and effectiveness of AVR in our institution. These findings contribute to the growing body of knowledge in cardiac surgery, providing valuable insights for future research and practice.

Aim: In the surgery of pilonidal sinus disease (PSD), positioning any incision away from the central axis of the crenae is expected to yield a reduced recurrence rate. If so, it can be anticipated that the modified Limberg flap (MLF) exhibits a lower recurrence rate than the Limberg flap (LF). Material and Methods: To perform a comparative meta-analysis of the recurrence rates, 1,338 studies encompassing 153,098 patients were identified. Out of these, 210 studies (both randomized controlled and nonrandomized controlled trials) with n=16,588 patients who had undergone either LF or MLF were included in the Kaplan-Meier Survival analysis. Results: In non-RCT analysis, the LF group exhibited a 5-year recurrence rate of 7.1% (CI 6.3-8.0), while the MLF group showed a 5-year recurrence rate of 4.9% (CI 3.7-6.1) (p<0.0001). After 8 years, which represents the most extended observation period for the MLF group, the recurrence rate was 10.9% (CI 9.6-12.1) for LF and 7.3% (CI 5.4-9.1) for MLF (p<0.0001). In the RCT analysis, the curves differ as a trend but not significantly, as PT numbers are scarce beyond year 2. The RCT-versus-nonRTC analysis of LF shows significantly higher RR for RCT studies, which is the same for MLF. Conclusion: This meta-analysis, which focused on recurrence rates associated with Limberg flap variants and analyzed data from 16,588 patients, shows that the modified Limberg flap technique effectively reduces the risk of recurrence compared to the already low recurrence rate associated with the classical Limberg flap. The presence of a scar in the caudal midline, as observed in the classical Limberg variant but not in the modified Limberg, is strongly correlated with a higher recurrence rate. Therefore, the modified Limberg flap variant is recommended in future surgical procedures. What does this paper add to the literature? This paper contributes significantly to the existing literature by providing robust evidence supporting the modified variant of the Limberg flap technique. While the Limberg flap's recurrence rate is already low, its modification notably diminishes recurrence rates even further. Consequently, the modified Limberg plasty may be considered the emerging gold standard.