Introduction: Chronic kidney disease significantly increases the risk of acute kidney injury, and delays in diagnosing acute kidney injury in emergency departments can lead to adverse clinical outcomes. This study aimed to develop a practical and effective tool for assessing the risk of acute kidney injury in patients with chronic kidney disease. Materials and Methods: This retrospective cohort study was conducted at a state hospital over eight months in 2024, involving 1,500 patients aged 18 years and older with a confirmed diagnosis of chronic kidney disease. Data were extracted from electronic medical records, encompassing demographic, clinical, and laboratory parameters. Risk factors were analyzed using logistic regression, and significant variables were used to develop a scoring system. The model's performance was evaluated using the area under the receiver operating characteristic curve, as well as sensitivity, specificity, Results: The developed model achieved an operating characteristic curve of 0.75, with a sensitivity of 68% and a specificity of 72%. In univariate analysis, diabetes and hypertension were significant, but not in multivariate analysis. Subgroup analysis revealed improved model performance in patients under 50 years old and those without diabetes. Conclusion: This study presents a valuable tool for predicting the risk of acute kidney injury in patients with chronic kidney disease, thereby potentially enhancing clinical decision-making and improving patient outcomes. However, prospective studies and applications across diverse patient populations are necessary to enhance the model’s generalizability.

Introduction: Liver injury is a frequent and frequently fatal consequence of both blunt and penetrating abdominal trauma. Due to its extensive vascularization and central position, hepatic trauma necessitates early and multidisciplinary treatment. Improvements in imaging, critical care, and interventional radiology over the past decade have made nonoperative management feasible for select individuals. Objective: To review the management plan, outcomes, and complications of liver trauma cases in a tertiary trauma center for three years. Materials and Methods: A retrospective analysis was performed on patients admitted with liver trauma between January 2022 and December 2024. Information on demographics, mechanism of injury, severity of injury (based on the AAST liver injury scale), imaging findings, type of treatment, and outcome was gathered. Results: 65% of the 186 patients presented with blunt trauma and 35% with penetrating trauma. Nonoperative management was applied in 144 (77.4%) of the cases with a success rate of 94.4%. Surgery was required in 42 (22.6%) cases, often due to hemodynamic instability or high-grade injury. Overall mortality was 9.1%, which was mainly due to severe trauma and concomitant injuries, interventional radiology, i.e., hepatic artery embolization, and enhanced nonoperative management success. Operative patients had higher incidences of complications such as bile leakage and intra-abdominal sepsis. Conclusion: Nonoperative therapy is effective and safe for most liver injury situations, provided that patient selection is correct. Surgery remains essential for unstable patients. A multidisciplinary, individualized strategy, aided by modern imaging and interventional tools, optimizes outcomes and minimizes morbidity.

Introduction: Osteoporosis, a common bone disorder marked by decreased bone density and heightened fracture risk, especially after minor trauma, presents a significant public health challenge. The effects of trauma on patients with osteoporosis, particularly in the hip and vertebrae, result in considerable morbidity, mortality, and healthcare expenses. This study aims to systematically review the existing literature on the relationship between osteoporosis and trauma. It explores the epidemiology, pathophysiology, clinical presentation, and management of trauma in osteoporotic patients while identifying gaps in preventive strategies. Material and Methods: A systematic review was conducted using peer-reviewed journal articles focusing on osteoporosis-related trauma. Inclusion criteria included studies evaluating osteoporotic patients with traumatic injuries or those undergoing trauma risk assessments. Data were extracted from randomized controlled trials, cohort studies, and case-control studies, excluding non-human and non-research articles. Statistical analysis and critical appraisal were performed, and the selected studies were ensured to have methodological rigor. Results: The findings emphasize a strong correlation between osteoporosis and trauma, with osteoporotic patients facing higher fracture rates and more extended recovery periods. The review reveals a significant gap in trauma prevention strategies, as current clinical approaches mainly prioritize pharmacological treatment over comprehensive fracture risk reduction. The increasing incidence of osteoporotic fractures, particularly in aging populations, highlights the need for early screening and multidisciplinary intervention. Conclusion: Osteoporosis significantly increases the risk of fractures after minor trauma, leading to serious health consequences and economic burdens. However, the existing treatment strategies, though inadequate, provide opportunities for enhancement. An integrative approach that combines pharmacological therapy, fall prevention programs, and patient education could significantly enhance trauma prevention. The future shows promise for developing standardized guidelines for trauma prevention and optimizing clinical pathways for osteoporotic patients.

Introduction: The Euro Heart Survey on Valvular Heart Disease reports that approximately 17% of patients with valvular heart disease are affected by two or more valves simultaneously. The most common combination requiring simultaneous surgery is aortic and mitral valve surgery. This procedure remains highly demanding for all surgical teams, even today. The primary focus of this study is to present, for the first time, the early postoperative results of simultaneous aortic and mitral valve surgery at our clinic. We aim to compare our outcomes with those reported by other cardiovascular surgical centers, with a strong emphasis on patient well-being and survival rates. Materials and Methods: This is a retrospective study that included adult patients who underwent simultaneous aortic and mitral valve surgery between January 2007 and December 2023 at the Cardiac Surgery Service, UHC "Mother Theresa", Tirana, Albania. The Data collection was performed using operating room registers and hospital medical records. Demographic, clinical, and non-clinical data were gathered for each patient before, during, and after the surgery. Results: This study included 121 patients, comprising 55 males (45.5%) and 66 females (55.5%). The average age of the study population was 56.41 ± 10.35 years. Most patients underwent elective surgery (111, 91.7%), while 10 (8.3%) were urgent surgical cases. Aortic valve regurgitation was the most prevalent pathology, affecting 58 patients (47.9%). The hospital mortality rate was 6.6% (8 patients). The most common postoperative complications included low cardiac output (17.4%), conduction disturbances requiring permanent pacemaker implantation (8.3%), new-onset atrial fibrillation (8.3%), and postoperative hemorrhage (5.8%). Conclusions: Our study on simultaneous aortic and mitral valve surgery at our clinic has demonstrated satisfactory early outcomes, including low rates of early mortality and major postoperative complications. These findings offer valuable insights for the medical community and contribute to the ongoing discourse on cardiac surgery outcomes.

Introduction: Fasciitis is an inflammation of the fascia, the connective tissue that surrounds muscles, blood vessels, and nerves, which can rapidly progress to necrosis of these structures, leading to life-threatening situations. It is a polymicrobial infection caused by bacterial agents, fungi, viruses, and parasites, resulting in septicemia, multiorgan failure, septic shock, and potentially death. The LRINEC score is a valuable tool in diagnosing necrotizing fasciitis (NF). Case Presentation: The patient is a 62-year-old woman with a history of Diabetes Mellitus type 2 and Bilinear Myelodysplasia, currently receiving high-dose corticosteroid therapy. She was recently diagnosed with Herpes Zoster affecting the S1, S2, S3, S4, and S5 dermatomes. Initially, she was treated for 8 days with antivirals and antibiotics for symptoms of fever, fatigue, and pain in the gluteal and lumbar regions. However, her condition worsened, prompting her readmission to the hospital, where she developed signs of sepsis. After imaging, laboratory tests, and consultations with surgeons, she was diagnosed with necrotizing fasciitis. Multidisciplinary management and complex therapy led to an excellent outcome. Conclusion: Necrotizing fasciitis presents a significant diagnostic challenge due to its rarity and its clinical resemblance to other critical conditions. It is an urgent pathology that requires not only surgical intervention but also immediate medical attention. It has always intrigued healthcare professionals both locally and internationally. Early diagnosis remains the primary challenge, and the management of these patients by experienced senior surgeons is crucial for successful outcomes.

Introduction: Antibiotic resistance represents a significant global public health issue, exacerbated by the misuse and overuse of antibiotics. In the fast-paced environment of emergency departments (EDs), the frequent need for empirical antibiotics leads to regular deviations from established guidelines, increasing the risks associated with antibiotic resistance. This study evaluates antibiotic prescribing practices in emergency departments (EDs) and examines how adherence to guidelines impacts clinical outcomes and contributes to reducing antibiotic resistance. Materials and Methods: A retrospective observational analysis was conducted involving 5,000 patient records from January to August 2024 at Esenyurt Necmi Kadıoğlu State Hospital. The data included demographics, clinical presentations, antibiotic usage, laboratory results, and adherence to guidelines. Statistical analyses were performed to assess the associations between prescription practices and patient outcomes. Results: Guideline adherence was observed in 73.08% of cases, significantly reducing treatment duration (p = 0.013). Antibiotic sensitivity testing indicated a sensitivity rate of 74.04%, with patient age significantly impacting antibiotic efficacy (p = 0.024). Logistic regression showed moderate predictive power for complications (accuracy = 51%). Subgroup analysis suggested a borderline association between guideline adherence and outcomes in patients with poor general health (p = 0.081). Conclusion: The findings of this study provide hope in the fight against antibiotic resistance. Adhering to antibiotic guidelines in emergency departments (EDs) not only enhances treatment efficiency and recovery rates but also lays a foundation for future research and policy. The significance of thorough microbiological and clinical evaluations in choosing antibiotics is highlighted, setting the stage for larger studies and the exploration of additional variables. By employing this approach, we can effectively mitigate resistance risks and ensure a brighter future for antibiotic use.

Introduction: Foreign body ingestion or insertion into the gastrointestinal tract is not uncommon, particularly in patients with psychiatric disorders, cognitive impairments, or cases of abuse. However, when such incidents go unreported due to altered mental status or inability to provide an accurate history, they present a significant diagnostic challenge, especially in primary or secondary healthcare facilities lacking advanced imaging modalities. Diagnosing intra-abdominal foreign bodies can be a significant challenge in primary or secondary care settings, particularly when advanced imaging modalities are unavailable, and the patient cannot provide a reliable medical history. We present the case of a male patient in his early 60s with a history of hypertension and psychiatric illness who arrived in an altered mental state, accompanied by fever and persistent vomiting for two days. Initial evaluation with a plain abdominal X-ray revealed a large, radio-opaque object in the abdomen. An emergency exploratory laparotomy was performed, which uncovered an unusual assortment of foreign bodies in the peritoneal cavity, including a pestle, a pencil, and multiple eraser fragments. A tear was identified in the anal canal as the likely point of entry. The patient underwent primary repair of the perforation and a diversion colostomy. Conclusion: This case highlights the necessity of maintaining a high index of suspicion for intra-abdominal foreign bodies in patients presenting with nonspecific abdominal symptoms, particularly when the history is limited or unreliable due to psychiatric or cognitive impairments. Prompt imaging, even basic radiographs, can provide crucial insights, and early surgical intervention can be life-saving. Surgeons must remain vigilant and receptive in their diagnostic approach, as rare and unexpected findings can significantly change management and outcomes.

Introduction: Hypertensive crises, which are marked by severe increases in blood pressure with or without acute target organ damage, represent a critical condition associated with substantial morbidity and mortality, particularly among older adults. As global life expectancy increases, the prevalence of hypertension and its complications also rises, creating an urgent need for effective strategies for early risk assessment and intervention. This study aims to develop and validate a risk model for predicting mortality in elderly patients experiencing hypertensive crises. Given the high morbidity and mortality rates associated with hypertensive crises in this population, an accurate risk assessment tool could enhance clinical decision-making and improve patient outcomes. Materials and Methods: A retrospective cohort study was conducted involving 1,500 patients aged 65 and older who presented to the emergency department with hypertensive crises between January and August 2024. Patients with a confirmed diagnosis and complete medical records were included. Data on demographics, clinical findings, laboratory results, and comorbidities were extracted from electronic health records. Univariable and multivariable logistic regression analyses were performed using SPSS version 25 to identify key predictors of mortality. Results: The dataset was complete, with no missing values. The mean patient age was 82.5 years (±10.3), and the overall mortality rate was 15%. A risk model was developed that categorized patients into low-risk (0.14% mortality), medium-risk (75% mortality), and high-risk (99.87% mortality) groups. Receiver Operating Characteristic (ROC) analysis indicated excellent model performance, with an Area Under the Curve (AUC) of 0.999. Conclusion: The proposed risk model demonstrates impressive predictive accuracy for mortality in elderly patients experiencing hypertensive crises. However, its retrospective design may limit external validity. This model can help emergency physicians optimize treatment strategies and improve patient outcomes.

Introduction: The anesthetic care of this pediatric patient with coloboma and indication for surgical intervention due to a dog bite injury is discussed in this case report. Coloboma can be part of several syndromes, and thus, perioperative risk for complications is increased, particularly elevated intraocular pressure during airway manipulation. Case Presentation: We selected Total Intravenous Anesthesia using a propofol-based general anesthetic without inhalational agents. We did this to maintain hemodynamic stability and circumvent the specific risks associated with coloboma. We selected Total Intravenous Anesthesia because it has been demonstrated to be capable of providing controlled anesthesia without increasing intraocular pressure, a vital consideration in this case. Discussion: The successful management of this complex case demonstrates the central role of personalized anesthetic planning in obtaining better outcomes for pediatric trauma patients with specific congenital anomalies. Total Intravenous Anesthesia proved effective in maintaining controlled anesthesia while minimizing the risk of raised intraocular pressure. Conclusion: This case serves as a reminder of the necessity of having an overall understanding of unusual congenital disorders like coloboma in the context of trauma. It is also a reminder of the critical role that the anesthesiologist plays in ensuring perioperative safety and the success of surgery. The contribution of the anesthesiologist is not only necessary but integral to the medical team, and this case serves as a reminder of that fact.

Introduction: Artificial intelligence (AI) is at the forefront of modern technology, with emerging applications in the healthcare sector now gaining recognition. Pathology is anticipated to be a key area where the impact of AI will be substantial. As more laboratories transition to digital pathology, this will create the essential infrastructure needed to implement these tools, making their application a reality in diagnostic practice. The potential of AI in pathology lies in developing image analysis tools that can support diagnosis or generate new insights into disease biology, beyond what a human observer can achieve. Examples currently exist providing diagnostic support for a limited but growing number of applications, such as tumor detection, automated tumor grading, immunohistochemistry scoring, and predicting mutation status. Several challenges remain, including the validation and establishment of a regulatory framework for these tools, as well as the ethical implications of AI in pathology. These include concerns about patient privacy and consent, along with the potential for AI to worsen existing healthcare disparities. In this article, we offer an overview of AI in histopathology, discuss its possible workflow applications, and highlight significant examples of AI's potential impact in clinical practice. We also explore considerations for implementing AI in practice. Conclusion: There has been a significant increase in the development and application of AI tools, including image-based algorithms, in pathology services, and they are expected to dominate the field in the coming years. The implementation of computational pathology and the use of pathology-related AI tools can be viewed as a paradigm shift that will transform the management of pathology services. While AI will undoubtedly enhance the efficiency of pathology services, it is crucial to recognize that it will not replace the role of pathologists. Instead, it will augment their capabilities, enabling them better to meet the demands of this era of precision medicine.