Introduction: Pleural effusion is a disturbance in the balance between fluid production and elimination in the pleural space, resulting in abnormal fluid accumulation. It can result from various medical conditions related to the lungs and pleura or systemic diseases. Identifying the etiology of pleural effusion is essential for effective treatment. According to Light's criteria, pleural effusions are transudative and exudative. Material and Methods: For this research, we collected data from the existing documentation in the Department of Pulmonology and Respiratory Allergology at PHI Clinical Hospital Tetovo from June 2022 to June 2023. This study included 133 patients with dyspnea, persistent chest pain, fatigue, hemoptysis, cough, a history of past illnesses, and other comorbid conditions. The data collection process was rigorous, and we followed ethical guidelines to ensure the reliability of our findings. Results: The patients included in our study were between 36 to 84 years old. Of them, 72,9% were males, and 27,1% were females. 85,7% were smokers, and 14,3% were non-smokers. 75,0% of patients complained of dyspnea, and 24,8% had hemoptysis. From the ultrasonography findings, 15,0% had an alteration in the left lung, 11,3% in the right lung, 20,3% of patients were punctuated to the left side, and 24,8% were punctuated to the right lung. In comparison, 1,5% were punctuated to both sides. In 2,3% of the subjects, computed tomography described an effusion in the left lung. Conclusion: The results suggest that pleural effusion is associated with various diseases, especially heart failure and malignant diseases. Our study underscores the importance of early detection of the cause of pleural effusion and the underlying disease for successfully managing and treating the disease. The insights from our research can guide healthcare professionals in developing effective treatment strategies and improving patient outcomes.

Introduction: Heart failure with reduced ejection fraction (HFrEF) is a progressive condition often complicated by acute decompensations that require advanced medical interventions. Cardiac resynchronization therapy with a defibrillator (CRT-D) has significantly improved outcomes in patients with severe heart failure. However, challenges persist when faced with acute events such as pulmonary edema, pneumonia, and multi-organ dysfunction syndrome. Multidisciplinary, intensive care unit (ICU)-based management is critical for these complex cases. This case report presents the successful management of a 61-year-old female patient with a history of severe HFrEF and implanted CRT-D. Despite severe hypoxemia, hypotension, and metabolic acidosis, a multidisciplinary approach—including mechanical ventilation, intra-aortic balloon pump (IABP), continuous renal replacement therapy (CRRT), and transfusion—enabled recovery. The patient was admitted to the ICU with acute pulmonary edema, pneumonia, and multi-organ dysfunction syndrome, characterized by severe hypoxemia, hypotension, and metabolic acidosis. Over three weeks, the patient regained hemodynamic stability, renal function, and respiratory independence. This case demonstrates the potential for recovery in patients with severe heart failure complicated by acute pulmonary edema and multi-organ dysfunction when treated with an integrated, multidisciplinary approach. Conclusion: Advanced critical care strategies, including mechanical ventilation, intra-aortic balloon pump support, and continuous renal replacement therapy, were essential in stabilizing the patient. The outcome underscores the value of personalized, team-based critical care in managing life-threatening complications in heart failure patients with CRT-D.

The 8th Albanian Congress of Trauma and Emergency Surgery (ACTES 2024) was a dynamic platform for exchanging cutting-edge knowledge, clinical expertise, and innovative trauma and emergency surgery research. This prestigious event will convene leading professionals from Albania and the international medical community, including surgeons, researchers, and healthcare providers. The congress aims to address contemporary challenges and advancements in trauma care, emergency surgical techniques, and interdisciplinary approaches to patient management. Key themes include the role of minimally invasive surgery in trauma, advancements in hemostatic techniques, damage control marks a pivotal event in the medical community, providing a dynamic platform for knowledge exchange, professional collaboration, and advancements in surgical science in Albania. This congress brings together experts, scholars, practitioners, and enthusiasts from trauma and emergency surgery, creating an opportunity for meaningful dialogue and innovation. Hosted in the vibrant city of Tirana, ACTES 2024 features a comprehensive program that addresses a broad spectrum of topics, including abdominal and chest injuries, vascular trauma, emergency surgical procedures, and the evolving challenges in nursing services for the modern era. The congress theme, "Trauma and emergency surgery and not only…” underscores a commitment to innovation, evidence-based practices, and groundbreaking discoveries. The event includes plenary sessions with renowned experts, scientific presentations, panel discussions, poster awards, networking opportunities, industry exhibitions, cultural activities, and Continuing Medical Education (CME) credits. Primary Content: Participants can expect an enriching professional experience complemented by opportunities for personal growth. The congress promotes collaboration, fosters international partnerships, and highlights the vital role of each attendee in advancing surgical knowledge and improving patient care. The ACTES 2024 is a dynamic platform for exchanging cutting-edge knowledge, clinical expertise, and innovative trauma and emergency surgery research. This prestigious event will convene leading professionals from Albania and the international medical community, including surgeons, researchers, and healthcare providers. The congress aims to address contemporary challenges and advancements in trauma care, emergency surgical techniques, and interdisciplinary approaches to patient management. Key themes include the role of minimally invasive surgery in trauma, advancements in hemostatic techniques, damage control resuscitation, the integration of trauma registries, and strategies for improving outcomes in mass casualty incidents. ACTES 2024 also emphasizes the importance of education and collaboration, featuring interactive workshops, live demonstrations, and case-based discussions. These sessions aim to enhance participants' practical skills and foster partnerships among institutions across the region and beyond. Through its comprehensive scientific program, ACTES 2024 underscores its commitment to elevating trauma and emergency surgical care standards, supporting evidence-based practice, and advocating for policy improvements in healthcare systems. This congress represents a unique opportunity to share insights, build networks, and shape the future of trauma and emergency surgery in Albania and the global healthcare community. Conclusion:ACTES 2024 is not just a gathering; it is a movement toward transforming the future of trauma and emergency surgery. Through active participation, the event aims to inspire innovation, encourage global collaboration, and make a lasting impact on surgical care worldwide. The 8th Albanian Congress of Trauma and Emergency Surgery is committed to continuously improving trauma and emergency care standards in Albania and beyond. By creating a space for learning, collaboration, and knowledge exchange, this congress strengthens the foundation for innovation and evidence-based practice. As healthcare professionals unite to share their expertise and insights, ACTES 2024 will undoubtedly impact trauma and emergency surgery trajectories, ultimately improving patient outcomes. Keywords: Trauma care; Emergency surgery; Damage control surgery; Minimally invasive techniquesMinimally invasive techniques; Multidisciplinary care; Acute care medicine; Hemostasis techniques; Mass casualty management; Surgical innovation; Trauma registries; Evidence-based practice; Healthcare systems improvement; Patient outcomes; Surgical education; Regional collaboration; ATLS, Trauma management; trauma education; BAT, PAT, abdominal injury, pelvic injury, acute care surgery, abdomen acute, oncologic surgery, cardiac surgery, AI, bariatric surgery, sleeve resection, chest trauma, lung cancer, vascular surgery, hernia surgery, colorectal cancer, pain, lung diseases, MVC, car accident, emergency medicine; Trauma care, emergency surgery, abdominal injuries, chest trauma, vascular injuries, nursing challenges, surgical innovation, CME credits, international collaboration, evidence-based practices.

Introduction: Prehospital emergency medical services (EMS) are essential to emergency medical care. They provide emergency assessment and treatment for seriously ill or injured patients and transport them by ambulance to an emergency department. Adopting triage methods for systematically prioritizing patients according to how urgent patients need care, including Triage of requests for acute medical treatment, is a promising development in our healthcare system. In Kosovo, there is a gap between the effects of prehospital triage systems and the impact of using the same triage system in two or more EMS settings. In this quality improvement study, implementing the TT app intervention was associated with higher rates of inefficient Triage in prehospital settings. However, supporting EMS professionals in their decision-making by calculating the probability of an individual patient needing specialized care at the scene of injury is a new and promising approach to optimize Triage in the field. If we can fully realize the potential of this approach, it could significantly improve the efficiency and effectiveness of our emergency medical care, leading to better patient outcomes. Standards and most health professionals need to be educated and trained in this critical component of EMS. Education, education, and training for the three levels of health care should be an obligatory component to enhance the quality of emergency medical care for children and adults at risk. It is high time to develop and test a conceptual triage scheme or model that will rely on a triage system that responds to the conditions of our health system. Develop clinical guidelines, algorithms, and triage protocols at the three levels of health care. All healthcare professionals must be educated and trained in ongoing coaching, communication courses, BLS AED, Pediatric, PHTLS, Adult Advanced Life Support, ATLS, and International Trauma Life Support. Conclusion: Triage is vital in optimizing patient outcomes in the high-pressure EMS world. It is the process of rapidly assessing a patient's condition to determine the urgency of care and the most appropriate destination for definitive treatment. Done effectively, prehospital Triage ensures that patients receive the right level of care at the right time, maximizing their chances of survival and minimizing long-term complications.

Introduction; Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a sporadic but underdiagnosed pulmonary disorder at the benign end of the neuroendocrine cell proliferation spectrum of preinvasive lesions of the lungs. This disease is characterized by hyperplasia of bronchiolar and bronchial pulmonary neuroendocrine cells. DIPNECH can be primary or reactive. In the WHO - IASLP classification of lung tumors (1999, 2004, 2005, 2015), DIPNECH is considered a preneoplastic lesion in the spectrum of pulmonary tumors. According to the WHO classification, the definition of DIPNECH is purely histological. The DIPNECH was initially described in 1992 by Aguayo et al., who reported six non-smoking patients with cough, exertional dyspnea, wheezing, less frequent hemoptysis, and a mixed obstructive/restrictive defect on pulmonary function tests. This disease has a predilection for non-smoking middle-aged women (female to male ratio is approximately 10:1) In this article, we present a 62-year-old, non-smoker woman presented with respiratory symptoms ascribable to DIPNECH. After surgery, the morphological study of lung specimens confirmed the DIPNECH, multiple tumors, one peripheral carcinoid, and obliterative bronchiolitis in the right middle pulmonary lobe. Conclusions: DIPNECH remains a rare pulmonary condition and is considered a preneoplastic lesion in the spectrum of pulmonary tumors. According to the WHO classification, the definition of DIPNECH is purely histological. While most patients experience a relatively uneventful clinical course, this condition may be associated with tumors, carcinoid tumors, and airway obstruction (Aguayo-Miller disease).

Introduction: Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by antiphospholipid antibodies (aPL), leading to a hypercoagulable state and an increased risk of thrombotic events. While abdominal complications have been reported as the initial presentation of APS in some cases, these instances are predominantly observed in female patients. Here, we present a case of a 49-year-old male patient who presented with complaints and a CT scan mimicking intestinal ileus. However, no mechanical or other evident cause of ileus could be found on the explorative laparotomy. After an uneventful postoperative hospitalization and being discharged in good condition, the patient was readmitted within two weeks, and this time, an extensive small bowel resection due to ischemia was done. After going home in a good and stable condition, he presents again, but this time with cerebral ischemia. Further investigations led to the APS diagnosis. With this case, we want to emphasize the importance of being aware of and considering the diagnosis of APS, especially in cases with repeated, unexplained abdominal pain and non-typical complaints, even in male patients. An early diagnosis could prevent a more complex disease complication. Conclusion: This case underscores the importance of considering APS in the differential diagnosis of unexplained abdominal pain, particularly in male patients with a history of thrombotic events or elevated aPL levels. Heightened awareness of APS in the emergency setting can facilitate timely diagnosis and appropriate management, ultimately optimizing patient care and outcomes.

Background: Sudden cardiac arrest is the third leading cause of death in Europe. A significant number of out-of-hospital sudden cardiac arrests are associated with acute myocardial infarction. Cardiac arrest is a complication of an acute myocardial infarction caused by malignant rhythm disorder, in most cases ventricular tachycardia or ventricular fibrillation. They result in sudden death in 25%-50% of patients with prior acute myocardial infarction. Sudden cardiac arrest in these patients occurs during the first hours after the onset of symptoms. Aim: show from the total number of out-of-hospital reanimations in the given period in canton Sarajevo the number of successful reanimations (return of spontaneous circulation – ROSC) and the number of successful reanimations in patients that went in to sudden cardiac arrest with prior acute myocardial infarction. Show the out-of-hospital management of these patients. Material and Methods: retrospective descriptive study that includes all out-of-hospital sudden cardiac arrest in the period from 1 January 2019 to the 31 December 2021 in canton Sarajevo that are associated with acute myocardial infarction in which there was the return of spontaneous circulation (ROSC). All patients from above-mentioned period were included in the study, without exclusion criteria related to their age, gender. Data was extracted from data registry of the Centre for education of the Emergency Medical Center of canton Sarajevo. Conclusion: Acute myocardial infarction still stays associated with a high level of mortality and represents one of the leading public health problems. Despite all advances in the field of diagnostics and treatment of patients with AMI that resulted in significant reduction of mortality in time.

Introduction: Significant variations in incidence rates have been observed in the analysis of anecdotal Pilonidal Sinus Disease (PSD) incidents worldwide. Objective: This study examines the accuracy of PSD incidence estimates and the variations associated with study size from 1833 to the present. Material and Methods: A comprehensive search was conducted in global literature databases, including PubMed, Embase, Science Direct, and others, to gather any PSD incidence data reported between 1833 and 2023. Results: The study sizes ranged from 26 to 82,217,837 individuals, with incidence rates varying from 8 to 30,000 cases per 100,000 persons. Notably, in study populations below 200,000 individuals, the incidence rate ranged from 8 to 30,000 cases per 100,000 persons. However, this range narrowed when studying populations exceeding 200,000 persons, with incidence rates ranging from 7 to 300 cases per 100,000 persons. Limitations: No limitations were identified in this study. Conclusion: The findings suggest reliable PSD incidences can be calculated with study populations exceeding 200,000 individuals. In such cases, the variability of incidence rates decreases as study size increases, although other known and unknown factors continue to influence the outcomes.