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Abstract

Background: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication in patients with liver cirrhosis, which is associated with high mortality. Various studies have shown that the prevalence of SBP varies from 20% to 40% in patients with cirrhosis and ascites. Not in all cases is it accompanied by noticeable symptoms, which makes early diagnosis difficult.

This study aimed to determine several clinical and laboratory features and risk factors in bacterial spontaneous peritonitis.

Methodology: In this study, 137 patients diagnosed with decompensated cirrhosis were divided into three groups: 83 cases with SBP and alcoholic cirrhosis, 22 cases with SBP and viral cirrhosis, and 32 cases with cirrhosis without SBP. All patients included in this study were over 18 years old. This is a retrospective study, where clinical and laboratory characteristics of patients with SPB and liver cirrhosis, admitted to the Service of Gastro-Hepatology, University Hospital Center, Tirana, Albania, during 2018-2022, are analyzed. Diagnosis of SBP is based on the European Association for the Study of Liver (EASL) guidelines. The Child-Pugh score and MELD score evaluate the degree of liver function damage, clinical and laboratory indicators, complications associated with cirrhosis, and PBS and ascitic fluid analyses. All categorical variables were analyzed by using SPSS version 25, and t-tests were used for continuous data.

Results: The average age of the 137 participants in the study was 54.15±12.5 years, with 132 males (96.4%) and 5 females (3.6%), and 105 patients had SBP. According to the MELD evaluation, the group with PBS had a higher value than those without PBS (p<0.05). From the laboratory data, this study identified the levels of platelets (p<0.015), serum creatinine (p<0.001), serum bilirubin (p<0.002), INR (p<0.049), and prothrombin (p<0.002) as predictive factors. The most frequent complications accompanying SBP were Encephalopathy (p<0.004), hepatorenal syndrome (p<0.002), and gastrointestinal hemorrhage (p<0.002).

Conclusions: The most probable predictive factors in the case of PBS in liver decompensated cirrhosis were found to be the low level of platelets, prolonged levels of INR and prothrombin, increased levels of creatinine, increased levels of bilirubin, and low ascetic protein. The most frequent associated complications were hepatic encephalopathy, HRS, GI hemorrhage, and jaundice.

Keywords: SBP, cirrhosis, complications, predictive, alcohol.

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Abstract

Purpose: This study examined the leadership development themes that global orthopaedic surgeons in differently resourced countries perceive as essential components and evaluated barriers to attending leadership development programs.

Methods: This multinational, 45-question survey engaged orthopaedic surgeons (one expert per country). The questionnaire collected participants' demographics, perception of effective leadership traits, and valuation of various leadership themes based on importance and interest.

Results: The survey was completed by 110 orthopaedic surgeons worldwide. Respondents most commonly reported holding a leadership position (87%) in hospital settings (62%), clinical settings (47%), and national orthopaedic societies (46%). The greatest proportion of participants reported having never attended a leadership course (42%). Participants regarded "high performing team-building," "professional ethics," and "organizational structure and ability to lead" as the most important leadership themes. No significant (P # 0.05) differences were identified among perceived importance or interest in leadership themes between income levels; however, statistically significant differences were identified in the questionnaire; respondents in low-and middle-income countries (LICs/LMICs) demonstrated a stronger interest in attending a leadership course than those in high-income countries (HICs) (98% vs. 79%, P 5 0.013), and fewer surgeons in LICs/LMICs had taken personality assessment tests than those in HICs (22% vs. 49%, P 5 0.019). The most common barriers to attending leadership courses were lack of opportunities and invitations (57%), difficulty missing work (22%), and cost of course attendance (22%).

Conclusions: These findings can better inform the development of effective curricula and provide a framework for a successful model for the future.

Level of Evidence: V.

Keywords: leadership development, orthopaedic surgery, capacity-building, didactic needs, instructional barriers

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Abstract

Introduction: Stroke, a prominent global cause of mortality and disability, is broadly categorized into ischemic and hemorrhagic types. An epidemiological survey of stroke and its risk factors can help identify individuals at higher risk and therefore promote stroke prevention strategies. The aim of this study was to estimate the current prevalence of stroke and evaluate stroke-associated risk factors in Albania.

Material and Methods: This was a single-center retrospective analysis conducted in Albania from May 2015 to September 2021. Data were collected retrospectively through hospital records. Stroke was defined as the sudden onset of a nonconvulsive and focal neurological deficit, and ischemic stroke was diagnosed using brain computed tomography (CT), magnetic resonance (MR) imaging, or both. We examined patient characteristics, including demographics, history of stroke, conventional vascular risk factors, and lifestyle-related risk factors. Results: The mean age of the 3860 patients was 74.6 ±10.4 years, and 73.5% were men. The prevalence of carotid stenosis, arrhythmia, obesity, and hypertension was significantly higher in males than in females (p < 0.001). Out of the 3860 patients in the study cohort, 641 (16.6%) subjects died, while 335 (8.7%) patients achieved complete recovery. Hemiparesis was observed in 386 (10%) patients, and hemiplegia in 868 (22.4%) patients.

Conclusions: Our analysis underscores the male predominance (2.2: 1) in stroke cases. Carotid and vertebral artery stenosis is a significant factor, emphasizing the life-saving potential of early intervention. Social and economic factors in Albania pose challenges that require comprehensive strategies. Prospective trials are crucial for exploring intervention efficacy and timing and for addressing socioeconomic impacts on timely stroke management.

Keywords: risk factors, stroke, epidemiological survey, ischemic