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Despite his late occurrence in Albanian literature, Franz Kafka’s influence has been particularly noticed in Musa Ramadani’s (1944-2020) novel “The Prophet from Prague” in Kosovo and Ridvan Dibra’s (1959) novel “Franz Kafka Writes to His Son”. This paper aims at examining Kafka’s influence in Albanian and Kosovan literature (e.g., through subjects and philosophical/aesthetic sensibilities) having Ramadani and Dibra’s works as primary comparative subjects. Dibra outlines his Kafka, the authorial Kafka, giving voice to his philosophy about life, love, and death. In addition, the biographical method has also been applied occasionally because Ramadani augments the narrative partly on Kafka’s biographical signs, but also on metaphysical and mystical ones. These findings reveal that Kafka’s cult, or more precisely Kafka’s myth has not been exempted even from Albanian literature; Albanian writers plunge into the labyrinth of research with their own means of literary expressiveness and thus become self-personified in their imagination. It is precisely in this regard that we find Kafka in Musa Ramadani and Ridvan Dibra’s novels.

Introduction; Trauma is the leading cause of death in United States in the younger population. National Trauma Data Bank in 2017 reported that 140 000 Americans dies and 80 000 are permanently disabled as a result of trauma each year. Cardiac trauma is identified in less than 10% of all trauma admissions but is associated with a much higher mortality than other organ system injuries. Considering the lethality of this type of injury, better guidelines should exist to direct management. We have analyzed data from pub med, surgery books, reviews and original presentations from many institutions to present actuality in management strategies of cardiac injuries. Cardiac injuries are classified penetrating and blunt. Penetrating trauma includes stab or guns wounds. All patients with a penetrating wound anywhere near the heart should be considered to have a cardiac injury. The penetrating cardiac traumas is a surgical emergency while the blunt injuries treatment consists mainly in observation. With early aggressive management only 1/3 of patient that arrive at hospital can be saved and this number can arise to more than 70 % if the patient survives until operating room. The results of treatment depend from infrastructural health system to the clinical presentation of the patients. Penetrating cardiac wounds mortality varies 5 % to 76 %. Blunt cardiac injuries are encountered mostly during motor vehicle accidents. The incidence of cardiac injuries in blunt trauma is 2.3-4.6 %. Overall mortality varies 11.4-24.5 %. Myocardial contusion is the most frequent type of blunt cardiac injuries. The diagnose of the cardiac trauma include: clinical assessment, physical examinations, chest radiographs, echocardiography, cardiac enzymes, ECG, CT scan and even chest drainage. Despite many diagnostic tools we have, it is very important the right management of these tools and the time. Conclusion: The surgery teams should be familiar with the management of the cardiac injuries and continuing education about this topic is the success key to manage better these emergencies.

Funding Acknowledgements Type of funding sources: None. Background Acute coronary syndrome (ACS) patients are associated with a higher risk of adverse cardiac events after percutaneous coronary intervention (PCI). A lower threshold level of low density cholesterol (LDL), less than 50 mg/dL, as recommended by most recent guidelines, has been associated with a lower risk of such events. An early and more pronounced achievement of such target LDL level could confer benefit to this high risk patient category. It is not known whether prior treatment with statins might have such beneficial effect in patients admitted with acute coronary syndromes undergoing PCI. Purpose To study the role of prior statin use in patients admitted with ACS and treated with PCI regarding the achievement of target LDL threshold. Methods We prospectively enrolled 400 consecutive ACS patients who underwent PCI treatment in our hospital. We collected peri- and postprocedural clinical and laboratory data; all patients were followed up and were asked to have their lipid profile measured at 1 month after discharge. Patients were divided in 2 groups: patients who were already on statin treatment on admission (group 1) and those who were not (group 2). Primary endpoint was achievement of target LDL threshold in accordance with current ESC guidelines 1 month after discharge, and secondary endpoint was in-hospital and 30-day occurrence of major adverse events (death, nonfatal myocardial infarction and re-hospitalization). Results Out of 400 patients, 105 of them composed group 1 and 295 patients composed group 2. Mean age was 64.96 +/- 10.26 years. 74.8% were males. 94.8% suffered from arterial hypertension, 41% from diabetes and 56.3% were active smokers. On admission, mean LDL level was 118.15 +/- 42.67 mg/dL in group 1 and 141.66 +/- 44.14 mg/dL in group (p= Conclusion In patients with acute coronary syndrome who are treated with PCI, prior treatment with statin, despite a numerically more favorable outcome, has no statistically significant impact on achievement of LDL target threshold in accordance with current guidelines or in in-hospital and 30-day MACE occurrence.

Funding Acknowledgements Type of funding sources: None. Introduction Recent European Society of Cardiology (ESC) guidelines on the treatment of dyslipidemia recommend a target threshold Purpose Patterns of statin treatment and efficasy based on the achivement of LDL target level according to current and previous ESC guidelines. Methods We obtained clinical and laboratory data from 100 consecutive patients, whom were previously diagnosed and treated for coronary artery disease, and were readmitted at our hospital either for planned intervention or for signs or symptoms of ischemic heart disease. During the period between the 2 hospitalizations, all patients were under the supervision of their family physician or local cardiologyst. We analyzed patterns of statin treatment and their effect on cholesterol level regarding achivement of target threshold based on current and previous ESC guidelines. Results At first hospitalization, mean age was 65 +/- 9. 80% of the patinets were male. Mean total cholesterol levels were 190+/-52 mg/dl and mean LDL cholesterol levels were 133 +/-45 mg/dl on admission. On discharge a high intensity statin was prescribed in 75% of the patients, and a combination of Ezetimibe with statin was prescribed in 5% of them. On readmission mean total cholesterol levels were 163+/-46 mg/dl and mean LDL cholesterol levels were 109 +/-42 mg/dl. 79% of the patients were on a high intensity statin regime, and none of them were taking Ezetimibe. A target LDL chol Conclusions Implementation of guidelines in dyslipidemia treatment for secondary prevention in clinical practice is far from optimal even for patients discharged from an University Hospital. Additional efforts should be done to raise the awareness of all health care actors about the necessity of treatment with high dose statins and achivements of recommendet LDL target threshold for patienst with coronary artery disease.

After a three-year quarantine from the deadliest global pandemic of the last century, ASTES is organizing to gather all health professionals in Tirana, The 6th Albanian Congress of Trauma and Emergency Surgery(ACTES 2022) on 11-12 November 2022, with the topic Trauma & Emergency Surgery and not only...with the aim of providing high quality, the best standards, and the best results, for our patients ...ACTES 2022 is the largest event that ASTES (Albanian Society for Trauma and Emergency Surgery) has organized so far with 230 presentations, and 67 foreign lecturers with enviable geography, making it the largest national and wider scientific event.The scientific program is as strong as ever, thanks to the inclusiveness, where all the participants with a mix of foreign and local lecturers, select the best of the moment in medical science, innovation, and observation.The scientific committee has selected all the presentations so that the participants of each medical discipline will have something to learn, discuss, debate, and agree with updated methods, techniques, and protocols.I hope you will join us on Friday morning, and continue the journey of our two-day event together.

Funding Acknowledgements Type of funding sources: None. Introduction Current guidelines for management of patients with ST-segment elevation myocardial infarction (STEMI) encourage an early discharge (48-72 h) after a successful primary percutaneous coronary intervention (PCI) in selected low risk patients. Yet, this strategy is not routinely applied. The evidence on the relative outcome of patients discharged early compared to those discharged later, has been limited. Purpose To assess safety of early discharge in low risk STEMI patients treated with primary PCI by analyzing 30 days outcomes relative to early and late discharge strategies. Methods We prospectively enrolled 109 patients presented with STEMI from April 2019 to September 2019, who were categorized as low risk according to Zwolle risk score. 60 (55%) patients were discharged after 48-72 hours and 49 (45%) after > 72 hours. We gathered clinical data at 30 days. Primary endpoints were occurrence of a major adverse event - a composite of death from any cause, nonfatal myocardial infarction and acute stent thrombosis. Secondary endpoints were acute angina and re-hospitalization. Results The mean age was 59.7 +/- 10.5 years in early discharge group compared to 62.8 +/- 10.5 years in late discharge group (p=0.132). 88 (80.7%) patients were male. 58 (53.2%) of them had inferior MI. Mean ejection fraction was 49.25% +/- 4.95%. Median symptom to balloon time was 9.3 +/- 6.7 hour. Median length of stay was 3.4 days +/-0.6. Primary endpoint occurred in one patient in the early discharge group, who had acute stent thrombosis and nonfatal myocardial infarction. No death from any cause was observed in both groups. Secondary endpoint occurred in 3 patients who had acute angina, 2 in late discharge group and 1 in early discharge group. Conclusion(s) Data from our study reveal that an early discharge strategy in selected low risk STEMI patients treated with successful primary PCI is not associated with a significant increase in major adverse events compared to late discharge strategy.

Funding Acknowledgements Type of funding sources: None. Background Most of studies have found no relevant impact of admission time on STEMI outcome among patients treated with primary PCI. Whether this observation has been affected by coronavirus disease (COVID-19) pandemic, in particular during the curfew application, has not been evaluated. Purpose To study the influence of admission time on the outcome of STEMI patients treated with primary PCI during COVID-19 pandemic in a large volume University Hospital Center, the only center capable of primary PCI serving a large area without an established STEMI network Methods Characteristics and outcomes of 308 consecutive STEMI patients admitted to our center between May 28 to December 2020, were collected. On-hours were defined as admission from Monday through Friday from 8:00 to 15:30 and off-hours admission from 15:30 to 8:00, weekends and non-working holidays. Clinical characteristics, key time delays and in-hospital and 3-month mortality were evaluated. Results 75 (24%) patients were admitted on-hours and 233 (76%) patients were admitted off-hours. There were no differences between groups regarding baseline clinical characteristics, laboratory data and STEMI clinical presentation. Median time from pain onset to coronary care unit admission was 4.0 hours in the on-hours group versus 6.0 hours in the off-hours group (p=0.11). Median time from coronary care unit to cathlab was 1.5 hours in the on-hours group versus 1.0 hour in the off-hour group (p=0.14). There was no difference between on-hours versus off- groups regarding in-hospital mortality (4% versus 6%, p=0.77) and 3-month mortality (10% versus 10%, p=0.76), as well as recurrent infarction (p=0.56) and stent thrombosis (p=0.64). Conclusion(s) Despite the lack of an organized STEMI network, patients admitted to a large-volume primary PCI tertiary center during COVID-19 pandemic, had similar outcome regardless their admission during on-hours or off-hours. Althgouh the specific impact of curfew on out of hospital time delays could not be assessed, it did not appear to influence patient outcomes.

Funding Acknowledgements Type of funding sources: None. Introduction Non-ST elevation myocardial infarction (NSTEMI) is a common cause of hospitalization for patients aged 75 years or older. The current guidelines recommend an early invasive approach for patients with NSTEMI who are at moderate to high risk, but have no specific consideration for the elderly. Data from clinical trials for this group of patients are lacking. We present short term outcomes of patients aged 75 years or older diagnosed with NSTEMI treated with an early invasive strategy versus conservative strategy. Purpose To evaluate short term outcome in NSTEMI patients >75 years of age who were treated with early invasive strategy versus conservative strategy. Methods We reviewed data from 201 patients > 75 years of age who presented with NSTEMI from August 2021 to February 2022. 96 (47%) patients underwent early invasive treatment and 105 (53%) were treated conservatively. The decision for the conservative treatment was based on the decision of the attending cardiologist and the preference of the patient. Primary endpoint was mortality at 3-month follow-up. Secondary endpoints were recurrent myocardial infarction, re-intervention and length of hospital stay. Results The mean age was 80.74 ± 3.7 years, ranging from 75 to 92 years old. Patients in the conservative group were more frequently affected from hypertension, heart failure, stroke and acute renal failure. Other basal characteristics were not statistically significant different between two groups. In-hospital mortality in the conservative group was higher than the invasive group (1.04% vs. 2.8%, p=0.037). 30-day survival was higher in the invasive group compared to the conservative group (94.8% vs. 82.4%, p=0.007) and 90-day survival was also higher in the invasive group compared to the conservative group (91.9% vs. 71%, p=0.001).There were no statistically significant differences with regard to secondary endpoints. In the multivariate analysis, ejection fraction Conclusion Among NSTEMI patients older than 75 years, an early invasive treatment is associated with a lower in-hospital mortality and better 3-month survival.

Supplementary Table S2. Analysis cohort.

Supplementary Figure Legends

supplemental figure and table legend

Supplementary Figure 2: Osteosarcomas developing in IL27RA-/- p53R172H/+ mice are aggressive and transplantable. (

Supplementary figures S1-4. Supplementary figure S1. Methylation variable positions distinguishing primary SI NET from normal small intestine. Supplementary figure S2. Kegg pathway analysis of differential methylated genes distinguishing primary SI NET from normal small intestine. Supplementary figure S3. Differentially expressed probes distinguishing subgroups of primary SI NET. Supplementary figure S4. Methylation and expression profiles of panel of 21 global driver candidate genes.

Supplementary Table S3. Chromosome 18 probes demonstrating differential methylation between SI NET within 18LOH group and normal small intestine.

Supplementary Video: Video portraying rear leg paresis in IL27RA-/- p53R172H/+ mice.

Purpose: Small intestinal neuroendocrine tumors (SINET) are the commonest malignancy of the small intestine; however, underlying pathogenic mechanisms remain poorly characterized. Whole-genome and -exome sequencing has demonstrated that SINETs are mutationally quiet, with the most frequent known mutation in the cyclin-dependent kinase inhibitor 1B gene (CDKN1B) occurring in only ∼8% of tumors, suggesting that alternative mechanisms may drive tumorigenesis. The aim of this study is to perform genome-wide molecular profiling of SINETs in order to identify pathogenic drivers based on molecular profiling. This study represents the largest unbiased integrated genomic, epigenomic, and transcriptomic analysis undertaken in this tumor type.Experimental Design: Here, we present data from integrated molecular analysis of SINETs (n = 97), including whole-exome or targeted CDKN1B sequencing (n = 29), HumanMethylation450 BeadChip (Illumina) array profiling (n = 69), methylated DNA immunoprecipitation sequencing (n = 16), copy-number variance analysis (n = 47), and Whole-Genome DASL (Illumina) expression array profiling (n = 43).Results: Based on molecular profiling, SINETs can be classified into three groups, which demonstrate significantly different progression-free survival after resection of primary tumor (not reached at 10 years vs. 56 months vs. 21 months, P = 0.04). Epimutations were found at a recurrence rate of up to 85%, and 21 epigenetically dysregulated genes were identified, including CDX1 (86%), CELSR3 (84%), FBP1 (84%), and GIPR (74%).Conclusions: This is the first comprehensive integrated molecular analysis of SINETs. We have demonstrated that these tumors are highly epigenetically dysregulated. Furthermore, we have identified novel molecular subtypes with significant impact on progression-free survival. Clin Cancer Res; 22(1); 250–8. ©2015 AACR.

Supplementary Figure 3: Recombinant IL27 induces proliferation and invasion but not migration in-vitro in an osteosarcoma cell line.

Supplementary Table S1. Supervised comparison of three subgroups of SI NET identifies methylation variable positions (MVPs) distinguishing the groups.

Supplementary Figure 1: Table showing tumor spectrum in IL27RA-/- p53R172H/+ mice.

Purpose: p53 is mutated in about 50% of human cancers, mostly through missense mutations. Expression of mutant p53 is associated with poor clinical outcomes or metastasis. Although mutant p53 is inherently instable, various stressors such as DNA damage or expression of the oncogenic Kras or c-myc affect the oncogenic properties of mutant p53. However, the effects of inflammation on mutant p53 are largely unknown. IL27 is an important immunomodulatory cytokine, but its impact on mutant p53-driven tumorigenesis has not been reported.Experimental Design: IL27RA−/− mice were bred with mutant p53 heterozygous (p53R172H/+) mice to obtain IL27RA−/−p53H/+ and IL27RA−/−p53H/H mice. Mouse survival and tumor spectra for the cohort were analyzed. Stability of p53 protein was analyzed via IHC and Western blot analysis.Results: This study unraveled that lack of IL27 signaling significantly shortened the survival duration of mice with tumors expressing both copies of the mutant p53 gene (Li-Fraumeni mouse model). Interestingly, in mice that were heterozygous for mutant p53, lack of IL27 signaling not only significantly shortened survival time but also doubled the incidence of osteosarcomas. Furthermore, lack of IL27 signaling is closely associated with increased mutant p53 stability in vivo from early age.Conclusions: These results suggest that IL27 signaling modulates the oncogenic properties of mutant p53 in vivo. Clin Cancer Res; 22(15); 3876–83. ©2016 AACR.

Supplementary Table S4. Genes demonstrating concordant methylation and expression changes in SI NET primaries.

Supplementary Figure Legends

PDF file - 120KB

To date, no specific marker exists for the detection of circulating tumor cells (CTC) from different types of sarcomas, though tools are available for detection of CTCs in peripheral blood of patients with cancer for epithelial cancers. Here, we report cell-surface vimentin (CSV) as an exclusive marker on sarcoma CTC regardless of the tissue origin of the sarcoma as detected by a novel monoclonal antibody. Utilizing CSV as a probe, we isolated and enumerated sarcoma CTCs with high sensitivity and specificity from the blood of patients bearing different types of sarcoma, validating their phenotype by single cell genomic amplification, mutation detection, and FISH. Our results establish the first universal and specific CTC marker described for enumerating CTCs from different types of sarcoma, thereby providing a key prognosis tool to monitor cancer metastasis and relapse. Cancer Res; 74(6); 1645–50. ©2014 AACR.

PDF file - 660KB, Detection of CD31, an endothelial cell marker on CTC.

PDF file - 3630KB, Detection of cell surface vimentin using western blotting, flow cytometry. Determination of specificity and sensitivity of 84-1 antibody.

PDF file - 2927KB, Cell surface vimentin expression in different sarcoma cell lines.

PDF file - 89KB, In vivo detection of CTC from Mice and Dog models.

PDF file - 2029KB, CTC enumeration in different Sarcoma cancer patient samples.

OBJECTIVE: Global studies report a significant decline in ST-elevation myocardial infarction (STEMI) related hospitalization rates during the coronavirus disease 2019 (COVID-19) pandemic outbreak. However, there have been several divergent reports on hospital outcomes. In this study, we aim to investigate the impact of the COVID 19 outbreak on hospitalizations because of STEMI and in-hospital outcomes in Albania. METHODS: This was a retrograde study, collecting data for hospitalizations because of STEMI from March 9, (first COVID 19 case in our country) to April 30, 2020, (period of total lockdown) compared with the same period in 2019 at our center. The incidence rate ratio (IRR) was used to compare admissions because of STEMI and procedures and the risk ratio (RR) to compare mortality and other complication rates. RESULTS: Admissions for STEMI declined during the COVID-19 period from a total of 217 in 2019 to 156 in 2020 (−28.1%) representing IRR 0.719 (p=0.033). PCIs also reduced from 168 procedures in 2019 to 113 in 2020 (−33%), representing an IRR of 0.67, p=0.021. The time from symptom onset to arrival at our intensive care unit was significantly higher in 2020 compared to 2019 (925.6±1097 vs. 438.7±385 minutes, p

Background A dreaded complication of laparoscopic sleeve gastrectomy (LSG) is suture leak. The study aimed to assess the efficacy of the nebulized comonomer Glubran 2® (N-butyl-cyanoacrylate + metacrylosysolfolane) applied to the LSG staple line. Methods A propensity-matched comparison analysis was conducted in 125 patients undergoing LSG between 2017 and 2019. Groups included those treated with Glubran® (group 1, n = 70) and those without Glubran® treatment (group 2, n = 55). Results There were differences in the mean body mass index (44.4 vs 43 kg/m2; P < 0.05) between the groups. There was a non-significant increase in the operative time for group 1 compared with group 2 (97 ± 8 vs 93.8 ± 10.7 min; P = 0.07), with a greater amount of estimated blood loss (94.5 mL vs 87.8; P < 0.01). There were more severe complications in group 2 over group 1 cases (8 vs 0%; P < 0.05), although postoperative bleeding did not differ between the two groups (1.4 vs 5.4%). There were no postoperative leaks in group 1 patients, but there were two leaks in group 2 cases with an increased length of hospital stay in patients with a leak. Conclusion Glubran® LSG support may reduce leak risk without increasing operating time.

BACKGROUND: Cardiologists and surveys from all over the world have reported an important drop in admissions of patients with acute coronary syndromes (ACS) and related coronary procedures during the outbreak of coronavirus disease 19 (COVID 19) pandemic. AIM: We investigated the impact of the COVID 19 pandemic on hospitalizations for ACS and related invasive procedures in a country with low COVID 19 incidence. METHODS: We conducted a single-center, observational retrospective study including all consecutive patients admitted for ACS in the Cardiology Department of University Hospital Center Mother Theresa from March 9, 2020 (1st day of application of social distance measures) to April 30th (period of total lockdown). Patients admitted in the same time period in 2019 served as controls. All data were collected from the medical files. Admissions were classified as ST-elevation myocardial infarction (STEMI) or non-ST-elevation ACS (NSTEACS). Total and weekly admissions and invasive procedures were assessed. Mean incidence difference (MID) in weekly ACS admissions and procedures was also calculated. RESULTS: Overall, 781 patients were included in this analysis: 321 patients (37%) were admitted during study period and 550 patients (63%) were admitted during the control period (overall reduction of 41.6%;weekly MID of 28.6 (95% confidence interval [CI] 13.3 to 44.0;p = 0.001). The occurrence of all ACS types was reduced: STEMI, by 28.1%;weekly MID 7.3 [0.6-15.2];p = 0.048];NSTEACS by 50.5%, weekly MID 19.1 [13.9-24.4];p

Albanian literature written from the 1940s to the present day can be called contempo-rary Albanian literature, or in other words, World Literature after the Second World War. The allowed literature was the only method of socialist realism, which was ideol-ogized and politicized, i.e. subject to communist ideology and politics. It was not free literature, but entirely engaged in the service of socialism and communism. The meth-od of socialist realism had some very narrow and binding criteria for all those who thought of publishing their works. Such were the communist members, the positive hero and the struggle against foreign middle-class influences. In such a situation, we can say that it was purely subject to ideology and communist politics. Due to its very narrow scheme, most of the literary work written during this period had its own value and function during the period of the communist system. This type of literature form some writers was accepted with conviction, while others were used to compromise to publish their works. Although under very strict censure, many important works were published which could have been contrary to socialist realism. Such works were with an indirect expression or with a subtext, often in symbolic and allegorical forms. These works consist of some of the greatest values of contemporary Albanian literature, the first and the foremost authors of this kind of literature, their best works, publishers, and their echoes in the language of translation.

Background Multiple studies conducted worldwide and in Albania documented an important reduction of acute ST-elevation myocardial infarction (STEMI) admissions during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding STEMI admissions and outcomes during the ongoing pandemic after the initial lockdown. We aimed to study STEMI admissions and in-hospital outcomes after the COVID-19 lockdown period. Methods A retrospective single-center study was conducted, collecting data for all consecutive STEMI admissions from March 9th, (the first COVID-19 case) until April 30

Funding Acknowledgements Type of funding sources: None. Background The incidence of acute coronary syndromes (ACS) decreased during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding gender differences in ACS admissions and outcomes during the pandemic that presented divergent results. Purpose The impact of COVID-19 pandemic on male and female ACS admissions and in-hospital outcomes. Methods A retrograde single-center study was conducted, collecting data for ACS admissions from March 9th (first COVID-19 case) until April 30th2020, compared with the same period of 2019. ACS admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). Incidence rate ratio (IRR) was used to compare all-ACS and subgroups admissions, and risk ratio (RR) to compare overall/male/female mortality. Results There were 321 ACS patients (238 males, 83 females) during the pandemic period and 550 patients (400 males, 150 females) during 2019. The IRR of all-ACS/males/females were significantly lower during COVID-19 period,respectively 0.58 (0.44-0.76), 0.59 (0.43-0.75) and 0.55 (0.37-0.74). The IRR for STEMI was significantly lower among females (0.59[0.39-0.89]), but not in males (0.76 [0.55-1.08]). The IRR for NSTEMI was lower but unsignificantly, meanwhile for UA it was significantly lower for both, males (0.40 [0.24-0.51]) and females (0.50 [0.33-0.84]). The overall ACS mortality was importantly increased during the COVID-19 period (7.4% vs. 3.4%) RR=2.16 (1.20-3.89). Significant increase was found in males (7.45% vs. 2.5%) RR=3.02 (1.42-6.44), but not in females (7.2% vs. 6%) RR=1.20 (0.44-3.27). Conclusions Admissions for ACS were reduced similarly in males and females during the COVID-19 pandemic. Main reductions were observed in UA group similarly in both genders and in STEMI predominantly in females. While we identified a substantial increase in the overall ACS mortality, significant increase was observed only in males reducing the differences between genders. Further studies are necessary for a better understanding of the increase in male mortality during this period.

Funding Acknowledgements Type of funding sources: None. Background Changes in atmospheric pressure act as a risk factor instability of atheromatous plaque and Acute Coronary Syndrome (ACS). Few studies have shown an association between atmosphere pressure, humidity, wind, sun rays, and cardiovascular disease. Purpose To evaluate the impact of atmospheric pressure on patients with Acute Coronary Syndrome. Methods This is a retrospective, observational, conducted in a single-center, in the period January-December 2018. We included patients with ACS, hospitalized in CCU, who performed emergency coronary angiography. The diagnosis of ACS was based on clinical, electrocardiographic, and laboratory findings. Data were collected retrospectively using patient records from archived files at the Statistics Center. Baseline demographic, clinical, and angiographic characteristics were collected. Data on atmospheric parameters, measured at the weather monitoring station, were obtained from the National Meteorological Service database (atmospheric pressure in each district of the country). The number of inhabitants for the respective districts is taken from the National Institute of Statistics. Results The number of patients involved was 1165. Significant changes in the average monthly values of atmospheric pressure were accompanied by a statistically significant increase in the number of cases with ACS, as occurred in March-April and October-November (p≤0.05). The highest number of ACS was in October 10.4%, whereas the lowest number was in January 10.6%, with a significant decreasing trend during May-June and the peak in October (p=0.04). A statistically significant relationship was observed between seasonal changes in atmospheric pressure with the number of cases with ACS. The autumn season prevails with 27.9% of the total cases, followed by the spring season with 25.6%, the summer season with 24.2%, and the winter season with 22.3%, (p = 0.04). Most cases in the cold period (November-March) occurred on days with statistically significant changes in Atmospheric Pressure. Conclusion The study notes an important relationship between seasonal, monthly changes in atmospheric pressure in relation to the frequency of cases with Acute Coronary Syndrome.

Funding Acknowledgements Type of funding sources: None. Background Multiple studies documented an important reduction of acute coronary syndromes (ACS) admissions during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding the ACS admissions and outcomes during the ongoing pandemic after the initial lockdown. Purpose We aimed to study the ACS admissions and in-hospital outcomes during and after the COVID-19 lockdown period. Methods A retrograde single-center study was conducted. The data for all admissions were collected from March 9th, (first COVID-19 case) until April 30th, the corresponding period of 2020 total lockdown, for three consecutive years from 2019 to 2021. The control period was considered the year 2019 and the study periods were in 2020 (lockdown) and 2021 (ongoing pandemic). ACS admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). Incidence rate ratio (IRR [95%CI]) was used to compare all-ACS and subgroups admissions, and risk ratio (RR [95%CI]) to compare the mortality between each study period with the control one. Results Were included 550 ACS patients (pts) during 2019, 321 pts during 2020, and 473 pts during 2021 period. The overall-ACS admissions IRR was significantly lower during 2020 lockdown (0.58 [0.44-0.76]), and not significant during 2021 ongoing pandemic (0.86 [0.62-1.18]). During 2020 lockdown, significant reduction for STEMI and UA, the IRR respectively (0.72 [0.56-0.94]) and (0.42 [0.22-0.76]), and not significant during 2021 respectively (0.87 [0.63-1.21]) and (0.86 [0.51-1.46]) were observed. The reduction in NSTEMI admissions was not significant in both periods. The overall mortality was, importantly increased during the lockdown period (7.45 vs. 3.4 %), RR=2.16 (1.2-3.89). Meanwhile the 2021 mortality was similar (4.2 vs. 3.4%), RR=1.22 (0.66-2.26). Conclusions After the initial reduction of admissions in all-ACS, STEMI and UA during the 2020 lockdown period and the increase of all-ACS mortality, the number of admissions and the mortality returned to a similar range during 2021 despite the ongoing COVID-19 pandemic.

Background The incidence of acute coronary syndromes (ACS) decreased during the coronavirus disease 2019 (COVID-19) pandemic. Few studies have investigated gender differences in ACS admissions and outcomes during pandemics and have presented divergent results. This study aimed to investigate the effect of the COVID-19 pandemic on male and female hospitalizations and in-hospital outcomes in patients presenting with ACS. Methodology We designed a retrograde, single-center trial gathering data for ACS hospitalizations during the lockdown (March 9, 2020, to April 30, 2020) compared with the same timeframe of 2019. ACS hospitalizations were subgrouped as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). We calculated the incidence rate ratio (IRR) to compare all-ACS and subgroups for male and female hospitalizations and the risk ratio (RR) to compare overall male/female mortality. Results This study included 321 ACS patients (238 males, 83 females) during the COVID-19 lockdown and 550 patients (400 males, 150 females) during 2019. The IRRs of all-ACS/males/females were significantly lower during the COVID-19 period at 0.58 (95% confidence interval (CI) = 0.44-0.76), 0.59 (95% CI = 0.43-0.75), and 0.55 (95% CI = 0.37-0.74), respectively. The IRR for STEMI was significantly lower among females (0.59 (95% CI = 0.39-0.89)), but not among males (0.76 (95% CI = 0.55-1.08)) The IRR for NSTEMI was not significantly lower, meanwhile it was significantly lower for UA among both males and females. The overall ACS mortality increased during the COVID-19 period (7.4% vs. 3.4%; RR = 2.16 (95% CI = 1.20-3.89)). Important increase was found in males (7.45% vs. 2.5%; RR = 3.02 (95% CI = 1.42-6.44)), but not in females (7.2% vs. 6%; RR = 1.20 (95% CI = 0.44-3.27). Conclusions The admissions of ACS reduced similarly in males and females during the COVID-19 pandemic. The admissions of STEMI reduced predominantly in females. We identified a substantial increase in the overall ACS mortality, but predominantly in males, reducing the differences between males and females. Further studies are necessary to better understand the increase in male mortality during the pandemic.

Background The Risk Assessment and Prediction Tool (RAPT) was developed and validated to predict discharge disposition after primary total hip and knee arthroplasty (THA/TKA). To date, there are no studies evaluating the applicability and accuracy of RAPT for revision THA/TKA. This study aims to determine the predictive accuracy of the RAPT for revision THA/TKA. Methods Prospectively collected data from a single tertiary academic medical center were retrospectively analyzed for patients undergoing revision THA/TKA between January 2016 and July 2019. RAPT score was used to predict their postoperative discharge destination and its predictive accuracy was calculated. Patient risk (low, intermediate, and high) for postoperative inpatient rehabilitation facilities or skilled nursing facilities were determined based on the predictive accuracy of each RAPT score. Other factors evaluated included patient-reported discharge expectation, body mass index, and American Society of Anesthesiologists scores. Results A total of 716 consecutive revision THA/TKA episodes were analyzed. Overall, predictive accuracy of RAPT for discharge disposition was 83%. RAPT scores 8 were deemed high and low risk of discharge to a post–acute care facility, respectively. RAPT scores of 4 to 7 were still accurate 65%-71% of the time and were deemed to be intermediate-risk. RAPT score and patient-reported discharge expectation had the strongest correlation with actual discharge disposition. Conclusion The RAPT has high predictive accuracy for discharge planning in revision THA/TKA patients. Patient-expected discharge destination is a powerful modulator of the RAPT score and we suggest that it be taken into consideration for preoperative discharge planning.

Aneurizmat gjigande e Aortës Ascendente (AAA) bashkëshoqëruar me zgjerim shumë të madh të rrënjës së aortës, janë të raportuar shumë rrallë. Ne do paraqesim rastin e një AAA gjigande tek një pacient 68 vjeçar i cili iu nënshtua një interventi kirurgjikal të suksesshëm të zëvendësimit të aortës ascendente dhe rrënjës së saj duke përdorur teknikën e modifikuar të Bentall nëpërmjet një konduiti të kompozuar me valvë mekanike dhe shoqëruar me implantim të arterieve koronare.

CITATIONRyals S, McCullough L, Wagner M, Berry R, Dibra M. A case of treatment-emergent central sleep apnea? J Clin Sleep Med. 2020;16(2):331–334.