Premtim Rashiti

Background: Europe’s population is ageing. Therefore, all medical students should receive basic geriatric medicine education. It is essential to gain insights into their perceived educational needs and attitudes towards geriatric medicine. Aims: To explore: medical students’ perceived knowledge, relevance, and interest across key geriatric topics and skills; their aspirations to become a geriatrician and interest in geriatric medicine. Methods: We analysed data from the multinational multilingual open online cross-sectional survey on educational needs by COST Action PROmoting GeRiAtric Medicine in countries where it is still eMergING (PROGRAMMING) 21,122. Medical students were asked to rate their perceived knowledge, the relevance to their profession and their interest in further training in each of 33 geriatric topics or skills, from “very low” (scored as 1) to “very high” (scored as 5). They were also asked about their exposure to and attitudes towards geriatric medicine. Results: A total of 448 medical students-274 (61.2%) women, 238 (53.1%) studying in EU-27 countries- completed the survey. Students’ mean (standard deviation, SD) perceived knowledge was highest in bone health (3.53, 0.86), depression (3.17, 0.93), and falls and mobility (3.16, 0.94), while lowest in gerodontology (2.14, 1.06), geriatric rehabilitation (2.45, 0.95), and orthogeriatrics (2.54, 0.99). Overall, 312 (69.7%) students reported exposure to geriatric medicine through specific courses and 257 (57.4%) through rotations in acute hospital wards. Only 30 (7%) students wanted to become geriatricians, while 147 (32.8%) students expressed high or very high enjoyment in engaging with older people. Conclusion: Medical students reported limited knowledge in several key geriatric medicine topics and skills and relatively low interest in careers in geriatric medicine. In many cases learning experiences were limited to traditional lecture-based teaching and ward-based rotations. Active learning approaches such as case-based and problem-based learning were preferred.

Background and Aim: Studies worldwide have documented a reduction in acute myocardial infarction (AMI) admissions during the COVID-19 pandemic. We aimed to assess AMI admissions, management, and in-hospital outcomes in Kosovo during the pandemic period. Methods: We conducted a retrospective single-centre study including all consecutive AMI admissions from 1 January 2018 to 31 December 2020 at the Clinic of Cardiology, University Clinical Centre of Kosovo, the only public tertiary primary percutaneous coronary intervention (PCI) centre in the country. The pre-pandemic (PP) period was defined as 1 January 2018–12 March 2020 and the ongoing pandemic (OP) period as 13 March–31 December 2020. Demographic, clinical, laboratory, angiographic, and outcome data were collected. In-hospital mortality was defined as death between admission and discharge. Interrupted time-series analyses were performed. Results: A total of 898 AMI patients were admitted during OP and 2955 during PP. Daily admissions decreased from 3.8/day to 3.05/day (p < 0.001). OP patients were younger, more often hypertensive and smokers, and more frequently male. Coronary angiography (81% vs. 76%, p = 0.001) and PCI (66% vs. 60%, p = 0.001) were more frequent during OP, while in-hospital mortality remained unchanged. Time-series analysis showed a sharp fall in admissions at OP (β = −12.66, p < 0.001) with gradual recovery, alongside an increase in PCI use (β = 0.184, p < 0.001) and stable mortality. The proportion of ST-segment elevation (STEMI) cases increased significantly during the pandemic period. Compared with the pandemic period, admission during the pre-pandemic period was associated with lower odds of undergoing PCI (aOR 0.81, 95% CI 0.69–0.95), while age ≥ 65 reduced the likelihood of PCI. Conclusions: AMI hospitalizations in Kosovo declined significantly during the COVID-19 pandemic. The pandemic cohort was younger, with the profile of admitted patients shifting toward younger age, male sex, and STEMI presentation. Despite fewer admissions, PCI use increased, while no statistically significant difference in in-hospital mortality was observed between the two periods. These findings describe changes in treatment patterns and short-term in-hospital outcomes during the pandemic but should not be interpreted as evidence of equivalent overall quality of AMI care.

Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder associated with increased cardiovascular morbidity and mortality. Continuous positive airway pressure (CPAP) is the standard treatment for OSA; however, its effects on cardiovascular outcomes remain incompletely established. This umbrella review synthesized and critically appraised the evidence regarding the effects of CPAP on surrogate, intermediate, and functional cardiovascular outcomes in adults with OSA. Materials and Methods: An umbrella review of systematic reviews and meta-analyses evaluating CPAP therapy in adults with OSA was conducted. A comprehensive literature search was performed in PubMed, Embase, and the Cochrane Library from database inception to 28 February 2026. Eligible reviews assessed cardiovascular outcomes, including blood pressure, cardiac function, autonomic function, cardiovascular biomarkers, and functional cardiovascular measures. Methodological quality was evaluated using AMSTAR 2, and the certainty of evidence for the main outcomes was assessed using the GRADE framework. Results: Thirty-eight systematic reviews and meta-analyses were included. CPAP therapy was consistently associated with reductions in systolic blood pressure (mean difference [MD] −4.8 mmHg) and diastolic blood pressure (MD −3.0 mmHg), with additional improvements in 24 h ambulatory blood pressure. Favorable effects were also observed for left ventricular ejection fraction (MD 3.27), left ventricular diastolic function (weighted mean difference [WMD] 0.22), and sympathetic nervous system activity, reflected by lower circulating noradrenaline levels (standardized mean difference [SMD] −1.10) in randomized controlled trials. Improvements in BNP/NT-proBNP concentrations and New York Heart Association functional class were reported among patients with heart failure, whereas no significant effect was observed on body mass index. The certainty of evidence ranged from low to moderate, and methodological confidence of the included reviews was predominantly moderate, low, or critically low. Conclusions: CPAP therapy was associated with improvements in several surrogate, intermediate, and functional cardiovascular outcomes in adults with OSA, particularly blood pressure, left ventricular function, and sympathetic activity. However, the certainty of evidence ranged from low to moderate, and substantial heterogeneity and methodological limitations warrant cautious interpretation. Current evidence remains insufficient to demonstrate a consistent reduction in major adverse cardiovascular events or cardiovascular mortality. Further high-quality randomized controlled trials with longer follow-up are needed to clarify the long-term cardiovascular impact of CPAP therapy.

The dorsal motor nucleus of the vagus (DMV) is a key brainstem structure involved in autonomic integration and vagal regulation of thoracic organs. This study examined whether localized GABA microinjection into the DMV modulates cholinergically induced airway mechanical responses in anesthetized male ferrets. Bilateral stereotaxic microinjections of GABA (10 µmol; 25–50 nL) were performed in the DMV (AP −12.6 mm, ML 0 mm, DV −7.6 mm). Airway mechanics were evaluated by measuring tracheal segment pressure (Ptseg), lung resistance (RL), and dynamic compliance (Cdyn) at baseline, following intravenous physostigmine (100 µg/kg), and after GABA administration. Physostigmine significantly increased Ptseg and RL (p < 0.01), indicating cholinergically mediated airway constriction. GABA microinjection attenuated these effects and significantly reduced Cdyn (p < 0.05). Under controlled mechanical ventilation, these findings support a central inhibitory influence of DMV GABAergic signaling on vagally mediated airway responses during cholinergic activation. This study provides mechanistic proof-of-concept evidence for central modulation of airway mechanics and highlights the role of brainstem inhibitory circuits in autonomic respiratory regulation.

Objective: The aim of this study was to assess the association between allergic reactions after COVID-19 vaccination and the history of high-risk allergy, individual predisposing factors such as age and gender, and COVID-19 vaccine type.Materials and methods: This retrospective cohort study included 234 adult patients (18 years old and above) who underwent a COVID-19 vaccine allergy test up until February 2023 in a Clinic of Allergy and Clinical Immunology in the University Clinical Center of Kosovo. All patients suspected of allergy underwent skin testing: SPT (skin prick test) and IDT (intradermal test) using either an mRNA (ribonucleic messenger acid) vaccine (BNT162b2, Pfizer-BioNTech) and/or an adenoviral vector vaccine (AZD1222, AstraZeneca). Subsequent immunization was administered under careful medical observation. Results: Among the 234 patients with a high-risk allergy profile, several potential risk factors were identified, including a history of multiple allergies, previous anaphylaxis, and/or drug allergies. In our cohort, food allergies were reported by 20 patients (8.5%) and multiple drug allergies were reported by 118 patients (50.4%). Due to the retrospective nature of the study, we cannot establish causality. Therefore, older age and receipt of the Pfizer-BioNTech vaccine were found to be associated with increased allergic reactions after COVID-19 vaccination, while male gender was associated with decreased risk. Although previous allergic manifestations were common among those with reactions, they were not significantly associated with increased risk after adjustment for confounders. The absence of a control group consisting of vaccinated individuals without a high-risk allergy history limits the generalizability of our findings. Conclusions: Immediate allergic reactions to COVID-19 vaccines are rare but can be severe and reoccur. Findings suggest that gender and age-specific factors may influence the response to the vaccine. Nevertheless, COVID-19 vaccines remain a critical tool in preventing severe dis-ease and controlling the ongoing pandemic.

Background: Despite being a frequent presenting complaint in emergency rooms, chest pain’s clinical therapy varies greatly. Our objectives were to identify the traits of people who complain of chest pain and to analyze the value of the HEART (history, electrocardiogram, age, risk factors, and initial troponin) score index for risk assessment. Depending on how bad it is, each abnormality can be given a score of zero, one, or two points. These five factors add up to the HEART score. Methods: Clinical information on 269 individuals with chest pain admitted to the Emergency Room was reviewed: January 2022 until January 2023. A prospective registry was used to record information about patients with nontraumatic chest discomfort who were admitted from the emergency department. Results: Over a 12-month period, patients admitted in emergency department were classified through HEART score. From them 101 patients (37%) belong to the age group older than or equal to 65 years, 134 patients (50%) belong to the age group 45–65 years, and 34 patients (13%) belong to the age group younger than or equal to 45 years. Strong positive correlation between troponin level (HEART score) and hospitalization, also p value 0.043 is typically considered to be statistically significant. According to HEART score classification 43 cases (60%) from the group with 7–10 (high risk) were hospitalized. According to anamnesis (history) on cardiovascular disease in relation to hospitalization, then 48 cases hospitalized (67%) belong to the classification 1-moderately suspicious and 21 cases hospitalized (29%) belong to the classification 2-highly suspicious classification. Conclusion: The HEART score can be used for triage since it is a simple, rapid, and accurate predictor of outcome in patients with chest pain. A medium risk group included about half of the patients who reported chest pain to an emergency room. Hospitalization and troponin level had a strong positive link (HEART score), with a p value of 0.043.

Background—Non-communicable diseases (NCDs) affect a growing share of the population in Kosovo. The country faces challenges with NCDs management, specifically detecting, screening, and treating people with NCDs. Objective—To assess the management of NCDs, including the inputs that influence the provision of NCDs and outcomes of NCD management. Eligibility criteria—Studies had to report NCD management in Kosovo. Sources of evidence—We systematically searched Google Scholar, PubMed, Scopus, and Web of Science. Charting methods—The data were charted by two researchers. We extracted data on general study details and design and information on the management and outcomes of NCDs in Kosovo. Synthesis of results—For the mix of studies that were included in the review, thematic narrative synthesis was used. We developed a conceptual framework based on health production core components to analyze the data. Results—Kosovo’s health care system is available to provide basic care for patients with NCDs. However, there are serious limitations in the availability of key inputs providing care, i.e., funding, medicines, supplies, and medical staff. Additionally, in terms of the management of NCDs, there are areas for improvement, such as limited application of clinical pathways and guidelines and issues with referrals of patients among levels and sectors of care. Finally, it is worth noting that there is overall limited information on NCD management and outcomes. Conclusions—Kosovo provides only basic services and treatment of NCDs. The data reporting the existing situation on NCD management are limited. The inputs from this review are helpful for existing policy efforts by the government aimed to enhance NCD care in Kosovo. Funding—This study is part of the research done for a World Bank review of the state of NCDs in Kosovo and was funded through the Access Accelerated Trust Fund (P170638).

Aim: this study aims to evaluate the pain scale during Arteriovenous fistula (AVF) puncture in patients undergoing regular haemodialysis sessions with and without Lidocaine gel 2%. Methods: The study is Cross-Sectional, conducted at the University Clinical Centre of Kosovo - Clinic of Nephrology and Haemodialysis in Pristina, Regional Haemodialysis Centre in Prizren, Regional Haemodialysis Centre in Gjilan and Regional Haemodialysis Centre in Mitrovica, all in Kosovo. In this research, 616 patients were surveyed during AVF puncture and the other group of 232 patients in whom 2% Lidocaine gel was applied before puncture at the fistula puncture site. Results: In the above mentioned centres, the total number of patients who are on dialysis through AVF is 632, of which 324 men and 308 women. 560 patients had created AVF on the left arm and 72 patients on the right arm. In our research, 616 patients were surveyed, of which 312 men and 304 women. The most affected age group was between 60 and 69. The pain scale reported during AVF punctuation was moderate in 304 (49%) patients, severe in 176 patients (29%) and mild in 136 (22%) patients. After the applying of Lidocaine gel 2%, the puncture of AVF was performed, so from the total number of 232 participants, 64 (28%) of them reported moderate pain and 168 (72%) of research participants reported mild pain during puncture of AVF. In order to compare results from both groups, we have chosen a random sample from the first group during AVF punctuation without Lidocaine gel 2% (234 in total from 616 patients) and compared the result with the second group during AVF puncture with Lidocaine gel 2% (232 in total). Conclusions: The average pain scale during AVF puncture without Lidocaine gel 2% was 5.04 while the average pain scale after applied Lidocaine gel 2% was 2.61.

The process of patient referral system at the level of health care is a comprehensive institutional framework with responsible, well-defined competencies, as a network of cooperation with the general goal of maintaining health, treatment, stabilization, transport and medical care up to in the complete recovery of the sick. The process of patient referral system in most countries in Europe and in the world is a challenge for most developing and developed countries. The mechanisms of the referral system function at different national, regional and municipal levels based on national laws and policies and work on the basis of efficient lines of communication by creating clear and simple steps and procedures described. The referral system in Kosovo is disorganized, chaotic, the Ministry of Health must have a national document of the referral system for patients at the health level, and before that all health care professionals are educated, trained on the way of the referral system, which cases must be sent from the primary, secondary and tertiary level. At the national level, the National Coordinating Council with a national plan of the patient referral system can convey the quality; help the health care professionals based on the current health legislation, the harmonization of unique standardized protocols with follow-up guidelines. Patients at the country level.