Young Queer Community Members Faced Higher Discrimination in Albania During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic has hit vulnerable populations harder. In this context, the aim of this study was to assess the negative personal impacts and discrimination experienced by the LGBTQ+ community in Albania during the COVID-19 pandemic.

METHODS

This cross-sectional study was carried out in Albania in 2021, as a part of a larger multicenter study conducted by the International Planned Parenthood Federation European Network (IPPF EN). Binary logistic regression was used to assess the likelihood of feeling discriminated, ashamed, or afraid due to sexual orientation, adjusting for main confounding factors.

RESULTS

In total, 279 youngsters aged 14-30 years were included in this study. Of these, 55 participants or 19.7% self-declared as LGBTQ+. Significantly higher proportions of LGBTQ+ were older and of Albanian ethnicity, whereas lower proportions were not married/cohabiting compared to non-LGBTQ+ participants. Significantly higher proportions of LGBTQ+ members have felt discriminated (32.7%), ashamed to discuss about sexual and reproductive health (SRH) issues of concern (32.7%), afraid to express their sexual orientation (45.5%), and lacked privacy to discuss SRH issues with people of trust (36.4%) compared to non-LGBTQ+ participants (5.4%, 15.2%, 4%, and 17.4%, respectively). LGBTQ+ participants were 19.57 times more likely to feel discriminated because of their sexual orientation and 25.05 times more likely to be afraid to express their sexual orientation compared to non-LGBTQ+ participants.

CONCLUSION

The LGBTQ+ community in Albania was more negatively impacted by the COVID-19 pandemic compared to non-LGBTQ+ participants. The findings should guide future interventions for addressing the needs of the LGBTQ+ community in emergency situations.

Pseudo-pheochromocytoma due to obstructive sleep apnea: a case report

SUMMARY

Obstructive sleep apnea (OSA) is a condition of intermittent nocturnal upper airway obstruction. OSA increases sympathetic drive which may result in clinical and biochemical features suggestive of pheochromocytoma. We present the case of a 65-year-old male with a 2.9-cm left adrenal incidentaloma on CT, hypertension, symptoms of headache, anxiety and diaphoresis, and persistently elevated 24-h urine norepinephrine (initially 818 nmol/day (89-470)) and normetanephrine (initially 11.2 µmol/day (0.6-2.7)). He was started on prazosin and underwent left adrenalectomy. Pathology revealed an adrenal corticoadenoma with no evidence of pheochromocytoma. Over the next 2 years, urine norepinephrine and normetanephrine remained significantly elevated with no MIBG avid disease. Years later, he was diagnosed with severe OSA and treated with continuous positive airway pressure. Urine testing done once OSA was well controlled revealed complete normalization of urine norepinephrine and normetanephrine with substantial symptom improvement. It was concluded that the patient never had a pheochromocytoma but rather an adrenal adenoma with biochemistry and symptoms suggestive of pheochromocytoma due to untreated severe OSA. Pseudo-pheochromocytoma is a rare presentation of OSA and should be considered on the differential of elevated urine catecholamines and metanephrines in the right clinical setting.

LEARNING POINTS

Obstructive sleep apnea (OSA) is a common condition among adults. OSA may rarely present as pseudo-pheochromocytoma with symptoms of pallor, palpitations, perspiration, headache, or anxiety. OSA should be considered on the differential of elevated urine catecholamines and metanephrines, especially in patients with negative metaiodobenzylguanidine (MIBG) scan results.

Severe hypocalcaemia in a COVID-19 female patient

SUMMARY

Comorbidities are a risk factor for patients with COVID-19 and the mechanisms of disease remain unclear. The aim of this paper is to present a case report of an COVID-19 patient with severe hypocalcaemia. This is a report of an 81-year-old female, suffered from myalgia and fatigue for more than 3-4 weeks. Fever and cough appear 2 days before she presented to the emergency room. On physical examination, she was febrile with a temperature of 38.8°C, accompanied by cough, sore throat, headache, fatigue, and muscle ache. Her past medical history was remarkable with no chronic disease. She had lymphopenia. Laboratory test revealed moderate liver dysfunction, hypoalbuminemia, and severe hypocalcaemia (serum corrected calcium level: 5.7 mg/dL). Parathyroid hormone (PTH) was 107.9 pg/mL (range: 15-65) and 25(OH)2D levels was 4.5 ng/mL (range: 25-80). Chest CT scan detected peripheral ground-glass opacity. Throat swab for coronavirus by RT-PCR assay tested positive for the virus. She was treated with lopinavir/ritonavir, third generation cephalosporin, anticoagulant, daily high-dose calcium acetate, vitamin D3, fresh frozen plasma and oxygen therapy. She was discharged after two negative throat swab tests for coronavirus by conventional RT-PCR.

LEARNING POINTS

Comorbidities are a risk factor for patients with COVID-19. Laboratory findings are unspecific in COVID-19 patients; laboratory abnormalities include lymphopenia, elevated of LDH, CPK and the inflammatory markers, such as C reactive protein, ferritinemia and the erythrocyte sedimentation rate. In addition to inflammatory markers, in COVID-19 patients it is crucial to check the level of vitamin D and calcium. There may be a correlation between vitamin D deficiency and the severity of COVID-19 disease.

Imported malaria in Albania and the risk factors that could allow its reappearance

Malaria is an infectious disease gradually becoming a serious concern for public health institutions, even in European countries where the eradication of the disease was previously taken for granted. Albania was listed as an endemic area from the beginning of the 20th Century, but the disease was gradually under control and some decades after the World War II it was merely considered a historical curiosity. Nevertheless, for many reasons, since 1994 and in increasing trend, Albanian health facilities have registered several cases of malaria. Tracing the remnants of the autochthonous disease and finding links with the actual situation seems difficult, due to the relatively long period separating the proclaimed eradication of malaria with the re-appearance of the infection. Among major factors leading to such re-appearance might be massive migratory movements, and environmental changes such as the flooding of areas close to river deltas that flow into the Adriatic and Ionian Seas. These factors, combined with the constant presence of several Anopheles species, have led to newly-diagnosed imported malaria cases in Albania. Although all reported cases are considered imported, measures have to be put in place, in order to prevent reappearance of autochthonous malaria cases, and to control disease spread.

An analysis of respondent driven sampling with Injection Drug Users (IDU) in Albania and the Russian Federation

Injection drug users in Tirana, Albania and St. Petersburg, Russia were recruited into a study assessing HIV-related behaviors and HIV serostatus using Respondent Driven Sampling (RDS), a peer-driven recruitment sampling strategy that results in a probability sample. (Salganik M, Heckathorn DD. Sampling and estimation in hidden populations using respondent-driven sampling. Sociol Method. 2004;34:193-239). This paper presents a comparison of RDS implementation, findings on network and recruitment characteristics, and lessons learned. Initiated with 13 to 15 seeds, approximately 200 IDUs were recruited within 8 weeks. Information resulting from RDS indicates that social network patterns from the two studies differ greatly. Female IDUs in Tirana had smaller network sizes than male IDUs, unlike in St. Petersburg where female IDUs had larger network sizes than male IDUs. Recruitment patterns in each country also differed by demographic categories. Recruitment analyses indicate that IDUs form socially distinct groups by sex in Tirana, whereas there was a greater degree of gender mixing patterns in St. Petersburg. RDS proved to be an effective means of surveying these hard-to-reach populations.