Background-Since influenza often presents non-specifically in infancy, we aimed to assess the extent to which existing respiratory surveillance platforms might underestimate the frequency of severe influenza disease among infants.Methods-The Influenza and Respiratory Syncytial Virus in Infants (IRIS) study was a prospective observational study done at four hospitals in Albania, Jordan, Nicaragua, and the Philippines. We included acutely ill infants aged younger than 1 year admitted to hospital within 10 days or less of illness onset during two influenza seasons (2015-16 and 2016-17) in Albania, Jordan, and Nicaragua, and over a continuous 34 week period in the Philippines. We assessed the frequency of influenza virus infections by real-time RT-PCR (rRT-PCR) and serology. The main study outcome was seroconversion, defined as convalescent antibody titres more than or equal to four-fold higher than acute sera antibody titres, and convalescent antibody titres of 40 or higher. Seroconverison was confirmed by haemagglutination inhibition assay for influenza A viruses, and by hemagglutination inhibition assay and microneutralisation for influenza B viruses.Findings-Between June 27, 2015, and April 21, 2017, 3634 acutely ill infants were enrolled, of whom 1943 were enrolled during influenza seasons and had complete acute-convalescent pairs and thus were included in the final analytical sample. Of the 1943 infants, 94 (5%) were influenzapositive by both rRT-PCR and serology, 58 (3%) were positive by rRT-PCR-only, and 102 (5%) were positive by serology only. Seroconversion to at least one of the influenza A or B viruses was observed among 196 (77%) of 254 influenza-positive infants. Of the 254 infants with influenza virus, 84 (33%) only had non-respiratory clinical discharge diagnoses (eg, sepsis, febrile seizures, dehydration, or other non-respiratory viral illness). A focus on respiratory diagnoses and rRT-PCR-confirmed influenza underdetects influenza-associated hospital admissions among infants by a factor of 2•6 (95% CI 2•0-3•6). Findings were unchanged when syndromic severe acute respiratory infection criteria were applied instead of clinical diagnosis. Interpretation-If the true incidence of laboratory-confirmed influenza-associated hospital admissions among infants is at least twice that of previous estimates, this substantially increases the global burden of severe influenza and expands our estimates of the preventive value of maternal and infant influenza vaccination programmes.

Introduction Cutaneous malignant melanoma prevalence, incidence and mortality rates are increasing in white populations worldwide more rapidly than any other cancer site (American Cancer Society, 2006). Despite the potential importance of regular skin self­examination and promotion of self­protection practices, little is known about the prevalence of these practices in medical students in Albanian population.Methods This is a descriptive, quantitative cross­sectional study. In this study were included a sample of 150 individuals chosen among the students of Faculty of Medicine based on their family history for skin cancer. This study was started on October the 3rd and finished on November the 12th. Subjects had to fill in a structured, self­administered questionnaire. All participants lived within Republic of Albania but at the time of the study were students in University of Tirana, Faculty of Medicine.Results In this study that we conducted we included 150 individuals supposed to have a risk for skin cancer based on their family history. 200 individuals were approached for participation. Of these, 150 individuals returned questionnaire data, yielding a response rate of 75% among eligible, successfully contacted participants. The mean age of the sample was20.05 years (Std. Dev. = 0.925), with males (22%) and females (78%) represented unequally, because the gender configuration of the faculty itself has gender disparities with more than 80% females and only 20% male students. The majority of the sample was born in city or town (85.3%), 14.7% was born in a village. In terms of income level, 79.3% of participants had a medium income family background, 15.3% high income and 5.3% had a low income level family background. Conclusion It is important for those individuals with family history for skin cancer (which inherently indicates risk for skin cancer) to develop self­examination and SSE behaviours and practices in order to have a protection and at least an early detection (if onset) of the different forms of Melanoma. The results of this study provide some guide as to the key areas or 'hot spots' on which to focus attention when designing supportive care interventions for melanoma survivors and those at high risk of skin cancer.

An 11-year-old male was admitted with cough and fever for the last 4 days and also complained of pain in the right lung for some weeks. The boy did not show any other symptoms and his past medical history was unremarkable as well. The radiologist findings showed an aspect that suggested for echinococcosis. At first, it was realised the heart intervention. About a 2-month period later, the child underwent another cyst removal in lung. He had begun taking albendazole 5 days before the heart intervention. The therapy was continued until the lung intervention and for 12 weeks post-operatively. The patient had an uneventful recovery and after about 4 years.

± 19.1 ml transfused volume and the mean Hb post-transfusion of 13.6 ± 2.1 g/dl. Only 5 (6%) of infants did not reach the desired Hb level post-transfusion and 4 of these infants were mechanically ventilated. There was a poor correlation between infant weight and post transfusion Hb (R = 0.028, p = 0.81). However, pre-transfusion Hb positively correlated with posttransfusion Hb (R = 0.509; p < 0.001) (Figure 1). Conclusion Incorporation of the pre-transfusion Hb value in the calculation of RBC transfusion volume may achieve the desired Hb threshold and hence reduce the need for further transfusion.

Introduction Propranolol is now being used as an alternative to steroid treatment for IIH. Aim of the study To evaluate the cardiac effects of propranolol in infancy. Methods All patients with IIH between January 2011–December 2013, treated with propranolol, underwent cardiac examination: heart rate (HR), blood pressure (BP), satO2, electrocardiogram and echocardiography (shortening fraction and ejection fraction). Cardiac evaluation was repeated after 1 week, 4 weeks, and then every 6 months. Results We have analysed 42 patients divided into 2 groups: 33 patients (1–6 months, mean weight 6.5 ± 1.3 kg) and 9 patients (6–15 months, mean weight 10.6 ± 2.4 kg). No adverse effects in any patients and none required discontinuation of treatment. In the first group the median HR centile was 50th at baseline, 41thafter 1month and 44th at the end of treatment. In the second group the median HR centile was 43th at baseline, 34th after 1 month and 37th at the end of treatment. In the first group the mean SF was 39% at baseline, 40% and 40% at the end of treatment: the mean EF was respectively 74.5%, 72% and 73%. For the second group the mean SF was 38%, 39% and 39%: the mean EF respectively was 73.1% at baseline, 74% after 1 month and 74.2% at the end of treatment. Conclusion In our study we have observed signs of rapid involution of hemangioma within the 2–3 first weeks of treatment in all patients. All patients have responded well to treatment, with no side effects and especially no cardiac effect.