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Introduction:The first data for COVID-19 in pregnancy showed mild to moderate forms of the disease while current data speaks of severe forms in these subjects. Here we present a case of a severe form of COVID-19 in a gemelar pregnant woman complicated with pneumomediastin and pneumothorax,during her hospital stay, in a late stage of disease. Case presentation: A 38 year-old multiparous woman was referred to university hospital at 25 weeks of gemelar pregnancy. On admission, the patient presented with signs of moderate respiratory insufficiency, which after 12 hours progressed further to severe ARDS. She tested pozitiv for SARS COV 2 on quantitative real-time polymerase chain reaction. Under these conditions it was decided that the pacient undergo a caesarean section for termination of pregnancy. Remdesivir200 mg/day and tocilizumab 8 mg/kg were administered,based on national guidelines. The patient's fever subsided, but her SpO2 remained at 94%, even with a 15 L/min oxygen mask. After 12 days the patient complains of a severe back pain and her respiratory condition rapidly worsened,reduced saturations up to 80% being under O2 therapy with facial mask with 15 l/min. Chest CT findings confirmed pneumomediastine and pneumothorax,which deteriorated the patient”s status. Thereafter tube thorakostomy was performed. There was a clinical and ABG analysis parameter”s improvement.The patient was discharged 34 days after cesarean delivery with a proper general health. Conclusion: Our case highlights even more convincingly the fact that in pregnancy, can be severe to life-threating forms of Covid 19. Pneumothorax and pneumomediastinum are complications that can be encountered even in the late stages of severe forms with COVID 19 in pregnancy. Early diagnosis of these complications is essential in adequate management and treatment to avoid fatal outcome.

Introduction: Despite the fact that there has been a steady rise in new infections rate since the first reported case in 1993, Albania remains a low prevalence country. This was the first cascade study for Albania. The aim was to construct a cascade of care for newly human immunodeficiency virus (HIV)-diagnosed individuals in 2016 in Albania. Material and methods: This retrospective descriptive study was conducted at the HIV/AIDS Ambulatory Clinic, Infectious Disease Service, University Hospital Centre of Tirana. Medical records of patients diagnosed and enrolled in care in 2016 were retrospectively screened and data on gender, age, HIV clinical stage, CD4+ T cell count, viral load measurement, and treatment history, with antiretro-viral treatment (ART) and adherence to treatment were collected. Results: Out of 127 new HIV cases reported, 100 (78.7%) entered care. The median age was 39 years (range, 20-75 years; male, 82%). Seventy one percent started ART within a median of 56 days (range, 1-317 days) from diagnosis, 34 (47.9%) patients received tenofovir disoproxil fumarate/emtricitabine + efavirenz (EFV), and 27 (38%) zidovudine + lamivudine + EFV. Among those who started ART, 19.7% were late presenters and 54.9% were very late presenters. Viral load after initiation of ART was assessed in 25 cases, with 56% of patients achieving an undetectable HIV-RNA. Conclusions: A large proportion of people living with HIV were lost at each step of the cascade. Efforts in Albania should be focused on scaling up HIV testing, promoting adherence to ART, improving access to diagnostics, and better ART regimens as well as proper monitoring of therapy.