AIM:To systematically review the latest pharmacoeconomic evidence regarding the costs associated with myasthenia gravis (MG) care and treatment. METHODS:We searched the National Health Service Economic Evaluation Database and PubMed for articles in English from any country reporting health economic analyses of pharmacological treatments, hospitalization, or surgical procedures related to MG. RESULTS:The study included 31 articles showing a considerable variability in the costs and cost-effectiveness of MG treatments across regions, therapies, and health care settings. Traditional therapies such as plasma exchange (PLEX) and intravenous immunoglobulin (IVIg) differ notably in cost, with PLEX generally being less expensive. Newer clinically effective treatments such as efgartigimod and eculizumab raise concerns about their economic sustainability, whereas rituximab might be a more affordable alternative in certain contexts. CONCLUSION:Future research should compare cost-effectiveness across health care systems, incorporating local pricing and reimbursement, and collecting real-world data.

The cosmetic industry represents a major sector of the global economy and is expected to significantly grow in the coming years. To enhance consumer acceptance and address increasing sustainability concerns, cosmetic companies are actively seeking innovative solutions to mitigate their environmental, economic, and social impacts. In accordance with this, several scientific studies focus on the development, scale-up, and life cycle assessment of sustainable cosmetic products, especially those derived from side streams in accordance with circular economy principles. Various reviews have addressed this topic; however, they typically cover one or two of these dimensions, providing only a partial perspective. In particular, existing studies mainly analyze the types of side streams used and the resulting products, often lacking a comprehensive framework that can effectively support the translation of these approaches into industrial-scale production. The aim of the present review is to address this gap by providing a comprehensive analysis of the maturity level of development, scale-up processes, and life cycle assessment of cosmetic products based on agro-industrial side streams. This analysis is intended to support companies in the transition towards more sustainable practices by reducing carbon footprint and limiting the intensive extraction of virgin raw materials. The different approaches and methodologies proposed for the development and scale-up of sustainable cosmetic products from agro-industrial side streams are also analyzed, considering whether life cycle assessment has been performed. Furthermore, the most suitable business models will be selected as innovative and sustainable value chains capable of generating economic benefits, fostering local development, and enhancing resource efficiency and supply security.

This study explores what drives subjective poverty in the Western Balkans, a region where many people still consider themselves poor despite two decades of economic growth and reforms. We provide evidence that the disconnect between measured income poverty and how people feel about their own poverty can undermine poverty reduction efforts and affect social cohesion during the EU accession process. Unlike earlier work that focuses mainly on income poverty, we offer a micro-level, cross-country analysis of subjective poverty in the six Western Balkan post-transition economies. Using data from the 2022–2023 Life in Transition Survey (LiTS IV), which covers 5,196 households in Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia, and Serbia, we examine how factors such as economic security, health, remittance income, COVID-19 impacts, and demographic characteristics influence individuals’ placement on a selfrated ten-step wealth ladder. We estimate generalized ordered logit models to re spect the ladder’s ordinal nature and to allow effects to differ across levels of subjective poverty. Our findings indicate that having financial buffers, owning a home, and being in good health significantly reduce the likelihood of feeling poor, whereas experiencing economic setbacks from the pandemic increases subjective poverty. Married individuals report greater subjective poverty, likely reflecting dependency and income-sharing not captured by income-based indicators. Cross-country differences are pronounced: Albania shows the highest levels of subjective poverty, whereas Kosovo the lowest. The evidence suggests that perceived vulnerability rather than income alone is a key driver of poverty assessments, highlighting the need for resilience-focused social policies during EU integration.

The first Albanian Righteous Among the Nations was recognized only in 1987, 24 years after the programmme's birth - one of the longest periods before the first recognition by Yad Vashem's database. Rescue took many forms and rescuers came from different social classes, professions and religions. The vast majority of the rescued were refugees arriving in 1940-43, when the country was under fascist occupation. The information about Albanian rescuers during the Holocaust is still incomplete, mostly due to the country's decades-long extreme isolation after World War II. Albania experienced the most severe dictatorship and repression in Europe. After the official recognition of the state of Israel in 1949, the Albanian government froze bilateral relations until the 1990s. During the communist period, several scholars from "enemy countries" requested information regarding the Jewish community and other important issues, but the authorities did never respond. In addition, the exchange of information between the rescuers and the rescued was impossible. Albania was the only Eastern Bloc state that did never establish diplomatic ties with Israel and other so-called revisionist countries.

Vendimi për të migruar është një funksion i disa variablave, të cilat ndihmojnë ose pengojnë migrimin dhe mund të shënohen me shenja pozitive ose negative. Faktorët negativë përfshijnë problemet sociale dhe ekonomike në vendet e origjinës, siç janë varfëria, shkelja e të drejtave, konfliktet politike dhe të armatosura etj. Nga ana tjetër, faktorët pozitivë lidhen me kushtet e vendeve pritëse si të ardhurat e larta, gjuha e përbashkët, niveli i sigurisë së lartë etj. Ky dokument përqendrohet në fenomenin e emigrimit në disa vende të Europës Qendrore dhe Lindore dhe mbi faktorët përcaktues përkatës. Ne vlerësojmë një model origjinal të gravitetit duke përfshirë disa variabla të pavarur që lidhen me çështjet tipike për vendet në zhvillim, siç janë varfëria, papunësia dhe korrupsioni. Sipas testeve diagnostifikuese, ekuacioni i vlerësuar përshtatet mirë me mostrën tonë. Autoritetet e vendeve të EQL duhet të orientojnë politikat e tyre drejt krijimit të vendeve të reja të punës dhe zbutjes së pabarazisë. Kjo do të çojë në një rritje të qëndrueshme ekonomike dhe në zvogëlimin e daljeve të ardhshme të migracionit.

Background: The prevention of myelomeningocele (MMC) and meningocele (MC) is a public health concern. A systematic review on economic factors associated with MMC and MC can help the policy makers to evaluate the cost-effectiveness of screening and treatment. To our knowledge, this is the first systematic review to provide up-to date pharmacoeconomic evidence of all economic studies present in literature on different aspects of MMC and MC. Methods: We searched in the National Health Service Economic Evaluation Database (NHSEED), PubMed, Cost-effectiveness Cochrane Library, and Econlit. The PRISMA guidelines were followed in the search and evaluation of literature. Only articles in English not limited by the year of publication that fulfilled the eligibility criteria were included in this systematic review. Results: Nineteen papers were included in the study. The studies were very heterogeneous and reported a comparison of the costs between prenatal versus postnatal repair, the cost of fetoscopic approach versus open surgery, the cost of ventriculoperitoneal shunting (VPS) versus endoscopic third ventriculostomy (ETV), and ETV with choroid plexus cauterization (ETV/CPC), the cost of hospitalization, and the cost of diagnosis for MMC. Conclusion: The results of this study can help in implementing new policies in different countries to assist MC and MMC patients with the cost of treatment and screening.

Ahmet Zog was the "King of the Albanians" from September 1928 until April 1939, when the country was invaded by fascist Italy. During his reign Albania experienced an unprecedented period of relative stability and progress. Zog's government took the first small steps towards the creation of a modern European country. King Zog developed a strong economic dependence on Mussolini's Italy, but he did not implement fascist ideas and policies. Albania welcomed and assisted persecuted Jews since 1933, when Hitler came to power as chancellor of Germany. Zog's attitude towards Jewish immigration was strongly influenced by Herman Bernstein, United States Ambassador to Albania during the years 1930-1933. Prior to Italian occupation, Albania was considered a safe transit point for Jewish refugees seeking to reach prosperous and stable destinations.

According to neoclassical models, migration takes place when there is a strong probability that individuals will recoup their human capital investments. As a result, workers typically move from low-income to high-income areas and the larger the expected income gap between areas, the higher the number of migrants. In countries where corruption is endemic, jobs are often secured through political connections and bribes. This will lead to a higher unemployment level as well as to a lower return to human capital. Consequently, a significant proportion of the population considers emigration as the only path to succeed. The present study is focused on the impact of corruption on emigration from six Western Balkan countries. A System Generalized Method of Moments is estimated to analyze migrant stocks in 28 receiving countries during the period from 2012 to 2022. We suggest that corruption can directly influence migration stocks in receiving countries.

Objective: Starvation in early life can cause poor bone health and metabolic aberrations in bone minerals, leading to abnormal bone development. Holocaust survivors have been exposed to starvation and malnutrition before and during World War II. This paper aims to provide the current state of knowledge on the osteoporosis risk in Holocaust survivors and their descendants. Methods: The PubMed and Scopus databases were searched. Papers that reported original data on the risk of osteoporosis in Holocaust survivors and in their offspring were included in the study. Results: Ten studies were included in this review. The majority of studies were case-control ones (n=7) versus two self-reported and one longitudinal study. Despite the limited cohort numbers and the small number of studies in the literature, the data showed a potential increased risk of osteoporosis in Holocaust survivors and especially in their descendants. Conclusions: The review of these studies showed a higher prevalence of osteoporosis among Holocaust survivors and their offspring. Knowledge of the trans-generational inheritance of osteoporosis in the descendants of Holocaust survivors should increase the awareness of primary care health workers on osteoporosis screening and early diagnosis and implementation of preventive measures, including adequate vitamin D and calcium supplementation, and pharmacological treatment.

BACKGROUND:Hereditary hemochromatosis (HH) is an autosomal recessive disorder that leads to iron overload and multiorgan failure.OBJECTIVES:The aim of this systematic review was to provide up-to-date evidence of all the current data on the costs and cost effectiveness of screening and treatment for HH.METHODS:We searched PubMed, Cochrane Library, National Health Service Economic Evaluation Database (NHSEED), Cost-Effectiveness Analysis Registry (CEA Registry), Health Technology Assessment Database (HTAD), Centre for Reviews and Dissemination (CRD), and Econlit until April 2023 with no date restrictions. Articles that reported cost-utility, cost-description, cost-minimization, cost-effectiveness, or cost-benefit analyses for any kind of management (drugs, screening, etc.) were included in the study. Patients with HH, their siblings, or individuals suspected of having HH were included in the study. All screening and treatment strategies were included. Two authors assessed the quality of evidence related to screening (either phenotype or genotype screening) and treatment (phlebotomy and electrophoresis). Narrative synthesis was used to analyse the similarities and differences between the respective studies.RESULTS:Thirty-nine papers were included in this study. The majority of the studies reported both the cost of phenotype screening, including transferrin saturation (TS), serum ferritin, and liver biopsy, and the cost of genotype screening (HFE screening, C282Y mutation). Few studies reported the cost for phlebotomy and erythrocytapheresis treatment. Data revealed that either phenotype or genotype screening were cost effective compared with no screening. Treatment studies concluded that erythrocytapheresis might be a cost-effective therapy compared with phlebotomy.CONCLUSIONS:Economic studies on either the screening, or treatment strategy for HH patients should be performed in more countries. We suggest that cost-effectiveness studies on the role of deferasirox in HH should be carried out as an alternative therapy to phlebotomy.

Purpose: This paper investigates the main factors of international tourist arrivals to three Mediterranean destinations, namely Greece, Albania and Montenegro. Methods: A gravity model for panel data was used to analyze the number of tourists from twenty of the most important origin countries during the period 2012-2021. Results: Findings show that international tourism is adversely affected by bilateral distance and large-scale crisis such as COVID-19 pandemic. On the other hand, the flow of international visitors is positively related to populations and incomes per capita in origin and destination countries, geographical contiguity and climate similarity. Other pull factors for tourism flows include total investments in infrastructure, and political stability and absence of violence or terrorism. Implications: The results of this research provide some important implications and recommendations for tourism industry policymakers and managers.

The fight against corruption remains one of the most fundamental problems for Western Balkans societies and governments. Hiring in the public sector is often determined by networks and clientelism. The exchange of favours and loyalty to a patron are the “normal” ways to access economic opportunities. As a result, a considerable portion of the population considers emigration as the only path to succeed. The main objective of this study is to analyse the impact of corruption on Western Balkan migrant stocks over the years from 2012 to 2020. The selected time period depends mainly on data availability and frequency. A gravity-based equation is developed to explain changes in the number of immigrants living in 31 European destinations. The proposed econometric model confirms the statistical significance of corruption variables in migrant stocks of receiving countries. Individuals tend to move from countries with high levels of corruption and poor governance toward richer and less corrupt destinations.

Introduction: Cerebral Palsy (CP) is a group of diseases that affect movement and posture due to brain damage. In Albania there are no studies indicating the current prevalence of infantile CP, the prevalence of respiratory symptoms, and access to respiratory physiotherapy of infants with CP. Aims and Objectives: The aim of this study is to evaluate the frequency of respiratory symptoms, and access to physiotherapy in Albanian children with cerebral palsy. Methods: We conducted a study with CP children at the Albanian National Therapeutic and Rehabilitation Center for Children. Results: Seventy-nine children (44 or 55.7% males; 35 or 44.3% females) with cerebral palsy and a mean age of 6.7 years old were included in the study. Thirty-four (43.3%) were born pre-term, mostly (24 children, 70.6%), at the seventh month of pregnancy. The median age at diagnosis for CP was 15 months. 55.7 % of participants were hospitalized at least once for respiratory problems, and their first appointment with a physiotherapist was around 22 months (mean age).57 participants or 72.2% reported coughing at least once weekly; 60.8% reported weekly phlegm; nightly snoring (35.4%), choking (30.4%), asthma (7.6%). Children had a median of three weekly appointment with a physiotherapist and in 60% they needed extra access to physiotherapy, that was not reimbursed by the National Health Services. Conclusions: In Albania there is an unmet need to carry out a national cohort based study on the prevalence of CP, and respiratory symptoms in CP patients. These studies should also increase awareness among the policy makers to provide free medical services and treatment and social support for these patients.

ABSTRACT Albania was the only German-occupied country in which the number of Jews increased after World War II. Almost all native Jews of Albania survived the Holocaust, and thousands of Jewish refugees from other European countries were assisted and protected during the years 1933–1945. The rescue was facilitated by a unique mixture of factors, but the main common motivation of Muslim, Catholic, and Orthodox rescuers was Besa, the crucial element of Kanun, the Albanian customary law.

Background Arachidonic acid (AA) is a polyunsaturated fatty acid, released in inflammatory disease, such as rheumatoid arthritis (RA). Cyclooxygenase (COX) and lypooxygenase (LOX) pathways have received greater attention than cytochrome P450 (CYP) pathway of AA, which also plays a significant role in RA. AA is a substrate of CYP enzymes through two different pathways: the ω-hydroxylase, and epoxygenase pathways, respectively. The epoxygenase gives rise to epoxyeicosatrienoic acids (EETs) (5,6-EET, 8,9-EET, 11,12-EET, 14,15-EET), whereas ω- hydroxylase produces hydroxyeicosatetraenoic acids (HETEs) [1]. Objectives The aim of this study is to evaluate the role of Cytochrome P450 metabolites of arachidonic acid and their therapeutic targeting in rheumatoid arthritis. Methods Pubmed and Scopus databases were the main databases used to identify all the studies conformed to the eligibility criteria. Results CYP enzymes (CYP3A, CYP2C19, CYP2C9, CYP1A2) suppression was observed in the synovial fluid of RA patients with higher IL-6 levels. EETs inhibit bone resorption and osteoclastogenesis, have an important role in blocking inflammation by reducing TNFα, and are negatively linked with pro-inflammatory cytokines (IL-1, IL-6, IL-8)[2]. The anti-inflammatory effects of EETs are potentially attributed to peroxisome proliferator–activated receptor gamma (PPARγ) activation. EETs are also metabolized through soluble epoxide hydrolase (sEH) to dihydroxyeicsatrienoic acids (DHETs), which have a pro-inflammatory activity. On the other hand, 20-HETE deriving from CYP ω-hydroxylase pathway has pro-inflammatory effect [3]. Data have shown that the genetic variations of CYP could affect the individual susceptibility to RA [4]. Conclusion sEH inhibitors (sEHi) can not only block the inflammation caused by EETs metabolite, but can also act on LOX and COX pathway, and can be used in chronic-phase arthritis to reduce both inflammation, and the pain. In a mouse model of RA, sEHi showed decent RA assessment score improvement [5]. Moreover, data suggest that sEHi inhibit also PGE2 production, and exert an additional anti-inflammatory effect in arthritis. Since NSAIDs can lead to gastric and cardiovascular problems, sEHi are considered a better pharmacological approach in inflammatory rheumatic disease. Despite the failure of some of sEHi to reach clinical trials, we believe that CYP-derived eicosanoids should be further studied as potential target in rheumatic disease. Dual inhibitors sEHI/5-LOX activating protein (FLAP) are also very promising compounds as they can inhibit leukotriene formation, without effecting the levels of anti-inflammatory pro-resolving mediators. In perspective we suggest that multiple ligands targeting different AA pathways or mediators should be further explored as potential targets for designing new compounds to treat RA patients. References [1]M. Hoxha, B. Zappacosta. CYP-derived eicosanoids: Implications for rheumatoid arthritis. Prostaglandins Other Lipid Mediat. 146 (2020) 106405. [2]X. Xu, X.A. Zhang, D.W. Wang, The roles of CYP450 epoxygenases and metabolites, epoxyeicosatrienoic acids, in cardiovascular and malignant diseases, Adv. Drug Deliv. Rev. 63 (8) (2011) 597–609. [3]D. Panigrahy, A. Kaipainen, E.R. Greene, S. Huang, Cytochrome P450-derived eicosanoids: the neglected pathway in cancer, Cancer Metastasis Rev. 29 (4) (2010) 723–735 [4]S. Puntarulo, A.I. Cederbaum, Production of reactive oxygen species by microsomes enriched in specific human cytochrome P450 enzymes, Free Radic. Biol. Med. 24 (7–8) (1998) 1324–1330 [5]J. Park, M.J. Cho, H.J. Park, Analgesic effects of soluble epoxide hydrolase inhibitor in K/BxN serum transfer arthritis mouse model, Anesth. Pain Med. 14 (2019) 76–94. Disclosure of Interests None declared

This paper aims to investigate some of the most important factors of tourism demand in Southern European Countries. The System Generalized Method of Moments is applied to a panel of 15 relevant tourist generating countries, for the period from 2005 to 2021. The considered explanatory variables follow the expected signs and have statistically significant effects on international tourist arrivals. The results suggest that tourism demand is negatively affected by bilateral distance, and global health emergencies such as COVID-19 pandemic. Moreover, lagged tourist arrivals, per capita income in origin countries, and the existence of a common border have a positive effect on the considered dependent variable.

Folic acid has been identified to be integral in rapid tissue growth and cell division during fetal development. Different studies indicate folic acid’s importance in improving childhood behavioral outcomes and underline its role as a modifiable risk factor for autism spectrum disorders. The aim of this systematic review is to both elucidate the potential role of folic acid in autism spectrum disorders and to investigate the mechanisms involved. Studies have pointed out a potential beneficial effect of prenatal folic acid maternal supplementation (600 µg) on the risk of autism spectrum disorder onset, but opposite results have been reported as well. Folic acid and/or folinic acid supplementation in autism spectrum disorder diagnosed children has led to improvements, both in some neurologic and behavioral symptoms and in the concentration of one-carbon metabolites. Several authors report an increased frequency of serum auto-antibodies against folate receptor alpha (FRAA) in autism spectrum disorder children. Furthermore, methylene tetrahydrofolate reductase (MTHFR) polymorphisms showed a significant influence on ASD risk. More clinical trials, with a clear study design, with larger sample sizes and longer observation periods are necessary to be carried out to better evaluate the potential protective role of folic acid in autism spectrum disorder risk.

Cysteinyl leukotrienes are proinflammatory mediators with a clinically established role in asthma and a human genetic and preclinical role in cardiovascular pathology. Given that cardiovascular disease has a critical inflammatory component, the aim of this work was to conduct an observational study to verify whether the use of a cysteinyl leukotriene antagonist, namely, montelukast, may protect asthmatic patients from a major cardiovascular event and, therefore, represent an innovative adjunct therapy to target an inflammatory component in cardiovascular disease. We performed an observational retrospective 3-year study on eight hundred adult asthmatic patients 18 years or older in Albania, equally distributed into two cohorts, exposed or nonexposed to montelukast usage, matched by age and gender according to information reported in the data collection. Patients with a previous history of myocardial infarction or ischemic stroke were excluded. In summary, 37 (4.6%) of the asthmatic patients, 32 nonexposed, and five exposed to montelukast suffered a major cardiovascular event during the 3-year observation period. All the cardiovascular events, in either group, occurred among patients with an increased cardiovascular risk. Our analyses demonstrate that, independent from gender, exposure to montelukast remained a significant protective factor for incident ischemic events (78% or 76% risk reduction depending on type of analysis). The event-free Kaplan–Meier survival curves confirmed the lower cardiovascular event incidence in patients exposed to montelukast. Our data suggest that there is a potential preventative role of montelukast for incident cardiac ischemic events in the older asthmatic population, indicating a comorbidity benefit of montelukast usage in asthmatics by targeting cysteinyl leukotriene-driven cardiac disease inflammation.

Background and Aims: Leukotriene receptor antagonists (LTRAs) are used in asthmatic patients, however different studies indicate that LTRAs can decrease intimal hyperplasia after vascular injury, and have a protective role in cerebral ischemia. The aim of our study was to assess the role of LTRAs in reducing myocardial infarction (MI) and ischemic stroke (IS) risk in patients from two Primary Health Care Centers of Granada.