Vaccine hesitancy (VH) is an increasing global concern, contributing to vaccine preventable disease outbreaks in the last decade. Over the past decade, Albania has experienced a rise in VH, with childhood immunisation coverage decreasing from 94

BACKGROUND:Several conditions may present with acute neurological symptoms, thus mimicking the presentation of stroke. Although the underlying disorder can be diagnosed after careful medical, neurological, and radiological examinations, a few conditions, such as Wernicke encephalopathy (WE), may present a particular diagnostic difficulty. WE is a neurological disorder caused by deficiency of thiamine (B1 vitamin), most often resulting from alcoholism, malnutrition, hyperemesis gravidarum or bariatric surgery. The diagnosis of WE in a certain historical, clinical setting is easily suggested, but in a few cases presenting with acute neurological deficits, it can be particularly challenging. CASE SUMMARY:We present the case of a 63-year-old man who was brought to the emergency department after developing weakness of the left extremities, dizziness and a confusional state, which had lasted for approximately 30 minutes. The patient had a similar episode of a confusional state approximately two months earlier; at that time, a transient ischemic attack was suspected and he was started on aspirin. The initial clinical evaluation and imaging findings were unremarkable for stroke, but the patient's symptoms, history of chronic alcohol abuse and abnormal liver function tests prompted the consideration of WE. Magnetic resonance imaging findings in subthalamic areas and electroencephalogram data of diffuse delta activity supported this diagnosis. CONCLUSION:Through this case report, we aim to underscore the importance of considering WE as a differential diagnosis in patients presenting with symptoms suggestive of stroke, especially when the presentation is atypical or when risk factors for thiamine deficiency are present. Since intravenous thiamine significantly improves outcomes, delayed recognition and treatment in some cases might be deleterious.

The diagnosis of a subarachnoid hemorrhage is challenging, and has important clinical, therapeutic and prognostic implications. Delayed NPMSAH (non-aneurysmal perimesencephalic SAH) may involve subtle venous injury, aberrant venous anatomy or increased intracranial venous pressure. In all "idiopathic" cases, a remote traumatic event should be considered, and approached accordingly.

Vaccination has been one of the most successful public health interventions, contributing significantly to the prevention of numerous infectious diseases and saving countless lives. However, its implementation has not been without ethical challenges. This paper examines key ethical issues related to vaccination, considering the tension between public health goals and individual autonomy. Through an exploration of informed consent, distribution equity, vaccine mandates, and misinformation, this paper aims to provide a comprehensive analysis of the complex ethical landscape in the realm of vaccination.

Hemifacial spasm and blepharospasm are crippling medical conditions that severely affect the quality of life of patients.Among differential diagnosis, the ectasia of vertebro-basilar vessels should be taken into account, and treated accordingly.Authors report the case of a 60-years old male with a two-year history of involuntary intermittent twitching of the right eye and right side of the upper lip.MRI of the brain suggested a dolichoectasia of the vertebral artery.The condition was almost refractory to drugs and the patient was referred for neurosurgical intervention.

Neurological expertise is requested from courts of law in some particular cases, both in criminal and civil proceedings. With the judiciary field falling mostly within the scope of legal medicine professionals, and forensic psychiatrists, the role of an expert from other medical specialties seems unfamiliar. While considering the neurological deficits and diagnoses, experts rely on classificatory systems that highly fragmentize isolated somatic injuries. Such a stand might not reflect the impact of the injury or deficit for the patient as a whole. Neurotraumatology has been the main field where expertise is necessary, following civil suits, litigation, malpractice, and remuneration requests. Other neurological disorders are not immune from being at the center of a legal issue, such as dementia, epilepsy and so on. Well known in the still debatable issue on epilepsy being a disease of mind or not. Thus, neurologists at court should carefully avoid psychiatric overlapping of opinions and remain within the limits of their specialty, while considering a multifaceted issue.

A sixty-two year old woman, under treatment since five years for lung sarcoidosis, presented in the ER of our facility with severe thunderclap headache and hypertensive crisis. The ongoing corticoid therapy (twenty milligrams of oral prednisolone daily), well tolerated before, was discontinued and the patient underwent an unenhanced brain CT scan.

Qëllimi i këtij studimi ka qenë vlerësimi i sensitivitetit të përdorimit të kortizolit të lirë urinar në diagnostikimin e sindromës Cushing dhe krahasimi i saj me testin e frenimit me dexametazon. Nëntëmbëdhjetë raste të diagnostikuar me sindromën Cushing, insufi ciencën adrenale kronike dhe incidentalomë adrenale për periudhën janar 2011- dhjetor 2014 u morën në një studim retrospektivë për vlerësimin e sensibilitetit te kortizolit të lirë urinar në diagnostikimin e sindromën Cushing. Sensitiviteti i kortizolit të lirë urinar në rastet e marra në studim ishte i ulur 28%. Nga pacientët e diagnostikuar me sindromën Cushing raporti femra/ meshkuj ishte 1:6. Shpërndarja sipas faktorit etiologjik: 28% të rasteve adenoma surenale, 28% të rasteve me mikroadenomë hipofi zare dhe 46% të rasteve me makroadenomë hipofi zare. 28% të rasteve kishin edhe diabet mellitus si edhe HTA si diagnoza bashkë shoqëruese të sindromës Cushing. Si përfundim, në studimin tonë u vu re një sensibilitet i ulur i kortizolit të lirë urinar, si një nga testet fi llestare të diagnostikimit të sindromës Cushing, duke venë në pikëpyetje përdorimin ose jo të këtij testi diagnostik në të ardhmen.

Authors report the case of an adult man showing cervical spine involvement with radicular pain of acute onset. The happening followed a Jet Ski use for recreational purposes, and the patient did not had any training before the event. MRI of the cervical spine showed a massive disc involvement at the C6-7 level, and a conservative treatment with supportive collar was warranted. Particular attention should be made with the advent of personal watercraft (PWC) engines and devices in our area, unknown before both to users or clients as well as to medical staff. PWC might show a wide range of bodily injuries, some of them even lethal, therefore guidelines and precautions might be needed extensively in the next future.

The documentation of psychological trauma is obviously a challenge to clinicians while they are diving deep into remote events related to their clients or patients. The potential role of psychological trauma in the early developmental stages, and even the existence of adverse childhood experiences, is important to prove, yet it is difficult to do so. A diverse range of methods have been applied, all of which presumably benchmark a big therapeutic step; however, these enthusiastic methods frequently do not last for long. While hypnosis supporters, Freudian and Neo-Freudian disciples can be acute enough to enhance and uncover suppressed memories, modern psychiatry relies mostly on diversely structured interviews. Functional magnetic resonance and its related subtleties might help, but the questions that remain unanswered are numerous and confusing. Connecting early experiences with long-term memory while identifying psychological trauma its importance for the individual's growth trajectory; thus, it remains an intriguing issue.

The medical profession has been surrounded from mixed feelings of admiration, mysticism, as well as of fear and refusal. Authors and enthusiastic directors have dedicated serials and movies to the physicians’ everyday work, in their ebbs and tides. Albanian cinema produced a score of titles dedicated to the medical profession, with some movies focusing on the physician as the principal role, and some others more peripherally. The physician as a movie character underwent serious changes in the way the directors and scripts defined it, and maybe even in the way the general audience perceived the same. Changes in this modeling of physician’s character were part of the maturation process of the Albanian cinematography that has otherwise been strongly politicized from scholars; this trend could as well, or mainly, be related to the intrinsic alterations of the Albanian society from the immediate post WWII, until the fall of the totalitarian regime.

The constant ageing of the population extends to the population behind bars. We consider and summarise medical, ethical, legal and societal concerns raised when older adults with dementia are charged and put into custody. Dementia in custody is a relatively new concept in forensic science. When you take into account the adversarial nature of the judicial system and the hardship posed by correctional facilities, an older adult with severe cognitive problems will increases the complexity of the situation. The possibility of an octogenarian in cognitive decline being detained in police custody is less remote than it seemed half a century ago.

Background:Prion diseases or TSE diseases are a group of neurodegenerative disorders that manifest in several forms in humans, such as Kuru disease, Creutzfeldt‒Jakob disease (CJD), Gerstmann-Sträussler-Scheinker syndrome (GSS) and fatal familial insomnia.Objective:In this study, we propose a multimodular hypothesis of prion diseases. According to this hypothesis, a prion disease manifests because of the interaction of two genetic modules, such as the PRNP gene module and that of the gene or genes responsible for one or more chaperones, with one or some chemical module on whose structure the products of the genes or genetic modules interact.Methods:This study presents the perspective that modular thinking can allow us to overcome conceptual obstacles in the understanding and interpretation of prion diseases.Results and Discussion:The structure of the chemical module or modules is directly responsible for the folding or misfolding of the PrPC protein. The etiology of acquired prion diseases is explained based on this hypothesis. Hence, it has been proposed that (g) CJD involves the PRNP gene mutant and one or more mutant genes for one or more chaperone genes. In contrast, sCJD has one or more mutant chaperone genes. When does iCJD occur? Healthy individuals manifest acquired prion disease through contamination when infected with one or more mutant chaperones. The mutant chaperones interact with the prion protein, and PrPC is converted to its isoform PrPSc. In a recent study, there was a case of an individual with CJD after COVID-19 infection.Conclusion:This case emphasizes the link between neuroinflammation and protein misfolding and provides proof that chemical module formation is a necessary condition for the manifestation of prion diseases.

The Yalta Conference of 1945 brought together three of the most influential leaders of the 20th century: Franklin D. Roosevelt, Joseph Stalin and Winston Churchill. Surprisingly, all three leaders would go on to suffer strokes after the conference. This manuscript examines the health status of these leaders during and after the Yalta Conference, the factors that contributed to their strokes (including the role of hypertension), and other modifiable risk factors present in each one of them, and the impact of their declining health on their countries and the world. Roosevelt's demise, prior to the conclusion of the war, triggered a leadership transition during a critical moment in history, while Churchill and Stalin's passing shaped the early Cold War era. A veil of secrecy shrouded the health conditions of these pivotal leaders. “The Big Three” made considerable efforts to hide their health conditions from both the press and the public at large.Understanding the health of political leaders is crucial as it can affect their decision-making abilities and the course of history. The fates of Roosevelt, Stalin and Churchill serve as important reminders of the potential consequences of poor health in the highest echelons of political power.