Background. Ankylosing spondylitis (AS) is a chronic seronegative spondyloarthropathy, which results in fusion (ankylosis) of the spine and sacroiliac (SI) joints, with the major histocompatibility antigen HLA B27. Although classically thought as a spinal disease, it can involve other organs such as eyes, lungs, and heart. Pleuroparenchymal involvement is uncommon and is seen in the later stages of the disease. 
Case Report. A 55-year-old male smoking patient was referred to our hospital for the evaluation of bilateral pleural effusion etiology which was determined on a chest x-ray. His past medical history revealed that he had not a diagnosis of AS. On physical examination there was kyphosis, loss of lumbar lordosis, and fixed bent-forward posturing. His chest X-ray was compatible with a pleural effusion on right sides and Contrast enhanced computed tomography of total body showed bilateral pleural effusion and vertebral lesions related to AS. He was positive for HLA-B27 antigen (95%). Diagnostic thoracentesis revealed that the bilateral pleural effusion was an exudate with a predominance of lymphocytes. He was diagnosed with AS based on the presence of inflammatory back pain, characteristic imaging findings consistent with sacroileitis, and HLA-B27 positivity. Based on these findings pleural effusion was suggested to be due to AS. Complete resolution of the bilateral pleural effusions was documented on chest radiography and echocardiography one month after initiation of prednisolone and sulfasalazine therapy.
Conclusion. Pleural effusion is extremely rare extra-articular manifestation of AS, and its diagnosis requires a coordinated multidisciplinary approach involving pulmonologists, imaging specialists, and rheumatologists toward appropriated therapy and subsequent remission.

https://doi.org/10.65413/QFRN1232 

Cholera is an acute diarrheal disease caused by Vibrio cholerae, a gram-negative, comma-shaped bacterium. It causes severe, large-volume watery diarrhea, leading to dehydration and death if left untreated. It spreads through contaminated food and water via the oral-fecal route.  
Aims: The present study aimed to compare cholera outbreaks in Kerbala city during 2015 and 2017, focusing on their duration, bacterial serotypes, and the role of local treatment plants as water sources in transmission.
Methods: This descriptive study was conducted among patients affected during outbreaks in September-November 2015 and during November 2017. It included 7609 patients in 2015 and 920 in 2017, along with 250 and 80 water samples collected from different sources during the respective cholera outbreak periods. Bacterial strains were isolated from stool and water samples and confirmed by culture and serotyping. Data collection involved direct patient visits and retrospective review of medical records. Inclusion criteria were based on physicians' clinical suspicion and adherence to the case definitions and detection protocols of the National Cholera Control Plan and the World Health Organization. 
Results: Two cholera outbreaks occurred in Kerbala. The bacterial strains were isolated, serotyped, and confirmed from stool and water samples. Water from water purification plants (tap water) and rivers was tested. A total of 188 laboratory-confirmed cholera cases were recorded during the 2015 outbreaks, and 21 of 250 water samples from rivers tested positive. In contrast, during the 2017 outbreak, 76 confirmed cholera cases were reported, with no positive findings among the 80 water samples collected from all water sources. A relatively short period of cholera incidence was observed, spanning from autumn through early winter (September to the end of November). During the 2015 outbreaks, cholera incidence was observed during a relatively short seasonal extension from early autumn to late November. Although 3 serotypes (Inaba and Ogawa) were reported in patients, NAG was reported in water sources. During the 2015 outbreaks, water samples were positive; during the 2017 outbreaks, water samples from different sources were tested for cholera, with none testing positive. Ultimately, all strains recovered during the 2015 and 2017 outbreaks were found to belong to a single serotype (Inaba).
Conclusion: Cholera cases in Kerbala decreased from 2015 to 2017, underscoring the impact of public health interventions. Nevertheless, remaining essentially vigilant community health and reducing healthcare burdens, but ongoing vigilance remains vital during mass gatherings and seasonal peaks.

https://doi.org/10.65413/XXXXXX

Background: Deep neck infection is an infection that occurs in the deep fascia and cervical spaces in the form of abscess or cellulitis. The impairment of the immune system due to the hyperglycemic state in patients with diabetes leads to different clinical presentations, prognosis, management and therapy in this group of patients and they can become life-threatening if they are not managed in the right time.
Aims: This study was undertaken to better define the clinical features and prognosis of deep neck infections in diabetic patients with special emphasis on the need for prompt surgical intervention and avoidance of life-threatening complications.
Patients and methods: In this study, we retrospectively reviewed the data of patients who were diagnosed with deep neck infection and who received treatment at the Department of Otorhinolaryngology at the ´Mother Teresa University Hospital Center´ during a two-year period between March 2023 and March 2025. 80 patients were included in our study. 15 patients with Diabetes Mellitus were compared with 65 other patients without Diabetes Mellitus in demographics, clinical features, involvement of several neck spaces, need for surgical intervention, possible complications, laboratory data and hospital stay.
Results: In the diabetic group compared to the non-diabetic group, older patient age was evidenced (mean age 56.2 vs. 37.8, p<0.001), a shorter duration of symptoms before hospitalization (4.6 days vs. 8.26 days, p=0.001), a wider involvement of neck spaces (≥3 spaces: 60% of patients in the diabetic group vs. 4.6% in the non-diabetic group, p=0.001), higher surgical intervention (80% of patients vs. 47.7%, p=0.024), higher number of complications (40% vs. 5%, p<0.001) and higher hospital stay (11.27 days vs. 4.25, p=0.002). No significant relationship was found between PCR values (14.11 ± 13.52 versus 10.44 ± 9.88 mg/dl, p=0.231) and WBC (13.27 ± 4.7 versus 14.39 ± 6.35× 109/L, p=0.447).
Conclusions: Diabetic patients tend to have deep neck infections with a more severe presentation and they have several typical characteristics compared to the non-diabetic hospitalized patients. They are older, have a tendency for infection to spread to multiple spaces, a more aggressive requirement for surgical intervention, a higher rate of complications, and a longer hospital stay. Thus, in their treatment, we must properly control diabetes, initiate antibiotic therapy as soon as possible, detect life-threatening complications early, and perform aggressive surgical treatment as soon as possible if complications occur.

https://doi.org/10.65413/XXXXXX

Background: Dental implants are now considered a predictable treatment option for tooth replacement. And before the surgical procedure, one should always think about the prosthetic part behind it. And to make this easier and more secure, surgical guides step in.
The aim of this study was to evaluate the accuracy of guided surgery planning and its role in helping us to choose the right prosthodontic system. In many cases, different factors contribute in making us choose the type of prosthetic component. In cases of cemented prosthetic selection, the loss of marginal bone is greater compared to screw-retained and that`s why we prefer to tend towards the screw-retained prosthetis.
Case report: The case presented in this report is about replacing a missing molar no. 36. After the radiographic evaluation with CBCT, the presence of the mesial roots of 36, infection and bone resorbtion is evident. After treatment of the 37, and post-extraction implant placement on 36 through a surgical guide, a personalized healing abutment is placed on it. After six months, we noticed not only zero bone deficit after implant placement but also an improvement of bone level, all this thanks to the surgical guide.
Conclusions: Thanks to the surgical guides, we can choose the right screw-retained type of prosthodontic restoration, which contributes even more in success and preserving the bone. 

https://doi.org/10.65413/XXXXXX

Introduction: Celiac disease is a chronic inflammatory autoimmune pathology of the intestine where its cornerstone is the immune reaction mediated to gluten. The disease has a prevalence of 1%-2% with an increasing trend in recent years. The inflammatory cascade that develops in the small intestine leads to progressive mucosal damage, villous atrophy and crypt hyperplasia in patients with genetic predisposition. It manifests with intraintestinal and extra-intestinal involvement, which often delays the diagnosis by exposing the patient to frequent and long-term complications. The basis of treatment is a gluten-free diet.
Methods: We describe a case with gastrointestinal and extraintestinal symptoms, which resulted in celiac disease. The diagnosis was based on laboratory, serological, and histopathological examinations, as well as the response to a gluten-free diet.
Results: A 55-year-old woman, with watery/frequent diarrhea, abdominal pain and bloating, headache for 9 days, while she had years of gastrointestinal problems, significant weight loss (35 kg in the last 2-3 years), emotional disorders. Laboratory, serological, imaging and histopathological examinations established the diagnosis of Celiac. The Anti tissue transglutaminase antibodies IgA test resulted positive, 392.9 U/mL (<20). The patient appears more stabilized and the recommended gluten-free diet enabled weight gain (46.6 kg five weeks after discharge, 50.7 kg eleven weeks, 55 kg ten months).
Conclusion: Celiac disease has numerous intra/extraintestinal manifestations, so clinicians must be vigilant in its timely identification. Proper dietary advice improves quality of life and avoids complications.


https://doi.org/10.65413/XXXXXX

Background: Peer physical examination (PPE) is a cost-effective preclinical method for learning physical examination skills, but its implementation requires careful evaluation of students’ acceptability.
Methods: We analyzed the responses of 2,085 undergraduate students of medicine and of BS programs in different health professions (mostly nursing students) to two questionnaires widely used to assess PPE acceptability: the Peer Physical Examination Questionnaire (PPEQ) and the Examining Fellow Students (EFS) questionnaire. Subscales were derived using Mokken scale analysis and Principal Component Analysis, and concurrent validity was examined.
Results: The PPEQ yielded three subscales—Emotional  (PPEQ-E, H = 0.50), Attitudinal (PPEQ-A, H = 0.68), and Concerns about Sexual Connotation (PPEQ-SC, H = 0.52). The EFS could be partitioned into Sensitive Areas (EFS-SA, H = 0.68) and Less Sensitive Areas (EFS-LSA, H = 0.59). All subscales showed good scalability and internal consistency, and were strongly intercorrelated. Each PPEQ subscale was independently associated with the EFS score after adjustment for sex and course type (p < 0.001). The subscales were able to detect differences in response patterns across sex and course type: female students reported lower emotional and attitudinal scores and higher sexual concerns on the PPEQ, and lower willingness to be examined in sensitive areas on the EFS (p < 0.001). Students of BS programs showed lower PPEQ scores than medical students, but also greater reluctance toward sensitive areas, while medical students reported fewer sexual concerns.
Conclusions: The PPEQ and EFS subscales provide complementary perspectives on students’ attitudes toward PPE. Their combined use enables a nuanced assessment of acceptability and its determinants across different student populations. These tools may support monitoring of trends over time and contribute to the design of educational activities that maximize learning benefits while minimizing discomfort.


https://doi.org/10.65413/XXXXXX

Existing preclinical and clinical evidence for nanotechnology-based therapies in the treatment of antibiotic-resistant urinary tract infections (UTIs) is reviewed in this narrative study. Antibiotic-resistant UTIs represent a growing global health concern, necessitating the development of new therapeutic approaches. This review examines the application of nanotechnology against antibiotic-resistant UTIs and the capability of nanocarrier systems to improve drug delivery, target bacterial cells, and block biofilms. Different nanocarriers, including liposomes, silver nanoparticles (AgNPs), and gold nanoparticles (AuNPs), have been investigated for their distinctive properties that improve treatment efficacy. This review also discusses the mechanisms of action of these nanostrategies, including targeted drug delivery and enhanced penetration of antimicrobial agents. Safety considerations, including cytotoxicity and genotoxicity, as well as strategies to minimize side effects, are evaluated. Future research should focus on refining these technologies to overcome antibiotic resistance, ensuring safer and more effective clinical applications in UTI management.


https://doi.org/10.65413/XXXXXX

Tuberculosis (TB) remains one of the most significant infectious diseases affecting global public health, with 8.2 million new cases reported in 2023. The burden of disease remains disproportionately high in low- and middle-income countries. The Bacillus Calmette–Guérin (BCG) vaccine currently represents the only licensed vaccine for the prevention of tuberculosis and continues to be a cornerstone of preventive strategies, particularly in protecting children against severe forms of the disease.
This article provides a comprehensive review of the global and Albanian experience with BCG vaccination, including the most recent national epidemiological data, global immunization policies, and the immunological mechanisms underlying vaccine action, with particular emphasis on the concept of “trained immunity”. In addition, it discusses the expanded therapeutic applications of BCG in oncology, as well as recent advances in TB vaccinology and future perspectives in the development of novel tuberculosis vaccines).

https://doi.org/XXXX/XXXXXXXX