Introduction: Severe traumatic brain injury is characterized by pathological external forces that disrupt or alter brain function. Globally, an estimated 50 million cases of Severe traumatic brain injury occur annually. Case presentation: This case study of an 18-year-old male patient, who suffered severe TBI in a motor vehicle accident, provides a valuable insight into the management of such cases. The patient's initial assessment revealed a Glasgow Coma Scale score of 8, asymmetric but reactive pupils, and bilateral motor strength of 3/5, with no abnormalities noted in the cranial nerves. Primary diagnosis by CT scan: severe traumatic brain injury with acute subdural hematoma in the right frontoparietal-temporal region, brain edema, and midline dislocation. Secondary findings: Acute epidural hematoma in the left frontoparietal-temporal region. Associated injuries: skull fractures, soft tissue contusions, and left lung contusion. Surgical Procedures: The patient underwent the following procedures: 1. Right decompressive craniotomy for acute subdural hematoma. 2. Left decompressive craniotomy for acute epidural hematoma. Conclusion: This case underscores the pivotal role of decompressive craniotomy in managing severe traumatic brain injury. Over the past two decades, this procedure has been instrumental in reducing secondary brain injury, enhancing cerebral perfusion, and managing elevated intracranial pressure. It has also been shown to decrease both mechanical ventilation dependence and intensive care unit length of stay, providing reassurance about its effectiveness.

Introduction: Successful endodontic therapy requires complete mechanical and chemical preparation of the root canal system, followed by three-dimensional obturation. Inadequate obturation, despite proper cleaning and shaping, may lead to treatment failure. This study aims to compare the obturation length achieved using the GuttaFlow®2 and Thermafill systems, evaluating their effectiveness through micro-computed tomography (micro-CT). Materials and Methods: Eighty extracted human anterior teeth were decoronated 1 mm below the cementoenamel junction and randomly assigned to two groups. Group 1 (n=40) was obturated with GuttaFlow®2 (Coltene/Whaledent, Germany), and Group 2 (n=40) with Thermafill (Dentsply DeTrey, Germany). All samples were scanned using a cone-beam micro-CT system (μCT 35, SCANCO Medical, Switzerland) to assess the length and quality of canal obturation. Results: Statistical analysis using the Kruskal-Wallis ANOVA test (H=4.0383, p=0.2574) showed no significant difference in obturation length between the two groups. Both cold (GuttaFlow®2) and warm (Thermafill) techniques achieved optimal filling lengths, indicating that obturation quality is not significantly influenced by the type of material or technique. Conclusion: Both GuttaFlow®2 and Thermafill systems are effective in achieving the desired obturation length. The choice between warm and cold obturation techniques may be based on clinician preference, as neither demonstrated superiority in this study.

Introduction: Total pancreatectomy with islet auto-transplantation is a realistic therapeutic choice and an advanced surgical operation for individuals with chronic pancreatitis. The primary purpose of total pancreatectomy with islet auto-transplantation is to alleviate the debilitating pain caused by chronic pancreatitis and thereby significantly improve the quality of life of patients with chronic pancreatitis. Although the permanent loss of the function of the pancreatic endocrine occurs due to total pancreatectomy, it may be substituted by autologous transplantation of islets. Patients receiving total pancreatectomy and Islet Transplantation may be less dependent on insulin than patients receiving total pancreatectomy. This process, although not without some difficulties, has consistently demonstrated promising results in reducing pain, improving glycemic control, mitigating diabetic complications, and enhancing the overall quality of life in patients with chronic pancreatitis. In this article, we review the global experience with Total pancreatectomy with islet auto-transplantation and examine the prospects for its implementation in the Albanian health system. They can alleviate the burden of chronic pancreatitis, improve patients' prognosis, and enhance the country's healthcare system capacity. However, the introduction will also necessitate a strategic transformation of infrastructure, training, and health policy, which is discussed below. Conclusions: Total pancreatectomy with islet auto-transplantation is a novel, effective treatment option for patients with recurrent acute pancreatitis and those with chronic pancreatitis. Its implementation in Albania, while promising, necessitates strategic reforms in infrastructure, training, and health policy. However, if constructed as a secondary project with the aim of institutional support, these reforms can significantly increase the quality of care for patients with chronic pancreatitis in our country.

Introduction: Celiac disease, or celiac sprue, is a T cell-mediated autoimmune disorder of the small intestine triggered by ingesting dietary gluten products in genetically susceptible individuals. The pathologic mechanism involves an immune response targeting gluten peptides, leading to inflammation, villous atrophy, and malabsorption in the small intestine. This research is a significant step in understanding the mechanisms of how CD4+ T cell (white blood cells that are an essential part of the human immune system) responses against gluten can lead to autoreactive B-cell responses and tissue destruction mediated by intraepithelial cytotoxic T cells in the small intestine. Your work in this field is crucial in advancing our understanding and managing celiac disease. It also discusses the overexpression of IL-15 on enterocytes in active celiac disease. This overexpression of IL-15 is believed to contribute to the pathogenesis of the condition by promoting the survival and activation of intraepithelial lymphocytes, leading to tissue damage. It addresses challenges in understanding specific phenotypes of celiac disease, such as slow-responsive, potential, and seronegative forms. These forms of the disease present unique diagnostic and management challenges, often requiring a multidisciplinary approach for effective treatment. Conclusion: The articles provide valuable insights into the cellular mechanisms underlying celiac disease, the immune responses involved, and the impact of gluten on intestinal cells. They also address the practical implications of this knowledge, such as the significance of dietary management in controlling the disease and preventing complications. This research empowers you, the reader, with actionable information that can make a real difference in the lives of those affected by celiac disease.

Background: Silver diamine fluoride (SDF) represents one of the most effective agents for the non-invasive management of dental caries, particularly in pediatric patients, where conventional treatment approaches often present significant challenges. The aim is to present our clinical experience in the non-invasive management of dental caries in preschool-aged children through the application of silver diamine fluoride (SDF) solution. Materials and Methods: This study involved 16 children, aged between 2 and 6 years, who were diagnosed with dental caries. All participants were managed using a non-invasive approach through the topical application of silver diamine fluoride (SDF) solution, aiming to arrest carious lesions and reduce the need for conventional restorative treatment, which can often be challenging in this age group. Results: All children were treated with a silver diamine fluoride (SDF) solution using a specialized applicator. In ten cases, the outcomes were highly satisfactory following the initial application. In five children, however, a second application was required after three months due to suboptimal results. Among these, only one child demonstrated insufficient improvement, necessitating a third application six months later. Conclusion: The findings of our study, consistent with those of numerous other investigations, unequivocally demonstrate that silver diamine fluoride (SDF) is a highly effective agent for both treating and preventing dental caries in preschool children. This success should instill confidence in the dental community about the potential of SDF in managing dental caries.

Introduction: Glomus tumors (GT) are sporadic mesenchymal neoplasms found in adults, comprising less than 2% of soft tissue tumors. GT originates from glomocytes, which are modified vascular smooth muscle cells located in the walls of specialized structures of the glomus body—a neuromyoarterial plexus in the dermis of the skin that typically plays a role in thermoregulation. Most GTs are benign, though some cases exhibiting atypical or malignant behavior have been documented. GT usually occurs in the skin and superficial soft tissues, primarily in the extremities, especially beneath the nail bed, and rarely affects internal organs; however, those organs lack glomus bodies. The occurrence of GT in the urinary bladder, which does not contain glomus bodies, is an infrequent occurrence and has been reported sporadically. The gene implicated in the pathogenesis of bladder GT is the glomulin gene (GLMN), situated on chromosome arm 1p21-22. Multiple subungual granular tumors (GTs) have been reported in neurofibromatosis type 1, originating from a mutation in the NF1 gene. The first case of benign GT of the urinary bladder was described by Tripodi SA et al. in 2013, while malignant GT of the urinary bladder was described by Shim HS et al. in 2005. Depending on the relative prominence of glomus cells, vascular structures, and smooth muscle, the GTs are subcategorized: Solid histotype, Glomangioma, and Glomangiomyoma. In this study, we report a case of benign GT of the urinary bladder in a 63-year-old man presenting with recurrent hematuria of unknown etiology. The cystoscopy showed a polypoid lesion at the anterior wall of the urinary bladder. The transurethral resection was performed, and the lesion was easily removed. In the microscopic examination of the biopsy, the final pathological diagnosis was a benign glomus tumor of the urinary bladder – a solid histotype. After resection of GT, the patient was followed according to standard follow-up protocol for patients with bladder tumors. One year after resection, the patient was in good health, with no recurrence or metastasis, demonstrating the successful treatment and follow-up of this rare case. Conclusions: GTs arising in the bladder are extremely rare. It is challenging to diagnose bladder GTs based on their clinical features. The gold standard method for diagnosing GT is histopathological examination and immunohistochemical analysis. Transurethral resection is the most common treatment used for benign or atypical bladder GT. However, it should also be considered in the differential diagnosis for Bladder neoplasms.

Background: Aortic valve surgery is the most essential part of worldwide heart valve surgery. In recent decades, the patient profile has changed even in our country, with the age of patients undergoing aortic valve surgery increasing significantly. The primary objectives of this study are the early results of aortic valve replacement surgery in patients over 75 years old and the negative predictors that affect hospital mortality. Materials and Methods: This is a retrospective study of 73 patients over 75 who underwent aortic valve surgery in 2014-2021 in our Cardiac Surgery Service, University Hospital Center “Mother Theresa” in Tirana. The patients' data regarding demographic, preoperative, operative, and postoperative variables were collected from the hospital's medical records. The data are presented in mean values and standard deviation. T-test and chi-squared test are also used. Results: This study involved 73 patients, 50 males and 23 females. The age range was 75-85, averaging 77.12±2.31 years. Hospital mortality was 4.1%. The incidence of major perioperative complications such as low cardiac output, stroke, respiratory problems, bleeding, atrial fibrillation, wound infection, and conduction disturbances was 6.8%, 2.7 %, 4.1%, 2.7 %, 21.9 %, 2.6%, and 4.2 %. Conclusions: Aortic valve surgery for elderly patients over 75 can be performed well. Concomitant procedures, prolonged extracorporeal circulation, and emergency intervention expose the patient to a high operative risk.

Introduction: The thymus gland plays a pivotal role in immune system regulation, but conditions such as thymic hyperplasia (TH) and thymoma pose distinct clinical challenges due to their rarity and complex presentation in surgical practice. Both conditions can mimic similar symptoms, particularly in patients with Myasthenia Gravis (MG), where surgery serves as both a diagnostic and therapeutic intervention. This report presents the surgical management and outcomes of two MG patients with distinct thymic pathologies: TH and Type B thymoma, alongside a review of the relevant literature. Two MG patients were referred to our clinic for surgical intervention. The first patient underwent a standard sternotomy for the resection of TH, while the second patient underwent a mini-sternotomy for thymectomy targeting a Type B thymoma. Both procedures were completed successfully with uneventful postoperative courses. Surgical resection remains the gold standard for the treatment and definitive diagnosis of thymic gland abnormalities. Advances in surgical techniques, including minimally invasive approaches, offer excellent outcomes with reduced morbidity, providing a viable alternative to traditional methods. Conclusion: The cases underscore the critical role of surgical intervention in managing thymic pathologies in MG patients. Both traditional and minimally invasive techniques yield excellent clinical outcomes, reinforcing their importance in the treatment paradigm for thymic hyperplasia and thymoma. Further studies are needed to refine surgical approaches and optimize patient outcomes.

Introduction: Postoperative myocardial infarction (PMI) is a severe complication after cardiac surgery, significantly impacting patient outcomes. Acute PMI after cardiac surgery is an infrequent event that can evolve rapidly and become a potentially life-threatening complication. Multiple factors are associated with acute PMI after cardiac surgery and may vary by the type of surgical procedure performed. Although the criteria defining nonprocedural myocardial ischemia are well established, there are no universally accepted criteria for diagnosing acute PMI. This retrospective study analyzed 600 patients who underwent cardiac surgery at a single center over one year. The incidence, diagnosis, and management of PMI were evaluated, focusing on diagnostic methods, therapeutic interventions, and the role of intra-aortic balloon pumps (IABPs). Our findings provide insights into the anesthesiologist’s role in identifying and managing PMI, highlighting strategies to reduce morbidity and mortality in this high-risk population. Conclusions: Early detection and tailored management of PMI are vital to reducing complications. Anesthesiologists and intensive care teams are key in optimizing outcomes through advanced support measures like intra-aortic balloon pumps. These findings, which provide practical insights to enhance perioperative care, empower us to manage this high-risk population better.