To assess the availability, prices and affordability of essential medicines in Albania, focusing on a standardised set of medicines from the Global Core List (GCL), using an adapted WHO/Health Action International (WHO/HAI) methodology.

Cross-sectional survey.

30 private community pharmacies across six urban areas in Albania (Tirana, Durrës, Fier, Vlorë, Kavajë and Lushnjë).

Licensed private community pharmacies, including both contracted and non-contracted pharmacies under the national health insurance scheme.

Availability, patient prices and affordability of 14 medicines from the GCL. Affordability was assessed using the daily wage of the lowest-paid government worker (LPGW), and prices were evaluated using the median price ratio (MPR) compared with international reference prices.

The mean availability of WHO/HAI GCL medicines was 79.8%, slightly below the WHO target of 80%. In a secondary analysis that included therapeutically equivalent alternative formulations availability increased to 83.3%. Ceftriaxone, amoxicillin and salbutamol were among the least available medicines and were frequently out of stock. All medicines, except ceftriaxone, met affordability criteria based on LPGW. MPR analysis showed that while most medicines were priced competitively, some, including diclofenac and ceftriaxone, were substantially higher than international reference prices, with five medicines exceeding an MPR of 4.0. Overall, 64% of medicines met both availability and affordability thresholds.

Access to essential medicines in Albania appears to be primarily constrained by availability rather than affordability. Gaps in the availability of key antibiotics and asthma medicines highlight the need for targeted policy interventions, including improved procurement, supply chain management and rational use strategies to strengthen equitable access to essential medicines.

Current UK guidelines recommend measurement of symphyseal fundal height and measurement of maternal blood pressure and urinalysis, with the aim of detecting women at increased risk of fetal growth restriction (FGR) and pre-eclampsia. Between 2008 and 2013, we conducted a prospective cohort study recruiting 4512 nulliparous women at the Rosie Hospital, Cambridge, where we performed serial ultrasonic imaging and serial blood sampling and generated a novel screening test for pre-eclampsia and FGR. The method involved measuring the ratio of two placental biomarkers (soluble fms-like tyrosine kinase receptor-1 and placenta growth factor) at ~36 weeks of gestational age (wkGA) and combining the result with maternal characteristics and ultrasonic imaging. Women who screened positive had a ~50% risk of a composite outcome, consisting of pre-eclampsia±delivery of a baby with a birth weight

Nulliparous women with an apparently normal singleton pregnancy will be recruited at their dating ultrasound scan. Blood will be obtained at this visit, at their anomaly scan (20 wkGA), and at two research appointments (28 wkGA and 36 wkGA) when research ultrasound scans will be performed. Blood for DNA will be obtained from the father of the baby where possible and the placenta will be sampled following birth. At 36 wkGA, women will be consented for participation in the randomised controlled trial (RCT) element of the study and their risk of term pre-eclampsia and FGR will be assessed using the novel approach. Women who screen high-risk will then be randomly allocated to either having the result revealed or masked. Women randomised to having the result revealed will be offered early delivery and/or enhanced monitoring. Where the result is masked, there will be no communication between the research team and the participant, and she will continue to receive routine care at the Rosie Hospital. The primary outcome is a composite of pre-eclampsia, FGR and perinatal morbidity and mortality. The study will also generate data and biological samples to support future research in novel screening methods and disease mechanisms.

The study received ethical approval from the East of England Research Ethics Committee. All women provide written informed consent to participate in the cohort. Women provide a second written informed consent to participate in the RCT. The study results will be disseminated by presentation at international conferences and publication in peer reviewed journals.

ISRCTN1218142.

Acne vulgaris is a chronic inflammatory condition primarily caused by Cutibacterium acnes, which disrupts skin homeostasis, thereby triggering immune responses and sebum metabolism. Dysbiosis is an imbalance in the skin and gut microbiota identified as a significant factor contributing to acne progression. Standard therapy often relies on antibiotics, but the long-term use has increased antibiotic resistance, including in Indonesia. Consequently, alternative methods, such as probiotics and mesenchymal stromal cell secretomes, are gaining attention for immunomodulatory and regenerative properties. These novel therapies have shown promising results in modulating the skin and gut microbiota while reducing inflammation.

A phase 2 double-blind randomised controlled trial will be conducted using a parallel group design with four arms, namely: (1) standard therapy with oral probiotics and topical secretome (placebo), (2) standard therapy with oral probiotics (placebo) and topical secretome, (3) standard therapy with oral probiotics and topical secretome and (4) standard therapy with oral probiotics (placebo) and topical secretome (placebo). Sixty-four patients with mild to moderate acne vulgaris will be randomly allocated to these groups. Interventions will be administered over a period of 8 weeks, with outcomes to be measured at baseline and post-therapy. This study will be conducted at the Dermatology and Venereology Department of Bali Mandara General Hospital (RSBM). The primary outcome will be the reduction of comedones and inflammatory lesions, assessed using the Yolov8 method. Secondary outcomes will include gut and skin health parameters, such as tryptophan metabolites, collagen, pH, moisture, sebum levels and IL-6, to explore the relationship between microbiome balance, skin condition and inflammation in acne.

This study will be conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and the International Conference on Harmonisation–Good Clinical Practice guidelines. Ethical approval has been granted by the Health Research Ethics Committee of Bali Mandara Regional Hospital (Approval Reference Number: 060/EA/KEPK.RSBM.DINKES/2024). All participants will provide written informed consent prior to enrolment. Data confidentiality and participant safety will be upheld throughout the trial. The results of this study will be disseminated through journals, scientific conferences and relevant academic platforms to ensure wide accessibility and to support further research and clinical application in the field of dermatology, particularly in addressing antibiotic resistance and microbiome-based acne therapies.

NCT06925386.