International Journal of Innovative Technologies in Social Science

A REVIEW OF PHARMACOLOGICAL ADVANCES IN THE MANAGEMENT OF GERD, 2015-2025

2026-01-06T19:38:43+00:00

Background: Gastroesophageal reflux disease (GERD) remains one of the most prevalent gastrointestinal disorders worldwide. Between 2015 and 2025, advances in understanding its multifactorial pathophysiology have driven significant changes in pharmacological management.

Aim: This review summarizes key developments in GERD pathophysiology and evaluates significant pharmacological advances from 2015 to 2025, including comparative safety profiles, limitations of current therapies, and emerging treatment directions.

Methods: A structured search of PubMed, Google Scholar, and major open-access databases was performed using keywords related to GERD, pathophysiology, proton pump inhibitors, P-CABs, prokinetics, neuromodulators, and novel therapies.

Results: Proton pump inhibitors remain first-line therapy but show variable efficacy in non-erosive disease and refractory symptoms. Newer agents such as potassium-competitive acid blockers, modern prokinetics, alginate-based formulations, neuromodulators, and mucosal protectants offer therapeutic benefits in selected phenotypes. Comparative analyses highlight the importance of optimizing long-term PPI use and monitoring potential adverse effects. Advances in diagnostics and improved understanding of sensory and functional mechanisms have enabled more individualized treatment strategies.

Conclusions: Pharmacological management of GERD has evolved substantially over the past decade, shifting toward mechanism-based and patient-specific therapy. Future progress will depend on integrating high-resolution diagnostics, refining reflux phenotypes, and developing novel treatments that target mucosal integrity, hypersensitivity, and non-acid reflux.

DIAGNOSIS, TREATMENT AND SOMATIC MANIFESTATION OF ENDOMETRIOSIS: AN UPDATED REVIEW

2026-01-09T19:37:34+00:00

Endometriosis is a chronic gynecological condition affecting millions of women worldwide. It involves the growth of endometrial-like tissue outside the uterine cavity, which leads to significant symptoms and a marked decline in quality of life.

The aim of the Study: The purpose of this work is to present the most recent knowledge on the diagnosis, treatment methods, and somatic symptoms of endometriosis. The analysis covers publications from 2020 to 2025 and focuses on evaluating current medical approaches as well as identifying areas that require further development to improve prognosis and the daily functioning of patients.

Materials and Methods: A structured search of publications from 2020–2025 was conducted in the PubMed and Google Scholar databases using keywords related to diagnostic methods, therapeutic options, and the somatic and psychosomatic symptoms of endometriosis.

Results: Our review highlights that while invasive laparoscopy remains the diagnostic gold standard for endometriosis, advanced imaging techniques like transvaginal ultrasound and MRI are increasingly crucial, particularly for deep infiltrative disease. Despite these tools, significant diagnostic delays persist due to non-specific symptoms and the lack of sensitive non-invasive biomarkers. Current treatments involve hormonal therapies and surgical removal of lesions, but these approaches face challenges such as side effects, recurrence risks, and complications. Crucially, endometriosis is recognized as a multisystem disorder with diverse somatic manifestations including gastrointestinal, urinary, and systemic symptoms like chronic fatigue, alongside significant mental health impacts and increased risks for conditions such as cardiovascular disease and certain cancers

Conclusions: The collected data indicate that endometriosis is a multisystem disorder, and its effective management requires collaboration among specialists from various fields. Such an approach enables better tailoring of therapy and improved symptom control. A major challenge remains the long diagnostic delay, which still ranges from several to more than ten years. Advances in modern imaging techniques and the development of sensitive biomarkers may substantially shorten this period and allow earlier intervention.

ALTERNATIVES TO STATINS IN THE TREATMENT OF HYPERCHOLESTEROLEMIA

2026-01-09T19:46:26+00:00

Hypercholesterolemia is one of the main modifiable risk factors for cardiovascular disease. Elevated levels of LDL (low-density lipoprotein) cholesterol lead to the development of atherosclerosis and cardiovascular complications. Statins are the mainstay of hypercholesterolemia therapy, but in some patients, therapeutic goals are not achieved or side effects occur. It is necessary to develop alternatives to statins for the treatment of hypercholesterolemia. Drugs that act on other stages of cholesterol synthesis are being sought. Publications covering observational studies, randomized controlled trials (RCTs), and meta-analyses on alternative therapies for hypercholesterolemia to statin treatment were analyzed. The following were described: cholesterol absorption inhibitor (ezetimibe), ATP citrate lyase inhibitor (bempedoic acid), PCSK9 inhibitors (evolocumab, alirocumab) , siRNA against PCSK9 (inclisiran), ANGPTL3 inhibitors (evinacumab), ANGPTL4, ANGPTL8 and ANGPTL3/8 complex inhibitors, fibrates and nutraceuticals (plant sterols, fermented red yeast rice extract (Red Yeast Rice, RYR) , berberine). The impact of these drugs on patients' lipid profiles and cardiovascular risk was discussed. Attention was also drawn to the need for individualization of hypercholesterolemia therapy.

Aim of this study: The objective of this study is to summarize the latest reports on alternative therapies for hypercholesterolemia to statins.

Materials and methods: A literature review was conducted using the professional PubMed database. Searches included combinations of the keywords: “hypercholesterolemia,” “ezetimibe,” “bempedoic acid,” and “PCSK9 inhibitors.”

HIRSCHSPRUNG'S DISEASE- DIAGNOSIS, TREATMENT AND NEW THERAPEUTIC STRATEGIES

2026-01-09T19:56:12+00:00

Hirschsprung's disease (HD, HSCR) is a congenital disorder of intestinal motility characterized by aganglionosis. It is the absence of ganglion cells in the nerve plexuses of the large intestine. It leads to peristalsis disorders and functional obstruction. The disease most often manifests itself in the neonatal period as delayed meconium passage, abdominal distension, vomiting, and symptoms of obstruction. Confirmation of the diagnosis requires a rectal biopsy with histopathological evaluation. Treatment consists of surgical removal of the aganglionic segment of the intestine and restoration of the continuity of the gastrointestinal tract. The choice of surgical method depends mainly on the surgeon's preference and the experience of the center. A common complication is Hirschsprung-associated enterocolitis (HAEC), which may occur before or after surgery. Research is currently underway on the use of cell therapy in the treatment of HD. The review presents the epidemiology, pathogenesis, diagnosis, and current therapeutic strategies for Hirschsprung's disease, with particular emphasis on recent reports from the scientific literature. We highlight also new directions in research and therapeutic perspectives.

Aim of this study: The objective of this study is to summarise the latest information on Hirschsprung's disease, including research on cell therapies and treatments aimed at tissue regeneration.

Materials and methods: A literature review was conducted using the professional PubMed database. Articles published between 2018 and 2025 were included. The searches included combinations of the keywords: “Hirschsprung's disease,” “pediatric surgery,” “aganglionosis,” and “stem cell therapy”.

WEARABLE TECHNOLOGIES IN HEALTH MONITORING: EFFECTIVENESS IN PREVENTING LIFESTYLE DISEASES

2026-01-10T14:00:04+00:00

Research objectives: This comprehensive systematic review and meta-analysis aims to critically evaluate the clinical evidence on the effectiveness, feasibility, and cost-effectiveness of wearable technologies in health monitoring and the prevention of lifestyle diseases between 2020 and 2024.

The study focuses on two main pillars of innovation: devices for monitoring physical activity and health parameters (smartwatches, fitness bands, continuous glucose monitors) and artificial intelligence (AI)-based data analysis systems that enable early risk detection and personalization of health interventions.

In addition, the review analyzes the ethical, legal, social, and implementation (ELSI) barriers that must be overcome to enable the large-scale implementation of wearable technologies in healthcare systems.

Methods: A scoping review of scientific literature was conducted in databases including PubMed, Scopus, and Google Scholar, using inclusion criteria that included randomized controlled trials (RCTs), systematic reviews, and meta-analyses published from January 2020 to July 2024.

Seven key meta-analyses and twenty RCTs were analyzed in detail, focusing on effect sizes (Hedges' g, standardized mean difference - SMD), adherence rates, and impact on clinical endpoints. The risk of systematic error and regulatory frameworks were also assessed.

Main results: Wearable technologies showed moderate to high effectiveness in monitoring health parameters and modifying health-related behaviors. A meta-analysis of interventions using wearable devices to monitor physical activity showed a statistically significant increase in the number of steps per day (weighted mean difference: 1519 steps/day, 95% CI 1096-1942) and moderate to large effect sizes (SMD = 0.449) compared to control groups (Hodkinson et al., 2021; Tang et al., 2020).

Continuous glucose monitoring (CGM) has shown particularly high effectiveness in diabetes control. A meta-analysis of 15 RCTs (2,461 patients) showed a significant reduction in HbA1c (weighted mean difference: -0.17%, 95% CI -0.29 to -0.06) and an increase in time in range (TIR) of 70.74 minutes (95% CI 46.73-94.76) compared to standard care (Maiorino et al., 2020).

The main barriers included: problems with measurement accuracy in real-world settings, user fatigue leading to low long-term adherence, protection of health data privacy, and lack of standardization and interoperability between devices and EHR (electronic health record) systems.

Conclusions: Wearable technologies are becoming an integral part of preventive medicine and chronic disease management. The future lies in blended care models that combine continuous health monitoring with AI predictive algorithms and clinical oversight.

Long-term RCT studies (≥12 months) and a clear regulatory framework regarding the accuracy of medical devices, data collection ethics, and legal liability must be established before widespread implementation in healthcare systems.

OMEGA-3 FATTY ACIDS: CAPSULES OR OIL? COMPARISON OF STABILITY, BIOAVAILABILITY AND EFFECTIVENESS OF EPA AND DHA SUPPLEMENTATION

2026-01-13T14:16:59+00:00

Omega-3 fatty acids, primarily eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), play a key role in human health, including protection of the cardiovascular system, support for neurological functions, and influence on anti-inflammatory processes. Despite the known importance of their consumption, the quality and form of supplementation (oil vs. capsules) are raising increasing doubts. One important aspect is the stability of these polyunsaturated fatty acids, as their susceptibility to oxidation may reduce their effectiveness or even lead to the formation of adverse products. In this context, the total oxidation index (TOTOX) is a commonly used marker for assessing the degree of oxidation of fish oils and omega-3 supplements. This article provides a comprehensive review of the scientific literature comparing oil and capsule forms of omega-3 supplements, taking into account criteria such as oxidative parameters (TOTOX, peroxide value, anisidine value), bioavailability, and user preferences. The results indicate that capsules often offer better protection against oxidation during storage (lower TOTOX values) compared to liquid forms. For example, syrup products achieved TOTOX values of ~97 meq/kg at the end of the study, while capsules achieved ~30 meq/kg under similar conditions. In addition, the bioavailability of EPA/DHA depended on the chemical form (triglycerides > ethyl esters) and the delivery system — emulsions or liquid forms showed faster absorption than traditional gel capsules.

Based on the data collected, it can be concluded that the choice of omega-3 supplement form should take into account not only the EPA/DHA content, but also the oxidative quality, chemical form, and storage method. For dietary practice, products with a low TOTOX index, adequately protected from light and oxygen, and taken with a meal containing fat to increase absorption are recommended.

THE IMPACT OF ARTIFICIAL INTELLIGENCE (AI) INNOVATIONS IN CARDIOLOGY: A COMPREHENSIVE REVIEW OF CLINICAL EFFECTIVENESS, ETHICAL CHALLENGES, AND SOCIO-SYSTEMIC IMPLICATIONS

2026-01-12T14:43:31+00:00

The aim of this review article is to provide an in-depth analysis of the current state of knowledge on the use of Artificial Intelligence (AI) in cardiology. We place particular emphasis on actual clinical effectiveness and the technological, ethical and social consequences of its implementation in healthcare systems. The review is based on carefully selected literature from 2018–2025, which was searched in the PubMed, Scopus and Web of Science databases, focusing on four key dimensions: technology, clinical practice, ethics and healthcare systems. AI (ML, DL) algorithms offer revolutionary potential in diagnostics (e.g., LVEF automation) and risk prediction (e.g., identification of hidden phenotypes in ECG). However, their implementation has often stalled due to critical non-clinical barriers. Among these, we identified: the problem of Explainability (XAI), which undermines legal accountability (especially with adaptive SaMD models); Algorithmic Bias, resulting from underrepresentation of training data, carrying the risk of exacerbating health inequalities (Health Equity); as well as serious systemic obstacles related to the need for continuous regulatory oversight (e.g., AI Act) and staff retraining. In order for us to reap the medical benefits of AI in a fair and safe manner, we urgently need policy recommendations on model validation across diverse cohorts, the development of transparent XAI architectures (rather than post-hoc methods), and the creation of flexible regulatory frameworks and educational programmes at the system level.

METHODS OF TREATMENT FOR STRESS URINARY INCONTINENCE (SUI): A REVIEW OF CURRENT RESEARCH

2026-01-16T05:37:33+00:00

Research objectives: This study aims to provide a comprehensive analysis of treatments for Stress Urinary Incontinence (SUI). Through a detailed discussion and review of the evidence, we examine conservative, pharmacological, and surgical approaches, highlighting their therapeutic benefits. This review also synthesizes the current literature to summarize the advantages and limitations of each method in relation to specific patient groups.

Methods: A literature search was conducted in PubMed and Google Scholar, with emphasis on publications from 2015-2025. The search strategy included terms such as ‘stress urinary incontinence’, ‘pessary’, ‘surgical intervention’, and ‘treatment choice’.

Key findings and conclusions: Stress urinary incontinence (SUI) is a common condition affecting women across a wide range of ages. Effective management requires an individualized approach in which the therapeutic method is selected based on the severity of symptoms, the patient’s anatomical characteristics, coexisting chronic diseases, reproductive plans, and personal expectations regarding treatment outcomes.

First-line therapy for SUI consists of conservative methods, including pelvic floor muscle training, behavioral modification, weight reduction, pessary use, and topical estrogen therapy in postmenopausal women. Although the benefits of duloxetine have been demonstrated, its clinical utility is limited by adverse effects and contraindications during pregnancy, resulting in a restricted role for pharmacotherapy in SUI management. When conservative treatment fails to provide adequate improvement, surgical intervention should be considered. Current evidence supports the mid-urethral sling (MUS) as the preferred surgical method due to its long-term effectiveness and favorable safety profile. MUS has largely replaced earlier techniques such as Burch colposuspension, although the latter may still offer advantages in selected patient groups.

In summary, the treatment of SUI encompasses a wide range of therapeutic options, each with distinct benefits and limitations. Therefore, shared decision-making that incorporates the patient’s medical characteristics and individual preferences is crucial for achieving optimal treatment outcomes.

CHRONIC STRESS AS A MODULATOR OF THE IMMUNE SYSTEM: NEUROENDOCRINE MECHANISMS, IMMUNOLOGICAL PATHWAYS AND CLINICAL CONSEQUENCES - A LITERATURE REVIEW

2026-01-17T20:08:40+00:00

Chronic stress is a significant factor influencing human immune system functioning. Prolonged activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system leads to hormonal and immunological dysregulation (Glaser & Kiecolt-Glaser, 2005; Segerstrom & Miller, 2004). Consequently, immune cells become less sensitive to glucocorticoids, cytokine balance is disrupted, and the organism remains in a state of chronic low-grade inflammation. These changes increase susceptibility to infections, delay wound healing, weaken vaccine responses, and may exacerbate the course of chronic diseases, including autoimmune and inflammatory disorders (Segerstrom & Miller, 2004; Alotiby, 2024).

This review presents current data from clinical and immunological studies published between 2000 and 2025. Molecular and cellular mechanisms are discussed, including HPA axis dysfunction, excessive sympathetic activity, cytokine profile alterations, and changes in innate and adaptive immunity. Attention is given to populations particularly vulnerable to chronic stress and the clinical consequences of these dysregulations (Katz et al., 2025; Chan et al., 2023; Bolton, 2024).

The review also considers strategies to mitigate stress-related immune impairment, such as mindfulness and meditation, regular physical activity, cognitive-behavioral therapy, and sleep hygiene improvement (Black & Slavich, 2016; Creswell et al., 2012; Carlson et al., 2007; Nieman & Wentz, 2019). Understanding these mechanisms may support clinical practice by enabling better identification of high-risk patients and the implementation of effective interventions.

THE ANTIDEPRESSANT EFFECTS OF PHYSICAL ACTIVITY: NEUROBIOLOGICAL MECHANISMS AND PSYCHOSOCIAL MECHANISMS

2026-01-18T02:22:48+00:00

Background: Depression is a leading cause of disability worldwide, affecting millions and imposing significant personal, social, and economic burdens. While pharmacological and psychotherapeutic interventions are standard treatments, physical activity has emerged as a promising complementary or alternative strategy.

Methods: A comprehensive literature review was conducted of peer-reviewed studies published between 2000 and 2025, including randomized controlled trials, meta-analyses, and observational research. Populations examined included adolescents, adults, and older adults. Data extraction focused on depressive symptom outcomes, exercise modalities, intervention duration and intensity, and underlying neurobiological and psychosocial mechanisms.

Results: Evidence consistently indicates that regular physical activity, particularly aerobic and combined aerobic–resistance exercise, produces moderate to large reductions in depressive symptoms. Mechanistically, exercise enhances brain-derived neurotrophic factor (BDNF) expression, modulates monoaminergic neurotransmission, regulates the hypothalamic–pituitary-adrenal (HPA) axis, and reduces systemic inflammation. Psychosocial benefits, including behavioral activation, increased self-efficacy, and social engagement, further support sustained mood improvement. Combined interventions often yield the greatest effect, integrating biological, psychological, and social pathways.

Conclusion: Physical activity is a safe, accessible, and effective intervention for depression, with benefits extending beyond symptom reduction to improved cognitive function, stress resilience, and overall well-being. Incorporating structured exercise into standard treatment protocols may optimize clinical outcomes and support long-term mental health across diverse populations.

COMPARATIVE EFFECTIVENESS OF PAIN-RELIEF METHODS DURING LABOUR: A LITERATURE REVIEW

2026-01-18T02:42:56+00:00

Effective management of labour and childbirth pain is one of the goals of modern obstetric care. This review compares the effectiveness of pharmacological and non-pharmacological methods of pain relief during labour and childbirth, based on recent randomized controlled trials, meta-analyses, and systematic reviews.

Epidural and combined spinal-epidural techniques provide the most profound and reliable pain relief with high maternal satisfaction, although they prolong the second stage of labour and require specialist monitoring. Systemic opioids – pethidine, fentanyl, and remifentanil – offer moderate analgesia; updated remifentanil protocols have improved safety and maternal autonomy where neuraxial services are limited. Nitrous oxide remains a safe, reversible alternative with limited efficacy.

Among non-pharmacological methods, evidence supports hydrotherapy, massage, acupuncture, acupressure, transcutaneous electrical nerve stimulation (TENS), relaxation and breathing techniques, and continuous emotional support. Emerging data highlight the benefits of sterile water injections for lower-back pain, as well as music therapy, mindfulness, virtual reality, peanut-ball positioning, aromatherapy, and thermal therapy as safe and complementary methods of relieving labour pain. These methods enhance maternal comfort and satisfaction and reduce anxiety and perceived pain intensity.

Comparative evidence confirms that no single intervention is universally superior. A multimodal, individualized approach that integrates pharmacological precision with supportive, behavioural, and sensory-based techniques offers the most effective pathway for improving maternal experience during labour.

LITHIUM AND ALZHEIMER’S DISEASE: NEUROBIOLOGICAL MECHANISMS, ETHICAL IMPLICATIONS, AND SOCIAL PERSPECTIVES ON COGNITIVE AGING

2026-01-19T18:36:42+00:00

Alzheimer’s disease is a progressive, idiopathic neurodegenerative disorder characterized by the accumulation of amyloid plaques, tau tangles, and synaptic degeneration. Its global prevalence continues to rise, posing significant challenges for healthcare systems and aging societies. Despite recent advances in disease-modifying treatment, such as monoclonal antibodies (donanemab, lecanemab, aducanumab), their high cost, limited efficacy, and risk of adverse effects underline the urgent need for therapies that are safe, effective, and economically accessible.

This review evaluates the role of lithium a long-established mood stabilizer in the prevention and modulation of Alzheimer’s disease. Drawing from preclinical studies, observational data, and early-phase clinical trials published between 2017 and 2025, it examines how lithium influences key pathological mechanisms including amyloid precursor protein processing, tau phosphorylation, oxidative stress, neuroinflammation, and synaptic plasticity. Chronic exposure to low or trace doses has been associated with delayed cognitive decline and reduced disease incidence in several populations. However, evidence from randomized trials remains inconclusive, warranting further rigorous investigation.

In addition to biological mechanisms, this review explores ethical and social dimensions of lithium use in older adults, including questions of informed consent, adherence, age-related pharmacokinetics, and the stigma of psychiatric medication.

Lithium emerges as a biologically plausible, cost-effective, and potentially scalable strategy for addressing cognitive aging. Future directions require ethically sound, large-scale clinical trials and a broader public health dialogue on the integration of preventive pharmacotherapy into neurodegenerative disease management.

PREVENTION OF SURGICAL SITE INFECTIONS: A COMPREHENSIVE REVIEW OF GUIDELINES AND SCIENTIFIC EVIDENCE (2017–2025)

2026-01-19T19:50:53+00:00

Surgical site infections (SSIs) remain one of the most significant challenges in modern medicine, representing a major cause of patient morbidity, prolonged hospitalization, and increased healthcare costs in medical institutions. This issue deserves particular attention due to the possibility of preventing adverse outcomes through the implementation of standardized, evidence-based preventive measures approved by international health authorities. This narrative review examines recommendations aimed at reducing the incidence of SSIs based on publications indexed in major scientific databases, along with guidelines issued by the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), European Centre for Disease Prevention and Control (ECDC), and the National Institute for Health and Care Excellence (NICE). The article focuses on perioperative recommendations, categorized as preoperative, intraoperative, and postoperative, while considering both the strength of evidence and areas of consistency or divergence among these guidelines. Researchers worldwide generally agree on the most essential preventive strategies, including proper timing of antimicrobial prophylaxis, the use of chlorhexidine-based antiseptics, maintenance of normothermia and glycemic control, and avoidance of unnecessary hair removal. However, differences persist in certain preventive components, such as the use of advanced wound dressings, intraoperative oxygen supplementation, and mechanical barriers, highlighting the need for further discussion and harmonization of global standards. The review emphasizes the importance of implementing these guidelines in clinical practice and identifies unresolved issues requiring additional research. Strengthening education among healthcare professionals and ensuring adherence to correct perioperative practices under expert supervision will undoubtedly contribute to improved surgical outcomes and reduced infection-related complications worldwide.

THE INVISIBLE BURDEN: A COMPREHENSIVE REVIEW OF PSYCHOLOGICAL ASPECTS IN PATIENTS WITH ANKYLOSING SPONDYLITIS

2026-01-20T00:37:58+00:00

Ankylosing Spondylitis (AS) is a chronic, inflammatory rheumatic disease primarily affecting the axial skeleton. While the physical manifestations are well-documented, the psychological burden is often under-recognized. This comprehensive review aims to synthesize current evidence on the prevalence, etiology, and impact of psychological comorbidities, particularly depression, anxiety, and reduced health-related quality of life (HRQoL), in patients with AS. A systematic literature search was conducted in PubMed, Scopus, and Web of Science databases for articles published between 2000 and 2024. Search terms included "ankylosing spondylitis," "psychology," "depression," "anxiety," "quality of life," "fatigue," "sleep," and "coping." Studies were included if they focused on adult human subjects with AS and assessed psychological outcomes. The reviewed literature consistently demonstrates a high prevalence of psychological distress in AS, with pooled estimates of depression and anxiety significantly higher than in the general population. Key factors contributing to this burden include chronic pain, fatigue, sleep disturbances, functional limitations, and disease activity. Furthermore, psychological factors, such as catastrophizing and passive coping strategies, are identified as significant mediators of pain perception and disability. The bidirectional relationship between psychological state and disease activity creates a vicious cycle that adversely affects treatment adherence and overall prognosis. Psychological comorbidity is a prevalent and debilitating aspect of AS that warrants systematic screening and integrated management. A multidisciplinary approach, combining pharmacological therapy with psychological interventions (e.g., Cognitive-Behavioral Therapy) and physical rehabilitation, is essential to address the biopsychosocial complexity of the disease and improve patient outcomes.

THE IMPACT OF CHRONIC CANNABINOID USE AND DEPENDENCE ON OPIOID ANALGESIC TREATMENT – A SYSTEMATIC REVIEW AND PREDICTIVE ANALYSIS

2026-01-20T01:13:18+00:00

In recent years, there has been growing interest in cannabinoids as potential analgesics and alternatives to opioids. Cannabinoids, through modulation of the endocannabinoid system, affect nerve transmission, neuroplasticity, and inflammatory processes, and their action on CB1 and CB2 receptors is similar to the mechanisms of the opioid system, in particular μ, δ, and κ receptors. The aim of this study was to compare the mechanisms of action of cannabinoids and opioids, review studies on their combined use, and assess the impact of chronic cannabinoid use and dependence on the effectiveness of opioid-based pain treatment.

Analysis of the available data showed that moderate use of cannabinoids, especially preparations with a balanced THC and CBD content, can lead to an "opioid-sparing" effect, allowing opioid doses to be reduced without losing the analgesic effect. However, chronic use of cannabinoids, especially those with high THC content, is associated with the development of tolerance, mood disorders, desensitization of CB1 receptors, and disturbances in the co-regulation of μ receptors, which may lead to compensatory escalation of opioid treatment and the development of cross-addiction. In addition, partial clinical benefits have been observed in patients with neuropathic pain from the combination of cannabinoid and opioid therapy, while no clear analgesic effects have been observed in acute pain.

The proposed predictive model integrates molecular, clinical, and psychological aspects, indicating that the effectiveness of analgesic therapy depends on the duration of exposure to cannabinoids, the type of pain, and the individual predisposition of the patient. The authors point to the need for further research involving patients who are chronic users of cannabinoids or addicted to them and who are scheduled to be treated with opioids. The results of such analyses could form the basis for the development of clinical guidelines for integrated pain therapy that minimizes the risk of addiction and treatment failure.

SHIFT WORK AND THE HEART: EFFECTS OF SHIFT WORK ON THE DEVELOPMENT AND PROGRESSION OF HEART FAILURE AND ITS ASSOCIATION WITH CHRONIC DISEASE RISKS - A NARRATIVE REVIEW

2026-01-21T18:05:28+00:00

Background: Shift work is increasingly prevalent worldwide as continuous service delivery becomes essential across sectors such as healthcare, transportation and industry. However circadian misalignment, sleep disruption, metabolic alterations and neurohormonal dysregulation make shift workers a population at heightened cardiometabolic risk. While the associations between shift work, hypertension and coronary artery disease (CAD) are well documented, its potential contribution to the development of heart failure (HF) remains less clearly defined.

Objectives: This narrative review synthesises current evidence on the impact of shift work - particularly night work and rotating schedules - on cardiovascular health with a focus on HF, CAD and hypertension. It contextualises HF risk within the broader metabolic and behavioural consequences of circadian disruption and identifies gaps in existing research.

Methods: A comprehensive review of epidemiological, clinical and experimental studies was conducted with emphasis on cardiometabolic pathways linking shift work to adverse cardiovascular outcomes.

Results: Shift work is consistently associated with an increased risk of hypertension and CAD with risk rising in proportion to cumulative exposure. Pathophysiology includes chronic sympathetic activation, inflammation, oxidative stress, hormonal dysregulation and frequent co-occurrence of unhealthy sleep, dietary and activity patterns. Evidence linking shift work to HF is more limited but suggests an elevated risk - particularly among women and permanent night-shift workers. Proposed mechanisms include chronic haemodynamic stress, myocardial fibrosis (supported by experimental models) and indirect effects mediated by worsened metabolic health. Heterogeneity in exposure definitions and inadequate adjustment for confounders remain key limitations of existing studies.

Conclusions: Shift work should be considered as an important, modifiable cardiovascular risk factor that may contribute not only to hypertension and CAD but also to HF development. Preventive strategies - including optimisation of shift schedules, adequate recovery periods and education targeting sleep hygiene, diet and physical activity - may mitigate these risks. Well-designed prospective studies with HF as a primary endpoint, detailed exposure assessment and phenotype-specific analyses are urgently needed. Greater awareness of the cardiovascular consequences of shift work is essential for clinicians, employers and public health policymakers.

VIRTUAL REALITY AND EXERGAMING FOR FALL PREVENTION IN OLDER ADULTS: A REVIEW OF CLINICAL EFFICACY AND PATIENT ENGAGEMENT

2026-01-27T14:26:16+00:00

Background: Falls are a primary cause of injury and loss of independence among older adults. Digital technologies like virtual reality (VR) and exergaming are increasingly used to enhance balance and mobility, yet their overall clinical efficacy requires synthesis.

Objective: This review consolidates evidence from 2015–2024 regarding the effectiveness of VR and exergaming interventions on fall prevention, specifically examining balance, functional mobility, dual-task performance, and patient engagement.

Methods: A narrative review was conducted using PubMed to identify peer-reviewed studies, including randomized controlled trials and meta-analyses. The review included interventions targeting balance or fall risk in adults aged 60 and older.

Results: The synthesized evidence indicates that both VR and exergaming yield significant improvements in balance, gait adaptability, and dual-task performance. These interventions utilize multisensory feedback and gamification to integrate cognitive and motor skills, thereby supporting motor learning and adherence. However, findings concerning actual reductions in fall incidence remain mixed due to methodological variations and limited long-term follow-up.

Conclusion: VR and exergaming serve as effective, engaging complementary tools for fall prevention. While they reliably improve functional outcomes, future research must focus on standardizing protocols and evaluating long-term efficacy to support clinical implementation.

DEVELOPMENTAL CARDIAC ANOMALIES IN CHILDREN WITH EDWARDS SYNDROME: A COMPREHENSIVE REVIEW

2026-01-26T03:19:41+00:00

Introduction and objective: Edwards Syndrome, also known as Trisomy 18, is the second most common autosomal trisomy following Down Syndrome. This chromosomal disorder is characterized by the presence of a third copy of chromosome 18, in contrast to the usual two. The condition is associated with a wide spectrum of severe congenital anomalies, significant developmental delays, and a high rate of fetal loss and infant mortality. Therefore, a comprehensive synthesis of these associated developmental anomalies is crucial for accurate prenatal counseling, clinical guidance, and postnatal management. The primary objective of this comprehensive review is to systematically identify, collate, and synthesize the existing literature regarding the range and prevalence of congenital heart defects in children diagnosed with Edwards Syndrome. Recognizing that cardiac anomalies are a cardinal feature and a leading cause of mortality in this condition, this review aims to provide a detailed, evidence-based overview of these specific manifestations. Ultimately, this focused analysis seeks to enhance clinical understanding of the cardiovascular complications in Edwards Syndrome and inform targeted management strategies.

Brief description of the state of knowledge: Edwards Syndrome (Trisomy 18) is characterized by a high burden of congenital anomalies, with cardiac defects affecting the vast majority of patients and serving as a primary determinant of survival. Historically regarded as a uniformly lethal condition requiring only palliative care, the clinical perspective is evolving. Recent data indicate that cardiac interventions may offer survival benefits, challenging traditional non-interventional paradigms and necessitating an updated understanding of the cardiovascular phenotype.

Methods: A systematic literature review was performed by searching major biomedical databases (PubMed, Google Scholar, Elicit) using a combination of keywords and MeSH terms, including "Edwards Syndrome" and "congenital abnormalities." Inclusion criteria prioritized peer-reviewed articles such as case series, observational studies, and systematic reviews. Data extraction focused on the types, frequency, and systemic impact of anomalies, as well as postnatal developmental outcomes. The collected data were then synthesized to create a comprehensive syndrome profile.

Conclusions: The clinical paradigm for Edwards Syndrome is shifting from a uniform designation of lethality toward a personalized, multidisciplinary model. Accurate prenatal diagnosis via fetal echocardiography is essential for early risk stratification. Contemporary management requires a balanced approach integrating palliative care with the option of active cardiac intervention. Consequently, parental counseling must emphasize shared decision-making, providing families with evidence-based data on potential surgical outcomes to optimize the quality of life for the affected child.

CURRENT ADVANCES IN LIPOPROTEIN(A) MANAGEMENT: CLINICAL SIGNIFICANCE AND EMERGING THERAPIES

2026-01-26T20:03:51+00:00

Background: Lipoprotein(a) [Lp(a)] is an independent, genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis. Despite its clinical importance, Lp(a) remains largely unaffected by traditional lipid-lowering therapies, contributing to significant residual cardiovascular risk.

Aim: This review aims to synthesize current knowledge regarding the clinical significance of elevated lipoprotein(a) levels and to explore the landscape of emerging therapeutic strategies designed to specifically address this challenging cardiovascular risk factor.

Materials and Methods: An extensive synthesis of the current literature, prioritizing comprehensive review articles and meta-analyses published within the last five years, was conducted using multiple electronic databases (PubMed, Scopus, Google Scholar).

Results: Epidemiological data indicate that 20–30% of the global population has elevated Lp(a) levels (>30–50 mg/dL). While lifestyle and statins show negligible effects on Lp(a) concentration, novel nucleic acid-based therapies - specifically antisense oligonucleotides (pelacarsen) and small interfering RNAs (olpasiran, lepodisiran, zerlasiran) have demonstrated the ability to reduce Lp(a) levels by 70% to over 95%. Furthermore, oral small-molecule inhibitors like muvalaplin offer promising alternatives by disrupting the assembly of the Lp(a) particle.

Conclusion: The emergence of targeted RNA-based and small-molecule therapies represents a paradigm shift in cardiovascular prevention. As phase 3 clinical trials progress, these interventions may provide the first definitive means of mitigating the residual risk associated with elevated Lp(a).

KETAMINE IN PREHOSPITAL MANAGEMENT OF TRAUMATIC BRAIN INJURIES: FROM CONTROVERSY TO ROUTINE USE. A SYSTEMATIC REVIEW OF CURRENT LITERATURE

2026-01-27T13:59:57+00:00

Research Objectives: To present the broadest available evidence regarding the safety and efficacy of ketamine in traumatic brain injury (TBI) and explain the evolution of clinical guidelines. This review aims to verify historical contraindications against current knowledge and demonstrate how ketamine's role has evolved from a contraindicated drug to a potentially beneficial therapeutic option in prehospital settings.

Methods: Systematic analysis of clinical studies and systematic reviews examining ketamine's effects on cerebral hemodynamics, intracranial pressure (ICP), and cerebral perfusion pressure (CPP). Evaluation of ketamine's utility as an analgesic-sedative drug in prehospital TBI care, including assessment of safety profiles and clinical outcomes across civilian and military settings.

Conclusions: Ketamine's effect on cerebral hemodynamics is at least neutral and often beneficial, contrary to historical concerns about increased ICP. The drug demonstrates high utility as a prehospital analgesic-sedative agent, providing effective pain control and sedation without compromising patient safety. Historical contraindications must be regularly re-verified in light of current evidence. Clinical guidelines have evolved significantly, reflecting growing recognition that proper ventilation control and hemodynamic monitoring eliminate previous safety concerns. Current evidence supports ketamine as a safe and potentially advantageous therapeutic option in prehospital TBI management, particularly for achieving rapid sequence intubation, maintaining hemodynamic stability, and preventing secondary brain injury in emergency settings.

PHYSICAL ACTIVITY AS A NON-PHARMACOLOGICAL INTERVENTION FOR INSOMNIA

2026-01-27T16:51:05+00:00

Insomnia, a prevalent sleep disorder affecting up to 18% of the population, is associated with significant health risks including depression, anxiety, cardiometabolic disease, and impaired physical and cognitive performance. Clinical guidelines prioritize non-pharmacological strategies such as cognitive-behavioral therapy for insomnia, with pharmacotherapy reserved for refractory cases. Physical activity has emerged as a promising adjunctive behavioral intervention, offering both sleep-specific and broad health benefits. This review synthesizes current evidence on exercise as a non-pharmacological intervention for insomnia, examining randomized controlled trials, epidemiological findings, and mechanistic studies. Across diverse populations, regular moderate-intensity physical activity - particularly aerobic exercise - improves sleep onset latency, efficiency, duration, and subjective quality. Additional benefits are observed with resistance, stretching, and mind-body modalities such as yoga and tai chi. Mechanisms include thermoregulatory cooling, circadian rhythm entrainment, neuroendocrine modulation, anxiety reduction, and enhanced sleep drive. Optimal outcomes are achieved with 150 minutes/week of moderate-intensity exercise, preferably in the morning or early afternoon; vigorous late-evening activity may be counterproductive. Integration with therapy and other treatments can amplify therapeutic effects, while tailoring type, intensity, and timing to patient characteristics enhances adherence and minimizes adverse effects. Given its accessibility, safety profile, and holistic benefits, physical activity should be considered a core component of insomnia management, offering a sustainable alternative or complement to pharmacological approaches.

INTERVENTIONS TARGETING IMPAIRED FASTING GLUCOSE: A COMPREHENSIVE REVIEW OF STRATEGIES TO PREVENT TYPE 2 DIABETES

2026-01-27T18:30:15+00:00

Objective: Impaired Fasting Glucose (IFG), a state of prediabetes characterized by elevated fasting glucose levels, signifies a significantly increased risk of developing Type 2 Diabetes Mellitus (T2D) and associated cardiovascular complications. This comprehensive review systematically analyzes evidence from original research, including Randomized Controlled Trials (RCTs), prospective and retrospective cohort studies, and single- and multi-center implementation experiences, to evaluate the effectiveness and translation challenges of interventions targeting IFG progression.

Methods: A targeted literature search was conducted across major medical databases, focusing on human intervention studies published between 2000 and 2025. Included articles were categorized based on intervention type (Intensive Lifestyle Intervention [ILI] or pharmacological) and study design, with an emphasis on T2D incidence rate reduction as the primary outcome.

Key Findings: The analysis confirms that ILI, focused on diet, physical activity, and achieving moderate weight loss (5–7%), remains the most efficacious long-term strategy, demonstrating superior and sustained T2D risk reduction (e.g., 58% in the Diabetes Prevention Program) (Diabetes Prevention Program Research Group, 2002); (Tuomilehto et al., 2001). Metformin therapy serves as a critical, cost-effective pharmacological alternative, particularly for high-risk subgroups (e.g., younger individuals, high BMI). Translational studies, including retrospective and multi-center experiences, highlight significant barriers to real-world implementation, such as low sustained adherence and scalability challenges within diverse populations.

Conclusion: Effective T2D prevention in individuals with IFG necessitates early, risk-stratified intervention. While ILI is the gold standard, future strategies must focus on developing tailored, technologically-supported, and scalable programs to overcome implementation barriers and maximize population-level health impact.

THE DAWN PHENOMENON AND GLYCEMIC VARIABILITY MEASURED WITH CONTINUOUS GLUCOSE MONITORING

2026-01-27T18:49:55+00:00

The dawn phenomenon (DP), defined as an early-morning rise in glucose unrelated to preceding nocturnal hypoglycemia, represents a significant yet often underrecognized contributor to fasting hyperglycemia and overall glycemic instability in individuals with diabetes. The expansion of continuous glucose monitoring (CGM) technologies over the past decade has enabled more precise characterization of nocturnal glucose patterns, offering new insights into the prevalence, magnitude, and clinical implications of DP across diverse glycemic states. This review synthesizes original observational, retrospective, and prospective studies published between 2010 and 2025 that used CGM to evaluate DP in type 1 diabetes, type 2 diabetes, impaired glucose tolerance, and non-diabetic populations. Data extraction focused on DP definitions, nocturnal glucose trajectories, glycemic variability metrics, associations with HbA1c and time-in-range, and emerging evidence linking severe DP to adverse clinical outcomes.

Findings indicate that DP is highly prevalent in both type 1 and type 2 diabetes, with magnitude varying widely depending on residual β-cell function, insulin sensitivity, and methodological differences in CGM-based definitions. DP correlates with increased total glucose exposure and greater glycemic variability, and may influence long-term metabolic risk. Understanding DP within the context of CGM-derived metrics is essential for optimizing individualized therapeutic strategies and improving morning glycemic control. Further standardized research is required to unify definitions and clarify the prognostic significance of DP.

INNOVATIVE TECHNOLOGIES IN THE DIAGNOSIS AND TREATMENT OF INFERTILITY: A COMPREHENSIVE REVIEW

2026-01-28T00:56:10+00:00

Infertility is increasingly recognized as a condition affecting diverse populations and one that requires advanced medical and technological approaches to support effective diagnosis and treatment. In recent years, significant progress in medical sciences and digital technologies has refined the ways infertility is assessed and managed. Contemporary diagnostic methods now include high-resolution imaging, hormonal and genetic testing, microbiome evaluation, and immunological analysis. These advancements enable clinicians to identify reproductive disorders with greater precision.

Artificial intelligence (AI) and robotic systems further support clinical decision-making by improving embryo selection, predicting treatment outcomes, and standardizing laboratory procedures. Advances in assisted reproductive technologies (ART) have expanded therapeutic options for patients who previously had limited chances of achieving pregnancy.

Although technology plays a crucial role in modern infertility care, patient experiences and psychological well-being remain equally important, as treatment can be both emotionally and physically demanding. This review summarizes current knowledge on innovative technologies used in the diagnosis and treatment of infertility and highlights how the continued development of these methods enhances clinical outcomes and patient care.

DETECTABLE IN-BLOOD BRCA1 METHYLATION AS A BIOMARKER OF BREAST CANCER PREDISPOSITION

2026-01-28T01:14:16+00:00

Germline BRCA1 mutations are a well-established risk factor for the development of breast cancer. Nevertheless, many patients who present with a clinical phenotype typical of BRCA1-associated tumors do not carry pathogenic BRCA1 mutations. Current risk models are inadequate, highlighting the need for new biomarkers. In this context, blood-based epigenetic markers such as DNA methylation are being explored. Many studies have examined BRCA1 promoter methylation in blood DNA as a BC risk marker. Retrospective analyses report that BRCA1 methylation in blood correlates with higher risk in triple-negative tumors. However, findings remain inconsistent due to numerous technical issues, including methodological variability, assay limitations, and differences in targeted CpG sites. This review highlights the risk of developing breast cancer in women with a methylated BRCA1 promoter in peripheral blood-derived DNA, as well as the potential drawbacks and challenges in this area.

Methodology: Relevant studies were identified through a targeted search of the PubMed database using keywords such as “BRCA1,” “methylation,” “breast cancer,” and “blood DNA.” Inclusion criteria comprised studies evaluating BRCA1 promoter methylation in blood-derived DNA in relation to breast cancer risk. Studies analyzing BRCA1 promoter methylation exclusively in tumor tissue or other non-blood specimens were excluded.

GLOBAL LONGITUDINAL STRAIN AND 3D ECHOCARDIOGRAPHY FOR EARLY DETECTION OF ANTHRACYCLINE-INDUCED SUBCLINICAL CARDIOTOXICITY: NARRATIVE REVIEW

2026-01-28T01:31:08+00:00

Introduction and purpose: Anthracyclines are highly effective chemotherapeutic agents but carry a significant risk of dose-dependent cardiac toxicity, often progressing silently before left-ventricular ejection fraction (LVEF) declines. The objective of this review was to evaluate the role of three-dimensional echocardiography (3D-ECHO) and global longitudinal strain (GLS) in the early detection of subclinical anthracycline-induced cardiotoxicity and to compare their diagnostic performance with conventional 2D-LVEF assessment.

Methods: A narrative review was conducted using clinical and observational studies indexed in PubMed over the last ten years. Only peer-reviewed human research evaluating anthracycline-induced cardiotoxicity was included. Studies comparing 2D-LVEF with 3D-LVEF and/or global longitudinal strain (GLS), as well as those assessing early markers of subclinical left-ventricular dysfunction, were selected. Extracted data focused on diagnostic effectiveness, time-to-detection of myocardial injury, and prognostic relevance of strain-based parameters.

Conclusion: GLS and 3D-echocardiography outperform conventional 2D-LVEF in identifying early, subclinical anthracycline-related cardiotoxicity. GLS provides the highest sensitivity for early myocardial injury, while 3D-STE enhances spatial assessment and detects dysfunction before EF decline. Routine integration of these modalities into cardio-oncology surveillance may enable earlier intervention, prevent irreversible damage, and improve long-term cardiac outcomes.

OBESITY AS AN IMMUNOMETABOLIC DISORDER: MECHANISMS OF IMMUNE IMPAIRMENT AND INCREASED SEVERITY OF INFECTIOUS DISEASES - A REVIEW OF CURRENT EVIDENCE

2026-01-29T19:03:57+00:00

Background: Obesity represents a major global health burden and is increasingly recognized as a complex immunometabolic disorder rather than a simple imbalance of energy intake and expenditure. Chronic low-grade inflammation, adipokine dysregulation, altered immune cell metabolism, and gut microbiota dysbiosis profoundly remodel immune responses in individuals with obesity. Growing evidence indicates that these alterations significantly affect susceptibility to infections, disease severity, and clinical outcomes, particularly in viral respiratory infections such as COVID-19 and influenza.

Aims: This narrative review aims to synthesize current epidemiological, mechanistic, and interventional evidence explaining why individuals with obesity experience more severe courses of infectious diseases. Particular attention is given to immunometabolic dysfunction, adipokine imbalance, inflammasome activation, microbiota-derived immune modulation, and the potential reversibility of immune impairment through metabolic interventions.

Methods: A comprehensive narrative literature review was conducted using PubMed, PubMed Central, Google Scholar, and ResearchGate. Eligible studies included randomized controlled trials, observational cohort and cross-sectional studies, mechanistic immunology research, microbiota studies, and systematic or narrative reviews focusing on adults with overweight or obesity. Evidence was synthesized qualitatively due to heterogeneity in study designs and outcomes.

Results: Across study types, obesity consistently emerged as an independent risk factor for immune dysfunction and severe infectious outcomes. Mechanistic studies demonstrated chronic activation of inflammatory pathways, including NLRP3 inflammasome signaling, leptin dominance with reduced adiponectin, impaired interferon responses, mitochondrial dysfunction, and exhaustion of T and NK cells. Microbiota studies revealed reduced diversity and depletion of short-chain fatty acid–producing bacteria. Clinical studies confirmed higher rates of hospitalization, intensive care admission, prolonged viral shedding, and mortality among individuals with obesity. Interventional studies showed that modest weight loss (5–10%) can partially restore immune function and reduce inflammatory burden.

Conclusion: Obesity profoundly impairs immune competence through interconnected metabolic, inflammatory, and microbiota-driven mechanisms, leading to increased susceptibility to infections and worse clinical outcomes. Although immunometabolic dysfunction is partially reversible, further long-term studies are required to determine its impact on clinical risk reduction.

KIDNEY STONES – WHEN TO USE MINI-PERCUTANEOUS NEPHROLITHOTOMY AND WHEN TO USE ULTRA-MINI PERCUTANEOUS NEPHROLITHOTOMY?: A NARRATIVE REVIEW

2026-01-29T19:23:52+00:00

Background: Miniaturized percutaneous nephrolithotomy techniques have been developed to reduce the morbidity associated with standard percutaneous nephrolithotomy (PCNL) while maintaining high stone clearance. Among these approaches, mini-PCNL and ultra-mini PCNL (UMP) are increasingly used; however, their optimal indications remain incompletely defined.

Aims: To review and synthesize current evidence regarding the efficacy, safety, and clinical indications of mini-PCNL and UMP in the management of kidney stone disease.

Methods: A narrative review of the literature was performed using PubMed/MEDLINE, Scopus, and Web of Science databases. Clinical studies, comparative analyses, meta-analyses, reviews, and international guideline documents addressing mini-PCNL and UMP were included. Evidence was synthesized descriptively with emphasis on stone- and patient-related factors influencing technique selection.

Results: Both mini-PCNL and UMP demonstrated high stone-free rates when applied in appropriately selected patients. Mini-PCNL achieved superior stone clearance for larger (15–30 mm), multiple, or high-density renal stones, owing to efficient fragment extraction. UMP was associated with lower perioperative morbidity, reduced bleeding risk, and shorter hospital stay, with optimal outcomes observed in smaller stone burdens. Differences in efficacy between techniques were minimal for stones <15 mm but became more pronounced with increasing stone size and complexity.

Conclusions: Mini-PCNL and UMP are complementary techniques in contemporary percutaneous stone surgery. Mini-PCNL is best suited for larger or more complex stones requiring active fragment removal, whereas UMP offers advantages in minimizing invasiveness and accelerating recovery in selected patients. Individualized treatment selection based on stone characteristics, patient factors, and surgical expertise is essential to optimize outcomes.

THE IMPACT OF CAFFEINE ON SURGERY

2026-01-29T21:25:59+00:00

Caffeine is one of the most widely consumed psychoactive substances and is commonly used by both surgical patients and healthcare professionals. While its primary effect on the central nervous system is the reduction of fatigue and enhancement of alertness, caffeine also influences cardiovascular function, skeletal muscle activity, metabolism, and neuroendocrine regulation. Owing to these multifaceted actions, caffeine may affect perioperative outcomes and complications in both beneficial and adverse ways.

This narrative review summarizes current evidence on habitual and perioperative caffeine consumption in the surgical setting, addressing its interactions with anesthetic and analgesic drugs, effects on physiological recovery and wound healing, influence on perioperative risk, and potential impact on surgeons’ alertness and procedural precision.

The available studies are limited in number, heterogeneous in design, and frequently inconclusive, which precludes clear clinical recommendations regarding habitual or perioperative caffeine consumption. Further well-designed studies are required to clarify the benefits and risks of caffeine use for both patients and surgical staff and to support the development of evidence-based perioperative guidance.

MODERN BIOLOGICAL TREATMENT METHODS FOR ALOPECIA AREATA: A COMPREHENSIVE REVIEW

2026-01-30T19:19:56+00:00

Introduction: Alopecia areata (AA) is a chronic, immune-mediated hair-loss disorder driven by cytotoxic T-cell activation and loss of hair-follicle immune privilege. Janus kinase (JAK) inhibitors and emerging targeted biologics have reshaped treatment options for moderate-to-severe AA. This review compared three approved JAK-based therapies (ritlecitinib, baricitinib, deuruxolitinib) and summarized evidence on investigational biologic agents.

Materials and Methods: This narrative review was based on a structured search of PubMed and Google Scholar for English-language publications available up to 2025. Search terms included “alopecia areata,” “biologic therapy,” “JAK inhibitors,” “ritlecitinib,” “baricitinib,” “deuruxolitinib,” and “immunomodulation.” Phase 2 and 3 trials, early-phase studies, observational research, and review articles were screened. Full texts were assessed to extract information on mechanisms of action, JAK-isoform selectivity, clinical efficacy measured by SALT outcomes, safety, and emerging therapeutic strategies.

Results: All three JAK inhibitors showed significant efficacy compared with placebo but differed in selectivity and response dynamics. Ritlecitinib (JAK3/TEC) demonstrated a rapid onset of action and a favorable safety profile. Baricitinib (JAK1/2) produced gradual, sustained improvement supported by extensive long-term data. Deuruxolitinib (JAK1/2/TYK2) achieved high SALT ≤20 response rates across THRIVE-AA trials. Emerging biologics such as bempikibart (anti–IL-7Rα) and early investigational agents (ALD-102, DR-01) showed preliminary efficacy, though evidence remains limited by short follow-up and lack of predictive biomarkers.

Conclusions: JAK inhibitors constitute a major therapeutic advance for moderate-to-severe AA, providing meaningful clinical benefit with acceptable safety. Novel biologic agents may offer more selective and durable immune modulation. Long-term studies and development of precision-medicine approaches will be essential to optimize future AA management.

MODERN TECHNOLOGICAL SOLUTIONS IN THE TREATMENT OF OBSTRUCTIVE SLEEP APNEA: A REVIEW OF INNOVATIONS AND THEIR SOCIAL IMPACT

2026-01-30T20:40:18+00:00

Introduction: The aim of this review is to analyze technological advancements in the treatment of Obstructive Sleep Apnea (OSA) published between 2019 and 2025, with a specific focus on their impact on therapeutic adherence and public health.

Materials and methods: A comprehensive literature review was conducted utilizing key databases such as PubMed, Scopus, Web of Science, and Google Scholar. The selection process prioritized innovative technological solutions, telemedicine applications, and e-health concepts.

Results: The comprehensive review of the scientific literature revealed several technological advancements significantly impacting the treatment of Obstructive Sleep Apnea:

Hypoglossal Nerve Stimulation: HNS serves as an effective alternative for moderate to severe OSA patients intolerant to CPAP [1]. This implantable treatment stimulates the hypoglossal nerve, activating muscles to maintain upper airway patency during sleep, resulting in significant reductions in Apnea-Hypopnea Index and improved sleep quality [2,3].
Advanced Algorithms in PAP Devices: Integrating AI and machine learning into PAP devices optimizes treatment and boosts patient adherence [4]. These algorithms analyze CPAP data to predict adherence issues, enabling clinicians to tailor interventions and personalize strategies for better patient outcomes [5].
Telemedicine: Telemedicine has advanced OSA management through remote patient interaction, monitoring, and follow-up [6]. This remote care often leads to comparable or improved treatment compliance, offering cost-effective solutions and increasing access to specialized care [7].
3D Printing in Oral Appliances: 3D printing revolutionizes the fabrication of custom Mandibular Advancement Devices for OSA [8,9]. Utilizing digital workflows from intraoral scanning to CAD design, highly precise appliances are produced, improving patient comfort and adherence [9].

Conclusion: The introduction of new technologies in OSA treatment, such as hypoglossal nerve stimulation, improved algorithms in PAP devices, telemedicine, and 3D printing, holds significant potential for increasing patient therapeutic adherence [10]. These technologies favor therapy personalization, which is crucial given the diverse pathophysiology and phenotypes of OSA [2]. Improved compliance and the availability of personalized treatment methods directly translate into better public health outcomes, a reduction in the risk of cardiovascular and metabolic complications, and an overall improvement in the quality of life for OSA patients [11, 12]. However, attention must be paid to ensuring that the implementation of these innovations is conducted thoughtfully, so as not to exacerbate existing inequalities in access to healthcare [12].

THE IMPACT OF PROTON PUMP INHIBITORS ON KIDNEY FAILURE: LITERATURE REVIEW

2026-01-31T05:37:45+00:00

Proton pump inhibitors (PPIs) are among the world's most frequently prescribed medications for treating acid-related gastrointestinal disorders. Increasing evidence from the past decade has raised concerns about their potential adverse effects on kidney function. This review examines multiple dimensions of PPI-associated nephrotoxicity, including acute interstitial nephritis (AIN), acute kidney injury (AKI), chronic kidney disease (CKD), progression and end-stage renal disease (ESRD). Multiple observational studies and meta-analyses have demonstrated connections between PPI use and adverse renal outcomes. The underlying mechanisms remain incompletely understood. The evidence suggests that PPIs may contribute to kidney dysfunction through various pathways, including immune-mediated reactions, alterations in magnesium homeostasis, changes in renal blood flow, and potential effects on gut microbiome-derived uremic toxins. While some recent studies challenge the strength of these correlations, the weight of evidence indicates a need for more judicious PPI prescribing, particularly in patients with existing kidney disease or risk factors for renal dysfunction. This work provides healthcare professionals with an understanding of current evidence, proposed mechanisms, clinical implications, and recommendations for PPI use in the context of kidney health.

EFFECTS OF BLUE LIGHT EXPOSURE ON RAPID EYE MOVEMENT SLEEP DURATION AND MELATONIN LEVELS IN CHILDREN: A COMPREHENSIVE LITERATURE REVIEW

2026-02-02T18:32:29+00:00

Blue light exposure from electronic devices has emerged as a significant environmental factor affecting children's sleep architecture and circadian physiology. This comprehensive literature review synthesizes empirical evidence from 2020-2025 examining the effects of blue light exposure on rapid eye movement (REM) sleep duration and melatonin levels in pediatric populations. A systematic search of PubMed, Web of Science, and related databases identified studies employing objective measurement methods, including polysomnography (PSG) and actigraphy validated against PSG, with melatonin measurement via salivary DLMO. The current evidence demonstrates that blue light exposure, particularly from electronic devices in the evening hours, significantly suppresses melatonin production in children even at very low illuminance levels (5-40 lux), producing melatonin suppression of 70-99% depending on light intensity and spectral composition. Blue light predominantly affects melatonin suppression and REM sleep through intrinsically photosensitive retinal ganglion cells (ipRGCs) expressing melanopsin with peak sensitivity at approximately 480 nm. Studies indicate that evening blue light exposure reduces REM sleep duration, increases REM fragmentation with elevated microarousals, increases sleep onset latency, and impairs sleep efficiency in children. The magnitude of effects on REM sleep and melatonin suppression demonstrates circadian timing dependency, with exposure during 21:00-22:30 hours producing maximum sleep disruption. Evening screen use, particularly interactive forms, is associated with delayed sleep onset and reduced total sleep duration in children measured via objective actigraphy. Interventions restricting blue light exposure before bedtime through screen abstinence and blue light-blocking glasses show slight improvements in sleep timing and circadian phase advancement. This review concludes that evidence-based guidelines recommending screen restriction in the 1-2 hours before bedtime are justified based on documented physiological mechanisms and objective sleep disruption in children.

TIRZEPATIDE AND RETATRUTIDE IN THE TREATMENT OF OBESITY AND TYPE 2 DIABETES MELLITUS: CURRENT EVIDENCE AND FUTURE DIRECTIONS. A SYSTEMATIC REVIEW OF CURRENT LITERATURE

2026-02-02T19:59:16+00:00

Background: The global prevalence of obesity and type 2 diabetes mellitus (T2DM) has achieved unprecedented levels, imposing substantial burdens on healthcare systems worldwide. Incretin-based pharmacotherapies have fundamentally transformed therapeutic approaches to these metabolic disorders over the past decade. Tirzepatide is a dual GIP/GLP-1 receptor agonist. Retatrutide additionally targets glucagon receptors. Both agents represent groundbreaking advances in metabolic pharmacotherapy.

Objective: This comprehensive review synthesizes clinical evidence from trials conducted between 2014 and 2024, examining pharmacological mechanisms, therapeutic efficacy, safety characteristics, and prospective clinical applications of these novel multi-receptor agonists.

Methods: We performed systematic literature searches across PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov databases. Selection criteria encompassed randomized controlled trials, systematic reviews, meta-analyses, and prospective cohort studies, adhering to PRISMA methodology throughout.

Results: Phase 3 clinical trials showed superior efficacy of tirzepatide compared to existing pharmacotherapies, reaching body weight reductions of approximately 22.5% and hemoglobin A1c (HbA1c) reductions of up to 2.4 percentage points. Phase 2 trials of retatrutide revealed even more remarkable outcomes, with weight reductions approaching 24.2% over 48 weeks. Both medications exhibited favorable cardiovascular profiles, though gastrointestinal adverse events constitute the predominant tolerability concern.

Conclusions: These pharmacological agents represent paradigm-shifting developments in obesity and diabetes management. Their therapeutic effectiveness approximates outcomes previously achievable only through surgical intervention, marking a transformative milestone for pharmacotherapy. Ongoing phase 3 trials will further elucidate their optimal positioning within clinical treatment algorithms.

ARTIFICIAL INTELLIGENCE IN ULTRASONOGRAPHIC DIAGNOSIS OF THYROID NODULES: ENHANCING RISK STRATIFICATION AND CLINICAL DECISON-MAKING

2026-02-03T00:04:53+00:00

Thyroid nodules are common clinical findings, increasingly detected due to the widespread use of high-resolution ultrasound imaging. While the majority of these nodules are benign, a minority may be malignant, necessitating accurate and efficient risk stratification. Traditional ultrasonographic evaluation relies heavily on the operator’s expertise and subjective interpretation, which introduces diagnostic variability.

This narrative review explores the evolving role of artificial intelligence in the ultrasonographic diagnosis of thyroid nodules. The principal objective of this review is to critically evaluate the diagnostic performance, clinical utility, and integration potential of artificial intelligence (AI)-based methodologies—including machine learning (ML) and deep learning (DL)—in the ultrasonographic assessment of thyroid nodules. Particular attention is devoted to the enhancement of existing risk stratification frameworks, and to identifying barriers to implementation in routine clinical. The review evaluates AI-integrated diagnostic systems in relation to existing classification frameworks, such as the thyroid imaging reporting and data system, and highlights innovations in elastography, 3D imaging, and automated segmentation. Evidence suggests that AI can enhance diagnostic accuracy, reduce interobserver variability, and improve the standardization of thyroid nodule assessment. Some algorithms demonstrate performance comparable to that of experienced clinicians, particularly in differentiating benign from suspicious nodules.

Despite promising results, limitations such as model generalizability, the need for large annotated datasets, and clinical validation remain challenges. The findings support the integration of artificial intelligence as a complementary tool to assist healthcare professionals in making more objective, consistent, and timely decisions regarding the evaluation and management of thyroid nodules

Methodology: A comprehensive narrative review of peer-reviewed literature was undertaken, encompassing both classical and AI-augmented ultrasonographic techniques, with a specific focus on diagnostic criteria, algorithmic accuracy, and classification consistency across TI-RADS variants (ACR-TIRADS, EU-TIRADS, K-TIRADS). Additionally, the role of emerging modalities such as ultrasound elastography was examined in the context of evaluating cytologically indeterminate nodules. Literature published between 2009 and 2025 was examined to assess how machine learning and deep learning algorithms contribute to image interpretation, classification, and malignancy prediction.

Abbreviated Description of The State Of Knowledge: Thyroid nodules are detected in up to 60% of the general adult population via ultrasonography. Although the malignancy rate remains relatively low (~5%), the clinical imperative is the accurate differentiation of malignant from benign lesions. Risk stratification relies on the assessment of sonographic features, including echogenicity, shape, margins, calcifications, and vascularity. Several standardized scoring systems—most notably TI-RADS—are employed to systematize malignancy risk and guide indications for fine-needle aspiration biopsy (FNAB). Despite its utility, ultrasonography remains inherently operator-dependent and subject to interpretive variability. AI-powered diagnostic systems have demonstrated promising potential in mitigating interobserver discrepancies, augmenting risk classification fidelity, and improving diagnostic throughput. Adjunctive techniques such as elastography provide additional biomechanical data, although limitations in methodological standardization currently preclude widespread adoption.

ZINC AND HUMAN HEALTH: IMPLICATIONS OF ZINC DEFICIENCY IN IMMUNE, GASTROINTESTINAL, DERMATOLOGICAL, AND METABOLIC DISORDERS

2026-02-03T01:39:24+00:00

Zinc is an essential trace element involved in key biological processes, including enzymatic activity, gene expression, and immune regulation. Zinc deficiency remains a relevant health issue in specific populations and has been associated with the development and progression of several disease states.

This narrative review summarizes current evidence on the role of zinc in selected immune-related, gastrointestinal, dermatological, and metabolic disorders. Data from clinical and observational studies are discussed in relation to disease-specific outcomes, dosage, formulation, and population characteristics. The aim of this review is to provide an evidence-based overview of the clinical relevance of zinc supplementation in the context of human health and disease.

Methodology: This narrative review was conducted using a structured literature search to identify and analyze scientific publications addressing the role of zinc in human health and disease. The PubMed and Google Scholar databases were searched for relevant articles.

The search strategy included the following keywords: “zinc”, “zinc supplementation”, “zinc deficiency”, “human health”, “immune function”, “gastrointestinal disorders”, “dermatological conditions”, and “metabolic disorders”. Additional publications were identified through manual screening of reference lists of selected articles.

Clinical studies, observational studies, and relevant reviews published in English were considered for inclusion based on their relevance to the selected disease states and clinical outcomes.

CRSTDLA-ARAFREQ: AN ARABIC LEXICAL DATABASE FOR SPEECH-LANGUAGE ASSESSMENT IN ALGERIAN PRIMARY SCHOOLS

2026-02-02T17:22:18+00:00

Lexical databases are increasingly recognized as indispensable resources for both speech-language pathology and education. This paper presents CRSTDLA-Arafreq, the first Modern Standard Arabic lexical database specifically constructed from Algerian textbooks (Preschool to Grade 3), integrating written and oral frequencies as well as student productions. While such tools enable clinicians to design sensitive assessments and support teachers in selecting age-appropriate materials, Algeria has lacked a reference database tailored to its specific school and clinical contexts.

To address this gap, the CRSTDLA-Arafreq project was launched at the Scientific and Technical Research Center for the Development of the Arabic Language. Conducted over three years by a multidisciplinary team, the project provides a robust, evidence-based lexical resource grounded in authentic Algerian primary school corpora to support inclusive education and validated diagnostic instruments.

THE NATIONAL APPLICATION OF FOREIGN LAW

2026-02-02T06:53:41+00:00

When a dispute is brought before a judge which is related to a legal relation in the field of private law, and includes a foreign element, the judge looks for the most appropriate law to govern the dispute. In this area, the legislator gives the judge, as an exception, the possibility to apply a foreign law instead of his own law, when the rules of reference (conflict rules) established by the legislator direct him to that. Here, a jurisprudential theory appeared, trying to put a legal basis upon which it is possible to rely when the national judge applies the foreign law.

CHALLENGES OF CONFLICT OF LAWS IN CYBERSPACE

2026-01-20T05:44:34+00:00

The borderless nature of the internet poses significant challenges to jurisdiction and conflict of laws, as traditional territorial legal frameworks struggle to keep pace with the digital age. Although private international law has historically addressed cross border disputes, its rules have not evolved at the speed of technological change. In response, legal scholars advocate for a unified global framework often referred to as Lex Electronica enforced by digital judicial bodies. They argue that the internet’s erosion of national boundaries necessitates new models of governance.

Nevertheless, private international law remains essential in practice, offering adaptable mechanisms such as tort liability principles for regulating online behavior. To effectively navigate the legal complexities of globalization, existing legal frameworks must be recalibrated, and national laws must evolve to reflect digital realities. At the same time, emerging actors like ICANN challenge traditional notions of sovereignty, exerting regulatory influence over cyberspace and raising critical questions about the capacity of legal systems to balance innovation with accountability.

COGNITIVE IMPAIRMENT, FATIGUE, AND WORKPLACE ACCOMMODATIONS IN MULTIPLE SCLEROSIS: IMPACT ON EMPLOYMENT RETENTION

2026-01-13T18:20:50+00:00

Multiple Sclerosis significantly impacts employment retention due to its early onset and progressive nature, necessitating a comprehensive understanding of contributing factors beyond physical disability. This narrative review explores the profound influence of cognitive impairment, fatigue, and the efficacy of workplace accommodations on maintaining employment for individuals with MS. Specifically, this review synthesizes current literature to delineate how these non-physical symptoms frequently precipitate job loss and absenteeism among people with MS (pwMS). Beyond merely physical limitations, factors such as fatigue, cognitive decline, and mental health issues are significant predictors of reduced working hours and early retirement for individuals with MS (Pokryszko-Dragan et al., 2022). These non-motor symptoms can create a complex "vicious circle" that adversely affects vocational status, often intertwining with mental health challenges that independently influence professional activities (Pokryszko‐Dragan et al., 2022). The diverse manifestations of MS, encompassing motor, sensory, and cognitive deficits, along with chronic fatigue, significantly impede work performance and overall quality of life (Pokryszko-Dragan et al., 2022; Valadkevičienė et al., 2024). While previous research has identified disease severity, fatigue, and cognitive impairments as key predictors of employment outcomes, persistent limitations in generalizability stem from sample variability, socioeconomic factors, and diverse healthcare systems (Iron et al., 2025). This narrative review aims to comprehensively address these gaps by synthesizing evidence on the multifaceted interplay between cognitive impairment, fatigue, workplace accommodations, and their collective impact on employment retention in MS. Understanding these intricate relationships is critical for developing targeted interventions and supportive strategies to enhance vocational longevity for individuals living with MS (Moccia et al., 2022; Pokryszko‐Dragan et al., 2022).

MULTISYSTEM ADVERSE EFFECTS OF ISOTRETINOIN: MECHANISTIC INSIGHTS AND CLINICAL IMPLICATIONS

2026-01-17T03:43:43+00:00

Isotretinoin (13-cis-retinoic acid) remains the most effective systemic therapy for severe acne, exerting its therapeutic action through modulation of retinoic acid (RAR) and retinoid X (RXR) receptors that regulate cell differentiation, apoptosis, and lipid metabolism. However, these same receptor-mediated pathways underlie a range of multisystem adverse effects. This review provides an updated synthesis of isotretinoin’s systemic toxicity profile, focusing on mechanistic insights and clinical relevance. Mucocutaneous reactions such as cheilitis and xerosis are the most frequent and predictable effects, reflecting sebaceous suppression. Hepatic enzyme elevations and dyslipidemia occur in a dose-dependent yet reversible manner, necessitating routine laboratory surveillance. Musculoskeletal, ocular, and neuropsychiatric effects are infrequent, generally mild, and self-limiting, though psychiatric monitoring remains advisable in predisposed individuals. Gastrointestinal and endocrine disturbances, including subclinical hypothyroidism, have been reported but lack strong causal evidence. Hematologic and renal alterations are minor and transient. The most critical safety concern remains isotretinoin’s potent teratogenicity, emphasizing the need for strict contraceptive protocols and post-therapy washout periods. Overall, isotretinoin’s adverse effects largely reflect its pharmacodynamic actions and are manageable through individualized dosing and systematic monitoring. Understanding the mechanisms and risk factors underlying these reactions is essential for optimizing therapeutic safety and patient outcomes.

DARIDOREXANT IN THE TREATMENT OF INSOMNIA IN ELDERLY PATIENTS WITH COMORBIDITIES

2026-01-19T18:15:23+00:00

Introduction and objective: Insomnia is one of the most prevalent sleep disorders in the adult population, thereby new methods of pharmacological treatment ought to be analyzed. Current novelty in insomnia treatment is daridorexant, a representative of the dual orexin receptor antagonist (DORA). Given that, the orexin system becomes overactive with age, explaining sleep of lower quality and quantity observed in older population, it is worth analysing the effect of the dual receptor antagonist (DORA) on the insomnia issue in older adults, and whether it proposes a safer choice among the existing pharmacological possibilities.

Review methods: A comprehensive literature review was conducted, analyzing studies from the PubMed database of articles published between 2020 and 2025.

Brief description of the state of knowledge: Insomnia treatment is based on both non-pharmacological and pharmacological methods. While among non-pharmacological methods cognitive-behavioral therapy is the one recommended, the choice of proper pharmacotherapy can impose more difficulties. The most commonly used medications, nonbenzodiazepine sedative hypnotics, lead to serious adverse effects and impose a risk of dependency. Daridorexant, a medication of proven efficacy, may propose a safer alternative, and furthermore, a more effective one.

Summary: In this review, we decided to analyse the existing literature to present the current state of knowledge on the above-mentioned issue with a perspective of the future of this branch of medicine.

REVIEW OF THE NEW AVALANCHE RESCUE PROCEDURES ACCORDING TO THE NEW ERC 2025 GUIDELINES

2026-01-19T23:14:05+00:00

Introduction and objective: Emergency medicine is nowadays a highly specialised branch of medicine. Regular updates on rescue procedures lead to the compilation of highly specialised guidelines. The rise in mobility among people encourages travel and participation in sports. Winter sports such as skiing and snowboarding increase the average time spent in mountain regions, thereby increasing the risk of avalanche exposure. To ensure high-quality avalanche rescue, official guidelines must be published and regularly revisited.

Review Methods: A comprehensive literature review was conducted, analyzing studies indexed in PubMed and the official ERC Guidelines from 2021 and 2025.

Brief description of the state of knowledge: The first official avalanche rescue guidelines were published in 2021 by the European Resuscitation Council. Since then, studies have examined their efficacy and sought better solutions. In 2022, a group of experts published an algorithm—Avalife—that outlined systematic, step-by-step Basic Life Support (BLS) recommendations in case of a shortage of rescuers at the site of an accident. The latest ERC Guidelines, published in 2025, introduce a new avalanche-rescue algorithm and incorporate the Avalife algorithm into official procedures, thereby establishing a cohesive avalanche-rescue policy.

Summary: In this review, we analyse the existing literature, with particular emphasis on the new ERC 2025 Guidelines, to present the current state of knowledge on this issue.

THE ROLE OF WEARABLE TECHNOLOGY AND TELEREHABILITATION IN OPTIMIZING POST-OPERATIVE ACL RECOVERY: A FRAMEWORK FOR EQUITABLE ACCESS

2026-01-27T14:25:59+00:00

Background: Anterior Cruciate Ligament (ACL) rupture is a debilitating injury requiring prolonged rehabilitation. The traditional clinic-based model of care presents significant socioeconomic barriers, including geographic distance and indirect costs, which contribute to suboptimal adherence and inequitable outcomes.

Objective: This descriptive review outlines a comprehensive framework integrating wearable sensor technology and telerehabilitation to optimize post-operative ACL recovery and democratize access to care.

Methods: We synthesized recent literature (2015–2025) focusing on the efficacy of remote monitoring, sensor validation, and the economic impact of telerehabilitation.

Results: Current evidence demonstrates that telerehabilitation is clinically non-inferior to standard face-to-face therapy regarding range of motion and functional milestones. Wearable sensors (IMUs) and mobile applications provide valid, objective data that enhances patient adherence through "digital visibility," bridging the gap between prescribed and actual exercise dosage. Furthermore, economic analyses indicate that this model significantly reduces patient-borne costs, establishing it as a dominant strategy for equitable healthcare delivery.

Conclusion: Integrating digital health technologies into ACL rehabilitation offers a scalable solution to the "rehabilitation gap." By combining objective data with remote access, this framework mitigates social determinants of health, ensuring that high-quality recovery is accessible regardless of a patient's geographic or financial status. A hybrid model utilizing these tools is recommended as the future standard of care.

INNOVATIVE TECHNOLOGIES IN ALZHEIMER’S DISEASE MANAGEMENT: A COMPREHENSIVE REVIEW OF DIAGNOSTIC AI, VIRTUAL REALITY INTERVENTIONS, AND WEARABLE MONITORING SYSTEMS

2026-01-27T19:15:18+00:00

Alzheimer’s Disease (AD) constitutes one of the most critical public health challenges of the 21st century, imposing an immense socioeconomic burden on global healthcare systems. As pharmacological treatments remain limited, there is a paradigm shift towards integrating digital health solutions into the continuum of care. This review article synthesizes recent advancements (2019–2025) across the full spectrum of assistive technologies: from Artificial Intelligence (AI) algorithms for early diagnosis and predictive analytics, through Virtual Reality (VR) and Socially Assistive Robotics (SAR) for non-pharmacological therapy, to Wearable IoT ecosystems for patient safety. Furthermore, the review expands the scope to the macro-level, analyzing the economic impact of these innovations and the role of Smart Cities in creating dementia-friendly environments. The findings indicate that while digital phenotypes and remote monitoring offer superior precision and can significantly reduce caregiver burden, their widespread adoption is hindered by the "digital divide," ethical concerns regarding privacy, and reimbursement gaps. The paper concludes that the future of AD management lies in a hybrid "High-Tech, High-Touch" model that balances technological efficiency with human empathy.

MOBILE HEALTH APPLICATIONS IN MANAGEMENT OF POLYCYSTIC OVARY SYNDROME (PCOS): A SYSTEMATIC REVIEW OF CLINICAL EFFICACY, QUALITY, AND SOCIO-ECONOMIC IMPLICATIONS

2026-01-29T02:37:18+00:00

Background: Polycystic Ovary Syndrome (PCOS) constitutes the most prevalent endocrine disorder in reproductive-aged women, affecting approximately 8–13% of this population globally. Although lifestyle modification is the designated first-line therapy, adherence is frequently impeded by economic barriers and the lack of continuous, personalized support. Mobile health (mHealth) technologies propose a scalable solution to this "care gap," yet the digital marketplace remains fragmented, often lacking alignment between commercial usability and clinical evidence.

Objectives: This systematic review evaluates the clinical efficacy, technical quality, and socio-economic implications of mHealth interventions in PCOS management to inform future clinical practice and reimbursement frameworks.

Methods: A systematic search of academic databases covering the period from January 2010 to January 2025 yielded 34 eligible studies. These included Randomized Controlled Trials (RCTs) assessing clinical outcomes and content analyses utilizing the Mobile App Rating Scale (MARS).

Results: Evidence from high-quality RCTs indicates that integrated mHealth interventions can function as effective "digital scaffolds" for behavioral change. Specific digital interventions demonstrated significant weight reduction (mean -3.19 kg) and improved insulin resistance with efficacy comparable to metformin. Furthermore, digital support significantly restored reproductive function, with long-term data showing a substantial increase in the prevalence of regular menstrual cycles, rising from 3.3% at baseline to 43.1% in intervention groups. However, technical analyses reveal a persistent "quality gap," where commercial applications prioritize aesthetics over evidence-based medical content.

Conclusion: Mobile health applications represent a clinically valid and cost-effective adjunct to standard PCOS care. To realize their public health potential, future frameworks must bridge the divide between commercial user experience and academic rigor, ensuring equitable access to validated digital therapeutics.

PSILOCYBIN IN PSYCHIATRIC PRACTICE AND PSYCHEDELIC-ASSISTED THERAPY FOR TREATMENT-RESISTANT DEPRESSION

2026-01-29T04:07:56+00:00

This manuscript comprehensively reviews psilocybin-assisted therapy for major depressive disorder and treatment-resistant depression. It aims to synthesize current understanding regarding its mechanisms, efficacy, safety, costs, and accessibility, comparing it with conventional antidepressant and ketamine treatments. The methodology involved a narrative synthesis of academic literature, drawing from systematic reviews, meta-analyses, and clinical trials identified through targeted database searches.

Key findings indicate that psilocybin therapy demonstrates rapid, robust, and sustained antidepressant effects, with high response and remission rates, often after one or two sessions. Its safety profile is generally favorable, with transient and mild adverse events. Mechanistically, psilocybin primarily acts on serotonin 5-HT2A receptors, modulating brain networks and enhancing neuroplasticity. However, significant challenges exist in terms of high costs, limited accessibility due to the intensive therapeutic model, and regulatory hurdles.

In conclusion, psilocybin-assisted therapy offers a promising alternative for depression, particularly where standard treatments fail, by providing rapid and durable symptom reduction through unique neurobiological pathways. Future research should focus on optimizing treatment protocols, exploring long-term outcomes, identifying predictors of response, and addressing systemic barriers to accessibility and cost-effectiveness to facilitate its integration into broader mental healthcare.

EFFECTIVENESS OF COGNITIVE-BEHAVIORAL THERAPY (CBT) IN REDUCING ANXIETY SYMPTOMS ACROSS DIFFERENT ANXIETY DISORDERS COMPARED TO CONTROL CONDITIONS AND ALTERNATIVE TREATMENTS: A SYSTEMATIC LITERATURE REVIEW

2026-01-30T20:47:40+00:00

Background: Anxiety disorders are among the most prevalent mental health conditions worldwide. Cognitive Behavioral Therapy (CBT) is widely regarded as a first-line treatment, but its evidence base is constantly evolving with new research on long-term outcomes, comparative efficacy, and novel delivery methods. The first aim of this mixed methods review is to explore the efficacy and long-term effectiveness of CBT for anxiety disorders. The secondary aims evaluate the comparative effectiveness of its various delivery modalities (e.g., face-to-face, digital, virtual reality) and its efficacy relative to other active treatments, such as pharmacotherapy and emerging psychotherapies.

Methods: A systematic review was conducted based on a synthesis of 12 peer-reviewed research summaries, including meta-analyses, randomized controlled trials, and longitudinal studies. The population included children, adolescents, and adults with diagnosed anxiety disorders. Interventions included standard CBT and its variants (e.g., ICBT, VRCBT, CBGT). Outcomes included reduction in anxiety symptoms, long-term maintenance of gains, quality of life improvements, and comparative efficacy between modalities.

Conclusions: The results from this review will provide evidence that CBT is a highly effective treatment for a range of anxiety disorders, showing medium to large effect sizes. CBT remains the gold-standard, evidence-based psychological intervention for anxiety disorders. Its benefits are durable over time and can be effectively delivered through both traditional and emerging digital formats, which can help bridge the accessibility gap. These findings clarify that, future research should focus on long-term follow-ups, optimizing digital engagement, and adapting protocols for diverse cultural and clinical populations.

DIGITAL COGNITIVE-BEHAVIORAL THERAPY FOR INSOMNIA: SAFETY, LIMITATIONS, AND PATIENT-SPECIFIC CONTRAINDICATIONS

2026-01-30T21:09:06+00:00

Introduction & objective: Insomnia is a well-established clinical problem that places a burden on the healthcare system. Due to low accessibility to professional therapists, high costs, and geographical barriers, cognitive-behavioural therapy, which is a first-line treatment for insomnia, is rarely prescribed in clinical practice. The development of digital CBT-I was aimed at overcoming those issues. However, there is still limited data regarding the safety and implementation of dCBT-I in real-life settings. Our aim was to select a specific patient group in which the traditional approach to CBT-I is preferred/advised.

Review methods: This review is based on a non-systematic review of PubMed articles published between 2015 and 2026.

Brief description of state knowledge: In numerous studies, dCBT-I has been proven to be an effective alternative to face-to-face therapy. It can be delivered in several technological forms and may vary in the level of therapist oversight. Although each form of digital CBT-I is to some extent automated, fully automated platforms raise the greatest concerns regarding safety and patient outcomes. Thus, some research suggests that there are patients for whom face-to-face therapy would be advisable.

Summary: Digital CBT‑I with therapist oversight may be particularly important for patients with psychiatric disorders, epilepsy, obstructive sleep apnea, safety‑critical occupations, and older adults; however, limited real‑world safety data highlight the need for further research to better define high‑risk groups and refine clinical guidelines.

SPORT-RELATED DYSTONIA – CURRENT STATE OF KNOWLEDGE IN DIAGNOSIS AND TREATMENT

2026-02-02T18:17:08+00:00

Sports-related dystonia (SRD) is believed to arise as a consequence of repetitive motor activity, often involving tens of thousands of movement repetitions performed during high-level athletic training. Professional sports practice is characterized by prolonged physical exertion and the frequent execution of specific motor tasks, repeated hundreds or even thousands of times in pursuit of technical perfection. This intensive regimen may lead to both physical and mental fatigue, potentially resulting in overuse injuries. SRD has been most frequently described in golfers, runners, cricketers, basketball players, and gymnasts. Despite growing awareness of its clinical presentation, SRD remains a diagnostic and therapeutic challenge.The aim of this study is to provide a comprehensive review of the current state of knowledge regarding SRD, based on publications available in the PubMed database.A literature search was conducted using relevant keywords to identify scientific publications not older than five years, retrieved from academic databases.

SRD represents a complex clinical syndrome that requires a multidisciplinary and individualized approach. The absence of specific diagnostic tests, combined with the variability and subtlety of symptoms, often results in significant diagnostic challenges. Effective treatment must be tailored to the specific symptom profile presented by each athlete, taking into account both motor and non-motor aspects of the condition. Currently, further research is needed to improve both the diagnostic criteria and therapeutic strategies for managing SRD. Early identification and preventive strategies—particularly in young athletes—should be emphasized. Educational efforts aimed at raising awareness of the potential career-threatening nature of SRD may facilitate earlier recognition of symptoms and help prevent premature discontinuation of athletic careers.Treatment of this disorder must be individualized and focused on the specific range of symptoms present in each athlete. Currently, further research on the diagnosis and therapeutic options for patients affected by this condition is necessary.

EFFECT OF PHYSICAL ACTIVITY ON REDUCING CARDIOVASCULAR DISEASE RISK IN ADULTS: A NARRATIVE REVIEW

2026-02-03T02:45:40+00:00

Background: Cardiovascular diseases (CVDs) remain the leading global cause of mortality, with physical inactivity contributing substantially to their development. Regular physical activity improves endothelial function, cardiometabolic health, inflammatory balance and cardiorespiratory fitness, which are key factors in reducing CVD risk.

Aims: The aim of this narrative review was to synthesise current epidemiological, interventional and mechanistic evidence on the role of physical activity in reducing cardiovascular disease risk in adults.

Methods: A structured narrative review was conducted using literature from PubMed, Scopus, Web of Science and Google Scholar (January–March 2025). Eligible studies examined adults (≥18 years), assessed physical activity or structured exercise as the main exposure and reported outcomes including blood pressure, lipid profile, glucose metabolism, inflammatory markers, vascular function, cardiorespiratory fitness or CVD incidence. Randomised controlled trials, cohort studies, cross-sectional studies and systematic or narrative reviews were included.

Results: Evidence from randomised trials shows that aerobic, resistance and combined exercise programs reduce blood pressure, improve lipid levels, enhance insulin sensitivity and increase cardiorespiratory fitness. Cohort studies demonstrate that higher habitual activity is associated with lower risks of coronary heart disease, stroke and cardiovascular mortality. Cross-sectional findings support favourable biomarker profiles, while systematic reviews highlight consistent mechanisms and dose–response patterns. Sedentary behaviour remains an independent predictor of cardiovascular risk.

Conclusion: Physical activity is an effective, accessible strategy for reducing cardiovascular disease risk. Promoting regular movement and limiting sedentary time should remain central elements of cardiovascular prevention.

EFFICACY AND TOLERABILITY OF DIFFERENT ORAL IRON PREPARATIONS IN IRON DEFICIENCY ANEMIA: REVIEW

2026-02-03T02:59:52+00:00

Background: iron deficiency anemia (IDA) is a widespread, preventable condition that diminishes work capacity, cognition, and overall health. Dysregulation of iron homeostasis — principally via hepcidin‑mediated sequestration — distinguishes absolute deficiency from functional deficiency, guides diagnostic interpretation and helps to choose the type therapy.

Aim: The aim of this article is to compare the available oral iron supplements with respect to efficacy, tolerability and practical use. It summarizes current evidence regarding optimal dosing and frequency of administration in individuals with iron deficiency and iron-deficiency anemia.

Methods: narrative review of literature up to 2025, prioritizing recent meta‑analyses, systematic reviews, randomized controlled trials, phase III randomized studies and other high‑quality studies. Searches were conducted in PubMed/MEDLINE, Embase, Web of Science and Google Scholar. Key search terms included oral iron, ferrous sulfate, liposomal iron, sucrosomial iron, ferric maltol and ferrous bisglycinate. This review compares their efficacy and tolerability. Study selection, data extraction, and quality evaluation followed standard review procedures; findings were synthesized and summarized in tables.

Results: new supplements generally achieve comparable or faster hematologic responses at lower elemental iron doses and are associated with fewer gastrointestinal side effects, which may improve adherence, particularly in patients intolerant of ferrous salts or with inflammatory conditions. Dosing approaches that account for hepcidin dynamics (alternate-day or single morning dosing) enhance absorption. Heterogeneity in study populations, dosing regimens and outcome measures limits direct comparisons.

Conclusion: oral iron formulations show broadly similar efficacy; selection should prioritize tolerability, comorbidity context, and dosing strategies that optimize absorption. Individualized therapy with routine monitoring of hemoglobin and ferritin improves outcomes and adherence.

THE IMPACT OF POLYPHARMACY ON FALL RISK IN PATIENTS WITH PARKINSON’S DISEASE

2026-02-03T22:36:50+00:00

Background: Falls are frequent and disabling in Parkinson’s disease (PD), and polypharmacy may heighten risk through adverse effects such as orthostatic hypotension, sedation, and cognitive decline. However, the specific contribution of multiple medications to fall risk in PD remains underexplored.

Aim: This study examined whether polypharmacy increases fall risk in PD and identified medication classes and patient factors influencing this relationship.

Methods: In a 12-month prospective cohort, adults with idiopathic PD were evaluated for demographics, PD severity, cognition, comorbidities, orthostatic blood pressure, medication use, and prior falls. Polypharmacy was defined as ≥5 medications and hyper-polypharmacy as ≥10. Falls were tracked monthly. Logistic regression and secondary moderation/mediation analyses assessed predictors of falls.

Results: Polypharmacy affected 40–63% of participants and was associated with a higher fall incidence (72.8% vs. 44.8%). It independently increased fall risk (OR = 2.49), with hyper-polypharmacy showing greater impact (OR = 3.11). Benzodiazepines, antipsychotics, antidepressants, and anticholinergics were the strongest medication-related contributors. Older age moderated, and cognitive impairment partly mediated the relationship.

Conclusion: Polypharmacy significantly elevates fall risk in PD, particularly when involving CNS-active or anticholinergic drugs. Routine medication review and deprescribing may help reduce falls and improve safety in this population.

PHYSICAL ACTIVITY IN WOMEN AFTER BREAST CANCER TREATMENT: AN ASSESSMENT STUDY

2026-02-03T23:06:43+00:00

Background: Breast cancer remains the most commonly diagnosed malignancy among women in Poland. Effective postoperative rehabilitation, including physical activity, plays a crucial role in restoring functional capacity, reducing complications, and improving overall quality of life.

Aim: To evaluate the level of physical activity in women after surgical breast cancer treatment, considering type of surgery, presence of lymphedema, psychological factors, and changes compared with pre-treatment activity

Methods: A cross-sectional survey was conducted among 58 women treated surgically for unilateral breast cancer. Data were collected using an author-designed questionnaire and the International Physical Activity Questionnaire (IPAQ).

Results: Most participants were older than 55 years, retired, and had undergone radical mastectomy. Lymphedema occurred in approximately one-quarter of the women. Across all subgroups, physical activity declined after treatment, regardless of surgery type or presence of lymphedema. Most women perceived physical activity as beneficial for recovery, but a significant proportion lacked clear guidance.

Conclusions: Physical activity levels decrease following breast cancer treatment, yet women recognize its value. Systematic patient education and structured rehabilitation programs should be integral to oncologic care.

THE IMPACT OF OBESITY ON CARDIOVASCULAR RISK. REVIEW OF THE LITERATURE

2026-02-03T23:20:51+00:00

Background: Obesity is a global health problem due to its increasing prevalence over the past several decades. It is strongly associated with an elevated risk of cardiovascular diseases, both directly through metabolic mechanisms affecting the circulatory system and indirectly through traditional risk factors such as hypertension, dyslipidemia, and type 2 diabetes.

Aim: This review discusses the pathological changes occurring in the cardiovascular system under the influence of obesity. It presents the mechanisms linking obesity with selected cardiovascular diseases and outlines the role of physical activity in obesity.

Methods: The review was conducted using the PubMed, Web of Science and Google Scholar databases, limited to full-text, open-access publications from the years 2013–2025.

Results: As body weight increases, the risk of cardiovascular diseases such as heart failure, hypertension, and arrhythmias also rises. Weight reduction helps lower the risk of developing these disorders. Combined aerobic and resistance training (CART), as well as High-Intensity Interval Training (HIIT), has a beneficial effect on well-being and the condition of the cardiovascular system.

Conclusion: Obesity and the metabolic disturbances it causes are strongly associated with an increased risk of cardiovascular diseases. Obesity is not only a co-existing factor but also an independent risk factor for cardiovascular conditions. Effective intervention requires an individual approach.

THE SIGNIFICANCE OF SLEEP IN GLUCOSE METABOLISM REGULATION – THE ROLE OF CIRCADIAN RHYTHM DISRUPTIONS IN TYPE 2 DIABETES DEVELOPMENT: A NARRATIVE REVIEW

2026-02-04T05:28:57+00:00

Background: Sleep and circadian rhythm disturbances constitute modifiable risk factors for type 2 diabetes mellitus (T2DM). Meta-analytic evidence demonstrates that short sleep duration (<6h/night) increases T2DM risk by 28–33% (OR 1.28–1.33), while shift work elevates incidence by 9–40% (RR 1.09–1.40).

Aims: The aim of this narrative review is to synthesise current epidemiological, interventional, and mechanistic evidence on how sleep disturbances and circadian rhythm disruptions influence type 2 diabetes pathophysiology in adults.

Methods: A structured narrative review was conducted using literature from PubMed, Scopus, Web of Science, and Google Scholar (2015–2025). Searches employed terms: "sleep duration glucose metabolism", "circadian rhythm type 2 diabetes", "clock genes insulin resistance", "shift work diabetes risk", "melatonin glucose homeostasis". Meta-analyses, systematic reviews, cohort studies, and randomized controlled trials were included.

Results: Epidemiological evidence reveals a U-shaped sleep–T2DM relationship with optimal risk at 7–8 hours/night. Short sleep (<6h) and long sleep (>9h) both increase T2DM risk (OR 1.28–1.48). Night shift work elevates risk dose-dependently (RR 1.40, 95% CI 1.15–1.71) across 1.16 million participants. Molecular mechanisms involve desynchronized clock genes (CLOCK, BMAL1, PER2, CRY1), mitochondrial dysfunction reducing oxidative capacity 20–30%, and altered melatonin signaling. Sleep extension interventions improve insulin sensitivity 17–45% within 1 week. Evening chronotherapy with glucose-lowering drugs demonstrates superior efficacy compared to morning dosing. CBT-I (cognitive behavioral therapy for insomnia) reduces T2DM incidence by 42% in prediabetic populations.

Conclusion: Sleep and circadian optimization represent cost-effective, modifiable strategies for T2DM prevention. Personalized chronotherapy guided by genetic profiling and objective sleep/activity monitoring warrants implementation in clinical practice and public health policies.

AI-BASED GUIDEBOOKS: CONCEPTS, KEY FEATURES, AND CHALLENGES

2026-01-27T14:18:52+00:00

The digital transformation of tourism and information services has accelerated the adoption of artificial intelligence in travel-related applications. An outcome of this process is the emergence of AI-based guidebooks, which differ from traditional guidebooks in their ability to personalize content, adapt to changing conditions, and interact with users in real time. This study aims to examine the core features, technological foundations, and challenges of AI-based guidebooks and their implications for contemporary tourism. The object of the research is AI-based guidebooks as intelligent guidance systems. It is focused on their functional characteristics, including personalization, context awareness, and interactive capabilities. The methodology is based on a conceptual and analytical review of academic literature on intelligent recommendation systems, natural language processing, geospatial analytics, and multimodal information delivery. The analysis identifies key advantages of AI-based guidebooks, such as adaptive content generation, context-sensitive recommendations, conversational interaction, and multimodal engagement. At the same time, important limitations are highlighted, including issues of information reliability, privacy and ethical concerns, and the risk of over-reliance on automated systems. The study concludes that AI-based guidebooks mark an important advancement in tourism information systems and stresses the need for more research on transparency, user trust, and hybrid methods that blend AI personalization with human-edited cultural content.