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.

THE NATIONAL APPLICATION OF FOREIGN LAW

2026-01-15T05:58:59+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.