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THE INVISIBLE BURDEN: A COMPREHENSIVE REVIEW OF PSYCHOLOGICAL ASPECTS IN PATIENTS WITH ANKYLOSING SPONDYLITIS
No full textAnkylosing 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
PREVENTION OF SURGICAL SITE INFECTIONS: A COMPREHENSIVE REVIEW OF GUIDELINES AND SCIENTIFIC EVIDENCE (2017–2025)
No full textSurgical 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
MULTISYSTEM ADVERSE EFFECTS OF ISOTRETINOIN: MECHANISTIC INSIGHTS AND CLINICAL IMPLICATIONS
No full textIsotretinoin (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
THE IMPACT OF OBESITY ON CARDIOVASCULAR RISK. REVIEW OF THE LITERATURE
No full textBackground: 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
DEVELOPMENTAL CARDIAC ANOMALIES IN CHILDREN WITH EDWARDS SYNDROME: A COMPREHENSIVE REVIEW
No full textIntroduction 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
PHYSICAL ACTIVITY IN WOMEN AFTER BREAST CANCER TREATMENT: AN ASSESSMENT STUDY
No full textBackground: 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 ROLE OF WEARABLE TECHNOLOGY AND TELEREHABILITATION IN OPTIMIZING POST-OPERATIVE ACL RECOVERY: A FRAMEWORK FOR EQUITABLE ACCESS
No full textBackground: 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
MOBILE HEALTH APPLICATIONS IN MANAGEMENT OF POLYCYSTIC OVARY SYNDROME (PCOS): A SYSTEMATIC REVIEW OF CLINICAL EFFICACY, QUALITY, AND SOCIO-ECONOMIC IMPLICATIONS
No full textBackground: 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
THE IMPACT OF POLYCYSTIC OVARY SYNDROME ON MENTAL HEALTH AND BODY IMAGE IN WOMEN: A CLINICAL LITERATURE REVIEW
No full textPolycystic ovary syndrome (PCOS) represents the most common endocrine disorder in women of reproductive age, affecting 6–20% of this population depending on diagnostic criteria applied. Beyond its metabolic and reproductive consequences, PCOS significantly impacts mental health, particularly depression, anxiety, and body image disturbance. This clinical literature review synthesizes evidence from clinical studies and observational research examining the psychological burden of PCOS. Evidence indicates that women with PCOS experience markedly elevated rates of depression (approximately 49%) and anxiety compared to healthy controls, with depression predominantly presenting as mild to moderate severity. Lifestyle factors, including lack of exercise (OR=7.5), psychological stress (OR=6.5), sleep disturbance, and high-fat diet, constitute significant modifiable risk factors for depression. Body image disturbance emerges as a critical mediating factor between PCOS symptoms and psychological distress, affecting quality of life and overall well-being. Body appreciation, in contrast to mere absence of dissatisfaction, constitutes a particularly important protective factor for mental health. Cognitive-behavioral therapy (CBT) and psychosocial interventions demonstrate substantial efficacy in reducing depression and anxiety symptoms. Routine mental health screening and implementation of evidence-based psychological interventions are essential components of comprehensive PCOS care. This review emphasizes the necessity of integrated, multidisciplinary approaches addressing both physical and psychological aspects of PCOS, with particular attention to lifestyle modification as a therapeutic strategy
SAFETY AND EFFECTIVENESS OF SSRIS AND SNRIS TREATMENT FOR PERINATAL DEPRESSION: A SYSTEMATIC REVIEW
No full textIntroduction and Purpose: Perinatal depression is a common and serious condition affecting maternal and child health. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), are widely used despite ongoing safety concerns. This review aims to evaluate current evidence on the safety and effectiveness of antidepressant treatment during pregnancy and the postpartum period to support individualized clinical decision-making in the management of perinatal depression.
Methods: A narrative systematic review of population-based cohort studies, systematic reviews, and meta-analyses published between 2014 and 2025 was conducted using PubMed. Results: The evidence indicates that SSRIs and SNRIs exposure during pregnancy is associated with small increases in the risk of preterm birth, neonatal adaptation syndrome, postpartum hemorrhage, and rare outcomes such as persistent pulmonary hypertension of the newborn, particularly with late-pregnancy exposure. Absolute risks remain low, and associations with neurodevelopmental disorders largely attenuate after adjustment for familial and maternal psychiatric factors. Postpartum antidepressant treatment is consistently associated with sustained improvements in maternal mental health and functional outcomes.
Conclusions: Current evidence supports individualized risk–benefit assessment when considering antidepressant use during the perinatal period. Maintaining maternal mental health is essential, and treatment decisions should consider illness severity, timing of exposure, and patient preferences