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THE IMPACT OF PROTON PUMP INHIBITORS ON KIDNEY FAILURE: LITERATURE REVIEW
No full textProton 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
COMPARATIVE EFFECTIVENESS OF PAIN-RELIEF METHODS DURING LABOUR: A LITERATURE REVIEW
No full textEffective 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
EFFECT OF PHYSICAL ACTIVITY ON REDUCING CARDIOVASCULAR DISEASE RISK IN ADULTS: A NARRATIVE REVIEW
No full textBackground: 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
AN AGE-OLD PROBLEM IN A HIGH-TECH WORLD: THE DIGITAL HEALTH CARE DIVIDE FOR ELDERLY PATIENTS
No full textThe rapid digitalization of health care, propelled by the COVID-19 pandemic, has led to a rapidly growing gap in use of medical technology for senior patients. The inclusion of wearable medical devices, patient portals, telemedicine, and access to information has created an opportunity for patients to have more control over their health than ever before. However, for elderly patients it also comes with new challenges due to fear or reluctance to use advanced technologies they are not familiar with, leaving them to rely on family members and caregivers. It was found that health care provider’s hesitation in offering digital options and the expenses associated with digital devices are another obstacle. There is a significant need for modification in health care personnel attitudes regarding technology, promotion of combining community centers and health care for improving overall quality of life and digital literacy, and advocacy for senior patients' opinions when creating new medical technology and possibly incorporating AI technology to aid in bridging the gap
SUDDEN SENSORINEURAL HEARING LOSS IN THE POST-COVID-19 ERA: A SYSTEMATIC REVIEW OF ETIOLOGY, DIAGNOSIS AND MANAGEMENT
No full textIntroduction: Sudden sensorineural hearing loss (SSHL) is a rare otorhinolaryngological emergency that, if not identified early, may lead to permanent hearing impairment. It is characterized by a sudden unilateral hearing loss developing within 72 hours, with a ≥30 dB reduction across three contiguous frequencies on pure-tone audiometry. Its pathophysiology remains poorly understood, and in over 70% of cases, the cause is idiopathic. SSHL is often unaccompanied by systemic symptoms but may present as a sensation of a “blocked ear,” which contributes to diagnostic delays. The estimated incidence ranges from 5 to 27 per 100,000 individuals annually, with a noted increase in cases during and after the COVID-19 pandemic.
Aim of the study: To summarize current knowledge on the etiology, diagnosis, and management of SSHL, and to review studies examining its potential link to SARS-CoV-2 infection.
Materials and methods: Data were collected from PubMed, Mendeley, and the Clinical Practice Guideline on Sudden Hearing Loss (Otolaryngology–Head and Neck Surgery journal). Searches used terms such as “Sudden Sensorineural Hearing Loss,” “Idiopathic Hearing Loss,” and “SSHL and COVID-19.”
Conclusion: SSHL poses a diagnostic and therapeutic challenge due to its rarity and narrow therapeutic window. Glucocorticoids—administered orally or via intratympanic injection—remain the primary treatment. Diagnostic work-up should rely on clinical evaluation and avoid unnecessary tests, such as CT or routine labs, unless specifically indicated. Poorer prognosis is associated with vertigo, dizziness, advanced age, and comorbidities. An increase in SSHL cases post-COVID-19 highlights the need for further research into pathogenesis, prognostic factors, and individualized therapy
MODERN TECHNOLOGICAL SOLUTIONS IN THE TREATMENT OF OBSTRUCTIVE SLEEP APNEA: A REVIEW OF INNOVATIONS AND THEIR SOCIAL IMPACT
No full textIntroduction: 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]
PSILOCYBIN IN PSYCHIATRIC PRACTICE AND PSYCHEDELIC-ASSISTED THERAPY FOR TREATMENT-RESISTANT DEPRESSION
No full textThis 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
TRANSTHYRETIN AMYLOIDOSIS - SYMPTOMS, DIAGNOSIS, TREATMENT - A SYSTEMIC REVIEW
No full textBackground: Transthyretin amyloidosis (ATTR) is a rare, progressive systemic disorder caused by extracellular deposition of misfolded transthyretin, most commonly affecting the heart and peripheral nervous system. Because early manifestations are nonspecific, the disease is often under-recognised and diagnosed late, when organ damage is advanced.
Methods: We performed a narrative review of the literature using PubMed and Google Scholar, searching for clinical and translational studies on transthyretin amyloidosis, with particular focus on symptoms, diagnostic pathways, and currently available as well as emerging treatments. Additional references were identified from the reference lists of key articles.
Results: ATTR may present with a broad spectrum of cardiac, neurologic, gastrointestinal, musculoskeletal, and autonomic symptoms. Red-flag features include unexplained heart failure with preserved ejection fraction, increased ventricular wall thickness with low QRS voltages, bilateral carpal tunnel syndrome, lumbar spinal stenosis, and biceps tendon rupture. Diagnosis relies on a combination of clinical assessment, biomarkers, advanced imaging, and tissue biopsy when required, together with exclusion of light-chain amyloidosis. Disease-modifying therapies, particularly transthyretin stabilisers and gene-silencing agents, have significantly improved prognosis, especially when initiated early in the disease course.
Conclusions: Clinicians should maintain a high index of suspicion for ATTR in patients with compatible multi-system features. Timely recognition and appropriate use of non-invasive diagnostic algorithms allow earlier initiation of targeted therapy, which is crucial for improving survival and quality of life in transthyretin amyloidosis
PHYSICAL ACTIVITY AS A NON-PHARMACOLOGICAL INTERVENTION FOR INSOMNIA
No full textInsomnia, 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
COBENFY (XANOMELINE-TROSPIUM CHLORIDE) AS A BREAKTHROUGH IN SCHIZOPHRENIA TREATMENT: POTENTIAL IMPACT ON PATIENT QUALITY OF LIFE AND HEALTHCARE ECONOMICS
No full textIn September 2024 FDA approved Cobenfy - the first antipsychotic with a novel mechanism of action in over 30 years. Unlike conventional antipsychotics that block D2 dopamine receptors, Cobenfy acts through muscarinic M1 and M4 receptor agonism. This matters because the side effects of traditional antipsychotics - weight gain, metabolic disturbances, movement disorders - are the main reason why about half of patients stop taking their medications. And when they stop, relapses follow. The EMERGENT trials demonstrated that Cobenfy achieves comparable efficacy (effect size 0.61) while avoiding the metabolic and extrapyramidal problems that plague existing treatments. For patients with schizophrenia, who already face a 15-20 year reduction in life expectancy largely due to cardiovascular disease, a medication that doesn't worsen their metabolic profile could be genuinely life-changing. But beyond individual health the implications extend to families exhausted by relapse cycles, to healthcare systems burdened by preventable hospitalizations, and to communities that have struggled to integrate people whose treatment makes normal functioning nearly impossible. Of course long-term data are still needed - approval came after relatively short trials. But the potential here is significant: better tolerability could mean better adherence, fewer relapses, less hospitalization, and ultimately patients who can actually participate in their own lives