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DIAGNOSIS AND TREATMENT OF ACUTE ADRENAL CRISIS IN THE SETTING OF THE EMERGENCY DEPARTMENT - A LITERATURE REVIEW
No full textIntroduction and objective: Acute adrenal crisis (AAC) is a life-threatening condition, often under-recognized due to its rarity. Over the years, technological advances have occurred across many branches of medicine, including new solutions for diagnosing and treating AAC. However, they remain fragmented across the literature. In this review, we sought to systematically evaluate and summarize contemporary innovations that may help emergency medicine practitioners to be more confident in their diagnoses and, therefore, make more confident under-pressure clinical decisions.
Review Methods: We searched the PubMed and Google Scholar databases, focusing on papers published between 2020 and 2025.
Brief description of knowledge: Currently, AAC is treated empirically with hydrocortisone. Quick tests for cortisol levels are not widely available; diagnosis is based mainly on clinical symptoms and electrolyte disturbances.
Summary: Developments in diagnostic approaches, such as saliva-based, aptamer-based point-of-care cortisol assays, may aid differential diagnosis of AAC in emergency departments (EDs) and reduce time to hydrocortisone administration
SUDDEN CARDIAC ARREST DURING MASS RUNNING EVENTS IN THE CONTEXT OF THE 2025 EUROPEAN RESUSCITATION COUNCIL GUIDLINES AND CURRENT SCIENTIFIC EVIDENCE
No full textIntroduction and objective: Sudden cardiac arrest (SCA) during outdoor sport training is a complication where a quick response from medical professionals is crucial for increasing chances of survival. In parallel with the global growth in running events, there is a need to implement new recommendations and technologies to improve prevention, detection, and treatment of SCA among runners.
Review Methods: A comprehensive literature review was conducted, analyzing studies indexed in PubMed, Google Scholar, and the official ERC Guidelines from 2021 and 2025.
Key findings: Recent data suggest that, although the number of SCA cases in mass running events has remained relatively stable over the past decade, running-related deaths have declined. These outcomes are likely attributable to significant improvements in emergency action planning, widespread AED availability, and enhanced first-aid education. There are also new ideas that can further improve those outcomes, not only in treatment but also in SCA prophylaxis. New preventive and diagnostic strategies, such as point-of-care blood gas analysis (POC BGA) and risk-profiling patient triage, focus primarily on early triage and smartwatch pulse-detector systems, offering a new perspective on more rapid detection of SCA during outdoor activity. Advances in treatment focus on optimizing the prehospital chain of survival through mobile AED teams, GPS-enabled responder coordination, and structured “field-of-play” protocols. Further research is needed to reduce the time to defibrillation and improve neurological outcomes during endurance events
THE ROLE OF VITAMIN D IN REPRODUCTIVE HEALTH AND INFERTILITY: A REVIEW OF THE LITERATURE
No full textVitamin D is increasingly recognized as a pleiotropic steroid hormone influencing numerous physiological systems, including reproductive function. Over the past decade, evidence has demonstrated a strong link between vitamin D deficiency and impaired ovarian function, suboptimal endometrial receptivity, reduced sperm quality, and adverse outcomes in assisted reproductive technologies (ART). This comprehensive review synthesizes clinical and mechanistic evidence on the role of vitamin D in female and male infertility, emphasizing ovulation, polycystic ovary syndrome (PCOS), endometrial function, ART outcomes, and male reproductive parameters. Systematic analysis of studies published from 2010 to 2025, including randomized controlled trials, cohort studies, and meta-analyses, shows that sufficient serum 25-hydroxyvitamin D [25(OH)D] levels are associated with improved reproductive parameters, including higher ovulation rates, enhanced implantation, clinical pregnancy, live birth rates, and better sperm quality and motility. Supplementation studies suggest potential benefits in correcting vitamin D deficiency in women with PCOS, women undergoing ART, and men with impaired sperm parameters, although heterogeneity in dosing regimens, baseline populations, and outcome measures limits definitive clinical recommendations. Mechanistic evidence indicates that vitamin D regulates steroidogenesis, endometrial immunomodulation, insulin sensitivity, placental angiogenesis, and spermatogenesis, which may underlie its clinical effects. While current findings support routine assessment and correction of vitamin D deficiency, optimal serum targets, timing, and supplementation protocols require further investigation. Large-scale randomized trials are necessary to establish standardized clinical guidelines and confirm long-term reproductive benefits in both sexes
THE IMPACT OF CHRONIC STRESS ON MENSTRUAL DISORDERS IN WOMEN OF REPRODUCTIVE AGE: A LITERATURE REVIEW
No full textChronic psychological and physical stress is a major contributor to menstrual disturbances in women of reproductive age. This review aims to synthesize current evidence on the mechanisms, clinical implications, and management of stress-related menstrual dysfunction, with particular focus on hypothalamic suppression. Methods included comprehensive evaluation of observational studies, clinical trials, and experimental research addressing neuroendocrine, metabolic, and behavioral pathways affected by prolonged stress, energy deficiency, and intensive physical activity. Findings indicate that chronic stress disrupts hormonal regulation by inhibiting gonadotropin secretion and impairing ovarian function, leading to reduced estrogen production and anovulation. Energy deficiency and excessive physical exertion exacerbate these effects, resulting in prolonged hypoestrogenism, impaired fertility, and decreased bone mineral density. Women affected may present with normal body weight, complicating early detection and diagnosis. Multidisciplinary management strategies, including lifestyle modification, nutritional support, moderated physical activity, and psychological interventions, have been shown to restore menstrual function and mitigate long-term complications. In selected cases, pharmacological interventions may be necessary to preserve bone health and support reproductive outcomes. Overall, stress-induced menstrual disorders result from a complex interplay between psychological, metabolic, and physical factors, requiring individualized assessment and treatment. Early identification and intervention are essential to prevent chronic health consequences, optimize reproductive potential, and maintain overall well-being. The review highlights gaps in understanding of individual susceptibility, recovery timelines, and long-term metabolic and cognitive outcomes, emphasizing the need for further research to develop targeted preventive and therapeutic strategies for women at risk of stress-related menstrual dysfunction
MALIGNANCY AND ATRIAL FIBRILLATION – HARDSHIPS TO MANAGE BLEEDING AND THROMBOEMBOLIC RISK
No full textAtrial fibrillation (AF) and cancer are conditions that often coexist. Both of them, as well as their treatment, are connected with changes in coagulation processes, increasing the risk of bleeding or thromboembolic events. Despite that, the level of evidence supporting existing recommendations remains low. (Lyon et al., 2022)
In this study, we focused on analyzing the existing literature on the assessment and management of bleeding and thromboembolic risk, with the aim of establishing an evidence-based approach to managing bleeding and thromboembolic risk in oncology patients with AF.
Cancer is widely associated with a hypercoagulability state, but in the case of AF and stroke risk, it does not seem to be higher in general in comparison with non-cancer populations. It changes when individual cancer types are analyzed. As for the bleeding risk, many malignancies seem to increase it. Another challenge is that the existing risk scores often show lower predictive value for patients with recent malignancy. There is a need for individual assessment in every patient, but we lack the tools to make it easier for clinicians. Cardio-oncology guidelines addressing AF do exist, but the level of evidence supporting them remains low; thus, further research in this field is needed
MICRODISCECTOMY AND PERCUTANEOUS ENDOSCOPIC LUMBAR DISCECTOMY: A BRIEF COMPARATIVE REVIEW
No full textBackground: Microdiscectomy (MLD) has long been considered the standard surgical treatment for lumbar disc herniation. Percutaneous endoscopic lumbar discectomy (PELD) has emerged as a minimally invasive alternative aimed at reducing tissue trauma and improving early postoperative recovery. Despite increasing adoption of endoscopic techniques, the relative advantages and limitations of these approaches remain debated [1–4].
Objective: This narrative review provides a concise comparison of microdiscectomy and percutaneous endoscopic lumbar discectomy based on available randomized controlled trials and comparative studies, with emphasis on clinical outcomes, perioperative recovery, complications, and practical considerations.
Methods: A focused narrative review of randomized controlled trials and comparative clinical studies evaluating MLD and PELD was performed. Outcomes of interest included pain relief, functional improvement, perioperative recovery, complication profiles, and technical considerations.
Results: Available evidence demonstrates comparable clinical outcomes between MLD and PELD in terms of pain relief and functional improvement [1–4]. PELD is associated with reduced postoperative tissue injury, less early postoperative back pain, and faster recovery [2,4,5]. Complication rates are similar overall, although the type of complications differs between techniques [1,4,14]. Outcomes after PELD are more strongly influenced by surgeon experience [19].
Conclusion: MLD and PELD provide comparable effectiveness in the treatment of lumbar disc herniation. PELD offers advantages in early recovery, while MLD remains a reliable and widely applicable technique. These procedures should be regarded as complementary
PHARMACOLOGICAL STRATEGIES FOR THE TREATMENT OF BIPOLAR DISORDER IN PREGNANT WOMEN: A SYSTEMATIC REVIEW
No full textIntroduction: Bipolar affective disorder (BAD) is a chronic mental disorder characterized by recurrent episodes of mania or hypomania and depression, with periods of remission in between. In women of reproductive age, BAD is associated with an increased risk of early pregnancy, perinatal complications, and postpartum relapse. The cornerstone of treatment is pharmacotherapy, including mood stabilizers as well as antipsychotic and antidepressant drugs. Pharmacological treatment during pregnancy reduces the risk of relapse but carries a potential risk of developmental defects and obstetric complications. Optimal therapeutic management requires individualized treatment.
Aim of the study: The aim of this work was to review the available literature on the pharmacological treatment of bipolar affective disorder (BAD) in pregnant women and to summarize the current state of knowledge. The safety profile of the drugs used and their effects on the mother and fetus during BAD pharmacotherapy are presented.
Methods and materials: A review of the literature available in the PubMed database was conducted using the following keywords: „treatment of bipolar disorder during pregnancy”, „teratogenicity”, „mood stabilizers”, „lithium”, „antidepressants”, „antipsychotic agents”, „congenital malformations”, „bipolar depression”, „valproate”, „lamotrigine”, „carbamazepine”, „postpartum relapse” and „anticonvulsants”.
Conclusion: Treatment of bipolar affective disorder in women of reproductive age is a significant clinical challenge. Continuation of pharmacotherapy during pregnancy is crucial for mood stabilization and prevention of postpartum episodes. Drug selection should be based on a risk–benefit assessment. Individualized pharmacotherapy and regular monitoring of mother and fetus are essential for optimal treatment outcomes and safety of both mother and child
ONE PATHWAY, INFINITE POTENTIAL? THE FUTURE OF GLP-1 THERAPIES: A 2026 CLINICAL UPDATE
No full textGlucagon-like peptide-1 receptor agonists (GLP-1 RAs) have advanced from incretin-based therapies for type 2 diabetes to multifaceted treatments addressing obesity, cardiovascular disease, and emerging neuropsychiatric conditions. This review examines their physiological mechanisms, pharmacological profiles, and clinical outcomes based on data through early 2026.
GLP-1 RAs mimic the incretin effect, enhancing insulin secretion, delaying gastric emptying, and modulating central reward pathways in the mesolimbic system. Approved agents like semaglutide and tirzepatide achieve 15-25% weight loss, reduce major adverse cardiovascular events by 12-26%, and show promise in heart failure with preserved ejection fraction and chronic kidney disease.
Recent trials indicate potential in alcohol use disorder, with semaglutide reducing heavy drinking and cravings, though cognitive benefits in major depressive disorder remain unproven. Safety analyses from large cohorts (2024-2025) confirm no increased thyroid cancer risk (HR 0.81-0.93), and FDA reviews (2026) find no causal suicidality link.
Overall, GLP-1 RAs bridge metabolic and behavioral health, supporting a unified view of energy regulation. Ongoing research on patient responders and targeted analogues will guide their integration into care for metabolic psychiatry, emphasizing balanced risk assessment
TRANSTHYRETIN AMYLOIDOSIS – OVERVIEW OF TREATMENT METHODS
No full textATTR amyloidosis is a rare disease associated with abnormal folding of the transthyretin (TTR) protein, leading to the deposition of amyloid fibrils in the heart and nervous system. Treatment to date has focused primarily on alleviating symptoms such as heart failure and neuropathy. Currently available disease-modifying therapies include TTR stabilizers (tafamidis, acoramidis), which prevent TTR tetramer dissociation, and gene silencers (siRNA and ASO), which reduce TTR production and slow the progression of polyneuropathy. Modern experimental strategies, including CRISPR-Cas9 gene editing and anti-ATTR monoclonal antibodies, offer the potential for one-time treatment and removal of existing amyloid deposits. The choice of therapy should be tailored to the patient's phenotype, disease stage, and clinical capabilities, and ongoing research will better determine the long-term efficacy and safety of new drugs.
The aim of this paper is to present contemporary therapeutic strategies in the treatment of transthyretin amyloidosis (ATTR), with particular emphasis on disease-modifying drugs such as TTR stabilizers, gene silencers, CRISPR-Cas9 gene editing therapies, and anti-ATTR monoclonal antibodies. The paper aims to evaluate the efficacy and safety of available therapies, discuss their clinical indications depending on the patient's phenotype (polyneuropathy, cardiomyopathy), and present directions for the development of new therapeutic strategies based on current clinical trials
NEW TECHNOLOGIES FOR CERVICAL CANCER SCREENING
No full textCervical cancer is still a health worry around the world, especially in poorer countries. Traditional methods for detecting this disease are no longer as effective as they need to be. Many people cannot get to them; they are too expensive. Participation in cervical cancer screening remains low in many populations. Recent advances offer promising strategies to improve the accessibility and effectiveness of screening programs. Emerging technologies may enhance early detection and increase patient engagement, ultimately reducing cervical cancer incidence and mortality. Please, take a look at what is happening in a few key areas: studying the tiny components that make up our bodies, diagnosing problems at a molecular level using light to detect diseases, teaching computers to assist doctors, and analyzing the free-floating DNA in our blood. This report looks at all these emerging tools and technologies.
Researchers use metabolomics to study physiological processes by identifying small-molecule biomarkers, such as TMAO, which is a potential indicator of disease. Advances in spectroscopy, combined with machine learning, now enable non-invasive diagnostics. Recent innovations include rapid HPV tests and self-sampling kits. Doctors can analyze DNA fragments in blood as a non-surgical alternative to biopsies. With AI computers can interpret medical images to aid diagnosis and predict outcomes.
New technology has the potential to improve cervical cancer screening worldwide significantly. The ultimate goal is to catch early disease, reduce mortality, and work toward the elimination of cervical cancer. This marks a significant advance, and with effective strategies, the global health community can make substantial progress