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DEPTH OF GENERAL ANESTHESIA: CLINICAL SIGNIFICANCE, MONITORING STRATEGIES, AND CURRENT CONTROVERSIES
No full textResearch Objectives: The depth of general anesthesia is a critical yet incompletely defined component of modern anesthetic practice. Both insufficient and excessively deep anesthesia have been associated with adverse intraoperative and postoperative outcomes, particularly in vulnerable patient populations. This narrative review aims to summarize current evidence on the clinical significance of anesthetic depth, discuss available monitoring strategies, and explore major limitations and controversies related to depth-of-anesthesia assessment, with particular emphasis on electroencephalography (EEG)-based monitoring.
Methods: A narrative review of experimental, observational, and clinical studies was conducted using the PubMed/MEDLINE and PubMed Central databases. Publications published between 2005 and 2025 were included, supplemented by selected foundational studies addressing the neurophysiological mechanisms of consciousness and anesthesia. In total, 40 peer-reviewed publications were analyzed. The review focused on the dynamic nature of general anesthesia, the risks associated with excessive anesthetic depth, and the performance, benefits, and limitations of EEG-based monitoring techniques, including the bispectral index and entropy.
Conclusions: General anesthesia represents a dynamic and multidimensional neurophysiological process rather than a binary loss of consciousness. Evidence suggests that excessively deep anesthesia is associated with cardiovascular depression, intraoperative hypotension, pathological EEG patterns, and an increased risk of postoperative delirium and cognitive dysfunction. EEG-based depth-of-anesthesia monitoring provides indirect insight into cerebral activity and may support anesthetic titration, reduction of excessive dosing, and improved hemodynamic stability. However, inter-device variability, susceptibility to artifacts, population-specific responses, and the absence of universally accepted cutoff values limit its use as a standalone tool. Depth-of-anesthesia monitoring should therefore complement comprehensive clinical assessment. Future research should focus on methodological standardization, multimodal monitoring, and individualized anesthetic strategies to improve perioperative safety
THE IMPACT OF ARTIFICIAL INTELLIGENCE (AI) INNOVATIONS IN CARDIOLOGY: A COMPREHENSIVE REVIEW OF CLINICAL EFFECTIVENESS, ETHICAL CHALLENGES, AND SOCIO-SYSTEMIC IMPLICATIONS
No full textThe 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
OBESITY AS AN IMMUNOMETABOLIC DISORDER: MECHANISMS OF IMMUNE IMPAIRMENT AND INCREASED SEVERITY OF INFECTIOUS DISEASES - A REVIEW OF CURRENT EVIDENCE
No full textBackground: Obesity represents a major global health burden and is increasingly recognized as a complex immunometabolic disorder rather than a simple imbalance of energy intake and expenditure. Chronic low-grade inflammation, adipokine dysregulation, altered immune cell metabolism, and gut microbiota dysbiosis profoundly remodel immune responses in individuals with obesity. Growing evidence indicates that these alterations significantly affect susceptibility to infections, disease severity, and clinical outcomes, particularly in viral respiratory infections such as COVID-19 and influenza.
Aims: This narrative review aims to synthesize current epidemiological, mechanistic, and interventional evidence explaining why individuals with obesity experience more severe courses of infectious diseases. Particular attention is given to immunometabolic dysfunction, adipokine imbalance, inflammasome activation, microbiota-derived immune modulation, and the potential reversibility of immune impairment through metabolic interventions.
Methods: A comprehensive narrative literature review was conducted using PubMed, PubMed Central, Google Scholar, and ResearchGate. Eligible studies included randomized controlled trials, observational cohort and cross-sectional studies, mechanistic immunology research, microbiota studies, and systematic or narrative reviews focusing on adults with overweight or obesity. Evidence was synthesized qualitatively due to heterogeneity in study designs and outcomes.
Results: Across study types, obesity consistently emerged as an independent risk factor for immune dysfunction and severe infectious outcomes. Mechanistic studies demonstrated chronic activation of inflammatory pathways, including NLRP3 inflammasome signaling, leptin dominance with reduced adiponectin, impaired interferon responses, mitochondrial dysfunction, and exhaustion of T and NK cells. Microbiota studies revealed reduced diversity and depletion of short-chain fatty acid–producing bacteria. Clinical studies confirmed higher rates of hospitalization, intensive care admission, prolonged viral shedding, and mortality among individuals with obesity. Interventional studies showed that modest weight loss (5–10%) can partially restore immune function and reduce inflammatory burden.
Conclusion: Obesity profoundly impairs immune competence through interconnected metabolic, inflammatory, and microbiota-driven mechanisms, leading to increased susceptibility to infections and worse clinical outcomes. Although immunometabolic dysfunction is partially reversible, further long-term studies are required to determine its impact on clinical risk reduction
TIRZEPATIDE AND RETATRUTIDE IN THE TREATMENT OF OBESITY AND TYPE 2 DIABETES MELLITUS: CURRENT EVIDENCE AND FUTURE DIRECTIONS. A SYSTEMATIC REVIEW OF CURRENT LITERATURE
No full textBackground: The global prevalence of obesity and type 2 diabetes mellitus (T2DM) has achieved unprecedented levels, imposing substantial burdens on healthcare systems worldwide. Incretin-based pharmacotherapies have fundamentally transformed therapeutic approaches to these metabolic disorders over the past decade. Tirzepatide is a dual GIP/GLP-1 receptor agonist. Retatrutide additionally targets glucagon receptors. Both agents represent groundbreaking advances in metabolic pharmacotherapy.
Objective: This comprehensive review synthesizes clinical evidence from trials conducted between 2014 and 2024, examining pharmacological mechanisms, therapeutic efficacy, safety characteristics, and prospective clinical applications of these novel multi-receptor agonists.
Methods: We performed systematic literature searches across PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov databases. Selection criteria encompassed randomized controlled trials, systematic reviews, meta-analyses, and prospective cohort studies, adhering to PRISMA methodology throughout.
Results: Phase 3 clinical trials showed superior efficacy of tirzepatide compared to existing pharmacotherapies, reaching body weight reductions of approximately 22.5% and hemoglobin A1c (HbA1c) reductions of up to 2.4 percentage points. Phase 2 trials of retatrutide revealed even more remarkable outcomes, with weight reductions approaching 24.2% over 48 weeks. Both medications exhibited favorable cardiovascular profiles, though gastrointestinal adverse events constitute the predominant tolerability concern.
Conclusions: These pharmacological agents represent paradigm-shifting developments in obesity and diabetes management. Their therapeutic effectiveness approximates outcomes previously achievable only through surgical intervention, marking a transformative milestone for pharmacotherapy. Ongoing phase 3 trials will further elucidate their optimal positioning within clinical treatment algorithms
KIDNEY STONES – WHEN TO USE MINI-PERCUTANEOUS NEPHROLITHOTOMY AND WHEN TO USE ULTRA-MINI PERCUTANEOUS NEPHROLITHOTOMY?: A NARRATIVE REVIEW
No full textBackground: Miniaturized percutaneous nephrolithotomy techniques have been developed to reduce the morbidity associated with standard percutaneous nephrolithotomy (PCNL) while maintaining high stone clearance. Among these approaches, mini-PCNL and ultra-mini PCNL (UMP) are increasingly used; however, their optimal indications remain incompletely defined.
Aims: To review and synthesize current evidence regarding the efficacy, safety, and clinical indications of mini-PCNL and UMP in the management of kidney stone disease.
Methods: A narrative review of the literature was performed using PubMed/MEDLINE, Scopus, and Web of Science databases. Clinical studies, comparative analyses, meta-analyses, reviews, and international guideline documents addressing mini-PCNL and UMP were included. Evidence was synthesized descriptively with emphasis on stone- and patient-related factors influencing technique selection.
Results: Both mini-PCNL and UMP demonstrated high stone-free rates when applied in appropriately selected patients. Mini-PCNL achieved superior stone clearance for larger (15–30 mm), multiple, or high-density renal stones, owing to efficient fragment extraction. UMP was associated with lower perioperative morbidity, reduced bleeding risk, and shorter hospital stay, with optimal outcomes observed in smaller stone burdens. Differences in efficacy between techniques were minimal for stones <15 mm but became more pronounced with increasing stone size and complexity.
Conclusions: Mini-PCNL and UMP are complementary techniques in contemporary percutaneous stone surgery. Mini-PCNL is best suited for larger or more complex stones requiring active fragment removal, whereas UMP offers advantages in minimizing invasiveness and accelerating recovery in selected patients. Individualized treatment selection based on stone characteristics, patient factors, and surgical expertise is essential to optimize outcomes
ARTHROSCOPY-ASSISTED VERSUS CONVENTIONAL FIXATION OF INTRA-ARTICULAR FRACTURES: A NARRATIVE REVIEW OF JOINT-SPECIFIC OUTCOMES
No full textArthroscopy-assisted fracture fixation has increasingly been adopted as an adjunct to conventional open reduction and internal fixation (ORIF) in the management of intra-articular fractures. While ORIF remains the standard surgical approach, arthroscopy enables direct visualization of articular surfaces and associated intra-articular pathology, potentially improving reduction accuracy and clinical outcomes. This narrative review compares functional and clinical outcomes of conventional fixation techniques with arthroscopy-assisted approaches across multiple joints, including the ankle, knee (tibial plateau), wrist (distal radius), and elbow. A comprehensive literature search was conducted using PubMed and supplemented by systematic reviews from Embase and Cochrane databases. Current evidence demonstrates that arthroscopy-assisted fixation provides joint- and fracture-specific advantages, particularly in ankle fractures, Schatzker I–III tibial plateau fractures, and complete intra-articular distal radius fractures. Evidence for elbow fractures remains limited but suggests potential benefits in carefully selected cases. Arthroscopy-assisted fixation should be considered a complementary technique and applied selectively based on fracture morphology, joint involved, and surgeon expertise
TARGETED PROSTATE BIOPSY: TECHNIQUES, CLINICAL OUTCOMES, AND FUTURE PERSPECTIVES – A NARRATIVE REVIEW
No full textProstate cancer is one of the most frequently diagnosed malignancies among men worldwide and continues to pose a major clinical and public health challenge (Rawla, 2019; Pernar et al., 2018). Despite substantial advances in screening and imaging, accurate identification of clinically significant prostate cancer remains a critical issue in contemporary urologic practice. Conventional systematic transrectal ultrasound-guided biopsy has long been considered the diagnostic standard; however, it is inherently limited by random sampling error and is associated with both underdiagnosis of aggressive disease and overdiagnosis of indolent tumors (Schoots et al., 2017; Kasivisvanathan et al., 2018).
The integration of multiparametric magnetic resonance imaging (mpMRI) into prostate cancer diagnostic pathways has led to the development of targeted prostate biopsy techniques aimed at improving diagnostic accuracy and risk stratification (Padhani et al., 2019; Turkbey et al., 2022). This narrative review summarizes current evidence on targeted prostate biopsy, including the epidemiological and diagnostic background of prostate cancer, imaging foundations, biopsy techniques, clinical outcomes, and emerging innovations.
A structured literature search was conducted using PubMed, ScienceDirect, and Google Scholar. The reviewed literature demonstrates that MRI-targeted biopsy improves detection rates of clinically significant prostate cancer while reducing the identification of clinically insignificant disease compared with systematic biopsy alone (Ahdoot et al., 2020; Drost et al., 2019). Targeted prostate biopsy has become a cornerstone of modern prostate cancer diagnostics, with ongoing research focusing on technique optimization, patient selection, and personalized diagnostic strategies
RADIATION DERMATITIS—CLINICAL MANIFESTATIONS AND TREATMENT. AN ANALYSIS OF CURRENT RESEARCH
No full textIntroduction: Radiation-induced skin injury is a frequent adverse effect of radiotherapy, ranging from early erythema and desquamation to chronic fibrosis, pigment alteration, and telangiectasia. These reactions can reduce patient comfort, impair daily activities, and occasionally limit delivery of optimal cancer therapy. This review outlines current knowledge on mechanisms, prevention, and management of radiation-induced skin injury, including pharmacological, physical, and supportive strategies.
Methodology: A targeted literature search was performed in a medical research database using terms related to radiation, radiotherapy, and management of skin reactions. Recent clinical trials, observational studies, and systematic reviews meeting inclusion criteria were analyzed to identify prevailing preventive and therapeutic approaches.
Results: Skin injury results from DNA damage, inflammatory signaling, and oxidative stress affecting normal skin cells. Acute reactions typically occur within three months of exposure, whereas chronic changes may persist for years. Key risk factors include high radiation dose, sensitive anatomical sites such as thin or folded skin, and concurrent systemic cancer therapies. Evidence supports preventive measures including gentle cleansing, routine moisturization, topical corticosteroids, protective barrier films, and optimized radiation planning. Adjunctive treatments such as hyperbaric oxygen therapy, silver-based dressings, botanical products, and vitamin-based agents show potential benefit, although current evidence is limited by small sample sizes and methodological variability.
Conclusion: Radiation-induced skin injury remains a clinical problem. Multimodal management combining standardized skin care, targeted pharmacologic treatments, and supportive interventions may reduce severity and improve patient outcomes. Further studies are required to define evidence-based management guidelines
REMOTE WORKS AS AN INNOVATIVE EMPLOYMENT PRACTICE: IMPLICATIONS FOR JOB SATISFACTION, SOCIAL ISOLATION, AND WORK-FAMILY CONFLICT
No full textRemote work has become a central topic in organizational research and practice due to its rapid growth and the variety of telecommuting arrangements. This paper aims to synthesize theoretical frameworks and empirical findings related to remote work. The research highlights the conceptual definitions of remote work, its main types, advantages, and disadvantages. Stakeholders can use this paper to understand how remote work relates to job satisfaction. The study also shows the connection between remote work and family life.
Remote work is convenient for several reasons, including its flexibility and the interest of talented individuals in remote work opportunities. This type of work environment can also help save taxes for both organizations and employees. However, there are challenges as well. Excessive remote work can lead to professional isolation, a situation where employees lack sufficient communication with their peers. Many workers view remote work as a “dream job,” but in reality, it has its downsides. Employees working exclusively remotely may find it difficult to establish personal relationships with colleagues.
This research distinguishes between full-time, occasional, formal, informal, employee-initiated, and employer-initiated contracts. Remote work is associated with increased autonomy, a high level of flexibility, and other valuable tools.
Finally, we can conclude that remote work is multidimensional and influenced by many factors. It has both positive and negative aspects, along with various consequences. There are strategies to establish effective remote work for both employees and employers effective
PATIENT DIGITAL TWINS AS THE FOUNDATION OF FUTURE MEDICINE: PERSONALIZED SIMULATION, PREDICTIVE MODELING, AND DATA-DRIVEN CLINICAL DECISION-MAKING
No full textBackground: The growing availability of high-resolution imaging, biosensors, molecular profiling, and artificial intelligence has enabled the development of digital patient twins—computational models that reproduce individual physiological and pathological processes in silico. While digital twins have been widely proposed as tools for personalised medicine, their clinical and translational value across major disease domains has not yet been systematically synthesised.
Methods: A narrative review was conducted of full-text publications from 2020–2025 addressing digital patient twins in cardiology, oncology, chronic disease management, and rehabilitation. The analysed literature included translational and clinical studies, mechanistic modelling papers, and healthcare system implementations. Evidence was prioritised from studies reporting patient-specific simulations, comparisons with real clinical or imaging data, and therapy-support scenarios.
Results: In cardiology, electrophysiological and haemodynamic digital twins demonstrated high concordance with invasive mapping and imaging data and were associated with improved ablation planning, device optimisation, and reduced arrhythmia recurrence. In oncology, tumour digital twins integrating imaging and molecular data predicted tumour growth and treatment response with clinically meaningful accuracy, supporting personalised and adaptive cancer therapy. In chronic diseases, sensor-driven digital twins enabled early detection of physiological deterioration and supported proactive intervention, reducing exacerbations and hospitalisations. In rehabilitation, biomechanical and neurophysiological digital twins improved functional recovery by guiding personalised and robot-assisted therapy.
Conclusions: Digital patient twins are transitioning from experimental computational tools to clinically relevant systems capable of influencing diagnosis, therapy selection, monitoring, and patient outcomes. By enabling in silico testing of therapeutic strategies on a virtual representation of the patient, digital twins reduce uncertainty in clinical decision-making and support truly personalised care. Continued progress in data integration, model validation, and regulatory governance will be essential for their safe and widespread adoption in clinical practice