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GLP-1 ANALOGUES IN OBESITY THERAPY: CURRENT EVIDENCE AND FUTURE DIRECTIONS – A SYSTEMATIC REVIEW
Get PDFIntroduction: Obesity remains one of the most significant global health problems, contributing to increased morbidity, premature mortality, and escalating healthcare expenditures. While lifestyle modification continues to serve as the foundation of therapy, its long-term effects are often modest and difficult to sustain. Bariatric surgery, though highly effective, is invasive and cannot be applied to all patients. For this reason, there is a pressing need for safe and effective pharmacological options. In recent years, glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as highly promising agents for the treatment of obesity.
Materials and Methods: A targeted literature search was conducted in PubMed/MEDLINE and PubMed Central covering studies published from 2012 through 2024. Search terms included”GLP-1 receptor agonists, ”“liraglutide, ”“semaglutide, ”“tirzepatide, ” and”obesity.” Eligible studies were randomized controlled trials (RCTs), systematic reviews, and meta-analyses reporting outcomes related to weight reduction and metabolic parameters. Ten key publications were selected for detailed analysis, encompassing pivotal trials of liraglutide, semaglutide, and tirzepatide.
Results: Treatment with liraglutide 3.0 mg daily resulted in average weight reductions of 7–8% over treatment periods ranging from 56 to 104 weeks. Semaglutide 2.4 mg once weekly achieved losses of 14–17% in both adult and adolescent populations. Tirzepatide, a dual GLP-1/GIP receptor agonist, demonstrated unprecedented efficacy, with reductions of up to 20.9% at higher doses. Across all agents, improvements were observed in glycemic control, blood pressure, and lipid metabolism. The most frequently reported adverse events were gastrointestinal, including nausea, vomiting, and diarrhea, typically mild, transient, and dose-dependent.
Conclusions: GLP-1RAs represent a paradigm shift in obesity pharmacotherapy, providing substantial and clinically relevant weight loss together with broader cardiometabolic benefits. Nonetheless, weight regain following treatment discontinuation, high financial costs, and the need for long-term safety data remain important challenges. Future research should focus on sustaining treatment effects, evaluating newer incretin-based agents, and improving accessibility in order to maximize their global clinical impact
AGENESIS OF THE INTERNAL CAROTID ARTERY - COLLATERAL VASCULARIZATION AND SYMPTOMATIC MANIFESTATIONS
Get PDFIntroduction and objective: Internal carotid artery agenesis is a rare anatomical anomaly involving the absence of the internal carotid artery. It is a congenital developmental defect that can present with varying symptoms depending on whether it is unilateral or bilateral. The aim of this article is to summarize the diversity and prevalence of symptoms associated with unilateral or bilateral agenesis of the internal carotid artery.
Methodology: In the literature review, scientific works related to internal carotid artery agenesis were utilized, including 26 studies addressing the described variability, which collectively encompass 52 cases of patients with internal carotid artery agenesis. After a thorough analysis of the cited literature, conclusions were drawn regarding the frequency and relationships between unilateral and bilateral absence of the ICA.
Discussion: Agenesis of the internal carotid artery is a rare anomaly; however, its detection is crucial in the diagnosis of cerebrovascular disorders. Among symptomatic patients with internal carotid artery agenesis, intracranial aneurysms leading to subarachnoid hemorrhages were frequently observed. Additionally, collateral pathways replacing its blood flow, such as perineural anastomoses, and alterations in the normal course of other vessels in the neck and head region were also noted.
Conclusions: Agenesis of the ICA occurs in 0.01% of cases and is additionally associated with the absence of the carotid canal, through which the artery typically traverses. It is more commonly seen as left-sided agenesis of the ICA, with bilateral agenesis occurring in less than 10% of cases. 25% of cases of internal carotid artery agenesis are associated with intracranial aneurysms. The majority of symptomatic patients are between 35 and 65 years of age. Patients with internal carotid artery agenesis most frequently exhibit neurological disorders as well as nonspecific symptoms such as headaches and nausea
EFFECTIVENESS OF LECANEMAB AND DONANEMAB TREATMENT FOR EARLY ALZHEIMER’S DISEASE
Get PDFAlzheimer's disease (AD) is a complex neurodegenerative disorder characterized by amyloid-beta (Aβ) plaques, tau neurofibrillary tangles, and other pathological factors like neuroinflammation and oxidative stress. This review discusses the effectiveness of Lanacemab and Donanemab - new anti-amyloid monoclonal antibodies- for the treatment of early Alzheimer’s Disease. While no cure exists, current symptomatic treatments are complemented by emerging disease-modifying therapies (DMTs). Recent breakthroughs with anti-amyloid monoclonal antibodies, Lecanemab and Donanemab, show promise in slowing disease progression. Clinical trials like CLARITY-AD for Lecanemab and TRAILBLAZER-ALZ 2 for Donanemab demonstrated significant reductions in brain amyloid and a slowed cognitive and functional decline in early AD. Lecanemab selectively targets Aβ protofibrils, while Donanemab targets N-terminally truncated Aβ in plaques, both facilitating amyloid clearance. These DMTs, though associated with side effects like ARIA, mark a pivotal shift towards targeting underlying AD pathology, offering hope for more effective interventions and potentially preventive strategies, such as those explored in the TRAILBLAZER-ALZ 3 trial
THE USE OF LUNG ULTRASOUND IN EMERGENCY MEDICINE - ULTRASOUND PROTOCOLS AND POCUS
Get PDFIntroduction: The development of ultrasound has led to an increase in its popularity and use in various medical fields. Emergency medicine, in particular, has enthusiastically adapted it to its needs by developing various examination protocols and diagnostic pathways, known as protocols, which allow for the rapid and effective diagnosis of life-threatening conditions.
Methods: This paper describes some of the emergency protocols we use in our work, along with our experiences. It also reviews the literature for various types of ultrasound protocols, and then selects those that include imaging of the lungs and pleura.
Results: The development of lung ultrasound has been extremely turbulent and controversial over the years, so this paper also serves as evidence of its very high usefulness in the diagnosis of life-threatening conditions. Ultimately, 19 protocols were selected, developed, and presented in the paper in terms of their method of execution, capabilities, popularity, and limitations.
Conclusions: Based on the review, it can be concluded that ultrasound protocols are very popular in medicine and their use allows for shortening the diagnostic time and, consequently, improving the patient's prognosis
THE IMPACT OF COVID-19 ON THE DEVELOPMENT AND COURSE OF AUTOIMMUNE DISEASES: A LITERATURE REVIEW
Get PDFBackground: There is growing evidence to support an association between the SARS-CoV-2 infection and the onset or flare of ADs (autoimmune diseases) in pediatric and adult patients. Immunological factors in these processes include molecular mimicry, hyperactivation of the immune system, and others. Moreover, a new clinical entity (Multisystem Inflammatory Syndrome in Children (MIS-C)) is an example of a severe immunologic mediated pattern after COVID-19.
Objective: This review describes available evidence regarding the impact of COVID-19 infection on the occurrence and course of autoimmune diseases in children as well as in adults. Significant emphasis is placed on population studies regarding the diagnosis of autoimmune diseases and their natural history, the immunological mechanisms, and the impact of COVID-19 vaccination in the setting of autoimmunity.
Methods: This review was conducted using findings of scientific search databases PubMed, Google Scholar and Scopus with words: COVID-19, SARS-CoV-2, autoimmunity, autoimmune diseases, rheumatic diseases, COVID-19 vaccination, MIS-C, molecular mimicry. Articles were selected based on relevance, methodological quality, and adherence to PRISMA 2020 guidelines.
Results: The immune dysregulation of SARS-CoV-2 infection might induce the onset of autoimmune diseases. Increased rates of newly diagnosed autoimmune diseases, such as type 1 diabetes, systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA), have been reported in both adult and pediatric populations following COVID-19. While autoimmune phenomena may rarely occur with COVID-19 vaccines, the risk is much higher with natural infection.
Conclusion: Further studies and systematic immunological follow-up of patients after COVID-19 are essential for the early detection and effective management of autoimmune complication
THE IMPACT OF OBESITY ON THE DEVELOPMENT OF HYPERTENSION IN CHILDREN – A LITERATURE REVIEW
Get PDFIntroduction: Childhood obesity is a growing global health concern that significantly increases the risk of developing hypertension during childhood, leading to serious health consequences. This review aims to present the current state of knowledge regarding the relationship between obesity and hypertension in children, with particular emphasis on pathophysiological mechanisms and prevention strategies.
Current Knowledge: Among all risk factors, overweight and obesity have the greatest impact, correlating proportionally with the degree of blood pressure elevation, especially systolic pressure. Studies have shown that the association between BMI and blood pressure is strongest during puberty. This relationship is influenced by complex mechanisms, including excessive activation of the sympathetic nervous system, the renin–angiotensin–aldosterone system (RAAS), hormonal imbalances, and chronic inflammation induced by adipokines. Additionally, excess adipose tissue mechanically compresses the kidneys, causing sodium retention and blood pressure elevation, while hyperinsulinemia enhances sodium reabsorption and vascular resistance, further contributing to hypertension development. These factors act synergistically, resulting in persistent dysregulation of blood pressure from an early age. Treatment primarily involves lifestyle modification, with pharmacotherapy (ACE inhibitors, ARBs, GLP-1 receptor agonists) reserved for cases resistant to non-pharmacological interventions.
Summary: The available literature unequivocally indicates that obesity constitutes a significant health threat from an early age and increases the risk of serious adult diseases. Given the involvement of numerous modifiable pathophysiological mechanisms and the rising prevalence of these conditions, early prevention, health education, and an interdisciplinary treatment approach are of paramount importance
CHRONIC USE OF SWEETENERS AND INSULIN RESISTANCE
Get PDFThe aim of this paper is to critically analyze the available data on the chronic use of low-calorie sweeteners (LCS) and their potential impact on the development of insulin resistance (IR). Insulin resistance, a key element of metabolic syndrome and a risk factor for type 2 diabetes, is increasing in parallel with the rising consumption of sweeteners used as sugar substitutes.
The review covers the classification of LCS (synthetic, natural, sugar alcohols), their metabolism, and biological mechanisms that may modulate carbohydrate metabolism. Potential pathways of action include activation of sweet taste receptors T1R2/T1R3 in the intestine and pancreas, effects on incretin secretion, modulation of gut microbiota, regulation of appetite in the central nervous system, and interactions with insulin signaling pathways in peripheral tissues.
Clinical studies indicate that short-term LCS intake usually does not affect glycemia and insulinemia in healthy individuals. However, in people with obesity or without prior exposure, an increased glycemic and insulin response has been observed, particularly after sucralose. Stevia has shown hypoglycemic benefits in some studies, while aspartame remains largely neutral. Data on saccharin and microbiota suggest possible individual sensitivity. Observational studies associate chronic LCS intake with a higher risk of type 2 diabetes, although this may result from reverse causality.
The conclusions emphasize that LCS may support sugar and body weight reduction when used as part of a healthy lifestyle. However, they do not provide universal protection against IR, and their effects depend on the type of sweetener, metabolic status, and gut microbiota. Long-term randomized studies including diverse populations are required
REHABILITATION AFTER ACL RECONSTRUCTION AND THE RISK OF SECONDARY CONTRALATERAL INJURY: A LITERATURE REVIEW OF RETURN TO SPORT TIME AND FUNCTIONAL CONTROL
Get PDFAnterior cruciate ligament (ACL) injuries are highly prevalent among athletes participating in pivoting sports and often result in functional limitations and long-term performance decline. While ipsilateral re-ruptures have been extensively studied, the risk of contralateral ACL injuries following reconstruction remains insufficiently explored. This review aimed to analyze literature published between 2020 and 2025 to investigate the relationship between rehabilitation duration and the incidence of contralateral ACL injury, as well as to propose return-to-sport (RTS) recommendations. A narrative review was conducted using PubMed, MDPI, ScienceDirect, and Google Scholar, with 20 studies meeting the inclusion criteria. These studies focused on athletic populations aged 15 to 40 years and addressed RTS timing and secondary injury outcomes. Results showed that athletes who returned to sport before nine months post-surgery had up to a fourfold increased risk of contralateral ACL injury. Key risk factors included lower limb strength asymmetry (LSI <90%), insufficient psychological readiness (ACL-RSI <70), and compensatory biomechanical patterns such as stiffer landings and altered joint loading. The findings support a minimum rehabilitation duration of 9–12 months, with RTS decisions guided by functional, psychological, and biomechanical criteria to reduce the risk of reinjury
PERCEIVED SOCIAL SUPPORT AND AFFECTIVE DISORDERS: A COMPARISON OF INDIVIDUALS WITH DEPRESSION AND BIPOLAR DISORDER
Get PDFBackground: Research on social functioning difficulties in individuals with bipolar disorder has produced inconsistent findings, ranging from significant social impairments to no differences or even superior outcomes compared to patients with depression. Current literature is limited by methodological constraints including use of non-validated self-report measures, lack of analysis of specific support sources, and absence of appropriate clinical comparison groups. These contradictory results necessitate investigation of alternative variables that may explain social support variations in affective disorders, which is crucial for developing targeted psychosocial interventions for bipolar disorder populations.
Methods: A quasi-experimental study recruited 89 participants (52 bipolar disorder, 37 depression) from online support groups across Polish, English, and Spanish-speaking populations. Perceived social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS). ANCOVA models controlled for age, gender, and psychiatric comorbidity.
Results: No significant differences emerged between diagnostic groups after controlling for covariates (p > .05). However, age was negatively correlated with global support (p = .021), friends support (r = −.28, p < .007), and significant other support (r = −.23, p = .028), while family support remained stable (r = −.06, p = .555). Both groups scored substantially below Polish population norms with large effect sizes (bipolar disorder: d = −1.11; depression: d = −1.29; p < .001).
Conclusions: Age, rather than diagnostic category, predicts perceived social support decline in affective disorders. Both groups demonstrate clinically meaningful social support deficits, suggesting common vulnerabilities requiring targeted interventions across affective disorder spectrum
POLYSOMNOGRAPHY VERSUS PORTABLE DEVICES AND MOBILE APPLICATIONS IN THE DIAGNOSIS OF OBSTRUCTIVE SLEEP APNEA: A NARRATIVE REVIEW OF CURRENT EVIDENCE
Get PDFBackground: Obstructive sleep apnea (OSA) represents a significant public health challenge affecting millions worldwide, yet remains largely underdiagnosed due to limitations in traditional diagnostic approaches. While polysomnography (PSG) remains the gold standard for OSA diagnosis, emerging portable devices and mobile applications offer promising Ralternatives for improving accessibility and reducing healthcare burden.
Objective: This narrative review synthesizes current evidence comparing the diagnostic accuracy and clinical utility of PSG with portable monitoring devices and mobile health applications in OSA detection, examining their role in advancing health equity and leveraging technology for improved healthcare delivery.
Methods: A comprehensive analysis of recent literature from 2016-2025 was conducted, examining studies that evaluated portable sleep monitoring devices, wearable technologies, smartphone applications, and artificial intelligence-driven solutions against PSG as the reference standard. The review focused on diagnostic accuracy metrics, technological innovations, and clinical implementation considerations.
Results: Portable monitoring devices demonstrated varying degrees of diagnostic accuracy, with home sleep apnea tests (HSATs) showing sensitivities ranging from 0.72-0.95 and specificities from 0.76-0.96 compared to PSG. Wearable devices utilizing photoplethysmography, accelerometry, and artificial intelligence algorithms achieved area under the curve (AUC) values between 0.80-0.95. Novel approaches including smartphone-based acoustic monitoring, radar technology, and bed-mounted sensors showed promising results with sensitivities exceeding 0.85 in several studies. Artificial intelligence integration significantly enhanced diagnostic performance across multiple device categories.
Discussion: The evolution of portable OSA diagnostic technologies represents a paradigm shift toward accessible, cost-effective screening and monitoring solutions. While PSG maintains superior diagnostic precision, portable devices offer substantial advantages in terms of patient comfort, cost-effectiveness, and scalability for population-based screening. The integration of artificial intelligence and machine learning algorithms has notably improved the diagnostic accuracy of these technologies.
Conclusion: Portable devices and mobile applications demonstrate significant potential for revolutionizing OSA diagnosis and management, particularly in addressing healthcare disparities and improving access to sleep medicine services. However, careful consideration of device limitations, patient selection criteria, and clinical context remains essential for optimal implementation in healthcare delivery systems