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NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD): DISEASE MECHANISMS AND CONTEMPORARY THERAPEUTIC APPROACHES - A LITERATURE REVIEW
Get PDFIntroduction: Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, representing a significant public health challenge. Over the past decades, it has been recognized as a multisystem disease closely associated with type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), and chronic kidney disease (CKD).
Objective: The aim of this review is to discuss contemporary pathogenetic mechanisms underlying NAFLD as well as current and experimental therapeutic strategies, encompassing non-pharmacological, pharmacological, and microbiota-targeted interventions.
Methods: An analysis and synthesis of data from preclinical studies, clinical trials (phases II and III), meta-analyses, and recommendations of scientific societies published over the past two decades was conducted. The review includes works indexed in PubMed, Scopus, and Web of Science databases, with a focus on NAFLD and NASH therapies.
Conclusions: NAFLD is a complex disease with a heterogeneous pathogenesis, in which lipotoxicity, cellular stress, gut dysbiosis, and insulin resistance play key roles. The most well-documented therapeutic approach remains lifestyle modification (Mediterranean diet, physical activity). Promising effects have been demonstrated by certain agents used in the treatment of type 2 diabetes (e.g., GLP-1 receptor agonists, SGLT2 inhibitors, pioglitazone) as well as novel molecules such as FXR agonists, THR-β agonists, and FGF19/FGF21 analogues. Further clinical studies are necessary to validate the efficacy and safety of these therapies
INNOVATIVE TECHNOLOGIES IN REPRODUCTIVE MEDICINE: PLATELET-RICH PLASMA FOR OVARIAN REJUVENATION AND INFERTILITY - A NARRATIVE REVIEW
Get PDFIntroduction and purpose: Regenerative medicine has introduced new biological strategies to improve ovarian function in women with diminished ovarian reserve (DOR) or premature ovarian insufficiency (POI). Among them, platelet-rich plasma (PRP) - a concentrate of platelets derived from the patient’s own blood - has gained interest for its potential to stimulate follicular growth and enhance reproductive capacity. PRP contains various growth factors and cytokines that promote angiogenesis, cell proliferation, and tissue repair. This review summarizes current evidence regarding PRP’s mechanisms of action, clinical effects, and safety in the context of ovarian rejuvenation.
State of knowledge: PRP is obtained by centrifuging autologous blood to increase platelet concentration, followed by activation using agents such as calcium chloride or thrombin. Once activated, platelets release growth factors including PDGF, VEGF, EGF, IGF, and TGF-β, which are involved in tissue regeneration and modulation of inflammation. When injected into the ovaries, PRP may stimulate dormant follicles, improve blood flow, and alter the ovarian microenvironment via anti-inflammatory and immunomodulatory effects. Early clinical studies report encouraging outcomes such as improved ovarian reserve markers and pregnancy rates.
Conclusions: PRP therapy is a promising, minimally invasive technique with potential to support ovarian function in selected patients with POI or DOR. Its use is biologically justified by the regenerative properties of platelet-derived factors. Nevertheless, due to limited and low-quality evidence, as well as a lack of standardized preparation and administration protocols, PRP cannot yet be recommended as routine treatment
THE IMPACT OF PHYSICAL ACTIVITY ON AUTOIMMUNE DISEASES: A NARRATIVE REVIEW OF MECHANISMS, OUTCOMES AND PRACTICAL IMPLICATIONS
Get PDFAutoimmune diseases are chronic, heterogeneous disorders characterized by immune-mediated tissue damage, systemic inflammation, and reduced quality of life. Pharmacological treatments often alleviate symptoms but rarely address functional limitations such as fatigue, deconditioning, and psychosocial distress. Physical activity (PA) is increasingly recognized as a safe and effective adjunctive therapy. This narrative review synthesizes biological mechanisms, disease-specific outcomes, and practical applications of PA across major autoimmune conditions including rheumatoid arthritis (RA), multiple sclerosis (MS), systemic lupus erythematosus (SLE), inflammatory bowel disease (IBD), and type 1 diabetes (T1D). Evidence shows that PA functions as a multimodal immunomodulator, reducing pro-inflammatory cytokines, enhancing regulatory T-cell activity, rebalancing adipokines, recalibrating neuroendocrine pathways, and supporting microbiome diversity. Clinically, PA improves fatigue, functional capacity, mood, and cardiometabolic risk, without increasing relapse or flare frequency. The FITT framework (Frequency, Intensity, Time, Type) offers a practical model for prescribing exercise, with disease-specific adaptations ensuring safety and adherence. Despite strong evidence, implementation remains limited due to patient fears, clinician knowledge gaps, and systemic barriers. Digital health and tele-exercise hold promise for precision exercise medicine. In conclusion, physical activity is a safe, effective, and indispensable adjunct in autoimmune disease management, warranting integration into standard care pathways
THE ROLE OF CYCLOSPORINE IN THE TOPICAL TREATMENT OF DRY EYE SYNDROME: A COMPREHENSIVE REVIEW
Get PDFDry eye disease (DED) is a multifactorial ocular surface disorder marked by instability of the tear film and inflammatory responses. This review examines the mechanisms of action, clinical effectiveness, and formulation developments of cyclosporine A (CsA). Current evidence shows CsA reduces inflammation, improves tear production, and alleviates symptoms by targeting immunopathological processes. The therapeutic outcome is influenced by the underlying cause of the disease and the specific attributes of the formulation used
THE ROLE OF DANCE MOVEMENT THERAPY IN THE TREATMENT OF DEPRESSION: AN OVERVIEW OF RECENT EVIDENCE
Get PDFBackground: Depression is a widespread mental disorder affecting approximately 280 million people worldwide. While pharmacological treatments and cognitive-behavioral therapy (CBT) are considered first-line interventions, there has been growing interest in recent years in complementary, non-pharmacological therapies, such as Dance Movement Therapy (DMT), which offers a holistic, body-centered approach to improving mental health outcomes.
Aim: This review aims to evaluate the current evidence on the effectiveness of Dance Movement Therapy (DMT) in the treatment of depression. It seeks to understand the mechanisms through which DMT exerts its effects and to identify specific populations that may benefit most from this intervention.
Methods: A literature review was conducted using PubMed and Google Scholar databases, covering the years 2015 to 2025.
Results: DMT has demonstrated positive effects on depressive symptoms across various populations. Improvements were noted not only in mood but also in cognitive functioning, physical health, interpersonal relationships, and emotional regulation. While effect sizes varied, consistent within-group improvements and high adherence rates were observed.
Conclusion: DMT is a safe, engaging, and potentially effective adjunctive treatment for depression, especially when personalized and delivered by trained professionals. Its multicausal mechanism of action makes it a valuable tool in the integrative treatment of depressive disorders. Further high-quality, randomized studies are needed to establish standardized clinical guidelines
CURRENT PERSPECTIVES ON THE MANAGEMENT OF ACUTE GRAFT-VERSUS-HOST DISEASE IN PEDIATRIC TRANSPLANTATION
Get PDFBackground: Hematopoietic stem cell transplantation (HSCT) has expanded its scope as a curative therapy for a wide range of severe pediatric diseases. However, its efficacy is frequently challenged by graft-versus-host disease (GVHD), a significant and potentially fatal complication. This is particularly relevant in the pediatric population, where unique immunological and physiological factors contribute to a distinct disease course.
Objective: This narrative review synthesizes the current evidence base on the treatment and management of GVHD in pediatric patients. It aims to provide a critical appraisal of the unique immunological determinants, current prophylactic and treatment interventions, and the long-term morbidities and clinical needs for this specific field.
Methods: A comprehensive systematic search of databases, including PubMed, Embase, and the Cochrane Library, was conducted to identify relevant literature. Articles were selected based on inclusion criteria focusing on GVHD management in patients aged 18 or younger, while excluding non-peer-reviewed articles and case reports. Data on study design, patient populations, treatment regimens, and key outcomes were extracted and synthesized.
Summary: The pathogenesis of acute GVHD (aGVHD) is described by the classic three-phase model, beginning with host tissue damage, followed by donor T-cell activation, and culminating in targeted organ destruction, particularly in the skin, liver, and gastrointestinal tract. Diagnostic methods have evolved from clinical and histological assessments to include advanced biomarker-driven approaches, such as the MAGIC algorithm, which provides more precise prognostic risk stratification. Current prophylaxis strategies primarily involve calcineurin inhibitors in combination with methotrexate or mycophenolate mofetil. Novel agents like ruxolitinib and vedolizumab are emerging as promising therapeutic tools for both prophylaxis and the treatment of steroid-refractory disease. Despite these advancements, significant clinical gaps persist, as many established guidelines for GVHD management are not tailored to the pediatric population. The evident age-related disparity in GVHD risk highlights the critical need for pediatric-specific research.
Conclusion: While substantial progress has been made in understanding and treating GVHD, there is a clear and urgent need for further research focused on pediatric-specific protocols. Continued efforts to validate existing therapies in pediatric cohorts, explore novel agents, and leverage biomarkers are essential to improve outcomes and the quality of life for young patients undergoing HSCT
ULTRASOUND DIAGNOSIS OF PNEUMOTHORAX - PITFAILES AND HOW TO PREVENT THEM
Get PDFIntroduction: Pneumothorax is a life-threatening condition resulting from the entry of air into the pleural cavity. The most popular imaging test used in its diagnosis is classical X-ray, and in doubtful cases, also computed tomography (CT). However, ultrasound (US) is becoming increasingly popular. Thanks to the development of diagnostic criteria, it is possible to quickly, safely, and extremely effectively detect pneumothorax using lung ultrasound. Despite its many advantages, this method has certain limitations, including conditions and diseases whose images may falsely suggest pneumothorax.
Methods: The following paper is based on a compilation of our own experiences from approximately 350 lung ultrasound examinations and a literature review to identify as many clinical conditions as possible that may falsely suggest an ultrasound image of pneumothorax, along with potential causes of error, taking into account the sonomorphology and pathophysiology of the lesions. Additionally, criteria have been developed to differentiate specific conditions from pneumothorax, and a classification has been prepared based on the difficulty of differentiation, with particular emphasis on situations requiring conclusive additional testing.
Conclusions: Ultrasound diagnosis of pneumothorax must be closely correlated with the clinical presentation to avoid errors. Adherence to diagnostic criteria will prevent errors in most cases. Less experienced examiners should pay particular attention to subtle differences in pleural sliding
THE ROLE OF SPORTS MEDICINE PROFESSIONALS IN ENSURING QUALITY CARE AND LONG-TERM ATHLETE DEVELOPMENT
Get PDFIn recent years, the role of sports medicine professionals (SMPs)—including physicians, physiotherapists, athletic trainers, and exercise physiologists—has expanded significantly. Once focused primarily on injury treatment, SMPs are now integral to proactive strategies that enhance athlete health, performance, and long-term development (LTAD).
This study investigates the multifaceted roles of SMPs across injury prevention, rehabilitation, performance optimization, and psychosocial support. A mixed-methods design was employed: a cross-sectional survey of 150 certified SMPs from 15 European countries gathered quantitative data on clinical practices, return-to-play protocols, and interdisciplinary collaboration. Qualitative thematic analysis of open-ended responses explored challenges and best practices. A systematic literature review (53 peer-reviewed studies, 2005–2024) further contextualized findings.
Results showed that sports organizations with fully integrated SMP teams experienced a 30% reduction in injury incidence—particularly in high-risk sports like soccer, basketball, and athletics. Evidence-based interventions such as neuromuscular training and load monitoring were especially effective in reducing ligament injuries and overuse syndromes. Athletes in these settings also showed an average 15% improvement in performance metrics.
Psychological support provided by SMPs—including mental health screening and resilience training—was linked to a 20% increase in athlete retention, particularly in youth sports. However, only 42% of respondents reported full interdisciplinary collaboration, citing funding gaps, unclear role definitions, and lack of standardized protocols as key barriers.
This study highlights SMPs as essential to modern athlete care and advocates for systemic reforms—standardized clinical guidelines, formalized roles, and interprofessional education—to enhance athlete outcomes and ensure sustainable LTAD
THE HYPERGLYCEMIC HYPEROSMOLAR SYNDROME: HISTORY AND ESSENTIAL CLINICAL INSIGHTS
Get PDFHyperglycemic hyperosmolar state (HHS) is one of the most severe acute complications of diabetes mellitus. It is characterized by profound hyperglycemia, absence of ketoacidosis, and altered mental status. With a mortality rate that may reach up to 20%, HHS remains a critical but often underrecognized clinical entity. Historically marginalized due to its relative rarity and poorly understood pathophysiology, its clinical relevance is increasing in parallel with lifestyle changes and the global rise in type 2 diabetes prevalence.
The aim of this article was to compile key information on the history, pathophysiology, and management of HHS in order to raise awareness among all healthcare professionals involved in the care of patients with diabetes. Early recognition of HHS is essential to initiate timely treatment and improve patient outcomes.
Classic symptoms such as excessive thirst with accompanying polyuria and altered mental status particularly in patients with seemingly mild infections or those with chronic but untreated or poorly controlled diabetes - should prompt increased vigilance among medical staff.
Rapid diagnostic evaluation and prompt initiation of treatment must be prioritized in emergency settings to reduce morbidity and mortality associated with this life-threatening condition
THE SOCIAL DETERMINANTS OF VACCINE HESITANCY: A REVIEW OF GLOBAL EVIDENCE
Get PDFThis review examines the social determinants that influence vaccine hesitancy and immunization rates globally. Key factors, including income, education, ethnicity, place of residence, and access to healthcare, are examined to highlight ongoing disparities in vaccine uptake. Vaccine reluctance remains most common among marginalized racial and ethnic groups, low-income communities, migrants, and individuals with limited education. However, recent data reveal a concerning rise in hesitancy among affluent and White populations in high-income countries. Additional influences, such as mistrust in health authorities, insufficient culturally sensitive care, and religious beliefs, further exacerbate these challenges. Evidence suggests that targeted interventions, including community-specific outreach, improved access to information, and engagement of trusted local leaders, can effectively reduce hesitancy. The review emphasizes the importance of developing equitable immunization strategies that address the unique social, cultural, and economic contexts of diverse groups. Addressing the root causes of vaccine hesitancy is crucial for rebuilding trust, narrowing health disparities, and advancing global vaccination goals.