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DIETARY IMPACT ON THE ANTICOAGULANT EFFICACY OF VITAMIN K ANTAGONISTS
No full textBackground: The vitamin K antagonists’ (VKA) mechanism of action is closely related to the metabolic pathways of vitamin K. Dietary vitamin K intake can directly translate into efficacy of VKA therapy.
Aim: The aim of the study was to summarize information about the role of vitamin K in the coagulation process and its impact on Vitamin K Antagonists.
Material and methods: A non-systematic litrerature review was conducted using databases such as Pubmed and Cochrane Database. Search terms included VKA pharmacokinetics, INR targets and dietary management strategies.
Results: Irregular intake of vitamin K negatively affects the action of hydroxycoumarin derivatives by causing INR fluctuations and subtherapeutic anticoagulation. Excessive doses of vitamin K reduce VKA activity and increase risk of side effects such as thromboembolic complications.
Conclusions: Effective anticoagulation with VKAs requires personalized dosage, regular INR monitoring and conscious management of vitamin K intake
COMPARISON OF THE ROLES OF PROBIOTICS, PREBIOTICS, AND SYNBIOTICS IN THE MANAGEMENT OF IRRITABLE BOWEL SYNDROME: A REVIEW OF RECENT EVIDENCE
No full textIrritable bowel syndrome (IBS) is a chronic disorder characterized by recurrent abdominal pain and altered bowel habits. Its heterogeneity has intensified interest in microbiota targeted therapies. This review summarizes evidence published between 2020 and 2024 on the use of probiotics, prebiotics, and synbiotics for the treatment of IBS. The search was limited to English language, full-text studies in humans and used the terms “probiotics”, “prebiotics”, “synbiotics”, “irritable bowel syndrome” and “IBS”. Studies indicate that improvements are strain and formulation specific rather than a class effect. Treatment duration and dose appear critical. Benefits are more likely with interventions lasting at least four weeks and daily doses around ≥10⁹ CFU. Signals for global symptom relief have been reported for Escherichia strains and Lactobacillus plantarum 299V, while reductions in abdominal pain have been observed with Saccharomyces cerevisiae CNCM I-3856, Bifidobacterium strains, and Bacillus coagulans. Overall comparisons across studies suggest outcome specific efficacy, with L. acidophilus DDS-1 and B. coagulans strains frequently showing favorable effects on symptom severity, abdominal pain, and stool related outcomes in IBS D. Some data suggest prebiotics can improve defecation frequency in IBS C. In contrast, prebiotics and synbiotics show more variable and product dependent effects. Overall, probiotics appear safe and potentially effective when appropriately selected, but heterogeneity across studies underscores the need for standardized endpoints, subtype stratified analyses, and precise reporting of strain identity, dose, and viability to guide individualized recommendations
BIOLOGIC AND TARGETED THERAPIES IN ATOPIC DERMATITIS: A BIOMARKER-INFORMED FRAMEWORK FOR PERSONALIZED TREATMENT SELECTION
No full textBackground: Atopic dermatitis is a chronic inflammatory skin disease characterized by pruritus, eczematous lesions, and impaired quality of life. Advances in understanding type 2 immune dysregulation have led to the development of biologic and targeted systemic therapies; however, treatment response remains heterogeneous, highlighting the need for personalized therapeutic strategies.
Objective: To review current biologic and targeted systemic therapies for moderate-to-severe atopic dermatitis, examine the role of clinical and molecular biomarkers in predicting treatment response, and propose a biomarker-informed framework for personalized treatment selection.
Methods: A narrative review was conducted of literature published between January 2020 and July 2024 using major scientific databases. Included publications comprised randomized controlled trials, cohort studies, systematic reviews, and expert consensus documents addressing systemic therapies, biomarker associations, and stratified treatment approaches in atopic dermatitis.
Results: Biologic agents, including dupilumab, tralokinumab, lebrikizumab, and nemolizumab, are associated with substantial improvements in skin inflammation and pruritus and demonstrate favorable safety profiles across diverse patient populations. Janus kinase inhibitors provide rapid symptom control but require careful patient selection due to safety considerations. Biomarkers such as thymus and activation-regulated chemokine, eotaxin-3, periostin, eosinophil count, and interleukin-13 gene expression contribute to the characterization of disease endotypes and may support biologically informed treatment decisions.
Conclusions: Biologic and targeted systemic therapies have transformed the management of atopic dermatitis; however, optimal outcomes depend on individualized treatment selection. Biomarker-informed approaches offer a rational framework to reduce empirical treatment cycling and advance precision medicine in atopic dermatitis, although further validation in real-world clinical settings is required
DIETARY INTERVENTIONS AND THEIR EFFECTIVENESS IN THE TREATMENT OF ENDOMETRIOSIS - NARRATIVE REVIEW
No full textEndometriosis is a chronic and complex systematic condition that impacts approximately 10% of women of reproductive age worldwide. Available literature has shown that selected diets have positive effects on the development and course of endometriosis.
This review aimed to present current data on various dietary interventions and their effectiveness in reducing endometriosis symptoms and risk.
The 19 included original studies were analyzed and included in the review. Most of the studies reported a positive effect on endometriosis-related symptoms. The Mediterranean diet was reported as a plausible adjunct therapy for symptom management without difficulty in adherence. More restrictive diet regimens, such as the Low-FODMAP diet and gluten-free diet, were reported to alleviate endometriosis-related symptoms, however adherence proved to be more difficult.
Further well-designed randomized controlled trials are crucial to determine the short-term and long-term effectiveness and safety of different dietary interventions
CHALLENGES OF CONFLICT OF LAWS IN CYBERSPACE
No full textThe borderless nature of the internet poses significant challenges to jurisdiction and conflict of laws, as traditional territorial legal frameworks struggle to keep pace with the digital age. Although private international law has historically addressed cross border disputes, its rules have not evolved at the speed of technological change. In response, legal scholars advocate for a unified global framework often referred to as Lex Electronica enforced by digital judicial bodies. They argue that the internet’s erosion of national boundaries necessitates new models of governance.
Nevertheless, private international law remains essential in practice, offering adaptable mechanisms such as tort liability principles for regulating online behavior. To effectively navigate the legal complexities of globalization, existing legal frameworks must be recalibrated, and national laws must evolve to reflect digital realities. At the same time, emerging actors like ICANN challenge traditional notions of sovereignty, exerting regulatory influence over cyberspace and raising critical questions about the capacity of legal systems to balance innovation with accountability
THE PSYCHEDELIC RENAISSANCE: A SYSTEMATIC REVIEW OF PSILOCYBIN AND LSD IN THE TREATMENT OF PSYCHIATRIC DISORDERS
No full textThe escalating global burden of mental health disorders, coupled with the stagnation of innovation in traditional monoaminergic pharmacotherapy (e.g., SSRIs), has precipitated a critical need for novel therapeutic paradigms. This article presents a comprehensive systematic review of the so-called "Psychedelic Renaissance," focusing on the clinical resurgence of classical serotonergic hallucinogens: psilocybin and Lysergic Acid Diethylamide (LSD). The review adopts an interdisciplinary structure to evaluate the efficacy, safety, and societal implications of these compounds. Firstly, the paper traces the historical evolution of psychedelics from indigenous sacramental use, through the research proliferation of the 1950s, to the prohibitive legislation of the late 20th century. Secondly, it delineates the neurobiological mechanisms of action, specifically 5-HT2A receptor agonism and the disintegration of the Default Mode Network (DMN), which correlates with the alleviation of rigid cognitive patterns in depression and anxiety. Thirdly, the review synthesizes data from contemporary clinical trials demonstrating significant therapeutic potential in Treatment-Resistant Depression (TRD), end-of-life existential distress, and substance use disorders. Unlike standard pharmacological reviews, this paper also analyzes the distinct psychotherapeutic framework ("set and setting"), integration processes, and socio-economic factors, including cost-effectiveness and access equity. The findings suggest that psychedelic-assisted therapy represents a transformative shift from chronic symptom management to rapid, episodic curative interventions, provided that regulatory and ethical challenges are adequately addressed
SLEEP DISTURBANCES IN MAJOR DEPRESSIVE DISORDER: A COMPREHENSIVE NARRATIVE REVIEW
No full textObjectives: To review and synthesize current evidence on the characteristics, underlying mechanisms, and clinical significance of sleep disturbances in Major Depressive Disorder (MDD).
Methods: A narrative review of thirty peer-reviewed articles published between 2010 and 2025 was conducted. The included studies investigated sleep architecture, circadian rhythms, neurobiological mechanisms, and therapeutic interventions related to sleep disturbances in MDD using neuroimaging, electrophysiological, molecular, and clinical approaches.
Results: The reviewed literature indicates that sleep disturbances are a core feature of MDD. The most consistently reported abnormalities include shortened rapid eye movement (REM) latency, reduced slow-wave sleep, and circadian rhythm dysregulation. These alterations are associated with dysfunctions of monoaminergic neurotransmission, hyperactivity of the hypothalamic-pituitary-adrenal axis, and disruptions of circadian clock gene regulation. Sleep disturbances were also linked to impairments in emotional regulation, cognitive functioning, metabolic processes, and treatment response. Sleep-focused interventions, including cognitive-behavioral therapy for insomnia, chronotherapy, and light-based treatments, demonstrated antidepressant effects.
Conclusions: Sleep disturbances play a fundamental role in the pathophysiology and clinical course of MDD. Addressing sleep-related mechanisms may improve diagnostic accuracy, enhance treatment effectiveness, and contribute to better long-term outcomes in patients with depression
DARIDOREXANT IN THE TREATMENT OF INSOMNIA IN ELDERLY PATIENTS WITH COMORBIDITIES
No full textIntroduction and objective: Insomnia is one of the most prevalent sleep disorders in the adult population, thereby new methods of pharmacological treatment ought to be analyzed. Current novelty in insomnia treatment is daridorexant, a representative of the dual orexin receptor antagonist (DORA). Given that, the orexin system becomes overactive with age, explaining sleep of lower quality and quantity observed in older population, it is worth analysing the effect of the dual receptor antagonist (DORA) on the insomnia issue in older adults, and whether it proposes a safer choice among the existing pharmacological possibilities.
Review methods: A comprehensive literature review was conducted, analyzing studies from the PubMed database of articles published between 2020 and 2025.
Brief description of the state of knowledge: Insomnia treatment is based on both non-pharmacological and pharmacological methods. While among non-pharmacological methods cognitive-behavioral therapy is the one recommended, the choice of proper pharmacotherapy can impose more difficulties. The most commonly used medications, nonbenzodiazepine sedative hypnotics, lead to serious adverse effects and impose a risk of dependency. Daridorexant, a medication of proven efficacy, may propose a safer alternative, and furthermore, a more effective one.
Summary: In this review, we decided to analyse the existing literature to present the current state of knowledge on the above-mentioned issue with a perspective of the future of this branch of medicine
THE ANTIDEPRESSANT EFFECTS OF PHYSICAL ACTIVITY: NEUROBIOLOGICAL MECHANISMS AND PSYCHOSOCIAL MECHANISMS
No full textBackground: Depression is a leading cause of disability worldwide, affecting millions and imposing significant personal, social, and economic burdens. While pharmacological and psychotherapeutic interventions are standard treatments, physical activity has emerged as a promising complementary or alternative strategy.
Methods: A comprehensive literature review was conducted of peer-reviewed studies published between 2000 and 2025, including randomized controlled trials, meta-analyses, and observational research. Populations examined included adolescents, adults, and older adults. Data extraction focused on depressive symptom outcomes, exercise modalities, intervention duration and intensity, and underlying neurobiological and psychosocial mechanisms.
Results: Evidence consistently indicates that regular physical activity, particularly aerobic and combined aerobic–resistance exercise, produces moderate to large reductions in depressive symptoms. Mechanistically, exercise enhances brain-derived neurotrophic factor (BDNF) expression, modulates monoaminergic neurotransmission, regulates the hypothalamic–pituitary-adrenal (HPA) axis, and reduces systemic inflammation. Psychosocial benefits, including behavioral activation, increased self-efficacy, and social engagement, further support sustained mood improvement. Combined interventions often yield the greatest effect, integrating biological, psychological, and social pathways.
Conclusion: Physical activity is a safe, accessible, and effective intervention for depression, with benefits extending beyond symptom reduction to improved cognitive function, stress resilience, and overall well-being. Incorporating structured exercise into standard treatment protocols may optimize clinical outcomes and support long-term mental health across diverse populations
OMEGA-3 FATTY ACIDS: CAPSULES OR OIL? COMPARISON OF STABILITY, BIOAVAILABILITY AND EFFECTIVENESS OF EPA AND DHA SUPPLEMENTATION
No full textOmega-3 fatty acids, primarily eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), play a key role in human health, including protection of the cardiovascular system, support for neurological functions, and influence on anti-inflammatory processes. Despite the known importance of their consumption, the quality and form of supplementation (oil vs. capsules) are raising increasing doubts. One important aspect is the stability of these polyunsaturated fatty acids, as their susceptibility to oxidation may reduce their effectiveness or even lead to the formation of adverse products. In this context, the total oxidation index (TOTOX) is a commonly used marker for assessing the degree of oxidation of fish oils and omega-3 supplements. This article provides a comprehensive review of the scientific literature comparing oil and capsule forms of omega-3 supplements, taking into account criteria such as oxidative parameters (TOTOX, peroxide value, anisidine value), bioavailability, and user preferences. The results indicate that capsules often offer better protection against oxidation during storage (lower TOTOX values) compared to liquid forms. For example, syrup products achieved TOTOX values of ~97 meq/kg at the end of the study, while capsules achieved ~30 meq/kg under similar conditions. In addition, the bioavailability of EPA/DHA depended on the chemical form (triglycerides > ethyl esters) and the delivery system — emulsions or liquid forms showed faster absorption than traditional gel capsules.
Based on the data collected, it can be concluded that the choice of omega-3 supplement form should take into account not only the EPA/DHA content, but also the oxidative quality, chemical form, and storage method. For dietary practice, products with a low TOTOX index, adequately protected from light and oxygen, and taken with a meal containing fat to increase absorption are recommended