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EFFECTIVENESS OF COGNITIVE-BEHAVIORAL THERAPY (CBT) IN REDUCING ANXIETY SYMPTOMS ACROSS DIFFERENT ANXIETY DISORDERS COMPARED TO CONTROL CONDITIONS AND ALTERNATIVE TREATMENTS: A SYSTEMATIC LITERATURE REVIEW
No full textBackground: Anxiety disorders are among the most prevalent mental health conditions worldwide. Cognitive Behavioral Therapy (CBT) is widely regarded as a first-line treatment, but its evidence base is constantly evolving with new research on long-term outcomes, comparative efficacy, and novel delivery methods. The first aim of this mixed methods review is to explore the efficacy and long-term effectiveness of CBT for anxiety disorders. The secondary aims evaluate the comparative effectiveness of its various delivery modalities (e.g., face-to-face, digital, virtual reality) and its efficacy relative to other active treatments, such as pharmacotherapy and emerging psychotherapies.
Methods: A systematic review was conducted based on a synthesis of 12 peer-reviewed research summaries, including meta-analyses, randomized controlled trials, and longitudinal studies. The population included children, adolescents, and adults with diagnosed anxiety disorders. Interventions included standard CBT and its variants (e.g., ICBT, VRCBT, CBGT). Outcomes included reduction in anxiety symptoms, long-term maintenance of gains, quality of life improvements, and comparative efficacy between modalities.
Conclusions: The results from this review will provide evidence that CBT is a highly effective treatment for a range of anxiety disorders, showing medium to large effect sizes. CBT remains the gold-standard, evidence-based psychological intervention for anxiety disorders. Its benefits are durable over time and can be effectively delivered through both traditional and emerging digital formats, which can help bridge the accessibility gap. These findings clarify that, future research should focus on long-term follow-ups, optimizing digital engagement, and adapting protocols for diverse cultural and clinical populations
THE IMPACT OF CHRONIC CANNABINOID USE AND DEPENDENCE ON OPIOID ANALGESIC TREATMENT – A SYSTEMATIC REVIEW AND PREDICTIVE ANALYSIS
No full textIn recent years, there has been growing interest in cannabinoids as potential analgesics and alternatives to opioids. Cannabinoids, through modulation of the endocannabinoid system, affect nerve transmission, neuroplasticity, and inflammatory processes, and their action on CB1 and CB2 receptors is similar to the mechanisms of the opioid system, in particular μ, δ, and κ receptors. The aim of this study was to compare the mechanisms of action of cannabinoids and opioids, review studies on their combined use, and assess the impact of chronic cannabinoid use and dependence on the effectiveness of opioid-based pain treatment.
Analysis of the available data showed that moderate use of cannabinoids, especially preparations with a balanced THC and CBD content, can lead to an "opioid-sparing" effect, allowing opioid doses to be reduced without losing the analgesic effect. However, chronic use of cannabinoids, especially those with high THC content, is associated with the development of tolerance, mood disorders, desensitization of CB1 receptors, and disturbances in the co-regulation of μ receptors, which may lead to compensatory escalation of opioid treatment and the development of cross-addiction. In addition, partial clinical benefits have been observed in patients with neuropathic pain from the combination of cannabinoid and opioid therapy, while no clear analgesic effects have been observed in acute pain.
The proposed predictive model integrates molecular, clinical, and psychological aspects, indicating that the effectiveness of analgesic therapy depends on the duration of exposure to cannabinoids, the type of pain, and the individual predisposition of the patient. The authors point to the need for further research involving patients who are chronic users of cannabinoids or addicted to them and who are scheduled to be treated with opioids. The results of such analyses could form the basis for the development of clinical guidelines for integrated pain therapy that minimizes the risk of addiction and treatment failure
EFFICACY AND TOLERABILITY OF DIFFERENT ORAL IRON PREPARATIONS IN IRON DEFICIENCY ANEMIA: REVIEW
No full textBackground: iron deficiency anemia (IDA) is a widespread, preventable condition that diminishes work capacity, cognition, and overall health. Dysregulation of iron homeostasis — principally via hepcidin‑mediated sequestration — distinguishes absolute deficiency from functional deficiency, guides diagnostic interpretation and helps to choose the type therapy.
Aim: The aim of this article is to compare the available oral iron supplements with respect to efficacy, tolerability and practical use. It summarizes current evidence regarding optimal dosing and frequency of administration in individuals with iron deficiency and iron-deficiency anemia.
Methods: narrative review of literature up to 2025, prioritizing recent meta‑analyses, systematic reviews, randomized controlled trials, phase III randomized studies and other high‑quality studies. Searches were conducted in PubMed/MEDLINE, Embase, Web of Science and Google Scholar. Key search terms included oral iron, ferrous sulfate, liposomal iron, sucrosomial iron, ferric maltol and ferrous bisglycinate. This review compares their efficacy and tolerability. Study selection, data extraction, and quality evaluation followed standard review procedures; findings were synthesized and summarized in tables.
Results: new supplements generally achieve comparable or faster hematologic responses at lower elemental iron doses and are associated with fewer gastrointestinal side effects, which may improve adherence, particularly in patients intolerant of ferrous salts or with inflammatory conditions. Dosing approaches that account for hepcidin dynamics (alternate-day or single morning dosing) enhance absorption. Heterogeneity in study populations, dosing regimens and outcome measures limits direct comparisons.
Conclusion: oral iron formulations show broadly similar efficacy; selection should prioritize tolerability, comorbidity context, and dosing strategies that optimize absorption. Individualized therapy with routine monitoring of hemoglobin and ferritin improves outcomes and adherence
SHIFT WORK AND THE HEART: EFFECTS OF SHIFT WORK ON THE DEVELOPMENT AND PROGRESSION OF HEART FAILURE AND ITS ASSOCIATION WITH CHRONIC DISEASE RISKS - A NARRATIVE REVIEW
No full textBackground: Shift work is increasingly prevalent worldwide as continuous service delivery becomes essential across sectors such as healthcare, transportation and industry. However circadian misalignment, sleep disruption, metabolic alterations and neurohormonal dysregulation make shift workers a population at heightened cardiometabolic risk. While the associations between shift work, hypertension and coronary artery disease (CAD) are well documented, its potential contribution to the development of heart failure (HF) remains less clearly defined.
Objectives: This narrative review synthesises current evidence on the impact of shift work - particularly night work and rotating schedules - on cardiovascular health with a focus on HF, CAD and hypertension. It contextualises HF risk within the broader metabolic and behavioural consequences of circadian disruption and identifies gaps in existing research.
Methods: A comprehensive review of epidemiological, clinical and experimental studies was conducted with emphasis on cardiometabolic pathways linking shift work to adverse cardiovascular outcomes.
Results: Shift work is consistently associated with an increased risk of hypertension and CAD with risk rising in proportion to cumulative exposure. Pathophysiology includes chronic sympathetic activation, inflammation, oxidative stress, hormonal dysregulation and frequent co-occurrence of unhealthy sleep, dietary and activity patterns. Evidence linking shift work to HF is more limited but suggests an elevated risk - particularly among women and permanent night-shift workers. Proposed mechanisms include chronic haemodynamic stress, myocardial fibrosis (supported by experimental models) and indirect effects mediated by worsened metabolic health. Heterogeneity in exposure definitions and inadequate adjustment for confounders remain key limitations of existing studies.
Conclusions: Shift work should be considered as an important, modifiable cardiovascular risk factor that may contribute not only to hypertension and CAD but also to HF development. Preventive strategies - including optimisation of shift schedules, adequate recovery periods and education targeting sleep hygiene, diet and physical activity - may mitigate these risks. Well-designed prospective studies with HF as a primary endpoint, detailed exposure assessment and phenotype-specific analyses are urgently needed. Greater awareness of the cardiovascular consequences of shift work is essential for clinicians, employers and public health policymakers
NUTRITIONAL INTERVENTIONS AND SUPPLEMENTATION AS SUPPORTIVE THERAPY FOR ENDOMETRIOSIS: A SYSTEMATIC REVIEW
No full textEndometriosis is a chronic disease characterised by the presence of endometrial tissue outside the uterine cavity. It is associated with pain, menstrual disorders, and infertility. Despite advances in research, its aetiology remains incompletely understood; however, genetic, hormonal and immunological factors and microbiome disorders are believed to contribute to its development. Diagnosis of the disease is frequently delayed, and laparoscopy remains the gold standard for confirmation. Current treatment options include hormonal pharmacotherapy, most commonly oral contraceptives and progestogens such as dienogest, and surgical intervention, which is associated with a risk of recurrence and postoperative complications. An increasing body of evidence highlights the role of nutritional interventions and supplementation in modulating inflammatory processes, oxidative stress, angiogenesis and estrogen metabolism. Nutrients and bioactive compounds such as omega - 3 fatty acids, vitamins D, C and E, phytoestrogens, resveratrol, curcumin and melatonin may reduce the severity of symptoms and the size of ectopic endometrial lesions. The microbiome also plays an important role - probiotics, short-chain fatty acids and faecal microbiota transplantation demonstrate therapeutic potential through modulation of the immune response and estrogen metabolism. A multidirectional approach integrating pharmacotherapy, surgical treatment, and lifestyle modification may improve patients’ quality of life; however, further research is required to evaluate the efficacy and safety of adjuvant therapies
ALTERNATIVES TO STATINS IN THE TREATMENT OF HYPERCHOLESTEROLEMIA
No full textHypercholesterolemia is one of the main modifiable risk factors for cardiovascular disease. Elevated levels of LDL (low-density lipoprotein) cholesterol lead to the development of atherosclerosis and cardiovascular complications. Statins are the mainstay of hypercholesterolemia therapy, but in some patients, therapeutic goals are not achieved or side effects occur. It is necessary to develop alternatives to statins for the treatment of hypercholesterolemia. Drugs that act on other stages of cholesterol synthesis are being sought. Publications covering observational studies, randomized controlled trials (RCTs), and meta-analyses on alternative therapies for hypercholesterolemia to statin treatment were analyzed. The following were described: cholesterol absorption inhibitor (ezetimibe), ATP citrate lyase inhibitor (bempedoic acid), PCSK9 inhibitors (evolocumab, alirocumab) , siRNA against PCSK9 (inclisiran), ANGPTL3 inhibitors (evinacumab), ANGPTL4, ANGPTL8 and ANGPTL3/8 complex inhibitors, fibrates and nutraceuticals (plant sterols, fermented red yeast rice extract (Red Yeast Rice, RYR) , berberine). The impact of these drugs on patients' lipid profiles and cardiovascular risk was discussed. Attention was also drawn to the need for individualization of hypercholesterolemia therapy.
Aim of this study: The objective of this study is to summarize the latest reports on alternative therapies for hypercholesterolemia to statins.
Materials and methods: A literature review was conducted using the professional PubMed database. Searches included combinations of the keywords: “hypercholesterolemia,” “ezetimibe,” “bempedoic acid,” and “PCSK9 inhibitors.
REVIEW OF THE NEW AVALANCHE RESCUE PROCEDURES ACCORDING TO THE NEW ERC 2025 GUIDELINES
No full textIntroduction and objective: Emergency medicine is nowadays a highly specialised branch of medicine. Regular updates on rescue procedures lead to the compilation of highly specialised guidelines. The rise in mobility among people encourages travel and participation in sports. Winter sports such as skiing and snowboarding increase the average time spent in mountain regions, thereby increasing the risk of avalanche exposure. To ensure high-quality avalanche rescue, official guidelines must be published and regularly revisited.
Review Methods: A comprehensive literature review was conducted, analyzing studies indexed in PubMed and the official ERC Guidelines from 2021 and 2025.
Brief description of the state of knowledge: The first official avalanche rescue guidelines were published in 2021 by the European Resuscitation Council. Since then, studies have examined their efficacy and sought better solutions. In 2022, a group of experts published an algorithm—Avalife—that outlined systematic, step-by-step Basic Life Support (BLS) recommendations in case of a shortage of rescuers at the site of an accident. The latest ERC Guidelines, published in 2025, introduce a new avalanche-rescue algorithm and incorporate the Avalife algorithm into official procedures, thereby establishing a cohesive avalanche-rescue policy.
Summary: In this review, we analyse the existing literature, with particular emphasis on the new ERC 2025 Guidelines, to present the current state of knowledge on this issue
IMMUNOMODULATORY EFFECTS OF VITAMIN D AND ITS STATUS IN PATIENTS WITH AUTOIMMUNE DISEASES
No full textThe incidence of autoimmune diseases is increasing year by year, especially in Western societies. Many factors, both genetic and environmental, are involved, and vitamin D (vD, 25(OH)D3) deficiency is considered to be one of the key factors. However, the precise etiopathogenesis of autoimmune disorders is still not fully understood, which is also reflected in the limitation of therapeutic possibilities. Recently, there has been a growing interest in the role of vitamin D in alleviating autoimmunological processes, as vD has the ability to stimulate or inhibit virtually every stage of the immune response through its vitamin D receptor (VDR), expressed on immune cells. Innate and adaptive immune system and endothelial membrane stability. This allows us to define this vitamin as a strong immunomodulator in terms of both innate and acquired immunity. The aim of this paper is to present the pathophysiology of selected autoimmune diseases and to demonstrate the modifying properties of vitamin D on the immune system. Our review also demonstrates the scale of deficiency, both in the general population and among individuals diagnosed with autoimmune disease
EFFECTS OF COLD-WATER IMMERSION (≤14°C) ON PHYSIOLOGICAL RECOVERY, INFLAMMATION, AND PERFORMANCE: A SYSTEMATIC REVIEW OF HUMAN STUDIES
No full textBackground: Cold-water immersion (CWI) is a widely used recovery strategy among athletes and physically active individuals, commonly applied to reduce post-exercise fatigue and muscle soreness. Although CWI is known to induce rapid thermoregulatory and autonomic responses, the magnitude and direction of its effects appear strongly dependent on protocol parameters such as water temperature, exposure duration, and immersion depth. Evidence remains fragmented, and many previous reviews have combined cold modalities above 14°C or non-immersion cryotherapies, limiting clarity regarding true cold-water exposure.
Aim: This review synthesizes current evidence regarding the physiological and performance-related effects of CWI performed at ≤14°C for ≥1 minute in healthy adults, with particular focus on recovery, inflammatory and immune responses, cardiovascular function, and neuromuscular performance.
Methods: We systematically searched PubMed, Google Scholar, and Cochrane Library using terms including cold water immersion, CWI, ice bath, cold-water immersion recovery, cold immersion muscle soreness, cold immersion performance, and related combinations. Only open-access human experimental studies reporting direct immersion ≤14°C were included. Twenty studies met the eligibility criteria.
Results: CWI consistently reduced delayed-onset muscle soreness and improved subjective recovery across protocols. Performance outcomes were variable: benefits were more evident in high-intensity and intermittent sports, whereas strength and endurance recovery showed mixed results. Inflammatory, immune, and oxidative markers demonstrated context-dependent modulation. Cardiovascular and metabolic responses increased with lower temperatures and longer exposures, and limited evidence suggests potential adaptive effects following repeated immersion.
Conclusion: CWI at ≤14°C is an effective modality for reducing muscle soreness and enhancing perceived recovery post-exercise, with conditional benefits for performance depending on protocol and sport type. Physiological responses are heterogeneous, underscoring the need for standardized protocols and further longitudinal research to clarify dose–response relationships and long-term adaptive outcomes
THE ROLE OF ARTIFICIAL INTELLIGENCE IN EARLY DETECTION OF HEART DISEASES: SOCIAL IMPLICATIONS AND ETHICAL CHALLENGES
No full textThe dynamic development of modern technologies, particularly artificial intelligence (AI), is significantly impacting the functioning of modern healthcare systems, opening up new opportunities for the early detection of cardiovascular diseases, which remain one of the leading causes of death worldwide. Lifestyle changes associated with technological advancements are contributing to the rise in the incidence of lifestyle diseases, significantly increasing the risk of developing cardiovascular disease. In this context, early diagnosis and effective prevention are becoming key public health priorities.
The aim of this paper is to analyze the role of AI in the early detection of heart disease, taking into account its medical, social, and ethical aspects. Methods based on machine and deep learning enable the analysis of large and complex medical datasets, such as electrocardiograms, imaging studies, electronic medical records, and data from wearable devices. The use of AI allows for the identification of subtle pathological changes that often appear before the onset of clinical symptoms, supporting the transition from reactive to preventive and personalized medicine.
At the same time, the implementation of AI systems for cardiology screening has significant social implications. While these technologies can increase the availability of early diagnosis and improve the utilization of healthcare resources, there is a risk of exacerbating health inequalities resulting from algorithmic biases, limited data representativeness, and the digital divide. Furthermore, ethical challenges arise related to the protection of sensitive data, the transparency and explainability of algorithms, and accountability for clinical decisions.
The paper emphasizes that artificial intelligence should serve as a tool supporting clinical decisions, while maintaining the physician's central role in the diagnostic and therapeutic process. Responsible integration of AI requires building trust, transparent communication with patients, and the creation of a coherent regulatory framework. The societal value of artificial intelligence in cardiology depends on its ethical, equitable, and human-centered implementation