Visual Article Details Journal of Education, Health and Sport eISSN 2391-8306 is a Humanistic Journal with an international reach, published in line with top standards applicable in scientific journals. Each issue contains original and review papers, and case reports of different specialties associated with Multidisciplinary Education Sections: Physical Culture Sciences; Health Sciences; Medical Sciences; Pedagogy; Socio-Economic Geography and Spatial Management; Earth and Environmental Sciences; Cultural and Religious Sciences; Proceeding; Book of Abstracts, is a double anonymized scientific published by the University Center for Sports Research, Nicolaus Copernicus University in Toruń, Poland. Manuscripts Preparation. Journal of Education, Health and Sport. 2025; eISSN2391-8306. In order to facilitate publication, the authors are kindly requested to submit texts written according to the rules presented below. Template How to prepare an Article for the Journal of Education, Health and Sport.docx How to prepare an Article for the Journal of Education, Health and Sport.pdf Journal of Education, Health and Sport is: a Humanistic Journal with a Global International Reach. Our mission is to offer the worldwide scientific community a broad, fast and direct access to publish the latest results of the research areas that are developing rapidly and where there are changes with a high potential impact. All Articles submitted for publication will be peer-reviewed within 2-30 weeks. All accepted articles will be published online before appearing in the print journal within 2-30 weeks from acceptance. The journal has had 40 points in Minister of Science and Higher Education of Poland parametric evaluation. Annex to the announcement of the Minister of Science and Higher Education of 05.01.2024 No. 32318. Has a Journal's Unique Identifier: 201159. Scientific disciplines assigned: Physical culture sciences / Nauki o kulturze fizycznej; Health sciences / Nauki o zdrowiu. Note: in the previous list from November 3, 2023: Sections: Physical Culture Sciences; Health Sciences; Medical Sciences; Pedagogy; Socio-Economic Geography and Spatial Management; Earth and Environmental Sciences; Cultural and Religious Sciences. Uwaga: na poprzednim wykazie z 3 listopada 2023 Dyscypliny: Nauki o Kulturze Fizycznej; Nauki o Zdrowiu; Nauki Medyczne; Geografia Społeczno-Ekonomiczna i Gospodarka Przestrzenna; Pedagogika; Nauki o Ziemi i Środowisku; Nauki o Kulturze i Religii. ERIH PLUS 2014-12-31 Journal of Education, Health and Sport formerly Journal of Health Sciences Approved 2015-06-29 Citations from Scopus 1141 documents found for Journal of Education, Health and Sport. 732 secondary documents found 732 Secondary documents Citations from Scopus for Journal of Education, Health and Sport. + from Scopus 1277 documents found for J Educ Health Sport. 773 secondary documents found 773 Citations from Scopus for J Educ Health Sport. 732+773=1505 Secondary documents Citations from Scopus for Journal of Education, Health and Sport. EBSCO Essentials <a href="https://essentials.ebsco.com/search/eds?query=%22Journal%20of%20Education%2C%20Health%20and%20Sport%22&limit=50&sort=date_asc" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://zasobygwp.pl/redirect?sig=e08af7423fdfd355d4fd245a2400ef7cac1289b549a11c57a7a7e1810a6b8449&url=aHR0cHM6Ly9lc3NlbnRpYWxzLmVic2NvLmNvbS9zZWFyY2gvZWRzP3F1ZXJ5PSUyMkpvdXJuYWwlMjBvZiUyMEVkdWNhdGlvbiUyQyUyMEhlYWx0aCUyMGFuZCUyMFNwb3J0JTIyJmxpbWl0PTUwJnNvcnQ9ZGF0ZV9hc2M=&platform=desktop&brand=wp">https://essentials.ebsco.com/search/eds?query=%22Journal%20of%20Education%2C%20Health%20and%20Sport%22&limit=50&sort=date_asc Frequency: First Semi-annually, Quarterly, Current is Monthly. Open access model. Accept Articles 43 %. Reject Articles 57 %. Days to First Editorial Decision 10-60. Days to Accept 15-210. Days to Reject 15-210. Formerly Journal of Health Sciences 2011-2014 Index Copernicus Archiwalne ISSN:1429-9623 eISSN: 2300-665X GICID:71.0000.1500.0665
Nicolaus Copernicus University, Toruń, Poland
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
The impact of a vegetarian diet on thyroid health – a review of current literature
Background: Thyroid dysfunction is one of the most common endocrine disorders and represents an important public health issue. Its etiology is multifactorial and includes genetic, immunological, environmental, and dietary factors. A vegetarian diet, rich in plant-based foods, provides bioactive compounds with antioxidant and anti-inflammatory properties that may influence immune regulation. However, poorly balanced vegetarian diets may result in deficiencies of nutrients essential for thyroid function, including iodine, selenium, and vitamin B12. Aim: This study aims to review current scientific evidence on the effects of a vegetarian diet on thyroid function, focusing on potential benefits, risks, and the role of supplementation. Materials and methods: A narrative literature review was conducted using publications from PubMed, Scopus, and Web of Science databases published between 2010 and 2025. Articles addressing vegetarian diets, thyroid function, autoimmune thyroid diseases, and micronutrient supplementation were analyzed. Results: Evidence suggests that a vegetarian diet may have both beneficial and adverse effects on thyroid health. Benefits include higher intake of antioxidants, lower body weight, and a potentially reduced risk of hyperthyroidism. Conversely, vegetarians show a higher risk of deficiencies in iodine, selenium, vitamin B12, and omega-3 fatty acids, which may contribute to hypothyroidism and exacerbate autoimmune thyroid diseases. Regular monitoring and targeted supplementation are therefore recommended. Conclusions: A well-planned vegetarian diet can support thyroid health when appropriate supplementation is ensured. Increased awareness of potential nutrient deficiencies, particularly in individuals with thyroid disorders and in pregnant women, is essential. Further research is needed to establish optimal dietary strategies for thyroid health in vegetarian populations.
Copyright (c) 2026 Bartosz Palacz, Katarzyna Trela , Natalia Marianna Kubiś , Julia Anna Wrona, Aleksander Polus , Wiktor Perz, Maria Magdalena Teper, Anhelina Korolchuk , Anna Gluzicka, Anna Matyas, Jędrzej Piotrowski https://creativecommons.org/licenses/by-nc-sa/4.0
Chronic Inflammation and Insulin Resistance as Links between Metabolic Syndrome and Musculoskeletal Disorders
Background: Metabolic syndrome (MetS) affects approximately 25-30% of adults worldwide and is traditionally associated with cardiovascular complications. However, emerging evidence suggests that MetS may also substantially increase the risk of musculoskeletal disorders, including osteoarthritis, sarcopenia, and osteoporosis. Objectives: This review synthesizes current evidence on the molecular and pathophysiological mechanisms connecting MetS to musculoskeletal disorders, with particular focus on chronic inflammation and insulin resistance as central mediators. Methods: A comprehensive literature search was conducted across PubMed and Google Scholar, focusing on publications from 2018-2026. Search terms included metabolic syndrome, chronic inflammation, insulin resistance, musculoskeletal disorders, adipokines, osteoarthritis, and sarcopenia. After reviewing and ranking for relevance, 40 high-impact studies were selected to form the evidence base for this review [40]. Results: The literature reveals that chronic inflammation in MetS, characterized by elevated pro-inflammatory cytokines (IL-6, TNF-α, IL-1β) and dysregulated adipokines (leptin, adiponectin, resistin), creates a systemic inflammatory environment that directly impacts musculoskeletal tissues. Conclusions: Chronic inflammation and insulin resistance represent critical mechanistic links between MetS and musculoskeletal disorders. Interventions targeting inflammation and insulin sensitivity—including lifestyle modifications, omega-3 fatty acids, metabolic drugs (metformin, GLP-1 agonists), intermittent fasting, and inflammasome-targeting approaches—may offer benefits for both metabolic and musculoskeletal health.
Copyright (c) 2026 Emilia Deka, Joanna Banatkiewicz, Oliwia Bartkowska, Sofia Czarnecka, Hanna Bojanowska, Karolina Babik, Gabriela Ewa Łuczyńska, Jan Domińczak, Adam Dobosz, Antoni Wojnowski https://creativecommons.org/licenses/by-nc-sa/4.0
Impact of Popliteal Artery Entrapment Syndrome on Exercise Tolerance and Athletic Performance: A Narrative Review
Introduction: Popliteal artery entrapment syndrome (PAES) is a rare vascular disorder observed mainly in young, physically active individuals. It involves compression of the popliteal artery, leading to exercise-induced ischemia and reduced athletic performance. The condition is frequently underdiagnosed due to symptom overlap with musculoskeletal disorders. Methods: A narrative review was conducted based on a non-systematic search of PubMed, Scopus, and Web of Science databases, including studies published up to 2026. The analysis focused on PAES in athletic populations, covering pathophysiology, clinical presentation, diagnosis, and management. Results: PAES may be structural or functional, both resulting in impaired blood flow during exercise. Common symptoms include intermittent claudication, muscle fatigue, and paresthesia, which negatively impact exercise tolerance. Diagnosis requires dynamic imaging techniques, as resting examinations are often inconclusive. Surgical treatment provides significant improvement in most symptomatic athletes. Conclusions: PAES is an important but often overlooked cause of exercise intolerance in athletes. Early diagnosis and appropriate management are essential to restore performance and prevent long-term complications.
Copyright (c) 2026 Agnieszka Janaszek, Agnieszka Chmurska, Aleksandra Strzępek, Mateusz Smerdzyński, Natalia Kałwa, Kinga Kałuża, Karolina Frączek, Aleksandra Majchrzyk, Julia Łyżwa, Michał Pater https://creativecommons.org/licenses/by-nc-sa/4.0
Modern Approaches to Prostate Cancer Diagnosis: From PSA to AI-Assisted Imaging
Background. Prostate cancer is one of the most common malignancies in men, and its early diagnosis remains challenging due to the lack of specific symptoms in the initial stages. Aim. This review aimed to present current methods used in prostate cancer diagnosis, with emphasis on modern imaging, biomarkers, and artificial intelligence. Materials and methods. A focused narrative review of the relevant literature was conducted, including studies on PSA testing, prostate biopsy, multiparametric MRI, MRI/TRUS fusion biopsy, PSMA PET, molecular biomarkers, and AI-based diagnostic tools. Summary. Traditional methods remain important but have limited specificity. Modern imaging techniques improve lesion detection and biopsy targeting, while biomarkers such as PCA3, PHI, and 4Kscore support risk stratification. AI shows growing potential in imaging and histopathological analysis. Conclusions. An integrated diagnostic approach may improve the detection of clinically significant prostate cancer while reducing unnecessary biopsies, overdiagnosis, and overtreatment.
Copyright (c) 2026 Paweł Sosnowski, Kamila Bakuła, Iga Maria Nowicka, Paweł Rios Turek, Emilia Dybała https://creativecommons.org/licenses/by-nc-sa/4.0
Diagnostic Challenges in Unusual Causes of Refractory GERD-Like Symptoms
Background: Refractory gastroesophageal reflux disease (GERD) describes persistent reflux‑like symptoms despite optimized proton pump inhibitor therapy and is frequently driven by alternative or overlapping pathologies rather than uncontrolled acid exposure. Aim: To review unusual causes of refractory GERD‑like symptoms, with emphasis on pathophysiology, diagnostic pitfalls, and practical evaluation strategies for achalasia, eosinophilic esophagitis, belching and rumination disorders, gastroparesis, and Zollinger-Ellison syndrome (ZES). Material and methods: A review of selected literature was conducted using the PubMed database. The search was performed using keywords including “refractory GERD,” “PPI refractory,” “achalasia,” “gastroparesis,” “esophageal motility disorders,” and “case reports”. Results: Achalasia, eosinophilic esophagitis, behavioural belching and rumination, gastroparesis, and gastrinoma‑driven acid hypersecretion all produce GERD‑like complaints yet require distinct diagnostic tools such as high‑resolution manometry, esophageal biopsies, impedance- pH monitoring, gastric emptying studies, and fasting gastrin measurement. Failure to recognize these entities risks inappropriate escalation of antireflux therapy, unnecessary surgery, and progression to complications. Conclusions: Systematic physiologic and endoscopic evaluation of PPI‑refractory symptoms is essential to uncover uncommon causative conditions, align therapy with underlying mechanisms, and prevent mislabeling patients with simple GERD when they harbour distinct motility, inflammatory, behavioural, or neuroendocrine disorders.
Copyright (c) 2026 Gabriela Jankowski , Kai Siemaszko, Mahmoud Badran, John Koladzyn, Marianna Jankowski, Luiza Wasilewski , Gregory Twombly, Weronika Margielewska, Anna Słodyczka https://creativecommons.org/licenses/by-nc-sa/4.0
Metformin as a Potential Geroprotective Agent: Mechanisms, Clinical Evidence and Implications for Healthy Aging
Background: Population aging represents a major medical and socioeconomic challenge worldwide. The increasing prevalence of age-related diseases, including cardiovascular disorders, neurodegeneration, cancer, and metabolic dysfunction, highlights the need for strategies aimed at extending healthspan rather than lifespan alone. In this context, pharmacological agents that modulate fundamental biological processes of aging have attracted significant attention. Metformin has emerged as a potential candidate beyond its established role in the treatment of type 2 diabetes mellitus. Aim: This narrative review aimed to evaluate current evidence regarding the potential geroprotective properties of metformin, with particular emphasis on underlying molecular mechanisms and available clinical data. Materials and Methods: A narrative literature review was conducted using the PubMed database. Articles published between January 2015 and March 2025 were identified using the keywords “metformin”, “aging”, “longevity”, and “geroprotection”. Peer-reviewed original studies and review articles in English were included, while case reports and non-peer-reviewed publications were excluded. Results: Evidence indicates that metformin influences multiple pathways involved in aging, including activation of AMP-activated protein kinase (AMPK), inhibition of the mechanistic target of rapamycin (mTOR), modulation of mitochondrial metabolism, reduction of oxidative stress, and attenuation of chronic inflammation. Observational studies suggest associations with reduced incidence of age-related diseases and improved survival; however, direct evidence in non-diabetic populations remains limited. Conclusions: Metformin demonstrates properties consistent with potential geroprotective effects. However, well-designed randomized controlled trials are required to confirm its efficacy and safety in the context of healthy aging.
Copyright (c) 2026 Paulina Kawalec, Kamil Bronikowski, Maksymilian Ryszkowski , Krystian Fornal, Natalia Będkowska-Kuśmierek, Sabina Zaborowska, Paulina Pawlak , Olaf Wojcieszuk , Łukasz Starczewski, Adrianna Babik https://creativecommons.org/licenses/by-nc-sa/4.0
The Impact of Supplementation and Adjuvant Pharmacotherapy on Bone Fracture Healing
Introduction and purpose: Bone fractures and healing complications, such as delayed union and non-union, present a substantial and growing global healthcare burden. While surgical fixation techniques have advanced significantly, optimizing the biological environment through targeted nutritional and pharmacological interventions remains critical for successful osteogenesis. This review aims to systematize the current knowledge regarding the impact of exogenous supplementation and adjuvant pharmacotherapy - ranging from basic nutrients to advanced biological drugs - on the bone fracture healing process. A brief description of the state of knowledge: Based on a comprehensive literature search of major medical databases focusing on the last 15 years, the synthesis of clinical and preclinical data indicates that correcting baseline nutritional deficiencies (particularly protein, amino acids, and vitamin D3) is an essential prerequisite for adequate soft callus formation and subsequent mineralization. Structural components like chondroitin sulphate and collagen, alongside phytotherapeutics such as Cissus quadrangularis, provide significant early-stage support for endochondral ossification. Conversely, routine administration of non-steroidal anti-inflammatory drugs (NSAIDs) during the acute inflammatory phase should be approached with high caution due to their potential to significantly delay healing. In recalcitrant cases, advanced therapies like systemic teriparatide and locally applied bone morphogenetic proteins (BMPs) offer potent osteoinductive rescue strategies. Summary (conclusions): A multifaceted approach that integrates early nutritional optimization, judicious analgesic management, and targeted osteoinductive pharmacotherapy is vital for enhancing physiological bone repair, reducing recovery time, and preventing severe non-union complications.
Copyright (c) 2026 Bartosz Machnio, Agata Świątek, Kamil Andruszkiewicz, Natalia Jasińska, Wojciech Frączyk, Mateusz Krysiak, Bogna Błachowska, Natalia Turzyńska, Katarzyna Mania, Julia Bąk https://creativecommons.org/licenses/by-nc-sa/4.0
Pre-Participation Cardiovascular Screening in Competitive Athletes: An Evidence-Based Review of Strategies and Risk Stratification
Background: Competitive athletes are exposed to sustained physiological stress that may reveal previously unrecognized structural or electrical cardiac disease, thereby predisposing susceptible individuals to exercise-related sudden cardiac events. Pre-participation cardiovascular screening has become an established component of athlete care. Aim: To review the rationale, components, strengths, and limitations of contemporary cardiovascular screening strategies in competitive athletes and to examine current controversies and future directions. Material and methods: A narrative review of PubMed-indexed literature published between 2017 and 2025 was conducted, focusing on guideline statements, systematic reviews, and cohort studies addressing cardiovascular screening in athletes. Summary: The reviewed literature indicates that structured screening based on history, physical examination, electrocardiography, and selective imaging facilitates early identification of occult cardiac disease and supports informed eligibility and management decisions. Variability in diagnostic performance, inconsistency in ECG interpretation, and differences in screening approaches remain areas of ongoing debate. Conclusions: Cardiovascular screening in competitive athletes functions as a structured strategy for risk mitigation that supports early detection and informed clinical decisions. Its effectiveness depends on appropriate expertise, consistent implementation, and access to follow-up pathways. Continued refinement of screening criteria and implementation models is needed to optimize athlete safety while preserving participation.
Copyright (c) 2026 Luiza Wasilewski , John Koladzyn, Anna Słodyczka, Gabriela Jankowski , Weronika Margielewska, Marianna Jankowski, Mahmoud Badran, Gregory Twombly, Kai Siemaszko https://creativecommons.org/licenses/by-nc-sa/4.0
The Impact of Nutrition and Early Dietary Introduction on the Prevalence, Severity and Management of Atopic Dermatitis in Infants. A Narrative Review
Background: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease affecting up to 20% of children worldwide, characterized by epidermal barrier dysfunction and immune dysregulation. The increasing prevalence of AD has led to a discussion on efficacy of allergen avoidance versus early immune tolerance induction strategies. Aim: This review aims to synthesize current evidence on prenatal and early-life nutritional interventions and their impact on the prevalence and severity of AD in infants. Materials and Methods: A narrative review was conducted using a structured search of major electronic databases for studies published between January 2015 and March 2026. Eligible articles included original studies, systematic reviews, and meta-analyses addressing maternal diet, breastfeeding, complementary feeding, and micronutrient supplementation. Results: Current evidence does not support maternal elimination diets as a preventive strategy but suggests that greater dietary diversity may reduce risk of AD. Role of breastfeeding in preventing AD remains inconclusive. Early introduction of allergenic products between 4 and 6 months promotes oral tolerance, although its impact on AD incidence is inconsistent. Vitamin D deficiency correlates with increased disease severity, and its supplementation may be beneficial. Findings regarding omega-3 fatty acids remain heterogeneous. Hydrolyzed formulas and elimination diets are not recommended for routine prevention of AD. Conclusions: Nutritional strategies in AD are shifting toward proactive tolerance induction. Early dietary exposures play a key role in immune programming, although further research is needed to define optimal, individualized interventions.
Copyright (c) 2026 Joanna Makowska, Jerzy Darmoń, Maria Windyga, Anna Sieczka, Natalia Piegza, Karolina Domańska, Aleksandra Papuga, Makary Hejduk https://creativecommons.org/licenses/by-nc-sa/4.0
Sweat in Skin Homeostasis and Dermatological Disorders in Athletes: Structural, Functional, and Clinical Perspectives - A Narrative Review
Introduction and purpose. Sweat is essential for skin homeostasis. In physically active individuals, increased sweating supports protective skin functions but may also trigger dermatological conditions. This review summarizes current knowledge on sweat gland types, their functional diversity, and the role of sweat in skin homeostasis, dermatoses, and gland disorders. Material and method. A narrative review of the literature was conducted using PubMed and Google Scholar, including original articles and reviews on sweat gland physiology, sweat composition, and related dermatoses. Results. Secretions from eccrine, apocrine, and apoeccrine glands contain water, electrolytes, and bioactive molecules that contribute to epidermal barrier integrity and immune functions. In physically active individuals, increased sweating improves heat dissipation, enhances stratum corneum hydration, and facilitates the delivery of antimicrobial and immunomodulatory factors to the skin surface. However, prolonged moisture and friction may disrupt the skin barrier and promote microbial overgrowth, contributing to inflammatory, infectious, and exacerbate dermatoses. Sweat gland disorders, further illustrate the consequences of dysregulated sweating, leading to impaired thermoregulation, inflammation, discomfort, and reduced physical performance. Conclusions. Sweat has multifactorial effects on skin health, influenced by environmental and individual factors. Understanding sweat physiology and related disorders is essential for preventing and managing skin diseases.
Copyright (c) 2026 Monika Jarowicz, Zuzanna Marczak, Maksymilian Sito, Filip Jurkowski, Łukasz Wójcik, Natalia Gawron, Hubert Tomasz Bojanowski, Aleksandra Dobracka, Kinga Zachar, Jędrzej Czmyr https://creativecommons.org/licenses/by-nc-sa/4.0
The role of Dupilumab in the treatment of Bullous Pemphigoid, Pemphigus and Hailey-Hailey Disease: A Narrative Review
Background: Autoimmune bullous diseases (AIBDs) and Hailey-Hailey disease are chronic skin disorders characterized by blister formation, pruritus, and reduced quality of life. Standard treatments, including systemic corticosteroids and immunosuppressants, often cause adverse effects and may not achieve long-term remission. Dupilumab, a monoclonal antibody targeting IL-4 and IL-13, has emerged as a promising alternative. Aim: To evaluate the efficacy and safety of dupilumab in patients with bullous pemphigoid, pemphigus vulgaris and foliaceus, and Hailey-Hailey disease. Material and Methods: Literature review including meta-analyses, randomized trials, retrospective studies, and case reports on dupilumab use in AIBDs and Hailey-Hailey disease. Disease activity was assessed using PDAI, BPDAI, or clinical evaluation; quality of life and adverse events were summarized. Results: In bullous pemphigoid, dupilumab reduced disease activity, pruritus, and cumulative corticosteroid dose, with most patients achieving complete or partial remission. Evidence in pemphigus vulgaris and foliaceus is limited but suggests potential benefit, particularly in patients ineligible for rituximab. In Hailey-Hailey disease, dupilumab improved lesions and quality of life, although relapse after discontinuation was reported. Therapy was generally well tolerated- with main adverse events being: injection site reactions, conjunctivitis, and eosinophilia. Conclusions: Dupilumab is an effective and safe option in bullous pemphigoid, offering pruritus relief and steroid-sparing benefits. Its use in pemphigus and Hailey-Hailey disease is promising but experimental. Further high-quality studies are needed to confirm long-term efficacy and safety.
Copyright (c) 2026 Natalia Będkowska-Kuśmierek, Sabina Zaborowska, Paulina Pawlak , Olaf Wojcieszuk , Łukasz Starczewski, Adrianna Babik, Kamila Kamińska , Anna Złotnik, Matylda Będkowska-Kuśmierek, Kinga Krzysztofik https://creativecommons.org/licenses/by-nc-sa/4.0
Trifarotene in the Treatment of Acne Vulgaris: Current Evidence and Place in Clinical Practice
Background: Acne vulgaris is a highly prevalent chronic inflammatory skin disease that significantly affects quality of life and psychological well-being. Topical retinoids remain a cornerstone of acne therapy due to their comedolytic and anti-inflammatory properties. Trifarotene, a selective retinoic acid receptor-γ agonist, is a recently developed fourth-generation retinoid introduced for the treatment of both facial and truncal acne. Aim: This review aims to summarize current evidence on the pharmacology, clinical efficacy, safety, and role of trifarotene in the management of acne vulgaris. Materials and Methods: A narrative literature review was conducted using PubMed and Embase, including clinical trials, meta-analyses, case reports, systematic reviews, post-marketing studies, and international treatment guidelines published up to 2026. Results: Randomized controlled trials demonstrate that trifarotene effectively reduces both inflammatory and non-inflammatory lesions on the face and trunk, with a generally favorable safety and tolerability profile, predominantly characterized by mild, localized adverse reactions. Long-term data support sustained efficacy and improvement in quality of life. However, comparative evidence, including network meta-analyses and tolerability studies, suggests that trifarotene may be less effective, associated with higher rates of treatment discontinuation, and exhibit a greater propensity for local irritation compared with other topical retinoids. Emerging evidence, including a case report, indicates potential benefit in combination therapy, particularly in treatment-resistant acne. Conclusions: Trifarotene is an effective and generally well-tolerated treatment for acne vulgaris, demonstrating efficacy in both facial and truncal acne. However, its precise role in clinical practice remains to be established, given the lack of clear superiority over existing therapies and its higher cost.
Copyright (c) 2026 Joanna Sowińska, Natalia Paluszkiewicz, Sandra Bryg, Aleksandra Cieślak, Sara Demkow, Zofia Leżańska, Mateusz Kwiatkowski, Katarzyna Marcinkowska, Karolina Siemińska, Emil Pałyga https://creativecommons.org/licenses/by-nc-sa/4.0
Virtual reality as a non-pharmacological method to support therapeutic interventions in palliative care patients
Aim: The aim of this study is to review the existing literature and research on the application of virtual reality technology in palliative care, with particular emphasis on its impact on pain intensity, psychological well-being, patients’ quality of life, as well as an analysis of its feasibility and safety. Materials and Methods: The literature was searched using the PubMed, Google Scholar, and Scopus databases (2013–2026). The following keywords were used: “virtual reality”, “palliative care”, “hospice care”, “end of life”, “pain”, “quality of life”, and “anxiety”. Results: The available evidence suggests that virtual reality represents a viable therapeutic option, generally not associated with significant adverse effects. Studies indicate a short-term reduction in perceived pain, a potential decrease in anxiety levels, and an improvement in psychological well-being. The effectiveness of the intervention depends, among other factors, on the type of content presented, such as nature-based imagery or materials tailored to the individual needs of the patient. However, there remains a lack of studies enabling the standardisation of parameters such as session duration and frequency, while the considerable heterogeneity of applied protocols makes comparison of results challenging. Conclusions: Virtual reality (VR) may constitute a valuable adjunct to standard palliative care in the management of symptoms and provision of psychological support, particularly as a short-term intervention in hospital and hospice settings. Further randomised clinical trials are warranted, alongside the development of guidelines for the implementation of VR in palliative care practice.
Copyright (c) 2026 Magdalena Maria Mulawa, Kamila Krycia, Karolina Mazur, Karolina Różycka, Emilia Piaszczyńska, Aleksandra Gałuszka, Dominika Matacz, Sandra Drabik, Maja Gałuszka, Adrianna Adamczyk https://creativecommons.org/licenses/by-nc-sa/4.0
The Burnout among medical students in Poland – a review article
Burnout, defined in the ICD-11 classification as a response to chronic stress, is characterized by feelings of exhaustion, mental distancing from work, and a reduced sense of professional efficacy. This paper summarizes previous publications regarding the scale of this phenomenon, its symptoms, and coping strategies among medical students in Poland, compared with international data. The review indicates that the problem is global and increasing in magnitude— in Poland, up to 53% of students may exhibit symptoms of exhaustion, and 42% struggle with burnout, with higher rates observed among women and senior students. The article discusses the symptomatology of the syndrome, including somatic symptoms such as headaches and fatigue, as well as psychological manifestations, including cynicism, depersonalization, and impostor syndrome. Coping strategies are also presented, contrasting destructive methods (substance use, social isolation) with effective preventive techniques such as mindfulness training, cognitive reinterpretation of mistakes, and peer support.
Copyright (c) 2026 Patryk Cegiełka, Adrian Pal, Krzysztof Cienkowski, Małgorzata Katra, Mikołaj Szczęsny, Karolina Żeżawska, Izabella Głowacka, Marcin Ślot, Aleksandra Adamczyk, Maria Sicińska https://creativecommons.org/licenses/by-nc-sa/4.0
Median Arcuate Ligament Syndrome (MALS), also known as Dunbar syndrome – pathophysiology. diagnosis and treatment: a narrative review
Introduction and purpose: Median arcuate ligament syndrome (MALS), also known as Dunbar syndrome, is a rare disorder caused primarily by compression of the celiac axis by the median arcuate ligament and diaphragmatic crura. This disorder usually causes weight loss, nausea, vomiting, and postprandial epigastric pain. Because the diagnosis of MALS requires ruling out other conditions, as it lacks specific criteria, it still presents as a diagnostic and therapeutic challenge. This narrative review was conducted to consolidate current knowledge of this syndrome, focusing on its etiology, diagnosis, and therapeutic strategies. A brief description of the state of knowledge: MALS remains a controversial diagnosis, which can only be established after excluding all other potential causes of abdominal pain. Nowadays, the primary first-line diagnostic tool is Doppler ultrasound, which typically reveals elevated peak systolic velocity during expiration; however, in most cases, the diagnosis must be confirmed by computed tomography angiography (CTA) or, in some cases, magnetic resonance angiography (MRA). Surgery may be performed using an open approach or a minimally invasive technique, including laparoscopic or robot-assisted methods. Summary: While MALS has been acknowledged for decades, standardized diagnostic and treatment protocols are still incomplete. Multiple treatment options exist, with selection often based on the patient's specific clinical presentation and preferences. Many concerns, including the long-term quality of life following robotic decompression and whether vascular reconstruction is needed in cases of persistent stenosis, still need thorough prospective studies.
Copyright (c) 2026 Adrian Baran, Michał Maciejowski, Mateusz Zdaniewicz, Jakub Adamiak, Bartłomiej Czyżak, Agnieszka Olejnik, Kacper Kiereta, Zuzanna Cichowska, Małgorzata Bacik, Klaudia Głodowska https://creativecommons.org/licenses/by-nc-sa/4.0
Exercise-Induced Hemostatic Changes: A Review of Acute Responses and Chronic Adaptations in Endurance Athletes
Background. Endurance exercise exerts complex effects on the human hemostatic system. Acute bouts of strenuous exercise may transiently induce a prothrombotic state, while habitual endurance training is associated with improved vascular health and reduced baseline thrombotic risk. Aim. To synthesize current evidence on acute and chronic exercise-induced hemostatic responses in endurance athletes and to evaluate their implications for venous thromboembolism (VTE) risk. Material and methods. A narrative literature review was conducted using searches of PubMed, Scopus, Web of Science, and the Cochrane Library up to March 2026 using combinations of keywords related to hemostasis, coagulation, fibrinolysis, endurance training, and athletes. Results. Acute endurance exercise increases platelet activation, thrombin generation, and coagulation factor activity, accompanied by parallel but often insufficient activation of fibrinolysis. In contrast, long-term endurance training promotes adaptive antithrombotic mechanisms, including improved endothelial function, enhanced fibrinolytic capacity, and reduced platelet reactivity. Factors such as genetic predisposition, dehydration, environmental stressors, travel, and age further modulate these responses and may increase thrombotic susceptibility in certain athletes. Preventive strategies, including optimized hydration, training periodization, biomarker monitoring, and targeted pharmacological prophylaxis for high-risk individuals, may mitigate exercise-associated thrombotic events. Conclusions. Endurance exercise induces a biphasic hemostatic pattern characterized by transient procoagulant responses superimposed on long-term protective adaptations. Understanding this physiological paradox is essential for developing evidence-based recommendations that support safe participation in endurance sports.
Copyright (c) 2026 Natalia Graczyk, Martyna Graczyk, Wiktor Wisoky, Natalia Czapla, Weronika Ziółkowska, Ewelina Strużyńska, Joanna Łopińska, Marta Majchrzycka, Piotr Ignyś, Mateusz Majchrzak https://creativecommons.org/licenses/by-nc-sa/4.0
Sexual dimorphism in hemodynamic, cholecystokinetic and microbiome variables in patients with chronic pyelonephritis and cholecystitis an original research article
BACKGROUND. Previous studies on the Truskavets' resort cohort analysed hemodynamic, cholecystokinetic and microbiome variables of patients with chronic pyelonephritis and cholecystitis without stratification by sex, with the sole exception of markedly different testosterone and calcitonin levels. Subsequent work by our group revealed sexual dimorphism in basal electroencephalographic, heart-rate-variability and neuro-endocrine responses to bicycle ergometry, prompting the present retrospective extension of this perspective to the full panel of cardiovascular, biliary and gut-microbiota markers. AIM. To quantify the magnitude and structure of sexual dimorphism across hemodynamic, cholecystokinetic and microbiome variables in patients with chronic pyelonephritis and cholecystitis, to derive a parsimonious discriminant model capable of classifying patient sex with accuracy materially exceeding chance, and to characterise the multivariate relationship between submaximal cardiorespiratory fitness (PWC₁₅₀) and central hemodynamics in both sexes. MATERIALS AND METHODS. Retrospective analysis of a dataset comprising 44 patients (34 men aged 23–70 years; 10 women aged 33–76 years) with verified chronic pyelonephritis and cholecystitis in remission, each tested twice — on admission and after 7–10 days of standard balneotherapy at Truskavets' Spa (drinking of Naftussya bioactive water, ozokerite applications, mineral pools) — yielding 88 observations in total. The following variables were measured: bacteriuria and leukocyturia (quantitative and semi-quantitative Popovych scale); faecal microbiota composition (lactobacilli, bifidobacteria, common and attenuated E. coli, Klebsiella & Proteus); gallbladder cholekinetics by echo-volumogram after xylitol challenge; central and intracardiac hemodynamics by echocardiography (ET, EDV, ESV, SV, CO, GPVR, SCAI, RPCAI); systolic and diastolic blood pressure; Stange's and Guenchi's breath-holding tests; Kerdö autonomic index; and submaximal PWC₁₅₀ on a bicycle ergometer. Raw variables were converted to Z-scores and analysed by forward-stepwise discriminant analysis (Wilks' Λ), multiple regression and canonical correlation using Statistica 6.4 (StatSoft Inc.). RESULTS. Forward-stepwise discriminant analysis selected ten variables — Height, Weight, BP Diastolic, BP Mean, Stange's test, PWC₁₅₀ in W/kg and W, Leukocyturia in lg leukocytes/mL and in Popovych's points, and faecal Bifidobacteria — yielding Wilks' Λ = 0.3815, canonical R = 0.786, χ²(10) = 78, p < 10⁻⁶. The canonical root separated men (centroid −0.68) from women (+2.32); squared Mahalanobis distance D² = 9.0, equivalent univariate effect size d ≈ 3.0; F(10, 8) = 12.5, p < 10⁻⁶. Retrospective sex-classification accuracy reached 95.5% (84/88 correct; 95% Wilson CI: 88.8%–98.5%). Contrary to healthy-population norms, women paradoxically exhibited higher absolute PWC₁₅₀ (164 ± 14 W vs. 147 ± 4 W) and relative PWC₁₅₀ (2.27 ± 0.15 W/kg vs. 1.79 ± 0.05 W/kg; d ≈ 1.6, p < 0.001), alongside more pronounced leukocyturia (d ≈ 0.9, p < 0.01) but comparable bacteriuria (p > 0.10), higher faecal attenuated E. coli and Klebsiella & Proteus, and reduced lactobacilli (all surviving Bonferroni correction, α′ = 0.0125). Multiple regression explained 53.1% of variance in absolute PWC₁₅₀ (R² = 0.531; F(6,81) = 15.3; p < 10⁻⁵; dominant predictor: GPVR, r = 0.52) and 58.3% in relative PWC₁₅₀ (R² = 0.583; F(6,81) = 18.9; p < 10⁻⁵; GPVR r = 0.62), with Sex Index (M=1; W=2) retaining an independent positive contribution (β* = +0.217; p = 0.009). Stange's and Guenchi's breath-holding tests were negligibly correlated with PWC₁₅₀ (|r| ≤ 0.21; equivalence CI ⊂ −0.30, +0.30). CONCLUSIONS. A robust, multisystem sexual dimorphism exists in the integrated hemodynamic, cholekinetic, urinary-inflammatory and gut-microbiota phenotype of patients with chronic pyelonephritis and cholecystitis, captured with 95.5% classification accuracy by ten routinely collected markers and characterised by a "huge" between-sex effect size (D² = 9.0; d ≈ 3.0). Women in this clinical cohort display a more dysbiotic microbiota and a more pronounced urinary-inflammatory profile than men, while paradoxically demonstrating superior cardiorespiratory fitness — a finding contrary to healthy-population norms that warrants prospective confirmation in larger, sex-balanced, multicentre samples. Central hemodynamics, particularly GPVR, are the dominant physiological drivers of PWC₁₅₀, whereas breath-holding tests are not valid proxies of submaximal aerobic capacity in this population.
Copyright (c) 2026 Nataliya V. Kozyavkina, Walery Zukow, Andriy I. Popovych, Halyna Y. Kovalchuk, Dariya V. Popovych https://creativecommons.org/licenses/by-nc-sa/4.0
GLP-1 receptor agonists in the regulation of the brain–metabolism axis: implications for mental health
Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs), widely used in the treatment of type 2 diabetes and obesity, have recently gained attention for their potential effects on the central nervous system and mental health, particularly within the metabolic–brain axis linking metabolic and neuropsychiatric processes. Aim: The aim of this study was to review the current evidence on the effects of GLP-1RAs on mental health, with particular focus on depression, cognitive function, substance use disorders, and psychiatric safety. Material and methods: A narrative review was conducted based on a targeted selection of review articles, including systematic reviews, meta-analyses, and comprehensive reviews identified in the PubMed/MEDLINE database; publications from the last five years were included using predefined inclusion and exclusion criteria, and the analysis focused on synthesizing the most clinically relevant findings. Results: GLP-1RAs may affect mental health through dopaminergic reward pathways, the HPA axis, and neuroinflammation. Meta-analyses show a small but significant reduction in depressive symptoms, and these drugs may also reduce addictive behaviors and improve eating patterns and cognitive function. Large-scale studies confirm a favorable psychiatric safety profile with no increased risk of adverse psychiatric events. Conclusions: GLP-1 receptor agonists show promise for mental health beyond their metabolic role, particularly for mood disorders and addiction. However, well-designed clinical studies are still needed to clarify the clinical relevance, durability, and practical applicability of these effects.
Copyright (c) 2026 Zuzanna Michalik, Zuzanna Kryś, Klaudia Kapelka, Zofia Bułka, Michał Chodor, Kacper Śliwiński, Karol Mirkowski https://creativecommons.org/licenses/by-nc-sa/4.0
From Balance to Rupture: Vaginal Microbiome in pPROM
PROM and its preterm form, pPROM, are major contributors to preterm birth and remain closely associated with serious maternal and neonatal complications. Growing evidence suggests that disruption of vaginal microbial homeostasis mayis closely linked to the pathogenesis of pPROM. In particular, the loss of protective Lactobacillus crispatus, accompanied by a shift toward Lactobacillus iners, anaerobic bacteria, and increased microbial diversity, appears to destabilize the vaginal ecosystem, promote local inflammation, activate matrix metalloproteinases, and ultimately compromise the structural integrity of the fetal membranes. Current empirical antibiotic therapy for pPROM does not account for interindividual variability in the vaginal microbiota and may paradoxically aggravate dysbiosis. In response to these limitations, emerging therapeutic strategies are increasingly focused on microbiota-targeted interventions, including personalized probiotic therapies, immunological and biological approaches, and vaginal microbiota transplantation. In addition, specific microbial signatures may serve as potential biomarkers of pPROM, thereby opening new avenues for personalized prevention and treatment. Although further prospective studies are required to validate the safety and efficacy of these emerging therapies, their potential already represents a promising direction for the future of modern perinatal medicine.
Copyright (c) 2026 Martyna Mrozek, Małgorzata Blecharczyk, Zuzanna Zofia Kamińska, Agnieszka Zielińska, Igor Zydlewski, Martyna Pacanowska-Trawnicka, Aleksandra Jakimowicz, Aleksandra Malcher https://creativecommons.org/licenses/by-nc-sa/4.0
Hemophilia A in children: prophylaxis, physical activity and rehabilitation in the prevention of hemophilic arthropathy
Background: Hemophilia A is a rare X-linked genetic disorder characterized by a deficiency of coagulation factor VIII. A key clinical problem in children is recurrent joint bleeding (hemarthrosis), which leads to the development of chronic synovitis and progressive hemophilic arthropathy, the main cause of disability in this patient population. Aim: The aim of this study is to present the significance of modern bleeding prophylaxis, systematic physical activity, and physiotherapy in preventing musculoskeletal complications in children with hemophilia. Material and methods: An analysis of current literature and guidelines regarding replacement therapy (factor VIII concentrates) and non-factor therapy (emicizumab) was performed. The use of functional diagnostic tools was discussed, including the Hemophilia Joint Health Score (HJHS 2.1), functional performance tests (6MWT, TUG), goniometry, and modern methods of objective assessment of muscle strength and posture. Results: The introduction of early bleeding prophylaxis allows for a significant reduction in the number of joint bleeds. Physical activity, especially low-impact types (swimming, cycling), enhances dynamic joint stabilization by strengthening the muscular corset and improving proprioception. Contemporary physiotherapy, based on progressive resistance training and biofeedback, is safe and essential for maintaining musculoskeletal function, while objective diagnostics enable early detection of subclinical joint changes. Conclusions: Effective prevention of hemophilic arthropathy in children requires an integrated interdisciplinary approach. The combination of modern pharmacological treatment with regular physical activity and functional rehabilitation allows pediatric patients to achieve functional capacity comparable to their peers and minimizes the risk of permanent disability.
Copyright (c) 2026 Michał Lubkowski, Zuzanna Leciej, Krzysztof Antczak https://creativecommons.org/licenses/by-nc-sa/4.0
Probiotics in Gut Health and Immunity: Mechanisms and Clinical Evidence
Background. Probiotics are live microorganisms that support human health mainly by influencing the gut microbiota. They help maintain the integrity of the intestinal barrier and play an important role in regulating immune responses. Their growing clinical relevance is linked to conditions associated with microbiota imbalance. Aim. The aim of this review was to present the main mechanisms of probiotic action and to assess their clinical effectiveness in selected gastrointestinal, infectious, and allergic diseases. Material and methods. This narrative review is based on data from randomized controlled trials and meta-analyses focusing on both molecular mechanisms and clinical outcomes of probiotic use. Results. Probiotics improve intestinal barrier function by supporting tight junction proteins and reducing intestinal permeability. They also modulate immune responses by limiting inflammation and promoting regulatory pathways, including the induction of regulatory T cells. Clinical studies show that multistrain preparations, especially those containing Lactobacillus and Bifidobacterium, are effective in reducing the risk of antibiotic-associated diarrhea and Clostridioides difficile infection. They also help relieve symptoms of functional gastrointestinal disorders and improve outcomes in allergic diseases such as atopic dermatitis and childhood asthma. Overall, probiotics are well tolerated and safe. Conclusions. Probiotics can be a valuable supportive therapy in disorders related to microbiota imbalance. Further studies should focus on better matching specific strains to individual patients in order to increase treatment effectiveness.
Copyright (c) 2026 Michał Filipski, Bartosz Wróbel, Lena Wójcik, Krzysztof Gadzalski, Konstancja Owczarenko, Kacper Szada-Borzyszkowski https://creativecommons.org/licenses/by-nc-sa/4.0
A Comparative Analysis of Pharmacological and Non-Pharmacological Treatments for Perinatal Depression
Introduction: Perinatal depression is one of the most common mental health disorders occurring during pregnancy and the postpartum period. It negatively affects maternal well-being, infant development, and overall family functioning. Due to limitations associated with pharmacotherapy during this sensitive period, as well as increasing interest in safer, non-pharmacological approaches, growing attention is being paid to the role of lifestyle factors in both prevention and treatment. Aim: The aim of this study was to review current evidence regarding the impact of selected lifestyle factors, including dietary supplementation and physical activity, as well as pharmacotherapy, on the risk and severity of perinatal depression. The study also evaluates their role as supportive therapeutic elements. Materials and Methods: A literature review was conducted using PubMed, SCOPUS, Web of Science, and ScienceDirect, including studies published up to January 2026. Randomized controlled trials, meta-analyses, and review articles were included, focusing on supplementation and physical activity. Results: Evidence suggests that vitamin D, iron, zinc, and probiotics may reduce depressive symptoms. Physical activity shows moderate benefits. SSRIs have limited effectiveness, while neurosteroids and ketamine are under investigation. Conclusion: Lifestyle factors may support treatment, but further research is needed. A combined therapeutic approach appears most effective.
Copyright (c) 2026 Lena Apanowicz, Joanna Mazur, Zofia Bułka, Zuzanna Michalik, Klaudia Kapelka, Stanisław Malik, Przemysław Paduch , Dawid Kłos, Duszan Leja, Klaudia Czech, Kaja Zdrojewska , Klaudia Gogól-Fijał, Patrycja Białowąs https://creativecommons.org/licenses/by-nc-sa/4.0
Sexual Dimorphism and Aging as Determinants of Serum Lipid Profiles and Cardiovascular Risk
The complex variability of circulating blood lipid profiles serves as a fundamental physiological indicator for the onset and progression of numerous metabolic and chronic conditions. It is clinically well-established that dyslipidemia—a multifaceted metabolic state characterized by pathologically elevated lipid concentrations—functions as a primary driver in the pathogenesis of atherosclerosis and subsequent cardiovascular disease. Given that the systematic reduction of these lipid fractions, whether through pharmacological intervention or lifestyle modification, can drastically improve a patient’s long-term cardiovascular prognosis, a nuanced understanding of lipid distribution is critical for effective clinical management. This review provides a comprehensive analysis of the various biological determinants that govern these fluctuations, with a particular emphasis on the distinct roles of sex-based hormonal profiles and age-related physiological shifts. By examining the interplay between these factors, we aim to elucidate how they independently and synergistically influence the serum concentrations of triglycerides, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol. Furthermore, the discussion explores how these demographic variables modulate the metabolic pathways responsible for both the accumulation of pro-atherogenic particles and the efficiency of reverse cholesterol transport, ultimately shaping an individual's overall cardiovascular risk profile.
Copyright (c) 2026 Mateusz Majchrzak, Natalia Graczyk, Martyna Graczyk, Wiktor Wisoky, Natalia Czapla, Weronika Ziółkowska, Ewelina Stróżyńska, Joanna Łopińska, Marta Majchrzycka, Piotr Ignyś https://creativecommons.org/licenses/by-nc-sa/4.0
Medial Approach Total Knee Arthroplasty in Severe Valgus Deformity due to Knee Osteoarthritis - A Case Report
A 69-year-old man presented with severe valgus deformity and pain related to progressive bilateral knee osteoarthritis. At admission, the patient could walk a maximum distance of 200 meters without any orthopaedic aids. The patient was scheduled for total knee arthroplasty (TKA) of his left knee. The left knee demonstrated a 5° extension deficit and maximum flexion of 90°. He underwent a medial approach TKA of the left knee using a rotating hinge prosthesis - Legion Hinge. After the operation, full extension and flexion of 129° were achieved, with stability throughout the entire range of motion (ROM). At discharge, he was walking with elbow crutches and was appointed for physiotherapy at a rehabilitation clinic. At the two-month follow-up control check-up, the patient presented with improved flexion to 135 degrees, better pain control and improved quality of life compared to the period preceding the operation.
Copyright (c) 2026 Julia Hypnar, Joanna Makowska, Maciej Zając, Anna Sieczka, Jakub Polczyk, Zofia Golińska, Edward Pędziwiatr https://creativecommons.org/licenses/by-nc-sa/4.0
Impact of environmental arsenic exposure on human health - a narrative review
Background. Arsenic is a naturally occurring metalloid known for its toxicity. Due to industrial activity and environmental pollution, human exposure, mainly through contaminated water and food, has become a global health problem. Aim. This review aims to present the main sources of arsenic exposure, its mechanisms of toxicity, and the clinical features and management of poisoning. Material and methods. A narrative review of the literature was conducted, focusing on environmental exposure, pathophysiology, and clinical aspects of arsenic toxicity. Results. Arsenic enters the body mainly through ingestion and inhalation, with groundwater and rice being key sources. The inorganic forms, especially trivalent arsenic, are the most toxic. After absorption, arsenic affects multiple cellular processes, leading to oxidative stress, enzyme inhibition, and impaired energy production. Acute poisoning typically presents with gastrointestinal symptoms, while chronic exposure leads to multisystem damage involving the skin, nervous, cardiovascular, and endocrine systems, and increases cancer risk. Diagnosis is based on history and arsenic levels in urine or hair. Treatment includes chelation therapy and supportive care. Conclusions. Arsenic exposure remains an important but often overlooked health risk. Early recognition and limiting exposure are crucial, and prevention should remain a priority in affected regions.
Copyright (c) 2026 Kacper Szada-Borzyszkowski, Konstancja Owczarenko, Michał Filipski, Bartosz Wróbel, Lena Wójcik, Krzysztof Gadzalski https://creativecommons.org/licenses/by-nc-sa/4.0
The Impact of Multimodal Prehabilitation on the Incidence of Postoperative Complications in Patients Undergoing Colorectal Cancer Resection: A Narrative Review
Background Colorectal cancer (CRC) resection imposes profound physiological stress, often leading to acute catabolism, immunosuppression, and a drastic decline in functional capacity. While Enhanced Recovery After Surgery (ERAS) protocols have revolutionized intra- and postoperative care, multimodal prehabilitation capitalizes on the preoperative window. By integrating physical therapy, targeted nutritional support, psychological interventions, and medical optimization, this approach aims to maximize the patient's physiological and psychological reserves prior to surgical trauma. Aim To evaluate the efficacy of multimodal prehabilitation in mitigating postoperative complications in CRC patients and to assess the physiological foundations and methodological challenges present in current literature. Materials and methods: This narrative review was conducted using articles sourced from PubMed by keywords: colorectal cancer, colorectal surgery, multimodal prehabilitation, postoperative complications, ERAS. We examined randomized clinical trials, observational studies, meta-analyses published between 2021-2026. Due to the narrative nature of this review, study selection was based on thematic relevance rather than strict methodological criteria. Results: The majority of studies included in this review demonstrated that multimodal prehabilitation significantly reduces the incidence of postoperative complications in patients undergoing colorectal cancer (CRC) resection. Conclusions: Multimodal prehabilitation proactively optimizes functional and immunological reserves, reducing the incidence of postoperative complications. However, considerable methodological heterogeneity persists across trials regarding intervention duration, adherence to FITT principles, and evaluation metrics. Future high-quality research must standardize protocols and assessment tools to facilitate the routine integration of prehabilitation into perioperative care.
Copyright (c) 2026 Katarzyna Sordyl, Oliwia Grzelak, Oliwia Bolek, Krzysztof Rogulski, Maria Fengier, Weronika Kuśmierczyk, Magdalena Majkowska, Piotr Szczepański, Justyna Kącikowska, Jakub Trzaskowski https://creativecommons.org/licenses/by-nc-sa/4.0
Psilocybin-Assisted Therapy in Depressive Disorders: Efficacy, Safety, and Persistence of Clinical Effects — A Narrative Review
Introduction and purpose: Depressive disorders, particularly major depressive disorder (MDD) and treatment-resistant depression (TRD), remain major causes of disability worldwide. Conventional treatments are limited by delayed onset, incomplete response, relapse, and adverse effects. This review summarizes current evidence on the efficacy, safety, and durability of psilocybin-assisted therapy in depressive disorders. Brief description of the state of knowledge: Evidence from randomized trials, open-label studies, follow-up analyses, and meta-analyses indicates that psilocybin-assisted therapy can produce rapid reductions in depressive symptoms, often within days, in carefully selected patients treated in controlled settings. Short-term benefits have been reported in both MDD and TRD, although findings in TRD are less consistent. In a head-to-head trial, psilocybin was not superior to escitalopram on the primary endpoint, while several secondary outcomes favored psilocybin. Follow-up studies suggest that benefits may persist for weeks to months, but longer-term evidence remains limited and heterogeneous. Under supervision, psilocybin was generally well tolerated, with mostly transient adverse effects, including anxiety, nausea, headache, dizziness, and brief cardiovascular activation. Summary: Psilocybin-assisted therapy appears to be a promising investigational approach for depressive disorders, with rapid onset and possible medium-term benefit in some patients. However, the evidence base remains limited by small samples, heterogeneous designs, restricted comparative data, and delivery in specialized settings. Larger and longer-term studies are needed to clarify comparative efficacy, durability, long-term safety, and feasibility in routine clinical practice.
Copyright (c) 2026 Kinga Zachar, Maksymilian Sito, Filip Jurkowski, Łukasz Wójcik, Natalia Gawron, Hubert Tomasz Bojanowski, Aleksandra Dobracka, Zuzanna Marczak, Monika Jarowicz, Jędrzej Czmyr https://creativecommons.org/licenses/by-nc-sa/4.0
Pulmonary Embolism Mimicking Other Diseases: Diagnostic Pitfalls and Atypical Clinical Presentations
Background: Pulmonary embolism (PE) remains a clinically significant and potentially fatal condition whose diagnosis may be difficult because its manifestations often overlap with more common cardiopulmonary, abdominal, and neurological disorders. In addition to classic presentations, PE may resemble acute coronary syndrome, heart failure, pneumonia, syncope, abdominal pathology, or neurological disease, which may contribute to delayed recognition. Material and methods: This manuscript was prepared as a narrative literature review based on selected publications addressing clinical variability, diagnostic pathways, disease mimicry, laboratory and imaging limitations, cognitive bias, and strategies to improve diagnostic accuracy in PE. The reviewed literature included observational studies, validation studies, systematic reviews, meta-analyses, guideline documents, and illustrative case reports. Results: The reviewed literature suggests that PE may present across a broad and often misleading clinical spectrum. Diagnostic difficulty appears to arise from nonspecific symptoms, overlap with alternative diagnoses, imperfect performance of clinical prediction rules, limited specificity of biomarkers, interpretive limitations of electrocardiography, and technical or contextual limitations of imaging. Cognitive biases may further contribute to diagnostic delay or initial misclassification. Evidence also suggests that probability-adjusted diagnostic approaches and careful integration of clinical assessment with imaging findings may improve diagnostic accuracy. Conclusions: PE may mimic a wide range of other conditions and may remain unrecognized when early findings are nonspecific or misleading. A structured diagnostic approach combined with sustained clinical suspicion may help reduce missed or delayed diagnosis, particularly in patients with atypical presentations.
Copyright (c) 2026 John Koladzyn, Weronika Margielewska, Anna Słodyczka, Kai Siemaszko, Mahmoud Badran, Luiza Wasilewski , Gregory Twombly, Gabriela Jankowski , Marianna Jankowski https://creativecommons.org/licenses/by-nc-sa/4.0
Photophobia as a result of ocular and neuronal mechanisms: pathophysiology and clinical implications
Background: Photophobia is a common symptom across a wide range of neurological and ophthalmological disorders that might be defined as an abnormal aversion or sensitivity to light. Despite its prevalence, the clinical spectrum and underlying pathophysiological mechanisms remain incompletely understood. Aim of the review: The present study was aimed at summarizing and comparing data from available literature regarding the current evidence on the conditions associated with photophobia and to clarify the mechanisms contributing to light sensitivity. Methods: This narrative review was conducted through a structured literature search of the PubMed database covering publications from January 2000 to March 2025. Additional relevant articles were identified through manual screening of reference lists. Eligible articles were selected based on predefined criteria and synthesized narratively due to the heterogeneity of study designs. Results: Photophobia was mostly associated with migraine, ocular surface disease, retinal disorders, and traumatic brain injury. Across studies, light sensitivity was linked to interactions between intrinsically photosensitive retinal ganglion cells, trigeminal nociceptive pathways, and thalamocortical processing networks. The reviewed literature also highlighted considerable variability in clinical presentation, reflecting the diverse mechanisms contributing to photophobia across different conditions. Conclusions: Photophobia is a multifaceted symptom arising from complex interactions between retinal, trigeminal, and central neural pathways. A deeper understanding of its neurobiological mechanisms and broad clinical spectrum enables clinicians to make more accurate diagnoses and to develop targeted interventions for diverse patient populations.
Copyright (c) 2026 Kamila Milewska, Katarzyna Fabis, Ewa Byjos, Mateusz Zbylut, Sylwia Buczek, Weronika Mstowska, Karolina Bury, Hanna Naliuka, Katarzyna Młynarczyk, Patrycja Mateja https://creativecommons.org/licenses/by-nc-sa/4.0
Orthorexia Nervosa and Muscle Dysmorphia as Emerging Mental Health Threats in Athletes: A Comprehensive Narrative Review
Background: In modern sports, the line between healthy dedication and unhealthy obsession is becoming increasingly blurred. While classic eating disorders like anorexia and bulimia are well-known, Orthorexia Nervosa (ON) and Muscle Dysmorphia (MD) are growing problems that affect athletes of all genders but often go unnoticed. Objective: This review summarizes current knowledge regarding the prevalence, causes, and health consequences of ON and MD in athletes, based on literature acquired from PubMed, Embase, and Web of Science. Results: Evidence clearly shows that athletes are at a much higher risk for both conditions compared to the general population. Because strict diets and constant body monitoring are considered "normal" in sports, these disorders are often difficult to spot. Key risk factors include perfectionistic personality traits, pressure to meet weight requirements in certain sports, and the influence of social media, which promotes unrealistic body standards. Conclusion: Both ON and MD can lead to serious physical health issues, such as Relative Energy Deficiency in Sport (RED-S). Current findings highlight an urgent need for better screening tools designed specifically for athletes. Furthermore, a significant change in how we educate athletes and coaches about mental health and nutrition is necessary.
Copyright (c) 2026 Hanna Bojanowska, Gabriela Łuczyńska, Joanna Banatkiewicz, Emilia Deka, Jan Domińczak, Adam Dobosz, Oliwia Bartkowska, Karolina Babik, Sofia Czarnecka, Antoni Wojnowski https://creativecommons.org/licenses/by-nc-sa/4.0
Small Intestinal Bacterial Overgrowth in Type 2 Diabetes Mellitus: Prevalence, Pathophysiology, and Clinical Implications - A Narrative Review
Background. Gastrointestinal symptoms affect up to two-thirds of patients with type 2 diabetes mellitus (T2DM) and are commonly attributed to autonomic neuropathy and dysmotility. Small intestinal bacterial overgrowth (SIBO) has been proposed as a specific small bowel manifestation of diabetic dysbiosis, potentially contributing to worsened glycemic control, impaired beta-cell function, and metabolic-associated fatty liver disease (MAFLD), however, its true prevalence in T2DM and clinical significance remain uncertain. Aim. To synthesize current evidence on the prevalence of SIBO in adults with T2DM, to examine the methodological and clinical factors that influence prevalence estimates, to evaluate proposed pathophysiological mechanisms, and to discuss clinical implications. Material and methods. A selective literature search was conducted in PubMed, Embase, and Web of Science up to March 2026. Observational studies, systematic reviews, meta-analyses, and mechanistic articles reporting SIBO prevalence or associated outcomes in adults with T2DM were included. Results. SIBO is common in T2DM, but prevalence estimates are highly heterogeneous due to differences in diagnostic methods, cut-offs and patient selection. SIBO in T2DM was consistently associated with poorer glycemic control, reduced beta-cell function, autonomic neuropathy, MAFLD, and use of GLP-1 receptor agonists. The distinction between hydrogen-predominant SIBO and IMO, was found to be clinically relevant in T2DM but remained largely underexplored in this population. Conclusions. SIBO affects approximately one in four patients with T2DM when actively investigated, but prevalence estimates vary widely and causal relationships with metabolic outcomes remain unproven. Universal screening is not currently justified; targeted evaluation should be considered in patients with refractory gastrointestinal symptoms, autonomic neuropathy, unexplained deterioration of glycemic control, or MAFLD.
Copyright (c) 2026 Michał Nowakowski, Aleksandra Musioł, Piotr Nowakowski, Jakub Marzec, Magdalena Rakuś, Lucyna Zagożdżon, Krzysztof Łukasz, Paweł Gwałt https://creativecommons.org/licenses/by-nc-sa/4.0
Surgical Management of Vesicoureteral Reflux and Ureteral Strictures in Atypical Ureteral Anatomy: A Narrative Review
Introduction and Objective: Congenital anomalies of the ureter affect 1% of the population and can lead to complications like vesicoureteral reflux (VUR) and ureteral strictures (US). This review aims to summarize current surgical treatments for these conditions, focusing specifically on patients with atypical anatomy, such as ectopic, retrocaval, or duplex ureters. Review Methods: A literature review of PubMed and Scopus databases was conducted, in accordance with the PRISMA guidelines, focusing on English-language papers published within the last five years. Evaluated surgical approaches included open, endoscopic, laparoscopic, and robotic methods. Following the application of specific inclusion and exclusion criteria, a total of 33 articles were selected for qualitative synthesis. Due to the early diagnosis of these anomalies, the analyzed data primarily concerns pediatric patients. Results: Open surgery remains the gold standard for severe VUR, but minimally invasive laparoscopic and robotic options are gaining popularity. For complex congenital anomalies, treatments must be highly customized. Functioning ectopic ureters require reimplantation, while poorly functioning ones are managed with laparoscopic clipping. Retrocaval ureters or duplex systems benefit from advanced robotic repairs. Obstructive megaureters and ureteroceles are initially treated with less invasive endoscopic methods (balloon dilation or incision) to relieve pressure. Summary: The management of VUR and US in patients with complex anatomy lacks a single standard approach, requiring individualization based on specific anatomy and kidney function. While open surgery is effective, urology is shifting toward minimally invasive techniques to lower risks. There is a notable lack of comprehensive literature regarding surgical outcomes in adults and complex congenital presentations.
Copyright (c) 2026 Monika Kamińska, Bartosz Niemiec, Zuzanna Drozd, Bruno Olesiński, Szymon Piosik, Natalia Dudziak, Łukasz Piasecki, Zuzanna Guzowicz, Patrycja Gągałka https://creativecommons.org/licenses/by-nc-sa/4.0
Muscle Imbalances and Their Role in Musculoskeletal Injury Risk in Physically Active Individuals: A narrative review
Introduction and Purpose: Muscle imbalances, particularly bilateral strength asymmetries and functional strength ratio deficits, are increasingly recognized as modifiable intrinsic risk factors for musculoskeletal injuries in physically active populations. This narrative review aims to synthesize current evidence on the definitions, mechanisms, assessment methods, and clinical implications of muscle imbalances regarding injury risk among athletes. Brief description of state of knowledge: Prospective studies indicate that bilateral strength asymmetries exceeding 10–15% are consistently associated with elevated injury risk, although specific thresholds depend on the muscle group and assessment method. Isokinetic dynamometry and force plate assessments are commonly employed for quantification. Evidence links quadriceps asymmetry, hamstring weakness, and adductor deficits to knee, hamstring, and groin injuries, respectively. Sport-specific demands significantly influence asymmetry profiles. Prevention strategies, such as targeted resistance training and neuromuscular interventions, are effective in reducing asymmetries. Summary (Conclusions): Muscle imbalances are critical risk factors requiring targeted intervention when exceeding sport-specific thresholds. Screening programs should utilize validated tools appropriate to the context. Future research must focus on methodological standardization and longitudinal studies. Clinicians are advised to implement individualized screening and corrective strategies within injury prevention frameworks.
Copyright (c) 2026 Adam Dobosz, Antoni Wojnowski, Jan Domińczak, Oliwia Bartkowska, Joanna Banatkiewicz, Emilia Deka, Sofia Czarnecka, Gabriela Łuczyńska, Karolina Babik, Hanna Bojanowska https://creativecommons.org/licenses/by-nc-sa/4.0
Role Of Pelvic Floor Muscle Training In Women’s Health And Quality Of Life A Narrative Review
Introduction: Pelvic floor muscle dysfunction disorders are a widespread and frequently undiagnosed health problem among women across all age groups. They can result in urinary and fecal incontinence, pelvic organ prolapse, and chronic pain, significantly reducing women’s quality of life. Conservative treatment, particularly pelvic floor muscle training (PFMT), is currently recognized as a highly effective first-line therapy. Purpose: This review aims to present the role of pelvic floor muscle training (PFMT) in improving women’s health and quality of life, with a particular focus on the effectiveness of this form of therapy in the prevention and treatment of pelvic floor muscle dysfunction disorders. A brief description of the state of knowledge: The pelvic floor muscles are crucial for holding urine and stool, keeping the pelvic organs in place, and supporting sexual function. Their dysfunction is linked to many risk factors, such as age, vaginal delivery, obesity, and lifestyle. Pelvic floor muscle training (PFMT) improves muscle tone and strength, leading to reduced symptoms, most commonly urinary incontinence. Pelvic floor muscle training (PFMT) also contributes to improving quality of life in physical, mental, and social dimensions. Biofeedback or electrostimulation are supportive methods, which can further enhance the effectiveness of therapy. Conclusions: Pelvic floor muscle training (PFMT) is an effective and safe method for the prevention and treatment of pelvic floor dysfunction disorders in women. It contributes to a significant improvement in symptoms and quality of life. An individualized and holistic approach to the patient is recommended, incorporating education and a supervised exercise program to ensure the effectiveness of therapy.
Copyright (c) 2026 Szymon Paruszewski , Aleksandra Dybcio, Mikołaj Jońca, Mikhail Kazachok, Adam Kubisa, Julia Kupczak, Katarzyna Kupczyk, Natasza Kurys, Mateusz Miluski, Dorota Szydłowska https://creativecommons.org/licenses/by-nc-sa/4.0
Advances in the Treatment of Complex Regional Pain Syndrome: An Analysis of Current Evidence and Future Directions
Background: Complex regional pain syndrome (CRPS) is a rare, multi-symptom condition characterised by severe pain that is disproportionate to the severity of the injury. Due to the lack of a standardised and fully effective treatment pathway, innovative supportive methods are being implemented in its management. Aim: The aim of this article is to summarise modern treatment methods and outline current research trends in the management of CRPS. Material and methods: A narrative review was conducted using the PICOS framework. Adult patients with CRPS type I or II were included. To focus on modern approaches, interventions for which moderate- and high-quality evidence was published after 2010 were considered, with priority given to systematic reviews and meta-analyses. Results: In neurorehabilitation, the efficacy of guided motor imagery (GMI), pain exposure therapy (PEPT) and virtual reality (VR) in reducing pain has been demonstrated. In early-phase pharmacotherapy, bisphosphonates (e.g. neridronate) demonstrate high efficacy. Ketamine infusions effectively interrupt the mechanisms of central sensitisation. In treatment-resistant patients, advanced interventional techniques are used successfully: dorsal root ganglion (DRG) stimulation, spinal cord stimulation (SCS), and repetitive transcranial magnetic stimulation (rTMS). Conclusion: Modern treatment of CRPS is based on the integration of neurorehabilitation, pharmacotherapy and precision interventional techniques. New therapeutic approaches, including targeted biological therapies and advanced neuromodulation, offer promising prospects.
Copyright (c) 2026 Daniel Grobecki, Jakub Korybski, Wiktoria Brzozowska, Franciszek Jabłoński, Hanna Jabłońska, Patrycja Waszkiewicz, Julia Lorek, Magda Sawin, Katarzyna Szeliga, Adam Jarczak https://creativecommons.org/licenses/by-nc-sa/4.0
Dupuytren’s Disease: A Comparative Narrative Review of Current Treatment Modalities
Background. Dupuytren’s contracture (DC) is a fibroproliferative disorder of the palmar fascia, characterized by progressive finger flexion deformities and impaired hand function. The condition has a multifactorial etiology, including genetic predisposition, metabolic factors (e.g., diabetes), and environmental factors such as microtrauma and occupational exposure. Its global prevalence is approximately 8%, highlighting the growing clinical need to optimize treatment strategies. The disorder is also frequently observed in athletes, particularly those engaged in sports involving repetitive hand use, such as field hockey. Objective. The aim of this narrative review is to provide a comprehensive synthesis of current evidence on the treatment of Dupuytren’s contracture (DD). The gathered data are intended to support clinical decision-making by comparing available therapeutic approaches. Material and methods. A narrative literature review was conducted using PubMed, covering studies published between 2016 and 2026. References in included articles were also screened. The analysis focused on comparing the effectiveness, recurrence, safety, and functional outcomes of surgical, minimally invasive, and non-surgical treatments. Results. Available evidence indicates that surgical treatment provides the most durable outcomes. Limited fasciectomy remains the reference standard in Dupuytren’s disease, offering the lowest recurrence rates, though it is associated with longer recovery and a higher risk of complications. Minimally invasive approaches enable faster recovery but are associated with higher recurrence rates. Non-surgical and emerging therapies currently lack robust supporting evidence. Conclusions. Treatment should be individualized, balancing effectiveness, recurrence risk, and recovery time. Further studies are needed to define the role of newer therapies and optimize management strategies
Copyright (c) 2026 Patrycja Hatala, Aleksandra Grzywacz-Guza, Berenika Kantor, Martyna Gruba, Patrycja Bździuch , Katarzyna Cencelewicz , Aleksandra Lewczuk , Nikodem Mozgała https://creativecommons.org/licenses/by-nc-sa/4.0
The Effects of Yoga on Physical Activity and Respiratory Health in Duchenne Muscular Dystrophy: A Literature Review
Purpose: Duchenne muscular dystrophy (DMD) is a progressive neuromuscular disorder characterized by declining motor performance and respiratory function. The aim of this study was to evaluate current scientific evidence on the effects of yoga-based interventions on physical activity and pulmonary function in individuals with DMD. Materials and Methods: A narrative literature review was conducted using PubMed and Google Scholar databases. The search included studies published between 2000 and 2026 focusing on Duchenne muscular dystrophy, rehabilitation, respiratory function, physical activity, and yoga-based interventions. Articles were screened according to their relevance to yoga-based rehabilitation approaches in patients with DMD. Results: The reviewed studies indicate that yoga interventions may improve functional capacity, balance, and tolerance for daily activities in children with DMD. Programs combining adapted postural exercises (asanas), breathing techniques (pranayama), and relaxation practices were associated with improved pulmonary function parameters and autonomic regulation, including increased heart rate variability. Yoga programs were generally safe and well tolerated. Conclusions: Yoga may be a supportive component of multidisciplinary rehabilitation in DMD. It may contribute to improved respiratory function, functional performance, and overall well-being. Further large-scale studies with standardized protocols are needed to confirm long-term clinical benefits.
Copyright (c) 2026 Karolina Frączek, Agnieszka Janaszek, Aleksandra Strzępek, Kinga Kałuża, Agnieszka Chmurska, Aleksandra Majchrzyk, Julia Łyżwa, Michał Pater, Natalia Kałwa, Mateusz Smerdzyński https://creativecommons.org/licenses/by-nc-sa/4.0
Non-thermal, minimally invasive methods for the treatment of chronic venous insufficiency of the lower limbs – analysis of efficacy and safety
Introduction Chronic venous insufficiency of the lower limbs (CVI) is a common disorder of the venous system, leading to significant clinical symptoms and reduced quality of life in patients. In recent years, there has been rapid development of minimally invasive endovascular methods, particularly non-thermal techniques, which provide an alternative to conventional surgical treatment and thermal ablation. Aim The aim of this study was to analyze the effectiveness and safety of non-thermal, minimally invasive methods for treating chronic venous insufficiency of the lower limbs, with particular emphasis on ultrasound-guided foam sclerotherapy (UGFS), cyanoacrylate adhesive embolization (CAC), and mechanochemical ablation (MOCA). Results Non-thermal methods for treating chronic venous insufficiency demonstrate high short-term effectiveness and a favorable safety profile. Foam sclerotherapy, cyanoacrylate adhesive embolization, and mechanochemical techniques enable effective closure of incompetent veins, significant symptom reduction, and improvement in quality of life, with minimal peri-procedural pain and a rapid return to daily activities. Conclusions Non-thermal, minimally invasive techniques constitute a safe and effective alternative to surgical treatment and thermal methods, particularly for patients who prefer less invasive approaches and shorter recovery times. Their limitation remains lower long-term durability compared to thermal ablation, which necessitates individualized method selection and further comparative studies.
Copyright (c) 2026 Krzysztof Szada-Borzyszkowski, Klaudia Kozyra, Sylwia Kozieł-Kwit, Filip Skowierzak, Bartłomiej Lisik, Aleksandra Sado, Mariusz Wręczycki, Kacper Sawczuk, Aleksandra Simlat, Wiktoria Rogowska https://creativecommons.org/licenses/by-nc-sa/4.0
Hydration Strategies and Their Impact on Physical Performance - A Systematic Review
Adequate hydration is one of the fundamental factors necessary for maintaining physiological homeostasis and optimal physical performance. Disturbances in water-electrolyte balance may occur during physical exercise, when increased fluid loss takes place through sweating and respiratory pathways. Dehydration negatively affects thermoregulatory mechanisms, cardiovascular function and overall exercise capacity. In recent years, hydration strategies have become one of the key areas of research in exercise physiology and sports science. The aim of this systematic review is to analyze the current scientific evidence regarding hydration strategies and their impact on physical performance in athletes and physically active individuals.
Copyright (c) 2026 Natalia Kałwa, Mateusz Smerdzyński, Kinga Kałuża, Michał Pater, Aleksandra Strzępek, Julia Łyżwa, Karolina Frączek, Agnieszka Janaszek, Aleksandra Majchrzyk, Agnieszka Chmurska https://creativecommons.org/licenses/by-nc-sa/4.0
Guanfacine Extended Release in the Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Narrative Review
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children and adolescents and is associated with substantial functional impairment. Although psychostimulants are considered first-line pharmacotherapy, a significant proportion of patients experience inadequate response, poor tolerability, or contraindications to stimulant use. Consequently, non-stimulant medications remain an important component of ADHD management. Guanfacine extended release (GXR), a selective α2A-adrenergic receptor agonist, is approved for the treatment of pediatric ADHD and represents a well-established non-stimulant option. Evidence derived from randomized controlled trials, meta-analyses, and systematic reviews indicates that GXR is effective as monotherapy and as adjunctive therapy to psychostimulants in children and adolescents aged 6–17 years. Across studies, GXR demonstrates clinically meaningful reductions in core ADHD symptoms compared with placebo, with reported effect sizes generally ranging from 0.5 to 0.8. The most commonly reported adverse events are sedation-related symptoms, including somnolence and fatigue, which are typically mild to moderate and tend to decrease with ongoing treatment. Cardiovascular effects are usually modest and consist mainly of small reductions in blood pressure and heart rate, with clinically significant events occurring infrequently. Overall, available data indicate that guanfacine extended release is an effective and generally well-tolerated non-stimulant treatment for ADHD in pediatric and adolescent populations. Its clinical utility is particularly relevant in patients with insufficient response or intolerance to stimulants, as well as in those requiring adjunctive pharmacotherapy. Further studies are warranted to evaluate long-term outcomes and to better define its comparative effectiveness in specific clinical subgroups.
Copyright (c) 2026 Sofia Czarnecka, Gabriela Łuczyńska, Joanna Banatkiewicz, Emilia Deka, Jan Domińczak, Adam Dobosz, Oliwia Bartkowska, Karolina Babik, Hanna Bojanowska, Antoni Wojnowski https://creativecommons.org/licenses/by-nc-sa/4.0
Advances in the Prevention and Treatment of High-Altitude Illnesses
Introduction and purpose High-altitude environments (>1500 m) expose climbers to reduced atmospheric pressure and hypoxia. These conditions increase the risk of acute mountain sickness, high-altitude cerebral edema, and high-altitude pulmonary edema. This review aims to summarize current knowledge of high-altitude illnesses (HAI), their prevention and treatment, with particular emphasis on recent advances in this field. A brief description of the state of knowledge Prophylaxis of HAI is based on proper acclimatization and a suitable ascent rate. Acetazolamide is among the most commonly used agents for pharmacologic prophylaxis. Treatment in severe cases requires prompt descent, oxygen therapy, dexamethasone, or portable hyperbaric chambers. There are numerous novel strategies used for reducing the risk of HAI. Emerging evidence suggests that probiotics may facilitate acclimatization. Pre-acclimatization and hypoxic training at sea level enable preparation for high-altitude exposure. Wearable sensors and closed-loop systems may provide more precise risk assessment; however, their effectiveness in mountainous conditions remains to be improved. Advanced prediction models, in turn, additionally improve the identification of people from risk groups and facilitate personalized prophylaxis. Summary (conclusions) HAI remain an important challenge in hypoxic, mountainous conditions. Apart from the currently well-established methods, novel strategies, such as probiotics, hypoxic training, and advanced monitoring technologies, may facilitate prophylaxis and individual risk assessment, thus improving the security of high-altitude expeditions.
Copyright (c) 2026 Filip Kowalik, Maria Deczkowska, Olga Stasiak, Aleksandra Wielogórska https://creativecommons.org/licenses/by-nc-sa/4.0
Hyponatremia as a Prognostic Factor in Heart Failure: A Narrative Review
Introduction and purpose: Hyponatremia is the most frequent electrolyte abnormality in heart failure (HF) and reflects neurohormonal activation, congestion, renal dysfunction, and treatment intensity. This narrative review assesses whether hyponatremia is only a marker of advanced HF or an independent prognostic factor, and summarizes its value for risk stratification. Brief description of the state of knowledge: Across acute and chronic HF cohorts, low serum sodium at admission is consistently associated with longer hospitalization, higher in-hospital mortality, greater post-discharge mortality, and more frequent rehospitalization. Prognostic relevance is also seen for persistent hyponatremia, discharge hyponatremia, hospital-acquired hyponatremia, and worsening sodium trajectories during admission. These associations are present in both reduced and preserved ejection fraction and become stronger when hyponatremia coexists with renal dysfunction, severe congestion, or elevated natriuretic peptides. Cohort studies suggest that sodium improvement during hospitalization is linked to better short-term outcomes, but randomized evidence shows that sodium correction alone does not lower mortality. Summary (conclusions): Hyponatremia should be considered a readily available, low-cost prognostic marker in HF rather than an isolated laboratory abnormality. Its value is greatest when interpreted together with congestion, kidney function, and natriuretic peptide burden. Persistent or hospital-acquired hyponatremia identifies particularly vulnerable patients who may benefit from closer monitoring, careful volume reassessment, and optimized guideline-directed therapy. Future studies should determine whether phenotype-guided correction strategies can improve hard clinical outcomes.
Copyright (c) 2026 Natalia Gawron, Filip Jurkowski, Hubert Tomasz Bojanowski, Jędrzej Czmyr, Maksymilian Sito, Zuzanna Marczak, Aleksandra Dobracka, Kinga Zachar, Monika Jarowicz, Łukasz Wójcik https://creativecommons.org/licenses/by-nc-sa/4.0
Reverse zoonosis of SARS-CoV-2: literature review
Introduction: SARS-CoV-2, the causative agent of COVID-19, was initially considered primarily a pathogen transmitted between humans. As the pandemic unfolded, attention turned to the phenomenon of reverse zoonosis—that is, the transmission of the virus from humans to animals—which may have significant epidemiological and environmental implications. Objective: The aim of this study was to analyze available data on SARS-CoV-2 reverse zoonosis, with particular emphasis on the susceptibility of various animal species, mechanisms of infection, and potential public health implications. Materials and methods: An analysis was conducted of the scientific literature cited in the study, encompassing experimental and observational studies as well as clinical reports. The analysis included results from molecular (RT-PCR) and serological tests, phylogenetic analyses, and data on ACE2 receptor homology across various animal species. Results: It was demonstrated that SARS-CoV-2 can infect numerous animal species, including domestic, farmed, and wild animals. The highest susceptibility is observed in felids, minks, and ferrets. In many cases, transmission of the virus from humans to animals has been confirmed, and sporadically also between animals and from animals to humans. The course of infection is most often asymptomatic or mild, although severe complications are possible. Conclusions: Reverse zoonosis of SARS-CoV-2 is a significant issue that requires further research and monitoring. Animals may serve as reservoirs for the virus and sources of new variants. It is essential to implement biosecurity measures and foster interdisciplinary collaboration to minimize the risk of interspecies transmission.
Copyright (c) 2026 Emil Cymer, Monika Adamczyk-Popławska, Malwina Kubuj-Pawliszyn, Michał Anasiewicz, Bartłomiej Wójcik, Maria Zagajewska, Julia Borodacz, Martyna Czampiel, Piotr Dryżałowski https://creativecommons.org/licenses/by-nc-sa/4.0
Blood Flow Restriction Training in Postoperative Musculoskeletal Rehabilitation
Background: Blood flow restriction (BFR) training applies partial vascular occlusion during low-load exercise, offering a clinically compelling adjunct in postoperative rehabilitation. It addresses the paradox of maintaining muscle mass when conventional high-load exercise is contraindicated. Aim: To conduct a narrative review of BFR's mechanisms, efficacy, and safety in postoperative musculoskeletal disorders, emphasizing ACL reconstruction, total knee arthroplasty (TKA), rotator cuff, and meniscal surgery. Material and Methods: A systematic search of PubMed, Web of Science, and Scopus was performed for English, peer-reviewed human studies published between January 2005 and March 2026. Included studies employed defined BFR protocols for perioperative or postoperative musculoskeletal rehabilitation. Results: Based on 29 studies, BFR significantly mitigates quadriceps atrophy and accelerates strength recovery post-ACL reconstruction compared to load-matched controls. Its efficacy extends to TKA, rotator cuff, and meniscal procedures. Mechanisms include metabolic stress, mTORC1 activation, hormonal upregulation, and regenerative intercellular mitochondrial transfer. BFR is safe when utilizing individualised limb occlusion pressure (LOP) protocols. Conclusions: BFR enables load-compromised patients to achieve resistance training adaptations previously requiring high intensities. Standardising protocols and conducting multicentre trials are priorities for evidence-based integration.
Copyright (c) 2026 Bartosz Rodziewicz, Mateusz Fidut, Mikołaj Kacperski https://creativecommons.org/licenses/by-nc-sa/4.0
The impact of resistance training and collagen supplementation on joint stability and prevention of recurrent ankle sprains in amateur athletes: A Literature review
Introduction: Ankle injuries are among the most common medical issues in the physically active population, accounting for nearly 15–30% of all sports-related injuries. The most frequent of these is the inversion sprain, which leads to damage of the lateral ligament complex, particularly the anterior talofibular ligament (ATFL). Although this injury is often downplayed in popular opinion, research indicates that improper treatment and a lack of rehabilitation lead to the development of chronic ankle instability (CAI) in nearly 40% of patients. Aim: The aim of this study is to review current literature regarding the role of sensorimotor training and collagen peptide supplementation in the process of strengthening ligamentous structures and improving the subjective perception of joint stability in athletes. Background: For the amateur athlete, recurrent sprains involve not only physical pain but, above all, a drastic decline in the Quality of Life (QoL), resulting from the necessity to interrupt training and increasing kinesiophobia—the fear of reinjury. Contemporary sports orthopedics is increasingly shifting away from a purely mechanical paradigm of injury treatment toward a holistic approach. The key pillars of this approach are resistance training focused on active stabilization and biochemical support through targeted collagen supplementation Review methods: A comprehensive analysis ofr esearch papers available on PubMed and GoogleScholar was conducted using keywords:
Copyright (c) 2026 Jakub Pietrucha, Wojciech Kuna, Kamil Igor Turczynowski, Konrad Olaf Turczynowski, Mateusz Józef Gołdyn , Zuzanna Łyko, Anna Rutkowska, Jakub Niski, Dawid Studziński https://creativecommons.org/licenses/by-nc-sa/4.0
Modifiable lifestyle factors influencing the severity of atopic dermatitis – implications for prevention and health education: a literature review
Atopic dermatitis (AD) is a chronic, relapsing, immune-mediated inflammatory skin disorder characterized by intense pruritus, erythema and dry, scaly lesions. Its clinical presentation varies by age. AD is frequently associated with other IgE-mediated conditions, such as allergic rhinitis, asthma, and food allergies. Genetic predisposition, immune dysregulation, and skin barrier dysfunction play central roles in pathogenesis. In addition, lifestyle and environmental factors- including diet, stress, sleep disturbances, physical activity, and environmental exposures- significantly influence disease severity and progression. Promoting individualized, evidence-based lifestyle interventions such as balanced diet, stress management, moderate physical activity, and environmental control- should be considered a shared responsibility among healthcare providers, patients, and caregivers in the management and prevention of atopic dermatitis.
Copyright (c) 2026 Julia Bort, Natalia Syncerz, Katarzyna Zadrożna, Kamila Cupryś, Bartłomiej Wójcik, Katarzyna Czajka, Julia Borodacz, Martyna Czampiel, Michał Nawracaj, Piotr Dryżałowski https://creativecommons.org/licenses/by-nc-sa/4.0
Physical Training in ICD Patients: Safety, Clinical Results, and Quality of Life Improvements
Background: Implantable cardioverter-defibrillators (ICDs) represent the most effective therapy for the prevention of sudden cardiac death in patients at high risk of malignant ventricular arrhythmias. Despite their proven survival benefit, many patients limit physical activity due to fear of arrhythmia or device shocks, which may negatively affect functional capacity and quality of life. Aim: The aim of this study was to summarize current evidence on the safety of exercise training in patients with ICDs and to analyze the impact of device therapy on patients’ physical activity levels. Material and Methods: A PRISMA-compliant literature review was conducted via PubMed, focusing on studies published between 2021–2026. Keywords included "ICD," "exercise training," "safety," "shock," and "quality of life." Specific case reports were included to provide insights into unique clinical interactions and the impact of exogenous substances. Results: Available evidence, including randomized controlled trials and meta-analyses, indicates that moderate aerobic exercise and structured cardiac rehabilitation programs are safe in ICD recipients and do not significantly increase the risk of ventricular arrhythmias or ICD shocks. The incidence of shocks during exercise is very low. However, experiencing ICD shocks is associated with a significant decline in daily physical activity and increased anxiety, whereas antitachycardia pacing (ATP) does not produce similar behavioral effects. Regular exercise improves cardiorespiratory fitness (VO₂peak), autonomic modulation, and quality of life. Conclusions: Current evidence supports appropriately prescribed and supervised exercise training as a safe and beneficial component of comprehensive care in patients with ICDs. Current evidence suggests that sedentary recommendations are often unjustified, while individualized risk assessment and optimal device programming remain essential.
Copyright (c) 2026 Aleksandra Strzępek, Julia Łyżwa, Agnieszka Chmurska, Agnieszka Janaszek, Mateusz Smerdzyński, Aleksandra Majchrzyk, Karolina Frączek, Natalia Kałwa; Kinga Kałuża; Michał Pater https://creativecommons.org/licenses/by-nc-sa/4.0
Age-Related Differences in Motivations and Barriers to Physical Activity: A Cross- Sectional Analysis Across the Lifespan
Physical activity is a key element of a healthy lifestyle and the quality of human functioning at every stage of life. Despite the widespread availability of knowledge about its health-promoting effects, the level of physical activity in the population remains insufficient. The aim of this article is to analyze the motives for engaging in physical activity and the barriers that hinder its regular participation in various age groups, as well as to assess the relationship between activity levels and selected socio-demographic factors. The study was quantitative in nature and was conducted using a diagnostic survey method using a proprietary online questionnaire. Data analysis was conducted using descriptive statistics and nonparametric statistical tests. The obtained results indicate significant differences in the structure of motives for engaging in physical activity between age groups. In younger groups, aesthetic and social motives dominated, while in older groups, health and functional motives dominated. The most frequently reported barriers were lack of time, work-related fatigue, and health problems. The study's conclusions emphasize the need to differentiate physical activity promotion activities depending on age and life situation.
Copyright (c) 2026 Agnieszka Chruścińska, Olga Smoleńska, Radosław Muszkieta, Magdalena Hagner-Derengowska; Anna Michalska https://creativecommons.org/licenses/by-nc-sa/4.0