Search Results (684)

Sodium–glucose cotransporter 2 (SGLT2) inhibitors are widely used in type 2 diabetes and cardiometabolic diseases, and their pharmacokinetic characteristics generally confer a low risk of clinically relevant drug–drug interactions (DDIs). Most clinical studies demonstrate that these agents can be co-administered safely with commonly prescribed medications without dose adjustment, although strong enzyme inducers such as rifampin can reduce systemic exposure, and pharmacodynamic interactions may still arise. However, existing evidence is largely derived from short-term studies in healthy volunteers, with limited data in special populations and minimal evaluation of metabolite- or transporter-mediated interactions. This review summarizes the available in vitro and in vivo pharmacokinetic and DDI data for SGLT2 inhibitors, identifies key knowledge gaps related to polypharmacy, metabolite effects, and vulnerable patient groups, and outlines future research priorities to ensure their safe and effective use in real-world clinical practice. Full article

Purpose: This review consolidates current evidence on how chronic kidney disease (CKD)-especially end-stage kidney disease (ESKD) and its treatments-alters choroidal and retinal vascular permeability, leading to changes in intraocular fluid homeostasis. Methods: A literature search of Medical Literature Analysis and Retrieval System Online (MEDLINE), reference lists, and key ophthalmology-nephrology texts was performed for studies published between 1980 and 2025. One-hundred-forty-four articles (clinical trials, observational cohorts, and case reports) met the inclusion criteria. Data were abstracted on choroidal thickness changes, blood-retinal barrier integrity, incidence of Central Serous Chororioretinopathy (CSCR) and Serous Retinal Detachment (SRD) in dialysis and transplant populations, and systemic variables such as oncotic pressure, hypertension, and corticosteroid exposure, with special attention to retinal pigment epithelium (RPE) pump function. Findings were synthesized qualitatively and tabulated where appropriate. Results: ESKD induces a triad of lowered plasma oncotic pressure, fluctuating hydrostatic forces, and impaired RPE pump function that collectively drive subretinal fluid accumulation. Hemodialysis acutely reduces sub-foveal choroidal thickness by a mean of ≈15–25 µm yet shows inconsistent effects on retinal thickness. Large population data demonstrate a three- to four-fold higher SRD risk and ~1.5-fold higher CSCR risk in dialysis patients versus controls, with peritoneal dialysis conferring the greatest hazard. After kidney transplantation, CSCR prevalence approaches 6%, driven by combined stresses of surgery, hypertension, and long-term corticosteroid or calcineurin-inhibitor therapy. Most reported SRDs resolve as systemic parameters normalize, underscoring the importance of promptly identifying systemic drivers. Conclusions: Systemic fluid-pressure imbalances and treatment-related factors in CKD significantly perturb the outer blood-retinal barrier. Regular ophthalmic surveillance, early visual-symptom screening (e.g., Amsler grid), and close nephrologist-ophthalmologist collaboration are essential for timely detection and management. Future research should quantify the relative contribution of hypoalbuminemia, hypertension, and immunosuppression to ocular permeability changes, and evaluate preventive strategies tailored to high-risk CKD subgroups. Full article

Background and Objectives: There is a worldwide increase in the demand for gender-affirming surgical treatments among transgender and gender-diverse (TGD) adults and adolescents. In Poland, transgender people generally lack trust in healthcare providers, which makes it more difficult for them to begin their transition process. This patient population is not well understood by many of the specialists who may potentially be involved in their care, in some way, reinforcing their concerns. The aim of this study is to present the sociodemographic characteristics of a group of female-to-male transgender patients who were admitted to a privately based plastic surgery center to undergo chest wall reconstruction. Materials and Methods: This study comprises a statistical analysis of data retrospectively obtained from the medical records of 100 patients from across the country undergoing female-to-male transition, who were operated on between 2021 and 2025 at a specialized private clinic in Poland. All individuals had already started gender-affirming medical treatment with testosterone at the time of first consultation. Results: The results show a trend toward a decreasing age at the time of the decision to undergo gender-affirming surgery. In the study group, 100% of patients were already undergoing hormone therapy. In our group of transgender individuals, we did not observe a correlation between cultural or social background, religion, and gender dysphoria. It is encouraging that more than half of the patients reported no longer needing psychiatric support, and that those who were still under specialist supervision stated that they experienced a significant improvement in their overall well-being. Conclusions: The rising demand for transgender healthcare highlights the need for studying and analyzing this group of patients in order to provide the best patient-centered care throughout the gender transition process by all specialists involved. Gender-affirming mastectomy, when combined with testosterone therapy, has a positive mental health impact on transgender individuals. Full article

Narcolepsy Type 1 (NT1) is a rare chronic neurological disorder characterized by core clinical manifestations such as excessive daytime sleepiness (EDS), cataplexy, sleep paralysis (SP), hypnagogic and hypnopompic hallucinations (HHs), and disrupted nocturnal sleep (DNS). Patients often experience comorbidities, including cognitive impairment, psychiatric disorders, and metabolic syndrome, necessitating lifelong management. Current therapeutic approaches primarily involve pharmacologic treatments for symptomatic relief, supplemented by non-pharmacologic interventions aimed at alleviating EDS and cataplexy. However, existing therapies are limited in efficacy and do not offer a cure. In recent years, a deeper understanding of the central role played by the orexin (hypocretin) system in the pathogenesis of NT1 has led to breakthrough advances in mechanism-based therapies targeting this pathway. Notably, selective orexin-2 receptor (OX2R) agonists such as TAK-861 have shown remarkable efficacy in Phase II/III clinical trials, holding the potential to fundamentally reshape the NT1 treatment landscape. This review systematically outlines current treatment options for NT1, with a focus on management strategies for atypical symptoms and special populations. It also highlights emerging therapeutic directions—including orexin-targeted agents, immunotherapies, and orexin cell/gene treatments—along with their future development. Full article

Onychomycosis is a common nail disease that manifests with varying severity and frequency in specific patient populations, warranting a personalized treatment approach. Novel topical antifungals, such as efinaconazole 10% approved for use in North America and Japan, offer a safe treatment option for many of these patients, though real-world use requires special considerations. In this scoping review, a literature search was conducted in October 2025 using PubMed, Embase (Ovid), the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science (Core Collection). In children and adolescents (≥6 years), efinaconazole 10% has shown higher efficacy rates than in adults, possibly attributed to less nail trauma, thinner nail plates, and faster nail growth. In the elderly, a mycological response can precede visual nail improvements, which may require extending treatment beyond the standard 48-week regimen, along with intermittent maintenance therapies. Although antifungal resistance is a concern, dermatophytes—including terbinafine-resistant strains—have generally shown high susceptibility to efinaconazole. In diabetic individuals, onychomycosis should be treated promptly to prevent secondary complications. Efinaconazole 10% showed similar efficacy in this population, regardless of glycemic control. In historically underserved populations, efinaconazole 10% showed no significant difference in efficacy for Latino/Hispanic patients, though further research is needed. Overall, efinaconazole 10% solution was well-tolerated across patient groups, with application-site reactions occurring without systemic sequalae. Healthcare providers are advised to check for concomitant tinea pedis, which increases the risk of relapse or re-infection, and advise patients on nail polish use, which may degrade after topical antifungal application. A shared decision-making framework can help improve treatment compliance and patient satisfaction. Full article

The field of radiology is experiencing rapid adoption of large language models (LLMs), yet their tendency to generate hallucinations (plausible but incorrect information) remains a significant barrier to trust. This comprehensive review evaluates emerging agentic artificial intelligence (AI) approaches, including multi-agent role-based systems, retrieval-augmented generation (RAG), and uncertainty quantification, to assess their potential for reducing hallucinations in radiology workflows. Evidence from 2024 to 2025 demonstrates that agentic AI can improve diagnostic accuracy and reduce error rates, though these methods remain computationally demanding and lack comprehensive clinical validation. Multi-agent frameworks enable cross-validation through role-based specialization and systematic workflow orchestration, while RAG strategies enhance accuracy by grounding responses in verified medical literature. Within multi-agent systems, uncertainty quantification enables agents to communicate confidence levels to one another, allowing them to appropriately weigh each other’s contributions during collaborative analysis. While multi-agent frameworks and RAG strategies show significant promise, practical deployment will require careful integration with human oversight, robust evaluation metrics tailored to medical imaging tasks, and regulatory adaptation to ensure safe clinical use in diverse patient populations and imaging modalities. Full article

Stroke is the second-largest cause of death and disability worldwide, and many patients require intensive care for airway compromise, hemodynamic instability, cerebral edema, or systemic complications. This review summarizes key aspects of ICU management in both acute ischemic stroke (AIS) and hemorrhagic stroke (HS). Priorities are airway protection, oxygenation, individualized blood pressure targets, and strict control of temperature and glucose. Neurological monitoring and prompt management of intracranial pressure (ICP), together with timely surgical interventions (hemicraniectomy or hematoma evacuation), are central to acute care. Seizures are treated promptly, while routine prophylaxis is not recommended. Prevention of aspiration pneumonia, venous thromboembolism, infections, and other intensive care unit (ICU) complications is essential, along with early nutrition, mobilization, and rehabilitation. Prognosis and decisions about intensity of care require shared discussions with families and involvement of palliative services, when appropriate. Many practices remain based on observational data or extrapolation from other populations, underlining the need for stroke-specific clinical trials. Outcomes are consistently better when patients are managed in specialized stroke or neurocritical care units with a multidisciplinary treatment approach Full article

Background: Advances in intensive care have markedly improved survival from acute critical illness. Nevertheless, the subsequent trajectory of these patients is heterogeneous: while most recover and are eventually discharged, approximately 10% remain dependent on life-support systems, forming a distinct group classified as chronic critical illness (CCI). These patients experience prolonged ICU stays, high mortality, and poor long-term outcomes. Prognostication in CCI remains challenging, as traditional severity scores based on admission data seem to lose prognostic accuracy progressively over longer ICU stays. This is particularly relevant in traumatic brain injury (TBI), where patients constitute a significant proportion of the CCI population and require specialized prognostic approaches. Objective: To develop and validate prognostic models for in-hospital mortality in patients with TBI who progress to chronic critical illness, comparing the performance of a traditional admission-based (left-aligned) model with a novel dynamic (right-aligned) model utilizing data from the week preceding the outcome. Methods: A real-world data analysis was conducted using the Russian Intensive Care Dataset (RICD v2.0). The cohort included 430 ICU admissions of adult TBI patients with a stay of ≥7 days. Multivariable logistic regression was used to develop two nomograms: one using parameters from ICU admission and another using data from 7 days prior to discharge or death. Model performance was assessed via ROC analysis, sensitivity, specificity, and predictive values. Results: The left-aligned model, based on admission data (coronary artery disease, multiorgan failure, CRP), showed moderate discriminative capacity (AUROC 0.720). In contrast, the right-aligned model, incorporating dynamic parameters from the pre-outcome period (lymphocyte count, platelet count, urea, CRP), demonstrated excellent predictive performance (AUROC 0.889), with 90.0% sensitivity and 98.6% negative predictive value. A high score on the right-aligned nomogram was associated with a 19.7-fold increased risk of mortality within the subsequent week. Conclusions: For patients with CCI following TBI, a dynamic prognostic model based on data from the immediate pre-outcome period significantly outperforms traditional admission-based models. The high negative predictive value of the right-aligned model provides a reliable tool for identifying patients with a low short-term risk of mortality, supporting a paradigm shift towards dynamic risk stratification in chronic critically ill patients. Full article

Background: Physiologically based pharmacokinetic (PBPK) modeling is applied to address clinical pharmacology issues including dose selection and exposure assessments for special populations (e.g., pediatrics, and renally or hepatically impaired patients). The objective of this study was to evaluate the predictive performance of a PBPK model for dosing assessment of intravenous immunoglobulin (IVIG) and anti-D immunoglobulin (anti-D Ig) products in pregnant women. Methods: A minimal PBPK (mPBPK) model that incorporates pregnancy-specific physiological parameters and allometric scaling approaches was developed and evaluated for predicting the exposure of IVIG and anti-D Ig in pregnant women. The concentration versus time data were obtained from the published literature. Results: The IVIG (n = 22) and anti-D Ig (n = 29) concentrations were predicted using the mPBPK model with an average fold error of 1.17 and 1.22, respectively. A total of 100% and 95% of IVIG concentrations were predicted within the 0.5–2-fold and 0.5–1.5-fold prediction error ranges, respectively. For anti-D Ig, predictions fell within the 0.5–2-fold and 0.5–1.5-fold ranges for 93% and 76% concentrations, respectively. A mPBPK model-based simulation following administration of 0.5 g/kg IVIG in 100 virtual nonpregnant and pregnant subjects revealed that the maximum plasma concentration (Cmax) was 15% lower and trough concentration (Ctrough) was 8% lower during the third trimester of pregnancy compared to nonpregnant subjects. In contrast, with flat dosing, Cmax and Ctrough were 32% and 26% lower in pregnant subjects, respectively. Overall, the model demonstrated reasonable predictive performance, and bodyweight-based dosing regimen is an acceptable approach that results in minimal change in exposure of IVIG in pregnant women. Full article

Background/Objectives: Diabetes is Mexico’s second-leading cause of death, primary cause of disability, and diabetic retinopathy (DR) associated with this disease is the leading cause of vision loss among the working population. Limited healthcare funding and inequitable access hinder diagnosis and treatment, leaving 32% undiagnosed and at risk of developing serious complications such as DR. With screening rates declining, nonprofits like the Association to Prevent Blindness in Mexico (APEC) play a crucial role in detecting diabetes and DR, reducing healthcare costs, and improving patient outcomes. Methods: This study analyzes data from over 25,000 first-time patients screened at APEC in 2023, providing a unique empirical resource on diabetes and DR in Mexico. Using the Social Return on Investment (SROI) approach, it evaluates program costs (medical resources, equipment, and personnel) against patient benefits. These benefits are quantified as the probability that newly diagnosed or uncontrolled diabetes patients begin treatment, thus preventing DR, weighted by the Value of Statistical Life (VSL). Results: Of the total screened patients, 17.2% had diabetes. Among them, 20.0% were unaware of their condition, while the remaining 80.0% knew their diagnosis. Notably, 25.8% of those who were aware of their diagnosis did not have diabetes under control. Considering all costs associated with the first-time ophthalmology patients screening program and assuming only a portion of patients would seek treatment, every peso invested by APEC has the potential to generate the equivalent to 542 pesos in patient well-being. When factoring in the subsequent costs of diabetes control treatment borne by the patients, the potential Benefit–Cost Ratio is estimated at 9:1. These results proved consistent to sensitivity analysis for key assumptions affecting the estimated benefits and costs. Conclusions: The study demonstrates that integrating routine diabetes screening into specialized ophthalmologic care can generate substantial social value through timely intervention, as early detection promotes better diabetes management and helps prevent complications beyond diabetic retinopathy. Full article

Dental phobia is a disabling yet underdiagnosed condition that prevents many patients from seeking essential oral healthcare, leading to avoidable pain, disease progression, and reduced quality of life. Cognitive Behavioral Therapy (CBT) is the most widely supported psychological intervention for specific phobias and has demonstrated significant efficacy in reducing dental anxiety and avoidance. This narrative review synthesizes recent evidence on CBT applications for phobia management, with particular emphasis on dental settings. In addition to reviewing established mechanisms of CBT, this paper highlights emerging adjunctive approaches such as virtual reality, eye movement desensitization and reprocessing (EMDR), and hypnosis. Special attention is given to pediatric populations, trauma-exposed individuals, and patients with neurodevelopmental disorders, who are often underrepresented in clinical research. The findings underscore the central role of CBT in addressing dental phobia while identifying gaps in standardized protocols, long-term outcomes, and accessibility across diverse healthcare contexts. Future research should prioritize controlled trials, cultural adaptations, and the integration of psychological training into dental curricula to enhance the translation of evidence into everyday practice. Full article

The prolongation of the lifespan of patients with congenital heart diseases (CHD) has caused them to experience symptoms and complications not only related to the defect itself or late complications of surgical treatment but also to be at risk of population diseases such as obesity or ischemic heart disease. As recently as two decades ago, fewer than one in five CHD patients received formal advice on physical activity. Once a patient has been thoroughly evaluated and the risk has been stratified, the clinician can develop a detailed and individualized exercise prescription. This prescription is a formal plan that specifies the recommended frequency, intensity, duration, and type of physical activity. The goal is to maximize the health benefits of exercise while minimizing any potential risks. Although the anatomical classification of the defect and the previously implemented method of treatment allow the estimation of the possible late complications to a certain extent, in reality, the clinical condition may vary significantly in individual cases. For this reason, we prepared a practical approach regarding physical activity in patients with CHD based on hemodynamic and electrophysiological parameters, instead of focusing solely on specific defects. We also paid attention to special CHD patient populations in which separate indications regarding physical activity must be implemented. Full article

Background/Objectives: Infective endocarditis (IE) remains a rare but increasingly complex condition, posing significant challenges for cardiologists and cardiac surgeons. Blood groups from the ABO/Rh system have been associated with susceptibility to various diseases, including infections and bacterial colonization tendencies. However, data on the distribution of ABO/Rh blood types among IE patients are lacking. We hypothesized that the prevalence of ABO/Rh blood types among IE patients differs from their frequency in the general population. This study aimed to assess the distribution of ABO/Rh blood types in the LODZ-ENDO database in comparison to general populations. Methods: LODZ-ENDO is a single-center retrospective study conducted in a tertiary cardiology and cardiac surgery facility serving 2.35 million residents. All consecutive patients with confirmed IE hospitalized between 1 January 2015 and 1 October 2025 were included. Clinical data and ABO/Rh blood types were collected and compared with national population data using Fisher’s exact and chi-square tests. Results: A total of 329 patients with IE were analyzed (median age 61 (41–68) years; 69% men), of whom 227 underwent cardiac surgery. Overall ABO/Rh distribution differed significantly from the general population (p = 0.033), driven by a tendency to an overrepresentation of B− (LODZ-ENDO 5.2% vs. Poland 2%; OR 2.88; 95% CI 1.17–7.29; p = 0.03; power 0.89; p(adj) = 0.23). Considering regional demographics and blood use (≈3 units per surgery), this represents an excess annual use of 1.9 B− units, equal to 0.23% of regional B− reserves, with additional indirect depletion of O− blood. Based on WHO data, if this overrepresentation exists elsewhere, IE-related surgeries could consume 0.2–1.3% of national B− stocks in smaller European countries such as Malta, Iceland, Luxembourg, Cyprus, Estonia, Lithuania, Latvia, and Slovenia. Conclusions: This, probably the first report of B− blood type overrepresentation in IE indicates disproportionate use of a rare blood group, highlighting the need for targeted blood management strategies, especially near specialized cardiac surgery centers. Full article

Endometriosis is traditionally regarded as a condition predominantly affecting women of reproductive age, often associated with infertility and cyclical pelvic pain. As a result, a significant body of research and clinical attention has been directed toward the younger patient population. However, there is growing recognition that endometriosis can persist or even arise anew in peri-menopausal and post-menopausal women, yet the impact of the disease in this group remains underappreciated. Many women may have lived with undiagnosed or misdiagnosed endometriosis for decades, often being reassured that period pain and pelvic discomfort were normal aspects of menstruation, and therefore not subjected to appropriate investigation or intervention. This review aims to highlight the clinical significance of endometriosis in peri-menopausal and post-menopausal women. We will examine the common symptoms encountered in this population, discuss current strategies and challenges in diagnosis, and review evidence-based approaches to management. Special consideration will be given to the complex interface between endometriosis and HRT, as well as the potential risk of malignant transformation. Finally, drawing from existing guidelines and expert opinion, we propose recommendations for the diagnosis, treatment, and long-term follow-up of these patients, with the goal of improving outcomes and quality of life for this often overlooked cohort of women. Full article

Background: Peripheral neuropathy (PN) refers to a spectrum of symptoms resulting from dysfunctions of the peripheral sensory, motor, and autonomic neurons. PN is associated with significant balance impairments and an increased risk of falls, contributing to reduced functional independence and quality of life. Although diabetic PN has been extensively investigated, there remains a lack of synthesized evidence regarding rehabilitation approaches for individuals with non-diabetic PN. This systematic review aims to evaluate the effectiveness of stabilometric platforms incorporating virtual reality (VR) and feedback (FB) in improving balance and related outcomes in patients with PN of various etiologies. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the protocol registered in PROSPERO (CRD420251086625). Seven major databases (PubMed, Scopus, ScienceDirect, Cochrane, Web of Science, Springer, and Wiley) were searched from inception to April 2025. Studies including adult patients with non-diabetic PN undergoing balance rehabilitation using stabilometric platforms with VR and FB were considered. The methodological quality of the included studies was assessed using the PEDro scale, RoB2, and ROBINS-I V2 tools. Results: A total of six studies met the inclusion criteria, encompassing 133 participants with non-diabetic PN. Interventions involving specialized balance training platforms incorporating VR and FB demonstrated significant improvements in both static and dynamic balance and postural control, as well as a reduction in the risk of falling. These systems also showed favorable adherence rates to rehabilitation programs. However, variability in intervention protocols and outcome measures limited the ability to perform direct comparisons across studies. Conclusions: The use of stabilometric platforms appears to be a promising approach for balance rehabilitation in patients with non-diabetic PN. Despite the limited number of included studies, the results support their integration into rehabilitation programs for this patient population. Further large-scale, high-quality studies are needed to establish standardized protocols and confirm long-term efficacy. Full article