John Paul II Hospital

The rabies virus is responsible for one of the most severe diseases transmitted from animals to humans. Rabies is associated with an almost 100% case-fatality rate once clinical symptoms develop. The aim of this study is to present the principal routes of rabies virus transmission to humans and to discuss strategies for limiting viral spread through preventive measures, based on the available literature concerning the pathogenesis, epidemiology, and prophylactic methods applied in both animals and humans. The primary route of transmission to humans is a bite from an infected animal. However, other, less common routes of infection are also possible, including contact of secretions from an infected animal with mucous membranes or damaged skin. Extremely rare cases of transmission have also been reported through aerosol exposure or through organ transplantation from an infected donor. In Europe, wild animals constitute the main reservoir of the rabies virus, with particular emphasis on foxes, highlighting the critical role of oral vaccination programs targeting these species. Vaccination of domestic animals, as well as pre-exposure and post-exposure prophylaxis in humans, also remain essential components of rabies prevention. A multidisciplinary approach to rabies control, integrating the efforts of veterinary and medical services through infection control in animal populations, improved access to vaccines and rabies immunoglobulin, and increased public awareness regarding the disease, its transmission routes, and preventive measures, may ultimately contribute to the complete elimination of human rabies in the future.

The present Reply addresses the commentary by Pagnoni et al. on our recent study exploring explainable artificial intelligence (AI) for mortality risk prediction in pulmonary arterial hypertension (PAH). We acknowledge the importance of several key issues raised by the authors, including endpoint selection, calibration, decision thresholds, and external validation, all of which are central to translating AI-based prognostic models into clinical practice. Our original endpoint, defined as death by the next follow-up visit, was driven by the structure of nationwide registry data and reflects real-world clinical workflows, although we recognize the advantages of predefined time horizons and time-to-event approaches for future analyses. We discuss the trade-off between sensitivity and precision, emphasizing our deliberate prioritization of minimizing false-negative classifications in high-risk patients, while acknowledging the need for structured clinical pathways to manage false-positive results. We further address calibration and threshold selection, underscoring the necessity of additional clinical studies to support intervention-oriented recommendations. The role of phenotypic determinants and modifiable risk factors in enhancing personalization is highlighted as a key direction for future model development. We reaffirm the value of SHAP-based explainability for improving model transparency, while recognizing the need for continued refinement and clinical validation. Finally, we emphasize the strengths and challenges inherent to registry-based analyses, the importance of external validation, and the need for methodologically sound comparisons with established risk calculators. Overall, this exchange underscores the critical role of interdisciplinary collaboration in advancing clinically actionable and interpretable AI solutions for PAH.

Background: Depressive disorders are among the leading contributors to global disability, affecting millions worldwide and imposing a major burden on public health systems. While pharmacotherapy and psychotherapy remain primary treatment modalities, physical activity (PA) has emerged as a promising strategy for both prevention and treatment of depression. Methods: This narrative review synthesizes evidence from high-quality meta-analyses, systematic reviews, prospective cohorts, randomized trials, and mechanistic research published between 2000 and 2025. Studies were selected based on relevance to PA’s preventive or therapeutic effects on depression and its underlying mechanisms. Results: Robust evidence indicates that higher levels of PA reduce the risk of incident depression by approximately 15–30% across populations [1–4]. Longitudinal studies demonstrate temporal and dose–response associations, fulfilling several Bradford Hill criteria. Exercise interventions produce moderate-to-large therapeutic effects in adults [5–7], significant improvements in adolescents and young adults [8], and additional benefits across perinatal, elderly, and medically comorbid groups [9–12]. Mechanistic research highlights neurobiological pathways, anti-inflammatory responses, autonomic improvements, enhanced cognitive function, and psychosocial resilience [13–18]. Conclusion: PA is a safe, feasible, and clinically meaningful intervention for preventing depressive disorders and improving outcomes among individuals with depression. Integrating structured exercise and lifestyle PA counselling within mental health and primary-care settings may enhance recovery, reduce cardiometabolic risk, and improve long-term prognosis.

Parry–Romberg syndrome (PRS) is a rare, progressive disorder characterized by hemifacial atrophy involving the skin, subcutaneous tissue, muscles, and bones. Although its exact cause remains unclear, autoimmune, neurogenic, and vascular mechanisms are considered likely contributors. Neurological manifestations, such as migraines and seizures, often complicate the clinical picture and can delay diagnosis. This report presents the case of a 39-year-old woman, who first noticed facial asymmetry at the age of 15. The initial symptoms included thinning of the upper lip, skin tightening, and persistent headaches. Over the years, the atrophy gradually progressed, predominantly affecting the left cheek and orbital region. Diagnostic imaging using magnetic resonance imaging (MRI) and computed tomography (CT), along with comprehensive laboratory tests, helped exclude differential diagnoses such as multiple sclerosis and infectious diseases. Given the extent of tissue loss, the patient underwent autologous fat grafting, which led to significant improvement in facial volume and symmetry. This case highlights the importance of early diagnosis and multidisciplinary approach in managing PRS. Although there is currently no definitive cure, reconstructive procedures like fat grafting can yield meaningful aesthetic and functional benefits. Ongoing research into the underlying mechanisms of PRS may eventually lead to the development of targeted therapeutic options.

Introduction: Whiplash injuries are one of the most prevalent consequences of traffic collisions and are associated with a wide range of conditions referred to as whiplash-associated disorders (WAD). These manifestations are most commonly associated with pain and limited mobility of the cervical spine. A growing number of research indicates that these injuries may also impair the function of the temporomandibular joints (TMJs), thereby contributing to the development of their subsequent disorders. The aim of the study: The objective of the study was to discuss the correlations and dependency between whiplash injury and temporomandibular joint function. Acquiring this knowledge enables specialists to make precise diagnoses and implement appropriate therapeutic procedures, thereby reducing the risk of misdiagnosis or misdiagnosis omissions. Materials and methods: The following literature review provides a comprehensive discussion of the association between whiplash injuries and temporomandibular joint function. In December 2025, an extensive search of prominent electronic databases (PubMed, Google Scholar) was undertaken in order to identify relevant published studies on this subject. Conclusions: Studies indicate that whiplash injury may impair TMJ function and contribute to the development of TMJ disorders. The mechanisms underlying this relationship may be functional or neurophysiological in nature, but remain under investigation.Symptoms may be transient or persist long-term for several years, underscoring the necessity for a holistic diagnosis and an interdisciplinary therapeutic approach in patients after whiplash injury.

Heart failure (HF) is a global health challenge affecting over 64 million people worldwide and is associated with high morbidity, mortality, and healthcare costs. Despite advances in therapy, outcomes remain poor, and the COVID-19 pandemic further worsened prognosis by limiting hospital access. Clinical trials demonstrated that RM improves quality of life and reduces HF-related hospitalizations, though effects on all-cause mortality remain inconsistent. The proposed project incorporates weight, blood pressure, fluid status, oxygen saturation, and two-lead ECG monitoring. Data are transmitted wirelessly to a central server, analyzed by AI algorithms, and are used to trigger automated feedback or medical intervention. This approach is supposed to minimize staff workload, enable personalized therapy adjustments, reduce costs, and provide emergency assistance. The SIRIO 10 Project represents an innovative, holistic strategy for managing chronic HF in large populations. By combining AI-powered analytics with user-friendly home-based monitoring, it has the potential to transform care delivery, improve outcomes, and enhance quality of life for patients with HF.