University Hospital of Lord’s Transfiguration

Background: Radical mastectomy often results in upper extremity complications, including shoulder impairment, pain, reduced range of motion, lymphedema, and diminished muscle strength, which significantly impact quality of life. Key risk factors include extent of lymph node dissection, older age, and axillary radiation, exacerbating morbidity. Aim: This review synthesizes current literature on upper extremity complications post-radical mastectomy and evaluates the effectiveness of rehabilitation strategies. Material and methods: A comprehensive search of PubMed, PEDro, and Scopus identified English-language studies from the last decade on shoulder impairment in adult women post partial or total mastectomy for breast cancer. Results: Complications are highly prevalent, with rehabilitation interventions demonstrating efficacy in improving shoulder function, reducing pain and lymphedema. Challenges persist due to heterogeneous protocols and limited high-quality trials. Conclusions: Targeted rehabilitation interventions post-radical mastectomy significantly improve shoulder function, range of motion, muscle strength, and reduce pain and lymphedema incidence, thereby enhancing quality of life and functional independence (Marco et al., 2023; Xu et al., 2024; Zhang et al., 2022). Despite these demonstrated benefits from early exercises and structured programs (Lazaraviciute & Chaturvedi, 2017; Naqvi, 2021), heterogeneous protocols, paucity of high-quality randomized trials, and variability due to risk factors like axillary dissection and radiation underscore the urgent need for standardized guidelines and further large-scale RCTs (Bruce et al., 2021).

Background: Over the past decade, electric scooters have become a common element of urban micromobility, offering a convenient and environmentally friendly alternative to short-distance car travel. However, the rapid growth in the number of users has not been supported by parallel infrastructure development or consistent legal regulations, leading to a growing number of injuries related to their use. These incidents place a growing burden on healthcare systems, particularly emergency departments and trauma surgery. Aim: The aim of the study was to review the current literature on epidemiology, accident mechanisms, types and locations of injuries, and strategies for preventing injuries related to the use of electric scooters, with particular emphasis on the pediatric population. Materials and methods: A narrative literature review was conducted using the PubMed and Scopus databases. Studies on e-scooter-related injuries were analyzed, including epidemiological data, injury mechanisms, risk factors, anatomical injuries, and preventive measures. Results: Available research indicates a rapid increase in the number of injuries associated with e-scooter use in various regions of the world. Young adults are the most injured group, but children and adolescents are at increased risk of serious injury. The predominant mechanism of injury is falls without the involvement of other road users. The most common injuries are head and facial injuries, as well as upper limb fractures. Failure to wear a helmet, driving under the influence of alcohol, driving at night, and excessive speed are the main risk factors. Conclusions: Injuries related to e-scooter use constitute a significant and growing public health challenge. Effective prevention requires comprehensive measures encompassing legal regulations, user education, infrastructure improvements, and the implementation of technological solutions.

Ankylosing Spondylitis (AS) is a chronic, inflammatory rheumatic disease primarily affecting the axial skeleton. While the physical manifestations are well-documented, the psychological burden is often under-recognized. This comprehensive review aims to synthesize current evidence on the prevalence, etiology, and impact of psychological comorbidities, particularly depression, anxiety, and reduced health-related quality of life (HRQoL), in patients with AS. A systematic literature search was conducted in PubMed, Scopus, and Web of Science databases for articles published between 2000 and 2024. Search terms included "ankylosing spondylitis," "psychology," "depression," "anxiety," "quality of life," "fatigue," "sleep," and "coping." Studies were included if they focused on adult human subjects with AS and assessed psychological outcomes. The reviewed literature consistently demonstrates a high prevalence of psychological distress in AS, with pooled estimates of depression and anxiety significantly higher than in the general population. Key factors contributing to this burden include chronic pain, fatigue, sleep disturbances, functional limitations, and disease activity. Furthermore, psychological factors, such as catastrophizing and passive coping strategies, are identified as significant mediators of pain perception and disability. The bidirectional relationship between psychological state and disease activity creates a vicious cycle that adversely affects treatment adherence and overall prognosis. Psychological comorbidity is a prevalent and debilitating aspect of AS that warrants systematic screening and integrated management. A multidisciplinary approach, combining pharmacological therapy with psychological interventions (e.g., Cognitive-Behavioral Therapy) and physical rehabilitation, is essential to address the biopsychosocial complexity of the disease and improve patient outcomes.

Background:Hearing loss affects roughly 65% of adults aged 70 and older, vision impairment 20–30%, and dual sensory loss becomes more common with age. Meta-analyses show that these forms of sensory decline are associated with higher risks of hypertension, stroke, coronary heart disease, and cardiovascular mortality, even after adjustment for traditional cardiovascular risk factors. Shared vascular pathology explains part of these associations, but psychosocial and communication pathways may also contribute. Aim:To summarize evidence on psychosocial and communication-mediated mechanisms linking sensory decline to cardiovascular risk in older adults and to outline an integrated conceptual model. Material and Methods:A narrative review was conducted using targeted searches of PubMed and Google Scholar. Meta-analyses, cohort studies, and relevant qualitative and mechanistic literature were included. Findings were synthesized qualitatively. Results:Sensory impairment increases cognitive and communicative demands, which may heighten chronic stress and influence neuroendocrine and inflammatory pathways linked to cardiovascular disease. Reduced sensory input limits social participation and contributes to social isolation and loneliness, both established cardiovascular risk factors. In healthcare settings, communication barriers can impair symptom reporting, treatment adherence, and management of complex cardiovascular regimens. These pathways complement biological mechanisms and help explain persistent associations between sensory decline and cardiovascular outcomes. Conclusions:Psychosocial and communication mechanisms appear to be modifiable contributors to cardiovascular vulnerability in older adults with sensory impairment. Potential strategies include routine sensory screening, communication-accessible care, and interventions addressing isolation and stress. Randomized trials are needed to determine whether sensory interventions can reduce cardiovascular events.

Background: Sudden cardiac death (SCD), defined as an unexpected fatal event within 1 hour of symptom onset (witnessed) or 24 hours (unwitnessed), is a leading cause of sport-related mortality, even in apparently healthy athletes. True incidence remains unclear due to variable definitions, reporting heterogeneity, and diagnostic limitations. Understanding mechanisms and risk factors is essential for effective screening and prevention. Aim: This review examines cardiac anomaly screening in athletes, focusing on optimal modalities, target groups, and economic considerations. It also synthesizes evidence on epidemiology, structural and physiological risk factors, prevention strategies, and knowledge gaps. Methods: A narrative review of PubMed and Google Scholar included original research, reviews, meta-analyses, and guidelines. Studies were analyzed for epidemiology, risk factors, pathomechanisms, and prevention strategies to provide an integrated overview. Results: SCD etiology and risk profiles are heterogeneous, limiting universal screening. ECG use remains debated due to cost and false results. Questionnaires and physical exams are widely recommended, but advanced diagnostics face financial and logistical constraints. Reporting inconsistencies, variable athlete definitions, and resource disparities complicate implementation. Conclusions: SCD in athletes arises from diverse cardiovascular disorders, making universal screening difficult. Evidence supports context-dependent, targeted strategies that balance feasibility, equity, and risk reduction.

Alzheimer's disease (AD) is a complex neurodegenerative disorder characterized by amyloid-beta (Aβ) plaques, tau neurofibrillary tangles, and other pathological factors like neuroinflammation and oxidative stress. This review discusses the effectiveness of Lanacemab and Donanemab - new anti-amyloid monoclonal antibodies- for the treatment of early Alzheimer’s Disease. While no cure exists, current symptomatic treatments are complemented by emerging disease-modifying therapies (DMTs). Recent breakthroughs with anti-amyloid monoclonal antibodies, Lecanemab and Donanemab, show promise in slowing disease progression. Clinical trials like CLARITY-AD for Lecanemab and TRAILBLAZER-ALZ 2 for Donanemab demonstrated significant reductions in brain amyloid and a slowed cognitive and functional decline in early AD. Lecanemab selectively targets Aβ protofibrils, while Donanemab targets N-terminally truncated Aβ in plaques, both facilitating amyloid clearance. These DMTs, though associated with side effects like ARIA, mark a pivotal shift towards targeting underlying AD pathology, offering hope for more effective interventions and potentially preventive strategies, such as those explored in the TRAILBLAZER-ALZ 3 trial.

Viral infections play a key role in the initiation of autoimmune processes and the development of virus-associated cancers. This review presents current knowledge on the mechanisms leading to autoimmunity following viral infections, such as molecular mimicry, epitope spreading, activation of the bystander phenomenon, and deregulation of regulatory T cells. Examples of infection-related autoimmune diseases (SLE, multiple sclerosis, Guillain-Barré syndrome, autoimmune thyroiditis) and the impact of COVID-19 as a trigger for new disease entities are also discussed. Particular attention is paid to the role of oncogenic viruses (HPV, HBV, HCV, EBV, HTLV-1) and chronic immunosuppression in the initiation of malignant transformation, as well as the mechanisms of tumor microenvironment formation. The intersection of autoimmunity and immuno-oncology is presented, including the relationship between the occurrence of adverse effects of immunotherapy and treatment efficacy. The importance of biomarkers (ANA, ENA antibodies, cytokine profile) in diagnosis and the challenges in differentiating autoimmunity from early-stage cancers are also discussed. The final section presents therapeutic and preventive strategies, including the role of vaccination, patient monitoring, and immunomodulation. The need for multicenter prospective studies and the development of personalized treatment methods is emphasized. This topic has significant clinical and health implications, particularly in the post-pandemic era, where the incidence of autoimmune disorders and cancers associated with viral infections is increasing.

Attention deficit hyperactivity disorder (ADHD) is among the most commonly diagnosed neurodevelopmental disorders in children, frequently continuing into adulthood. Recent years have witnessed an increasing interest in the importance of physical activity as an adjunctive therapy for controlling ADHD symptoms, including impulsivity, focus difficulties, and hyperactivity. This article aims to review the existing evidence about the effects of physical activity on individuals with ADHD, focusing specifically on contemporary digital methods, including mobile applications, exergaming, virtual reality (VR) technologies, wearable fitness trackers and artificial intelligence (AI) programs. Studies confirm that physical activity improves executive functions, attention, inhibitory control and cognitive flexibility. The article presents the neurobiological mechanisms that elucidate the advantageous effects of exercise on executive functions, together with a review of empirical data validating the efficacy of these interventions. The essay additionally explores the possibility for customizing digital physical activity programs. The findings suggest that physical activity, augmented by digital technologies, can serve as a significant component of a comprehensive ADHD treatment framework, particularly in terms of personalizing therapy and enhancing patient involvement. Materials and methods: A review of the literature available in the PubMed and Google Scholar database was performed, using the key words: “Attention Deficit Hyperactivity Disorder”, “ADHD”, “physical activity”, “digital interventions”, “exergaming”, “virtual reality”, “VR”.

Cervical cancer is one of the most common genital malignancies in women worldwide, although its development is largely preventable through effective primary and secondary prevention programs. The main cause of the development of this cancer is chronic infection with oncogenic types of human papillomavirus (HPV), particularly types 16 and 18. The introduction of HPV vaccination and regular screening (cytology, HPV DNA testing) has significantly contributed to the decline in incidence in developed countries. Unfortunately, in many regions of the world, including Poland, vaccination and screening rates remain inadequate, resulting in a high incidence and death rate. The standard treatment for locally advanced cervical cancer is combination chemoradiotherapy, which combines radiotherapy with the simultaneous administration of cisplatin. In recurrent and metastatic cases, where radical treatment is not possible, systemic treatment is used - mainly chemotherapy based on a combination of cisplatin and paclitaxel, often with the addition of bevacizumab, an angiogenesis inhibitor. Advances in targeted therapies and immunotherapies (e.g., PD-1/PD-L1 checkpoint inhibitors) are opening up new therapeutic options, increasing the chances of prolonging survival and improving quality of life for patients with advanced disease. Numerous clinical trials are currently underway to evaluate the efficacy of new drugs and combination treatment strategies. There is also a growing emphasis on personalizing therapy based on molecular biomarkers. Effective control of cervical cancer requires an integrated approach - combining prevention, early detection, and access to modern treatments. The future of the fight against this cancer involves global implementation of HPV vaccination, expansion of screening programs, and development of precision systemic therapies. This review synthesizes the current state of knowledge, challenges, and new directions in the prevention, diagnosis, and treatment of cervical cancer.

Introduction and purpose Hypertension is one of the most common diseases worldwide affecting more than 30% of the global adult population. It can lead to serious complications. Making it a major concern for modern medicine. While traditional risk factors such as obesity, diet and lifestyle choices are well known, recent evidence suggests that short sleep duration may also play a significant role in the development of hypertension. The aim of this study is to summarise information on the impact of short sleep duration on the incidence and pathophysiology of hypertension. Methods A systematic review of scientific articles published between 2015 and 2024 was conducted using PubMed. Articles were searched using the following terms: hypertension, high blood pressure, short sleep duration, sleep deficiency . Brief Description Of The State Of Knowledge Current literature suggests that sleep deprivation influences blood pressure regulation through multiple pathways, including autonomic nervous system dysfunction, increased inflammation, oxidative stress, and metabolic disturbances. Observational studies indicate a higher incidence of hypertension among individuals sleeping less than six hours per night, with variations based on age and sex. Meta-analyses confirm the relationship, where short sleep durations correlate with increased hypertension risk. Summary Short sleep duration is a modifiable yet often overlooked risk factor for hypertension. Given the high prevalence of sleep deficiency in modern society, integrating sleep hygiene recommendations into hypertension prevention strategies may be beneficial. Further research utilizing objective sleep measurements is essential to establish causality and develop targeted interventions.