Dual antiplatelet therapy (DAPT) with aspirin and a P2Y₁₂ inhibitor is the pharmacological cornerstone of ST-segment elevation myocardial infarction (STEMI) management. The evolution from clopidogrel to the more potent agents prasugrel and ticagrelor has improved ischaemic outcomes in PCI-treated patients, while cangrelor provides an intravenous alternative when oral absorption is compromised. Direct comparative data from ISAR-REACT 5 have established a hierarchy favoring prasugrel in patients proceeding to invasive management, although methodological limitations temper definitive conclusions. Beyond agent selection, contemporary practice increasingly emphasizes calibrated therapy: DAPT duration, de-escalation strategies — guided by CYP2C19 genotyping, platelet function testing, or applied empirically — and P2Y₁₂ monotherapy after short DAPT have been validated as approaches that preserve ischaemic protection while reducing bleeding. Special populations, including elderly patients, those with renal impairment, concomitant oral anticoagulation, or cardiogenic shock, require individualized decision-making that exceeds what any single trial provides. Emerging approaches, including subcutaneous selatogrel for patient self-administration and anti-GPVI strategies, signal a shift toward precision antiplatelet therapy. This review synthesizes current evidence across agent pharmacology, duration modulation, special population management, and future directions, framing the transition from potency to precision as the defining trajectory of the field.
Abstract Cervical cancer remains a major global public health challenge, especially affecting women of reproductive age. In the context of a societal shift towards delayed childbearing, fertility preservation has become an integral component of oncologic care for early-stage disease. Radical trachelectomy has emerged as a viable fertility-sparing surgical option in carefully selected patients. This review aims to assess the role of fertility-sparing radical trachelectomy in the modern management of early-stage cervical cancer by emphasizing the evolving criteria for patient selection, advances in surgical techniques, and the critical balance between oncologic safety and reproductive potential. An analysis of the literature from the past two decades shows that radical trachelectomy, whether performed via vaginal or abdominal routes, provides excellent oncologic control for early-stage lesions. Therefore, optimal results of such a technique depend on careful patient selection along with a multidisciplinary approach in order to reduce obstetrical complications.
Background: Degenerative aortic stenosis (AS) and transthyretin cardiac amyloidosis (ATTR-CM), particularly wild-type ATTR (ATTRwt), are age-associated disorders that frequently converge in elderly patients. Their coexistence may obscure diagnosis, amplify heart-failure burden, and complicate risk stratification before and after aortic valve replacement. Methods: This narrative review was conducted using a structured literature search focused on ATTR-CM, AS, transcatheter aortic valve implantation/replacement (TAVI/TAVR), and nuclear cardiology. Priority was given to cohort studies, systematic reviews, consensus documents, and guideline statements. Main findings: Across observational cohorts and meta-analyses, ATTR-CM is consistently identified in a clinically meaningful minority of older patients with severe AS, especially among those referred for TAVI. Reported prevalence varies with age, referral pathway, diagnostic protocol, and whether equivocal grade 1 uptake is included, but most contemporary TAVI-oriented cohorts place definite ATTR-CM in the high single-digit to mid-teen percentage range. Clinical suspicion should increase in patients with disproportionate left-ventricular wall thickening, low-flow low-gradient AS, restrictive physiology, elevated cardiac biomarkers, conduction disease, atrial fibrillation, or extracardiac ATTR clues such as bilateral carpal tunnel syndrome. Conclusions: Bone-avid tracer scintigraphy with 99mTc-pyrophosphate, 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid, or 99mTc-hydroxymethylene diphosphonate, interpreted with SPECT or SPECT/CT and combined with mandatory exclusion of a monoclonal protein, enables robust non-biopsy diagnosis of ATTR-CM. In severe AS, nuclear diagnosis should be embedded in a pragmatic, multidisciplinary pathway that identifies patients likely to benefit from valve intervention, ATTR-specific therapy, genetic testing, and tailored follow-up.
Background: This narrative review explores the multidimensional impact of Mental Health Literacy (MHL) among military personnel, a population frequently exposed to high-stress environments and associated psychological risks. It aims to synthesize evidence on how MHL influences various individual, organizational, and social outcomes. Methods: A narrative review was conducted by analyzing relevant peer-reviewed articles published between 2015 and 2025. Comprehensive searches were performed across major databases, including PubMed, Web of Science, Scopus, the Scientific Information Database (SID), and MagIran. From an initial pool of 43 records, 8 duplicates were removed, leaving 35 articles for screening. After full-text assessment, 7 studies met the inclusion criteria. The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)reporting guidelines, and the methodological quality of the included studies was appraised using the Mixed Methods Appraisal Tool (MMAT). Results: The results demonstrate that the impact of MHL in military personnel spans five core dimensions: (1) Education and Awareness, (2) Prevention and Treatment, (3) Performance Improvement, (4) Leadership and Social Support, and (5) Societal and Family Impact. Enhanced MHL not only reduces stigma and promotes help-seeking behavior but also improves stress management, early crisis identification, and timely intervention, contributing to overall psychological resilience. Conclusions: Strengthening MHL is essential for improving the quality of life, operational performance, and psychological well-being of military personnel. Commanders and military managers should prioritize developing and implementing targeted educational programs and interventions to foster mental health awareness and resilience.
Military mass-casualty (MASCAL) incidents impose severe constraints on analgesia delivery due to rapid triage, limited monitoring capacity, and heterogeneous provider qualifications. This review aimed to map current evidence on battlefield analgesics and identify options suitable for high-throughput MASCAL conditions. A scoping review was conducted following PRISMA-ScR methodology, including a systematic PubMed/MEDLINE search (2017-2023), dual-review screening, predefined eligibility criteria, and structured data extraction. Sixty-six articles met the inclusion criteria. Evidence indicates that transmucosal opioids – oral transmucosal fentanyl citrate (OTFC) and the sufentanil sublingual tablet (SST) – provide rapid, effective analgesia but require continuous observation, airway-rescue competence, and governance controls, which may limit their safe use in large-scale MASCAL operations. Ketamine demonstrates the most favorable operational profile, combining reliable analgesia with preserved airway reflexes, cardiovascular stability, flexible dosing routes, and minimal monitoring requirements. Cannabinoid preparations and α2- agonists lack sufficient evidence for acute trauma analgesia and present pharmacologic or safety limitations that preclude routine prehospital use. Based on these findings, we propose a triage-linked analgesia framework that aligns agent selection with provider level, monitoring capacity, and evacuation timelines. Overall, ketamine emerges as the primary analgesic option for MASCAL incidents, whereas transmucosal opioids should be reserved for trained personnel operating under protocolized oversight.
(1) Introduction: Artificial intelligence (AI) is transforming healthcare and has particular relevance in military medicine, where austere environments, uncertainty, and time-critical decisions are common; (2) Methods: A literature review was conducted in PubMed/MEDLINE, Scopus, and Web of Science, covering studies published between 2000 and 2026. Relevant articles on AI in military medicine were identified and grouped into three domains: clinical, operational, and educational; (3) Results: Forty-one studies were included. In the clinical domain, AI supports decision-making, trauma care, medical imaging, and mental health, including early detection of post-traumatic stress disorder (PTSD). Operational applications include physiological monitoring, triage optimization, and medical evacuation. In education, AI enhances medical simulation and adaptive learning. Key limitations include poor data quality and availability, algorithmic bias, and limited validation in real operational settings; (4) Conclusions: AI can substantially improve military medical practice by increasing diagnostic accuracy, supporting rapid decisions, and improving operational efficiency. However, implementation requires rigorous clinical validation, transparent and reliable systems, and careful attention to ethical and organizational issues. AI should be used as a complementary tool that supports, rather than replaces, clinical judgment.
Background: Digital transformation in cardiology is reshaping diagnosis, monitoring, and therapy through connected devices, digital biomarkers, telemedicine, and artificial intelligence. This paper synthesizes recent advances and emphasizes the shift from episodic assessment to continuous surveillance and personalized predictive care. Methods: The article included 81 studies published between 2015 and 2026, identified in PubMed, Google Scholar, and ScienceDirect, encompassing clinical trials, meta- analyses, observational studies, and reviews focused upon continuous cardiovascular monitoring, remote care, and AI-supported analysis. According to the selection criteria, studies with weak methodology or limited clinical relevance were removed. Results: Continuous monitoring enables early detection of physiological changes, individualized prevention, reduces hospitalizations, and supports cost efficiency and the expansion of remote services. Artificial intelligence and multimodal analytics facilitate dynamic risk stratification, clinical decision support, and the development of cardiovascular digital twin models for precision medicine. Implementation remains constrained by requirements for robust validation, potential algorithmic bias, data protection and cybersecurity concerns, and regulatory or acceptance barriers. Conclusions: Digital cardiology enables anticipatory, patient- centered healthcare based on continuous monitoring and AI as core clinical tools, promoting integrated patient–hospital–home ecosystems, real-time therapeutic guidance, and sustained cardiovascular prevention. The priorities defined by these directions are subjects for further research and healthcare development worldwide in the next decades. improves
(1) Background and aim: Multimodal treatment is the current standard approach for managing lymphedema, with the goal of normalizing or reducing volume discrepancies, improving function, and enhancing appearance. However, following the reduction of the solid component and enhancement of lymph flow through physiological procedures involving supermicrosurgery, residual areas of fibrosis or lipodystrophy may persist, causing dissatisfaction for both the patient and the physician. (2) Methods: We present a three-case series of lymphedema, two affecting the upper limb and one affecting a lower limb, all previously treated with lymphaticovenular anastomosis (LVA) and/or debulking liposuction, which resulted in satisfactory overall volume reduction of the limbs, but with persistent swelling of the dorsum of the hand and forefoot, respectively. All patients were subsequently treated with a combination of bioengineered enzymatic cocktail (BEC). (3) Results: All three patients demonstrated stable reduction of swelling in the affected areas at one-month follow-up, with improved quality of life and function, which was maintained at six months followup. (4) Conclusion: These preliminary observations suggest that multi-enzyme cocktails warrant investigation as adjuncts for localized, post-surgical residual lymphedema, particularly for distal, anatomically challenging regions, such as the hand, foot, and digits, where surgical options are limited.
Introduction. Management of moderate-severe psoriasis is challenging in the presence of severe systemic comorbidities, such as HIV infection, recent history of cancer, latent tuberculosis infection, or advanced liver disease. These patients are almost invariably excluded from randomized clinical trials, an aspect that limits the availability of standardized therapeutic options. Material and methods. This narrative review summarizes the current literature on immunomodulatory therapeutic strategies in patients with psoriasis and severe systemic comorbidities, integrating existing evidence in the literature with relevant clinical observations from real-world practice. Results. Available data suggest that therapeutic decisions should be individualized according to the type of comorbidities and severity of the disease. In well-controlled HIV infection, conservative strategies may be preferred. In patients with a history of cancer, systemic therapies may be used with caution and in interdisciplinary collaboration. In latent tuberculosis infection, prophylaxis is necessary, but isoniazid-induced hepatotoxicity is an important limitation. In liver disease, biological therapies may constitute a safer alternative to conventional systemic therapy. Conclusion. In this context, patients with psoriasis and severe associated systemic comorbidities require a personalized, multidisciplinary approach and close monitoring. Real-world data play an essential role in guiding therapeutic decisions in this patient population.
The therapeutic landscape for multiple sclerosis has evolved markedly in recent years, with an expanding arsenal of disease- modifying therapies offering clinicians more tools to manage the disease. This progress presents both opportunities and complexities, as treatment decisions increasingly require individualized strategies balancing efficacy, safety, and long-term outcomes. While current therapies effectively reduce inflammation and delay disease progression, they fall short in halting neurodegeneration, highlighting a critical unmet need. Treatment paradigms range from escalation strategies prioritizing safety to early high-efficacy approaches aimed at aggressive disease control. Data increasingly support early initiation of high-efficacy DMTs in patients with poor prognostic indicators, but concerns over long-term safety and tolerability remain. Shared decision-making, informed by patient preferences and evolving evidence, is central to modern MS care. The future is promising, with new therapies in advanced stages of research, which seek to exceed the limits of current therapy, to act in a targeted manner, limiting both inflammation and neurodegeneration, for better control of disease activity, with an improved safety profile.
