As reported by literature, rheumatoid arthritis is a rheumatic disease with an increased risk of developing cardiovascular complications. Early detection of atherosclerosis by non-invasive techniques represent a current challenge of patient management. Current EULAR guidelines recommend careful monitoring of cardiovascular risk factors by stratification of patients and strict control of rheumatic disease activity to reduce it. The classic evaluation of intima- medium thickness (IMT) was completed by quantifying the degree of inflammation of the carotid plate using positron emission tomography or the degree of coronary calcifications by calculating Agatston score using Coronary Computer Tomography. These modern investigation techniques allow identification of several subclinical stages of atherosclerosis, the interest in their early detection resulting from the fact that, in this stage, through specific measures, the cardiovascular complications can be prevented.
Splenic injuries causedby traumatic events are common in the emergency departments, mostly because the spleen is frequently affected in trauma. The lesions of the spleen can be diagnosed using a contrast enhanced computed tomography and based on the results, the injury of the spleen is graded. The management of the patient can be operative or nonoperative. The choice of treatment is decided by the hemodynamic stability of the patient.
Evidenced-based medicine drives best practices. The Lessons Learned (LL) process in clinical medicine for deployed and military support services drive the NATO Military Medical Center of Excellence (MILMED COE). This review article focuses on the Lessons Learned process and its use in NATO and partner countries medical services. Organizational learning drives development and progress; capturing lessons from mistakes, colleagues’ interactions and institutional experience can be lost without an organized lesson learned process. Therefore, in 2014, NATO institutions and Centers of Excellence across disciplines began to focus on the quality management, information sharing and evidence-based practices to maximize outcomes. Since this inception, NATO has implemented the Lessons Learned process and expanded the impact across the alliance in order to save life and prevent illness. The Lessons Learned process and sharing of experience is also a way to improve the quality of care in the military medicine, from preventive, epidemiological, trauma related, casualty evacuation and forward surgical care, among many others, to the medical standardization and organization of military medical services. The Lessons Learned process is an undertaking and an instrument that can also be used to achieve better international and civil-military cooperation. Finally, we deal with the current situation and use of the information obtained from the areas of military health care.
A unique approach to the treatment of posttraumatic stress disorder (PTSD) is difficult to support, because of the complexity and heterogeneity of this pathology. Multiple evidence-based guidelines for PTSD treatment exist, elaborated by prestigious institutions around the world, but a certain level of the inconsistency of their recommendations appears when these sources are compared with each other. Therefore, a review of current guidelines and extraction of the most supported by evidence recommendations is considered important for clinical practice, due to the need to approach such complex cases as PTSD-diagnosed patients in a stepwise manner. Structured monitoring of the clinical status during the treatment is also an important and rather neglected aspect of the case management in PTSD, and the necessity of follow-up visits for efficacy and tolerability should be taken into consideration. Psychotherapy (especially cognitive- behavioral oriented therapies and eye movement desensitization and reprocessing therapy) is supported by evidence as a first-line approach, as well as certain antidepressants, like the selective serotonin reuptake inhibitors and venlafaxine. Many second-line pharmacological agents and psychotherapies are also available, but there is an obvious need for more pragmatic trials with PTSD patients.
Cardiovascular-kidney-metabolic (CKM) syndrome describes the complex, bidirectional interplay among cardiovascular, renal, and metabolic dysfunctions, where impairment in one system accelerates decline in the others. This interconnected pathophysiology significantly elevates the risk and progression of heart disease, particularly heart failure, through mechanisms involving insulin resistance, systemic inflammation, neurohormonal activation, and endothelial dysfunction. In this context, therapeutic strategies targeting heart disease must address the multifaceted drivers of CKM. Recent advances highlight the need for an integrated, patient-centered approach that combines lifestyle interventions with pharmacological treatments tailored to individual cardiovascular risk. While foundational therapies such as RAAS inhibitors and statins remain essential, novel agents now offer additional prognostic and quality-of-life benefits. SGLT2 inhibitors have emerged as a cornerstone therapy, improving outcomes in heart failure with both preserved and reduced ejection fraction, independent of glycemic control. GLP-1 receptor agonists and dual GLP-1/GIP agonists like tirzepatide demonstrate cardiometabolic and renal protection, while finerenone shows promise in diabetic kidney disease and several heart failure phenotypes. These therapies not only target glycemic control but also reduce cardiovascular mortality, hospitalizations, and renal decline. Optimizing cardiovascular outcomes in CKM syndrome requires early, multifactorial therapeutic intervention, informed by evolving evidence and a deeper understanding of the heart–kidney–metabolism axis.
Recent advances in technology and artificial intelligence have transformed radiology. Artificial intelligence, which uses machine learning, deep learning algorithms, and cellular neural networks, is now applicable to image analysis, enabling the analysis of large volumes of data and the early identification of lesion features, such as tumors. Integrating artificial intelligence into clinical workflows increases the efficiency of medical report generation and enables efficient prioritization of complex or urgent cases. Predictive analytics based on artificial intelligence uses extensive patient data, including demographics, medical history, tests, and imaging, to build more accurate predictive models. Among the areas where artificial intelligence is successfully implemented in radiology is the automated detection of lung nodules. In the field of neurology, artificial intelligence helps track progressive lesions through volumetric analysis of the brain and surveillance of demyelinating diseases. In oncologic radiology, artificial intelligence is used for automated image segmentation, lesion review, and standardized report generation. Therefore, in this ever-evolving landscape, radiologists must embrace emerging technological advances in order to occupy a unique position at the intersection of different diagnostic fields.
Diabetes mellitus refers to metabolic disorders whose main characteristic is chronic hyperglycaemia. The cause is either disturbed insulin secretion, insulin resistance, or usually both. MicroRNAs represent a subclass of non-coding RNA molecules that are short in length, about 17-26 nucleotides. Since they are circulant and can be tissue-specific, their use as diagnostic biomarkers or screening for different diseases is currently undergoing deeper studies. It was found that 22 miRNAs were associated with the pathophysiology of T1DM, 34 with T2DM, and 16 miRNAs were identified to be common amongst T1DM and T2DM. All of them were reconfirmed in at least two separate studies.
This narrative review examines psychotherapeutic interventions for combat soldiers who deal with post-traumatic distress and face a complex therapeutic setting where the relationships between clients and therapy providers are often conflictual. Despite available emotional aid, gaps between traumatized soldiers’ emotional needs and institutional solutions are inevitable and are challenging for clients and therapists alike. These issues are discussed through Israeli soldiers’ experiences, a population at high risk for trauma-related distress, due to this country’s ongoing security threats. Following a narrative literature review, four key themes emerged: mutual difficulties in admitting mental injury, intergenerational trauma, preserving the soldier identity upon discharge, and choosing among therapeutic opportunities. The study highlights the need and rationale for diverse biopsychosocial interventions for veterans and proposes considerations for enhancing treatment success. Results emphasize the importance of tailored approaches that address both individual and systemic factors affecting veterans’ mental health. Guidance for psychosocial interventions is provided, considering the multifaceted nature of combat-related trauma.
: Background: More than half of patients with locally advanced esophageal cancer are unresponsive to first-line chemotherapy. To date, there is no standard second-line regimen; new agents, such as immune-checkpoint inhibitors or anti-Neurotrophic Tropomyosin-Related Kinas agents, have only been recently recommended. This study aimed to assess the benefits of classical second-line chemotherapy in terms of survival and tolerance. Materials and Methods: This retrospective analysis assessed the benefits and tolerance of different second-line regimens of chemotherapy in progressive, locally advanced or metastatic oesophageal cancer treated at the department of Radiotherapy-Oncology at the Institute of Oncology between January 2011 and January 2017. Results: The analysis found 87 patient files with a median age 59.5 years (ranging between 41 and 84), of which 40.2% (35 patients) failed the first-line platinum and 5- fluorouracil combination. Histology favoured adenocarcinomas (63.2%). The patients were in good clinical condition, with ECOG 0–1 in 86.1% (74 patients), and less than five percent had more than three metastatic sites (3.4%, 3 patients). The regimens were mostly two-drug cytotoxic (53.9%, 47 patients): FOLFIRI in 18 patients (20.7%), FOLFOX in 18 patients (20.7%), vinorelbine–platinum combination in 11 patients (12.6%), and docetaxel in 40 patients (38.7%). The median treatment duration was 7.74 weeks (range 1 to 12). The general response rate was 47.1% (41 patients), including stable disease. The median time to progression was 7.61 weeks, with a range between 1.6 and 8.6 weeks, with no differences in this respect among the fourth type of treatment received (p = 0.170). Grade 3–4 toxicities, including neutropenia, gastrointestinal problems, and metabolic disorders, were observed in 44 patients (50.6%). The median event-free survival was 2 months (range between 1 and 6.3), and 63.2% (55 patients) subsequently received a third line of chemotherapy. Conclusion: Second-line chemotherapy is still the first-choice recommendation in all fit patients with advanced oesophageal cancer. The new agents are efficacious only in cases with PD-L1 positive or high microsatellite instability.
During the late adolescence, it can be reached the highest level of mental operative functions and other intelligent human manifestations. Abstract mental operations can be done at this level: synthesis of syntheses, generalization of generalizations, abstraction of abstractions. Students go through many attempts to find which is their personal style of learning new materials, new contents. The study was conducted on a number of 31 participants. The group was divided into two subgroups: 16 students in the 5th year at Faculty of General Medicine and 15 master students in the second year at University of Sports, Sports Performance program. The used instrument consists of 21 questions (11 questions are about the individual studying process of the participants and 10 are about their beliefs about the teaching process of academics in courses), along with 4 more questions related to personal data. It is an opinion questionnaire. The teaching style of academics differs: those of Faculty of General Medicine are focusing on a lecture type style (75%), and University of Sports on an interactive style (67%). We discovered differences in the process of self-learning: between continuous and discontinuous style. For medical students, there was a longer distribution of the self-taught learning process; instead, University of Sports students organize their learning time in the last part of the semester. University of Sports students are more concerned with on the development and refinement of their personal practical skills, but also of the subjects they work with (kids or athletes), their goal being to accumulate their own experience as rich as possible from working with as many individuals and less to take from the experience of other colleagues. The coach-athlete/sports teacher-pupil relationship is more personalized and longer-lasting than the doctor-patient relationship.
