Folia Medica Cracoviensia

The development of safe and efficient therapeutic interventions in irritable bowel syndrome (IBS) is challenged by the complexity of its pathophysiology and a wide range of symptoms. On the other hand, with the progress in design of diagnostic and analytical tools (including software and artificial intelligence), we understand more about the disease what brings us closer to its successful treatment. In this review we discuss currently available and potential future pharmacological and non-pharmacological treatments, focusing mainly on clinical proof of their efficiency. Moreover, we aim at identifying risk and challenges that need to be overcome to obtain a marketed drug.

Premature ovarian insufficiency (POI) is a heterogeneous multifactorial disorder characterized by amenorrhoea, hypoestrogenism and elevated serum gonadotropins in women below 40 years. Genetic predisposition, infections, iatrogenic, autoimmune conditions and endocrinopathies are few of the known causes of POI, but majority cases of POI are idiopathic which is attributed to be due to environmental factors, epigenetic changes, oxidative DNA damage or faulty DNA repair mechanisms. These epigenetic changes and cumulative oxidative DNA damage can pass transgenerationally to subsequent generations. Management of POI involves hormone replacement to alleviate the symptoms of hypoestrogenism and in some cases treatment for infertility, comorbid stress and depression. The broad spectrum of decreased quality of life and psychosocial impact of the medical condition is less often addressed. Lifestyle modification and yoga can act as adjunct therapy in conjunction with the standard treatment protocol to alleviate the stress, anxiety and depression. YBLI exerts immunomodulatory effects and provides a natural way to decrease oxidative stress, DNA damage, inflammation, restoring hormonal normality and in turn protect accelerated oocyte atresia.

Training-induced resting bradycardia is characteristic of endurance athletes, but it also often occurs in less trained, physically active people. It is commonly believed that slowing of the heart rate is a positive sign of systemic adaptation to physical training, but severe bradycardia phenomenon (below 40 beats per minute) could be a matter of concern for athletes’ health. In this review, we present the fascinating history of research into this one of the most fundamental adaptive responses of the cardiovascular system to exercise training, which teaches us an important scientific truth — that nothing that has not been questioned has truly been proven. In the context of training-induced resting bradycardia, this refers to many aspects of the phenomenon, from its name and meaning to its physiological mechanisms.

Background: Platelet transfusion refractoriness (PTR) presents a significant clinical challenge, often requiring specialized diagnostic and donor-matching strategies. Existing immunoassays detect anti- platelet antibodies but do not assess their functional impact. Objective: This study aimed to evaluate the feasibility of using ultrasound-induced chemiluminescence (UICL) as a functional assay to detect interactions between platelet concentrates (PCs) and selected antibodies (anti-HLA and ABO antibodies). Methods: Native and antibody-exposed PCs were analyzed using luminol-based chemiluminescence following high-frequency ultrasound stimulation. The signal intensity, reflecting reactive oxygen species production, was measured and standardized using an activation index. Microscopic, cytometric, and hematologic assessments were performed to validate platelet activation. Results: Native PCs present low spontaneous chemiluminescence, which increase approximately tenfold upon ultrasound stimulation. The presence of anti-platelet antibodies additionally enhances the chemiluminescence signal following ultrasound activation. Using a quantitative activation index allows for comparison of platelet–antibody interactions and differentiation of compatible versus incompatible PCs. The lower the activation index, the better the antigenic match between the donor platelets and the patient’s immune system. The method correlates with conventional HLA matching techniques (e.g., flow cytometry) and may support the selection of compatible PCs for alloimmunized patients. Morphological and volumetric changes confirm platelet activation post-sonication. Conclusion: UICL is a rapid, sensitive, and functionally informative method for assessing platelet–antibody interactions. It holds promise as a complementary or alternative approach to traditional immunologic testing in the management of immune-mediated PTR and may enhance transfusion decision-making, especially in settings where immunogenetic data are limited or time-sensitive.

Background: The benzodiazepine midazolam is widely used pre- and intraoperatively in intensive care units. 1´-OH-midazolam, one of the major metabolites, is pharmacologically active. Accumulation of 1´-OH-midazolam, e.g. due to hepatic dysfunction or renal insufficiency, may therefore enhance pharmacological activity. Growing evidence suggests that sex, age, drug interactions, and inflammation also have an impact on midazolam disposition and activity. Due to the complex interplay of these factors, finding the optimal midazolam dose for each critically ill patient is challenging. Methods: We aimed to elucidate the factors that contribute significantly to pharmacokinetics of midazolam and its main metabolites in patients undergoing cardiac surgery. We collected serum and urine samples from 15 patients 1, 2, 3, 4, and 5 hours after the beginning of cardiac surgery and determined the concentrations of midazolam, 1´-OH-midazolam, 4-OH-midazolam, 1´-OH-midazolam-β-D-glucuronide, and 4-OH-midazolam- β-D-glucuronide by LC-MS/MS. Results: Oxidation to 4-OH-midazolam and subsequent glucuronidation played a role in metabolism and elimination of midazolam in our patient cohort. Patients showed relatively variable concentrations of midazolam and its metabolites, due to differences in midazolam dose and administration routes, demographic and clinical parameters. Thus, we evaluated pharmacokinetic parameters for individual patients and not for the whole patient cohort. We established a logarithmic multiple regression model linking urinary concentrations of midazolam, 1´-OH-midazolam, and 1´-OH-midazolam-β-D-glucuronide with explanatory variables. Conclusion: Our model linked urinary concentrations of midazolam, 4-OH-midazolam, and 1’-OH-midazolam- β-D-glucuronide to serum concentration, age, surgery infusion volume, creatinine concentration, and/or body temperature.

Oxysterols, the oxidized derivatives of cholesterol, are biologically active molecules involved in a wide range of physiological and pathological processes. Small structural changes in the cholesterol backbone (such as additional hydroxyl or keto groups on the sterol rings or side chain) dramatically alter their biological effects, ranging from beneficial roles in cholesterol homeostasis and antiviral activity to harmful contributions to diseases like atherosclerosis, neurodegeneration, and cancer. Molecular dynamics (MD) simulations and density functional theory (DFT) calculations have emerged as powerful tools to investigate these molecules at an atomic level. By complementing experimental studies, computational approaches reveal how oxysterols interact with membrane lipids, providing mechanistic insight into their function. This review highlights key findings from MD and DFT studies on various oxysterols — including 7-hydroxycholesterol epimers, 7-ketocholesterol, 22-hydroxycholesterol epimers, 24(S)-, 25- and 27-hydroxycholesterol — in the context of pharmaceutical and medical research. We discuss how these methods uncovered differences in orientation, hydration, and intermolecular interactions of oxysterols in model membranes, lipid rafts, and complexes, explaining phenomena such as membrane domain destabilization or stabilization, rapid transbilayer “flip-flop” translocation, and stereochemistry-dependent biological activity. Understanding these molecular details is crucial for pharmacists and medical researchers, as it connects oxysterol structure–function relationships to their roles as potential biomarkers, therapeutic targets, or bioactive compounds involved in disease pathophysiology. Computational chemistry thus provides a valuable complement to experimental pharmacology, enabling the prediction of oxysterol behavior in biological systems.

Drug resistance in bacteria and fungi is a global threat to public health. The purpose of this publication is to review the latest scientific achievements, mainly from 2020–2025, concerning the use of hemp compounds from Cannabis sativa in combating drug-resistant bacterial and fungal infections. The literature review confirms that C.sativa, a plant with a documented centuries-old therapeutic history, is a rich source of cannabinoids and terpenes that combat drug-resistant bacteria: Mycobacterium tuberculosis, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae, and fungi: Cryptococcus neoformans, as well as species from the Candida and Aspergillus. The potential of hemp compounds is based on their activity in interacting directly with pathogens by disrupting cell membrane integrity, eradicating biofilm, having a bactericidal effect on bacterial spores, acting synergistically, affecting host inflammatory pathways, and the human endocannabinoid system.

Introduction: The occurrence of depressive disorders with a varied clinical picture and intensity of symptoms among young people has been confirmed by numerous studies. Their dynamic development during a period of life full of changes and related activities directs efforts towards their early detection, identification of risk factors, and preventive measures. The aim of this study was to assess the prevalence and severity of depressive disorders among people aged 18–25. Material and Methods: The study was conducted using a diagnostic survey among 236 young people using the Beck Depression Inventory and the author’s questionnaire. Results: 15.68% of the respondents admitted to having diagnosed depressive disorders, while the results based on the Beck Depression Inventory indicated moderate depression in 54.66% of the respondents and severe depression in 13.98%. The severity of depressive symptoms was associated with the presence of mental and somatic symptoms, female gender, stress related to family and social life, studying or working remotely due to the COVID-19 pandemic, and substance abuse. Conclusions: Depressive disorders of varying severity occur among young people in the study and are associated with many factors. Due to the consequences of depressive disorders, there is a need for preventive measures aimed at promoting knowledge and therapeutic measures to facilitate recovery.

Introduction: Cardiovascular diseases caused by atherosclerosis are one of the leading causes of death in Poland and worldwide. Atherosclerosis develops from the earliest years of life and is influenced by modifiable risk factors resulting from health behaviors, which provides opportunities to reduce cardiovascular risk, especially in young people, by addressing these factors. Aim of the study: assessment of health behaviors adopted by young adults in the context of preventing cardiovascular diseases caused by atherosclerosis. Material and Methods: The study was conducted among 200 people aged between 18 and 35, with the application of a diagnostic survey method, a questionnaire technique using the Health Behavior Inventory (Inwentarz Zachowań Zdrowotnych — IZZ) and a self-designed questionnaire. Results: The average score obtained by the respondents in the Health Behavior Inventory (IZZ) test was 80.44 ± 13.0 points, with the highest average score obtained in the area of positive mental attitude (3.43 ± 0.69 points) and the lowest in the category of preventive behaviors (3.26 ± 0.68 points). In the knowledge test, the respondents scored an average of 19.68 ± 2.60 points. Among the socio-geographic factors, gender had the most significant impact on the respondents’ health behaviors — it significantly influenced the overall result, as well as all its components, except for positive mental attitude. Conclusions: The largest percentage of respondents presented average or low levels of health behaviors, and the level of knowledge was also average among the largest percentage of respondents. Among the variables analyzed, gender had the most significant impact on health behaviors, while health behaviors did not differ significantly depending on the respondents’ level of knowledge.

Background: There is insufficient research on the distribution of foot pressure in American football players, categorized by player positions on the field. Objective: To assess the impact of American football training on static foot pressure distribution during bipedal standing with eyes open and closed, comparing offensive and defensive players. Methods: In this cross-sectional observational study, 105 men (70 American football players, 35 controls) were examined using the Zebris FDM-S podobarographic platform. Parameters related to foot pressure and postural balance were analyzed. Results: American football players demonstrate good balance and pressure distribution in their feet during bipedal standing with open eyes. The foot pressure patterns worsen during bipedal standing with closed eyes for offensive players compared to visual control (p = 0.02). Conclusions: When visual input was removed, the offensive players exhibited more forefoot loading, while the defensive group showed higher hindfoot loading. A significant difference in the total load of the left foot between the attack and control groups further emphasizes the variability in the distribution of foot load within the groups, and due to the position on the field when vision is limited. In our opinion, the greater exposure to foot load changes in offensive players provides some basis for the implementation of preventative measures for pronated feet and training aimed at strengthening the short foot muscles, stabilizing the ankle joints, and improving proprioception.

Introduction: The COVID-19 pandemic has affected the life quality and young adults’ health behaviors. Aim Assessment of health behaviors and life quality in young adults during the COVID-19 pandemic. Material and Methods: The study was conducted in a group of 161 people aged 18–25 years. The study employed a diagnostic survey method using the World Health Organization Quality of Life Questionnaire in the Polish version and the Health Behavior Inventory, as well as a self-designed questionnaire. Results: The average value of the total health behavior intensity index in the examined group was 75.83 ± 13.9. The average scores obtained in each domain were similar, with the highest score referring to undertaking health practices (3.31 ± 0.68) and the lowest referring to proper eating habits (2.95 ± 0.81). Only 11.80% of respondents presented a high level of health behaviors. The average score for overall quality of life was 3.87 ± 0.81 points, with the physical domain scoring most favorably (15.18 ± 2.65 points) and the psychological domain scoring the lowest (13.45 ± 3.48 points). There was a significant positive correlation between respondents’ health behaviors and their quality of life (r =0.288; p <0.001). Respondents indicated that the pandemic negatively affected their quality of life in the psychological (63.98%), social (60.25%) and environmental (45.34%) domains. Conclusions: Nearly half of the respondents reported low intensity of health behaviors. Their quality of life was good. The physical domain scored highest and the mental domain scored lowest, which was also reflected in the highest score for the adverse impact of the pandemic on the quality of life in the same domain.

Temporomandibular disorder (TMD) is a condition affecting a growing population of people worldwide. It is an etiologically, diagnostically and therapeutically challenging condition. The aim of this article was to present difficult and important subjects for doctors, who are less experienced yet but who are treating patients with TMD. This article presents modern general methods for treating patients with temporomandibular disorders. The principles of treatment are described on the basis of the author’s more than 30 years of clinical experience and taking into account the contemporary literature describing this issue. The therapeutic management of the use of appliances called occlusal splints is characterized, and the importance of stopping the pathological habits of clenching or grinding teeth is described. In addition, procedures such as intramuscular injections of botulinum toxin type A and intraarticular injections of hyaluronic acid have been described. Additionally, the physiotherapeutic procedures used, such as laser biostimulation, sonophoresis, postisometric muscle relaxation, or manual therapy, and the need for psychotherapeutic support are described. The description of the procedures includes valuable tips for each of the sections of primary and supportive treatment of TMD. This article highlights all the necessary steps in the treatment of this group of patients and offers an overview of the methods. This paper highlights the most innovative methods that are currently used in the treatment of TMD. The use of the described methods guarantees therapeutic progress and pain relief. In addition, the article explains the importance of psychological support due to the predominant etiological factors of TMD.

Extra-hilar branching refers to the main renal artery dividing before reaching the hilum of the kidney into an anterior and posterior branch. Embryologically, initial segmentation of renal artery may occur due to ablation of renin cell precursors and mutations of the renin-angiotensin system or due to delay in communication between the constituents located within the mesenchyme of the vascular structures and those found in the mesenchyme of the metanephros, such as hepatocyte growth factor and glial-derived neurotrophic factor. The variations in renal vascular anatomy is of clinical relevance to surgeons and radiologists in cases of renal transplantation, vascular reconstruction and assessment of renovascular hypertension. The present case report involves the extra hilar branching of bilateral renal arteries with its embryological basis and clinical elucidation.

Introduction: Urinary incontinence (UI) and pelvic organ prolapse (POP) are prevalent conditions that significantly impair women’s quality of life, yet awareness of conservative treatment options remains limited. Aim: To assess women’s knowledge and awareness regarding urogynaecological physiotherapy, as well as to evaluate quality of life and satisfaction after gynaecological and urogynaecological surgeries. Material and Methods: The study included 438 women undergoing surgery for pelvic floor dysfunction or other gynaecological conditions. Participants completed self-designed and validated questionnaires regarding physiotherapy knowledge, pre- and postoperative engagement, preventive behaviours and treatment satisfaction. Results: Nearly half of the participants (48.1%) had never heard of pelvic floor physiotherapy, with POP patients being the least informed (53.6%). Only 24.3% received a physiotherapy referral before surgery, and 16.7% underwent preoperative therapy, most often limited to one or two sessions. After surgery, 30.5% were referred to physiotherapy, while 18.0% participated. Women who attended physiotherapy — especially preoperatively — were significantly more likely to perform pelvic floor muscle training (PFMT) correctly (78.6% vs. 18.9%, p <0.001) and to engage in preventive behaviours (92.9% vs. 54.1%, p <0.001). Subjective outcomes were also better: patients with physiotherapy both before and after surgery most frequently rated their health as “much better” and expressed greater willingness to repeat surgery (p = 0.003). Conclusion: Awareness of urogynaecological physiotherapy remains insufficient. Physiotherapy, particularly when integrated both pre- and postoperatively, enhances PFMT performance, preventive behaviours, subjective treatment outcomes and satisfaction with surgery. Expanding access to physiotherapy and improving patient education could optimise long-term management of UI and POP.

Introduction: Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs, i.e., aspirin, diclofenac, dipyrone, ibuprofen, naproxen) and paracetamol are commonly ingested medications during pregnancy that for a long time were classified as relatively safe for mothers and fetuses. Areas covered: The review focuses on developmental toxicity of OTC NSAIDs. Expert opinion: Same epidemiological studies show that OTC antipyretics and painkillers may increase risk of spontaneous abortion, intrauterine growth retardation, preterm constriction of ductus arteriosus with secondary persistent pulmonary hypertension, reduced fetal renal perfusion that leads to oligohydramion, prolonged pregnancy, as well as selected congenital anomalies, including orofacial cleft, cardiovascular (i.e. ventricular septal defect, pulmonary valve stenosis) and neural tube defects (i.e., anophthalmia/microphthalmia, encephalocele, spina bifida), amniotic bands/limb body wall defects, and transverse limb deficiencies. However, other reports prove high prenatal tolerability or even beneficial effect in case of selected maternal sicknesses, especially influenza or disease with fever and thrombotic complications. The best advice for pregnant women is to avoid any xenobiotic, especially multidrug therapy, but in case OTC NSAIDs are needed they should be ingested in lowest effective dose under physician consultation. After gestational week 20, NSAIDs could be ingested with caution and withdrawn at gestational week 32, since they may induce constriction of the ductus arteriosus and affect renal function. The only exception is low-dose of aspirin, ingestion of which should be stopped one week before delivery with epidural anesthesia or could be prolonged until the end of pregnancy in patients with antiphospholipid syndrome.