Insulin resistance is documented in clamp studies in 75% of women with polycystic ovary syndrome (PCOS). Although it is not included in the diagnostic criteria of PCOS, there is a crucial role of this metabolic impairment, which along with hormonal abnormalities, increase each other in a vicious circle of PCOS pathogenesis. Insulin resistance in this group of patients results from defects at the molecular level, including impaired insulin receptor-related signaling pathways enhanced by obesity and its features: Excess visceral fat, chronic inflammation, and reactive oxygen species. While lifestyle intervention has a first-line role in the prevention and management of excess weight in PCOS, the role of anti-obesity pharmacological agents in achieving and maintaining weight loss is being increasingly recognized. Glucagon-like peptide-1 receptor agonists (GLP1-RAs) not only act by reducing body weight but also can affect the mechanisms involved in insulin resistance, like an increasing expression of glucose transporters in insulin-dependent tissues, decreasing inflammation, reducing oxidative stress, and modulating lipid metabolism. They also tend to improve fertility either by increasing LH surge in hypothalamus-pituitary inhibition due to estrogen excess connected with obesity or decreasing too high LH levels accompanying hyperinsulinemia. GLP1-RAs seem promising for effective treatment of obese PCOS patients, acting on one of the primary causes of PCOS at the molecular level.

Polypharmacy is a global therapeutic problem, with various medical definitions. Even though there is no universal description of this phenomenon, it is consistently connected with improper use of medications. Studies show an increase in the population of people older than 65 years. These...

Australian ana Canadian health service provides palliative care at the highest global level. The medical policy decision-making system in both countries is very similar. Due to the inequal-ities in access to palliative care services noticed by the governmental organizations of both coun-tries, national guidelines have recently been developed to raise its standards. Both frameworks have settled very similar fundamental principles to ensure that all people experience the palliative care they need. They are palliative care is person-centred and the patient receives help, which is consistent with his will and beliefs, caregivers are valued and receive the care they need, death is considered part of life, providing appropriate therapy for those social groups that have not been treated with adequate care so far, with particular emphasis on the indigenous peoples of both countries and to increase accessibility to home provided palliative care. Due to the lack of palli-ative medicine specialists in both countries, trainings to develop basics palliative competencies among other practitioners are required. The implementation process of both frameworks will be supervised by special established governmental organizations.

Background and Objectives: The conventional technique for atrial fibrillation (AF) ablation has gradually been supplemented by ‘single-shot’ devices. Comparisons of devices using three different energy sources are rare. We aimed to evaluate the outcomes of patients with AF who underwent pulmonary vein isolation (PVI) using three various single-shot ablation techniques. We also examined factors associated with arrhythmia recurrence during the 12-month follow-up. Materials and Methods: We prospectively analyzed single-center data from consecutive adult patients undergoing PVI with different single-shot devices between January and December 2024. For cryoablation, a second-generation cryoballoon (AFA, Medtronic, Minneapolis, MN, USA) was used; for radiofrequency balloon ablation, the RFB catheter (Heliostar, Biosense Webster, California, CA, USA) was applied; and for the PFA-guided procedure, the Farawave (Boston Scientific, Massachusetts, MA, USA) ablation catheter was used. The procedural endpoint was to achieve intraoperative PVI. Arrhythmia recurrence was defined as any episode lasting >30 s documented by electrocardiographic recordings. Results: Ultimately, the analysis included 115 patients. Of these, 41 underwent PVI by cryoablation, 22 underwent RFB therapy, and 52 underwent PFA. The total skin-to-skin procedure time was the shortest among PFA-patients, primarily due to shorter left atrial dwell time. After 12 months of follow-up, 30 patients experienced recurrence of atrial arrhythmia. A larger left atrium diameter increased the risk of arrhythmia recurrence, whereas propafenone therapy at discharge was associated with a lower risk of recurrence during the 12-month follow-up. Conclusions: In this single-center observational study, PVI performed with PFA was associated with the shortest procedure time compared with procedures using CBA or RFB, with no difference in the risk of arrhythmia recurrence among the single-shot ablation modalities during the 12-month follow-up.