Metformin, a well-established antidiabetic agent, has emerging neuroactive properties extending beyond glycemic control. Evidence suggests effects on neurotransmission, neuroprotection, and neuroinflammatory pathways, offering potential in neurodegenerative disorders. Following PRISMA 2020 guidelines and PROSPERO registration (CRD420251105355), we systematically searched PubMed, Scopus, Web of Science, and Google Scholar (November 2024-July 2025) for in vivo and clinical studies in humans or animals reporting CNS-related outcomes. Two reviewers independently screened and extracted data; risk of bias was assessed with validated tools appropriate to study design. A total of 166 studies met inclusion criteria, including animal models, mechanistic experiments, and clinical observations. Metformin crosses the blood-brain barrier and modulates CNS pathways through anti-inflammatory and mitochondrial-supportive actions. Crucially, it regulates major neurotransmitter systems - serotonin, dopamine, glutamate, GABA, acetylcholine, and norepinephrine - restoring excitatory/inhibitory balance and enhancing synaptic plasticity. Most of the current evidence arises from preclinical studies, which consistently demonstrate neuroprotective and neuromodulatory effects of metformin in models of Alzheimer's disease, Parkinson's disease, stroke, and fragile X syndrome. Clinical data, while promising, remain limited and heterogeneous, mainly suggesting potential cognitive benefits. Metformin shows promise for repurposing in CNS disorders via direct neurotransmitter regulation alongside mitochondrial and anti-inflammatory effects. Given that the majority of available data are preclinical, translational studies and well-designed clinical trials are essential to establish efficacy, dosing, and target populations. These findings underscore the metabolic-neurological interface and suggest a shift from viewing metformin solely as a metabolic therapy to recognizing its neurotherapeutic potential. Long-term use warrants vitamin B12 monitoring.

This review aims to evaluate the efficacy of hormonal therapy, including gonadotropin-releasing hormone agonists (GnRH agonists), aromatase inhibitors (AIs), selective estrogen receptor modulators (SERMs) and combination therapy in the management of aggressive angiomyxoma (AAM). A comprehensive literature search was conducted to identify studies reporting the use of hormonal interventions in AAM treatment. Seventy-five scientific papers were analyzed to gather data on treatment modalities, response rates, and adverse effects, which were then extracted and synthesized. The review was structured according to the PICO(S/T) framework to ensure consistency in data synthesis and interpretation. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure methodological transparency and rigor. Gonadotropin-releasing hormone agonists demonstrated anti-tumoral activity by inducing hypoestrogenism, resulting in tumor shrinkage and prevention of recurrence. Aromatase inhibitors stabilized disease progression and improved symptoms. Selective estrogen receptor modulators administered postoperatively prolonged progression-free survival. Combination therapies exhibited synergistic effects, with notable responses observed in neoadjuvant and adjuvant settings. Hormonal therapy presents an effective adjunct to surgical resection in AAM management, especially in cases demonstrating estrogen receptor (ER) and progesterone receptor (PR) positivity. While effective, careful monitoring for adverse effects and individualized treatment approaches are necessary to optimize outcomes and minimize risks. This review highlights the evolving role of hormonal interventions in the multidisciplinary management of AAM, emphasizing the need for further research to refine treatment strategies and improve patient outcomes.

Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited kidney disorder marked by cyst growth and progressive renal failure. This systematic review aims to summarize current preclinical and clinical evidence on the potential role of metformin in ADPKD, focusing on its effects on glucose metabolism, kidney function, inflammation, and survival. A comprehensive search was conducted in PubMed and Google Scholar up to June 2025, following PRISMA guidelines. Forty-two articles met the inclusion criteria and were analyzed. Included studies examined metformin use in ADPKD patients or models and reported outcomes such as renal function, cyst growth, metabolic markers, and mortality. In preclinical studies, it reduced cyst formation, improved kidney structure, and decreased inflammation. Clinical studies confirmed its safety and suggested benefits in slowing kidney function decline, especially in early-stage ADPKD. Metformin may be a promising supportive therapy in ADPKD due to its metabolic and anti-inflammatory effects.

Background: Stroke burden, measured by DALYs, reveals a growing concern in sub-Saharan Africa. Ischemic stroke, exacerbated by modifiable risk factors like hypertension and household air pollution, poses a significant health challenge. Regional disparities, economic development, and healthcare inefficiencies underscore the need for targeted interventions and further research.Objective: This study aims to analyze trends in the burden of ischemic stroke across specific regions in sub-Saharan Africa from 2000 to 2019. The objective is to identify key changes in stroke burden progression and highlight modifiable risk factors.Material and methods: Utilizing World Health Organization (WHO) data from 2000 and 2019, national estimates of ischemic stroke DALYs in 49 sub-Saharan African countries were collected. DALYs were calculated per 100,000 population to reduce the impact of population size. Statistical analyses and visual representations using MapChart were employed to interpret the trends.Results: The study reveals wide variations in ischemic stroke DALYs changes across sub-Saharan African countries from 2000 to 2019. Predominantly, countries in the Eastern and Southern regions experienced adverse increases, while those in the Central and West regions mostly exhibited declines in DALYs. Countries such as Lesotho, Zimbabwe, and Mauritius, saw the most significant DALYs increases, whereas Rwanda, Malawi, and Equatorial Guinea experienced the most favorable changes.Conclusions: Stroke is a pressing health concern in sub-Saharan Africa. Modifiable risk factors like hypertension and household air pollution necessitate targeted interventions. Tailored healthcare policies, reinforced health systems and comprehensive research into region-specific risk factors are crucial to alleviate stroke-related morbidity and mortality in the region. Addressing these challenges is vital to mitigate the increasing burden of stroke in the particular regions of sub-Saharan Africa.

Chronic kidney disease (CKD) represents a significant global epidemiological challenge, demanding considerable financial resources for treatment. Renal transplantation is the optimal approach for end-stage renal failure, being the most cost-effective option among renal replacement therapies. This narrative review aims to explore clinical conditions associated with excessive healthcare costs among renal transplant recipients, particularly focusing on high-resource users (HRU). We reviewed literature examining conditions generating high costs in kidney transplant patients, including infections, sepsis, pneumonia, antibody-mediated rejection (AMR), graft failure, advanced recipient age, heart failure, and fractures. Immunosuppressive therapies heighten the risk of infections, with sepsis and pneumonia posing significant costs. AMR is a major contributor to healthcare costs, but effective treatment of AMR can extend graft longevity and improve patient outcomes. Graft failure significantly increases medical expenses and adversely affects patient outcomes. Older recipients face higher post-transplant morbidity and mortality rates, though transplantation still offers better long-term survival compared to dialysis. Heart failure and fractures further elevate post-transplant costs and underscore the necessity of targeted interventions to mitigate associated risks. Ensuring kidney transplant care is sustainable and accessible requires a comprehensive strategy. This approach aims to improve patient outcomes while keeping costs reasonable.

Temat badania: Doustne bezpośrednie leki przeciwzakrzepowe (DOAC) stanowią niekwestionowaną opcję terapii przeciwzakrzepowej, zapewniając pacjentom najwyższą jakość życia. DOAC bezpośrednio hamują aktywowane czynniki krzepnięcia: dabigatran działa jako inhibitor trombiny, a rywaroksaban, apiksaban i edoksaban to wysoce selektywne doustne inhibitory czynnika Xa, oddziałujące zarówno na wewnętrzny, jak i zewnętrzny szlak kaskady krzepnięcia. Cel badania: Ocena przewagi DOAC nad innymi terapiami przeciwzakrzepowymi w różnych scenariuszach klinicznych oraz charakterystyka korzyści związanych z ich stosowaniem. Analizowane przypadki obejmowały pacjentów onkologicznych, pacjentów z mechanicznymi zastawkami serca, stosowanie DOAC w interwencjach medycznych oraz różnorodne grupy pacjentów. Pomimo ustalonych wytycznych, optymalne leczenie żylnej choroby zakrzepowo-zatorowej u pacjentów z nowotworami pozostaje wyzwaniem. Materiał i metody: Przeprowadzono systematyczną analizę literatury w bazach PubMed i Google Scholar, stosując słowa kluczowe takie jak „terapia przeciwzakrzepowa,” „Doustne bezpośrednie leki przeciwzakrzepowe (DOAC),” „żylna choroba zakrzepowo-zatorowa,” „zatorowość płucna” oraz „zakrzepica żył głębokich.” Wybrano 51 artykułów spełniających kryteria włączenia, koncentrując się na skuteczności i bezpieczeństwie DOAC w leczeniu żylnej choroby zakrzepowo-zatorowej. Zsyntetyzowano dane dotyczące wyników leczenia, działań niepożądanych oraz zastosowań klinicznych, zgodnie z wytycznymi PRISMA, aby zapewnić kompleksowy i przejrzysty przegląd. Wyniki: DOAC oferują atrakcyjną alternatywę w różnych sytuacjach klinicznych, w tym po wymianie zastawki serca. Badania porównujące DOAC z antagonistami witaminy K u pacjentów po TAVI wskazują na porównywalną skuteczność i profil bezpieczeństwa, z potencjalnymi korzyściami, takimi jak łatwość stosowania, mniejsza liczba interakcji lekowych i lepsza współpraca pacjentów. Zarządzanie powikłaniami krwotocznymi u pacjentów stosujących terapię przeciwzakrzepową pozostaje wyzwaniem klinicznym. Ponadto unikalne trudności dotyczą pacjentów w podeszłym wieku, u których zmiany związane z wiekiem wpływają na metabolizm leków i zwiększają ryzyko krwawień, szczególnie przy stosowaniu niektórych doustnych antykoagulantów, takich jak rywaroksaban. Konieczne są jednak dalsze badania, aby ustalić długoterminowe bezpieczeństwo i skuteczność, zoptymalizować strategie dawkowania i dopracować protokoły postępowania, szczególnie w grupach pacjentów wysokiego ryzyka. Wnioski: Doustne antykoagulanty celowane zrewolucjonizowały terapię przeciwzakrzepową, oferując porównywalną skuteczność do antagonistów witaminy K przy jednoczesnym zwiększeniu bezpieczeństwa i wygody stosowania. Ich ukierunkowane mechanizmy działania zapewniają skuteczną profilaktykę zakrzepowo-zatorową, szczególnie u pacjentów onkologicznych oraz po wymianie zastawki serca, jednocześnie poprawiając jakość życia. Niemniej jednak wyzwania, takie jak zapobieganie krwawieniom i optymalne dawkowanie w populacjach wysokiego ryzyka, podkreślają potrzebę dalszych badań w celu zoptymalizowania ich stosowania w różnych kontekstach klinicznych.