Chronic pancreatitis (CP) and autoimmune pancreatitis (AIP) are diseases with overlapping features, both requiring complex management strategies. CP is characterized by pancreatic exocrine insufficiency (PEI) and pain, with treatment focused on symptom relief through pancreatic enzyme replacement therapy (PERT), pain control, and lifestyle and nutritional changes. However, the standard therapy does not address the underlying inflammation or fibrosis, which drives disease progression. AIP, on the other hand, presents with obstructive jaundice and fibrosis and is classified into two subtypes: Type 1 (AIP-1), linked to IgG4-related disease, and Type 2 (AIP-2), associated with inflammatory bowel disease. Treatment for AIP typically involves oral steroids. Immunomodulators and rituximab are used for recurrent or refractory cases. Novel therapies targeting the inflammation and fibrotic components of CP are being explored. A multidisciplinary approach is essential to optimize care and improve patients’ outcomes.

Acute pancreatitis (AP) is an inflammatory condition with varying severity, ranging from mild self-limiting episodes to life-threatening complications. The incidence, clinical presentation, and outcomes of AP differ significantly across age groups, with elderly patients demonstrating distinct challenges. Biliary pancreatitis is more prevalent in older adults, whereas alcohol-induced AP dominates in younger populations. Elderly patients frequently present with atypical or less pronounced abdominal symptoms, which may delay diagnosis. Comorbidities such as kidney failure, cardiovascular disease, diabetes mellitus and arterial hypertension are significantly more common in the elderly and are associated with increased risk of organ dysfunction, systemic complications such as organ failure, multiple organ dysfunction syndrome (MODS), and prolonged hospitalization. The higher incidence of intensive care unit admissions and mortality is noted in the elderly, particularly in those over 80 years, in particular. Evidence on age-related differences in local pancreatic complications is inconsistent, with a possible trend toward lower rates in older adults. Early identification and individualized treatment planning are essential. Abundant fluid administration should be limited in older patients due to frequent cardiac insufficiency but should be carefully monitored due to the present or threatening renal insufficiency. Pain control with opioids may cause severe CNS complications for elderly patients. In contrast, ERCP, when indicated, is usually well tolerated in older patients. Personalized management in elderly patients is strongly recommended.

Background: Low back pain is a common clinical complaint, most often of mechanical origin. However, a subset of patients presents with inflammatory back pain related to axial spondyloarthritis (axSpA), a condition frequently associated with significant diagnostic delay and adverse outcomes. Objective: To review and summarize the key clinical, laboratory, and imaging features that differentiate inflammatory from mechanical back pain, with the aim of improving early recognition of axial spondyloarthritis in clinical practice. Materials and Methods: A narrative literature review was conducted using the PubMed database. Articles published mainly between 2000 and 2024 were identified using the following keywords: “axial spondyloarthritis”, “inflammatory back pain”, “mechanical back pain”, and “diagnostic delay”. Relevant clinical trials, observational studies, systematic reviews, and clinical guidelines written in English were included. The review focused on the epidemiology, clinical presentation, laboratory markers, imaging findings, treatment implications, and prognostic consequences of delayed diagnosis in axial spondyloarthritis, and the selected studies were analyzed qualitatively. Results: Inflammatory back pain is characterized by insidious onset, improvement with exercise, nocturnal pain, and poor response to rest. HLA-B27 positivity and elevated inflammatory markers support the diagnosis, while imaging of the sacroiliac joints—particularly MRI—plays a key role in early detection. In contrast, mechanical back pain is typically activity-related, improves with rest, and rarely shows inflammatory laboratory or imaging findings. Diagnostic delay in axSpA is associated with worse functional outcomes, reduced spinal mobility, and increased radiographic progression. Conclusions: Accurate differentiation between inflammatory and mechanical back pain is essential for timely diagnosis and appropriate management of axial spondyloarthritis. Increased clinical awareness and a structured diagnostic approach may reduce diagnostic delay and improve long-term patient outcomes.

Background:Regular physical activity during pregnancy is recommended due to its beneficial effects on maternal and fetal health. In recent years, increasing attention has been directed toward potential long-term benefits of antenatal physical activity extending into the postpartum period. However, evidence regarding its influence on postpartum mental health, body weight outcomes, and quality of life remains heterogeneous. Aim:The aim of this narrative review was to synthesize evidence on the association between physical activity during pregnancy and selected maternal outcomes after childbirth, focusing on postpartum depressive symptoms, postpartum weight retention, and maternal quality of life. Materials and methods:A narrative literature review was conducted using the PubMed database. Articles published between 2000 and 2026 were identified using keywords and MeSH terms related to physical activity, exercise, pregnancy, postpartum outcomes, depression, gestational weight gain, postpartum weight retention, and quality of life. Randomized controlled trials, cohort studies, systematic reviews, meta-analyses, umbrella reviews, and clinical guidelines were included. Results:Evidence from systematic reviews and meta-analyses suggests that physical activity during pregnancy may reduce postpartum depressive symptoms, particularly in structured exercise interventions. Prenatal physical activity may also contribute to lower postpartum weight retention by limiting excessive gestational weight gain. Limited evidence indicates a positive association between prenatal physical activity and postpartum quality of life. Conclusions:Physical activity during pregnancy may provide benefits extending into the postpartum period, particularly for maternal mental health and weight outcomes. Current evidence supports promoting regular and safe physical activity during pregnancy as part of preventive health strategies.

Background. Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age, which collectively impair fertility. Insulin-sensitizing agents have emerged as a key therapeutic strategy to improve metabolic, hormonal, and reproductive outcomes in this population. Aim. This review critically evaluates current evidence on insulin-sensitizing agents in women with PCOS, addressing both their mechanisms of action at the metabolic and ovarian levels and their effects on reproductive outcomes. Material and Methods. A review of randomized controlled trials, meta-analyses, and high-quality observational studies published up to 2025 evaluated the effects of metformin, myo-inositol, and berberine on reproductive outcomes in women with PCOS. Results. Insulin-sensitizing agents improve metabolic dysfunction and ovulatory outcomes in PCOS. Metformin increases ovulation and clinical pregnancy rates, particularly in women with insulin resistance or higher BMI, though its effect on live birth is inconsistent. Myo-inositol and berberine show beneficial effects on metabolic parameters and ovulatory function, but evidence for live birth and miscarriage remains limited. Conclusions. Insulin-sensitizing therapies support reproductive function in women with PCOS, particularly in metabolically compromised phenotypes. Metformin has the strongest evidence base, whereas myo-inositol and berberine are promising adjunctive or alternative options. Future high-quality randomized trials focusing on live birth and miscarriage outcomes, standardized reporting, and precise patient stratification are needed to optimize the clinical use of these agents in PCOS-related infertility.

Background: Preterm infants, particularly those with very low birth weight (VLBW) and extremely low birth weight (ELBW), have substantially increased nutritional requirements. Although human milk provides many protective benefits, it does not fully meet the nutritional needs of this population, which justifies the routine use of human milk fortifiers. Traditionally used bovine milk–based fortifiers (BMBF) have raised concerns regarding their potential association with necrotizing enterocolitis (NEC), which led to the development of human milk–based fortifiers (HMBF). Objective: This narrative review aimed to present the current state of knowledge regarding the clinical benefits and limitations of HMBF in preterm infants, with particular emphasis on NEC, sepsis, growth, and mortality. Materials and Methods: A narrative literature review was conducted including randomized controlled trials, observational studies, and systematic reviews and meta-analyses comparing HMBF and BMBF in preterm infants. The analysis focused on clinically relevant outcomes, particularly in ELBW infants and in the context of an exclusive human milk diet. Results: The reviewed studies indicate a lower incidence of NEC among infants receiving HMBF, particularly within exclusively human milk–based diets. Mortality was also reported to be lower in some cohorts, particularly among ELBW infants. Rates of late-onset sepsis and other major morbidities were generally comparable between groups. Some studies reported slower short-term weight gain with HMBF, whereas long-term growth outcomes showed no consistent differences between feeding strategies. Conclusions: Current evidence suggests that HMBF may reduce the risk of NEC and mortality in highly vulnerable preterm infants, particularly those with ELBW. Although some studies report slower short-term weight gain, randomized trials have not demonstrated clinically meaningful differences in long-term growth or body composition. Overall, the potential clinical benefits appear to outweigh these temporary differences in growth velocity.