Hanna Pietruszewska

Background: The escalating global burden of Treatment-Resistant Depression (TRD) and comorbid anxiety necessitates a fundamental shift in psychiatric therapeutic strategies. Traditional monoaminergic hypotheses often fail to account for the systemic inflammatory nature of affective disorders. Recent evidence identifies chronic, low-grade neuroinflammation - driven by the Microbiota-Gut-Brain (MGB) axis - as a primary mediator of treatment failure and neuronal atrophy. Postbiotics, specifically the short-chain fatty acid (SCFA) butyrate, offer a stable, standardized, and bioavailable alternative to live probiotics.Aim of the study: This review provides a comprehensive synthesis of the molecular mechanisms by which butyrate modulates neuroinflammatory pathways, stabilizes biological barriers, and acts as a potent epigenetic regulator to improve clinical outcomes in TRD.Material and methods: A comprehensive narrative review of 49 high-impact studies published between 2010 and 2025 was conducted using PubMed, Web of Science, and Google Scholar.Results: Preclinical data demonstrate that butyrate serves as a potent Histone Deacetylase (HDAC) inhibitor, promoting the expression of Brain-Derived Neurotrophic Factor (BDNF). Furthermore, butyrate mitigates "leaky gut" by upregulating Tight Junction (TJ) proteins (ZO-1, occludin) via the AMPK/Akt pathways and shifts microglial polarization from a pro-inflammatory (M1) to a neuroprotective (M2) phenotype through FFAR2 signaling.Conclusions: Butyrate represents a cornerstone for the future of precision psychiatry. Integrating metabolic profiling (e.g., CRP, IL-6, and fecal SCFA levels) into clinical protocols may enable targeted postbiotic interventions in patients refractory to conventional pharmacotherapy.

BACKGROUND The Dark Triad Scale (DTS) encompasses 3 personality traits: narcissism, psychopathy, and Machiavellianism. While numerous studies have explored the structure and social, medical, and behavioral implications of Dark Triad personality, its association with attitudes toward brain death, organ donation, and futile therapy has not been previously examined. The aim of this study was to assess how DTS traits influence perceptions of these end-of-life issues. MATERIAL AND METHODS This cross-sectional study used the DTS and an original questionnaire. Participants included Polish paramedic and midwifery students (n=48) and non-medically educated (NM) individuals recruited via Facebook (n=88). Due to underrepresentation of males in the NM group, only female respondents (n=75) from this group were included in cluster analysis. RESULTS Students of both genders were significantly more willing to become organ donors after death than were NM participants (mean score 3.92±1.3 vs 3.33±1.4 on a 1-5 scale; P=0.014). Among male and female students, higher Machiavellianism was associated with the belief that futile therapy is unethical. In NM females, psychopathy was correlated with denial of the existence of brain death, while Machiavellianism correlated with acceptance of withdrawing futile therapy. Cluster analysis identified 3 subgroups of NM females. Individuals with the highest levels of Dark Triad traits showed the greatest acceptance of withdrawing futile therapy, whereas those tending to deny brain death had moderate levels of these traits. CONCLUSIONS DTS traits are associated with attitudes toward futile therapy and brain death. Higher Machiavellianism is linked to greater acceptance of withdrawing futile therapy, while denial of brain death among females is associated with intermediate Dark Triad traits and higher psychopathy.

Dry eye disease (DED) is a complex, multifactorial, progressive disease that has consequences both for individuals and society. Symptoms reported by patients include discomfort in the eye and periodic blurred vision, while in the broader perspective, the disease is associated with economic burdens and challenges for healthcare systems. Globally, dry eye disease remains a growing problem observed in many countries. It is estimated that symptoms of dry eye syndrome occur in approximately 10 to 20 per cent of people over the age of 40. This prevalence is on the rise, which is associated with both the aging population and increased incidence among younger adults. In this group, factors such as contact lens wear and prolonged use of digital devices are considered to be contributing factors. Further epidemiological studies, conducted in different regions of the world, covering diverse populations and a wide range of age groups, with a particular focus on younger cohorts, may contribute to a more accurate understanding of the prevalence of dry eye disease. There are more and more methods of diagnosing DED. In addition to well-known procedures like the Schirmer test or tear break-up time, there are also methods that focus on the evaluation of the tear film or imaging of the ocular surface. Moreover, usage of artificial intelligence is also playing a significant role in it. However, the key issue in individual cases is introducing the most effective treatment based on combining available substances, including corticosteroids, antibiotics and supplements, which leads to a reduction in inflammation and improvement in visual comfort.

ATTR amyloidosis is a rare disease associated with abnormal folding of the transthyretin (TTR) protein, leading to the deposition of amyloid fibrils in the heart and nervous system. Treatment to date has focused primarily on alleviating symptoms such as heart failure and neuropathy. Currently available disease-modifying therapies include TTR stabilizers (tafamidis, acoramidis), which prevent TTR tetramer dissociation, and gene silencers (siRNA and ASO), which reduce TTR production and slow the progression of polyneuropathy. Modern experimental strategies, including CRISPR-Cas9 gene editing and anti-ATTR monoclonal antibodies, offer the potential for one-time treatment and removal of existing amyloid deposits. The choice of therapy should be tailored to the patient's phenotype, disease stage, and clinical capabilities, and ongoing research will better determine the long-term efficacy and safety of new drugs. The aim of this paper is to present contemporary therapeutic strategies in the treatment of transthyretin amyloidosis (ATTR), with particular emphasis on disease-modifying drugs such as TTR stabilizers, gene silencers, CRISPR-Cas9 gene editing therapies, and anti-ATTR monoclonal antibodies. The paper aims to evaluate the efficacy and safety of available therapies, discuss their clinical indications depending on the patient's phenotype (polyneuropathy, cardiomyopathy), and present directions for the development of new therapeutic strategies based on current clinical trials.

Background: Geographic atrophy is an advanced form of age related macular degeneration that causes irreversible loss of retinal structures. Imaging shows structural changes but does not reflect molecular mechanisms, which creates a need for biomarkers that can support earlier detection and guide therapeutic development. Aims: This review analyses molecular biomarkers associated with geographic atrophy, their links to pathogenic mechanisms and disease progression and their potential use in prediction and targeted therapeutic strategies. Methods: A structured search of peer reviewed English language literature was performed in PubMed and Google Scholar for publications from 2002 to September 2025. Search terms included geographic atrophy, age related macular degeneration, biomarkers, aqueous humor, tear fluid, proteomics, oxidative stress and complement system. Eligible studies included reviews, clinical and observational studies, case series and clinical guidelines. Preprints and studies without biomarker related data were excluded. Fifty publications were included. Results: Identified biomarkers in aqueous humor, tear fluid, plasma, urine and retinal tissues reflect oxidative stress, complement activation, inflammatory pathways and lipid dysregulation. These markers show associations with disease activity and may complement imaging by indicating underlying molecular processes. Experimental evidence suggests that modulation of complement activity, oxidative stress and inflammation may influence progression and that biomarker profiles may support patient stratification. Conclusions: Biomarkers provide insight into mechanisms of geographic atrophy and may assist in prediction, risk assessment and planning of targeted therapies. Further validation and methodological standardization are required to determine their diagnostic and prognostic value.

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory joint disease which has a significant, negative influence of patients’ quality of daily life. In routine clinical practice there is a usage of classic biomarkers, such as rheumatoid factor (RF) and anti-citrullinated antibodies (anti-CCP), as well as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in detecting onset or exacerbation of the disease and in monitoring its course. Aim: The study presents other markers with higher sensitivity and specificity which will let doctors identify even smoldering systemic inflammation and introduce appropriate treatment to prevent serious consequences of RA, including joints’ erosion and disability. Methodology: This review was conducted using a systematic approach to identify and analyze relevant scientific literature on the potential biomarkers of RA activity and progression and to indicate their practical clinical implications. We searched PubMed and Google Scholar databases. Articles were searched using following words : “Rheumatoid arthritis”, “biomarkers”, “ inflammatory”, “progression”,” treatment”. Summary: In a group of promising markers there are: calprotectin (S100A8/S100A9), 14-3-3η, antibodies against carbamylated proteins (anti-CarP), metalloproteinase 3 (MMP-3), other MMPs and cytokines (IL-1, IL-6, TNF-α).

Introduction: Type 1 diabetes is a chronic autoimmune disease that leads to permanent lack of insulin. In recent years, advances in insulin formulations and delivery methods have improved the ability to mimic natural insulin secretion and support better diabetes management. Aim: The aim of this article is to review the most commonly used forms of insulin therapy and modern technologies supporting the treatment of type 1 diabetes, with attention to their effectiveness, safety, and impact on patients’ quality of life. Methods: A search of PubMed and ScienceDirect was performed for publications from January 2008 to June 2025. The review included clinical trials and review articles about insulin therapy in type 1 diabetes. Titles and abstracts were screened, full texts were analysed, and reference lists of key papers were checked. Results: Modern insulin therapy is based on insulin analogues with different action profiles and on delivery systems such as insulin pens, pumps, and hybrid closed-loop devices. New basal and prandial analogues help improve glycaemic control and reduce complications. Automated Insulin Delivery systems increase time in range and improve daily functioning. However, problems such as variability of insulin absorption, lipodystrophy, and high costs still remain. Conclusions: Although progress in insulin therapy has improved diabetes care, further research, better access to modern technologies, and further patient education is essential.

Introduction: Forest bathing (shinrin- yoku) is a Japanese practice, involving immersion in forested areas with engaging all five senses. Its potential preventive benefits have increasingly attracted interest within the international scientific community, since forest bathing appears to be a safe and low- cost complementary approach, while offering therapeutic value. This narrative review summarizes current evidence on the physiological and psychological benefits of forest therapy, with particular focus on its importance in the treatment of depression- a prevalent mental health disorder, that affects approximately 332 million people worldwide. Studies showed that forest bathing alleviates depressive symptoms, reduces stress, increases feelings of relaxation, happiness and overall mental well being, through several biological pathways, including serotonin modulation, oxytocin increase, cortisol reduction and increased parasympathetic activity. However, further high quality research is needed to clarify its clinical value and long term effects in the treatment of depression. Methodology: A narrative review of literature available in the PubMed database was undertaken, incorporating recent randomized controlled trials, cohort studies, and meta-analyses published in peer- reviewed journals. Articles were searched in English using key terms such as: forest bathing, shinrin- yoku, nature therapy, depression.

Premature graying of hair (PMGH) is a phenomenon resulting from the interaction of genetic, metabolic, and environmental factors, leading to melanocyte dysfunction in the hair follicle. This article discusses the key etiopathogenic mechanisms of PMGH, with particular emphasis on the roles of oxidative stress, micronutrient deficiencies, autoimmune processes, hormonal disorders, and metabolic alterations. Population data indicate that gender and ethnicity influence both the incidence and course of PMGH, while clinical observations suggest that it may serve as an early marker of endocrine, autoimmune, hematological, or cardiovascular disorders. Although the psychosocial burden varies, in many young individuals graying negatively affects their sense of attractiveness and overall mental well-being. Current therapeutic strategies include optimizing nutritional status, antioxidant supplementation, modulation of α-MSH pathways, as well as selected pharmacological treatments and phototherapy. Case reports confirm the possibility of partial or complete repigmentation. Despite a growing body of evidence, the pathogenesis of PMGH remains incompletely understood, highlighting the need for further research into the mechanisms underlying the reversibility of this process and the development of effective, targeted therapies.

Background: Chronic pelvic pain syndrome (CPPS) with vaginal dysbiosis is challenging to diagnose and can significantly affect women's health and daily life. Objective: To review recent research on the symptoms, diagnosis, and treatment of CPPS with vaginal dysbiosis, and to summarize new findings and clinical practices. Methods: Articles from PubMed, Scopus, and Google Scholar published between 2000 and 2025 were included. The review focused on original studies and systematic reviews involving adult women with CPPS and vaginal microbiota assessment. Case reports, non-English articles, and studies lacking vaginal microbiota analysis were excluded from the analysis. Data extraction and quality assessment were conducted using the Newcastle-Ottawa Scale and AMSTAR 2. Results: Women with CPPS and vaginal dysbiosis often experience persistent pelvic pain, sexual and urinary symptoms, and emotional distress. Diagnosis typically includes clinical examination, laboratory testing, and vaginal microbiota analysis using bacterial or genetic methods. Treatment may involve antibiotics, microbiota restoration, physical therapy, and mental health support. Advances in vaginal microbiome research and precision medicine are expected to shape future treatments.