Medycyna Faktow (J EBM)

2025 update of the 2019 ESC/EAS guidelines for the management of dyslipidaemia. Ten key changes and their practical implications

Marcin Barylski, Stanisław Surma — Sun, 30 Nov 2025 00:00:00 +0100

In 2025, the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) presented updated guidelines for the management of dyslipidemia, supplementing the 2019 recommendations. This document reflects the latest advances in both cardiovascular risk assessment and lipid-lowering treatment strategies. It includes, among other things, updated SCORE2 and SCORE2-OP prediction models, an emphasis on early risk stratification and intensification of therapy in patients at high and very high risk, and an expansion of therapeutic options with new medications. The guidelines also present recommendations for the treatment of dyslipidemia in patients with HIV infection and in the oncology population. The overall document emphasizes the need for a comprehensive and personalized approach to cardiovascular disease prevention. This article presents ten key changes in the updated ESC/EAS guidelines, which have significant practical implications.

Practical guidance on the use of rivaroxaban 2,5 mg twice daily in patients at high risk of atherosclerotic cardiovascular complications – perspectives from a cardiologist, a family medicine specialist, and a vascular surgeon

Marcin Grabowski, Agnieszka Mastalerz-Migas, Zbigniew Krasiński — Sun, 30 Nov 2025 00:00:00 +0100

This article presents a multidisciplinary overview of the practical use of rivaroxaban 2.5 mg twice daily in patients at high risk of atherosclerotic cardiovascular complications. The clinical rationale for this therapy is discussed, with emphasis on evidence from the COMPASS and VOYAGER PAD trials, which demonstrated that combining rivaroxaban with acetylsalicylic acid effectively reduces myocardial infarction, stroke, and cardiovascular mortality. Patient selection criteria for chronic coronary syndrome and peripheral arterial disease are summarized, along with practical implications for cardiologists, vascular surgeons, and family medicine specialists. The article highlights the importance of early initiation of therapy, careful assessment of bleeding risk, monitoring of renal function, and patient education. Rivaroxaban 2.5 mg twice daily combined with ASA is presented as an effective, safe, and guideline-recommended long-term secondary prevention strategy for patients with multivessel atherosclerosis and PAD.

How to recognize and treat depression in primary care?

Dominika Dudek — Sun, 30 Nov 2025 00:00:00 +0100

Depression is one of the most common mental disorders, with an increasing prevalence – it affects over 10% of the population, with women being affected approximately twice as often as men. In primary care practice, patients with depression account for around 20% of visits, often presenting with somatic symptoms, persistent insomnia, or coexisting chronic diseases. Depression manifests with diverse affective, cognitive, behavioral, and somatic symptoms. The dominant symptom is low mood and anhedonia, often accompanied by guilt, apathy, and a negative view of oneself, the world, and the future. Frequent somatic symptoms can complicate diagnosis, especially in cases of masked depression. Diagnosis is based on ICD-11 criteria and an assessment of the patient’s mental state. In primary care, screening tools such as PHQ-2 and PHQ-9 are useful for the preliminary detection of depression and assessment of its severity. Most patients can be treated in primary care. Referral to a psychiatrist is recommended for patients with severe, chronic, or treatment-resistant depression, those at risk of suicide, during pregnancy, or in complex clinical situations. The goal of treatment is rapid and complete symptom remission, prevention of relapse, and a return to pre-illness functioning. Treatment of mild and moderate depressive episodes includes pharmacotherapy and/or psychotherapy. For moderate to severe depression, the foundation of treatment is antidepressant medication, supplemented as needed with psychotherapy or adjunctive drugs.

Combination therapy with atorvastatin and ezetimibe – its place in contemporary lipidology

Stanisław Surma, Michał Holecki, Marcin Barylski — Sun, 30 Nov 2025 00:00:00 +0100

Hypercholesterolaemia represents the most prevalent modifiable risk factor for cardiovascular disease in Poland, with only a small proportion of patients achieving target LDL cholesterol levels. Atorvastatin, a potent statin, effectively lowers LDL cholesterol and significantly reduces the incidence of cardiovascular events such as myocardial infarction and stroke. Its pleiotropic effects include endothelial improvement, anti-inflammatory action, and renal protection. The addition of ezetimibe to statin therapy produces an additional 20–25% reduction in LDL cholesterol concentrations without increasing adverse effects. Combination therapy with atorvastatin and ezetimibe decreases all-cause and cardiovascular mortality as well as the occurrence of major adverse cardiovascular events. This therapeutic approach is particularly indicated in patients at high and very high cardiovascular risk, especially those with diabetes mellitus, chronic kidney disease, or intolerance to high-dose statin therapy, constituting a fundamental element of contemporary lipid management.

Difficulties in choosing analgesic treatment in antidepressants treated patient

Anna Antosik-Wójcińska, Jarosław Woroń — Sun, 30 Nov 2025 00:00:00 +0100

Pain is a symptom of many diseases, including depression. It can be a component of depression itself, as well as a mask for it. In turn, depression itself increases sensitivity to pain. This means that pain treatment must be taken into account in the treatment of a patient with depression. Non-steroidal anti-inflammatory drugs are the most commonly used group of analgesics, but their long-term use is associated with the risk of hemorrhagic complications, which can be exacerbated by certain SSRI antidepressants. For this reason, it is important to use drugs with the least potential to cause hemorrhagic complications and interact with each other in the treatment of depressive pain. Etoricoxib does not increase the incidence of clinically relevant interactions with antidepressants and, as a coxib, has a reduced risk of causing hemorrhagic complications. In addition, in the context of the inflammatory hypothesis of depression, its use may support the treatment of depression.

Naproxen – known and unknown faces of a non-steroidal anti-inflammatory drug in clinical practice. Part II

Magdalena Bitner-Bieleszuk, Adrian Bryła, Magdalena Kocot-Kępska — Sun, 30 Nov 2025 00:00:00 +0100

Naproxen is a well-known, prescription and over-the-counter nonsteroidal anti-inflammatory drug (NSAID), whose analgesic, anti-inflammatory, and antipyretic properties are used in the treatment of numerous pain syndromes, both acute and chronic. Its pharmacological activity includes, in addition to inhibiting cyclooxygenases, other multifaceted mechanisms of action, including blocking purine receptors and antiviral effects confirmed in in vitro and human studies. Numerous clinical studies have confirmed its effectiveness in the treatment of conditions such as rheumatoid arthritis, osteoarthritis, gout, nonspecific low back pain, primary menstrual pain, headaches, and fever. Its relatively rapid analgesic effect, long half-life, and well-established safety profile among NSAIDs make it an effective drug used in everyday medical practice. This paper presents key aspects of naproxen, including its mechanisms of action, possible side effects, efficacy and safety in pain relief in many conditions, as well as in the treatment of fever and colds.

Why do I choose esomeprazole to treat acid-dependent diseases?

Maria Janiak — Sun, 30 Nov 2025 00:00:00 +0100

Proton pump inhibitors are the strongest medications used in the treatment of acid-dependent gastroenterology diseases that inhibit the secretion of hydrochloric acid in the stomach. The strength of the proton pump inhibitors is different in each patient and is caused by genetic conditions, metabolic differences dependent of cytochrome P450 (CYP) and also dependent of the type of acid inhibitor substance. Esomeprazole is a S-isomer of the omeprazole and it is metabolized in the liver more slowly than omeprazole, the consequence of this process is longer-lasting and higher blood concentration of the medication.

The reasons why I choose biotin

Paulina Szczepanik-Kułak — Sun, 30 Nov 2025 00:00:00 +0100

The skin is the first line of defense that protects the human body from the effects of damaging external factors. Undoubtedly, the appearance of the skin depends on many factors, including lifestyle and diet. The importance of micronutrients such as vitamins and minerals for skin well-being is well known.

Biotin, also known as vitamin B7 or vitamin H, is a member of the B vitamin family. In mammals, biotin serves as an essential cofactor for four biotin-dependent carboxylases, all of which are crucial for cellular metabolism: fatty acid synthesis, gluconeogenesis and branched-chain amino acid catabolism. In addition, biotin is also an essential cofactor for mitochondrial carboxylases in hair follicles, and modulates the production of pro-inflammatory cytokines in the immune system. In the dermatological aspect, biotin has been suggested to be involved in disorders involving hair (excessive loss), nails (excessive brittleness), and skin (seborrheic dermatitis). In addition, biotin has been shown to play a beneficial role in reducing excessive skin dryness in patients using isotretinoin.

The following article outlines the benefits of biotin and the indications for its use.

Amoxicillin with clavulanic acid – therapeutic signposts

Adam J. Sybilski, Weronika Balas — Sun, 30 Nov 2025 00:00:00 +0100

Amoxicillin with clavulanic acid is a frequently used antibiotic for the treatment of respiratory tract infections in children, especially when amoxicillin alone is insufficient. In the treatment of acute otitis media, the introduction of pneumococcal vaccines has changed the epidemiology, increasing the involvement of β-lactamase-producing bacteria, such as Haemophilus influenzae and Moraxella catarrhalis. Although amoxicillin remains the first-line treatment, amoxicillin with clavulanic acid is recommended for acute otitis media in children aged 6 months to 12 years, particularly when β-lactamase-producing bacteria are suspected, amoxicillin treatment has failed, recurrent infections occur, or in patients at risk. In daily practice, the combination of amoxicillin with clavulanic acid at a concentration of 90 mg/6.4 mg/kg/24 h is very helpful in severe infections. Strengthening the profile by increasing the amoxicillin dose expands the spectrum of amoxicillin’s antibacterial activity to most penicillin-resistant strains, including strains with elevated amoxicillin minimum inhibitory concentrations. In the case of community-acquired pneumonia, amoxicillin with clavulanic acid is crucial in situations where narrow-spectrum antibiotics are insufficient. It is considered when β-lactamase-positive bacteria are suspected, amoxicillin treatment has failed, or in hospitalized children with moderate to severe community-acquired pneumonia of unknown etiology. The duration of community-acquired pneumonia therapy is typically 5–10 days. Rational use of this antibiotic, according to guidelines, is crucial to minimize the development of antibiotic resistance.

Comparison of the role of sitagliptin and sulfonylureas in the treatment of type 2 diabetes

Michał Skrzypek, Bernadetta Fałkowska — Sun, 30 Nov 2025 00:00:00 +0100

Sitagliptin and sulfonylureas in the pharmacological management of type 2 diabetes represent a group of secretagogues, that is, drugs that stimulate pancreatic β cells to secrete insulin. In current therapeutic regimens for type 2 diabetes, these agents are primarily used for therapy intensification, enhancing the hypoglycemic effect of previously introduced medications. However, they differ significantly in terms of safety profile and potency: sitagliptin, unlike sulfonylureas, does not carry a risk of hypoglycemia and does not lead to weight gain, though it provides a weaker glucose-lowering effect. Therefore, sitagliptin represents a valuable therapeutic option for overweight patients, not treated with GLP-1 receptor agonists or tirzepatide, and for those with cardiovascular disease or other comorbidities that increase susceptibility to the adverse effects of hypoglycemia.

Microbiota under the microscope of a gastroenterologist. In what situations should you reach for probiotics?

Dorota Waśko-Czopnik — Sun, 30 Nov 2025 00:00:00 +0100

Our knowledge of probiotics remains insufficient, despite new research and recommendations for their use. The pharmaceutical market offers a wide range of products with varying indications and compositions, making it often difficult to choose the right one. The following article provides a synthesized overview of the effects probiotics have on the body, as well as suggestions that can help guide the selection of the right product, leading to better therapeutic outcomes.

The role of the psychobiotic Lactobacillus plantarum PS128 in the modulation of autism spectrum symptoms

Anna Antosik-Wójcińska, Amelia Jankowska — Sun, 30 Nov 2025 00:00:00 +0100

In recent years, we have observed a growing interest in the relationship between gut microbiota and the functioning of the central nervous system, as well as the role of the gut-brain axis in integrating neural, hormonal, immune, and metabolic signals. This interest has translated into a growing number of publications confirming the beneficial effects of psychobiotics in the treatment of mental disorders. While previous studies focused on patients with mood disorders, recently published research confirms that psychobiotics can also support the treatment of autism spectrum disorders, including the pediatric population. Scientific evidence indicates that the Lactobacillus plantarum PS128 strain, in particular, can alleviate symptoms associated with disruptive and rule-breaking behaviors and have a beneficial effect on hyperactivity and impulsivity, symptoms that have the most disruptive impact on the functioning of individuals with autism spectrum disorders. What is particularly important, these effects seem to be more significant in the population of younger children, for whom we are still looking for an effective model of early therapeutic and pharmacological intervention that would give the greatest chance of correcting disorders of social interactions, communication, stereotyped patterns of behavior and activity.

When do I choose omeprazole and when famotidine?

Miłosz Caban, Ewa Małecka-Wojciesko — Sun, 30 Nov 2025 00:00:00 +0100

The article discusses the most common indications for therapy with omeprazole or famotidine. Particular attention was paid to the profiles of patients with the particular indications for omeprazole versus famotidine.

Superficial fungal infections

Katarzyna Rychlik, Dorota Purzycka Bohdan, Roman J. Nowicki — Sun, 30 Nov 2025 00:00:00 +0100

Superficial fungal infections are common worldwide, mainly caused by dermatophytes, yeasts (Candida spp.), and occasionally non-dermatophyte molds. They affect about 20–25% of the population, with risk factors including immune deficiencies, environmental conditions, and socioeconomic status. Clinically, they present as well-demarcated, itchy, scaly lesions on smooth skin and the scalp, as well as changes in the nail plates, causing physical discomfort and psychosocial problems. Dermatophytes are classified as anthropophilic, zoophilic, or geophilic, each with unique epidemiology and clinical features. Common infections include tinea capitis, corporis, pedis, cruris, manuum, barbae, and onychomycosis. Diagnosis is based on a clinical examination, which should be supported by microscopic analysis and/or culture, and less commonly by PCR or, in some cases, the use of a Wood’s lamp. Treatment primarily involves the use of topical antifungal agents, such as imidazoles, allylamines, and ciclopiroxolamine, while in severe cases, systemic antifungal therapy is employed. New formulations of antifungal drugs (e.g., nanogels) enhance efficacy and improve treatment adherence. Accurate diagnosis and treatment are essential to prevent recurrences and complications.

How to support natural immunity during infectious periods? The role of the brain-gut axis in maintaining the body’s immunity

Dorota Waśko-Czopnik — Sun, 30 Nov 2025 00:00:00 +0100

A weakened immune system is most common during the fall and winter months. Typically, previous viral or bacterial infections and medications such as anti-inflammatory drugs and antibiotics also negatively impact the immune system. This deficiency can be further exacerbated by poor diet, stimulants, or chronic illnesses. Supplementation with carefully tested probiotics and butyric acid is a solution to restoring the proper microbiota composition and functioning of the brain-gut axis. These improve not only the immune system but also the functioning of the gastrointestinal tract, which is impaired by dysbiosis.

Diarrhea – more effective and safer in accordance with WHO and ESPGHAN guidelines

Piotr Albrecht — Sun, 30 Nov 2025 00:00:00 +0100

Diarrhea, especially acute diarrhea, is one of the most common reasons for medical consultations, both in children and adults. According to the WHO, there are 2 billion episodes of acute diarrhea worldwide each year. Diarrhea requires treatment that is appropriate to the patient’s condition – primarily symptomatic therapy, such as rehydration – because regardless of the cause, it can lead to dehydration, electrolyte imbalances (hypokalemia, hypernatremia, hyponatremia), acid-base disturbances (most commonly metabolic acidosis), wasting, and in some cases even death. The most frequent causes of acute diarrhea are infectious agents, most of which resolve spontaneously with proper hydration. Chronic diarrhea has many causes, but these are not the primary focus of this paper. In cases where dehydration is classified as mild to moderate (body weight loss <9%), rehydration can usually be managed with oral rehydration solutions. Despite their simplicity, oral rehydration solutions are considered one of the greatest achievements in medicine. The correct ratio of sodium to glucose enables the use of the sodium-glucose cotransport mechanism to promote the absorption of water and electrolytes, compensating for losses even in the most severe cases of diarrhea – such as cholera. Studies have shown that the effectiveness of oral rehydration solutions can be enhanced by the addition of diosmectite, which may reduce the duration of diarrhea by up to two days.

The practical benefits of SPC combination therapy, or how to improve patient adherence? Clinical case studies

Maciej Janiszewski, Marek Kuch — Sun, 30 Nov 2025 00:00:00 +0100

Fixed-dose single-pill combination therapy has long been a mainstay of hypertension management, enabling more rapid attainment of treatment targets and improving long-term outcomes. Single-pill combinations are increasingly employed in other indications as well, such as the treatment of dyslipidaemia and heart failure. The spectrum of available combinations is expanding – beyond the traditional pairings of renin–angiotensin system blockers with calcium-channel blockers or thiazide/thiazide-like diuretics, new options are being introduced. One combination that may be a valuable choice in selected clinical scenarios is a single-pill angiotensin-converting enzyme inhibitor with a β-adrenergic blocker. This article presents two clinical cases in which a ramipril–bisoprolol single-pill combination proved advantageous, substantially improving medication adherence and treatment effectiveness.

When is cefixime the best choice? Clinical decisions based on the patient profile

Adam J. Sybilski — Sun, 30 Nov 2025 00:00:00 +0100

Cefixime, an oral third-generation cephalosporin, holds a strategic position in rational antibiotic therapy, particularly amid rising antimicrobial resistance. Its selection is driven by its unique pharmacological profile and specific patient needs, especially within the pediatric population. Key advantages:
1. Stability and spectrum – it demonstrates enhanced resistance to β-lactamases, making it effective against resistant strains of H. influenzae, M. catarrhalis, and E. coli. It provides a broad spectrum of activity against key pathogens causing urinary tract infections and respiratory tract infections.
2. Compliance – its pharmacokinetics allow for once-daily dosing, which significantly improves treatment adherence (compliance), particularly in children where an easy-to-administer suspension is available.

Optimal clinical applications (in pediatrics):
1. Step-down therapy – it is ideal for continuing intravenous treatment orally (e.g., following ceftriaxone) in cases of acute pyelonephritis in children. This approach allows for reduced hospitalization time while maintaining full efficacy.
2. Respiratory tract infections with resistance risk – it is a drug of choice for acute otitis media, especially after amoxicillin failure, due to its stability against β-lactamases.
3. Penicillin allergy – it serves as an effective alternative (e.g., in the 10-day treatment of streptococcal pharyngitis) for children with a documented penicillin allergy.

Cefixime is the optimal choice when effectiveness against βlactamase-producing pathogens and maximal dosing convenience are required.

Profiles of patients with non-receptor pain treated with pregabalin

Monika Białecka — Sun, 30 Nov 2025 00:00:00 +0100

This article discusses the use of pregabalin in the treatment of non-nociceptive pain, particularly neuropathic and nociplastic pain, as well as its role in the treatment of generalized anxiety disorder and epilepsy. The drug’s mechanism of action and clinical efficacy are presented using two case studies of patients with different pain profiles and comorbidities. Pregabalin, with its good safety profile and documented efficacy, is an important therapeutic tool in the treatment of complex pain syndromes, especially in patients with multimorbidity.