Medicine and Public Health

Background:
Ectopic pregnancy (EP) occurs in up to 2% of all pregnancies, and its most common location is the fallopian tube. Treatment options include methotrexate (MTX), surgery and expectant management.

Material and methods:
This review synthesizes the most important studies investigating the effect of MTX therapy for EP on subsequent female fertility.

Results:
MTX treatment for EP does not seem to influence ovarian reserve. There are few studies and multiple discrepancies regarding tubal patency after MTX treatment. The pooled long-term rate of intrauterine pregnancies after MTX treatment was 69.6%, and of recurrent EP, 10.1%. MTX administered for EP treatment has a similar or better effect on subsequent fertility compared to surgery or expectant management.

Conclusions:
MTX administration for EP gives equal or better outcomes in terms of subsequent fertility compared to other treatment methods. However, the chances of pregnancy are lower than in the general population. Due to the small number of RCTs and studies with long-term follow-up, future research is needed to provide definitive conclusions.

Background:
Keratoconus, a progressive ectatic disorder of the cornea, presents significant challenges in clinical management due to its unpredictable progression and individualized nature. Advances in treatment modalities, particularly corneal cross-linking (CXL), have revolutionized the ability to halt disease progression. Yet, a significant gap remains in achieving personalized, outcome-driven interventions.

Material and methods:
Literature review

Results:
New personalized CXL approach based on theranostic biomarkers proved safe and effective in the treatment of KC and offers personalized approach to treat the disease.

Conclusions:
Theranostics technology integrated with advanced UV-A device for CXL procedure permits to deliver the precise therapeutical dose of riboflavin and personalized UV-A light amount for the photo-activation in the cornea. This real-time monitoring of riboflavin concentration in the cornea during CXL procedure permits to obtain better predictability of the final outcome on personal basis.

Background:
Gastroesophageal reflux disease (GERD) is a prevalent chronic gastrointestinal disorder causing significant symptoms and complications, with varying prevalence worldwide. It leads to substantial healthcare costs, particularly in the USA. Effective management relies on clear diagnostic evidence from endoscopy or reflux monitoring.

Material and methods:
The Montreal Consensus defines GERD based on symptoms and complications. Diagnosis can be complex, requiring various tools. GERD is categorized into esophageal and extra-esophageal syndromes, influencing diagnostic and therapeutic strategies. The Polish Society of Gastroenterology emphasizes history, clinical symptoms, and empirical PPI tests, supported by endoscopy, manometry, and pH monitoring.

Results:
Endoscopy is indicated for alarm symptoms or multiple risk factors, identifying hiatal hernias and esophageal inflammation. Manometry evaluates esophageal motor function before anti-reflux surgery, measuring LES pressure to exclude motility disorders.Twenty-four-hour pH monitoring with impedance is considered the gold standard in diagnosing GERD.

Conclusions:
GERD diagnosis and management need symptom assessment, empirical testing, and specific diagnostics like endoscopy, manometry, and pH monitoring for accurate diagnosis and effective treatment. These approaches ensure tailored management and improved patient outcomes.

Background:
Dengue fever remains a major health risk, with 100 to 400 million clinical cases occurring each year. TAK-003 a tetravalent live-attenuated vaccine, offers potential protection against all four dengue virus (DENV) serotypes (DENV-1, DENV-2, DENV-3, DENV-4), providing a new option for travelers to dengue-endemic areas.

Material and methods:
This paper examines the efficacy and safety of the TAK-003 dengue vaccine, with a focus on its potential to protect seronegative travelers visiting regions endemic to dengue. The analysis includes data from clinical trials assessing its performance in both seropositive and seronegative individuals, and its ability to prevent severe disease and hospitalizations.

Results:
TAK-003 dengue vaccine has shown high efficacy against DENV-1 and DENV-2, while efficacy against DENV-3 was comparatively lower, particularly in seronegative individuals. The vaccine is generally well-tolerated, with mild side effects such as injection site pain and headaches. Importantly, it offers strong protection against severe dengue cases and hospitalizations, making it a valuable tool for travelers.

Conclusions:
TAK-003 dengue vaccine provides high protection in dengue-endemic regions, particularly against DENV-1 and DENV-2. Protection is higher in seropositive individuals, likely due to prior infection. Vaccination is not recommended for travelers with no history of dengue fever. A booster dose study is under consideration.