Doxorubicin-Induced Cardiotoxicity (DIC) is a challenge in clinical settings, with limited therapeutic options. This research was designed to investigate the enhanced cardioprotective potential of combined silymarin and vitamin E therapy.

An in vivo approach was used in order to examine the efficacy of silymarin and vitamin E in protecting myocardial tissue from doxorubicin-induced damage. Doxorubicin was given intraperitoneally at a weekly dose of 5 mg/kg. This study analysed changes in body weight, markers of oxidative stress, inflammation and apoptosis, serum activity of lactate dehydrogenase and cardiac Troponin, in addition to the histological examination of heart tissue samples of the treated animals.

Doxorubicin administration caused a significant reduction in body weight and elevated serum levels of Lactate Dehydrogenase (LDH) and Troponin I compared to the control group (P<0.05). In cardiac tissue, doxorubicin treatment significantly increased malondialdehyde (MDA), Interleukin-6 (IL-6), Caspase-3, and the Bax/Bcl-2 ratio, while significantly decreasing superoxide dismutase (SOD) activity and Bcl-2 levels (P<0.001). The co-administration of silymarin and vitamin E significantly attenuated these biochemical alterations, maintained body weight, and restored oxidative and inflammatory markers to levels comparable to the control group. Histopathological examination revealed that the combination therapy effectively preserved myocardial architecture and reduced fibrosis and congestion compared to the doxorubicin-only group.

The present study confirmed that at the examined doses, silymarin and vitamin E exhibit a protective effect on the heart tissue against doxorubicin-induced toxicity.

Osteogenesis imperfecta (OI) is a congenital bone fragility disorder, in which 90% of patients have abnormalities in type 1 collagen. Cardiovascular complications, including valvular heart disease and vascular aneurysms, are reportedly comorbid with this disease.

Forty-three adult Japanese patients clinically diagnosed with OI were recruited. Participants underwent echocardiography, brain magnetic resonance imaging (MRI), and magnetic resonance angiography. We compared the prevalence of cardiovascular comorbidities with that of a healthy Japanese population using direct age-standardization and a one-sample binomial test.

The median age was 42.5 (IQR 37.4-53.5) years. OI severity was mild in 11, moderate in 11, and severe in 21 patients. Two patients had ⩾ moderate aortic regurgitation (moderate OI: 1; severe OI: 1), one patient had severe mitral regurgitation (moderate OI: 1), and another had previously received valvuloplasty for mitral regurgitation (mild OI: 1). The prevalence of valvular heart disease (9.3%) was significantly higher than that of the healthy Japanese population (0.8%) (p < 0.001). Five patients (11.6%) had unruptured intracranial aneurysms (UIAs) (mild OI: 2; severe OI: 3), and the prevalence was significantly higher than that of the healthy Japanese population (2.5%) (p < 0.005). Notably, two patients presented with both valvular heart disease and a UIA. Additionally, 27 patients (62.8%) had tortuosity in the intracranial arteries, and seven patients (16.3%) had significant cortical atrophy.

This study revealed an increased prevalence of valvular heart disease, UIAs, and possibly intracranial arterial tortuosity and cortical atrophy among adults with clinically diagnosed OI. Routine echocardiography, and brain MRI and MRA are recommended regardless of disease severity.

UMIN-CTR; UMIN000041901.

We have previously described how children with complex CHD access developmental and psychosocial services in Maine, most often beyond the reach of the surgical centre. In this follow-up study, we describe a similar pattern for children in Vermont. Of 406 at-risk children between 2017 and 2019, 37% had an encounter. Very few individuals underwent developmental assessment or psychological or neuropsychological testing (1-4%). Visit volume was highest for mental health assessments in children older than 5 years and occurred predominately in community clinics and private practices close to home.

Serdexmethylphenidate/dexmethylphenidate (SDX/d-MPH) is a novel methylphenidate formulation designed to provide rapid onset and sustained symptom control in attention-deficit/hyperactivity disorder (ADHD). This phase 3 study evaluated its efficacy, safety, and tolerability in Chinese children with ADHD.

This multicenter, randomized, double-blind, placebo-controlled bridging study enrolled children aged 6-12 years who met DSM-5 criteria for ADHD. The primary endpoint was least squares mean (LSM) change from baseline to week 3 in ADHD Rating Scale-5 (ADHD-RS-5) total score, an 18-item DSM-5-based scale rating symptoms from 0 (never/rarely) to 3 (very often). Secondary endpoints included change from baseline to week 4 in ADHD-RS-5, and weekly changes in Clinical Global Impressions-Severity (CGI-S), Clinical Global Impressions-Improvement (CGI-I), and Weekly Ratings of Evening and Morning Behavior-Revised (WREMB-R). Safety was assessed throughout the study.

Overall, 55 participants were randomized (SDX/d-MPH, n = 28; placebo, n = 27). At week 3, SDX/d-MPH demonstrated significantly greater improvement in ADHD-RS-5 total score versus placebo (between-group LSM change [standard error]: - 5.8 [2.58], p = 0.0292), with an effect size of 0.61, meeting the prespecified efficacy consistency criterion (≥ 0.25). At week 4, significant improvements versus placebo were observed across ADHD-RS-5 total score (- 8.4 [2.69]), inattention and hyperactivity-impulsivity sub-scores (- 4.4 [1.69] and - 3.7 [1.27], respectively), CGI-S (- 0.8 [0.28]), CGI-I (0.9 [0.27]), and WREMB-R total (- 3.7 [1.35]) and evening scores (- 3.2 [1.03]). Most treatment-emergent adverse events were mild to moderate, with no new safety signals.

SDX/d-MPH significantly improved ADHD symptoms and was generally well tolerated in Chinese children, supporting extension of global trial results to this population.

gov identifier: NCT06359899 (registered on 25 March 2024).

Since the escalation of the war in Ukraine in February 2022, more than six million Ukrainians have sought refuge across Europe, facing significant psychosocial strain. Disrupted social networks, family separation, economic uncertainty, and barriers to services contribute to elevated levels of anxiety, depression, and post-traumatic stress, particularly among women and single mothers who constitute the majority of refugees. Despite host countries' efforts to provide protection and basic services, access to mental health care remains limited due to overstretched systems, language barriers, bureaucratic hurdles, and culturally incongruent care models. While several psychological interventions have been proposed, their scalability and accessibility remain constrained. This commentary argues that peer support represents a promising yet underutilized complement to existing mental health responses. Grounded in shared lived experience, peer-led approaches can foster social connection, emotional validation, and practical guidance while helping to reduce some barriers to formal care. Integrating structured peer-support programs into mental health strategies may help address service gaps and strengthen resilience among Ukrainian refugees in Europe.

Emotional support animals (ESAs) may provide companionship and psychological support to individuals with mental health conditions, and dermatologists may encounter patients requesting ESA documentation or seeking to bring an animal into the clinical setting. These situations raise distinct ethical, legal, and practical considerations. Unlike service animals trained to perform disability-related tasks, ESAs do not have the same federal public-access protections. This paper provides a framework to help dermatologists distinguish service animals from ESAs, evaluate requests for ESA documentation, determine when additional evaluation is needed, and manage animal-access questions in clinical settings. A proportionate approach can support patients with disability-related needs while maintaining appropriate professional boundaries and consistent clinical practice.

Mental health and resilience change rapidly early in substance use disorder (SUD) treatment. However, these processes have not been characterized among Native Hawaiian and Pacific Islander (NHPI) patients, despite disproportionate trauma exposure and treatment barriers. Examining how posttraumatic stress disorder (PTSD) symptoms, optimism, and quality of life satisfaction fluctuate during early treatment may help improve care. This study investigated within- and between-person associations among PTSD, optimism, and life satisfaction over the first month of treatment.

From 2021 to 2024, N = 180 NHPI patients completed up to four weekly surveys assessing PTSD symptoms, optimism, and life satisfaction. Mixed-effects models with random intercepts separated predictors of PTSD symptoms into between- and within-person effects, controlling for treatment week. We estimated single-predictor models for life satisfaction and optimism, a combined model including both, and a covariate-adjusted combined model.

Across models, less severe PTSD symptoms were associated with higher mean (between-person) and week-to-week (within-person) optimism and life satisfaction. In the covariate-adjusted combined model, lower PTSD severity remained associated with higher mean optimism (b = -0.12, SE = 0.02, p < .001), higher mean life satisfaction (b = -0.05, SE = 0.02, p < .001), and higher-than-usual week-to-week levels of optimism (b = -0.06, SE = 0.01, p < .001) and life satisfaction (b = -0.03, SE = 0.01, p = .007).

During early treatment, higher between-person and week-to-week (within-person) optimism and life satisfaction were consistently associated with lower PTSD severity. Findings suggest that strengths-based factors are important considerations when delivering trauma-informed, culturally responsive care to NHPI patients in early recovery.

Self-rated health status may be considered a good predictor of morbidity and mortality and is useful for understanding the sociodemographic, environmental, and clinical conditions associated with self-rated health.

The aim of the study is to analyze self-rated health status in the population of medical workers in Georgia and its relationship with socio-economic characteristics, lifestyle, clinical status, and work-related characteristics.

The study included 471 participants aged 18 to 83 years (48+15), including 351 women and 120 men. All participants completed a self-administered questionnaire that included socio-economic characteristics, lifestyle, clinical status, and job characteristics. Health was assessed by respondents as poor, average, good, or very good. Statistical analysis was performed using the SPSS 23 software package.

More than half of the study participants rated their health as average, 34% as good, and only a small proportion as very good and poor, namely 6% and 5%, respectively. The odds ratio of good or very good self-rated health increase with Physician - p=0.0320, OR=1.65 (95%CI:1.04-2.60); Therapist - p=0.0250, OR=1.94 (95%CI:1.09-3.46); Underweight - p=0.0190, OR=1.69 (95%CI:1.09-2.60) and decrease with Age - p<0.0001, OR=0.97 (95%CI:0.96-0.99); Professional burnout - p<0.0001, OR=0.33 (95%CI:0.18-0.58); Other workplace stress - p=0.0060, OR=0.48 (95%CI:0.28-0.81); Alcohol - p=0.0080, OR=0.20 (95%CI:0.06-0.66); Physical inactivity - p=0.0390, OR=0.63 (95%CI:0.40-0.98); Oncological Diseases - p=0.0230, OR=0.08 (95%CI:0.01-0.70); Fast food - p=0.0070, OR=0.55 (95%CI:0.35-0.85).

Self-rated health among medical workers in Georgia is associated with psychosocial as well as behavioral and clinical factors-professional burnout, work stress, mental health problems, insomnia, overweight and physical inactivity, unhealthy eating behaviors, and self-medication. The relative odds of good and very good self-rated health increase with underweight status and the professional factors of being a physician and a therapist, and decrease with age, professional burnout, workplace stress, alcohol consumption, fast food, physical inactivity, and oncological diseases.

Medical students carry a heavier psychological burden than the general student population, and data from Georgia and the South Caucasus region are scarce. The present study aimed to describe levels of perceived stress, anxiety, and sleep disturbance among medical students at five universities in Tbilisi, Georgia, and to compare these outcomes across years of undergraduate medical training.

A cross-sectional observational study enrolled 300 medical students from five universities, all located in Tbilisi, Georgia, using stratified purposive sampling rather than random selection (n = 60 per institution; n = 50 per year of study). Data were collected face-to-face during March-April 2026 using the English-language versions of three validated self-report instruments: the Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorder scale (GAD-7), and the Pittsburgh Sleep Quality Index (PSQI). Analyses included Pearson correlations, independent-samples t-tests, and one-way analysis of variance (ANOVA) with Tukey post-hoc comparisons. Ethics approval was obtained from the Research Development and Support Department of Georgian American University (No. #ethc-00012026).

The mean PSS-10 score was 26.20 (SD=8.19); 96.3% of students fell in the moderate-to-high stress range. The mean GAD-7 score was 13.45 (SD=5.72); 73.7% met criteria for moderate-to-severe anxiety. A total of 58.0% reported fairly or very bad sleep quality. All three outcomes were significantly intercorrelated: PSS-10 vs. GAD-7 (r=0.736, P<0.001); PSS-10 vs. PSQI disturbance (r=0.561, P<0.001). Senior students (years 4-6) reported significantly higher stress than junior students (years 1-3): t(298)=-5.379, P<0.001, Cohen's d=0.62. One-way ANOVA showed higher scores in successive years of study: F(5,294)=8.220, P<0.001, η²=0.123, with the highest mean in year 6 (29.84).

Psychological distress was highly prevalent in this sample, and stress scores were higher in later years of study. Year 3, when students move from preclinical to clinical training, marked the point at which scores began to rise. Because the sample was purposive and limited to Tbilisi, the findings should not be generalized to all medical students in Georgia. Within these limits, the results support routine mental health screening and stronger support services at the participating universities.

This study aimed to assess changes in stress levels in the dental environment among students over a three-year period and to investigate associations with gender and academic level. A total of 149 students from a public university in southern Brazil completed the Dental Environment Stress (DES) questionnaire between 2020 and 2023, where higher scores reflect greater perceived stress. Stress evolution was evaluated using delta (Δ) scores (2023 minus 2020), meaning positive values indicate an increase in stress over time. Associations were tested by paired t-test and by adjusted linear regression. Most of participants were women (66.4%) and enrolled in undergraduate programs at baseline. Although women had higher absolute DES scores, men and undergraduate students showed greater increases over time. In addition to the total DES score, significant increases over time were observed in two specific domains: Patient Responsibilities (Δ = +3.94 ± 4.33 for men [p < 0.001] vs. +2.85 ± 4.95 for women [p < 0.001]) and Institutional Factors (Δ = +4.98 ± 6.18 for men [p < 0.0p1] vs. +2.26 ± 7.26 for women [p = 0.003]). In the adjusted models, men gender (β = 8.99; 95% confidence interval [CI]: 0.22-17.76) and undergraduate status (β = 13.36; 95% CI: 3.79-22.94) remained significantly associated with greater delta changes in DES scores. These findings suggest that the return to in-person clinical and academic activities after the pandemic may have affected students differently, depending on gender and academic level.