Cocaine use is occasionally associated with development of acute leukoencephalopathy but only rarely do the magnetic resonance imaging (MRI) features resemble Baló concentric sclerosis, a demyelinating disorder traditionally considered within the multiple sclerosis spectrum. Here, we report 2 patients with history of cocaine use living in the same geographic area who were referred for acute multifocal leukoencephalopathy with a Baló-like pattern.Patient 1, a 31-year-old woman originally from the Philippines with chronic cocaine use history, presented with 1 week of rapidly worsening nonfluent aphasia, neglect, severe right hemiparesis, and numbness on the same side. Two months later, patient 2, a 25-year-old man originally from Morocco with chronic cocaine use history, presented with acute left leg weakness, confusion, and neglect. In both patients, brain MRI revealed multiple T2-hyperintense rounded lesions in the white matter, characterized by a concentric target-like appearance and gadolinium-enhanced incomplete ring pattern. In patient 1, a stereotactic biopsy confirmed a demyelinating inflammatory process with microcystic degeneration, increased cellularity, and macrophage/CD4+ lymphocyte infiltration. Both patients were treated with high-dose IV corticosteroid, resulting in significant clinical and radiologic improvement sustained at 1-year follow-up. Although corticosteroids yield promising outcomes, long-term prognosis hinges on sustained treatment adherence and abstinence from cocaine.The temporal and geographic proximity of these cases, occurring within 2 months in the same Italian province (covering an area of approximately 70 miles), raises the possibility of a shared toxic exposure which might explain the unique pathology and provide clues to the immune mechanisms that drive Baló-like demyelination.

Parental miscarried helping, self-efficacy, and treatment adherence among adolescents and young adults with epilepsy: A mediation model.

Introduction: Schizophrenia is a complex mental health disorder characterised by variable treatment responses. Previous research has explored factors influencing patient experiences; however, the understanding of how modifiable and non-modifiable factors relate to treatment effectiveness remains limited and, at times, inconsistent. Aim: To explore how the sociodemographic and clinical factors influence illness severity, treatment outcomes, and functional adjustment in work and social domains in patients with Schizophrenia. Materials and Methods: The present cross-sectional observational study was conducted at Sree Balaji Medical College and Hospital, Chennai, India, from July 2022 to July 2023, on 74 schizophrenia patients with at least six months of follow-up. The study assessed sociodemographic factors, treatment adherence, and illness severity in relation to therapeutic outcomes and social adaptation. Data were analysed using Epi Info software version 7, applying Mann-Whitney, Chi-square, and Wilcoxon signed-rank tests, with a significance level set at p <0.05. Results: The current study included individuals diagnosed with schizophrenia spectrum disorders (mean age: 36.1 years), with balanced gender distribution. Most participants were unemployed (71.6%) and married (59.5%). A significant reduction in illness severity was observed post-intervention (p <0.001). Demographic variables such as age, sex, and marital status showed no significant differences; however, marked and severe illness was associated with lower treatment efficacy (p<0.001) and poor resilience (p=0.001). Treatment response assessed via effectiveness index and global improvement categories. Treatment effectiveness was significantly associated with factors such as employment status (p=0.028), illness severity (p<0.001), age of illness onset (p=0.021), Higher Mental Function (HMF) (p=0.002), insight (p=0.007), resilience (p=0.019), and antipsychotic dose (p=0.041). Global improvement was significantly associated with factors such as employment status (p=0.012), illness severity (p<0.001), age of illness onset (p=0.035), HMF (p=0.003), insight (p=0.037), resilience (p<0.001), and treatment adherence (p=0.023). Individuals with milder illness, better insight, preserved HMF, higher resilience scores, and active treatment adherence showed more favourable outcomes. Functional impairment was significantly greater among those with inadequate treatment response and higher illness severity, particularly affecting work, home management, leisure, and interpersonal relationships (p<0.001). Despite overall improvement, a subset of patients continued to experience residual functional limitations, highlighting the link between treatment effectiveness and real-world functioning. Conclusion: According to the present study results, higher resilience, good insight, employment and strong family support are the key factors associated with better outcomes. The study also supports the role of early intervention, sustained treatment engagement and a recovery oriented approach for better clinical and psychosocial care.

Treatment Persistence and Adherence with Overactive Bladder Medications in Taiwan: A Retrospective Database Analysis.

New conversations in an old argument: Lessons learnt from the PIONEER randomised feasibility study in resectable stage III-N2 NSCLC.

It is estimated that, globally, the mean point prevalence of diagnosable mental disorders in children and adolescents is higher than 11%, and around half of cases of major mental disorders have their onset before the age of 18. Mental disorders with onset in childhood or adolescence have an enormous impact on the developing brain, body and personal identity, as well as on the short- and long-term social, educational and functional capacity of individuals. Child and adolescent psychiatry - as a discipline, profession, academic field, and network of clinical services - is still relatively young, with its formal evolution beginning in the 20th century. Therefore, it is not surprising that there are currently many challenges, but also opportunities and expected future developments, in this area. In this paper, we identify and address the core challenges, possible solutions, opportunities, and future directions of child and adolescent psychiatry. In the first part of the paper, challenges and possible solutions are discussed regarding diagnostic issues, stigma, access to care, shortage of mental health professionals, evidence-based treatments, treatment adherence, parental participation/engagement, integration with schools, digital influences and cyberbullying, and war/forced displacement. In the second part, opportunities and developments are addressed that relate to early identification and intervention, resilience, interdisciplinary collaborations, integration with primary care, community-based approaches, use of digital technologies, precision child and adolescent psychiatry, artificial intelligence and related ethical issues, and cultural diversity and competences. Despite the significance and impact of mental disorders in children and adolescents, clinical delivery and research on these conditions remain underfunded and underprioritized, even in high-income countries, with clinical services and prevention/early intervention research receiving minimal investment. Addressing mental health in children and young people requires multi-level strategies beyond individual treatment, including tackling structural and socioeconomic barriers and creating opportunities for strengthening resilience and well-being. A well-trained workforce, adequate policies, and increased public awareness are crucial. Overall, the current gaps demand urgent action and global funding rebalancing to more adequately meet the critical needs of children and young people challenged by mental illness.

Diabetes mellitus is associated with a high burden of mental health issues, including both formal psychiatric disorders, such as depression and anxiety, and diabetes-specific psychological challenges like diabetes-related distress, psychological insulin resistance, and fear of hypoglycemia. These mental health difficulties significantly impair self-management, treatment adherence, and quality of life, increasing the risk of complications and mortality. The paper reviews the bidirectional relationship between diabetes and mental disorders, driven by biological and behavioural mechanisms. It highlights the high prevalence of depression, anxiety, cognitive impairment, and eating disorders among people with diabetes. The consequences of untreated mental health conditions include poor glycemic control, greater healthcare costs, increased hospitalization, and lower health-related quality of life. The review presents a range of evidence-based management strategies, including early screening, psychological and pharmacological interventions, lifestyle changes, and integrated collaborative care models. Particular emphasis is placed on the role of physicians and endocrinologists in recognizing and managing psychological difficulties. The paper also discusses challenges in low-resource settings and underscores the need for culturally adapted accessible interventions. It argues for a paradigm shift towards integrated, person-centred care models that address both physical and mental health needs in diabetes, offering practical recommendations for clinicians and policymakers.

There is a bidirectional relationship between epilepsy-related stigma (ERS) and medical outcomes. ERS negatively influences treatment adherence and disease management, whereas insufficient medical improvement can, in turn, exacerbate ERS. ERS remains a significant challenge, often leading to delays in diagnosis, limiting appropriate therapies, and creating difficulties in social integration for patients with epilepsy. Even when treatment successfully achieves seizure cessation, failure to address ERS can limit patient social integration, reduce quality of life, and hamper long-term psychosocial recovery. Previous studies suggest that a holistic and personalized medicine approach that addresses both the medical and psychosocial aspects of epilepsy, with a particular focus on reducing ERS, can significantly improve diagnosis and treatment outcomes. Integrating culturally sensitive mental health support and community-specific advocacy initiatives targeting ERS reduction into the routine management of epilepsy can promote clinical and psychosocial outcomes and help patients in their reintegration into normal daily life. Key initiatives may include personalized counseling to mitigate the emotional and psychological impact of ERS, targeted cultural competency training for healthcare professionals, and public awareness campaigns. Integrating these strategies into comprehensive epilepsy care is particularly important for marginalized populations, where poverty and limited healthcare access exacerbate ERS. A personalized anti-ERS plan that integrates individualized clinical management with targeted interventions designed for the specific ERS experiences of each patient can improve treatment adherence, enhance cognitive and emotional well-being, and promote better social integration by addressing both the psychological and social dimensions of ERS.

Women's biopsychosocial experiences following embryo transfer: A qualitative study.

Vascular Age: A narrative review of assessment methods, clinical applications, and future directions.

Effects of dignity therapy on psychological and behavioral outcomes in patients with end-stage renal disease undergoing hemodialysis: A randomized controlled trial.

This article presents a state-of-the-art review of wrist rehabilitation systems based on wearable sensory gloves and gamification approaches. It examines how these technologies can support functional recovery of the wrist and addresses the need for accessible solutions in clinical and home-based contexts. A systematic search was conducted in PubMed, IEEE Xplore, and Scopus for studies in English and Spanish (2010–2025) on wrist rehabilitation using wearable devices, virtual reality, and/or gamification, and the selected works were grouped by technologies employed, effectiveness of gamification, and clinical outcomes. The review shows that commercial sensory gloves offer high precision, durability, and mature development ecosystems but are limited by high cost and proprietary technologies, while open-hardware solutions provide lower-cost and flexible devices with reduced precision and durability. Evidence indicates that gamification and integration with virtual reality environments can enhance patient motivation, treatment adherence, and functional performance. The review also identifies gaps in economic accessibility, therapy personalization, and system usability, and proposes as a future direction the development of low-cost, gamified, user-centered sensory gloves for wrist rehabilitation in both clinical and home settings.

The relationship between mental health disorders and LUTS.

The incidence of Type II diabetes (T2D) is increasing rapidly in low- and middle-income countries (LMICs). Dedicated nutrition interventions may be a low-cost low-burden method to improve glycemic control. A systematic review was conducted to explore dedicated nutrition interventions in LMICs for people with T2D. An intentionally broad search of Pubmed, ProQuest, and Scopus databases was conducted with multiple terms for diabetes, nutrition, and LMICs. The study authors screened 6778 unique abstracts for inclusion criteria. Following a thorough screening procedure, 37 publications reporting on 38 interventions were included for data extraction. The interventions were conducted in the Middle East and North Africa (n = 14), Southeast Asia (n = 7) and East Asia (n = 7), Africa (n = 5), South Asia (n = 3), and Latin and South America (n = 2), including a total of 2950 participants (55% women). Intervention duration was highly varied (18 ± 13 weeks), and led to a decrease in glycated hemoglobin (8.6% to 7.4%, Cohen's d = 1.0) and fasting glucose (172 to 135 mg/dL, Cohen's d = 1.3) in most studies. Intervention adherence was 87 ± 15%; parameters such as session duration, intensity, mode, setting, and study reporting varied greatly between trials and were often incompletely reported. Nutrition interventions in LMICs show great potential for improving glycemic control among people with T2D, although little research has been conducted in low-income countries. More research should be conducted with standardized reporting procedures to develop and test evidence-based strategies.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogenous inflammatory disease that often persist despite optimal medical and surgical treatment. Advances in the understanding of CRS immunopathophysiology have led to the development of biologic therapies targeting specific inflammatory pathways. This review summarizes the current knowledge on the downstream biologics and the latest update on the next generation upstream biologics therapies in CRSwNP, with focus on endotype-driven treatment selection. Biologic therapies targeting downstream mediators of type 2 inflammation, including immunoglobulin E and interleukins interleukin (IL)-4, IL-5 and IL-13, have demonstrated substantial clinical benefit in selected patients. Nevertheless, CRSwNP commonly involves overlapping inflammatory endotypes, which may limit treatment response. Newer biologics targeting upstream epithelial-derived cytokines offer broader approach by modulating multiple inflammatory pathways simultaneously and may address current therapeutic gaps. The development of long-acting biologics also improves treatment convenience and adherence. Biologic therapy has shifted CRSwNP management towards a more personalized, mechanism-based approach. Upstream-targeted treatments represent an important step forward, particularly for patients with refractory or mixed disease. Future research should focus on biomarker-guided therapy and long-term clinical outcomes.

Real-world patient characteristics and utilization patterns in patients with cholangiocarcinoma who received pemigatinib in the United States of America.

Adherence to anti-Tuberculosis treatment during the COVID-19 pandemic: a single-centre, retrospective analysis.

Guideline implementation for low back pain in German healthcare: a tale of overuse and underuse.

Antipsychotics are commonly recommended for the treatment of delirium; however, alternative options are warranted due to the limitations of oral and injectable formulations. The blonanserin (BNS) transdermal patch may improve treatment adherence; however, evidence regarding its efficacy in managing delirium remains limited. This retrospective case series describes 51 cases of delirium managed with BNS patches at Kyoto University Hospital between January 2020 and June 2022. The effectiveness of the BNS patch for delirium, the rationale for its selection, and the associated adverse events were retrospectively evaluated using electronic medical records. Delirium was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria by physicians from the consultation-liaison or palliative care teams, and the symptoms were regularly monitored. Effectiveness was assessed based on non-standardized clinical judgment documented in the medical records. Hyperactive and mixed delirium were observed in 41.2% and 56.9% of patients, respectively. Overall, the therapeutic response rate across all patients was 84.3%. The main reasons for the selection of BNS patches were difficulty or inability to take oral medications (60.8%). Adverse events occurred in 29.4% of patients; all resolved after discontinuation of the BNS patch, and no serious or irreversible reactions were observed. These findings indicate that the BNS patch has potential as an effective treatment option for delirium, particularly in patients with challenges in the administration of medication. However, given the retrospective and exploratory nature of this study, the findings should be interpreted with caution.

Feasibility and preliminary efficacy of an online yoga program for managing symptoms of post-treatment lyme disease syndrome.