Abstract Parabens, often used as preservatives in consumer products, have raised concerns due to their endocrine-disrupting properties. The aim of this study was to quantify the levels of methyl and propyl paraben in adult urine samples and to assess potential health risks. Using high-performance liquid chromatography (HPLC), methyl and propyl parabens were detected in 20 participants at different concentrations. Methylparaben was more prevalent than propylparaben. Risk assessment was performed by calculating the estimated daily intake (EDI) and the hazard quotient (HQ), with HQ values indicating no significant health risk for the participants. Although current exposure levels appear to be safe, the long-term effects of chronic exposure remain uncertain, highlighting the need for further research. This preliminary study provides insight into paraben exposure in adults and contributes to the growing literature on the safety and prevalence of parabens.

Occlusive cervical artery dissection (CeAD) is associated with worse patient outcome. The net clinical benefit of acute revascularization measures has to be weighed against the likelihood of spontaneous recanalization. Our aim was to assess the hitherto un-addressed impact of spontaneous recanalization on stroke risk in patients with occlusive CeAD. MRI verified CeAD patients with initially occlusive CeAD within cohort study that did not undergo acute revascularization measures were assessed. Follow-up data derived from clinical routine and study specific assessments. Outcomes of interest were occurrence of (i) recanalization and (ii) ischemic stroke upstream of CeAD-related occlusion. Adjusted logistic regression analysis addressed the impact of recanalization on said outcomes. 97/328 (29.6%) patients had occlusive CeAD and did not undergo acute revascularization treatment. Upon follow-up, 56/97 (57.7%) showed spontaneous recanalization of initially occlusive CeAD. Female sex (OR 0.41[0.18, 0.97]; P = 0.043) and internal carotid artery dissection (OR 0.33[0.14, 0.78]; P = 0.012) were the only factors independently associated with recanalization. Within a median follow-up of 8.2 (1.58, 12.8) years, a total of 18/97 (18.6%) patients suffered ischemic stroke upstream of the initially CeAD-affected vessel. After adjusting for confounders, spontaneous recanalization was independently associated with lower rates of cerebral ischemia upon follow-up (OR 0.28[0.09, 0.90]; P = 0.032), most notably also independent of type of antithrombotic treatment. Spontaneous recanalization in occlusive CeAD is associated with lower rates of stroke upon follow-up. These results indicate that persistent CeAD-related occlusion remains a risk-factor for recurrent ischemic events, thus calling for future trials addressing optimal medical treatment. N/A. Lukas Mayer-Suess.

Anomalous origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA), also known as Bland-White-Garland syndrome, is a rare congenital coronary anomaly with an estimated incidence of 1 in 300,000 live births. While commonly diagnosed in infancy, adult presentations are exceedingly rare and pose significant diagnostic challenges. Delayed diagnosis may result in progressive myocardial ischemia, heart failure, arrhythmias, or sudden cardiac death. Surgical correction is the definitive treatment, with the goal of restoring a dual coronary artery system and preventing irreversible myocardial damage. We present the case of a 30-year-old male with a prior history of non–ST-elevation myocardial infarction who was referred for evaluation of exertional angina and symptoms of heart failure. Transthoracic echocardiography revealed a dilated left ventricle with an ejection fraction (LVEF) of 35%. Coronary angiography and cardiac MDCT identified an anomalous origin of the left circumflex artery (LCx) from the right pulmonary artery (RPA) and a coronary–pulmonary artery fistula involving the LAD. The patient underwent successful surgical correction with reimplantation of the LCx into the ascending aorta. Postoperative recovery was uneventful. At 3-month follow-up the patient was symptom-free, though echocardiography revealed persistent LV dilation and reduced LVEF, necessitating continued pharmacologic therapy and monitoring. This case highlights the importance of maintaining a high index of suspicion for ALCAPA in adult patients with unexplained cardiomyopathy or ischemic symptoms. Early diagnosis and surgical intervention remain crucial for improving long-term outcomes and preventing life-threatening complications.

OBJECTIVES The primary aim of this study is to detect and quantify the presence of Sildenafil (SDF) and Tadalafil (TDF) in dietary supplements marketed as natural sexual enhancers in Bosnia and Herzegovina. Additionally, the study seeks to utilize these findings to inform relevant authorities, enabling further testing in reference laboratories and prompting the necessary actions to remove these adulterated products from the market. METHODS Using high-performance liquid chromatography with diode array detection (HPLC-DAD), 20 samples were analysed for the PDE-5 inhibitors. RESULTS The analysis revealed that seven of the samples contained either SDF or TDF, with mean concentrations ± standard deviation (SD) ranging from 2,075.57 ± 0.47 µg/g to 33,808.857 ± 99.43 µg/g, and TDF concentrations ranging from 24.16 ± 0.11 µg/g to 3,994.66 ± 6.95 µg/g. CONCLUSION These findings indicate a significant health risk posed by the adulteration of these products. The widespread presence of these active pharmaceutical ingredients (APIs) in products falsely labelled as natural underscores the urgent need for stringent regulatory oversight and enhanced quality control measures to protect consumer safety. This study adds to the growing body of evidence concerning the adulteration of dietary supplements and emphasizes the critical importance of regulatory compliance and monitoring in safeguarding public health.

The journal retracts the article titled "Resilience and Perceived Social Support in Cancer Survivors: Validity, Levels, and Sociodemographic Correlates of CD-RISC-25 and MSPSS Scales" [...].

OBJECTIVE The optimal management of patients with asymptomatic (AsxCS) and symptomatic (SxCS) carotid stenosis is controversial and includes intensive medical management (i.e., best medical therapy [BMT]) with/without an additional carotid revascularization procedure (i.e., carotid endarterectomy [CEA], transfemoral carotid artery stenting [TFCAS] or TransCarotid Artery Revascularization [TCAR]). The aim of this international, expert-based, multispecialty Delphi Consensus document was to reconcile the conflicting views regarding the optimal management of AsxCS and SxCS patients. METHODS A three-round Delphi Consensus process was performed including 63 experts from Europe (n=37) and the United States (n=26). A total of 6 different clinical scenarios were identified involving patients with either AsxCS or SxCS. For each scenario, 5 treatment options were available: (i) BMT alone, (ii) BMT plus CEA, (iii) BMT plus TFCAS, (iv) BMT plus TCAR, or (v) BMT plus CEA/TFCAS/TCAR. Differences in treatment preferences between U.S. and European participants were assessed using Fisher's Exact Test, and odds ratios were used to quantify the magnitude and direction of association. Consensus was achieved when >70% of the Delphi Consensus participants agreed on a therapeutic approach. RESULTS Most participants concurred that BMT alone is not adequate for the management of a 70-year-old fit male or female patient with 80-99% AsxCS (52/63; 82.5% and 45/63; 71.5%, respectively). In contrast, most panelists would opt for BMT alone for an 80-year-old male AsxCS patient with several co-morbidities (48/63; 76.2%). The majority of participants would opt for BMT plus a carotid revascularization procedure for an 80-year-old male SxCS patient with a recent ipsilateral cerebrovascular event, an ipsilateral 70-99% SxCS and a 5-year predicted risk of ipsilateral ischemic event of 10% (54/63; 85.7%), 15% (59/63; 93.6%), or 20% (63/63; 100%). The opinion of U.S.-based participants varied from that of Europe-based respondents in some scenarios. CONCLUSIONS The panel agreed that BMT alone is insufficient for most patients with SxCS, and that select subgroups of AsxCS patients may also benefit from revascularization, especially when high-risk features are present. Patients should be stratified according to their predicted stroke risk, as well as their individual clinical/anatomical/imaging features and should be treated accordingly.

Introduction: The risk of cognitive impairment, including dementia and moderate cognitive impairment (MCI), is higher in patients with diabetes and prediabetes. The need for early diagnosis biomarkers has increased due to the rise in the prevalence of type 2 diabetes mellitus (T2DM) and its related cognitive problems worldwide, as well as the lack of clear biochemical indicators and efficient treatments for dementia or cognitive decline. Chronic low-grade inflammation, reflected by elevated complete blood count-derived inflammatory indices (CBCIIs), has been implicated in both metabolic dysregulation and neurodegeneration. However, their relationship with cognitive impairment in T2DM remains insufficiently explored. The objective of this study was to investigate the association between CBCIIs and cognitive function in patients with T2DM. Methods and materials: This cross-sectional observational study included 116 patients with T2DM recruited from diabetes counseling centers in the Public Institution Health Center of Sarajevo Canton, Bosnia and Herzegovina. Based on the assessed cognitive status, patients with T2DM were divided into two groups: with cognitive impairment (n= 76) and without cognitive impairment (n=40). A validated assessment tool, the Montreal Cognitive Assessment (MoCA), a quick test designed to screen for milder forms of cognitive impairment, was used for cognitive screening. Venous blood samples were analyzed for standard complete blood count parameters, from which 11 CBCIIs were calculated: neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), neutrophil-to-platelet ratio (NPR), neutrophil-to-lymphocyte-to-platelet ratio (NLPR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), aggregate index of systemic inflammation (AISI), systemic inflammation response index (SIRI), lymphocyte-to-monocyte ratio (LMR), and monocyte-to-neutrophil ratio (MNR).. Results: The results of our study showed that NLR, dNLR, NPR, NLPR, PLR, MLR, SII, AISI, and SIRI were significantly higher in the group of T2DM patients with cognitive impairment compared to the group without cognitive impairment. On the other hand, LMR and MNR were significantly lower in the group of T2DM patients with cognitive impairment compared to the group without cognitive impairment (p<0.05). The MoCA score was significantly negatively correlated with NLR, dNLR, NPR, NLPR, and SII, and positively with MNR (p<0.05) Conclusion: Elevated CBCIIs are significantly associated with cognitive impairment in patients with T2DM. These inexpensive and widely available indices may serve as adjunctive markers for early cognitive screening in this population.

Objectives The primary objective of this study was to examine the potential association between glutathione S-transferases (GSTT1/GSTM1) deletion polymorphisms and the development of apical periodontitis (AP) in a population of patients at two university centers: the Faculty of Medicine at the University of Banja Luka in Bosnia and Herzegovina and the School of Dental Medicine at the University of Belgrade in Serbia. Materials and Methods The study involved 200 patients with AP in the experimental and 250 healthy individuals without AP in the control group. As a source of genomic DNA, sterile buccal swabs were taken from each patient. Genotyping of GSTM1 and GSTT1 deletion polymorphisms was conducted using multiplex Polymerase Chain Reaction (PCR). The risk of AP development with regard to the genotypes was evaluated based on odds ratios (ORs) and 95% confidence intervals (CIs) that were calculated via unconditional logistic regression. Results There were significant differences in demographic characteristics between the investigated groups (p = 0.446, p = 0.154, respectively). GSTM1 and GSTT1 deletions were associated with a 3.05-fold and 5.69-fold risk (OR = 3.05, 95% CI = 2.07–4.49, OR = 5.69, 95% CI = 3.66–8.86, p < 0.001, p < 0.001, respectively) for the AP development. The co-occurrence of both deletions posed a significantly higher risk for AP development (OR = 52.76. 95% CI = 18.20–152.94, P < 0.001). Conclusions The carriers of null GSTT, null GSTM, and double null GSTT/GSTM genotypes are more susceptible to AP development in the populations examined at the two centers.

Background/Objectives: Syncope is a common clinical problem often requiring pharmacological treatment, yet evidence-based therapies remain limited. Midodrine, a vasopressor agent, is frequently used, though its autonomic effects over time remain unclear. This study aimed to assess autonomic nervous system changes and blood pressure response in syncope patients treated with Midodrine, placebo, or their combination. Additionally, the structural properties of the Midodrine placebo were analyzed using nanotechnological methods. Methods: A total of 67 patients with syncope were randomized to receive Midodrine, sucrose placebo, or their combination over three weeks. All participants underwent 24 h Holter ECG with heart rate variability (HRV) analysis and ambulatory blood pressure monitoring before and after therapy. Structural analysis of Midodrine tablets, sucrose, and Midodrine placebo was performed using Raman spectroscopy and X-ray diffraction (XRD). Results: Patients receiving the Midodrine–placebo combination showed a significant reduction in HRV markers of parasympathetic activity (RMSSD, pNN50, HF) and an increase in sympathetic dominance (LF/HF ratio) compared to the other groups. Only this group showed a statistically significant rise in average systolic and diastolic blood pressure. Raman and XRD analyses revealed structural alterations in the sucrose-based placebo compared to its original form, indicating subtle changes in crystalline structure. Conclusions: In this exploratory study, the combination of Midodrine and placebo was associated with autonomic imbalance and modest increases in blood pressure, which may indicate a potential effect in patients with hypotensive syncope phenotypes. These preliminary findings should be interpreted with caution, and the structural modifications observed in the placebo formulation are presented as hypotheses requiring further investigation rather than established mechanisms.