Considering the outbreak pandemic of Coronavirus Disease 2019 (COVID‐19), the lack of effective therapeutic strategies for the management of this viral disease, and the increasing evidence on the antiviral potential of silymarin, this study aimed to investigate the effectiveness of silymarin nanomicelles on the symptom's resolution time, laboratory parameters, and liver enzymes in patients with COVID‐19. The participants were assigned to the nano‐silymarin ( n = 25) (receiving SinaLive soft gel, containing 70 mg silymarin as nanomicelles) or placebo groups ( n = 25) three times daily for two weeks. Patients' symptoms and laboratory findings were assessed at baseline and during the follow‐up period (one week and one month after the beginning of the treatment). No significant differences were observed between the two groups in terms of symptoms resolution time, laboratory parameters, and hospitalization duration ( p > 0.05). However, the alanine aminotransferase level decreased significantly in the treatment group, compared to the placebo group ( p < 0.001). Concomitant use of dexamethasone and remdesivir with silymarin might make the effects of silymarin on the improvement of patients' condition unclear. Further clinical trials are recommended with diverse dosages and larger sample sizes.

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Background: Defense mechanisms are essential to personality and behavior that help individuals deal with stress. These mechanisms might act in different ways, rendering medical students caring physicians or egoistic individuals, and thus, a good understanding of defense mechanisms can contribute to the efforts made to improve the psychological well-being of medical students. Objectives: We studied the prevalence of generalized anxiety disorder (GAD) and alexithymia as determinants of psychological well-being and the mechanisms by which medical students might cope with stress and anxiety. Methods: The present cross-sectional study was conducted on 232 medical students, 126 (60%) females and 96 (40%) males, in northeast Iran. Data were collected through GAD-7, the Farsi version of the Toronto Alexithymia Scale (FTAS-20), and the Defense Styles Questionnaire (DSQ-40). Statistical analysis was performed with IBM SPSS 22.0. Pearson's chi-square test, bivariate correlations, and multiple linear regression analysis were used to identify associations between GAD, alexithymia, and defense mechanisms. Results: A total of 87 (37.5%) participants showed moderate to severe anxiety. Alexithymia was detected in 49 (21%) participants. Mature defense mechanisms had the highest prevalence among participants (56.5%), while immature mechanisms had the least (23.3%). A significant positive correlation was noted between GAD and alexithymia. Also, GAD was positively correlated with immature and neurotic defense mechanisms (P < 0.05). A negative correlation was found between mature defense mechanisms and GAD (P < 0.001). Suppression and humor (mature mechanisms) were the negative predictors of GAD. Reaction formation, somatization, autistic fantasy, splitting, passive aggression, displacement, and pseudo-altruism (an immature and neurotic mechanism) were the positive predictors of GAD. Conclusions: The statistically significant correlations found among GAD, alexithymia, and defense mechanisms suggest that a good understanding of these conditions and mechanisms can contribute to alleviating anxiety among medical students and improving their psychological well-being.

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