Duchenne muscular dystrophy (DMD) is a severe, progressive, and life-limiting neuromuscular disorder that imposes a substantial economic burden on healthcare systems and families. While the clinical severity of DMD is well established, limited data exist regarding its socioeconomic and psychological impacts in Saudi Arabia. This study investigated patient and caregiver demographics, direct out-of-pocket expenditures, caregiver depression and anxiety, and health-related quality of life (HRQoL).

A descriptive, cross-sectional, questionnaire-based telephone survey was conducted over a 12-month period, from September 2023 to September 2024 among caregivers recruited from outpatient neurology clinics at a university-affiliated tertiary care center in Riyadh, Saudi Arabia. Data were collected using validated Arabic-language instruments, including the Costs for Patients Questionnaire (CoPaQ) for expenditures, the 9-item Patient Health Questionnaire (PHQ-9) for depression, the 7-item Generalized Anxiety Disorder (GAD-7) scale for anxiety, and the EuroQol 5-Dimension 5-Level (EQ-5D-5L) for HRQoL.

The study included 40 informal caregivers, predominantly fathers (57.5%) and males (57.5%), with a mean age of 42 years. Most participants (77.5%) did not have private health insurance. Families incurred significant financial strain, with a mean total out-of-pocket expenditure of US$ 12,400 ± 14,070.27, driven primarily by prescription medications, annual medical travel, and home modifications. Low-income families were disproportionately affected. Caregivers experienced considerable psychological distress, as indicated by a mean PHQ-9 score of 8.18 and a mean GAD-7 score of 7.2. Bivariate linear regression showed that greater depression severity (p = 0.0003), greater anxiety severity (p < 0.0001), the presence of caregiver chronic health conditions (p = 0.0034), and caring for more DMD patients (p = 0.0008) were significantly associated with lower EQ-5D-5L utility scores. In contrast, higher monthly income (p = 0.0029) and male gender (p = 0.0454) were significantly associated with higher utility scores.

Informal caregiving for children with DMD in Saudi Arabia frequently results in severe psychological distress and substantial out-of-pocket expenses. Assessment of HRQoL and caregiver mental health highlights an urgent need for national clinical pathways, enhanced physician education, and comprehensive, family-centered public health interventions.

Declining testosterone levels are associated with reduced muscle mass, fatigue, and reproductive challenges in men. Although testosterone replacement therapy is available, it is often associated with risks such as cardiovascular complications and endocrine imbalance, highlighting the need for safer alternatives. Nutraceutical approaches offer a promising strategy for supporting endogenous testosterone production. In this study, Testolift, a novel testosterone-supporting nutraceutical formulation, was developed under the Natural Ingredients for Mental and Performance (NIMP) Platform using InSitu360 molecular complexation technology. The formulation integrates fenugreek saponins, black ginger (Kaempferia parviflora) polymethoxyflavones, and zinc methionine to achieve synergistic enhancement of testosterone. The formulation was characterized using FT-IR, SEM, TEM, DSC, EDS, and UPLC, confirming the successful integration of bioactives and favorable physicochemical properties. Quantitative analysis verified the presence of 20% saponins, 0.93% polymethoxyflavones, and 1.4% elemental zinc. Morphological studies revealed uniformly dispersed spherical nano- and microspheres with sub-200 nm particles, supporting structural stability and efficient incorporation of bioactives within the matrix. Dynamic light scattering analysis confirmed a mean particle size of 193 nm with a distribution range of 120-260 nm, while the zeta potential of -32.24 mV indicated good colloidal stability. A 180 days stability study demonstrated >95% retention of methoxyflavones, saponins, and zinc across refrigerated (4 ± 2 °C), ambient (25 ± 2 °C), and accelerated (45 ± 2 °C) conditions, confirming excellent compositional and physicochemical stability. In a 42 days in vivo experimental study in male rats, Testolift significantly increased serum testosterone by 22.7% compared to 4.1% in controls (p < 0.05) without adverse effects. The InSitu360 technology enhanced the physicochemical and compositional stability of the formulation, supporting its robustness and suggesting potential for improved bioavailability, which warrants confirmation in future clinical studies. These results position Testolift as a promising natural testosterone-support formulation with potential applications in male health and muscle endurance.

The objective of this scoping review is to identify how adolescent mental health is assessed and the psychological factors it has been associated with young people in education in Low- and Middle-Income Countries (LMICs).

A review of the published academic literature was conducted to explore the breadth, scope, and nature of research using the eligibility criteria of school/college-attending young people (aged 4-22 years) from LMICs with use of standardized measures. Three databases were searched: Medline, EMBASE, and PsycINFO, covering the period from 1970 to September 30, 2025. A logic grid using relevant population, construct, and context search terms guided the search. The six-stage scoping review methodological framework by Arksey and O'Malley was used.

The search yielded 1,493 records, of which 498 duplicates were removed and 995 were screened. Thirty six studies met the inclusion criteria. Thirty-two of these studies were conducted in middle-income countries. Ten of the articles described intervention studies and most of the studies were cross sectional. Mental health outcomes assessed were depression, anxiety, trauma, suicidality, eating disorder symptoms, psychological distress and general mental health screening. Assessed psychological factors associated with mental health outcomes included self-esteem, self-efficacy, resilience, coping, perceived social support, school connectedness, emotional intelligence and emotional regulation, mastery, and life satisfaction. Findings show that depression was the most commonly assessed mental health outcome and self-esteem was the most frequently researched psychological factor.

The study revealed considerable variability in how mental health was assessed, underscoring the need for greater consistency and contextual sensitivity. These findings highlight the importance of developing interventions tailored to local contexts in LMICs to more effectively support youth mental health. The need for measurement consistency and contextual adaptation of intervention in this literature is indicated.

Shift work is the norm in modern industrialised societies and is associated with disruptions in circadian rhythms as well as adverse mental health and sleep outcomes. However, many studies have examined sleep-related and mental health outcomes independently, limiting understanding of their interrelationship. This systematic review aimed to evaluate the association between shift work exposure and both sleep-related and mental health outcomes among adult workers. A systematic review was conducted using a predefined and structured methodology for study identification, selection, and reporting. A comprehensive search of PubMed, Cochrane CENTRAL, Europe PMC, PsycINFO, and ClinicalTrials.gov was performed for studies published between January 2016 and January 2026. Eligible studies included adult shift-working populations that reported both sleep-related and mental health outcomes. Observational studies and randomized controlled trials were included. Study selection, screening, and quality appraisal were performed using established methodological assessment approaches appropriate to the included study designs. A total of 386 records were identified, of which 36 duplicates were removed. Following screening and full-text assessment of 80 articles, 11 studies met the inclusion criteria. Included studies were conducted across Europe, North America, Asia, and Australia and involved diverse occupational groups, including healthcare workers, correctional officers, and industrial workers. Across studies, shift work exposure was associated with sleep-related outcomes such as insomnia, poor sleep quality, and shift work sleep disorder, as well as mental health outcomes including depression, anxiety, stress, and fatigue. Overall methodological quality was moderate to high. Shift work exposure is associated with adverse sleep-related and mental health outcomes among adult workers. These findings support the need for integrated occupational health strategies addressing both sleep and psychological well-being in shift-working populations.

Post-COVID-19 syndrome encompasses persistent cognitive, neurological, and psychiatric symptoms following SARS-CoV-2 infection, profoundly affecting global quality of life. Clarifying the neurobiological basis of these symptoms is vital for effective therapeutic interventions. This study utilized normative modelling of brain structure ("CentileBrain") to quantify subject-level deviations in cortical thickness, surface area, and subcortical volumes among 20 patients experiencing persistent fatigue following mild COVID-19, compared to 20 matched healthy controls. Group-level analyses on deviation scores revealed subtle yet distinct regional alterations in cortical thickness, specifically decreased thickness within orbitofrontal cortices and increased thickness in occipital/sensory cortices. Although at the individual regional level, the proportion of patients exhibiting infranormal or supranormal thickness values was relatively low (<35%) and comparable to controls, deviations frequently clustered within structurally connected circuits, affecting up to 50% more of patients. Spatial analysis of regional cortical thickness alterations correlated significantly with the constitutive expression patterns of TMPRSS2, an essential protein facilitating SARS-CoV-2 cellular entry. Canonical correlation analyses further identified specific cell-type distributions and neuroreceptor densities predictive of regional thickness changes, highlighting neurons and molecular targets associated with serotoninergic, cannabinoid, cholinergic, and glutamatergic signalling pathways. Network-diffusion modelling constrained by a canonical structural connectome significantly outperformed null models based on permuted connectomes and Euclidean distance metrics, identifying posterior-parietal regions as probable initiation points ("seeds") for network-wide structural changes. Seed likelihood correlated positively with TMPRSS2 expression levels, suggesting that these posterior-parietal regions may be particularly susceptible to SARS-CoV-2 infection. This highlights a plausible mechanism where structural alterations could propagate through connected neural networks, although direct evidence of such propagation requires further investigation. These findings provide novel insights into potential mechanisms underlying neural circuit disruptions in post-COVID-19 fatigue and suggest avenues for therapeutic neuromodulation.

Primary CNS lymphoma (PCNSL) is treated with intensive chemotherapy and autologous stem cell transplant (HDT-ASCT), yet up to one-third of patients relapse. Standard MRI response criteria may not reliably distinguish residual tumour from post-treatment change; additional MRI sequences, such as apparent diffusion coefficient (ADC), could assist in the determination of early relapses, although their prognostic value remains uncertain.

We retrospectively analysed 63 PCNSL patients, assessed pre-HDT-ASCT IPCG response and ADC values, and examined associations with 2-year relapse-free survival.

Only pre-HDT-ASCT IPCG status, not the lesion ADC value, significantly predicted the 2-year outcome (p = 0.005). An overall CR rate of 85% was observed at a median follow-up of 24.7 months.

Pre-HDT-ASCT IPCG status, not ADC values, predicts 2-year IPCG status in PCNSL patients.

ObjectiveTo examine the impact of the COVID-19 pandemic on adolescent psychiatric inpatient admissions by comparing sociodemographic, diagnostic, and clinical characteristics before and during the pandemic.MethodsA Melbourne adolescent psychiatric inpatient unit admitted 963 adolescents during March-December 2019 (pre-pandemic) and March-December 2020 (pandemic). Comparisons of demographics, diagnoses, symptom severity and functioning (HoNOSCA, SDQ), and admission characteristics including restraint and seclusion were analysed.ResultsAdmission volume increased by 17% while overall symptom severity remained stable. Personality and Autism Spectrum Disorder diagnoses increased, as did use of physical restraint and symptoms of hyperactivity, psychosis, and somatic complaints. Substance misuse decreased significantly. Most demographic variables were unchanged, except for a decline in Indigenous admissions. Effect sizes were small.ConclusionWhile concerns about increased mental health problems have been expressed during the pandemic period, adolescent admissions did not show increased symptom severity or functioning difficulties. The increased admission rate was accompanied by increases in only two diagnostic groups; possibly overlapping in heightened internal distress amid pervasive social disruption. That one vulnerable group - indigenous young people - had lower admission rates, may talk to stronger community supports or to further marginalisation from the health care system, during the pandemic.

BackgroundNo validated Persian version of the short-form Child Parental Acceptance-Rejection Questionnaire (Child-PARQ) has been available for Iranian populations. The present study aimed to examine the psychometric properties, internal consistency, and factor structure of the Persian short form of the Child-PARQ among Iranian adolescents.MethodsA total of 1075 adolescents aged 12-17 years participated in this cross-sectional study. Participants completed the Persian Child-PARQ, the Strengths and Difficulties Questionnaire, and the WHO-5 Well-Being Index. Data were analyzed using exploratory and confirmatory factor analyses, reliability tests, and validity assessments.ResultsThe EFA and CFA supported a two-factor model, Warmth/Affection and Rejection which demonstrated excellent model fit. Internal consistency was high across both forms. Convergent and discriminant validity were confirmed through significant correlations with SDQ and WHO-5. ROC analysis supported criterion validity. Measurement invariance was established across gender, and developmental comparisons indicated higher perceived rejection among adolescents relative to adults.ConclusionThe Persian short-form Child-PARQ demonstrated robust psychometric properties and a stable two-factor structure, making it a reliable and valid tool for assessing perceived parental acceptance and rejection among Iranian adolescents. Although suitable for large-scale research and screening, its moderate discriminative power suggests that the long form is preferable for clinical assessments.

Undernutrition, characterized by insufficient energy and protein intake and/or malabsorption, leads to adverse physical and mental health outcomes. Addressing Undernutrition is complex, requiring adequate dietary intake and consideration of the gut microbiota, which is crucial for nutrient absorption and metabolism. Probiotics have shown potential in restoring the gut microbiota balance, enhancing nutrient absorption, and improving growth and immune function. The proposed double-blind, randomized controlled trial (RCT) aims to evaluate the effects of a novel probiotic combination in conjunction with a weight gain intervention on body composition, appetite, gut permeability, oxidative stress, and inflammation in severely underweight adults.

A double-blind, randomized controlled trial in which 100 underweight (BMI < 18.5 kg/m²) adults will be recruited and randomly assigned to receive either a probiotic combination (Lactobacillus rhamnosus GG, Lactobacillus acidophilus, and Lactobacillus casei) or an identical placebo alongside a weight gain dietary intervention providing an additional 500 kcal/day for eight weeks will be performed. The primary endpoint will be the difference in body mass index (BMI), calculated as weight/height² (kg/m²), between the two groups. The secondary endpoints include (1) body composition evaluated by bioelectrical impedance, (2) appetite evaluated via a visual analog scale, (3) gut permeability assessed by the serum zonulin concentration, (4) oxidative stress evaluated by the serum concentration of malondialdehyde (MDA), total antioxidant capacity (TAC), total oxidant status (TOS), glutathione peroxidase (GPx), and inflammation assessed via the C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR), (5) bowel function assessed via the Bristol stool chart, and (6) dietary intake evaluated via 24-h dietary recall.

This study outlines a comprehensive approach to investigating the impact of probiotics in combination with dietary intervention on multiple health parameters in underweight adults. The results of this trial will contribute to further ways of managing malnutrition.

This study was approved by the Ethics Committee of the Research Vice-Chancellor at Mashhad University of Medical Sciences (IR.MUMS.MEDICAL.REC.1401.589) (IR.MUMS.MEDICAL.REC.1402.057). All participants will be asked to complete the consent form at the beginning of the study. The results will be actively disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION {2A AND 2B}: Iranian Registry of Clinical Trials, IRCT20230310057667N1 (Issue date 30 March 2023), https://irct.behdasht.gov.ir/trial/69130.

Given the academic and clinical demands faced by nursing students, mental health is a critical component of their well-being. To promote a culture of wellness, Mental Health Bulletin Boards were implemented at a large, multicampus nursing college to provide an interactive space for students to share mental health strategies. A thematic analysis of 339 individually posted bulletin board notes revealed five overarching categories: physical health, connectedness, mental and emotional health, leisure and creative outlets, and personal management strategies. The findings inform nursing education wellness initiatives, including curriculum integration, faculty messaging, and community outreach.