Prevalence and factors associated with the correlation between malnutrition and pain in hemodialysis patients.

Malnutrition and pain are common in patients with chronic kidney disease who undergo hemodialysis. Although both pain and malnutrition are associated with increased morbidity and mortality, few studies have explored the correlation between pain and nutritional status. This study aimed to investigate the factors associated with pain intensity in patients undergoing hemodialysis, focusing on the risk of malnutrition. This was a cross-sectional study conducted at a regional dialysis center in a large tertiary hospital. Convenience sampling was used to recruit adult patients who had undergone hemodialysis for more than three months. An interviewer-administered questionnaire was used to gather sociodemographic and clinical data related to dialysis status, comorbidities, and body mass index (BMI). Pain severity and pain interference with functioning domains of the Brief Pain Index (BPI) were used to assess pain, and the malnutrition inflammation score (MIS) was used to assess nutritional status. Descriptive and inferential statistics were used to report the findings. The data were analyzed using the 25th version of the Statistical Package for the Social Sciences (IBM-SPSS) software. Of the final sample of 230 patients, 63.0% were males and 37.0% were females, with an average age of 58.3 years. Almost one-third of the participants had a BMI within the normal range (33.9%), and nearly one-third had a BMI within the underweight range (33.9%). Slightly more than half had a normal nutritional status or mild malnutrition (54.8%), while just under half had moderate or severe malnutrition (45.2%). The prevalence of pain was 47.0%. At the multivariate level, the severity of pain was associated with malnutrition (p < 0.001). Pain interference with function was associated with marital status (p = 0.045), number of comorbidities (p = 0.012), and malnutrition (p < 0.001). The MIS was positively correlated with both the severity of pain and the interference score. Pain and malnutrition were found to be prevalent in patients undergoing hemodialysis. Pain severity was associated with malnutrition, and pain interference was associated with malnutrition, marital status, and the number of comorbidities. Hemodialysis treatment should follow a patient-tailored approach that addresses pain, nutritional status, and associated chronic conditions. In addition, pain assessment and management should be included in the curriculum of nephrology training programs.

Symptom Clusters and Their Impact on Spiritual Well-Being Among Women with Breast Cancer.

Purpose: To explore symptom experience and symptom clusters among Jordanian women with breast cancer and investigate whether these clusters predict patients' spiritual well-being. Patients and Methods: A sample of 142 Jordanian women with breast cancer were asked to complete the Memorial Symptom Assessment Scale (MSAS), Functional Assessment of Chronic Illness Therapy- Spiritual Well-being (FACIT-Sp) scale, and socio-demographic questionnaire. Exploratory factor analysis was used to group symptoms into clusters, and multiple linear regression was used to explore the symptom clusters that predict spiritual well-being. Results: The most prevalent symptoms among women with breast cancer were fatigue, anxiety, tension, and pain. All these symptoms have a prevalence greater than 50%. Three clusters were found: treatment-related symptom cluster consisting of eight symptoms, gastrointestinal symptom cluster consisting of seven symptoms, and psychological symptom cluster consisting of five symptoms. The psychological symptom cluster was the only cluster predicting the women's spiritual well-being (t (141) = -3.049; p < 0.01). Conclusion: Women with breast cancer experience several concurrent symptoms and symptom clusters. Screening for psychological symptom clusters and their treatment improves patients' spiritual well-being. The majority of women with breast cancer did not receive any complementary therapies and hardly any spiritual or psychological support, which should be provided in the future to support their spiritual well-being.

Comparative Analysis on Vestibular Schwannoma Surgery with and without Intraoperative Fluorescein Sodium Enhancement.

BACKGROUND: Vestibular schwannoma (VS), also known as acoustic neuroma, is a benign, well-encapsulated, and slow-growing tumor that originates from Schwann cells, which form the myelin sheath around the vestibulocochlear nerve (VIII cranial nerve). The surgical treatment of this condition presents a challenging task for surgeons, as the tumor's location and size make it difficult to remove without causing damage to the surrounding structures. In recent years, fluorescein sodium (FS) has been proposed as a tool to enhance surgical outcomes in VS surgery. This essay will provide an analytical comparison of the use of FS in VS surgery, evaluating its benefits and limitations and comparing surgical outcomes with and without FS-assisted surgery. METHODS: In a retrospective study conducted at San Filippo Neri Hospital, we examined VS cases that were operated on between January 2017 and December 2023. The patients were divided into two groups: group A, which consisted of patients who underwent surgery without the use of FS until January 2020 (102 cases), and group B, which included patients who underwent surgery with FS after January 2020 (55 cases). All operations were performed using the retrosigmoid approach, and tumor size was classified according to the Koos, et al. classification system. The extent of surgical removal was evaluated using both the intraoperative surgeon's opinion and postoperative MRI imaging. Preoperatively and postoperatively, facial nerve function and hearing were assessed. In group B, FS was used to assist the surgical procedures, which were performed using a surgical microscope equipped with an integrated fluorescein filter. Postoperative clinical and MRI controls were performed at six months and annually, with no patients lost to follow-up. RESULTS: This study investigated the impact of intraoperative fluorescein exposure on tumor resection and clinical outcomes in patients with VS. The study found a statistically significant difference in the tumor resection rates between patients who received fluorescein intraoperatively (p = 0.037). Further analyses using the Koos classification system revealed a significant effect of fluorescein exposure, particularly in the Koos 3 subgroup (p = 0.001). Notably, no significant differences were observed in hearing loss or facial nerve function between the two groups. A Spearman correlation analysis revealed a positive correlation between tumor size and Koos, age, and size, but no significant correlation was found between facial nerve function tests. CONCLUSIONS: FS-assisted surgery for VS may potentially enhance tumor resection, allowing for more comprehensive tumor removal.

Accuracy of ChatGPT in Neurolocalization.

Introduction ChatGPT (OpenAI Incorporated, Mission District, San Francisco, United States) is an artificial intelligence (AI) chatbot with advanced communication skills and a massive knowledge database. However, its application in medicine, specifically in neurolocalization, necessitates clinical reasoning in addition to deep neuroanatomical knowledge. This article examines ChatGPT's capabilities in neurolocalization. Methods Forty-six text-based neurolocalization case scenarios were presented to ChatGPT-3.5 from November 6th, 2023, to November 16th, 2023. Seven neurosurgeons evaluated ChatGPT's responses to these cases, utilizing a 5-point scoring system recommended by ChatGPT, to score the accuracy of these responses. Results ChatGPT-3.5 achieved an accuracy score of 84.8% in generating "completely correct" and "mostly correct" responses. ANOVA analysis suggested a consistent scoring approach between different evaluators. The mean length of the case text was 69.8 tokens (SD 20.8). Conclusion While this accuracy score is promising, it is not yet reliable for routine patient care. We recommend keeping interactions with ChatGPT concise, precise, and simple to improve response accuracy. As AI continues to evolve, it will hold significant and innovative breakthroughs in medicine.

Assessment of depression symptoms among cancer patients: a cross-sectional study from a developing country.

Cancer patients experience psychological symptoms such as depression during the cancer treatment period, which increases the burden of symptoms. Depression severity can be assessed using the beck depression inventory (BDI II). The purpose of the study was to use BDI-II scores to measure depression symptoms in cancer patients at a large tertiary hospital in Palestine. A convenience sample of 271 cancer patients was used for a cross-sectional survey. There are descriptions of demographic, clinical, and lifestyle aspects. In addition, the BDI-II is a tool for determining the severity of depression. Two hundred seventy-one patients participated in the survey, for a 95% response rate. Patients ranged in age from 18 to 84 years, with an average age of 47 years. The male-to-female ratio was approximately 1:1, and 59.4% of the patients were outpatients, 153 (56.5%) of whom had hematologic malignancies. Most cancer patients (n = 104, 38.4%) had minimal depression, while 22.5%, 22.1%, and 17.0% had mild, moderate, and severe depression, respectively. Education level, economic status, smoking status, and age were significantly associated with depression. The BDI-II is a useful instrument for monitoring depressive symptoms. The findings support the practice of routinely testing cancer patients for depressive symptoms as part of standard care and referring patients who are at a higher risk of developing psychological morbidity to specialists for treatment as needed.

An efficient methodological approach for synthesis of selenopyridines: generation, reactions, anticancer activity, EGFR inhibitory activity and molecular docking studies.

In the present work, we successfully synthesized Se-alkyl selenopyridines 1 and 3, selenopheno[2,3-b]pyridine 2, and bis-selenopyridine 4 derivatives using an eco-friendly method by utilizing NaHSe instead of toxic hydrogen selenide. The effect of the temperature on the reaction was screening at various temperatures. The regiospecific reaction of selenopyridine 1 with bromine afforded an unexpected product 4,6-diamino-5-bromo-2-[(cyanomethyl)selenyl]-pyridine-3-carbonitrile (5), which was cyclized to selenopheno[2,3-b]pyridine (7) by refluxing in the presence of TEA. While its treatment with thiophenol and/or p-chlorothiophenol gave 8a, b. On the other hand, its reaction with aminothiophenol afforded 2-(benzo[d]-thiazol-2-yl)-5-bromoselenopheno[2,3-b]pyridine-3,4,6-triamine (9). Also, N-(2-cyano-4-methyl-5H-1-seleno-3,5,8-triazaacenaphthylen-7-yl)acetamide (11) and a novel series of selenoazo dyes 12a-d were synthesized by treatment of selenopheno[2,3-b]pyridine 2 with acetic anhydride and/or diazonium chlorides of aromatic amines, respectively. Then, we ascertained the potential activity of synthesized compounds against highly metastatic prostate cancer cells (PC-3) and osteosarcoma cells (MG-63) and found that 12a, 12b, 12c, and 12d were more cytotoxic than doxorubicin in both tested cell lines, showing nearly the same anticancer activity with IC50 values ranging from 2.59 ± 0.02 µM to 3.93 ± 0.23 µM. Mechanistically, the most potent compounds 12a and 12b proved to be potent EGFR inhibitors with IC50 values of 0.301 and 0.123 µM, respectively, compared to lapatinib as a positive reference (IC50 = 0.049 µM). Moreover, the docking results are in good agreement with the anticancer activity as well as the EGFR inhibitory activity, suggesting these two compounds as promising EGFR anticancer candidates.

Acquired Lymphangioma Circumscriptum of the Scrotum: A Case Report.

Lymphangioma circumscriptum (LC) is an uncommon malformation affecting the skin and subcutaneous tissue. This report documents a case of LC that developed in the scrotum of a 35-year-old male. Upon examination, numerous clusters of clear vesicles were found on the scrotum's surface. The patient had no previous exposure to infections, trauma, surgery, or radiation treatment. A skin biopsy revealed enlarged lymphatic channels in the dermis, aligning with a diagnosis of LC. The patient was treated with cryotherapy using liquid nitrogen, specifically targeting the translucent yellowish vesicles. The cryotherapy was administered in a series of eight sessions, each involving double freeze-thaw cycles, spaced out at two-week intervals. Following treatment, the patient's lesions regressed, indicating a favorable therapeutic outcome. The patient was followed up for nearly one year, during which no new lesions developed, suggesting the treatment's effectiveness in preventing recurrence. The complete resolution of lesions and absence of recurrence during follow-up indicate a good prognosis and successful response to cryotherapy. Scrotal LC, particularly the acquired form in adults without any precipitating factors, is extremely rare. This case underlines the need to include acquired LC in the diagnostic considerations when adult patients present with vesicular lesions on the scrotum, to ensure accurate diagnosis and subsequent proper treatment.

DNA glycosylases provide antiviral defence in prokaryotes.

Bacteria have adapted to phage predation by evolving a vast assortment of defence systems1. Although anti-phage immunity genes can be identified using bioinformatic tools, the discovery of novel systems is restricted to the available prokaryotic sequence data2. Here, to overcome this limitation, we infected Escherichia coli carrying a soil metagenomic DNA library3 with the lytic coliphage T4 to isolate clones carrying protective genes. Following this approach, we identified Brig1, a DNA glycosylase that excises α-glucosyl-hydroxymethylcytosine nucleobases from the bacteriophage T4 genome to generate abasic sites and inhibit viral replication. Brig1 homologues that provide immunity against T-even phages are present in multiple phage defence loci across distinct clades of bacteria. Our study highlights the benefits of screening unsequenced DNA and reveals prokaryotic DNA glycosylases as important players in the bacteria-phage arms race.

Thyroidectomy Effects on the Body Mass Index and Thyroid-Stimulating Hormone: A Systematic Review and Meta-Analysis.

Thyroidectomy is common and is performed for malignancy, goiters with pressure symptoms, and certain types of Grave's disease. Weight and body mass index (BMI) following thyroidectomy were discussed controversially. This meta-analysis aimed to assess weight and BMI following thyroidectomy. A systematic literature search was conducted in PubMed, Medline, and Google Scholar with interest in articles that assessed body weight and BMI following total or subtotal thyroidectomy. The search engine was limited to the period from inception up to January 2024. Keywords "total thyroidectomy", "subtotal thyroidectomy", "Graves' disease", "multinodular goiter", "differentiated thyroid carcinoma", and "toxic nodules" were used. Out of the 634 articles retrieved, 89 full texts were screened, and only six studies (five retrospective and one prospective cohort) fulfilled the inclusion and exclusion criteria. No differences were evident regarding weight and BMI before and after thyroidectomy (odds ratio: -0.63, 95%CI: -1.50 to -0.24, P-value for the overall effect: 0.15; and odds ratio: -0.12, 95% CI: -0.41 to -0.16, P-value for the overall effect: 0.40 respectively). No heterogeneity was observed (I2 for heterogeneity: 0.0%). No association between thyroidectomy (when performed for differentiated thyroid carcinoma and hyperthyroidism), weight, and BMI was found. Further studies assessing thyroid-stimulating hormone (TSH) levels, radioactive iodine therapy, and thyroxine dose are needed.

Broken Epidural Catheter After Vaginal Delivery.

The breakage of the epidural catheter is an alarming, rare, yet well-known complication. Despite the advances in modern imaging technologies, visualization of the broken catheter remains challenging, and surgical intervention might be necessary to remove the broken catheter. We report a case of a broken epidural catheter post-vaginal delivery, which was managed by surgical intervention.

Knowledge and practice of community pharmacists regarding the safety of drugs during pregnancy: a cross-sectional study from a developing country.

BACKGROUND: Drug use during pregnancy can cause unfavorable fetal and maternal outcomes. Information sharing is essential for pharmacists' role within intricate, modern healthcare systems. Community pharmacists (CPs) have demonstrated unsatisfactory knowledge across various pharmacological domains in most developing countries. This study aimed to explore the knowledge and practices of CPs regarding medications and herb safety during pregnancy. METHODS: A cross-sectional study was conducted in a developing country using a self-administered questionnaire. A sample of CPs working in the northern governorates of the West Bank was selected by convenience sampling. The questionnaire included questions on sociodemographic characteristics, practices and knowledge. Descriptive and inferential statistics were calculated using the Statistical Package for the Social Sciences (SPSS) to analyze the data. RESULTS: A total of 207 questionnaires were completed. Most respondents had only a bachelor's degree (89.9%) but did not participate in continuous professional development (CPD) (71.0%). Almost one-third of the CP workload involved dispensing drugs to pregnant women. The majority of the participants reported that they inquire about pregnancy status (59.9%), refer to scientific sources (82.6%), and contact a prescribing physician (51.2%) in cases of uncertainty. A higher knowledge score was associated with receiving a master's degree and CPD programs. Most CPs identified folic acid, paracetamol and amoxicillin as safe, while tetracycline, isotretinoin, enalapril, pseudoephedrine and ibuprofen were among the drugs mostly reported as unsafe. Castor oil, Senna, St. John's wort and ginseng were the most frequently reported herbs as unsafe. CONCLUSIONS: Despite the gaps in knowledge about herb pharmacology, CPs demonstrated acceptable knowledge and practice regarding drug safety during pregnancy. CPD is recommended for addressing gaps in knowledge and practice. Future research evaluating knowledge and practice may benefit from developing a specific, accurate, validated instrument.

Synthesis and Insecticidal Evaluation of 3,5-Dicyanopyridines Against Cotton Aphids via Microwave-Assisted Multicomponent Reactions.

Certain 2-amino-6-alkoxy-4-arylpyridine-3,5-dicyanide 1a-e were prepared via a straightforward process using microwave technology rather than conventional methods. This involved reaction of arylidenemalononitrile thru propanedinitrile in the occurrence of sodium alkoxide under MW. While, their positional isomer 4-amino-6-alkoxy-2-arylpyridine-3,5-dicyanide 3a-j have been separated from the reaction of aryl aldehydes with 2-aminoprop-1-ene-1,1,3-tricarbonitrile 2 in the presence of sodium alkoxide using microwave technic. Furthermore, the insecticidal properties of all synthesized compounds were observed with respect to Cotton aphid nymphs and adults. Neonicotinoid pesticides are indicated as the most effective pesticides toward aphids and many other pests. Many insecticides are discovered as novelties. As a result, several pyridine compounds were chemical method synthesized to serve as equivalents of neonicotinoids, a broad class of insecticides. With LC50 value of 0.03 mg/L, components 3g exhibit the highest insecticidal bioactivity. This work discusses how to find new chemicals that could be used as insecticidal agents in the future.

Prevalence of acne and its impact on quality of life and practices regarding self-treatment among medical students.

Acne vulgaris is one of the most common skin diseases worldwide and causes great distress to patients. In addition, most acne patients suffer from low self-esteem and social withdrawal. This study aimed to assess the prevalence of acne and its impact on quality of life among medical students. It also evaluates the patterns of self-treatment use. The study population consisted of all medical students from An-Najah National University (ANU) and the hospital. The questionnaire consists of three parts, and the first part consists of questions regarding demographic information. The second part consisted of questions to measure the severity of acne using the acne severity scale as well as the Cardiff Disability Index, which assesses the quality of life concerning acne in medical students. Finally, the third part consisted of questions exploring and assessing acne self-treatment. The mean age of our study sample was 21.3 ± 1.9 years, with a female predominance of 72.3%. The prevalence of acne among medical students was 80.9%, and 36.6% practiced self-medication. Acne was strongly associated with female sex (p < 0.001) and skin type (p = 0.024). Regarding diet, dairy consumption (p = 0.007), sweets (p < 0.001), chocolate (p < 0.001), and oily food (p = 0.006) were all significantly associated with acne. Skin type was strongly associated with the severity of acne (p < 0.001) and the Cardiff acne disability index (p = 0.016). Gender (p = 0.039) was also associated with Cardiff acne disability. A significant correlation was found between the severity of acne and impaired quality of life. The most commonly used topical agent for self-treatment remedies was antibiotics (70.3%). The most commonly used oral agent was isotretinoin (9.4%). A total of 22.7% of the students used herbal products, while 47.7% used home remedies. Acne is prevalent among medical students, with a high percentage of students having different degrees of impairment in their daily lives. As a result, self-medication among acne sufferers is highly common. Awareness of the appropriate use of self-medication should increase among medical students.

Designing, Characterization, DFT, Biological Effectiveness, and Molecular Docking Analysis of Novel Fe(III), Co(II), and Cu(II) Complexes Based on 4-Hydroxy-2H-pyrano[3,2-c]quinoline-2,5(6H)-dione.

The main target of the current framework is the designing and synthesizing of novel iron(III), cobalt(II), and cupper(II) complex compounds emanating from bioactive nucleus, 4-hydroxy-2H-pyrano[3,2-c]quinoline-2,5(6H)-dione ligand, to enhance comprehension as potential antibacterial, antifungal, and antioxidant alternatives by means of using DFT calculations and molecular docking investigation. Thus, the new complexes had been synthesized and characterized using various analytical techniques, including elemental analysis, infrared spectroscopy, mass spectrometry, UV spectroscopy, conductivity, and magnetic testing, as well as thermal analysis. The 4-hydroxy-2H-pyrano[3,2-c]quinoline-2,5(6H)-dione ligand exhibits monobasic bidentate OO donor properties toward the metal core, as shown by its infrared spectroscopic characteristics. The use of thermal analysis techniques allows for the identification and characterization of water molecules present inside the complexes, as well as the determination of their distribution patterns. The molecular structures of free ligand and its metal complex compounds have been verified through the use of density functional theory (DFT) simulations. These simulations also provide a valuable understanding of the quantum chemical characteristics associated with these structures. In vitro experiments were conducted to evaluate the antioxidant, antibacterial, as well as antifungal and the properties of the free ligand and its corresponding complex compounds. DATA revealed that synthesized metal complex compounds have heightened biological efficacy as related to the unbound ligand. Furthermore, molecular docking analysis was done to understand the interactions between the studied compounds and proteins derived from Escherichia coli (pdb ID: 2vf5), Aspergillus flavus (pdb ID: 3cku), and humans (pdb ID: 5IJT), which are considered to be significant in drug design. Lastly, a correlation between in vitro efficacies with molecular docking data was done and analyzed.

Histone Deacetylase Inhibitors Directly Modulate T Cell Gene Expression and Signaling and Promote Development of Effector-Exhausted T Cells in Murine Tumors.

Epigenetic regulation plays a crucial role in the development and progression of cancer, including the regulation of antitumor immunity. The reversible nature of epigenetic modifications offers potential therapeutic avenues for cancer treatment. In particular, histone deacetylase (HDAC) inhibitors (HDACis) have been shown to promote antitumor T cell immunity by regulating myeloid cell types, enhancing tumor Ag presentation, and increasing expression of chemokines. HDACis are currently being evaluated to determine whether they can increase the response rate of immune checkpoint inhibitors in cancer patients. Although the potential direct effect of HDACis on T cells likely impacts antitumor immunity, little is known about how HDAC inhibition alters the transcriptomic profile of T cells. In this article, we show that two clinical-stage HDACis profoundly impact gene expression and signaling networks in CD8+ and CD4+ T cells. Specifically, HDACis promoted T cell effector function by enhancing expression of TNF-α and IFN-γ and increasing CD8+ T cell cytotoxicity. Consistently, in a murine tumor model, HDACis led to enrichment of CD8+ T cell subsets with high expression of effector molecules (Prf1, Ifng, Gzmk, and Grmb) but also molecules associated with T cell exhaustion (Tox, Pdcd1, Lag3, and Havcr2). HDACis further generated a tumor microenvironment dominated by myeloid cells with immune suppressive signatures. These results indicate that HDACis directly and favorably augment T cell effector function but also increase their exhaustion signal in the tumor microenvironment, which may add a layer of complexity for achieving clinical benefit in combination with immune checkpoint inhibitors.

Incidental lymphadenopathy in renal transplantation.

INTRODUCTION: Iliac lymphadenectomy is performed to provide anastomotic access during the vascular implantation procedure in renal transplantation. Iliac lymph nodes (LNs) are often enlarged, but there are no standardised guidelines for the management of incidentally enlarged LNs during transplantation. We aimed to evaluate histological findings of LNs sent for examination at our unit. METHODS: Patients were evaluated in two distinct date cycles. In the first cycle, lymphadenectomy and histological assessment were performed at the discretion of the transplanting surgeon. In the second cycle, all incidentally enlarged LNs were sent for histological assessment, regardless of size. RESULTS: In the first cycle (n = 76), 11 patients (14.47%) had incidentally enlarged iliac LNs on lymphadenectomy and histology showed only reactive changes. In the second cycle (n = 165), eight patients (4.85%) had incidentally enlarged LNs on lymphadenectomy. One patient was found to have mature B cell chronic lymphocytic leukaemia. The patient was referred to haematology and a "watch and wait" approach was taken, with the patient still alive at last follow-up (511 days post-transplantation). DISCUSSION: There are currently no published guidelines on the management of incidentally enlarged iliac LNs during transplantation. Current literature suggests that clinically significant lymphadenopathy needs to be investigated in all patients. Based on our centre's experience of a 5.26% (1 in 19) positive pathological LN sampling, we recommend that all incidental LNs with suspicious features and/or that are greater than 10mm in diameter should be considered for histological, microbiological and molecular assessment as appropriate.

Prevalence, awareness, and patterns of non-steroidal anti-inflammatory drug use among health science students in Palestine: a cross-sectional study.

Despite the widespread use of nonsteroidal anti-inflammatory drugs (NSAIDs), many people lack sufficient awareness regarding their side effects and proper usage. Consequently, this study aimed to assess the knowledge, behavior, and usage patterns of NSAIDs among students enrolled in Palestinian health colleges. The study was conducted in December 2020 using a cross-sectional design, and a convenience sampling method was employed to enroll a total of 206 students. The questionnaire comprised seven sections, each containing approximately 5 to 10 closed-ended questions. Data were analyzed using version 21 of the Statistical Package for the Social Sciences (IBM-SPSS Statistics 21). The percentage of respondents who admitted that NSAIDs were used several times in the year was 35.9%. More than half of the students believed that NSAIDs were generally safe. Seventy-two percent of the students were aware that more than one type of NSAID at the same time increased the side effects. The median knowledge score of NSAID side effects was 9 [6.25-11] out of 13. The knowledge score increased significantly with age (p < 0.001), higher academic year (p < 0.001), and pharmacy and medicine specialties (p = 0.002). The college students surveyed in this study possess a general awareness of NSAIDs. Nonetheless, there remains a necessity to enhance their behavior and practices concerning the utilization of NSAIDs through the implementation of programmed educational strategies.

Synthesis, X-ray crystallography and antimicrobial activity of 2-cyanoguanidinophenytoin.

The optimized synthesis of [5-oxo-4,4-diphenylimidazolidin-2-ylidene]cyanamide, which is known as 2-cyanoguanidinophenytoin (CNG-DPH) (3), and (imidazo[4,5-d]imidazole-2,5-diylidine)dicyanamide (4) has been reported in the present work. Furthermore, new Mannich bases derived from CNG-DPH were synthesized via its reaction with formaldehyde and using the corresponding amines, piperidine (base 5), and morpholine (base 6). Also, the antimicrobial activity and X-ray crystal structures for CNG-DPH and their Mannich bases were studied. The bases 3 and 6 crystallized in a monoclinic system; the crystal structure of 3 containing four molecules in the unit cell with a P21/c space group. The unit cell of 6 has eight molecules with a C2/c space group. The inter and intra hydrogen bond contacts packed and stabilized both of the structures. The morpholine ring of base 6 demonstrated a distinctive chair configuration. Mannich bases 5 and 6 showed promising antimicrobial effects. base 4 has a greater percentage for in vitro cytotoxicity (IC50) against normal cells, whereas 3 has the lowest ratio.