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Anabolic-androgenic steroid (AAS) use is prevalent among noncompetitive bodybuilders, with potential severe vascular complications. While thrombotic events have been reported with AAS use, bilateral acute limb ischemia (ALI) requiring amputation is rare. We present a case of bilateral limb ischemia, in a young adult who use AAS. Our patient is a 40-year-old male, a bodybuilder with a 4-year history of cyclic AAS use, who presented with bilateral leg pain and burning sensations from the knees to the feet. CT angiography revealed multiple embolic occlusions in both lower extremities, with no other identifiable risk factors for ALI. Management included intravenous heparin therapy and 3 attempts at right leg revascularization through percutaneous angioplasty, mechanical thrombectomy, and pharmacologic thrombolysis. After failed revascularization and subsequent rhabdomyolysis, right below-knee amputation was required. Amputation was successful, and the patient underwent rehabilitation with no complications. This case highlights AAS use as a potential cause of severe vascular complications in young patients. When traditional risk factors for ALI are absent, clinicians should screen for the use of AAS. Early recognition and intervention may prevent limb loss in this population.

Storm Daniel struck northeastern Libya on September 10, 2023, causing severe infrastructure damage and significant human loss. Derna was the most affected city, with the University of Derna suffering extensive damage and the tragic loss of 37 medical students. Medical students face unique psychological and academic stressors, and tend to have higher rates of psychiatric disorders compared to their peers of the same age. This is the first study to investigate the storm’s psychological impact on medical students at the University of Derna. The study has a cross-sectional design and lasted from February 1 to March 1, 2024. We used the Generalized Anxiety Disorder-7 (GAD-7) to assess anxiety and the Patient Health Questionnaire-9 (PHQ-9) to assess depression, along with sociodemographic questions in our questionnaire. We included only active students enrolled in the 7-year undergraduate program at the University of Derna. Statistical tests such as the chi-square test and binary logistic regression were used in the analysis. About 225 students completed the survey. The means and standard deviations for GAD-7 and PHQ-9 scores were 9.2 (3.9) and 10.8 (5.0), respectively. The prevalence of anxiety was 42.2% for cases classified as moderate and severe (cut-off ≥10). Depression had a prevalence of 51.1% for cases classified as moderate, moderately severe and severe (cut-off ≥ 10). Suicidal ideation was reported at a rate of 48.9% for “several days” or more and at 16.5% for “more than half of the days” and “nearly every day.” Internal displacement following the storm was significantly associated with both anxiety (p = 0.033) and depression (p = 0.003). However, age, gender, year of study, monthly allowance and residence status (living with family or alone) did not show a statistically significant association with either anxiety or depression (p > 0.05 for all variables). Logistic regression analysis identified gender as the only significant predictor of anxiety (p = 0.041) and internal displacement as the sole significant predictor of depression (p = 0.023). Medical students at the University of Derna reported high rates of anxiety, depression and suicidal ideation following Storm Daniel. Internal displacement was significantly associated with both anxiety and depression. These results highlight the need for targeted interventions to address medical students’ mental health challenges and improve their overall well-being.

Epidermal cysts are usually found in the head, neck, and trunk, and they are very rare to be found in the popliteal fossa. Baker's cyst is the most common cause of popliteal fossa swelling. To our knowledge, this is the seventh reported case of an epidermal inclusion cyst in the knee area. A 39-year-old male presented with popliteal swelling that had been present since 2016. It was not associated with pain or restriction of movement. On examination, the swelling was firm, well-capsulated, freely mobile, and not fixed to the underlying structure. There was no tenderness, warmth, or any signs of inflammation. The MRI revealed a 1.5×3 cm circumscribed subcutaneous lesion with low T1 and intermediate T2W signal, with normal adjacent joint structures. A total excision was performed, and the pathology report confirmed the diagnosis of epidermal inclusion cyst. Popliteal fossa masses are commonly due to Baker's cysts. Other pathologies should be considered when the presentation is atypical, unclear, or not supported by imaging. Our literature search highlighted the rare occurrence of epidermal cysts around the knee joint. Long-standing asymptomatic popliteal swellings that are either stable or progressive should raise suspicion of alternative pathologies.

Background: Cirrhosis is associated with significant morbidity and mortality. Recent studies have highlighted the potential role of allopurinol in reducing the incidence of hepatic decompensation among individuals with cirrhosis. This study aimed to evaluate the association of allopurinol use with the incidence of hepatic decompensation and overall mortality in patients with cirrhosis in a large, propensity-matched cohort. Methods: A retrospective cohort study of adults with cirrhosis was conducted using the national TriNetX database, with 1:1 propensity score matching. Allopurinol exposure was assessed in three categories compared to individuals with no allopurinol use: 100 mg, 300 mg, and exposure at any dose. The primary outcome was the incidence of overall hepatic decompensation. Secondary outcomes included the incidence of ascites, esophageal variceal bleeding, hepatic encephalopathy (HE), hepatorenal syndrome, spontaneous bacterial peritonitis (SBP), hepatocellular carcinoma, and overall mortality. The outcomes were assessed at 6, 12, and 18 months. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: After propensity score matching, 5,358 patients who received allopurinol were compared with 5,358 controls. Dose-specific analyses included two additional matched cohorts: 2,124 patients receiving 100 mg of allopurinol and their matched controls, and 1,020 patients receiving 300 mg of allopurinol and their matched controls. At 18 months, a statistically significantly lower incidence of hepatic decompensation was seen in the overall allopurinol exposure cohort (OR: 0.77; 95% CI: 0.70–0.84), the 100 mg cohort (OR: 0.66; 95% CI: 0.57 to 0.76), and 300 mg cohort (OR: 0.76; 95% CI: 0.62 to 0.94). Allopurinol exposure was associated with a decreased incidence of esophageal variceal bleeding (OR: 0.71; 95% CI: 0.55 to 0.92), ascites (OR: 0.77; 95% CI: 0.69 to 0.84), HE (OR: 0.76; 95% CI: 0.63 to 0.92), SBP (OR: 0.61; 95% CI: 0.46 to 0.80), and overall death (OR: 0.86; 95% CI: 0.77 to 0.96) compared to the control group. Conclusion: In a propensity score-matched analysis of a large national database, individuals with cirrhosis and allopurinol use had significantly lower risk of hepatic decompensation and overall mortality. These findings suggest that allopurinol may play a potential role in managing cirrhosis, and randomized clinical trials are needed to confirm these findings.

Probléme Avec le déclin de la couverture vaccinale dans les regions en conflit, le Yemen encourt un risque accru d'épidémies de poliomyélite dues à un poliovirus derivé d'une souche vaccinale. Approche Face aux épidémies de poliomyélite, le Ministere de la Santé yéménite et ses partenaires ont lancé plusieurs campagnes de vaccination des enfants. Nous avons égalementdéployé de nombreuses mesures vi santa améliorer la communication, l'éducation, la promotion de la santé et l'hygiéne, en particulier dans les camps abritant des personnesdéplacéesa ľintérieurdu pays. Environnement local En 2009, le Yemen avait été declaré exempt de poliomyélite et a conservé ce statut jusqu'en 2019. Toutefois, les luttes politiques qui font rage depuis 2015, associées aux difficuItés rencontrées dans la fourniture du vaccin antipoliomyélitique dans les régions en conflit, ont entraíné deux épidémies: 35 cas ont été causes par un poliovirus derivé d'une souche vaccinale de type 1 entre 2019 et 2021, et 230 cas par un poliovirus derivé d'une souche vaccinale de type 2 entre novembre 2021 et decembre 2022. Changements significatifs Pour lutter contre la premiere epidémie, fin 2020, nous avons vaccine 7,2 millions d'enfants dans le cadre de campagnes de vaccination à l'échelle nationale, à l'exception du gouvernorat de Saada, en raison de l'interdiction imposée par les autorites. Fin 2021,3 800 313 enfants de moinsde cinq ans avaient reçu leur vaccin antipoliomyélitique. Lors de la seconde epidémie, fin 2022, 4463 389 vaccins avaient été administres aux enfants de moinsde 10 ans et 1 217 423 aux enfants de moins de 5 ans. Leçons tirées Les campagnes de vaccination dans les régions en conflit oír la couverture vaccinale est faible demeurent cruciales pour l'éradication de la poliomyélite. Des efforts sont nécessaires pour atteindre les groupes vulnerables tels que les populations déplacées. Les actions de sensibilisation, de communication et de mobilisation sociale permettent de toucher un plus large public et d'encourager la participation aux efforts de vaccination, essentiels dans la prevention des épidémies de poliomyélite.

Two series of dimethoxy-halogenated chalcones (DM1–DM20) were synthesized and tested for their ability to inhibit monoamine oxidase (MAOs). Compound DM2 exhibited the most significant inhibition against MAO-B with an IC50 value of 0.067 µM, followed by compound DM18 (IC50 = 0.118 µM), with selectivity index (SI) values of 93.88 and >338.98, respectively. However, none of the substances successfully inhibited MAO-A. The MAO-B inhibitors DM2 and DM18 were competitive and reversible, with Ki values of 0.032 ± 0.004 and 0.045 ± 0.001 µM, respectively. DM2 was non-toxic below 100 µg/mL in the cytotoxic test using the Vero epithelial cell line by the MTT method. According to molecular docking studies, DM2 and DM18 formed very similar conformations within the MAO-B binding pocket, with the ortho-chlorine and ortho-fluorine aromatic rings sandwiched between F168 and Y326. These conformations were predicted to show better interactions with the targeted MAO-B than MAO-A. In particular, the induced-fit docking of the dimethoxy phenyl ring of DM2 facing the hydrophobic pocket made up of FAD, Y398, and Y435 had an impact on F168 in the docking pocket. Taken together, DM2 and DM18 may be suitable candidates for treating neurodegenerative conditions such as Parkinson’s disease.

In the field of education, ongoing processes, and optimal schoolwork outcomes require educational leadership, especially in developing countries, due to the lack of sustainable teaching performance and effective leadership. The present study aims to examine the mediating role of teachers’ commitment to transformational leadership and sustainable teaching performance. The sample of the study was selected using a stratified random sampling technique. Out of the 450 copies distributed to the participants, only 374 were retrieved as valid. The hypotheses of the study were tested using PLS–SEM. The findings showed a positive effect of transformational leadership on teachers’ commitment. Moreover, transformational leadership was also found to positively impact teachers’ performance. In contrast, the teachers’ commitment was revealed to positively affect sustainable teaching performance. Finally, the study showed that the teachers’ commitment mediated the relationship between transformational leadership and sustainable teaching performance. This study is unique for being among the few studies that examine the effects of principals’ transformational leadership. It provides educational leaders and policymakers with significant insights by providing a roadmap that aids in understanding the most influential factors on teaching performance sustainability. Consequently, this study holds significant practical relevance for leaders in the field of education and policymakers, as they provide valuable insights into policies and practices that can be implemented to foster sustainability in the school environment.

Approach In response to polio outbreaks, the Yemeni health ministry and partners initiated multiple vaccination campaigns to deliver vaccines to children. We also implemented several measures to enhance communication, education, health promotion and hygiene, especially in camps for internally displaced people. Approche Face aux epidemies de poliomyelite, le Ministere de la Sante yemenite et ses partenaires ont lance plusieurs campagnes de vaccination des enfants. Nous avons egalement deploye de nombreuses mesures visant a ameliorer la communication, l'education, la promotion de la sante et l'hygiene, en particulier dans les camps abritant des personnes deplacees a l'interieur du pays.

In the current study, eight new hybrids of the NSAIDs, ibuprofen and ketoprofen with five pyrrolizine/indolizine derivatives were designed and synthesized. The chemical structures of these hybrids were confirmed by spectral and elemental analyses. The antiproliferative activities of these hybrids (5 μM) was investigated against MCF-7, A549, and HT-29 cancer cell lines using the cell viability assay, MTT assay. The results revealed 4–71% inhibition of the growth of the three cancer cell lines, where 8a,e,f were the most active. In addition, an investigation of the antiproliferative activity of 8a,e,f against MCF-7 cells revealed IC50 values of 7.61, 1.07, and 3.16 μM, respectively. Cell cycle analysis of MCF-7 cells treated with the three hybrids at 5 μM revealed a pro-apoptotic increase in cells at preG1 and cell cycle arrest at the G1 and S phases. In addition, the three hybrids induced early apoptotic events in MCF-7 cells. The results of the molecular docking of the three hybrids into COX-1/2 revealed higher binding free energies than their parent compounds 5a,c and the co-crystallized ligands, ibuprofen and SC-558. The results also indicated higher binding free energies toward COX-2 over COX-1. Moreover, analysis of the binding modes of 8a,e,f into COX-2 revealed partial superposition with the co-crystallized ligand, SC-558 with the formation of essential hydrogen bonds, electrostatic, or hydrophobic interactions with the key amino acid His90 and Arg513. The new hybrids also showed drug-likeness scores in the range of 1.06–2.03 compared to ibuprofen (0.65) and ketoprofen (0.57). These results above indicated that compounds 8a,e,f deserve additional investigation as potential anticancer candidates.

The soft computing models used for predicting land surface temperature (LST) changes are very useful to evaluate and forecast the rapidly changing climate of the world. In this study, four soft computing techniques, namely, multivariate adaptive regression splines (MARS), wavelet neural network (WNN), adaptive neurofuzzy inference system (ANFIS), and dynamic evolving neurofuzzy inference system (DENFIS), are applied and compared to find the best model that can be used to predict the LST changes of Beijing area. The topographic change is considered in this study to accurately predict LST; furthermore, Landsat 4/5 TM and Landsat 8OLI_TIRS images for four years (1995, 2004, 2010, and 2015) are used to study the LST changes of the research area. The four models are assessed using statistical analysis, coefficient of determination (R2), root mean square error (RMSE), and mean absolute error (MAE) in the training and testing stages, and MARS is used to estimate the important variables that should be considered in the design models. The results show that the LST for the studied area increases by 0.28°C/year due to the urban changes in the study area. In addition, the topographic changes and previously recorded temperature changes have a significant influence on the LST prediction of the study area. Moreover, the results of the models show that the MARS, ANFIS, and DENFIS models can be used to predict the LST of the study area. The ANFIS model showed the highest performances in the training (R2 = 0.99, RMSE = 0.78°C, MAE = 0.55°C) and testing (R2 = 0.99, RMSE = 0.36°C, MAE = 0.16°C) stages; therefore, the ANFIS model can be used to predict the LST changes in the Beijing area. The predicted LST shows that the change in climate and urban area will affect the LST changes of the Beijing area in the future.