Evaluation of serial QuantiFERON-TB Gold in tube test results and tuberculosis infection status in patients with psoriasis receiving anti-IL-17 treatment (secukinumab and ixekizumab): Real-world data from a tuberculosis-endemic country.

BACKGROUND: In comparison with TNF-α inhibitors, anti-IL-17A agents are considered to have a lower risk of active tuberculosis (TB) or latent TB infection (LTBI) reactivation. METHODS: In this study, we aimed to evaluate the TB infection status and serial QuantiFERON-TB-Gold in tube test (QFT) results of psoriasis patients using IL-17 inhibitors (secukinumab [SEC] and ixekizumab [IXE]) in a real-world setting from a tuberculosis-endemic country. Patients who used an anti-IL-17 agent for at least 3 months in our follow-up were included in the study. Patients' clinical and demographic features, baseline QFT results and latest QFT results (if any), and TB infection status were noted from the past medical records. RESULTS: A total of 717 patients, of whom 333 (46.4%) were female, were included in the study. The cumulative exposure time to an anti-IL-17 agent was 14,147 patient-months, 9743 patient-months for SEC and 4404 patient-months for IXE. Also, 459 (SEC = 305/IXE = 154) patients used an anti-IL-17 agent for ≥ 12 months. Of these, 125 had positive baseline QFT results. In all, 334 had negative baseline QFT results. The latest QFT result of 309 was also negative (persistent seronegative group). During follow-up, the QFT results of 10 patients changed from negative to positive (positive seroconversion group). Seven of them were using SEC and three were using IXE, respectively. No case of active TB infection was detected. CONCLUSION: In our study, the positive seroconversion rate of 10/334 seems high, but this did not translate to active disease. However, closer monitoring may be required, especially in patients with advanced age, the presence of PsA, long disease duration and long anti-IL-17 treatment duration.

Association Between Pandemic-Related Maternal Perinatal Anxiety and Early Postpartum Breastfeeding Success.

BACKGROUND AND OBJECTIVES: Prior studies have shown conflicting results on the impact of maternal anxiety on breastfeeding initiation and success. Furthermore, a substantial increase in maternal anxiety levels was shown in response to the COVID-19 pandemic. In this study, we aimed to investigate the relationship between maternal perinatal anxiety induced by the COVID-19 pandemic and early breastfeeding outcomes. MATERIALS AND METHODS: This cross-sectional study was conducted in two regional maternity hospitals, involving 220 first-time pregnant patients with a gestational age of ≥37 weeks. All patients had no current diagnosis of COVID-19 and no cases of COVID-19 in their close environment at the time of admission. At 24-48 hours postpartum or at the time of discharge, three following scoring systems were employed: the Coronavirus Anxiety Scale (CAS), the State-Trait Anxiety Inventory (STAI), and the LATCH (short for latch, audible swallowing, type of nipple, comfort, and hold) score. A LATCH score of ≥8 was chosen as the cutoff point for defining successful breastfeeding performance. Spearman's rank correlation was used to evaluate relationships between the CAS, STAI scores, maternal and infant factors, and LATCH scores. RESULTS: There were no differences in baseline characteristics between groups categorized as successful and unsuccessful in breastfeeding initiation. The mean total STAI score was 86.3±13.2, the CAS score was 1.07±1.91, and the LATCH score was 8.42±1.7. Although there was an increase in State-Trait Anxiety Inventory-State Anxiety (STAI-S) scores compared to State-Trait Anxiety Inventory-Trait Anxiety (STAI-T) scores, and the STAI-S score and CAS score were higher in the unsuccessful group, these differences did not reach statistical significance (p = 0.22 and 0.16, respectively). When we evaluated the correlation of the LATCH score with STAI total, STAI-S and STAI-T scores, CAS score, and maternal and infant factors, only the type of delivery showed a significant correlation with the LATCH score (p = 0.008). CONCLUSIONS: Early postpartum breastfeeding efficiency, as measured by the LATCH score, was only correlated with the type of delivery. No significant correlation was found between pandemic-related maternal perinatal anxiety and early postpartum breastfeeding success.

Health conditions of first-degree relatives of children with familial Mediterranean fever.

BACKGROUND: Given the strong genetic background of familial Mediterranean fever (FMF), the frequently reported co-existing diseases in children with FMF should also be investigated in other family members. Therefore, we aimed to examine the medical conditions of first-degree relatives (FDRs) of our pediatric patients with FMF in the present study. METHODS: Chronic diseases of FDRs of pediatric 449 FMF, 147 juvenile idiopathic arthritis (JIA) patients and 93 healthy controls (HC) were questioned during their routine clinical visits for 9 consecutive months. RESULTS: A total of 1975 FDRs of 449 FMF, 690 FDRs of 147 JIA patients, and 406 FDRs of 93 HC were included into the study. The most common medical conditions were non-atopic asthma (n=71, 3.6%), type 2 DM (n=14, 2%), and tonsillectomy history (n=12, 2.95%) in the FMF, JIA, and HC groups, respectively. Atopic diseases (FMF vs. JIA: p=0.013; FMF vs. HC: p=0.014), rheumatic diseases (FMF vs. JIA: p=0.030; FMF vs. HC: p=0.017), and surgical histories (FMF vs. JIA: p<0.01; FMF vs. HC: p=0.026), including adenoidectomy, tonsillectomy, and appendectomy, were significantly more common in the FMF group than in other groups. CONCLUSIONS: Our novel findings may contribute to understanding the hereditary burden of co-existing diseases in children with FMF and encourage further studies involving genetic screenings.

Syntheses, characterizations, crystal structures and Hirshfeld surface analyses of methyl 4-[4-(di-fluorometh-oxy)phen-yl]-2,7,7-trimethyl-5-oxo-1,4,5,6,7,8-hexa-hydro-quinoline-3-carboxyl-ate, isopropyl 4-[4-(di-fluoro-meth-oxy)phen-yl]-2,6,6-trimethyl-5-oxo-1,4,5,6,7,8-hexa-hydro-quinoline-3-carboxyl-ate and tert-butyl 4-[4-(di-fluoro-meth-oxy)phen-yl]-2,6,6-trimethyl-5-oxo-1,4,5,6,7,8-hexa-hydro-quinoline-3-carboxyl-ate.

The crystal structures and Hirshfeld surface analyses of three similar compounds are reported. Methyl 4-[4-(di-fluoro-meth-oxy)phen-yl]-2,7,7-trimethyl-5-oxo-1,4,5,6,7,8-hexa-hydro-quinoline-3-carboxyl-ate, (C21H23F2NO4), (I), crystallizes in the monoclinic space group C2/c with Z = 8, while isopropyl 4-[4-(di-fluoro-meth-oxy)phen-yl]-2,6,6-trimethyl-5-oxo-1,4,5,6,7,8-hexa-hydro-quinoline-3-carb-oxyl-ate, (C23H27F2NO4), (II) and tert-butyl 4-[4-(di-fluoro-meth-oxy)phen-yl]-2,6,6-trimethyl-5-oxo-1,4,5,6,7,8-hexa-hydro-quinoline-3-carboxyl-ate, (C24H29F2NO4), (III) crystallize in the ortho-rhom-bic space group Pbca with Z = 8. In the crystal structure of (I), mol-ecules are linked by N-H⋯O and C-H⋯O inter-actions, forming a tri-periodic network, while mol-ecules of (II) and (III) are linked by N-H⋯O, C-H⋯F and C-H⋯π inter-actions, forming layers parallel to (002). The cohesion of the mol-ecular packing is ensured by van der Waals forces between these layers. In (I), the atoms of the 4-di-fluoro-meth-oxy-phenyl group are disordered over two sets of sites in a 0.647 (3): 0.353 (3) ratio. In (III), the atoms of the dimethyl group attached to the cyclo-hexane ring, and the two carbon atoms of the cyclo-hexane ring are disordered over two sets of sites in a 0.646 (3):0.354 (3) ratio.

The Relationship Between Adolescents' Perception of Family Emotional Atmosphere and Acne Severity, Self-Esteem, and Quality of Life in Adolescents Diagnosed with Acne Vulgaris.

OBJECTIVE: Acne vulgaris, a prevalent chronic condition among adolescents, significantly impacts patients' quality of life and self-esteem. Our aim was to investigate whether how adolescents perceive their family emotional atmosphere has an impact on their acne severity, quality of life, and self-esteem. MATERIALS AND METHODS: This study included 118 patients with acne vulgaris who completed various assessments, including a sociodemographic data form, the Acne Quality of Life Scale, the Hospital Anxiety and Depression Scale, the Shortened Level of Expressed Emotion Scale (SLEES) and, the Rosenberg Self-Esteem Scale. The Global Acne Grading System is performed by an experienced dermatologist to determine the severity of acne. RESULTS: Out of 118 patients, 78 (66.1%) were female and 40 (33.9%) were male. The mean age of patients was 15.2 ± 1.3 years. There was a positive correlation between the severity of acne and the levels of perceived intrusiveness subscores of SLEES (P = .021, r = 0.212). Significant correlations were also observed among quality of life scores, anxiety and depression levels, lack of emotional support (LES) scores, and self-esteem levels. The initial linear regression analysis demonstrated that the level of LES subscores of SLEES and levels of anxiety and depression were predictors of self-esteem. In the second regression analysis, anxiety and depression levels were identified as significant predictors of quality of life. CONCLUSION: The perceived family emotional atmosphere may be an important factor in evaluating the severity of acne as well as the self-esteem and quality of life of adolescent patients with acne vulgaris.

Characteristics and Outcomes of Women With Mild and Moderate Forms of COVID-19 Giving Birth During the COVID-19 Pandemic.

INTRODUCTION: We aim to investigate the clinical course and impact of mild and moderate forms of coronavirus disease 2019 (COVID-19) infection on pregnant women. METHOD: A retrospective cohort study was conducted on pregnant women who delivered in a hospital with confirmed COVID-19 infection. Demographic features, clinical characteristics, and perinatal outcomes were retrospectively evaluated. RESULTS: In total, 157 pregnant women with COVID-19 were hospitalized. In a total of 46 deliveries, three (6.5%) had comorbidities and six (13%) were symptomatic. Myalgia and cough were the leading symptoms. In total, 11 (23.8%) patients received COVID-19 therapy, 41 (90%) had mild disease, and five (10.9%) were transferred to the intensive care unit (ICU). Maternal mortality was observed in two (4.3%) cases. Of the patients, 15 (32.6) had pregnancy complications (preterm delivery) (n = 13, 28.2%), and the cesarean section rate was 91.3%. CONCLUSION: The course of COVID-19 was mild in the majority of cases. However, accompanying comorbid conditions may accelerate the return to severe form and cause death.

Crystal structures and Hirshfeld surface analyses of N,N-di-methyl-acetamide-1-(dimethyl-λ4-aza-nyl-idene)ethan-1-ol tribromide (1/1), N,N-di-methyl-acetamide-1-(dimethyl-λ4-aza-nyl-idene)ethan-1-ol di-bromido-iodate (1/1) and N,N-di-methyl-acetamide-1-(dimethyl-λ4-aza-nyl-idene)ethan-1-ol di-chlorido-iodate (1/1).

In the title compounds, N,N-di-methyl-acetamide-1-(dimethyl-λ4-aza-nyl-idene)ethan-1-ol tribromide (1/1), C4H9NO·C4H10NO+·Br3 - or [(C4H9NO)·(C4H10NO)](Br3), (I), N,N-di-methyl-acetamide-1-(dimethyl-λ4-aza-nyl-idene)ethan-1-ol di-bromido-iodate (1/1), C4H9NO·C4H10NO+·Br2I- or [(C4H9NO)·(C4H10NO)](Br2I), (II), and N,N-di-methyl-acetamide-1-(dimethyl-λ4-aza-nyl-idene)ethan-1-ol di-chlorido-iodate (1/1), C4H9NO·C4H10NO+·Cl2I- or [(C4H9NO)·(C4H10NO)]·(Cl2I), (III), all the anions are almost linear in geometry and all the cations, except for the methyl H atoms, are essentially planar. In the crystal structure of (I), the cations are linked by pairs of C-H⋯O hydrogen bonds, forming inversion dimers with an R 2 2(8) ring motif. These dimers also exhibit O-H⋯O hydrogen bonding. Dimerized cation pairs and anions are arranged in columns along the a axis. In the crystal of (II), the cations are linked by pairs of O-H⋯O and C-H⋯O hydrogen bonds, forming an R 4 4(14) ring motif. These groups of cations and the anions form individual columns along the a axis and jointly reside in planes roughly parallel to (011). In the crystal of (III), cations and anions also form columns parallel to the a axis, resulting in layers parallel to the (020) plane. Furthermore, the crystal structures of (I), (II) and (III) are consolidated by strong halogen (Br and/or I and/or Cl)⋯H and weak van der Waals inter-actions. In addition to the structural evaluation, a Hirshfeld surface analysis was carried out.

Synthesis, crystal structure and Hirshfeld surface analysis of tert-butyl 4-[4-(di-fluoro-meth-oxy)phen-yl]-2,7,7-trimethyl-5-oxo-1,4,5,6,7,8-hexa-hydro-quinoline-3-carboxyl-ate.

The 1,4-di-hydro-pyridine ring of the title compound, C24H29F2NO4, adopts a distorted boat conformation, while the cyclo-hexene ring is in an almost twist-boat conformation. In the crystal, N-H⋯O and C-H⋯O hydrogen bonds as well as C-H⋯π inter-actions connect mol-ecules, forming layers parallel to the (100) plane. These layers are linked by van der Waals forces and C-H⋯F inter-actions, which consolidate the crystal structure. Hirshfeld surface analysis shows the major contributions to the crystal packing are from H⋯H (54.1%), F⋯H/H⋯F (16.9%), O⋯H/H⋯O (15.4%) and C⋯H/H⋯C (12.6%) contacts.

Crystal structures and Hirshfeld surface analyses of (E)-1-[1-(4-tert-butyl-phen-yl)-2,2-di-chloro-ethen-yl]-2-phenyl-diazene, (E)-1-[1-(4-tert-butyl-phen-yl)-2,2-di-chloro-ethen-yl]-2-(4-methyl-phen-yl)diazene, (E)-1-[1-(4-tert-butyl-phen-yl)-2,2-di-chloro-ethen-yl]-2-(4-meth-oxy-phen-yl)diazene and (E)-1-[1-(4-tert-butyl-phen-yl)-2,2-di-chloro-ethen-yl]-2-(3-methyl-phen-yl)diazene.

The crystal structures and Hirshfeld surface analyses of four similar azo compounds are reported. (E)-1-[1-(4-tert-Butyl-phen-yl)-2,2-di-chloro-ethen-yl]-2-phenyl-diazene, C18H18Cl2N2, (I), and (E)-1-[1-(4-tert-butyl-phen-yl)-2,2-di-chloro-ethen-yl]-2-(4-methyl-phen-yl)diazene, C19H20Cl2N2, (II), crystallize in the monoclinic space group C2/c with Z = 8, and (E)-1-[1-(4-tert-butyl-phen-yl)-2,2-di-chloro-ethen-yl]-2-(4-meth-oxy-phen-yl)diazene, C19H20Cl2N2O, (III), in the monoclinic space group P21/c with Z = 4. (E)-1-[1-(4-tert-Butyl-phen-yl)-2,2-di-chloro-ethen-yl]-2-(3-methyl-phen-yl)diazene, C19H20Cl2N2, (IV), crystallizes in the triclinic space group P with Z = 4 and comprises two mol-ecules (A and B) in the asymmetric unit. In the crystal structures of (I) and (II), mol-ecules are linked by C-H⋯π and C-Cl⋯π inter-actions, forming layers parallel to (02), while mol-ecules of (III) are linked by C-H⋯O contacts, C-H⋯π and C-Cl⋯π inter-actions forming layers parallel to (02). The stability of the mol-ecular packing is ensured by van der Waals forces between these layers. In the crystal structure of (IV), mol-ecules are linked by C-H⋯π and C-Cl⋯π inter-actions, forming a tri-periodic network.

Synthesis and crystal structure of catena-poly[[[aqua-{2-[(E)-(1-cyano-2-imino-2-meth-oxy-ethyl-idene)hydrazin-yl]benzene-sulfonato}-sodium]-di-µ-aqua] dihydrate].

In the polymeric title compound, {[Na(C10H9N4O4S)(H2O)3]·2H2O} n , sixfold coordinated Na+ cations are linked into a chain parallel to [010] by sharing common water mol-ecules. Next to the four bridging water mol-ecules, each Na+ cation of the chain is bonded to the O atom of a terminal water mol-ecule and an O atom of the SO3 - group of the sulfonate anion. Classical O-H⋯O, O-H⋯N and N-H⋯O hydrogen bonds and additional π-π inter-actions connect these chains into a three-dimensional network.

Crystal structure and Hirshfeld surface analysis of N-[2-(5-methyl-furan-2-yl)phen-yl]-3-nitro-N-[(3-nitro-phen-yl)sulfon-yl]benzene-sulfonamide.

In the title compound, C23H17N3O9S2, C-H⋯O hydrogen bonds link adjacent mol-ecules in a three-dimensional network, while π-π stacking inter-actions, with centroid-centroid distances of 3.8745 (9) Å, between the furan and an arene ring of one of the two (3-nitro-phen-yl)sulfonyl groups, result in chains parallel to the a axis. The Hirshfeld surface analysis indicates that O⋯H/H⋯O (40.1%), H⋯H (27.5%) and C⋯H/H⋯C (12.4%) inter-actions are the most significant contributors to the crystal packing.

Scabies Affects Quality of Life in Correlation with Depression and Anxiety.

INTRODUCTION: Scabies is a highly contagious disease affects many people worldwide each year and a major public health problem. A small number of studies have shown that scabies causes impairment in the quality of life in adult patients. OBJECTIVES: The aims of this study are to assess the impact of scabies on adult patients quality of life (QoL) and evaluate the relationship between depression and anxiety levels and impairment in life quality. METHODS: This cross-sectional study included adult patients diagnosed with scabies in our dermatology outpatient clinic. The effect of scabies on QoL was evaluated by Dermatology Life Quality Index (DLQI), and the levels of depression and anxiety were evaluated by Beck Depression Scale (BDS) and Beck Anxiety Scale (BAS). RESULTS: Totally, 85 patients included to the study. QoL of 72.2% of the patients was moderate to extremely large affected. There was a positive correlation between the duration of the disease, the total DLQI score and the severity of the disease impact on QoL (rs= 0.287, P = 0.01 and rs=0.280, P = 0.008, respectively). A positive correlation was found between the number of treatments received and the total DLQI (rs= 0.223, P = 0.042). There was a positive correlation between BDS and BAS, and total DLQI score (rs=0.448 and P = 0.000; rs=0.456 and P = 0.000, respectively). CONCLUSIONS: Scabies has a moderate to severe effect on QoL. There was a positive correlation between impairment QoL and anxiety and depression scores.

Crystal structure and Hirshfeld surface analysis of (22 RS,23 SR,25 RS,26 SR)-23,25,5-trimethyl-21-(2,2,2-tri-fluoro-acet-yl)-5-aza-2(2,6)-piperidina-1,3(2,5)-di-furana-cyclo-hexa-phan-24-one.

The title compound, C20H21F3N2O4, features a main twelve-membered difuryl ring with which the furan rings make dihedral angles of 76.14 (5) and 33.81 (5)°. The dihedral angle between the furan rings is 42.55 (7)°. The six-membered nitro-gen heterocycle has a twist-boat conformation. In the crystal, pairs of mol-ecules are connected by inter-molecular C-H⋯O inter-actions, generating an R 2 2(14) ring motif. These pairs of mol-ecules form zigzag chains along the a-axis direction by means of C-H⋯F inter-actions. Furthermore, C-H⋯π and C-F⋯π inter-actions link the mol-ecules into chains along the b-axis direction, forming sheets parallel to the (001) plane. These sheets are also connected by van der Waals inter-actions.

Crystal structure and Hirshfeld surface analysis of isopropyl 4-[2-fluoro-5-(tri-fluoro-meth-yl)phen-yl]-2,6,6-trimethyl-5-oxo-1,4,5,6,7,8-hexa-hydro-quinoline-3-carboxyl-ate.

In the title compound, C23H25F4NO3, the 1,4-di-hydro-pyridine ring adopts a distorted boat conformation, while the cyclo-hexene ring is almost showing a half-chair conformation. In the crystal, inter-molecular N-H⋯O hydrogen bonds connect the mol-ecules into chains with graph-set motif C(6) parallel to the a-axis. These chains are linked together by C-H⋯O and C-H⋯F inter-actions, forming a three-dimensional network. In addition, C-H⋯π inter-actions link the mol-ecules into layers parallel to the (100) plane. A Hirshfeld surface analysis was performed to further investigate the inter-molecular inter-actions.

The Effect of Active and Passive Maternal Smoking During Pregnancy on the Uterine Artery Blood Flow and Obstetric Outcomes: A Prospective Study.

BACKGROUND AND AIM: Maternal smoking is associated with an increased risk of obstetric and neonatal complications during pregnancy. We aimed to investigate the effects of active and passive smoking on fetal-maternal blood flow and fetal complications in mid-trimester pregnant women. METHODS: This prospective study was conducted at Zekai Tahir Burak Women's Research and Training Hospital and included women who were 20 to 22 weeks old, with no fetal anomalies, and with a singleton pregnancy. The data used in the analysis were obtained from a total of 168 pregnant women (50 smokers, 50 passive smokers, and 68 non-smokers). Starting from their 20th week of pregnancy, the women were examined at least once in each trimester. Fetal and maternal pregnancy results were evaluated. Fetal biometry, umbilical, and uterine artery Doppler ultrasonography were performed. To evaluate the flow in these veins, the pulsatility index, resistance index, and systole/diastole (S/D) ratio were performed. RESULTS: The mean age of study patients was 25.06 ± 4.36 years and the mean gestational week was 20.03 ± 0.6 weeks. In terms of the umbilical artery pulsatility index (UMBAPI), umbilical artery systolic/diastolic ratio (UMBAS/D),uterine artery resistance index (UARI), uterine artery pulsatility index (UAPI), and uterine artery systolic/diastolic ratio (UAS/D) levels, the mean value of the smoker group was significantly higher compared to the non-smoker group (p<0.001, p=0.043, p=0.021, p=0.020, and p=0.037, respectively). The birth weight of the fetus was significantly lower in the active and passive smoker groups than in the non-smoker group (p=0.009 and p=0.006, respectively). The number of patients diagnosed with intrauterine growth restriction (IUGR) and oligohydramnios were significantly higher in the smoker group than in the passive smoker and non-smoker groups (p=0.003 and p<0.001, respectively). The risk of low birth weight (OR, (95% CI): 3.38 (2.05 - 5.57); p=0.024), oligohydramnios (OR (95% CI): 13.44 (5.22 - 34.57); p=0.001), IUGR (OR (95% CI): 9.33 (4.50 - 19.33); p=0.001), and preterm birth (OR (95% CI): 4.56 (1.25 - 17.32); p=0.001) increased significantly in the active and passive cigarette exposure groups, compared to the non-smokers. CONCLUSION: During pregnancy, both smoking and passive exposure to cigarette smoke adversely affect the fetus and the newborn. Uterine and umbilical artery Doppler measurements in pregnant women who smoke are significantly higher than the pregnant women who do not smoke.

Serum vitamin D levels and vitamin D receptor gene ApaI and TaqI polymorphisms in patients with morphea: a case-control study.

A uncommon inflammatory condition called morphea causes fibrosis in the skin and subcutaneous tissue. The key stages in the pathophysiology are vascular damage, immunological response, and fibrosis. Numerous research have examined the relationships between the immune system, fibrosis, and vitamin D, but the exact pathogenetic pathways of morphea remain poorly understood. The purpose of this study was to investigate serum 25(OH)D levels and the ApaI (rs7975232) and TaqI (rs731236) polymorphisms of the vitamin D receptor (VDR) in morphea patients. There were 48 age- and sex-matched controls and 41 morphea patients total. VDR polymorphisms were found using PCR tests and gel electrophoresis, and serum 25(OH)D levels were determined using liquid chromatography combined with tandem mass spectrometry (LC-MS/MS). The patient group consisted of 37 females (90.2%) and 4 males (9.8%). The patients' mean age was 38.68 ± 17.54 years. In terms of VDR ApaI and TaqI polymorphisms, there was no discernible difference between the patient and control groups. TaqI polymorphism heterozygosity was discovered in all patients with progressive disease, and this finding was statistically significant (p = 0.012). Patients' mean serum 25(OH)D levels were 16.98 ± 11.55 ng/mL, while those in the control group were 18.02 ± 14.30 ng/mL. VDR polymorphisms, vitamin D levels, disease subtype, age of onset, and responsiveness to treatment did not significantly correlate. In our research, we discovered that TaqI polymorphism may be related to the severity of the disease and that the polymorphisms of the VDR ApaI and TaqI were not associated with morphea susceptibility.

Omalizumab treatment in combination with any other biologics: Is it really a safe duo?

BACKGROUND: Chronic spontaneous urticaria (CSU) is a mast cell-mediated disease, which is sometimes associated with various inflammatory disorders. Omalizumab is a commonly used biological agent, which is a recombinant, humanized, monoclonal antibody against human immunoglobulin E. However, there are only few reports about the combination of omalizumab for CSU with any other biologics for accompanying inflammatory diseases in the literature. The aim of this study was to evaluate the patients whose treatment of omalizumab for CSU were combined with any other biologics for associated inflammatory disorders and to describe whether these combinations might have any safety concerns. METHODS: We conducted a retrospective cohort study of adult patients with CSU treated with omalizumab concurrently using another biological agent for their other dermatological conditions. RESULTS: Thirty-one patients, 19 women and 12 men, were evaluated. The mean age was 45.13 years. The median duration of omalizumab was 11 months. Biological agents which patients were treated other than omalizumab were as follows: adalimumab biosimilar (n = 3), ustekinumab (n = 4), secukinumab (n = 17) and ixekizumab (n = 7). The median duration of concurrent use of omalizumab and other biologics was 8 months. None of the drug combinations was stopped because of side effects. CONCLUSION: This observational study demonstrated that omalizumab treatment for CSU in combination with any other biological agents for dermatological disorders appeared to be well tolerated without any major safety concerns.

Renal involvement, presence of amyloidosis, and genotype-phenotype relationship in pediatric patients with Familial Mediterranean fever: a single center study.

The aim of the study is to investigate how renal involvement is correlated with frequency of amyloidosis, risk factors, and demographic and clinical characteristics in pediatric patients with Familial Mediterranean fever (FMF). Demographic and clinical characteristics and laboratory data of the pediatric patients diagnosed with FMF between 1990 and 2018 were recorded from their files. The diagnosis of patients with amyloidosis (AA) was proven by renal biopsy, and as for patients with non-amyloidosis renal involvement (RI wo AA), amyloidosis could not be detected but they were followed up with the diagnosis of proteinuria and/or hematuria. A total of 1929 FMF pediatric patients were included in the study. About 962 (49.9%) participants were male. There were 134 (6.9%) patients with RI wo AA and 23 (1.2%) patients with AA diagnosed by biopsy. The most common M694V heterozygous/homozygous(het/hom) (31%) mutation was observed. Delay in diagnosis and presence of colchicine resistance were more in patients with RI wo AA and AA (p < 0.05). M694V het/hom mutation was high in both RI wo AA and AA, while the presence of compound heterozygous with M694V mutation was high in RI wo AA (p < 0.01, p = 0.02, p = 0.048, respectively). There was a positive correlation between M694V mutation and monoarthritis/polyarthritis, between compound heterozygous with M694V mutations and presence of chest pain, and between V726A mutation and constipation. Also a negative correlation was found between E148Q and chest pain and between R202Q mutation and monoarthritis/polyarthritis. While M694V mutation increased the risk 2.6 times for AA and 1.7 times for RI wo AA, colchicine resistance increased the risk 33 times for AA and 25 times for RI wo AA.    Concluson: It was concluded in the present study that M694V mutation and colchicine resistance were two important risk factors for RI wo AA (6.9%) and amyloidosis (1.2%) in FMF patients. It should be kept in mind that compound heterozygous with M694V mutations may be associated with chest pain and R202Q mutation may be negatively correlated with arthritis, unlike M694V. The genetic results and clinical findings of the patients should be evaluated together and followed up closely. What is Known: • M694V mutation and colchicine resistance were two important risk factors for RI wo AA and amyloidosis in FMF patients. What is New: • Compound heterozygous with M694V mutations were associated with chest pain and may be more serious than thought. • Another point is that while R202Q mutations were negatively correlated with arthritis, M694V mutations were positively correlated.

Reporting the clinical spectrum of children with IgAV in a retrospective 24-year cohort: Influences of age and sex on clinical presentation.

Background/aim: Immunoglobulin A vasculitis (IgAV) is one of the most common types of vasculitis in children. The aims of this study were to investigate the clinical characteristics of the disease, and the effects of age and sex on the clinical course in children with IgAV. Materials and methods: This was a retrospective study including pediatric patients diagnosed with IgAV who attended follow-ups at the pediatric rheumatology department of a tertiary healthcare institution between January 1997 and December 2020. The patients were grouped and compared according to sex and age at diagnosis (<7 years vs. ≥7 years). Results: The study included 709 children with IgAV, 392 (55.3%) of whom were male. The mean age at diagnosis was 7.9 ± 3.2 years. The most common disease onset season was autumn (31.2%). Upper respiratory infections (27.8%) were the most common predisposing factors. Gastrointestinal system (GIS), joint, and renal involvement were observed in 52.8%, 47.5%, and 17.5% of patients, respectively. Renal involvement, GIS involvement, and disease relapse were significantly more common among those diagnosed after 7 years of age compared to those diagnosed before the age of 7 (p < 0.001, p = 0.033, and p < 0.001, respectively). Scrotal involvement and subcutaneous edema were more common among those diagnosed at younger than 7 years compared to those aged ≥7 years at diagnosis (p < 0.001 and p = 0.016, respectively). GIS involvement was more frequently seen in males compared to females (p = 0.046). Conclusion: It was demonstrated that being ≥7 years of age at diagnosis or being a male were associated with higher likelihood of renal and GIS involvement in children with IgAV.

Synthesis, characterization, crystal structure and Hirshfeld surface analysis of isobutyl 4-[4-(di-fluoro-meth-oxy)phen-yl]-2,6,6-trimethyl-5-oxo-1,4,5,6,7,8-hexa-hydro-quinoline-3-carboxyl-ate.

In the title compound, C24H29F2NO4, which crystallizes in the ortho-rhom-bic Pca21 space group with Z = 4, the 1,4-di-hydro-pyridine ring adopts a distorted boat conformation, while the cyclo-hexene ring is in a distorted half-chair conformation. In the crystal, the mol-ecules are linked by N-H⋯O and C-H⋯O inter-actions, forming supra-molecular chains parallel to the a axis. These chains pack with C-H⋯π inter-actions between them, forming layers parallel to the (010) plane. The cohesion of the crystal structure is ensured by van der Waals inter-actions between these layers. Hirshfeld surface analysis shows the major contributions to the crystal packing are from H⋯H (56.9%), F⋯H/H⋯F (15.7%), O⋯H/H⋯O (13.7%) and C⋯H/H⋯C (9.5%) contacts.