Brain abscess following kidney transplantation: A single centre observational study from North India.

Background: Amongst the infections in kidney transplant recipients, brain abscess represents an uncommon life-threatening complication. Mortality continues to be high despite improvements in diagnostics and therapeutics. Method: We conducted an observational study, describing the incidence, presentation, implicating pathogen, management and outcome of brain abscess following kidney transplantation at our centre. Result: Amongst the 1492 patients who underwent kidney transplantation at our centre between June 1991 and January 2023 (cumulative follow-up: 4936 patient-years), five females and four males, developed brain abscesses. The incidence proportion (risk) is 0.6% with an incidence rate of 6.03 cases per 1000 patient years. The median duration from transplant to development of brain abscess was 5 weeks (range: 4 weeks to 9 years). The commonest presentation was a headache. A definitive microbiological diagnosis was established in eight out of nine patients. The commonest implicated organism was a dematiaceous fungus, Cladophialophora bantiana (3 patients, 33.3%). Despite the reduction in immunosuppression, surgical evacuation and optimal medical therapy, five (55.55%) patients succumbed to their illness. Conclusions: Brain abscesses following kidney transplantation is an uncommon, life-threatening condition. It usually occurs in the early post-transplant period and the presentation is often subtle. Unlike immunocompetent individuals, a fungus is the most common causative organism in those with solid organ transplants. The management includes a reduction in immunosuppression, early antimicrobial therapy, and surgical decompression.

Parvovirus B19 infection after kidney transplantation: A single centre experience.

Background: Parvovirus B19 is an uncommon cause of anaemia in kidney transplant recipients (KTRs). The study aims to determine the incidence, clinical presentation, laboratory findings and outcome of parvovirus B19-related anaemia in KTR. Method: We conducted a 12-year retrospective, single-centre study describing the clinical profile of KTRs with parvovirus B19-related anaemia. Result: Amongst the 714 patients who underwent kidney transplantation between January 2011 and January 2023, (cumulative follow-up: 1287 patient-years), six females and one male, developed parvovirus B19-related anaemia. The incidence proportion (risk) is 0.98% with an incidence rate of 5.43 cases per 1000 patient-year. The median duration from transplant to development of anaemia was 6 weeks (range: 4-40 weeks). The mean fall in haemoglobin was 2.88 ± 1.55 gm/dl; concomitant leukopenia and thrombocytopenia were observed in 57.1 and 28.6% of patients. Three patients responded to a reduction in immunosuppression, the four non-responders required the administration of low-dose intravenous immunoglobulin. The mean duration from initiation of therapy to a sustained rise in haemoglobin was 7.71 ± 2.62 weeks. None of the patients had a relapse of the infection. Conclusions: Parvovirus B19 infection is an uncommon cause of post-transplant refractory anaemia. The key to successfully managing such patients includes a high index of suspicion, early diagnosis and reduction of immunosuppression with or without administration of intravenous immunoglobulin.

tert-Butyl 2-{[5-(4-cyano-phen-yl)pyridin-3-yl]sulfon-yl}acetate.

In the title compound, C18H18N2O4S, the dihedral angle between the aromatic rings is 33.71 (9)° and an intra-molecular C-H⋯O hydrogen bond closes an S(6) ring. In the crystal, mol-ecules are linked by C-H⋯O and C-H⋯N hydrogen bonds to generate a three-dimensional network. A very weak aromatic π-π stacking inter-ction is also observed [centroid-centroid separation = 3.9524 (10) Å].

Crystal structure of N-(3-hy-droxy-phenyl)succinimide.

In the title compound, C10H9NO3, the dihedral angle between the benzene and pyrrolidine rings is 53.9 (1)°. In the crystal, mol-ecules are linked through strong O-H⋯O hydrogen bonds into zigzag C(8) chains running along [010]. The chains are linked by C-H⋯π inter-actions forming sheets lying parallel to (100).

(1Z)-1-(1-Benzo-furan-2-yl)ethanone oxime.

The title compound, C10H9NO2, is almost planar (r.m.s. deviation for the non-H atoms = 0.027 Å) and the conformation across the C=N bond is syn. Further, the O atom of the benzo-furan ring is syn to the CH3 group in the side chain. In the crystal, mol-ecules are linked into C(3) chains propagating in [010] by O-H⋯N hydrogen bonds.

2-(6-Hy-droxy-1-benzo-furan-3-yl)acetamide.

In the title compound, C10H9NO3, the dihedral angle between the benzo-furan ring system (r.m.s. deviation for the non-H atoms = 0.009 Å) and the -C-C(O)-N- segment is 83.76 (1)°. In the crystal, mol-ecules are linked by N-H⋯O and O-H⋯O hydrogen bonds, generating (001) sheets, which feature C(4) and C(10) chains.

1-Fluoro-4-[(E)-2-nitro-vin-yl]benzene.

The title compound, C8H6FNO2, is almost planar (r.m.s. deviation for the non-H atoms = 0.019 Å) and the conformation across the C=C bond is trans. The C and H atoms of the side chain are disordered over two sets of sites in a 0.56 (3):0.44 (3) ratio. In the crystal, mol-ecules are linked by C-H⋯O inter-actions, thus forming C(5) chains propagating in [001].

N-(4-Methyl-phenyl-sulfon-yl)-3-nitro-benzamide.

In the title compound, C14H12N2O5S, the dihedral angle between the aromatic rings is 86.29 (1)° and the conformation between the C=O bond of the amide group and the meta-NO2 group is syn. The C-S-N-C torsion angle is -65.87 (19)° and the mol-ecule has an L-shaped conformation. In the crystal, the mol-ecules are connected into inversion dimers through pairs of N-H⋯O hydrogen bonds and C-H⋯O inter-actions forming R 2 (2)(8) and R 2 (2)(14) loops, respectively. The dimers are connected by further C-H⋯O inter-actions, thereby forming (100) sheets.

N-(4-Meth-oxy-benzo-yl)benzene-sulfon-amide.

In the title compound, C14H13NO4S, the dihedral angle between the aromatic rings is 69.81 (1)°; the dihedral angle between the planes defined by the S-N-C=O segment of the central chain and the sulfonyl benzene ring is 74.91 (1)°. In the crystal, the mol-ecules are linked by weak N-H⋯O hydrogen bonds into C(4) chains running along [100]. The mol-ecules in adjacent chains are linked by weak C-H⋯O inter-actions, generating R 2 (2) (16) dimeric pairs. Weak C-H⋯π inter-actions connect the double chains into (001) sheets.

N-(4-Meth-oxy-benzo-yl)-2-methyl-benzene-sulfonamide.

In the title compound, C15H15NO4S, the dihedral angle between the aromatic rings is 80.81 (1)° and the dihedral angle between the planes defined by the S-N-C=O fragment and the sulfonyl benzene ring is 86.34 (1)°. In the extended structure, dimers related by a crystallographic twofold axis are connected by pairs of both N-H⋯O hydrogen bonds and C-H⋯O inter-actions, which generate R 2 (2)(8) and R 2 (2)(14) loops, respectively. A weak aromatic π-π stacking inter-action is also observed [centroid-centroid separation = 3.7305 (3) Å].

2-Chloro-N-(4-meth-oxy-benzo-yl)-benzene-sulfonamide.

In the title compound, C14H12ClNO4S, the dihedral angle between the aromatic rings is 82.07 (1)° and the dihedral angle between the planes defined by the S-N-C=O fragment and the sulfonyl benzene ring is 82.46 (3)°. In the crystal, the mol-ecules are linked into C(4) chains running along [001] by strong N-H⋯O hydrogen bonds. A C-H⋯O intera-ction reinforces the [001] chains: its graph-set symbol is C(7). The chains are cross-linked into (100) sheets by further C-H⋯O inter-actions as C(6) chains along [001]. The structure also features weak π-π stacking inter-actions [centroid-centroid distances = 3.577 (1) and 3.8016 (1) Å].

N-Ethyl-2,2-dimethyl-N-(3-methyl-phen-yl)propanamide.

In the title compound, C14H21NO, the conformation across the N-C(O) bond is syn-periplanar, the C-N-C-C torsion being -5.9 (5)°. The atoms of the ethyl group attached to the N atom are disordered over two sets of sites with occupancy ratios of 0.65 (2):0.35 (2) (CH2) and 0.689 (14):0.311 (14) (CH3)are linked by very weak C-H⋯O inter-actions forming C(8) chains along [001]. C-H⋯π inter-actions link the mol-ecules along the c-axis direction.

6-(4-Fluoro-phen-yl)-3-phenyl-7H-1,2,4-tri-azolo[3,4-b][1,3,4]thia-diazine.

In the title compound, C16H11FN4S, the dihedral angles between the triazole ring and the phenyl and fluoro-benzene rings are 23.22 (17) and 18.06 (17)°, respectively. The six-membered heterocyclic ring adopts a distorted envelope conformation, with the methyl-ene C atom as the flap. In the crystal, the mol-ecules are linked by two C-H⋯N and C-H⋯F inter-actions along [010], forming C(5), C(8) and C(13) chains repectively. C-H⋯π inter-actions involving the phenyl ring and π-π inter-actions [centroid-centroid separation for triazole rings = 3.5660 (18) Å] are also observed.

Crystal structure of ethyl (6-hy-droxy-1-benzo-furan-3-yl)acetate sesquihydrate.

In the title hydrate, C12H12O4·1.5H2O, one of the water mol-ecules in the asymmetric unit is located on a twofold rotation axis. The mol-ecule of the benzo-furan derivative is essentially planar (r.m.s. deviation for the non-H atoms = 0.021 Å), with the ester group adopting a fully extended conformation. In the crystal, O-H⋯O hydrogen bonds between the water mol-ecules and the hy-droxy groups generate a centrosymmetric R 6 (6)(12) ring motif. These R 6 (6)(12) rings are fused, forming a one-dimensional motif extending along the c-axis direction.

Crystal structure of (R)-6'-bromo-3,3-dimethyl-3',4'-di-hydro-2'H-spiro-[cyclo-hexane-1,3'-1,2,4-benzo-thia-diazine] 1',1'-dioxide.

In the title compound, C14H19BrN2O2S, the 1,2,4-thia-diazinane ring adopts an envelope conformation with the N atom (attached to the sulfonyl group) as the flap, while the cyclo-hexane ring adopts a chair conformation. The mean plane of the cyclo-hexane ring is almost normal to the benzene ring and the mean plane of the 1,2,4-thia-diazinane ring, making dihedral angles of 70.4 (2) and 71.43 (19)°, respectively. Furthermore, the dihedral angle between the benzene ring and the mean plane of the 1,2,4-thia-diazinane ring is 4.91 (18)°. The mol-ecular structure is stabilized by an intra-molecular C-H⋯O hydrogen bond, which encloses an S(6) ring motif. In the crystal, mol-ecules are linked by N-H⋯O hydrogen bonds into chains along [10-1], forming a C(6) graph-set motif. These chains are inter-connected via C-H⋯π inter-actions, leading to chains along [-101], so finally forming sheets parallel to (010).

Design and evaluation of a deep learning-based automatic segmentation of maxillary and mandibular substructures using a 3D U-Net.

Background: Current segmentation approaches for radiation treatment planning in head and neck cancer patients (HNCP) typically consider the entire mandible as an organ at risk, whereas segmentation of the maxilla remains uncommon. Accurate risk assessment for osteoradionecrosis (ORN) or implant-based dental rehabilitation after radiation therapy may require a nuanced analysis of dose distribution in specific mandibular and maxillary segments. Manual segmentation is time-consuming and inconsistent, and there is no definition of jaw subsections. Materials and methods: The mandible and maxilla were divided into 12 substructures. The model was developed from 82 computed tomography (CT) scans of HNCP and adopts an encoder-decoder three-dimensional (3D) U-Net structure. The efficiency and accuracy of the automated method were compared against manual segmentation on an additional set of 20 independent CT scans. The evaluation metrics used were the Dice similarity coefficient (DSC), 95% Hausdorff distance (HD95), and surface DSC (sDSC). Results: Automated segmentations were performed in a median of 86 s, compared to manual segmentations, which took a median of 53.5 min. The median DSC per substructure ranged from 0.81 to 0.91, and the median HD95 ranged from 1.61 to 4.22. The number of artifacts did not affect these scores. The maxillary substructures showed lower metrics than the mandibular substructures. Conclusions: The jaw substructure segmentation demonstrated high accuracy, time efficiency, and promising results in CT scans with and without metal artifacts. This novel model could provide further investigation into dose relationships with ORN or dental implant failure in normal tissue complication prediction models.

Evaluating the Efficacy, Safety, and Tolerability of Combination Therapy of Dapagliflozin and Linagliptin Over Dapagliflozin and Vildagliptin in Patients With Type 2 Diabetes Mellitus Inadequately Controlled With Metformin.

Background Type 2 diabetes mellitus (T2DM) patients commonly undergo metformin monotherapy. This study aims to compare the efficacy, safety, and tolerability of combination therapy of dapagliflozin plus linagliptin versus dapagliflozin plus vildagliptin as add-on therapy in T2DM patients inadequately controlled on metformin. Methodology This was an 18-week, multicenter, randomized, double-blind, active-controlled, parallel-group, phase III clinical study. About 236 participants were randomly assigned to receive either a fixed-dose combination of dapagliflozin 10 mg plus linagliptin 5 mg tablets or a fixed-dose combination of dapagliflozin 10 mg plus vildagliptin SR 100 mg tablets added to metformin monotherapy. The primary outcome was the mean change in hemoglobin A1c (HbA1c) from baseline to the end of week 16. The key secondary endpoints were mean change in postprandial blood glucose (PPBG), fasting blood glucose (FBG), body weight, and the proportion of participants achieving HbA1c less than 7.0%. Results The dapagliflozin/linagliptin combination therapy showed a more significant change in HbA1c from baseline to the end of 16 weeks (mean reduction: -1.59% vs. -1.25%) compared to dapagliflozin/vildagliptin (p < 0.0001). Additionally, compared to the dapagliflozin/vildagliptin group, the dapagliflozin/linagliptin group demonstrated a significant reduction in both PPBG (mean reduction: -59.99 mg/dL vs. -55.34 mg/dL) and FPG (mean reduction: -32.91 mg/dL vs. -26.78 mg/dL). A total of 18 adverse events were reported in 17 (7.20%) participants, all of which were mild and resolved completely. There were no serious adverse events. Conclusions Compared to dapagliflozin and vildagliptin combination therapy, dapagliflozin and linagliptin fixed-dose combination provided clinically significant improvements in glycemic control. Because of its effectiveness, safety, and tolerability, the fixed-dose combination of dapagliflozin and linagliptin was a better option for treating T2DM patients who had previously only received metformin monotherapy.

Long-term outcomes after single-balloon enteroscopy in patients with obscure gastrointestinal bleeding.

BACKGROUND: Limited data exists on the long-term outcomes of patients with obscure gastrointestinal bleeding (OGIB) following single-balloon enteroscopy (SBE). AIM: To examine the long-term outcomes of patients undergoing SBE for OGIB. METHODS: Consecutive patients undergoing SBE for OGIB at a tertiary care center between 2008 and 2010 were retrospectively identified. Clinical data and SBE findings were extracted from the medical record. Recurrence of OGIB during follow-up through 2012 was assessed by a combination of chart review and telephone interviews. RESULTS: One hundred and forty-seven patients were included in the study. The overall diagnostic yield of SBE was 64.6% (95/147 patients). Findings of SBE included vascular lesions (VLs, 53.7%), small bowel neoplasm (2.7%), inflammatory lesions (4.8%), and normal SBE (35.4%). One hundred and ten patients (56.4% female, mean age 70.6±11.3 years) were followed for an average 23.9 months after initial SBE. During follow-up, OGIB recurred in 39.5% of patients in whom a source of OGIB was identified on SBE and 55.9% of patients with normal findings on SBE. OGIB recurred in 47.6% of patients in whom small bowel VLs were treated endoscopically. None of the 13 patients in whom a non-VL lesion was identified as the source of bleeding on SBE experienced recurrent bleeding (p=0.019). CONCLUSIONS: SBE is a safe and valuable method for managing patients with OGIB. More than 50% of patients experienced no recurrent bleeding during 2 years of follow-up after SBE. The long-term management of OGIB due to small bowel VLs remains challenging.

N'-Hy-droxy-pyridine-2-carboximidamide.

The title mol-ecule, C6H7N3O, is almost planar (r.m.s. deviation = 0.0068 Å) and adopts an E conformation about the C=N double bond. In the crystal, mol-ecules are linked by pairs of strong N-H⋯N hydrogen bonds, forming inversion dimers with R 2 (2)(10) motifs. The dimers are further linked into C(3) chains through O-H⋯N hydrogen bonds.