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.

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.

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.

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.

A real life experience with ustekinumab: The effectiveness of 45 mg on patients greater than 80 kg but lower than 100 kg.

Ustekinumab is a fully human monoclonal antibody has been demonstrated efficacious and safe in clinical trials. However, there are few real-life data evaluating the efficacy of ustekinumab. The aim of this retrospective follow up study was showing the efficacy in 58 adult patients with moderate to severe psoriasis treated at least 24 weeks with ustekinumab. The efficacy was evaluated as PASI75, PASI90, and PASI100 response rates at week 4, 12, 24, and 36 in patient groups according to the treatment dose, weight, biologic treatment naivety, and obesity. PASI75, PASI90, and PASI100 response rates were 79.3%, 62.1%, and 8.6% respectively, at week 12 and, 92.5%, 71.7% and 9.4%, respectively, at week 36. PASI75, PASI90, and PASI100 responses were generally higher in naive patients to the biologic therapy. Also, the responses were generally higher in non-obese patients at 4 and 12 weeks. According to the weight categories, PASI100 response rates were higher in the 81-99 kg group at week 12. In conclusion, ustekinumab is an effective and safe treatment option for moderate to severe psoriasis patients. It seems to be more effective in biologic treatment naive patients and non-obese patients. A 45 mg dose of ustekinumab seems to be effective in patients weighing 99 kg or less.

The frequency of and factors affecting functional gastrointestinal disorders in infants that presented to tertiary care hospitals.

This study aimed to determine the prevalence of infantile functional gastrointestinal disorders (FGIDs) based on Rome IV diagnostic criteria, and to determine the associated patient demographic and nutritional characteristics. A total of 2383 infants aged 1-12 months which were evaluated by 28 general pediatricians and pediatric gastroenterologists on the same day at nine tertiary care hospitals around Istanbul, Turkey, between November 2017 and March 2018, were included in the study. Patients included consulted the pediatric outpatient clinics because of any complaints, but not for vaccines and/or routine well child follow-ups as this is not part of the activities in the tertiary care hospitals. The patients were diagnosed with FGIDs based on Rome IV diagnostic criteria. The patients were divided into a FGID group and non-FGID group, and anthropometric measurements, physical examination findings, nutritional status, risk factors, and symptoms related to FGIDs were evaluated using questionnaires. Among the 2383 infants included, 837 (35.1%) had ≥1 FGIDs, of which 260 (31%) had already presented to hospital with symptoms of FGIDs and 577 (69%) presented to hospital with other symptoms, but were diagnosed with FGIDs by a pediatrician. Infant colic (19.2%), infant regurgitation (13.4%), and infant dyschezia (9.8%) were the most common FGIDs. One FGID was present in 76%, and ≥2 FGIDs were diagnosed in 24%. The frequency of early supplementary feeding was higher in the infants in the FGID group aged ≤6 months than in the non-FGID group (P = 0.039).Conclusion: FGIDs occur quite common in infants. Since early diversification was associated with the presence of FGIDs, nutritional guidance and intervention should be part of the first-line treatment. Only 31% of the infants diagnosed with a FGID were presented because of symptoms indicating a FGID. What is Known: • The functional gastrointestinal disorders (FGIDs) are a very common disorder and affect almost half of all infants. • In infants, the frequency of FGIDs increases with mistakes made in feeding. When FGIDs are diagnosed in infants, nutritional support should be the first-line treatment. What is New: • This study shows that only a third of children presented to hospital because of the symptoms of FGIDs, but pediatricians were able to make the diagnosis in suspected infants after appropriate evaluation. • The early starting of complementary feeding (<6 months) is a risk factor for the development of FGIDs.

An investigation of vitamin D deficiency in pregnant women and their infants in Giresun province located in the Black Sea region of Turkey.

The aim of this study is to investigate vitamin D deficiency and the associated risk factors in pregnant women and their infants in the Black Sea region of Turkey. One hundred and twenty healthy pregnant women in the last trimester and their healthy newborn pairs were observed between June and August 2017 in Giresun province. The serum 25(OH)D3 and calcium levels were measured through the samples collected from maternal and neonatal cord blood. The effects of maternal lifestyle on the maternal vitamin D levels were assessed by multiple regression analysis. The mean concentrations of 25(OH)D3 were found to be 9.54 ± 6.35 ng/mL and 11.16 ± 6.52 ng/mL in the maternal and neonatal cord blood sera, respectively. Vitamin D deficiency (≤20 ng/mL) and severe vitamin D deficiency (≤5 ng/mL) were observed in between 94.2% and 24.2% of mothers and 90% and 10% of infants, respectively. The clothing style, the consumption of milk/dairy products and antenatal multivitamin supplement usage were found as significant factors on the serum vitamin D levels. Even during the Summer months, the vitamin D deficiency in mothers and infants was observed at high rates in the Eastern Black Sea region of Turkey. As a result, it has been concluded that routine maternal serum 25(OH)D3 measurements for clinical follow-up, vitamin D supplementation and regular consumption of dairy products should be recommended. Impact Statement What is already known on this subject? Vitamin D deficiency is a very important risk factor to be considered for maternal and infant health. In a large number of studies, it has been observed that the risk of a vitamin D deficiency in women during their pregnancy was found to be higher, depending on the various strong influences such as the demographic and maternal lifestyles. What the results of this study add? A vitamin D deficiency associated with the demographic and lifestyle factors of pregnant women and their infants was investigated in Giresun province, located in the Eastern Black Sea region of Turkey. The results of this study add that a vitamin D deficiency in the maternal and in the infants may be observed at high rates in regions with mostly rainy weather, even during the Summer months. What the implications are of these findings for clinical practice and/or further research? The vitamin D levels in infants can be determined indirectly by looking at the vitamin D levels in third trimester pregnancies. Furthermore, it is suggested as a non-invasive method to determine vitamin D levels by taking advantage of the maternal level, without measuring the vitamin D levels of infants. Thus, this will be effective to reduce health costs and to prevent the possible diseases affecting the future life of infants. Routine maternal serum 25(OH)D3 measurements for clinical follow-up, vitamin D supplementation and the regular consumption of dairy products should be recommended to pregnant women with risk factors, even in the Summer in the Black Sea Region of Turkey. In addition, further studies are needed to investigate the vitamin D deficiency associated with the demographic and lifestyle factors of pregnant women and their infants, especially for the different locations of Turkey.

DRESS Syndrome or Hematologic Malignancy?: A Case Report of a 4-Year-Old Boy.

Drug reaction with eosinophilia and systemic symptom (DRESS) is a serious idiosyncratic drug reaction. It is characterized by skin eruption, fever, hematologic abnormalities, and multi-organ involvement. Diagnosis is challenging because of the wide clinical spectrum. Its association with aromatic antiepileptic drugs, such as phenytoin, phenobarbital, and carbamazepine, has been well described in adults. There are few reports of DRESS syndrome in children, and knowledge about the relationship between new antiepileptic drugs such as oxcarbazepine and this syndrome is limited. The DRESS syndrome is a challenging entity and probably underdiagnosed because many of its clinical findings can mimic those of other serious systemic disorders such as infections and hematologic disorders. Virus reactivation and use of some drugs together with suspected drugs, such as amoxicillin, can trigger the symptoms of DRESS syndrome. This is a case report of a 4-year-old boy with oxcarbazepine-induced DRESS syndrome possibly triggered by amoxicillin; hematologic malignancy was included in the differential diagnosis.

Acute aortic dissection mimicking acute abdomen in a 14-year-old boy.

Aortic dissection is extremely rare in children. Although it usually presents with severe chest pain, atypical clinical presentations mimicking various illnesses may cause misdiagnosis. In this report, the case of a 14-year-old boy with symptoms suggestive of acute abdomen, which was finally diagnosed as aortic dissection, is discussed.

Synthetic Cannabinoid Abuse in Adolescents: A Case Series.

BACKGROUND: Synthetic cannabinoids, referred to as "Bonzai" in Turkey, are relatively new recreational drugs of abuse. Although the use of synthetic cannabinoids has been dramatically increasing in young populations in many countries, their adverse effects are not well known. OBJECTIVES: To report on the clinical features and social history of pediatric patients with a diagnosis of synthetic cannabinoid intoxication and to highlight the dangers of these drugs to public health. METHODS: We retrospectively reviewed 16 cases presenting to our Emergency Department (ED) with synthetic cannabinoid intoxication in the last 10 months. Usage characteristics and the psychoactive, physical, and metabolic effects of synthetic cannabinoids were analyzed. RESULTS: The mean age of the 16 patients with a diagnosis of synthetic cannabinoid intoxication was 15.4 ± 1.7 years (15 males, 1 female). The most common physical symptoms were eye redness, nausea/vomiting, sweating, and altered mental status; the main psychoactive findings were agitation, anxiety, hallucinations, and perceptual changes. We observed hypotension and bradycardia in 8 (50%) and 5 (31.3%) of the patients, respectively. Although most patients were discharged from the ED, 25% were transferred to an intensive care unit. They all had reduced school attendance and performance. The rates of cigarette smoking and alcohol drinking were also significantly higher. CONCLUSION: Synthetic cannabinoids are unsafe and potentially harmful drugs of abuse; they may even cause life-threatening effects. It is important for pediatricians to be familiar with the signs and symptoms of consumption of synthetic cannabinoid products. Education of parents, teachers, and adolescents about the potential health risks of using these products is essential.

4-Hy-droxy-5-meth-oxy-N,1-dimethyl-2-oxo-N-[4-(tri-fluoro-meth-yl)phen-yl]-1,2-di-hydro-quinoline-3-carboxamide.

The title compound, C20H17F3N2O4, named tasquinimod, is a second-generation oral quinoline-3-carboxamide analogue, which is currently in phase III clinical trials for the treatment of metastatic prostate cancer. The quinoline unit is almost planar (r.m.s. deviation of fitted atoms = 0.0075 Å). The carboxamide side chain, substituted at position 3, is tilted by 88.07 (7)° to the quinoline plane. Both the methyl and carbonyl groups of this carboxamide side chain are in a syn conformation. The 4-(tri-fluoro-meth-yl)phenyl plane is inclined at 50.62 (17)° to the plane of the carboxamide side chain, and at 87.14 (4)° to the plane of the quinoline ring system. The 4-hy-droxy H atom acts as a double proton donor in an intra-molecular hydrogen bond to the 5-position meth-oxy O atom and in an inter-molecular contact to the 2-oxo group, generating a chain along [010] in the crystal structure.

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.

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.

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.

catena-Poly[[[O,O'-bis-(2-methyl-phen-yl) dithio-phosphato-κ(2) S,S]lead(II)]-µ-O,O'-bis-(2-methyl-phen-yl) dithio-phosphato-κ(3) S,S':S].

In the title compound, [Pb(C14H14O2PS2)2] n , the metal atom is surrounded by two O,O'-bis-(2-methyl-phen-yl) dithio-phosphate ligands bonding through the S-donor atoms. Three of the Pb-S bond lengths are are close to each other at 2.7710 (18), 2.8104 (16) and 2.8205 (16) Å, while the fourth Pb-S bond is elongated at 3.0910 (18) Šand reflects the fact that this atom is involved in inter-molecular bridging to an adjacent Pb(II) atom [Pb-S = 3.145 (2) Å]. The bond angles demonstrate that the Pb(II) atom contains a stereochemically active lone pair with a distorted octa-hedral geometry about the Pb(II) atom. This distortion is shown by the S-Pb-S bite angles of 73.63 (4) and 69.50 (4)°, while the remaining S-Pb-S angles range from 81.03 (5) to 143.66 (5)°. One of the benzene rings shows positional disorder over two orientations with occupancy factors of 0.747 (11) and 0.253 (11).

Cinnarizinium fumarate.

In the title salt {systematic name: 4-diphenyl-methyl-1-[(E)-3-phenyl-prop-2-en-1-yl]piperazin-1-ium (2Z)-3-carb-oxy-prop-2-enoate}, C26H29N2(+)·C4H3O4(-), the piperazine ring in the cation adopts a distorted chair conformation and contains a positively charged N atom with quaternary character. The dihedral angle between the mean planes of the phenyl rings of the diphenyl-methyl group is 74.2 (7)° and those between these rings and the phenyl ring of the 3-phenyl-prop-2-en-1-yl group are 12.7 (9) and 80.6 (8)°. In the crystal, N-H⋯O and O-H⋯O hydrogen bonds form chains along [001]. Weak C-H⋯O inter-actions connect parallel chains along [010], forming layers perpendicular to the a-axis direction.

Ethyl 2,7,7-trimethyl-4-(1-methyl-1H-indol-3-yl)-5-oxo-1,4,5,6,7,8-hexa-hydro-quinoline-3-carboxyl-ate.

In the title mol-ecule, C24H28N2O3, the cyclo-hexene ring is in a sofa conformation and the 1,4-dihydro-pyridine ring is in a slight boat conformation. In the indole ring system, the pyrrole and benzene rings form a dihedral angle of 2.63 (7)°. In the crystal, N-H⋯O hydrogen bonds connect the mol-ecules into C(6) chains parallel to the b axis and pairs of weak C-H⋯O hydrogen bonds link inversion-related chains into a ladder motif through R2(2)(18) rings. A weak intra-molecular C-H⋯O hydrogen bond is also observed.

2-(1-Phenyl-1H-benzimidazol-2-yl)phenol.

In the title mol-ecule, C19H14N2O, the benzimidazole unit is close to being planar [maximum deviation = 0.0253 (11) Å] and forms dihedral angles of 68.98 (6) and 20.38 (7)° with the adjacent phenyl and benzene rings; the dihedral angle between the latter two planes is 64.30 (7)°. An intra-molecular O-H⋯N hydrogen bond generates an S(6) ring motif. In the crystal, mol-ecules are linked by C-H⋯N and C-H⋯O hydrogen bonds, and consolidated into a three-dimensional architecture by π-π stacking inter-actions, with a centroid-centroid distance of 3.8428 (12) Å.

2,2,7,7-Tetra-methyl-1,2,3,4,5,6,7,8-octa-hydro-acridine-1,8-dione.

The whole molecule of the title compound, C17H21NO2, is generated by twofold rotational symmetry. The N atom and the C and H atoms in position 4 of the pyridine ring lie on the twofold axis. The cyclohexene ring has a sofa conformation with the CH2 C atom adjacent to the dimethyl-substituted C atom displaced by 0.5949 (16) Šfrom the mean plane of the other five C atoms. In the crystal, weak C-H⋯O inter-actions link the mol-ecules into chains parallel to the a axis. In addition, π-π stacking inter-actions [centroid-centroid distance = 3.8444 (7) Å] contribute to the stabilization of the crystal structure.

1-(2-Furo-yl)-3-(2-meth-oxy-4-nitro-phen-yl)thio-urea.

The asymmetric unit of the title compound, C13H11N3O5S, contains two independent mol-ecules, which are linked by a pair of inter-molecular N-H⋯S hydrogen bonds, forming an R2(2)(8) ring motif. The central thio-urea core forms dihedral angles of 3.02 (12) and 14.00 (10)° with the essentially planar furoyl groups [maximum deviations = 0.030 (2) and 0.057 (2) Å] in the two mol-ecules and dihedral angles of 2.43 (13) and 8.03 (12)° with the benzene rings. The dihedral angles between the furoyl and benzene rings in the two mol-ecules are 3.97 (10) and 5.98 (9)°. The trans-cis geometry of the thio-urea group is stabilized by three intra-molecular N-H⋯O hydrogen bonds involving carbonyl and meth-oxy O atoms with the H atom of the cis-thio-amide group and between furan O atom and the other thio-amide H atom. There is also a weak intra-molecular C-H⋯S inter-action in each mol-ecule.