9-Allyl-9H-fluoren-9-ol.

The asymmetric unit of the title compound, C16H14O, contains two independent mol-ecules differing in the orientations of the allyl groups; the corresponding O-C-C(H2)-C(H) torsion angles are -61.01 (13) and -177.43 (10)°. In the crystal, O-H⋯O hydrogen bonds link four mol-ecules into a centrosymmetric tetra-mer, in which each hy-droxy group acts as a donor and an acceptor of hydrogen bonds.

Santal monohydrate, an isoflavone isolated from Wye-thia mollis.

THE TITLE COMPOUND [SYSTEMATIC NAME: 3-(3,4-di-hydroxy-phen-yl)-5-hy-droxy-7-meth-oxy-4H-chromen-4-one monohydrate], C16H12O6·H2O, is a monohydrate of a natural product santal isolated from Wye-thia mollis. In the santal mol-ecule, the dihedral angle between the benzo-quinone and di-hydroxy-phenyl fragments is 53.9 (1)° and an intra-molecular O-H⋯O hydrogen bond occurs. In the crystal, O-H⋯O hydrogen bonds link the components into corrugated layers parallel to the ac plane. The short distance of 3.474 (5) Šbetween the centroids of the benzene rings in neighbouring santal mol-ecules reveals then existence of π-π inter-actions within the layers.

Isotenulin.

Isotenulin, C17H22O5, is a sesquiterpene lactone isolated from sneezeweed Helenium amarum. It crystallizes with two independent mol-ecules in the asymmetric unit. In each mol-ecule, two five-membered rings (cyclo-pentenone and lactone) are trans-fused to the central seven-membered ring. The five-membered rings each adopt envelope conformations. The seven-membered ring adopts a twist-chair conformation. In the crystal, the molecules are linked by C-H⋯O interactions, which generate a three-dimensional network.

Tenulin 0.25-hydrate, a sesquiterpene lactone isolated from Helenium amarum.

The asymmetric unit of the title compound, C17H22O5·0.25H2O [systematic name: 2-hy-droxy-2,2a,6,9a-tetra-methyl-2a,4a,5,6,6a,9a,9b,9c-octa-hydro-2H-1,4-dioxadi-cyclo-pent[cd,f]azulene-3,9-dione 0.25-hydrate], a natural product isolated from Helenium amarum, contains two independent tenulin mol-ecules and half a water mol-ecule of crystallization situated on a twofold rotation axis. The hy-droxy group of the hemiketal moiety is in a ß-position. In the crystal, each water mol-ecule inter-acts with four tenulin mol-ecules via O-H⋯O hydrogen bonds. The two independent tenulin mol-ecules (A and B) differ only in the character of their participation in hydrogen bonding. Specifically, while A is an acceptor of Owater-H⋯O A and a donor of O A -H⋯O B hydrogen bonds, mol-ecule B is an acceptor of the latter hydrogen bond and the donor of an O B -H⋯Owater hydrogen bond. In the crystal, these O-H⋯O hydrogen bonds link the tenulin and water mol-ecules into layers parallel to the ac plane.

Myxedema Secondary to Levothyroxine Malabsorption in Newly Diagnosed Celiac Disease.

Celiac disease (CD) is an autoimmune disorder that predominantly affects the small intestine and is related to antibodies created against gluten when the substance is ingested. It is uncommon comorbidity in patients with Hashimoto's thyroiditis (HT). Myxedema is a severe form of hypothyroidism that is commonly related to new diagnoses, medication non-compliance, or malabsorption of thyroid supplementation that can have life-threatening associated conditions like heart failure and coma. In this article, we will describe a case of myxedema secondary to levothyroxine malabsorption in the setting of a newly diagnosed CD.

Acute Renal Failure and Nephrotic Syndrome Secondary to Collapsing Glomerulopathy Associated With Hepatitis C.

Collapsing glomerulopathy (CG) is a rare variant of focal segmental glomerulosclerosis (FSGS) that commonly presents as nephrotic syndrome in patients. CG is almost always associated with human immunodeficiency virus (HIV) infection but is rarely from other infectious sources such as parvovirus, Epstein-Barr virus, cytomegalovirus, and SARS-CoV-2. CG has also been reported to be related to other etiologies such as genetic disorders, lupus, malignancy, and post-renal transplant but is exceedingly rare when related to hepatitis C virus (HCV). In this report, we describe the case of a patient presenting with nephrotic syndrome secondary to CG caused by newly diagnosed HCV.

Boerhaave Syndrome: An Unexpected Complication of Diabetic Ketoacidosis.

Boerhaave syndrome (BS) is a rare gastrointestinal condition related to esophageal rupture that carries a high mortality rate without prompt medical attention. BS is commonly associated with repeated episodes of severe retching, straining, or vomiting. Diabetic ketoacidosis (DKA), a serious acute complication of diabetes, is characterized in part by laboratory findings of profound hyperglycemia and ketoacidosis. Clinically, nausea and vomiting are seen commonly in DKA patients, which can often include repeated forceful retching, but rarely associated with esophageal rupture. In this article, we will describe a case of BS secondary to repeated episodes of emesis in the setting of DKA.

High-Grade Mucinous Adenocarcinoma of the Appendix With Signet Features and Omental Metastasis.

Primary adenocarcinoma of the appendix is an uncommon malignancy of the gastrointestinal tract. The most common symptom is right lower abdominal pain, which could be indistinguishable from acute appendicitis. However, the clinical presentation is usually non-specific. In this present report, we describe a rare case of primary signet ring cell carcinoma of the appendix with omental metastases in an 81-year-old male who underwent laparoscopic appendectomy. He then received palliative systemic chemotherapy using a combination of Capecitabine and Bevacizumab.

Implementation and initial evaluation of falls risk reduction resources in a rural Native American Community.

BACKGROUND: Although falls are common and can cause serious injury to older adults, many health care facilities do not have falls prevention resources available. Falls prevention resources can reduce injury and mortality rates. Using the Centers for Disease Control and Prevention's (CDC) Stopping Elderly Accidents, Deaths & Injuries (STEADI) model, a falls risk clinic was implemented in a rural Indian Health Service (IHS) facility. METHODS: A Fall Risk Questionnaire was created and implemented into the Provider's Electronic Health Records system interface to streamline provider screening and referral of patients who may be at risk for falls to a group falls risk reduction class. RESULTS: Participants exhibited average improvements in the Timed Up and Go (6.8 s) (P = 0.0001), Five-Time Sit-to-Stand (5.1 s) (P = 0.0002), and Functional Reach (3.6 inches) (P = 1.0) tests as compared to their own baseline. Results were analyzed via paired t test. 71% of participants advanced out of an "increased risk for falls" category in at least one outcome measure. Of the participants to complete the clinic, all were successfully contacted and three (18%) reported one or more falls at the 90-day mark, of which one (6%) required a visit to the Emergency Department but did not require hospital admission. CONCLUSIONS: In regards to reducing falls in the community, per the CDC STEADI model, an integrated approach is best. All clinicians can play a part in reducing elder falls.

Crystal structure of (E)-4,4'-(but-2-ene-1,4-di-yl)bis-(2-meth-oxy-phenol).

The title compound, C18H20O4, was synthesized via the ruthenium-catalyzed alkene methathesis dimerization of eugenol. The whole mol-ecule is generated by inversion symmetry; the center of inversion being located at the mid-point of the trans C=C bond. The phenol ring is inclined to the mean plane of the central C-C=C-C unit (r.m.s. deviation = 0.014 Å) by 68.83 (16)°. In the crystal, mol-ecules are linked via O-H⋯O hydrogen bonds, involving the hy-droxy and meth-oxy groups, forming undulating sheets parallel to (010).

Crystal structure of N-[4-amino-5-cyano-6-(methyl-sulfan-yl)pyridin-2-yl]-2-chloro-acetamide.

In the title compound, C9H9ClN4OS, the dihedral angle between the acetamide moiety and the pyridine ring is 4.83 (12)°. The O=C-C-Cl torsion angle is 46.4 (3)° and an intra-molecular C-H⋯O inter-action generates an S(6) ring. In the crystal, mol-ecules are linked by N-H⋯O, N-H⋯N and C-H⋯N hydrogen bonds, generating sheets lying parallel to (120).

Crystal structure of N-[4-amino-5-cyano-6-(methyl-sulfan-yl)pyridin-2-yl]acetamide hemihydrate.

The title compound, C9H10N4OS·0.5H2O, crystallizes with two independent mol-ecules (A and B) in the asymmetric unit, together with a water mol-ecule of crystallization. The acetamide moiety, which has an extended conformation, is inclined to the pyridine ring by 7.95 (16)° in mol-ecule A and by 1.77 (16)° in mol-ecule B. In the crystal, the A and B mol-ecules are linked by two N-H⋯Ocarbon-yl hydrogen bonds, forming a dimer. The dimers are linked via N-H⋯N hydrogen bonds, forming ribbons that are linked by N-H⋯Owater hydrogen bonds to form sheets parallel to (110). The sheets are linked by O-H⋯N hydrogen bonds, forming slabs, and between the slabs there are weak slipped parallel π-π inter-actions [inter-centroid distance = 3.734 (2) Å, inter-planar distance = 3.3505 (11) Šand slippage = 1.648 Å], forming a three-dimensional structure.

Crystal structure of 4,6-di-amino-2-(methyl-sulfan-yl)pyridine-3-carbo-nitrile.

The title pyrimidine derivative, C7H8N4S, is essentially planar, with a maximum deviation of 0.029 (2) Šfrom the mean plane of the non-H atoms. In the crystal, mol-ecules are linked by an inter-molecular bifurcated N-H⋯N hydrogen bond between the cyano N atom and the two amino groups, an N-H⋯N hydrogen bond between the two amino groups and a weak C-H⋯π inter-action, forming a three-dimensional network.

The true identity of the triterpene component of Wyethia mollis, a lanosta-diene containing a tetrahydropyran E-ring.

The crystal structure of a triterpene component of Wyethia mollis has been obtained and compared with the previously reported structure of the compound. The compound in the crystal structure, lanosta-8,24-dien-3-one, 16,23-epoxy-(161beta, 23R), (1), is different from the previously reported compound, but has identical NMR and mass spectrometric data. The revised structure contains a tetrahydropyran E ring, a structural moiety rare in steroid triterpenes.