1-Chloro-acetyl-r-2,c-6-bis-(4-methoxy-phen-yl)-t-3-methyl-piperidin-4-one

There are two crystallographically independent mol-ecules in the asymmetric unit of the title compound, C(22)H(24)ClNO(4). The piperidine ring in both mol-ecules adopts a distorted boat conformation. The crystal packing is stabilized by C-H⋯O and C-H⋯Cl inter-actions.

c-3,t-3-Dimethyl-r-2,c-7-diphenyl-1,4-diazepan-5-one

In the title compound, C₁₉H₂₂N₂O, the diazepine ring adopts a distorted chair conformation. One of the N—H groups forms an inter­molecular N—H⋯O hydrogen bond generating an R₂²(8) graph-set motif. The other N—H group does not form a hydrogen bond.

t-3-Ethyl-r-2,c-7-bis-(4-methoxy-phen-yl)-1,4-diazepan-5-one

The title compound, C(21)H(26)N(2)O(3), crystallizes with two independent mol-ecules in the asymmetric unit. In both independent mol-ecules, the diazepine ring adopts a chair conformation. In the crystal, the independent mol-ecules exist as N-H⋯O hydrogen-bonded R(2) (2)(8) dimers which are linked via N-H⋯O hydrogen bonds, forming tetra-mers. The tetra-mers are linked by C-H⋯O hydrogen bonds. In one of the molecules in the asymmetric unit, the terminal C atom of the ethyl group is disordered over two positions with refined occupancies of 0.742 (4) and 0.258 (4).

5-Chloro-acetyl-4-methyl-2,3,4,5-tetra-hydro-1H-1,5-benzodiazepin-2-one

In the title compound, C₁₂H₁₃ClN₂O₂, the benzodiazepine ring adopts a distorted boat conformation. The carbonyl O atom and the Cl atom of the chloro­acetyl group are in a cis conformation. The crystal packing is controlled by inter­molecular C—H⋯O and N—H⋯O inter­actions.

4-Methyl-2-oxo-2,3,4,5-tetra-hydro-1H-1,5-benzodiazepine-5-carbaldehyde

In the title compound, C₁₁H₁₂N₂O₂, a benzodiazepine derivative, the seven-membered ring adopts a distorted boat conformation. The crystal packing is controlled by inter­molecular N—H⋯O and C—H⋯O inter­actions.

(Benzyl-amine)chloridobis(ethane-1,2-diamine)cobalt(III) dichloride hemihydrate

In the title compound, [CoCl(C(2)H(8)N(2))(2)(C(7)H(9)N)]Cl(2)·0.5H(2)O, there are two crystallographically independent cations and anions and one water mol-ecule in the asymmetric unit. Both Co(III) ions are bonded to two chelating ethylenediamine ligands, one benzylamine molecule and one chloride ion. The crystal packing is through N-H⋯O, N-H⋯Cl and O-H⋯Cl inter-actions.

1-Acetyl-c-3,t-3-dimethyl-r-2,c-6-diphenyl-piperidin-4-one

In the title compound, C(21)H(23)NO(2), the piperidine ring adopts a distorted boat conformation. The two phenyl rings form dihedral angles of 64.6 (1) and 87.8 (1)° with the best plane through the piperidine ring. The crystal packing is governed by inter-molecular C-H⋯O inter-actions.

1-Benzoyl-c-3,t-3-dimethyl-r-2,c-6-diphenyl-piperidin-4-one

In the title compound, C₂₆H₂₅NO₂, the piperidine ring adopts a distorted boat conformation. The three phenyl rings form dihedral angles of 67.58 (8), 59.82 (8) and 86.41 (8)° with the best plane through the piperidine ring. The crystal packing is governed by inter­molecular C—H⋯O inter­actions.

1'-Methyl-2,2''-dioxoindoline-3-spiro-2'-pyrrolidine-3'-spiro-3''-indoline-4',4'-di-carbonitrile

In the title compound, C(21)H(15)N(5)O(2), the pyrrolidine ring adopts a twist conformation. Both the oxindole rings are planar [maximum deviations of 0.076 (1) and 0.029 (1) Å in the two rings] and are oriented at a dihedral angle of 72.7 (1)°. The crystal structure is stabilized by C-H⋯O, N-H⋯O, N-H⋯N and C-H⋯π inter-actions.

Purification, crystallization and preliminary X-ray analysis of haemoglobin from ostrich (Struthio camelus)

Haemoglobin is a tetrameric protein that carries oxygen from the lungs to tissues and carbon dioxide from tissues back to the lungs. The oxygen-binding properties of haemoglobin are regulated through the binding of allosteric effectors. The respiratory system of avian species is unique and complex in nature when compared with that of mammals. In avian species, inositol pentaphosphate (inositol-P(5)) is present in the erythrocytes of the adult and is thought to be the major factor responsible for the relatively high oxygen affinity of the whole blood. The ostrich (Struthio camelus) is a large flightless bird which contains inositol tetrakisphosphate (inositol-P(4)) in its erythrocytes and its whole blood oxygen affinity is higher. Efforts have been made to explore the structure-function relationship of ostrich haemoglobin. Ostrich haemoglobin was purified using ion-exchange chromatography. Haemoglobin crystals were grown by the hanging-drop vapour-diffusion method using PEG 3350 as the precipitant in 50 mM phosphate buffer pH 7.2. Data were collected using a MAR345 image-plate detector system. The crystals of ostrich haemoglobin diffracted to 2.2 A resolution. They belonged to the orthorhombic space group P2(1)2(1)2(1) with one whole biological molecule in the asymmetric unit; the unit-cell parameters were a = 80.93, b = 81.68, c = 102.05 A.

4-(4-Chlorophenyl)-6-methoxy-2,2′-bipyridine-5-carbonitrile

There are two independent mol­ecules in the asymmetric unit of the title compound, C₁₈H₁₂ClN₃O. The two pyridine rings are almost coplanar [dihedral angles between the rings: 2.87 (15) and 5.36 (16)°] while the chloro­phenyl rings are twisted out of the plane of the adjacent bipyridine ring by 44.1 (1) and 43.8 (1)° in the two mol­ecules. The crystal packing is stabilized by C—H⋯N and C—H⋯Cl inter­actions.

4-(2,4-Dichloro-phen-yl)-6-(1H-indol-3-yl)-2,2'-bipyridine-5-carbonitrile

The title compound, C(25)H(14)Cl(2)N(4), crystallizes with two independent mol-ecules in the asymmetric unit. The two pyridine rings are almost coplanar, making dihedral angles of 3.2 (1) and 8.6 (1)° in the two independent mol-ecules. The dichloro-phenyl and indole rings are twisted away from the bipyridine ring by 64.32 (5) and 18.46 (4)°, respectively in the first molecule and by 51.0 (1) and 27.99 (5)°, respectively in the second molecule. The crystal packing is stabilized by C-H⋯N, C-H⋯Cl, N-H⋯N and C-H⋯π inter-actions.

3'-Benz-yloxy-3-hydr-oxy-3,3'-bi-1H-indole-2,2'(3H,3'H)-dione monohydrate

In the title compound, C(23)H(18)N(2)O(4)·H(2)O, the two oxindole rings subtend a dihedral angle of 54.29 (5)°. The crystal structure is stabilized by intermolecular N-H⋯O, O-H⋯O and C-H⋯π inter-actions.

4-(4-Bromo-phen-yl)-6-(1H-indol-3-yl)-2,2'-bipyridine-5-carbonitrile

In the title compound, C₂₅H₁₅BrN₄, the two pyridine rings lie in a common plane [r.m.s. deviation = 0.023 (2) Å], whereas the bromo­phenyl and indole rings are twisted away from this plane by 52.82 (12) and 28.02 (10)°, respectively. The crystal structure is stabilized by inter­molecular N—H⋯N inter­actions.

2-(1H-indol-3-ylcarbon-yl)acetonitrile

The title compound, C(11)H(8)N(2)O, crystallizes with two crystallographically independent mol-ecules in the asymmetric unit which are approximately perpendicular to each other [79.97 (6)°]. The indole ring system is planar [r.m.s. deviation = 0.010 (1) Å]. The crystal structure is stabilized by inter-molecular C-H⋯N and N-H⋯O inter-actions.

Ethyl 4′-ethenyl-2′-oxo-4-phenyl-2-(3,4,5-trimethoxyphenyl)spiro[pyrrolidine-3,3′-indoline]-5-carboxylate monohydrate

In the title compound, C₃₁H₃₂N₂O₆·H₂O, the pyrrolidine ring adopts an envelope conformation. The ethyl C atoms of the ethoxy­cabonyl group are disordered over two positions with occupancies of ca 0.80 and 0.20. Intra­molecular N—H⋯O hydrogen bonds form S(5) and S(6) ring motifs. Mol­ecules are linked into a three-dimensional framework by O—H⋯O, N—H⋯O and C—H⋯O hydrogen bonds, and by C—H⋯π inter­actions.

(E)-3-(4-Methylphenyl)-3-[3-(4-methylphenyl)-1H-pyrazol-1-yl]-2-propenal

In the title compound, C₂₀H₁₈N₂O, the pyrazole ring adopts a planar conformation. The C—N bond lengths in the pyrazole ring are shorter than a standard C—N single bond (1.443 Å), but longer than a standard double bond (1.269 Å), indicating electron delocalization. The propenal group assumes an extended conformation. Inter­molecular C—H⋯O hydrogen bonds connect mol­ecules into cyclic centrosymmetric R₂²(26) dimers, which are cross-linked via C—H⋯π inter­actions.

Fiberoptic bronchoscopy in children an audit from a tertiary care center

A retrospective review of 529 fiberoptic bronchoscopies was done with an aim to identify conditions where it will be most useful. The common indications were persistent/ recurrent pneumonia, persistent collapse, stridor and pulmonary hemorrhage. The diagnostic yield was maximum when it was performed to identify structural abnormalities and the yield was relatively poor in suspected drug resistant tuberculosis, and interstitial lung diseases. Serious complications were seen in children with pulmonary arterial hypertension. Fiberoptic bronchoscopy is an important tool for management of respiratory problems but should be performed with caution in children with pulmonary arterial hypertension.

4-(Cyclo-hexyl-sulfan-yl)-1-[(E)-2-(cyclo-hexyl-sulfan-yl)-1-phenyl-ethen-yl]-3-phenyl-1H-pyrazole

In the title compound, C₂₉H₃₄N₂S₂, the pyrazole ring is planar and both cyclo­hexane rings adopt chair conformations. The dihedral angles between the pyrazole ring and the two benzene rings are 59.9 (2) and 19.8 (2)°. The conformation and packing of the mol­ecules in the unit cell are stabilized by a weak intra­molecular C—H⋯S and C—H⋯N interactions, in addition to van der Waals forces.

1-[(E)-2-Formyl-1-(4-methylphenyl)ethenyl]-3-(4-methylphenyl)pyrazole-4-carbaldehyde

In the crystal structure of the title compound, C₂₁H₁₈N₂O₂, mol­ecules are linked through C—H⋯O inter­actions. Two symmetry-related mol­ecules form a cyclic centrosymmetric R₂²(20) dimer. These dimers are further connected into chains running along the b axis.

3-Cyclohexylsulfanyl-2-(4-methylphenyl)-5,7-dinitro-1H-indole

In the title compound, C₂₁H₂₁N₃O₄S, the cyclo­hexane ring adopts a chair conformation. The nitro and methyl­phenyl groups are all coplanar with the indole ring system. Intra­molecular N—H⋯O and C—H⋯S hydrogen bonds generate S(6) ring motifs. The mol­ecules form R₂²(20) centrosymmetric dimers via inter­molecular C—H⋯O hydrogen bonds. A short O⋯O contact [2.842 (2) Å] is observed in the dimer.

Methyl 2-benzyl-5-[1-(4-methoxyphenyl)-4-oxo-3-phenylazetidin-2-yl]-4-nitro-3-phenylpyrrolidine-2-carboxylate

In the title mol­ecule, C₃₅H₃₃N₃O₆, the pyrrolidine ring adopts a twist conformation. The mol­ecules are paired into centrosymmetric dimers by weak inter­molecular C—H⋯O hydrogen bonds. The dimers inter­act further again via C—H⋯O hydrogen bonds and N—H⋯O intramolecular interaction also stabilize the crystal packing.

1-(2,4-Dinitro-phenyl)-3-(4-methyl-phenyl)-4-phenyl-sulfanyl-1H-pyrazole

In the title compound, C₂₂H₁₆N₄O₄S, the dihedral angles between the pyrazole ring and the pendant aromatic rings are 26.2 (1), 41.1 (1) and 89.5 (1)°. In the crystal structure, an intermolecular C—H⋯N bond helps to establish the packing. A short C⋯C contact of 3.110 (12) Å is observed between the C atom of the pyrazole CH group and one of the α-C atoms of the 4-methyl­phenyl ring.

4-(4-Chloro-phenyl-sulfan-yl)-1-[(E)-2-(4-chloro-phenyl-sulfan-yl)-1-phenyl-ethen-yl]-3-phenyl-1H-pyrazole

In the title compound, C₂₉H₂₀Cl₂N₂S₂, the pyrazole ring adopts a planar conformation. The chlorophenyl rings are twisted from the pyrazole ring at angles of 52.74 (14) and 29.92 (13)°, respectively. The crystal structure is stabilized by C—H⋯N and C—H⋯π inter­actions.

Post obstructive pulmonary edema in a child who attempted suicidal hanging

Postobstructive pulmonary edema occurs rarely in children. We describe here a child who attempted suicide by hanging and developed postobstructive pulmonary edema and was successfully managed. There was a rapid response to management with morphine and supportive care, enabling extubation by 30 hours of ventilatory support. The case highlights an unusual cause of postobstructive pulmonary edema.

Ethyl 1-(4-chloro-phen-yl)-3-[1-(4-meth-oxy-phen-yl)-4-oxo-3-phenyl-azetidin-2-yl]-2-nitro-2,3,10,10a-tetra-hydro-1H,5H-pyr-rolo[1,2-b]isoquinoline-10a-carboxyl-ate

In the title compound, C(37)H(34)ClN(3)O(6), the pyrrolidine and piperidine rings adopt envelope and boat conformations, respectively. The β-lactam ring is planar and forms dihedral angles of 21.3 (2) and 73.9 (2)°, respectively, with the attached methoxy-phenyl and phenyl rings. Intra-molecular C-H⋯O and C-H⋯N hydrogen bonds are observed. Centrosym-metrically related mol-ecules are linked together by weak C-H⋯O hydrogen bonds to form dimers.

4-(2,4-Dichlorophenyl)-2-(1H-indol-3-yl)-6-(2-pyridyl)-1,4-dihydropyridine-4-carbonitrile

The title compound, C(25)H(16)Cl(2)N(4), has intra-molecular N-H⋯N and C-H⋯Cl hydrogen bonds. In the crystal structure, mol-ecules are linked through N-H⋯N hydrogen bonds, forming a centrosymmetric R(2) (2)(16) dimer.

Primary treatment of acute myeloid leukemia (non M3) in elderly: a review

Treatment of acute myeloid leukemia (AML) in the elderly has always been a challenging task. Acute myeloid leukemia in older adults is a biologically and clinically distinct entity. Based on analysis of cytogenetic and molecular data, it is known that leukemic cells in older patients are intrinsically resistant to standard chemotherapy. Due to comorbid disease and impaired bone marrow stem cell reserve, older adults tolerate myelosuppressive chemotherapy poorly, with a treatment-related mortality rate of 25%. In spite of various available targeted therapies, the overall survival has not improved dramatically in the past decade. The ideal post remission regimen in this population has always been a matter of debate. Standard allogeneic bone marrow transplantation is too dangerous to be considered as a mean to eradicate minimal residual disease after remission is obtained and myelointensive chemotherapy is not a beneficial post-remission strategy in this age cohort. These disappointing results call for more effective and less toxic therapeutic options. The advent of non-myeloablative regimens has shown some prospects in select group of patients with good performance status. This review focuses on current therapeutic options available in this group of patients.

Hepatopulmonary syndrome, an unusual cause of hypoxemia

A six-year-old boy presented with cough, cyanosis and clubbing. Investigations revealed hypoxia (PaO2 53 mm Hg on room air) which was only partially correctable (PaO2 73 mm Hg) with 100% oxygen administered through a non re breathing face mask. Liver function tests showed elevated total bilirubin, and transaminases, liver biopsy confirmed chronic hepatitis and endoscopy showed grade three varices. A contrast enhanced echocardiography (bubble study) revealed pulmonary arterio-venous communication. A diagnosis of hepatopulmonary syndrome was made based on the triad of hypoxemia, liver disease and intra pulmonary vascular communications.

Montelukast vs. inhaled low-dose budesonide as monotherapy in the treatment of mild persistent asthma: a randomized double blind controlled trial

BACKGROUND

Guidelines recommend daily controller therapy for mild persistent asthma. Montelukast has demonstrated consistent benefit in controlling symptoms of asthma and may be an alternative, orally administered, nonsteroidal agent for treating mild asthma.

AIM

To determine whether montelukast is as effective as budesonide in controlling mild persistent asthma as determined by FEV(1).

METHODS

Between November 2003 to October 2005, participants aged 5-15 years with recently diagnosed mild persistent asthma (n = 62) were randomized to oral montelukast (5 mg daily) [N(1) = 30] or inhaled budesonide (400 microg per day in two doses) [N(2) = 32] in a single center, double-blind study.

RESULTS

Baseline demographic and spirometric parameters were comparable. The median (95% confidence interval) percentage predicted FEV(1) was similar in the two groups after 12 weeks of treatment (budesonide: 76.70 (67.96-90.53%), montelukast: 75 (67.40-88.47)%; p = 0.44). There was similar improvement in spirometric parameters and clinical symptom scores in both the groups. There was no statistically significant difference between the groups in the need for rescue drugs as well as side effects reported by parents.

CONCLUSION

Montelukast is as effective as inhaled budesonide in the treatment of mild persistent asthma in children aged 5-15 years. Montelukast may be used as an alternative to low dose inhaled corticosteroids for management of mild persistent asthma.

Hydroxyapatite moldable formulation using natural rubber latex as binder

A simple but efficient processing method for shaping intricate bioceramic green bodies has been developed by using natural rubber latex as binder. Different shapes of hydroxyapatite Ca10(PO4)6(OH)2 (HAP) were molded from a composite formulation containing wet precipitated HAP, natural rubber latex (NRL), and a stabilizer. On controlled heat treatment followed by sintering, dense shapes of HAP contours were obtained. The thermal degradation profile of HAP-NRL composites shows that NRL degrades slowly without any abrupt exotherm. The results of energy dispersive X-ray analysis together with inductively coupled plasma (ICP) analysis indicate that the inorganic residue of NRL does not contain any heavy element. The sintered density of the samples increased with increased HAP content in the formulation and percentage shrinkage reduced accordingly. On varying the HAP content in the formulation from 35 to 95 wt %, the compositions with 85, 90, 92, and 95 wt % HAP showed better flexural strength in the range 40-54 MPa and a flexural modulus value in the range 36-50 GPa. The fracture morphology, as observed by the scanning electron microscope confirms that with increased HAP content in the formulation the sample microstructure attains higher uniformity. The Vickers microhardness for the samples sintered at two different temperatures (1150 and 1250 degrees C) showed that hardness increases with increase in the sintering temperature with a maximum for the highest HAP loaded formulation.

Aggressive digital papillary adenocarcinoma of the hand

This paper reports the case of a 26-year-old Caucasian male with an aggressive digital papillary adenocarcinoma of his right index finger. Aggressive digital papillary adenocarcinoma is a rare tumour arising from sweat glands which occurs characteristically on the hands, fingers and toes. It has a high rate of local recurrence and can metastasise, occasionally resulting in mortality.

Determination of zinc diethyldithiocarbamate released into artificial sweat from natural rubber latex vulcanizates by HPLC

A simple high-performance liquid chromatography method is adopted in order to quantitate the amount of zinc diethyldithiocarbamate (ZDEC) released into artificial sweat from natural rubber latex vulcanizates. The artificial sweat is extracted with dichloromethane, and the residue is recovered and re-dissolved in a known quantity of dichloromethane. ZDEC is quantitated as its copper complex by reacting with copper(II) sulphate. A reversed-phase C18 column and detection wavelength of 435 nm are used to measure the copper-dithiocarbamate complex. The procedure is repeated with cobalt(II) chloride, and the amount of ZDEC obtained by both the methods is compared. It is found that the recovery of ZDEC from the artificial sweat is high when copper(II) sulphate is used, indicating that the copper(II) sulphate is a better complexing agent than cobalt(II) chloride under the conditions used in the present study. The limits of detection and the quantitation of ZDEC are found to be 0.25 and 0.86 microg/mL, respectively. The present method, based on precolumn derivatization using copper(II) sulphate, facilitates the quantitation of ZDEC in latex products.

Human osteosarcoma cell adhesion behaviour on hydroxyapatite integrated chitosan-poly(acrylic acid) polyelectrolyte complex

A novel degradable composite system has been prepared by integrating hydroxyapatite, Ca(10)(PO(4))(6)(OH)(2), (HAP) in a polyelectrolyte complex matrix of chitosan (CHI) and poly(acrylic acid) (PAA). The composite was formulated by integrating 80 wt.% HAP in the polyelectrolyte complex matrix of CHI and PAA in the ratio 40/60 (designated as CPH). The composite could be easily fabricated into clinically significant shapes by a simple moulding procedure intended for bone graft applications. The adhesion behaviour of human osteosarcoma (HOS) cells on this degradable composite system was studied by selecting the polyelectrolyte complex, CHI/PAA 40/60 (designated as CP) as control sample. Light microscopic observations show that cells around CPH retained the typical morphology of HOS cells while cells around the polyelectrolyte complex showed a cytotoxic effect. The adhesion behaviour as well as morphological responses of the seeded cells was further investigated by scanning electron microscopy. The scanning electron micrographs of the polyelectrolyte complex, CP, showed the presence of rounded cells with raised nuclear regions, indicating delayed spreading; cells adhered on CPH were flattened with filopodia and showed good attachment and spreading, indicating better adhesion onto the HAP integrated composite. Comparing the MTT assay for quantitative evaluation of cell viability, CPH showed a higher percentage of metabolically active cells compared to CP.